BalanCI: Head-Referenced Cochlear Implant Stimulation Improves Balance in Children with Bilateral Cochleovestibular Loss

2019 ◽  
Vol 25 (Suppl. 1-2) ◽  
pp. 60-71 ◽  
Author(s):  
Nikolaus E. Wolter ◽  
Karen A. Gordon ◽  
Jennifer L. Campos ◽  
Luis D. Vilchez Madrigal ◽  
David D. Pothier ◽  
...  
Keyword(s):  
Postural Control ◽  
Cochlear Implant ◽  
Virtual Environment ◽  
Clinical Setting ◽  
Spatial Information ◽  
Center Of Pressure ◽  
Effective Means ◽  
Sensory Information ◽  
Clinical Test ◽  
The Impact

Introduction: To determine the impact of a head-referenced cochlear implant (CI) stimulation system, BalanCI, on balance and postural control in children with bilateral cochleovestibular loss (BCVL) who use bilateral CI. Methods: Prospective, blinded case-control study. Balance and postural control testing occurred in two settings: (1) quiet clinical setting and (2) immersive realistic virtual environment (Challenging Environment Assessment Laboratory [CEAL], Toronto Rehabilitation Institute). Postural control was assessed in 16 and balance in 10 children with BCVL who use bilateral CI, along with 10 typically developing children. Children with neuromotor, cognitive, or visual deficits that would prevent them from performing the tests were excluded. Children wore the BalanCI, which is a head-mounted device that couples with their CIs through the audio port and provides head-referenced spatial information delivered via the intracochlear electrode array. Postural control was measured by center of pressure (COP) and time to fall using the WiiTM (Nintendo, WA, USA) Balance Board for feet and the BalanCI for head, during the administration of the Modified Clinical Test of Sensory Interaction in Balance (CTSIB-M). The COP of the head and feet were assessed for change by deviation, measured as root mean square around the COP (COP-RMS), rate of deviation (COP-RMS/duration), and rate of path length change from center (COP-velocity). Balance was assessed by the Bruininks-Oseretsky Test of Motor Proficiency 2, balance subtest (BOT-2), specifically, BOT-2 score as well as time to fall/fault. Results: In the virtual environment, children demonstrated more stable balance when using BalanCI as measured by an improvement in BOT-2 scores. In a quiet clinical setting, the use of BalanCI led to improved postural control as demonstrated by significant reductions in COP-RMS and COP-velocity. With the use of BalanCI, the number of falls/faults was significantly reduced and time to fall increased. Conclusions: BalanCI is a simple and effective means of improving postural control and balance in children with BCVL who use bilateral CI. BalanCI could potentially improve the safety of these children, reduce the effort they expend maintaining balance and allow them to take part in more complex balance tasks where sensory information may be limited and/or noisy.

scholarly journals Maximal stability limits in adolescents with Tourette syndrome

2021 ◽  
Vol 4 (1) ◽  
pp. 013-022
Author(s):  
Blanchet Mariève ◽  
Prince François ◽  
Lemay Martin ◽  
Chouinard Sylvain ◽  
Messier Julie
Keyword(s):  
Postural Control ◽  
Tourette Syndrome ◽  
Center Of Pressure ◽  
Phase 1 ◽  
Sensory Information ◽  
Control Group ◽  
Eyes Closed ◽  
Highly Sensitive ◽  
Eyes Open ◽  
Stability Limits

We explored if adolescents with Gilles de la Tourette syndrome (GTS) had functional postural control impairments and how these deficits are linked to a disturbance in the processing and integration of sensory information. We evaluated the displacements of the center of pressure (COP) during maximal leaning in four directions (forward, backward, rightward, leftward) and under three sensory conditions (eyes open, eyes closed, eyes closed standing on foam). GTS adolescents showed deficits in postural stability and in lateral postural adjustments but they had similar maximal COP excursion than the control group. The postural performance of the GTS group was poorer in the eyes open condition (time to phase 1 onset, max-mean COP). Moreover, they displayed a poorer ability to maintain the maximum leaning position under the eyes open condition during mediolateral leaning tasks. By contrast, during forward leaning, they showed larger min-max ranges than control subjects while standing on the foam with the eyes closed. Together, these findings support the idea that GTS produces subclinical postural control deficits. Importantly, our results suggest that postural control disorders in GTS are highly sensitive to voluntary postural leaning tasks which have high demand for multimodal sensory integration.

scholarly journals Postural control among elderly women with and without osteoporosis: is there a difference?

2010 ◽  
Vol 128 (4) ◽  
pp. 219-224 ◽  
Author(s):  
Thomaz Nogueira Burke ◽  
Fabio Jorge Renovato França ◽  
Sarah Rúbia Ferreira de Meneses ◽  
Viviam Inhasz Cardoso ◽  
Rosa Maria Rodrigues Pereira ◽  
...  
Keyword(s):  
Postural Control ◽  
Elderly Women ◽  
Center Of Pressure ◽  
The Elderly ◽  
Cross Sectional Study ◽  
Clinical Test ◽  
Mineral Density ◽  
Maximum Displacement ◽  
Cross Sectional ◽  
School Of Medicine

CONTEXT AND OBJECTIVE: Little is known about postural control among elderly individuals with osteoporosis and its relationship with falls. It has been suggested that elderly women with kyphosis and osteoporosis are at greater risk of falling. The aim of this study was to evaluate posture and postural control among elderly women with and without osteoporosis. DESIGN AND SETTING: Cross-sectional study conducted at the Physical Therapy and Electromyography Laboratory, School of Medicine, Universidade de São Paulo (USP). METHODS: Sixty-six elderly women were selected from the bone metabolism disorders clinic, Division of Rheumatology, USP, and were divided into two groups: osteoporosis and controls, according to their bone mineral density (BMD). Postural control was assessed using the Limits of Stability (LOS) test and the Modified Clinical Test of Sensory Interaction and Balance (CTSIBm) and posture, using photometry. RESULTS: The elderly women with osteoporosis swayed at higher velocity on a stable surface with opened eyes (0.30 versus 0.20 degrees/second; P = 0.038). In both groups, the center of pressure (COP) was at 30% in the LOS, but with different placements: 156° in the osteoporosis group and 178° in the controls (P = 0.045). Osteoporosis patients fell more than controls did (1.0 versus 0.0; P = 0.036). CONCLUSIONS: The postural control in elderly women with osteoporosis differed from that of the controls, with higher sway velocity and maximum displacement of COP. Despite postural abnormalities such as hyperkyphosis and forward head, the COP position was posteriorized.

Sensory Reweighting During Bipedal Quiet Standing in Adolescents

Motor Control ◽  
2020 ◽  
Vol 24 (3) ◽  
pp. 383-396
Author(s):  
Alberto Pardo-Ibáñez ◽  
Jose L. Bermejo ◽  
Sergio Gandia ◽  
Julien Maitre ◽  
Israel Villarrasa-Sapiña ◽  
...  
Keyword(s):  
Postural Control ◽  
Center Of Pressure ◽  
Age Groups ◽  
Sensory System ◽  
Sensory Information ◽  
Quiet Standing ◽  
Proprioceptive Information ◽  
Sensory Reweighting ◽  
Cross Sectional ◽  
Older Adolescents

A cross-sectional, prospective, between-subjects design was used in this study to establish the differences in sensory reweighting of postural control among different ages during adolescence. A total of 153 adolescents (five age groups; 13–17 years old) performed bipedal standing in three sensory conditions (i.e., with visual restriction, vestibular disturbance, and proprioceptive disturbance). Center of pressure displacement signals were measured in mediolateral and anteroposterior directions to characterize reweighting in the sensory system in static postural control when sensory information is disturbed or restricted during adolescent growth. The results indicate a development of postural control, showing large differences between subjects of 13–14 years old and older adolescents. A critical change was found in sensory reweighting during bipedal stance with disturbance of proprioceptive information at 15 years old. Adolescents of 13–14 years old showed less postural control and performance than older adolescents during the disturbance of proprioceptive information. Moreover, the results demonstrated that the visual system achieves its development around 15–16 years old. In conclusion, this research suggests that a difference of sensory reweighting under this type of sensorial condition and sensory reweight systems would seem to achieve stabilization at the age of 15.

scholarly journals Virtual-Reality-Induced Visual Perturbations Impact Postural Control System Behavior

2019 ◽  
Vol 9 (11) ◽  
pp. 113 ◽  
Author(s):  
Harish Chander ◽  
Sachini N. K. Kodithuwakku Arachchige ◽  
Christopher M. Hill ◽  
Alana J. Turner ◽  
Shuchisnigdha Deb ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Control System ◽  
Postural Control ◽  
Repeated Measures ◽  
Postural Stability ◽  
Postural Sway ◽  
Center Of Pressure ◽  
Postural Control System ◽  
Postural Responses ◽  
The Impact

Background: Virtual reality (VR) is becoming a widespread tool in rehabilitation, especially for postural stability. However, the impact of using VR in a “moving wall paradigm” (visual perturbation), specifically without and with anticipation of the perturbation, is unknown. Methods: Nineteen healthy subjects performed three trials of static balance testing on a force plate under three different conditions: baseline (no perturbation), unexpected VR perturbation, and expected VR perturbation. The statistical analysis consisted of a 1 × 3 repeated-measures ANOVA to test for differences in the center of pressure (COP) displacement, 95% ellipsoid area, and COP sway velocity. Results: The expected perturbation rendered significantly lower (p < 0.05) COP displacements and 95% ellipsoid area compared to the unexpected condition. A significantly higher (p < 0.05) sway velocity was also observed in the expected condition compared to the unexpected condition. Conclusions: Postural stability was lowered during unexpected visual perturbations compared to both during baseline and during expected visual perturbations, suggesting that conflicting visual feedback induced postural instability due to compensatory postural responses. However, during expected visual perturbations, significantly lowered postural sway displacement and area were achieved by increasing the sway velocity, suggesting the occurrence of postural behavior due to anticipatory postural responses. Finally, the study also concluded that VR could be used to induce different postural responses by providing visual perturbations to the postural control system, which can subsequently be used as an effective and low-cost tool for postural stability training and rehabilitation.

Assessing the Impact of Control and Sensory Compatibility on Sickness in Virtual Environments

1996 ◽  
Vol 40 (22) ◽  
pp. 1122-1125 ◽  
Author(s):  
Christopher J. Rich ◽  
Curt C. Braun
Keyword(s):  
Virtual Environments ◽  
Virtual Environment ◽  
Motion Sickness ◽  
Sensory Information ◽  
Conflict Theory ◽  
Simulator Sickness ◽  
Sensory Inputs ◽  
Simulator Sickness Questionnaire ◽  
Main Effects ◽  
The Impact

Virtual reality (VR) users are frequently limited by motion sickness-like symptoms. One factor that might influence sickness in VR is the level of control one has in a virtual environment. Reason's Sensory Conflict Theory suggested that motion sickness occurs when incompatibilities exist between four sensory inputs. It is possible that control and sensory compatibility are positively related. If this is the case, increasing control in a virtual environment should result in decreasing symptomology. To test this, the present study used the Simulator Sickness Questionnaire to measure symptomology of 163 participants after exposure to a virtual environment. Three levels of control and compatibility were assessed. It was hypothesized that the participants with control and compatible sensory information would experience fewer symptoms than participants in either the control/incompatible or no control/incompatible conditions. Although significant main effects were found for both gender and condition, the findings were opposite of those hypothesized. Possible explanations for this finding are discussed.

Nociceptive capacity of plantar irritating stimulus reduction influences postural control in children, teenagers, and adults.

2015 ◽  
Vol 13 ◽  
pp. 298 ◽  
Author(s):  
Janin Marc ◽  
Lisandro Antonio Ceci ◽  
Rodolfo Borges Parreira
Keyword(s):  
Postural Control ◽  
Postural Balance ◽  
Center Of Pressure ◽  
Sensory Information ◽  
Control Group ◽  
Age Group ◽  
Sensory Organization ◽  
Pressure Area ◽  
Adolescents And Adults ◽  
Eyes Open

Introduction: Sensory information from vestibular, visual, proprioception, and feet contribute on postural control. Plantar afferent contribution comes from the tactile and nociceptive cues of the plantar sole. Nociceptive capacity of plantar irritating stimulus (NCPIS) is one of the foot problems that induce nociception. Objective: Was to determine the postural impact of sensory input flow modifications induced by foam in people with and without nociceptive plantar irritating stimuli in different ages (children, adolescents, and adults). Method: 120 participants with (NP) and X without (Ct) NCPIS in different age group were evaluated (20 subjects in each age group and conditions). Postural balance assessment was performed during two-legged stance test using a force platform. Postural recoding was performed with eyes open in two conditions: on a hard surface and on a foam surface. The postural balance parameter analyzed was center of pressure area and variance of speed. Results: Area and variance of speed in control group increased, whereas decreased in NP subjects. No differences were observed for mean speed. In the Ct group, nociceptor and mechanoreceptor afferent sensations on foam induced postural variation with more oscillations (area and speed). Conclusion: NCPIS influenced postural control, and this foam neutralization of afferent nociception induced a new sensory organization. Foam surface imitated afferent plantar sensory information, induced postural variation as measured by CoP parameters with increasing postural control in subjects without NCIPS and decreasing postural control in subjects with NCPIS.

scholarly journals The Impact of Visual Input and Support Area Manipulation on Postural Control in Subjects after Osteoporotic Vertebral Fracture

Entropy ◽  
2021 ◽  
Vol 23 (3) ◽  
pp. 375
Author(s):  
Michalina Błażkiewicz ◽  
Justyna Kędziorek ◽  
Anna Hadamus
Keyword(s):  
Postural Control ◽  
Vertebral Fractures ◽  
Center Of Pressure ◽  
Health Concern ◽  
Eyes Closed ◽  
Osteoporotic Vertebral Fractures ◽  
Increased Risk ◽  
Support Area ◽  
Risk Factors For Falls ◽  
The Impact

Osteoporosis is a prevalent health concern among older adults and is associated with an increased risk of falls that may result in fracture, injury, or even death. Identifying the risk factors for falls and assessing the complexity of postural control within this population is essential for developing effective regimes for fall prevention. The aim of this study was to assess postural control in individuals recovering from osteoporotic vertebral fractures while performing various stability tasks. Seventeen individuals with type II osteoporosis and 17 healthy subjects participated in this study. The study involved maintaining balance while standing barefoot on both feet for 20 s on an Advanced Mechanical Technology Inc. (AMTI) plate, with eyes open, eyes closed, and eyes closed in conjunction with a dual-task. Another three trials lasting 10 s each were undertaken during a single-leg stance under the same conditions. Fall risk was assessed using the Biodex Balance platform. Nonlinear measures were used to assess center of pressure (CoP) dynamics in all trials. Reducing the support area or elimination of the visual control led to increased sample entropy and fractal dimension. Results of the nonlinear measurements indicate that individuals recovering from osteoporotic vertebral fractures are characterized by decreased irregularity, mainly in the medio-lateral direction and reduced complexity.

scholarly journals Idiosyncratic multisensory reweighting as the common cause for motion sickness susceptibility and adaptation to postural perturbation

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0260863
Author(s):  
Merrick Dida ◽  
Corinne Cian ◽  
Pierre-Alain Barraud ◽  
Michel Guerraz ◽  
Rafael Laboissière
Keyword(s):  
Postural Control ◽  
Motion Sickness ◽  
Postural Stability ◽  
Center Of Pressure ◽  
Sensory Information ◽  
Principal Component ◽  
Postural Perturbation ◽  
Baseline Phase ◽  
Low Frequencies ◽  
Eyes Closed

Numerous empirical and modeling studies have been done to find a relationship between postural stability and the susceptibility to motion sickness (MS). However, while the demonstration of a causal relationship between postural stability and the susceptibility to MS is still lacking, recent studies suggest that motion sick individuals have genuine deficits in selecting and reweighting multimodal sensory information. Here we investigate how the adaptation to changing postural situations develops and how the dynamics in multisensory integration is modulated on an individual basis along with MS susceptibility. We used a postural task in which participants stood on a posturographic platform with either eyes open (EO) or eyes closed (EC) during three minutes. The platform was static during the first minute (baseline phase), oscillated harmonically during the second minute (perturbation phase) and returned to its steady state for the third minute (return phase). Principal component (PC) analysis was applied to the sequence of short-term power density spectra of the antero-posterior position of the center of pressure. Results showed that the less motion-sick a participant is, the more similar is his balance between high and low frequencies for EO and EC conditions (as calculated from the eigenvector of the first PC). By fitting exponential decay models to the first PC score in the return phase, we estimated, for each participant in each condition, the sluggishness to return to the baseline spectrum. We showed that the de-adaptation following platform oscillation depends on the susceptibility to MS. These results suggest that non motion-sick participants finely adjust their spectrum in the perturbation phase (i.e. reweighting) and therefore take longer to return to their initial postural control particularly with eyes closed. Thus, people have idiosyncratic ways of doing sensory reweighting for postural control, these processes being tied to MS susceptibility.

scholarly journals A Pilot Study to Assess the Immediate Effect of Dynamic Carbon Ground Reaction Ankle Foot Orthoses on Balance in Individuals with Charcot-Marie-Tooth in a Clinical Setting

2021 ◽  
Vol 8 (3) ◽  
Author(s):  
Burke K ◽  
◽  
Cornell K ◽  
Swartz Ellrodt A ◽  
Grant N ◽  
...  
Keyword(s):  
Pilot Study ◽  
Clinical Setting ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Dynamic Balance ◽  
Clinical Test ◽  
Foot Orthoses ◽  
Charcot Marie Tooth ◽  
Ankle Foot Orthoses ◽  
The Impact

Charcot-Marie-Tooth (CMT) causes muscle weakness and atrophy generally in distal extremities, with or without sensory changes. These impairments contribute to impaired balance and gait and increase risk for falls and secondary injuries. Dynamic Carbon Ground Reaction Ankle Foot Orthoses (DCGR-AFOs) are one type of lower extremity orthosis that can be prescribed to help improve gait and balance in this patient population. To our knowledge, no studies have evaluated the immediate impact of DCGR-AFOs on gait and balance in this population. In this pilot study, 9 individuals with CMT and gait impairment were seen in clinical setting by a physical therapist and orthotist. Participants were asked to complete the modified Clinical Test of Sensory Interaction and Balance (mCTSIB) and tasks on the 4-Item Dynamic Gait Index (DGI) with and without bilateral DCGR-AFOs to assess static and dynamic balance. The average DGI scores were 6/12 without the DCGR-AFOs and 10/12 with the DCGR-AFOs. Improvements on the mCTSIB varied. The findings in this study suggest an immediate improvement in dynamic balance during ambulation with the use of DCGR-AFOs, as assessed by the 4-Item DGI. Data on static balance did not reach significance suggesting the need for future studies to further assess the effects of DCGR-AFOs on static standing balance, as well as the impact of training with physical therapists. This pilot study demonstrates that it is possible to demonstrate potential benefits of DCGR-AFOs with a gross fitting in a clinical setting, prior to referral to an orthotist for custom fitting.

Exploring the Benefits of Early Contractor Involvement (ECI) and the Mechanism for Automated 5D BIM Quantification Process in Offsite Modular Construction

2016 ◽  
Author(s):  
Tochukwu Moses ◽  
David Heesom ◽  
David Oloke ◽  
Martin Crouch
Keyword(s):  
Effective Means ◽  
Cost Effective ◽  
Modular Construction ◽  
Automated Quantification ◽  
Building Information ◽  
Project Risks ◽  
Value Add ◽  
The Uk ◽  
The Impact ◽  
Level 2

The UK Construction Industry through its Government Construction Strategy has recently been mandated to implement Level 2 Building Information Modelling (BIM) on public sector projects. This move, along with other initiatives is key to driving a requirement for 25% cost reduction (establishing the most cost-effective means) on. Other key deliverables within the strategy include reduction in overall project time, early contractor involvement, improved sustainability and enhanced product quality. Collaboration and integrated project delivery is central to the level 2 implementation strategy yet the key protocols or standards relative to cost within BIM processes is not well defined. As offsite construction becomes more prolific within the UK construction sector, this construction approach coupled with BIM, particularly 5D automated quantification process, and early contractor involvement provides significant opportunities for the sector to meet government targets. Early contractor involvement is supported by both the industry and the successive Governments as a credible means to avoid and manage project risks, encourage innovation and value add, making cost and project time predictable, and improving outcomes. The contractor is seen as an expert in construction and could be counter intuitive to exclude such valuable expertise from the pre-construction phase especially with the BIM intent of äóÖbuild it twiceäó», once virtually and once physically. In particular when offsite construction is used, the contractoräó»s construction expertise should be leveraged for the virtual build in BIM-designed projects to ensure a fully streamlined process. Building in a layer of automated costing through 5D BIM will bring about a more robust method of quantification and can help to deliver the 25% reduction in overall cost of a project. Using a literature review and a case study, this paper will look into the benefits of Early Contractor Involvement (ECI) and the impact of 5D BIM on the offsite construction process.

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