Vestibular Rehabilitation in Isolated Otolith Dysfunction After Covid-19: A Case Report

A 56-year-old female with dizziness, imbalance, and a slight floating sensation was evaluated. Her symptoms started after infection with the novel coronavirus (SARS-CoV-2). Routine auditory test (pure tone audiometry), vestibular assessment (videonystagmography), and neurologic test results were in the normal range, but the otolith evaluations, such as cervical vestibular evoked myogenic potentials (cVEMP) and subjective visual vertical tests, showed abnormal findings. The patient underwent a ten-session individualized vestibular rehabilitation program (one session per week). After completing rehabilitation sessions, her chief complaints were alleviated, the performance on computerized posturography was improved, and the abnormal cVEMP amplitude asymmetry between ears disappeared. In conclusion, vestibular disorders can happen after COVID-19 infection, presenting exclusively with isolated otolith dysfunction. In these patients, functional integrity assessment of the whole vestibular system is crucial, and vestibular rehabilitation may be beneficial.

Paretic and nonparetic step tests are noninterchangeable in stroke: a prospective cohort study

Objective The step test (ST) is a common clinical assessment of dynamic balance among survivors of stroke. The ST assesses a person’s ability to place their paretic (paretic ST) or nonparetic (nonparetic ST) foot rapidly and repeatedly on and off a standardized block while standing. No study has formally explored if the 2 tests are interchangeable. Our study aimed to (1) differentiate the correlates of paretic and nonparetic ST and (2) compare their associations with physical function and falls. Methods Eighty-one survivors of stroke were consecutively recruited from inpatient rehabilitation units (n = 4) and were assessed within 1 week prior to discharge. In addition to the ST, a handheld dynamometer and computerized posturography were used to measure lower limb muscle strength and standing balance, respectively. Self-selected gait speed and Timed “Up and Go” (TUG) test were also assessed as measures of physical function. Falls data were monitored for 12 months postdischarge using monthly calendars. Multivariable regression analyses were used to differentiate (1) the correlates of paretic and nonparetic STs and (2) their associations with physical function and falls. Results The median score for the paretic and nonparetic ST were 8 and 9 steps, respectively. Paretic ankle plantar-flexor and dorsiflexor strength were the strongest correlates of nonparetic ST, whereas both paretic ankle and knee extensor strength were the strongest correlates of paretic ST. In multivariable analyses adjusting for each other, both STs were independently associated with gait speed and TUG scores. Paretic ST (odds ratio [OR] = 0.37; 95% CI = 0.22 to 0.62) was a stronger predictor than nonparetic ST (OR = 0.51; 95% CI = 0.34 to 0.78) in predicting future falls. Conclusion This study confirmed that the paretic and nonparetic STs are noninterchangeable. ST scores should be assessed separately to achieve a more complete interpretation. Impact This study is the first to objectively evaluate the similarities and differences between the paretic and nonparetic STs. This information may refine the use and interpretation of the 2 STs in the stroke population.

The Influence of Hearing Aids on Balance Control: A Systematic Review

<b><i>Aim:</i></b> To assess the current opinion on the effects of hearing loss treatment by hearing aids (HAs) and the benefits of HA use on imbalance. <b><i>Methods:</i></b> PRISMA-compliant systematic review was done, including observational studies in patients affected by mild to severe sensorineural hearing loss with HAs, investigating the benefits of HAs on balance. Electronic searches were performed through Medline, Cochrane, Embase, Web of Science, and Scopus. <b><i>Results:</i></b> A total of 200 patients in 8 studies were included in this systematic review. Four studies were cross-sectional, 3 cross-sectional controlled and 1 prospective nonrandomized study. Static and dynamic balance in the aided condition improved in patients assessed using clinical investigations including Romberg test and Functional Ambulation Performance/mini-BESTest, respectively. Variable outcomes were found measuring static and dynamic balance during the aided condition with objective tests (computerized posturography, Mobility Lab device). Improved quality of life outcomes and self-confidence were noted, while subjective measurements of balance had conflicting results. <b><i>Conclusion:</i></b> Although an improvement in balance in patients with HAs has been shown in certain conditions, the overall benefit is still unclear and it is only possible to speculate that HAs may also improve static, dynamic, or subjective perception of balance function in adults affected by hearing loss.

Proposal of standardization of Horus® computerized posturography in adults

ABSTRACT Purpose: To propose a normalization model of a posturography platform in adults without changes in body balance, through descriptive analysis by age group and sex. Methods: Cross-sectional observational study. Adults, with no changes in body balance and no vestibular complaints were submitted to 6 sensory conditions on the Horus® posturography platform. The following variables were analyzed: stability limit area and confidence ellipse area, trajectory length and average velocity for each condition tested. The variables were analyzed by age group and sex. The equilibrium score, the sensory integration test and the equilibrium index were calculated on the conditions. Results: Sixty-one subjects (38.3%) and 23 (37.7%) were male, 40 (65.57%) between the ages of 20 and 40 and 21 (34.43). %) between 41 and 59 years. The area of the stability limit and pressure center variables for 6 sensory conditions tested - confidence ellipse area, trajectory length, total mean velocity and confidence ellipse ratio by the area of the stability limit were described. There was a statistically significant difference in the comparison between the area of the stability limit between sexes and between age groups, being a higher value in males and in younger patients. Regarding the analysis of the variables by each condition, there was no difference of results between the sexes and age groups. Conclusion: Subjects of different sexes and age groups should be considered separately only in the analysis of the stability limit.

Evaluation of the effectiveness of alpha training for acute nonspecific neck and lower back pain using stabilometry

Impaired postural control and balance and abnormal compensatory postural strategies are one of the pathogenetic mechanisms of development and chronicity of acute nonspecific neck and lower back pain. Stabilometry is a common and objective diagnostic technique that evaluates the postural control. The purpose is to determine the effectiveness of the alpha neurofeedback training for acute nonspecific neck and lower back pain, using the stabilometry. Material and methods. The study included 60 patients with acute nonspecific vertebrogenic pain. The patients were divided into two equal groups (30 people in each group) by random sampling depending on the treatment protocol. The neurofeedback technique and basic therapy was applied for patients of the main group while 30 patients of the control group had only basic therapy applied to them. All measurements were performed before and after treatment. Postural control was assessed using computerized posturography (stabilometry). Postural variables examined were the centre of pressure (CoP) location, CoP average sway, total CoP area sway, and CoP sway velocity. The effectiveness of treatment was assessed by the dynamics of postural stability, the pain score (VAS), the anxiety score (SCL-90-R) and the alpha rhythm index. Results. The intervention group displayed significant (p < 0,05) improvement in postural stability at the end of treatment. There were significant differences between the intervention and control groups in CoP average sway and total CoP area sway. Both groups exhibited a decrease in anxiety scale. Conclusions. The alpha neurofeedback training yielded improvements in posturography and pain outcomes. Our study also confirms the applicability of stabilometry in evaluating postural instability in patients with nonspecific neck and lower back pain.

Evaluation of user experience of a computer vision-based stabilometry system in Multiple Sclerosis

Computarized posturography is a set of methods and techniques intended to provide objective measures of the balance function of a subject with postural control system alterations, in order to support diagnostic and therapeutic procedures. Modern computerized posturography systems yield accurate and reliable representations of the patient performance, such as force platform-based stabilograms (an account of the center of pressure trajectory along a balance test). However, such tests are quite expensive and usually imply uncomfortable displacements and procedures, such as marker placement protocols. As an alternative, recent developments on video-based stabilometry systems offer portable, low-cost computarized posturography solutions. This work presents an exploratory study on the user experience of the application of such systems in balance function assessment tests for both patients with diagnosis of Multiple Sclerosis and clinical personnel. The reception reported by the survey is highly positive, yet it points out that some improvements in the preparation of clinical staff to interpert stabilometry results are required, and summarized balance function descriptors could be necessary.

Comparative analysis of the data obtained in computerized posturography and videonystagmography for patients with peripheral vestibular deficit

BACKGROUND. Vestibular disorders are a group of widely spread diseases that have as a common denominator the disturbance of the equilibrium system. The assessment of vestibular disorders consists in a complex examination of the patient including a thorough anamnesis, a rigorous clinical examination and multiple functional explorations. OBJECTIVE. To asses weather there is a correlation between the data obtained in posturography and those obtained in the videonystagmography in patients with peripheral vestibular disorders. MATERIAL AND METHODS. Collecting data from the observation sheets of patients diagnosed with peripheral vestibular syndrome and examined in the Department of Otorhinolaryngology of the “Sfanta Maria” Hospital in Bucharest over a period of 18 months. RESULTS. We analyzed a number of 97 cases of patients diagnosed with peripheral vestibular disorder. A large number of patients (49) had correlated changes in the caloric tests and also in the posturography. A second group of patients (43) had changes in caloric tests but with no changes in posturography. The third group of 5, paradoxically, had a vestibular deficiency in posturography associated with normal caloric reactivity. CONCLUSION. The results obtained with the videonystagmography are correlated with those of the caloric and rotational videonystagmographic tests in the case of acute vestibular diseases. In chronic vestibular diseases, it is possible to find caloric vestibular paresis in the presence of a normal posturography. The “vestibular omission” is a phenomenon in which the patient does not use the vestibular input of a normal labyrinth with caloric and rotary tests within normal limits. As no vestibular examination can be considered as selfstaging diagnosis, we always have to establish the final diagnosis correlating the results of all the tests available.

Effects of Bilateral Hearing Aid Use on Balance in Experienced Adult Hearing Aid Users

Purpose The purpose of this study was to evaluate the balance of experienced adult hearing aid users with and without their hearing aids via computerized posturography. Method Computerized posturography was accomplished by employing the Sensory Organization Test (SOT) on the NeuroCom Balance Master (Natus Medical Incorporated). The SOT assessed each participant's balance and the strategy used to maintain balance in 6 progressively challenging conditions. Twenty-two adults using bilateral at-the-ear hearing aids participated in the study. All participants completed all SOT protocols with and without their hearing aids. Results No statistically significant differences in participants' balance were identified regardless of the presence or absence of their hearing aids during the SOT. Conclusions These results failed to support previous research, which indicated that amplification of auditory input could benefit balance in individuals with hearing and balance disorders. Further research utilizing randomized controlled trials is needed to resolve the disparity between the current results and those of previous studies.

Altering Visual Feedback Conditions Impacts Postural Sway Performance in Children After Controlling for Body Mass Index and Habitual Physical Activity

This study examined postural sway in children in eyes open (EO) and eyes closed (EC) conditions, controlling for body mass index (BMI) and physical activity (PA). Sixty two children (aged 8–11years) underwent sway assessment using computerized posturography from which 95% ellipse sway area, anterior/posterior (AP) sway, medial/lateral (ML) sway displacement and sway velocity were assessed. Six trials were performed alternatively in EO and EC. BMI (kg/m2) was determined from height and mass. PA was determined using sealed pedometry. AP amplitude (p = .038), ML amplitude (p = .001), 95% ellipse (p = .0001), and sway velocity (p = .012) were higher in EC compared with EO conditions. BMI and PA were not significant as covariates. None of the sway variables were significantly related to PA. However, sway velocity during EO (p = .0001) and EC (p = .0001) was significantly related to BMI. These results indicate that sway is poorer when vision is removed, that BMI influences sway velocity, but that pedometer-assessed PA was not associated with postural sway.