Composite Test Scores Research Articles

"Interpreting the g loadings of intelligence test composite scores in light of Spearman's law of diminishing returns": Correction to Reynolds (2013).

"Interpreting the g loadings of intelligence test composite scores in light of Spearman's law of diminishing returns": Correction to Reynolds (2013).

A randomized controlled phase II trial of riluzole in early multiple sclerosis.

ObjectivesWe evaluated the effect of riluzole versus placebo added to weekly IM interferon beta-1a in early multiple sclerosis (MS).MethodsThis is a randomized (1:1), double-blind, placebo-controlled trial of riluzole 50 mg twice daily in subjects with MS onset less than 1 year prior. Trial participation was up to 3 years. The primary endpoint was change in percent brain volume change. Secondary endpoints included changes in normalized gray and normal-appearing white matter volumes, retinal nerve fiber layer thickness (RNFL), MS Functional Composite and Symbol Digit Modalities Test scores. Mixed model regression analysis was used to compare the changes over time between groups.ResultsForty-three subjects were randomized to study drug (22 riluzole, 21 placebo). Baseline characteristics were overall similar between groups except for older age (P = 0.042), higher normalized cerebrospinal fluid volume (P = 0.050), lower normalized gray matter volume (P = 0.14), and thinner RNFL (P = 0.043) in the riluzole group. In the primary analysis, percent brain volume change in the placebo group decreased at a rate of 0.49% per year whereas the riluzole group decreased by 0.86% per year (0.37% more per year; 95% CI −0.78, 0.024; P = 0.065). Although age did not influence the rate of brain volume decline, the difference between groups was attenuated after adjustment for baseline normalized gray matter and lesion volume (0.26% more per year in riluzole group; 95% CI −0.057, 0.014; P = 0.22). Analyses of secondary outcomes showed no differences between groups.InterpretationThis trial provides class 1 evidence that riluzole treatment does not meaningfully reduce brain atrophy progression in early MS.

Outcomes, utility, and feasibility of single task and dual task intervention programs: Preliminary implications for post-concussion rehabilitation

To examine neurocognitive and balance performance in recreational athletes, prior to and following a dual-task training intervention compared to single-task controls in order to assess the utility and feasibility of these interventions in the clinical setting. Controlled laboratory study. Thirty healthy, physically active recreational athletes (dual-task group = 15; single-task group = 15; age: 20.3 ± 1.9 years) completed neurocognitive and balance assessments before and after a four-week intervention. Sensory Organization Test composite score and ratio scores, Balance Error Scoring System total score, and nine CNS Vital Signs composite scores served as outcome measures. Mixed model analyses of variance were used to examine each measure. The single-task group showed greater improvement for complex attention (F1,26 = 5.48, p = .027) following the training period. Both groups improved their performance on the complex attention domain (F1,26 = 6.73, p = .015), the Balance Error Scoring System score (F1,26 = 42.34, p < .001), and the Sensory Organization Test vestibular ratio score (F1,28 = 6.55, p = .016) following the intervention. Our findings suggest combining cognitive and balance tasks as performed does not provide additional benefit to performing these tasks independently among healthy individuals, but appear to be feasible in this setting. Future research should examine integration of single-task and dual-task exercises for concussed patients.

Student Performance in a Principle of Microeconomics Course under Hybrid and Face-to-Face Delivery

Designing a hybrid course entails the challenge of choosing learning activities for each of the face-to-face and online environments--and sequencing and coordinating the activities across the two environments--to promote student attainment of the course’s learning objectives. This paper presents a study comparing student performance in an undergraduate Principles of Microeconomics course taught by the same instructor under hybrid (n = 51) and face-to-face (n = 24) delivery. The percentage of hybrid students completing the course (71%) was not significantly different (chi-square = .61, p = .433) than that (79%) of the face-to-face students. A regression analysis controlling for student GPA indicated that, for students completing the course, the composite test score was, on average, an estimated 4.8 percentage points lower (p = .025, one-tailed) under hybrid delivery than under face-to-face delivery. Student GPA had a strong positive ceteris paribus impact (p = .000, one-tailed) on the composite test score. The finding of a lower level of student learning under hybrid relative to face-to-face delivery is attributed to inattentiveness to pedagogical principles in designing the hybrid course. The study serves as a caution to colleges and universities initiating or expanding their hybrid course offerings in the absence of faculty training or quality control checks. The paper closes with suggestions for further research.

EXAMINER ERRORS ON THE REYNOLDS INTELLECTUAL ASSESSMENT SCALES COMMITTED BY GRADUATE STUDENT EXAMINERS

Protocols from 108 administrations of the Reynolds Intellectual Assessment Scales were evaluated to determine the frequency of examiner errors and their impact on the accuracy of three test composite scores, the Composite Ability Index (CIX), Verbal Ability Index (VIX), and Nonverbal Ability Index (NIX). Students committed at least one administration, scoring, or recording error on 98% of protocols and averaged 7.53 errors per protocol. Administration errors were most common on VIX subtests (Guess What and Verbal Reasoning), whereas recording errors occurred most frequently on NIX subtests (Odd Item Out and What's Missing). Error correction and rescoring resulted in changes to all three index scores, although VIX and CIX changed most frequently.

Baseball Players Diagnosed With Ulnar Collateral Ligament Tears Demonstrate Decreased Balance Compared to Healthy Controls

Cross-sectional. To compare lower extremity balance and shoulder range of motion in baseball players with ulnar collateral ligament (UCL) tears to a healthy cohort. Background Throwing is a complex motion that requires balance and coordination to effectively transfer energy through the kinetic chain. In theory, poorer balance could negatively affect throwing mechanics and lead to injury. Thirty baseball players (mean ± SD age, 18.5 ± 1.9 years) with a diagnosis of a UCL tear of their throwing arm were compared to 30 players (age, 19.0 ± 1.1 years) without a UCL tear. All participants were competing at either the high school or collegiate level and reported an average ± SD of 13.5 ± 1.7 years of playing experience. The Y Balance Test composite scores were calculated for the stance and lead lower extremities of all players. Shoulder range of motion was used to calculate glenohumeral internal rotation deficit and side-to-side differences in total rotational motion. Group comparisons were made between participants with and without UCL tears using independent t tests. Baseball players with UCL tears scored significantly lower on the Y Balance Test for both the stance (P<.001) and lead (P<.001) lower extremities compared to the noninjured cohort. No between-group differences were noted in glenohumeral internal rotation deficit (P = .453), whereas the mean ± SD side-to-side difference in total rotational motion was -6.0° ± 9.6° for the injured group, compared to -0.4° ± 9.6° for the control group (P = .028). Participants with a UCL tear demonstrated decreased performance for their stance and lead lower extremities during the Y Balance Test. These data are consistent with a clinical hypothesis of a potential association between impaired balance and UCL tears in high school and collegiate baseball players. The lower total rotational motion of the dominant shoulder in participants with UCL tears needs to be considered in the interpretation of those results.

I. NIH Toolbox Cognition Battery (CB): introduction and pediatric data.

This monograph presents the pediatric portion of the National Institutes of Health (NIH) Toolbox Cognition Battery (CB) of the NIH Toolbox for the Assessment of Neurological and Behavioral Function. The NIH Toolbox is an initiative of the Neuroscience Blueprint, a collaborative framework through which 16 NIH Institutes, Centers, and Offices jointly support neuroscience-related research, to accelerate discoveries and reduce the burden of nervous system disorders. The CB is one of four modules that measure cognitive, emotional, sensory, and motor health across the lifespan. The CB is unique in its continuity across childhood, adolescence, early adulthood, and old age, and in order to help create a common currency among disparate studies, it is also available at low cost to researchers for use in large-scale longitudinal and epidemiologic studies. This chapter describes the evolution of the CB; methods for selecting cognitive subdomains and instruments; the rationale for test design; and a validation study in children and adolescents, ages 3-15 years. Subsequent chapters feature detailed discussions of each test measure and its psychometric properties (Chapters 2-6), the factor structure of the test battery (Chapter 7), the effects of age and education on composite test scores (Chapter 8), and a final summary and discussion (Chapter 9). As the chapters in this monograph demonstrate, the CB has excellent psychometric properties, and the validation study provided evidence for the increasing differentiation of cognitive abilities with age.

The Support to Rural India's Public Education System (STRIPES) Trial: A Cluster Randomised Controlled Trial of Supplementary Teaching, Learning Material and Material Support

BackgroundThe aim of the STRIPES trial was to assess the effectiveness of providing supplementary, remedial teaching and learning materials (and an additional ‘kit’ of materials for girls) on a composite of language and mathematics test scores for children in classes two, three and four in public primary schools in villages in the Nagarkurnool division of Andhra Pradesh, India.MethodsSTRIPES was a cluster randomised trial in which 214 villages were allocated either to the supplementary teaching intervention (n = 107) or to serve as controls (n = 107). 54 of the intervention villages were further randomly allocated to receive additional kit for girls. The study was not blinded. Analysis was conducted on the intention to treat principle, allowing for clustering.ResultsComposite test scores were significantly higher in the intervention group (107 villages; 2364 children) than in the control group (106 villages; 2014 children) at the end of the trial (mean difference on a percentage scale 15.8; 95% CI 13.1 to 18.6; p<0.001; 0.75 Standard Deviation (SD) difference). Composite test scores were not significantly different in the 54 villages (614 girls) with the additional kits for girls compared to the 53 villages (636 girls) without these kits at the end of the trial (mean difference on a percentage scale 0.5; 95% CI -4.34 to 5.4; p = 0.84). The cost per 0.1 SD increase in composite test score for intervention without kits is Rs. 382.97 (£4.45, $7.13), and Rs.480.59 (£5.58, $8.94) for the intervention with kits.ConclusionsA 18 month programme of supplementary remedial teaching and learning materials had a substantial impact on language and mathematics scores of primary school students in rural Andhra Pradesh, yet providing a ‘kit’ of materials to girls in these villages did not lead to any measured additional benefit.Trial RegistrationControlled-Trials.com ISRCTN69951502

Epidemiology and age comparisons of patients presenting to a dedicated community concussion clinic

ObjectiveTo describe the epidemiology of student-athletes presenting to a community concussion clinic and to compare post-concussive outcomes between younger and older patients.DesignRetrospective cohort.SettingCommunity concussion clinic.PatientsStudent-athletes (10–18 years) presenting to a...

Interpreting the g loadings of intelligence test composite scores in light of Spearman's law of diminishing returns.

The linear loadings of intelligence test composite scores on a general factor (g) have been investigated recently in factor analytic studies. Spearman's law of diminishing returns (SLODR), however, implies that the g loadings of test scores likely decrease in magnitude as g increases, or they are nonlinear. The purpose of this study was to (a) investigate whether the g loadings of composite scores from the Differential Ability Scales (2nd ed.) (DAS-II, C. D. Elliott, 2007a, Differential Ability Scales (2nd ed.). San Antonio, TX: Pearson) were nonlinear and (b) if they were nonlinear, to compare them with linear g loadings to demonstrate how SLODR alters the interpretation of these loadings. Linear and nonlinear confirmatory factor analysis (CFA) models were used to model Nonverbal Reasoning, Verbal Ability, Visual Spatial Ability, Working Memory, and Processing Speed composite scores in four age groups (5-6, 7-8, 9-13, and 14-17) from the DAS-II norming sample. The nonlinear CFA models provided better fit to the data than did the linear models. In support of SLODR, estimates obtained from the nonlinear CFAs indicated that g loadings decreased as g level increased. The nonlinear portion for the nonverbal reasoning loading, however, was not statistically significant across the age groups. Knowledge of general ability level informs composite score interpretation because g is less likely to produce differences, or is measured less, in those scores at higher g levels. One implication is that it may be more important to examine the pattern of specific abilities at higher general ability levels.

Supplemental Material for Interpreting the g Loadings of Intelligence Test Composite Scores in Light of Spearman's Law of Diminishing Returns

Supplemental Material for Interpreting the g Loadings of Intelligence Test Composite Scores in Light of Spearman's Law of Diminishing Returns

Antiretroviral Monocyte Efficacy Score Linked to Cognitive Impairment in Hiv

Monocytes transmigrating to the brain play a central role in HIV neuropathology. We hypothesized that the continued existence of neurocognitive impairment (NCI) despite potent antiretroviral (ARV) therapy is mediated by the inability of such therapy to control this monocyte/macrophage reservoir. Cross-sectional and longitudinal analyses were conducted within a prospectively enrolled cohort. We devised a monocyte efficacy (ME) score based on the anticipated effectiveness of ARV medications against monocytes/macrophages using published macrophage in vitro drug efficacy data. We examined, within an HIV neurocognitive database, its association with composite neuropsychological test scores (NPZ8) and clinical cognitive diagnoses among subjects on stable ARV medications unchanged for >6 months prior to assessment. Among 139 subjects on ARV therapy, higher ME score correlated with better NPZ8 performance (r=0.23, P<0.01), whereas a score devised to quantify expected penetration effectiveness of ARVs into the brain (CPE score) did not (r=0.12, P=0.15). In an adjusted model (adjusted r(2)=0.12), ME score (β=0.003, P=0.02), CD4(+) T-cell nadir (β=0.001, P<0.01) and gender (β=-0.456, P=0.02) were associated with NPZ8, whereas CPE score was not (β=0.003, P=0.94). A higher ME score was associated with better clinical cognitive status (P<0.01). With a range of 12.5-433.0 units, a 100-unit increase in ME score resulted in a 10.6-fold decrease in the odds of a dementia diagnosis compared with normal cognition (P=0.01). ARV efficacy against monocytes/macrophages correlates with cognitive function in HIV-infected individuals on ARV therapy within this cohort. If validated, efficacy against monocytes/macrophages may provide a new target to improve HIV NCI.

P20 Frontal white matter connections and cognitive change in amyotrophic lateral sclerosis: a DTI-tractography study

<h3>Objective</h3> Traditionally considered a motor-neuron disorder, cognitive and behavioural impairments in a subset of non-demented amyotrophic lateral sclerosis (ALS) patients are now well-acknowledged. This study aimed to define the structural basis of cognitive abnormalities in ALS, by clarifying the involvement of specific cognitive domains and the respective contribution of white matter damage to the integrity of the uncinate (UF), inferior longitudinal (ILF) and inferior-frontal occipital (IFOF) fasciculi. <h3>Method</h3> 26 ALS patients and 27 healthy controls underwent a detailed neuropsychological assessment and a whole brain diffusion tensor imaging (DTI) scan. The two groups were matched for age, IQ, years of education, and anxiety and depression scores. Individual neuropsychological test scores were converted into four composite scores, measuring executive functions, language, memory and visuospatial ability. Changes in fractional anisotropy (FA) and mean diffusivity (MD) were measured along the UF, ILF, and the IFOF using a two-region of interest approach. <h3>Results</h3> ALS patients were found to exhibit impaired performance on the executive and language composite test scores, but not on memory and visuospatial composite test scores. DT-MRI investigations of the white matter association tracts (ie, UF, ILF and IFOF) identified no significant differences in ALS-patients compared to healthy controls with respect to mean FA values, indicating that water diffusion within these tracts still followed the main axonal direction. MD values however were found to be significantly increased within the uncinate fasciculus of ALS-patients compared to healthy controls. This is associated with neurodegeneration, as an increased MD typically arises from reduced barriers of diffusion, indicating weak axonal myelination. Correlational analysis did not find significant relationships between white matter tracts and neuropsychological composite scores. <h3>Conclusion</h3> The findings confirm the presence of executive dysfunction in ALS patients and also suggest that language deficits maybe more extensive and prevalent than has been suggested by previous research. These results suggest involvement of the UF within the disease-profile of ALS, however correlations to significant deficits remain to be found. If confirmed in a larger study this frontal white matter change could represent an important biomarker for trials in ALS.

Testing for Evidence of an X-Linked Genetic Basis for a Greater Proportion of Males with High Cognitive Ability

X-linked genetic differences between male and females have been posited to cause greater variance in cognitive ability in males. Males with only one X chromosome tend to express the genes on the X chromosome more fully than females, who express an "average" of their two X chromosomes due to X-inactivation. Greater variability in expression of genes on the X chromosome could account for greater variability in male cognitive ability. This would affect both the high and low ends of the cognitive ability distribution, but the possibility of high-end impact has drawn the most attention and controversy. The objective of this paper was to outline a method to test for empirical evidence that greater X-chromosomal variation in males is associated with greater variation in cognitive ability in males at the high end of the distribution. The method utilizes exogenous variation in the maternal X chromosome of twins to test the effect of sex on within-pair variation. We applied this method to g composite test scores at age 10 using data from the Twins Early Development Study. Twin-pair zygosity was used as an instrument reflecting whether twins had different maternal X chromosomes. We estimated differences in the association between variation in the maternal X chromosome in males and females and within-pair variation in test scores using a difference in differences specification of a linear regression model. We found no evidence supporting the proposition that the "averaging" effect of X-inactivation in females resulted in greater variation in male cognitive ability. There was evidence of differential selection for cognitive ability in the sample, however, indicating that the value of our study was primarily to introduce a novel method of addressing the question.

The effects of school-based management in the Philippines: an initial assessment using administrative data

This paper estimates the effect of school-based management on student performance in the Philippines using the administrative dataset of all public schools in 23 school districts over a three-year period, 2003–2005. The authors test whether schools that received early school-based management interventions (training in school-based management and direct funding for school-based reforms, based on school improvement plans) attained higher average test scores than those that did not receive such inputs. The analysis uses school-level overall composite test scores (comprising all subject areas tested) and test scores in three separate subject areas: English, mathematics, and science. Their preferred estimator, difference-in-difference with propensity score matching, shows that the average treatment effect of participation in school-based management was higher by 1.5 percentage points for overall composite scores, 1.2 percentage points for mathematics scores, 1.4 percentage points for English scores, and 1.8 percentage points for science scores. These results suggest that the introduction of school-based management had a statistically significant, albeit small, overall positive effect on average school-level test scores in 23 school districts in the Philippines. The paper provides a first glimpse of the potential for school-based management in a Southeast Asian context based on available administrative data. The authors suggest that the next order of research is to answer policy-related questions regarding the reforms: what aspects of the reform lead to desired results; are there differential effects across subpopulations; and what are the potential downsides to the reforms? The authors recommend that countries embarking on implementation of school-based management reforms specify their school-based management model and theories of change clearly and advance mechanisms for rigorous evaluations simultaneously. Such evaluations should not only provide more accurate estimates of the effectiveness of the reforms, but also help answer policy-related questions regarding design and implementation of those reforms in different sociocultural contexts.

For debate: substituting placebo controls in long-term Alzheimer's prevention trials

IntroductionNovel compounds with potential to attenuate or stop the progression of Alzheimer's disease (AD) from its presymptomatic stage to dementia are being tested in man. The study design commonly used is the long-term randomized, placebo-controlled trial (RPCT), meaning that many patients will receive placebo for 18 months or longer. It is ethically problematic to expose presymptomatic AD patients, who by definition are at risk of developing dementia, to prolonged placebo treatment. As an alternative to long-term RPCTs we propose a novel clinical study design, termed the placebo group simulation approach (PGSA), using mathematical models to forecast outcomes of presymptomatic AD patients from their own baseline data. Forecasted outcomes are compared with outcomes observed on candidate drugs, thus replacing a concomitant placebo group.MethodsFirst models were constructed using mild cognitive impairment (MCI) data from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database. One outcome is the Alzheimer Disease Assessment Scale - cognitive subscale (ADAScog) score after 24 months, predicted in a linear regression model; the other is the trajectory over 36 months of a composite neuropsychological test score (Neuro-Psychological Battery (NP-Batt)), using a mixed model. Demographics and clinical, biological and neuropsychological baseline values were tested as potential predictors in both models.ResultsADAScog scores after 24 months are predicted from gender, obesity, Functional Assessment Questionnaire (FAQ) and baseline scores of Mini-Mental State Examination, ADAScog and NP-Batt with an R2 of 0.63 and a residual standard deviation of 0.67, allowing reasonably precise estimates of sample means. The model of the NP-Batt trajectory has random intercepts and slopes and fixed effects for body mass index, time, apolipoprotein E4, age, FAQ, baseline scores of ADAScog and NP-Batt, and four interaction terms. Estimates of the residual standard deviation range from 0.3 to 0.5 on a standard normal scale. If novel drug candidates are expected to diminish the negative slope of scores with time, a change of 0.04 per year could be detected in samples of 400 with a power of about 80%.ConclusionsFirst PGSA models derived from ADNI MCI data allow prediction of cognitive endpoints and trajectories that correspond well with real observed values. Corroboration of these models with data from other observational studies is ongoing. It is suggested that the PGSA may complement RPCT designs in forthcoming long-term drug studies with presymptomatic AD individuals.

Emotional and Neuropsychological Profiles of Children With Complex Regional Pain Syndrome Type-I in an Inpatient Rehabilitation Setting

Examine the emotional and neuropsychological profiles of pediatric Complex Regional Pain Syndrome Type-I in an inpatient setting. Seventeen children and adolescents (all female; ages 9 to 18 y) admitted to an inpatient rehabilitation facility who completed neuropsychological assessments that included emotional functioning questionnaires, projective personality measures, and neuropsychological measures. Consistent evidence for somatization was found. Thirty-eight percent of patients exhibited at-risk/elevated mood symptoms (anxiety or depression) based on self-report or parent report. Overall, few patients exhibited at risk/impaired neuropsychological test composite scores. A sizable proportion of patients (36%), however, showed at risk/impaired attention/working memory composite scores. Children with Complex Regional Pain Syndrome Type-I may experience emotional distress that is better identified through using multiple assessment methods. Results provide support for an elevated risk of somatic symptoms and emotional distress, especially anxiety, among certain individuals in this population. Results also provide preliminary evidence for an elevated risk of difficulties with attention/working memory.

Olfactory testing in clinical settings - is there additional benefit from unilateral testing?

In clinical settings, olfactory testing is usually performed bilaterally; thus, unilateral olfactory loss may go unnoticed. The aims of this study were to evaluate 1) whether patients presenting with self-reported olfactory disorders demonstrate significant side differences in odour perception, depending on the prevalance of measured unilateral disorder, and 2) to evaluate the existing testing procedure. In 518 patients presenting with olfactory disorders, olfactory testing was performed using the "Sniffin' Sticks" test battery (consisting of a threshold, discrimination, and odour identification test) examining each nostril separately. According to the history and results from the clinical examination, olfactory disorders were classified as related to trauma, sinunasal disease, upper respiratory tract infection (URTI), tumour, congenital, idiopathic, and other. A difference of three or more points in one of the subtests or six or more points in the composite olfactory test score was considered a side difference. In almost one quarter of all presenting patients (23.4%), a side difference was detected. To not to miss lateralized disorders, we recommend testing each nostril separately. Depending on the presence or absence of a significant difference, testing then can be continued birhinally or separately for each nostril.

Correlation of cognitive symptoms with cognitive performance among brain cancer patients after radiation therapy.

2084 Background: Cognitive symptoms can occur among cancer patients, though the incidence and severity vary across cancer type, location, treatment and time. Some have argued that subjective cognitive symptoms reflect patients' mood or fatigue more than objective cognitive functioning per se and there are studies showing no correlation between complaints and performance. Methods: The present study describes the correlations at baseline between subjective cognitive symptoms (FACT-Brain symptoms subscale), fatigue (FACT-Fatigue) and mood (Profile of Mood States) and objective cognitive performance (Controlled Oral Word Association Test, Hopkins Verbal Learning Test-Revised, Digit Span Test, Trail Making Test, Grooved Pegboard and summary Cognitive Composite Score [CCS]), among 82 brain cancer survivors who are ≥ 6 months post partial or whole brain irradiation participating in a phase III clinical trial of an acetylcholinesterase inhibitor, donepezil. Results: The sample (mean age = 52 yrs.; 50% female; 83% > HS) had primary (n = 52, 63%) and metastatic (n = 30, 37%) brain tumors. Significant bivariate correlations between the FACT-Br and the CCS (r = 0.42, p < 0.0001) and 7 of 10 cognitive tests (range:-0.26 to 0.44, p < 0.05) indicate that more symptoms predicted poorer performance. Neither overall fatigue (r = 0.19, p = 0.08) nor distressed mood (r = -0.05, p = 0.67) was associated with CCS. Adjusting for tumor type (primary vs. metastatic), age, education, fatigue, QOL, sex and race revealed a very similar pattern. Conclusions: Among 6+ month survivors of brain irradiation, there is an association between objective cognitive performance and subjective cognitive symptoms while mood and fatigue are minimally related to performance. Self-reported cognitive problems are not a substitute for cognitive performance measures, however they can be a valid and useful indicator of well-being and used as a clinical outcome in this population. This study was supported by Eisai, Inc., and NIH grants NCI/DCP 2 U10 CA 81851-09-13 and NINR 5R01NR009675. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Eisai Pfizer Eisai Eisai, Pfizer

Effects of electrotactile vestibular substitution on rehabilitation of patients with bilateral vestibular loss

The present study evaluated the effectiveness of electrotactile tongue biofeedback (BrainPort ®) as a sensory substitute for the vestibular apparatus in patients with bilateral vestibular loss (BVL) who did not have a good response to conventional vestibular rehabilitation (VR). Seven patients with BVL were trained to use the device. Stimulation on the surface of the tongue was created by a dynamic pattern of electrical pulses and the patient was able to adjust the intensity of stimulation and spatially centralize the stimulus on the electrode array. Patients were directed to continuously adjust head orientation and to maintain the stimulus pattern at the center of the array. Postural tasks that present progressive difficulties were given during the use of the device. Pre- and post-treatment distribution of the sensory organization test (SOT) composite score showed an average value of 38.3 ± 8.7 and 59.9 ± 11.3, respectively, indicating a statistically significant improvement ( p = 0.01). Electrotactile tongue biofeedback significantly improved the postural control of the study group, even if they had not improved with conventional VR. The electrotactile tongue biofeedback system was able to supply additional information about head position with respect to gravitational vertical orientation in the absence of vestibular input, improving postural control. Patients with BVL can integrate electrotactile information in their postural control in order to improve stability after conventional VR. These results were obtained and verified not only by the subjective questionnaire but also by the SOT composite score. The limitations of the study are the small sample size and short duration of the follow-up. The current findings show that the sensory substitution mediated by electrotactile tongue biofeedback may contribute to the improved balance experienced by these patients compared to VR.