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Johansson R, Jensen L, Barnett CT, Rusaw DF. Quantitative methods used to evaluate balance, postural control, and the fear of falling in lower limb prosthesis users: A systematic review. Prosthet Orthot Int 2023; 47:586-598. [PMID: 37318276 DOI: 10.1097/pxr.0000000000000250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 04/23/2023] [Indexed: 06/16/2023]
Abstract
Problems with balance, postural control, and fear of falling are highly prevalent in lower limb prosthesis users, with much research conducted to understand these issues. The variety of tools used to assess these concepts presents a challenge when interpreting research outcomes. This systematic review aimed to provide a synthesis of quantifiable methods used in the evaluation of balance, postural control, and fear of falling in lower limb prosthesis users with an amputation level at or proximal to the ankle joint. A systematic search was conducted in CINAHL, Medline, AMED, Cochrane, AgeLine, Scopus, Web of Science, Proquest, PsycINFO, PsycArticles, and PubPsych databases followed by additional manual searching via reference lists in the reviewed articles databases. Included articles used quantitative measure of balance or postural control as one of the dependent variables, lower limb prosthesis users as a sample group, and were published in a peer-reviewed journal in English. Relevant assessment questions were created by the investigators to rate the assessment methods used in the individual studies. Descriptive and summary statistics are used to synthesize the results. The search yielded (n = 187) articles assessing balance or postural control (n = 5487 persons in total) and (n = 66) articles assessing fear of falling or balance confidence (n = 7325 persons in total). The most used test to measure balance was the Berg Balance Scale and the most used test to measure fear of falling was the Activities-specific Balance Confidence scale. A large number of studies did not present if the chosen methods were valid and reliable for the lower limb prosthesis users. Among study limitations, small sample size was common.
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Affiliation(s)
- Robin Johansson
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Louise Jensen
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Southern Älvsborg Hospital, Borås, Sweden
| | - Cleveland T Barnett
- School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - David F Rusaw
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Monaco A, Cattaneo R, Di Nicolantonio S, Strada M, Altamura S, Ortu E. Central effects of trigeminal electrical stimulation. Cranio 2023:1-24. [PMID: 38032105 DOI: 10.1080/08869634.2023.2280153] [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: 12/01/2023]
Abstract
This is a review of the literature on the main neuromodulation techniques, focusing on the possibility of introducing sensory threshold ULFTENS into them. Electro neuromodulation techniques have been in use for many years as promising methods of therapy for cognitive and emotional disorders. One of the most widely used forms of stimulation for orofacial pain is transcutaneous trigeminal stimulation on three levels: supraorbital area, dorsal surface of the tongue, and anterior skin area of the tragus. The purpose of this review is to trigger interest on using dental ULFTENS as an additional trigeminal neurostimulation and neuromodulation technique in the context of TMD. In particular, we point out the possibility of using ULFTENS at a lower activation level than that required to trigger a muscle contraction that is capable of triggering effects at the level of the autonomic nervous system, with extreme ease of execution and few side effects.
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Affiliation(s)
- Annalisa Monaco
- MeSVA Department, Dental Unit, University of L'Aquila, L'Aquila, Italy
| | - Ruggero Cattaneo
- MeSVA Department, Dental Unit, University of L'Aquila, L'Aquila, Italy
| | | | - Marco Strada
- MeSVA Department, Dental Unit, University of L'Aquila, L'Aquila, Italy
| | - Serena Altamura
- MeSVA Department, Dental Unit, University of L'Aquila, L'Aquila, Italy
| | - Eleonora Ortu
- MeSVA Department, Dental Unit, University of L'Aquila, L'Aquila, Italy
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Kirby ED, Jones CB, Fickling SD, Pawlowski G, Brodie SM, Boyd LA, Venter J, Moser N, Kalsi-Ryan S, Medvedev G, D’Arcy RCN. Real world evidence of improved attention and cognition during physical therapy paired with neuromodulation: a brain vital signs study. Front Hum Neurosci 2023; 17:1209480. [PMID: 37362950 PMCID: PMC10289164 DOI: 10.3389/fnhum.2023.1209480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
Background Non-invasive neuromodulation using translingual neurostimulation (TLNS) has been shown to advance rehabilitation outcomes, particularly when paired with physical therapy (PT). Together with motor gains, patient-reported observations of incidental improvements in cognitive function have been noted. Both studies in healthy individuals and case reports in clinical populations have linked TLNS to improvements in attention-related cognitive processes. We investigated if the use of combined TLNS/PT would translate to changes in objective neurophysiological cognitive measures in a real-world clinical sample of patients from two separate rehabilitation clinics. Methods Brain vital signs were derived from event-related potentials (ERPs), specifically auditory sensation (N100), basic attention (P300), and cognitive processing (N400). Additional analyses explored the attention-related N200 response given prior evidence of attention effects from TLNS/PT. The real-world patient sample included a diverse clinical group spanning from mild-to-moderate traumatic brain injury (TBI), stroke, Multiple Sclerosis (MS), Parkinson's Disease (PD), and other neurological conditions. Patient data were also acquired from a standard clinical measure of cognition for comparison. Results Results showed significant N100 variation between baseline and endpoint following TLNS/PT treatment, with further examination showing condition-specific significant improvements in attention processing (i.e., N100 and N200). Additionally, CogBAT composite scores increased significantly from baseline to endpoint. Discussion The current study highlighted real-world neuromodulation improvements in neurophysiological correlates of attention. Overall, the real-world findings support the concept of neuromodulation-related improvements extending beyond physical therapy to include potential attention benefits for cognitive rehabilitation.
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Affiliation(s)
- Eric D. Kirby
- BrainNet, Faculty of Applied Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Christina B. Jones
- Centre for Neurology Studies, HealthTech Connex, Vancouver, BC, Canada
- Brain Behaviour Laboratory, Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Shaun D. Fickling
- BrainNet, Faculty of Applied Sciences, Simon Fraser University, Vancouver, BC, Canada
- Centre for Neurology Studies, HealthTech Connex, Vancouver, BC, Canada
| | | | - Sonia M. Brodie
- Centre for Neurology Studies, HealthTech Connex, Vancouver, BC, Canada
| | - Lara A. Boyd
- Brain Behaviour Laboratory, Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Jan Venter
- Centre for Neurology Studies, HealthTech Connex, Vancouver, BC, Canada
- Healthcode, Vancouver, BC, Canada
| | - Nicholas Moser
- KITE Research Institute-UHN, Toronto, ON, Canada
- Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Sukhvinder Kalsi-Ryan
- KITE Research Institute-UHN, Toronto, ON, Canada
- Department of Physical Therapy, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - George Medvedev
- Royal Columbian Hospital, Fraser Health, Vancouver, BC, Canada
| | - Ryan C. N. D’Arcy
- BrainNet, Faculty of Applied Sciences, Simon Fraser University, Vancouver, BC, Canada
- Centre for Neurology Studies, HealthTech Connex, Vancouver, BC, Canada
- DM Centre for Brain Health, Department of Radiology, The University of British Columbia, Vancouver, BC, Canada
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Fujimoto C, Kawahara T, Kinoshita M, Ichijo K, Oka M, Kamogashira T, Sugasawa K, Yamasoba T, Iwasaki S. Minimally important differences for subjective improvement in postural stability in patients with bilateral vestibulopathy. Neurosci Lett 2021; 747:135706. [PMID: 33548406 DOI: 10.1016/j.neulet.2021.135706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/24/2021] [Accepted: 01/29/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine minimally important differences (MIDs) for subjective improvement in postural stability after a therapeutic intervention in patients with bilateral vestibulopathy (BVP). METHODS Thirteen BVP patients received noisy galvanic vestibular stimulation (nGVS) for 30 min and their static posture with eyes closed was monitored after the stimuli. The velocity of the center of pressure (COP) movement, the area enclosed by the COP movement, and the root mean square (RMS) of the displacement of the COP were measured for 30 s. Subjective evaluation of postural stability after nGVS was graded as worsened, slightly worsened, unchanged, slightly improved and improved in comparison with postural stability measured without nGVS. Anchor-based methods were used to estimate MIDs for subjective improvement. Velocity, area and RMS for each anchor-response group were averaged (2 sessions, each with 5 measurement periods during 3 h after the stimuli). The mean changes between the slightly improved group and unchanged group were used as estimates for MID for improvement. RESULTS A total of 129 anchors were analyzed. Subjective evaluations numbered 83 (64%) for unchanged and 33 (26%) for slightly improved. Anchor-based methods yielded estimates for MIDs of -0.43 cm/s in velocity improvement (p < 0.01), -0.77 cm2 for area improvement (p < 0.01) and -0.23 cm for RMS improvement (p < 0.001). CONCLUSION The present study provides the estimation of MIDs for improving postural stability in BVP patients and may be useful for interpreting whether the results from clinical trials are meaningful in future studies.
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Affiliation(s)
- Chisato Fujimoto
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Takuya Kawahara
- Clinical Research Promotion Center, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Makoto Kinoshita
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Kentaro Ichijo
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Mineko Oka
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Teru Kamogashira
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Keiko Sugasawa
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Shinichi Iwasaki
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan; Department of Otolaryngology, Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences and Medical School, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
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Adair D, Truong D, Esmaeilpour Z, Gebodh N, Borges H, Ho L, Bremner JD, Badran BW, Napadow V, Clark VP, Bikson M. Electrical stimulation of cranial nerves in cognition and disease. Brain Stimul 2020; 13:717-750. [PMID: 32289703 PMCID: PMC7196013 DOI: 10.1016/j.brs.2020.02.019] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 02/13/2020] [Accepted: 02/17/2020] [Indexed: 02/06/2023] Open
Abstract
The cranial nerves are the pathways through which environmental information (sensation) is directly communicated to the brain, leading to perception, and giving rise to higher cognition. Because cranial nerves determine and modulate brain function, invasive and non-invasive cranial nerve electrical stimulation methods have applications in the clinical, behavioral, and cognitive domains. Among other neuromodulation approaches such as peripheral, transcranial and deep brain stimulation, cranial nerve stimulation is unique in allowing axon pathway-specific engagement of brain circuits, including thalamo-cortical networks. In this review we amalgamate relevant knowledge of 1) cranial nerve anatomy and biophysics; 2) evidence of the modulatory effects of cranial nerves on cognition; 3) clinical and behavioral outcomes of cranial nerve stimulation; and 4) biomarkers of nerve target engagement including physiology, electroencephalography, neuroimaging, and behavioral metrics. Existing non-invasive stimulation methods cannot feasibly activate the axons of only individual cranial nerves. Even with invasive stimulation methods, selective targeting of one nerve fiber type requires nuance since each nerve is composed of functionally distinct axon-types that differentially branch and can anastomose onto other nerves. None-the-less, precisely controlling stimulation parameters can aid in affecting distinct sets of axons, thus supporting specific actions on cognition and behavior. To this end, a rubric for reproducible dose-response stimulation parameters is defined here. Given that afferent cranial nerve axons project directly to the brain, targeting structures (e.g. thalamus, cortex) that are critical nodes in higher order brain networks, potent effects on cognition are plausible. We propose an intervention design framework based on driving cranial nerve pathways in targeted brain circuits, which are in turn linked to specific higher cognitive processes. State-of-the-art current flow models that are used to explain and design cranial-nerve-activating stimulation technology require multi-scale detail that includes: gross anatomy; skull foramina and superficial tissue layers; and precise nerve morphology. Detailed simulations also predict that some non-invasive electrical or magnetic stimulation approaches that do not intend to modulate cranial nerves per se, such as transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS), may also modulate activity of specific cranial nerves. Much prior cranial nerve stimulation work was conceptually limited to the production of sensory perception, with individual titration of intensity based on the level of perception and tolerability. However, disregarding sensory emulation allows consideration of temporal stimulation patterns (axon recruitment) that modulate the tone of cortical networks independent of sensory cortices, without necessarily titrating perception. For example, leveraging the role of the thalamus as a gatekeeper for information to the cerebral cortex, preventing or enhancing the passage of specific information depending on the behavioral state. We show that properly parameterized computational models at multiple scales are needed to rationally optimize neuromodulation that target sets of cranial nerves, determining which and how specific brain circuitries are modulated, which can in turn influence cognition in a designed manner.
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Affiliation(s)
- Devin Adair
- Department of Biomedical Engineering, City College of New York, New York, NY, USA
| | - Dennis Truong
- Department of Biomedical Engineering, City College of New York, New York, NY, USA
| | - Zeinab Esmaeilpour
- Department of Biomedical Engineering, City College of New York, New York, NY, USA.
| | - Nigel Gebodh
- Department of Biomedical Engineering, City College of New York, New York, NY, USA
| | - Helen Borges
- Department of Biomedical Engineering, City College of New York, New York, NY, USA
| | - Libby Ho
- Department of Biomedical Engineering, City College of New York, New York, NY, USA
| | - J Douglas Bremner
- Department of Psychiatry & Behavioral Sciences and Radiology, Emory University School of Medicine, Atlanta, GA, USA; Atlanta VA Medical Center, Decatur, GA, USA
| | - Bashar W Badran
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Vitaly Napadow
- Martinos Center for Biomedical Imaging, Department of Radiology, MGH, Harvard medical school, Boston, MA, USA
| | - Vincent P Clark
- Psychology Clinical Neuroscience Center, Dept. Psychology, MSC03-2220, University of New Mexico, Albuquerque, NM, 87131, USA; Department of Psychology, University of New Mexico, Albuquerque, NM, 87131, USA; The Mind Research Network of the Lovelace Biomedical Research Institute, 1101 Yale Blvd. NE, Albuquerque, NM, 87106, USA
| | - Marom Bikson
- Department of Biomedical Engineering, City College of New York, New York, NY, USA.
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Bao T, Klatt BN, Carender WJ, Kinnaird C, Alsubaie S, Whitney SL, Sienko KH. Effects of long-term vestibular rehabilitation therapy with vibrotactile sensory augmentation for people with unilateral vestibular disorders – A randomized preliminary study. J Vestib Res 2020; 29:323-334. [PMID: 31609716 PMCID: PMC9249282 DOI: 10.3233/ves-190683] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVE: This pilot study aimed to investigate the effects of incorporating vibrotactile sensory augmentation (SA) on balance performance among people with unilateral vestibular disorders (UVD). METHODS: Eight participants with UVD were recruited. Participants completed 18 balance training sessions across six weeks in a clinical setting. Four participants (68.1±7.5 yrs) were randomized to the experimental group (EG) and received trunk-based vibrotactile SA while performing the balance exercises, and four participants (63.1±11.3 yrs) were assigned to the control group (CG); CG participants completed the balance training without SA. Clinical and kinematic balance performance measures were collected before training; midway through training; and one week, one month, and six months after training. RESULTS: All participants, regardless of group, demonstrated improvements in a subset of the clinical or balance metrics immediately following completion of the balance training protocol. The EG showed significantly greater improvements than the CG for the Activities-specific Balance Confidence Scale and postural stability during the two standing balance exercises with head movements. The EG also had larger improvements than the CG for the Sensory Organization Test (SOT), Mini Balance Evaluations Systems Test, Gait Speed Test, Dynamic Gait Index, Functional Gait Assessment, and vestibular reliance metric calculated based on the SOT. CONCLUSIONS: Incorporating vibrotactile SA into vestibular rehabilitation programs may lead to additional benefits that may be retained up to six months after training compared to training without vibrotactile SA. A larger study is warranted to demonstrate statistical significance between the groups.
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Affiliation(s)
- Tian Bao
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Brooke N. Klatt
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Wendy J. Carender
- Otolaryngology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Catherine Kinnaird
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Saud Alsubaie
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Therapy and Health Rehabilitation, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Susan L. Whitney
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Otolaryngology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kathleen H. Sienko
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA
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Fujimoto C, Yagi M, Murofushi T. Recent advances in idiopathic bilateral vestibulopathy: a literature review. Orphanet J Rare Dis 2019; 14:202. [PMID: 31426838 PMCID: PMC6701126 DOI: 10.1186/s13023-019-1180-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/14/2019] [Indexed: 11/10/2022] Open
Abstract
Background Idiopathic bilateral vestibulopathy (IBV) is an acquired bilateral peripheral vestibular dysfunction of unknown etiology, with persistent unsteadiness but without sensorineural hearing loss (SNHL) other than age-related hearing loss (ARHL). Main text The prevalence of IBV is unknown. The most common symptom is persistent unsteadiness, particularly in darkness and/or on uneven ground. The other main symptom is oscillopsia during head and body movements. IBV is neither associated with SNHL, except for ARHL, nor any other neurological dysfunction that causes balance disorders. The clinical time course of IBV can generally be divided into two main types: progressive type and sequential type. The progressive type involves gradually progressive persistent unsteadiness without episodes of vertigo. The sequential type involves recurrent vertigo attacks accompanied by persistent unsteadiness. Originally, IBV was found to exhibit bilateral dysfunction in the lateral semicircular canals (LSCCs) and the superior vestibular nerve (SVN) system. However, recently, with the development of more sophisticated vestibular function tests of the otolith organs and vertical semicircular canals, it has been revealed that IBV involves peripheral vestibular lesions other than those already identified in the LSCC and the SVN system. Furthermore, novel subtypes of IBV that do not involve bilateral dysfunction of the LSCC and/or the SVN system have been proposed. Therapeutically, exercise-based vestibular rehabilitation in adult bilateral vestibulopathy (BVP) patients has resulted in improved gaze and postural stability moderately. There are several technical approaches for the treatment of BVP such as vestibular implants, sensory substitution devices and noisy galvanic vestibular stimulation. Conclusions Combined use of various vestibular function tests, including recently developed tests, revealed the diversity of lesion sites in IBV. Further studies are required to determine the therapeutic effects of the technical approaches on IBV.
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Affiliation(s)
- Chisato Fujimoto
- Department of Otolaryngology, Tokyo Teishin Hospital, 2-14-23, Fujimi, Chiyoda-ku, Tokyo, 102-8798, Japan. .,Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Masato Yagi
- Department of Otolaryngology, Tokyo Teishin Hospital, 2-14-23, Fujimi, Chiyoda-ku, Tokyo, 102-8798, Japan
| | - Toshihisa Murofushi
- Department of Otolaryngology, Tokyo Teishin Hospital, 2-14-23, Fujimi, Chiyoda-ku, Tokyo, 102-8798, Japan.,Department of Otolaryngology, Teikyo University School of Medicine Mizonokuchi Hospital 5-1-1, Futako, Takatsu-ku, Kawasaki, Kanagawa, 213-8507, Japan
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8
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Sienko KH, Seidler RD, Carender WJ, Goodworth AD, Whitney SL, Peterka RJ. Potential Mechanisms of Sensory Augmentation Systems on Human Balance Control. Front Neurol 2018; 9:944. [PMID: 30483209 PMCID: PMC6240674 DOI: 10.3389/fneur.2018.00944] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/22/2018] [Indexed: 12/30/2022] Open
Abstract
Numerous studies have demonstrated the real-time use of visual, vibrotactile, auditory, and multimodal sensory augmentation technologies for reducing postural sway during static tasks and improving balance during dynamic tasks. The mechanism by which sensory augmentation information is processed and used by the CNS is not well understood. The dominant hypothesis, which has not been supported by rigorous experimental evidence, posits that observed reductions in postural sway are due to sensory reweighting: feedback of body motion provides the CNS with a correlate to the inputs from its intact sensory channels (e.g., vision, proprioception), so individuals receiving sensory augmentation learn to increasingly depend on these intact systems. Other possible mechanisms for observed postural sway reductions include: cognition (processing of sensory augmentation information is solely cognitive with no selective adjustment of sensory weights by the CNS), “sixth” sense (CNS interprets sensory augmentation information as a new and distinct sensory channel), context-specific adaptation (new sensorimotor program is developed through repeated interaction with the device and accessible only when the device is used), and combined volitional and non-volitional responses. This critical review summarizes the reported sensory augmentation findings spanning postural control models, clinical rehabilitation, laboratory-based real-time usage, and neuroimaging to critically evaluate each of the aforementioned mechanistic theories. Cognition and sensory re-weighting are identified as two mechanisms supported by the existing literature.
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Affiliation(s)
- Kathleen H Sienko
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Rachael D Seidler
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Wendy J Carender
- Michigan Balance Vestibular Testing and Rehabilitation, Department of Otolaryngology, Michigan Medicine, Ann Arbor, MI, United States
| | - Adam D Goodworth
- Department of Rehabilitation Sciences, University of Hartford, Hartford, CT, United States
| | - Susan L Whitney
- Departments of Physical Therapy and Otolaryngology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Robert J Peterka
- Department of Neurology, Oregon Health & Science University and National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, OR, United States
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9
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Lucieer F, Duijn S, Van Rompaey V, Pérez Fornos A, Guinand N, Guyot JP, Kingma H, van de Berg R. Full Spectrum of Reported Symptoms of Bilateral Vestibulopathy Needs Further Investigation-A Systematic Review. Front Neurol 2018; 9:352. [PMID: 29915554 PMCID: PMC5994412 DOI: 10.3389/fneur.2018.00352] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/01/2018] [Indexed: 12/16/2022] Open
Abstract
Objective To systematically review the symptoms reported by patients with bilateral vestibulopathy (BV) in clinical studies and case reports. This would serve as the first step in establishing a validated patient-reported outcome measures (PROM) for BV. Methods A search on symptoms reported by patients with BV was performed in PubMed, and all publications covering these symptoms were included. Exclusion criteria comprised reviews and insufficient details about the frequency of occurrence of symptoms. Results 1,442 articles were retrieved. 88 studies were included (41 clinical studies, 47 case reports). In consensus, 68 descriptions of symptoms were classified into 6 common and generic symptoms. Frequency of symptoms in clinical studies and case reports were reviewed, respectively; imbalance (91 and 86%), chronic dizziness (58 and 62%), oscillopsia (50 and 70%), and recurrent vertigo (33 and 67%). BV could be accompanied by hearing loss (33 and 43%) and tinnitus (15 and 36%). 15 clinical studies and 10 case reports reported symptoms beyond vestibular and hearing deficits such as limited social activities, depression, concentration, and memory impairment and reduced quality of life in general. Conclusion The literature on BV symptomatology mainly focuses on classic symptoms such as imbalance and oscillopsia, while only few report additional symptoms such as cognitive memory impairment and performing dual tasks. In fact, none of the reviewed clinical studies and case reports provided a comprehensive overview of BV symptoms. To develop a validated PROM, qualitative research using semi-structured and unstructured interviews is needed to explore the full spectrum of BV symptoms.
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Affiliation(s)
- Florence Lucieer
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, Netherlands
| | - Stijn Duijn
- Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, Netherlands
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Angelica Pérez Fornos
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Nils Guinand
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Jean Philippe Guyot
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Herman Kingma
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, Netherlands.,Faculty of Physics, Tomsk State Research University, Tomsk, Russia
| | - Raymond van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, Netherlands.,Faculty of Physics, Tomsk State Research University, Tomsk, Russia
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10
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Sienko KH, Whitney SL, Carender WJ, Wall C. The role of sensory augmentation for people with vestibular deficits: Real-time balance aid and/or rehabilitation device? J Vestib Res 2018; 27:63-76. [PMID: 28387692 DOI: 10.3233/ves-170606] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This narrative review highlights findings from the sensory augmentation field for people with vestibular deficits and addresses the outstanding questions that are critical to the translation of this technology into clinical and/or personal use. Prior research has demonstrated that the real-time use of visual, vibrotactile, auditory, and multimodal sensory augmentation technologies can improve balance during static and dynamic stance tasks within a laboratory setting. However, its application in improving gait requires additional investigation, as does its efficacy as a rehabilitation device for people with vestibular deficits. In some locomotor studies involving sensory augmentation, gait velocity decreased and secondary task performance worsened, and subjects negatively altered their segmental control strategies when cues were provided following short training sessions. A further question is whether the retention and/or carry-over effects of training with a sensory augmentation technology exceed the retention and/or carry-over effects of training alone, thereby supporting its use as a rehabilitation device. Preliminary results suggest that there are short-term improvements in balance performance following a small number of training sessions with a sensory augmentation device. Long-term clinical and home-based controlled training studies are needed. It is hypothesized that sensory augmentation provides people with vestibular deficits with additional sensory input to promote central compensation during a specific exercise/activity; however, research is needed to substantiate this theory. Major obstacles standing in the way of its use for these critical applications include determining exercise/activity specific feedback parameters and dosage strategies. This paper summarizes the reported findings that support sensory augmentation as a balance aid and rehabilitation device, but does not critically examine efficacy or the quality of the research methods used in the reviewed studies.
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Affiliation(s)
- K H Sienko
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - S L Whitney
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA.,Rehabilitation Research Chair, Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - W J Carender
- Department of Otolaryngology, University of Michigan Health System, Ann Arbor, MI, USA
| | - C Wall
- Jenks Vestibular Diagnostic Laboratory, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.,Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA
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Improving training for sensory augmentation using the science of expertise. Neurosci Biobehav Rev 2016; 68:234-244. [PMID: 27264831 DOI: 10.1016/j.neubiorev.2016.05.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 05/04/2016] [Accepted: 05/23/2016] [Indexed: 11/20/2022]
Abstract
Sensory substitution and augmentation devices (SSADs) allow users to perceive information about their environment that is usually beyond their sensory capabilities. Despite an extensive history, SSADs are arguably not used to their fullest, both as assistive technology for people with sensory impairment or as research tools in the psychology and neuroscience of sensory perception. Studies of the non-use of other assistive technologies suggest one factor is the balance of benefits gained against the costs incurred. We argue that improving the learning experience would improve this balance, suggest three ways in which it can be improved by leveraging existing cognitive science findings on expertise and skill development, and acknowledge limitations and relevant concerns. We encourage the systematic evaluation of learning programs, and suggest that a more effective learning process for SSADs could reduce the barrier to uptake and allow users to reach higher levels of overall capacity.
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Deveze A, Bernard-Demanze L, Xavier F, Lavieille JP, Elziere M. Vestibular compensation and vestibular rehabilitation. Current concepts and new trends. Neurophysiol Clin 2014; 44:49-57. [DOI: 10.1016/j.neucli.2013.10.138] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 10/18/2013] [Accepted: 10/18/2013] [Indexed: 10/26/2022] Open
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Ghulyan-Bedikian V, Paolino M, Paolino F. Short-term retention effect of rehabilitation using head position-based electrotactile feedback to the tongue: influence of vestibular loss and old-age. Gait Posture 2013; 38:777-83. [PMID: 23623605 DOI: 10.1016/j.gaitpost.2013.03.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 02/15/2013] [Accepted: 03/23/2013] [Indexed: 02/02/2023]
Abstract
Our objective was to evaluate whether the severity of vestibular loss and old-age (>65) affect a patient's ability to benefit from training using head-position based, tongue-placed electrotactile feedback. Seventy-one chronic dizzy patients, who had reached a plateau with their conventional rehabilitation, followed six 1-h training sessions during 4 consecutive days (once on days 1 and 4, twice on days 2 and 3). They presented bilateral vestibular areflexia (BVA), bilateral vestibular losses (BVL), unilateral vestibular areflexia or unilateral vestibular losses and were divided into two age-subgroups (≤65 and >65). Posturographic assessments were performed without the device, 4h before and after the training. Patients were tested with eyes opened and eyes closed (EC) on static and dynamic (passively tilting) platforms. The studied posturographic scores improved significantly, especially under test conditions restricting either visual or somatosensory input. This 4-h retention effect was greater in older compared to younger patients and was proportional to the degree of vestibular loss, patients with increased vestibular losses showing greater improvements. In bilateral patients, who constantly fell under dynamic-EC condition at the baseline, the therapy effect was expressed by disappearance of falls in BVL and significant prolongation in time-to-fall in BVA subgroups. Globally, our data showed that short training with head-position based, tongue-placed electrotactile biofeedback improves balance in chronic vestibulopathic patients some 16.74% beyond that achieved with standard balance physiotherapy. Further studies with longer use of this biofeedback are needed to investigate whether this approach could have long-lasting retention effect on balance and quality of life.
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Affiliation(s)
- Vénéra Ghulyan-Bedikian
- Hôpital Privé Clairval, Explorations Oto-Neurologiques et Réhabilitation des Troubles de l'Equilibre, Marseille, France.
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Badke MB, Sherman J, Boyne P, Page S, Dunning K. Tongue-based biofeedback for balance in stroke: results of an 8-week pilot study. Arch Phys Med Rehabil 2011; 92:1364-70. [PMID: 21878206 DOI: 10.1016/j.apmr.2011.03.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 03/23/2011] [Accepted: 03/29/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To assess balance recovery and quality of life after tongue-placed electrotactile biofeedback training in patients with stroke. DESIGN Prospective multicenter research design. SETTING Outpatient rehabilitation clinics. PARTICIPANTS Patients (N=29) with chronic stroke. INTERVENTIONS Patients were administered 1 week of therapy plus 7 weeks of home exercise using a novel tongue based biofeedback balance device. MAIN OUTCOME MEASURES The Berg Balance Scale (BBS), Timed Up and Go (TUG), Activities-Specific Balance Confidence (ABC) Scale, Dynamic Gait Index (DGI), and Stroke Impact Scale (SIS) were performed before and after the intervention on all subjects. RESULTS There were statistically and clinically significant improvements from baseline to posttest in results for the BBS, DGI, TUG, ABC Scale, and some SIS domains (Mobility, Activities of Daily Living/Instrumental Activities of Daily Living, Social, Physical, Recovery domains). Average BBS score increased from 35.9 to 41.6 (P<.001), and DGI score, from 11.1 to 13.7 (P<.001). Time to complete the TUG decreased from 24.7 to 20.7 seconds (P=.002). Including the BBS, DGI, TUG, and ABC Scale, 27 subjects improved beyond the minimal detectable change with 95% certainty (MDC-95) or minimal clinically important difference (MCID) in at least 1 outcome and 3 subjects improved beyond the MDC-95 or MCID in all outcomes. CONCLUSIONS Electrotactile biofeedback seems to be a promising integrative method to balance training. A future randomized controlled study is needed.
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Affiliation(s)
- Mary Beth Badke
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI, USA.
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Wildenberg JC, Tyler ME, Danilov YP, Kaczmarek KA, Meyerand ME. High-resolution fMRI detects neuromodulation of individual brainstem nuclei by electrical tongue stimulation in balance-impaired individuals. Neuroimage 2011; 56:2129-37. [PMID: 21496490 DOI: 10.1016/j.neuroimage.2011.03.074] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2010] [Revised: 03/24/2011] [Accepted: 03/28/2011] [Indexed: 11/15/2022] Open
Abstract
High-resolution functional magnetic resonance imaging (fMRI) can be used to precisely identify blood oxygen level dependent (BOLD) activation of small structures within the brainstem not accessible with standard fMRI. A previous study identified a region within the pons exhibiting sustained neuromodulation due to electrical tongue stimulation, but was unable to precisely identify the neuronal structure involved. For this study, high-resolution images of neural activity induced by optic flow were acquired in nine healthy controls and nine individuals with balance dysfunction before and after information-free tongue stimulation. Subjects viewed optic flow videos to activate the structures of interest. Sub-millimeter in-plane voxels of structures within the posterior fossa were acquired using a restricted field of view. Whole-brain functional imaging verified that global activation patterns due to optic flow were consistent with previous studies. Optic flow activated the visual association cortices, the vestibular nuclei, and the superior colliculus, as well as multiple regions within the cerebellum. The anterior cingulate cortex showed decreased activity after stimulation, while a region within the pons had increased post-stimulation activity. These observations suggest the pontine region is the trigeminal nucleus and that tongue stimulation interfaces with the balance-processing network within the pons. This high-resolution imaging allows detection of activity within individual brainstem nuclei not possible using standard resolution imaging.
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Affiliation(s)
- Joseph C Wildenberg
- Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI 53705, USA.
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Gharib NM, El-Maksoud GMA, Rezk-Allah SS. Efficacy of gait trainer as an adjunct to traditional physical therapy on walking performance in hemiparetic cerebral palsied children: a randomized controlled trial. Clin Rehabil 2011; 25:924-34. [PMID: 21427153 DOI: 10.1177/0269215511400768] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the effects of additional gait trainer assisted walking exercises on walking performance in children with hemiparetic cerebral palsy. DESIGN A randomized controlled study. SETTING Paediatric physical therapy outpatient clinic. SUBJECTS Thirty spastic hemiparetic cerebral palsied children of both sexes (10-13 years - 19 girls and 11 boys). METHODS Children were randomly assigned into two equal groups; experimental and control groups. Participants in both groups received a traditional physical therapy exercise programme. Those in the experimental group received additional gait trainer based walking exercises which aimed to improve walking performance. Treatment was provided three times per week for three successive months. MAIN MEASURES Children received baseline and post-treatment assessments using Biodex Gait Trainer 2 assessment device to evaluate gait parameters including: average step length, walking speed, time on each foot (% of gait cycle) and ambulation index. RESULTS Children in the experimental group showed a significant improvement as compared with those in the control group. The ambulation index was 75.53±7.36 (11.93 ± 2.89 change score) for the experimental group and 66.06 ± 5.48 (2.13 ± 4.43 change score) for the control group (t = 3.99 and P = 0.0001). Time of support for the affected side was 42.4 ± 3.37 (7 ± 2.20 change score) for the experimental group and 38.06 ± 4.63 (3.33 ± 6.25 change score) for the control group (t = 2.92 and P = 0.007). Also, there was a significant improvement in step length and walking speed in both groups. CONCLUSION Gait trainer combined with traditional physiotherapy increase the chance of improving gait performance in children with spastic hemiparetic cerebral palsy.
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Affiliation(s)
- Nevein Mm Gharib
- Department of Physical Therapy for Neuromuscular Disorders and its Surgery, Cairo University, Giza, Egypt.
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Wildenberg JC, Tyler ME, Danilov YP, Kaczmarek KA, Meyerand ME. Sustained cortical and subcortical neuromodulation induced by electrical tongue stimulation. Brain Imaging Behav 2011; 4:199-211. [PMID: 20614202 DOI: 10.1007/s11682-010-9099-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This pilot study aimed to show that information-free stimulation of the tongue can improve behavioral measures and induce sustained neuromodulation of the balance-processing network in individuals with balance dysfunction. Twelve balance-impaired subjects received one week of cranial nerve non-invasive neuromodulation (CN-NINM). Before and after the week of stimulation, postural sway and fMRI activation were measured to monitor susceptibility to optic flow. Nine normal controls also underwent the postural sway and fMRI tests but did not receive CN-NINM. Results showed that before CN-NINM balance-impaired subjects swayed more than normal controls as expected (p ≤ 0.05), and that overall sway and susceptibility to optic flow decreased after CN-NINM (p ≤ 0.005 & p ≤ 0.05). fMRI showed upregulation of visual sensitivity to optic flow in balance-impaired subjects that decreased after CN-NINM. A region of interest analysis indicated that CN-NINM may induce neuromodulation by increasing activity within the dorsal pons (p ≤ 0.01).
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Affiliation(s)
- Joseph C Wildenberg
- Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI 53705, USA.
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Abstract
PURPOSE OF REVIEW Recent reports on vestibular testing, relevant to clinical diagnosis, are reviewed.Besides the case history and bedside examination, objective measurement of the vestibuloocular reflex in all of its facets remains the cornerstone in the diagnostic process. RECENT FINDINGS In recent years, this has been enhanced considerably by reliable unilateral tests for the otolith organs, most notably by vestibular-evoked myogenic potential recording and estimation of subjective visual vertical. In addition, progress has been made in the investigation of multisensory interaction, involving visual acuity and posturography.Technological developments include improved eye movement measurement techniques, electrotactile and vibrotactile sensory enhancement or substitution, the use of virtual reality devices and motion stimulators such as hexapods and the rediscovery of galvanic vestibular stimulation as a research and diagnostic tool. SUMMARY The recent introduction of new tests, together with the development of novel technologies, is gradually increasing the scope of the physical and bedside examination of the dizzy patient (see chapter 'Medical management of peripheral disorders' in this issue). The use of more complex equipment, such as rotating chairs, linear sleds, hexapods and posturography platforms, is likely to become limited to specialized laboratories and rehabilitation centers in future years. Further, high resolution magnetic resonance tomography (MRT) and computed tomography have allowed insight into the morphology and determination of malformations of the human labyrinth.
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