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PubMed1996

Effects of hormonal replacement therapy on the postural balance among postmenopausal women.

OBJECTIVE: To establish whether hormone replacement therapy affects postural balance in postmenopausal women. METHODS: Nineteen healthy postmenopausal women with vasomotor symptoms were included. Median age was 54 years, median time since menopause was 3 years. They underwent dynamic posturography before and after 4 and 12 weeks of transdermal estrogen treatment (17 beta-estradiol 50 micrograms/day) as well as after 2 additional weeks of combined estrogen-progestagen treatment. The dynamic posturography method quantifies the amplitude, frequency, and pattern of body sway and tests the visual, vestibular, and somatosensory systems, which together maintain balance. The two most difficult tests either cancel visual and distort somatosensory inputs or give distorted information from both the visual and somatosensory systems. RESULTS: Hormone replacement therapy increased static balance performance assessed by dynamic posturography. A highly significant improvement was seen in the two most difficult tests between the pretreatment test and the test performed after 4 weeks of estrogen therapy (P < .01, P < .001, respectively). This improvement was sustained after 12 weeks and also during the 14th week, with the women on combined estrogen-progestagen treatment. CONCLUSION: Estrogen treatment increased balance performance measured by dynamic posturography, indicating that the beneficial effects from estrogens on postmenopausal fracture risk may include central nervous system effects on balance. Two weeks' addition of gestagen to the treatment regimen did not counteract the estrogen effects.

Estradiol↗
PubMed1998

Evaluation of clinical measures of equilibrium.

OBJECTIVE: Evaluate the clinical utility of several simple measures of static and dynamic equilibrium in human subjects. In particular, one proposed clinical measure, the Clinical Test of Sensory Integration and Balance (CTSIB) was compared with dynamic posturography for the measurement of postural control capabilities. STUDY DESIGN: Cross-sectional study of normal subjects and prospective observational study of the same performance measures in vestibular disorder patients. SETTING: Academic tertiary care referral center. PARTICIPANTS: Data were collected for all test measures from a group of normal subjects (ages, 20 to 79 years), as well as for a group of patients undergoing treatment for vestibular dysfunction. RESULTS: Data suggest that several semiquantitative clinical tests of static and dynamic equilibrium can be helpful in evaluating and monitoring patients with chronic vestibular dysfunction. The CTSIB results seem to correlate well with dynamic posturography, suggesting that this measure may be useful in identifying patients with abnormal postural control. Formal dynamic posturography testing appears to be more sensitive in detecting abnormal postural control and more exact in defining the specific pattern of dysfunction. CONCLUSION: Simple clinical measures of static and dynamic equilibrium can reliably distinguish vestibular disorder patients from normal subjects. Dynamic posturography continues to play an important role in the functional evaluation and management of vestibular disorder patients.

Adult↗
PubMedDate not supplied

Vestibular system abnormalities in otosclerotic subjects.

A technique to quantify the tandem Romberg test (posturography) was used to study ten patients with otosclerosis before (series 1), 48 hours after (series 2), and between two to four months after (series 3) a stapedectomy. The results were analyzed by power spectrum analysis and then compared to findings from electronystagmographic testing performed with series 1 and 3. There was no significant change in the electronystagmography (ENG) test findings between series 1 and 3. Posturography, however, demonstrated an uncompensated vestibular pattern in the immediate postoperative period which, after two months, converted to a compensated vestibular pattern. Posturography serves as a useful quantitative test for the study of patients with balance disorders because the procedure supplements rather than complements the ENG. In addition, posturography detects vestibular reflex abnormalities in stapedectomized patients two months afterwards. Other testing modalities have not consistently demonstrated this postoperative vestibular system instability.

Adult↗
PubMed1989

Vestibulo-ocular and vestibulo-spinal reflexes in evaluation of vestibular lesions.

In order to evaluate to what extent different diseases causing vertigo can be detected by studying vestibulo-spinal and vestibulo-ocular reflexes, 146 patients were examined. The diagnosis classes were: periodical attacks, position induced attacks, vestibular neuronitis, brain concussion, cerebrovascular disorders and acoustic neurinoma. Dynamic posturography was performed on all the patients, standard bithermal caloric test on 129 and voluntary saccades on 127 patients. The proportion of pathological test results in posturography exceeded that in the caloric test in all but one diagnosis class. In vestibular neuronitis the amount of abnormal test results was low in posturography, probably due to vestibular compensation. Posturography tested with eyes open and with 80 Hz vibration revealed disturbances in equilibrium the most sensitively.

Caloric Tests↗
PubMed2002

[Results of combined treatment for vestibular receptor impairment with physical therapy and Ginkgo biloba extract (Egb 761)].

UNLABELLED: Vestibular receptor impairment causes symptoms called vestibular organ peripheral lesion syndrome. Subjective and objective symptoms of vestibular lesion diminish gradually in the process of vestibular compensation. Stimulating a patient to action is a basic factor that influences on the compensation process. The aim of our studies was an evaluation of treatment results in patients with vertigo of peripheral origin with the use of gingko biloba extract together with kinezytherapy. Ginkgo biloba extract shows vasoactive, rheologic, metabolic and neural effects. We have examined 45 persons aged between 35 and 48 years (38 on average, 35 female, 13 male) with clinical symptoms of peripheral vestibular lesion. In each case we performed as follows: ORL physical examination, pure tone audiometry, suprathreshold audiometry, electronystagmography (eyes open and closed nystagmus, cervical tests, caloric tests according to Hallpike), static and dynamic posturography. In all of the cases vestibular rehabilitation originally programmed in our Clinic was applied. N 23 cases (17 female and 6 male) chosen at random, kinezytherapy together with gingko biloba in tablet was applied: 2 tablets twice a day for 3 months. Control examination were performed on 30, 60 and 90 days of treatment. Treatment results evaluation was based on anamnesis, electronystagmography, static and dynamic posturography. CONCLUSIONS: 1. In almost all of the cases with peripheral lesion of vestibular organ, after 30 days of application of gingko biloba extract together with kinezytherapy and without gingko biloba there was vestibular compensation confirmed in electronystagmography but there were disturbances in static and dynamic posturography. 2. Control examination in the course of treatment revealed gradual improvement in vestibular tests in both group (with and without biloba extract). But in patients treated with gingko biloba extract the improvement was more clear and faster an dynamic posturography. It implies central effect of gingko biloba extract that allows to gain full vestibular compensation sooner.

Adult↗
PubMedDate not supplied

Evaluation of abnormalities of orthostatic postural control in systemic sclerosis.

OBJECTIVE: Systemic sclerosis (SSc) is a multi-systemic disease of unknown etiology characterized by damage to the small arteries, arterioles and capillaries. The documented occurrence of various neuropathies in SSs patients led us to hypothesize that there is a potential for postural control impairments in such disease. This study was aimed at evaluating the orthostatic postural control of SSc patients who do not manifest balance or hearing symptoms. METHODS: Postural stability was assessed in 36 female SSc patients by means of a static computerized posturography technique. Their immunological and microvascular condition were evaluated by means of blood tests and microcapillaroscopy of the digital vessels. Posturography and microcapillaroscopy were performed before and after treating the patients with Iloprost. In order to compare results, posturography was also carried out on a control group composed of 10 healthy women of similar age. Both groups were studied in two different sensory conditions, i.e. with eyes opened and with eyes closed. RESULTS: Posturography results showed relevant differences in body sway between patients and control subjects. Fourier spectral analysis of body sway showed that, independently from visual control, SSc patients exhibit a higher level of low/middle frequency oscillations (both on the lateral and the anteroposterior axis). No relationship was established between disease stage and postural performance. CONCLUSION: This study seems to indicate a subtle neurophysiological dysfunction in the orthostatic postural control of female SSc patients. Further tests on the somatosensory neurological function of SSc patients may help support the above mentioned findings.

Dizziness↗
PubMed1990

Posture in otoneurology. Volume I.

In this study, posture is studied in the context of neuro-otological problems. In the several chapters, postural elements, postural influence upon balance aspects as well as postural components of the balance function in normal and pathological conditions are emphasized. Two main applications are put forward: rehabilitation by postural treatment techniques (REHAB) and examination techniques for the vestibulospinal aspects (posturography--PG). I. Balance function Balance is provided by automatic reflexes for stabilization of the visual field (vestibulo-ocular reflex--VOR) and for a correct posture, erect standing (vestibulo-spinal reflex--VSR) and head position (vestibulo-collic reflex--VCR). The fundamental characteristics of these reflexes are described, especially of those related to posture. The reflexes are elaborated on the basis of sensory inputs that inform about changed relations to space and environment, provided by visual, vestibular and proprioceptive systems. The sensory signals are further processed by the centers to adequate reflexes and to some extent to a conscious awareness. II. Dysfunction and adaptation Dysfunction in the balance mechanisms leads to erroneous reflexes, but most importantly to frightening sensations of vertigo. The peripheral disturbances produce a sensory mismatch which is the primum movens of vertigo. Built-in adaptive mechanisms cope with this disturbance and restore global balance function. The mechanisms involved have been studied as vestibular compensation and habituation, VOR-reflex plasticity and sensory "substitutive" compensation. The mechanisms are set into action by the dysfunctional situation and constitute an error-controlled process. Emphasis is laid upon the items related to rehabilitation treatment and posturography. A survey of clinical entities of vestibular peripheral dysfunction is included. III. Examination techniques The logical approach to the patient with vertigo consists in an analysis of the complaints pattern, correlation of it with the dysfunctional state revealed by clinical observation, and functional tests of balance. Correct interpretation of the test results is a pre-requisite. Postural aspects of these examination techniques, especially posturography, are put into evidence in this review. The strategy used in the department is sketched. IV. Contribution of the examination techniques: functional evaluation results The several data obtained by each examination technique are discussed within the scope of the experiences in the department. Data from the literature and from personal experience, especially interpreted in the context of rehabilitation and posturography, are analysed. V. Reh

Adaptation, Physiological↗
PubMed1998

A dual-task study of interference between mental activity and control of balance.

OBJECTIVE: This study aimed to examine interference between mental activity and control of balance. STUDY DESIGN: In a mixed design, dual-task study, the performance of patients and healthy control subjects was compared on computerized dynamic posturography, on a visuospatial mental task, and when performing the mental task while balancing. SETTING: The study was performed at a tertiary referral outpatient neuro-otology clinic. PATIENTS AND SUBJECTS: The patient group comprised 24 patients seen consecutively at the clinic because of vertigo and dizziness. The control group consisted of 24 subjects with no complaint or medical history of dizziness or balance disorder, matched with the patients for age and gender. MAIN OUTCOME MEASURES: Performance on a visuospatial mental task and on the computerized dynamic posturography test (conditions 4 and 5) was measured. RESULTS: Balancing on the posturography test resulted in a deterioration in performance on the mental task for both patients and control subjects. The effect was more marked when subjects had their eyes closed. Results on the balance test showed that normal subjects and patients with normal balance also swayed more when performing the mental task, whereas patients who had failed the posturography test swayed less when performing the mental task. CONCLUSIONS: These results show that mental performance deteriorates when performing a demanding balance task. In addition, in both normal subjects and patients, balance also may be affected by mental activity in complex and varied ways that merit further investigation.

Adult↗
PubMed1998

[The evaluation of the balance organ in workers occupationally exposed to organic solvents and tinctorial dusts].

The aim of the study was to evaluate the balance organ in persons occupationally exposed to organic solvent vapours. The study was performed in a group of 35 workers employed for eight years on average in two departments of the Polifarb S.A. factory of patients and lacquers, Wrocław. The control group consisted of 53 healthy persons. Static and dynamic posturography was used to assess the condition of the balance organ. In the persons exposed static posturography tests revealed statistically significant increase in the field of spread area and extent of sways, and dynamic posturography tests indicated an increased radius. It was shown that posturography ensure an objective assessment of balance disorders and can be applied in the screening of persons exposed to toxic substances. It is also useful in recording functional condition of the balance organ.

Adult↗
PubMed1998

Dizziness from whiplash and head injury: differences between whiplash and head injury.

OBJECTIVE: Large discrepancies exist in the literature regarding incidence and types of symptomatology in whiplash. This is because of the evolution of whiplash injury over the years with the advent of head rests and seat belts. Previous authors have regarded symptoms of dizziness as a result of brainstem or cerebellar injury or both. It has been difficult in those studies to ascribe a mechanism of injury, as patients with whiplash injury only have been grouped with those who have incurred mild traumatic brain injury as a result of a significant blow to the head. The authors saw the need to delineate patients who had suffered whiplash injury from those who also had suffered mild head injury, as defined in the rehabilitation-neurosurgical literature, to attempt to define differences in symptoms, abnormalities, and mechanisms of recovery in these two groups. STUDY DESIGN: The study design was a retrospective case review. SETTING: The study was conducted at a tertiary-quaternary referral clinic. PATIENTS: The records of 36 patients were reviewed. Nineteen of these patients suffered a whiplash-associated disorder and 17 suffered a mild head injury as well. These patients were referred for assessment of symptoms persisting for at least 2 years after their injury. Patients were excluded if they had not completed clinical assessment, including electronystagmography (ENG) and computerized dynamic posturography (CDP). INTERVENTIONS: A full history, otolaryngologic examination, including assessment of eye movements, corneal reflexes and gait, as well as an investigation, including ENG and CDP, and history taking and detailed recording of related complaints immediately before diagnostic work-up were performed. MAIN OUTCOME MEASURES: Symptoms reported by patients who had received either whiplash alone or whiplash plus mild head trauma as defined in the literature were measured. Patients were classified according to type of accident, type of injury suffered, and degree and nature of posturographic abnormalities. RESULTS: Patients often have similar complaints regardless of whether or not they had suffered a head injury. Although CDP showed abnormalities in both groups, standard ENG assessment, including caloric testing, showed abnormalities only in the head-injured group. The posturographic abnormalities also were analyzed in both groups, and it was found that there was a correlation between the type of posturographic abnormality and the type of injury suffered. Although ENG testing is done routinely, posturography is shown to be more sensitive in picking up abnormalities. In addition, the authors have shown that posturography can delineate the type of injury suffered by exhibiting the compensation strategy used as well as the efficacy of that compensation strategy. CONCLUSIONS: Because ENG abnormalities are limited to patients who have suffered a head injury, the inference is that these two groups of patients have suffered damage at different sites along the balance system pathways, but both of these lesions can lead to similar symptoms. Although the mechanisms of whiplash injury and how they affect the vestibular system are poorly understood, posturography testing is essential in inferring how a patient is recovering by measuring how and how well the patient is overcoming his or her deficit. This has important medical legal implications regarding legitimizing a patient's problem, prognostic factors, as well as rehabilitation plans, measures, and outcomes.

Adolescent↗
PubMed2004

Simulator based rehabilitation in refractory dizziness.

UNLABELLED: Patients with chronic vestibular symptoms are common in neurological practice but the most effective treatment remains an open question. The purpose of our study was to conduct a controlled, between-group comparison of patients' responses to a customised exercise regime (Group C, for customised) versus treatment additionally incorporating simulator based desensitisation exposure (Group S, for simulator) integrating whole-body or visual environment rotators. Forty chronic peripheral vestibular patients who had previously undergone conventional vestibular rehabilitation without notable improvement were randomly assigned into Group C or S. Individuals attended therapy sessions twice weekly for eight weeks and were provided with a customised home programme. Response to treatment was assessed at four-week intervals with dynamic posturography, vestibular time constants, and questionnaires concerning symptoms, symptom-triggers and emotional status. At final assessment posturography and subjective scores had significantly improved for both groups, although Group S showed greater improvement. A statistically significant improvement for visual vertigo symptom scores was noted only for Group S (p < 0.01; total improvement 53.5 %). Anxiety and depression levels significantly decreased for both groups; improvements were significantly correlated particularly to improvements in visual vertigo (SCQ) (p < 0.01; r = 0.53 and r = 0.57, respectively). Significant differences were noted between groups (p = 0.02) for posturography scores. Vestibular time constants showed no notable change in either group. CONCLUSIONS: Both groups improved but exposure to simulator motion gave overall better results. These effects were also observed in psychological symptoms and partly relate to simulator effects on visual vertigo symptoms. Visual motion and visuo-vestibular conflict situations should be incorporated in the rehabilitation of patients with refractory dizziness.

Adult↗
PubMed1984

Quantification of postural sway in normals and patients with cerebellar diseases.

Posturography was performed in 41 patients with cerebellar diseases by means of a force measuring platform using an on-line computer program which calculated sway path, sway area, antero-posterior and lateral sway components and the amount of visual stabilization. Postural ataxia was quantitatively studied in 8 patients with spinal ataxia (Friedreich's), 6 patients with vestibulocerebellar lesions, 11 patients with anterior lobe atrophy, 7 patients with hemispheral cerebellar lesions, and 9 patients with a disease affecting all parts of the cerebellum. Patients with lesions of the cerebellar hemispheres could not be separated from normals by means of posturography. Lesions of the spino-cerebellar afferents (Friedreich' ataxia) caused an omnidirectional low frequency sway with preserved visual stabilization. Patients with anterior lobe atrophy showed a predominant antero-posterior sway, often with a spontaneous high frequency body tremor around 3 Hz. Vestibulo-cerebellar lesions exhibited omnidirectional low frequency sway poorly stabilized by vision. Quantitative posturography helps to localize cerebellar lesions and allows for quantitative follow-up studies of cerebellar diseases.

Adult↗
PubMed1987

A critical examination of vestibular function in motor-impaired learning-disabled children.

This study examined the role of the vestibular system in balance and coordination problems found in motor-impaired, learning-disabled (LD) children. Vestibulo-ocular reflex (VOR) and vestibulo-spinal tests (moving platform posturography) were performed on 15 learning disabled and 54 normal children. Twelve LD children had normal VOR scores suggesting normal peripheral vestibular inputs. All 15 LD children had abnormal posturography. Motor-impaired LD children could not appropriately integrate vestibular information with visual and somatosensory inputs for postural orientation. Results suggest that the best discriminator of abnormal sensorimotor function in LD children are posturography trials requiring orientation to gravity despite absent or inaccurate visual and somatosensory cues, rather than traditionally relied on VOR and Romberg tests.

Child↗
PubMed2005

[Home postural evaluation in the elderly: comparison between fallers and non fallers].

OBJECTIVES: To determine the main clinical and posturographic factors correlated with falls in elderly individuals and to specify the role of static posturography in this appraisal. MATERIALS AND METHODS: The study involved 38 people living in an residential center who were autonomously ambulatory and had a Mini Mental Test score> or =24. Fallers (N = 15) had fallen within 1 month, and nonfallers (N = 23) had not fallen for at least a year. Assessment consisted of a series of questions, a complete clinical appraisal, specific independently validated tests, and static posturographic analysis different parameters of the stabilogram with the eyes first open and then closed, all carried out in the center. RESULTS: From the clinical standpoint, spinal pathologic features and the scores on the Functional Reach Test were significantly different between the fallers and nonfallers. In static posturography, fallers' equilibrium was more precarious than that of nonfallers with eyes are closed: significant differences were observed in surface, X length and overall fast Fourier transform score. The comparison between results with open and closed eyes showed that the fallers had a pronounced tendency to retropulsion in the absence of visual participation: a significant difference as regards overall length, Y length, minimum Y and FFT Y (0.5-2 Hz). CONCLUSIONS: To complement a satisfactorily conducted clinical examination, static posturography allows for rapid assessment of equilibrium and posture in elderly patients who fall? Performed at the place where an individual resides, this appraisal constitutes an original and pragmatic element. As an evaluation strategy, it can reveal nonnegligible information within the framework of an appraisal of such, and thereby allows for adjustment of the rehabilitation or compensatory strategy.

Accidental Falls↗
PubMed2004

Aging and vestibular system: specific tests and role of melatonin in cognitive involvement.

Balance disorders are frequent with aging. They are particularly important because they decrease social autonomy of the aged subjects and they often provoke falls. The cause is always multifactorial. There is evidence that aging affects multiple sensory inputs, as well as the muscoloskeletal system and central nervous system ability to perform sensorimotor integration. For the evaluation of decreased balance skills in elderly, a specific questionnaire has been prepared, in order to identify high risk of falling called falling risk inventory (FRI) questionnaire, and a complex psycho-sensory-motor test has been studied by means of posturography, in order to detect specific vestibular impairment. Regarding ethiopathogenesis of balance disorders in aged subjects, because the decline of behavioral and cognitive performances are due also to decline of biological rhythm control, the role of melatonin (the hormone regulating circadian rhythms, being strictly connected with cerebellar function, and it is well known that cerebellum acts in elderly both at motor and cognitive regulation. The goals of the present paper are: (i) To present a self-administered FRI questionnaire aimed at identifying possible causes of falls and quantifying falling risk in aged. (ii) To validate posturography as a specific test to investigate vestibular involvement in elderly in correlation with FRI. (iii) To present a complex behavioral test (NT) aimed at evaluating both spatial orientation and spatial memory in elderly, factors involved into the genesis of complex dizziness and unsteadiness. (iv) To evaluate the role of melatonin in cognitive involvement in dizzy, old subjects due to the functional correlations between circadian rhythms, cerebellum balance disturbances and cognitive disorders. General conclusions are: FRI correlates with falling risk. Posturography identifies specific vestibular impairments correlated to balance disorders and elderly falls. Spatial orientation is altered in about 40% of dizzy patients but no significant differences are revealed in melatonin rhythm. Spatial memory is highly altered only in subjects with inversion of circadian melatonin rhythm it is possible to hypothesize that the alteration of the normal circadian melatonin rhythm plays some role in the genesis of dizziness in a subpopulation of patients.

Accidental Falls↗
PubMed2004

Improvement of motor development and postural control following intervention in children with sensorineural hearing loss and vestibular impairment.

OBJECTIVE: The purpose of this study was to determine the effect of exercise intervention on the progressive motor development delay and postural control impairments in children with sensorineural hearing loss and concurrent vestibular impairment. METHODS: Twenty-one children with sensorineural hearing loss and vestibular impairment were randomly assigned to two groups (exercise and placebo) matched for age and gross motor development level. Exercise intervention consisted of compensatory training, emphasizing enhancement of visual and somatosensory function, and balance training. Placebo intervention focused on language development activities. Each intervention was administered three times weekly for 12 weeks. Motor development and posturography testing was completed pre- and post-intervention. To examine the mechanisms of change, somatosensory, visual and vestibular functional effectiveness ratios were calculated from posturography stability scores. Children in the placebo group later participated in exercise intervention, and a second post-test completed. Data were analyzed by group, as well as merged once all had received exercise intervention. RESULTS: Post-intervention, motor development scores significantly improved in the exercise, not the placebo group (P=0.004). Although not significant, improvement in posturography scores were evident in the exercise group. Once the post-exercise data from both groups were merged (n=21), improvements in these scores were significant (< or =0.02). The difference from the normative sample was eliminated. CONCLUSIONS: Exercise intervention focused on the enhancement of sensory integrative postural control abilities is effective for the arrest of the progressive motor development delay in children with sensorineural hearing loss and vestibular impairment.

Child↗
PubMed2003

Evaluation of neuropsychological domain scores and postural stability following cerebral concussion in sports.

CONTEXT: With increasing knowledge and research about concussion, there have been few objective studies that have used neuropsychological domain scores and postural stability to assess concussion. OBJECTIVE: To evaluate the recovery curve of athletes who incur sport-related concussion from repeated serial testing of neuropsychological and posturography testing. DESIGN: A prospective epidemiological model was used for the course of the study. SETTING: Division I intercollegiate athletics. PARTICIPANTS: Athletes participating in football, soccer, basketball, softball, and cheerleading. MAIN OUTCOME MEASURES: Neuropsychological scores and posturography measures were obtained preseason and serially at day 1, day 2, day 3, and day 10 postconcussion. Control participants were tested at the same intervals. Neuropsychological scores were converted to standards score and then into domains of attention, learning, speed of information processing, concentration, memory, and verbal fluency. Analysis of covariance with the baseline test as the covariate was used to analyze the data with univariate post hoc tests performed. RESULTS: Significant group differences were found for self reported symptoms (P = 0.001), speed of information processing (P = 0.005), mean stability (P = 0.002), and vestibular function (P = 0.003) between injured and control participants. A group, by day, planned comparison found that speed of information processing and composite balance measures demonstrated significant differences through day 10 postinjury, while symptoms and the vestibular ratio remained significant only through day 3. CONCLUSIONS: The concussion recovery curve demonstrated short-term neuropsychological and posturography deficits following injury. A comprehensive approach to concussion management should be used to assess the injury and make return-to-play decisions.

Adult↗
PubMed2005

A new set of criteria for evaluating malingering in work-related vestibular injury.

OBJECTIVE: To develop and use a set of criteria using computerized dynamic posturography results to detect aphysiologic behavior in patients with complaints of imbalance, and to compare the efficacy of this system with present quantitative techniques and with subjective methods of evaluating malingerers. STUDY DESIGN: Prospective study of two groups of sequentially referred patients complaining of dizziness and/or imbalance. SETTING: A tertiary and quaternary care ambulatory referral center. PATIENTS: Two groups of patients were studied. One was a group of patients who had suffered work-related head trauma and had subsequent complaints of dizziness and/or imbalance. The other was a group of patients referred for dizziness and/or imbalance who had no history of head trauma, work-related injury, or litigation procedures. INTERVENTIONS: Standard vestibular assessment including computerized dynamic posturography was carried out on all patients. MAIN OUTCOME MEASURES: All patients in both groups were scored for aphysiologic behavior using a quantified formula that has been used to detect malingerers, an analysis criterion using different aspects of computerized dynamic posturography performance that has been used for some time, and our newly developed nine-point scoring method. Results of all three methods were compared to determine the effectiveness of each one in detecting malingering behavior. RESULTS: Our nine-point protocol was effective in assessing patients in a consistent manner. Assessment using the quantitative formula in the literature raised suspicions of malingering in many patients with no known ulterior motives, some of whom had documented vestibular disease. Our criteria also evaluate other aspects of performance not evaluated by the presently used techniques. CONCLUSION: Our newly developed criteria are effective at evaluating the medicolegal patients from both the quantitative and qualitative viewpoints, and provide a more thorough assessment than has previously been available.

Adult↗