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PubMed2002

Virtual reality stimuli for force platform posturography.

People relying much on vision in the control of posture are known to have an elevated risk of falling. Dependence on visual control is an important parameter in the diagnosis of balance disorders. We have previously shown that virtual reality methods can be used to produce visual stimuli that affect balance, but suitable stimuli need to be found. In this study the effect of six different virtual reality stimuli on the balance of 22 healthy test subjects was evaluated using force platform posturography. According to the tests two of the stimuli have a significant effect on balance.

Adult↗
PubMed1992

Lateralising value of the computerized dynamic posturography (CDP) test.

The side of labyrinthine pathology, as indicated by caloric tests, Quix test, audiometry or otoscopy is investigated by Computerised Dynamic Posturography. The correlation level fluctuates from high with audiometry to low with caloric tests. The quantification possibility of the dynamic posture is stressed.

Adult↗
PubMed2004

Vision preference in dynamic posturography analysed according to vestibular impairment and handicap.

OBJECTIVE: The objective of this work was to characterise the implications of vision preference derived from the sensory organisation test of computerised dynamic posturography, in terms of impairment, disability and handicap. MATERIAL AND METHOD: This was a prospective assessment of 88 patients suffering from dizziness who denied experiencing any visually induced vertiginous symptoms. The level of impairment of each patient was estimated by performing a complete analysis of vestibular function by means of the caloric and rotatory stimulation tests. Disability and handicap were determined with the Dizziness Handicap Inventory questionnaire (DHI). RESULTS: The results of the caloric test in patients were independent of vision preference although canal paresis was more frequently abnormal in patients without visual preference. No differences were found in the results of rotatory stimulation by means of impulse and sinusoidal tests, both at high velocities of stimuli, in between patients with and without vision preference. Similarly, the responses in the DHI, a common questionnaire for vestibular disability and handicap and, specifically to questions addressing the problem of visual and vestibular disability, were not able to differentiate either group of patients. Nevertheless, we have found that patients with vision preference tend to have poorer balance. CONCLUSION: We consider that in the patients studied here, vision preference must be considered as a normal finding as this represents a normal strategy in a subject that relies more heavily on visual cues for his or her postural control.

Adult↗
PubMed2005

Preoperative computerized dynamic posturography as a prognostic indicator of balance function in patients with acoustic neuroma.

We conducted a study to determine the prognostic reliability of preoperative computerized dynamic posturography (CDP) in patients undergoing surgical excision of an acoustic neuroma. Our goal was to determine the correlation between objective preoperative assessments of balance function and subjective postoperative patient self-assessments. To that end, we retrospectively reviewed the records of 21 adults who had undergone preoperative CDP, and we subsequently obtained their subjective assessments of balance function by follow-up telephone surveys at least 1 year postoperatively. We conclude that although CDP has proven to be useful in many aspects of balance evaluation, it did not appear to be a valuable predictor of subjective postoperative balance function in these patients.

Adult↗
PubMed2005

VEMPs and dynamic posturography after intratympanic gentamycin in Menière's disease.

In this study, we investigated whether vestibular evoked myogenic potentials (VEMPs) and dynamic posturography (DP) are useful in the evaluation of the vestibular function in patients affected by active monoaural Menière's disease (MD) treated with intratympanic gentamycin. Twelve subjects affected by monoaural MD were treated with weekly intratympanic injections of 0.5 ml of gentamycin at a concentration of 20 mg/ml. VEMPs were used to test saccular function, while postural control was analyzed by DP. The results obtained with these two techniques were compared with those obtained by using bithermal caloric test. The mean follow-up was 15.3 months (6--28 months). Therapy resulted in complete absence of the caloric response in six subjects (50) and in caloric test-induced asymmetry in the remaining individuals, ranging from 83 to 27. At follow-up, eleven patients (91.6%) were free of vertigo, while one patient had two vertigo spells 9 months after treatment. Before treatment, VEMPs were present in the affected ear of eleven patients. After treatment VEMPs were absent in all the patients. At the end of follow-up, reappearance of VEMPs was observed in two patients, with no changes in latency values and amplitude ratio. DP demonstrated a reduction of the Composite Score (CS) one week after therapy, with a prevalent reduction of the vestibular component. After 6 months, there was an improvement of the CS and, in particular, of the vestibular component. The present study demonstrates that bithermal caloric test and VEMPs allow for the functional evaluation of both the horizontal semicircular canal and the sacculus, suggesting that these techniques might be used together to monitor the efficacy of intratympanic gentamycin therapy. In addition, our data indicate that DP might provide important information on compensation phenomena and show that intratympanic gentamycin can improve postural control in MD patients.

Adult↗
PubMed1991

The tilting room and posturography.

The tilting room examination technique is detailed. The advantages of posturography with the tilting room as an additional tool in the clinical vestibular examination are described for patients with uni- and bilateral loss of vestibular function, for patients with an acoustic neurinoma and for patients suffering from cervical ataxia. Some illustrations are also given of other applications of the tilting room.

Ataxia↗
PubMed1991

Enhancement of posturography testing with head tilt and energy measurements.

We have attempted to increase the sensitivity of dynamic posturography testing by adding head extension and sway energy measurement to the standard Equitest protocol. Both procedures were applied to 121 patients and to 89 normal subjects. A portion of the standard protocol was repeated with the patient's head extended 55 degrees. Head extension significantly increases the number of "falls" or losses of balance experienced by normal subjects 50 years or older. Using the formula, Energy = Force x Distance, and appropriate corrections for platform tilt and body weight, any previously recorded test can be analyzed with computer programming to give energy values in joules per kilogram. Adding the two criteria of head extension and sway energy to the standard protocol increased the percentage of patients classified as abnormal from 48 to 68 percent. The two added criteria are useful in separating symptomatic from asymptomatic subjects and patients.

Adult↗
PubMed1990

[Dynamic posturography in normal subjects].

The relative lack of data on the dynamic posturography led us to start a study in order to give our contributions to the standardization of M1, M2, M3, response parameters in normal subjects. Our research was carried out on 35 normal subjects aged 21 to 50. All of them were standing in Romberg's position on a Tönnies model board in a normally lit and ventilated room. We performed two tests: the first one open-eyed staring at no point, the second, 5 minutes later, closed-eyed. The EMG signals were obtained by surface electrodes on triceps sural and front tibial muscles. The EMG recording was determined by a "tilt" movement of the board at a steady speed of 50 per sec. and 4 wide. We use a XT 286 IBM computer with "T POST" software for checking and testing the data. Our results showed a significant variation in the value of the duration parameter in open-eyed and closed-eyed tests. Latency and area values were inferior to those obtained by other authors, except for Diener and Dichgans (3) whose results differ in latency value only.

Electromyography↗
PubMed1989

The clinical use of dynamic posturography in the elderly.

We provide an overview of the clinical uses of dynamic posturography. Although the equipment described to perform this testing is expensive, the concepts, especially those for sensory organization, can be applied for +20.00. To apply the six sensory organization conditions, one merely needs some way to disrupt proprioceptive information by maintaining ankle angle and providing for visual conflict stimuli. We found that proprioceptive information can be disrupted easily by asking the patient to stand on a thick (4-inch) dense piece of foam rubber like that used in cushions for furniture. Visual stabilization conflict can be provided by having the patient wear a 19- to 20-inch Japanese lantern with a head-mounting system in the center so that the patient's movements do not reflect themselves in relative movements to the visual environment. With use of these two simple tools, the six sensory organization tests can be approximated in a clinical situation in a short time and can provide some relative information about a patient's postural control capabilities. With minor additional work, a quantitative measure of output that gives indications of the amount of anterior-posterior sway also can be provided. For elderly patients with a variety of problems ranging from general unsteadiness to frank vertigo, the risk of falling can be devastating, and it is important to provide a thorough investigation of the total balance system. The systematic investigation, qualitatively or quantitatively, of integration of sensory input and motor outputs provides a dimension that typically has been lacking in the routine "dizzy patient workup" for all ages but especially for elderly patients. Therefore, the application of the postural maintenance theory with the above-described procedures or variations in these procedures appears to have a great deal of clinical relevance in the evaluation of patients with gait and balance disorders. These types of evaluations represent an adjunct or addition to the evaluation of the vestibular system and the vestibulo-ocular reflexes and by no means should be considered a substitute for that traditional evaluation. It is the combination of information that can provide the clinician with a more global picture of the entire balance system and its functional capabilities.

Adult↗
PubMed1984

Posturography and vestibular compensation.

In unilateral vestibular hypofunction, compensation has to be achieved at the several levels of the balance function. The development of compensation at each level has not necessarily a parallel course. Accordingly, a thorough evaluation of the functional state of the patient, requires a separate assessment for each level. In clinical practice, compensation is evaluated by the testing of provoked vertigo (with eventual positional nystagmus) and by the rotation test results. To these data a measurement of the vestibulospinal level has to be added. Posturography provides this assessment and in this way the global functional state is completed. In many cases the complaints can be objectified and the elaboration of adequate rehabilitation exercises can be founded upon these posturographic data. The detailed analysis of the posturograpohic curves furnishes a diversification of the dysfunctional patterns at this balance level, with also emphasis upon the sensory interaction.

Adaptation, Physiological↗
PubMed1983

Evaluation of the vestibulospinal reflex by posturography. New perspectives in the otoneurology.

The vestibulospinal aspect of the vestibular function has been neglected in the evaluation of a patient with balance troubles. The attention is focused on vertigo rather than on problems of instability and ataxia, whereas also the examination of the patient is based upon the evaluation of the vestibulo-ocular reflex. Recent technical progress allows us to assess the vestibulospinal reflex in the global balance regulation of the standing patient by means of posturography, i.e. the recording and micro-computer analysis of the postural sway. In this way a precise description of this function is obtained and can be used in the approach to the patient, especially for a functional follow-up.

Humans↗
PubMed1995

Dizziness Handicap Inventory correlates of computerized dynamic posturography.

To assess the handicapping effect of dizziness related to posture and balance, the Dizziness Handicap Inventory (DHI) and Computerized Dynamic Posturography (CDP) were used to assess 101 consecutive patients referred for neurotologic evaluation of dizziness. Most patients, regardless of diagnosis, related some level of preexisting handicap, most often in the DHI Physical subscale. Generally, females and patients with bilateral lesions scored higher in all DHI subscales. No clinically useful correlations emerged between DHI and CDP testing, although DHI scores were marginally higher for patients failing CDP conditions. Functional balance ability could not be correlated with patient handicap, but a literature review suggests that the desynchrony between dizziness signs and symptoms may be related to underlying patient anxiety and differences in coping strategies.

Adaptation, Psychological↗
PubMedDate not supplied

Does posturography differentiate malingerers from vertiginous patients?

Voluntary, simulated vertigo and acute vertigo due to vestibular neuritis were examined by means of static posturography in 81 tests to evaluate the extent to which intentional malingering can be detected. Thirty healthy, normal subjects were first instructed to stand as still as possible on a static force platform and then to simulate dizziness. The true cases consisted of 21 patients with vestibular neuritis. The parameters analyzed included body sway velocity (BSV), body sway area of ellipse (BSE), and the Romberg quotient. Both the simulated and pathological posturographic BSV and BSE values differed from normal values under all test conditions, but they did not differ from each other, whereas the simulated values could be differentiated from the pathological ones with the Romberg quotient based on BSV. Five staff members of our audiological department were able to differentiate between the simulations and pathological cases quite well, with a median sensitivity of 0.77 and a specificity of 0.71 in a blinded test. A posturographic measurement, even performed once, can be useful to some extent for detecting simulation, but more investigation and development of the analysis system is required to obtain more specific results. For the present, the results obtained by trained observation of the subject in the test situation are at least as reliable as those obtained through the analysis of statistical measurements.

Adult↗
PubMedDate not supplied

Static posturography and intravenous alcohol.

Twelve health subjects were assessed using static posturography before and after intravenous alcohol infusion in a double-blind experiment. The dose was 0.5 g ethanol per kg body weight in 15 minutes, which raised the blood alcohol concentration to a level of approximately 1 mg/mL. Among other parameters, the average body sway velocity (BSV) and area of body sway (BSA) were measured. BSV was the most sensitive parameter for detecting increased body sway after alcohol infusion, and a significant effect of alcohol on its values was seen at 0.46 to 1.0 mg/mL alcohol concentrations. The second best indicator was the BSA. There was a positive correlation between the BSV and the BSA. The other parameters were not affected. The Romberg quotient remained constant during the alcohol test. The test battery used was relevant to distinguish the effect of alcohol on balance. In this study, acute blood alcohol concentrations of around 0.5 to 1.0 mg/mL affected BSV more significantly than BSA. The authors do not, however, recommend the test for forensic purposes in examining drivers with alcohol in their blood, as there is too much interindividual dispersion in the results.

Adolescent↗
PubMedDate not supplied

[Static posturography: analysis of the area parameter in normal and abnormal subjects].

Static posturography was evaluated in the diagnosis of vestibular disease. The battery of tests carried out on a force platform (DINASCAN) included standing on one or two feet with eyes opened and closed. Fifty-six study subjects were divided into healthy and vestibular disease groups, which in turn were subdivided by age. Area was a study parameter and results were evaluated with the Student "t" test. The only significant differences found were in tests 3 and 4 in the healthy group and test y in the vestibular disease group. Comparisons by age and presence of vestibular disease disclosed no differences. These results suggest that area is not a suitable parameter for detecting latent vestibular disease.

Adult↗
PubMed1987

Vestibular compensation evaluated by rotation tests and posturography.

In patients with unilateral vestibular hypofunction (UVH), compensation plays an indispensable role in reorganizing and returning to normal the vestibulo-ocular reflex (VOR) and the vestibulospinal reflex (VSR). These compensatory and adaptive processes, however, may have an independent course because the results for VOR are nontransferable to VSR. Discordance between results of rotation tests (evaluating the compensation for the VOR) and posturographic (PG) results (evaluating compensation for the VSR) are observed in 50% of the patients with UVH. The complaint of "instability" shows correlation with abnormal PG data. Accordingly, a thorough evaluation of a patient with UVH has to include information about the VSR as it can be provided by PG.

Humans↗