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Therapeutic game based exercise during hemodialysis to improve balance and mobility

Award Information
Agency: Department of Health and Human Services
Branch: National Institutes of Health
Contract: 1R41AG057743-01A1
Agency Tracking Number: R41AG057743
Amount: $225,000.00
Phase: Phase I
Program: STTR
Solicitation Topic Code: NIA
Solicitation Number: PA16-303
Solicitation Year: 2016
Award Year: 2017
Award Start Date (Proposal Award Date): 2017-09-15
Award End Date (Contract End Date): 2019-08-31
Small Business Information
Cambridge, MA 02139-4654
United States
DUNS: 802270988
HUBZone Owned: No
Woman Owned: No
Socially and Economically Disadvantaged: No
Principal Investigator
 (520) 626-7097
Business Contact
Phone: (888) 589-6213
Research Institution
HOUSTON, TX 77030-3411
United States

 Nonprofit College or University

Chronic kidney disease CKD disproportionately impacts older adults Balance mobility and falls are serious
problems for CKD patients due to associated peripheral neuropathy and peripheral arterial disease which also
contribute to foot ulcers and other foot problems in this population Among older adults these problems are often
compounded by other comorbid conditions leaving older adults with CKD at a particularly high risk for falls
Patients with CKD require hemodialysis unless and until they can receive a liver transplant These patients visit
clinics multiple times a week and must sit or lie still for hours hours at a time while receiving hemodialysis
This coupled with generally low activity levels leads to further deconditioning of the lower extremities muscle
wasting and an increased risk of falls
Exercise interventions have been shown to improve mobility and balance reduce the incidence of falls and
improve peripheral blood flow which is essential to reduce foot problems and peripheral arterial disease
However uptake of exercise programs for individuals who are undergoing hemodialysis HD process has been
limited The three main factors limiting uptake and adherence among HD patients are time availability post
dialysis fatigue and transportation to exercise programs which are usually offered in rehabilitation departments
or cardiovascular centers but not in nephrology departments or in free standing dialysis clinics
To address the factors limiting uptake and adherence of therapeutic exercise among HD individuals we have
developed a game based exercise program Exergame platform that can be performed while receiving HD The
exergaming system consists of a wireless inertial sensor worn on the dorsum of each foot and a laptop computer
The sensors track D motion while patients move their feet ankle joint rotations to navigate a computer cursor
to execute motor cognitive exercise tasks This real time ankle foot motion biofeedback exercises sensorimotor
control Patients do not need to be supervised during the exercise session because the exergames are
computerized low risk patients remain seated or recumbent and performance is tracked automatically We
have developed a prototype and tested its feasibility In summary HD patients were randomly assigned
to either the intervention group with Exergame platform IG n or the control group without exergame
platform CG n Both groups underwent a weeks lower extremities exercise program during HD sessions
twice per week for duration of min Significant improvement in gait and balance was observed in the IG group
after sessions of exercise compared to the baseline measurements These preliminary results support the
scientific premise and feasibility to implement exergame intervention in HD clinics
Through this STTR project we will transfer our exergame platform from Baylor College of Medicine to
BioSensics LLC for further development and commercialization In Phase I we will improve the industrial
design of the sensor and evaluate the efficacy of the intervention program for hemodialysis patients in a
convenience sample of HD individuals We will investigate the effects of the proposed exergaming program
on gait balance lower extremity vascular performance daily physical activity and fatigue The clinical
effectiveness of the proposed platform will be further examined during Phase II based on a randomized
controlled trial that will be powered based on the results of the Phase I pilot study Therapeutic game based exercise during hemodialysis to improve balance and mobility
Project Narrative
Balance mobility falls and foot problems are serious problems for older adults who are undergoing
hemodialysis process Many of these patients visit clinics multiple times a week to receive hemodialysis
providing an optimal opportunity for intervention We are developing an interactive foot and ankle exercise game
that can be played during hemodialysis to improve mobility and balance as well as to improve blood flow to the
feet helping to reduce foot ulcers

* Information listed above is at the time of submission. *

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