Development of sensory stimulating orthotic insoles to aid balance and independent walking following brain injury

Dr. Kristen Hollands

Sensation from the soles of the feet provides important information about how much the body is leaning over the feet and characteristics of the surface beneath the feet (e.g. slippery bathroom floor, vibrating floor of a bus etc). This information is important in controlling balance while standing and walking and recovering from trips/slips. As many as 34% of people with traumatic brain injury and 85% of people with strokes due to bleeding have deficits of sensation. Difficulties with sensation limit full recovery of balance and the likelihood of regaining independent mobility. There has recently been a rapid growth in the development of insoles which use textures or vibration on the foot sole to stimulate or enhance foot sensation and there is some evidence these can improve balance, walking on slopes and control of footplacement in healthy older adults. There is thus potential for stimulating orthotic insoles to help manage a wide range of important sensory and mobility challenges faced by people with brain injury. However, current sensory stimulating orthotic insole designs have not been developed based on an understanding of how foot sensation is used to control balance. What is required to develop effective technologies to help address sensory and balance problems following brain injury is a clear definition of the specific sensory and balance needs of people with brain injury.

Although it is well known that a high number of people with brain injury experience sensory and balance impairments, sensory function is more usually assessed on hands. As a result we know very little about the clinical extent and nature of foot sensation impairments and how they relate to balance problems and limited physical activity in people with brain injury. To improve the design and concepts of orthotic insole technologies which could improve balance and physical activity, we need people with brain injury to identify the specific sensory and balance problems they face, what they would want an orthotic insole to help them with and how to design an orthotic insole that is acceptable (so that people are willing to wear them).

We wish to improve orthotic insole technology design and orthotic insole product concepts to improve balance and thereby promote physical activity for people with brain injury. We request funds to:

  1. investigate previously undefined problems in sensation of the feet and balance from a clinical/scientific perspective. This will be achieved through detailed clinical/laboratory assessments of foot sensation and balance problems in people with brain injury
  2. investigate patient perspectives on loss of sensation and use of orthotic insole devices to address sensation and balance/mobility issues . This will be achieved through interviews with people with brain injury and carers. This will capture the personal impact of sensory and balance impairments and enable any orthotic orthotic insole solutions to be led by patient perspectives.
  3. bring clinical, academic, patient and industrial partners together in close collaboration to integrate clinical and patient needs determined in phases 1 & 2 to develop and improve sensory stimulating orthotic insole product concepts.