Efficacy of CDP and ENG in Detecting Balance Impairment Associated With Cerebral White Matter Changes

The effect of brace use on balance in individuals with adolescent idiopathic scoliosis

BACKGROUND

Patients with adolescent idiopathic scoliosis (AIS) have poorer standing balance compared with their healthy peers. However, the immediate effects of the braces used in the treatment on balance remain uncertain.

OBJECTIVE

To investigate the effect of brace use on balance and weight-bearing symmetry in patients with AIS and to compare the results of different brace designs.

STUDY DESIGN

Observational.

METHODS

A total of 21 patients with AIS aged 10-17 years using 10 Boston and 11 Cheneau braces participated. Immediate balance and weight-bearing symmetries of patients with and without their own braces were evaluated. Balance assessment was performed using the Sensory Organization Test (SOT) on a computerized dynamic posturography device. Weight-bearing symmetry was evaluated on the computerized dynamic posturography device with the knees in full extension, with the knees flexed at 30°, 60°, and 90°.

RESULTS

Regardless of its design, it was found that brace use had no effect on immediate balance and weight-bearing symmetry ( p > 0.05). Of the patients using a Boston brace, unbraced SOT condition 2, 3, and 5 and composite scores were found to be higher than their braced scores ( p < 0.05). Braced SOT condition 3 scores of the patients using a Cheneau brace were higher than those using a Boston brace ( p = 0.037). Brace use and brace types have no statistical effect on weight-bearing symmetry.

CONCLUSIONS

It was observed that brace use in patients with AIS has no positive effect on immediate balance and weight-bearing symmetry, and the use of Boston brace negatively affects immediate balance scores and increases visual dependence.

Association of Static Posturography With Severity of White Matter Hyperintensities

Background: Impaired gait and balance are associated with severity of leukoaraiosis. Evaluation of balance is based on neurological examination using Romberg's test with bipedal standing, assessment scale, and posturographic parameters. The goal of this study was to determine the relationship between static equilibrium and grades of white matter hyperintensities (WMHs) using static posturography as a quantitative technical method.

Method: One hundred and eighteen (118) patients with lacunar infarct were recruited and assessed on MRI with Fazekas's grading scale into four groups. On admission, age, gender, height, weight, Berg Balance Scale (BBS), mini-mental state examination (MMSE), and static posturography parameters were recorded, and their correlations with WMHs were determined.

Results: Age was significantly and positively correlated with severity of WMHs (r = 0.39, p < 0.05). WMH score was negatively correlated with BBS score (r = −0.65, p < 0.05) and MMSE score (r = −0.79, p < 0.05). There was a significant positive correlation between track length anteroposterior (AP, with eyes closed) and severity of WMHs (r = 0.70, p < 0.05). Partial correlation analysis and multiple logistic regression analysis indicated that track length AP with eyes closed, was a predictor for the severity of WMHs (p< 0.05).

Conclusion: The severity of WHMs is associated with age, cognitive decline, and impairment in balance. Posturography parameter in track length in AP direction with eyes closed in relation to cognition and balance, may be a potential marker for disease progression in WMHs.

Neuroimaging correlates of lateral postural control in older ambulatory adults

BACKGROUND

In older adults, impaired postural control contributes to falls, a major source of morbidity. Understanding central mechanisms may help identify individuals at risk for impaired postural control.

AIMS

To determine the relationship between gray matter volume (GMV), white matter hyperintensities (WMH), mean diffusivity (MD), and fractional anisotropy (FA) with lateral postural control.

METHODS

Neuroimaging and postural control were assessed in 193 community-dwelling older adults (mean age 82, 55.4% female, 44.6% black). GMV, WMH, and diffusion tensor-derived markers of microstructure (MD and FA) were quantified for total brain and regions of interest. Lateral postural control was defined as the root mean square error (RMSE) of lateral sway during a visual feedback test. Associations were assessed with linear regression, adjusted for total brain atrophy and risk factors for impaired postural control.

RESULTS

RMSE was higher for women than men (p < 0.001) and inversely correlated with gait speed (r = - 0.20, p = 0.01), modified mini-mental state (r = - 0.27, p < 0.001), digit symbol substitution test (r = - 0.20, p = 0.01) and quadriceps strength (r = - 0.18, p = 0.01). RMSE was inversely associated with GMV of bilateral precuneus (r = - 0.26, p = 0.01) and FA of corpus callosum and selected tracts in the right hemisphere (anterior thalamic radiation, cingulum, inferior longitudinal and fronto-occipital fasciculi), independent of covariates (r = - 0.34 to - 0.18, p ≤ 0.04).

DISCUSSION

Lower GMV and microstructural white matter integrity in selected networks can explain worse lateral postural control in older ambulatory adults without neurologic diseases.

CONCLUSION

Neuroimaging markers of poor postural control in healthy aging may help identify increased fall risk and design preventative fall strategies.

Assessment of vestibular function in elderly patients

PURPOSE OF REVIEW

Individuals over the age of 60 are at an increased risk of falls, even if they do not have an isolated dysfunction of the vestibular system. The aim of this article is to review the various vestibular testing currently available and its usefulness in determining the presence of vestibular dysfunction in the elderly population. The primary vestibular tests to be reviewed include: balance function testing, vestibular evoked myogenic potentials (VEMPs), and video head impulse testing (vHIT).

RECENT FINDINGS

Balance function testing is important as it evaluates the integration of vestibular information along with sensory and visual information, which may also be impaired. VEMP testing provides a small diagnostic yield as most elderly patients have absent or reduced responses. vHIT gain is reduced in this population, but will still be within the normal range for individuals with normal balance function.

SUMMARY

The combination of various vestibular tests provides complimentary information instead of redundant information on the patient's balance function. Each test evaluates various aspects of the vestibular system which are all needed to determine stable balance in the elderly population.