title: Use of an electrotactile vestibular substitution system to facilitate balance and gait of an individual with gentamicin-induced bilateral vestibular hypofunction and bilateral transtibial amputation.
abstract: OBJECTIVE
  This case report describes the use of an electrotactile vestibular substitution system (ETVSS; BrainPort Balance Device, Wicab, Inc., Middleton, WI) to facilitate balance and gait of an individual with bilateral vestibular hypofunction and bilateral transtibial amputation.
  
  
  METHODS
  A 69-year-old man with a 2.5-year history of bilateral vestibular hypofunction, due to gentamicin toxicity, participated in a rehabilitation program using an ETVSS. Because of lower extremity infection, the patient had bilateral prosthetic legs after bilateral transtibial amputation.
  
  
  METHODS
  Focused on the following three phases of training with the ETVSS during 12 months: orientation, clinical training, and in-home training. The patient was periodically assessed with balance and gait tests, in addition to surveys of patient confidence and perception of handicap. All testing was performed without ETVSS.
  
  
  RESULTS
  : Improvements were demonstrated in all outcome measures used with this patient. Sensory Organization Test composite scores increased from 23 to 48, Dynamic Gait Index scores increased from 11/24 to 21/24, and distance walked during six minutes increased from 212 to 363 m. Standing balance with eyes-closed improved from less than two seconds to more than 20 minutes. The patient reported improved confidence and lower perception of handicap with fewer functional limitations.
  
  
  CONCLUSIONS
  For this patient, an intervention program of sensory substitution using the ETVSS improved outcome measures beyond those previously achieved with vestibular rehabilitation therapy and balance training. The feedback provided by the ETVSS may have facilitated the patient's ability to use proprioception, thus allowing better balance control.
authors.affiliation: Department of Physical Therapy, Missouri State University, Springfield, Missouri, USA. susanrobinson@missouristate.edu
authors.forename: Barbara Susan
authors.initials: BS
authors.lastname: Robinson
authors.forename: Jeanne L
authors.initials: JL
authors.lastname: Cook
authors.forename: Cynthia McCormick
authors.initials: CM
authors.lastname: Richburg
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Price
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D001186:Artificial Limbs; D001424:Bacterial Infections / Q000188:drug therapy; D004558:Electric Stimulation / Q000295:instrumentation* / Q000379:methods; D004566:Electrodes; D005684:Gait; D005839:Gentamicins / Q000009:adverse effects; D019416:Head Movements; D006801:Humans; D008297:Male; D026741:Physical Therapy Modalities / Q000295:instrumentation*; D004856:Postural Balance; D011434:Proprioception; D014059:Tongue / Q000294:innervation*; D015837:Vestibular Diseases / Q000139:chemically induced / Q000534:rehabilitation*
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins