Balance Difficulties Research Articles

Long-term evaluation of deep brain stimulation of the thalamus

The effects of thalamic deep brain stimulation (DBS) on essential tremor (ET) and Parkinson disease (PD) have been well documented, but there is a paucity of long-term data. The aim of this study was to evaluate the long-term safety and efficacy of DBS of the ventralis intermedius nucleus (VIM) of the thalamus for PD and ET. Thirty-eight of 45 patients enrolled at five sites completed a 5-year follow-up study. There were 26 patients with ET and 19 with PD undergoing 29 unilateral (18 ET/11 PD) and 16 bilateral (eight ET/eight PD) procedures. Patients with ET were evaluated using the Tremor Rating Scale, and patients with PD were evaluated using the Unified Parkinson's Disease Rating Scale. The mean age of patients with ET was 70.2 years and 66.3 years in patients with PD. Unilaterally implanted patients with ET had a 75% improvement of the targeted hand tremor; those with bilateral implants had a 65% improvement in the left hand and 86% in the right compared with baseline. Parkinsonian patients with unilateral implants had an 85% improvement in the targeted hand tremor and those with bilateral implants had a 100% improvement in the left hand and 90% improvement in the right. Common DBS-related adverse events in patients receiving unilateral implants were paresthesia (45%) and pain (41%), and in patients receiving implants bilaterally dysarthria (75%) and balance difficulties (56%) occurred. Device-related surgical revisions other than IPG replacements occurred in 12 (27%) of the 45 patients. Thalamic stimulation is safe and effective for the long-term management of essential and Parkinsonian tremors. Bilateral stimulation can cause dysarthria and incoordination and should be used cautiously.

スポーツ選手の足機能間の相関および姿勢制御能との関連

The purpose of this study was to evaluate interrelation among knee muscle force, foot grip power, toe grasp ability, and single-legged balance. The evaluation was carried out on 21 university handball club members (11 male, 10 female, mean age 22.1 years). Concentric and eccentric muscle torques of knee flexors and extensors were measured using a Kin/Com dynamometer. Foot grip power was measured using a hand grip dynamomenter. Toe grip ability was evaluated to rotate the axis of a special device using toes as fast as possible. The movement of lower limbs on monopodal stance was recorded using a triaxial accelerometer attached firmly to the skin on both knees. Maximal amplitude of acceleration was used as a parameter for postural sway. We analyzed functional correlation using a Spearman rank correlation coefficient and ANCOVA for the right and left legs separately. As a result, single legged balance was found to correlate significantly with toe grip ability. The toe grip ability of the left foot showed no relationship with knee muscle power nor foot grip power, however relationship with balance failure and difficulty to perform rock, paper, and scissor movement was seen to some extent.

The Chiari Pseudotumor Cerebri Syndrome: Symptom Recurrence after Decompressive Surgery for Chiari Malformation Type I

Introduction: The etiology of Chiari malformation type I (CM1) as well as other anomalies associated with CM1 remains poorly defined. We have noted the presence of elevated CSF pressures with small ventricles, consistent with the pseudotumor cerebri (PTC) syndrome in a group of CM1 patients that did not respond over the long term to posterior fossa decompression. In order to better understand this association, we reviewed a series of CM1 patients treated by posterior fossa decompression to define the prevalence and nature of post-Chiari PTC. Methods: We performed a retrospective chart review of 192 patients diagnosed with CM1 and treated by posterior fossa decompression. Patients who failed to respond to surgery were evaluated by CINE MR flow studies to assess presence of CSF flow at the foramen magnum and then by lumbar puncture if flow was present. The diagnosis of Chiari PTC was defined by recurrence of Chiari-like symptoms after decompression, elevated lumbar CSF pressure in the absence of ventriculomegaly, and transient resolution of symptoms with large volume lumbar CSF drainage. Results: Thirty-six of 192 patients did not improve with surgical decompression. Fifteen of 36 operative CM1 patients (41.6%) were found to have Chiari PTC. The most frequent symptoms of CM1/PTC patients were head pain, body aches, and balance difficulties. Three patients also experienced visual complaints. The mean maximum lumbar CSF pressure documented in this cohort was 26 cm of water in adults and 25.3 in children. All patients received treatment for the CM1/PTC that culminated with CSF shunt placement in 14/15. Seven of 9 pediatric patients had significant symptom resolution while 6/6 adult patients remained variably symptomatic. Conclusion: CM1 and PTC co-exist in a surprising percentage of failed operative CM1 patients and present with a syndrome that is difficult to treat. The etiology of this association after Chiari decompression is unclear, though perhaps posterior fossa surgery in the setting of abnormal anatomy and potentially anomalous CSF flow dynamics contributes to CSF malabsorption and resultant or coexistant PTC.

Multiple sclerosis management for low-income minorities

Low-income minorities with complex chronic diseases and physical disabilities have difficulty accessing appropriate healthcare often resulting in suboptimal care. A survey was performed to determine the impact of cultural and socioeconomic factors on the quality of care for low-income minorities with multiple sclerosis (MS) enrolled in Independence Care System (ICS), a Medicaid long-term managed care plan. All 92 ICS members with a diagnosis of MS were surveyed on three aspects of their care: specialty contact, immunomodulating drug therapy and osteoporosis prevention. Of those surveyed, 32% were never seen by an MS specialist. One third were not taking immunomodulatory medications, primarily due to noncompliance caused by a lack of understanding about these drugs. The prevention of osteoporosis and potential fracture in this high-risk population was largely neglected by providers despite the fact that the majority of those surveyed also reported balance difficulties and a history of falling. The survey revealed several deficiencies in the care of low-income minorities with MS. A major issue was the lack of adequate education, particularly about the immunomodulating drugs. Education about the importance of osteoporosis prevention, falls mitigation programmes and rehabilitation evaluations are critical interventions to decrease the risk of fracture.

An Examination of the Challenges Daughters Face in Family Business Succession

The literature on daughter successors of family-owned businesses suggests that they face many challenges. The purpose of this article is to determine the extent to which daughters face these challenges and discover new areas for study. Qualitative data were gathered via interviews with 10 female family business owners. Respondents encountered employee rivalry, experienced work-life balance difficulties, and never assumed they would one day be the successor. Although participants reported few problems with their fathers upon succession, many experienced difficulties succeeding their mothers. An interesting finding was the daughter's likelihood of being compared with her mother's managerial style. Future research directions are offered.

Are Measures Employed in the Assessment of Balance Useful for Detecting Differences among Groups that Vary by Age and Disease State?

This study explored the usefulness of measures commonly employed in the examination of persons with balance impairment to discriminate between performances of young and older adults and older adults with and without neurological disease. Eighteen young adults, 22 healthy older adults, 12 individuals with Parkinson disease, and 20 older adults with peripheral neuropathy were recruited from the community.Performances on the following measures were compared: Mini Mental State Exam, grip strength, timed chair rise, semitandem and tandem stance, Timed Up and Go (TUG), and Berg Balance Scale (BBS). Survival analysis was used to analyze semitandem and tandem stance. Grip strength and other tests were analyzed using analysis of variance. Tukey multiple comparison procedure was employed to assess differences in performance among groups. Significant differences in performance were found for all measures. Grip and timed chair rise discriminated young and older adult groups. Timed chair rise, tandem stance, TUG, and BBS detected differences between healthy individuals and those with disease. Semitandem stance and BBS discriminated between individuals with disease conditions. When examining individuals with balance difficulty, combinations of measures are needed to discriminate between clinically distinct groups.

Late-onset Tay-Sachs disease: Phenotypic characterization and genotypic correlations in 21 affected patients

PurposeThe purpose of this study was to describe the phenotype (and corresponding genotype) of adult patients with late-onset Tay-Sachs disease, a clinical variant of the GM2-gangliosidoses. MethodsA comprehensive physical examination, including neurological assessments, was performed to establish the current disease pattern and severity. In addition, the patients' past medical histories were reviewed. The patients' α-subunit mutations (β-Hexosaminidase A genotype) were determined and correlated with their corresponding clinical findings and disease course. ResultsTwenty-one patients (current mean age: 27.0 years; range: 14–47 years) were identified. The pedigree revealed a relative with the “classic” infantile or late-onset form of Tay-Sachs disease in four (out of 18) unrelated families. The patients were predominantly male (15/21 individuals) and of Ashkenazi Jewish ancestry (15/18 families). Mean age at onset was 18.1 years; balance problems and difficulty climbing stairs were the most frequent presenting complaints. In several cases, the diagnosis was delayed (mean age at diagnosis: 27.0 years). Analysis of the β-hex A gene revealed the G269S mutation as the most common disease allele; found in homozygosity (N = 1) or heterozygosity (N = 18; including 2 sib pairs). Disease onset (age 36 years) was delayed and progression relatively slower in the homozygous G269S patient. Two siblings (ages 28 and 31 years), of non-Jewish ancestry, were compound heterozygotes (TATC1278/W474C); their clinical course is dominated by psychiatric problems. Brain imaging studies revealed marked cerebellar atrophy in all patients (N = 18) tested, regardless of disease stage. ConclusionsLate-onset Tay-Sachs disease is an infrequent disorder and the diagnosis is often missed or delayed (by approximately 8 years). Early on, the majority of patients develop signs of either cerebellar or anterior motor neuron involvement. Affected individuals may also develop psychotic episodes. In most cases, the later-onset of expression results from the presence of at least one allele (usually the G269S mutation), associated with residual enzyme (β-hexosaminidase A) activity. A positive family history is a valuable clue, enabling early diagnosis. Nonspecific cerebellar atrophy on brain imaging is another important finding. This entity should be considered among patients presenting with speech, gait, and balance problems, and those with psychiatric disorders even when focal neurologic deficits may be initially absent. Accurate diagnosis will permit appropriate genetic counseling regarding disease prognosis and reproductive risks.

Spillover Between Work and Personal Life for Lodging Managers

ABSTRACT The hospitality and tourism industry is characterized by long and erratic work hours. Many jobs are unsuitable for working at home. The unique features of the lodging industry and the demands of lodging managers' jobs often have interfered with the personal lives and marital relationships of these managers. The situation may even lead to a decision to leave the specific occupation or the industry permanently. The primary goal of this research was to investigate the perspectives of Taiwan hotel managers' regarding work-personal life balance and its relationship to various demographic variables, such as gender, marital status, etc. Results indicate that very few of Taiwanese managers had difficulty balancing work and personal lives. Indeed, the majority of these managers reported their perception of success in balancing work and personal life as from neutral to very successful. No statistically significant differences were found between female and male managers in terms of perceived difficulty or success in work and personal life balance. Neither was there a significant difference among married or single female/male managers. Results also suggested that work interfered with personal life more frequently than personal life did with work.

Postural Instability and Consequent Falls and Hip Fractures Associated with Use of Hypnotics in the Elderly

The aim of this review is to establish the relationship between treatment with hypnotics and the risk of postural instability and as a consequence, falls and hip fractures, in the elderly. A review of the literature was performed through a search of the MEDLINE, Ingenta and PASCAL databases from 1975 to 2005. We considered as hypnotics only those drugs approved for treating insomnia, i.e. some benzodiazepines and the more recently launched 'Z'-compounds, i.e. zopiclone, zolpidem and zaleplon. Large-scale surveys consistently report increases in the frequency of falls and hip fractures when hypnotics are used in the elderly (2-fold risk). Benzodiazepines are the major class of hypnotics involved in this context; falls and fractures in patients taking Z-compounds are less frequently reported, and in this respect, zolpidem is considered as at risk in only one study. It is important to note, however, that drug adverse effect relationships are difficult to establish with this type of epidemiological data-mining. On the other hand, data obtained in laboratory settings, where confounding factors can be eliminated, prove that benzodiazepines are the most deleterious hypnotics at least in terms of their effects on body sway. Z-compounds are considered safer, probably because of their pharmacokinetic properties as well as their selective pharmacological activities at benzodiazepine-1 (BZ(1)) receptors. The effects of hypnotics on balance, gait and equilibrium are the consequence of differential negative impacts on vigilance and cognitive functions, and are highly dose- and time-dependent. Z-compounds have short half-lives and have less cognitive and residual effects than older medications. Some practical rules need to be followed when prescribing hypnotics in order to prevent falls and hip fractures as much as possible in elderly insomniacs, whether institutionalised or not. These are: (i) establish a clear diagnosis of the sleep disorder; (ii) take into account chronic conditions leading to balance and gait difficulties (motor and cognitive status); (iii) search for concomitant prescription of psychotropics and sedatives; (iv) use half the recommended adult dosage; and (v) declare any adverse effect to pharmacovigilance centres. Comparative pharmacovigilance studies focused on the impact of hypnotics on postural stability are very much needed.

Results of Surgical Treatment for Degenerative Cervical Myelopathy

This retrospective study involves 26 patients with degenerative cervical myelopathy who were surgically treated by anterior corpectomy, titanium mesh cage (TMC) filled with autogenous bone, and anterior plate +/- posterolateral plate and fusion. This study was conducted to determine the indications, efficacy, and complication rate associated with performing corpectomy to achieve anterior decompression of neural elements or for removing anterior lesions. This retrospective study involves patients with degenerative cervical myelopathy who were surgically treated by > or =2-level anterior corpectomy, TMC filled with autogenous bone, and anterior plate +/- posterolateral plate and fusion. The purpose was to evaluate and compare the results in terms of neurologic recovery and function and effectivity of TMC as a structural support. Twenty-six patients with degenerative cervical myelopathy who had surgical treatment and average 30 months (range, 24-52 months) follow up were included. The mean age was 64.9 years (range, 55-74 years) and average period between myelopathic symptoms and surgery was 2.8 years (range, 6 months-5 years). Preoperative evaluation of every patient consisted of anterior-posterior, lateral, bilateral oblique, flexion, and extension radiographs, computed tomography reconstructions and magnetic resonance imaging of the cervical spine, Doppler ultrasound of the carotid arteries, vertebral artery magnetic resonance angiography, neurologic examination, and electromyography. Degree of pre- and postoperative myelopathy was determined according to the scoring systems developed by Nurick and Japanese Orthopedic Association (JOA). Twelve patients had a mild balance problem and difficulty while walking but were able to perform their daily activities. Fourteen patients had spastic quadriparesis ambulating on either crutches or with wheelchairs. Of these, 11 experienced bladder disturbance as well. Surgical treatment in 18 patients consisted of anterior decompressive corpectomy, structural TMC, and anterior plate stabilization in 14 patients who had 2-level corpectomy. Posterior plate stabilization without laminectomy was added to this procedure in another 4 patients who had 3- or more level corpectomy. The remaining 8 patients had first laminectomy and posterolateral plate, then anterior corpectomy, TMC, and anterior plate on the same stage. Corpectomy levels were between C3 and T1, and anterior corpectomy, structural TMC, and anterior plating was the procedure that all patients had in common. Mean sagittal Cobb angle (C2-C7) was 9 degrees (range, 0-23 degrees) before surgery, 17.1 degrees (range, 11-22 degrees) on the third postoperative month, and 16.9 degrees (range, 10-22 degrees) at last follow-up. The difference in sagittal alignment on the third month and last follow up was not statistically significant (P > 0.05). Average preoperative Nurick score was 3.5 (range, 2-5) and JOA score was 7 (range, 1-14). Major and statistically significant neurologic recovery was within the first 3 months, and average Nurick and JOA scores at 3 months were 2 (range, 0-3) and 11 (range, 8-17) (P < 0.001), respectively. All patients had improved neurologic status at final follow up. As confirmed by plain radiographs and computed tomography reconstructions, solid fusion was achieved across the TMC with no settling or migration, and we had no implant-related complication or failure. As major complications, 1 (3.8%) early deep posterior infection developed but responded to early debridement and antibiotics. Also, 3 patients (11.5%) had transient C5 nerve root injury. At final follow up, all patients were able to ambulate without support and maintain their daily activities. Anterior decompression provides good neurologic recovery in patients with degenerative cervical myelopathy. TMC provides good structural support, and solid fusion can be achieved with TMC and anterior plate (for < or =2-level corpectomy) and/or posterior plate (> or =3-level corpectomy). There is increased risk of C5 nerve root injury when first laminectomy and posterolateral plate stabilization are performed.

Flexion gap configuration in total knee arthroplasty following high tibial osteotomy

Previous reports have described the potentially compromising effect of a high tibial osteotomy (HTO) on the results of a subsequent total knee arthroplasty (TKA). Although the reasons are not clear, some authors reported problems in soft-tissue balancing. In a prospective study, 22 patients with an average interval of 5.8 years after closed-wedge HTO were operated for TKA. All operations were performed with a CT-free navigation system, and measurements of the extension and flexion gap were assessed. The intraoperative data were compared to a control group of 100 consecutive computer-assisted TKA without previous osteotomy. In the study group, a highly significant shift towards a medial opening of the flexion gap between the posterior condylar line and the tibial resection (study group 0.4+/-4.7 degrees medial opening versus control group 3.4+/-3.3 degrees lateral opening, p<0.001) was observed. In the study group, 10/22 showed a medial opening of the flexion gap compared to 11/100 in the control group. Surgeons should be aware of difficulties in soft-tissue balance in TKA following HTO, especially for the flexion gap configuration and the axial rotation of the femoral component.

Psycho-socio-economic outcomes in acoustic neuroma patients and their carers related to tumour size.

The objective was to explore psycho-socio-economic outcomes of a 2-year cohort of patients having surgery for an acoustic neuroma, and carers and their relationship to tumour size after surgery. The Wessex Patient Carer Questionnaire was designed in conjunction with Patients and Carers, to determine psycho-socio-economic outcomes. The results were juxtaposed against clinical profiles. The House-Brackman (HB) scale was used to assess facial function at 6 and 12 months after operation. The cohort contained 102 patients. There were 87% effective responders. Half were aged below 54 years and 30% had school-aged children. The majority (93%) of patients were operated via the translabyrinthine approach. Patients with large tumours, i.e. greater than 3 cm (28%), had most post-treatment physical problems, including hearing and balance difficulties, and 42% reported difficulty eating in public. Thirty-four per cent felt 'stressed' and 18%'depressed'. After 6 months, facial function was recorded as HB scale 5/6 in 21% of patients but by 1 year only 8% of patients were HB 5/6. Patients and carers were generally very satisfied with their in-patient neurosurgical care, but significantly dissatisfied with post-discharge care - particularly the shortcoming of the community services. The majority of families felt 'unsupported' and only 20% of patients had confidence in their General Practitioner's knowledge. Families faced severe socio-economic disruption and patients"time-off-work' was estimated to cost pound 954,000. Carers carried considerable post-discharge psychological burdens and costs to the public purse were calculated to be pound 52,000.

Webwatch

In the current climate of midwifery, student midwives find themselves facing numerous challenges, ranging from financial hardship, work/life balance difficulties and frustrations with organization and delivery of programmes.

Applied physiology: the newborn skin

The most important function of the skin is to provide a protective barrier between the body and the environment. It limits loss of body water, prevents absorption of noxious agents and protects against physical trauma. The epidermal barrier begins to develop in mid-gestation and is fully formed by about 32 weeks gestation. In the extremely preterm infant, it is poorly formed and functionally weak. Exposure to air after birth accelerates epidermal development. Transepidermal water loss is high in the immature infant, causing difficulties in fluid balance and temperature control. The percutaneous absorption of topically applied agents may lead to accidental poisoning. Adhesive trauma strips the epidermis, predisposing to infection. These problems can be minimized by limiting the use of skin probes and adhesive tape, nursing the infant in a high ambient humidity and sparing use of aqueous chlorhexidine as an antiseptic. The routine use of emollients or skin coverings is not recommended.

On the logic of psychoanalytic theory.

Psychoanalytic theory shows some specific features and problems. It exists in a number of variations, according to different schools as well as cultural and subcultural conditions, with different understandings even of core concepts. Instead of producing definite knowledge, results remain uncertain. They vary in use and imply a permanent reworking of ideas and conceptions. This is the effect of the kind of theory psychoanalysis has to use. Since psychodynamics are a special kind of heterogeneous, changing, always different, emergent--in a word, autopoietic--reality, psychoanalysis cannot use the methods of a denotative theory (algorithmic reduction leading to strictly defined and formulated calculations) but has to use connotative theories. Connotative theories use open concepts which provide an active and flexible access to autopoietic reality. They are able to cope with the difference between singularities as well as with the distance between general logic and empirical reality. Problems tied to this possibility are structural fuzziness, a dependence on forms of use, multiple paradigms and difficulties in legitimation and balance of theories. This causes problems of institutionalisation. These problems are not a sign of immaturity but the normal way in which connotative theories appear and develop. They can therefore not be eliminated but only be treated in a better way.

On the logic of psychoanalytic theory

Psychoanalytic theory shows some specific features and problems. It exists in a number of variations, according to different schools as well as cultural and subcultural conditions, with different understandings even of core concepts. Instead of producing definite knowledge, results remain uncertain. They vary in use and imply a permanent reworking of ideas and conceptions. This is the effect of the kind of theory psychoanalysis has to use. Since psychodynamics are a special kind of heterogeneous, changing, always different, emergent‐in a word, autopoietic‐reality, psychoanalysis cannot use the methods of a denotative theory (algorithmic reduction leading to strictly defined and formulated calculations) but has to use connotative theories. Connotative theories use open concepts which provide an active and flexible access to autopoietic reality. They are able to cope with the difference between singularities as well as with the distance between general logic and empirical reality. Problems tied to this possibility are structural fuzziness, a dependence on forms of use, multiple paradigms and difficulties in legitimation and balance of theories. This causes problems of institutionalisation. These problems are not a sign of immaturity but the normal way in which connotative theories appear and develop. They can therefore not be eliminated but only be treated in a better way.

A sensitivity analysis for nonrandomly missing categorical data arising from a national health disability survey.

Using data from 145,007 adults in the Disability Supplement to the National Health Interview Survey, we investigated the effect of balance difficulties on frequent depression after controlling for age, gender, race, and other baseline health status information. There were two major complications: (i) 80% of subjects were missing data on depression and the missing-data mechanism was likely related to depression, and (ii) the data arose from a complex sample survey. To adjust for (i) we investigated three classes of models: missingness in depression, missingness in depression and balance, and missingness in depression with an auxiliary variable. To adjust for (ii) we developed the first linearization variance formula for nonignorable missing-data models. Our sensitivity analysis was based on fitting a range of ignorable missing-data models along with nonignorable missing-data models that added one or two parameters. All nonignorable missing-data models that we considered fit the data substantially better than their ignorable missing-data counterparts. Under an ignorable missing-data mechanism, the odds ratio for the association between balance and depression was 2.0 with a 95% CI of (1.8, 2.2). Under 29 of the 30 selected nonignorable missing-data models, the odds ratios ranged from 2.7 with 95% CI of (2.3, 3.1) to 4.2 with 95% CI of (3.9, 4.6). Under one nonignorable missing-data model, the odds ratio was 7.4 with 95% CI of (6.3, 8.6). This is the first analysis to find a strong association between balance difficulties and frequent depression.

Disabling symptoms: what do older women report?.

To answer the question, "What do older disabled women report as the main symptoms causing their disability?" Cross-sectional study of 876 women aged 65 and older who participated in the second interview of the Women's Health and Aging Study, a longitudinal study of community-living women, representing the one third of older women with at least mild to moderate disability. Women were asked to identify the symptom and the condition that was the main cause of disability in basic and instrumental activities of daily living, and lower extremity mobility. Musculoskeletal pain symptoms were reported as the main cause of disability by at least one third of women with each type of disability. Other symptoms that were less frequently reported as main causes of disability were weakness, fatigue, and unsteadiness. Fear of falls was reported by 14% (95% confidence interval, 11.2% to 17.6%) of 472 women with disability in bathing. When asked to report on the main condition causing their disability, many women responded, "old age" or "no specific disease," but were able to identify symptoms causing their disabilities. Musculoskeletal pain was the most common cause of disability reported by older women, followed by weakness and balance difficulties. Greater attention to symptoms that interfere with daily activities of older persons may reduce the burden of disability.

Exploration of Balance Difficulties in AIDS Neuropathy

Background and Purpose: Often, patients with balance difficulties cannot function effectively in their environment due to an inability to perform activities of daily living (ADL). Severe balance difficulties may even restrict an individual's ability to remain employed. It is well documented in the literature that peripheral neuropathy resulting from diabetes mellitus (DM) is a common cause of balance difficulties among patients with diabetics. Cancer patients also frequently suffer from sensory neuropathies which result from the neoplasm itself, as well as use of chemotherapeutic agents. Similar neuropathic conditions are often found in persons living with AIDS; however, few studies have explored balance problems in this population. The purpose of this study was to examine balance dysfunctions that exist in a population with AIDS. Subjects: Three patients with AIDS-related neuropathy. All had pain in both legs and feet which is greatest in the feet. Neurological assessment revealed that all 3 individuals had decreased sensation in the distal portion of their bilateral lower extremities as well as decreased ankle proprioception bilaterally. Methods: The postural ability of 3 patients with AIDS neuropathy and 3 age-matched healthy men were assessed with the Balance Master®. Path sway and movement time of patients and healthy subjects were recorded and compared with a two-sample t-test. Results: Patients had prolonged movement time in relation to healthy subjects (patients = 5.23 ± 0.88 sec., healthy subjects = 4.51 ± 0.27 sec., P<0.05). There was no significant difference in path sway between patients and healthy subjects. Conclusion: There may be potential for balance difficulties in patients with AIDS neuropathy based on the findings of this small cohort.

Acoustic Neuroma: An Exploration of Patients’ Beliefs

Objectives: Identification of patients’ beliefs about their illness is important as these beliefs can shape subsequent emotional responses and coping behaviours. This study examined acoustic neuroma patients’ illness representations using a health psychology model as the basis for the question development. Patients: One hundred and sixty-five patients who had undergone treatment/management at a London teaching hospital between 1985 and 2001. Methods: Participants completed a series of 6 open-end questions, which were mailed as part of a larger questionnaire study. The open questions elicited a wide range of responses. Results and Conclusions: The main symptoms experienced by patients prior to treatment were hearing loss (68% of respondents), balance difficulties (53%) and tinnitus (34%). The consequences of hearing loss, such as conversational difficulties, were the greatest concern of patients, although changes in social and work activities were also highlighted. The results of the study improve our understanding of the symptoms, concerns and beliefs that acoustic neuroma patients may hold prior to treatment. In addition, the results highlight concerns and misconceptions among patients that may need to be addressed through the provision of appropriate information.