The Influence of Unilateral Saccular Impairment on Functional Balance Performance and Self-Report Dizziness

2011 ◽  
Vol 22 (08) ◽  
pp. 542-549 ◽  
Author(s):  
Devin L. McCaslin ◽  
Gary P. Jacobson ◽  
Sarah L. Grantham ◽  
Erin G. Piker ◽  
Susha Verghese
Keyword(s):  
Postural Control ◽  
Postural Stability ◽  
Vestibular Nerve ◽  
Self Report ◽  
Vestibular Evoked Myogenic Potentials ◽  
Balance Function ◽  
Dizziness Handicap Inventory ◽  
Inferior Vestibular Nerve ◽  
Caloric Response ◽  
Function Testing

Background: Postural stability in humans is largely maintained by vestibular, visual, and somatosensory inputs to the central nervous system. Recent clinical advances in the assessment of otolith function (e.g., cervical and ocular vestibular evoked myogenic potentials [cVEMPs and oVEMPs], subjective visual vertical [SVV] during eccentric rotation) have enabled investigators to identify patients with unilateral otolith impairments. This research has suggested that patients with unilateral otolith impairments perform worse than normal healthy controls on measures of postural stability. It is not yet known if patients with unilateral impairments of the saccule and/or inferior vestibular nerve (i.e., unilaterally abnormal cVEMP) perform differently on measures of postural stability than patients with unilateral impairments of the horizontal SCC (semicircular canal) and/or superior vestibular nerve (i.e., unilateral caloric weakness). Further, it is not known what relationship exists, if any, between otolith system impairment and self-report dizziness handicap. Purpose: The purpose of this investigation was to determine the extent to which saccular impairments (defined by a unilaterally absent cVEMP) and impairments of the horizontal semicircular canal (as measured by the results of caloric testing) affect vestibulospinal function as measured through the Sensory Organization Test (SOT) of the computerized dynamic posturography (CDP). A secondary objective of this investigation was to measure the effects, if any, that saccular impairment has on a modality-specific measure of health-related quality of life. Research Design: A retrospective cohort study. Subjects were assigned to one of four groups based on results from balance function testing: Group 1 (abnormal cVEMP response only), Group 2 (abnormal caloric response only), Group 3 (abnormal cVEMP and abnormal caloric response), and Group 4 (normal control group). Study Sample: Subjects were 92 adult patients: 62 were seen for balance function testing due to complaints of dizziness, vertigo, or unsteadiness, and 30 served as controls. Intervention: All subjects underwent videonystagmography or electronystagmography (VNG/ENG), vestibular evoked myogenic potentials (VEMPs), self-report measures of self-perceived dizziness disability/handicap (Dizziness Handicap Inventory), and tests of postural control (Neurocom Equitest). Data Collection and Analysis: Subjects were categorized into one of four groups based on balance function test results. All variables were subjected to a multifactor analysis of variance (ANOVA). The Dizziness Handicap Inventory (DHI) total scores and equilibrium scores served as the dependent variables. Results: Results showed that patients with abnormal unilateral saccular or inferior vestibular nerve function (i.e., abnormal cVEMP) demonstrated significantly impaired postural control when compared to normal participants. However, this group demonstrated significantly better postural stability when compared to the group with abnormal caloric responses alone and the group with abnormal caloric responses and abnormal cVEMP results. Patients with an abnormal cVEMP did not differ significantly on the DHI compared to the other two impaired groups. Conclusions: We interpret these findings as evidence that a significantly asymmetrical cVEMP in isolation negatively impacts performance on measures of postural control compared to normal subjects but not compared to patients with significant caloric weaknesses. However, patients with a unilaterally abnormal cVEMP do not differ from patients with significant caloric weaknesses in regard to self-perceived dizziness handicap.

Methodology for Skull Tap Vestibular Evoked Myogenic Potentials (Tap-cVEMP)

2017 ◽  
Vol 6 (3) ◽  
pp. 26-29
Author(s):  
Paulina Glinka ◽  
Magdalena Lachowska ◽  
Kazimierz Niemczyk
Keyword(s):  
Cerebellopontine Angle ◽  
Pathological Process ◽  
Sternocleidomastoid Muscle ◽  
Vestibular Nerve ◽  
Vestibular Evoked Myogenic Potentials ◽  
Nerve Bundle ◽  
Cerebellopontine Angle Tumor ◽  
Functional Integrity ◽  
Nerve Bundles ◽  
Inferior Vestibular Nerve

Objective: The aim of this study is to present a methodology of vestibular evoked myogenic potentials registered from sternocleidomastoid muscle (SCM) using skull tap stimulation (Tap-cVEMP) in a patient with cerebellopontine angle tumor (CPAT). Material and methods: A 23-year-old female with CPAT. The methodology of Tap-cVEMP is introduced. The results of VEMP is confronted with surgical information about the tumor. Results: The results of AC-cVEMP and Tap-cVEMP revealed the inferior vestibular nerve bundle to be affected by the tumor with intact superior bundle. Information obtained from VEMP was confirmed during surgery. Conclusion: Skull Tap Vestibular Evoked Myogenic Potentials (Tap-cVEMP) may be the useful method in the diagnostics of CPAT. AC-cVEMP and Tap-cVEMP may be helpful to evaluate the functional integrity of both vestibular nerve bundles providing the information about their involvement in the pathological process.

Effects of unilateral dysfunction of the inferior vestibular nerve system on postural stability

2010 ◽  
Vol 121 (8) ◽  
pp. 1279-1284 ◽  
Author(s):  
Chisato Fujimoto ◽  
Toshihisa Murofushi ◽  
Yasuhiro Chihara ◽  
Munetaka Ushio ◽  
Takuhiro Yamaguchi ◽  
...  
Keyword(s):  
Postural Stability ◽  
Vestibular Nerve ◽  
Inferior Vestibular Nerve ◽  
Nerve System

Preservation of tap vestibular evoked myogenic potentials despite resection of the inferior vestibular nerve

2004 ◽  
Vol 14 (4) ◽  
pp. 347-351 ◽  
Author(s):  
Krister Brantberg ◽  
Tiit Mathiesen
Keyword(s):  
Bone Conduction ◽  
Vestibular Function ◽  
Vestibular Nerve ◽  
Vestibular Evoked Myogenic Potentials ◽  
Nerve Function ◽  
Sound Stimulation ◽  
Vestibular Loss ◽  
Vestibular Neurectomy ◽  
Inferior Vestibular Nerve ◽  
Healthy Side

Sound and skull-tap induced vestibular evoked myogenic potentials (VEMP) were studied in a 43-year-old man following inferior vestibular neurectomy. Surgery was performed because of a small acoustic neuroma. Postoperative caloric testing suggested sparing of superior vestibular nerve function on the operated side. In response to sound stimulation there were no VEMP on the operated side, irrespective of whether sounds were presented by air- or bone-conduction. This suggests sound-induced VEMP to be critically dependent on inferior vestibular nerve function and this is in agreement with present knowledge. However, VEMP were obtained in response to forehead skull taps, i.e. positive-negative VEMP not only on the healthy side but also on the operated side. This suggests remnant vestibular function on the operated side of importance for forehead skull tap VEMP, because with complete unilateral vestibular loss there are no (positive-negative) VEMP on the lesioned side. Thus, forehead skull-tap VEMP depend, at least partly, on the superior vestibular nerve function.

Deaf Individuals Who Report Having Good Balance Function Present with Significant Vestibular Deficits

2021 ◽  
Vol 32 (08) ◽  
pp. 510-520
Author(s):  
Chizuko Tamaki ◽  
Kristen Maul ◽  
Daniel S. Talian ◽  
Sarah Sparks
Keyword(s):  
Health Care ◽  
Case History ◽  
Self Report ◽  
Vestibular Evoked Myogenic Potentials ◽  
Clinical Test ◽  
Balance Function ◽  
Care Providers ◽  
Increased Risk ◽  
Balance Ability ◽  
Abc Scale

Abstract Background Vestibular and/or balance deficits are well documented in deaf individuals. In the adult population, poor vestibular and/or balance function can lead to activity limitations and increased risk of falling. An effective case history by health care providers to probe for potential balance concerns is necessary for appropriate referral; however, patients may not consistently report vestibular and balance symptoms. Currently, there is little information available as to how deaf individuals report these symptoms and how their reported balance ability relates to measures of balance and vestibular functions. Purpose The aim of the current study was to evaluate self-perceived balance ability in participants who self-identify as either deaf or hearing, and compare these results to measures of balance and vestibular functions. Research Design This is a prospective, between-group design. Study Sample Data from 57 adults between the ages of 18 to 29 years who self-reported as deaf (39) or hearing (18) were evaluated. Participants completed the activities-specific balance confidence (ABC) scale, a brief case history, self-report rating of balance (SRRB), the Modified Clinical Test of Sensory Integration of Balance (mCTSIB), along with both ocular vestibular-evoked myogenic potentials (oVEMPs) and cervical vestibular-evoked myogenic potentials (cVEMPs). Only participants with SRRBs of good or excellent were included in the inferential analyses. Results Proportions of participants rating their balance ability as either good or excellent were similar between both groups, as were the results on the ABC scale. Statistical analyses revealed significant associations between the groups on both oVEMPs and cVEMPs. No significant differences were observed on sway velocities in any of the mCTSIB conditions; however, more than one-third of deaf participants had mCTSIB Condition 4—on foam, eyes closed—scores above 2 standard deviations of the hearing group. Conclusion Deaf participants self-report similar ratings of balance ability as hearing participants despite significant differences in vestibular function. A relatively large subset of deaf participants had increased sway velocity on balance function testing that required increased reliance on vestibular cues. A thorough discussion of balance and vestibular symptoms should be completed when a patient who self-identifies as deaf is seen by a health care provider so that appropriate screenings or referrals can be completed as necessary.

POSTURAL STABILITY IN PATIENTS WITH LATENT TRIGGER ZONES OF NECK MUSCULATURE

2019 ◽  
pp. 114-123
Author(s):  
E.R. Mukhametova ◽  
A.D. Militskova ◽  
T.V. Baltina
Keyword(s):  
Postural Control ◽  
Postural Stability ◽  
Test Group ◽  
Trigger Points ◽  
Control Group ◽  
Neck Muscle ◽  
Pressure Center ◽  
Cervical Muscles ◽  
Equilibrium Function ◽  
Romberg Test

There are many reasons for postural disorder development, but dysfunction of the cervical spine muscles is the most disputable reason. The purpose of the study is to reveal the influence of latent myogenic trigger zones of the cervical muscles on postural resistance. Materials and Methods. The authors used the method of computer posturography. Latent myogenic trigger zones (LMTZs) were determined by an indurated nodule or bundle in the neck muscle and by hyperesthesia in this zona. Assessment of postural resistance in subjects with LMTZs was carried out using standard posturography tests and Romberg test. Both classical and vector indicators were evaluated in a standard sample. Results. In fact, only vector indicators changed significantly in subjects with multiple LMTZs (4 or more). Thus, a decrease in the equilibrium function quality was established, as well as an increase in the average linear velocity of the pressure center and an increase in the normalized vectorogram area if compared with the indices in the control group and the group with sporadic LMTZs (from 1 to 3). The obtained results indicate a postural control decrease in individuals with multiple LMTZs. Subjects with sporadic LMTZs demonstrated a significant decrease in classical and a number of vector indicators, which shows the improvement in postural resistance in this test group. In Romberg test, all subjects with LMTZs, regardless of the zone number, showed an increasd Romberg coefficient. Conclusion. Multiple LMTZs of cervical muscles can reduce postural stability through increased afferentation from the cervical proprioreceptors. It is more obvious during in case of eye control elimination. Keywords: latent myogenic trigger points, postural control, posturography, Romberg test. Выделяют множество причин развития постуральных нарушений, среди которых дисфункция мышц шейного отдела позвоночника является наиболее спорной. Цель исследования. Выявить влияние латентных миогенных триггерных зон шейной мускулатуры на постуральную устойчивость. Материалы и методы. Использовался метод компьютерной стабилографии. Латентные миогенные триггерные зоны (лМТЗ) определялись по наличию в мышце шеи уплотненного узелка или пучка и по повышенной болевой чувствительности в этой области. Оценка постуральной устойчивости у испытуемых с лМТЗ осуществлялась с помощью стандартного стабилографического тестирования и теста Ромберга. В стандартной пробе оценивались как классические, так и векторные показатели. Результаты. Показано, что у испытуемых с множественными лМТЗ (4 и более) достоверно изменяются только векторные показатели. Так, установлено снижение качества функции равновесия, а также повышение средней линейной скорости центра давления и увеличение нормированной площади векторограммы по сравнению показателями в группе контроля и группе с единичными лМТЗ (от 1 до 3), что указывает на снижение постурального контроля у лиц с множественными лМТЗ. У испытуемых с единичными лМТЗ отмечено достоверное снижение классических показателей и ряда векторных, что свидетельствует об улучшении постуральной устойчивости в данной группе испытуемых. В пробе Ромберга все субъекты с лМТЗ независимо от количества последних показали повышение коэффициента Ромберга. Выводы. Множественные лМТЗ шейной мускулатуры могут снизить постуральную устойчивость через усиление афферентации от шейных проприорецепторов, что наиболее выражено при элиминации зрительного контроля. Ключевые слова: латентные миогенные триггерные точки, постуральный контроль, стабилография, тест Ромберга.

scholarly journals Postural Stability of Patients with Schizophrenia during Challenging Sensory Conditions: Implication of Sensory Integration for Postural Control

PLoS ONE ◽  
2016 ◽  
Vol 11 (6) ◽  
pp. e0158219 ◽  
Author(s):  
Ya-Ling Teng ◽  
Chiung-Ling Chen ◽  
Shu-Zon Lou ◽  
Wei-Tsan Wang ◽  
Jui-Yen Wu ◽  
...  
Keyword(s):  
Postural Control ◽  
Sensory Integration ◽  
Postural Stability

scholarly journals Time-to-Boundary Function to Study the Development of Upright Stance Control in Children

2017 ◽  
Vol 11 (1) ◽  
pp. 49-58
Author(s):  
Carmen D'Anna ◽  
Maurizio Schmid ◽  
Andrea Scorza ◽  
Salvatore A. Sciuto ◽  
Luisa Lopez ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Postural Control ◽  
Postural Stability ◽  
Age Groups ◽  
Boundary Function ◽  
Mean Value ◽  
Upright Stance ◽  
Eyes Closed ◽  
The Mean ◽  
Spatio Temporal

Background: The development of postural control across the primary school time horizon is a complex process, which entails biomechanics modifications, the maturation of cognitive ability and sensorimotor organization, and the emergence of anticipatory behaviour. Postural stability in upright stance has been thus object of a multiplicity of studies to better characterize postural control in this age span, with a variety of methodological approaches. The analysis of the Time-to-Boundary function (TtB), which specifies the spatiotemporal proximity of the Centre of Pressure (CoP) to the stability boundaries in the regulation of posture in upright stance, is among the techniques used to better characterize postural stability in adults, but, as of now, it has not yet been introduced in developmental studies. The aim of this study was thus to apply this technique to evaluate the development of postural control in a sample population of primary school children. Methods: In this cross-sectional study, upright stance trials under eyes open and eyes closed were administered to 107 healthy children, divided into three age groups (41 for Seven Years' Group, Y7; 38 for Nine Years' Group, Y9; 28 for Eleven Years' Group, Y11). CoP data were recorded to calculate the Time-to-Boundary function (TtB), from which four spatio-temporal parameters were extracted: the mean value and the standard deviation of TtB minima (Mmin, Stdmin), and the mean value and the standard deviation of the temporal distance between two successive minima (Mdist, Stddist). Results: With eyes closed, Mmin and Stdmin significantly decreased and Mdist and Stddist increased for the Y7 group, at Y9 Mmin significantly decreased and Stddist increased, while no effect of vision resulted for Y11. Regarding age groups, Mmin was significantly higher for Y9 than Y7, and Stdmin for Y9 was higher than both Y7 and Y11; Mdist and Stddist resulted higher for Y11 than for Y9. Conclusion: From the combined results from the spatio-temporal TtB parameters, it is suggested that, at 9 years, children look more efficient in terms of exploring their limits of stability than at 7, and at 11 the observed TtB behaviour hints at the possibility that, at that age, they have almost completed the maturation of postural control in upright stance, also in terms of integration of the spatio-temporal information.

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