Learning Effects of Repetitive Administrations of the Sensory Organization Test in Healthy Young Adults

Evaluation of Balance with Computerized Dynamic Posturography in Children with Otitis Media

BACKGROUND

Otitis media with effusion (OME) frequently leads to vestibular symptoms in children. However, young children face difficulty expressing their symptoms due to their limited language abilities.

METHODS

The balance of study and patient group evaluated with computer dynamic posturography, single-leg stance test with eyes closed and regular Head Impulse Test. The study group was assessed once again after the insertion of a ventilation tube two months later.

RESULTS

In the Sensory Organization Test, the scores for conditions 5, 6, and composite equilibrium of the preoperative patient group were notably lower compared with both the control and postoperative patient groups (p < 0.05). Additionally, a significant correlation was found between single-leg stance test with eyes closed results and conditions 5, 6, and composite equilibrium scores.

CONCLUSION

The impact of OME on the vestibular system is negative. This effect can be objectively assessed using Computer Dynamic Posturography and following tube insertion, there is a notable improvement in vestibular function. Furthermore, the single-leg stance (SLS) test with eyes closed has shown its reliability in assessing balance disorders, notably in children with OME.

LEVEL OF EVIDENCE

2 Laryngoscope, 134:4126-4133, 2024.

Recovery Is Similar Between Black and White College Athletes Following Sport-Related Concussion

CONTEXT

Racial identity may associate with clinical outcomes following sport-related concussion (SRC). This study compared clinical outcome scores before and after recovery from a SRC between Black or White college athletes.

DESIGN

Prospective cohort.

METHODS

Participants were self-reported White (n = 61, 18.5 [1.1] y of age) and Black (n = 24, 18.3 [1.1] y of age) NCAA Division 1 college athletes. The revised Head Injury Scale (HIS-r), the Immediate Postconcussion and Cognitive Test (ImPACT) battery, and the Sensory Organization Test (SOT) at baseline (T1), upon symptom resolution (T2) following a diagnosed SRC, and upon establishing a new baseline assessment (T3). Race was collected from paper and electronic medical records. The revised Head Injury Scale total symptom severity, ImPACT's Verbal Memory, Visual Memory, Visual Motor Speed (VMS), and Reaction Time, and the SOT Equilibrium Score, were compared between groups at each time point. Multivariate analyses of variance (2 [group] × 3 [time]) were used to compare revised Head Injury Scale, ImPACT, and SOT outcome scores. Post hoc analyses consisted of independent and paired sample t tests.

RESULTS

A significant main effect for time (λ = 0.66, F2,82 = 21.55, P < .001, ηp2=.34) was observed for the SOT. White athletes significantly improved on the Equilibrium Score between all time points (all P < .006). Similarly, Black athletes significantly improved on the Equilibrium Score between T1-T2 and T1-T3 (all P < .001). A significant main effect of time was observed for ImPACT's Verbal Memory, Visual Memory, and VMS outcome scores (all P < .001). VMS improved for White athletes between T1-T2 (P = .02) and T3 (P = .006). Black athletes had improved VMS scores between T1-T3 (P = .015) and T2-T3 (P = .005). A between-group difference was observed for VMS at T2 (P = .004).

CONCLUSIONS

There was 1 small and not clinically significant difference between groups for the VMS score at T2. Overall, groups performed consistently or improved upon their baseline balance, cognition, and symptom outcome scores at clinically relevant time points following a SRC.

Effects of non-specific low back pain on static balance in emerging adults

BACKGROUND

Postural control impairments in middle-aged or older people with chronic low back pain (CLBP) have been extensively documented. However, little is known about changes in postural control early in the disease process which may underlie compensatory movement strategies.

OBJECTIVE

Our purpose was to quantify postural sway and sensory weighting in emerging adults with and without CLBP.

METHODS

Nineteen emerging adults with CLBP (age = 18-26 years (21.11 ± 1.73)) and 19 matched peers without CLBP (18-27 years (22.20 ± 1.97)) participated in a cross-sectional study. Displacement of the center of mass during Quiet stance (QS), Tandem stance (TS), and Unilateral stance (US) on 2 surfaces (stable, unstable) were used to assess postural sway. Sensory Organization Test (SOT) was used to assess sensory weighting.

RESULTS

Emerging adults with CLBP showed large, significant increases in postural sway during unstable TS (p ≤ .020). Participants with CLBP relied more on somatosensory input, as evidenced by lower equilibrium scores during conditions favoring visual (p = .020) or vestibular (p < .001) input during the SOT.

CONCLUSION

Emerging adults with CLBP showed postural control impairments related to altered sensory weighting. These findings provide insights into the development of CLBP and its effects on postural control. This information may aid early identification, monitoring, and treatment of individuals in the initial stages of disease development who may have unrecognized postural impairments.

The Convergent Validity of the SWAY Balance Application to Assess Postural Stability in Military Cadets Recovering from Concussion

Background

Concussions are often accompanied by balance disturbances. Clinically accurate evaluation systems are often expensive, large, and inaccessible to most clinicians. The Sway Balance Mobile Application (SWAY) is an accessible method to quantify balance changes.

Purpose

To determine the known groups and convergent validity of the SWAY to assess balance after a concussion.

Study Design

Case-Control Study.

Methods

Twenty participants with acute concussion and twenty controls were recruited. At initial, one-week, and final return to activity (RTA) evaluations, all participants completed the Sports Concussion Assessment Tool (SCAT-5), and balance control measured by SWAY mBESS and NeuroCom Balance Master Sensory Organization Test (SOT). Mixed model ANOVAs were used to detect differences in SWAY mBESS and NeuroCom SOT scores with time (initial, one-week, final RTA) as the within-subjects factor and group (concussed, healthy) as the between-subjects factor. Spearman's Rho correlations explored the associations between NeuroCom SOT scores, SWAY scores, SCAT-5 symptom scores, and time in days to final RTA.

Results

The sampled population was predominantly male and age (20 ± 1), and BMI differences were insignificant between groups. The SWAY did not detect differences between healthy and concussed participants and did not detect change over time [F(2,40) = .114, p = 0.89; F(2,40)= .276, p =0.60]. When assessing the relationship between the SWAY and the SOT, no correlation was found at any time point (r = -0.317 to -0.062, p > 0.05). Time to RTA demonstrated a moderate correlation with both SCAT-5 symptom severity score (r = .693, p < 0.01) and SCAT-5 total symptom score (r = .611, p < 0.01) at the one-week follow-up.

Conclusion

The SWAY mBESS does not appear to be a valid balance assessment for the concussed patient. The SWAY mBESS in patients with concussion failed to demonstrate convergent validity and did not demonstrate an ability to validate known groups. When assessing the time to final RTA, the one-week post-initial assessment SCAT-5 symptom severity and total scores may help determine the length of recovery in this population.

Level of Evidence

Level 3.

Impact of Concussions on Postural Stability Performance Using the Head Shake-Sensory Organization Test

Background

A concussion is a traumatic brain injury that can result in vestibular and oculomotor dysfunctions. The Head Shake-Sensory Organization Test was developed from the original Sensory Organization Test to measure a subject's ability to maintain balance while moving their head.

Purpose

The purpose of this study was to compare the performance of adults with no history of concussion to those with a history of concussion on the Head Shake-Sensory Organization Test to determine if long-standing balance deficits are present after concussion.

Study Design

Cross-sectional study.

Methods

Subjects with a history of concussion and healthy normal controls completed the Dizziness Handicap Inventory, the Activities-Specific Balance Confidence Scale, the sensory organization test, the head shake SOT, and the Foam Head Shake-Sensory Organization test in a single testing session. Scores were analyzed for differences between the two groups.

Results

Twenty-five participants (nine patients with history of concussion and 16 healthy controls; mean age, 21.08±4.10 years) completed testing. The equilibrium scores in both groups significantly decreased with more complex tasks. Furthermore, the concussion group had significantly worse equilibrium scores than the control group during the Head Shake (p = 0.007) and Foam Head Shake-Sensory Organization Test (p = 0.002) tasks but not during the Sensory Organization Test task.

Conclusion

Adding head shake and foam cushion conditions to postural stability tests improves sensitivity in detecting balance deficits in individuals with a concussion.

Level of Evidence

3.

The effect of intratympanic gentamicin as a prehabilitation strategy for objective and subjective vestibular function in patients undergoing microsurgery for a unilateral vestibular schwannoma

OBJECTIVE

To review the literature on intratympanic gentamicin treatment as prehabilitation for patients undergoing surgery for a unilateral vestibular schwannoma.

DATA SOURCES

A systematic literature search was conducted up to March 2023 in Pubmed, Embase, Cochrane, Web of Science, Academic Search Premier, Google Scholar and Emcare databases.

REVIEW METHODS

Articles on the effect of intratympanic gentamicin followed by vestibular schwannoma surgery were reviewed. Data on objective vestibular function and subjective outcomes were compiled in tables for analysis. Relevance and methodological quality were assessed with the methodological index for non-randomized tool.

RESULTS

A total of 281 articles were identified. After screening and exclusion of duplicates, 13 studies were reviewed for eligibility, of which 4 studies could be included in the review. The posturography test, the subjective visual horizontal test, and the optokinetic nystagmus test showed decreased vestibular function in the group of patients who received intratympanic gentamicin before microsurgery compared to the group of patients without gentamicin. Other objective tests did not show significant differences between patient groups. Subjective vestibular outcomes, as evaluated by questionnaires on quality of life and/or dizziness, did not seem to improve from intratympanic gentamicin pretreatment.

CONCLUSION

Vestibular schwannoma patients who received intratympanic gentamicin before surgical resection of the tumor performed better in the posturography test, subjective visual horizontal test, and the optokinetic nystagmus test afterwards. However, studies that also evaluated subjective outcomes such as dizziness, anxiety, depression, and balance self-confidence did not show a positive effect of intratympanic gentamicin on the vestibular complaints and symptoms.

The acute effect of cervical mobilization on balance in patients with multiple sclerosis: a single-blind, randomized, controlled trial

The cervical region plays an important role in providing proprioceptive and vestibular input to the postural control system.

OBJECTIVE

To investigate the effect of cervical mobilization on balance in multiple sclerosis (MS) patients.

METHODS

The study was undertaken at the neurological rehabilitation unit with 36 MS participants who were assigned randomly to the study (n = 18) and control group (n = 18). While the study group received a single session of 15 minutes of cervical and soft tissue mobilization, no intervention was applied to the control group to investigate the learning effect of the assessment. Patients were evaluated using Computerized Dynamic Posturography (CDP) (Sensory Organization Test (SOT), Limits of Stability (LoS), and Adaptation Test (ADT)), which reflects postural stability.

RESULTS

In the study group, a treatment effect was found on the vestibular ratio (VEST) score (p < 0.001) and the composite score of SOT (p = 0.002). Improvements were achieved in all parameters of the LoS and ADT in the study group. There was no statistically significant difference in terms of CDP results in the control group.

CONCLUSION

Cervical mobilization has beneficial effects on balance in MS patients. Our findings support that cervical mobilization can be included in MS balance rehabilitation programs.

An Absence of Persistent Postural Stability Deficits Following a Sport Concussion in Collegiate Athletes

OBJECTIVE

The purpose of our study was to determine whether persistent postural stability deficits exist in athletes following sport concussion (SC) in comparison with preinjury (baseline) values using Sample Entropy (SampEn).

SETTING

Sports medicine clinic.

PATIENTS OR OTHER PARTICIPANTS

Participants consisted of 71 collegiate athletes (44 male, 27 female) with an average age of 19.9 ± 0.96 years who had a history of 1 concussion that occurred during their time as a collegiate athlete.

DESIGN

In our prospective, cohort design participants completed the Sensory Organization Test (SOT) at baseline, upon reporting symptom-free following a diagnosed SC, and upon establishing a new baseline prior to the start of the subsequent sport season.

MAIN OUTCOME MEASURES

The SOT's condition scores were calculated and analyzed in alignment with the manufacturer's instructions. SampEn was calculated in the anterior-posterior (AP) and medial-lateral (ML) directions from the center-of-pressure oscillations over the 20-second time series for each SOT condition. The SOT and SampEn outcome scores for each condition were analyzed with repeated-measures analyses of variance.

RESULTS

Significant main effects were observed for the SOT's conditions 3 ( F1.6, 114.8 = 7.83, P = .001, η2 = 0.10 [0.02-0.20]), 5 ( F1.8, 126.8 = 11.53, P < .001, η2 = 0.14 [0.04-0.25]), and 6 ( F1.9, 134.5 = 25.11, P < .001, η2 = 0.26 [0.14-0.37]), with significant improvements across time. Significant main effects were also observed for SampEn in the AP direction for conditions 3 ( F2, 140 = 7.59, P = .001, η2 = 0.10 [0.02-0.19]) and 6 ( F2, 140 = 6.22, P = .003, η2 = 0.08 [0.011-0.170]), with significant improvements across time.

CONCLUSIONS

Following a diagnosed SC, our results suggest that collegiate athletes returned if not exceeded baseline values at the symptom-free and new baseline assessments. The application of linear and nonlinear measures of postural stability following a SC yielded similar outcomes in conjunction with a baseline assessment. Our findings support the clinical utility of the baseline SC assessment when evaluating persisting balance deficits when using linear or nonlinear measures.

Developing a multivariate prediction model of falls among older community-dwelling adults using measures of neuromuscular control and proprioceptive acuity: A pilot study

OBJECTIVE

To examine whether measures of neuromuscular control and proprioceptive acuity were predictive of falls in an older community-dwelling population and to develop a multivariate prediction model.

METHODS

Fifty-eight adults aged above 60 living independently in the community were recruited for a prospective falls study. On entry, they undertook a Sensory Organisation Test (SOT) and an Active Movement Extent Discrimination Assessment (AMEDA) and completed a short fall risk questionnaire. Participants were monitored for falls over the subsequent 12 months. Prior to analysis, falls were classified into three categories based on the difficulty of the activity being undertaken and the demands of the environment in which the fall occurred. Logistic regression was used to predict the probability of a fall.

RESULTS

For falls occurring under the least challenging circumstances, the model fitted using the AMEDA score and two of the questions from the fall risk questionnaire, related to balance and confidence, achieved a specificity of 87% and sensitivity of 83%. Falls occurring in more challenging circumstances could not be predicted with any accuracy based on the variables recorded at inception.

CONCLUSIONS

This study highlights the importance of considering the heterogeneous nature of falls. Poorer proprioceptive acuity appears to play a role in falls occurring where neither the environment nor the activity is challenging, but not in falls occurring in other circumstances. Falls in the least-challenging circumstances affected 15% of participants, but this group was considerably more likely to have multiple falls, increasing their vulnerability to adverse consequences.

Balance alterations are associated with neck pain and neck muscle endurance in migraine

BACKGROUND

Migraine patients may present with both cervical and balance dysfunctions. The neck plays an important role in balance by providing substantial proprioceptive input, which is integrated in the central nervous system and influences the balance control systems. Whether balance and neck dysfunctions are associated in patients with migraine is still to be explored.

OBJECTIVES

This study aimed to assess the association between the sensory organization test of balance with neck pain features, cervical strength, endurance, and range of motion in patients with migraine.

METHODS

Sixty-five patients with migraine underwent the sensory organization test assessed with the Equitest-Neurocom® device. Maximum voluntary isometric contraction, cervical flexion and extension range of motion, and cervical flexor and extensor endurance were assessed. In addition, the features of migraine and neck pain were collected. Patients were dichotomized according to cut-off scores of balance performance and the association between outcomes were explored.

RESULTS

Patients with reduced balance performance presented a higher frequency of migraine (p = 0.035), a higher frequency of aura (p = 0.002), greater neck pain intensity (p = 0.013), and decreased endurance of cervical flexors (p = 0.010) and extensors (p < 0.0001). The total balance score was correlated with age (r = -0.33; p = 0.007), migraine frequency (r = -0.29; p = 0.021), neck pain intensity (r = -0.26; p = 0.038), and endurance of the cervical flexors (r = 0.39; p = 0.001) and extensors (r = 0.36; p = 0.001). Migraine frequency, neck pain intensity, and endurance of the cervical flexors can predict 21% of the sensory organization test variability.

CONCLUSION

Neck pain features and endurance of the cervical muscles are related to reduced balance performance in patients with migraine. These results shed light to a better understanding of balance alterations in migraine patients.

A modified two-dimensional sensory organization test that assesses both anteroposterior and mediolateral postural control

Background

The Sensory Organization Test (SOT) was designed to measure changes in postural control in response to unreliable visual and/or proprioceptive feedback. However, secondary to the manipulation of sensory cues in only the sagittal plane, the SOT is capable of only describing postural control in a single direction. The present study aimed to characterize postural responses to a modified SOT designed to concurrently challenge both anteroposterior and mediolateral postural control.

Methods

Twenty-one healthy adult volunteers (30.6 ± 10.2 years) completed the standard anteroposterior one-dimensional (1D) SOT, in addition to a modified SOT with the support surface sway-referenced to both anteroposterior and mediolateral postural sway (two-dimensional, 2D). Our primary analysis concerned a comparison of mediolateral, as well as anteroposterior postural sway measured during the standard one-dimensional (i.e., pitch tilt) and the novel two-dimensional (i.e., roll and pitch tilt) sway-referenced paradigms. Here, postural sway was quantified by calculating the root mean square distance (RMSD) of the center of pressure (CoP) during each trial.

Results

Our data showed that the 2D sway-referenced conditions yielded a selective increase in mediolateral postural sway relative to the standard 1D conditions for both wide (η2 = 0.66) and narrow (η2 = 0.78) stance conditions, with anteroposterior postural sway being largely unaffected (η2 = 0.001 to 0.103, respectively). The ratio between mediolateral postural sway in the sway-referenced conditions and postural sway in the corresponding stable support surface conditions was greater for the 2D (2.99 to 6.26 times greater) compared to 1D paradigms (1.25 to 1.84 times greater), consistent with a superior degradation of viable proprioceptive feedback in the 2D paradigm.

Conclusion

A modified 2D version of the SOT was shown to provide a greater challenge to mediolateral postural control relative to the standard 1D SOT protocol, putatively as a result of a superior capacity to degrade proprioceptive feedback in the mediolateral direction. Given these positive findings, future studies should investigate the clinical utility of this modified SOT as a means by which to better characterize sensory contributions to postural control in the presence of various sensorimotor pathologies, including vestibular hypofunction.

Dynamic posturography after computerized vestibular retraining for stable unilateral vestibular deficits

BACKGROUND

Balance deficits increase the risk of falls and compromise quality of life. Current treatment modalities do not resolve symptoms for many patients.

AIMS/OBJECTIVES

To measure changes in objective posturography after a computerized vestibular retraining therapy protocol.

MATERIALS AND METHODS

This was a single-arm interventional study of individuals with a stable unilateral vestibular deficit present for greater than six months. Participants underwent 12 twice-weekly sessions of computerized vestibular retraining therapy. Objective response was measured by the Sensory Organization Test and questionnaires were administered to measure subjective changes.

RESULTS

We enrolled 13 participants (5 females and 8 males) with a median age of 51 years (range 18 to 67). After retraining, the Sensory Organization Test composite score improved by 8.8 (95% CI 0.6 to 19.1) and this correlated with improvement in the Falls Efficacy Scale-International questionnaire (r_s -0.6472; 95% CI -0.8872 to - 0.1316). Participants with moderate-to-severe disability at baseline (n = 7) demonstrated greater improvement in the composite score (14.6; 95% CI 7.0 to 36.9).

CONCLUSIONS AND SIGNIFICANCE

Computerized vestibular retraining therapy for stable unilateral vestibular deficits is associated with improvement in dynamic balance performance. Posturography improvements correlated with a reduction in perceived fall risk.Trial Registration Information Clinicaltrials.gov registration NCT04875013; 04/27/2021.

Relationship Between Sensory Organization Testing Scores With Lower Extremity Injuries and Prior Concussion in Professional Soccer Players

OBJECTIVE

To evaluate for associations between concussion history or lower extremity (LE) injury and computerized sensory organization testing (SOT) performance in professional soccer players.

DESIGN

Cross-sectional study.

SETTING

Tertiary care center.

PARTICIPANTS

Thirty-three, professional, male soccer players on an American club, between the years 2019 and 2021.

ASSESSMENT OF RISK FACTORS

Player age, history of reported LE injury (gluteal, hamstring, ankle, knee, hip, groin, and sports hernia), history of diagnosed concussion, and the number of prior concussions were documented for each player.

MAIN OUTCOME MEASURES

Baseline SOT of postural sway was conducted in 6 sensory conditions for all players.

RESULTS

Eleven athletes (33%) reported a previous concussion, and 15 (45%) reported a previous LE injury. There were no significant differences in SOT scores between those with and without a previous diagnosis of concussion ( P > 0.05). Those reporting a previous LE injury performed better on condition 3 (eyes open, unstable visual surround) than those who did not ( P = 0.03). Athletes aged 25 years or younger performed worse on condition 3 ( P = 0.01) and had worse, although not statistically significant, median performance on all other balance measures than those older than 25 years. Intraclass correlation coefficient for repeat SOT assessment was 0.58, indicating moderate reliability, without an evident practice effect.

CONCLUSIONS

Professional soccer players with a previous concussion or history of LE injury did not demonstrate long-term deficits in postural control, as assessed by multiyear computerized SOT baseline testing. The SOT was reliable over time with younger athletes exhibiting greater postural sway than older athletes.

Investigation of Head Shake Sensory Organization Test (HS-SOT) in three planes: Test-retest reliability and age-related differences

BACKGROUND

In recent years, it has been determined that SOT sensitivity is insufficient in patients who develop vestibular compensation and therefore the Head Shake Sensory Organization Test (HS-SOT) has been developed.

RESEARCH QUESTION

How differs the balance performance of healthy adults that is tested with HS-SOT according to age and test planes? What is the test-retest reliability level of the HS-SOT in three planes?

METHODS

Our prospective study, which has a methodological research design, included 80 participants divided into three groups by age range (Group 1: 20-39 years (n = 30); Group 2: 40-49 years (n = 30) and Group 3: 50-64 years (n = 20)). SOT and HSSOT ( yaw, pitch, roll) were performed to all participants. To investigate the testretest reliability of the HS-SOT, a total of 27 participants were re-evaluated one week later. The HS-SOT performance of the participants was compared between age groups and test planes. Intra-class correlation coefficient and minimum detectable change values (MDC) was calculated to test-retest reliability of HS-SOT.

RESULTS

HS-SOT scores (HS-2 and HS-5) did not differ significantly between age groups. The balance performance of individuals for the pitch plane was lower than other planes. Only the HS-5 score showed a significant difference between the sessions. HS-5 scores were higher in the re-test; for the first group in the pitch plane and for the third group in the yaw plane. The test-retest reliability level of these conditions was "moderate-good" for both groups. The corresponding MDC value was highest (14.01) for the HS-5 (yaw) score of the elderly group.

SIGNIFICANCE

The findings from this study demonstrated that the test plane influences the HS-SOT, a learning/practice effect may occur because of repeated HS-SOT evaluation, and this effect is more explicit in the elderly. This study provides a perspective for the evaluation and follow-up processes of patients with balance problems.

The effects of augmenting traditional rehabilitation with audio biofeedback in people with persistent imbalance following mild traumatic brain injury

Complaints of non-resolving imbalance are common in individuals with chronic mild traumatic brain injury (mTBI). Vestibular rehabilitation therapy may be beneficial for this population. Additionally, wearable sensors can enable biofeedback, specifically audio biofeedback (ABF), and aid in retraining balance control mechanisms in people with balance impairments. In this study, we described the effectiveness of vestibular rehabilitation therapy with and without ABF to improve balance in people with chronic mTBI. Participants (n = 31; females = 22; mean age = 40.9 ± 11 y) with chronic (>3 months) mTBI symptoms of self-reported imbalance were randomized into vestibular rehabilitation with ABF (n = 16) or without ABF (n = 15). The intervention was a standard vestibular rehabilitation, with or without ABF, for 45 min biweekly for 6 weeks. The ABF intervention involved a smartphone that provided auditory feedback when postural sway was outside of predetermined equilibrium parameters. Participant's completed the Post-Concussion Symptom Scale (PCSS). Balance was assessed with the sensory organization test (SOT) and the Central Sensorimotor Integration test which measured sensory weighting, motor activation, and time delay with sway evoked by surface and/or visual surround tilts. Effect sizes (Hedge's G) were calculated on the change between pre-and post-rehabilitation scores. Both groups demonstrated similar medium effect-sized decreases in PCSS and large increases in SOT composite scores after rehabilitation. Effect sizes were minimal for increasing sensory weighting for both groups. The with ABF group showed a trend of larger effect sizes in increasing motor activation (with ABF = 0.75, without ABF = 0.22) and in decreasing time delay (with ABF = −0.77, without ABF = −0.52) relative to the without ABF group. Current clinical practice focuses primarily on sensory weighting. However, the evaluation and utilization of motor activation factors in vestibular rehabilitation, potentially with ABF, may provide a more complete assessment of recovery and improve outcomes.

Treating peripheral neuropathy in individuals with type 2 diabetes mellitus with intraneural facilitation: a single blind randomized control trial

Objective

To evaluate the effectiveness of intraneural facilitation (INF) for the treatment of diabetic peripheral neuropathy (DPN).

Methods

This single-blind, randomized clinical trial enrolled patients with type 2 diabetes mellitus and moderate-to-severe DPN symptoms below the ankle. Patients were randomly assigned to receive INF or sham treatment. In the INF group, trained INF physical therapists provided therapy for 50–60 min, three times a week for 3 weeks. Sham treatment consisted of patients believing they received anodyne therapy for 3 weeks. Pre- and post-treatment data were compared between the two groups for quality of life, balance, gait, protective sensory function and pain outcome measures.

Results

A total of 28 patients (17 males) were enrolled in the study (INF group n = 17; sham group n = 11). There was a significant decrease in the overall pain score in both the INF and sham groups over time, but the decrease was greater in the INF group (1.11 versus 0.82). Between-group comparisons demonstrated significant differences in unpleasant pain and protective sensory function. The INF group showed post-treatment improvements in protective sensory function and composite static balance score.

Conclusions

INF treatment improved pain perception, the composite static balance score and protective sensations in patients with DPN.

Research Registry number: CNCT04025320

Postural stability and flexibility responses of yoga training in women: Are improvements similar in both sexes?

The researchers' aim is to examine the postural stability and flexibility responses of yoga training in women. The authors conducted the yoga training program 2 days a week and they assessed flexibility using the sit and reach test, trunk hyperextension test and trunk lateral flexion test. The researchers measured static and dynamic balance employing the device and database system. Then, the authors repeated all assesments were at the end of the first, the fifth and the tenth sessions. As a result of this study, the researchers revealed that the male participants had significantly poorer results in a single parameter (longitudinal sway) when compared with the female group, but the groups were statistically equivalent in this parameter after the first yoga training session. The authors also revealed that yoga was effective in improving flexibility among healthy young adults of both sexes, although the males showed greater improvement than females in the flexibility results.

Migraine and balance impairment: Influence of subdiagnosis, otoneurological function, falls, and psychosocial factors

OBJECTIVE

To assess the balance sensory organization among patients with migraine, considering the influence of migraine subdiagnosis, otoneurological function, falls, and psychosocial factors.

BACKGROUND

Migraine has been associated with vestibular symptoms and balance dysfunction; however, neither comprehensive balance assessment nor associated factors for greater impairment have been addressed thus far.

METHODS

Patients from a tertiary headache clinic with a diagnosis of episodic migraine with aura (MWA), without aura (MWoA), and chronic migraine (CM) were included for this cross-sectional study (30 patients per group). Thirty headache-free controls (CG) were recruited. Participants underwent a comprehensive evaluation protocol, including the Sensory Organization Test (SOT) and otoneurological examination. Questionnaires about fear of falls, dizziness disability, and kinesiophobia were administered.

RESULTS

All migraine groups presented lower composite SOT scores than controls (CG: 82.4 [95% confidence interval (CI): 79.5-85.3], MWoA: 76.5 [95% CI: 73.6-79.3], MWA: 66.5 [95% CI: 63.6-69.3], CM: 69.1 [95% CI: 66.3-72.0]; p < 0.0001). Compared to controls and to MWoA, MWA and CM groups exhibited greater vestibular (CG: 75.9 [95% CI: 71.3-80.4], MWoA: 67.3 [95% CI: 62.7-71.8], MWA: 55.7 [95% CI: 51.2-60.3], CM: 58.4 [95% CI: 53.8-63.0]; p < 0.0001) and visual functional impairment (CG: 89.6 [95% CI: 84.2-94.9], MWoA: 83.2 [95% CI: 77.9-88.6], MWA: 68.6 [95% CI: 63.3-74.0], CM: 71.9 [95% CI: 66.5-77.2], p < 0.0001). Fall events during the assessment were documented more often among patients with migraine (CG: 0.0, interquartile range [IQR], 0.0, 0.0); MWoA: 1.0 [IQR: 1.0, 1.0], MWA: 2.0 [IQR: 1.8, 4.3], CM: 1.0 [IQR: 1.0, 2.0]; p = 0.001). The SOT scores correlated with fear of falls (r = -0.44), dizziness disability (r = -0.37), kinesiophobia (r = -0.38), and migraine frequency (r = -0.38). There was no significant influence of the vestibular migraine diagnosis in the study outcomes when used as a covariate in the analysis (composite score [F = 3.33, p = 0.070], visual score [F = 2.11, p = 0.149], vestibular score [F = 1.88, p = 0.172], somatosensory score [F = 0.00, p = 0.993]).

CONCLUSIONS

Aura and greater migraine frequency were related to falls and balance impairment with sensory input manipulation, although no otoneurological alterations were detected. The diagnosis of vestibular migraine does not influence the balance performance. The vestibular/visual systems should be considered in the clinical examination and treatment of patients with migraine.

Retention Effects of Long-Term Balance Training with Vibrotactile Sensory Augmentation in Healthy Older Adults

Vibrotactile sensory augmentation (SA) decreases postural sway during real-time use; however, limited studies have investigated the long-term effects of training with SA. This study assessed the retention effects of long-term balance training with and without vibrotactile SA among community-dwelling healthy older adults, and explored brain-related changes due to training with SA. Sixteen participants were randomly assigned to the experimental group (EG) or control group (CG), and trained in their homes for eight weeks using smart-phone balance trainers. The EG received vibrotactile SA. Balance performance was assessed before, and one week, one month, and six months after training. Functional MRI (fMRI) was recorded before and one week after training for four participants who received vestibular stimulation. Both groups demonstrated significant improvement of SOT composite and MiniBESTest scores, and increased vestibular reliance. Only the EG maintained a minimal detectable change of 8 points in SOT scores six months post-training and greater improvements than the CG in MiniBESTest scores one month post-training. The fMRI results revealed a shift from activation in the vestibular cortex pre-training to increased activity in the brainstem and cerebellum post-training. These findings showed that additional balance improvements were maintained for up to six months post-training with vibrotactile SA for community-dwelling healthy older adults.

Individuals with Chronic Mild-to-Moderate Traumatic Brain Injury Exhibit Decreased Neuromuscular Complexity During Gait

BACKGROUND

Synergy analysis provides a means of quantifying the complexity of neuromuscular control during gait. Prior studies have shown evidence of reduced neuromuscular complexity during gait in individuals with neurological disorders associated with stroke, cerebral palsy, and Parkinson's disease.

OBJECTIVE

The purpose of this study was to investigate neuromuscular complexity during gait in individuals who experienced a prior traumatic brain injury (TBI) that resulted in chronic balance deficits.

METHODS

We measured and analyzed lower extremity electromyographic data during treadmill and overground walking for 44 individuals with residual balance deficits from a mild-to-moderate TBI at least 1 year prior. We also tested 20 unimpaired controls as a comparison. Muscle synergies were calculated for each limb using non-negative matrix factorization of the activation patterns for 6 leg muscles. We quantified neuromuscular complexity using Walk-DMC, a normalized metric of the total variance accounted for by a single synergy, in which a Walk-DMC score of 100 represents normal variance accounted for. We compared group average synergy structures and inter-limb similarity using cosine similarity. We also quantified each individual's gait and balance using the Sensory Organization Test, the Dynamic Gait Index, and the Six-Minute Walk Test.

RESULTS

Neuromuscular complexity was diminished for individuals with a prior TBI. Walk-DMC averaged 92.8 ± 12.3 for the TBI group during overground walking, which was significantly less than seen in controls (100.0 ± 10.0). Individuals with a prior TBI exhibited 13% slower overground walking speeds than controls and reduced performance on the Dynamic Gait Index (18.5 ± 4.7 out of 24). However, Walk-DMC measures were insufficient to stratify variations in assessments of gait and balance performance. Group average synergy structures were similar between groups, although there were considerable between-group differences in the inter-limb similarity of the synergy activation vectors.

CONCLUSIONS

Individuals with gait and balance deficits due to a prior TBI exhibit evidence of decreased neuromuscular complexity during gait. Our results suggest that individuals with TBI exhibit similar muscle synergy weightings as controls, but altered control of the temporal activation of these muscle weightings.

Reliability and learning effects of repeated exposure to the Bertec Balance Advantage sensory organisation test in healthy individuals

BACKGROUND

The Sensory Organisation Test (SOT) of computerised dynamic posturography (CDP) is a well-established clinical test used to measure postural control. Advances in technology have enabled new CDP systems to use immersive virtual reality, such as the Bertec® Balance Advantage®. While the Bertec provides an innovative approach to posturography, the reliability and learning effects of the Bertec in administering the SOT has not been thoroughly investigated.

RESEARCH QUESTION

To evaluate the reliability and performance during repeated administration of the Bertec® Balance Advantage® SOT.

METHODS

Fourteen healthy adults (age 27.17 ± 5.5years; 10 females) participated. Each participant performed five SOTs over three sessions. The first two sessions were approximately two days apart and the third one month later. In the first two sessions, two SOTs were conducted, and in the third session, one was performed. Composite, equilibrium, and ratio scores were used for analysis.

RESULTS

Poor within-session reliability was found in the first session for the composite score (ICC: 0.73, 95% CI: 0.32-0.91), which improved by the second session (ICC: 0.84, 95% CI: 0.58-0.94). Poor within-session reliability (ICC <0.5) was found for all ratio and equilibrium scores, except for the equilibrium score of condition 3, which demonstrated moderate reliability (ICC: 0.84, 95% CI: 0.57-0.95). Poor between-session reliability was found for all outcomes. There was an increase in the composite and equilibrium scores for conditions 5 and 6 over the 5 tests, which plateaued after the fourth test, and were retained at 1 month.

SIGNIFICANCE

The data demonstrate a steady increase in performance with repeated exposure to the Bertec SOT, which was maintained one month later, indicating a learning effect. We recommend that a minimum of two familiarisation sessions should be administered to establish baseline performance and improve reliability.

Concussion Baseline Retesting Is Necessary When Initial Scores Are Low

OBJECTIVE

To determine whether (1) initial baseline scores are significantly better for those who have valid (initial valid) versus invalid scores (initial invalid) on their concussion baseline testing, (2) retesting results in significantly improved baseline scores, and (3) there is a significant difference in scores between those who have valid scores on their initial attempt and those who retook baseline tests (retest valid).

DESIGN

Prospective, repeated-measures.

SETTING

Two years of collegiate preparticipation concussion baseline testing.

PARTICIPANTS

Five hundred forty-seven male and female Division I collegiate athletes (19.02 ± 1.31 years, female = 217).

INDEPENDENT VARIABLES

Participants were divided into initial valid and initial invalid. The retest group was further divided into their initial (initial invalid) and final valid attempt (retest valid).

MAIN OUTCOME MEASURES

Data were analyzed to determine the relationship between the 3 groups and overall initial and final scores on 28 individual items: total symptoms score, coordination, near-point convergence, CNS Vital Signs (CNSVS), Senaptec Sensory Station, and Neurocom Sensory Organization Test (SOT).

RESULTS

The initial valid group scored significantly better than the initial invalid group on 8 CNSVS items and 5 Senaptec items (P < 0.002). The retest valid scores were significantly better compared with the initial invalid scores on 17 items (P < 0.002).

CONCLUSIONS

Retesting is recommended for individuals who score below acceptable ranges. This is important because athletes may experience a learning effect and are highly motivated during postinjury testing, so accurate baseline scores are imperative for athlete safety. Completion time for the coordination test may be a more informative option.

A Prospective, Multicenter Study to Assess the Safety and Efficacy of Translingual Neurostimulation Plus Physical Therapy for the Treatment of a Chronic Balance Deficit Due to Mild-to-Moderate Traumatic Brain Injury

OBJECTIVES

Translingual neurostimulation (TLNS) studies indicate improved outcomes in neurodegenerative disease or spinal cord injury patients. This study was designed to assess the safety and efficacy of TLNS plus targeted physical therapy (PT) in people with a chronic balance deficit after mild-to-moderate traumatic brain injury (mmTBI).

MATERIALS AND METHODS

This international, multicenter, randomized study enrolled 122 participants with a chronic balance deficit who had undergone PT following an mmTBI and had plateaued in recovery. Randomized participants received PT plus either high-frequency pulse (HFP; n = 59) or low-frequency pulse (LFP; n = 63) TLNS. The primary efficacy and safety endpoints were the proportion of sensory organization test (SOT) responders (SOT composite score improvement of ≥15 points) and fall frequency after five weeks of treatment, respectively.

RESULTS

The proportion of SOT responders was significant in the HFP + PT (71.2%) and LFP + PT (63.5%) groups compared with baseline (p < 0.0005). For the pooled population, the SOT responder rate was 67.2% (p < 0.00005), and there were clinically and statistically significant improvements in SOT composite scores after two and five weeks (p < 0.0005). Both groups had reductions in falls and headache disability index scores. Mean dynamic gait index scores in both groups also significantly increased from baseline at weeks 2 and 5.

CONCLUSIONS

Significant improvements in balance and gait, in addition to headaches, sleep quality, and fall frequency, were observed with TLNS plus targeted PT; in participants who had a chronic balance deficit following an mmTBI and had plateaued on prior conventional physiotherapy.

Adaptations in Reactive Balance Strategies in Healthy Older Adults After a 3-Week Perturbation Training Program and After a 12-Week Resistance Training Program

Both resistance training (RT) and perturbation-based training (PBT) have been proposed and applied as interventions to improve reactive balance performance in older adults. PBT is a promising approach but the adaptations in underlying balance-correcting mechanisms through which PBT improves reactive balance performance are not well-understood. Besides it is unclear whether PBT induces adaptations that generalize to movement tasks that were not part of the training and whether those potential improvements would be larger than improvements induced by RT. We performed two training interventions with two groups of healthy older adults: a traditional 12-week RT program and a 3-week PBT program consisting of support-surface perturbations of standing balance. Reactive balance performance during standing and walking as well as a set of neuro-muscular properties to quantify muscle strength, sensory and motor acuity, were assessed pre- and post-intervention. We found that both PBT and RT induced training specific improvements, i.e., standing PBT improved reactive balance during perturbed standing and RT increased strength, but neither intervention affected reactive balance performance during perturbed treadmill walking. Analysis of the reliance on different balance-correcting strategies indicated that specific improvements in the PBT group during reactive standing balance were due to adaptations in the stepping threshold. Our findings indicate that the strong specificity of PBT can present a challenge to transfer improvements to fall prevention and should be considered in the design of an intervention. Next, we found that lack of improvement in muscle strength did not limit improving reactive balance in healthy older adults. For improving our understanding of generalizability of specific PBT in future research, we suggest performing an analysis of the reliance on the different balance-correcting strategies during both the training and assessment tasks.

Sensory Organization Test Conditions Influence Postural Strategy Rather than Footwear or Workload

BACKGROUND

Postural strategies such as ankle, hip, or combined ankle-hip strategies are used to maintain optimal postural stability, which can be influenced by the footwear type and physiological workload.

PURPOSE

This paper reports previously unreported postural strategy scores during the six conditions of the sensory organization test (SOT).

METHODS

Fourteen healthy males (age: 23.6 ± 1.2 years; height: 181 ± 5.3 cm; mass: 89.2 ± 14.6 kg) were tested for postural strategy adopted during SOT in three types of occupational footwear (steel-toed work boot, tactical work boot, low-top work shoe) every 30 min during a 4-h simulated occupational workload. Postural strategy scores were analyzed using repeated measures analysis of variance at 0.05 alpha level.

RESULTS

Significant differences among postural strategy scores were only evident between SOT conditions, and but not between footwear type or the workload.

CONCLUSIONS

Findings indicate that occupational footwear and occupational workload did not cause a significant change in reliance on postural strategies. The significant changes in postural strategy scores were due to the availability of accurate and/or conflicting sensory feedback during SOT conditions. In SOT conditions where all three types of sensory feedback was available, the ankle strategy was predominantly adopted, while more reliance on hip strategy occurred in conditions with absent or conflicting sensory feedback.

Vestibular rehabilitation with mobile posturography as a "low-cost" alternative to vestibular rehabilitation with computerized dynamic posturography, in old people with imbalance: a randomized clinical trial

BACKGROUND

Vestibular rehabilitation (VR), specifically, VR with dynamic computerized posturography (CDP) has proven to be useful to improve balance and reduce the risk of falling in old patients. Its major handicap is probably its cost, which has hindered its generalisation. One solution to reduce this cost is performing VR with mobile posturography systems, which allow assessment of stability at the center of body mass in daily-life conditions. Also, rehabilitation with vibrotactile neurofeedback training could be used in dynamic tasks.

OBJECTIVE

To assess whether two different protocols of vestibular rehabilitation (using CDP and the Vertiguard system) show significant differences in the improvement of balance among older persons with imbalance METHODS: A clinical trial comparing VR with CDP exercises and VR with mobile posturography (Vertiguard) exercises, was designed. The participants were people over 65 years, with imbalance. The composite (average balance) in the sensory organization test (SOT) of the CDP was the main outcome measure; it was compared before and 3 weeks after VR, and between both intervention groups.

RESULTS

40 patients were included in the study (19 in the CDP-VR group and 21 in the Vertiguard-VR group). Average balance was significantly improved in both intervention groups (51% pre-VR vs 60% post-VR, p = 0.002, CDP-VR group; 49% pre-VR vs 57% post-VR, p = 0.008, Vertiguard-VR group); no significant differences in this improvement were found comparing both groups (p = 0.580).

DISCUSSION AND CONCLUSIONS

VR using mobile posturography is useful to improve stability in old people with instability, showing similar improvement rates to those of VR using CDP.

UNIQUE IDENTIFIER

NCT03034655 www.clinicaltrials.gov Registered on 25 January 2017.

Potential Mechanisms of Acute Standing Balance Deficits After Concussions and Subconcussive Head Impacts: A Review

Standing balance deficits are prevalent after concussions and have also been reported after subconcussive head impacts. However, the mechanisms underlying such deficits are not fully understood. The objective of this review is to consolidate evidence linking head impact biomechanics to standing balance deficits. Mechanical energy transferred to the head during impacts may deform neural and sensory components involved in the control of standing balance. From our review of acute balance-related changes, concussions frequently resulted in increased magnitude but reduced complexity of postural sway, while subconcussive studies showed inconsistent outcomes. Although vestibular and visual symptoms are common, potential injury to these sensors and their neural pathways are often neglected in biomechanics analyses. While current evidence implies a link between tissue deformations in deep brain regions including the brainstem and common post-concussion balance-related deficits, this link has not been adequately investigated. Key limitations in current studies include inadequate balance sampling duration, varying test time points, and lack of head impact biomechanics measurements. Future investigations should also employ targeted quantitative methods to probe the sensorimotor and neural components underlying balance control. A deeper understanding of the specific injury mechanisms will inform diagnosis and management of balance deficits after concussions and subconcussive head impact exposure.

Reevaluating clinical assessment outcomes after unrestricted return to play following sport-related concussion

PRIMARY OBJECTIVE

The objective of this study was to examine neurocognition, postural control, and symptomology at multiple timepoints following concussion. We hypothesized that collegiate athletes would perform similar to or better than their baseline in terms of each outcome at both timepoints.

RESEARCH DESIGN

This was a retrospective study of 71 collegiate athletes (18.3 ± 0.89 years old; 182.2 ± 10.05 cm; 84.2 ± 20.07 kg) to observe changes in outcomes from a previously established clinical protocol.

METHODS AND PROCEDURES

Participants were administered ImPACT™, the Sensory Organization Test (SOT), and the revised head injury scale (HIS-r) prior to their seasons (baseline); upon reporting symptom-free following concussion (post-injury); and approximately 8-months after return-to-play to establish a new baseline.

MAIN OUTCOMES AND RESULTS

There were no changes in ImPACT scores or HIS-r reporting over time. ImPACT total symptom score (TSS) decreased over time (p = .002, η_p² = 0.08). Significant main effects occurred for the SOT equilibrium score (p < .01, η_p² = 0.34) and Vestibular sensory ratio (p < .001, η_p² = 0.22).

CONCLUSIONS

Our data suggest no decline in neurocognition, balance, or symptom burden approximately eight months post-injury. As clinicians continue to explore "best practices" for concussion management and potential long-term implications of these injuries it is important to monitor outcome measures longitudinally.

Association between Anthropometric Variables, Sex, and Visual Biofeedback in Dynamic Postural Control Assessed on a Computerized Wobble Board

Anthropometrics and sex influence balance performances, and visual information can change anthropometrics’ relation and the postural sway. Therefore, the aim of the present study was to evaluate the effect of anthropometric characteristics, sex, and visual biofeedback and/or their interaction on a computerized wobble board. Twenty-seven (14 females, 13 males) young adults performed three 30-s double leg stance trials on a wobble board during two conditions: with visual and without visual biofeedback. Visual biofeedback improved (p = 0.010) balance on a wobble board with respect to the condition without visual biofeedback. Regardless of sex, no differences between conditions were found (p = 0.088). When investigating the effect of anthropometrics variables, sex, and their interactions on conditions, a significant main effect of the lower limb/height ratio, sex, and their interaction on the condition without visual biofeedback was found (p = 0.0008; R2 = 0.57). For the visual biofeedback condition, significant effects for sex and body mass (p = 0.0012; R2 = 0.43) and sex and whole-body moment of inertia (p = 0.0030; R2 = 0.39) were found. Results from the present study showed (1) visual biofeedback improved wobble board balance performance; (2) a significant main effect of lower limb/height ratio, sex, and their interaction on the wobble board performances without visual biofeedback emerged; (3) significant effects were found for sex and body mass and sex and moment of inertia in the visual biofeedback condition. Findings from the present study could have an impact on training and evaluations protocols, especially when several populations such as children, athletes, older adults and people with balance disorders are involved.

Examining the Relationship Between Conventional Outcomes and Immersive Balance Task Performance in Service Members With Mild Traumatic Brain Injury

INTRODUCTION

Mild traumatic brain injury (mTBI) is associated with significant financial cost and reduced military readiness and impacts quality of life for active duty service members (SMs). Post-concussive symptoms can include vestibular impairments, such as chronic dizziness and postural instability, which can be compounded by psychological comorbidities like PTSD. Comprehensive vestibular evaluations are required to assess symptoms and guide clinical decision-making. At the National Intrepid Center of Excellence (NICoE), in addition to traditional vestibular assessments, clinicians can also leverage virtual environments (VEs) in the Computer-Assisted Rehabilitation Environment (CAREN) to further evaluate balance. The objective of this study was to examine the relationship between conventional outcomes and VE performance on immersive balance tasks in the CAREN, determine whether VE performance could predict conventional outcomes, and explore the impact of PTSD.

MATERIALS AND METHODS

This retrospective analysis included 112 SMs from the NICoE Intensive Outpatient Program who provided informed consent for their clinical data to be used for research purposes. All had a history of mTBI, underwent vestibular evaluations, and completed immersive balance tasks on the CAREN. Conventional outcomes included the Sensory Organization Test (SOT), Functional Gait Assessment (FGA), Activities Balance Confidence (ABC) Scale, and Dizziness Handicap Inventory (DHI). The PTSD Checklist-Military Version was added to account for behavioral symptoms. Computer-Assisted Rehabilitation Environment outcomes included total time to complete the Balance Cubes VE, with the platform static (BC-Static) and with random platform motion (BC-PM) as well as composite scores for the Shark Hunt VE, with (SH-Recall) and without a recall task (SH-Standard). Statistical analyses included independent t-tests to determine group differences, Pearson's correlations to examine relationships between conventional outcomes and VE performance, and binary logistic regressions to determine if VE performance predicted conventional outcomes based on clinically relevant cutoffs.

RESULTS

SMs who took less time to complete BC-Static had better overall balance, indicated by higher ABC, SOT, and FGA scores (P <.001). Those with greater self-reported dizziness, higher DHI scores, took longer to complete BC-Static (P < .05). FGA and SOT, objective gait and balance, were similarly correlated to BC-PM performance (P <.001). SMs with higher SOT scores, better balance, also tended to have higher SH-Standard scores (P <.1). SMs, who were above normative SOT, FGA, and ABC cutoffs, completed BC-Static significantly faster than those below (P <.05). This remained true for BC-PM but was only significant for SOT (P = .004). Performance on BC-Static, BC-PM, and SH-Standard was significant predictors of SOT score. For SMs with comorbid mTBI and PTSD, increased functional disability was observed in conventional outcomes and diminished VE performance was noted.

CONCLUSION

Objective balance and gait, SOT and FGA, demonstrated the strongest relationships to immersive VE performance in the CAREN. Our findings suggest that these immersive balance tasks may be effective as an adjunct assessment to examine balance. Future work will focus on moving these VEs from the CAREN to a portable system, which could be more readily utilized in a variety of clinical settings, increasing accessibility.

Comparison of efficacy of vestibular rehabilitation and noisy galvanic vestibular stimulation to improve dizziness and balance in patients with multiple sclerosis

BACKGROUND

Dizziness and imbalance are common symptoms in patients with multiple sclerosis (PwMS), and rehabilitation interventions varying greatly in effectiveness.

OBJECTIVE

To compare the effectiveness of vestibular rehabilitation therapy (VRT) and noisy galvanic vestibular stimulation (nGVS) on dizziness and balance in PwMS.

METHODS

This was a single-blind, randomized controlled trial. Twenty-four PwMS were randomly divided into groups of VRT, nGVS, and Control. The VRT and the nGVS groups underwent the intervention program. The patients were assessed with the composite score in anteroposterior and lateral directions (CS AP and LAT) obtained by sensory organization test (SOT), Dizziness Handicap Inventory (DHI), and Activities-Specific Balance Confidence Scale (ABC).

RESULTS

The VRT group showed greater improvements in CS AP and LAT, DHI total score, and ABC total score compared with the nGVS group and the control group. No significant difference was found between the nGVS group and the control group. These results were approximately stable at the 4-week follow-up.

CONCLUSIONS

These findings provided evidence for effectiveness of the VRT in improvement of dizziness and balance in PwMS. These improvements were not associated with the nGVS. Further studies are needed to assess the effectiveness of the nGVS on dizziness and balance in PwMS.

Baduanjin Qigong Improves Balance, Leg Strength, and Mobility in Individuals With Chronic Stroke: A Randomized Controlled Study

BACKGROUND

Effective and sustainable exercise training methods for improving balance poststroke are needed.

OBJECTIVE

To evaluate the effect of Baduanjin Qigong for improving balance after stroke.

METHODS

This was a single-blinded randomized controlled study in which only the assessor was blinded. Fifty-eight people with chronic stroke (mean age: 62.5 ± 11.8 years) were randomly assigned to the experimental (n = 29) or control group (n = 29). The experimental group underwent 8 weeks of supervised Baduanjin training (3 sessions per week). This was followed by home-based practice of the same exercises 3 days a week for another 8 weeks. The control group underwent 2 sessions of supervised conventional fitness training in the first week, followed by home-based exercise practice 3 days a week until the end of week 16. All outcomes were measured at baseline, week 8, and week 16.

RESULTS

Significantly greater improvements in the Mini-Balance Evaluation Systems Test (Mini-BESTest), composite equilibrium score (Sensory Organization Test), 5 Times Sit to Stand, and Timed Up and Go test were detected at week 8 in the experimental group than in the control group (P < .017). Further improvement in the Mini-BESTest was observed from week 8 to 16 in the experimental group (P < .001). Other outcomes (Limit of Stability, Fall-Efficacy Scale, Modified Barthel Index, Stroke-Specific Quality of Life) showed no significant results.

CONCLUSION

Baduanjin is effective in improving balance, leg strength, and mobility and is a safe and sustainable form of home-based exercise for people with chronic stroke.

Effect of Repetitive Administration of a Next-generation Sensory Organization Test in Adults With and Without Vestibular Dysfunction

HYPOTHESIS

The overall aim was to assess the effects of repetitive testing on performance on a next-generation Sensory Organization Test (NG-SOT).

BACKGROUND

The psychometric properties of sensory organization assessment with a next-generation posturography device are not fully characterized. Thus, a better understanding of the reliability of the NG-SOT is required to support its use as an outcome measure.

METHODS

Forty adults (20 vestibular-impaired) participated. Test-retest reliability was determined using the interclass correlation coefficient [ICC (3,1)] for the composite, somatosensory, vision, vestibular, and visual preference scores. Learning effects were assessed by analyzing the change in the composite score over time.

RESULTS

Analyzing the NG-SOT scores across all participants produced the following interclass correlation coefficients [95% confidence interval (CI)]: composite = 0.95 (0.92, 0.97), somatosensory = 0.20 (-0.06, 0.44), vision = 0.93 (0.88, 0.96), vestibular = 0.91 (0.85, 0.94), and visual preference = 0.19 (-0.07, 0.43). The mean differences (95% CI; p value) for the composite score between administrations were: 2.7 (1.0, 4.4; 0.002) for visits 1 and 2; 1.4 (-0.3, 3.1; 0.099) for visits 2 and 3; 0.7 (-1.0, 2.4; 0.403) for visits 3 and 4; and 0.4 (-1.3, 2.1; 0.653) for visits 4 and 5.

CONCLUSIONS

Test-retest reliability was excellent for the composite, vision, and vestibular scores, but it was poor for the somatosensory and visual preference scores. A learning effect for the composite score was identified, but performance was stable after two administrations. Changes in the composite score that are greater than 6.5 points exceed the measurement error for the test.

Validation of a next-generation sensory organization test in adults with and without vestibular dysfunction

BACKGROUND

The traditional Sensory Organization Test (T-SOT) is a gold standard balance test; however, the psychometric properties of assessing sensory organization with a virtual-reality-based posturography device have not been established.

OBJECTIVE

Our overall aims were to assess the criterion, concurrent, and convergent validity of a next-generation Sensory Organization Test (NG-SOT).

METHODS

Thirty-four adults (17 vestibular-impaired) participated. We compared the area under the curve (AUC) for receiver operator characteristic (ROC) analysis for the T-SOT and NG-SOT composite scores. Between-group and between-test differences for the composite and sensory analysis scores from each SOT were assessed using Wilcoxon Rank Sum tests. Additionally, we ran Spearman correlations between the NG-SOT composite score and outcomes of interest.

RESULTS

The AUCs for the NG-SOT and T-SOT were 0.950 (0.883, 1) and 0.990 (0.969, 1) respectively (p = 0.168). The median composite, vision, and visual preference scores were lower on the NG-SOT compared to the T-SOT; whereas, the median somatosensory score was higher on the NG-SOT compared to the T-SOT. Associations between the composite score and patient-reported or performance-based outcomes ranged from poor to strong.

CONCLUSIONS

The NG-SOT is a valid measure of balance in adults. However, the results of the NG-SOT and T-SOT should not be used interchangeably.

A block randomised controlled trial investigating changes in postural control following a personalised 12-week exercise programme for individuals with lower limb amputation

BACKGROUND

Individuals with a lower limb amputation (LLA) have an increased risk of falls and often report lower balance confidence. They must compensate for altered mechanics and prosthetic limitations in order to execute appropriate motor responses to postural perturbations. Personalised exercise could be an effective strategy to enhance balance and reduce falls.

RESEARCH QUESTION

In this study, we investigated whether a personalised exercise programme could improve postural control and self-reported balance confidence in individuals with an LLA.

METHODS

Participants were block randomised into two groups (exercise, n = 7; control, n = 7) based on age and level of amputation. The exercise group completed a 12-week personalised exercise programme, including home-based exercise sessions, consisting of balance, endurance, strength, and flexibility training. The control group continued with their normal daily activities. All participants performed the Sensory Organization Test (SOT) and Motor Control Test (MCT) on the NeuroCom SMART Equitest, and completed the Activities-specific Balance Confidence-UK (ABC) self-report questionnaire, at baseline and post-intervention.

RESULTS AND SIGNIFICANCE

Exercise group equilibrium scores improved significantly when standing on an unstable support surface with no visual input and inaccurate somatosensory feedback (SOT condition 5, P < 0.012, d = 1.45). There were significant group*time interactions for medium (P = 0.029) and large (P = 0.048) support surface forward translations, which were associated with a trend towards increased weight-bearing on the intact limb in the control group (medium: P = 0.055; large: P = 0.087). No significant changes in ABC score were observed. These results indicate reduced reliance on visual input, and/or enhanced interpretation of somatosensory input, following an exercise programme. However, objective improvements in aspects of postural control were not associated with subjective improvements in self-reported balance confidence. More weight-bearing asymmetry in the control group suggests that a lack of targeted exercise training may have detrimental effects, with potential adverse long-term musculoskeletal consequences, that were quantifiable within a short timeframe.

Comparison of Activity-Based Home Program and Cawthorne-Cooksey Exercises in Patients With Chronic Unilateral Peripheral Vestibular Disorders

OBJECTIVE

This study aimed to investigate the effects of an activity-based home program and an exercise-based home program on dizziness severity, balance, and independent level of daily life activities in patients with dizziness due to chronic unilateral peripheral vestibular disorders.

DESIGN

A single-blind randomized controlled trial.

SETTING

University dizziness management clinics.

PARTICIPANTS

Individuals (N=75) between 18 and 65 years of age who had chronic unilateral peripheric vestibular disorders and vestibular rehabilitation indication.

INTERVENTION

Participants were randomly divided into 3 groups: an activity-based home program (group 1/activity group), an exercise-based home program (group 2/exercise group), and a control group (group 3). After an initial assessment, all groups participated in the patient education program. In addition, the activity-based home program was administered to the first group, while the Cawthorne-Cooksey home exercise program was administered to the second group.

MAIN OUTCOME MEASURES

Visual analog scale (VAS), Vestibular Disorders Activities of Daily Living Scale (VADL), and computerized dynamic posturography before and immediately after the treatment program.

RESULTS

A statistically significant improvement was found in the activity and exercise groups in terms of VAS, VADL, Sensory Organization Test (SOT) 5, SOT 6, and SOT (composite) scores compared with the control group (P<.05). A statistically significant improvement was found in the activity group in terms of the instrumental subscale of VADL, SOT 5, SOT 6, and SOT (composite) scores compared with the exercise group.

CONCLUSIONS

The activity-based home program was more effective in improving the home management task, the occupational task, and balance than the exercise-based home treatment program in patients with chronic peripheral vestibular disorders.

Osteopathic manipulative treatment in individuals with vertigo and somatic dysfunction: a randomized, controlled, comparative feasibility study

Context

There is a paucity of research assessing the efficacy of osteopathic manipulative treatment (OMT) in patients with vertigo.

Objective

To assess the feasibility of conducting a randomized, controlled trial comparing OMT and vestibular rehabilitation therapy (VRT), alone or in combination, in patients with vertigo and somatic dysfunction.

Methods

Volunteers with vertigo who were also diagnosed with somatic dysfunction (SD) were prospectively enrolled in a blinded, randomized, controlled cohort comparative effectiveness study and assigned to 1 of 4 groups: OMT alone, VRT alone, a combination of OMT and VRT (OMT/VRT), or a nonintervention control group. Participants between 18 and 79 years of age were included if they had experienced symptoms of vertigo for at least 3 months' duration, demonstrated somatic dysfunction, and could participate in computerized dynamic posturography (CDP) testing, tolerate manual therapy and exercises, and communicate effectively in English or Spanish. A total of 3 treatments lasting 45 minutes each were administered 1 week apart to each participant. OMT in this study consisted of counterstrain, myofascial release, balanced ligamentous tension, soft tissue, HVLA, and articulatory techniques. Comparisons were made between composite scores (CS) assessed with computerized dynamic posturography (CDP), dizziness handicap inventory (DHI), optometric evaluation, and osteopathic structural examinations collected before the first treatment, after the third/final treatment, and 3 months after the final treatment. (ClinicalTrials.gov number NCT01529151).

Results

A total of 23 patients were included in the study: 7 in the OMT group, 5 in the VRT group, 6 in the OMT/VRT group, and 5 in the control group. The OMT/VRT group demonstrated significant improvement in DHI score (P=0.0284) and CS (P=0.0475) between pre- and 3-month posttreatment measures. For total severity, improvements were significant in the OMT group both from pretreatment to immediate posttreatment measures (P=0.0114) and from pretreatment to 3-month posttreatment measures (P=0.0233). There was a statistical difference between the OMT and control groups from pretreatment to 3-month posttreatment DHI scores (P=0.0332). Also, there was a statistical difference in DHI score between VRT and control from pre- to 3-month posttreatment scores (P=0.0338). OMT/VRT statistically and clinically improved visual acuity in patients' right eyes from pre- to posttreatment (P=0.0325). In all participants, vergence dysfunction was prevalent (5; 21.7%) in addition to vertical heterophoria (15; 65.2%).

Conclusion

A combination of OMT and VRT significantly reduced vertigo and improved balance 3 months after treatment (P<0.05). There was a high prevalence in vergence and vertical heterophoria, which are not typical screening measurements used by physical therapists and physicians to assess vertigo patients. With a small sample size, this study demonstrated the feasibility of an interdisciplinary team evaluating and treating patients with vertigo in a community setting. A larger study is needed to assess the efficacy of OMT/VRT in vertigo patients.

Vestibular Physical Therapy Evaluation of Individuals Exposed to Directed Energy

INTRODUCTION

Directed energy has been described as exposure to a unique sound/pressure phenomenon such as infrasonic or ultrasonic acoustic or electromagnetic energy. Following suspected sonic attacks on U.S. Embassies, a subset of individuals presented with a unique cluster of symptoms believed to have resulted from exposure to directed energy. The Joint Force does not have an established protocol to guide the vestibular physical therapy evaluation of individuals exposed to directed energy. Therefore, we sought to provide evidence-based guidance for conducting a comprehensive vestibular physical therapy evaluation in persons exposed to directed energy.

MATERIALS AND METHODS

A comprehensive search of relevant databases was performed from 2018 to the present. Four seminal articles were used to inform suggestions for clinical best practice.

RESULTS

The physical therapist should ask open-ended questions to understand what the individual is experiencing and use key questions to focus attention on the mechanism of injury, symptom report, and symptom timeline. The physical therapist should perform an evaluation to determine if the peripheral vestibular apparatus (semicircular canals and otoliths), vestibular nerve, and/or central pathways have been affected by directed energy exposure. Components of the quantitative examination were selected because they provide information on health condition(s), body structure and function impairments, and activity limitations but require little to no specialized equipment.

CONCLUSIONS

Evidence-based guidance for conducting a comprehensive vestibular physical therapy evaluation in individuals exposed to directed energy may aid in the identification and diagnosis of unconventional brain injury. This standardized approach can help physical therapists to evaluate complaints that do not match any previously known medical conditions but resemble brain injury or vestibular pathology.

Effects of local vibration and cervical stabilization exercises on balance, joint position sense, and isometric muscle performance in young adults: A randomized controlled study

BACKGROUND: Cervical stabilization exercises and local vibration may improve proprioception and balance and prevent musculoskeletal problems. OBJECTIVE: To compare the effects of local vibration and cervical stabilization exercises on balance, cervical joint position sense, and muscle performance in healthy participants. METHODS: Forty-eight healthy male participants without neck pain were included. The participants were randomly divided into three groups: a home exercise program lasting eight weeks to the cervical stabilization group; 60 s of vibration to the neck muscles of the local vibration group and a control group. Balance, joint position sense, and muscle performance were evaluated twice in all subjects, before and after the intervention. RESULTS: Joint position sense error values were decreased in both the local vibration and cervical stabilization groups. Balance was improved (p< 0.001) in the local vibration group while improvement in muscle performance parameters was only seen in the cervical stabilization group (p< 0.05). CONCLUSIONS: The methods used in the present study may be used for improving the proprioceptive and vestibular components of balance in individuals with musculoskeletal problems such as cervical disc herniation, cervical spondylosis, or neck pain. However, given the limitations, much more research is needed to firmly establish these recommendations.

Is There a Link between Stress and Cognition, and Capacity to Execute Motor Skill?

PURPOSE

This study aimed to examine the link between stress (measured via salivary cortisol and testosterone), cognition (measured via pupillometry, with greater pupil constriction and reduced pupil constriction latency associated with increased attention and improved information processing), and motor skill capacity (measured via somatosensory processing).

METHODS

Twenty-five professional rugby players participated in this study. Saliva samples were collected upon waking, before pupillometry and somatosensory processing testing, and after testing. Testing times varied for participants; however, it was always in the morning, and the order of testing was randomized.

RESULTS

Very small differences in hormone concentrations were seen across the morning (effect size = 0.01). Moderate to large differences in left eye pupil constriction for direct (left eye) versus consensual (right eye) stimulus were also seen (P < 0.01; effect size = 0.51 to 1.04). No differences for pupil constriction latency were seen for direct versus consensual stimulus. Some positive weak to moderate relationships were seen for testosterone and pupil constriction latency (r = 0.37 to 0.39, P < 0.05). Moderate to strong inverse relationships were seen for hormones with left eye pupil constriction difference between direct and consensual stimulus, and for pre- to posttest testosterone-to-cortisol ratio decline with left eye pupil constriction for direct and consensual stimulus (r = 0.41 to 0.52, P < 0.05). Weak to moderate inverse relationships for testosterone-to-cortisol ratio decline and somatosensory processing were seen (r = 0.36 to 0.47, P < 0.05).

CONCLUSION

Stress may affect ability to receive information and ability to execute motor tasks. Thus, stress may compromise ability to make appropriate objective decisions and consequently execute skill/task behavior. Strategies to help mitigate negative stress responses are noted.

Does vestibular rehabilitation improve postural control of subjects with chronic subjective dizziness?

Postural control is the ability to maintain equilibrium and orientation in a gravitational environment. Patients with chronic subjective dizziness have some troubles with their postural stability. The present study aimed to assess the benefit of home-based vestibular rehabilitation in patients with chronic subjective dizziness using computerized dynamic posturography. Therefore, 100 subjects, between 19 to 86 years, diagnosed with dizziness were included in the study. Computerized dynamic posturography was performed to assess postural stability. Vestibular rehabilitation programs included exercises tailored to the particular needs of each patient. After vestibular rehabilitation, patients were re-examined using the same tests. Posturographic data were analyzed and compared for before and after vestibular rehabilitation findings. The mean composite scores before the intervention (58,92 ±11,64) was significantly (p<0.01) lower than the mean composite scores after vestibular rehabilitation (73,83 ± 8,26). This result is found to be statistically significant. In conclusion it could be suggested that the effectiveness of vestibular rehabilitation could be verified by means of computerized dynamic posturography as a concrete method.

Sway Balance Mobile Application: Reliability, Acclimation, and Baseline Administration

OBJECTIVES

To describe historic baseline session administration practices, to assess the utility of a practice trial (an acclimation trial) before the official balance session, and to examine the within-session reliability of the Sway Balance Mobile Application (SBMA).

DESIGN

Retrospective observational study.

SETTING

Middle schools, high schools, and colleges across the United States.

PARTICIPANTS

More than 17 000 student-athletes were included in the Sway Medical database with 7968 individuals meeting this study's inclusion criteria.

INDEPENDENT VARIABLES

The Sway Medical database included the following subject characteristics for each student-athlete: age, sex, weight, and height.

MAIN OUTCOME MEASURES

Balance assessment score generated by the SBMA.

RESULTS

Variable administration practices with significant differences between baseline session averages across methods were found. Individuals who performed an acclimation trial had a significantly higher baseline session average than those who did not. Within-session reliability estimates were in the low to adequate range (r = 0.53-0.78), with higher estimates found for 2 consecutive baseline tests (r = 0.75-0.78).

CONCLUSIONS

For maximum clinical utility, a standardized protocol for postural control baseline acquisition is necessary. Acclimation trial should be administered before a baseline session to minimize variability, especially with only 1 to 2 baseline tests. The highest reliability was observed across 2 consecutive baseline tests within the same baseline session. We suggest obtaining baseline balance measurements with an acclimation trial followed by a baseline session with 2 baseline tests. Prospective studies are required for validation.

Vestibular prognosis in idiopathic sudden sensorineural hearing loss with vestibular dysfunction treated with oral or intratympanic glucocorticoids: a protocol for randomized controlled trial

Background

Idiopathic sudden sensorineural hearing loss (ISSNHL) is a rapid-onset sensorineural hearing impairment with unclear etiology and unsatisfying treatment effects. Vestibular dysfunction has been considered as a poor indicator in the clinical manifestations and prognosis of ISSNHL, which occurred in approximately 28–57% cases. Glucocorticoids, administered through oral or intratympanic way, are currently regularly and standardly applied for ISSNHL to improve the hearing outcome. However, the vestibular prognosis of ISSNHL after routine treatments remains seldom explored. This study aims to compare the effectiveness of oral and intratympanic glucocorticoids in ISSNHL with vestibular dysfunction in terms of the pattern and trajectory of possible process of vestibular function recovery.

Methods/design

A randomized, outcome-assessor- and analyst-blinded, controlled, clinical trial (RCT) will be carried out. Seventy-two patients with ISSNHL complaining of vestibular dysfunction appearing as vertigo or imbalance will be recruited and randomized into either oral or intratympanic glucocorticoid therapy group with a 1:1 allocation ratio. The primary outcomes will be vestibular function outcomes assessed by sensory organization test, caloric test, video head impulse test, cervical vestibular evoked myogenic potential, and ocular vestibular evoked myogenic potential; the secondary outcomes include self-reported vestibular dysfunction symptoms; dizziness-related handicap, visual analogue scale for vertigo and tinnitus; and pure tone audiometry. Assessments of primary outcomes will be performed at baseline and at 4 and 8 weeks post-randomization, while assessments of secondary outcomes will be performed at baseline and 1, 2, 4, and 8 weeks post-randomization.

Discussion

Previous intervention studies of ISSNHL included only hearing outcomes, with little attention paid on the prognosis of vestibular dysfunction. This trial will be the first RCT study focusing on the progress and prognosis of vestibular dysfunction in ISSNHL. The efficacy of two commonly used therapies of glucocorticoids will be compared in both auditory and vestibular function fields, rather than in the hearing outcome alone.

Trial registration

ClinicalTrials.gov NCT03974867. Registered on 23 July 2019

Vestibular Rehabilitation Using Posturographic System in Elderly Patients with Postural Instability: Can the Number of Sessions Be Reduced?

Purpose

Vestibular rehabilitation (VR) using posturography systems has proved useful in improving balance among elderly patients with postural instability. However, its high cost hinders its use. The objective of this study is to assess whether two different protocols of VR with posturography, one of them longer (ten sessions) and the other shorter (five sessions), show significant differences in the improvement of balance among old patients with instability.

Patients and Methods

This is a prospective, experimental, single-center (Department of Otorhinolaryngology of a tertiary referral hospital), randomized (into balanced patient blocks) study with two parallel arms, in 40 people over 65 years of age, with instability and at a high risk of falling. The percentage of the average balance (composite) in the sensory organization test (SOT) of the CDP (main outcome measure), other CDP scores, time and steps in the "timed up and go" test, scores of Dizziness Handicap Inventory (DHI), short Falls Efficacy Scale - International (short FES-I), and Vertiguard were compared before and 3 weeks after VR between both intervention groups.

Results

The two treatment groups (20 patients per group) were comparable in age, sex, and pre-VR balance evaluation. In both groups, we observed a significant improvement in global balance (composite) after VR (49±11.34 vs 57±13.48, p=0.007, in the group undergoing 10 sessions; 51±12.55 vs 60±12.99, p=0.002, 5 sessions). In both groups, we also observed improvements in other posturographic parameters (in the SOT and limits of stability) but not in the timed up and go scores or in the questionnaires. Comparison of the improvement level achieved in both groups revealed no significant differences between them.

Conclusion

The protocols of vestibular rehabilitation by posturography of 5 sessions in elderly patients with postural instability are as effective as those of 10 sessions for improving balance among elderly patients with postural instability.

Trial Registration

ClinicalTrials.gov identifier: NCT03034655. Registered on 25 January 2017.

Transcranial Magnetic Stimulation as Treatment for Mal de Debarquement Syndrome: Case Report and Literature Review

This manuscript presents the case of an adult, male patient with mal de debarquement syndrome (MdDS); results from his experimental treatment with repetitive transcranial magnetic stimulation (rTMS) are also provided. Additionally, we included a review of literature related to the neurophysiology of MdDS and its treatment with rTMS. A 41-year-old man had been experiencing symptoms of MdDS, which initially emerged following a car ride, for 11 to 12 years. Pharmacologic approaches had failed to provide symptom relief; thus, we investigated an intervention using low-frequency (1 Hz) rTMS unilaterally for 2 consecutive weeks. The outcome measures included a standardized, computerized dynamic posturography test to quantify the patient's balance and identify abnormalities in his use of the sensory systems contributing to postural control, as well as the Hospital Anxiety and Depression Scale (HADS) to measure his anxiety and depression. An rTMS treatment log was created to document any adverse events. Following rTMS, the patient's balance scores improved significantly; these improvements were mostly related to the patient's increased reliance on the visual and vestibular systems. Our patient's HADS Anxiety and Depression subscores also showed improvement post-rTMS. The presented case study provides preliminary evidence that rTMS may be a noninvasive treatment option for improving balance, specifically in individuals with MdDS. This evidence can be used to further therapeutic research on, and provide strategies for treating, MdDS.

Acute Effect of Kinesiology Taping on Postural Stability in Individuals With Unilateral Chronic Ankle Instability

Background

Chronic ankle instability (CAI), which is characterized by deficient postural control, could be improved through kinesiology taping (KT). However, the effect of KT on postural control in CAI individuals is controversial. Therefore, this study aimed to investigate the acute effect of KT on postural control through computerized dynamic posturography (CDP) and self-perceived sensation in CAI individuals.

Methods

Participants with CAI received four different ankle treatments randomly, including KT, athletic taping (AT), sham taping (ST), and no taping (NT). A series of postural stability measurements was performed using CDP subsequently. The measurements included sensory organization test (SOT), unilateral stance (US), limit of stability (LOS), motor control test (MCT), and adaption test (ADT). In addition, self-perceived sensation was measured through visual analog scaling. Repeated measures analysis of variance was conducted to determine whether the difference among KT, AT, ST, and NT was significant; Bonferroni test was used for post hoc analysis.

Results

No significant difference was observed for parameters in SOT, US, and LOS in four different taping treatments. In MCT, the amplitude scaling scores of KT were 35.87% significantly lower than that of NT [p < 0.001, 95% confidence interval (CI) = 0.548–1.795] in forward-small slip and 21.58% significantly lower than that of ST (p = 0.035, 95% CI = 0.089–3.683) in backward-large slip. In ADT, sway energy scores were 7.59% significantly greater in ST than in AT (p = 0.028, 95% CI = −8.343 to −0.320). For perceived stability, KT was significantly greater than ST (p < 0.001, 95% CI = 0.552–1.899) and NT (p < 0.001, 95% CI = 0.797–2.534), and AT was significantly greater than ST (p = 0.001, 95% CI = 0.423–2.246) and NT (p < 0.001, 95% CI = 0.696–2.852). For perceived comfort, KT was significantly greater than AT (p = 0.001, 95% CI = 0.666–3.196) and NT (p = 0.031, 95% CI = 0.074–2.332), and ST was significantly greater than AT (p = 0.007, 95% CI = 0.349–2.931).

Conclusion

KT and AT have limited effect to facilitate postural control for CAI individuals during SOT, US, and LOS. However, KT and AT could provide effective support to cope with sudden perturbation in MCT and ADT. Moreover, KT provided excellent perceived stability and comfort, whereas AT provided excellent perceived stability but least comfort.

No evidence for after-effects of noisy galvanic vestibular stimulation on motion perception

Noisy galvanic vestibular stimulation (nGVS) delivered at imperceptible intensities can improve vestibular function in health and disease. Here we evaluated whether nGVS effects on vestibular function are only present during active stimulation or may exhibit relevant post-stimulation after-effects. Initially, nGVS amplitudes that optimally improve posture were determined in 13 healthy subjects. Subsequently, effects of optimal nGVS amplitudes on vestibular roll-tilt direction recognition thresholds (DRT) were examined during active and sham nGVS. Ten of 13 subjects exhibited reduced DRTs during active nGVS compared to sham stimulation (p < 0.001). These 10 participants were then administered to 30 mins of active nGVS treatment while being allowed to move freely. Immediately post-treatment , DRTs were increased again (p = 0.044), reverting to baseline threshold levels (i.e. were comparable to the sham nGVS thresholds), and remained stable in a follow-up assessment after 30 min. After three weeks, participants returned for a follow-up experiment to control for learning effects, in which DRTs were measured during and immediately after 30 min application of sham nGVS. DRTs during both assessments did not differ from baseline level. These findings indicate that nGVS does not induce distinct post-stimulation effects on vestibular motion perception and favor the development of a wearable technology that continuously delivers nGVS to patients in order to enhance vestibular function.

Effects of long-term vestibular rehabilitation therapy with vibrotactile sensory augmentation for people with unilateral vestibular disorders – A randomized preliminary study

BACKGROUND AND OBJECTIVE:

This pilot study aimed to investigate the effects of incorporating vibrotactile sensory augmentation (SA) on balance performance among people with unilateral vestibular disorders (UVD).

METHODS:

Eight participants with UVD were recruited. Participants completed 18 balance training sessions across six weeks in a clinical setting. Four participants (68.1±7.5 yrs) were randomized to the experimental group (EG) and received trunk-based vibrotactile SA while performing the balance exercises, and four participants (63.1±11.3 yrs) were assigned to the control group (CG); CG participants completed the balance training without SA. Clinical and kinematic balance performance measures were collected before training; midway through training; and one week, one month, and six months after training.

RESULTS:

All participants, regardless of group, demonstrated improvements in a subset of the clinical or balance metrics immediately following completion of the balance training protocol. The EG showed significantly greater improvements than the CG for the Activities-specific Balance Confidence Scale and postural stability during the two standing balance exercises with head movements. The EG also had larger improvements than the CG for the Sensory Organization Test (SOT), Mini Balance Evaluations Systems Test, Gait Speed Test, Dynamic Gait Index, Functional Gait Assessment, and vestibular reliance metric calculated based on the SOT.

CONCLUSIONS:

Incorporating vibrotactile SA into vestibular rehabilitation programs may lead to additional benefits that may be retained up to six months after training compared to training without vibrotactile SA. A larger study is warranted to demonstrate statistical significance between the groups.

Multi-sensory training and wrist fractures: a randomized, controlled trial

Background

Asymmetric vestibular function, decreased plantar sensation, postural control and functional ability have been associated with fall-related wrist fractures.

Objective

To investigate whether multi-sensory training (MST) improves postural control, vestibular function, foot sensation and functional ability among people with fall-related wrist fractures compared to wrist stabilization training (WT).

Methods

This was an assessor-blinded, randomized controlled trial. Ninety-eight participants, age 50–75 years, were randomized to MST or WT. Pre- and post-training measurements: Head Shake Test (HST), Video-Head Impulse Test (vHIT), Semmes–Weinstein Monofilaments (SWF), Biothesiometer (BT), Sensory Organization Test (SOT), 10-m Walk Test (10MWT), Five Times Sit to Stand Test (FTSTS), Activities-Specific Balance Confidence (ABC) and Dizziness Handicap Inventory Scales (DHI). The training period was 12 weeks, with six supervised sessions by a physical therapist and daily home exercises for both groups.

Results

There were significant endpoint differences in SOT (p = 0.01) between the two groups, in favor of the MST group, but no changes were seen in other outcome variables. Subgroup analysis with participants below normal baseline SOT composite scores indicated that the MST was more effective in improving 10MWT fast (p = 0.04), FTSTS (p = 0.04), SWF (p = 0.04) and SOT scores (p = 0.04) than the WT.

Conclusions

MST improves postural control among people with a fall-related wrist fracture. The results further suggest that the program is more effective for those with SOT balance scores below age-related norms.