Balance Right in Multiple Sclerosis (BRiMS): a feasibility randomised controlled trial of a falls prevention programme

Abstract Background Balance, mobility impairments and falls are problematic for people with multiple sclerosis (MS). The “Balance Right in MS (BRiMS)” intervention, a 13-week home and group-based exercise and education programme, aims to improve balance and minimise falls. This study aimed to evaluate the feasibility of undertaking a multi-centre randomised controlled trial and to collect the necessary data to design a definitive trial. Methods This randomised controlled feasibility study recruited from four United Kingdom NHS clinical neurology services. Patients ≥ 18 years with secondary progressive MS (Expanded Disability Status Scale 4 to 7) reporting more than two falls in the preceding 6 months were recruited. Participants were block-randomised to either a manualised 13-week education and exercise programme (BRiMS) plus usual care, or usual care alone. Feasibility assessment evaluated recruitment and retention rates, adherence to group assignment and data completeness. Proposed outcomes for the definitive trial (including impact of MS, mobility, quality of life and falls) and economic data were collected at baseline, 13 and 27 weeks, and participants completed daily paper falls diaries. Results Fifty-six participants (mean age 59.7 years, 66% female, median EDSS 6.0) were recruited in 5 months; 30 randomised to the intervention group. Ten (18%) participants withdrew, 7 from the intervention group. Two additional participants were lost to follow up at the final assessment point. Completion rates were &gt; 98% for all outcomes apart from the falls diary (return rate 62%). After adjusting for baseline score, mean intervention—usual care between-group differences for the potential primary outcomes at week 27 were MS Walking Scale-12v2: − 7.7 (95% confidence interval [CI] − 17.2 to 1.8) and MS Impact Scale-29v2: physical 0.6 (CI − 7.8 to 9), psychological − 0.4 (CI − 9.9 to 9). In total, 715 falls were reported, rate ratio (intervention:usual care) for falls 0.81 (0.41 to 2.26) and injurious falls 0.44 (0.41 to 2.23). Conclusions Procedures were practical, and retention, programme engagement and outcome completion rates satisfied a priori progression criteria. Challenges were experienced in completion and return of daily falls diaries. Refinement of methods for reporting falls is therefore required, but we consider a full trial to be feasible. Trial registration ISRCTN13587999 Date of registration: 29 September 2016 </jats:sec

Lateral vehicle co-pilot to avoid unintended roadway departure.

A detailed investigation of road departure warning systems is presented. A method known as time-to-lane-crossing is compared with rumble strips placed a fixed distance from the road edge, and is found to provide enhanced performance in terms of reduced false warnings and increased warning anticipation. A new approach, called variable rumble strip (VRBS), is proposed as an electronic implementation of rumble strips where the rumble strip threshold is allowed to vary according to the risk of the vehicle departing the road. The rule-based system is realized using a fuzzy logic structure. Performance of the VRBS system is similar to that of the time-to-lane-cross based approach, but requires less sensor information. Performance is measured by comparison with a validation warning set generated by static rumble strip warnings, and subjective assessment of road departure criticality. The algorithms are tested on 12 two-hour driving runs conducted in a full-vehicle driving simulator. One extension of the VRBS system involves an estimate of driver lane-keeping performance used to modify the VRBS threshold adjustment. The estimate, based on the standard deviation of lateral vehicle position, is effective at increasing the anticipatory warning time, and is readily implemented in the fuzzy rule structure. A separate driver modeling effort was undertaken using a system identification approach to develop a driver model, and to update its parameters during driving. Although preliminary driving simulator results indicated that changes in the damping ratio, natural frequency, and DC gain of such a model may be useful indicators of driver fatigue, the identified model parameters were found to not exhibit the expected trends as lane-keeping performance deteriorated on more extensive data sets. Addition of an intervention function is the topic of a second extension, and examines the usefulness of a brake steer system which uses differential brake forces for steering intervention. The steering function achieved can be used to provide limited control authority on vehicle lateral position. Control design models for the vehicle and the brake system are presented. Computer simulation results, using a nonlinear seven degree-of-freedom vehicle model are included, and show the feasibility and limitations of brake steer.Ph.D.Applied SciencesArtificial intelligenceAutomotive engineeringMechanical engineeringSystems scienceUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/130330/2/9722063.pd

A lane-departure warning and control system

Intelligent Vehicle-Highway Systems, U-M College of Engineeringhttp://deepblue.lib.umich.edu/bitstream/2027.42/108523/1/84822.pdfDescription of 84822.pdf : Final repor