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.

Disinhibition of Primitive Reflexes in Attention Deficit and Hyperactivity Disorder: Insight Into Specific Mechanisms in Girls and Boys

Objective: Cognitive and motor disintegration and other functional disturbances in various neuropsychiatric disorders may be related to inhibitory deficits that may manifest as a persistence or re-expression of primitive reflexes and few recent data suggest that these deficits may occur in Attention Deficit and Hyperactivity Disorder (ADHD).Methods: We have tested a hypothesis to which extent ADHD symptoms and balance deficits are related to persisting primitive reflexes, such as Asymmetric Tonic Neck Reflex (ATNR) and Symmetric Tonic Neck Reflex (STNR) in 80 medication-naïve children with ADHD (40 boys and 40 girls) in the school age (8–11 years) and compared these data with a control group of 60 children (30 boys and 30 girls).Results: These data show new finding that ADHD symptoms and balance deficits are strongly and specifically associated with persistent ATNR in girls and STNR in boys.Conclusions: These results provide first evidence in medical literature that ADHD in girls and boys is specifically related to distinguished neurological developmental mechanisms related to disinhibition of primitive reflexes.

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.

Effects of Stretching on Injury Risk Reduction and Balance

ABSTRACT Evidence for the effectiveness of acute and chronic stretching for improving range of motion is extensive. Improved flexibility can positively impact performances in activities of daily living and both physical and mental health. However, less is known about the effects of stretching on other aspects of health such as injury incidence and balance. The objective of this review is to examine the existing literature in these areas. The review highlights that both pre-exercise and chronic stretching can reduce musculotendinous injury incidence, particularly in running-based sports, which may be related to the increased force available at longer muscle lengths (altered force-length relationship) or reduced active musculotendinous stiffness, among other factors. Evidence regarding the acute effects of stretching on balance is equivocal. Longer-term stretch training can improve balance, which may contribute to a decreased incidence of falls and associated injuries and may thus be recommended as an important exercise modality in those with balance deficits. Hence, both acute and chronic stretching seem to have positive effects on injury incidence and balance, but optimum training plans are yet to be defined.

Sex-Specific Difference in Dynamic Balance Following Total Hip Replacement

Background and Objectives Total hip replacement (THA) is a common surgical procedure in older adults (65 years or older). THA has high patient satisfaction, but little is known about balance and mobility limitations after surgery and if outcomes are sex-specific. To evaluate post-THA asymmetry during unilateral standing and a dynamic balance and reach test and test the hypotheses that balance performance would be decreased on the surgical limb and that balance deficits would be greater in women than men. Research Design and Methods Primary, unilateral THA (70 male, 57 female) patients completed a bilateral 10-second single leg stance test. Sixty male but only 34 female participants could maintain unilateral balance for 10 seconds or greater. The cohort who successfully completed the 10-second single limb stance test then completed a Lower Quarter Y-Balance Test (YBT-LQ) in which the maximum anterior (ANT), posteromedial (PM) and posterolateral (PL) reach distances were obtained bilaterally and used to calculate the asymmetry score. All variables were compared using a mixed-model repeated-measures ANOVA (sex by limb), while independent samples t-tests were used to assess sex-specific asymmetry. Results Women failed single leg stance at a higher rate than men (85.7% vs. 59.6%; p=0.001). Reach distance was different between limbs for all reach directions (p&lt;0.004) with greater reach distance on the non-operative limb for all patients. Men had a greater reach distance in the ANT (p=0.004), and PM (p=0.006) directions. Discussion and Implications These results indicate that post-THA the operative limb and female patients have greater balance limitations. These results are novel and reveal sex-specific patterns that emphasize the need for sex-specific post-operative rehabilitation programs to improve long-term outcomes, especially in older adults with muscle weakness and balance deficits.

Abnormal center of mass feedback responses during balance: A potential biomarker of falls in Parkinson’s disease

Although Parkinson disease (PD) causes profound balance impairments, we know very little about how PD impacts the sensorimotor networks we rely on for automatically maintaining balance control. In young healthy people and animals, muscles are activated in a precise temporal and spatial organization when the center of body mass (CoM) is unexpectedly moved that is largely automatic and determined by feedback of CoM motion. Here, we show that PD alters the sensitivity of the sensorimotor feedback transformation. Importantly, sensorimotor feedback transformations for balance in PD remain temporally precise, but become spatially diffuse by recruiting additional muscle activity in antagonist muscles during balance responses. The abnormal antagonist muscle activity remains precisely time-locked to sensorimotor feedback signals encoding undesirable motion of the body in space. Further, among people with PD, the sensitivity of abnormal antagonist muscle activity to CoM motion varies directly with the number of recent falls. Our work shows that in people with PD, sensorimotor feedback transformations for balance are intact but disinhibited in antagonist muscles, likely contributing to balance deficits and falls.

Feasibility of motor-assisted elliptical to improve walking, fitness and balance following pediatric acquired brain injury: A case series

PURPOSE: Walking, fitness, and balance deficits are common following acquired brain injury (ABI). This study assessed feasibility, acceptability, and usefulness of a modified motor-assisted elliptical (ICARE) in addressing walking, fitness, and balance deficits in children with chronic ABIs. METHODS: Three children (> 5 years post-ABI) completed 24 ICARE exercise sessions (exercise time, speed, and time overriding motor-assistance gradually increased) to promote mass repetition of gait-like movements and challenge cardiorespiratory fitness. Parents’ and children’s perceptions of ICARE’s safety, comfort, workout, and usability were assessed. Cardiovascular response, gait and balance outcomes were assessed. RESULTS: No adverse events occurred. Parent’s Visual Analogue Scale (VAS) scores of perceived device safety (range 80–99), workout (range 99–100), and usability (range 75–100) were high, while comfort were 76–80 given commercial harness fit and arm support. Children’s VAS scores all exceeded 89. Comfortable walking velocity, 2-Minute Walk Test, fitness, and Pediatric Balance Scale scores improved post-training, with many outcomes surpassing established minimal clinically important differences. CONCLUSION: Following engagement in moderate- to vigorous-intensity exercise promoting repetitive step-like movements on a specially adapted motor-assisted elliptical, three children with chronic ABI demonstrated improvements in walking, fitness and balance. Future research in community-based environments with a larger cohort of children with ABI is needed.