An overview of the clinical use of dynamic posturography in the differential diagnosis of balance disorders

1999 ◽  
Vol 9 (4) ◽  
pp. 223-252
Author(s):  
John H.J. Allum ◽  
Neil T. Shepard
Keyword(s):  
Differential Diagnosis ◽  
Functional Disability ◽  
Balance Control ◽  
Test Subject ◽  
Motor Deficits ◽  
Support Surface ◽  
Dynamic Posturography ◽  
Balance Disorders ◽  
Balance Disorder ◽  
Proprioceptive Reflex

Dynamic posturography comprises a series of balance control tests which help physicians overcome numerous diagnostic and treatment challenges arising when examining patients complaining of a debilitating balance disorder. These challenges include the specific differential diagnosis, documentation of symptoms and assessment of functional disability. It must be determined whether the cause of the disability is an organic sensory deficit, a central nervous system (CNS) lesion or a non-organic (that is, possibly psychogenic or just overtly simulated) disorder. This review is targeted towards providing the reader (a) an overview of the effects sensori-motor deficits have on balance control, specifically vestibulo-spinal and proprioceptive reflex deficits; and, (b) how these effects may be assessed objectively in a clinical setting to differentiate between various organic and non-organic balance-disorders. The techniques used to study these effects are based on the analysis of both rapid balance-correcting and slow balance-stabilizing responses to fast and slow movements in the pitch plane of the support surface on which the test subject stands.

scholarly journals Vasopressin-vermittelte Wasserrückresorption im Sammelrohr der Niere

BIOspektrum ◽  
2021 ◽  
Vol 27 (2) ◽  
pp. 165-167
Author(s):  
Sandrine Baltzer ◽  
Enno Klussmann
Keyword(s):  
Water Balance ◽  
Small Molecules ◽  
High Throughput ◽  
Molecular Mechanisms ◽  
Collecting Duct ◽  
Water Channel ◽  
Water Reabsorption ◽  
Balance Disorders ◽  
Water Homeostasis ◽  
Balance Disorder

AbstractVasopressin-mediated water reabsorption from primary urine in the renal collecting duct is essential for regulating body water homeostasis and depends on the water channel aquaporin-2 (AQP2).Dysregulation of the process can cause water balance disorders. Here, we present cell-based high-throughput screenings to identify proteins and small molecules as tools to elucidate molecular mechanisms underlying the AQP2 control and as potential starting points for the development of water balance disorder drugs.

scholarly journals Videonystagmography

2012 ◽  
Vol 4 (1) ◽  
pp. 17-24
Keyword(s):  
Clinical Evaluation ◽  
Therapeutic Modality ◽  
Weak Links ◽  
Functional Abilities ◽  
Vestibular Disorder ◽  
Vestibular Evoked Myogenic Potential ◽  
Dynamic Posturography ◽  
Computerized Tests ◽  
Balance Disorder ◽  
The Individual

ABSTRACT The goals of any test that evaluates balance function are manifold; primarily to determine the presence of a true balance disorder and to topographically locate it. Secondarily, to determine the extent of residual functional abilities of the patient as regards the ‘deficit’ caused by the disorder, and evaluate the possibility of recovery. Thirdly, and most importantly, to determine whether the individual is likely to benefit from some therapeutic modality, whether single or combined, based on the results of the tests. Testing for vertiginous patients involves eliciting a detailed history, followed by a clinical evaluation. Investigations include the audiological, radiological and computerized tests. Computerized vestibular testing includes various computerized modules, such as: Electronystagmography (ENG), videonystagmography (VNG), rotational testing, computerized dynamic posturography (sensory organizational test—SOT; motor control testing—MCT) and vestibular evoked myogenic potential (VEMP) testing. VNG is thus only one of the computerized tests and should always be interpreted in conjunction with the others mentioned above. This, however, does not mean that VNG should be performed in all patients complaining of vertigo. It is thus, prudent to understand the indications and possible information that may be obtained from a VNG evaluation and its application to clinical science. Analysis is often carried out by a technician and the results presented to the surgeon or physician. The analysis is often carried out automatically, or at least semi-automatically by a computer, where the automatic artefact rejection is usually poor, or in the least, suboptimal. These potentially ‘weak links’ in the chain can often mislead the clinician, and lead to errant diagnosis, such as ‘central vestibular disorder’, either due to an artifactual recording, or poor interpretation! It is thus, extremely important, that the ENG/VNG results are correlated with the clinical evaluation of the same tests, which may be done with the naked eye or in the least, using Frenzel's glasses. How to cite this article Hathiram BT, Khattar VS. Videonystagmography. Int J Otorhinolaryngol Clin 2012;4(1): 17-24.

scholarly journals Differential Diagnosis of Vertigo in Children

2019 ◽  
Vol 02 (01) ◽  
pp. 21-26
Author(s):  
Anita Bhandari ◽  
Arpana Goswami
Keyword(s):  
Differential Diagnosis ◽  
Management Strategy ◽  
Pediatric Patients ◽  
Age Groups ◽  
Clinical History ◽  
Chief Complaint ◽  
Balance Disorders ◽  
Peripheral Vestibulopathy ◽  
Delay Of Treatment

Abstract Introduction Vertigo and balance disorders can affect all age groups. It is common to misdiagnose the cause of dizziness in children, which eventually results in the delay of treatment. The purpose of this study was to review the clinical characteristics and neurotological evaluation of vertigo in patients younger than 16 years and assist in making a differential diagnosis for children with vertigo and balance disorders. The differential diagnosis can help determine the correct management strategy to treat vertigo and imbalance in pediatric patients. Methods Children and adolescents presenting with a chief complaint of vertigo or unsteadiness to Vertigo and Ear Clinic, Jaipur, were selected for this study on the basis of clinical history, physical examination, and neurotological evaluation. Results A total of 90 patients with a mean age of 10.67 years were evaluated. The most common cause associated with vertigo or dizziness was found to be vestibular migraine seen in 38 participants of this study. This was followed by unilateral peripheral vestibulopathy in 15 patients, bilateral peripheral vestibulopathy in 11 patients, and central vestibulopathy in 6 patients. Vertigo was also seen to be associated with various other disorders. Conclusion Vertigo in children must be recognized as a definite symptom, which should be taken seriously by the clinician and family. Pediatric vertigo can be due to many etiologies. History and evaluation are the only way to diagnose the etiology and site of lesion. This will prevent misdiagnosis and delay in the treatment, which can ultimately lead to deterioration of the quality of life.

scholarly journals Head Position and Posturography: A Novel Biomarker to Identify Concussion Sufferers

2020 ◽  
Vol 10 (12) ◽  
pp. 1003
Author(s):  
Frederick Robert Carrick ◽  
Guido Pagnacco ◽  
Melissa Hunfalvay ◽  
Sergio Azzolino ◽  
Elena Oggero
Keyword(s):  
Balance Control ◽  
Normal Subjects ◽  
Neutral Plane ◽  
Clinical Test ◽  
Standard Group ◽  
Neutral Position ◽  
Dynamic Posturography ◽  
Post Concussion Syndrome ◽  
Eyes Open ◽  
Head Positions

Balance control systems involve complex systems directing muscle activity to prevent internal and external influences that destabilize posture, especially when body positions change. The computerized dynamic posturography stability score has been established to be the most repeatable posturographic measure using variations of the modified Clinical Test of Sensory Integration in Balance (mCTSIB). However, the mCTSIB is a standard group of tests relying largely on eyes-open and -closed standing positions with the head in a neutral position, associated with probability of missing postural instabilities associated with head positions off the neutral plane. Postural stability scores are compromised with changes in head positions after concussion. The position of the head and neck induced by statically maintained head turns is associated with significantly lower stability scores than the standardized head neutral position of the mCTSIB in Post-Concussion Syndrome (PCS) subjects but not in normal healthy controls. This phenomenon may serve as a diagnostic biomarker to differentiate PCS subjects from normal ones as well as serving as a measurement with which to quantify function or the success or failure of a treatment. Head positions off the neutral plane provide novel biomarkers that identify and differentiate subjects suffering from PCS from healthy normal subjects.

Incorporating Voluntary Knee Flexion Into Nonanticipatory Balance Corrections

2007 ◽  
Vol 98 (5) ◽  
pp. 3047-3059 ◽  
Author(s):  
Lars B. Oude Nijhuis ◽  
Bastiaan R. Bloem ◽  
Mark G. Carpenter ◽  
John H. J. Allum
Keyword(s):  
Knee Flexion ◽  
Balance Control ◽  
Critical Role ◽  
Support Surface ◽  
Trunk Flexion ◽  
Postural Perturbation ◽  
Automatic Balance ◽  
Human Balance ◽  
Balance Deficits ◽  
Balance Corrections

Knee movements play a critical role in most balance corrections. Loss of knee flexibility may cause postural instability. Conversely, trained voluntary knee flexions executed during balance corrections might help to overcome balance deficits. We examined whether bilateral knee flexion could be added to automatic balance corrections generated by sudden balance perturbations. We investigated how this could be achieved and whether it improved or worsened balance control. Twenty-four healthy subjects participated in three different test conditions, in which they had to flex their knees following an auditory cue (VOLUNTARY condition), had to restore their balance in response to multidirectional rotations of a support surface (REACTIVE condition), or the combination of these two (COMBINED condition). A new variable set (PREDICTED), calculated as the mathematical sum of VOLUNTARY and REACTIVE, was compared with the COMBINED variable set. COMBINED responses following forward rotations were close to PREDICTED, or greater, suggesting adequate integration of knee flexion into the automatic balance reactions. For backward rotations, the COMBINED condition resulted in several near-falls, and this was generally associated with smaller knee flexion and smaller EMG responses. Subjects compensated by using greater trunk flexion and arm movements. Activity in several muscles displayed earlier onsets for the COMBINED condition following backward rotations. We conclude that healthy adults can incorporate voluntary knee flexion into their automatic balance corrections and that this depends on the direction of the postural perturbation. These findings highlight the flexibility of the human balance repertoire and underscore both the advantages and limitations of using trained voluntary movements to aid balance corrections in man.

scholarly journals Applying the Minimal Detectable Change of a Static and Dynamic Balance Test Using a Portable Stabilometric Platform to Individually Assess Patients with Balance Disorders

Healthcare ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 402 ◽  
Author(s):  
Juan De la Torre ◽  
Javier Marin ◽  
Marco Polo ◽  
José J. Marín
Keyword(s):  
Center Of Pressure ◽  
Balance Control ◽  
Dynamic Balance ◽  
Static Balance ◽  
Minimal Detectable Change ◽  
Detectable Change ◽  
Balance Test ◽  
Balance Disorders ◽  
Eyes Closed ◽  
Specialist Physician

Balance disorders have a high prevalence among elderly people in developed countries, and falls resulting from balance disorders involve high healthcare costs. Therefore, tools and indicators are necessary to assess the response to treatments. Therefore, the aim of this study is to detect relevant changes through minimal detectable change (MDC) values in patients with balance disorders, specifically with vertigo. A test-retest of a static and dynamic balance test was conducted on 34 healthy young volunteer subjects using a portable stabilometric platform. Afterwards, in order to show the MDC applicability, eight patients diagnosed with balance disorders characterized by vertigo of vestibular origin performed the balance test before and after a treatment, contrasting the results with the assessment by a specialist physician. The balance test consisted of four tasks from the Romberg test for static balance control, assessing dynamic postural balance through the limits of stability (LOS). The results obtained in the test-retest show the reproducibility of the system as being similar to or better than those found in the literature. Regarding the static balance variables with the lowest MDC value, we highlight the average velocity of the center of pressure (COP) in all tasks and the root mean square (RMS), the area, and the mediolateral displacement in soft surface, with eyes closed. In LOS, all COP limits and the average speed of the COP and RMS were highlighted. Of the eight patients assessed, an agreement between the specialist physician and the balance test results exists in six of them, and for two of the patients, the specialist physician reported no progression, whereas the balance test showed worsening. Patients showed changes that exceeded the MDC values, and these changes were correlated with the results reported by the specialist physician. We conclude that (at least for these eight patients) certain variables were sufficiently sensitive to detect changes linked to balance progression. This is intended to improve decision making and individualized patient monitoring.

Impairments of Postural Balance in Surgically Treated Lumbar Disc Herniation Patients

2020 ◽  
Vol 36 (4) ◽  
pp. 228-234
Author(s):  
Ziva M. Rosker ◽  
Jernej Rosker ◽  
Nejc Sarabon
Keyword(s):  
Postural Balance ◽  
Center Of Pressure ◽  
Balance Control ◽  
The Body ◽  
Surface Velocity ◽  
Body Sway ◽  
Support Surface ◽  
Balance Task ◽  
Lateral Body ◽  
Unstable Support

Reports on body sway control following microdiscectomy lack reports on side-specific balance deficits as well as the effects of trunk balance control deficits on body sway during upright stances. About 3 weeks post microdiscectomy, the body sway of 27 patients and 25 controls was measured while standing in an upright quiet stance with feet positioned parallel on an unstable support surface, a tandem stance with the involved leg positioned in front or at the back, a single-leg stance with both legs, and sitting on an unstable surface. Velocity, average amplitude, and frequency-direction–specific parameters were analyzed from the center of pressure movement, measured by the force plate. Statistically significant differences between the 2 groups were observed for the medial–lateral body sway frequency in parallel stance on a stable and unstable support surface and for the sitting balance task in medial-lateral body sway parameters. Medium to high correlations were observed between body sway during sitting and the parallel stance, as well as between the tandem and single-legged stances. Following microdiscectomy, deficits in postural balance were side specific, as expected by the nature of the pathology. In addition, the results of this study confirmed the connection between proximal balance control deficits and balance during upright quiet balance tasks.

scholarly journals Subject-Specific Muscle Synergies in Human Balance Control Are Consistent Across Different Biomechanical Contexts

2010 ◽  
Vol 103 (6) ◽  
pp. 3084-3098 ◽  
Author(s):  
Gelsy Torres-Oviedo ◽  
Lena H. Ting
Keyword(s):  
Muscle Activation ◽  
Balance Control ◽  
Nonnegative Matrix ◽  
The Body ◽  
Muscle Synergy ◽  
Muscle Synergies ◽  
Support Surface ◽  
Activation Patterns ◽  
Muscle Activation Patterns ◽  
Specific Muscle

The musculoskeletal redundancy of the body provides multiple solutions for performing motor tasks. We have proposed that the nervous system solves this unconstrained problem through the recruitment of motor modules or functional muscle synergies that map motor intention to action. Consistent with this hypothesis, we showed that trial-by-trial variations in muscle activation for multidirectional balance control in humans were constrained by a small set of muscle synergies. However, apparent muscle synergy structures could arise from characteristic patterns of sensory input resulting from perturbations or from low-dimensional optimal motor solutions. Here we studied electromyographic (EMG) responses for balance control across a range of biomechanical contexts, which alter not only the sensory inflow generated by postural perturbations, but also the muscle activation patterns used to restore balance. Support-surface translations in 12 directions were delivered to subjects standing in six different postural configurations: one-leg, narrow, wide, very wide, crouched, and normal stance. Muscle synergies were extracted from each condition using nonnegative matrix factorization. In addition, muscle synergies from the normal stance condition were used to reconstruct muscle activation patterns across all stance conditions. A consistent set of muscle synergies were recruited by each subject across conditions. When balance demands were extremely different from the normal stance (e.g., one-legged or crouched stance), task-specific muscle synergies were recruited in addition to the preexisting ones, rather generating de novo muscle synergies. Taken together, our results suggest that muscle synergies represent consistent motor modules that map intention to action, regardless of the biomechanical context of the task.

Original study. The clinical value of foam posturography in assessing patients with peripheral vestibular dysfunction – our experience

2017 ◽  
Vol 7 (26) ◽  
pp. 93-101
Author(s):  
Raluca Enache ◽  
Dorin Sarafoleanu ◽  
Codrut Sarafoleanu
Keyword(s):  
Center Of Pressure ◽  
Balance Control ◽  
Vestibular Dysfunction ◽  
Control Group ◽  
Vestibular Disorders ◽  
Clinical Value ◽  
Dynamic Posturography ◽  
Eyes Closed ◽  
Peripheral Vestibulopathy ◽  
Romberg Test

Abstract BACKGROUND. Computerized dynamic posturography is the most important battery test designed to assess the ability to use visual, vestibular and proprioceptive cues in the maintenance of posture. Foam posturography reduces the availability of proprioceptive inputs, which makes more difficult the balance control. OBJECTIVE. The objective of the study was to assess the clinical use of foam posturography in evaluating peripheral vestibular dysfunction. MATERIAL AND METHODS. We evaluated 41 patients with vestibular disorders and 41 normal patients by using the sensory organization test in eyes opened, eyes closed and mislead vision conditions with and without the foam. We measured several parameters: the position of the center of pressure, the displacement in the center of pressure in anteroposterior and mediolateral planes and Romberg’s ratio on static and foam rubber. RESULTS. The values of all parameters were significantly higher in patients with peripheral vestibular disorders than in the control group (p<0.05). Also. comparing the Romberg test results, the foam surface used by the patient was larger than the static one. CONCLUSION. Foam posturography can be a reliable test in assessing patients with peripheral vestibulopathy, being also able to identify the visual and proprioceptive dependence levels.

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