Computerized Dynamic Posturography Research Articles

ABSTRACT: IMPROVEMENT IN VERTIGO, FATIGUE, HIGH BLOOD PRESSURE AND SLEEP QUALITY FOLLOWING A PROGRAM OF VESTIBULAR REHABILITATION AND SPINAL MANIPULATIVE THERAPY

Event Abstract Back to Event ABSTRACT: IMPROVEMENT IN VERTIGO, FATIGUE, AND SLEEP QUALITY FOLLOWING A PROGRAM OF VESTIBULAR REHABILITATION AND SPINAL MANIPULATIVE THERAPY David Schiller1* 1 Dr. David Schiller, United States Background: A 29 year old female presented to the clinic with symptoms of vertigo, fatigue and sleep disturbance that escalated after a pregnancy three years prior. Additionally, she has noticed tremors in both hands and cramping in both feet. She also claimed “bad pain” in both hands and wrists. There was a previous diagnosis of Benign Paroxysmal Positional Vertigo (BPPV) in 2005. The patient claims that “something internally is off.” She was prescribed Meclizine to take as needed. Methods: Neurological examination revealed positive Romberg’s test, finger to nose testing revealed intention tremor on the left, downbeat nystagmus was observed with opthalmoscopic examination and optokinetic nystagmus stimulation was abnormal to the left. Saccodometry revealed a heteroscedastic distribution of 100 saccades in terms of latency, velocity and accuracy. Computerized Dynamic Posturography (CDP) revealed abnormal stability patterns including more stability with eyes closed than open. A program of vestibular rehabilitation (VR) and spinal manipulative therapy (SMT) was initiated to address the neurological findings. VR included gaze-holding exercises, passive and active vestibular canal stimulation and multi-planar upper extremity movements. Results: Patient reported resolution of the vertigo and the fatigue improved. Romberg’s test normalized. Intention tremor and downbeat nystagmus resolved. Optokinetic nystagmus normalized. Saccadic latency, velocity, and amplitude improved and the distributions of 100 saccades became more homoscedastic. CDP showed improvement in stability and balance scores. Treatment produced an increase in hours of continuous sleep. Tremors in hands and cramps in feet resolved. Conclusion: this author recommends further investigation into multimodal treatment protocols that include VR and SMT to address vertigo, sleep disturbance and fatigue Keywords: Vertigo, BPPV, benign paroxysmal positional vertigo, insomnia, Hypertension, high blood pressure, Meclizine, Fatigue, Neurorehabilitation, Vestibular Rehabilitation, saccodometry, Saccadic eye movements, Romberg test, spinal manipulation Conference: International Symposium on Clinical Neuroscience: TBI and Neurodegeneration, Orlando, Florida, United States, 10 Dec - 14 Dec, 2015. Presentation Type: Poster Presentation Topic: Case Reports for Poster Presentation Citation: Schiller D (2015). ABSTRACT: IMPROVEMENT IN VERTIGO, FATIGUE, AND SLEEP QUALITY FOLLOWING A PROGRAM OF VESTIBULAR REHABILITATION AND SPINAL MANIPULATIVE THERAPY. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience: TBI and Neurodegeneration. doi: 10.3389/conf.fneur.2015.58.00007 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 01 Nov 2015; Published Online: 02 Nov 2015. * Correspondence: Dr. David Schiller, Dr. David Schiller, Avon, Connecticut, 06001, United States, drschiller@comcast.net Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers David Schiller Google David Schiller Google Scholar David Schiller PubMed David Schiller Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

The Mulligan ankle taping does not affect balance performance in healthy subjects: a prospective, randomized blinded trial.

[Purpose] The aim of this study was to evaluate the immediate effects of Mulligan fibular taping on static and dynamic postural balance in healthy subjects using computerized dynamic posturography (CDP). [Subjects and Methods] Forty-four volunteers (26 males and 18 females) aged 21 ±2 years participated in the study. The Mulligan tape was applied by a specialist in this technique. The placebo group received a treatment with a similar tape but with several cuts to avoid the fibular repositioning effect produced by Mulligan tape. Main outcome measures: The Sensory Organization Test (SOT) and the Motor Control Test (MCT) were performed by each subject at baseline and after the interventions. Outcome measures included equilibrium and strategy scores from each trial and condition of the SOT, and speed of reaction (latency period) from the MCT. [Results] Mulligan ankle taping did not have an impact on postural control during static and dynamic balance in subjects with healthy ankles when compared with placebo taping. [Conclusion] There was no difference in, equilibrium and strategy (SOT) and speed of reaction (MCT) in any of the subjects in this study. Therefore, this study suggests that Mulligan ankle taping does not have an impact on balance in healthy subjects.

UNEXPLAINED LOWER BACK PAIN WITH BILATERAL LOWER EXTREMITY STIFFNESS IN A HEALTHY 28 YEAR OLD MALE

Event Abstract Back to Event UNEXPLAINED LOWER BACK PAIN WITH BILATERAL LOWER EXTREMITY STIFFNESS IN A HEALTHY 28 YEAR OLD MALE Ryan Weaver1* 1 Integrative Chiropractic Center, United States UNEXPLAINED LOWER BACK PAIN WITH BILATERAL LOWER EXTREMITY STIFFNESS IN A HEALTHY 28 YEAR OLD MALE Ryan F. Weaver, DC DACNB Integrative Chiropractic Center 1970 N. Broad St., Lansdale, PA 19438 Backround:A healthy 28 year old male with a 4 month history of lower back and unexplained bilateral lower extremity symptoms including: stiffness, aching, and burning, graded 8/10 on a Visual analog scale(VAS). The symptoms could not be explained by MRI, Ultrasound, or blood work. Computerized Dynamic Posturography (CDP) showed a Posterior center of pressure of -2.37 in the Anterior-Posterior Plane. Severe instability 60% stability score, was found with with head extended on a pertubated surface with eyes closed (PECHE). The patient had resting tremor in the upper extremity and Finger tapping test graded a 3 Unified Parkinson’s Disease Rating Scale (UPDRS). Methods: Somatosensory stimulation, Saccade eye exercises, Tonic Graviceptive roll exercises were performed in office with 13 treatments over 60 days. A home program of saccades and static graviceptive roll exercises were performed 3 times per day. Results: VAS was reduced to 1/10, UPDRS score was normal. Center of pressure was lessen in the posterior plane, becoming -.63. CDP test PECHE score improved to 75% stability. Tremor was observantly less. Conclusion: This author suggest intensive in office with supplemental home program of vestibular rehabilitation can possibly assist in treatment of unexplained lower back and lower extremity stiffness and pain in healthy individuals. Conflict of interest: The author declare that the research conducted was done son in the absence of any financial or other relationships that could be construed as a conflict of interest. Keywords: Tremor, Pain Measurement, UPDRS, Pain Management, Back Pain, Lower Extremity Conference: International Symposium on Clinical Neuroscience: TBI and Neurodegeneration, Orlando, Florida, United States, 10 Dec - 14 Dec, 2015. Presentation Type: Poster Presentation Topic: Case Reports for Poster Presentation Citation: Weaver R (2015). UNEXPLAINED LOWER BACK PAIN WITH BILATERAL LOWER EXTREMITY STIFFNESS IN A HEALTHY 28 YEAR OLD MALE. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience: TBI and Neurodegeneration. doi: 10.3389/conf.fneur.2015.58.00069 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 22 Oct 2015; Published Online: 02 Nov 2015. * Correspondence: Dr. Ryan Weaver, Integrative Chiropractic Center, Lansdale, Pennsylvania, 19446, United States, Drryanweaver@yahoo.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Ryan Weaver Google Ryan Weaver Google Scholar Ryan Weaver PubMed Ryan Weaver Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

POST-STROKE IMPROVEMENTS IN BALANCE AND MOBILITY BY EMPLOYING FUNCTIONAL NEUROLOGY TREATMENTS

Event Abstract Back to Event POST-STROKE IMPROVEMENTS IN BALANCE AND MOBILITY BY EMPLOYING FUNCTIONAL NEUROLOGY TREATMENTS Susan Esposito1*, Adrian C. Santiago1 and Linda Mullin Elkins1 1 Life University, United States Background: A housewife in her mid sixties presented to a university functional neurology clinic with chronic symptomatology that had commenced two years prior, after having suffered a left cerebral ischemic stroke. The patient suffered from right-sided hemiparesis with flexor posturing, imbalance and weakness. She also experienced episodes of severe anxiety, fatigue and insomnolence. Finger to thumb tapping test exhibited a grade 3 on the left for velocity and inaccuracy and a grade 4 on the right due to the inability to approximate her fingers. She fell during her computerized dynamic posturography (CDP) exam, which gave her a stability score of zero. Her right foot dragged during ambulation, slowing her gait. Methods: The patient was treated daily for one week; each day’s treatment consisted of three sessions. Each session included brain based eye exercises specifically designed to stimulate the left cerebral cortex and enhance gaze stability. Treatment also included passive complex right arm and leg movement exercises, mirror therapies, stimulation of the right hypoglossal and trigeminal nerves, breathing exercises as well as adjustments of the cervical spine and ribs. Results: At the end of the week’s treatment, she showed significant improvement. She had balance and stability that were within normal limits on CDP exam. Finger tapping test showed a grade 1 on the left and a grade 2 on the right. She was able to extend her right arm and perform fine movements of the fingers on her right hand such as opening a button and using a knife and fork. Her gait increased in speed and was without foot drag. She had resolution of her anxiety and fatigue, which allowed her to sleep through the night for the first time in years. Conclusion: Persistent post-stroke symptoms and limitations may be improved with specific brain based therapies. The positive outcomes in this case point to the need for further research in these areas. Keywords: Functional Neurology, Imbalance, Hemi-paresis, stroke rehabilitation, Chiropractic Conference: International Symposium on Clinical Neuroscience: TBI and Neurodegeneration, Orlando, Florida, United States, 10 Dec - 14 Dec, 2015. Presentation Type: Poster Presentation Topic: Case Reports for Poster Presentation Citation: Esposito S, Santiago AC and Mullin Elkins L (2015). POST-STROKE IMPROVEMENTS IN BALANCE AND MOBILITY BY EMPLOYING FUNCTIONAL NEUROLOGY TREATMENTS. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience: TBI and Neurodegeneration. doi: 10.3389/conf.fneur.2015.58.00034 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 01 Nov 2015; Published Online: 02 Nov 2015. * Correspondence: Dr. Susan Esposito, Life University, Marietta, Georgia, 30060, United States, susan.esposito@life.edu Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Susan Esposito Adrian C Santiago Linda Mullin Elkins Google Susan Esposito Adrian C Santiago Linda Mullin Elkins Google Scholar Susan Esposito Adrian C Santiago Linda Mullin Elkins PubMed Susan Esposito Adrian C Santiago Linda Mullin Elkins Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Resolution of Vertigo, Headaches, and Numbness in Right Hand after Functional Neurological and Vestibular Treatment

Event Abstract Back to Event Resolution of Vertigo, Headaches, and Numbness in Right Hand after Functional Neurological and Vestibular Treatment Wayne R. Miller1* 1 Miller Chiropractic, United States Background: A 53- year old female presented to the clinic for assessment of vertigo for 2 years duration and somatosensory disturbance of the right upper extremity and frequent headaches, following a left Cerebellar infarct. Both medical and previous Chiropractic care proved ineffective. Methods: A neurological exam including Computerized Dynamic Posturography (CDP) and videonystagmography (VNG) testing confirmed BPPV, and a centrally maintained vestibulopathy, with somatosensory lesions. She underwent functional neurological treatment that included complex passive movement of the upper extremity, brain-based therapeutic exercises, and whole-body multiaxis vestibular rehabilitation. . Results: All vertigo and right extremity symptoms as well as headaches were gone. Improved OPK and saccadic intrusions on VNG testing. Conclusion: Functional neurological treatments including vestibular rehahilitaion strategies were used with positive outcomes in this case of central imbalance with somatosensory disturbances. Further study in the use of these strategies is suggested. Keywords: VNG, Vestibular Rehabilitation, Whole Body Rotaion, posturography, Functional Neurology Conference: International Symposium on Clinical Neuroscience: TBI and Neurodegeneration, Orlando, Florida, United States, 10 Dec - 14 Dec, 2015. Presentation Type: Poster Presentation Topic: Case Reports for Poster Presentation Citation: Miller WR (2015). Resolution of Vertigo, Headaches, and Numbness in Right Hand after Functional Neurological and Vestibular Treatment. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience: TBI and Neurodegeneration. doi: 10.3389/conf.fneur.2015.58.00060 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 30 Oct 2015; Published Online: 02 Nov 2015. * Correspondence: Dr. Wayne R Miller, Miller Chiropractic, Santa Maria, California, 93455, United States, wayne@weadju.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Wayne R Miller Google Wayne R Miller Google Scholar Wayne R Miller PubMed Wayne R Miller Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

CHRONIC SYMPTOMS FROM MULTIPLE CONCUSSIONS IMPROVED THROUGH FUNCTIONAL BRAIN-BASED STRATEGIES.

Event Abstract Back to Event CHRONIC SYMPTOMS FROM MULTIPLE CONCUSSIONS IMPROVED THROUGH FUNCTIONAL BRAIN-BASED STRATEGIES. Susan Esposito1* and David Koentop2 1 Life University, United States 2 Atlantic Medicine and Wellness, United States Background: A male graduate student in his mid-twenties presented to a functional neurology clinic for assessment of tremors, head fogginess, impaired reading comprehension, and inability to focus. Examination revealed a right hypertropia and a 6Hz tremor of his hands bilaterally. The patient showed decreased ability of gaze stabilization in all visual planes with aberrant saccades and pursuits. The patient’s history included numerous concussions and cranial impacts over years of playing hockey. Methods: A thorough neurological exam including Computerized Dynamic Posturography (CDP) and video nystagmography (VNG) testing confirmed a central vestibular lesion, cortical desynchronization, and inability to gaze fixate. He underwent a two month long program of functional neurological treatment that included complex passive movements of upper and lower extremities, brain-based therapeutic eye exercises, somatosensory evoked potential stimulations, and whole-body multiaxis vestibular rehabilitation. Results: The tremors in his hands completely disappeared immediately after treatment, but subsequently re-emerged with reduced amplitude and frequency. Head fogginess, inability of reading comprehension, decreased mental focus, and aberrant eye motions have reduced substantially. CDP scores improved drastically with eyes closed, head in extension on a perturbed surface from 0 to 46.5% stability. Square wave jerks and other eye movement aberrations were markedly diminished on VNG testing. Conclusion: Functional neurological treatments including vestibular rehabilitation strategies were used with positive outcomes in this case of tremors, head fogginess, impaired reading comprehension and mental focus. Further research in of the use of these strategies is suggested. Keywords: Functional Neurology, Tremor, brain fog, vestibular therapy, Chiropractic Conference: International Symposium on Clinical Neuroscience: TBI and Neurodegeneration, Orlando, Florida, United States, 10 Dec - 14 Dec, 2015. Presentation Type: Poster Presentation Topic: Case Reports for Poster Presentation Citation: Esposito S and Koentop D (2015). CHRONIC SYMPTOMS FROM MULTIPLE CONCUSSIONS IMPROVED THROUGH FUNCTIONAL BRAIN-BASED STRATEGIES.. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience: TBI and Neurodegeneration. doi: 10.3389/conf.fneur.2015.58.00037 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 31 Oct 2015; Published Online: 02 Nov 2015. * Correspondence: Dr. Susan Esposito, Life University, Marietta, Georgia, 30060, United States, susan.esposito@life.edu Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Susan Esposito David Koentop Google Susan Esposito David Koentop Google Scholar Susan Esposito David Koentop PubMed Susan Esposito David Koentop Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

IMPROVEMENTS IN DELAYED SPEECH, MOTOR ACTIVITY AND BEHAVIOR IN A 5-YEAR-OLD MALE

Event Abstract Back to Event IMPROVEMENTS IN DELAYED SPEECH, MOTOR ACTIVITY AND BEHAVIOR IN A 5-YEAR-OLD MALE Susan E. Esposito1* and Linda Mullin Elkins1 1 Life University, United States Background: Parents of a 5-year-old male brought him to a university functional neurology clinic with concerns regarding his lack of normal and expected proficiency in speech, motor activity and behavior for a child of his age. His parents reported that he suffered from severe constipation and he had difficulties with balance and coordination. They reported that he had not be diagnosed or assessed for pervasive development disorder, despite possessing many of the common symptoms, such as his lack of attention and aversion to being touched or touching others. Methods: On examination the patient was unable to attend to any stimulation for more than a few seconds at a time and avoided all physical contact. On ophthalmic exam his V:A ratio was 2.5:1 on the right and 3:1 left. He had a sluggish constriction to light and was photophobic and phonophobic. Optokinetic testing revealed nystagmus that was poor in all directions and absent to downward stimulus. There was a hyposensitivity to pinwheel testing on the left side of his body with decreased myotactic reflex. He was unable to sustain a tandem stance with either foot in the posterior position. He was unable to complete the entire Computerized Dynamic Posturography (CDP) testing due to imbalance and difficulty following directions. Results: After five consecutive full days of treatment including off-vertical-axis vestibular rehabilitation, specific eye exercises, targeting and complex movement therapy, he was able to follow directions and complete CDP testing. His stability score on a flat surface with eyes open improved from 48 to 71. He had the ability to balance in a tandem stance for 16 seconds. Constipation, photophobia and phonophobia were completely resolved. His V:A ratio was 2:1 bilaterally. Optokinetics were present and improved in all directions. He was able to sustain eye contact for several seconds at a time. Motor skills, feeling sensation, reflex response and gait all showed marked improvement. He was now able to button and unbutton his shirt, which he was previously unable to do. His speech was clearer and understandable and he initiated hand holding with his parents for the first time in his life. Conclusion: Development delays in children can have devastating effects on the entire family. The positive outcomes that were appreciated in this case warrant further research in this area of treatment. Keywords: Functional Neurology, Pervasive developmental disorder, Dysmetria, Speech Therapy, Chiropractic Conference: International Symposium on Clinical Neuroscience: TBI and Neurodegeneration, Orlando, Florida, United States, 10 Dec - 14 Dec, 2015. Presentation Type: Poster Presentation Topic: Case Reports for Poster Presentation Citation: Esposito SE and Mullin Elkins L (2015). IMPROVEMENTS IN DELAYED SPEECH, MOTOR ACTIVITY AND BEHAVIOR IN A 5-YEAR-OLD MALE. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience: TBI and Neurodegeneration. doi: 10.3389/conf.fneur.2015.58.00002 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 01 Nov 2015; Published Online: 02 Nov 2015. * Correspondence: Dr. Susan E Esposito, Life University, Marietta, United States, susanesposito@gmail.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Susan E Esposito Linda Mullin Elkins Google Susan E Esposito Linda Mullin Elkins Google Scholar Susan E Esposito Linda Mullin Elkins PubMed Susan E Esposito Linda Mullin Elkins Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Postural control and sensory information integration abilities of boys with two subtypes of attention deficit hyperactivity disorder: a case-control study

Background Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed psychiatric disorder in childhood. ADHD children with overlapping symptoms and signs of motor problems have more serious prognosis than that of children with ADHD only. However, the motor and sensory processing problems in children with ADHD have not been studied well. Few people adopt the technique of computerized dynamic posturography (CDP) in the study of ADHD, which is applied widely in clinical and laboratory research to objectively evaluate human's balance performance. This study aimed to assess the characteristics of postural control and sensory information processing of boys with two subtypes of ADHD by using CDP, so as to provide the proof for non-drug therapy of ADHD. Method From June 2003 to September 2004, a total of 73 boys (7–15 years of age) with ADHD and 73 normal developing boys matched by age and intelligence quotient from Peking University Institute of Mental Health were recruited in the study. The Sensory Organization Test was adopted to test the static balance performance under six sensory input conditions by SMART EquiTest 8.0 (NeuroCom) instrument. The sensory information from three sensory systems were available under condition 1, the visual inputs were removed or distorted under condition 2 or 3, the somatosensory inputs were in conflict with or without the visual inputs removed under condition 4 or 5, and both the visual and somatosensory inputs were in conflict under condition 6. The indexes of equilibrium score, somatosensory, vestibular, and visual ratios, and strategy scores were analyzed to indicate the subjects’ postural control ability. Results ADHD boys had significantly lower composite equilibrium score (CES) than the normal group (P <0.05). Under condition 1 and conditions 3–6, the equilibrium scores (ES) of the ADHD group were significantly lower (all P <0.05) than those of the control. Significantly lower visual and vestibular ratios and strategy scores under conditions 4–6 were found in boys with ADHD compared with the control group (P <0.05). Boys of ADHD-predominantly inattentive (ADHD-I) type had a significantly lower CES and ES under conditions 4–6 than the controls (all P <0.05) while the ESs of ADHD-combined type (ADHD-C) boys under each condition were similar with that of boys with ADHD-I and no significant difference was found between boys with ADHD-C and the control group (all P >0.05). Compared with the control group, the ADHD-I boys showed significantly lower visual and vestibular ratios and strategy scores under conditions 4–6 whereas the ADHD-C boys showed a trend of lower visual ratio (all P <0.05). Conclusions ADHD boys had a poorer static postural control ability and impaired function of processing visual and vestibular information compared with the normal control. Boys with ADHD-I showed particularly severe defect of static postural control and vestibular function integrating conflict information than normal boys. These deficits may be an important contributor to the clinical presentation of ADHD children and their cognitive deficits. Assessment and training of postural control function would be suggested during the diagnosis and treatment of ADHD children.

Gait and computerized dynamic posturography (CDP) aspects in early progressive supranuclear palsy (PSP) - a case report.

BACKGROUND: Posture and gait instability may cause of morbidity in individuals with progressive supranuclear palsy (PSP). OBJECTIVE: To quantitatively measure balance control by using computerized dynamic posturography (CDP) and to assess gait analysis in early PSP.CASE REPORT: She was evaluated for Berge balance scale, Functional Independence Measure (FIM) and postural stability using CDP device in early PSP with still able to walk or stand unassisted. Also, Gait analysis was conducted using an 8 M-camera Vicon 612 data capturing system set. Berge balance scale improved from 41/56 to 48/56. The score of FIM improved from 71/126 points to 95/126 points in early PSP. In CDP analysis, there was a decrease of composite equilibrium score (38 %). There was an increase of composite equilibrium score (59%) after three months of treatment. In gait analysis, there was no difference of gait parameters after three months of treatment in early PSP.CONCLUSIONS: Both CDP and gait analysis are important quantitative tools in the assessment of posture and gait instability as well as allow for early disclosure of the failure of the postural control system in early PSP.

Gait and Computerized Dynamic Posturography (CDP) Aspects in Early Progressive Supranuclear Palsy (PSP) - A Case Report

BACKGROUND: Posture and gait instability may cause of morbidity in individuals with progressive supranuclear palsy (PSP). OBJECTIVE: To quantitatively measure balance control by using computerized dynamic posturography (CDP) and to assess gait analysis in early PSP.CASE REPORT: She was evaluated for Berge balance scale, Functional Independence Measure (FIM) and postural stability using CDP device in early PSP with still able to walk or stand unassisted. Also, Gait analysis was conducted using an 8 M-camera Vicon 612 data capturing system set. Berge balance scale improved from 41/56 to 48/56. The score of FIM improved from 71/126 points to 95/126 points in early PSP. In CDP analysis, there was a decrease of composite equilibrium score (38 %). There was an increase of composite equilibrium score (59%) after three months of treatment. In gait analysis, there was no difference of gait parameters after three months of treatment in early PSP.CONCLUSIONS: Both CDP and gait analysis are important quantitative tools in the assessment of posture and gait instability as well as allow for early disclosure of the failure of the postural control system in early PSP.

Tailored balance exercises on people with multiple sclerosis: A pilot randomized, controlled study

Background: Altered integration of signals from visual (VIS), somatosensory (PROP) and vestibular system (VEST) lead to balance control impairments affecting the daily living activities of patients with multiple sclerosis (PwMS). As a consequence, tailored interventions could be crucial in improving efficacy of balance rehabilitation treatments. Objective: The objective of this paper is to assess the efficacy of tailored rehabilitation treatments for balance disorders based on visual, somatosensory and vestibular deficits versus traditional rehabilitation exercises. Methods: Thirty-two PwMS were assessed with the Berg Balance Scale (BBS), the composite score (CS) obtained by computerized dynamic posturography (CDP) test and the Modified Fatigue Impact Scale (MFIS). Based on CDP analysis, prevalent VIS, PROP or VEST deficits were identified and patients randomly allocated to a personalized (PRG) or traditional (TRG) rehabilitation group. Results: BBS score showed a significant difference between pre- and post-treatment scores of 6.3 and 2.0 points respectively for PRG and TRG. CS showed a significant difference between pre- and post-treatment scores of 16.6 and 7.6 points respectively for PRG and TRG. No interaction effect was found for MFIS score. Conclusions: BBS and CS showed changes in the PRG group that met clinical relevant difference, underlining that tailored rehabilitation interventions based on patient-specific sensory system impairment could improve balance and postural control in PwMS.

Disequilibrium in patients with posterior fossa arachnoid cysts.

Arachnoid cysts (AC) are benign, congenital malformations of the leptomeninges. In our experience, dizziness and vertigo are common complaints in patients with such cysts. To quantify dizziness and imbalance in patients with arachnoid cysts in the posterior fossa using the Dizziness Handicap Inventory (DHI), Vertigo Symptom Scale Short-Form (VSS-SF) and Computerized Dynamic Posturography (CDP). We also wanted to investigate whether any dizziness and imbalance are reversible after surgical cyst decompression. The study includes four patients with AC in the posterior fossa (two in the cerebellopontine angle and two supracerebellar in the midline) and 15 control subjects undergoing ENT surgery for benign lesions of the larynx (n=10) or the parotid glands (n=5). All participants answered the DHI and VSS-SF and underwent CDP the day before, and at follow-up after surgery. The AC patients also graded their dizziness through the use of a Visual Analogue Scale (VAS). Preoperatively, cyst patients scored higher than controls on subjective symptoms (DHI, VSS-SF A and VSS-SF V) and had a lower score on postural sway (CDP). Symptom scores decreased after surgery; the cyst patients improved in the subjective tests (DHI, VAS and VSS-SF), and three of the patients improved their CDP scores. In the controls, symptom and CDP scores were unchanged after surgery. Patients with fossa posterior cyst had a significant preoperative impairment compared with the controls, and they exhibited post-operative improvement in their subjective dizziness.

Monitoring of motor function affection and postural sway in patients with type 2 diabetes mellitus

BackgroundDiabetes is a chronic metabolic disease with impaired glucose tolerance. Diabetic neuropathy affects sensory, autonomic, and motor neurons of the peripheral nervous system so that nearly every type of nerve fiber in the body is vulnerable. ObjectivesEvaluation of variation in motor functions and postural sway in patients with type 2 diabetes mellitus (DM) and comparing the results with those obtained from the control group. This will help in rehabilitation programs for diabetic patients to avoid postural instability and risk of falling. MethodologyForty patients with the diagnosis of type 2 DM (group 1) participated in this study and twenty subjects who had no diagnosis of type 2 DM were evaluated as a control group (group 2). Blood glucose level of patients was measured then they referred to audiovestibular assessment. Computerized dynamic posturography (CDP) was done in the form of motor control test and functional limitation assessment; Tandem walk. ResultsFindings showed a statistically significant difference between the study group and control group as regards response latency, speed of the forward progression and endpoint sway velocity. A statistically significant correlation was found between response latency and speed of the forward progression with FBS level in the study group. ConclusionsSpeed of the forward progression was less, however response latency and endpoint sway velocity were more in diabetic patients in comparison with normal subjects. Response latency and speed of the forward progression showed a statistically significant correlation with FBS level in diabetic patients.

Balance as a measurement of fatigue in postcall residents.

To determine the degree to which balance is impaired by fatigue in postcall medical residents and to assess the validity of posturography in quantifying that impairment. Prospective study. Medical residents underwent the following tests before and immediately after overnight call: 1) computerized dynamic posturography (CDP) using the Equitest force platform (Natus Medical Inc., Clackamas, OR); 2) Clinical Test of Sensory Interaction and Balance, in which the residents stood on a compliant foam mat with closed eyes and flexed and extended their necks; 3) a computerized reaction time test (available at www.humanbenchmark.com). All tests were performed before and after call at approximately the same time of day to exclude circadian rhythm influence on fatigue. The residents also completed questionnaires, including the Stanford Sleepiness Scale, describing their level of fatigue before and after call. A statistically significant difference was found between a resident's pre- and postcall test with regard to reaction time (P = .01), Stanford Sleepiness Scale score (P = .001), and preference for the visual system as measured by CDP (P = .05). Linear regression analysis showed a statistically significant relationship between sleep deprivation and multiple performance variables measured by CDP. With the growing attention paid to resident duty hours, there is an increasing need for research involving fatigue and practical ways to measure it. This study shows that residents who are measurably fatigued (both objectively and subjectively) may have difficulty utilizing vestibular input during quiet standing but can compensate by means of somatosensory and visual input. NA.

Selective skin sensitivity changes and sensory reweighting following short-duration space flight

Skin sensory input from the foot soles is coupled with vestibular input to facilitate body orientation in a gravitational environment. Anecdotal observations suggest that foot sole skin becomes hypersensitive following space flight. The veritable level of skin sensitivity and its impact on postural disequilibrium observed post space flight have not been documented. Skin sensitivity of astronauts (n = 11) was measured as vibration perception at the great toe, fifth metatarsal and heel. Frequencies targeted four classes of receptors: 3 and 25 Hz for slow-adapting (SA) receptors and 60 and 250 Hz for fast-adapting (FA) receptors. Data were collected pre- and post-space flight. We hypothesized that skin sensitivity would increase post-space flight and correlate to balance measures. Decreased skin sensitivity was found on landing day at 3 and 25 Hz on the great toe. Hypersensitivity was found for a subset of astronauts (n = 6) with significantly increased sensitivity to 250 Hz at the heel. This subset displayed a greater reduction in computerized dynamic posturography (CDP) equilibrium (EQ) scores (-54%) on landing vs. non-hypersensitive participants (-11%). Observed hyposensitivity of SA (pressure) receptors may indicate a strategy to reduce pressure input during periods of unloading. Hypersensitivity of FAs coupled with reduced EQ scores may reflect targeted sensory reweighting. Altered gravito-inertial environments reduce vestibular function in balance control which may trigger increased weighting of FAs (that signal foot contact, slips). Understanding modulations to skin sensitivity has translational implications for mitigating postural disequilibrium following space flight and for on-Earth preventative strategies for imbalance in older adults.

A tool for balance control training using muscle synergies and multimodal interfaces.

Balance control plays a key role in neuromotor rehabilitation after stroke or spinal cord injuries. Computerized dynamic posturography (CDP) is a classic technological tool to assess the status of balance control and to identify potential disorders. Despite the more accurate diagnosis generated by these tools, the current strategies to promote rehabilitation are still limited and do not take full advantage of the technologies available. This paper presents a novel balance training platform which combines a CDP device made from low-cost interfaces, such as the Nintendo Wii Balance Board and the Microsoft Kinect. In addition, it integrates a custom electrical stimulator that uses the concept of muscle synergies to promote natural interaction. The aim of the platform is to support the exploration of innovative multimodal therapies. Results include the technical validation of the platform using mediolateral and anteroposterior sways as basic balance training therapies.

The effect of height and BMI on computer dynamic posturography parameters in women.

The human body's posture control is a complex system of organs and mechanisms which controls the body's centre of gravity (COG) over its base of support (BOS). Computerised Dynamic Posturography (CDP) allows for the quantitative and objective assessment of the sensory and motor components of the body's posture control system as well as of the integration and adaptation mechanisms in the central nervous system. The aim of this study was to assess the relationships between the body's height and BMI on CDP results in a group of young healthy women without any clinical symptoms of balance disorders. It was found that the MS depended significantly on the height and BMI of the subjects as well as on the SOT conditions. As the height and BMI increased the MS value decreased. The postural response latency (LC) in the MCT statistically significantly depended only on height and showed a positive correlation. The postural response latency increased with height. The postural response amplitude for both right and left lower limbs significantly depended on height and BMI, but only for the backward movement of the platform. The response amplitude for all platform translations under all MCT conditions increased with height and BMI. The body's resultant imbalance caused by the platform perturbations in the ADT was greater in shorter people and those with a lower BMI.

Age-related changes in posture response under a continuous and unexpected perturbation

Aging is a critical factor to influence the functional performance during daily life. Without an appropriate posture control response when experiencing an unexpected external perturbation, fall may occur. A novel six-degree-of freedom platform with motion control protocol was designed to provide a real-life simulation of unexpected disturbance in order to discriminate the age-related changes of the balance control and the recovery ability. Twenty older adults and 20 healthy young adults participated in the study. The subjects stood barefoot on the novel movable platform, data of the center of mass (COM) excursion, joint rotation angle and electromyography (EMG) were recorded and compared. The results showed that the older adults had similar patterns of joint movement and COM excursion as the young adults during the balance reactive-recovery. However, larger proximal joint rotation in elderly group induced larger COM sway envelop and therefore loss of the compensatory strategy of posture recovery. The old adults also presented a lower muscle power. In order to keep an adequate joint stability preventing from falling, the EMG activity was increased, but the asymmetric pattern might be the key reason of unstable postural response. This novel design of moveable platform and test protocol comprised the computerized dynamic posturography (CDP) demonstrate its value to assess the possible sensory, motor, and central adaptive impairments to balance control and could be the training tool for posture inability person.

Electromyographic latency of postural evoked responses from the leg muscles during EquiTest Computerised Dynamic Posturography: Reference data on healthy subjects

No normative data are available for the latencies of the EMG signals from the ankle muscles in response to sudden sagittal tilt (toes-UP or toes-DOWN) or shift (shift-FOR or shift-BACK) of the support surface during standing. In this study the postural evoked response (PER) paradigm on the EquiTest™ force platform was applied to 31 healthy adults (18 women and 13 men; mean age 29years). The EMG latencies (PEREMG) were computed both through the standard manual procedure and through a specially designed automated algorithm. The manually computed PEREMG onset yielded a 95% tolerance interval between 82ms and 148ms after toes-UP perturbation, between 93ms and 182ms after toes-DOWN perturbation, between 67ms and 107ms after shift-BACK perturbation, and between 73ms and 113ms after shift-FOR perturbation. When comparing the two methods, paired t-tests showed no significant mean difference (Bonferroni-adjusted p-values ranged from 0.440 to 1.000) and all Bland–Altman plots included zero difference within the limits of agreement. Therefore, the manual and the automated methods appear to be sufficiently consistent. These results foster the clinical application of PEREMG testing on the EquiTest platform.

Pre‐ and post‐operative dizziness and postural instability in temporal arachnoid cyst patients

Arachnoid cysts (AC) are benign, congenital malformations of the leptomeninges, with a predilection for the temporal fossa. In our clinical experience, patients with temporal AC often complain of dizziness and imbalance. However, these symptoms and the effect of surgery on them have not been studied before. Dizziness and imbalance in patients with temporal AC were quantified before and after surgical cyst decompression, using the Dizziness Handicap Inventory (DHI), Vertigo Symptom Scale - Short-Form (VSS-SF) and computerized dynamic posturography (CDP). The study includes 16 patients with temporal AC and 15 control subjects undergoing surgery for benign lesions of the larynx (n = 10) or the parotid glands (n = 5). All participants answered the DHI and VSS-SF and underwent CDP the day before and 3-6 months after surgery. The patients with AC also graded their dizziness through the use of a visual analogue scale (VAS). Preoperatively, cyst patients scored higher than controls on subjective symptoms (DHI, VSS-SF A and VSS-SF V), but not on postural sway (CDP). Symptom scores decreased after surgery; the cyst patients improved significantly in the subjective tests (DHI, VAS and VSS-SF), while CDP scores did not. In the controls, symptom and CDP scores were unchanged after surgery. Patients with temporal AC have a significant preoperative impairment and post-operative improvement in their subjective dizziness, but not in postural sway as measured by CDP.