A Comparison of Balance Performance of the Sensory Organization Test to the Head Shake Sensory Organization Test in Healthy Adults

ObjectiveTo compare equilibrium scores between computerized dynamic posturography tests of the Sensory Organization Test (SOT) to the Head Shake-Sensory Organization Test (HS-SOT) in healthy adults.BackgroundApproximately 50% of the brain's pathways are related to vision and many of these pathways are susceptible to injury in concussion. Visual-motor disruptions occur in 65%–90% of concussed patients. These disruptions impair balance and can be measured. The SOT is a computerized postural test that evaluates balance by altering visual, proprioceptive, and vestibular cues. The HS-SOT modifies 2 of the standard SOT conditions by including dynamic head motions that stimulate the semicircular canals within the vestibular system.Design/MethodsParticipants completed the Dizziness Handicap Inventory, Activities of Balance Confidence Scale, SOT, and HS-SOT in one session.ResultsTwenty-five individuals (17 females, 8 males; mean age, 21.08 ± 4.10 years, range, 18–33 years) completed outcome measures and 3 trials of testing. There was a significant difference in mean values between the SOT and the HS-SOT for both condition 2 (t(16) = 3.034, p = 0.008) and 5 (t(16) = 5.706, p < 0.001). Additionally, there was a significant difference in mean values between the SOT and the foam HS-SOT for condition 2 (t(16) = 4.673, p < 0.001) and condition 5 (t(16) = 7.263, p < 0.001). There was not a significant difference in means between the foam and without foam for HS-SOT for condition 2 (t(16) = 1.77, p = 0.095) and condition 5 (t(16) = 1.825, p = 0.087).ConclusionsThe HS-SOT may quantify subtle balance deficits and enhance the clinical standard use of the SOT. Unlike the SOT where the head is static, the HS-SOT requires head movements, as if saying no repeatedly at approximately 100°/second as measured by an accelerometer. The HS-SOT may quantify subtle balance deficits and enhance the clinical standard use of the SOT.

Migraine With Aura Is Related to Delayed Motor Control Reaction and Imbalance Following External Perturbations

Background: It is evidenced that migraineurs present balance deficits. However, the balance recovery following unexpected ground perturbations, which reflect conditions of everyday activities, has not been investigated in this population.Aim: We aimed to assess the reactive postural responses among patients with migraine with and without aura, chronic migraine, and controls. We further aimed to assess the factors associated with greater self-report of falls.Methods: Ninety patients diagnosed by headache specialists were equally classified into three migraine subgroups according to the presence of aura and chronic migraine. Thirty controls were also recruited. All participants underwent the motor control test (MCT) and adaptation test (ADT) protocols of dynamic posturography tests (EquiTest®, NeuroCom, USA). Clinical and headache features and information on falls in the previous year, fear of falling, and vestibular symptoms were also assessed.Results: Patients with aura presented a greater sway area in most of the MCT conditions than the other three groups (p = 0.001). The aura group also presented delayed latency responses after perturbations compared with controls and patients without aura (p &lt; 0.03). In the ADT, a greater sway area was observed in patients with aura than in groups without aura, chronic migraine, and controls (p &lt; 0.0001). The MCT and ADT sway area, the frequency of aura, and the fear of falling explained 46% of the falls in the previous 12 months.Conclusion: Patients with aura exhibited greater delay and sway area after unexpected ground perturbations than controls and other migraine subgroups, which are related to the reported number of falls.

Effect of using smart phones on balance functions

Objective To investigate the effect of visual fatigue caused by smart phone on the balance function. Subjects and Methods Forty subjects divided into 2 groups were included in the present study . Group I, twenty normal healthy subjects with mean age of 28.8 years. Group II, twenty subjects with a clinical diagnosis of peripheral vestibular disorder with mean age of 38.85years. They were subjected to a computer vision syndrome questionnaire (CVS-Q) , occulomotor tests of videonystagmography (VNG) and sensory organization test (SOT) of computerized dynamic posturography (CDP) before and after visual fatigue induction. Results Significant differences existed between C5, 6 and composite scores in group I and in C4 and composite scores in group II after visual fatigue induction. However, there was no significant difference between occulomotor tests in both groups after visual fatigue induction. Conclusions The smart phone use can affect the balance function in healthy subjects and augment the deficit in those with balance problem. Reducing visual fatigue should be considered through various procedures as taking proper rest, adjusting the brightness of screen, avoid any wrong posture and using filters if possible.

Assessment of postural instability in Parkinson’s disease patients

Background Parkinson’s disease (PD) is a degenerative, progressive, neurological condition that influences the control of a person’s body movements. Computerized dynamic posturography (CDP) is a clinical tool intended to evaluate the integration of visual, vestibular, and somatosensory inputs to maintain postural gait. Posturography can be used to measure postural instability in PD patients. So, the aim of this study was to evaluate the postural control and elaborate on the pathophysiology of the balance impairment in PD patients in the “on” state. Results All antero-posterior (AP) and medio-lateral (ML) sensory balance scores, except vestibular ones, were significantly lower in the study group compared to the control group. AP and ML sway were generally higher in the study group at all frequencies, with AP being mostly greater compared to ML sway in PD subjects. Global sensory scores were shown to deteriorate with increased durations of the disease and treatment. Conclusions PD patients have higher postural instability in comparison to controls with AP sway being higher compared to ML.

Gait Difficulties and Postural Instability in Adrenoleukodystrophy

Background: Gait and balance difficulties are among the most common clinical manifestations in adults with X-linked adrenoleukodystrophy, but little is known about the contributions of sensory loss, motor dysfunction, and postural control to gait dysfunction and fall risk.Objective: To quantify gait and balance deficits in both males and females with adrenoleukodystrophy and evaluate how environmental perturbations (moving surfaces and visual surrounds) affect balance and fall risk.Methods: We assessed sensory and motor contributions to gait and postural instability in 44 adult patients with adrenoleukodystrophy and 17 healthy controls using three different functional gait assessments (25 Foot Walk test, Timed Up and Go, and 6 Minute Walk test) and computerized dynamic posturography.Results: The median Expanded Disability Status Scale score for the patient cohort was 3.0 (range 0.0–6.5). Both males and females with adrenoleukodystrophy showed impairments on all three functional gait assessments relative to controls (P &lt; 0.001). Performance on walking tests and Expanded Disability Status Scale scores correlated with incidence of falls on computerized dynamic posturography, with the 25 Foot Walk being a moderately reliable predictor of fall risk (area under the ROC curve = 0.7675, P = 0.0038).Conclusion: We demonstrate that gait difficulties and postural control deficits occur in patients with adrenoleukodystrophy, albeit at an older age in females. Postural deficits were aggravated by eyes closed and dynamic conditions that rely on vestibular input, revealing challenges to the interplay of motor, sensory and vestibular circuitry in adrenoleukodystrophy.

Gait and balance impairments in patients with subcortical vascular cognitive impairment

Background Subcortical vascular cognitive impairment (SVCI) is a subtype of vascular cognitive impairment associated with extensive cerebral small vessel diseases (CSVDs) imaging biomarkers. The objectives of this work were to study the existence and patterns of gait and balance impairments in patients with SVCI due to CSVDs. Methods The study was conducted on 28 newly diagnosed SVCI patients and 22 healthy control subjects (HCS) submitted to the advanced activity of daily living scale (AADLs), Berg balance test (BBT), Montreal Cognitive Assessment Scale (MoCA), computerized dynamic posturography (CDP), vision-based 3-D skeletal data gait analysis, and brain MRI volumetric assessment. Results SVCI patients showed a significant decrease in AADLs as well as total cerebral white matter volume, total cerebral cortical volume, and mean cortical thickness which were proportional to the degree of cognitive impairment as measured by the MoCA score. Regarding CDP analysis, patients with SVCI revealed prolongation of cancelation time and spectral power for mid- and high frequencies in dynamic positions. In respect to gait analysis, there were significant decreases in mean stride length and mean cadence as well as increases in mean step width and left to right step length difference in the SVCI group compared to HCS while doing a single task. These variables get highly significant during the dual-task performance with a p value < 0.001 for each one. Conclusion Patients with SVCI suffer from gait and balance impairments that are proportional to the severity of their cognitive decline and greatly impair their ADLs.

Sensory, voluntary, and motor postural control in children and adolescents with mucopolysaccharidosis

Objectives This study aimed to investigate automatic and voluntary motor control performances, which have an important function in maintaining balance, in children and adolescents with mucopolysaccharidosis (MPS). Methods The records of 70 patients were retrospectively analyzed. The results of Computerized Dynamic Posturography (CDP) performed according to the age and development of the individuals were examined. The results of 10 children and adolescents with MPS (mean age: 9.43 ranging from 6 to 14; four males and six females) who completed the sensory analysis, Weight-Bearing Squat Test, and Adaptation Test were retrieved from the database of the CDP. Nine healthy children and adolescents with typical development (mean age: 9.63 ranging from 6 to 14; four males and five females) were included as the control group. Results In the sensory analysis test, there was a statistically significant difference between the two groups in the visual ratio parameter. In the adaptation test, there was a statistically significant difference between the two groups in the toes up and toes down trials. There was no statistically significant difference between the groups in the Weight-Bearing Squat test at 0° knee extension and various knee flexions. Conclusions Children and adolescents with MPS should be directed to the appropriate exercise and therapy programs to develop postural and balance control, which have a significant effect on their quality of life and the ability to independently perform daily activities of living. In addition to routine hearing assessments for patients with MPS, other objective tests used in the differential diagnosis of balance and vestibular system should also be implemented.

COMORBIDITY CHARACTERISTICS OF ADULT PATIENTS WITH REPORTED NECK AND LOW BACK COMPLAINTS - AN OUTPATIENT CLINICAL POPULATION-BASED COHORT STUDY

In clinical practice, a comprehensive history and examination often includes questionnaires covering all systems. Physical examination is augmented by functional assessment using subjective (neck and lumbar disability indexes, NDI and LBDI respectively) and objective measures (computerized dynamic posturography, CDP). In this retrospective chart review of patients with complaints of postural instability and neck or low back pain, the presence and number of comorbidities and their classification were analyzed by age, gender, and severity of the disability. In general subjects showed higher disability in the NDI than in the LBDI (with more significant impact of the proximal vs. distal pain, joint and receptor dysfunction); they had a wide range of CDP results (the more difficult the test, the higher the number of subjects that were not able to complete it and the lower the number that had healthy balance); and on average 3.84 comorbid conditions were present, with 21 subjects presenting with 5 or more, 3 with 10 or more, and one reporting 15 comorbidities. No statistically significant differences were found for age, BMI and LBDI; sex and NDI affected metabolic comorbidities; certain tests of the CDP affected the Musculoskeletal and Other type of comorbidities. It was difficult to detect strong correlation trends that could be easily explained. Complex subjects cases complicate the possibility of doing practice based clinical research, but more importantly they create a challenge for the clinician in deciding the best course of action for treating the patient. New algorithmic assessments and integrated approaches are needed.