The Impact of Ambient Light Changes on Static Balance

Primary Investigator: Suzanne R. Brown, PhD, PT

An Application for Touro University Nevada Mentored Student Research Grant 2013

February 7, 2013

Student Research Project: The impact of ambient light changes on static balance. Faculty Researcher: Suzanne Brown, PhD, PT

Introduction and background/significance

The public health imperative to reduce falls in the elderly has led to research about how visual awareness impacts balance for elderly. As people age, their sensory and motor functions worsen and are compromised with light perturbations, which can adversely affect proprioception and promote disorientation (I. Pyykko et al., 1990). The dependence on visual information for maintenance of postural stability and control increases with age due to age-related changes that occur in the vestibular and somatosensory systems (J. O. Judge et al., 1995). Literature has shown that ambient light is associated with visual acuity in the elderly and their ability to assess obstacles and hazards; with that, darkness is associated with the inability to use visual cues to supplement balance. Currently, there is no research on the response to light changes on balance and reaction times. Specific Aims and Hypothesis The primary objective is to determine if a relationship exists between retinal reaction to light perturbations (no light, dim light, room light, bright light) and balance, as measured by the Biodex Balance System. We will test the hypothesis that there is no difference in maintaining balance as a result of light intensity change. This pilot will be focused on normal subjects to establish if a normal relationship occurs. Methodology Human Protections This study proposal has been approved by the Touro University Nevada Institutional Review Board. All subjects will be informed consented as to the purpose, risks and benefits of participation prior to joining the study sample. Design This pilot study is a quasi-experimental cross-sectional design with within-subject control. As a quasi-experimental design, no formal control group will be used, each subject will be tested under no perturbation and perturbation of balance conditions. No randomization of perturbations is planned in this pilot study. Population The target population is all persons between 20 and 50 years of age who volunteer for the study and meet the inclusion criteria. Persons residing or working in the Las Vegas area are the primary target population. Inclusion criteria: Subjects for this study must be between the age of 20-50 without medical conditions causing balance or lower extremity use problems. Persons without history of neurological or vestibular problems will be included. Persons must not be taking any medications within the previous 96 hours with balance or hypertension side-effects. Exclusion criteria: Subjects for this study will be excluded if they have medical conditions causing dizziness, balance or lower extremity problems, a history of two or more unexplained

Student Research Project: The impact of ambient light changes on static balance. Faculty Researcher: Suzanne Brown, PhD, PT

falls within the previous six weeks. Individuals on medications with known side effects of hypotension, vestibular or balance problems, or individuals who have been treated for balance conditions within the prior twelve months. Sample: For this pilot study of normal subjects, 30 (30) subjects are desired. This number of subjects will provide sufficient evidence if a relationship exists. Procedure Each subject will be informed consented and complete a medical screening questionnaire. The researchers will review the questionnaire for inclusion/exclusion factors and determine if the subject is eligible for the study. The protocol will be that of the Biodex Balance System SD for General Postural Stability. Eligible subjects will first be tested in normal room light according to the standard General Postural Stability Balance Test using the Biodex Balance System. All tests will consist of three trials using a standard protocol . Following this control test, each subject will rest for 15 minutes and then be subjected to the test protocol under the four test conditions: normal (ambient) light, intermittent bright light, constant dim light, and no light. Light conditions will be provided in the same order for each subject. The intermittent bright light will be provided every 5 seconds through the 20 second test trial. Total testing time should be no more than 90 minutes per person. Data Analysis Data collected on each subject will be analyzed for descriptive and correlational statistics both within and between subjects. A standard statistical software package will be used, most likely the Statistical Package for Social Sciences (SPSS). Public Health Impact Results from this study will build upon the limited knowledge the scientific community about the visual acuity in the elderly, how a loss of visual awareness can affect balance, and the public health implications to help reduce the incidence of falls (M. G. Figueiro et al., 2011). References
Figueiro, M. G.; B. Plitnick; M. S. Rea and L. Z. Gras. 2011. "Lighting and Perceptual Cues: Effects on Gait Measures of Older Adults at High and Low Risk for Falls." BMC Geriatr, 11, 49. Judge, J. O.; M. B. King; R. Whipple; J. Clive and L. I. Wolfson. 1995. "Dynamic Balance in Older Persons: Effects of Reduced Visual and Proprioceptive Input." J Gerontol A Biol Sci Med Sci, 50(5), M263-70. Pyykko, I.; P. Jantti and H. Aalto. 1990. "Postural Control in Elderly Subjects." Age Ageing, 19(3), 215-21.