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.

Object Transformations in the Play of Language-Impaired Children

1988 ◽  
Vol 53 (4) ◽  
pp. 459-466 ◽  
Author(s):  
Brenda Y. Terrell ◽  
Richard G. Schwartz
Keyword(s):  
Normal Subjects ◽  
Play Behavior ◽  
Chronological Age ◽  
Standard Group ◽  
Language Impaired ◽  
Normal Language ◽  
Mean Length Of Utterance ◽  
Impaired Children

The play behavior of 10 language-impaired children was observed. Their performances in play were compared to those of 10 normal-language children matched for chronological age as well as to those of 10 normal-language children matched for mean length of utterance. The children were observed as they played spontaneously with a standard group of toys and as they played with objects that required object transformations for successful play. The chronological age-matched normal subjects showed a trend toward performance of more object transformations in play than either the language-impaired or younger normal-language children. Additionally, although object transformations were observed in both segments, all children performed more object transformations with objects than with toys.

scholarly journals Effects of head positions on awake fiberoptic bronchoscope oral intubation: a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhuo Liu ◽  
Li Zhao ◽  
Zhongfeng Ma ◽  
Meiqi Liu ◽  
Xiaohang Qi ◽  
...  
Keyword(s):  
Tracheal Tube ◽  
Orotracheal Intubation ◽  
Neutral Position ◽  
Fiberoptic Bronchoscope ◽  
Glottic Opening ◽  
Vocal Cords ◽  
Oral Intubation ◽  
Vas Scores ◽  
Head Positions ◽  
Position Group

Abstract Background There are many factors affecting the success rate of awake orotracheal intubation via fiberoptic bronchoscope. We performed this study was to investigate the effects of head positions on awake Fiberoptic bronchoscope oral intubation. Methods Seventy-five adult patients, received general anaesthesia were included in this study. After written informed consent, these patients were undergoing awake orotracheal intubation via fiberoptic-bronchoscope and according to the head position, the patients were randomized allocated to neutral position group (NP group), sniffing position group (SP group) or extension position group (EP group). After sedation the patients were intubated by an experienced anesthesiologist. The time to view the vocal cords, the percentage of glottic opening scores (POGO), the time to insert the tracheal tube into trachea and the visual analog scale (VAS) scores for ease experienced of passing the tracheal tube through glottis, the hemodynamic changes and the adverse events after surgery were recorded. Results The time to view the vocal cords was significantly shorter and the POGO scores was significantly higher in the EP group compared with the other two groups (P < 0.05); The SpO2 in the EP group was higher than NP group at before intubation and higher than SP group and NP group at immediate after intubation (P < 0.05); The time to insert the tracheal tube into trachea, the VAS scores for passing the tracheal tube through glottis, the coughing scores had no significant differences among groups (P > 0.05). There were also no significant differences regard to the incidence of postoperative complications, mean arterial pressure and heart rate among the groups (P > 0.05). Conclusions The head at extension position had a best view of glottic opening than neutral position or sniffing position during awake Fiberoptic bronchoscope oral intubation, so extension position was recommended as the starting head position for awake Fiberoptic bronchoscope oral intubation. Trial registration Clinical Trials.gov. no. NCT02792855. Registered at https://register.clinicaltrials.gov on 23 september 2017.

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.

The role of vision on postural strategy evaluated in patients affected by congenital nystagmus as an experimental model

1999 ◽  
Vol 9 (6) ◽  
pp. 445-451
Author(s):  
S. Di Girolamo ◽  
W. Di Nardo ◽  
A. Cosenza ◽  
F. Ottaviani ◽  
A. Dickmann ◽  
...  
Keyword(s):  
Visual System ◽  
Postural Control ◽  
Visual Stimulus ◽  
Postural Balance ◽  
Visual Cues ◽  
Normal Subjects ◽  
Congenital Nystagmus ◽  
Dynamic Posturography ◽  
Normal Controls

The role of vision in postural control is crucial and is strictly related to the characteristics of the visual stimulus and to the performance of the visual system. The purpose of this investigation was to evaluate the effects of chronically reduced visual cues upon postural control in patients affected by Congenital Nystagmus (CN). These patients have developed since birth a postural strategy mainly based on vestibular and somatosensorial cues. Fifteen patients affected by CN and 15 normal controls (NC) were enrolled in the study and evaluated by means of dynamic posturography. The overall postural control in CN patients was impaired as demonstrated by the equilibrium score and by the changes of the postural strategy. This impairment was even more enhanced in CN than in NC group when somatosensorial cues were experimentally reduced. An aspecific pattern of visual impairment and a pathological composite score were also present. Our data outline that in patients affected by CN an impairment of the postural balance is present especially when the postural control relies mainly on visual cues. Moreover, a decrease in accuracy of the somatosensory cues has a proportionally greater effect on balance than it has on normal subjects.

scholarly journals Hallux Valgus Surgery May Produce Early Improvements in Balance Control

2013 ◽  
Vol 103 (6) ◽  
pp. 489-497 ◽  
Author(s):  
Saba Sadra ◽  
Adam Fleischer ◽  
Erin Klein ◽  
Gurtej S. Grewal ◽  
Jessica Knight ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Study Design ◽  
Balance Control ◽  
Center Of Mass ◽  
Cross Sectional Study ◽  
Static Balance ◽  
Long Term Effects ◽  
Cross Sectional ◽  
Eyes Open ◽  
Falls In Older Adults

Background: Hallux valgus (HV) is associated with poorer performance during gait and balance tasks and is an independent risk factor for falls in older adults. We sought to assess whether corrective HV surgery improves gait and balance. Methods: Using a cross-sectional study design, gait and static balance data were obtained from 40 adults: 19 patients with HV only (preoperative group), 10 patients who recently underwent successful HV surgery (postoperative group), and 11 control participants. Assessments were made in the clinic using body-worn sensors. Results: Patients in the preoperative group generally demonstrated poorer static balance control compared with the other two groups. Despite similar age and body mass index, postoperative patients exhibited 29% and 63% less center of mass sway than preoperative patients during double-and single-support balance assessments, respectively (analysis of variance P =.17 and P =.14, respectively [both eyes open condition]). Overall, gait performance was similar among the groups, except for speed during gait initiation, where lower speeds were encountered in the postoperative group compared with the preoperative group (Scheffe P = .049). Conclusions: This study provides supportive evidence regarding the benefits of corrective lower-extremity surgery on certain aspects of balance control. Patients seem to demonstrate early improvements in static balance after corrective HV surgery, whereas gait improvements may require a longer recovery time. Further research using a longitudinal study design and a larger sample size capable of assessing the long-term effects of HV surgical correction on balance and gait is probably warranted. (J Am Podiatr Med Assoc 103(6): 489–497, 2013)

The Sensitivity and Specificity of Tests for Carpal Tunnel Syndrome Vary with the Comparison Subjects

1998 ◽  
Vol 23 (2) ◽  
pp. 151-155 ◽  
Author(s):  
F. GERR ◽  
R. LETZ
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Diagnostic Tests ◽  
Normal Subjects ◽  
Clinical Test ◽  
Test Results ◽  
Electrophysiological Tests ◽  
Tunnel Syndrome ◽  
Electrophysiological Test ◽  
Hand Symptoms

The performance of a variety of common office-based clinical tests for detection of carpal tunnel syndrome (CTS) was assessed in 119 subjects with and without electrophysiological evidence of CTS. Symptoms compatible with CTS and electrophysiological tests positive for median mononeuropathy at the wrist were observed in 57 hands, symptoms compatible with CTS and normal electrophysiological test results were observed in 58 hands, and no symptoms compatible with CTS and normal electrophysiological test results were observed in 123 hands. For all the diagnostic tests studied, the proportion of subjects who had a false positive clinical test result was much higher in the electrophysiologically normal subjects who had CTS compatible hand symptoms than in the electrophysiologically normal subjects who were asymptomatic. These results suggest that many studies that have evaluated diagnostic tests for CTS have produced falsely optimistic estimates of the test’s performance because of their use of asymptomatic comparison subjects.

scholarly journals The Role of Clinical and Instrumented Outcome Measures in Balance Control of Individuals with Multiple Sclerosis

2013 ◽  
Vol 2013 ◽  
pp. 1-10 ◽  
Author(s):  
Neeta Kanekar ◽  
Alexander S. Aruin
Keyword(s):  
Multiple Sclerosis ◽  
Balance Control ◽  
Clinical Test ◽  
Balance Performance ◽  
Performance Deficits ◽  
Clinical Scales ◽  
Balance Confidence ◽  
High Fatigue ◽  
Healthy Control ◽  
Stability Limits

Purpose. The aim of the study was to investigate differences in balance control between individuals with multiple sclerosis (MS) and healthy control subjects using clinical scales and instrumented measures of balance and determine relationships between balance measures, fatigue, and disability levels in individuals with MS with and without a history of falls.Method. Twelve individuals with MS and twelve healthy controls were evaluated using the Berg Balance and Activities-specific Balance Confidence Scales, Modified Clinical Test of Sensory Interaction on Balance, and Limits of Stability Tests as well as Fatigue Severity Scale and Barthel Index.Results. Mildly affected individuals with MS had significant balance performance deficits and poor balance confidence levels (P<0.05). MS group had higher sway velocities and diminished stability limits (P<0.05), significant sensory impairments, high fatigue and disability levels (P<0.05). Sway velocity was a significant predictor of balance performance and the ability to move towards stability limits for the MS group. For the MS-fallers group, those with lower disability levels had faster movement velocities and better balance performance.Conclusion. Implementation of both clinical and instrumented tests of balance is important for the planning and evaluation of treatment outcomes in balance rehabilitation of people with MS.

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.

scholarly journals Sensorimotor integration for multisegmental frontal plane balance control in humans

2012 ◽  
Vol 107 (1) ◽  
pp. 12-28 ◽  
Author(s):  
Adam D. Goodworth ◽  
Robert J. Peterka
Keyword(s):  
Time Delay ◽  
Sensory Feedback ◽  
Sensorimotor Integration ◽  
Balance Control ◽  
Frontal Plane ◽  
Impulse Response Functions ◽  
Response Functions ◽  
Stimulus Amplitude ◽  
Sensory Reweighting ◽  
Eyes Open

To quantify the contribution of sensory information to multisegmental frontal plane balance control in humans, we developed a feedback control model to account for experimental data. Subjects stood with feet close together on a surface that rotated according to a pseudorandom waveform at three different amplitudes. Experimental frequency-response functions and impulse-response functions were measured to characterize lower body (LB) and upper body (UB) motion evoked during surface rotations while subjects stood with eyes open or closed. The model assumed that corrective torques in LB and UB segments were generated with no time delay from intrinsic musculoskeletal mechanisms and with time delay from sensory feedback mechanisms. It was found that subjects' LB control was primarily based on sensory feedback. Changes in the LB control mechanisms across stimulus amplitude were consistent with the hypothesis that sensory reweighting contributed to amplitude-dependent changes in balance responses whereby subjects decreased reliance on proprioceptive cues that oriented the LB toward the surface and increased reliance on vestibular/visual cues that oriented the LB upright toward earth vertical as stimulus amplitude increased in both eyes open and closed conditions. Sensory reweighting in the LB control system also accounted for most of the amplitude-dependent changes observed in UB responses. In contrast to the LB system, sensory reweighting was not a dominant mechanism of UB control, and UB control was more influenced by intrinsic musculoskeletal mechanisms. The proposed model refines our understanding of sensorimotor integration during balance control by including multisegmental motion and explaining how intersegmental interactions influence frontal plane balance responses.

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