Computerized dynamic platform posturography

Computerized static posturographic assessment after treatment of equinus deformity in children with cerebral palsy

Assessment of treatments in children with cerebral palsy has been well developed, especially in the gait laboratory. However, the prerequisite for walking is adequate postural control. We hypothesize that a treatment of an equinus deformity should improve postural control. Balance control was assessed by static posturography on the Balance Master. Nine diplegic children, six girls and three boys, participated in the study. Assessment was conducted before and after treatment of the equinus deformity. Two static tests (Weight Bearing Squat and the modified Clinical Test for Sensory Interaction on Balance), and two dynamic balance tests (Limits of Stability and Rhythmic Weight Shift) were performed on the Balance Master. After treatment, mean weight-bearing asymmetry measured by the Weight Bearing Squat was significantly improved at 30 degrees of knee flexion. In the modified Clinical Test for Sensory Interaction on Balance, there was a significant improvement in two conditions (eyes closed on foam surface and the composite score). The Limits of Stability was very difficult to perform for almost all the children. In the Rhythmic Weight Shift, mean directional control improved significantly in three conditions (left/right weight shift at 1 s of transition, front/back weight shift at 2 s of transition and the composite score of the front/back direction). The Balance Master offers the opportunity for an objective and easy assessment of postural control in children with cerebral palsy.

A double-blind, randomized, placebo-controlled trial of intravenous L-ornithine-L-aspartate on postural control in patients with cirrhosis

INTRODUCTION

Hepatic encephalopathy (HE) is a complication of liver disease. Several treatments have been introduced but only L-ornithine-L-aspartate (LOLA) shows proven efficacy. This double-blind, randomized, placebo-controlled trial evaluated the effect of LOLA on postural control in cirrhotics.

METHODS

Forty patients were randomized to either LOLA or a placebo. HE was evaluated by psychometric testing (PSE Syndrome Test) and critical flicker frequency (CFF). Posturography [equilibrium score (ES)] provided information regarding postural control. Peripheral blood was analysed for ammonia concentration (NH(3)) and the partial pressure of ammonia (pNH(3)).

RESULTS

Both groups were comparable regarding baseline variables. Posturography and PSE Syndrome Test improved in both groups; improvement was greater in the LOLA group (ES: 5.3%; PSE: 1.9) compared with the placebo (ES: 3.9%; PSE: 1.3) but did not reach significance (ES: P=0.3; PSE: P=0.5). CFF remained unchanged during treatment and between groups (P=NS). NH(3) decreased in the LOLA group (Delta: -15 micromol/L) and slightly increased in the placebo group (Delta: 11.1 micromol/L), but the differences did not reach statistical significance (P=0.07). pNH(3) remained largely unchanged (LOLA Delta: -1.2 x 10(-5) mmHg vs. placebo Delta: -0.3 x 10(-5) mmHg; P=0.21).

CONCLUSION

In the LOLA group, an improvement of posturographic control and PSE Syndrome Test was observed, but a similar improvement was also achieved by the placebo. In LOLA, ammonia levels tended to decrease while they tended to increase in the placebo group. LOLA might augment the improvement achieved by intravenous fluids alone but a larger cohort will be needed to show this effect with statistical significance.

Challenge-oriented gait and balance training in sporadic olivopontocerebellar atrophy: a case study

BACKGROUND AND PURPOSE

Sporadic olivopontocerebellar atrophy (OPCA) is a rare and debilitating neurologic disease of insidious onset. It is characterized by atrophy of the cerebellum, pons, and inferior olivary nuclei with concomitant ambulation deficits and dyscoordination. To our knowledge, there has been no published study investigating any aspect of rehabilitation in OPCA. Therefore, the purpose of this study was to investigate the use of challenge-oriented gait and balance training to improve gait and balance in OPCA.

CASE DESCRIPTION

An otherwise healthy 19-year-old woman with moderate to severe upper and lower extremity ataxia, secondary to sporadic OPCA, participated in this prospective case study. She also had a vestibulotoxic treatment procedure to decrease the severity of her vertigo.

INTERVENTION

This individual participated in a 12-week gait and balance training program (five times per week), which consisted of one to two hours of various challenging static and dynamic balance tasks. To measure her progress, the following scales and tests were used: Berg Balance Scale, Dynamic Gait Index, Activities-Specific Balance Confidence Scale, computerized dynamic posturography (sensory organization test and limits of stability), and self-selected gait velocity.

OUTCOMES

: Improvements were noted in all the dependent measures (pre to post): Berg Balance Scale (34/56 to 39/56), Dynamic Gait Index (1/24 to 7/24), Activities-Specific Balance Confidence Scale (50.6%-85.1%), sensory organization test (composite score, 31/100 to 47/100), limits of stability (maximum excursion, 89-105; endpoint excursion, 57-93; directional control, 60-78), and SSGV (0.375-0.526 m/sec).

DISCUSSION

Results from this case study suggest that a gait and balance training program may be beneficial to individuals with ataxia from OPCA. This early evidence warrants further investigation using more rigorous methods.

Postural control in patients with liver cirrhosis: a posturographic study

BACKGROUND

Ataxia has been suggested in the literature to be a symptom of hepatic encephalopathy (HE), but so far has not been objectively quantified. In this study, we wanted to objectively quantify ataxia in patients with liver cirrhosis.

METHODS

One hundred and seven patients with liver cirrhosis were tested for postural control using posturography and compared with 25 controls. For quantification of HE, we used the number connection tests A and B, ammonia levels (NH3), and the partial pressure of ammonia in the arterial blood (pNH3).

RESULTS

Patients showed an impaired postural control compared with controls. Patients with Child C cirrhosis had lower scores in the posturography than those with Child A or B cirrhosis. Patients with alcohol-induced (AIC) Child B cirrhosis achieved lower scores in the posturography than those with non-alcohol-induced (NAIC) Child B cirrhosis. Patients with AIC Child C had lower scores than the corresponding NAIC patients, although this did not reach statistical significance. In the NAIC group Child C patients, in the AIC group Child B and C patients had lower scores than the controls. Patients with abnormal results in the number connection tests, as well as those with high NH3 and pNH3 levels showed worse postural control than those with normal results.

CONCLUSION

Patients with cirrhosis have an impaired postural control compared with controls and this impairment deteriorates with progression of liver disease. HE as well as past alcohol abuse contribute to the pathogenesis of ataxia in liver cirrhosis and past alcohol abuse leads to an earlier and more pronounced manifestation of ataxia in the affected patients.

A framework for assessment in oncology rehabilitation

Although the incidence of cancer in the United States is high, improvements in early diagnosis and treatment have significantly increased survival rates in recent years. Many survivors of cancer experience lasting, adverse effects caused by either their disease or its treatment. Physical therapy interventions, both established and new, often can reverse or ameliorate the impairments (body function and structure) found in these patients, improving their ability to carry out daily tasks and actions (activity) and to participate in life situations (participation). Measuring the efficacy of physical therapy interventions in each of these dimensions is challenging but essential for developing and delivering optimal care for these patients. This article describes the acute and long-term effects of cancer and its treatment and the use of the World Health Organization's International Classification of Functioning, Disability and Health (ICF) as a basis for selection of assessment or outcome tools and diagnostic or screening tools in this population.

Clinical tools for assessing balance disorders

Three main issues have to be addressed by the examination of a patient complaining from balance disorders: physiopathology and aetiology, severity and consequences, and evolution. A precise clinical analysis must be then conducted, including close anamnesis and clinical examination, with scale measurements depending on the objectives. Daily consequences can be assessed by the Dizziness Handicap Inventory, which considers a large field of daily activities. The International Classification of Functioning evaluates activities and participation, influence of environmental factors, and quality of life. Then, patient's examination aims at objectifying and measuring the balance disorder. Quantified measurement is possible even in a simple doctor's office. Clinical scales for balance assessment should be used for a standardized assessment and to allow comparison of different subjects. Although the Tinetti test is the most-widely used in older people, it is quite approximate. The Berg Balance Scale has also been first validated in older people, it is rather easy to use, but uncertainty between two close scores is frequent. The Timed Up-and-Go Test is the simplest one and probably the most reliable. The Unipodal Stance Testing is also a simple test and a good predictor of fall. The Functional Ambulation Classification focuses attention on the physical support needed by the patient during walking. The Postural Assessment Scale for Stroke Patients (PASS) is easy to use after a recent stroke. Instrumental analysis by means of static and dynamic platforms, often coupled together with accelerometers or video, can be used to complete the clinical examination. Its main interest is to contribute to give insight into physiologic and pathologic mechanisms underlying the postural trouble.

The effect of a senior jazz dance class on static balance in healthy women over 50 years of age: a pilot study

The purpose of this pilot study is to assess the impact of a senior jazz dance class on static balance for healthy women over 50 years of age using the NeuroCom Smart Balance Master System (Balance Master). A total of 12 healthy women aged 54-88 years completed a 15-week jazz dance class which they attended 1 time per week for 90 min per class. Balance data were collected using the Sensory Organization Test (SOT) at baseline (pre), at 7 weeks (mid), and after 15 weeks (post). An equilibrium score measuring postural sway was calculated for each of six different conditions. The composite equilibrium score (all six conditions integrated to 1 score) was used as an overall measure of balance. Repeated measures analyses of variance (ANOVAs) were used to compare the means of each participant's SOT composite equilibrium score in addition to the equilibrium score for each individual condition (1-6) across the 3 time points (pre, mid, post). There was a statistically significant difference among the means, p < .0005. Pairwise (Bonferroni) post hoc analyses revealed the following statistically significant findings for SOT composite equilibrium scores for the pre (67.33 + 10.43), mid (75.25 + 6.97), and post (79.00 + 4.97) measurements: premid (p = .008); prepost (p < .0005); midpost (p = .033). In addition, correlational statistics were used to determine any relationship between SOT scores and age. Results indicated that administration of a 15-week jazz dance class 1 time per week was beneficial in improving static balance as measured by the Balance Master SOT.

Comparison of electronystagmography results with dynamic posturography findings in patients with vestibular schwannoma

CONCLUSION

Condition-5-score (C5S) and condition-6-score (C6S) of computerized dynamic platform posturography (CDPP) can detect the presence of a functional deficit of the lateral semicircular canal (and the superior vestibular nerve), irrespective of the central vestibular compensatory status, in vestibular schwannoma (VS) patients.

OBJECTIVES

To test whether CDPP findings differ between VS patients with and without asymmetry on caloric and/or rotational ENG studies.

PATIENTS AND METHODS

This was a retrospective review of 216 consecutive patients with VS. C5S and C6S of CDPP (Equitest) were compared among patients with normal caloric and rotational studies, patients with asymmetry on caloric studies and normal rotational studies, and patients with asymmetric caloric and rotational studies using the Wilcoxon-Mann-Whitney test.

RESULTS

C5S and C6S of VS patients with normal caloric and rotational studies were significantly higher than in VS patients with either asymmetry on both rotational and caloric test results (p<0.001 for both C5S and C6S) or normal rotational studies and asymmetry on caloric testing (p<0.001 for both C5S and C6S). Neither C5S nor C6S were significantly different between patients with asymmetry on caloric testing and normal rotational studies and patients with asymmetry on both rotational and caloric testing.

Effects of whole body vibration training on postural control in older individuals: a 1 year randomized controlled trial

This randomized controlled trial investigated the effects of a 12 month whole body vibration training program on postural control in healthy older adults. Two hundred and twenty people were randomly assigned to a whole body vibration group (n=94), a fitness group (n=60) or a control group (n=66). The whole body vibration and fitness groups trained three times a week for 1 year. The vibration group performed exercises on a vibration platform and the fitness group performed cardiovascular, strength, balance and stretching exercises. Balance was measured using dynamic computerized posturography at baseline and after 6 and 12 months. Whole body vibration training was associated with reduced falls frequency on a moving platform when vision was disturbed and improvements in the response to toes down rotations at the ankle induced by the moving platform. The fitness group showed reduced falls frequency on the moving surface when vision was disturbed. Thus, whole body vibration training may improve some aspects of postural control in community dwelling older individuals.

Balance in healthy individuals assessed with Equitest: maturation and normative data for children and young adults

OBJECTIVE

The purpose of the present prospective study was to obtain normative data for Equitest computerized dynamic posturography (CDP) in children and young adults and to observe the balance maturation process.

METHODS

Equilibrium pattern and SOT of 195 healthy children aged from 6 to 14 years were compared to those of 64 young adults aged 20 years, using Equitest.

RESULTS

The mean stability scores for children progressively improve with age and are significantly lower than those of young adults. Furthermore, sensory organization scores were lower in children compared to young adults, whereas visual preference scores were similar for the whole studied groups.

CONCLUSIONS

According to previous literature, it may be stressed that due to a presumed incomplete development of vestibular system and central nervous system integration, children unlike young adults have lower equilibrium scores, especially when visual information was not available or was incorrect. Our results confirm previous ones obtained in children and young adults with Equitest CDP. This study also provides Equitest data for these age groups, which complete those that have been previously reported.

Dynamic Posturography Findings Predict Balance Status in Vestibular Schwannoma Patients

OBJECTIVE

To test whether condition 5 score (C5S) and condition 6 score (C6S) of the sensory organization test of computerized dynamic platform posturography (CDPP) differ between vestibular schwannoma (VS) patients with and without vestibular symptoms.

STUDY DESIGN

Retrospective review of prospectively collected data.

SETTING

Tertiary academic referral center.

PATIENTS

Two hundred and sixteen consecutive patients with a histological diagnosis of a VS (103 women; 113 men; age range, 18-78 years; median, 54 years) who had been preoperatively evaluated by CDPP. A hundred and twelve patients had a history of vertigo, dizziness, and/or imbalance, and 104 patients had neither present nor past vestibular symptoms at all.

INTERVENTION

Diagnostic. Preoperative CDPP in VS patients with and without vestibular symptoms.

MAIN OUTCOME MEASURES

Condition 5 score and C6S of the sensory organization test of CDPP of VS patients. To test whether C5S and C6S differ between VS patients with and without vestibular symptoms, the Wilcoxon-Mann-Whitney rank sum test was applied.

RESULTS

Both C5S (p = 0.001) and C6S (p < 0.0005) were significantly lower in VS patients with vestibular symptoms than in VS patients without vestibular symptoms.

CONCLUSION

There is a significant difference in the distribution of C5S and C6S between VS patients with and without vestibular symptoms. Thus, patients with symptoms tend to have lower C5S and C6S than patients without symptoms, although this trend is not sufficient for reliable discrimination for all patients.

Influence of nerve of origin and tumor size of vestibular schwannoma on dynamic posturography findings

CONCLUSION

Condition 5-score (C5S) and vestibular ratio (VER) correlate, but condition-6-score (C6S) and mean overall balance score (MOBS) do not, with the size of an inferior vestibular nerve (IVN) vestibular schwannoma (VS). In IVN VS patients the visual system plays a major role in the maintenance of postural stability.

OBJECTIVES

To test whether the size of a superior vestibular nerve (SVN) or IVN VS, as measured on MRI scans, correlates with computerized dynamic platform posturography (CDPP) findings and whether CDPP findings could preoperatively predict the nerve of origin of the VS.

PATIENTS AND METHODS

This was a retrospective study. Seventy-five consecutive VS patients were evaluated. C5S, C6S, VER, and MOBS were evaluated. Spearman's rank correlation coefficients were calculated between the tumor's larger dimension and each of the four parameters for SVN and IVN VS. The nerve of VS origin was identified intraoperatively. To test for differences between CDPP findings of the SVN and IVN groups of VS patients, the Wilcoxon-Mann-Whitney sum rank test was applied.

RESULTS

Larger dimension of VS was correlated with C5S and VER in IVN VS patients (r = - 0.358, p=0.008 and r = - 0.356, p=0.008, respectively). Neither C6S nor MOBS showed any significant correlation with the tumor's larger dimension. None of the four scores showed any significant difference between the SVN and IVN groups of VS patients.

Balance performance in adult epilepsy patients

PURPOSE

To evaluate the magnitude of subclinical balance dysfunction in adult epilepsy patients and to assess the relative contribution of different variables to balance impairment.

METHODS

Balance performance was evaluated by computerized dynamic platform posturography (CDPP) in 25 adult patients following a generalized tonic-clonic seizure (GTCS) and in 11 healthy subjects.

RESULTS

The GTCS was a breakthrough seizure in 20 patients with epilepsy and a first seizure in 5. Seven of the patients had localization-related epilepsy and 13 had generalized epilepsy. Mean epilepsy duration was 6.6 years. Nineteen of the patients were treated with antiepileptic drugs (AEDs), 16 on monotherapy and three on polytherapy. Brain CT scan and EEG abnormalities were found in 7 and 14 patients, respectively. None of the patients had clinical signs of balance dysfunction. Postural function, measured by Sway Index (SI), was worse in the patients compared to controls. A lower SI was found in patients who did not receive AEDs, had one or two seizures, had a disease duration of less than a year and had a generalized epilepsy.

CONCLUSIONS

Although the study group was small and heterogeneous and only a small number of parameters have reached statistical significance, it seems that posturography can be helpful in the evaluation of postural stability in adult patients with epilepsy.

Vestibular assessment with Balance Quest Normative data for children and young adults

OBJECTIVE

The purpose of the present study was to compare equilibrium pattern in 12-year-old children with 20-year-old young adults and to obtain normative data for the BQ in both groups.

METHODS

Mean stability percentages and synthesis ratios of 29 healthy children aged 12 years were compared to those of 68 young adults aged 20 years, using BQ.

RESULTS

The mean stability percentages for children were significantly lower than for young adults. Vestibular ratios were lower in children compared to young adults, whereas somesthesic ratios were similar for the two groups. Visual dependence was significant higher in children.

CONCLUSIONS

Children unlike young adults had lower stability percentages when visual information was not available or was incorrect. Ratio synthesis pattern was different in the two groups. Our results on BQ partially confirms previous results obtained in children assessed with Equitest CDP. This study also provides BQ normative data for these two age groups.

[Physiological changes in balance control of adults aged 20 to 60 years assessed with Equitest]

OBJECTIVES

The sense of balance depends on many factors including age. A considerable amount of time is spent in medical clinics attempting to identify potential balance problems and retrain individuals with posture and balance limitations. Since the past decades the development of computerized dynamic posturography (CDP) provided the clinicians a tool to objectively assess balance disorders. The aim of this study was to evaluate physiological changes in balance control of adults aged from 20 to 60 years.

MATERIAL AND METHODS

108 healthy adults volunteers were involved in the study. The Equitest CDP was used to record equilibrium pattern in four age groups: "a" 20-30 years old, "b" 3040 years old, "c" 40-50 years old and "d" 50-60 years old.

RESULTS

Equilibrium patterns worsen progressively with age in the studied age groups, especially vestibular pattern, whereas visual dependence increases.

CONCLUSION

Ours results show that: 1- presbyvestibulia takes place progressively with age. 2- between 20 and 60 years old, normative data should be established by decade age steps. 3- From a preventive point of view raises the question if this evolution is uneluctable or could be counteracted by physical training or adapted treatment.

The Relationship Between Falls History and Computerized Dynamic Posturography in Persons With Balance and Vestibular Disorders

OBJECTIVE

To describe the relationship between Sensory Organization Test (SOT) scores and reported falls in persons with vestibular and balance disorders.

DESIGN

Descriptive cross-sectional.

SETTING

Outpatient tertiary balance and falls clinic.

PARTICIPANTS

One hundred physical therapy (PT) charts of people referred to a balance and falls clinic were reviewed. Criteria for inclusion were that the patients had completed the SOT of computerized dynamic posturography (CDP), had a vestibular diagnosis, and had the numbers of falls recorded from patient report within the last 6 months at the initial examination. Rotational chair, caloric testing, oculomotor test, and Activities-Specific Balance Confidence (ABC) results were recorded, if available.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The SOT composite and ABC scores as they related to reports of falls in the last 6 months.

RESULTS

The overall proportion of persons with vestibular disorders with positive 6-month history for 1 or more falls was 30% and for recurrent falls (>/=2) was 17%. Vestibular laboratory findings, age, sex, and vestibular diagnosis were not related to reported falls status. Patients who reported multiple falls prior to the PT examination had lower SOT composite scores than patients who reported 1 or no falls in the previous 6 months. The receiver operating characteristic curve identified a composite SOT score of less than 38 as demonstrating the highest likelihood ratio for differentiating between those people who reported no falls in the past 6 months and those who reported 2 or more falls.

CONCLUSIONS

Persons who are recurrent fallers perform worse on SOT than either nonfallers or 1-time fallers. CDP performance can help guide the clinician in the development of a safe exercise program.

Modeling postural instability with Galvanic vestibular stimulation

In this study the effect of a pseudorandom binaural bipolar Galvanic stimulus generated by a sum of nonharmonically related sine waves on postural control was functionally assessed using computerized dynamic posturography (CDP), and the results compared to vestibulopathic patient populations and astronauts exposed to microgravity. The standardized CDP test battery comprised six sensory organization tests (SOTs) that combined three visual conditions (eyes open, eyes closed, and sway-referenced vision) with two proprioceptive conditions (fixed and sway-referenced support surfaces). Subjects (12) performed 18 randomized trials (three trials of each of the six SOTs) as a baseline, repeated the 18 trials with Galvanic vestibular stimulation (GVS), and then performed a post-GVS baseline. A 10 min rest period was inserted between each test battery. Anterioposterior postural sway increased significantly and was in the abnormal range (fifth percentile) during GVS for SOTs where visual input was compromised (sway-referenced surround) or absent. Postural stability returned to baseline when GVS was removed. An analysis of sensory input scores (somatosensory, visual, and vestibular) demonstrated the specificity of GVS in distorting vestibular input to postural control. The SOT scores observed in astronauts on landing day did not differ significantly to that generated by GVS in our normal subjects. GVS also induced a similar pattern of instability on CDP as profound bilateral vestibular loss, although not as severe. The results suggest that unpredictably varying GVS quantitatively and qualitatively models postural instability of vestibular origin.

A markerless sub-pixel motion estimation technique to reconstruct kinematics and estimate the centre of mass in posturography

A novel method to evaluate postural sway is presented: balance strategies are identified by applying a markerless image processing algorithm to video sequences obtained from commercially available systems. The motion estimation technique for the analysis of video sequences is a coarse to fine procedure based on the block matching algorithm (BMA). The method makes it possible to estimate the movement of selected elements on the scene with a sub-pixel precision. It has been done by applying a bicubic spline interpolation to the coarse results obtained by the BMA. Results achieved through the analysis of synthetic video tests make it possible to determine the accuracy of the proposed sub-pixel algorithm. Figures show how the proposed method can be confidently applied to evaluate postural sway. The proposed method has been applied to videos recorded during orthostatic posture trials in different conditions, and to combined tests where signals from a balance plate have been acquired simultaneously to the video sequence. The results show the usefulness of the proposed approach in order to evaluate balance strategies in posturography.

Ankle joint proprioception and postural control in basketball players with bilateral ankle sprains

BACKGROUND

Deficiencies in ankle proprioception and standing balance in basketball players with multiple ankle sprains have been reported in separate studies. However, the question of how ankle proprioceptive inputs and postural control in stance are related is still unclear.

HYPOTHESIS

Ankle repositioning errors and the amount of postural sway in stance are increased in basketball players with multiple ankle sprains.

STUDY DESIGN

Controlled laboratory study.

METHODS

Twenty healthy male basketball players and 19 male basketball players who had suffered bilateral ankle sprains within the past 2 years were examined. Both groups were similar in age. Passive ankle joint repositioning errors at 5 degrees of plantar flexion were used to test for ankle joint proprioception. The Sensory Organization Test was applied with dynamic posturography to assess postural sway angle under 6 sensory conditions.

RESULTS

A significant increase in ankle repositioning errors was demonstrated in basketball players with bilateral ankle sprains (P < .05). The mean errors in the right and left ankles were increased from 1.0 degrees (standard deviation, 0.4 degrees ) and 0.8 degrees (standard deviation, 0.2 degrees ), respectively, in the healthy players to 1.4 degrees (standard deviation, 0.7 degrees ) and 1.1 degrees (standard deviation, 0.5 degrees ) in the injured group. A significant increase in the amount of postural sway in the injured subjects was also found in conditions 1, 2, and 5 of the Sensory Organization Test (P < .05). Furthermore, there were positive associations between averaged errors in repositioning both ankles and postural sway angles in conditions 1, 2, and 3 of the Sensory Organization Test (r = 0.39-0.54, P < .05).

CONCLUSIONS

Ankle repositioning errors and postural sway in stance increased in basketball players with multiple ankle sprains. A positive relationship was found between these 2 variables.

CLINICAL RELEVANCE

Such findings highlight the need for the rehabilitation of patients with multiple ankle sprains to include proprioceptive and balance training.

Soccer

The aim of our study was to determine if any immediate changes in balance were discernable in college soccer players after a specially designed heading session. Eight male and two female skilled collegiate soccer players had a baseline balance pre-test using the Balance Master, followed by heading 20 balls kicked consecutively by a teammate from the touchline to a point near the goal, which was followed by a post-test using the same testing technique. Paired t-tests were used to compare balance ability between pre- and post-test conditions. There was no difference in balance pre- to post-test (85.3% and 86.2% respectively). No significant difference was noted from pre- to post-test in the mean equilibrium scores for conditions three through six on the Sensory Organization Test, with the exception of condition four, which revealed a significant increase from pre- to post-test. We concluded that an acute session of heading soccer balls may not result in balance changes in collegiate soccer players.

Inner Ear Decompression Sickness and Inner Ear Barotrauma in Recreational Divers: A Long-Term Follow-Up

OBJECTIVES/HYPOTHESIS

The objectives were to report the authors' experience with the long-term follow-up of patients with diving-related inner ear decompression sickness and inner ear barotrauma and to discuss residual cochlear and vestibular damage in relation to the question of fitness to dive.

STUDY DESIGN

Retrospective consecutive case series.

METHODS

Eleven recreational divers with inner ear decompression sickness and nine with inner ear barotrauma (IEB) were followed. A complete otoneurological physical examination and laboratory evaluation were carried out. The latter included audiometry, electronystagmography, a rotatory chair test using the sinusoidal harmonic acceleration protocol, and computerized dynamic posturography.

RESULTS

Residual cochleovestibular deficits were found in 10 (91%) of the patients with inner ear decompression sickness and 3 (33%) of those with IEB (P <.02, Fisher's Exact test; odds ratio, 20). A significantly shorter follow-up period was required for the inner ear barotrauma group (P <.05, simple t test) because three patients (33%) recovered completely within 1 month of the diving accident. Eight patients had residual vestibular deficits on follow-up, but only one (12.5%) was symptomatic. However, five (56%) of the nine patients who had a cochlear insult, as documented by follow-up audiometry, complained of significant hearing loss and tinnitus.

CONCLUSION

Inner ear decompression sickness carries a high risk for residual inner ear damage despite hyperbaric oxygen recompression therapy. A favorable prognosis might be anticipated for inner ear barotrauma. The finding that most patients with residual vestibular deficits were asymptomatic at the time of follow-up emphasizes the need for a complete vestibular evaluation, including specific bedside testing and laboratory examinations, before a return to diving activity may be considered.

The effects of balance training and high-intensity resistance training on persons with idiopathic Parkinson's disease

OBJECTIVE

To assess immediate and near-term effects of 2 exercise training programs for persons with idiopathic Parkinson's disease (IPD).

DESIGN

Randomized control trial.

SETTING

Public health facility and medical center.

PARTICIPANTS

Fifteen persons with IPD.

INTERVENTION

Combined group (balance and resistance training) and balance group (balance training only) underwent 10 weeks of high-intensity resistance training (knee extensors and flexors, ankle plantarflexion) and/or balance training under altered visual and somatosensory sensory conditions, 3 times a week on nonconsecutive days. Groups were assessed before, immediately after training, and 4 weeks later.

MAIN OUTCOME MEASURES

Balance was assessed by computerized dynamic posturography, which determined the subject's response to reduced or altered visual and somatosensory orientation cues (Sensory Orientation Test [SOT]). Muscle strength was assessed by measuring the amount of weight a participant could lift, by using a standardized weight-and-pulley system, during a 4-repetition-maximum test of knee extension, knee flexion, and ankle plantarflexion.

RESULTS

Both types of training improved SOT performance. This effect was larger in the combined group. Both groups could balance longer before falling, and this effect persisted for at least 4 weeks. Muscle strength increased marginally in the balance group and substantially in the combined group, and this effect persisted for at least 4 weeks.

CONCLUSION

Muscle strength and balance can be improved in persons with IPD by high-intensity resistance training and balance training.

Dynamic and static tests of balance and postural sway in boys: effects of previous wrist bone fractures and high adiposity

Ninety-three males aged 10-21 years undertook the Bruininks-Oseretsky balance test and two computerized posturography tests to evaluate the effects of (a) previous forearm fracture and (b) high body weight on balance and postural sway. Body composition was measured by dual energy X-ray absorptiometry. Fracture history did not affect balance measures. However, Bruininks-Oseretsky balance scores were negatively correlated with body weight, body mass index, percentage fat and total fat mass. Overweight subjects (n=25) had lower scores (P<0.05) than boys of healthy weight (n=47), supporting the view that overweight adolescents have poorer balance than those of healthy weight.

[Relation between clinical symptoms and the results of a computerized dynamic posturography]

The computerized dynamic posturography (CDP) is a quantitative method for the evaluation of balance function under different conditions that simulates the ones found in normal life. Its applications are centered in the diagnosis and rehabilitation of balance dysfunction. We report a descriptive study on 96 patients with balance disorders who underwent a CDP, stablishing a relation between their main symptoms and the results in the test. A high percentage of patients with symptoms that suggested peripheral vestibular pathology did not present alterations at this level by means of the CDP. However a considerable number of patients who referred symptoms classically related to a non vestibular origin did show an alteration at this level.

The assessment and management of the dizzy patient

A significant number of individuals are affected by symptoms of dizziness. It is the most common complaint among patients over 75 years of age. A large number of these patients seek counsel from their physicians. It is imperative for the evaluating physician to obtain a thorough history and perform a complete physical exam. The proper diagnostic studies must also be obtained to confirm or rule out particular diagnoses. The physician should never assume that the dizziness is the result of normal aging prior to ruling out pathologic conditions.

What can posturography tell us about vestibular function?

Patients with balance disorders want answers to the following basic questions: (1) What is causing my problem? and (2) What can be done about my problem? Information to fully answer these questions must include status of both sensory and motor components of the balance control systems. Computerized dynamic posturography (CDP) provides quantitative assessment of both sensory and motor components of postural control along with how the sensory inputs to the brain interact. This paper reviews the scientific basis and clinical applications of CDP. Specifically, studies describing the integration of vestibular inputs with other sensory systems for postural control are briefly summarized. Clinical applications, including assessment, rehabilitation, and management are presented. Effects of aging on postural control along with prevention and management strategies are discussed.

Physical therapy outcomes for persons with bilateral vestibular loss

OBJECTIVE

The purpose of the study was to assess the efficacy of physical therapy for patients with bilateral vestibular loss.

STUDY DESIGN

Retrospective case series.

METHODS

Twenty-four patients with a diagnosis of bilateral vestibular loss were identified by a retrospective chart review. Thirteen of the 24 patients met the inclusion criteria of having a moderate or greater loss of vestibular function bilaterally as rated by an otoneurologist based on the patient's vestibular function tests. These patients were treated with a custom-designed physical therapy program for a mean of 4.6 visits over an average period of 3.8 months. Patients completed the Dizziness Handicap Inventory and the Activities-specific Balance Confidence Scale at initial evaluation and discharge. Patients were asked to perform the balance and gait tasks of the Dynamic Gait Index, Sensory Organization Test of computerized dynamic posturography, and the Timed "Up and Go" test at their first and last physical therapy sessions. The number of falls in the previous 4 weeks and the use of an assistive device at initial evaluation and discharge were reported. Composite score, an overall score of clinical outcome, was calculated to determine clinically significant changes in physical performance and subjective information.

RESULTS

On a population basis, statistically significant improvement was observed after physical therapy for each of the outcome measures including the composite score (P < .05). Clinically significant changes were demonstrated by 33% to 55% of the patients on the various outcome measures. No change was noted in the patients' risk of falling, their number of falls, and the use of assistive devices.

CONCLUSION

Many patients with bilateral vestibular loss benefit from an individualized vestibular physical therapy exercise program based on improved physical function and reduced self-perceived levels of handicap.

Comparison of elderly nonfallers and fallers on performance measures of functional reach, sensory organization, and limits of stability

BACKGROUND

Previous literature indicates that balance impairment is a primary risk factor in the occurrence of falls, which has led clinicians to develop gross standardized balance assessment tests to distinguish elderly nonfallers from fallers. The purpose of this study was to compare functional reach (FR), limits of stability (LOS), and sensory organization among elderly nonfallers and fallers.

METHODS

FR was examined in 15 elderly nonfallers and 10 idiopathic fallers who were at least 60 years of age. Forceplate measures from the NeuroCom Smart Balance Master system, which included the LOS test and the sensory organization test (SOT), were used to quantify limits of stability and balance. Associations among the three tests were examined.

RESULTS

There was no significant difference in mean FR distance between elderly nonfallers and fallers using the functional reach test. FR distance did not correlate with anterior displacement on the LOS test. There was a significant difference in mean composite score on the SOT between nonfallers and fallers as well as a significant positive correlation between the SOT composite score and anterior displacement on the LOS test for fallers.

CONCLUSIONS

The results suggest that FR measures do not differentiate nonfallers from fallers. In contrast, this study demonstrates that using the SOT protocol could differentiate elderly nonfallers from fallers for balance impairment. Caution should be used when interpreting information from the FR test in determining a balance-impaired population.

Outcome measures for assessment of treatment of the dizzy and balance disorder patient

There are a variety of measurement tools available for assessing the treatment outcomes for patients with dizziness and imbalance. Some of these tools, however, may not be appropriate or valid for the patients in question. In this article, the various outcome measures are described and evaluated in terms of their reliability, validity, and sensitivity. There is no clearly superior outcome measure at this time, and the choice of the measurement tool depends on the patient and the aims of the treatment.

Posturographic performance in patients with the potential for secondary gain

OBJECTIVES

To determine the incidence of nonorganic sway patterns on computerized dynamic posturography (CDP) among patients with potential secondary gain compared with patients without any obvious secondary gain.

METHODS

A retrospective chart review of 100 patients who underwent clinical evaluation, audiometry, electronystagmography, and CDP was undertaken. Group 1 consisted of 50 patients who were randomly selected from a group who had pending lawsuits, worker's compensation claims, or disability claims. Group 2 consisted of 50 randomly selected patients who had no pending legal status, worker's compensation claims, or disability claims. Previously published criteria for nonorganic sway patterns were then applied to each group. Statistical analysis was performed.

RESULTS

The average age of group 1 patients was 43.8 years compared with 63.2 years for group 2 patients (P < 0.0001). Among group 1 patients 50% had normal audiovestibular evaluations compared with only 4% of group 2 patients (P < 0.0001). Nonorganic sway patterns were found in 76% of group 1 patients, but only in 8% of group 2 patients (P < 0.0001).

CONCLUSION

Patients who have the potential for secondary gain are generally younger and have a much higher prevalence of normal audiovestibular evaluations and a much higher prevalence of nonorganic sway patterns on CDP. A high degree of clinical suspicion should be maintained when evaluating the dizzy patient who has a pending lawsuit, worker's compensation claim, or disability claim.

Computerized dynamic posturography and seasickness susceptibility

OBJECTIVE/HYPOTHESIS

The neural mismatch theory emphasizes the role of conflicting multimodal sensory interactions in producing both motion sickness and the rearrangement process that finally leads to habituation to the adverse motion conditions. If this theory is, indeed, correct, the patterns of the response to the integrated signal from simultaneous multisensory stimulation, characterized by unusual relationships between the senses responsible for spatial orientation, should differ according to motion sickness susceptibility. Computerized dynamic posturography (CDP) provides the opportunity to simultaneously change the interactions between visual, somatosensory, and vestibular inputs, thus giving an indication of the relative importance of these senses in maintaining balance. The objective was to investigate balance strategies in naval crew members with differing susceptibility to sea conditions using CDP.

STUDY DESIGN

Cross-sectional, parallel-group design.

METHODS

Twenty subjects susceptible to seasickness (SS) and 20 nonsusceptible subjects (NSS), healthy male volunteers aged 18 to 25, were tested using the EquiTest system (NeuroCom, Inc., Clackamas, OR).

RESULTS

The SS group exhibited significantly less stability than the NSS group in condition 5 of the sensory organization test (SOT). The ratio of the SOT scores of conditions 5 to 1 (the vestibular organization pattern) was also found to be significantly lower in the SS group.

CONCLUSIONS

The results suggest that SS might be more dependent on somatosensory and visual inputs and less on vestibular inputs for maintenance of balance compared with NSS. Higher susceptibility to seasickness might reflect abnormal weighting of sensory modalities during the integration process. This would result in disruption of the integration process required to maintain balance and a sense of orientation in space in conditions producing conflicting sensory inputs.