A head shake sensory organization test to improve the sensitivity of the sensory organization test in the elderly

Normative Values for the Head Shake Sensory Organization Test in an Active Duty Military Cohort

INTRODUCTION

The Head Shake Sensory Organization Test (HS-SOT) assesses postural stability while the head is moving and may also identify deficits in attention associated with the dual task conditions of moving the head at a specified speed while maintaining balance. Normative values for the HS-SOT have not been established in a healthy military population or other highly trained populations such as athletes. Establishing normative values in a military population will enable clinicians to compare the scores of patients with medical conditions that affect postural stability and sensory integration such as concussion or traumatic brain injury, vestibular dysfunction, or migraine to those of a healthy population to determine a need for intervention and for return to duty considerations. The purposes of this cross-sectional study were to establish normative values for the HS-SOT within the military population, to determine whether HS-SOT scores differed between men and women or among age groups, and to determine whether HS-SOT scores differed from scores on similar conditions of the Sensory Organization Test (SOT).

MATERIALS AND METHODS

Active duty service members (n = 237, 54 female) at Joint Base Lewis-McChord, Washington, Fort Campbell, Kentucky, and the National Capitol Region (Washington, D.C, Maryland, and Virginia) completed the SOT and HS-SOT on the NeuroCom® Balance Master™. Parametric and non-parametric comparisons were analyzed for the equilibrium scores for the SOT and HS-SOT conditions 2 (SOT-2, HS-SOT-2, respectively) and 5 (SOT-5, HS-SOT-5, respectively) and the equilibrium score ratios (ESRs) for HS-SOT-2 and HS-SOT-5 for the total sample, men and women, and age group categories (18-26 years, 27-35 years, and 36-45 years).

RESULTS

There were no differences in HS-SOT-2 or HS-SOT-5 equilibrium ratio scores between men (0.99 ±.029 and 0.83 ±0.25, respectively) and women (1.00 ±0.03 and 0.81 ±0.21, respectively). There were no differences in the SOT-2 equilibrium scores (F = 2.29, P = 0.10) or SOT-5 equilibrium scores (Kruskal-Wallis H = 3.26, P = 0.20) among the different age groups. SOT-2 equilibrium scores were higher than the HS-SOT-2 equilibrium scores (Z = -4.10, P < 0.001). SOT-5 equilibrium scores were also higher than HS-SOT-5 equilibrium scores (Z = -12.22, P < 0.001), and the HS-SOT-2 and HS-SOT-5 equilibrium scores differed from each other (Z = -13.26, P < 0.001).

CONCLUSIONS

This study established normative values for the HS-SOT in a military population. Equilibrium scores did not differ between men and women or among age groups, suggesting that these values can be used as reference points for most service members. Postural stability was found to be significantly challenged during head motion, indicating the HS-SOT is a valuable tool for identifying subtle impairments in postural stability. These findings have important implications for early detection and intervention in individuals with medical conditions affecting balance, particularly concussions or vestibular disorders.

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

Background

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

Purpose

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

Study Design

Cross-sectional study.

Methods

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

Results

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

Conclusion

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

Level of Evidence

3.

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

BACKGROUND

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

RESEARCH QUESTION

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

METHODS

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

RESULTS

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

SIGNIFICANCE

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

Test-Retest Reliability of Postural Control Assessment on Biodex BioSway™

Background

Recent protocols for posturographic assessment of postural control and balance have included head shake test conditions to challenge the vestibular contributions of postural control in an effort to increase the diagnostic accuracy of identifying individuals with impaired balance. However, evidence is limited regarding the test-retest reliability of such assessment protocols.

Purpose

The purpose of this study was twofold: to determine the test-retest reliability of postural control assessment on the Biodex Biosway™, an accessible and field expedient tool for posturographic assessment, and to determine the test-retest reliability of the Head Shake Sensory Interaction and Balance Test (HS-SIB), an adaptation of the modified Clinical Test of Sensory Interaction and Balance (mCTSIB) which adds two head shake conditions to challenge the vestibular contributions to postural control. Study Design. This was a correlational time series cohort study completed in a biomechanics laboratory.

Methods

The sample consisted of nineteen healthy adults (10 females, 9 males). Sway Index, Equilibrium Score, and the area of the ellipse enclosing 95% of the anterior-posterior (AP) and medial-lateral (ML) center of gravity (COG) displacement (AREA₉₅) are the 3 summary variables. Standard Error of Measurement (SEM) and Minimum Detectable Change (MDC) are also reported.

Results

Test-retest reliability was generally poor with limited exceptions. Moderate to good reliability was observed for the more challenging stance conditions (ICC range 0.58-0.81), including those with head shake.

Conclusions

Field-expedient systems, such as the Biodex BioSway™, may offer reliable posturographic testing where gold-standard methods are not available. Clinicians should be aware that less demanding test conditions have limited reliability; however, test-retest reliability of this assessment tool is improved with more challenged stance conditions and the inclusion of a head shake task.

Posturography with head movements in the assessment of balance in chronic unilateral vestibular lesions

The aim of our study was to validate the method of head-shake static posturography (HS-posturography) in healthy individuals and to establish the value of this novel method in the diagnostics of patients with unilateral vestibular lesion (UV). The study included 202 participants divided into two groups, one consisting of 133 patients with canal paresis CP > 19% and one of 69 healthy subjects. Participant was tested according to the standard protocol of static posturography (SP), and with head movements of 0.3 Hz (HS 40), 0.6 Hz (HS 70) in random order controlled by a metronome. HS-posturography revealed a similar repeatability and internal consistency as the standard posturography. In patients with UV, 4th condition revealed higher sensitivity (74%) and specificity (71%) in HS 40 than in the standard posturography (67%, 65% respectively) and HS 70 (54%, 70% respectively). Static posturography and HS- posturography revealed a high reliability of the testing method. The head movements added to static posturography improve the sensitivity and specificity of the method in group with vestibular impairment. The most important test for that purpose seems to be the one on unstable surface with the eyes closed, with low frequency of head movements.

Measuring Vestibular Contributions to Age-Related Balance Impairment: A Review

Aging is associated with progressive declines in both the vestibular and human balance systems. While vestibular lesions certainly contribute to imbalance, the specific contributions of age-related vestibular declines to age-related balance impairment is poorly understood. This gap in knowledge results from the absence of a standardized method for measuring age-related changes to the vestibular balance pathways. The purpose of this manuscript is to provide an overview of the existing body of literature as it pertains to the methods currently used to infer vestibular contributions to age-related imbalance.

Clinical significance of head shake movement in three planes in individuals with dizziness

PURPOSE

This study aims to evaluate the efficacy of head shake movement on three head movement planes (yaw, pitch and, roll) in patients with dizziness despite normal vestibular test results.

MATERIALS AND METHODS

Twenty individuals aged between 20 and 51 years with complaints of dizziness were included in the study, and their results were compared with the results from twenty age- and gender-matched controls. Participants were assessed using the Sensory Organization Test, Head Shake-Sensory Organization Test which is based on the modification of the Sensory Organization Test on the yaw, pitch, and roll planes, videonystagmography, caloric test, and Dizziness Handicap Inventory.

RESULTS

Significant differences were found in the yaw (p = 0.007), pitch (p < 0.001), and roll (p = 0.002) planes between the study and control groups of the Head Shake-Sensory Organization Test-5 scores. There were no statistically significant differences between the two groups of the Head Shake-Sensory Organization Test-2 scores in the yaw (p = 0.448), pitch (p = 0.213), and roll (p = 0.531) planes. When the sensitivity and specificity of Head Shake-Sensory Organization Test-5 conditions were examined, the highest specificity was observed in the pitch plane (100%), followed by the yaw (95%) and roll plane (95%).

CONCLUSION

Dynamic head movements are an important parameter for the evaluation of balance performance. The head shake modification could be used effectively in three-movement planes in individuals with dizziness.

A review on screening tests for vestibular disorders

Although many studies have reported on tests of the vestibular system a valid and reliable, evidence-based screening battery for easy clinical use remains elusive. Many screening tests attempt to assess the vestibulo-ocular reflex. Therefore, head shaking, the Dix-Hallpike maneuver, the supine roll test, and head impulse tests are discussed. Other tests address the spatial orientation functions of the vestibular system, such as the Bucket Test and the Fukuda Stepping test. Still, other tests are based on the known correlates with balance skills, both static and dynamic, such as tandem walking and the modern variation of the Romberg test, the modified Clinical Test of Sensory Interaction and Balance. This review provides a critical overview of the literature on some of these tests and their value for clinical use and in epidemiological studies.

Unique approach to sensorimotor training with a new device combining air cushion with stochastic translations-A prospective randomized controlled clinical trial

Sensorimotor training with a wide variety of available devices represents an important component in rehabilitation and prevention of different sports injuries and chronic diseases. The purpose of this study was to evaluate the effects of a sensorimotor training with a newly developed device, which consists of an instable platform moving on an air cushion, providing dynamic balance training by tilting and unanticipated stochastic translations on postural control. Seventy-two healthy young subjects were included in this prospective, randomized, controlled, and observer-blinded study. Balance was objectively assessed by posturography and Functional Reach Test (FRT). Additionally we evaluated the subjective rating of balance. After randomization the sensorimotor training group performed a training program on the new device over a 5-6 week study period. After this time improvement in objective and subjective measurements as a result of training became evident. A significant difference in challenging posturographic parameters (Sensory Organization Test 5: training group 5.32±5.25 vs. control group 1.78±5.05, p=0.006 and Head Shake Sensory Organization Test 5: training group 11.94±8.97 vs. control group 5.41±10.17, p=0.01) as well as a significant difference in the FRT (training group 3.34±3.35cm vs. control group 0.01±2.97cm, p=0.0001) was found. Subjective assessment revealed a significant improvement in the participants' rating of balance and alteration of balance. Subjects showed a high satisfaction with the new training device. Our findings suggest that the newly developed device could be a promising option for sensorimotor training to improve postural control.

Evaluation of uncompensated unilateral vestibulopathy using the modified clinical test for sensory interaction and balance

OBJECTIVE

To compare the results of the Modified Clinical Test for Sensory Interaction and Balance (mCTSIB) and the Sensory Organization Test (SOT) of computerized dynamic posturography (CDP) to better understand the role and limitations of the mCTSIB in the diagnosis and rehabilitation of patients with uncompensated unilateral vestibulopathy.

STUDY DESIGN

Prospective blind study.

SETTING

Tertiary referral center.

INTERVENTIONS

Ninety-eight patients with uncompensated unilateral vestibulopathy were enrolled. After diagnosis was established through ocular motor studies, head roll and Dix-Hallpike tests, caloric testing, and pure tone audiometry, the mCTSIB and SOT were administered simultaneously.

MAIN OUTCOME MEASURE

Composite or comprehensive scores and equilibrium scores.

RESULTS

When composite or comprehensive scores were used to classify subjects as normal or abnormal, the mCTSIB and SOT showed significant agreement (p > 0.256). SOT condition 2 (eyes closed on a firm surface) showed a greater degree of correlation than did other conditions; the foam-surface or eyes-open conditions yielded poor correlation coefficients.

CONCLUSION

The mCTSIB can be used instead of the SOT in screening to distinguish normality from abnormality in dizzy patients with unilateral vestibulopathy. However, the degree of dizziness assessed by SOT condition was poorly correlated with mCTSIB results, especially in conditions with the eyes open and those using a foam surface.