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PubMed1992

A dynamic posturography study of balance in healthy elderly.

Using dynamic posturography, we studied the balance of 234 community-dwelling elderly subjects (mean age, 76 +/- 5 years) as well as 34 young controls (mean age, 34 +/- 12 years). Almost all measures of balance were worse in elderly subjects compared with young controls. The decrements in older persons indicate a diminished capacity to process conflicting sensory input as well as a possible narrowing of the limit of stability (or, alternatively, an increase in sway). We propose that this occurs most likely as a result of biomechanical or central processing changes as opposed to diminished sensory or vestibular input. Furthermore, with difficult tasks sequentially presented, the performance of the older subjects improved, suggesting that balance, at least in the short term, adapts to stressful conditions. In these elderly subjects screened for age-related diseases affecting balance, only small decrements of balance occurred between the ages of 70 and 85 years. This nominal decrease over a 15-year span suggests that clinically significant balance impairment is the result of age-related disease rather than an inevitable consequence of aging and is therefore potentially treatable.

Adult↗
PubMed2004

Usefulness of posturography after epidural block.

After a nerve block, observation of the course of effects is necessary until discharge of patients. Particularly epidural block in the lumbar region markedly affects ambulation and postural stability. Although there are few methods of objective evaluation of the postural stability, safe and early discharge is desired. We evaluated the influences of epidural block with 5 ml of 1% lidocaine on equilibrium before as well as 30, 60 and 90 minutes after epidural block. Computerized posturography allows the objective evaluation and quantitative assessment of impairment of receptors and the central nervous system involved in the maintenance of postural stability by analyzing of results. Locus length per unit area with the eyes open and that with the eyes closed 30 minutes after epidural block (27.339 +/- 11.761 cm and 25.804 +/- 10.561 cm, respectively) were significantly (P = 0.0067 and 0.0175, respectively) higher than baseline values (19.528 +/- 8.240 cm and 19.496 +/- 7.450 cm, respectively). Sway area with the eyes open 30 minutes after epidural block (3.923 +/- 2.494 cm2) was significantly (P = 0.0190) larger than the baseline value (2.533 +/- 1.309 cm2). These results suggest that marked effect remain after epidural block even when standing appears to be stable, and the observation of the course of effects after epidural block is still necessary for the safety of patients. We considered that locus length per unit area is a useful parameter for the assessment of an early discharge.

Adult↗
PubMed1993

Clinical comparisons of posturography and electronystagmography.

A retrospective study was conducted of 103 balance-disturbed patients of mixed etiologies tested with electronystagmography (ENG) and computerized dynamic posturography (CDP). CDP was abnormal for 83% of the group as compared to 42% abnormal ENG results. In cases of otolithic dysfunction, ENG was more sensitive and gave specific information. Results of this preliminary study indicate that CDP has merit when used in the evaluation of patients with undifferentiated balance complaints. ENG testing is still needed in cases of vestibular dysfunction to establish anatomic level and laterality as well as for lesions involving the otolith. Additional study will be needed to verify these findings and to develop a means of detecting otolith dysfunction with CDP.

Adult↗
PubMed1991

Application of tetra-ataxiametric posturography in clinical and developmental diagnosis.

Tetra-ataxiametric posturography is based on the measurement and computerized elaboration of electronic signals emitted by four footplates, one for each heel and toe, respectively. These are sensitive to vertical pressure produced by a subject standing straight but in various positions (feet parallel, in tandem, eyes closed, on pads, etc.). The method yields additional parameters not obtained by the traditional monoplate stabilometers, namely, weight-distribution patterns and correlations among six combinations of paired outputs from the two heels, two toes, heel/toe of each foot, and the two diagonals (tetra-ataxiametric synchronisations). Comparing age-matched learning disabled, mentally retarded, autistic, and hearing impaired (with and without labyrinthine hypofunction) with normal children, significant and clinically meaningful differences were detected between the tetra-ataxiametric measures of stability, interaction between Fourier Spectral Power Ranges of body sway, weight distributions, and synchronisations of toe parts. The same parameters correlated significantly with cognitive school readiness in normal populations. While the stability and spectral quotients show significant developmental changes, weight distribution and toe synchronisations are stable from 5 years onwards. The method is suitable for young subjects and attractive to children who may ordinarily be reluctant to cooperate, such as the autistic ones. The equipment is portable and tests can be conveniently carried out in a child's familiar educational setting.

Age Factors↗
PubMed1988

Computerized posturography, a development of the measuring system.

A computerized posturography system is composed of a custom made strain gauge force platform and it utilizes commercially available amplifiers. The body sway response signals are digitized for the calculation of the following parameters by a computer: average velocity of body sway, mean value for fore-aft and lateral body sway, and maximal amplitude of body sway. Calf muscles were exposed to vibration to disturb the postural control. The program contains appropriate filters to remove transient and quantification noise.

Humans↗
PubMed1991

Dynamic posturography in cervical vertigo.

Cervical vertigo, the entity of neck disorder and associated vestibular symptoms, was investigated in 15 suspected subjects and results were compared with 15 age-matched controls. A modified dynamic posturography investigation with different head positions was used. Head position was recorded 3-dimensionally with electrogoniometry. Differences on a sway-referenced forceplate were found.

Adult↗
PubMed1994

Can posturography contribute to the diagnosis of vertigo in patients where other tests fail to do so?

In this study, patients showing abnormal posturographic results in a test-configuration upon examination of the visuo-proprioceptive-vestibular interaction (Static Posturography type III, SPGIII) are reviewed. Group I (n = 81) comprised patients for whom no clear diagnosis could be obtained (neither central nor peripheral) and with rather atypical complaints. Group II (n = 77) comprised patients in whom a well-defined peripheral disorder could be found (typical provoked vertigo as BPPV (n = 30) and Meniere's disease (n = 30)). Group I consisted of s subgroup Ia, including patients with a complete negative classical examination (n = 32), a subgroup Ib with patients showing minor central signs (n = 28), and subgroup Ic comprising patients with slight peripheral indications (n = 21). The findings in SPGIII were compared between these two groups and are discussed in the light of earlier experience with such data in typical peripheral vestibular disorders. Similar sensory interaction patterns were found in both groups, with only small differences between them, suggesting that in some of these cases, especially in subgroups Ia and Ic, vestibular disturbance might be present, which would not have been sufficiently and clearly revealed by the classical tests. Especially the negative effects, i.e. when the withdrawal of a sensory input improved stability instead of aggravating it, which is the opposite to what should be expected, suggest that the other sensory inputs, vision and proprioception, play a role in the definition of the posturographic results in typical vestibular disorders as well as in diagnosis.

Adult↗
PubMed1995

Posturography: head stabilisation compared with platform recording. Application in vestibular disorders.

Posturography with simultaneous recording of the head movements (H-recording) and of the pressure of the feet on the platform (P-recording) has been applied in patients with peripheral vestibular disorders. For the whole testing (four tests with visual and proprioceptive interaction) 40% showed an identical degree of abnormality for the measurements of surface in P- and H-recording. In a large majority of the patients, showing a difference between H- and P-recording, this difference indicated a lower degree for the H-recording. Concerning the four tests separately, the differences for eyes closed tests were more frequently positive (larger surface for head movements) than for eyes open tests. Also on foam rubber there was more difference than on stable platform. Especially the test with eyes closed on foam rubber showed more differences. These data show that in a minority of patients the comparison of H-recording and P-recording affords complementary information showing in these cases some independence of head stabilisation and foot-stabilisation. Head-recording can be used as a posturographic technique but one has to keep in mind the possible differences with platform-recording.

Functional Laterality↗
PubMed1997

Stability limits for visual feedback posturography in vestibular rehabilitation.

Vestibular rehabilitation therapy (VRT) is used to enhance compensation after peripheral vestibular lesion. In visual feedback posturography (VFP) a patient can practice postural control actively on a force platform and progress in the VRT can be objectively measured. The aim of the study was to determine normative values for stability limits (SL) in the VFP. Eleven healthy subjects were measured with force platform in visual feedback condition. Subjects were instructed to move their center of gravity (COG) marker to given targets, which were displayed on a computer screen in front of them. Target distance from the center of the platform was increased step by step to determine the SL in 8 directions. Hit delays (HD) to the targets and hold percentages (HP) within the targets were measured to quantify the difficulty of the individual targets as a function of subject's shoe size. With fixed feet position the SL in anterior direction increased 1.2 times the absolute increase in shoe length. An almost similar increase was found in anterolateral direction. The knowledge of the mechanical SL is important, because targets near SL should be avoided for safety reasons.

Adult↗
PubMed1999

An overview of the clinical use of dynamic posturography in the differential diagnosis of balance disorders.

Dynamic posturography comprises a series of balance control tests which help physicians overcome numerous diagnostic and treatment challenges arising when examining patients complaining of a debilitating balance disorder. These challenges include the specific differential diagnosis, documentation of symptoms and assessment of functional disability. It must be determined whether the cause of the disability is an organic sensory, deficit, a central nervous system (CNS) lesion or a non-organic (that is, possibly psychogenic or just overtly simulated) disorder. This review is targeted towards providing the reader (a) an overview of the effects sensorimotor deficits have on balance control, specifically vestibulospinal and proprioceptive reflex deficits; and, (b) how these effects may be assessed objectively in a clinical setting to differentiate between various organic and non-organic balance-disorders. The techniques used to study these effects are based on the analysis of both rapid balance-correcting and slow balance-stabilizing responses to fast and slow movements in the pitch plane of the support surface on which the test subject stands.

Diagnosis, Differential↗
PubMed2000

Effects of dimenhydrinate on computerized dynamic posturography.

OBJECTIVE: Previous studies have demonstrated that sedatives and antiemetics commonly used by patients suppress the vestibulo-ocular reflexes during electronystagmography, making it more difficult to quantify function in such patients. The effects of these medications on computerized dynamic posturography (CDP) have not been studied, and the influences, if any, on the vestibulospinal reflexes are not known. We aimed to study the influence, if any, of dimenhydrinate on CDP performance. DESIGN: A double-blinded study using a randomized protocol to compare the effects of dimenhydrinate and placebo on CDP performance in normal subjects. SETTING: A tertiary/quaternary care facility using a standardized CDP assessment protocol. METHODS: After a CDP training session (one assessment) to rule out any learning effect, 10 subjects underwent CDP assessment on 2 separate days after ingestion of either a standard single dose of dimenhydrinate or placebo. MAIN OUTCOME MEASURES: Pre- and post-medication CDP performance was measured using Sensory Organization Test (SOT) composite scores and also scores on CDP conditions particularly sensitive to measurement of vestibular impairment (SOT conditions 5 and 6). RESULTS: Analysis of data showed no significant effect on CDP performance of normal subjects after dimenhydrinate administration, although there may be a trend toward a slight effect on performance. CONCLUSIONS: There seems to be no significant effect of dimenhydrinate on CDP performance in normal subjects, although there may be a trend. Further studies using a dose causing more significant symptoms or using a higher number of subjects may clarify this.

Adult↗
PubMed2002

Computerized platform posturography for children: test-retest reliability of the sensory test of the VSR System.

The purpose of this study was to examine the consistency of scores from typically developing children on the sensory test of the NeuroCom International VSR System. Participants included 18 children between five and nine years of age. Postural sway was measured using the VSR System, a computerized platform posturography assessment tool. The sensory test protocol examines the relative contributions of the visual, somatosensory, and vestibular systems to maintain postural stability by systematically manipulating the availability and accuracy of sensory inputs. Test-retest intraclass correlation coefficients for all four sensory conditions ranged from .76 to .83.

Child↗
PubMed2002

Effects of lifetime ethanol consumption on postural control: a computerized dynamic posturography study.

The relationship between lifetime alcohol consumption and postural control was investigated in 35 subjects with no clinically-detectable neurologic abnormalities, using computerized dynamic posturography (CDP) procedures. The estimated total number of lifetime alcoholic drinks was positively correlated with anteroposterior sway spectral power within the 2-4 Hz and 4-6 Hz frequency bands, in three Sensory Organization Test (SOT) conditions: eyes closed with stable support surface (SOT 2), eyes open with sway-referenced support (SOT 4), and eyes closed with sway-referenced support (SOT 5). All correlations remained significant after controlling for subject age, and were increased after excluding nine drug-abusing subjects. In contrast to the strong findings for frequency-based measures, no correlation was observed using conventional amplitude-based sway measures. These results suggest that 1) alcohol consumption compromises postural control in an exposure-dependent manner, and 2) sway frequency analysis reveals pathological processes not manifested in conventional CDP measures of sway amplitude.

Adult↗
PubMed2001

[The development of body posturography device using inclinometer technique].

A kind of body posturography device using inclinometer technique is described in this paper. Comparing with a device using gravimeter technique it shows following advantages: 1) As the signal of body sway angle is obtained by the incline-sensor, it is easy to test subject's balance function on the multifarious body supporters; 2) When the platform of the global bottom is used, the subject may come into contact with ground at one point, so as to weaken significantly subject's somatosensory of moving center of gravity.

Algorithms↗
PubMed2002

[Influence of foot position in the static posturography].

OBJECTIVE: To study the effect of position of the feet on posturography. METHOD: The quantitative significance of the standing position in posturographic measurements was evaluated with 30 healthy volunteers studied under nonvisual conditions, using 5 foot positions: heels toghther with the toes 30 degrees apart or at an angle of the voleer's own choice, and the feet parallel and 0.5 or 10 cm apart were studied respectively. RESULT: Five test methods showed different results. The feet parallel and 10 cm apart is the most stable position among 5 test methods, the most unstable position is feet parallel and together. CONCLUSION: Feet position can influence the results of test. For those who can hardly stand with the feet parallel and together can choose the feet apart position.

Adult↗
PubMed1992

Effect of positioning of the feet in posturography.

Static posturography has been developed from a basic research test to a widely used clinical tool for evaluating dizzy patients. Before any actual standardization can be achieved, however, several aspects of the test situations have to be evaluated, including the position of the feet. The quantitative significance of the standing position in posturographic measurements was evaluated with healthy volunteers studied under visual and nonvisual conditions, using 4 foot positions: heels together with the toes 30 degrees apart or at an angle of the volunteer's own choice, and the feet parallel and either 0 or 10 cm apart were studied separately. Each measurement was characterized in terms of 5 parameters (body sway velocity, vibration-induced shift of centre of force in anteroposterior and lateral directions, and maximum displacement of centre of force in the same directions). Body sway velocities were smallest when the feet were parallel and 10 cm apart. Although the position chosen by the subject was usually more stable than that with the toes 30 degrees apart, the difference was nonsignificant. According to our results, the standing position is not crucial in posturographic measurements provided that the distance between the heels is determined, and the subject can just as well choose the angle between the feet if the heels are kept together.

Adult↗
PubMed2000

Sonovestibular symptoms evaluated by computed dynamic posturography.

The investigation of stability under bilateral acoustic stimulation was undertaken in an attempt to mimic the real-life conditions of noisy environment (e.g., industry, aviation). The Tullio phenomenon evaluated by computed dynamic posturography (CDP) under acoustic stimulation is reflected in postural unsteadiness, rather than in the classic nystagmus. With such a method, the dangerous effects of noise-induced instability can be assessed and prevented. Three groups of subjects were submitted. The first (group A) included 20 patients who complained of sonovestibular symptoms (i.e., Tullio phenomenon) on the background of an inner-ear disease. The second group (B) included 20 neurootological patients without a history of Tullio phenomenon. Group C consisted of 20 patients with normal hearing, as controls. A pure-tone stimulus of 1,000 Hz at 110 dB was delivered binaurally for 20 seconds during condition 5 and condition 6 of the CDP sensory organization test. The sequence of six sensory organization conditions was performed three times with two intermissions of 15-20 minutes between the trials. The first was performed in the regular mode (quiet stance). This was followed 20 minutes by a trial carried out in quiet stance in sensory organizations tests (SOTs) 1 through 4, and with acoustic stimulation in SOT 5 and SOT 6. The last test was performed in quiet stance throughout (identical to the first trial). A significant drop in the composite equilibrium score was witnessed in group A patients upon acoustic stimulation (p < .0001). This imbalance did not disappear completely until 20 minutes later when the third sensory organization trial was performed. In fact, the composite score obtained on the last SOT was still significantly worse than the baseline. Group B and the normal subjects (group C) showed no significant change in composite score. As regards the vestibular ratio score, again, group A marked a drop on stimulation with sound (p < .004). This decrease contrasted once more with the other two groups. The leading sensory organization pattern was vestibular dysfunction (i.e., 40%, 10%, and 0% before acoustic stimulation in groups A, B, and C, respectively). The initial proportion of vestibular dysfunction increased on acoustic stimulation to 55% in group A, but this subsequently decreased in the third trial. The percentages of vestibular dysfunction remained constant during repeated trials in the other two groups. The positive medical history of sonovestibular symptoms was confirmed objectively by CDP with sound stimulation with a high statistical significance. This establishes the described method as a sensitive testing technique for validating the existence of the Tullio phenomenon in patients with a variety of disorders of the inner ear, especially chronic noise-induced hearing loss and acute acoustic trauma. All patients who suffered phonic trauma, chronic exposure to noise (e.g., aviation employees, industry and army personnel), or other neurootological disorders and who complain of sonovestibular symptoms should be tested for the presence of the Tullio phenomenon. This should be carried out preferably by means of CDP with acoustic stimulation for an objective corroboration of their complaint before continuing activity in a noisy environment, thus preventing dangerous loss of balance when exposed to noise.

Acoustic Stimulation↗
PubMed2004

Role of dynamic posturography (Equitest) in the identification of feigned balance disturbances.

Clinico-instrumental criteria to reliably detect simulated vertigo remain to be defined. Computed dynamic posturography (Equitest) has been used to identify additional factors to distinguish simulated, from real vertigo. The present study population comprised 23 normal subjects and 16 patients with documented vestibular impairment. Normal subjects were also studied during a state of simulated vertigo. In malingerers, the Equilibrium Score and the Composite Equilibrium Score showed a statistically significant reduction in all test conditions as compared to normal subjects, patients and "non-malingerers". Upon Sensory Analysis, statistically significant differences were found for the somatosensory component between malingerers and "non-malingerers". In 20/23 cases, Strategy Score values recorded in malingerers were 2 Standard Deviations lower than the mean obtained in "non-malingerers" in at least one of the six test conditions. By combining the latter observation with Goebel's 1st criterion it was possible to differentiate malingerers from non-malingerers with 86.9% sensitivity and 89.7% specificity. The Equitest, therefore, in combination with conventional methods, provides the clinician with an important tool, in the identification of a state of simulated vertigo.

Adolescent↗