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Balayi E, Sedaghati P, Ahmadabadi S. Effects of neuromuscular training on postural control of children with intellectual disability and developmental coordination disorders : Neuromuscular training and postural control. BMC Musculoskelet Disord 2022; 23:631. [PMID: 35780104 PMCID: PMC9250263 DOI: 10.1186/s12891-022-05569-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 06/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background Children with Intellectual disabilities who suffer from developmental coordination disorder represent insignificant physical fitness, strength, and balance. The prime objective of this research is to explore the impact of eight weeks of neuromuscular (combined physio-hemsball) training on postural control and balance of students with intellectual disabilities suffering from developmental coordination disorder. Methods The present study was a prospective randomized clinical trial with a pretest–posttest design. The statistical population consisted of boys with intellectual disabilities, suffering from developmental coordination disorder randomly divided into two groups: the experimental group (n = 15) and the control group (n = 15). informed consent was obtained from all participants’ parents. Parents completed developmental coordination disorder questionnaires. Tests (Balance Error Scoring System, Y-Balance, timed Get Up & Go) were used to determine postural control, dynamic balance, and functional balance of subjects. The experimental group performed a combined physio-hemsball training for 8 weeks. Ethical considerations were observed according to the Helsinki Declaration and the CONSORT guidelines and regulations were followed to report this study. Results Results showed that combined physio-hemsball training for 8 weeks can greatly improve postural control and dynamic and postural balance among students with intellectual disabilities suffering from developmental coordination disorder. Conclusions According to the results, instructors can use this type of training to improve postural control and balance in boys with intellectual disabilities enduring developmental coordination disorders. Trial registration This research was registered by the clinical trial centers of Iran (code IRCT20200125046254N1, Date of registration: 24/04/2020). Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05569-2.
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Affiliation(s)
- Esmail Balayi
- Adapted Physical Education, University of Guilan, Rasht, Iran
| | - Parisa Sedaghati
- Faculty of Physical Education and Sports Sciences, University of Guilan, Rasht, Iran.
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Baran E, Emekci T. Static and dynamic postural control of postpartum women of different delivery methods. Gait Posture 2022; 93:240-245. [PMID: 35190316 DOI: 10.1016/j.gaitpost.2022.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/24/2022] [Accepted: 02/11/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to determine whether there is a difference in postural control between nulligravida women and women who have given birth by vaginal or cesarean section. METHODS Women who had only vaginal delivery in the previous 1-3 years were included in the vaginal delivery group (n = 27), those who had only cesarean delivery in the previous 1-3 years were included in the cesarean section group (n = 28), and those who had never given birth were included in the control group (n = 32). Evaluations were administered 6-8 days after the ovulation phase. Postural control of the participants was evaluated with the computerized dynamic posturography device. RESULTS A total of 87 women with a mean age of 29.4 ± 4 years and a mean body mass index of 24.1 ± 3.1 kg/m2 were included in the study. Antero-posterior somatosensory organization test values of the vaginal delivery group were lower than the control group (p = 0.0016). The cesarean delivery group had statistically lower antero-posterior somatosensory (p < 0.001 and p = 0.0013) and medio-lateral somatosensory (p = 0.002 and p = 0.017, respectively) test scores compared to the control group and the vaginal delivery group. CONCLUSIONS It was observed that women who birthed with vaginal or cesarean delivery had impaired somatosensory postural control. There is definitely a need for further studies with a long-term follow-up examining the effects of postural control during pregnancy and the postpartum period.
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Affiliation(s)
- Emine Baran
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hitit University, Çorum, Turkey.
| | - Tuğba Emekci
- Faculty of Medicine, Ear-Nose-Throat Clinic, Necmettin Erbakan University, Konya, Turkey.
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Smith JL, Trofimova A, Ahluwalia V, Casado Garrido JJ, Hurtado J, Frank R, Hodge A, Gore RK, Allen JW. The "vestibular neuromatrix": A proposed, expanded vestibular network from graph theory in post-concussive vestibular dysfunction. Hum Brain Mapp 2021; 43:1501-1518. [PMID: 34862683 PMCID: PMC8886666 DOI: 10.1002/hbm.25737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 11/07/2022] Open
Abstract
Convergent clinical and neuroimaging evidence suggests that higher vestibular function is subserved by a distributed network including visuospatial, cognitive-affective, proprioceptive, and integrative brain regions. Clinical vestibular syndromes may perturb this network, resulting in deficits across a variety of functional domains. Here, we leverage structural and functional neuroimaging to characterize this extended network in healthy control participants and patients with post-concussive vestibular dysfunction (PCVD). Then, 27 healthy control subjects (15 females) and 18 patients with subacute PCVD (12 female) were selected for participation. Eighty-two regions of interest (network nodes) were identified based on previous publications, group-wise differences in BOLD signal amplitude and connectivity, and multivariate pattern analysis on affective tests. Group-specific "core" networks, as well as a "consensus" network comprised of connections common to all participants, were then generated based on probabilistic tractography and functional connectivity between the 82 nodes and subjected to analyses of node centrality and community structure. Whereas the consensus network was comprised of affective, integrative, and vestibular nodes, PCVD participants exhibited diminished integration and centrality among vestibular and affective nodes and increased centrality of visual, supplementary motor, and frontal and cingulate eye field nodes. Clinical outcomes, derived from dynamic posturography, were associated with approximately 62% of all connections but best predicted by amygdalar, prefrontal, and cingulate connectivity. No group-wise differences in diffusion metrics or tractography were noted. These findings indicate that cognitive, affective, and proprioceptive substrates contribute to vestibular processing and performance and highlight the need to consider these domains during clinical diagnosis and treatment planning.
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Affiliation(s)
- Jeremy L Smith
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Anna Trofimova
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Vishwadeep Ahluwalia
- Georgia State University, Atlanta, Georgia, USA.,Center for Advanced Brain Imaging, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Jose J Casado Garrido
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
| | | | | | | | - Russell K Gore
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA.,Shepherd Center, Atlanta, Georgia, USA
| | - Jason W Allen
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA.,Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA.,Department of Neurology, Emory University School of Medicine Emory University Hospital, Atlanta, Georgia, USA
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Yap W, Hairodin Z, Kwek E. Axillary versus Forearm Crutches: A Prospective Cohort Comparing which is Superior for 3-Point Crutch Gait. Malays Orthop J 2021; 15:36-42. [PMID: 34429820 PMCID: PMC8381660 DOI: 10.5704/moj.2107.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 02/20/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Two common crutches utilised for orthopaedic rehabilitation include the axillary crutch and forearm crutch, with either crutch providing weight transfer through different mechanisms. This study aims to determine which crutch is best for patients, with specific reference to crutch gait and stability. Material and Methods: This is a level 2 prospective cohort study, recruiting 20 volunteers between 40 to 80 years old. Participants underwent 3 stations in 3 point crutch gait: straight line ambulation of 20m, timed-up-and-go-test, and computerised dynamic posturography. Participants also answered a subjective questionnaire on their crutch preferences. Results: Axillary crutches demonstrated a faster speed of ambulation compared to forearm crutches (Axillary crutch v=0.5m/s, Forearm crutch v=0.44m/s, p=0.002). There was a lower increase in heart rate post activity for axillary crutches. For the timed-up-and-go test, completing the circuit with Axillary crutches was faster (t=63.06, p<0.001) versus the forearm crutch (t=75.36, p<0.001). For computerised dynamic posturography, participants recorded lower effort scores for backward tilts when using axillary crutches (39.13, p=0.0497) versus forearm crutches (42.03, p=0.0497). Subjectively, majority of participants felt that axillary crutches had an easier learning curve and were superior in the areas of ambulation, balance and stability. Conclusion: Our study demonstrated that axillary crutches were superior to forearm crutches for 3-point crutch gait; axillary crutches had a faster ambulation speed, required less effort during use, provided superior stability and were the preferred choice subjectively. This study would be helpful for clinicians and therapists when prescribing mobility aids to individuals with impaired gait.
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Affiliation(s)
- Wmq Yap
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - Z Hairodin
- Department of Physiotherapy, Tan Tock Seng Hospital, Singapore
| | - Ebk Kwek
- Department of Orthopaedic Surgery, Woodlands Health Campus, Singapore
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Manlapaz DG, Sole G, Jayakaran P, Chapple CM. Exergaming to improve balance and decrease the risk of falling in adults with knee osteoarthritis: a mixed-methods feasibility study. Physiother Theory Pract 2021; 38:2428-2440. [PMID: 34280069 DOI: 10.1080/09593985.2021.1952670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Exergaming (exercise and gaming) is useful in improving balance in various health conditions, yet there is limited research regarding its application in individuals with knee osteoarthritis (OA). OBJECTIVES The primary aim of this study was to investigate the feasibility and acceptability of exergaming using Nintendo Wii Fit™ to improve balance and reduce the risk of falls in individuals with knee OA. METHODS A mixed-methods explanatory sequential study design was utilized in this study. Participants with knee OA and history of falling participated in a single-group pre-post experimental study design: eight weeks of usual care followed by eight weeks of an exergaming program. This was followed by semi-structured focus groups to determine the acceptability of the study. RESULTS The pre-defined feasibility criteria such as recruitment, retention rate (83%), and compliance (78%) were successfully met. The participants found the frequency and duration of the assessment and intervention sessions acceptable. Participants reported enjoying the exergaming, finding it motivating and interactive despite some barriers with technology. No adverse events were reported. There were encouraging results in the clinical outcome measures such as knee muscle strength, balance, fear of falling, and performance of physical function. CONCLUSION The study found that it is feasible and acceptable to use Nintendo Wii Fit™ as an exergaming tool to improve balance and decrease the risk of falling in adults with knee OA. Findings from this feasibility study are encouraging and support the need to conduct a fully powered randomized controlled trial study.
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Affiliation(s)
- Donald G Manlapaz
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Gisela Sole
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Prasath Jayakaran
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Cathy M Chapple
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Yigit O, Aksoy S, Akyol U, Tokatlı A, Sivri HS. Sensory, voluntary, and motor postural control in children and adolescents with mucopolysaccharidosis. J Pediatr Endocrinol Metab 2021; 34:583-589. [PMID: 33838084 DOI: 10.1515/jpem-2020-0630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 01/13/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study aimed to investigate automatic and voluntary motor control performances, which have an important function in maintaining balance, in children and adolescents with mucopolysaccharidosis (MPS). METHODS The records of 70 patients were retrospectively analyzed. The results of Computerized Dynamic Posturography (CDP) performed according to the age and development of the individuals were examined. The results of 10 children and adolescents with MPS (mean age: 9.43 ranging from 6 to 14; four males and six females) who completed the sensory analysis, Weight-Bearing Squat Test, and Adaptation Test were retrieved from the database of the CDP. Nine healthy children and adolescents with typical development (mean age: 9.63 ranging from 6 to 14; four males and five females) were included as the control group. RESULTS In the sensory analysis test, there was a statistically significant difference between the two groups in the visual ratio parameter. In the adaptation test, there was a statistically significant difference between the two groups in the toes up and toes down trials. There was no statistically significant difference between the groups in the Weight-Bearing Squat test at 0° knee extension and various knee flexions. CONCLUSIONS Children and adolescents with MPS should be directed to the appropriate exercise and therapy programs to develop postural and balance control, which have a significant effect on their quality of life and the ability to independently perform daily activities of living. In addition to routine hearing assessments for patients with MPS, other objective tests used in the differential diagnosis of balance and vestibular system should also be implemented.
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Affiliation(s)
- Oznur Yigit
- Department of Audiology, Faculty of Health Science, Hacettepe University, Ankara, Turkey
| | - Songul Aksoy
- Department of Audiology, Faculty of Health Science, Hacettepe University, Ankara, Turkey
| | - Umut Akyol
- Department of ENT, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Aysegul Tokatlı
- Department of Pediatrics, Section of Metabolism, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Hatice Serap Sivri
- Department of Pediatrics, Section of Metabolism, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Grove CR, Whitney SL, Hetzel SJ, Heiderscheit BC, Pyle GM. Effect of Repetitive Administration of a Next-generation Sensory Organization Test in Adults With and Without Vestibular Dysfunction. Otol Neurotol 2021; 42:e363-e370. [PMID: 33165160 PMCID: PMC8205109 DOI: 10.1097/mao.0000000000002950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
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.
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Affiliation(s)
| | | | | | | | - G Mark Pyle
- University of Wisconsin-Madison, Madison, Wisconsin
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Grove CR, Whitney SL, Hetzel SJ, Heiderscheit BC, Pyle GM. Validation of a next-generation sensory organization test in adults with and without vestibular dysfunction. J Vestib Res 2021; 31:33-45. [PMID: 33325418 DOI: 10.3233/ves-200040] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
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.
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Affiliation(s)
| | | | | | | | - G Mark Pyle
- University of Wisconsin-Madison, Madison, WI, USA
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The Effect of Whole Body Vibration on Postural Control of Ataxic Patients: a Randomized Controlled Cross-Over Study. THE CEREBELLUM 2021; 20:533-541. [PMID: 33475935 DOI: 10.1007/s12311-021-01233-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
Whole body vibration (WBV) applications have been used in recent years to increase muscle strength, power, and postural control in healthy and various disease populations. This study aims to investigate the effects of WBV on postural control in patients with ataxia. Twenty-four patients were randomly allocated to two groups. In the first group, whole body vibration and exercise therapy (WBV + E) were applied together for the first 8 weeks; after 1 week washout, only exercise program (OE) was applied for the second 8 weeks. In the second group, the OE program was applied first followed by the WBV + E program. Outcome measures were Sensory Organization Test (SOT), Adaptation Test (ADT), Limits of Stability Test (LOS), International Classification Ataxia Ratio Scale (ICARS), Berg Balance Scale (BBS), and Timed Up and Go Test with cognitive task (TUG-C). Twenty patients (mean age ± SD, 34.00 ± 9.16 years) completed the study. The scores of SOT, ICARS, and BBS improved significantly after both OE and WBV + E program (p < 0.05). Improvements in the WBV + E program were higher (p < 0.05). The scores of ADT, TUG-C, and three parameters of LOS improved significantly after WBV + E (p < 0.05), while there was no significant change after OE (p > 0.05). This study demonstrated that exercise programs supported by WBV can play an important role in the improvement of all components of postural control in patients with ataxia. ClinicalTrial.gov Identifier: NCT02977377.
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Wang CH, Winnick AA, Ko YH, Wang Z, Chang TP. Test-retest reliability of subjective visual vertical measurements with lateral head tilt in virtual reality goggles. Tzu Chi Med J 2021; 33:294-300. [PMID: 34386369 PMCID: PMC8323649 DOI: 10.4103/tcmj.tcmj_207_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/25/2020] [Accepted: 10/07/2020] [Indexed: 11/29/2022] Open
Abstract
Objective: The objective is to investigate the test-retest reliability of subjective visual vertical (SVV) in the upright position and with lateral head tilts through a computerized SVV measuring system using virtual reality (VR) goggles. Materials and Methods: Thirty healthy controls underwent SVV test in upright position, with the head tilted to the right 30°, and with the head tilted to the left 30°. Subjects wore SVV VR goggles, which contained a gyroscope for monitoring the angle of head tilt. Each subject completed 10 adjustments in each head position. The mean value of SVV deviations and SVV imprecision (the intra-individual variability of SVV deviations from the 10 adjustments) were recorded and compared across different head positions. The participants then repeated the same SVV protocol at least 1 week later. The test-retest reliability of SVV deviation and SVV imprecision were analyzed. Results: The SVV deviation (mean ± standard deviation) was 0.22° ± 1.56° in upright position, −9.64° ± 5.91° in right head tilt, and 7.20° ± 6.36° in left head tilt. The test-retest reliability of SVV deviation was excellent in upright position (intra-class correlation coefficient [ICC] = 0.77, P < 0.001), right head tilt (ICC = 0.83, P < 0.001) and left head tilt (ICC = 0.84, P < 0.001). The SVV values from the 10 adjustments made during right and left head tilts were less precise than when measured at upright (P < 0.001). The test-retest reliability of SVV imprecision was poor at upright (ICC = 0.21, P = 0.26) but fair-to-good in right head tilt (ICC = 0.72, P < 0.001) and left head tilt (ICC = 0.44, P = 0.04). Conclusion: The test-retest reliability of SVV deviation during lateral head tilts via VR goggles is excellent, which supports further research into the diagnostic value of head-tilt SVV in various vestibular disorders. In addition, the degree of SVV imprecision during head tilt has fair-to-good test-retest reliability, which suggests SVV imprecision may have clinical applicability.
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Affiliation(s)
- Chia-Han Wang
- Department of Chinese Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Ariel A Winnick
- Soroka University Hospital and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,School of Optometry, University of California, Berkeley, Berkeley, CA, USA
| | - Yu-Hung Ko
- Department of Research, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Zheyu Wang
- Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tzu-Pu Chang
- Department of Neurology, Neuro-Medical Scientific Center, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan.,Department of Neurology, School of Medicine, Tzu Chi University, Hualien, Taiwan
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Grove CR, Heiderscheit BC, Pyle GM, Loyd BJ, Whitney SL. The Gait Disorientation Test: A New Method for Screening Adults With Dizziness and Imbalance. Arch Phys Med Rehabil 2020; 102:582-590. [PMID: 33338462 DOI: 10.1016/j.apmr.2020.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To develop and evaluate a new method for identifying gait disorientation due to vestibular dysfunction. DESIGN The gait disorientation test (GDT) involves a timed comparison of the ability to walk 6.096 m with eyes open versus eyes closed. In this prospective study, participants were grouped based on vestibular function. All participants completed a clinical examination, self-report- and performance-based measures relevant to vestibular rehabilitation, and the tasks for the GDT. Vestibular-impaired participants underwent the criterion standard, videonystagmography and/or rotational chair testing. SETTING Ambulatory clinic, tertiary referral center. PARTICIPANTS Participants (N=40) (20 vestibular-impaired, 30 women, 49.9±16.1years old) were enrolled from a convenience/referral sample of 52 adults. MAIN OUTCOME AND MEASURE(S) We determined test-retest reliability using the intraclass correlation coefficient model 3,1; calculated the minimal detectable change (MDC); examined concurrent validity through Spearman correlation coefficients; assessed criterion validity with the area under the curve (AUC) from receiver operator characteristic analysis; and computed the sensitivity, specificity, diagnostic odds ratio (DOR), likelihood ratios for positive (LR+) and negative (LR-) tests, and posttest probabilities of a diagnosis of vestibulopathy. The 95% confidence interval demonstrates measurement uncertainty. RESULTS Test-retest reliability was 0.887 (0.815, 0.932). The MDC was 3.7 seconds. Correlations with other measures ranged from 0.59 (0.34, 0.76) to -0.85 (-0.92, -0.74). The AUC was 0.910 (0.822, 0.998), using a threshold of 4.5 seconds. The sensitivity and specificity were 0.75 (0.51, 0.91) and 0.95 (0.75, 1), respectively. The DOR=57 (6, 541.47), LR+ =15 (2.18, 103.0), and LR- =0.26 (0.12, 0.9). Positive posttest probabilities were 89%-94%. CONCLUSIONS AND RELEVANCE The GDT has good reliability, excellent discriminative ability, strong convergent validity, and promising clinical utility.
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Affiliation(s)
- Colin R Grove
- School of Medicine and Public Health, Department of Surgery, University of Wisconsin-Madison, Madison, WI; Institute for Clinical and Translational Research, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI.
| | - Bryan C Heiderscheit
- Institute for Clinical and Translational Research, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI; Department of Orthopedics and Rehabilitation, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - G Mark Pyle
- School of Medicine and Public Health, Department of Surgery, University of Wisconsin-Madison, Madison, WI
| | - Brian J Loyd
- Department of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, MT; Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT
| | - Susan L Whitney
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA
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Nusseck M, Spahn C. Comparison of Postural Stability and Balance Between Musicians and Non-musicians. Front Psychol 2020; 11:1253. [PMID: 32655447 PMCID: PMC7324747 DOI: 10.3389/fpsyg.2020.01253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/13/2020] [Indexed: 11/13/2022] Open
Abstract
Good postural stability and balance provide a basis for optimal movement. For instrumental musicians, particular postures are demanded during long periods of playing and practicing. These postures can potentially also affect the postural control system even in situations when the musician is not playing the instrument. The goal of this exploratory study was to measure the postural stability and balance of instrument musicians in non-instrumental situations. By comparing these measures with a control group of non-musicians, postural differences were identified which can be ascribed to certain playing positions arising from playing the instrument. The measurement technique used was a pressure platform (Zebris force plate) to record static posturography. The postural sway of the center of pressure (COP) and the postural balance (body weight distribution) in a standing position were measured in 390 students including music students (n = 346) and a control group (n = 44). The analyses revealed significant differences for specific instrumental groups. Around 23% of the pianists, 25% of the upper strings players, and 33% of the guitar players showed a weight distribution significantly shifted more to the left compared to the control group (9%). In contrast, 23% of the lower strings players and 33% of the percussionists were found to stand more to the right side than the control group (5%). The results indicate that there are certain unbalanced postural patterns in musicians, outside of the music performance situation, which can be provoked by instrumental playing postures. As postural misalignments can lead to severe postural disorders in older age, preventive activities to improve postural stability and balance should be considered in instrumental education, not only during, but also outside of instrumental playing situations.
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Affiliation(s)
- Manfred Nusseck
- Freiburg Institute for Musicians' Medicine, Medical Center University of Freiburg, University of Music Freiburg, Faculty of Medicine at the Albert-Ludwigs-University of Freiburg, Freiburg Centre for Research and Teaching in Music, Freiburg, Germany
| | - Claudia Spahn
- Freiburg Institute for Musicians' Medicine, Medical Center University of Freiburg, University of Music Freiburg, Faculty of Medicine at the Albert-Ludwigs-University of Freiburg, Freiburg Centre for Research and Teaching in Music, Freiburg, Germany
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13
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Maudsley-Barton S, Hoon Yap M, Bukowski A, Mills R, McPhee J. A new process to measure postural sway using a Kinect depth camera during a Sensory Organisation Test. PLoS One 2020; 15:e0227485. [PMID: 32023256 PMCID: PMC7001893 DOI: 10.1371/journal.pone.0227485] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 12/19/2019] [Indexed: 01/10/2023] Open
Abstract
Posturography provides quantitative, objective measurements of human balance and postural control for research and clinical use. However, it usually requires access to specialist equipment to measure ground reaction forces, which are not widely available in practice, due to their size or cost. In this study, we propose an alternative approach to posturography. It uses the skeletal output of an inexpensive Kinect depth camera to localise the Centre of Mass (CoM) of an upright individual. We demonstrate a pipeline which is able to measure postural sway directly from CoM trajectories, obtained from tracking the relative position of three key joints. In addition, we present the results of a pilot study that compares this method of measuring postural sway to the output of a NeuroCom SMART Balance Master. 15 healthy individuals (age: 42.3 ± 20.4 yrs, height: 172 ± 11 cm, weight: 75.1 ± 14.2 kg, male = 11), completed 25 Sensory Organisation Test (SOT) on a NeuroCom SMART Balance Master. Simultaneously, the sessions were recorded using custom software developed for this study (CoM path recorder). Postural sway was calculated from the output of both methods and the level of agreement determined, using Bland-Altman plots. Good agreement was found for eyes open tasks with a firm support, the agreement decreased as the SOT tasks became more challenging. The reasons for this discrepancy may lie in the different approaches that each method takes to calculate CoM. This discrepancy warrants further study with a larger cohort, including fall-prone individuals, cross-referenced with a marker-based system. However, this pilot study lays the foundation for the development of a portable device, which could be used to assess postural control, more cost-effectively than existing equipment.
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Affiliation(s)
- Sean Maudsley-Barton
- Department of Computing and Mathematics, Manchester Metropolitan University, Manchester, United Kingdom
- * E-mail:
| | - Moi Hoon Yap
- Department of Computing and Mathematics, Manchester Metropolitan University, Manchester, United Kingdom
| | - Anthony Bukowski
- Department of Computing and Mathematics, Manchester Metropolitan University, Manchester, United Kingdom
| | - Richard Mills
- Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, United Kingdom
| | - Jamie McPhee
- Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, United Kingdom
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14
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Ahmadi SA, Vivar G, Frei J, Nowoshilow S, Bardins S, Brandt T, Krafczyk S. Towards computerized diagnosis of neurological stance disorders: data mining and machine learning of posturography and sway. J Neurol 2019; 266:108-117. [PMID: 31286203 DOI: 10.1007/s00415-019-09458-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 06/28/2019] [Accepted: 06/30/2019] [Indexed: 10/26/2022]
Abstract
We perform classification, ranking and mapping of body sway parameters from static posturography data of patients using recent machine-learning and data-mining techniques. Body sway is measured in 293 individuals with the clinical diagnoses of acute unilateral vestibulopathy (AVS, n = 49), distal sensory polyneuropathy (PNP, n = 12), anterior lobe cerebellar atrophy (CA, n = 48), downbeat nystagmus syndrome (DN, n = 16), primary orthostatic tremor (OT, n = 25), Parkinson's disease (PD, n = 27), phobic postural vertigo (PPV n = 59) and healthy controls (HC, n = 57). We classify disorders and rank sway features using supervised machine learning. We compute a continuous, human-interpretable 2D map of stance disorders using t-stochastic neighborhood embedding (t-SNE). Classification of eight diagnoses yielded 82.7% accuracy [95% CI (80.9%, 84.5%)]. Five (CA, PPV, AVS, HC, OT) were classified with a mean sensitivity and specificity of 88.4% and 97.1%, while three (PD, PNP, and DN) achieved a mean sensitivity of 53.7%. The most discriminative stance condition was ranked as "standing on foam-rubber, eyes closed". Mapping of sway path features into 2D space revealed clear clusters among CA, PPV, AVS, HC and OT subjects. We confirm previous claims that machine learning can aid in classification of clinical sway patterns measured with static posturography. Given a standardized, long-term acquisition of quantitative patient databases, modern machine learning and data analysis techniques help in visualizing, understanding and utilizing high-dimensional sensor data from clinical routine.
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Affiliation(s)
- Seyed-Ahmad Ahmadi
- German Center for Vertigo and Balance Disorders, Ludwig Maximilians Universität, Marchioninistr. 15, 81377, Munich, Germany. .,Computer Aided Medical Procedures, Technical University of Munich, 85748, Garching, Germany.
| | - Gerome Vivar
- German Center for Vertigo and Balance Disorders, Ludwig Maximilians Universität, Marchioninistr. 15, 81377, Munich, Germany.,Computer Aided Medical Procedures, Technical University of Munich, 85748, Garching, Germany
| | - Johann Frei
- German Center for Vertigo and Balance Disorders, Ludwig Maximilians Universität, Marchioninistr. 15, 81377, Munich, Germany.,Computer Aided Medical Procedures, Technical University of Munich, 85748, Garching, Germany
| | - Sergej Nowoshilow
- IMP Research Institute of Molecular Pathology, Campus-Vienna-Biocenter 1, 1030, Vienna, Austria
| | - Stanislav Bardins
- German Center for Vertigo and Balance Disorders, Ludwig Maximilians Universität, Marchioninistr. 15, 81377, Munich, Germany
| | - Thomas Brandt
- German Center for Vertigo and Balance Disorders, Ludwig Maximilians Universität, Marchioninistr. 15, 81377, Munich, Germany
| | - Siegbert Krafczyk
- German Center for Vertigo and Balance Disorders, Ludwig Maximilians Universität, Marchioninistr. 15, 81377, Munich, Germany
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Ku J, Kim YJ, Cho S, Lim T, Lee HS, Kang YJ. Three-Dimensional Augmented Reality System for Balance and Mobility Rehabilitation in the Elderly: A Randomized Controlled Trial. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2018; 22:132-141. [PMID: 30596530 DOI: 10.1089/cyber.2018.0261] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We attempted to evaluate the clinical efficiency of a novel three-dimensional interactive augmented reality system (3D-ARS) for balance and mobility rehabilitation. This system enables participant training with a realistic 3D interactive balance exercise and assessing movement parameters and joint angles by using a kinetic sensor system. We performed a randomized controlled trial in a general hospital. Thirty-six participants (age, 56-76 years) who could independently walk and stand on one leg were recruited. The participants were randomly assigned to either group. The control group (n = 18) underwent a conventional physical fitness program such as lower-extremity strengthening and balance training thrice per week for 1 month. The experimental group (n = 18) experienced 3D-ARS training thrice per week (1 session = 30 minutes) for 4 weeks. Training comprised a balloon game for hip exercise, cave game for knee exercise, and rhythm game for one-leg balance exercise. Lower-extremity clinical scale scores, fall index, and automatic balance score were measured by using Tetrax® posturography before, during, and after training. Significant group (3D-ARS vs. control) × time (before and after exercise) interaction effect was observed for Berg balance scale (BBS) scores (p = 0.04) and timed-up-and-go (TUG; p < 0.001). Overall improvements occurred in stability index, weight distribution index, fall risk index, and Fourier transformations index of posturography for both groups. However, score changes were significantly greater in the 3D-ARS group. Significant group × time interaction effect was observed for the fall risk index. This demonstrates that the 3D-ARS system can improve balance in the elderly more effectively.
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Affiliation(s)
- Jeonghun Ku
- 1 Department of Biomedical Engineering, College of Medicine, Keimyung University, Daegu, Korea
| | - Yeun Joon Kim
- 2 Department of Rehabilitation Medicine, KCOMWEL Gyeonggi Hospital, Hwaseong, Korea
| | - Sangwoo Cho
- 3 Dental Instrumentation R&BD Platform, Seoul National University Dental Hospital, Seoul, Korea
| | - Teo Lim
- 4 Department of Physical Therapy, Eulji Hospital, Seoul, Korea
| | - Hye Sun Lee
- 5 Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Youn Joo Kang
- 6 Department of Rehabilitation Medicine, Eulji Hospital, Eulji University School of Medicine, Seoul, Korea
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16
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The use of Goal Attainment Scaling (GAS) in the rehabilitation of ataxic patients. Neurol Sci 2018; 39:893-901. [DOI: 10.1007/s10072-018-3304-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 02/23/2018] [Indexed: 10/17/2022]
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17
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Smalley A, White SC, Burkard R. The effect of augmented somatosensory feedback on standing postural sway. Gait Posture 2018; 60:76-80. [PMID: 29161626 DOI: 10.1016/j.gaitpost.2017.11.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 07/11/2017] [Accepted: 11/13/2017] [Indexed: 02/02/2023]
Abstract
Impaired balance resulting from reduced postural control occurs with aging and various medical conditions. Sensory input for balance control is provided by the visual, vestibular and somatosensory systems. Previous research suggests that increased proprioceptive feedback from various lower extremity devices improves balance. Mixed results have been reported with the use of orthoses such as ankle foot orthoses (AFOs). In this study, 20 healthy subjects wore footplates in their shoes or straps around their lower legs in order to imitate the somatosensory feedback produced by wearing AFOs, but without providing ankle restriction. Subjects' standing balance was assessed using force plates and computerized dynamic posturography (the sensory organization test-SOT) to determine if either the footplates or the lower-leg straps would affect standing balance. The results revealed no significant difference with the use of the footplates, however, wearing the straps resulted in reduced postural sway for conditions when visual cue deprivation was combined with manipulation of somatosensory or vestibular feedback. This effect was more pronounced in participants with the poorest baseline measures of balance. These findings suggest that lower extremity devices, such as AFOs, may augment somatosensory feedback that could improve balance during challenging sensory deprivation conditions, independent of orthotic support at the ankle.
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Affiliation(s)
- Angela Smalley
- University at Buffalo, School of Public Health and Health Professions, Department of Rehabilitation Science, Kimball Tower, 3435 Main St., Buffalo, NY 14215, United States.
| | - Scott C White
- University at Buffalo, School of Public Health and Health Professions, Department of Exercise Science, Kimball Tower, 3435 Main St., Buffalo, NY 14215, United States
| | - Robert Burkard
- University at Buffalo, School of Public Health and Health Professions, Department of Rehabilitation Science, Kimball Tower, 3435 Main St., Buffalo, NY 14215, United States
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18
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Nam GS, Jung CM, Kim JH, Son EJ. Relationship of Vertigo and Postural Instability in Patients With Vestibular Schwannoma. Clin Exp Otorhinolaryngol 2018; 11:102-108. [PMID: 29307173 PMCID: PMC5951069 DOI: 10.21053/ceo.2017.01277] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 11/01/2017] [Accepted: 11/08/2017] [Indexed: 12/26/2022] Open
Abstract
Objectives Growth of vestibular schwannomas (VS) causes progressive vestibular symptoms and postural instability. Since the tumor grows slowly, compensation of decaying vestibular input may decrease subjective symptoms of dizziness. This study aims to estimate the relationship of subjective vestibular symptoms and objective postural instability in patients with VS. Methods A retrospective review of 18 patients newly diagnosed with VS and with subjective vertigo symptoms was performed. The results of vestibular function tests including the sensory organization test (SOT) using computerized dynamic posturography, caloric test, and self-report measures of subjective dizziness handicap (Dizziness Handicap Inventory) and visual analogue scale were compared according to the onset of vertigo symptoms. Results In VS patients, SOT showed decreased equilibrium score for all vestibular function related conditions, condition (C) 5 and 6, and composite (COMP) score. COMP scores were not correlated with visual analogue scale or Dizziness Handicap Inventory scores. Acute onset group included six patients and insidious onset group, 12 patients. Equilibrium scores for C5 and C6, and COMP scores were lower for insidious onset group, but the difference was not statistically significant. Conclusion Our findings confirmed postural instability is prevalent in VS patients. SOT parameters did not differ significantly between acute onset and insidious onset groups, but increased tumor size and canal weakness were noted in the insidious onset group. Clinicians should consider that postural instability is likely present even in patients who do not complain of acute vertigo, and appropriate counseling should be discussed with the patients.
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Affiliation(s)
- Gi-Sung Nam
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chan Min Jung
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hyung Kim
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Jin Son
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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19
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Standing balance and strength measurements in older adults living in residential care communities. Aging Clin Exp Res 2017; 29:1021-1030. [PMID: 28000144 DOI: 10.1007/s40520-016-0693-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 11/24/2016] [Indexed: 10/20/2022]
Abstract
Research on balance and mobility in older adults has been conducted primarily in lab-based settings in individuals who live in the community. Although they are at greater risk of falls, residents of long-term care facilities, specifically residential care communities (RCCs), have been investigated much less frequently. We sought to determine the feasibility of using portable technology-based measures of balance and muscle strength (i.e., an accelerometer and a load cell) that can be used in any RCC facility. Twenty-nine subjects (age 87 ± 6 years) living in RCCs participated. An accelerometer placed on the back of the subjects measured body sway during different standing conditions. Sway in antero-posterior and mediolateral directions was calculated. Lower extremity strength was measured with a portable load cell and the within-visit reliability was determined. Assessments of grip strength, gait speed, frailty, and comorbidity were also examined. A significant increase in postural sway in both the AP and ML directions occurred as the balance conditions became more difficult due to alteration of sensory feedback (p < 0.001) or reducing the base of support (p < 0.001). There was an association between increased sway and increased frailty, more comorbidities and slower gait speed. All strength measurements were highly reliable (ICC = 0.93-0.99). An increase in lower extremity strength was associated with increased grip strength and gait speed. The portable instruments provide inexpensive ways for measuring balance and strength in the understudied RCC population, but additional studies are needed to examine their relationship with functional outcomes.
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20
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Eichhorn S, Foerster S, Friemert B, Willy C, Riesner HJ, Palm HG. Can a Balance Wristband Influence Postural Control? J Strength Cond Res 2017; 34:3416-3422. [PMID: 28723821 DOI: 10.1519/jsc.0000000000002091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Eichhorn, S, Foerster, S, Friemert, B, Willy, C, Riesner, H-J, and Palm, H-G. Can a balance wristband influence postural control? J Strength Cond Res 34(12): 3416-3422, 2020-Top sports performances cannot be achieved without a high level of postural control. Balance wristbands purport to improve the mental and physical balance of the wearer. It is still unclear, however, whether these wristbands can indeed enhance postural control. Our aim was to ascertain through computerized dynamic posturography whether balance wristbands can improve postural stability. In this randomized controlled single-blind clinical study, posturography was used to assess postural control in 179 healthy subjects with or without a balance wristband. Tests were also performed with the subjects blinded to whether they were wearing an intact or a defective wristband. Analysis of variance (ANOVA) was used to detect significant differences (p ≤ 0.05). Stability indexes did not reveal significant differences in postural control between wearing and not wearing a wristband. Our study did not provide evidence of an improvement in postural stability. Because the single-blind trials too revealed no significant differences, a placebo effect could be ruled out.
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Affiliation(s)
- Sven Eichhorn
- Department of Orthopedics and Trauma Surgery, Trauma Research Group, German Armed Forces Hospital of Ulm, Ulm, Germany; and
| | - Sonja Foerster
- Department of Orthopedics and Trauma Surgery, Trauma Research Group, German Armed Forces Hospital of Ulm, Ulm, Germany; and
| | - Benedikt Friemert
- Department of Orthopedics and Trauma Surgery, Trauma Research Group, German Armed Forces Hospital of Ulm, Ulm, Germany; and
| | - Christian Willy
- Department of Orthopedics and Trauma Surgery, German Armed Forces Hospital of Berlin, Berlin, Germany
| | - Hans-Joachim Riesner
- Department of Orthopedics and Trauma Surgery, Trauma Research Group, German Armed Forces Hospital of Ulm, Ulm, Germany; and
| | - Hans-Georg Palm
- Department of Orthopedics and Trauma Surgery, Trauma Research Group, German Armed Forces Hospital of Ulm, Ulm, Germany; and
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21
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Assessment of balance and vestibular functions in patients with idiopathic sudden sensorineural hearing loss. ACTA ACUST UNITED AC 2017; 37:264-270. [DOI: 10.1007/s11596-017-1726-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 02/27/2017] [Indexed: 10/18/2022]
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22
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Chow GC, Yam TT, Chung JW, Fong SS. Effects of postexercise ice-water and room-temperature water immersion on the sensory organization of balance control and lower limb proprioception in amateur rugby players: A randomized controlled trial. Medicine (Baltimore) 2017; 96:e6146. [PMID: 28207546 PMCID: PMC5319535 DOI: 10.1097/md.0000000000006146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This single-blinded, three-armed randomized controlled trial aimed to compare the effects of postexercise ice-water immersion (IWI), room-temperature water immersion (RWI), and no water immersion on the balance performance and knee joint proprioception of amateur rugby players. METHODS Fifty-three eligible amateur rugby players (mean age ± standard deviation: 21.6 ± 2.9 years) were randomly assigned to the IWI group (5.3 °C), RWI group (25.0 °C), or the no immersion control group. The participants in each group underwent the same fatigue protocol followed by their allocated recovery intervention, which lasted for 1 minute. Measurements were taken before and after the fatigue-recovery intervention. The primary outcomes were the sensory organization test (SOT) composite equilibrium score (ES) and the condition-specific ES, which were measured using a computerized dynamic posturography machine. The secondary outcome was the knee joint repositioning error. Two-way repeated measures analysis of variance was used to test the effect of water immersion on each outcome variable. RESULTS There were no significant within- and between-group differences in the SOT composite ESs or the condition-specific ESs. However, there was a group-by-time interaction effect on the knee joint repositioning error. It seems that participants in the RWI group had lower errors over time, but those in the IWI and control groups had increased errors over time. The RWI group had significantly lower error score than the IWI group at postintervention. CONCLUSION One minute of postexercise IWI or RWI did not impair rugby players' sensory organization of balance control. RWI had a less detrimental effect on knee joint proprioception to IWI at postintervention.
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Affiliation(s)
- Gary C.C. Chow
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong
- Faculty of Liberal Arts and Social Sciences
| | - Timothy T.T. Yam
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - Joanne W.Y. Chung
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong
| | - Shirley S.M. Fong
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong
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Zainun Z Z, Mohamed Zain KA, Abdullah Zawawi SN, El Saboni L, Manaf AA. The determination of normative data for a cost-effective Bal Ex ABEVR: Preliminary data - Case study. AIP CONFERENCE PROCEEDINGS 2017. [DOI: 10.1063/1.4993394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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24
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Abram K, Bohne S, Bublak P, Karvouniari P, Klingner CM, Witte OW, Guntinas-Lichius O, Axer H. The Effect of Spinal Tap Test on Different Sensory Modalities of Postural Stability in Idiopathic Normal Pressure Hydrocephalus. Dement Geriatr Cogn Dis Extra 2016; 6:447-457. [PMID: 27790243 PMCID: PMC5075737 DOI: 10.1159/000450602] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Postural instability in patients with normal pressure hydrocephalus (NPH) is a most crucial symptom leading to falls with secondary complications. The aim of the current study was to evaluate the therapeutic effect of spinal tap on postural stability in these patients. METHODS Seventeen patients with clinical symptoms of NPH were examined using gait scale, computerized dynamic posturography (CDP), and neuropsychological assessment. Examinations were done before and after spinal tap test. RESULTS The gait score showed a significant improvement 24 h after spinal tap test in all subtests and in the sum score (p < 0.003), while neuropsychological assessment did not reveal significant differences 72 h after spinal tap test. CDP showed significant improvements after spinal tap test in the Sensory Organization Tests 2 (p = 0.017), 4 (p = 0.001), and 5 (p = 0.009) and the composite score (p = 0.01). Patients showed best performance in somatosensory and worst performance in vestibular dominated tests. Vestibular dominated tests did not improve significantly after spinal tap test, while somatosensory and visual dominated tests did. CONCLUSION Postural stability in NPH is predominantly affected by deficient vestibular functions, which did not improve after spinal tap test. Conditions which improved best were mainly independent from visual control and are based on proprioceptive functions.
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Affiliation(s)
- Katrin Abram
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Silvia Bohne
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
| | - Peter Bublak
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Panagiota Karvouniari
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany; Center for Vertigo and Dizziness, Jena University Hospital, Jena, Germany
| | - Carsten M Klingner
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany; Biomagnetic Center, Jena University Hospital, Jena, Germany
| | - Otto W Witte
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | | | - Hubertus Axer
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany; Center for Vertigo and Dizziness, Jena University Hospital, Jena, Germany
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25
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Use of Mobile Device Accelerometry to Enhance Evaluation of Postural Instability in Parkinson Disease. Arch Phys Med Rehabil 2016; 98:649-658. [PMID: 27670925 DOI: 10.1016/j.apmr.2016.08.479] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/21/2016] [Accepted: 08/29/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the accuracy of inertial measurement unit data from a mobile device using the mobile device relative to posturography to quantify postural stability in individuals with Parkinson disease (PD). DESIGN Criterion standard. SETTING Motor control laboratory at a clinic. PARTICIPANTS A sample (N=28) of individuals with mild to moderate PD (n=14) and age-matched community-dwelling individuals without PD (n=14) completed the study. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Center of mass (COM) acceleration measures were compared between the mobile device and the NeuroCom force platform to determine the accuracy of mobile device measurements during performance of the Sensory Organization Test (SOT). Analyses examined test-retest reliability of both systems and sensitivity of (1) the equilibrium score from the SOT and (2) COM acceleration measures from the force platform and mobile device to quantify postural stability across populations. RESULTS Metrics of COM acceleration from inertial measurement unit data and the NeuroCom force platform were significantly correlated across balance conditions and groups (Pearson r range, .35 to .97). The SOT equilibrium scores failed to discriminate individuals with and without PD. However, the multiplanar measures of COM acceleration from the mobile device exhibited good to excellent reliability across SOT conditions and were able to discriminate individuals with and without PD in conditions with the greatest balance demands. CONCLUSIONS Metrics employing medial-lateral movement produce a more sensitive outcome than the equilibrium score in identifying postural instability associated with PD. Overall, the output from the mobile device provides an accurate and reliable method of rapidly quantifying balance in individuals with PD. The portable and affordable nature of a mobile device with the application makes it ideally suited to use biomechanical data to aid in clinical decision making.
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Ayhan C, Bilgin S, Aksoy S, Yakut Y. Functional contributors to poor movement and balance control in patients with low back pain: A descriptive analysis. J Back Musculoskelet Rehabil 2016; 29:477-86. [PMID: 26519117 DOI: 10.3233/bmr-150643] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Automatic and voluntary body position control is essential for postural stability; however, little is known about individual factors that impair the sensorimotor system associated with low back pain (LBP). OBJECTIVE To evaluate automatic and voluntary motor control impairments causing postural instability in patients with LBP. METHODS Motor control impairments associated with poor movement and balance control were analyzed prospectively in 32 patients with LBP. Numeric Rating Scale (NRS) for pain assessment, Oswestry Disability Index (ODI) for disability measurement, and computerized dynamic posturography (CDP) for analysis of postural responses were used to measure outcomes of all patients. Computerized dynamic posturography tests including Sensory organization test (SOT), limits of stability test (movement velocity, directional control, endpoint, and maximum excursion), rhythmic weight shift (rhythmic movement speed and directional control), and adaptation test (toes-up and toes-down tests) were performed and the results compared with NeuroCom normative data. RESULTS The mean age of the patients was 40.50 ± 12.28 years. Lower equilibrium scores were observed in SOT (p < 0.05). There was a significant increase in reaction time and decrease in movement velocity, directional control, and endpoint excursion (p < 0.05). Speed of rhythmic movement along the anteroposterior direction decreased, while speed increased along the lateral direction (p < 0.05). Poor directional control was recorded in the anteroposterior direction (p < 0.05). Toes-down test showed an increased COG sway in patients compared with that in the controls (p < 0.05). CONCLUSIONS LBP causes poor voluntary control of body positioning, a reduction in movement control, delays in movement initiation, and a difficulty to adapt to sudden surface changes.
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Affiliation(s)
- Cigdem Ayhan
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Sevil Bilgin
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Songul Aksoy
- Department of Audiology, Voice and Speech Disorders, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Yavuz Yakut
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
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Gandelman-Marton R, Arlazoroff A, Dvir Z. Posturography in MS patients treated with high dose methylprednisolone. Neurol Res 2016; 38:570-4. [PMID: 27151095 DOI: 10.1080/01616412.2016.1177927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To evaluate the sensitivity of the balance sway index (SI) to drug-induced functional changes during acute relapse in patients with MS. METHODS Dynamic posturography was used to derive the SI in 11 healthy subjects and 13 MS patients before and after intravenous high dose methylprednisolone (HDMP). RESULTS In both groups, SI was lower in the least demanding task and increased with test complexity. Compared to the healthy group, patients were distinguished by a higher SI both prior to and following administration of HDMP (p < 0.008). However, the effect of the drug on patients' SI was unremarkable. Total Expanded Disability Status Scale score was lower after treatment compared to pre-treatment values (p < 0.001), with significantly lower mean score recorded in patients with pyramidal and cerebellar abnormalities (p = 0.017 and p = 0.011, respectively). DISCUSSION The SI measure of dynamic posturography is not sensitive to short-term HDMP-induced functional changes during acute relapse in patients with MS. Further studies are needed to evaluate modified balance protocols and the possible long-term treatment effects of HDMP on SI.
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Affiliation(s)
| | - Aharon Arlazoroff
- a Department of Neurology , Assaf Harofeh Medical Center , Zerifin , Israel
| | - Zeevi Dvir
- b The Sackler Faculty of Medicine, Department of Physical Therapy , Tel Aviv University , Tel Aviv , Israel
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Armistead-Jehle P, Lange BJ, Green P. Comparison of Neuropsychological and Balance Performance Validity Testing. APPLIED NEUROPSYCHOLOGY-ADULT 2016; 24:190-197. [PMID: 27078046 DOI: 10.1080/23279095.2015.1132219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Performance validity testing in the context of neuropsychological assessment is well established. While such measures are also available with balance testing, little research has investigated these two domains in concert. The purpose of this study was to compare scores on two measures of performance validity across cognitive and balance modalities. Seventy-eight subjects independently evaluated by a neuropsychologist and an otolaryngologist in the context of disability evaluations were administered the Word Memory Test and Computerized Dynamic Posturography. Results of the measures were significantly correlated (rφ = 0.35, p = .002) and demonstrated 70.5% agreement. These data suggest that if symptom exaggeration occurs within one modality, other modalities may also be exaggerated and should be independently evaluated.
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Affiliation(s)
| | - Beth J Lange
- b Neurovestibular Program, University of Calgary , Alberta , Canada
| | - Paul Green
- c Private Practice , Edmonton , Alberta , Canada
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de Souza NS, Martins ACG, Alexandre DJA, Orsini M, Bastos VHDV, Leite MAA, Teixeira S, Velasques B, Ribeiro P, Bittencourt J, Matta APDC, Filho PM. The Influence of Fear of Falling on Orthostatic Postural Control: A Systematic Review. Neurol Int 2015; 7:6057. [PMID: 26788265 PMCID: PMC4704471 DOI: 10.4081/ni.2015.6057] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 08/02/2015] [Accepted: 11/12/2015] [Indexed: 01/08/2023] Open
Abstract
Posture is a complex sensory-motor behavior that can be influenced by the fear of falling (FoF) during environmental changes. The aim of this paper is to investigate the influence of FoF on orthostatic postural control in healthy individuals by a systematic review. Thirteen articles were selected. Some other articles (31 references) were used to contextualize and discuss the topic. Studies in the environment made changes on the environment, in which participants were positioned in high hydraulic platforms at different heights, showed a decrease in the center of pressure in the anteroposterior oscillation where the platform was higher. This change in postural control strategy and the FoF are correlated. It can modulate the activity of the muscle spindle (H-reflex) and probably induce postural freezing phenomenon (anticipated postural anxiety). We can conclude that further studies are needed to understand the physiological echanisms involved in FoF and its relation to changes in postural control strategy.
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Affiliation(s)
- Nélio Silva de Souza
- University Center Serra dos Órgãos, Teresópolis; Science of Rehabilitation, Centro Universitário Augusto Motta, Rio de Janeiro
| | - Ana Carolina Gomes Martins
- University Center Serra dos Órgãos, Teresópolis; Integrated Health of Women and Children, Fluminense Federal University, Niterói
| | | | - Marco Orsini
- Science of Rehabilitation, Centro Universitário Augusto Motta, Rio de Janeiro; Severino Sombra University Center, Medicine Department, Vassouras, Rio de Janeiro
| | - Victor Hugo do Vale Bastos
- Science of Rehabilitation, Centro Universitário Augusto Motta, Rio de Janeiro; Department of Neurology, Antônio Pedro University Hospital, Fluminense Federal University, Niterói; Biomedical Sciences stricto sensu, Federal University of Piauí
| | - Marco Antônio A Leite
- Fluminense Federal University Medical School, Niterói; Movement Disorders Unit, Antônio Pedro University Hospital, Fluminense Federal University, Niterói
| | | | - Bruna Velasques
- Brain Mapping and Sensory Motor Integration, Institute of Psychiatry of Federal University of Rio de Janeiro; Institute of Applied Neuroscience, Rio de Janeiro, Brazil
| | - Pedro Ribeiro
- Brain Mapping and Sensory Motor Integration, Institute of Psychiatry of Federal University of Rio de Janeiro; Institute of Applied Neuroscience, Rio de Janeiro, Brazil
| | - Juliana Bittencourt
- Brain Mapping and Sensory Motor Integration, Institute of Psychiatry of Federal University of Rio de Janeiro
| | | | - Pedro Moreira Filho
- Department of Neurology, Antônio Pedro University Hospital, Fluminense Federal University , Niterói
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Quantification of postural stability in older adults using mobile technology. Exp Brain Res 2014; 232:3861-72. [DOI: 10.1007/s00221-014-4069-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 08/05/2014] [Indexed: 10/24/2022]
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Vestibular deficits leading to disequilibrium and falls in ambulatory amyotrophic lateral sclerosis. Arch Phys Med Rehabil 2014; 95:1933-9. [PMID: 24946083 DOI: 10.1016/j.apmr.2014.05.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 05/06/2014] [Accepted: 05/29/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess vestibular deficits in response to disequilibrium in ambulatory individuals with amyotrophic lateral sclerosis (ambALS). DESIGN All participants completed standard protocols for the Sensory Organization Test (SOT) by computerized dynamic posturography. SETTING Multidisciplinary amyotrophic lateral sclerosis clinic at an academic medical center. PARTICIPANTS Study participants (N=34) consisted of ambALS (n=19) and healthy controls (HC) (n=15). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Equilibrium scores (ESs) obtained from averaged sway amplitude in condition 5 (ES5) and condition 6 (ES6) of the SOT. RESULTS In conditions of altered somatosensory information with vision absent or vision sway-referenced, the mean ± SD scores for ambALS (ES5=51.4±22.5; ES6=50.8±22.1) were lower than those for HC (ES5=65.4±11.7, P≤.03; ES6=58.9±12.5, P>.05). Seven ambALS (37%) experienced a total of 19 falls during the sway-referenced support test conditions. There were no falls in the HC. CONCLUSIONS Nearly 37% of ambALS with normal clinical balance testing have decreased ability to use the vestibular input and required increased reliance on visual input for postural orientation to sustain equilibrium. The mechanism of this alteration in sensory preference is not completely clear. Extrapyramidal involvement early in ALS may be indicated.
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Vérité F, Bachta W, Morel G. Closed loop kinesthetic feedback for postural control rehabilitation. IEEE TRANSACTIONS ON HAPTICS 2014; 7:150-160. [PMID: 24968379 DOI: 10.1109/toh.2013.64] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Postural control rehabilitation may benefit from the use of smart devices providing biofeedback. This approach consists of increasing the patients perception of their postural state. Namely, postural state is monitored and fed back in real time to the patients through one or more sensory channels. This allows implementing rehabilitation exercises where the patients control their posture with the help of additional sensory inputs. In this paper, a closed loop control of the Center-Of-Pressure (CoP) based on kinesthetic feedback is proposed as a new form of biofeedback. The motion of a one Degree of Freedom (DoF) translational device, lightly touched by the patient's forefinger, is servoed to the patient's CoP position extracted from the measurements of a force plate on which he/she stands. As a result, the patient's CoP can be controllably displaced. A first set of experiments is used to prove the feasibility of this closed-loop control under ideal conditions favoring the perception of the kinesthetic feedback, while the subject is totally unaware of the context. A second set of experiments is then proposed to evaluate the robustness of this approach under experimental conditions that are more realistic with regards to the clinical context of a rehabilitation program involving biofeedback-based exercises.
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Yeh JR, Hsu LC, Lin C, Chang FL, Lo MT. Nonlinear analysis of sensory organization test for subjects with unilateral vestibular dysfunction. PLoS One 2014; 9:e91230. [PMID: 24632582 PMCID: PMC3954723 DOI: 10.1371/journal.pone.0091230] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 02/11/2014] [Indexed: 11/18/2022] Open
Abstract
Vestibular disorder is the cause of approximately 50% of dizziness in older people. The vestibular system is a critical postural control mechanism, and posturography analysis is helpful for diagnosing vestibular disorder. In clinical practice, the sensory organization test (SOT) is used to quantify postural control in an upright stance under different test conditions. However, both aging and vestibular disorder cause declines of postural control mechanisms. The aim of this study was to enhance the performance of the SOT using a nonlinear algorithm of empirical mode decomposition (EMD) and to verify the differences of effects caused by aging and/or illnesses benefits to clinical diagnosis. A total of 51 subjects belonging to 3 groups--healthy-young, healthy-elderly and dizzy--were recruited for this study. New dynamic parameters of the SOT were derived from the center of pressure (COP) signals. EMD served as an adaptive filter bank to derive the low- and high-frequency components of the COP. The effects on four ratios of sensory analysis caused by aging and vestibular disorder can be investigated for the specific frequency bands. According to our findings, new SOT parameters derived from the component with the specific frequency band more sensitively reflect the functional condition of vestibular dysfunction. Furthermore, both aging and vestibular dysfunction caused an increase in magnitude for the low-frequency component of the AP-direction COP time series. In summary, the low-frequency fluctuation reflects the stability of postural control, while the high-frequency fluctuation is sensitive to the functional condition of the sensory system. EMD successfully improved the accuracy of SOT measurements in this investigation.
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Affiliation(s)
- Jia-Rong Yeh
- Research Center for Adaptive Data Analysis and Center for Dynamical Biomarkers and Translational Medicine, National Central University, Taoyuan, Taiwan
| | - Li-Chi Hsu
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan
- National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Chen Lin
- Research Center for Adaptive Data Analysis and Center for Dynamical Biomarkers and Translational Medicine, National Central University, Taoyuan, Taiwan
| | - Fu-Ling Chang
- Taiwan Textile Research Institute, New Taipei City, Taiwan
- National Yunlin University of Science and Technology Graduate School of Design, Yunlin, Taiwan
| | - Men-Tzung Lo
- Research Center for Adaptive Data Analysis and Center for Dynamical Biomarkers and Translational Medicine, National Central University, Taoyuan, Taiwan
- * E-mail:
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Hong HR, Shim DB, Kim TS, Shim BS, Ahn JH, Chung JW, Yoon TH, Park HJ. Results of caloric and sensory organization testing of dynamic posturography in migrainous vertigo: comparison with Meniere's disease and vestibular neuritis. Acta Otolaryngol 2013; 133:1236-41. [PMID: 23947606 DOI: 10.3109/00016489.2013.820343] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Our findings suggest that migrainous vertigo (MV) has a substantial vestibulo-spinal abnormality that can be uncovered by posturography. Patients with MV also showed a difficulty in using multisystem information, especially somatosensory information. Caloric and sensory organization tests (SOTs) have complementary roles in assessing vestibulo-ocular and vestibulo-spinal function, particularly for Meniere's disease (MD) and MV. OBJECTIVES To compare vestibular dysfunction through caloric testing and posturography in patients with MV, MD, and acute vestibular neuritis (VN). METHODS Caloric tests and SOTs were performed in 31 patients with MV, 23 with MD, and 37 with VN. The abnormal results in caloric test, SOT conditions, and somatosensory, visual, and vestibular ratios were analyzed. RESULTS Abnormal canal paresis was found in 7 patients with MV (23%), 11 with MD (48%), and 37 with VN (100%). An abnormal vestibular ratio in SOT was found in 14 patients with MV (45%), 6 with MD (26%), and 23 with VN (62%). In MV, an abnormal vestibular ratio was more common than canal paresis and an abnormal vestibular ratio was more common than in MD. An abnormal somatosensory ratio (19%) in MV was significantly more common than in VN and MD (3% and 0%). For condition 2, MV showed a significantly higher abnormal rate than VN. An abnormal visual ratio in MV was more common than in VN and MD but this was not significant.
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Affiliation(s)
- Hye Ran Hong
- Departments of Otolaryngology, 1Asan Medical Center, University of Ulsan
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Gad GI, Mohamed ST, Awwad KS, Mohamed RF. Study of audiovestibular dysfunction in children with systemic lupus erythematosus. Int J Pediatr Otorhinolaryngol 2013; 77:1561-6. [PMID: 23916731 DOI: 10.1016/j.ijporl.2013.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 07/02/2013] [Accepted: 07/03/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Inner ear dysfunction in systemic lupus erythematosis patients has been reported but audiovestibular involvement is not well documented especially in pediatrics. This study was designed to evaluate silent audiovestibular dysfunction among SLE children. METHODS Case control study examined in allergy and immunology clinic; pediatrics hospital and audiovestibular clinic; Ain Shams University from January 2009 to December 2010. Thirty-five systemic lupus erythematosus children (diagnosed according to American College of Rheumatology); age group 8-16 years, were randomly selected. Five of them were excluded due to one or more exclusion criteria (previous otitis media, stroke, lupus cerebritis, meningitis or encephalitis, audiovestibular symptom). Ten of them refused enrollment or could not complete full battery. Seventeen females and three males, mean age 12.9 ± 2.6 years, completed the study. Control group included 20 normal subjects, age and sex matched. Full clinical assessment, basic audiological evaluation and vestibular testing (videonystagmography VNG and computerized dynamic posturography CDP) were conducted for children included in the study. RESULTS Five systemic lupus erythematosus patients had sensorineural hearing loss strongly associated with +ve antiphospholipid antibody and two had conductive hearing loss. Two children in control group had conductive hearing loss (p=0.05). Abnormal VNG findings was significantly higher among systemic lupus erythematosus children (40%) compared to controls (0%) and associated with +ve antiphospholipid antibodies (χ(2)=10, p=0.002, Fisher exact test=0.003). Twenty-five percentage of systemic lupus erythematosus children had abnormal CDP findings reflecting impaired balance function associated with positive antiphospholipid antibodies showing significant statistical difference compared to controls (0% affection) (χ(2)=5.7, p=0.017, Fisher exact test=0.047). CONCLUSION Silent audiovestibular dysfunction is prevalent among systemic lupus erythematosus children especially those positive for antiphospholipid antibodies necessitating routine regular evaluation.
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Affiliation(s)
- Ghada Ibrahim Gad
- Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
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Furman GR, Lin CC, Bellanca JL, Marchetti GF, Collins MW, Whitney SL. Comparison of the balance accelerometer measure and balance error scoring system in adolescent concussions in sports. Am J Sports Med 2013; 41:1404-10. [PMID: 23585486 PMCID: PMC4899870 DOI: 10.1177/0363546513484446] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND High-technology methods demonstrate that balance problems may persist up to 30 days after a concussion, whereas with low-technology methods such as the Balance Error Scoring System (BESS), performance becomes normal after only 3 days based on previously published studies in collegiate and high school athletes. PURPOSE To compare the National Institutes of Health's Balance Accelerometer Measure (BAM) with the BESS regarding the ability to detect differences in postural sway between adolescents with sports concussions and age-matched controls. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS Forty-three patients with concussions and 27 control participants were tested with the standard BAM protocol, while sway was quantified using the normalized path length (mG/s) of pelvic accelerations in the anterior-posterior direction. The BESS was scored by experts using video recordings. RESULTS The BAM was not able to discriminate between healthy and concussed adolescents, whereas the BESS, especially the tandem stance conditions, was good at discriminating between healthy and concussed adolescents. A total BESS score of 21 or more errors optimally identified patients in the acute concussion group versus healthy participants at 60% sensitivity and 82% specificity. CONCLUSION The BAM is not as effective as the BESS in identifying abnormal postural control in adolescents with sports concussions. The BESS, a simple and economical method of assessing postural control, was effective in discriminating between young adults with acute concussions and young healthy people, suggesting that the test has value in the assessment of acute concussions.
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Affiliation(s)
- Gabriel R. Furman
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Chia-Cheng Lin
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jennica L. Bellanca
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Gregory F. Marchetti
- Department of Physical Therapy, Duquesne University, Pittsburgh, Pennsylvania
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael W. Collins
- Department of Orthopedics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Susan L. Whitney
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania
- Address correspondence to: Susan L. Whitney, DPT, PhD, ATC, University of Pittsburgh, Departments of Physical Therapy and Otolaryngology, 6035, Forbes Tower, Pittsburgh, PA 15261 ()
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Proprioceptive accuracy in women with early and established knee osteoarthritis and its relation to functional ability, postural control, and muscle strength. Clin Rheumatol 2013; 32:1365-74. [PMID: 23673439 DOI: 10.1007/s10067-013-2285-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 04/22/2013] [Accepted: 04/29/2013] [Indexed: 10/26/2022]
Abstract
The purpose of this study was to identify differences in knee proprioceptive accuracy between subjects with early knee osteoarthritis (OA), established knee OA, and healthy controls. Furthermore, the relation between proprioceptive accuracy on the one hand and functional ability, postural balance, and muscle strength on the other hand was also explored. New MRI-based classification criteria showing evidence of beginning joint degeneration have been used to identify subjects with early knee OA. A total of 45 women with knee OA (early OA, n = 21; established OA, n = 24) and 20 healthy female control subjects participated in the study. Proprioceptive accuracy was evaluated using the repositioning error of a knee joint position sense test using a three-dimensional motion analysis system. Subjective and objective functional ability was assessed by the knee injury and osteoarthritis outcome score, the timed "Up & Go" test, and the stair climbing test. The sensory organization test measured postural control. Muscle strength was measured by isokinetic dynamometry. Early OA subjects showed no significant differences in proprioceptive accuracy compared to healthy controls. In contrast, established OA subjects showed a higher repositioning error compared to early OA subjects (+29 %, P = 0.033) and healthy controls (+25 %, P = 0.068). Proprioceptive accuracy was not significantly associated with functional ability, postural balance, and muscle strength. Knee joint proprioceptive deficits were observed in established OA but not in early OA, suggesting that impaired proprioception is most likely a consequence of structural degeneration, rather than a risk factor in the pathogenesis of knee OA. Impaired proprioceptive accuracy was not associated with disease-related functionality in knee OA patients. Treatment strategies designed to address proprioceptive deficits may be not effective in prevention of knee OA progression and may have no impact on patients' functionality. However, this should be confirmed further in well-designed clinical trials.
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Rine RM, Schubert MC, Whitney SL, Roberts D, Redfern MS, Musolino MC, Roche JL, Steed DP, Corbin B, Lin CC, Marchetti GF, Beaumont J, Carey JP, Shepard NP, Jacobson GP, Wrisley DM, Hoffman HJ, Furman G, Slotkin J. Vestibular function assessment using the NIH Toolbox. Neurology 2013; 80:S25-31. [PMID: 23479540 DOI: 10.1212/wnl.0b013e3182872c6a] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Development of an easy to administer, low-cost test of vestibular function. METHODS Members of the NIH Toolbox Sensory Domain Vestibular, Vision, and Motor subdomain teams collaborated to identify 2 tests: 1) Dynamic Visual Acuity (DVA), and 2) the Balance Accelerometry Measure (BAM). Extensive work was completed to identify and develop appropriate software and hardware. More than 300 subjects between the ages of 3 and 85 years, with and without vestibular dysfunction, were recruited and tested. Currently accepted gold standard measures of static visual acuity, vestibular function, dynamic visual acuity, and balance were performed to determine validity. Repeat testing was performed to examine reliability. RESULTS The DVA and BAM tests are affordable and appropriate for use for individuals 3 through 85 years of age. The DVA had fair to good reliability (0.41-0.94) and sensitivity and specificity (50%-73%), depending on age and optotype chosen. The BAM test was moderately correlated with center of pressure (r = 0.42-0.48) and dynamic posturography (r = -0.48), depending on age and test condition. Both tests differentiated those with and without vestibular impairment and the young from the old. Each test was reliable. CONCLUSION The newly created DVA test provides a valid measure of visual acuity with the head still and moving quickly. The novel BAM is a valid measure of balance. Both tests are sensitive to age-related changes and are able to screen for impairment of the vestibular system.
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Affiliation(s)
- Eun Joo Kim
- Department of Physical Medicine and Rehabilitation, National Rehabilitation Hospital, Korea
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Wallmann HW, Player KR, Bugnet M. Acute Effects of Static Stretching on Balance in Young Versus Elderly Adults. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2012. [DOI: 10.3109/02703181.2012.719076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Harvey W Wallmann
- 1Department of Physical Therapy, Western Kentucky University,
Bowling Green, Kentucky, USA
| | | | - Matthew Bugnet
- 3Rehab and Industrial Services of Nevada,
Winnemucca, Nevada, USA
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The ABLE scale: the development and psychometric properties of an outcome measure for the spinal cord injury population. Phys Ther 2012; 92:1046-54. [PMID: 22577065 DOI: 10.2522/ptj.20110257] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND A paucity of information exists on the psychometric properties of several balance outcome measures. With the exception of the Modified Functional Reach Test, none of these balance outcome measures were developed specifically for the population with spinal cord injury (SCI). A new balance assessment tool for people with SCI, the Activity-based Balance Level Evaluation (ABLE scale), was developed and tested. OBJECTIVE The purposes of this study were: (1) to develop a scale capturing the wide spectrum of functional ability following SCI and (2) to assess the initial psychometric properties of the scale using a Rasch analysis. DESIGN A methodological research design was used to test the initial psychometric properties of the ABLE scale. METHODS The Delphi technique was used to establish the original 28-item ABLE scale. People with SCI at each of 4 centers (n=104) were evaluated using the ABLE scale. A Rasch analysis was conducted to test for targeting, item difficulty, item bias, and unidimensionality. An analysis of variance was completed to test for discriminant validity. RESULTS The Rasch analysis revealed a scale with minimal floor and ceiling effects and a wide range of item difficulty capturing the large scope of functional capacity after SCI. Multiple redundancies of item difficulty were observed. Limitations All raters were experienced physical therapists, which may have skewed the results. The sample size of 104 participants precluded a principal component analysis. CONCLUSION Development of an all-inclusive clinical instrument assessing balance in the SCI population was accomplished using the Delphi technique. Modifications of the ABLE scale based on the Rasch analysis yielded a 28-item scale with minimal floor or ceiling effects. Larger studies using the revised scale and factor analyses are necessary to establish unidimensionality and reduction of the total item number.
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Nanhoe-Mahabier W, Allum JHJ, Overeem S, Borm GF, Oude Nijhuis LB, Bloem BR. First trial reactions and habituation rates over successive balance perturbations in Parkinson's disease. Neuroscience 2012; 217:123-9. [PMID: 22542872 DOI: 10.1016/j.neuroscience.2012.03.064] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 03/18/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Balance control in Parkinson's disease is often studied using dynamic posturography, typically with serial identical balance perturbations. Because subjects can learn from the first trial, the magnitude of balance reactions rapidly habituates during subsequent trials. Changes in this habituation rate might yield a clinically useful marker. We studied balance reactions in Parkinson's disease using posturography, specifically focusing on the responses to the first, fully unpractised balance disturbance, and on the subsequent habituation rates. METHODS Eight Parkinson patients and eight age- and gender-matched controls received eight consecutive toe-up rotations of a support-surface. Balance reactions were measured with a motion analysis system and converted to centre of mass displacements (primary outcome). RESULTS Mean centre of mass displacement during the first trial was 51% greater in patients than controls (P=0.019), due to excessive trunk flexion and greater ankle plantar-flexion. However, habituated trials were comparable in both groups. Patients also habituated slower: controls were fully habituated at trial 2, whereas habituation in patients required up to five trials (P=0.004). The number of near-falls during the first trial was significantly correlated with centre of mass displacement during the first trial and with habituation rate. CONCLUSIONS Higher first trial reactions and a slow habituation rate discriminated Parkinson's patients from controls, but habituated trials did not. Further work should demonstrate whether this also applies to clinical balance tests, such as the pull test, and whether repeated delivery of such tests offers better diagnostic value for evaluating fall risks in parkinsonian patients.
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Affiliation(s)
- W Nanhoe-Mahabier
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Maranhão-Filho PA, Maranhão ET, Silva MMD, Lima MA. Rethinking the neurological examination I: static balance assessment. ARQUIVOS DE NEURO-PSIQUIATRIA 2011; 69:954-8. [DOI: 10.1590/s0004-282x2011000700021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Accepted: 07/19/2011] [Indexed: 11/21/2022]
Abstract
The authors advocate a modernization of the neurologic exam with regard to the evaluation of static equilibrium through the application of some easily performed and interpreted bedside maneuvers like the Clinical Test of Sensory Integration and Balance - modified and the Functional Reach Test. The authors also believe that these and other assessments, such as that of the risk of falling for elderly patients, should be incorporated into the routine neurological examination.
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Trato J, Johnson EG. Differential diagnosis and management of a patient with peripheral vestibular and central nervous system disorders: a case study. J Man Manip Ther 2011; 18:159-65. [PMID: 21886427 DOI: 10.1179/106698110x12640740712491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Clinical examination and management of patients with meningiomas is primarily dependent upon appropriate diagnosis of tumor type and surgical intervention. Physical therapists should be able to identify patients presenting with signs and symptoms suggestive of potential central nervous system (CNS) disorders and refer the patient appropriately. PATIENT CHARACTERISTICS In this case report, a 52-year-old female was referred to physical therapy after 18 months of unresolved dizziness. EXAMINATION Oculomotor examination revealed evidence of peripheral vestibular and potential CNS disorders. The physical therapist referred the patient to a physician who ordered magnetic resonance imaging (MRI). INTERVENTION The patient received five physical therapy sessions while waiting for the MRI which revealed a meningioma. The meningioma was surgically removed and the patient was subsequently relieved of all symptoms. OUTCOMES Despite the presence of the meningioma, the patient reported improved stability during work-related activities and decreased dizziness as a result of physical therapy intervention pre-operatively. DISCUSSION This case report emphasizes the importance of a physical therapists ability to perform and interpret an oculomotor examination in a patient presenting with signs consistent with peripheral vestibular and CNS disorders. It also demonstrates the role of physical therapy in collaboration with physicians in order to provide appropriate patient care management.
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Affiliation(s)
- Jill Trato
- Department of Physical Therapy, Long Beach Memorial Medical Center, USA
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Van Impe A, Coxon JP, Goble DJ, Doumas M, Swinnen SP. White matter fractional anisotropy predicts balance performance in older adults. Neurobiol Aging 2011; 33:1900-12. [PMID: 21872363 DOI: 10.1016/j.neurobiolaging.2011.06.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Revised: 06/14/2011] [Accepted: 06/17/2011] [Indexed: 11/17/2022]
Abstract
Aging is characterized by brain structural changes that may compromise motor functions. In the context of postural control, white matter integrity is crucial for the efficient transfer of visual, proprioceptive and vestibular feedback in the brain. To determine the role of age-related white matter decline as a function of the sensory feedback necessary to correct posture, we acquired diffusion weighted images in young and old subjects. A force platform was used to measure changes in body posture under conditions of compromised proprioceptive and/or visual feedback. In the young group, no significant brain structure-balance relations were found. In the elderly however, the integrity of a cluster in the frontal forceps explained 21% of the variance in postural control when proprioceptive information was compromised. Additionally, when only the vestibular system supplied reliable information, the occipital forceps was the best predictor of balance performance (42%). Age-related white matter decline may thus be predictive of balance performance in the elderly when sensory systems start to degrade.
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Affiliation(s)
- Annouchka Van Impe
- Research Center for Movement Control and Neuroplasticity, Department of Biomedical Kinesiology, K.U. Leuven, Heverlee, Belgium
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Influence of age and gender in the sensory analysis of balance control. Eur Arch Otorhinolaryngol 2011; 269:673-7. [PMID: 21789678 DOI: 10.1007/s00405-011-1707-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 07/04/2011] [Indexed: 10/18/2022]
Abstract
Postural control is achieved through the integration at the central nervous system level of information obtained by the visual, somatosensory and vestibular systems. Computerized dynamic posturography and the Sway Star system are both used to carry out sensory analysis. The purpose of this study was to determine the influence of sex and age on sensory analysis, measured with these two systems, and to compare their results. A prospective trial was conducted with 70 healthy individuals (average age: 44.9 years) uniformly distributed in seven age groups, who underwent postural study with both systems. We used SPSS 16.0 for statistical study: comparison of means test for influence of gender and age and Pearson's correlation test (p < 0.05). Gender variable had no influence. The influence of age in vestibular input was found to be significant with both posturography systems, while visual input was only found to be significant with the Sway Star. The results with the two systems were not comparable. Sensory contribution does not remain stable throughout life. Visual information decreases with age, reaching a minimum at 40-49 years, and may correspond to the deterioration of eyesight with age. Propioceptive information showed no statistically significant changes, and several forms of treatment might correct the deterioration of this system. Vestibular information reaches a maximum in the 40-49 years age group in an attempt to compensate for visual deterioration, and decreases again in subsequent decades. This may be due to aging of the vestibular system and the difficulty in its correction.
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Mockford KA, Mazari FA, Jordan AR, Vanicek N, Chetter I, Coughlin PA. Computerized Dynamic Posturography in the Objective Assessment of Balance in Patients With Intermittent Claudication. Ann Vasc Surg 2011; 25:182-90. [DOI: 10.1016/j.avsg.2010.07.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Revised: 05/17/2010] [Accepted: 07/19/2010] [Indexed: 10/19/2022]
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Rao N, Aruin AS. Auxiliary sensory cues improve automatic postural responses in individuals with diabetic neuropathy. Neurorehabil Neural Repair 2010; 25:110-7. [PMID: 20829412 DOI: 10.1177/1545968310376760] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A loss of sensation in the lower limbs, observed in individuals with diabetes as well as elderly individuals, contributes to postural instability, altered gait patterns, increased risk of falling, and decreased quality of life. OBJECTIVE To determine if somatosensory cues delivered to sensate areas of the lower limbs above the ankle joints enhance the control of posture in individuals with peripheral neuropathy. METHODS Twelve subjects with sensory neuropathy due to diabetes participated in static and dynamic balance tests with and without auxiliary sensory cues provided to the lower limbs without stabilizing the ankle joints. During the tests the subjects were required to stand on a fixed or moving computer-controlled platform with their eyes open or closed. Equilibrium scores and response latency were obtained. RESULTS For all tests, equilibrium scores were significantly larger in experiments with auxiliary sensory cues in comparison with conditions without cues (P < .05). Smaller latency scores were recorded in conditions with auxiliary sensory information. The results indicate that auxiliary sensory cues improved automatic postural responses. CONCLUSIONS The observed enhancement of automatic postural responses has clinical implications that aid in the understanding of postural control in individuals with peripheral neuropathy. Future controlled trials could examine whether devices that provide auxiliary sensory cues can improve balance, mobility, and the performance of daily activities.
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Affiliation(s)
- Noel Rao
- Marianjoy Rehabilitation Hospital, Wheaton, IL, USA
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Ferreira ADS, Gave NDS, Abrahão F, Silva JG. Influência da morfologia de pés e joelhos no equilíbrio durante apoio bipodal. FISIOTERAPIA EM MOVIMENTO 2010. [DOI: 10.1590/s0103-51502010000200003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: A relação entre o padrão morfológico de pés/joelhos e o equilíbrio é estudada por meio de diversos modelos experimentais. Entretanto, as investigações ainda são controversas, especialmente na comparação estabilométrica dos tipos de joelho em apoio bipodal. OBJETIVO: Analisar a influência da morfologia de pés e joelhos nos parâmetros estabilométricos de indivíduos saudáveis. METODOLOGIA: Participaram 53 indivíduos hígidos (21 [39,6%] do sexo masculino, 26,9 ± 5,2 anos, 68,4 ± 17,1 kg, 1,71 ± 0,09 m). A avaliação morfológica de pés/joelhos foi realizada por meio de avaliação postural pelo método visual não quantitativo, e o resultado foi dado por dois avaliadores simultaneamente. O protocolo de estabilometria (50 segundos) avaliou as combinações de olhos abertos/fechados com base aberta/fechada. Na análise estatística foi utilizado o coeficiente de contingência para verificar associação entre os achados morfológicos. As variáveis antropométricas e estabilométricas foram analisados pela ANOVA, com significância de p < 0,05. RESULTADOS: Indivíduos com joelho varo apresentaram menor velocidade de oscilação que os classificados como joelho neutro nos protocolos de olhos abertos (joelho varo: 6,86 ± 3,04 10-2 m/s; joelho neutro: 11,61 ± 6,36 10-2 m/s; p = 0,009) e olhos fechados (joelho varo: 6,92 ± 2,77 10-2 m/s; joelho neutro: 11,38 ± 5,82 10-2 m/s; p = 0,007), ambos em base fechada. Não foram observadas diferenças significativas entre os indivíduos nas variáveis área de oscilação (elipse percentil 95) e deslocamento máximo no sentido ântero-posterior. CONCLUSÃO: A morfologia do pé não alterou significativamente a velocidade de oscilação, a área de oscilação ou o deslocamento ântero-posterior. A redução da base de suporte reduz a velocidade de oscilação em indivíduos com joelho varo.
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