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PubMed1998

Balance disorders in older persons: quantification with posturography.

We measured sway velocity using static and dynamic posturography in a group of young normal subjects and two groups of subjects older than 75 years; one older group considered their balance normal for their age, and the other reported imbalance. The latter group consisted of patients with documented peripheral and central vestibular disorders and patients with dizziness and imbalance of unknown cause. The velocity of sway was higher in older subjects than in younger subjects and in older subjects who reported imbalance than in age-matched controls. The difference was greater with dynamic posturography than with static posturography, but the posturography data provided little information about the cause of the imbalance and did not correlate with the frequency of reported falls.

Accidental Falls↗
PubMed1987

Vestibulospinal function in two syndromes with spontaneous attacks of vertigo: evaluation by posturography.

Two vestibular syndromes comprising attacks of spontaneous vertigo were studied and disturbance of the vestibulospinal reflex was evaluated. Patients with Menière's disease were examined between attacks and patients with a sudden unilateral vestibular loss syndrome at least 3-4 weeks after the initial attack. Posturography, (recording and analysing the postural sway) was used to evaluate the influence of these disorders upon the vestibulospinal reflex. In 50% of the patients, the postural sway was disturbed compared with the performance of a normal control group. Menière's disease had a more pronounced effect on the posturographic results, whereas for the unilateral vestibular loss syndrome the rotation tests showed more asymmetry. It is obvious that the effect upon the vestibulospinal reflex cannot be deduced from the rotational test results. Indeed in a large number of patients discordance between rotational test results and posturography was seen. The presence or absence of attacks during the previous year in patients with Menière's disease had no influence on the presence of abnormal posturographic results. If other complaints of dizziness were mentioned by the patient, posturography was nearly always abnormal. It is evident that a complete evaluation of such patients must include information obtained by posturography.

Adult↗
PubMed1989

Dynamic posturography and caloric test results in patients with and without vertigo.

Patients with dizziness were evaluated with caloric stimulation and with dynamic platform posturography (Neurocom Equitest). The ability of these tests to detect abnormalities in patients with and without vertigo was assessed. In 159 patients, roughly a third had abnormal calorics while half experienced one or more "falls" during posturography. Calorics revealed proportionately more abnormalities in patients with vertigo, whereas posturography alone did not distinguish between patients with or without vertigo. Posturography did, however, identify abnormalities in a third of patients with normal calorics, regardless of their history of vertigo. Overall, more patients with vertigo had at least one abnormal test result (70%) compared with patients without vertigo (47%). We conclude that caloric abnormalities correlate with a history of vertigo, whereas posturographic deficits can be identified regardless of the presence of vertigo.

Adolescent↗
PubMed1989

The role of dynamic posturography in neurotologic diagnosis.

Electronystagmography and rotary vestibular testing are of definite but limited value in screening the dizzy patient. Objective identification of a vestibular abnormality is valuable, but there is an additional need to appraise the functional capacity of those suffering central or peripheral disorders causing spatial disorientation or disequilibrium. Records of 175 patients undergoing posturography in the author's practice over a 1-year period were reviewed. Diagnosis was established by conventional neurotologic means including computerized electronystag-mography. Abnormal results on posturography were identified by criteria established through the national users group of Equi-Test participants. There were 112 peripheral cases with 50 (45%) abnormal on posturography, in contrast to 53 central patients with 38 (72%) abnormal. Posturography established a functional level of balance in certain peripheral and central disorders and provides limited but significant aid to assist in distinguishing between the two.

Central Nervous System Diseases↗
PubMed1991

Effect of alcohol measured by dynamic posturography.

Thirteen healthy male volunteers aged 21-42 years (mean 27 years) were assessed by dynamic posturography before and after ingestion of alcohol. Each subject was given 0.6 g alcohol per kg body weight in fruit juice to be drunk within 10 min. Alcohol levels in blood samples at 15, 45 and 75 min after ingestion were assessed by gas chromatography. Posturographic measurements were conducted at 30 and 60 min after alcohol administration. Dynamic posturography comprises a sensory organization part in which the support surface and visual surround are either stable or referenced to the patient's sway and the test conditions are eyes open or eyes closed. In a movement coordination part the platform makes active movements. Alcohol levels were 0.40% (SD 0.14) after 45 min and 0.51% (SD 0.14) at 75 min. All subjects presented positional alcohol nystagmus and gaze nystagmus after 45 min. In the sensory organization part of the dynamic posturography in test conditions with eyes closed and the head in neutral position, both with stable (p less than 0.039) and sway-referenced platform (p less than 0.017), alcohol effects were found. In the test condition with sway referenced platform and stable visual surround the effect of alcohol was close to significance (p less than 0.069). When the head was tilted to either side, no effect of alcohol was detected, nor in the movement coordination test. It is concluded that dynamic posturography can detect the effect of alcohol on static and dynamic equilibrium. Test conditions with absent vision appear to be the most sensitive. The results in static conditions are well in agreement with previous studies; the findings under dynamic conditions are new.

Adult↗
PubMedDate not supplied

[Evaluation of the treatment of vestibular disorders in children with computerized dynamic posturography: preliminary results].

OBJECTIVE: This study aimed at evaluating dynamic posturography as an evaluation method in children with balance problems due to peripheral vestibulopathy, before and after treatment with vestibular rehabilitation, establishing its correlation with classical clinical evaluation. METHOD: Ten children (six boys and four girls) with vestibular symptoms of peripheral origin were evaluated through a complete clinical history and with dynamic computerized posturography after being treated by vestibular rehabilitation therapy. Posturographic data were analyzed and compared to standard clinical evaluation parameters. RESULTS: Dynamic posturography showed a significant improvement of condition 1 (orthostatic position, fixed support and open eyes) and 5 (orthostatic position, sway-referenced support and closed eyes) of the vestibular function and of the composite balance score. The data showed significant correlation with the clinical improvement observed. A significant reduction of proprioceptive influence was also observed. CONCLUSIONS: Data showed that the dynamic posturography adds important quantitative information to the conventional clinical evaluation of vestibular symptoms, especially in children.

Child↗
PubMedDate not supplied

Dynamic posturography in assessment of polyneuropathic disease.

Twenty-eight patients with polyneuropathy aged 49-82 years (mean 67 years) were assessed by dynamic posturography. The patient group was compared to a control group comprising 29 healthy controls aged 70 through 75 years (mean 73 years). The dynamic posturography method comprises a sensory organization part in which the platform and visual surround are either stable or referenced to the patient's sway; furthermore, the eyes are open or closed. In a movement coordination part the platform makes active movements. In the sensory organization part of the dynamic posturography the patient group showed significantly lower equilibrium performance compared to the control group in the test conditions with absent vision, sway-referenced surrounding, and, finally, sway referenced platform and surrounding. In these conditions the influx of somatosensory information is of paramount importance for stable posture. In the movement coordination test, the patient group showed prolonged muscular response latencies in both forward and backward platform perturbations compared to the control group. It is concluded that dynamic posturography is a valuable diagnostic tool in assessment of the dynamic equilibrium performance in patients with polyneuropathy.

Aged↗
PubMed1997

Balance in the healthy elderly: posturography and clinical assessment.

OBJECTIVES: To measure balance changes in the healthy elderly using quantitative dynamic posturography. To relate these changes to clinical measures of balance and gait. DESIGN: Elderly subjects screened for health criteria in a longitudinal study were examined using standardized cognitive, neurological, and performance-based tests. Quantitative posturography (Equitest, Neurocom International, Clackamas, Ore) was performed to determine the subject's response to sensory (Sensory Organization Test) and motor perturbations (Motor Coordination Test). SUBJECTS: Thirty-three healthy, old old subjects (> or =80 years; mean+/-SD age, 88+/-5 years) were compared with 15 subjects younger than 80 years (mean+/-SD age, 72+/-3 years). All were free of centrally active medications. RESULTS: The old old had worse quantitative equilibrium scores compared with subjects younger that 80 years when proprioceptive input was inaccurate and visual input was either preserved or completely absent. Old old subjects showed diminished adaptation to repeated platform rotations and fell more frequently during posturography. Quantitative balance measures correlated with age and functional measures of balance (Tinetti Balance Scale score, timed 1 leg standing). CONCLUSIONS: Progressive, functionally evident, age-related quantitative balance changes occur independent of typical geriatric pathological changes. These data should facilitate clinical decisions by allowing the distinction to be made between age-related and pathological changes.

Aged↗
PubMed1998

Gaze stabilization during dynamic posturography in normal and vestibulopathic humans.

Dynamic posturography by measurement of center of pressure (COP) is a widely employed technique for evaluating the vestibular system. However, the relationship of COP motion to vestibulo-ocular reflex (VOR) function and image stability on the retina has not been determined previously. To assess these relationships, we report gaze, head, and trunk stability during dynamic posturography in 11 normal volunteers, 7 subjects with unilateral vestibular lesions, and 3 subjects with bilateral vestibular lesions. Posturographic tasks consisted of standing still and standing on a platform that was sliding (0.2 Hz), tilting (0.1 Hz), or covered with a foam cushion 6 cm thick while tilting (0.1 Hz). Each perturbation was imposed in the anterior-posterior and repeated in the medial-lateral direction, in both light and darkness. Subjects viewed (or in darkness remembered) a target located 50, 100, or 500 cm distant. COP, angular eye position, and angular and linear orbit and trunk positions were measured using magnetic search coils and flux gate magnetometer sensors. With the target visible, the velocity of image motion on the retina was on average always less than 1 degree/s, well within the range consistent with high visual acuity. In darkness, gaze velocity increased for normal and vestibulopathic subjects. During tilt, vestibulopathic subjects had a significantly greater gaze velocity than controls. Gain of the angular VOR (eye velocity/head velocity) was significantly lower in darkness than in light and in vestibulopathic as compared to control subjects. Gain of the VOR was significantly correlated with gaze instability, but variation in VOR gain accounted for only 20-40% of the variance. In darkness, the velocity of the COP was significantly greater in vestibulopathic than control subjects for every condition tested. In light, this difference was small and often not significant. Although spectral analysis of the COP indicated frequencies above 1 Hz that were not observed in motion of the trunk and orbit, root mean square (RMS) velocities of the trunk and orbit in the horizontal plane were higher in darkness and in vestibulopathic subjects, mirroring COP findings. Only in vestibulopathic subjects tested in darkness was there a correlation between COP velocity and gaze velocity; COP velocity was otherwise uncorrelated with gaze. Gaze velocity was greater with near than with distant targets. Vertical VOR gain was higher with near targets. No other significant effects of target distance were found. Head movement strategy, VOR gain, and COP were all unaffected by target proximity. These data show that gaze velocity measurements during dynamic posturography in darkness are sensitive to vestibular loss. With a visible target, both COP and gaze stability of vestibulopathic subjects are difficult to distinguish from normal. During visual feedback, it is likely that image stabilization over the range of frequencies tested is achieved through better head stability and through visual tracking, allowing vestibulopathic subjects to maintain adequate visual acuity.

Adult↗
PubMed2003

Can low frequency sound stimulation during posturography help diagnosing possible perilymphatic fistula in patients with sensorineural hearing loss and/or vertigo?

Perilymphatic fistula (PLF) is often difficult to diagnose because of the similar symptomatology, such as vertigo, tinnitus and hearing loss, which is found in several inner ear diseases. We attempted to correlate a positive result of low frequency sound (LFS) stimulation tests in posturography with the presence or absence of a PLF confirmed by transtympanic endoscopy in 209 patients with various inner ear diseases (Meniere's disease ( n=128), vestibulopathy ( n=41), cochleopathy ( n=28) and sudden deafness ( n=12). LFS provoked unsteadiness in posturography without PLF in 24 patients with Meniere's disease, in 5 patients with vestibulopathy, in 3 patients with cochleopathy and in 2 patients with sudden deafness. In one patient, tympanoscopy revealed fistula in the round window membrane that was covered with a fibrinous layer. In four cases there was abnormal light reflex in the round window but without PLF. In eight cases, Hennebert's sign was present with nystagmus, without PLF. We conclude that pathological responses to the LFS test in posturography can also be encountered in other inner ear diseases without PLF.

Acoustic Impedance Tests↗
PubMed2005

Effect of age on body sway assessed by computerized posturography.

The swaying and postural instability frequently seen in elderly subjects had not been analyzed quantitatively in detail until the introduction of computerized posturography. In order to assess the changes of body sway with aging, we performed computerized posturography in 144 subjects (51 men and 93 women, between the ages of 22 and 88 years) without specific neurological or metabolic disorders. The total and timed track length of the center of gravity, reflecting the distance of sway, increased with advancing age, with a highly significant positive correlation, without marked sex differences. The total area covered by the track of the center of gravity (expressing the extent of sway) also showed a similar tendency. Track density per unit area, expressing the efficiency of postural control, in contrast, decreased with age, showing a significant negative correlation with age, but only when the subjects had their eyes open; this decrease did not occur when they had their eyes closed. The Romberg ratio, an index of exacerbation of sway on eye closure, showed little change with a tendency for slight alleviation of sway and improvement in the efficiency of its control. Computerized posturography appears to be a useful tool with which to analyze the mechanism of swaying associated with old age.

Adult↗
PubMed1997

Computerized dynamic platform posturography.

Computerized dynamic platform posturography is defined in this technology assessment. The review discusses what computerized dynamic platform posturography measures, what the reliability and validity of the information are, and the uniqueness of the information provided. The clinical contribution and indications for testing are discussed. There are comments on future directions for research on computerized dynamic platform posturography and a summary and conclusion.

Diagnostic Techniques, Neurological↗
PubMed1995

Aphysiologic performance on dynamic posturography.

The remarkable ability of the body to maintain balance is the result of central nervous system integration of sophisticated inputs from the vestibular, visual, and somatosensory systems. Strategies by patients with balance dysfunction are aphysiologic when their performance is relatively better on more difficult conditions of sensory conflict than on easier ones. Twenty-two aphysiologic patterns on computerized dynamic posturography were compared with age-matched normal and vestibular patterns. The aphysiologic group performed significantly better than the patients in the vestibular dysfunction group on the most difficult subtests of computerized dynamic posturography, conditions 5 and 6, yet significantly poorer on the easier subtests, conditions 1 through 4. In addition, patients in the aphysiologic group tended to show greater intertrial variability compared with patients in both normal and vestibular system dysfunction groups. A stepwise linear discriminant analysis was used to determine a set of conditions that had significant value in discriminating between the three patient groups. Case studies are presented to further illustrate the clinical usefulness of computerized dynamic posturography testing in the evaluation of patients suspected of having a functional component to their on-feet balance problems.

Adult↗
PubMed1997

Clinical multisegmental posturography: age-related changes in stance control.

Unlike conventional platform posturography, which analyses the sway in the projection of the body baricentre on a supporting plane, multisegmental posturography provides information about body segmental movements during stance, including those that keep the baricentre still. This paper presents a new technical approach to multisegmental posturography using Virtual Reality electromagnetic tracking devices. This device was used to study age-related differences in normal subjects in the control of upright posture. Body sway was studied by recording the oscillations of two trackers placed on the head and the hip during the Romberg test. The tracking device allowed us to detect age-related differences in postural stance strategies. Although the amplitude and velocity of the oscillations measured at the head did not differ in the two groups, the flexibility of the ankle-hip head axis differed significantly: elderly subjects exhibited a more rigid stance. Closing the eyes increased rigidity in both age groups and this change appear more pronounced in the young.

Adolescent↗
PubMed2001

Differential diagnosis of proprioceptive and vestibular deficits using dynamic support-surface posturography.

The objective of this study was to evaluate how effective dynamic support-surface posturography could be as a diagnostic tool in patients with balance disorders (proprioceptive or vestibular deficits). Specifically, we studied whether measures of trunk control and simple toe-up rotational perturbations, selected using statistical techniques, could provide a better diagnostic yield than either the analysis of lower-body movements or use of a "nulled" ankle input paradigm. The test subjects were 15 control subjects, five patients with bilateral peripheral vestibular loss (VL) and five patients with selective bilateral, lower-leg proprioceptive loss (PL). Amplitudes and onset latencies of bursts of EMG activity in upper and lower-leg muscles, paraspinals and trapezius muscles, concurrent changes in ankle torque, and peak amplitudes of upper-leg, lower-leg, and trunk angular-velocities were measured. Stimuli included three different types of sudden movements of the support surface, a "nulled" ankle input paradigm, a simple toe-up rotation paradigm, and a combined toe-up rotation and backwards translation of the support surface. All stimuli were tested under eyes-open and eyes-closed conditions. For each type of movement and condition the diagnostic classification accuracy (i.e. the overall sensitivity and specificity) was calculated based on those posturography measures providing the highest diagnostic separation between the three populations. Both patient groups showed increased trunk sway, changed support-surface reaction forces and muscle amplitudes compared with controls for toe-up and "nulled" test conditions. Measures providing the greatest diagnostic utility were the amplitude of trunk-angular velocity (increased in VL subjects, less so in PL), the amplitude of balance-correcting paraspinal responses (increased in VL subjects, decreased in PL subjects), the amplitude of trapezius stabilising responses (increased in both patient groups) for simple toe-up rotations under eyes-closed conditions. We conclude, that diagnosis of balance disorders using dynamic posturography is best achieved using measures of trunk control following pure toe-up rotational perturbations tested under eyes-closed conditions.

Adult↗
PubMedDate not supplied

The use of dynamic posturography to detect neurosensorial disorder in IDDM without clinical neuropathy.

The main aim was to evaluate the relative importance of sensory interactions for postural stability in 45 patients with insulin-dependent diabetes mellitus (IDDM) with and without peripheral neuropathy. All subjects had normal electronystagmography. Dynamic posturography provides functional, selective testing of three sensory modalities in maintenance of balance, i.e., vestibular, visual, and somatosensory. The Sensory Organization Test (SOT) includes six test conditions during which the subject tries to maintain an upright stance with as little sway as possible. The subject stands on a movable platform facing a square visual surrounding, which can be rotated independently. The test is performed first with the eyes open, then with the eyes closed. The second component of posturography testing consists of the Motor Control Test (MCT) concerning motor responses routinely used in balance maintenance. Compared to control subjects, IDDM patients with peripheral neuropathy but not patients without neuropathy showed lower scores for test conditions SOT 1 (analysis of variance, ANOVA F = 8.3; Scheffe test: p = 0.0007), SOT 2 (F = 6.6; p = 0.004), SOT 3 (F = 3.4; p = 0.04), and SOT 6 (F = 3.4; p = 0.04). The muscle response latencies in MCT were prolonged for small forward perturbations (F = 4.6; p = 0.02) in neuropathic patients (148.3+/-14.2 ms) with respect to control subjects, but not in non-neuropathic patients with respect to control subjects (135.2+/-13.3 ms). Sural (r = 0.2; p = 0.002) and peroneal (r = 0.12; p = 0.02) nerve conduction velocities showed significant correlations with muscle response latencies of MCT for small forward perturbations. Our results suggest a subclinical dysequilibrium in IDDM patients with peripheral neuropathy. The results of dynamic posturography may reflect the impairment of the somatosensory system, rather than a specific lesion of vestibular and/or visual modalities.

Adult↗
PubMed1994

Comparison of static and dynamic posturography in young and older normal people.

OBJECTIVE: To measure sway velocity during static and dynamic posturography in "normal" older people and to determine which tests best distinguish young from older subjects. SUBJECTS: A sample of 30 young (18-39 years) and 82 community-dwelling older (> 75 years) subjects who reported normal balance underwent a battery of balance tests. MEASUREMENTS: Velocity and frequency of sway, Tinetti gait and balance score, self-reported fear of falling and number of falls. RESULTS: Mean sway velocity and the ratio of high to low frequency sway velocity were significantly increased in older subjects compared with younger subjects for static and dynamic tests with eyes open and with eyes closed. Measures of anterior-posterior sway velocity during angular tilt of the platform with eyes closed best distinguished young from older subjects (almost three-fourths of older subjects had values greater than 2 standard deviations from the young normal mean). Older subjects who reported falls in the past year did not have a significantly higher sway velocity on static or dynamic tests compared with those who did not report falls. However, subjects who reported a fear of falling had significantly higher sway velocity on dynamic tests with eyes closed compared to those who did not report a fear of falling. CONCLUSIONS: On average, velocity of sway is higher in older subjects compared with younger subjects, and the difference between young and old is greater with dynamic posturography than with static posturography.

Accidental Falls↗
PubMed1995

Head extension effect in static posturography.

The effect of head extension on the standing position has been studied by analysis of recordings made by static posturography type III (SPGIII), a set of six test of posturography for sensory interaction. The head extension effect in posturography was evaluated by comparing the results of testing with head extension on a stable platform and on foam rubber to testing with a normal head position. In normal subjects head extension increased the postural sway, but there was no more effect on foam rubber than on the stable platform. For patients with peripheral vestibular disorders the head extension effect on the measured postural sway was evaluated by the difference from the normal condition. This difference could be positive, zero, or negative on the stable platform as well as on foam rubber. In both patients and normal subjects, foam rubber had no more effect than the stable platform. The several types of results could be seen in each category of peripheral vestibular disorders. Only minor nuances could be observed: positive differences were more pronounced in benign paroxysmal positional vertigo, whereas negative ones were more obvious in unilateral vestibular deficits. These findings, moreover, deny that head extension in SPGIII should be considered a condition revealing vestibular dysfunction, as has been supposed. As head extension has an influence on the neck proprioceptor as well as on the position of the otoliths, its effect is ambiguous, which makes the interpretation rather difficult. A neck proprioceptive as well as an otolithic explanation appears to have some clinical support.

Head↗