Use of the Head Shake-Sensory Organization Test as an Outcome Measure in the Rehabilitation of an Individual with Head Movement Provoked Symptoms of Imbalance

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.

Effects of local vibration and cervical stabilization exercises on balance, joint position sense, and isometric muscle performance in young adults: A randomized controlled study

BACKGROUND: Cervical stabilization exercises and local vibration may improve proprioception and balance and prevent musculoskeletal problems. OBJECTIVE: To compare the effects of local vibration and cervical stabilization exercises on balance, cervical joint position sense, and muscle performance in healthy participants. METHODS: Forty-eight healthy male participants without neck pain were included. The participants were randomly divided into three groups: a home exercise program lasting eight weeks to the cervical stabilization group; 60 s of vibration to the neck muscles of the local vibration group and a control group. Balance, joint position sense, and muscle performance were evaluated twice in all subjects, before and after the intervention. RESULTS: Joint position sense error values were decreased in both the local vibration and cervical stabilization groups. Balance was improved (p< 0.001) in the local vibration group while improvement in muscle performance parameters was only seen in the cervical stabilization group (p< 0.05). CONCLUSIONS: The methods used in the present study may be used for improving the proprioceptive and vestibular components of balance in individuals with musculoskeletal problems such as cervical disc herniation, cervical spondylosis, or neck pain. However, given the limitations, much more research is needed to firmly establish these recommendations.

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.

Vestibular functioning and migraine: comparing those with and without vertigo to a normal population

Objective:

This study compared vestibular functioning in a migrainous vertigo group, a migraine without vertigo group and a control group. It was hypothesised that the migrainous vertigo group would perform worse in tests of vestibular function and gait than the other groups during a non-migrainous period.

Methods:

Sixty-six participants (22 per group) were assessed using the head shake sensory organisation test, the gaze stabilisation test, the dynamic visual acuity test and the functional gait assessment. Separate analyses of variance and planned pair-wise comparisons (alpha = 0.05) were performed.

Results:

There was a difference between the results of the non-migraine group and the two migraine groups for the gaze stabilisation pitch test (p < 0.003), in which the control group showed faster head movement. There were also group differences in functional gait (p < 0.0001); the control group scored highest and the migrainous vertigo group scored lowest. There were no differences in the vestibular spinal reflex and balance tests.

Conclusion:

These findings indicate underlying differences in the vestibular ocular reflexes and function of migraine sufferers compared with those who do not suffer migraines, but the difference is most pronounced for those with migrainous vertigo. This suggests that vestibular rehabilitation for migrainous vertigo should focus on vestibular ocular reflexes and functional retraining.

Balance performance in head-shake computerized dynamic posturography: aging effects and test-retest reliability

BACKGROUND

The ability of the Sensory Organization Test (SOT) to detect subtle balance problems has been challenged. The Head-Shake Sensory Organization Test (HS-SOT) has been developed to improve the delineation of balance performance.

OBJECTIVE

The purposes of this study were: (1) to examine age-related differences in balance measured with the HS-SOT and (2) to establish the test-retest reliability of the HS-SOT in younger adults who were healthy and older adults who were healthy.

DESIGN

A test-retest design was used in this observational measurement study.

METHODS

Ninety-two younger adults who were healthy (mean age=28.3 years) and 73 older adults who were healthy (mean age=60.3 years) underwent the SOT and the HS-SOT. Seventy-seven of them (56 younger adults, 21 older adults) underwent the same assessments 1 to 2 weeks later.

RESULTS

The equilibrium scores in HS-SOT conditions 2 (head movements with eyes closed while standing on a firm surface) and 5 (head movements with eyes closed while standing on a sway-referenced surface) were significantly lower than those in tests without dynamic head movements added (SOT conditions 2 and 5). Older adults attained significantly lower scores in both HS-SOT conditions than their younger peers. The test-retest reliability values, reported as intraclass correlation coefficients (ICC [3,2]), of the HS-SOT scores in conditions 2 and 5 for the younger adults were .85 and .78, respectively; those for the older adults were .64 and .55, respectively. The corresponding minimal detectable change values for the former were 2.7 and 16.2, and those for the latter were 3.6 and 22.7.

LIMITATIONS

Only head rotation movements on the horizontal plane were tested.

CONCLUSIONS

Adding head movements to the SOT increased the separation of younger adults who were healthy and older adults who were healthy. The HS-SOT has good reliability, and the reported minimal detectable change values may facilitate the interpretation of clinical studies in which the HS-SOT is used to assess changes in balance performance in younger and older adults.

Effects of dynamic head tilts on sensory organization test performance: a comparison between college-age athletes and nonathletes

STUDY DESIGN

Controlled laboratory study.

OBJECTIVE

To compare postural performance measures of athletes with those of nonathletes when completing the standard Sensory Organization Test (SOT) and a modified SOT that included dynamic head tilts (DHT-SOT).

BACKGROUND

Authors of recently published research have suggested that modifications to the SOT protocol (eg, introduction of pitch and roll head tilts) may enhance the test's sensitivity when assessing postural stability in individuals with higher balance capabilities or with well-compensated sensory deficits.

METHODS AND MEASURES

Nineteen athletes and 19 nonathletes (group) completed both the SOT and DHT-SOT (protocol). During the SOT, participants stood upright as steadily as possible for 20 seconds during each of 6 different sensory conditions. As a variation of the SOT, the DHT-SOT incorporated active pitch and roll head tilts into the SOT protocol. Four 2-way mixed-model analyses of variance (with protocol as the repeated factor) were performed to determine if the composite equilibrium score or the visual, vestibular, or somatosensory ratio scores differed between the 2 groups across the 2 testing protocols.

RESULTS

Significant group-by-protocol interaction effects were present for both the composite equilibrium score and visual ratio. Follow-up simple main-effects analyses indicated that these measures did not differ between groups for the SOT protocol but were significantly different on the DHT-SOT.

CONCLUSIONS

The addition of dynamic head tilts to the SOT protocol resulted in subtle differences in balance function between athletes and nonathletes. Athletes demonstrated an increased ability to adapt to sensory disruptions during the DHT-SOT. Therapists should consider including active pitch and roll head tilts to the SOT when evaluating individuals with higher balance function or to detect subtle deficits in balance function.

LEVEL OF EVIDENCE

Diagnosis, level 3b.