Test order effects of computerized dynamic posturography and calorics

Concussion Baseline Retesting Is Necessary When Initial Scores Are Low

OBJECTIVE

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

DESIGN

Prospective, repeated-measures.

SETTING

Two years of collegiate preparticipation concussion baseline testing.

PARTICIPANTS

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

INDEPENDENT VARIABLES

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

MAIN OUTCOME MEASURES

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

RESULTS

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

CONCLUSIONS

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

Firefighter protective clothing and self contained breathing apparatus does not alter balance testing using a standard sensory organization test or motor control test in healthy, rested individuals

BACKGROUND

There is a high rate of injury associated with firefighting: in 2016, 21% of all fireground injuries were attributed to falls, jumps and slips. Examining factors related to balance, including experience in wearing firefighter gear, may assist in reducing injury related to falls.

OBJECTIVES

To assess the effects of wearing firefighter gear on postural balance in firefighters and non-firefighters in a rested condition.

METHODS

Each subject attended two sessions. In session 1, informed consent was obtained, a threshold audiogram was collected, and the sensory organization test (SOT) and motor control test (MCT) were administered with the subject dressed in street clothes. The second session was comprised of three different conditions with the order of testing randomized across subjects: street clothing, firefighter protective garments (coat, pants, helmet, hood) with breathing apparatus but no facemask, and firefighter protective garments with breathing apparatus and facemask. Twenty subjects participated: ten firefighters (8 males) and sex and age-matched non-firefighters (8 males) completed the study.

RESULTS

SOT scores were obtained for each sub-condition, including the overall performance score and sensory weightings. For the MCT, latency and amplitude data were obtained for the three forward and three reverse translation conditions. A significant difference was found for large forward surface translations in the MCT in firefighters.

CONCLUSION

In spite of the altered center of balance created by breathing apparatus and the altered visual cues created by the facemask, wearing firefighter gear did not substantively affect anterior-posterior postural stability or motor response to linear translation in rested, healthy individuals. Firefighters and non-firefighters performed similarly across all except one of the experimental conditions.

Effects of backpack and double pack loads on postural stability

Measurement of postural stability is crucial for identifying predictors of performance, determining the efficacy of physical training and rehabilitation techniques and evaluating and preventing injuries, particularly for heavy load carriage in hikers, mountain search and rescue personnel and soldiers. This study investigated the effect of load distribution on postural stability in an upright stance using backpack and double pack loads under conflicting or impaired somatosensory, visual and vestibular conditions. The sensory organisation tests were conducted on 20 young adults before and after a 10-min level walking exercise. Young adults' ability to use inputs from somatosensory and visual systems to maintain postural stability was significantly reduced following a 10-min walking exercise with a heavy backpack (30% of body weight), whereas no significant changes were observed for double pack carriage. Thus, the distribution of heavy loads to the front and back provides superior balance control compared with back-only loading. Practitioner summary: This study investigated the effects of heavy (30% of body weight) load distribution on postural stability after a 10-min walking exercise. Backpack carriage significantly reduced postural stability, whereas there was no significant effect under double pack loads. Distribution of heavy loads on the front-and-back is desirable for superior balance control.

Learning Effects and the Sensory Organization Test: Influence of a Unilateral Peripheral Vestibular Impairment

PURPOSE

Healthy young controls exhibit a learning effect after undergoing repeated administrations of the sensory organization test (SOT). The primary objective of the present experiment was to determine if an SOT learning effect is present in individuals with a unilateral vestibular impairment (UVI), and if so, whether it is different from healthy controls. The secondary objective was to determine if the learning effect is dependent on the time frame of repeated SOT assessments.

METHOD

Eleven individuals diagnosed with a UVI and 11 controls underwent 6 repetitions of the SOT over 2 visits (3 per visit all within 1 week). A second control group underwent 3 SOT repetitions, with each repetition separated by 1 week, to evaluate the time course of the SOT learning effect.

RESULTS

No statistically significant differences were found between the UVI group and the control group. In addition, the magnitude of the learning effect was found to be similar regardless of the length of time that separated the repetitions.

CONCLUSIONS

If the SOT is to be used as a measure of improvement, the learning effect should be exhausted (which typically occurs following the third administration) prior to the introduction of therapy. Future research should further investigate the results from those with other vestibular pathologies.

Balance in multiple sclerosis: relationship to central brain regions

Dizziness, postural instability, and ataxia are among the most debilitating symptoms of multiple sclerosis (MS), reflecting, in large part, dysfunctional integration of visual, somatosensory, and vestibular sensory cues. However, the role of MS-related supratentorial lesions in producing such symptoms is poorly understood. In this study, motor control test (MCT) and dynamic sensory organization test (SOT) scores of 58 MS patients were compared to those of 72 healthy controls; correlations were determined between the MS scores of 49 patients and lesion volumes within 26 brain regions. Depending upon platform excursion direction and magnitude, MCT latencies, which were longer in MS patients than controls (p < 0.0001), were correlated with lesion volumes in the cortex, medial frontal lobes, temporal lobes, and parietal opercula (r's ranging from 0.20 to 0.39). SOT test scores were also impacted by MS and correlated with lesions in these same brain regions as well as within the superior frontal lobe (r's ranging from - 0.28 to - 0.40). The strongest and most consistent correlations occurred for the most challenging tasks in which incongruent visual and proprioceptive feedback were given. This study demonstrates that supratentorial lesion volumes are associated with quantitative balance measures in MS, in accord with the concept that balance relies upon highly convergent and multimodal neural pathways involving the skin, muscles, joints, eyes, and vestibular system.

Effects of Torso-Weighting on Standing Balance and Falls During the Sensory Organization Test in People with Multiple Sclerosis

Background

In people with multiple sclerosis (MS), common gait and balance impairments can lead to falls, fear of falling, activity restriction, and social isolation. Sensory augmentation in the form of torso-weighting has resulted in improvement in gait and balance, but research on its effect on falls in MS is lacking.

Methods

60 people with MS and 10 bin-matched controls completed the Sensory Organization Test (SOT) while nonweighted and again while weighted using the Balance-Based Torso-Weighting assessment method. This was a quasi-experimental pre-post intervention study. The SOT composite scores, equilibrium scores, and number of falls occurring across six SOT conditions were compared between and within groups using 2-way analysis of variance, α = .05 with planned t test analyses of weighting effects.

Results

A significant increase in composite score of 9.14 points nonweighted to weighted occurred in the MS group (P < .001) but not in controls (P = .626). Equilibrium scores were significantly higher with weights in the MS group (P < .001) but not in controls (P = .5). Falls during the SOT were reduced by 35% with weights in the MS group versus without weights (P < .001), with the greatest number of falls occurring in the most challenging SOT conditions.

Conclusions

During a single testing session, torso-weighting produced significant improvements in postural stability and fall reduction during the SOT for people with MS but no change in controls. Further research is needed to determine whether torso-weighting has the potential to reduce falls in MS during real-world activities.

Superior short-term learning effect of visual and sensory organisation ability when sensory information is unreliable in adolescent rhythmic gymnasts

Rhythmic gymnasts specialise in dynamic balance under sensory conditions of numerous somatosensory, visual, and vestibular stimulations. This study investigated whether adolescent rhythmic gymnasts are superior to peers in Sensory Organisation test (SOT) performance, which quantifies the ability to maintain standing balance in six sensory conditions, and explored whether they plateaued faster during familiarisation with the SOT. Three and six sessions of SOTs were administered to 15 female rhythmic gymnasts (15.0 ± 1.8 years) and matched peers (15.1 ± 2.1 years), respectively. The gymnasts were superior to their peers in terms of fitness measures, and their performance was better in the SOT equilibrium score when visual information was unreliable. The SOT learning effects were shown in more challenging sensory conditions between Sessions 1 and 2 and were equivalent in both groups; however, over time, the gymnasts gained marginally significant better visual ability and relied less on visual sense when unreliable. In conclusion, adolescent rhythmic gymnasts have generally the same sensory organisation ability and learning rates as their peers. However, when visual information is unreliable, they have superior sensory organisation ability and learn faster to rely less on visual sense.

Test-retest reliability of the Sensory Organization Test in older persons with a transtibial amputation

OBJECTIVE

To determine the test-retest reliability of the Sensory Organization Test (SOT) in older persons with a unilateral transtibial amputation.

DESIGN

Cross-sectional observational study with repeated measures.

SETTING

A University balance laboratory.

PARTICIPANTS

Fifteen participants (12 men and 3 women) who had undergone a unilateral transtibial amputation that was performed as a result of either trauma or complications of diabetes or peripheral vascular disease were recruited from a patient database. The mean age of the participants was 69.53 years (SD, 6.60), with 11.94 mean years of prosthetic use.

INTERVENTION

All participants completed 3 trials of the 6 balance testing conditions in the standard SOT protocol with use of the NeuroCom SMART Equitest system on 2 occasions approximately 2 weeks apart.

MAIN OUTCOME MEASURES

Reliability of the mean equilibrium and strategy scores for the 6 SOT conditions and the overall composite score was evaluated using intraclass correlation coefficients.

RESULTS

The test-retest reliability coefficients (intraclass correlation coefficient model 2,1) for the equilibrium scores ranged from 0.67-0.90 for conditions 1 to 4 and 6, indicating fair-to-good reliability. The coefficients obtained for the strategy scores of all the conditions and the composite score showed excellent reliability (intraclass correlation coefficients >0.75).

CONCLUSIONS

This study suggests that the majority of outcome measurements associated with the SOT protocol on the SMART Equitest provide a reliable measure of dynamic balance performance in older persons with a unilateral transtibial amputation, even in the presence of comorbidities. The equilibrium, strategy, and composite scores obtained from the testing protocol with the exception of condition 5, can be used reliably in clinical practice to monitor for changes in balance with rehabilitation or to monitor the effects of a specific intervention and/or in patients with comorbidities that could potentially affect their balance capacities.