Clinical Test Of Sensory Integration Research Articles

Audiovestibular Manifestations in Patients With Limited Systemic Sclerosis and Centromere Protein-B (CENP-B) Antibodies

Audiovestibular dysfunction has been reported in patients with connective tissue disease. Systemic sclerosis (SSc; scleroderma) is a rare connective tissue disease of unknown etiology. In the current study we assess whether audiovestibular involvement is present in patients with limited scleroderma (lSSc). To answer this question we studied a series of 35 consecutive patients who fulfilled well-established classification criteria for lSSc and had antibodies against the major centromere protein-B (CENP-B), and 59 matched controls. Individuals with a history of cerebrovascular complications, syphilis, Ménière and other vestibular syndromes, infections involving the inner ear, barotrauma, or in treatment with ototoxic drugs were excluded. The majority of patients with lSSc were women (94%). The mean age at time of study was 64.5 years, and the mean age at time of disease diagnosis was 56.9 years. Besides Raynaud phenomenon, most patients with lSSc had other typical features of CREST (calcinosis, Raynaud phenomenon, esophageal hypomotility, sclerodactyly, and telangiectasia) syndrome. Twenty-seven (77%) patients showed abnormal hearing loss in the audiogram compared with only 15 (26%) of the controls (p < 0.001). Values of audiometric tests (pure-tone average and speech reception threshold) yielded significant differences between patients and controls (p < 0.001). The typical pattern of hearing impairment in our series of lSSc patients was a bilateral and symmetrical sensorineural hearing loss with a flat pattern in the audiogram. Abnormal tympanogram and abnormal stapedial reflex were more commonly observed in patients than controls (p < or = 0.001). Similarly, a significantly increased frequency of abnormal oculocephalic response (10 patients, 29%) and head-shaking nystagmus (9 patients, 26%) was observed in patients compared with controls (p < 0.001 for both comparisons). Finally, a significantly increased frequency of abnormal caloric test and clinical test of sensory integration and balance was observed in lSSc patients (31% and 46% of patients, respectively) compared with controls (0% and 12%, respectively) (p < 0.001 for both comparisons). The current study demonstrates strong evidence for inner ear compromise in patients with lSSc.

The Effect Of Textured Plantar Surfaces On Postural Stability

PURPOSE Balance training has become an integral part of therapeutic exercise interventions. Based on his clinical observations, Janda (1996) suggested using textured surfaces on the sole of the foot to stimulate the plantar cutaneous mechanoreceptors, increasing proprioceptive information into the central nervous system during balance training. The purpose of this pilot study was to determine the effects of a textured plantar surface on postural sway compared to a non-textured, flat surface. METHODS Eight orthopaedic physical therapy patients (4 males, 4 females, ages 22–58) performed a modified clinical test of sensory integration and balance (mCTSIB) using computerized posturography. Subjects stood without shoes (wearing socks) on a specially designed textured surface made out of PVC, with nodule width of 4.5 mm, height of 7.0 mm, and density of 9 nodules per 6.5 cm2. The mCTSIB consisted of three trials of each: eyes open flat surface, eyes open textured surface, eyes closed flat surface, and eyes closed textured surface. Sway velocity, sway amplitude, and sway index were compared on the flat and textured surfaces. RESULTS Due to the low number of subjects for this pilot study and high variability between subjects, statistical significance between the textured and flat surfaces could not be determined. However, comparison of descriptive data revealed that subjects demonstrated less increase in postural sway with eyes closed while standing on the textured surface compared to the flat surface (a higher sway index indicates more postural sway). The mean change in sway index with eyes closed between flat and textured surfaces was +.01, and +.11 with eyes open. Additionally, greater sway was observed during the flat condition as subjects went from the eyes open to eyes closed conditions. Mean change in sway index from eyes open to closed on textured was +.15, and +.23 on the flat surface. CONCLUSIONS The results of this pilot testing indicate a trend in which postural sway with textured surfaces only slightly increases as they subject moves from eyes open to eyes closed, compared to larger increases on flat surfaces. It is hypothesized that the textured surfaces help replace the loss of visual input to maintain postural stability by increasing afferent proprioceptive input into the sole of the foot. Consequently, the expected increase in postural sway from eyes open to eyes closed conditions may be attenuated by the textured surface. Future research should include additional subjects and investigate the effect of different textured surfaces on postural sway.

The Effect Of Textured Plantar Surfaces On Postural Stability

PURPOSE Balance training has become an integral part of therapeutic exercise interventions. Based on his clinical observations, Janda (1996) suggested using textured surfaces on the sole of the foot to stimulate the plantar cutaneous mechanoreceptors, increasing proprioceptive information into the central nervous system during balance training. The purpose of this pilot study was to determine the effects of a textured plantar surface on postural sway compared to a non-textured, flat surface. METHODS Eight orthopaedic physical therapy patients (4 males, 4 females, ages 22–58) performed a modified clinical test of sensory integration and balance (mCTSIB) using computerized posturography. Subjects stood without shoes (wearing socks) on a specially designed textured surface made out of PVC, with nodule width of 4.5 mm, height of 7.0 mm, and density of 9 nodules per 6.5 cm2. The mCTSIB consisted of three trials of each: eyes open flat surface, eyes open textured surface, eyes closed flat surface, and eyes closed textured surface. Sway velocity, sway amplitude, and sway index were compared on the flat and textured surfaces. RESULTS Due to the low number of subjects for this pilot study and high variability between subjects, statistical significance between the textured and flat surfaces could not be determined. However, comparison of descriptive data revealed that subjects demonstrated less increase in postural sway with eyes closed while standing on the textured surface compared to the flat surface (a higher sway index indicates more postural sway). The mean change in sway index with eyes closed between flat and textured surfaces was +.01, and +.11 with eyes open. Additionally, greater sway was observed during the flat condition as subjects went from the eyes open to eyes closed conditions. Mean change in sway index from eyes open to closed on textured was +.15, and +.23 on the flat surface. CONCLUSIONS The results of this pilot testing indicate a trend in which postural sway with textured surfaces only slightly increases as they subject moves from eyes open to eyes closed, compared to larger increases on flat surfaces. It is hypothesized that the textured surfaces help replace the loss of visual input to maintain postural stability by increasing afferent proprioceptive input into the sole of the foot. Consequently, the expected increase in postural sway from eyes open to eyes closed conditions may be attenuated by the textured surface. Future research should include additional subjects and investigate the effect of different textured surfaces on postural sway.

The Effect of Depression on Balance Decline in Mature Women

Depression has been identified as a risk factor for falls, and a change in balance ability over time has yet to be investigated. This study aimed to identify if, over a 3-year period, balance ability changed in 26 women who were on medication for depression, compared to 26 non-depressed women. The two groups were matched for age, number of co-morbidities, activity level, medications, and height. All participants were simultaneously enrolled in a larger, longitudinal study of ageing. Balance measures included the Functional Reach (FR) test, Lateral Reach (LR) test, Step Test (ST), Timed Up and Go, and the Modified Clinical Test of Sensory Integration and Balance, Unilateral Stance (ULS) and Limit of Stability (LOS) laboratory tests. Results showed a significant difference between the groups on ST, right ULS (eyes closed) and forward end point excursion of the LOS. There was no difference in the number of falls between groups. Analysis of the depressed group alone showed that right FR declined significantly and left and right LR tended towards decline, but not differently between groups. There was no between-group differences for these measures. There was no significant decline in non-depressed women for any measurement. Depressed women have less ability to maintain their balance than non-depressed women, and should be encouraged to participate in appropriate activities known to improve or maintain balance.

Evaluation of clinical measures of equilibrium.

Evaluate the clinical utility of several simple measures of static and dynamic equilibrium in human subjects. In particular, one proposed clinical measure, the Clinical Test of Sensory Integration and Balance (CTSIB) was compared with dynamic posturography for the measurement of postural control capabilities. Cross-sectional study of normal subjects and prospective observational study of the same performance measures in vestibular disorder patients. Academic tertiary care referral center. Data were collected for all test measures from a group of normal subjects (ages, 20 to 79 years), as well as for a group of patients undergoing treatment for vestibular dysfunction. Data suggest that several semiquantitative clinical tests of static and dynamic equilibrium can be helpful in evaluating and monitoring patients with chronic vestibular dysfunction. The CTSIB results seem to correlate well with dynamic posturography, suggesting that this measure may be useful in identifying patients with abnormal postural control. Formal dynamic posturography testing appears to be more sensitive in detecting abnormal postural control and more exact in defining the specific pattern of dysfunction. Simple clinical measures of static and dynamic equilibrium can reliably distinguish vestibular disorder patients from normal subjects. Dynamic posturography continues to play an important role in the functional evaluation and management of vestibular disorder patients.