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Bertuccelli M, Bisiacchi P, Del Felice A. Disentangling Cerebellar and Parietal Contributions to Gait and Body Schema: A Repetitive Transcranial Magnetic Stimulation Study. CEREBELLUM (LONDON, ENGLAND) 2024:10.1007/s12311-024-01678-x. [PMID: 38438828 DOI: 10.1007/s12311-024-01678-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 03/06/2024]
Abstract
The overlap between motor and cognitive signs resulting from posterior parietal cortex (PPC) and cerebellar lesions can mask their relative contribution in the sensorimotor integration process. This study aimed to identify distinguishing motor and cognitive features to disentangle PPC and cerebellar involvement in two sensorimotor-related functions: gait and body schema representation. Thirty healthy volunteers were enrolled and randomly assigned to PPC or cerebellar stimulation. Sham stimulation and 1 Hz-repetitive-Transcranial-Magnetic-Stimulation were delivered over P3 or cerebellum before a balance and a walking distance estimation task. Each trial was repeated with eyes open (EO) and closed (EC). Eight inertial measurement units recorded spatiotemporal and kinematic variables of gait. Instability increased in both groups after real stimulation: PPC inhibition resulted in increased instability in EC conditions, as evidenced by increased ellipse area and range of movement in medio-lateral and anterior-posterior (ROMap) directions. Cerebellar inhibition affected both EC (increased ROMap) and EO stability (greater displacement of the center of mass). Inhibitory stimulation (EC vs. EO) affected also gait spatiotemporal variability, with a high variability of ankle and knee angles plus different patterns in the two groups (cerebellar vs parietal). Lastly, PPC group overestimates distances after real stimulation (EC condition) compared to the cerebellar group. Stability, gait variability, and distance estimation parameters may be useful clinical parameters to disentangle cerebellar and PPC sensorimotor integration deficits. Clinical differential diagnosis efficiency can benefit from this methodological approach.
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Affiliation(s)
- Margherita Bertuccelli
- Department of Neuroscience, Section of Neurology, University of Padova, Padua, Italy
- Padova Neuroscience Center, University of Padova, Padua, Italy
| | - Patrizia Bisiacchi
- Department of Neuroscience, Section of Neurology, University of Padova, Padua, Italy
- Department of General Psychology, University of Padova, Padua, Italy
| | - Alessandra Del Felice
- Department of Neuroscience, Section of Neurology, University of Padova, Padua, Italy.
- Padova Neuroscience Center, University of Padova, Padua, Italy.
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Lin ME, Gallagher TJ, Straughan A, Marmor S, Adams ME, Choi JS. Association of Symptomatic Dizziness With All-Cause and Cause-Specific Mortality. JAMA Otolaryngol Head Neck Surg 2024; 150:257-264. [PMID: 38329761 PMCID: PMC10853869 DOI: 10.1001/jamaoto.2023.4554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 12/10/2023] [Indexed: 02/09/2024]
Abstract
Importance Dizziness is a highly prevalent complaint with wide-ranging causes and resultant morbidity. Whether symptomatic dizziness and its various manifestations are associated with all-cause and cause-specific mortality is unknown. Objective To examine the associations of symptomatic dizziness and its manifestations with all-cause and cause-specific mortality. Design, Setting, and Participants This cohort study is a mortality follow-up study based on the 1999-2004 National Health and Nutrition Examination Survey. The study cohort included adults 40 years and older who completed questions about symptomatic dizziness, including problems with dizziness, balance, falling, and positional dizziness, within the past 12 months. Respondents were linked to mortality data through December 31, 2019. Data were analyzed from February to August 2023. Exposure Self-reported symptomatic dizziness. Main Outcomes and Measures All-cause and cause-specific (cardiovascular disease, diabetes, cancer, and unintentional injuries) mortality. Cox proportional hazard regression models were used to examine associations between symptomatic dizziness and all-cause and cause-specific mortality while adjusting for demographics and medical history. Results In this nationally representative cohort of 9000 middle-aged and older US adults (mean [SD] age, 61.8 [13.8] years; 4570 [50.8%] female), prevalence of symptomatic dizziness was 23.8%. Specifically, 18.3% reported problems with dizziness, 14.5% reported problems with balance, 5.7% reported problems with falling, and 3.8% reported dizziness when turning in bed (positional dizziness). At a median (range) of 16.2 (0.1-20.6) years of follow-up, all-cause mortality for adults with symptomatic dizziness was higher than for those without (45.6% vs 27.1%). Symptomatic dizziness was associated with elevated risk for cause-specific mortality from diabetes (hazard ratio [HR], 1.66; 95% CI, 1.23-2.25), cardiovascular disease (HR, 1.33; 95% CI, 1.12-1.55), and cancer (HR, 1.21; 95% CI, 0.99-1.47) but not unintentional injuries (HR, 0.98; 95% CI, 0.51-1.88). Reporting problems with balance or falling was associated with increased all-cause mortality (balance: HR, 1.27; 95% CI, 1.17-1.39; and falling: HR, 1.52; 95% CI, 1.33-1.73), cardiovascular disease-specific mortality (balance: HR, 1.41; 95% CI, 1.20-1.66; and falling: HR, 1.49; 95% CI, 1.15-1.94), and diabetes-specific mortality risks (balance: HR, 1.74; 95% CI, 1.26-2.39; and falling: HR, 2.01; 95% CI, 1.26-3.18). There was no association between positional dizziness and mortality (HR, 0.98; 95% CI, 0.82-1.19). Conclusions and Relevance In this cohort study, symptomatic dizziness was associated with increased risk for all-cause and diabetes-, cardiovascular disease-, and cancer-specific mortality. The imprecision of the effect size estimate for cancer-specific mortality prevents making a definitive conclusion. Future studies are needed to determine whether symptomatic dizziness indicates underlying health conditions contributing to mortality or if early intervention for imbalance and falls can reduce mortality risk.
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Affiliation(s)
- Matthew E. Lin
- Keck School of Medicine of the University of Southern California, Los Angeles
| | - Tyler J. Gallagher
- Keck School of Medicine of the University of Southern California, Los Angeles
| | - Alexander Straughan
- Department of Otolaryngology–Head & Neck Surgery, University of Minnesota Medical School, Minneapolis
| | - Schelomo Marmor
- Department of Surgery, University of Minnesota Medical School, Minneapolis
| | - Meredith E. Adams
- Department of Otolaryngology–Head & Neck Surgery, University of Minnesota Medical School, Minneapolis
| | - Janet S. Choi
- Department of Otolaryngology–Head & Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles
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Hazzaa N, Shalaby A, Hassanein S, Khattab A, Metwally N, Naeem F. Balance functions and primitive reflexes in dyslexic children. HEARING, BALANCE AND COMMUNICATION 2023. [DOI: 10.1080/21695717.2023.2176657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Nagwa Hazzaa
- Audiology Unit, ORL Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Amany Shalaby
- Audiology Unit, ORL Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Sahar Hassanein
- Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed Khattab
- Phoniatrics Unit, ORL Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Nancy Metwally
- ORL Department, Abou El-Monagga Central Hospital, Ministry of Health, Cairo, Egypt
| | - Fathy Naeem
- Audiology Unit, ORL Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Friello P, Silver N, Sangi-Haghpeykar H, Cohen HS. Screening for balance in children and adults in a community science education setting: Normative data, influence of age, sex, and body mass index, and feasibility. PLoS One 2022; 17:e0268030. [PMID: 35584130 PMCID: PMC9116616 DOI: 10.1371/journal.pone.0268030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/20/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Screening standing and walking balance is useful for people suspected of having vestibular disorders, a variety of neurologic and musculoskeletal disorders, and for screening astronauts returning after exposure to microgravity. Visitors to a community science education center children and adults, aged 4 to 85, were tested on tandem walking with eyes closed and the modified Romberg test on compliant foam. They were then asked about their experience participating in research, many people for the first time. METHODS Subjects performed 10 steps of tandem walking with eyes closed, and three trials of the modified Romberg, or Clinical Test of Sensory Integration and Balance, with eyes closed, standing on compliant memory foam, with a) head still, b) head shaking in yaw, and c) head nodding in pitch. Afterward, staff queried subjects about the experience of participating in science. RESULTS Age-related changes across the life span occurred in both sets of tests. Therefore, look-up tables by age are provided. Body mass index significantly affected tandem walking. Some sex differences were found. The tests were easy to administer in a community setting. Most participants enjoyed the experience and reported that they learned about the process of scientific research. DISCUSSION These data support and extend the evidence for age-related changes in balance performance across the lifespan and for an influence of body mass index on some balance skills. Clinicians and sports educators should be cognizant of these differences when they use these tests for screening. The community science education environment provided a useful laboratory in which to collect valid and reliable data, while simultaneously educating participants about the process of science.
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Affiliation(s)
- Phyllis Friello
- Applied Research Collaborative, Space Center Houston, Houston, TX, United States of America
| | - Nathan Silver
- Department of Otolaryngology–Head and Neck Surgery, Baylor College of Medicine, Houston, TX, United States of America
| | - Haleh Sangi-Haghpeykar
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, United States of America
| | - Helen S. Cohen
- Department of Otolaryngology–Head and Neck Surgery, Baylor College of Medicine, Houston, TX, United States of America
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Jardak M, Chaari F, Bouchaala F, Fendri T, Harrabi MA, Rebai H, Sahli S. Does piriformis muscle syndrome impair postural balance? A case control study. Somatosens Mot Res 2021; 38:315-321. [PMID: 34519264 DOI: 10.1080/08990220.2021.1973404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND PURPOSE While patients with musculoskeletal disorders reported postural balance impairments, it is unknown whether patients with piriformis muscle syndrome (PMS) may exhibit postural balance disorders compared to controls. The aim was to compare postural balance in patients with PMS to controls in static and dynamic conditions. MATERIAL AND METHODS Twelve patients with PMS and twelve controls were enrolled. Static postural balance was assessed by calculating the symmetry index (SI) in the unipedal posture. To measure vision contribution, the Romberg index (RI) was computed. Dynamic postural balance was evaluated with the Timed up and go test (TUGT). Besides, inter-limb strength asymmetry (SA), pain and the short form-36 (SF-36) were assessed. RESULTS The PMS group (PMSG) exhibited significant (p < 0.001) higher SI in eyes opened (EO) and eyes closed (EC) conditions compared to the control group (CG). Besides, PMSG had significant higher RI (p < 0.05), TUGT scores (p < 0.001), SA values (p < 0.05), pain intensity (p < 0.001), and worse SF-36 scores on all physical health (p < 0.05) and psychological health (only in vitality and mental health [p < 0.05]), compared to CG. CONCLUSION Our data revealed impaired static and dynamic postural balance, and reduced quality of life in PMSG compared to CG. Postural balance impairments could explain the poor quality of life, which are likely due to the higher SA and higher pain intensity. Clinicians and physiotherapists should consider postural balance disorders while designing rehabilitation programs in these patients.
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Affiliation(s)
- Mariem Jardak
- Research Laboratory Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Fatma Chaari
- Research Laboratory Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Fatma Bouchaala
- Research Laboratory Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Thouraya Fendri
- Research Laboratory Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Mohammed Achraf Harrabi
- Research Laboratory Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Haithem Rebai
- Research Laboratory Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Sonia Sahli
- Research Laboratory Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
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Zhang Q, Zhou X, Li Y, Yang X, Abbasi QH. Clinical Recognition of Sensory Ataxia and Cerebellar Ataxia. Front Hum Neurosci 2021; 15:639871. [PMID: 33867960 PMCID: PMC8046926 DOI: 10.3389/fnhum.2021.639871] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 01/27/2021] [Indexed: 11/13/2022] Open
Abstract
Ataxia is a kind of external characteristics when the human body has poor coordination and balance disorder, it often indicates diseases in certain parts of the body. Many internal factors may causing ataxia; currently, observed external characteristics, combined with Doctor’s personal clinical experience play main roles in diagnosing ataxia. In this situation, different kinds of diseases may be confused, leading to the delay in treatment and recovery. Modern high precision medical instruments would provide better accuracy but the economic cost is a non-negligible factor. In this paper, novel non-contact sensing technique is used to detect and distinguish sensory ataxia and cerebellar ataxia. Firstly, Romberg’s test and gait analysis data are collected by the microwave sensing platform; then, after some preprocessing, some machine learning approaches have been applied to train the models. For Romberg’s test, time domain features are considered, the accuracy of all the three algorithms are higher than 96%; for gait detection, Principal Component Analysis (PCA) is used for dimensionality reduction, and the accuracies of Back Propagation (BP) neural Network, Support Vector Machine (SVM), and Random Forest (RF) are 97.8, 98.9, and 91.1%, respectively.
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Affiliation(s)
- Qing Zhang
- First Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University Health Science Center, Xi'an Jiaotong University, Xi'an, China.,Northwest Women's and Children's Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Xihui Zhou
- First Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Yajun Li
- Northwest Women's and Children's Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Xiaodong Yang
- School of Electronic Engineering, Xidian University, Xi'an, China
| | - Qammer H Abbasi
- James Watt School of Engineering, University of Glasgow, Glasgow, United Kingdom
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Gallamini M, Piastra G, Lucarini S, Porzio D, Ronchi M, Pirino A, Scoppa F, Masiero S, Tognolo L. Revisiting the Instrumented Romberg Test: Can Today's Technology Offer a Risk-of-Fall Screening Device for Senior Citizens? An Experience-Based Approach. Life (Basel) 2021; 11:life11020161. [PMID: 33672455 PMCID: PMC7923416 DOI: 10.3390/life11020161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/09/2021] [Accepted: 02/12/2021] [Indexed: 11/16/2022] Open
Abstract
Risk of fall (ROF) is a worldwide major concern for its prevalence and consequent dramatic outcomes in the elderly population. The growing age-related risk appears to be associated with increasing motor, sensory, and cognitive problems in the elderly population. There is a consensus on the need to screen for these balance dysfunctions, but the available methods are largely based on subjectively assessed performances. The instrumented Romberg test using a force plate represents a validated assessment process for the evaluation of balance performances. The purpose of this study is to propose an innovative instrumental method to identify balance deficits, assess their severity, and give an automated indication of the most likely etiology. The proposed new method was applied to the instrumented Romberg test, using force plate data recorded in a cohort of 551 females aged >65 participating in adapted physical activity courses. The method allowed us to identify 145 dysfunctional subjects and to determine the likely origin of their deficit: 21 central, 5 vestibular, 9 visual, 59 proprioceptive (musculoskeletal etiology), and 51 functional. Based on the preliminary findings of the study, this test could be an efficient and cost-effective mass screening tool for identifying subjects at risk of fall, since the procedure proves to be rapid, non-invasive, and apparently devoid of any contraindications.
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Affiliation(s)
- Michele Gallamini
- Eng. Freelance MD Consultant, Sal. Maggiolo di Nervi, 16167 Genoa, Italy;
- Ben-Essere Sport and Wellness Association Rapallo, Third-Sector Liguria Region Registry, 16135 Genoa, Italy; (D.P.); (M.R.)
| | - Giorgio Piastra
- ASL 4 Liguria (Liguria Regional Health Service), Sports Medicine, N.S. di Montallegro Hospital, 16035 Rapallo, Italy;
| | - Simonetta Lucarini
- ASL 4 Liguria (Liguria Regional Health Service), Geriatric Service, Chiavari, 16043 Chiavari, Italy;
| | - Debora Porzio
- Ben-Essere Sport and Wellness Association Rapallo, Third-Sector Liguria Region Registry, 16135 Genoa, Italy; (D.P.); (M.R.)
| | - Matteo Ronchi
- Ben-Essere Sport and Wellness Association Rapallo, Third-Sector Liguria Region Registry, 16135 Genoa, Italy; (D.P.); (M.R.)
| | - Alessio Pirino
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Fabio Scoppa
- Faculty of Medicine and Dental Surgery, Sapienza University of Rome, 00185 Rome, Italy;
- Chinesis I.F.O.P. Istituto di Formazione in Osteopatia e in Posturologia, Osteopathy School, 00152 Rome, Italy
| | - Stefano Masiero
- Department of Neurosciences, Physical Medicine and Rehabilitation School, University of Padua, 35128 Padua, Italy;
- Rehabilitation Unit, Laboratory of Robotic and Bioengineering and Clinical of Movement, Padua University-General Hospital, 35128 Padua, Italy
| | - Lucrezia Tognolo
- Department of Neurosciences, Physical Medicine and Rehabilitation School, University of Padua, 35128 Padua, Italy;
- Correspondence: ; Tel.: +39-0498-213-353
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Cohen HS, Sangi-Haghpeykar H. Differences in Responses on the Modified Clinical Test of Sensory Interaction and Balance on Medium Firm and Medium Density Foam in Healthy Controls and Patients with Vestibular Disorders. Biomed Hub 2020; 5:1548-1555. [PMID: 32775332 DOI: 10.1159/000507180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 03/12/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose To determine whether foam density affects modified Romberg balance test performance. Materials and Methods Controls and patients with vestibular disorders performed Romberg tests on medium and medium firm foam, with their eyes closed and the head still and moving in yaw and pitch. The trial duration and number of head movements were measured. Results Subjects aged >60 years performed longer and with more head movements on medium firm foam than on medium foam. Older controls did not differ between medium firm and medium foam. Older patients had higher scores on head-still and head-yaw trials on medium firm foam versus medium foam but pitch trials did not differ. Females, controls, and patients had longer trial durations and more head movements on medium firm foam than on medium density foam; male controls did not differ by foam density. Male patients differed in yaw trials. Conclusion Foam density affects scores. Clinical decision-making may be adversely affected if the clinician uses foam of a density that is not the same as that of the foam that was used in the studies that developed descriptive statistics, sensitivity, and specificity.
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Affiliation(s)
- Helen S Cohen
- Bobby R. Alford Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Haleh Sangi-Haghpeykar
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
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Screening for Vestibular Disorders Using the Modified Clinical Test of Sensory Interaction and Balance and Tandem Walking With Eyes Closed. Otol Neurotol 2020; 40:658-665. [PMID: 31083095 DOI: 10.1097/mao.0000000000002173] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Determine accurate cut-points and optimal combinations of screening tests of balance to detect patients with vestibular disorders. STUDY DESIGN Case-control study. SETTING Out-patient tertiary care. SUBJECTS AND METHODS Community-dwelling adults, without known neurological deficits or significant musculoskeletal disorders, including patients with vestibular disorders and healthy controls without vestibular disorders were tested while standing on medium density compliant foam with feet together and eyes closed under three head movement conditions, head stationary, and head moving in yaw and pitch at 0.33 Hz, for up to 30 seconds per trial. Dependent measures were trial duration, number of head movements during head movement trials, trunk kinematic measures, and number of correct tandem steps during tandem walking trials. RESULTS Receiver operator characteristics (ROC), sensitivity and specificity, and specific cut-points were calculated. Individual tests had moderate ROC values, from 0.67 to 0.84. ROC values were higher in the head moving trials than the head stationary trial and best for subjects aged 40 to 79. Using combined analyses of two or more tests, including published data on tandem walking, ROC values were higher, 0.80 to 0.90. Age- and sex-related performance differences were found. CONCLUSION Balance skills in standing and walking differ, so testing both skills is optimal and increases the likelihood of finding a deficit. Patients should be compared to age-appropriate norms. Kinematics and number of head movements were not very useful. This combined set of rapid, low-tech balance tests is useful in an initial approach to screening patients who may have vestibular disorders.
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10
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Inojosa H, Schriefer D, Klöditz A, Trentzsch K, Ziemssen T. Balance Testing in Multiple Sclerosis-Improving Neurological Assessment With Static Posturography? Front Neurol 2020; 11:135. [PMID: 32174886 PMCID: PMC7057229 DOI: 10.3389/fneur.2020.00135] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 02/06/2020] [Indexed: 01/17/2023] Open
Abstract
Background: Balance problems can severely limit the quality of life for people with Multiple Sclerosis (pwMS) already in the early stages of the disease. PwMS are usually assessed with the Expanded Disability Status Scale (EDSS), which includes a Romberg test for assessing balance. As the EDSS assessments are subjective to the examining neurologist, the postural stability of pwMS could be objectively quantified by implementing static posturography to detect balance problems and address preventive medical care. Methods: In this cross-sectional study, we added static posturography to the neurological EDSS examination in pwMS and healthy subjects to determine how this technique could supply additional information during the evaluation of the cerebellar functional system of the neurostatus EDSS as clinical outcome already in early disease stages. Static posturography was performed with subjects standing on a force platform while outcome variables such as delineated area, average speed and average sway were obtained. Unpaired t-test as well as (Welch's) analysis of variance (ANOVA) with pairwise post-hoc comparisons according to Games-Howell were used. Spearman rank correlations were implemented to study associations of balance outcomes with EDSS-associated outcomes. Results: A total of 99 pwMS (mean age: 35.01 years; EDSS median: 2.0, 68.69% females) and 30 healthy subjects (mean age: 34.03 years; 70% females) were enrolled. PwMS had worse performances in the three evaluated balance parameters than the healthy group (all p < 0.001). Even patients without postural instability as documented in the Romberg test score of the EDSS assessment showed significantly worse outcome regarding the delineated area [+1.97 cm2, 95%-CI (0.61-3.34); p = 0.002] vs. healthy controls. Similar results were observed for the comparison between pwMS with normal cerebellar function EDSS-systems and healthy subjects. There were significant correlations with the EDSS, cerebellar function score and Romberg test for the delineated area and average speed (r's ranging from 0.330 to 0.537, p < 0.001). Conclusions: Static posturography can complement neurological assessment of EDSS as an objective and quantitative test, especially for MS patients in early stages of the disease.
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Affiliation(s)
- Hernan Inojosa
- MS Center, Center of Clinical Neuroscience, Department of Neurology, Carl Gustav Carus University Hospital, University of Dresden, Dresden, Germany
| | - Dirk Schriefer
- MS Center, Center of Clinical Neuroscience, Department of Neurology, Carl Gustav Carus University Hospital, University of Dresden, Dresden, Germany
| | - Antonia Klöditz
- MS Center, Center of Clinical Neuroscience, Department of Neurology, Carl Gustav Carus University Hospital, University of Dresden, Dresden, Germany
| | - Katrin Trentzsch
- MS Center, Center of Clinical Neuroscience, Department of Neurology, Carl Gustav Carus University Hospital, University of Dresden, Dresden, Germany
| | - Tjalf Ziemssen
- MS Center, Center of Clinical Neuroscience, Department of Neurology, Carl Gustav Carus University Hospital, University of Dresden, Dresden, Germany
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11
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Meehan A, Hebert D, Deru K, Weaver LK. Longitudinal study of hyperbaric oxygen intervention on balance and affective symptoms in military service members with persistent post-concussive symptoms. J Vestib Res 2019; 29:205-219. [PMID: 31282447 DOI: 10.3233/ves-180671] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Dizziness and imbalance are common after mild traumatic brain injury (mTBI). Hyperbaric oxygen (HBO2) has been proposed for persistent post-concussive symptoms after mTBI, but its effect on vestibular function is unknown. OBJECTIVE To describe balance function in military service-members before and after intervention, and to explore the influence of post-traumatic stress disorder (PTSD), anxiety, and depression on vestibular outcomes. METHODS Seventy-one participants with mTBI and seventy-five healthy adults without brain injury were enrolled (NCT01611194 and NCT01925963). mTBI participants were randomized to 40 HBO2 sessions or 40 sham chamber sessions over 12 weeks. Normative controls received no intervention. Balance and neuropsychological function were measured at baseline, 13 weeks, and 6 months. RESULTS The mTBI cohort performed worse than healthy controls on balance and gait measures and reported more affective symptoms. Some within-group improvements were noted at 13 weeks and 6 months. Significant between-intervention differences on balance measures were minimal but effects on postural control generally favored HBO2. Those with affective symptoms, particularly PTSD, had the most improvement in postural control and otolith function following 13 weeks of HBO2. CONCLUSION HBO2 may influence balance function after mTBI, particularly in those with affective symptoms.
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Affiliation(s)
- Anna Meehan
- Lovelace Biomedical Research, Albuquerque, New Mexico, USA
| | | | - Kayla Deru
- Division of Hyperbaric Medicine Intermountain Medical Center, Murray, UT, and Intermountain LDS Hospital, Salt Lake City, UT, USA
| | - Lindell K Weaver
- Division of Hyperbaric Medicine Intermountain Medical Center, Murray, UT, and Intermountain LDS Hospital, Salt Lake City, UT, USA.,Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
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12
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Christe G, Hall T. The screening process of a patient with low back pain and suspected thoracic myelopathy: a case report. J Man Manip Ther 2018; 26:11-17. [PMID: 29456443 DOI: 10.1080/10669817.2017.1282189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Background Thoracic disc herniations are rare and difficult to diagnose. Myelopathy is a potential consequence that can lead to irreversible neurological impairment if not treated appropriately. It is incumbent on all clinicians who see patients with low back pain (LBP) to be aware of such pathologies. This case describes a screening process in the detection of a rare serious spinal pathology and discusses the use of red flags and central nervous system signs and symptoms in the decision leading to immediate referral. Case Description The subject in this case was a 69-year-old male referred to physical therapy for the treatment of LBP after having seen two medical doctors. He presented with severe spinal pain with gait disturbance, postural balance deficits and bilateral loss of plantar flexor strength. Decreased sensation in the buttocks and a subtle episode of urinary incontinence were also present. Outcomes Based on the results of the history and physical examination, the patient was referred back to his medical practitioner, who ordered magnetic resonance imaging. A thoracic disc herniation associated with spondyloarthritis at T10-11 causing myelopathy was detected, and the patient underwent immediate decompressive surgery. One month following initial evaluation, the patient had completely recovered without any neurological compromise. Discussion This case highlights the importance of the screening of serious pathologies and the assessment of central nervous impairments in certain cases of LBP. The integration of a cluster of subjective and physical examination findings led to the prompt referral of this patient for urgent medical attention. Level of Evidence 4.
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Affiliation(s)
- Guillaume Christe
- Haute Ecole de Santé Vaud (HESAV)//HES-SO, Physiotherapy Department, University of Applied Sciences Western Switzerland, Lausanne, Switzerland
| | - Toby Hall
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
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Rivas Neira S, Pasqual Marques A, Pegito Pérez I, Fernández Cervantes R, Vivas Costa J. Effectiveness of Aquatic Therapy vs Land-based Therapy for Balance and Pain in Women with Fibromyalgia: a study protocol for a randomised controlled trial. BMC Musculoskelet Disord 2017; 18:22. [PMID: 28103853 PMCID: PMC5244527 DOI: 10.1186/s12891-016-1364-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 12/13/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fibromyalgia is a disease with an increasing incidence. It impairs the quality of life of patients and decreases their functional capacity. Aquatic therapy has already been used for managing the symptoms of this syndrome. However, aquatic therapy has only recently been introduced as a treatment modality for improving proprioception in fibromyalgia. The main objective of this study is to determine the effectiveness of two physiotherapy protocols, one in and one out of water, for improving balance and decreasing pain in women with fibromyalgia. METHODS/DESIGN The study protocol will be a single-blind randomised controlled trial. Forty women diagnosed with fibromyalgia will be randomly assigned into 2 groups: Aquatic Therapy (n = 20) or Land-based Therapy (n = 20). Both interventions include 60-min therapy sessions, structured into 4 sections: Warm-up, Proprioceptive Exercises, Stretching and Relaxation. These sessions will be carried out 3 times a week for 3 months. Primary outcomes are balance (static and dynamic) and pain (intensity and threshold). Secondary outcomes include functional balance, quality of life, quality of sleep, fatigue, self-confidence in balance and physical ability. Outcome measures will be evaluated at baseline, at the end of the 3-month intervention period, and 6-weeks post-treatment. Statistical analysis will be carried out using the SPSS 21.0 program for Windows and a significance level of p ≤ 0.05 will be used for all tests. DISCUSSION This study protocol details two physiotherapy interventions in women with fibromyalgia to improve balance and decrease pain: aquatic therapy and land-based therapy. In current literature there is a lack of methodological rigour and a limited number of studies that describe physiotherapy protocols to manage fibromyalgia symptoms. High-quality scientific works are required to highlight physiotherapy as one of the most recommended treatment options for this syndrome. TRIAL REGISTRATION Date of publication in ClinicalTrials.gov: 18/02/2016. ClinicalTrials.gov Identifier: NCT02695875 .
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Affiliation(s)
- Sabela Rivas Neira
- Psychosocial Intervention and Functional Reabilitation Research Group. Physiotherapy Department, Faculty of Physiotherapy, University of A Coruña, Campus de Oza, A Coruña, 15006 Spain
- Department of Physical Therapy, Speech and Occupational Therapy, Faculty of Medicine, University of São Paulo, Rua Cipotânea, 51 – Cidade Universitária, São Paulo, 05360-160 Brazil
| | - Amélia Pasqual Marques
- Department of Physical Therapy, Speech and Occupational Therapy, Faculty of Medicine, University of São Paulo, Rua Cipotânea, 51 – Cidade Universitária, São Paulo, 05360-160 Brazil
| | - Irene Pegito Pérez
- Psychosocial Intervention and Functional Reabilitation Research Group. Physiotherapy Department, Faculty of Physiotherapy, University of A Coruña, Campus de Oza, A Coruña, 15006 Spain
| | - Ramón Fernández Cervantes
- Psychosocial Intervention and Functional Reabilitation Research Group. Physiotherapy Department, Faculty of Physiotherapy, University of A Coruña, Campus de Oza, A Coruña, 15006 Spain
| | - Jamile Vivas Costa
- Psychosocial Intervention and Functional Reabilitation Research Group. Physiotherapy Department, Faculty of Physiotherapy, University of A Coruña, Campus de Oza, A Coruña, 15006 Spain
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Lanska DJ. The Dercum-Muybridge Collaboration and the Study of Pathologic Gaits Using Sequential Photography. JOURNAL OF THE HISTORY OF THE NEUROSCIENCES 2016; 25:23-38. [PMID: 26684421 DOI: 10.1080/0964704x.2015.1070032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In the late 1870s and 1880s, prior to the development of movie cameras or projectors, English-American photographer Eadweard Muybridge (1830-1904) photographed sequential images of people and animals in motion, using arrays of sequentially triggered single-image cameras. In 1885, Philadelphia neurologist Francis Dercum (1856-1931) collaborated with Muybridge at the University of Pennsylvania to photograph sequential images of patients with various neurological disorders involving abnormal movements, and particularly various gait disorders, including both the sensory ataxic gait of tabes dorsalis and various spastic gaits. Dercum used tracings of sequential photographic images to plot trajectories of limbs as a way to characterize and distinguish pathologic gaits. The Dercum-Muybridge collaboration produced the first motion-picture sequences of neurological gait disorders ever filmed. These sequences and the trajectory-based studies that derived from them were a milestone in studies of pathologic gaits.
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Affiliation(s)
- Douglas J Lanska
- a Veterans Affairs Medical Center , Great Lakes Healthcare System , Tomah , Wisconsin
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Alnajjar F, Itkonen M, Berenz V, Tournier M, Nagai C, Shimoda S. Sensory synergy as environmental input integration. Front Neurosci 2015; 8:436. [PMID: 25628523 PMCID: PMC4292368 DOI: 10.3389/fnins.2014.00436] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 12/11/2014] [Indexed: 11/24/2022] Open
Abstract
The development of a method to feed proper environmental inputs back to the central nervous system (CNS) remains one of the challenges in achieving natural movement when part of the body is replaced with an artificial device. Muscle synergies are widely accepted as a biologically plausible interpretation of the neural dynamics between the CNS and the muscular system. Yet the sensorineural dynamics of environmental feedback to the CNS has not been investigated in detail. In this study, we address this issue by exploring the concept of sensory synergy. In contrast to muscle synergy, we hypothesize that sensory synergy plays an essential role in integrating the overall environmental inputs to provide low-dimensional information to the CNS. We assume that sensor synergy and muscle synergy communicate using these low-dimensional signals. To examine our hypothesis, we conducted posture control experiments involving lateral disturbance with nine healthy participants. Proprioceptive information represented by the changes on muscle lengths were estimated by using the musculoskeletal model analysis software SIMM. Changes on muscles lengths were then used to compute sensory synergies. The experimental results indicate that the environmental inputs were translated into the two dimensional signals and used to move the upper limb to the desired position immediately after the lateral disturbance. Participants who showed high skill in posture control were found to be likely to have a strong correlation between sensory and muscle signaling as well as high coordination between the utilized sensory synergies. These results suggest the importance of integrating environmental inputs into suitable low-dimensional signals before providing them to the CNS. This mechanism should be essential when designing the prosthesis' sensory system to make the controller simpler.
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Affiliation(s)
- Fady Alnajjar
- Intelligent Behavior Control Unit, Brain Science Institute-TOYOTA Collaboration Center of RIKENNagoya, Japan
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The influence of very low illumination on the postural sway of young and elderly adults. PLoS One 2014; 9:e103903. [PMID: 25084015 PMCID: PMC4118987 DOI: 10.1371/journal.pone.0103903] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Accepted: 07/07/2014] [Indexed: 01/09/2023] Open
Abstract
The purpose of the present study was to evaluate the influence of very low ambient illumination and complete darkness on the postural sway of young and elderly adults. Eighteen healthy young participants aged 23.8±1.5 years and 26 community-dwelling elderly aged 69.8±5.6 years were studied. Each participant performed four tests while standing on a force platform in the following conditions: in normal light (215 lx) with open eyes and with closed eyes, in very low illumination (0.25 lx) with open eyes, and in complete darkness with open eyes. The sequences of the tests in the altered visual conditions were determined by random blocs. Postural sway was assessed by means of the force platform measurements. The centre of pressure variables: the medio-lateral and antero-posterior path lengths, mean velocities, sway areas, and fractal dimensions were analysed. Very low illumination resulted in a statistically significant increase in postural sway in both the young and elderly groups compared to normal light, although the increase was significantly smaller than those observed in the eyes closed and complete darkness condition, and no significant effects of illumination on fractal dimensions were detected. The gains of the sways in the very low or no illumination conditions relative to the normal light condition were significantly larger in the group of young participants than in the group of elderly participants (up to 50% and 25%, respectively). However, the response patterns to changes in illumination were similar in the young and elderly participants, with the exception of the short-range fractal dimension of the medio-lateral sway. In conclusion, very low illumination resulted in increased postural sway compared to normal illumination; however, in the closed eye and complete darkness conditions, postural sway was significantly higher than in the very low illumination condition regardless of the age of the participants.
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Cohen HS, Mulavara AP, Peters BT, Sangi-Haghpeykar H, Bloomberg JJ. Standing balance tests for screening people with vestibular impairments. Laryngoscope 2013; 124:545-50. [PMID: 23877965 DOI: 10.1002/lary.24314] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To improve the test standards for a version of the Romberg test and to determine whether measuring kinematic variables improved its utility for screening. STUDY DESIGN Healthy controls and patients with benign paroxysmal positional vertigo, postoperative acoustic neuroma resection, and chronic peripheral unilateral weakness were compared. METHODS Subjects wore Bluetooth-enabled inertial motion units while standing on the floor or medium-density, compliant foam, with eyes open or closed, with head still or moving in pitch or yaw. Dependent measures were time to perform each test condition, number of head movements made, and kinematic variables. RESULTS Patients and controls did not differ significantly with eyes open or with eyes closed while on the floor. With eyes closed, on foam, some significant differences were found between patients and controls, especially for subjects older than 59 years. Head movement conditions were more challenging than with the head still. Significantly fewer patients than controls could make enough head movements to obtain kinematic measures. Kinematics indicated that lateral balance control is significantly reduced in these patients compared to controls. Receiver operator characteristics and sensitivity/specificity analyses showed moderately good differences with older subjects. CONCLUSIONS Tests on foam with eyes closed, with head still or moving, may be useful as part of a screening battery for vestibular impairments, especially for older people. LEVEL OF EVIDENCE 3b.
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Affiliation(s)
- Helen S Cohen
- Bobby R. Alford Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, U.S.A
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Mulavara AP, Cohen HS, Peters BT, Sangi-Haghpeykar H, Bloomberg JJ. New analyses of the sensory organization test compared to the clinical test of sensory integration and balance in patients with benign paroxysmal positional vertigo. Laryngoscope 2013; 123:2276-80. [PMID: 23553110 DOI: 10.1002/lary.24075] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 12/26/2012] [Accepted: 02/05/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine whether the Sensory Organization Test (SOT) of the computerized dynamic posturography battery or the Clinical Test of Sensory Integration and Balance (CTSIB) is more likely to indicate balance disorders in people with benign paroxysmal positional vertigo (BPPV). STUDY DESIGN Normal controls were compared to patients with unilateral BPPV of the posterior semicircular canal. METHODS Subjects performed tests with eyes open or closed on stable and unstable surfaces, with head still or with head moving at 0.33 Hz in pitch or yaw. Dependent variables were the percent time of the standard duration each subject could perform the task, the number of head motions made, and kinematic variables measured with head- and torso-mounted inertial motion units. RESULTS Because equilibrium scores of control subjects improved significantly over repeated trials on SOT, patients were given only one trial per condition. For percent time between-group differences were found on CTSIB with eyes closed, on foam, head moving in yaw showing significantly reduced performance by BPPV subjects compared to controls. Compared to controls, patients made significantly fewer head movements on CTSIB, eyes closed, on foam, head still, in pitch and yaw. Kinematic data also differed between the groups on tests with eyes closed and unstable surfaces with different head movement combinations, indicating increased instability in BPPV patients. CONCLUSIONS For screening, CTSIB with head movements is more likely than SOT to indicate balance deficits, especially when dependent measures include percent time as well as head movement counts and kinematic measures.
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Romero-Franco N, Martínez-López E, Lomas-Vega R, Hita-Contreras F, Martínez-Amat A. Effects of Proprioceptive Training Program on Core Stability and Center of Gravity Control in Sprinters. J Strength Cond Res 2012; 26:2071-7. [DOI: 10.1519/jsc.0b013e31823b06e6] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Fontani V, Rinaldi S, Castagna A, Margotti ML. Noninvasive radioelectric asymmetric conveyor brain stimulation treatment improves balance in individuals over 65 suffering from neurological diseases: pilot study. Ther Clin Risk Manag 2012; 8:73-8. [PMID: 22368448 PMCID: PMC3284218 DOI: 10.2147/tcrm.s28812] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Purpose In the elderly population, problems with walking and balance are very common. These problems seriously affect the quality of life of the elderly. When gait and balance problems are caused by neurological disease, these problems can be more serious and difficult to handle. The aim of this pilot study was to verify the effect of a noninvasive radioelectric conveyor asymmetric brain stimulation protocol, named neuropostural optimization (NPO), to improve balance in neurological elderly. Patients and methods Twelve patients suffering from various neurological diseases participated in this study. They were assessed with the Romberg test, which was performed on a computerized stabilometric platform before, immediately following, and 72 hours after NPO was used to improve balance. Results The results showed that a stabilization of balance was recorded in all subjects a few minutes after administration of NPO. This stabilization increased 72 hours after treatment. Conclusion The results show that NPO could be a valuable therapeutic approach to improve sensory-motor strategies and neurological control of balance in elderly patients suffering from various neurological diseases.
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Affiliation(s)
- Vania Fontani
- Department of Neuro Psycho Physio Pathology, Rinaldi Fontani Institute, Florence, Italy
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Maranhão-Filho PA, Maranhão ET, Silva MMD, Lima MA. Rethinking the neurological examination I: static balance assessment. ARQUIVOS DE NEURO-PSIQUIATRIA 2011; 69:954-8. [DOI: 10.1590/s0004-282x2011000700021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Accepted: 07/19/2011] [Indexed: 11/21/2022]
Abstract
The authors advocate a modernization of the neurologic exam with regard to the evaluation of static equilibrium through the application of some easily performed and interpreted bedside maneuvers like the Clinical Test of Sensory Integration and Balance - modified and the Functional Reach Test. The authors also believe that these and other assessments, such as that of the risk of falling for elderly patients, should be incorporated into the routine neurological examination.
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Computerized static posturographic assessment after treatment of equinus deformity in children with cerebral palsy. J Pediatr Orthop B 2010; 19:211-20. [PMID: 20101192 DOI: 10.1097/bpb.0b013e32832e957a] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Assessment of treatments in children with cerebral palsy has been well developed, especially in the gait laboratory. However, the prerequisite for walking is adequate postural control. We hypothesize that a treatment of an equinus deformity should improve postural control. Balance control was assessed by static posturography on the Balance Master. Nine diplegic children, six girls and three boys, participated in the study. Assessment was conducted before and after treatment of the equinus deformity. Two static tests (Weight Bearing Squat and the modified Clinical Test for Sensory Interaction on Balance), and two dynamic balance tests (Limits of Stability and Rhythmic Weight Shift) were performed on the Balance Master. After treatment, mean weight-bearing asymmetry measured by the Weight Bearing Squat was significantly improved at 30 degrees of knee flexion. In the modified Clinical Test for Sensory Interaction on Balance, there was a significant improvement in two conditions (eyes closed on foam surface and the composite score). The Limits of Stability was very difficult to perform for almost all the children. In the Rhythmic Weight Shift, mean directional control improved significantly in three conditions (left/right weight shift at 1 s of transition, front/back weight shift at 2 s of transition and the composite score of the front/back direction). The Balance Master offers the opportunity for an objective and easy assessment of postural control in children with cerebral palsy.
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Findlay GFG, Balain B, Trivedi JM, Jaffray DC. Does walking change the Romberg sign? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2009; 18:1528-31. [PMID: 19387702 DOI: 10.1007/s00586-009-1008-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Revised: 03/16/2009] [Accepted: 04/08/2009] [Indexed: 11/26/2022]
Abstract
The Romberg sign helps demonstrate loss of postural control as a result of severely compromised proprioception. There is still no standard approach to applying the Romberg test in clinical neurology and the criteria for and interpretation of an abnormal result continue to be debated. The value of this sign and its adaptation when walking was evaluated. Detailed clinical examination of 50 consecutive patients of cervical myelopathy was performed prospectively. For the walking Romberg sign, patients were asked to walk 5 m with their eyes open. This was repeated with their eyes closed. Swaying, feeling of instability or inability to complete the walk with eyes closed was interpreted as a positive walking Romberg sign. This test was compared to common clinical signs to evaluate its relevance. Whilst the Hoffman's reflex (79%) was the most prevalent sign seen, the walking Romberg sign was actually present in 74.5% of the cases. The traditional Romberg test was positive in 17 cases and 16 of these had the walking Romberg positive as well. Another 21 patients had a positive walking Romberg test. Though not statistically significant, the mean 30 m walking times were slower in patients with traditional Romberg test than in those with positive walking Romberg test and fastest in those with neither of these tests positive. The combination of either Hoffman's reflex and/or walking Romberg was positive in 96% of patients. The walking Romberg sign is more useful than the traditional Romberg test as it shows evidence of a proprioceptive gait deficit in significantly more patients with cervical myelopathy than is found on conventional neurological examination. The combination of Hoffman's reflex and walking Romberg sign has a potential as useful screening tests to detect clinically significant cervical myelopathy.
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Affiliation(s)
- Gordon F G Findlay
- Walton Centre for Neurology and Neurosurgery NHS Trust, Lower Lane, Fazakerley, Liverpool, UK
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Ionescu E, Morlet T, Froehlich P, Ferber-Viart C. Vestibular assessment with Balance Quest Normative data for children and young adults. Int J Pediatr Otorhinolaryngol 2006; 70:1457-65. [PMID: 16672161 DOI: 10.1016/j.ijporl.2006.03.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2005] [Accepted: 03/21/2006] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of the present study was to compare equilibrium pattern in 12-year-old children with 20-year-old young adults and to obtain normative data for the BQ in both groups. METHODS Mean stability percentages and synthesis ratios of 29 healthy children aged 12 years were compared to those of 68 young adults aged 20 years, using BQ. RESULTS The mean stability percentages for children were significantly lower than for young adults. Vestibular ratios were lower in children compared to young adults, whereas somesthesic ratios were similar for the two groups. Visual dependence was significant higher in children. CONCLUSIONS Children unlike young adults had lower stability percentages when visual information was not available or was incorrect. Ratio synthesis pattern was different in the two groups. Our results on BQ partially confirms previous results obtained in children assessed with Equitest CDP. This study also provides BQ normative data for these two age groups.
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Affiliation(s)
- E Ionescu
- Hôpital Neurologique Pierre Wertheimer, Département d'Otoneurologie, Lyon, France.
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Fabbri M, Martoni M, Esposito MJ, Brighetti G, Natale V. Postural control after a night without sleep. Neuropsychologia 2006; 44:2520-5. [PMID: 16690088 DOI: 10.1016/j.neuropsychologia.2006.03.033] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2005] [Revised: 03/14/2006] [Accepted: 03/26/2006] [Indexed: 11/17/2022]
Abstract
The present study analysed the efficiency of postural control after 12 h of nocturnal forced wakefulness using Romberg's test comprising 1 min of recording with eyes-open and 1 min of recording with eyes-closed, with a 1 min break between the two sessions. Our aim was to see if the decreased postural control efficiency after a sleepless night was unspecific (in both eyes-closed and eyes-open conditions) or selective (in only one of the conditions). A total of 55 students spent a whole night awake at our laboratory and were tested at 22:00 and 08:00 h. In general, the results showed that postural sway increased, performing the recording from eyes-open to eyes-closed condition. The statokinesigram length (SL or efficiency of the postural system) increased after the sleepless night, while in eyes-open condition, the length in function of surface (LFS or accuracy of postural control) and Romberg's index (or contribution of vision to maintain posture) significantly decreased. This could indicate that after a night without sleep, there is a slower elaboration of visual inputs in the postural control process. On the basis of these results, the effects of sleep deprivation on cognitive performance were considered from a neuropsychological point of view.
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Affiliation(s)
- Marco Fabbri
- Department of Psychology, University of Bologna, Viale Berti Pichat, 5, Bologna 40127, Italy.
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