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| Name | Class |
|---|---|
| Biogen | INDUSTRY |
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The objective of this study is to understand how spatiotemporal and kinetic gait parameters are associated with bone health in pwSMA who are receiving DMT. We hypothesize that gait parameters are associated with BMD and can determine fracture risk in pwSMA. This is an observational study that involves one in-clinic visit (approximately 3 hours) with remote follow-up visits (approximately 15 minutes) every 3 months for 1 year to collect fracture and medical history. Each of the assessments included in this study are non-interventional and are not intended as a treatment nor are they at the level of standard of care.
Addressing bone health is a high priority and remains a concern for the SMA community despite the availability of DMTs. Fractures often have devastating, irrecoverable impacts on function, especially in ambulatory pwSMA. While the most recent standards of care for SMA recommend annual screening, supportive treatments are not recommended until there has been a fracture, a reactive approach which may not be enough to mitigate LBM. Implementing novel, wearable technology and machine learning (ML) models to identify fracture risk will lead to a proactive approach to manage bone health and attenuate the negative sequalae of fractures. This is an observational cross-sectional study of ambulatory children and adults with SMA. The aims of this study are to (1) Identify gait-related digital biomarkers of bone health in ambulatory pwSMA, (2) Determine the ability of digital biomarkers to differentiate between pwSMA with and without a history of fractures, and (3) Investigate the ability of risk profiles derived from the digital biomarkers to predict prospective fractures over one year.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Spinal Muscular Atrophy | Ambulatory children and adults at least 8 years old by the time of enrollment with genetically confirmed SMA. |
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| Measure | Description | Time Frame |
|---|---|---|
| Dual X-Ray Absorptiometry (DXA) | Bone mineral density (BMD), a measure of the mineral content in bones is assessed using dual x-ray absorptiometry (DXA). DXA can be used to identify individuals with low bone mass (LBM). DXA uses low-power x-ray and is a safe and reliable measure validated to diagnose osteoporosis. DXA provides a t-score and z-score so that based on age, low bone mass can be appropriately determined. DXA also provides a subtotal BMD score as well as scores specific to certain body regions, both of which will be utilized in the first aim. | Baseline |
| Blood collection | Blood will be collected to assess for routine markers related to bone mineral density. Blood will be tested for levels of calcium, vitamin D, bone alkaline phosphatase (BALP), and C-terminal telopeptide of type I collagen (CTx). The amount of blood collected will be within hospital rules for children. The total amount of blood will be approximately 2 mL or 1/2 a teaspoon. BALP is a bone formation marker while CTx is a bone resorption marker. Calcium and vitamin D are known to be positively associated with BMD. | Baseline |
| Fracture history | Details regarding lifetime fracture history will be collected via questioning at the in-clinic visit and during remote follow up visits, every three months for one year. The participant will be asked to describe each incident separately, including the age at fracture, mechanism of injury (how it happened, its nature, and force), any preceding events like falls or dizziness, and associated symptoms. Fractures will be characterized by location, type and treatment (surgical or conservative). | Baseline, months 3, 6, 9, and 12 |
| Fall history | Details regarding falls, that occurred within the past year, will be collected using a structured questionnaire at the in-clinic visit and during the one-year follow-up. Falls will be described by mechanism, environment and outcome. | Baseline, months 3, 6, 9 and 12 |
| Measure | Description | Time Frame |
|---|---|---|
| Ten Meter Walk Run (10MWR) | The 10MWR is an objective evaluation of function that measures the speed at which an individual can complete 10 meters. Gait speed is a commonly used indicator in NMD, and this test can be done by either walking or running. The 10MWR has been demonstrated to be safe to administer in individuals with SMA. | Baseline |
| Measure | Description | Time Frame |
|---|---|---|
| SMA EFFORT | The SMA EFFORT is a perceived physical fatigability patient-reported outcome measure (PROM) that provides a percent (PPF%) total score to each participant based on their participation over the past 30 days. PPF% total scores are calculated as the sum of activity item ratings divided by the number of items rated multiplied by five (highest rating on Likert scale), with higher scores indicating greater perceived physical fatigability (PPF).Participants are instructed to not endorse any item that has not been performed in the past 30 days, ensuring a PPF% total score that is unique to their current level of function. In addition to the PPF% total score (across all activities performed), PPF% subscale scores corresponding to the specific activities across 4 different domains of function are similarly derived (Exercise/Recreation, Mobility, Postural Control, and Activities of Daily Living (ADLs). |
Inclusion Criteria:
Exclusion Criteria:
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The study sample will include 22 ambulatory SMA participants.
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Cara Kanner, PT, DPT, EdD | Contact | 516-581-8150 | chy2112@cumc.columbia.edu |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Columbia University Irving Medical Center | Recruiting | New York | New York | 10032 | United States |
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| ID | Term |
|---|---|
| D014897 | Spinal Muscular Atrophies of Childhood |
| D009134 | Muscular Atrophy, Spinal |
| D050723 | Fractures, Bone |
| ID | Term |
|---|---|
| D013118 | Spinal Cord Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
| D020271 | Heredodegenerative Disorders, Nervous System |
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Blood for assay of bone biomarkers: calcium serum, 25-hydroxyvitamin D2/D3 (vitamin D), bone-specific alkaline phosphatase, C-terminal telopeptide serum
| Collection of spatiotempoal and kinetic gait parameters using instrumented insoles (AI-Sole) | Stride-by-stride spatiotemporal and kinetic gait parameters will be collected with AI-Sole continuously during the 6MWT. Spatiotemporal parameters included stride length (SL), stride velocity (SV), percent time in stance phase (%St), and percent time in terminal double support (%DS). Kinetic parameters included the anteroposterior (AP-COP) and mediolateral (ML-COP) ranges of the center-of-pressure normalized by shoe size, as well as the Absolute COP-Cyclogram Asymmetry Index (|ASI|). | Baseline |
| Six Minute Walk Test | Participants will complete the six minute walk test in a corridor which includes the instrumented walkway, while wearing the insoles. This is to measure spatial parameters, kinetic parameters, temporal parameters, and metrics of cumulative activity in order to compare against the gold standard instrumented walkway. The six minute walk test is an objective evaluation of functional exercise capacity, and measures the maximum distance a person can walk in six minutes over a 25 meter course. | Baseline |
| IPAQ-SF | A quantitative assessment of usual physical activity will be captured using the International Physical Activity Questionnaire Short Form (IPAQ-SF).The IPAQ-SF is a commonly used self-administered questionnaire designed to obtain internationally comparable data on health-related physical activity. The IPAQ-SF is composed of seven questions from four domains of physical activity, including vigorous and moderate physical activity, walking physical activity, and sitting time. A weighted total from vigorous physical activity, moderate physical activity, and walking physical activity is calculated to produce a total amount of physical activity in MET-min/week. | Baseline |
| Timed Up and Go Test (TUG) | The TUG test, a method to assess balance and mobility, measures the time it takes an individual to stand up from a chair, walk 3 meters, turn around, and sit down in the same chair. In SMA, TUG scores are associated with total leg and knee flexor strength, gross motor function, the 10-meter walk/run, and 6MWT. TUG test is a sensitive and reliable measure of functional impairment in inherited neuromuscular disorders. | Baseline |
| 30 Second Sit to Stand (30-STS) | The 30-STS test is used to evaluate basic muscle power and function. The participant is to complete as many sit-to-stands as possible, with or without using their hands for support, in 30 seconds. | Baseline |
| Baseline |
| D019636 | Neurodegenerative Diseases |
| D016472 | Motor Neuron Disease |
| D009468 | Neuromuscular Diseases |
| D030342 | Genetic Diseases, Inborn |
| D009358 | Congenital, Hereditary, and Neonatal Diseases and Abnormalities |
| D014947 | Wounds and Injuries |