Sensory Organization Test Research Articles

Executive function and relation to static balance metrics in chronic mild TBI: A LIMBIC-CENC secondary analysis.

Among patients with traumatic brain injury (TBI), postural instability often persists chronically with negative consequences such as higher fall risk. One explanation may be reduced executive function (EF) required to effectively process, interpret and combine, sensory information. In other populations, a decline in higher cognitive functions are associated with a decline in walking and balance skills. Considering the link between EF decline and reduction in functional capacity, we investigated whether specific tests of executive function could predict balance function in a cohort of individuals with a history of chronic mild TBI (mTBI) and compared to individuals with a negative history of mTBI. Secondary analysis was performed on the local LIMBIC-CENC cohort (N = 338, 259 mTBI, mean 45 ± STD 10 age). Static balance was assessed with the sensory organization test (SOT). Hierarchical regression was used for each EF test outcome using the following blocks: (1) the number of TBIs sustained, age, and sex; (2) the separate Trail making test (TMT); (3) anti-saccade eye tracking items (error, latency, and accuracy); (4) Oddball distractor stimulus P300 and N200 at PZ and FZ response; and (5) Oddball target stimulus P300 and N200 at PZ and FZ response. The full model with all predictors accounted for between 15.2% and 21.5% of the variability in the balance measures. The number of TBI's) showed a negative association with the SOT2 score (p = 0.002). Additionally, longer times to complete TMT part B were shown to be related to a worse SOT1 score (p = 0.038). EEG distractors had the most influence on the SOT3 score (p = 0.019). Lastly, the SOT-composite and SOT5 scores were shown to be associated with longer inhibition latencies and errors (anti-saccade latency and error, p = 0.026 and p = 0.043 respectively). These findings show that integration and re-weighting of sensory input when vision is occluded or corrupted is most related to EF. This indicates that combat-exposed Veterans and Service Members have greater problems when they need to differentiate between cues when vision is not a reliable input. In sum, these findings suggest that EF could be important for interpreting sensory information to identify balance challenges in chronic mTBI.

Relationship Between Sensory Organization Testing Scores With Lower Extremity Injuries and Prior Concussion in Professional Soccer Players.

To evaluate for associations between concussion history or lower extremity (LE) injury and computerized sensory organization testing (SOT) performance in professional soccer players. Cross-sectional study. Tertiary care center. Thirty-three, professional, male soccer players on an American club, between the years 2019 and 2021. Player age, history of reported LE injury (gluteal, hamstring, ankle, knee, hip, groin, and sports hernia), history of diagnosed concussion, and the number of prior concussions were documented for each player. Baseline SOT of postural sway was conducted in 6 sensory conditions for all players. Eleven athletes (33%) reported a previous concussion, and 15 (45%) reported a previous LE injury. There were no significant differences in SOT scores between those with and without a previous diagnosis of concussion ( P > 0.05). Those reporting a previous LE injury performed better on condition 3 (eyes open, unstable visual surround) than those who did not ( P = 0.03). Athletes aged 25 years or younger performed worse on condition 3 ( P = 0.01) and had worse, although not statistically significant, median performance on all other balance measures than those older than 25 years. Intraclass correlation coefficient for repeat SOT assessment was 0.58, indicating moderate reliability, without an evident practice effect. Professional soccer players with a previous concussion or history of LE injury did not demonstrate long-term deficits in postural control, as assessed by multiyear computerized SOT baseline testing. The SOT was reliable over time with younger athletes exhibiting greater postural sway than older athletes.

Ai Chi for Balance and Gait in Individuals with Parkinson's Disease: A Pilot Study

Background and Purpose: Parkinson disease (PD) has effects on an individual's balance, and Ai Chi can be used to improve balance and gait performance. The aim of this study was to investigate the effectiveness of Ai Chi in improving the balance and gait of individuals with idiopathic PD. Method: Ten individuals with PD at Hoehn and Yahr stages 1-3 were included in this 6-week study. Participants underwent a structured Ai Chi program (1 hour per session, twice weekly) for 6 weeks (12 sessions in total). Balance was assessed at baseline and week 6 using the Timed Up and Go (TUG) test, the Five Times Sit-to-Stand (FTSTS) test, the Four Square Step Test (FSST), the Ten Meter Walk Test (10MWT), and the Sensory Organization Test (SOT). Gait parameters were measured by inertial measurement units and videotaping for 2-dimentional motion analysis. Surface electromyography was used for measuring muscle activity during gait in the bilateral rectus femoris, biceps femoris, gastrocnemius, and tibialis anterior. Results: In a pre- and postintervention comparison, significant improvements were observed in the FTSTS, FSST, and TUG scores as well as in the composite, vision, and vestibular scores in the 10MWT and SOT (P < .005). The results indicated improvement in balance. As for the gait analysis, no significant differences were observed in spatiotemporal parameters, including speed, cadence, step length, stride length, step duration, stride duration, swing-phase duration, stance-phase duration, and double support duration. Insignificant changes in the percentage maximum voluntary contraction of all the muscles examined were found, while a significant decrease in maximum voluntary contraction was identified in the left biceps femoris. Conclusions: The Ai Chi program produced a significant improvement in balance in individuals with PD, with insignificant results shown in gait. Ai Chi is an appropriate intervention to improve balance in individuals with PD.

Screening testing and computerized vestibulometry in vestibular neuronitis

Introduction. The demonstrative example of unilateral peripheral vestibulopathy is vestibular neuronitis. This disease of infectious-toxic origin has the involvement of vestibular ganglia neurons or vestibular nerve fibers. The overwhelming moment in topic diagnostics of vestibular impairments is within-patient comparison anamnesis data and vestibulometry results. In cases of vestibular neuronitis exception of central vestibular system pathology is mandatory. Objective. To attain objectification of disequilibrium in vestibular neuronitis by means of registration and assessment of oculogyric and postural reactions. Materials and methods. Vestibular passport trials are recommended in the examination of patients with acute vertiginous complaints. Special attention has been given to the revelation of impairments of command eye movements, disturbances of ocular pursuit, spontaneous nystagmus, and catch-up saccades in Halmagyi – Curthoys test. Possible impairments of static and dynamic balance control are assessed in modified Romberg test and Unterberger test. Gaze tests with registration of saccadic and pursuit eye movements, spontaneous and optokinetic nystagmus reactions as well bithermal caloric test are carried out in computerized electrooculography and videooculography. Deviations of body gravity center are analyzed with the help of sensory organization test in computerized dynamic posturography. Results and discussion. The results of screening and computerized vestibular testing of 24 patients are presented. High diagnostic value of registration and analysis of oculogyric reactions as well as postural control signs is demonstrated in cases of acute vestibular neuronitis and acerbation of its chronic recurrent variant. The key objective symptom, which confirms peripheral level of vestibular dysfunction, is spontaneous nystagmus registration in elimination of gaze fixation. Unsteadiness in static and dynamic trials confirms the vestibular decompensation extent in acute phase of vestibular ganglia / neurons pathology in cases of vestibular neuronitis. Decompensation signs revelation of this peripheral vestibular dysfunction needs urgent medicine: possible etiotropic and obligate symptomatic therapy as well as spare vestibular rehabilitation exercises. Conclusion. Combination of oculogyric impairments and disturbances of postural control enables to improve accuracy of diagnostics in decompensated stage of vestibular neuronitis.

Implementation outcomes of a sensory integration therapy program with computerized dynamic posturography in patients with balance and sensory dysfunction

ObjectiveWe describe the first-year implementation experience of an Instrumented Sensory Integration Therapy Program in Audiological & Balance Center patients. DesignThis is a retrospective descriptive study. Participants included Seventy-three adults with diagnoses of acute, episodic, or chronic vestibular syndromes. They were classified into the following two groups: group 1 included 46 individuals treated with ISIT plus VRT, and group 2 included 27 individuals treated only with ISIT. ResultsThe Sensory Organization Test (SOT) for both groups showed a statistical significance for all three sensory inputs; visual systems (G1: p = 0.0003; G2: p = 0.0337), vestibular system (G1: p < 0.0001; G2: p = 0.0003), and balance as demonstrated by compound balance score (G1: p < 0.0001; G2: p = 0.0035), and balance percentage deficit (G1: p < 0.0001; G2: p = 0.0078). ConclusionsThe severity and complexity of functional neurological disorders in the context of vestibular syndromes seem to require between 10 and 20 therapy sessions, and combined ISIT plus VRT appears to be more effective than ISIT as a monotherapy.

A new paradigm for assessing postural stability

BackgroundThe sensory organization test (SOT) is an established and effective method for assessing postural stability and determining fall risk. SOT equilibrium scores are derived from the relationship between an individual’s peak sway amplitude and a standard, theoretically-derived normal limits of stability (tLOS). Determining an individual’s postural stability and fall risk based on this one-size-fits-all tLOS may overestimate functional equilibrium scores and underestimate fall risk when personal stability limits (pLOS) are reduced. Research questionThe purpose of this study is to investigate whether LOS measured from a group of healthy adults is different from the tLOS, and whether SOT equilibrium scores are significantly different when calculated using pLOS versus the standard tLOS. MethodsSixty healthy volunteers were recruited into three age-groups: young (18−39), middle-aged (40−64), and elderly (65−80), with 10 males and 10 females in each age-group. Outcome measures included SOT and LOS. Additional measures o balance perception and functional mobility were obtained including the Activities Balance Confidence (ABC) scale and the timed-up-and-go test (TUG). The tLOS and pLOS were used to calculate standard (tSOT) and personalized (pSOT) equilibrium scores. ResultsThe mean pLOS from the group of healthy adults was significantly lower than the tLOS. Consequently, the pSOT equilibrium scores were significantly lower than the standard SOT scores derived using the tLOS. SignificanceIndividual measures of LOS are significantly lower than theoretical estimates of the LOS in healthy adults. This suggests that use of tLOS in the calculation of SOT equilibrium scores often overestimates postural stability and may have implications for the determination of fall risk.

Experience-based functional gains in gait and stability with torso-weighting in people with multiple sclerosis: Randomized pilot study

BACKGROUND: Balance-based torso-weighting has improved gait and balance performance in people with multiple sclerosis (MS) in a single session with torso-weights on, demonstrating an orthotic effect. Daily use of torso-weighting may promote motor learning and more enduring therapeutic effects but has not yet been studied. PURPOSE: Confirm orthotic effects and compare therapeutic effects of daily torso-weighting versus shape/sham-weighting or no weighting. We hypothesized that daily torso-weighting would result in positive effects on gait and balance, tested without weights. METHODS: Five participants with MS experienced three conditions for 2-4 weeks each: no weights first, then double-blinded randomization to torso-weighting or shape-weighting first then cross-over to the alternate condition. Personalized torso-weighting on a vest-like garment countered individual reactive balance responses following manual perturbations. Postural sway recorded orthotic effects with/without torso-weights while standing on a force plate with eyes open/closed. Clinical measures recorded therapeutic effects while unweighted: gait parameters, 6-Minute Walk Test (6MWT), and Sensory Organization Test (SOT). Weighting conditions were compared using paired t-tests with one-tailed alpha at 0.05. RESULTS: Postural sway decreased significantly with torso-weights. Cadence and step width improved significantly after torso-weighting versus shape-weight periods. Average gait parameters showed no improvement after shape-weight periods. Velocity, 6MWT, and SOT tended to improve with torso-weighting, averaging improvements of+15%,+16%, and+13.8%, respectively. CONCLUSIONS: Findings support both orthotic and therapeutic effects of torso-weighting. Daily use of torso-weights for multiple weeks may promote motor learning of gait parameters and balance. Further research is warranted to examine sensory augmentation as a potential mechanism.

Evaluation and clinical practice of vestibular function tests in acoustic neuroma

Objective:This study was conducted to evaluate the applications of vestibular function tests in diagnosis, identifying tumor origins and prognosis of vestibular rehabilitation of patients with acoustic neuroma. Methods:This research is a single-center cross-sectional clinical study, which retrospectively analyzed the data of 335 patients with acoustic neuroma from March 2013 to March 2020 in the Eye and ENT Hospital of Fudan University. The study included caloric test, cervical and ocular vestibular evoked myogenic potentials（cVEMP, oVEMP）, video head impulse test（vHIT） and sensory organization test（SOT）. Firstly, the sensitivity, specificity, and Yoden index of each test were calculated. Secondly, the internal relevance of these tests was studied for application in judging the origins of the tumor. Results:The abnormal rates of caloric test, cVEMP, oVEMP, vHIT and SOT was 85.3%, 86.1%, 85.5%, 55.6% and 67.7% in these participants. Among all the vestibular function tests included, the caloric test showed the best sensitivity（0.855）, specificity（0.981）, and Yoden index（0.836）. The study found that the higher the Koos grades, the higher the abnormal rates of the caloric test, vHIT, and oVEMP（Cochran-Armitage test, P<0.05）. There was no significant relationship between the combination of abnormal vestibular function tests and tumor origin nerves（P>0.05）. Conclusion:Majorlty of the participants in this study with acoustic neuroma showed abnormal results in SOT related to poor balance control. More than half of the patients had at least two abnormal result of the battery of vestibular function tests, among which the caloric test was proved to have better sensitivity and specificity. The higher the Koos grades of the tumor, the higher the abnormal rates of the caloric test, vHIT, and oVEMP.

Patterns of vestibular dysfunction in chronic traumatic brain injury.

Dizziness and imbalance are common following traumatic brain injury (TBI). While these symptoms are often attributed to vestibular dysfunction, the relative contribution of peripheral vs. central mechanisms is unclear. This study investigated the prevalence of semicircular canal and otolith abnormalities in a cohort of patients with chronic TBI and symptoms of dizziness or imbalance. The relationship between vestibular, oculomotor and posturography results was further explored. Clinical records of patients attending the New Zealand Dizziness and Balance Centre from January 2015 to December 2019 were reviewed for consideration in the study. Inclusion required: an age of 18-80 years, a diagnosed TBI, and vestibular assessment using three-dimensional video head impulses (vHIT), cervical and ocular vestibular-evoked myogenic potentials (c and o VEMPs, respectively) and caloric testing. Severe TBI, pre-existing vestibular diagnoses, and incomplete test results were excluded. Rates of abnormalities were determined for each test and compared with results of oculomotor function testing and postural control, measured using the sensory organization test (SOT). Of 158 reviewed records, 99 patients aged 49 ± 15 years (59 female) fulfilled criteria for inclusion in the study. The median time between the head injury and the clinical assessment was 12 (IQR 6-21) months. Abnormalities involving one or more components of the vestibular labyrinth and/or nerve divisions were identified in 33 of 99 patients (33.3%). The horizontal semicircular canal was most frequently affected (18.2%), followed by the saccule (14.1%), utricle (8.1%), posterior (7.1%) and anterior (2.0%) semicircular canals. Vestibular test abnormalities were associated with skull-base fractures, superior canal dehiscence, and focal ear trauma. Oculomotor dysfunction and postural instability were recorded in 41.1 and 75.5% of patients, respectively. Postural instability correlated with abnormal oculomotor function (p = 0.008) but not peripheral vestibular hypofunction (p = 0.336). Dizziness and/or imbalance in chronic TBI was associated with impaired postural stability for tasks requiring high levels of use of vestibular and visual input for balance. Vestibular hypofunction identified through vHIT, VEMP and caloric testing was recorded but was less common, except when the injury involved a fractured skull-base. There was no specific pattern of end-organ or nerve involvement which characterized this group of patients.

Exploring the Potential of Machine Learning for the Diagnosis of Balance Disorders Based on Centre of Pressure Analyses

Balance disorders are caused by several factors related to functionality deficits in one or multiple sensory systems such as vision, vestibular, and somatosensory systems. Patients usually have difficulty explaining their dizziness, often using ambiguous words to describe their symptoms. A common practice by clinicians is to objectively evaluate the patient's dizziness by applying the Sensory Organization Test (SOT), which measures the contribution of each sensory system (vestibular, visual, somatosensory). The SOT protocol can record up to 2000 measurements in 20 s to generate the Equilibrium Score (EQS) with its five load sensors. EQS is an indicator that reflects how well a patient can maintain balance. However, its calculation only considers two instances from these 2000 measurements that reflect the maximum anterior and posterior sway angle during the test performance; therefore, there is an opportunity to perform further analysis. This article aims to use the Centre of Pressure (COP) time series generated by the SOT and describes a methodology to pre-process and reduce the dimensionality of this raw data and use it as an input for machine learning algorithms to diagnose patients with balance disorder impairments. After applying this methodology to data from 475 patients, the logistic regression model (LR) produced the highest f1-score with 76.47%, and the support vector machine (SVM) performed almost as well, with an f1-score of 76.19%.

Sensory organization of balance control in children with vestibular migraine and recurrent vertigo of childhood.

Migraine plays an important role in some subgroups of children with recurrent vertigo. Moreover, the migraine component varies from definite to possibly absent as defined in this spectrum of three disorders-vestibular migraine of childhood (VMC), probable VMC (pVMC), and recurrent vertigo of childhood (RVC). However, studies on the sensory organization of balance control in these three disorders are rare. To explore the balance control of children with RVC, VMC, and pVMC, when the three sensory systems are challenged. A retrospective analysis was performed on 125 children with VMC (18 female and 15 male; aged 11.64 ± 2.74), pVMC (10 female and eight male; aged 11.78 ± 2.51), and RVC (32 female and 42 male; aged 11.10 ± 2.60). All children in each subtype were divided into groups of children aged ≤ 12 years old and 13-17 years old. Vestibular examination screening and assessment for postural control using the six conditions of the sensory organization test (SOT) were performed. The three primary outcome measures were: equilibrium score (ES), strategy score (SS), and sensory analysis score of the SOT. Equilibrium score under six different conditions and composite score increased with age (all P-values < 0.05). The somatosensory and visual scores also improved with growing (P-values < 0.05). However, vestibular scores did not increase significantly with age as the other senses did (P > 0.05). In the children ≤ 12 year-old group, children with VMC had a significantly higher visual preference score than those with pVMC and RVC (P < 0.05). There was an effect of age on the horizontal HIT. Ocular vestibular evoked myogenic potential (oVEMP), cervical vestibular evoked myogenic potential (cVEMP), and unilateral weakness (UW) values showed no significant difference among three diseases. Compared with patients at the age of 13-17 years old and with RVC and pVMC (both ≤ 12 years old), children with VMC had a higher degree of reliance on visual signals to maintain their balance and a poorer central integration of peripheral information before reaching 12 years of age. In addition, vision may predominate by weakening vestibular function based on visuo-vestibular interactions. It must be noted that peripheral vestibular examinations could not distinguish the three disease subtypes.

Age- and gender-specific normative data on computerized dynamic posturography in a cohort of Danish adults.

Balance performance can be measured with a computerized dynamic posturography (CDP). Frequently used CDP protocols include the sensory organization test (SOT), motor control test (MCT) and adaptation test (ADT). The primary aim of this study was to produce normative data using the Bertec® Balance Advantage CDP on a cohort of healthy adults aged 20-79years for the SOT, MCT and ADT. The secondary aim was to determine age- and gender-related differences. The study population of 120 participants were divided into age groups of 20-29, 30-39years, etc., with an equal number of men and women in each group. Using the Bertec® CDP, the SOT, MCT and ADT protocols were performed. SOT found that the 70-79 age group and men scored lower equilibrium scores (ES) on SOT4, and SOT6. Women had higher ES on SOT1. For the MCT, backward translation. latencies were higher for the 60s and 70s age groups. The 60s age group had higher forward translation latencies. Women had lower latencies on all MCTs. For the ADT toes up test, the 70-79 age group scored higher sway energy. On the toes down test, higher sway energy was registered for the 50-79 age groups. Women had lower sway energy for both ADT's. We have produced normative data for healthy adults aged 20-79years for the SOT, MCT and ADT protocols using the Bertec® Balance Advantage CDP. Balance performance differences might be due to decline in visual acuity, presbyvestibulopathy and differences in body composition.

Relationship Between Obstructive Sleep Apnea and Balance on Computerized Dynamic Posturography.

Obstructive sleep apnea (OSA) leads to chronic sleep deprivation. The relationship between OSA and balance is poorly understood. This study aimed to determine if OSA adversely affects standing balance. Adults with a clinically indicated polysomnogram (PSG) diagnostic of OSA, who were not on therapy, were recruited from an academic tertiary care referral clinic. Subjects completed the Epworth Sleepiness Scale (ESS), the Stanford Sleepiness Scale (SSS), and the STOP-BANG questionnaire (SBQ). Their balance was tested with the Sensory Organization Test (SOT) of computerized dynamic posturography (CDP). Sixteen subjects participated in the study, including three with mild OSA, six with moderate OSA, and seven with severe OSA. CDP scores were not related to the subjective screening for OSA (ESS, SSS, and SBQ) or to objective measures of OSA (apnea-hypopnea index, respiratory disturbance index, and oxygen saturation nadir). Subjective and objective measures of sleepiness and sleep disorder are not related to standing balance. The sleep deficit from OSA did not affect standing balance. Therefore, OSA patients are unlikely to be at significant risk for falls due to OSA.

Postural Control Alterations in Children with Mild Forms of Spastic Cerebral Palsy.

To determine the postural control responses' differences between children with mild spastic Cerebral Palsy (CP) and children who are typically developing (TD). Children with spastic CP, Level I-II (n=20, mean age=9.42±4.59 years, 50% girls, 50% boys) and children with TD (N=20, mean age=9.65±3.03, 55% girls, 45% boys) were included in the study. All participants were evaluated with Computerized Dynamic Posturography, Sensory Organization Test (SOT). There were differences between children with spastic CP and children with TD in visual and composite balance score of SOT significantly (p<0.05); there were no differences at vestibular and somatosensory scores of SOT. Children with CP had more postural sway than children with TD (p<0.05). There were differences between children with mild CP and TD in terms of postural control responses.

Clinical measures of balance and gait cannot differentiate somatosensory impairments in people with lower-limb amputation

BackgroundIn addition to a range of functional impairments seen in individuals with a lower-limb amputation, this population is at a substantially elevated risk of falls. Studies postulate that the lack of sensory feedback from the prosthetic limb contributes heavily to these impairments, but the extent to which sensation affects functional measures remains unclear. Research questionThe purpose of this study is to determine how sensory impairments in the lower extremities relate to performance with common clinical functional measures of balance and gait in individuals with a lower-limb amputation. Here we evaluate the effects of somatosensory integrity to clinical and lab measures of static, reactive and dynamic balance, and gait stability. MethodsIn 20 individuals with lower-limb amputation (AMP) and 20 age and gender-matched able-bodied controls (CON), we evaluated the effects of sensory integrity (pressure, proprioception, and vibration) on measures of balance and gait. Static, reactive, and dynamic balance were assessed using the Sensory Organization Test (SOT), Motor Control Test (MCT), and Functional Gait Assessment (FGA), respectively. Gait stability was assessed through measures of step length asymmetry and step width variability. Sensation was categorized into intact or impaired sensation by pressure thresholds and differences across groups were analyzed. ResultsThere were significant differences between AMP and CON groups for reliance on vision for static balance in the SOT, MCT, and FGA (p < 0.01). Despite differences across groups, there were no significant differences within the AMP group based on intact or impaired sensation across all functional measures. SignificanceDespite being able to detect differences between able-bodied individuals and individuals with an amputation, these functional measures cannot distinguish between levels of impairment within participants with an amputation. These findings suggest that more challenging and robust metrics are needed to evaluate the effects of sensation and function in individuals with an amputation.

Evaluation of postural stability and vestibulo-ocular reflex in adults with chronic suppurative otitis media

PurposeTo evaluate the vestibulospinal reflex and vestibulo-ocular reflex (VOR) in patients with chronic suppurative otitis media (CSOM) using posturography and the video head impulse test (vHIT).MethodsSixty-five patients with CSOM and 65 healthy participants as controls were included. Patients with CSOM were instructed to complete the dizziness handicap inventory (DHI). All participants underwent otoscopy, pure-tone audiometry, posturography sensory organization test (SOT), and vHIT.ResultsPatients with CSOM exhibited a high prevalence of dizziness. The CSOM group had poor SOT vestibular scores compared to the control group. Patients with CSOM had worse sways in the antero-posterior and mediolateral planes. The CSOM group was divided into two subgroups according to the type of hearing loss. SOT vestibular scores were significantly poorer in the mixed hearing loss group than those in the conductive hearing loss group. We found a positive correlation between disease duration and poor SOT vestibular scores. Moreover, poor SOT vestibular scores correlated with high DHI scores. We found abnormalities in the vHIT results in the CSOM group in the form of low VOR gain and corrective saccades.ConclusionOur study provides clinical evidence of dizziness, poor postural control, and VOR abnormalities in patients with CSOM. The presence of sensory elements of hearing loss in patients with CSOM appears to be positively associated with vestibular dysfunction.

Central sensorimotor integration assessment reveals deficits in standing balance control in people with chronic mild traumatic brain injury.

Imbalance is common following mild Traumatic Brain Injury (mTBI) and can persist months after the initial injury. To determine if mTBI subjects with chronic imbalance differed from healthy age- and sex-matched controls (HCs) we used both the Central SensoriMotor Integration (CSMI) test, which evaluates sensory integration, time delay, and motor activation properties and the standard Sensory Organization Test (SOT). Four CSMI conditions evoked center-of-mass sway in response to: surface tilts with eyes closed (SS/EC), surface tilts with eyes open viewing a fixed visual surround (SS/EO), visual surround tilts with eyes open standing on a fixed surface (VS/EO), and combined surface and visual tilts with eyes open (SS+VS/EO). The mTBI participants relied significantly more on visual cues during the VS/EO condition compared to HCs but had similar reliance on combinations of vestibular, visual, and proprioceptive cues for balance during SS/EC, SS/EO, and SS+VS/EO conditions. The mTBI participants had significantly longer time delays across all conditions and significantly decreased motor activation relative to HCs across conditions that included surface-tilt stimuli with a sizeable subgroup having a prominent increase in time delay coupled with reduced motor activation while demonstrating no vestibular sensory weighting deficits. Decreased motor activation compensates for increased time delay to maintain stability of the balance system but has the adverse consequence that sensitivity to both internal (e.g., sensory noise) and external disturbances is increased. Consistent with this increased sensitivity, SOT results for mTBI subjects showed increased sway across all SOT conditions relative to HCs with about 45% of mTBI subjects classified as having an "Aphysiologic" pattern based on published criteria. Thus, CSMI results provided a plausible physiological explanation for the aphysiologic SOT pattern. Overall results suggest that rehabilitation that focuses solely on sensory systems may be incomplete and may benefit from therapy aimed at enhancing rapid and vigorous responses to balance perturbations.

Posturographic Analysis in Patients Affected by Central and Peripheral Visual Impairment.

Although vision loss is known to affect equilibrium maintenance, postural control in patients affected by low vision has been poorly investigated. We evaluated postural stability and the ability to use visual, proprioceptive and vestibular information in different low vision patterns. Ten adults with normal vision (NC), fourteen adults affected by central visual impairment (CLV) and eight adults affected by peripheral visual impairment (PLV) were enrolled in our study. Patients underwent visual, vestibular and postural evaluation (bedside examination, Computed Dynamic Posturograophy). Motor Control Tests were performed to analyze automatic postural adaptive responses elicited by unexpected postural disturbances. Clinical evaluations did not show abnormality in all patients. In the Sensory Organization Test, CLV and PLV patients performed more poorly in conditions 3–6 and 3–4, as compared to NC subjects. The condition 5 score was significantly lower in the CLV group with respect to the PLV patients. Composite equilibrium scores demonstrated significant differences between low-vision subjects vs. NC subjects. No differences were found for somatosensorial contribution. Visual afferences showed lower values in all visually impaired subjects, while vestibular contribution was lower in the CLV patients as compared to the NC and PLV patients. MCT latencies were significantly worse in the CLV subjects. In the low-vision patients, postural control was modified with a specific pattern of strategy adaptation. Different modulations of postural control and different adaptive responses seemed to characterize CLV patients as compared to PLV subjects.

The effects of augmenting traditional rehabilitation with audio biofeedback in people with persistent imbalance following mild traumatic brain injury.

Complaints of non-resolving imbalance are common in individuals with chronic mild traumatic brain injury (mTBI). Vestibular rehabilitation therapy may be beneficial for this population. Additionally, wearable sensors can enable biofeedback, specifically audio biofeedback (ABF), and aid in retraining balance control mechanisms in people with balance impairments. In this study, we described the effectiveness of vestibular rehabilitation therapy with and without ABF to improve balance in people with chronic mTBI. Participants (n = 31; females = 22; mean age = 40.9 ± 11 y) with chronic (>3 months) mTBI symptoms of self-reported imbalance were randomized into vestibular rehabilitation with ABF (n = 16) or without ABF (n = 15). The intervention was a standard vestibular rehabilitation, with or without ABF, for 45 min biweekly for 6 weeks. The ABF intervention involved a smartphone that provided auditory feedback when postural sway was outside of predetermined equilibrium parameters. Participant's completed the Post-Concussion Symptom Scale (PCSS). Balance was assessed with the sensory organization test (SOT) and the Central Sensorimotor Integration test which measured sensory weighting, motor activation, and time delay with sway evoked by surface and/or visual surround tilts. Effect sizes (Hedge's G) were calculated on the change between pre-and post-rehabilitation scores. Both groups demonstrated similar medium effect-sized decreases in PCSS and large increases in SOT composite scores after rehabilitation. Effect sizes were minimal for increasing sensory weighting for both groups. The with ABF group showed a trend of larger effect sizes in increasing motor activation (with ABF = 0.75, without ABF = 0.22) and in decreasing time delay (with ABF = −0.77, without ABF = −0.52) relative to the without ABF group. Current clinical practice focuses primarily on sensory weighting. However, the evaluation and utilization of motor activation factors in vestibular rehabilitation, potentially with ABF, may provide a more complete assessment of recovery and improve outcomes.

Balance control impairments in Fabry disease.

BackgroundFabry disease (FD) is a rare inherited lysosomal storage disorder caused by the deficiency of the enzyme alpha-galactosidase A. This deficiency leads to an accumulation of glycosphingolipids leading to progressive and multisystemic disease, including renal, cardiac, and neurological damages. FD may also have neuro-otological and visual impairments, which can generate postural control alterations, inner ear, and vision being involved in this function. This study aimed to evaluate the impact of FD on postural control.MethodsIn total, fourteen adult patients (8 men/6 women, mean age = 37.6 ± 11.4 years) and two children (mean age = 11 years) with FD and 19 healthy adults (12 men/7 women, mean age = 36.5 ± 16.9 years) and two healthy children (mean age = 10.5 years) took part in this study. Postural control was evaluated by a sensory organization test combining three visual situations (eyes open, eyes closed, and sway referenced visual surround motion) with two platform situations (stable platform and sway referenced platform motion), aiming to calculate a composite equilibrium score (CES), a high score being representative of good postural control. Somatosensory (RSOM), visual (RVIS), and vestibular (RVEST) contributions to postural control were calculated, a low score reflecting a poor use of the indicated sensory input.ResultsThe CES was lower in adult patients with FD compared with the healthy subjects (p < 0.001). RVIS (p = 0.001) and RVEST (p = 0.003) were lower in patients with FD compared with the control group, whereas no difference in RSOM was observed.ConclusionInner ear and visual pathologies associated with the central nervous system impairments are factors of postural control impairments. Physical activities, which can also be rehabilitative, by maintaining or increasing the weight of proprioception, may help diminish dependency on altered sensorial inputs.