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. 2024 Dec 19:18:1507559.
doi: 10.3389/fnhum.2024.1507559. eCollection 2024.

Galvanic vestibular stimulation for the postural rehabilitation of HTLV-1-associated myelopathy

Tatiana Rocha Silva  1 , Ludimila Labanca  2 , Júlia Fonseca de Morais Caporali  1 , Mauricio Campelo Tavares  3 , Nathália de Castro Botini Rausse  2 , Maria Júlia Amaral Abranches de Almeida  1 , Maxmilliam de Souza Martins  1 , Laura Fernandes Amorim  1 , Léo Dantas Sitibaldi  1 , Denise Utsch Gonçalves  1
Affiliations

Galvanic vestibular stimulation for the postural rehabilitation of HTLV-1-associated myelopathy

Tatiana Rocha Silva et al. Front Hum Neurosci. .

Abstract

Introduction: Galvanic vestibular stimulation (GVS) is a simple, safe, and noninvasive method of neurostimulation that can be used to improve body balance. Several central nervous system diseases cause alterations in body balance, including HTLV-1-associated myelopathy (HAM).

Objective: To test GVS as a balance rehabilitation strategy for HAM.

Methods: This study is a quasi-experimental clinical trial in which postural balance was compared before and after a GVS rehabilitation protocol applied to 20 patients with HAM, 12 women and 8 men, average age of 78 and 79 years, respectively. They were followed for nine months after the end of the GVS protocol, which consisted of one GVS session per week for 12 consecutive weeks. The GVS current intensity was progressively increased from 1.0 milliamperes (mA) to 3.5 mA until the third session and maintained at 3.5 mA until the 12th session. The electrical stimulation time progressively increased from 9 min in the first session to 18 min in the second session and maintained at 30 min from the third session onwards. Postural balance was assessed by Time up and go test (TUG), Berg balance scale (BBS) and posturography that were performed before the beginning of the intervention, during the intervention (6th week), at the end of the intervention (12th week) and after 9 months of follow-up without electrical stimulation.

Results: In a blind comparison, in the 12th week of stimulation, improvement was observed in all the tests. In TUG, time in seconds changed from 28 before to 18 after GVS (p < 0,001). In BBS, the score changed from 29.00 before to 41.00 points after GVS. In posturography, the stability limit improved after the intervention (p < 0.05). However, after nine months without stimulation, the gain was lost for TUG, for BBS and for stability limit.

Conclusion: GVS was an effective method to improve postural instability of patients with HAM in the short term, but the gain in postural stability was not maintained in the long term. A device for home use may be an option for long-term use.

Keywords: central nervous system; electric stimulation; electric stimulation therapy; postural balance; vestibular diseases.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Stimulus format.
Figure 2
Figure 2
Patient undergoing the electrical (galvanic) vestibular stimulus with the electrodes on both mastoid bones. (A) Electrodes on the mastoids; (B) patient submitted to GVS must be seated; (C) GVS equipment connected to the computer.
Figure 3
Figure 3
Comparison of stability limit in static posturography of 20 patients with HTLV-1 associated myelopathy before, after the 6th session and 12th session of Galvanic Vestibular Stimulation and after the 9th month of follow-up without galvanic vestibular stimulation. GVS, Galvanic Vestibular Stimulation. *p ≤ 0.05. Friedman Test / Friedman’s two-way ANOVA (p ≤ 0.05). Bonferroni Test.
Figure 4
Figure 4
Average performance of 20 patients with HTLV-1 Associated Myelopathy in POST in relation confidence ellipse, before GVS, after the 6th and the 12th session of GVS and after 9 months follow-up without GVS. AP, displacement anteroposterior displacement; ML, displacement mediolateral displacement; GVS, Galvanic Vestibular Stimulation. Data are expressed as median.
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