Age-related differences in Fukuda stepping and Babinski-Weil tests, within-day variability and test-retest reliability

Linking the preference in a bilateral asymmetric task with handedness, footedness, and eyedness: The case of ice-hockey

Most people know whether they are left-handed or right-handed, and usually base this assessment on preferences during one-handed tasks. There are several manual tasks that require the contribution of both hands, in which, in most cases, each hand plays a different role. In this specific case, holding an ice-hockey stick is particularly interesting because the hand placement may have an incidence on the playing style. In this study (n = 854), the main objective was to determine to what extent the way of holding an ice-hockey stick is associated with other lateralized preferences. Amongst the 131 participants reporting a preference for the left hand in unilateral tasks, 70.2% reported a preference for shooting right (placing the right hand in the middle of the stick); and amongst the 583 participants reporting a preference for writing with the right hand, 66.2% reported a preference for shooting left. 140 (16.4%) participants were classified as ambidextrous and 61.4% of them reported a preference for shooting right. This preference on the ice-hockey stick is closely correlated (uncrossed preference) to the way one holds a rake, shovel, or broom, or a golf club, but inversely related to the way one holds an ax and a baseball bat. The link between the way of holding the ice-hockey stick and eyedness or footedness is weak. These results are contrasted with the results reported by Loffing et al. (2014) and reveal the need to clarify the exact nature and requirements of the targeted tasks when studying bilateral asymmetric preferences.

A gait-based paradigm to investigate central body representation in cervical dystonia patients

BACKGROUND

Cervical dystonia (CD) is a common adult-onset idiopathic form of dystonia characterized by an abnormal head posture caused by an excessive activity of the neck muscles. The position of the head is important to direct viewpoint in the rounding environment, and the body orientation, during gait, must be coherent with the subjective straight ahead (SSA). An alteration of the SSA, as in the case of CD patients, could affect gait when visual input is not available. The aim of this study was to probe the behavior of patients with CD during blindfolded walking, investigating the ability to walk straight ahead based only on somatosensory and vestibular information.

METHODS

In this observational cross-sectional study, patients with CD and healthy control subjects (HC) were compared. All participants were evaluated through a gait analysis during blindfolded walking on a GAITRite carpet, relying on their own sense of straightness.

RESULTS

Patients with CD showed lower values of path length (p < 0.001), a lower number of steps on the carpet (p < 0.001). A higher number of CD patients deviated during the task, walking out of the carpet, (p < 0.005) compared to HS. No relation was found between the dystonic side and the gait trajectory deviation. A significant correlation was found between pain symptom and gait performance.

CONCLUSIONS

CD patients showed dysfunctions in controlling dynamic body location during walking without visual afferences, while the dystonic side does not seem to be related to the lateral deviation of the trajectory. Our results would assume that a general proprioceptive impairment could lead to an improper body position awareness in patients with CD.

Balance Problem in Individuals with Normal Hearing Across Age Groups - A Behavioural Study

Purpose

This study was done to find the hidden balance problem in individuals across age groups using perceptual measure (Dizziness Index of Impairment in Activities of Daily Living Scale questionnaire, DII-ADL) and vestibulospinal-cerebellar function tests (Sharpened Romberg test, Fukuda stepping test, Tandem gait test, and Finger-to-nose test).

Methods

A total of 150 individuals in three age groups, young adults (20-40 years), middle-aged adults (40-60 years), and older adults (> 60 years) were considered. All the individuals had normal hearing sensitivity with no reported perceptual balance issues. DII-ADL questionnaire, Sharpened Romberg test, Fukuda stepping test, Tandem gait test, and Finger-to-nose test were administered to all the participants.

Results

Balance disturbances were observed in all three age groups. The symptoms and test findings showed increased abnormality with the increase in age. DII-ADL questionnaire suggests older adults have more difficulty performing activities of daily living than young and middle-aged adults. The sharpened Romberg test result showed a moderate negative correlation and the Fukuda stepping test showed a moderate positive correlation with the sections of the DII-ADL questionnaire.

Conclusion

Individuals of any age can have difficulty performing activities of daily living even though they do not have evident balance disorder perceptually. Thus there is a need to spread awareness among professionals and emphasize the need for screening individuals across age groups for balance disturbances.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-022-03459-6.

Test-re-test reliability and dynamics of the Fukuda–Unterberger stepping test

Background

The Fukuda-stepping-test (FST), i.e., repetitive walking on the spot while blindfolded, has been proposed as a means to assess the integrity of the vestibular pathways. While its sensitivity to detect abnormalities in patients is limited, it may be useful in studying the physiology of the subjective-straight-ahead (SSA). Considering reported systematic shifts in SSA in humans, we hypothesize that such asymmetries arise from individual differences in the orientation/configuration of the macular organs and in central processing of vestibular input. We hypothesize that such asymmetries are stable over time in individual subjects. Alternatively, such asymmetries may arise from random noise in the sensory/motor systems involved, demonstrating low reproducibility over time.

Materials and methods

Twenty-four subjects walked on the spot over 60 s while blindfolded (n = 6 trials per subject). Using an inertial measurement unit (IMU) placed at the chest, angular deviations were recorded and compared to manually-measured final positions. Both static (direction, magnitude) and dynamic (time-to-onset of deviation, pattern of deviations) parameters were retrieved from the yaw slopes.

Results

Significant deviations were found in 15/24 participants for the manual measurements (leftwards = 8; rightwards = 7), whereas when using the IMU-sensor 13/24 participants showed significant shifts (leftwards = 9; rightwards = 4). There was a high correlation (0.98) between manually measured rotation angles (average absolute deviations = 58.0 deg ± 48.6 deg; intra-individual variability = 39 deg ± 24 deg) and sensor-based yaw slopes (1.00 deg/s ± 0.88 deg/s; 0.67 deg/s ± 0.41 deg/s). Relevant yaw deviation was detected 22.1 s ± 12.3 s (range = 5.6 s-59.2 s) after the onset of marching (no relevant yaw-deviation in 15/139 measurements), showing a mostly linear behavior over time.

Conclusion

We observed significant inter-individual variability in task performance in the FST, reproducing findings from previous studies. With test-re-test reliability being moderate only, but at the same time observing a preference in the side of shifts in most trials and subjects, we conclude that likely both individually varying estimates of straight-ahead and random noise contribute to the pattern of angular deviations observed. Using an IMU-sensory based approach, additional dynamic parameters could be retrieved, emphasizing the value of such a quantitative approach over manual measurements. Such an approach may provide useful additional information to distinguish patients from healthy controls.

Impaired Balance in Patients with Fibromyalgia Syndrome: Predictors of the Impact of This Disorder and Balance Confidence

Patients with fibromyalgia syndrome (FMS) have a nonspecific postural balance disorder and a greater prevalence of falls. Objective: to clarify which aspects of maintaining balance are associated with the impact of the disorder and with balance confidence. Methods: A total of 182 persons with FMS agreed to participate in this study. After re-evaluation, 57 fully met inclusion criteria: age 40–70 years and moderate-severe impact of the illness according to the Fibromyalgia Impact Questionnaire (FIQ). All participants underwent a posture control analysis with a stabilometric platform, an evaluation of the perception of verticality and an exploration of the vestibular system via functional tests. Additionally, they self-completed questionnaires about balance confidence, central sensitization, pain catastrophizing, kinesiophobia, dizziness and days with episodes of instability. Results: The FIQ was associated with central sensitization and dizziness, which explained 56% of its variance (AdjR2 = 0.566), while days with instability, kinesiophobia and dizziness also explained more than half of the variance of the balance confidence scale (AdjR2 = 0.527). A high percentage of positive responses was found for functional tests (>50%) and a high dispersion in the stabilometric parameters. Conclusion: the detection of factors susceptible to intervention, such as disability due to dizziness, takes on special relevance in patients with FMS.

Association between the Unterberger-Fukuda test and vectoelectronystagmography

ABSTRACT Purpose: to study and characterize anteroposterior and angular deviations in the Unterberger-Fukuda Test (UFT) in relation to the results of the caloric tests in patients complaining of dizziness or vertigo. Methods: 44 subjects-men and women between 20 and 79 years of age-who had symptoms of vertigo or dizziness and had been referred for vectoelectronystagmography were examined. The exclusion criteria were gait difficulties arising from orthopedic and/or spinal disorders, and syndromes or neurological diseases that affect balance. Two procedures were performed: vectoelectronystagmography and UFT. Results: the caloric test showed that 25.00% of the patients had hyporeflexia-the most frequent result. In the open-eyes UFT, only 2.30% presented altered results in anteroposterior displacement. In the closed-eyes test, the equivalent value was 31.80%. Anteroposterior deviation showed a greater correlation with age than the angular one. Abnormal results in the caloric test were associated with the UFT. Conclusion: the results of the closed-eyes UFT were associated with the caloric test. Anteroposterior deviation was correlated with age, while angular deviation was not.

Disturbed cervical proprioception affects perception of spatial orientation while in motion

The proprioceptive, visual and vestibular sensory systems interact to maintain dynamic stability during movement. The relative importance and interplay between these sensory systems is still not fully understood. Increased knowledge about spatial perception and postural orientation would provide better understanding of balance disorders, and their rehabilitation. Displacement of the body in space was recorded in 16 healthy subjects performing a sequence of stepping-in-place tests without any visual or auditory cues. Spatial displacement and orientation in space were determined by calculating two parameters, “Moved distance (sagittal + lateral displacement)” and “Rotation”. During the stepping-in-place tests vibration were applied in a randomized order on four different cervical muscles, and the effects were compared between muscles and to a non-vibration baseline condition. During the tests a forward displacement (“Moved distance”) was found to be the normal behavior, with various degrees of longitudinal rotation (“Rotation”). The moved distance was significantly larger when the vibration was applied on the dorsal muscles (916 mm) relative to on ventral muscles (715 mm) (p = 0.003) and the rate of displacement was significantly larger for dorsal muscles (36.5 mm/s) relative to ventral (28.7 mm/s) vs (p = 0.002). When vibration was applied on the left-sided muscles, 16° rotation to the right was induced (p = 0.005), whereas no significant rotation direction was induced with right-sided vibration (3°). The rate of rotation was significantly larger for vibration applied on ventral muscles (0.44°/s) relative to on dorsal (0.33°/s) (p = 0.019). The results highlight the influence of cervical proprioception on the internal spatial orientation, and subsequent for postural control.