The Use of the PoNS™ Device in the Treatment of Blunt and Blast Induced Vestibular Disorders

This study is not yet open for participant recruitment. (see Contacts and Locations)
Verified January 2013 by United States Naval Medical Center, San Diego
The Geneva Foundation
Information provided by (Responsible Party):
Michael E. Hoffer, United States Naval Medical Center, San Diego Identifier:
First received: January 14, 2013
Last updated: January 16, 2013
Last verified: January 2013

Traumatic brain injury (TBI) is a major worldwide health issue. Figures from the Centers for Disease control show that 1.7 million people suffer a TBI annually. Meanwhile the World Health Organization recognizes TBI as one of the most significant health issues in developing countries. In the military, mild traumatic brain injury (mTBI) is one of the most frequent sequela of modern war. Dizziness and balance disorders are the most frequent sequela of mTBI and account for a significant degree of mTBI morbidity. At the current time, the best treatment modality for dizziness secondary to mTBI is vestibular rehabilitation (VR). While VR is effective, the therapy is time consuming, not universally successful, and results in incomplete recovery by many patients. Work needs to be done in an attempt to improve therapy outcomes. This project will study the use of neuromodulation (through stimulation of the tongue) as an adjuvant to improve the effectiveness of VR and reduce the time involved in VR. Given past work with variants on this minimal medical impact appliance, using the PoNS™ device to augment therapy may result in a significant improvement in VR outcomes. Given the enormous public health and military burden of mTBI, and given that dizziness is a major component often responsible for significant morbidity, this project has significant military and civilian impact and can be beneficial to those who suffer mTBI worldwide.

Condition Intervention
Hearing and Vestibular Disorders
Other: Placebo device
Device: PoNS™ device

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Single Blind (Outcomes Assessor)
Primary Purpose: Treatment
Official Title: The Use of the PoNS™ Device in the Treatment of Blunt and Blast Induced Vestibular Disorders

Further study details as provided by United States Naval Medical Center, San Diego:

Primary Outcome Measures:
  • Change in Sensory Organization Test score [ Time Frame: Change from Baseline SOT score at 3 months ] [ Designated as safety issue: No ]
    Posturography for Sensory Organization Test: Utilizing a computerized dynamic posturography (Neurocom Inc., Clackmas, OR) the sensory organization test (SOT) is conducted by measuring postural sway on a force plate under six different conditions as follows 1) Normal Stance eyes open, 2) Normal Stance with eyes closed, 3) Normal Stance with sway referenced visual surround, 4) Sway reference stance eyes open, 5) Sway reference stance with eyes closed, and 6) Sway reference stance with sway referenced vision. The SOT will conduct three trials in each condition and utilize the information to produce a computer generated objective score of balance/posture function. The exam takes less than ten minutes to produce.

Secondary Outcome Measures:
  • Change in Vestibular-Ocular Reflex scores [ Time Frame: Change from Baseline VOR score at 3 months ] [ Designated as safety issue: No ]
    VOR Tests: A Neuro Kinetics IPortal Video-oculography system (Neurokinetics Inc., Pittsburgh, PA) with a six degree of freedom accelerometer will be used to (1) document head thrust test findings qualitatively and (2) provide objective measurements of test results. The software will be configured for (1) detection of head thrusts of appropriate direction and orientation (re: earth vertical) and (2) real-time determination of performance parameters (VOR).

Other Outcome Measures:
  • Change in Functional Gait Assessment Test scores [ Time Frame: Change from Baseline FGAT score at 3 months ] [ Designated as safety issue: No ]
    The Functional Gait Assessment Test (FGAT) is a 10 item gait task test in which each task is graded on a 0-3 scale with 0 indicating could not perform and 3 indicating performed without error. Grading is done by an experienced rater. The FGAT produces an ordinal score on a 0-30 point scale and is normed from previous civilian and military studies.

  • Change in Dizziness Handicap Index scores [ Time Frame: Change from Baseline DHI score at 3 months ] [ Designated as safety issue: No ]
    The Dizziness Handicap Index (DHI) is a well-validated self report the produces a score on a hundred-point scale.

  • Change in Activities specific Balance Confidence scale scores [ Time Frame: Change from Baseline ABC score at 3 months ] [ Designated as safety issue: No ]
    The Activities specific Balance Confidence scale (ABC) is a 16 question survey in which individuals' answer how confident they are about being able to perform a balance related task on a 0%-100% scale. The questionnaire is scored by adding the percentages and dividing by 100% to arrive at a scaled score form 0-100.

Estimated Enrollment: 60
Study Start Date: February 2013
Estimated Study Completion Date: January 2016
Estimated Primary Completion Date: June 2015 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Treatment Arm
PoNS™ device
Device: PoNS™ device
The PoNS™ device uses electrotactile waveform in conjunction with the Cranial Nerve - Non-Invasive NeuroModulation (CN-NINM) intervention. This involves using both balance and gait training methods to stabilize symptoms, regain balance & gait, and affect the functional transfer of improved stability and mobility to activities of daily living. It is based on a body of work focused on developing the tongue-based human-machine interface and application of this technology for balance, vision, and auditory substitution and more recently as neuromodulation for brain rehabilitation after injury and disease.
Other Name: Portable Neuromodulation Stimulator, version 2.2
Placebo Comparator: Placebo Arm
placebo device
Other: Placebo device
Placebo device


Ages Eligible for Study:   18 Years to 40 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Head Injury from blunt or blast suffered within the lines of duty
  • Not meeting any of the exclusion criteria
  • Injury occurred 21 -365 days ago

Exclusion Criteria:

  • History of a diagnosed balance disorder prior to injury
  • Going through board process before starting participation
  • Significant medical issues including but not limited to heart disease, pulmonary disease, autoimmune disorders, severe arthritis, etc.
  • Orthopedic injuries that prevent standing and walking
  • Age less than 18 or greater than 40 years of age
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT01771575

Contact: Sara A Murphy, MPH 619-532-6820

United States, California
Naval Medical Center, San Diego Not yet recruiting
San Diego, California, United States, 92134
Contact: Sara A Murphy, MPH    619-532-6820   
Principal Investigator: Michael E. Hoffer, M.D.         
Sponsors and Collaborators
United States Naval Medical Center, San Diego
The Geneva Foundation
Principal Investigator: Michael E. Hoffer, M.D. United States Naval Medical Center, San Diego
  More Information

No publications provided

Responsible Party: Michael E. Hoffer, CAPT MC USN, United States Naval Medical Center, San Diego Identifier: NCT01771575     History of Changes
Other Study ID Numbers: NMCSD.2013.0011
Study First Received: January 14, 2013
Last Updated: January 16, 2013
Health Authority: United States: Federal Government

Additional relevant MeSH terms:
Ear Diseases
Vestibular Diseases
Labyrinth Diseases
Otorhinolaryngologic Diseases processed this record on July 30, 2015