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 < 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.

USING NECK DISABILITY INDEX, NUMERICAL PAIN RATING SCALE AND COMPUTERIZED DYNAMIC POSTUROGRAPHY TO ASSESS CORTICAL INTEGRATIVE THERAPY IN PRACTICE BASED CLINICAL RESEARCH

In this retrospective study of adult patient’s charts from an outpatient clinical practice, three tools, Neck Disability Index (NDI), Numerical Pain Rating Scale (NPRS), and Computerized Dynamic Posturography (CDP), were investigated to evaluate how they are affected by demographics, anthropometry and clinical status, and if they are can detect the effects of Cortical Integrative Therapy (PedroCIT®) received by these patients all affected by neck pain. The results show that they are robust metrics not affected by sex, age, payee’s type, treatment duration, or comorbidities number. CDP is affected by the primary diagnosis (traumatic brain injury/concussion, vertigo/dizziness, migraine/headaches, or other), NDI and NPRS are not. Whereas NDI and NPRS could be used interchangeably as an overall measure of the pain the patient is experiencing, their results do not correlate in general with CDP, indicating the need to use both a subjective (NDI or NPRS) and an objective tool (CDP) as they capture different aspects: how the subject rates its ability to perform daily activities and how much pain it feels, and how the postural control system maintains balance. When considering the time constraint physicians often face when dealing with patients, this chart review points toward the possibility of using the simple NPRS as subjective measure of pain, and only one instead of several CDP tests to determine the pre-post effect of a therapy. Future studies evaluating PedroCIT® outcomes for specific diagnoses in larger populations, multiple location settings, and observation for longitudinal cohesion are needed before these metrics can be fully endorsed.

Assessment of anxiety and postural balance in strategy for health care for elderly women

Introduction. The relevance of the study is determined by the tasks set in the National Project “Demography” (Federal Project “Senior Generation”), and consists in the need for registration of functional characteristics of the organism of older age groups in the accounting system of measures to preserve their health.Aim of the study is to establish the characteristics of anxiety and components of the postural balance (CPB) in elderly women with the risk of recurrent falls.Material and methods. We examined 232 women aged 55-69 years who reported that they experienced two or more falls over the past 12 months. The first age group included women whose calendar age was in the range of 55-64 years (n = 72), the second - women aged 65-69 years (n = 160). Using the self-assessment diagnostic technique by Spielberger, Ch. D., and Khanin, Yu. L. we determined the level of situational (SA) and personal (PA) anxiety. To assess the features of the CPB, a US-manufactured computerized dynamic posturography complex Smart Equitest Balance Manager was used. Sensory Organization Test (SOT) and Motor Control Test (MCT) tests were conducted. Results. When analyzing anxiety scale values, a high level of PA was revealed in both groups of women, however, the SA indices in women 55-64 years old were lower than for women 65-69 years old (p = 0.005). All this indicates that the development of recurrent falls among women older 64 years will be accompanied by mental tension and pronounced emotional responses to postural changes. According to computerized dynamic posturography testing, age-related differences in CPB have been revealed. There was a decrease in the quality of the equilibrium function by test 5 SOT and vestibular information in postural control found in women of age group 55-64, whereas for women in the age group 65-69 there was a decrease in the quality of equilibrium function by test 4 and visual information in balance control. In the latter, there was also found an increase in the time of coordinated motor response by the test of unexpected external impact on the shift of the center of gravity capable of enhancing the risks of stuttering and falls when walking fast.Conclusion. The suggested criteria for assessing the risk of falls in elderly women can be used to develop individual health programs to prevent serious consequences in such events.

Effects of Soccer Training on Body Balance in Young Female Athletes Assessed Using Computerized Dynamic Posturography

The aim of this study was to determine the effect of regular soccer training on the balance system for young women. Computerized dynamic posturography of female footballers (n = 25) and control group (n = 50) was assessed during three tests: Sensory Organization Test, Motor Control Test, and Adaptation Test. Statistically significant differences between the groups was found in Composite Equilibrium Score with higher values, indicating better postural stability, for footballers. Regular trainees also showed better usefulness of vestibular system while maintaining balance. Weight symmetry of the lower limbs during Motor Control Test also showed statistically significant differences between the groups. This study shows that female footballers have better postural stability than their inactive peers and that regular workouts may improve the balance system.