Assessing the influence of sensory interaction of balance. Suggestion from the field

Performance of static standing balance in children with spastic diplegic cerebral palsy under altered sensory environments

Seven children with spastic diplegic cerebral palsy and 14 age- and gender-matched nondisabled children participated in the present study for an investigation and comparison of their static standing balance under altered sensory environments. The type of visual input (full, occluded, or sway referenced vision) and the type of somatosensory input (fixed or compliant foot support) were varied factorially to give six sensory environments. Each participant was tested barefooted for 30 s under all six conditions. A force platform collected the ground reaction force, from which standing balance was calculated as the sway area of the center of pressure. The results showed that when somatosensory information was reliable (fixed foot support), there was no significant difference in stance stability between the children with spastic diplegic cerebral palsy and their matched controls, and both types of children were equally affected by the type of visual input. However, when somatosensory information was unreliable (compliant foot support), the difference in stance stability between the children with spastic diplegic cerebral palsy and their matched controls was significantly greater when the visual input was deprived (occluded) or unreliable (sway referenced) than when it was reliable. These results suggest that the children with spastic diplegic cerebral palsy may have difficulties in resolving intersensory conflicts for maintenance of standing balance, or the demands of motor control in sensory conflict conditions outweigh the motor ability of children with spastic diplegic cerebral palsy.

Relationship between Clinical and Forceplate Measures of Postural Stability

Although sophisticated forceplate systems are available for postural stability analyses, their use is limited in many sports medicine settings because of budgetary constraints. The purpose of this investigation was to compare a clinical method of evaluating postural stability with a force-platform sway measure. Participants completed a battery of three stance variations (double, single, and tandem) on two different surfaces (firm and foam) while standing on a force platform. This arrangement allowed for simultaneous comparisons between forceplate sway measures and clinical assessments using the Balance Error Scoring System (BESS). Significant correlations were revealed for the single-leg and tandem stances on the firm surface and for double, single, and tandem stances on the foam surface. These results suggest that the BESS is a reliable method of assessing postural stability in the absence of computerized balance systems.

Equilibrium and limb coordination in mild cognitive impairment and mild Alzheimer's disease

OBJECTIVE

To examine changes in equilibrium and limb coordination in normal aging, mild cognitive impairment, and moderate cognitive impairment associated with early probable Alzheimer's disease (AD), by means of parametric clinical measures.

DESIGN

Case series

SETTING

Out-patient clinic.

PARTICIPANTS

A consecutive sample of 365 community-residing ambulatory volunteers (137 men, 228 women; mean age 70.4 +/- 9.4 years; mean educational attainment 14.6 +/- 3.1 years), who were followed in an ongoing longitudinal study of aging and AD, comprising cognitively intact individuals, persons with mild cognitive impairment, and patients with mild AD.

MEASUREMENTS

For general magnitude of cognitive function, the Global Deterioration Scale (GDS). For cognition, the Mini-Mental State Examination (MMSE). Equilibrium was assessed with parametric measurements of single leg stance (SLS) and tandem walking (TW). Limb coordination was assessed with parametric measurements of foot tapping (FT), alternating pronation and supination (PS), and sequential finger to thumb tapping (FTH).

MAIN RESULTS

After adjustment for age, persons with mild cognitive impairment or mild AD had significantly poorer performance on parametric clinical tests of equilibrium and limb coordination compared with cognitively intact individuals (P < .05).

CONCLUSIONS

Changes in equilibrium and limb coordination are clinically demonstrable in persons with mild cognitive impairment and mild AD using simple parametric tests. Such tests could potentially identify individuals with increased risk of falling. Early diagnosis and treatment of conditions that can jeopardize equilibrium and limb coordination, as well as balance and coordination training, might help cognitively impaired older people to maintain optimal function and may decrease the risk of falls and injuries.

Changes in balance and locomotion measures during rehabilitation following stroke

BACKGROUND AND PURPOSE

This study aimed to examine the utility of a number of measures of balance and locomotion for the purpose of measuring change in a group of stroke patients undergoing in-patient rehabilitation. The aim was to select a core group of measures based on empirical evidence of usefulness rather than personal preference.

METHODS

Twenty-nine stroke patients undergoing in-patient rehabilitation (mean age 71.8 +/- 10.5 years; 66% male) participated in the study. A prospective design was utilized with repeated measurement undertaken at four, six and eight weeks post-stroke. Static standing, the Clinical Test of Sensory Interaction of Balance (CTSIB) (Shumway-Cook & Horak, 1986), functional reach (FR), repetitive reach (RR), step test (ST), gait velocity, stride length and the Motor Assessment Scale (Carr et al., 1985) (walking item) were assessed at each interval.

RESULTS

All measures of dynamic balance showed significant change over the four-week measurement period (p < 0.0036). Factor analysis identified two factors which grouped tests into static and dynamic, with a trend towards a third factor incorporating bipedal dynamic tests. Tests of static balance suffered from ceiling effects, whereas dynamic tests of balance and gait suffered from floor effects. Dynamic tests were more responsive (Standardized Response Measure (SRM) > 0.75) to change over the rehabilitation period than static tests.

CONCLUSIONS

The findings suggest that a clinically useful and responsive balance and mobility test battery should include one component of the CTSIB (Shumway-Cook & Horak, 1986), RR (step stance), ST and gait velocity.

The reliability of the star-excursion test in assessing dynamic balance

Quantification of dynamic balance is often necessary to assess a patient's level of injury or ability to function in order to initiate an appropriate plan of care. Some therapists use the star-excursion test in an attempt to quantify dynamic balance. This test requires the patient to balance on one leg while reaching with the other leg. For the purpose of this study, the reach was performed in four directions. No previous researchers have attempted to evaluate the reliability of this test. Twenty healthy subjects between the ages of 18 and 35 years participated in this study. During two testing sessions, each subject was required to perform five reaching trials in four directions. Reliability estimates, calculated using the intraclass correlation coefficient (2, 1), ranged from 0.67 to 0.87. Six duplicate practice sessions were suggested to increase this range above 0.86. Task complexity may account for the moderate reliability estimates. Subjects should engage in a learning period before being evaluated on the star-excursion test.

Evaluation of clinical measures of equilibrium

OBJECTIVE

Evaluate the clinical utility of several simple measures of static and dynamic equilibrium in human subjects. In particular, one proposed clinical measure, the Clinical Test of Sensory Integration and Balance (CTSIB) was compared with dynamic posturography for the measurement of postural control capabilities.

STUDY DESIGN

Cross-sectional study of normal subjects and prospective observational study of the same performance measures in vestibular disorder patients.

SETTING

Academic tertiary care referral center.

PARTICIPANTS

Data were collected for all test measures from a group of normal subjects (ages, 20 to 79 years), as well as for a group of patients undergoing treatment for vestibular dysfunction.

RESULTS

Data suggest that several semiquantitative clinical tests of static and dynamic equilibrium can be helpful in evaluating and monitoring patients with chronic vestibular dysfunction. The CTSIB results seem to correlate well with dynamic posturography, suggesting that this measure may be useful in identifying patients with abnormal postural control. Formal dynamic posturography testing appears to be more sensitive in detecting abnormal postural control and more exact in defining the specific pattern of dysfunction.

CONCLUSION

Simple clinical measures of static and dynamic equilibrium can reliably distinguish vestibular disorder patients from normal subjects. Dynamic posturography continues to play an important role in the functional evaluation and management of vestibular disorder patients.

Computerized dynamic platform posturography

Computerized dynamic platform posturography is defined in this technology assessment. The review discusses what computerized dynamic platform posturography measures, what the reliability and validity of the information are, and the uniqueness of the information provided. The clinical contribution and indications for testing are discussed. There are comments on future directions for research on computerized dynamic platform posturography and a summary and conclusion.

Alternative approaches to the assessment of mild head injury in athletes

OBJECTIVES

Athletic trainers and team physicians are often faced with decisions concerning the severity and timing of an athletes return to play following mild head injury (MHI). These decisions can be the most difficult ones facing clinicians because of the limited amount of quantitative information indicating injury severity. Several authors have published guidelines for return to play following MHI, however these guidelines are based on limited scientific data. The purpose of this paper was to examine the effects of MHI on two objective measures, postural stability and cognitive function, to determine their usefulness in MHI assessment. The data gathered from these two measures has the potential to establish recovery curves based on objective data.

METHODS

Eleven Division I collegiate athletes who sustained a MHI and eleven matched control subjects were assessed for postural stability and cognitive function at four intervals following injury. Postural stability was assessed using the Sensory Organization Test on the NeuroCom Smart Balance Master. Cognitive functioning was measured through the use of four neuropsychological tests: Stroop Test, Trail Making Test, Digits Span and Hopkins Verbal Learning Test. Separate mixed model repeated measures ANOVAs were calculated for the composite score and three ratio (vestibular, visual and somato-sensory) scores from the Sensory Organization Test and the scores from the neuropsychological test to reveal significant differences between groups and across days postinjury.

RESULTS

A significant group by day interaction for overall postural stability (composite score) revealed that MHI athletes displayed increased postural instability for the first few days following MHI (p < .05). Analysis of the ratio scores revealed a significant interaction for the visual ratio. No significant group differences were revealed for any of the neuropsychological tests (p > .05), however significant day differences were revealed (p < .05).

CONCLUSIONS

The results from this study indicate that athletes demonstrate decreased stability until 3 days postinjury. It appears this deficit is related to a sensory interaction problem, whereby the injured athlete fails to use their visual system effectively. These findings suggest that measures of postural stability may provide clinicians with a useful clinical tool for determining when an athlete may safely return to competition, although these findings need to be confirmed in larger groups of athletes.

The ankle strategy for postural control--a comparison between a model-based and a marker-based method

When analysing postural control statistical characteristics of the centre of pressure or the ground reaction force are often used. A complement would be to analyse movement strategies as well. The purpose of this study was to determine to what extent the ankle strategy is used to maintain the balance in standing. One important question is if it is sufficient to use only force plate data in this determination, or if markers have to be used. To answer this question we studied two different methods--a marker-based method and a model-based method. The latter needs force plate data only as input to an inverted pendulum model. Different measures were calculated and used to draw conclusions of to what extent the ankle strategy was used. Experiments demonstrated that the data from the two methods provided the same general conclusions, although there were some differences in the estimated measures. By using the model-based method instead of tracking markers we can increase the clinical effectiveness considerably, get a lesser amount of data, and still get results comparable to the marker-based method.

The reliability of postural sway measures using the 3SPACE Tracker

OBJECTIVE: To investigate the reliability of three-dimensional postural control sway measures, in a normal population, using an electromagnetic device. DESIGN: A repeated measures design was used within and between sessions. BACKGROUND: Electromagnetic measurement has been proposed as a method of measuring postural sway; however, reliability within a normal population has not been shown. METHOD: An electromagnetic device, the 3SPACE Tracker, measured postural sway at the pelvis using sway path length and displacements in the anterior-posterior, medial-lateral and vertical direction. Ten subjects performed a postural control task involving two trials for six different sensory conditions, on two separate occasions, two weeks apart. RESULTS: The reliability of the technique was demonstrated by the repeatability of results for individual subjects within and between sessions. Individual subjects and sensory conditions were discriminated. Sway path length was the most consistent of the measures used. CONCLUSIONS: Three dimensional measures of postural sway are reliable and discriminatory in a normal population.

Quantitative measurement of improvement in sitting balance in children with spastic cerebral palsy after selective posterior rhizotomy

Severe muscular spasticity encountered frequently in patients with spastic cerebral palsy not only affects patient locomotor function but also causes musculoskeletal complications. Significant reduction of spasticity over pelvis and lower limbs after selective posterior rhizotomy (SPR) results in improvement of trunk stability, locomotor function, and function of upper limbs also. The purpose of this study was to investigate the difference of sitting balance before and after SPR using a quantitative measurement in sitting stability represented as dispersion index provided by the Chattecx Balance System. Seventeen children with spastic cerebral palsy, ten boys and seven girls, with a mean age of 5.06 yr, underwent SPR. Their sitting stability under static and dynamic, visual and nonvisual testing conditions was assessed before SPR and three mo after SPR. Their sitting balance showed significant improvement at postoperative evaluation except for the static-nonvisual testing condition. Dispersion index under the dynamic testing condition was significantly higher than under the static testing condition, which implies that dynamic sitting balance was worse than static sitting balance in these patients. There was no statistical difference of sitting performance between visual and nonvisual condition both preoperatively and postoperatively. Quantitative measurement of dispersion index provided by the Chattecx Balance System offers an objective evidence of improvement in sitting balance for children after SPR.

Concepts and Methods for Assessing Postural Instability

Current research suggests that there are complex interactions between intrinsic factors related to the individual and extrinsic environmental factors, all of which contribute to falls in the older adult. A new approach to balance assessment, the task-oriented conceptual framework for clinical intervention, takes into account many of these intrinsic and extrinsic variables in assessing balance function. It contains three levels of assessment of balance and gait function: performance-based functional assessment, strategy assessment, and impairment assessment. This approach quantifies performance on functional tests of balance, determines the strategies used by the individual to carry out functional tasks, and evaluates the relative contribution of specific neural and musculoskeletal variables to normal postural control. Results of recent experiments suggest that older adults who are given a sensory training program that is designed to improve the organization of sensory inputs contributing to balance control (strategy level) are able to significantly improve sway and that this training effect transfers to other balance conditions.

Reliability and validity of measures obtained from stroke patients using the Balance Master

OBJECTIVE

To determine the test-retest reliability and validity of data obtained using the Balance Master (BM), a computerized balance assessment and training tool.

DESIGN

Data were collected on three occasions, 1 week apart. Intraclass correlation coefficients (ICCs) were calculated if significant (p < .05) between-subject variance was found using a univariate analysis of variance for repeated measures. Concurrent validity of the BM data was determined using the Berg Balance Scale and gait velocity as criterion standards.

PARTICIPANTS

Twenty ambulatory hemiparetic subjects who had no history of lower extremity orthopedic problems, no neurological deficits apart from stroke, and had not trained using the BM.

MAIN OUTCOME MEASURES

BM data relating to static and dynamic balance performance, gait velocity, and the total score from the Berg Balance Scale.

RESULTS

ICCs indicated that only the BM test requiring subjects to shift their center of gravity to randomly highlighted targets (positioned in a circle representing 75% of the individual's limits of stability) was reliable, both in terms of movement path (ICC = .84) and movement time (ICC = .88). Concurrent validity of the BM data was established for the dynamic measures of balance only, which correlated with both the Berg Balance Scale and gait velocity outcomes (r > or = .48, p < .05).

CONCLUSIONS

These findings suggest that in stroke patients the test-retest reliability of data obtained using the BM is greatest for complex tests of balance and that dynamic rather than static balance measures are valid indicators of functional balance performance.

Use of an obstacle course to assess balance and mobility in the elderly. A validation study

An obstacle course, consisting of a series of 12 simulated functional tasks, has been developed to aid in the evaluation of rehabilitation interventions for elderly individuals with balance and mobility dysfunction. The validity of the obstacle course as a measure of balance and functional mobility was tested by comparing obstacle course performance scores of a sample of 237 community-dwelling veterans, aged 67 to 93 yr, with clinical indicators of balance and mobility including age, history of falls, symptoms of balance dysfunction, medication use, orthostatic blood pressure changes, neurologic examination abnormalities, muscle strength, joint range of motion, self-reported activity level, and functional status. Significant correlations were found between obstacle course scores and all clinical indicators except blood pressure changes and age. Multiple regression analysis of selected variables showed that activity level and neurologic abnormalities best determined both qualitative and quantitative obstacle course performance. Non-fallers performed significantly better on the obstacle course than fallers. These results suggest that the obstacle course is valid and has potential as a useful tool in the evaluation of older persons with balance and mobility impairment.

Research and Clinical Applications of Assessing Balance

Returning athletes to competition following injury often creates a dilemma for athletic trainers and team physicians. Most clinicians gather as much data as possible before deciding whether to return an athlete to competition following injury. The status of the postural control system and balance is important for certain pathologies and therefore should be considered in these clinical decisions. As more high-tech balance systems become available, it is important for clinicians to understand not only what is available but what these devices measure. This paper will review the relationship between the postural control system and the kinetic chain, traditional and contemporary techniques for assessing balance, and ways in which clinicians can bridge the gap between balance research and clinical practice.

Balance abilities of professional dancers on select balance tests

Documentation that dancers have better balance abilities than nondancers is important because of the number of dancers who sustain injury and then are referred to physical therapists for treatment. The purpose of this study was to compare balance abilities of professional dancers with nondancers on selected balance conditions. Fifteen dancers and 15 age- and gender-matched nondancers maintained one-legged stance under six combinations of visual and support surface conditions (Foam and Dome Test modified from two feet to one foot). Each condition was maintained for 30 seconds. A composite balance score was obtained for each subject by summing the number of seconds the individual maintained balance for each test condition. There was a significant difference in the mean composite balance score (across the six balance conditions) for the dance group compared with the control group (731 seconds and 563 seconds, respectively). Under sensory challenged conditions, it appeared that dancers were better able to maintain their postures upright against gravity. The balance strategies and techniques learned by professional dancers should be carefully analyzed to determine if they could be incorporated into treatment programs for nondancers who have balance instability and dancers who are injured.

The use and interpretation of the Friedman test in the analysis of ordinal-scale data in repeated measures designs

The purpose of this paper is to review the use and interpretation of the Friedman two-way analysis of variance by ranks test for ordinal-level data in repeated measurement designs. Physical therapists frequently make three or more repeated measurements of the same individual to compare different treatments, or to assess the effect of a single treatment over time. When the measurements are ordinal-scaled, such as some ratings of functional status and muscle strength, statistical significance may be determined by the Friedman test. We illustrate the use of the Friedman test and a post hoc multiple comparison test with data from 27 subjects whose performance on a lifting task was rated on three occasions by use of an ordinal scale. We discuss the interpretation of ordinal-level data and recommend that therapists understand the limitations a measurement scale imposes on the inferences that can be made from these tests.

Balance abilities in individuals with moderate and severe traumatic brain injury

Balance characteristics, latency, amplitude, and symmetry were measured in 23 moderate and 23 severe traumatic brain-injured (TBI) patients. Patients received two graded forward and two graded backward linear perturbations. Although within normal limits, latency was high. Patients were able to appropriately grade force in relation to the size of the perturbation. Standing posture prior to and during perturbation was recorded by the amount of force generation through each lower extremity. Some individuals used an asymmetrical balance response following perturbations, whereas others shifted to a more symmetrical weight-bearing balance response. TBI patients may be prone to instability due to a combination of long latency of onset of the balance response coupled with asymmetrical stance patterns during recovery from an unexpected linear perturbation.

Occupation and visual/vestibular interaction in vestibular rehabilitation

Otolaryngologists often prescribe head movement exercise programs for patients with vestibular disorders, although the effectiveness of these programs and the critical features of the exercises are poorly understood. Because many patients who dislike exercising do not follow through with their exercises, alternatives to the traditional repetitive exercises would be useful. Subjects diagnosed with vestibular disorders were treated for 6 weeks with either an outpatient exercise program that incorporated interesting, purposeful activities or a simple home program of head movements, comparable with the exercises otolaryngologists often give their patients when they do not refer to rehabilitation. Both treatments incorporated repetitive head movements in all planes in space, graduated in size and speed. Subjects were all tested before and after treatment with standard measures of vestibulo-ocular reflex and balance, level of vertigo, gross motor skills, and self-care independence. Subjects in both groups improved significantly on the functional measures, with slightly greater improvements in the occupational therapy group. The results were maintained 3 months after the cessation of intervention. These data suggest that graded purposeful activities are a useful alternative for treating this patient population and that the essential factor in any exercise program is the use of repetitive head movements.

Sensory interaction testing in platform posturography

Mostly techniques measuring the vestibulo-ocular reflex (VOR) have been used for the evaluation of patients with dizziness problems. Some investigators, however, have also tried to take into account the vestibulospinal reflex (VSR). So recording techniques for the Romberg-test have been proposed and called posturography (PG). By interfering with the visual and proprioceptive sensory inputs during this PG-testing one tries to find out how 'sensory interaction' is organized in the balance performance of the patient examined. To interfere with vision, closure of the eyes has been commonly used and to interfere with proprioception, the patient can be put on foam-rubber, which makes the contribution of the foot-ankle proprioception less adequate. These interferences are applied once separately and once combined. The degree of 'abnormality' is assessed by a score-system for parameters surface (S) and velocity (V), which measure the postural sway. A comparison of tests with and without influence on the sensory inputs gives an idea of the sensory interaction. Patients with peripheral vestibular disorders were examined: patients with BPPV, with spontaneous vertigo attacks and with a sudden vestibular deficit. When applying this evaluation technique different formulae or patterns can be found. Firstly complete normal evaluation, which means that there is no influence of the vestibular disturbance upon the PG results. Secondly a normal balance when using all available sensory information, but disturbed balance as soon as one of the sensory inputs is influenced by the test conditions. Thirdly striking destabilization when closing the eyes. Fourthly striking destabilization when misleading the ankle and foot proprioceptor.(ABSTRACT TRUNCATED AT 250 WORDS)

Visual destabilisation of posture in normal subjects

A new and simple method of assessing reliance on vision for postural control was evaluated in 41 normal subjects. Left-right reversal of peripheral vision induced by a head-mounted mirror device caused an initial dramatic instability in approximately half the subjects, when standing on foam to reduce the value of proprioception. Lateral reversal of central vision by means of a prism device evoked similar responses. Sensitivity to vision reversal was significantly correlated with motion sickness susceptibility. Despite some rapid habituation (partially retained over several weeks) sway remained as great as with eye closure in the anterior-posterior as well as lateral direction, indicating complete suppression of the visual input. Balancing with vision reversal caused a selective decrement in performance of a visuo-spatial memory task, suggesting that coping with misleading visual input may place continuous demands on cortical spatial processing.

Stabilometry in balance assessment of dizzy and normal subjects

Normal adults and patients referred to the Dizzy Clinic at the Medical College of Ohio had their standing balance assessed during combinations of normal and altered visual and somatosensory orientation conditions using a fixed-force platform to measure center-of-pressure translations. Significant differences were identified between normal subjects and dizzy patients, depending on the particular diagnostic category, the sensory condition tested, and the particular sway component being measured. Patients with central and peripheral vestibular dysfunctions had significantly greater sway than all other categories in most test conditions, especially with eyes closed and with a visual conflict dome while standing on a foam surface. The central vestibular dysfunction and peripheral vestibular dysfunction groups could be differentiated statistically under eyes-closed and visual conflict-foam conditions. The normal and psychogenic groups could not be differentiated statistically for any test conditions except one: there was significantly greater mean anterior/posterior sway displacement in the psychogenic group compared with all other diagnostic categories for the eyes-open foam test condition. Our results indicate that static stabilometry recordings of postural sway can be used to evaluate and quantify a dizzy patient's ability to receive and process vestibular, visual, and somatosensory-proprioceptive cues for postural stability. It can also be used to monitor patients with vestibular disorders and to document their responses to rehabilitation programs.

Habituation therapy for chronic vestibular dysfunction: preliminary results

Chronic vestibular dysfunction is often a frustrating problem for both patient and physician. A program of customized vestibular habituation therapy is introduced and its efficacy in a group of 65 patients is evaluated. Preliminary findings suggest that 59% of patients will have a dramatic improvement, after which their vestibular symptoms no longer cause any restriction in their lifestyles. An additional 23% of patients note considerable improvement, but have persistent symptoms that continue to restrict their activities. Vestibular habituation therapy is a rational, multidisciplinary approach to the treatment of chronic vestibular dysfunction that is a significant alternative to traditional pharmacologic management. Failure of vestibular compensation after involvement in a disciplined program of habituation therapy constitutes a much stronger indication for vestibular surgery in patients with unilateral peripheral lesions.

Kinematic properties of voluntary postural sway in patients with unilateral primary hemispheric lesions

The temporal and spatial characteristics of rapid voluntary body sway following unilateral cerebrovascular accident were assessed in single and combined planes of motion during a visually cued non-choice reaction time movement. Three distinct directions of intentional body sway were assessed: forward, toward the paretic, and toward the non-paretic lower extremity. Fluctuations in the center of foot pressure served as the basis for calculating body displacement and velocity by combining frontal and sagittal movement in an X-Y coordinate system (a bi-planar analysis). A linear regression analysis was used on individual force output channels to reduce the sway motion into separate component parts. The velocity profile in each direction of intended sway was calculated from the slope of the regression line (a single-plane analysis). Bi-planar velocity analysis showed that hemiplegics swayed as fast as normal subjects in any sway direction. In contrast, single plane analysis revealed a decrease in the velocity of hemiplegic sway when weight shifts were directed toward the paretic extremity. Response velocity in the non-paretic direction was similar to a comparison group of normal individuals. The apparent contradiction between single and bi-planar analyses was attributed to hemiplegic sway in extraneous planes of motion surrounding the intended sway path. During the course of body sway, hemiplegics showed a statistically larger range of extraneous movement away from the plane of intended movement. The directional deficits in sway velocity and excursion are compared to previously reported sway pathology associated with lesions of the human central nervous system.

Review of tests of standing balance abilities

This review examines tests of standing balance abilities in patients with traumatic brain injury. Patients may compensate for vestibular dysfunction by using other sensory systems. As a result, subtle deficits in balance abilities may not be detected by traditional tests. The purpose of this paper is to provide a compilation of standing balance tests and to provide the clinician with the latest technological advances that can be used to assess balance abilities.

Vestibular function and motor proficiency of children with impaired hearing, or with learning disability and motor impairments

Vestibular status and motor proficiency of 30 hearing-impaired and 15 motor-impaired learning-disabled children were documented to determine whether vestibular loss can account for deficits in motor co-ordination. Vestibular loss was differentiated from sensory organization deficits by means of VOR and postural orientation test results, which were compared with those of 54 normal seven-to 12-year-olds. Reduced or absent vestibular function in 20 hearing-impaired children did not affect development of motor proficiency, except in specific balance activities. However, sensory organization deficits in the learning-disabled group and in three of the hearing-impaired children were associated with widespread deficits in motor proficiency.