Postural Performance In Patients Research Articles

P124. Evaluation of gait parameters in functional gait disorders

Objective To identify thresholds for pathognomonic gait parameters in functional gait disorders. Background Characteristics of functional gait disorders are e.g. transient fluctuations in stance and gait, excessive slowness or hesitation that is not compatible with neurological disease, uneconomic postures with wastage of muscular energy, the ‘walking on ice’ gait pattern with typical small cautious steps with fixed ankle joints and sudden buckling of the knees that generally do not lead to falls ( Lempert et al., 1991 ). Early diagnosis is important: Over half of the patients with psychogenic disorder of stance and gait remain unchanged after five and a half years. If the disorder is present no longer than four months complete remission can often be achieved ( Brandt et al., 1994 ). Methods We used a pressure-sensitive GAITRite© carpet to assess gait analysis during eight gait conditions (three different walking speeds, two sensory and three cognitive tasks). Each of the 23 gait parameters was edited with custom software. A binary logistic regression, ROC (receiver operating characteristic) analysis and an inversed regression were performed to identify thresholds for pathological deviations from normal range. Results In the preferred speed condition, patients with functional gait disorder differed from healthy subjects in all gait parameters, particularly in velocity, spatial, and variability measures. In the cognitive dual task condition (i.e. dual task words), however, the gait parameters almost normalized, especially the variability parameters assimilate healthy subjects. Conclusion Characteristics of gait parameters of patients with functional gait disorder were similar to postural performance in patients with phobic postural vertigo (PPV; Wuehr et al., 2017 ): The dual-task effect in patients with functional gait disorder revealed that cognitive distraction led to a normalization in walking. This is typical for functional disorders and can also be observed in patients with PPV.

Examining the diagnostic accuracy of static postural stability measures in differentiating among knee osteoarthritis patients with mild and moderate to severe radiographic signs

BackgroundClinicians need a reliable and accurate tools that can best identify and classify balance impairments between mild and moderate to severe grades of knee osteoarthritis (OA). Research questionThis study was designed to investigate the accuracy of postural measurements to discriminate between these two groups of knee OA. MethodsA total of 130 patients with knee OA based on the Kellgren-Lawrence (KL) grading scale were categorized into 65 patients with mild (a KL grade≤ 2) and 65 patient with moderate to severe (a KL grade≥3) radiographic sign. Static postural control was assessed on the force plate in three conditions of double leg stance with open (DO) and closed eyes (DC) and single leg stance with open eyes (SO). The accuracy for static postural control parameters was determined by calculation of sensitivity, specificity, area under the Receiver Operating Characteristic (ROC) curve (AUC) and likelihood ratios (LRs). ResultsOur results showed that standard deviation (SD) of velocity in anterior-posterior (AP) direction had the highest sensitivity and specificity in conditions of DO and DC, respectively. ROC curve analysis indicated that measures of mean and SD velocity in medio-lateral (ML) direction in conditions of DO and DC had acceptable levels of accuracy (AUC > 0.70) in discriminating between the two groups of knee OA patients. Also, based on LR results, SD of velocity in AP direction had the best ability for ruling in and ruling out moderate to severe grade of knee OA patients in conditions of DC and DO, respectively. SignificanceOur findings provide evidence for selection of mean velocity and SD of velocity in identifying and discriminating static postural performance in patients with mild and moderate to severe grades of knee OA.

Effect of rhythmic auditory cueing on parkinsonian gait: A systematic review and meta-analysis

The use of rhythmic auditory cueing to enhance gait performance in parkinsonian patients’ is an emerging area of interest. Different theories and underlying neurophysiological mechanisms have been suggested for ascertaining the enhancement in motor performance. However, a consensus as to its effects based on characteristics of effective stimuli, and training dosage is still not reached. A systematic review and meta-analysis was carried out to analyze the effects of different auditory feedbacks on gait and postural performance in patients affected by Parkinson’s disease. Systematic identification of published literature was performed adhering to PRISMA guidelines, from inception until May 2017, on online databases; Web of science, PEDro, EBSCO, MEDLINE, Cochrane, EMBASE and PROQUEST. Of 4204 records, 50 studies, involving 1892 participants met our inclusion criteria. The analysis revealed an overall positive effect on gait velocity, stride length, and a negative effect on cadence with application of auditory cueing. Neurophysiological mechanisms, training dosage, effects of higher information processing constraints, and use of cueing as an adjunct with medications are thoroughly discussed. This present review bridges the gaps in literature by suggesting application of rhythmic auditory cueing in conventional rehabilitation approaches to enhance motor performance and quality of life in the parkinsonian community.

ノイズ前庭電気刺激を利用した両側前庭障害患者の体平衡機能改善

The peripheral vestibular organs sense angular and linear accelerations of the head, and help to maintain gaze and posture during head movements through the vestibulo-ocular and vestibulo-spinal reflexes. Bilateral vestibular dysfunction causes persistent imbalance and oscillopsia while moving the body or the head, and so far no effective treatments have been found for this condition except vestibular rehabilitation. We used noisy galvanic vestibular stimulation (noisy GVS), which was delivered as zero-mean current noise, of an imperceptible amplitude to improve postural performance in patients with bilateral vestibular dysfunction. We demonstrated that the application of noisy GVS for 30 sec significantly improved postural performance as measured by stabilometry in patients with bilateral vestibulopathy. We then examined the effect of noisy GVS on locomotion, and showed that it significantly increased the gait velocity and stride length, but significantly decreased the stride time in patients with vestibulopathy. Furthermore, to examine the effect of noisy GVS on vestibular function, we examined the effects of noisy GVS on ocular vestibular evoked myogenic potentials (oVEMP) in response to bone-conducted vibration (BCV). The noisy GVS increased the amplitude of oVEMP responses without affecting the latencies of oVEMP responses, suggesting that noisy GVS improves static and dynamic postural stability by enhancing the function of the vestibular afferents. Finally, we tested the long-term effects of noisy GVS on postural stability in elderly adults, and showed that noisy GVS can lead to a postural stability improvement that lasts for several hours after the cessation of the stimulus, probably via neuroplasticity. This newly discovered effect could contribute to an increase in the application of noisy GVS in appropriate patients.

Impact of fatigue on postural control in quiet standing in fibromyalgia

Fibromyalgia fatigue was described as an overwhelming feeling of tiredness that is not relieved by sleep or rest and is often not in proportion to the effort realized. In fibromyalgia syndrome (FMS), the fatigue has an important functional impact, often limiting the activities of daily living, can induce a state of deconditioning, and causing disturbance of locomotion, whose reasons are not fully understood. The aims of this study was to evaluate the postural performance in quite standing of FMS patients, and to compare them to a control group, and to assess the influence on the posture of a fatigue induced by a short walk. Were included: 11 fibromyalgia patients in fibromyalgia groupe (FMG) and 12 healthy subjects appaired in control group (CG). Foot center of pressure (CP) displacements on a task-force platform under two conditions: eyes opened – i.e. vision and eyes closed – i.e. no-vision, before and after a six-minutes walk test (6MWT) were recorded. The results showed that subjects with fibromyalgia have a surface displacement of center of pressure more important than healthy subjects. Therefore, before 6MWT, in “No-vision” condition, CP displacement was 200.05 ± 145.31 mm 2 (m ± SD) in CG vs 397.03 ± 242.82 mm 2 in FMG ( P < 0.05). In “Vision” condition CP displacement were respectively 139.08 ± 61.78 mm 2 vs 237.70 ± 136.41 mm 2 ( P = 0.06). The deterioration was more significant in FMG after the 6MWT, only in “No-vision” condition ( P < 0.05). FMG had postural impaired performance compared to healthy subjects, especially in the absence of compensation with visual input. This might be explained by sensory changes induced by chronic painful condition affecting muscles. In addition, the disturbance of postural performance is more important after 6MWT (unlike CG), highlighting the state of fragility of subjects and the risk of falls in fatigue condition. We conclude that the compensation by the vision is important. The walk test induced fatigue property and a possible decrease in sensitivity of proprioceptive system. Thus, this study demonstrates lower postural performance in patients with fibromyalgia and a higher sensitivity to fatigue, but other explanatory factors are to be found, such as the influence of pain.

Effects of dual-task balance training on postural performance in patients with Multiple Sclerosis: a double-blind, randomized controlled pilot trial

Objective: To investigate the effects of dual-task balance training on postural performance in patients with multiple sclerosis as compared with single-task balance training. Design: Double-blind, pretest-posttest, randomized controlled pilot trial. Setting: Local Multiple Sclerosis Society. Subjects: A total of 47 patients were randomly assigned to two equal groups labeled as single-task training and dual-task training groups. Interventions: All patients received supervised balance training sessions, 3 times per week for 4 weeks. The patients in the single-task group performed balance activities, alone. However, patients in dual-task group practiced balance activities while simultaneously performing cognitive tasks. Main measures: The 10-Meter Walk Test and Timed Up-and-Go under single-task and dual-task conditions, in addition to Activities-specific Balance Confidence, Berg Balance Scale, and Functional Gait Assessment were assessed pre-, and post intervention and also 6-weeks after the end of intervention. Results: Only 38 patients completed the treatment plan. There was no difference in the amount of improvement seen between the two study groups. In both groups there was a significant effect of time for dual-10 Meter Walk Test (F1, 36=11.33, p=0.002) and dual-Timed Up-and-Go (F1, 36=14.27, p=0.001) but not for their single-tasks. Moreover, there was a significant effect of time for Activities-specific Balance Confidence, Berg Balance Scale, and Functional Gait Assessment (P<0.01). Conclusions: This pilot study did not show more benefits from undertaking dual-task training than single-task training. A power analysis showed 71 patients per group would be needed to determine whether there was a clinically relevant difference for dual-task gait speed between the groups.

Postural stability under globus pallidus internus stimulation for dystonia

ObjectiveDeep brain stimulation of the globus pallidus internus (GPi-DBS) is an efficient and safe treatment for medically refractory dystonia. However, recent studies reported gait problems, falls and bradykinesia in patients after the DBS procedure. The aim of this study was to quantify the effect of GPi-DBS on postural performance in patients with cranio-cervical dystonia. MethodsThirteen patients with focal/segmental dystonia and GPi-DBS participated in the study. We performed two postural tests (pull test and push and release test) in on- and off-stimulation conditions and recorded the movements of the patients with inertial sensors. ResultsUnder stimulation patients exhibited a higher number of steps (p=0.015), reduced first step length (p=0.011) and lower stepping velocity (p=0.001), compared to off stimulation. We observed a higher number of steps in the push and release test compared to the pull test (p=0.038). The interaction between stimulation condition and test type was significant (p=0.027). ConclusionsThe velocity and amplitude of postural reactions are compromised by GPi-DBS in patients with cranio-cervical dystonia. SignificanceThis information corresponds to patient’s reports of falls and postural instability after GPi-DBS. Pre-operatively, patients should be informed about the possibility of the occurrence of such phenomena.

Effect of 3,4‐Diaminopyridine on the Postural Control in Patients with Downbeat Nystagmus

Downbeat nystagmus (DBN) is a common, usually persistent ocular motor sign in vestibulocerebellar midline lesions. Postural imbalance in DBN may increase on lateral gaze when downbeat nystagmus increases. 3,4-Diaminopyridine (3,4-DAP) has been shown to suppress the slow-phase velocity component of downbeat nystagmus and its gravity-dependent component with concomitant improvement of oscillopsia. Because the pharmacological effect is thought to be caused by improvement of the vestibulocerebellar Purkinje cell activity, the effect of 3,4-DAP on the postural control of patients with downbeat nystagmus syndrome was examined. Eye movements were recorded with the video-based Eyelink II system. Postural sway and pathway were assessed by posturography in lateral gaze in the light and on eye closure. Two out of four patients showed an improvement of the area of postural sway by 57% of control (baseline) on eye closure. In contrast, downbeat nystagmus in gaze straight ahead and on lateral gaze did not benefit in these two patients, implying a specific influence of 3,4-DAP on the vestibulocerebellar control of posture. It was concluded that 3,4-DAP may particularly influence the postural performance in patients with downbeat nystagmus.

Head movement restriction and postural stability in patients with compensated unilateral vestibular loss

Objective: To study whether restriction of head-neck movements improves postural performance in patients with compensated unilateral total vestibular loss. Design: Randomized controlled experimental study. Setting: Laboratory for clinical and experimental vestibular testing at a tertiary referral center. Patients: Fifteen consecutive patients (seven men, eight women, mean age 53 years) at routine follow-up, 6 months after translabyrinthine extirpation of acoustic neurinomas (mean tumor size 13.5mm, range 5 to 25mm). None of the patients had signs or symptoms of central nervous system dysfunction. Intervention: Posturographic tests comparing patients with and without a semirigid neck collar. Test order was randomized between patients to reduce training effects. Main Outcome Measure: Posturography measuring velocity and variance of quiet stance and measuring body sway induced by vibration at 60, 80, and 100Hz to the calf muscles. Tests were conducted with eyes open and closed. Results: In tests with vibration at 100Hz to the calf muscles and with eyes open, body sway velocity was significantly higher when patients were wearing a neck collar. No significant difference was found in any other test. Conclusion: Restricting head-neck movements with a neck collar does not improve postural stability in patients with compensated unilateral total vestibular loss. A tendency toward impaired postural performance leads to the conclusion that it is not appropriate to treat such patients with neck collars to improve their balance.

Effects of Different Treatments on Postural Performance in Patients with Cervical Root Compression1

Patients with cervical root compression were used as a "model" to investigate the possible importance of neck disorders and cervical sensory information in postural control. We assessed postural performance with posturography before and after treatment in 71 consecutive patients with MRI-verified cervical root compression without medullary compression. The patients were randomized to surgery (n = 22), physiotherapy (n = 24) or treatment with cervical collars (n = 25). There were no differences in postural performance or pain intensity between the groups before treatment. After treatment, the surgery group manifested significant improved postural performance and reduced neck pain scores, as compared to the two conservative treatment groups, and their postural performance had improved to the same level manifested by healthy controls. The conservative treatment groups manifested no consistent significant changes in postural performance or pain scores. Decreased muscular tension due to reduction of cervical pain after surgery and normalization of cervical proprioception are suggested as possible explanations of the improved postural control.

Postural and symptomatic improvement after physiotherapy in patients with dizziness of suspected cervical origin

Objective: To assess postural performance in patients with dizziness of suspected cervical origin in whom extracervical causes had been excluded, and to assess the effects of physiotherapy on postural performance and subjective complaints of neck pain and dizziness. Design: Prospective, randomized, controlled trial. Setting: Primary care centers and a tertiary referral center. Patients and Subjects: Of 65 referrals, 43 patients were excluded because extracervical etiology was suspected. Of the remaining 22 patients, 17 completed the study (15 women, 2 men, x̄ age 37yr, range 26–49). The controls were 17 healthy subjects (15 women, 2 men, x̄ age 36yr, range 25–55). Intervention: Physiotherapy based on analysis of symptoms and findings, and aimed to reduce cervical discomfort. Patients were randomized either to receive immediate physiotherapy ( n = 9), or to wait 2 months, undergo repeat measurements, and then receive physiotherapy ( n = 8). Main Outcome Measures: Posturography, measuring velocity and variance of vibration-induced body sway and variance of galvanically induced body sway. Subjective intensity of neck pain (Visual Analog Scale ratings, 0–100), intensity and frequency of dizziness (subjective score 0–4). Results: The patients manifested significantly poorer postural performance than did healthy subjects (.05 > p >.0001). Physiotherapy significantly reduced neck pain and intensity and the frequency of dizziness ( p <.01), and significantly improved postural performance (.05 > p >.0007). Conclusions: Patients with dizziness of suspected cervical origin are characterized by impaired postural performance. Physiotherapy reduces neck pain and dizziness and improves postural performance. Neck disorders should be considered when assessing patients complaining of dizziness, but alternative diagnoses are common.