The effect of the type of foam pad used in the modified Clinical Test of Sensory Interaction and Balance (mCTSIB) on the accuracy in identifying older adults with fall history

Time of day and athlete status effects on the modified clinical test of sensory integration and balance (mCTSIB) and stability evaluation test (SET)

BACKGROUND

Concussions or musculoskeletal injuries may impair postural control, which is one diagnostic to help determine return-to-activity decisions. Postural control may be affected by diurnal rhythm.

RESEARCH QUESTION

Does time of day influence postural control as measured by two Neurocom Balance Master diagnostic protocols, the Modified Clinical Test of Sensory Interaction on Balance (mCTSIB) and the Stability Evaluation Test (SET)?

METHODS

Following Institutional Review Board (IRB) approval, consented participants completed the SET and mCTSIB twice: between 0700 and 1000; and between 1600 and 1900. We randomized and balanced testing order. Familiarization trials were completed for the mCTSIB and SET. Assessments were completed in a controlled laboratory environment. We instructed participants to get a normal night's sleep prior to testing and refrain from caffeine use and exhaustive exercise on the day of testing. Sixty-nine participants (48 female, 21 male: age = 21.42±2.56 years, height = 168.20±7.53 cm, mass = 72.05±16.60 kg) completed the study. Thirty-one of the participants were National Association of Intercollegiate Athletes (NAIA) student-athletes from the sports of baseball, soccer and softball. Average postural sway velocity was measured and compared by time of day for each of the balance conditions in the mCTSIB and SET protocols.

RESULTS

According to repeated measures ANOVA, there were no significant postural sway velocity main effects by time of day for any of the balance conditions. We found significant postural sway main effects by foam, stance and eyes. We also noted significant ANOVA between participants' differences for athlete status, but not for sex.

SIGNIFICANCE

These results inform practitioners about the importance of controlling time-of-day between baseline and post-injury testing, which may allow for more flexible, accurate and reliable diagnosis and return-to-activity decisions. Athletes displayed better static postural control, possibly warranting different normative values for diagnostic comparison.

Immediate Improvement in Subjective Visual Vertical and Disequilibrium Predicts Resolution of Benign Paroxysmal Positional Vertigo Following Single Canalith Repositioning Maneuver

Objective

To evaluate whether immediate post-canalith repositioning maneuver (CRM) vestibular changes are predictive of benign paroxysmal positional vertigo (BPPV) resolution.

Study Design

Retrospective cohort study.

Setting

Tertiary referral center.

Patients

Adults (n = 27) with posterior canal BPPV.

Interventions

Single CRM with Frenzel goggles.

Main Outcome Measures

The Visual Analog Scale (VAS) for disequilibrium, the subjective visual vertical (SVV), the subjective visual horizontal (SVH), and the Modified Clinical Test of Sensory Interaction on Balance (mCTSIB) were administered pre- and immediately following single CRM. Dix-Hallpike was performed 1-3 weeks after CRM to assess for BPPV resolution. Pre- and post-treatment vestibular assessments were compared between groups to determine if post-CRM vestibular changes could predict BPPV resolution.

Results

The change in VAS score following CRM treatment was statistically different between patients who responded to CRM treatment (n = 15) and those who did not (n = 12), (-0.07 points versus -2.40 points, respectively; P = 0.03). Likewise, a significantly greater improvement in SVV score was observed for CRM responders compared with CRM nonresponders (0.92° versus -0.06°, respectively; P = 0.02). Change in SVH and mCTSIB scores did not differ significantly between groups. Additionally, patient age was found to predict outcome of CRM treatment, with older patients more likely to experience persistent BPPV (P ≤ 0.01).

Conclusions

Immediate improvement in VAS and SVV scores following CRM may be useful in predicting resolution of BPPV and may assist in directing the timing and need for future interventions. Younger age may have a favorable predictive value for improvement following single CRM.

Impact of Sensory Afferences in Postural Control Quantified by Force Platform: A Protocol for Systematic Review

Older adults’ postural balance is a critical domain of research as balance deficit is an important risk factor for falls that can lead to severe injuries and death. Considering the effects of ageing on sensory systems, we propose that posturographic evaluation with a force platform exploring the effect of sensory deprivation or perturbation on balance could help understand postural control alterations in the elderly. The aim of the future systematic review and meta-analysis described in this protocol is to explore the capacity of older adults to maintain their balance during sensory perturbations, and compare the effect of perturbation between the sensory channels contributing to balance. Seven databases will be searched for studies evaluating older adults’ balance under various sensory conditions. After evaluating the studies’ risk of bias, results from similar studies (i.e., similar experimental conditions and posturographic markers) will be aggregated. This protocol describes a future review that is expected to provide a better understanding of changes in sensory systems of balance due to ageing, and therefore perspectives on fall assessment, prevention, and rehabilitation.

Kohonen Neural Network Investigation of the Effects of the Visual, Proprioceptive and Vestibular Systems to Balance in Young Healthy Adult Subjects

Kohonen neural network (KNN) was used to investigate the effects of the visual, proprioceptive and vestibular systems using the sway information in the mediolateral (ML) and anterior-posterior (AP) directions, obtained from an inertial measurement unit, placed at the lower backs of 23 healthy adult subjects (10 males, 13 females, mean (standard deviation) age: 24.5 (4.0) years, height: 173.6 (6.8) centimeter, weight: 72.7 (9.9) kg). The measurements were based on the modified Clinical Test of Sensory Interaction and Balance (mCTSIB). KNN clustered the subjects’ time-domain sway measures by processing their sway’s root mean square position, velocity, and acceleration. Clustering effectiveness was established using external performance indicators such as purity, precision-recall, and F-measure. Differences in these measures, from the clustering of each mCTSIB condition with its condition, were used to extract information about the balance-related sensory systems, where smaller values indicated reduced sway differences. The results for the parameters of purity, precision, recall, and F-measure were higher in the AP direction as compared to the ML direction by 7.12%, 11.64%, 7.12%, and 9.50% respectively, with their differences statistically significant (p < 0.05) thus suggesting the related sensory systems affect majorly the AP direction sway as compared to the ML direction sway. Sway differences in the ML direction were lowest in the presence of the visual system. It was concluded that the effect of the visual system on the balance can be examined mostly by the ML sway while the proprioceptive and vestibular systems can be examined mostly by the AP direction sway.

Detection of Postural Control in Young and Elderly Adults Using Deep and Machine Learning Methods with Joint-Node Plots

Postural control decreases with aging. Thus, an efficient and accurate method of detecting postural control is needed. We enrolled 35 elderly adults (aged 82.06 ± 8.74 years) and 20 healthy young adults (aged 21.60 ± 0.60 years) who performed standing tasks for 40 s, performed six times. The coordinates of 15 joint nodes were captured using a Kinect device (30 Hz). We plotted joint positions into a single 2D figure (named a joint–node plot, JNP) once per second for up to 40 s. A total of 15 methods combining deep and machine learning for postural control classification were investigated. The accuracy, sensitivity, specificity, positive predicted value (PPV), negative predicted value (NPV), and kappa values of the selected methods were assessed. The highest PPV, NPV, accuracy, sensitivity, specificity, and kappa values were higher than 0.9 in validation testing. The presented method using JNPs demonstrated strong performance in detecting the postural control ability of young and elderly adults.