Posturography examination as a diagnostic tool in children - a review of the literature

Introduction. Posturograph tests are used to assess the vestibular reflex, which can be helpful for specialists who analyze body balance disorders. Despite many studies on the stability of body posture in pediatric patients, there is still a lack of reliable analysis.Aim. Performing a review of the literature to verify the relationship between balance and body posture as well as stomatognathic system as a part of motor system and the craniofacial complex using a posturograph.Material and Methods. A review of the literature has been carried out for the posturographic examination as a diagnostic tool. The following work is for reference only. A review of the Google Schoolar database and PubMed was made. Keywords used in the search are: (children) and (posturography, posture control, balance, temporomandibular joint). The authors took into account reports published in Polish and English. For the purposes of this review, strict criteria for the inclusion and exclusion of research work have been created.Results. The authors analyzed 335 research papers, of which 5 articles were qualified after the analysis. Studies show that there is a relationship between posturographic examination and postural disorders in children. However, the results are not conclusive and further research is necessary before these results can be considered as fully generalized.Summary. It is necessary to standardize the research using a posturograph. There is a need for further research due to the lack of standardized measurements showing norms for individual age groups.

Effects of galvanic mastoid stimulation in seated human subjects

The vestibular responses evoked by transmastoid galvanic stimulation (GS) in the rectified soleus electromyogram (EMG) in freely standing human subjects disappear when seated. However, a GS-induced facilitation of the soleus monosynaptic (H and tendon jerk) reflex has been described in few experiments in subjects lying prone or seated. This study addresses the issue of whether this reflex facilitation while seated is of vestibulospinal origin. GS-induced responses in the soleus (modulation of the rectified ongoing EMG and of the monosynaptic reflexes) were compared in the same normal subjects while freely standing and sitting with back and head support. The polarity-dependent biphasic responses in the free-standing position were replaced by a non-polarity-dependent twofold facilitation while seated. The effects of GS were hardly detectable in the rectified ongoing voluntary EMG activity, weak for the H reflex, but large and constant for the tendon jerk. They were subject to habituation. Anesthesia of the skin beneath the GS electrodes markedly reduced the reflex facilitation, while a similar, although weaker, facilitation of the tendon jerk was observed when GS was replaced with purely cutaneous stimulation, a tap to the tendon of the sternomastoid muscle, or an auditory click. The stimulation polarity independence of the GS-induced reflex facilitation argues strongly against a vestibular response. However, the vestibular afferent volley, insufficient to produce a vestibular reflex response while seated, could summate with the GS-induced tactile or proprioceptive volley to produce a startle-like response responsible for the reflex facilitation.

cVEMP Testing in Patients with a Third Mobile Window

Objective To determine the usefulness of cervical vestibular-evoked auditory potential (cVEMP) testing for the evaluation of patients with and without a third mobile window (superior canal dehiscence or large vestibular aqueduct). Methods A retrospective review of charts from patients who underwent cVEMP testing at a single tertiary referral center was performed. The cVEMP is a vestibular reflex generated by an air-conducted stimuli, causing an inhibitory potential in the ipsilateral sternocleidomastoid muscle measured by external electrodes. cVEMP results were correlated with demographic characteristics, hearing testing, diagnosis, and imaging. Mean cVEMP thresholds (at 500 Hz) and amplitudes (@ 95dB nHL and 500 Hz) were compared between ears and between patients with and without a third mobile window (TMW). Unequal variance t-Test was used to determine significance. Patients were excluded if they had a history of Meniere's disease, middle ear disease or otologic surgery. Results 63 patients received cVEMP testing, of which 8 had either unilateral or bilateral TMW. 114 non-TMW ears were compared to 10 ears with TMW. Ears with TMW had a lower mean threshold (68 dB nHL) vs. non-TMW (83 dB nHL) (p<0.003) and a higher mean amplitude (321?V) vs. non-TMW (78?V)(p<0.009). Conclusions Patients with TMW have lower thresholds and higher amplitudes on cVEMP testing. This study supports the use of cVEMPs to diagnose TMW in patients who present with an unexplained air-bone gap, autophony, aural fullness, or dizziness.

Factors Associated with Survival and Neurological Outcome after Cardiopulmonary Resuscitation of Neurosurgical Intensive Care Unit Patients

OBJECTIVE: We investigated predictors of survival and the neurological outcomes of neurosurgical patients who experienced cardiac arrest and received cardiopulmonary resuscitation after being admitted to the neurosurgical intensive care unit. METHODS: A retrospective study was conducted of adult patients in the neurosurgical intensive care unit who had experienced cardiac arrest and received cardiopulmonary resuscitation. Factors relevant to the cardiac arrest (before and after arrest) were used to study association with survival (immediate or short-term) and neurological outcome (unconscious or conscious) via statistical methods. RESULTS: Immediate survival was seen in 105 patients (49%), 19 survived until hospital discharge, and 11 were still alive at the conclusion of this study. Of the immediate survivors, 41 patients were conscious and 64 were unconscious. Multivariate analysis showed increased mortality in patients with infection, asystole, or resuscitation time exceeding 30 minutes (P &lt; 0.05). Additional factors associated with high in-hospital mortality included lack of spontaneous respiration, no caloric-vestibular reflex, and unconsciousness after resuscitation (P &lt; 0.05). In addition, neurological recovery was poor in patients with infection, asystole, no caloric-vestibular reflex, conscious recovery, or resuscitation lasting more than 30 minutes (P &lt; 0.05). CONCLUSION: Even after initially successful resuscitation, survival and neurological recovery is quite dismal in patients with cerebral lesions. Prognostic factors for neurosurgical patients should be assessed on an individual basis to determine medical futility in the early post-resuscitation period.