Sensory Organization Research Articles

A 16-week Exercise Intervention Improves Balance In Breast Cancer Survivors And Healthy Controls

The ability to maintain balance and postural control are crucial for performing daily activities and preventing falls. Balance worsens with age and decreases can be exacerbated by other conditions, such as breast cancer treatment with chemotherapy. Exercise interventions are one potential method of maintaining or improving balance but have not been extensively investigated in breast cancer survivors (BCS). PURPOSE: To analyze the effect of a 16-week exercise training intervention on balance in BCS and healthy age-matched sedentary controls (HC). Exploratory aims investigated a relationship between muscle strength and balance changes, as well as differences in BCS displaying chemotherapy induced peripheral neuropathy (CIPN) versus those who did not. METHODS: BCS (n = 30 women, 54.6 yrs (12.0), BMI 27.8 kg/m2 (5.2), n = 11 with CIPN) and HC (n = 14 women, 54.6 yrs (8.4), BMI 28.9 kg/m2 (4.9)) had balance assessed using a Neurocom Smart Balance Master Sensory Organization Test (SOT) before and after a 16-week combined aerobic and resistance training intervention, at a community-based program. Visual, somatosensory, vestibular, preference, and composite scores were evaluated from the SOT. Maximal isometric voluntary contraction (MIVC), isokinetic peak torque (PT), and rate of torque development (RTD) of the knee extensors were determined as measures of strength and power, respectively. RESULTS: At baseline, no statistical group differences in SOT scores were observed. Overall, vestibular [Pre: 69(18), Post: 77(14); p = 0.016] and composite [73(11), 79(9); p < 0.001] scores improved with training. No difference was found between the BCS and control, or CIPN and non-CIPN participants for any of the SOT measures. PT, RTD, and MIVC were not correlated with composite balance scores. CONCLUSIONS: A 16-week exercise intervention program appears to improve vestibular and composite balance scores for BCS and HC. General exercise interventions may be beneficial for both BCS and healthy women in improving balance to prevent falls with age and in clinical populations, although larger sample size are needed to confirm these findings.

Clinical effectiveness of virtual reality versus conventional clinic-based vestibular physical therapy on balance and function in active duty service members. A pilot randomized controlled trial

Virtual reality (VR) may be useful during rehabilitation of service members with persistent vestibular impairment following concussion. Thirty-eight active duty US military service members with persistent balance impairment resulting from concussion were randomized into three groups [Conventional Vestibular Physical Therapy (CVPT, n = 13), Virtual Reality Vestibular Physical Therapy (VRVPT, n = 12), and Hybrid Virtual Reality and Conventional Vestibular Physical Therapy (HybridVPT, n = 13)] and were treated twice weekly for 6 weeks. Changes in clinical measures such as Activities-specific Balance Confidence (ABC) Scale, Dizziness Handicap Inventory (DHI), Functional Gait Assessment (FGA), and Sensory Organization Test (SOT) were assessed from pre-, mid-, and post-treatment scores. A significant main time effect was observed demonstrating clinical improvement over time (ABC: p < .001, η2p = .54; DHI: p < .001, η2p = .57; FGA: p < .001, η2p = .74; SOT: p < .001, η2p = .35). Both CVPT and HybridVPT groups demonstrated significant improvements in patient-reported confidence and function earlier in the treatment course (p < .005). FGA significantly and incrementally improved at each assessment time point in all treatment groups. The SOT significantly improved early in treatment in the CVPT group only and pre-to-post-treatment in the CVPT and VRVPT groups only. The HybridVPT group did not demonstrate any significant improvement with time in the instrumented SOT measure. In the comparison of pre-to-post-effects of VRVPT and HybridVPT effects compared to CVPT, there was no clear superiority or inferiority observed in either of the experimental treatments. This preliminary work shows initial efficacy of using VR-based therapy for concussed individuals allowing future work to personalize treatment that may improve adherence and engagement to therapy.

Role of Occupational Footwear and Prolonged Walking on Lower Extremity Muscle Activation during Maximal Exertions and Postural Stability Tasks

Background: Occupational footwear and a prolonged duration of walking have been previously reported to play a role in maintaining postural stability. The purpose of this paper was to analyze the impact of three types of occupational footwear: the steel-toed work boot (ST), the tactical work boot (TB), and the low-top work shoe (LT) on previously unreported lower extremity muscle activity during postural stability tasks. Methods: Electromyography (EMG) muscle activity was measured from four lower extremity muscles (vastus medialis (VM), medial hamstrings (MH), tibialis anterior (TA), and medial gastrocnemius (MG) during maximal voluntary isometric contractions (MVIC) and during a sensory organization test (SOT) every 30 min over a 4 h simulated workload while wearing ST, TB, and LT footwear. The mean MVIC and the mean and percentage MVIC during each SOT condition from each muscle was analyzed individually using a repeated measures ANOVA at an alpha level of 0.05. Results: Significant differences (p &lt; 0.05) were found for maximal exertions, but this was limited to only the time main effect. No significant differences existed for EMG measures during the SOT. Conclusion: The findings suggest that occupational footwear type does not influence lower extremity muscle activity during both MVIC and SOT. Significantly lower muscle activity during maximal exertions over the course of the 4 h workload was evident, which can be attributed to localized muscular fatigue, but this was not sufficient to impact muscle activity during postural stability tasks.

Proof-of-Concept of the Virtual Reality Comprehensive Balance Assessment and Training for Sensory Organization of Dynamic Postural Control.

Accurate quantification of the impact of visual, somatosensory, and vestibular systems on postural control may inform tailor-made balance intervention strategies. The aim of this proof-of-concept study was to determine the safety, sense of presence, system usability, and face validity of a newly developed Virtual Reality Comprehensive Balance Assessment and Training (VR-ComBAT) in healthy young individuals. The VR-ComBAT included six balance condition: (1) stable surface with fixed virtual reality (VR) surroundings; (2) stable surface with blacked out VR surroundings; (3) stable surface with VR visual conflict; (4) unstable surface with fixed VR surroundings; (5) unstable surface with blacked out VR surroundings; and (6) unstable surface with VR visual conflict. Safety was evaluated using the number of adverse events, including scores on the Simulator Sickness Questionnaire. Sense of presence was evaluated using the igroup Presence Questionnaire (iPQ). System usability was assessed using the Systems Usability Scale (SUS). Friedman analyses with post hoc Wilcoxon Signed Rank tests were employed to demonstrate face validity by quantifying center of pressure (COP) changes in mean distance, mean velocity, and mean frequency in the anteroposterior (AP) and mediolateral (ML) direction across the six conditions. Twenty-three participants (27.4 ± 8.0 years old; 13 women) reported no adverse events. Participants scores on average 44.9 ± 9.6 on the iPQ and 79.7 ± 9.9 on the SUS. Post hoc analyses showed significant changes in COP-based measures when compared to baseline. The mean frequency change of COP showed direction-dependence in which increased frequency change in AP was observed while decreased change in ML was noted. The VR-ComBAT provides a safe, feasible, and cost-effective VR environment that demonstrates consistent sensory re-weighting between visual, somatosensory, and vestibular systems. Future studies should investigate whether VR-ComBAT can be used to inform precision rehabilitation of balance and fall prevention in older adults without and with neurological conditions.

Effect of Smartphone Use on Static and Dynamic Postural Balance in Healthy Young Adults

Purpose The purpose of this study was to investigate the possible effects of smartphone usage in the biomechanical balance system. Method Twenty-five healthy young adults (10 men, 15 women) between the ages of 18 and 25 years without balance problems were included in the study. Sensory organization, adaptation, rhythmic weight shift, and functional limitation tests (unilateral stance, sit to stand, walk across, tandem walk, step quick turn, step up down, forward lunge) have been applied. Results Significant results were obtained in parameters of sensory organization, tandem walk, walk across, and unilateral stance tests (p < .05). Conclusion The effects of using smartphones on postural control and balance in different circumstances, such as standing and walking, must be comprehensively determined to prevent accident.

Efficacy evaluation of vestibular rehabilitation based on mobile internet in patients with otogenic vertigo

Twenty-five patients diagnosed with otogenic vertigo at the outpatient clinic of the Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital from January to June 2020 were selected. Among them, 8 cases were male and 17 cases were female, aged (48±13) years. All the patients underwent internet combined with offline follow-up vestibular rehabilitation for 12 weeks, which included vestibulo-ocular reflex exercises, proprioceptive exercises and static/dynamic balance exercises. Computerized dynamic posturography (CDP) and dizziness handicap inventory (DHI) scores were compared before and after rehabilitation. The DHI score improved significantly after 12 weeks of vestibular rehabilitation (48.3±15.9 vs 26.7±17.9, t=5.319, P<0.001). Meanwhile, the sensory organization test (SOT) score was also improved (73.3±8.1 vs 76.1±6.6, t=2.066, P=0.050), while the difference of motor control test (MCT) latent stage score before and after rehabilitation was not statistically significant (140±13 vs 141±16, t=0.791, P=0.436). The current study demonstrates that vestibular rehabilitation based on mobile internet is convenient, economical and effective, and patients can benefit from it.

Clinical values of different vestibular function examinations to evaluate the curative effect of vestibular neuritis rehabilitation

The clinical values of video head impulse test (vHIT), caloric test (CT) and sensory organization test (SOT) at different stages before and after rehabilitation of 30 patients with vestibular neuritis (VN) in Vertigo Center Ward of Air Force Special Medical Center from January 2019 to January 2020 were analyzed and compared. There were 19 males (63.3%) and 11 females (36.7%), respectively, aged 18-68 (44±14) years. After 1 week and 3 months of rehabilitation in VN patients, the results of the three examinations were detached, and the recovery rates among the three observed indicators of each examination were statistically different (P<0.001). After 1 week of rehabilitation, the total recovery rate of vHIT was 0, which was lower than that of CT (40.0%) and SOT (43.3%) (both P<0.001). After 3 months of rehabilitation, the total recovery rate of vHIT was 13.3%, which was also lower than CT (86.7%) and SOT (80.0%) (both P<0.001). The current study indicates that the results of observed indicators from vHIT, CT and SOT were detached at different stages of VN rehabilitation. Therefore, the clinical significance of different vestibular function examinations is different but complementary.

VESTIBULAR TESTING IN CHILDREN WITH DIZZINESS AND BALANCE CONCERNS AFTER CONCUSSION: LABORATORY AND CLINICAL RESULTS

Background:Dizziness is the second most common symptom in people who sustain a concussion and there are few reports on vestibular laboratory findings in the concussed pediatric population. Studies to date have shown conflicting findings regarding incidence of peripheral vestibular disorders. Hypothesis/Purpose: The purpose of this study is to report vestibular laboratory and clinical examination findings in concussed youth referred to a multidisciplinary vestibular clinic.Methods:A retrospective chart review was performed for all patients (n=474) seen from August 2017 to March 2020 for a single comprehensive examination in a multidisciplinary pediatric vestibular specialty clinic. Data was extracted from the charts of patients (n=64) with a history of concussion referred because of chronic dizziness and/or imbalance. Each patient was examined by a neurotologist, physical therapist, and audiologist with specialized training in vestibular disorders. Vestibular laboratory testing performed by audiologists included video nystagmography (VNG) evaluation of oculomotor function and BPPV, rotational chair, video head impulse test (vHIT), vestibular evoked myogenic potentials (VEMPs), post-headshake nystagmus, and caloric irrigation. Physical therapy clinical examination included dynamic visual acuity testing (DVA), vestibular/oculomotor screening (VOMS), and sensory organization test (SOT). Not all tests were performed on every patient secondary to factors such as insurance coverage, patient tolerance, and young age.Results:1 or more components of VOMS was abnormal in 30 of 53 patients examined. DVA was completed on 40 patients, 23 of which were reported as abnormal. SOT was completed on 46 patients, 18 of which demonstrated below normal composite equilibrium scores. Laboratory findings were as follows: VEMPs (n=50) were normal in all but 1 patient, vHIT (n=59), caloric irrigation (n=26), post-headshake nystagmus (n=49), and positional testing (n=55) were normal on all patients tested. Rotational chair (n=60) was performed at 4 different frequencies and revealed low gain in 3 patients.Conclusion:Vestibular laboratory examination was normal in nearly all subjects tested. These results suggest that in concussed youth with chronic dizziness and/or imbalance, laboratory vestibular test outcomes indicative of peripheral dysfunction are rare, which contradicts previous research in this population. In contrast, clinical vestibular assessment was abnormal in more than 50% of subjects examined which suggests that clinicians should use caution interpreting clinical examination findings for diagnosing peripheral vestibular dysfunction. Abnormal clinical examination findings may be indicative of central vestibular conditions such as space and motion intolerance and PPPD in chronically dizzy pediatric patients after concussion.Tables/Figures:

Sensory organization test results for maintaining an upright balance in patients with type 2 diabetes mellitus and patients with peripheral vestibular disorders

Objective:To research the differences of sensory organization testing in maintaining postural stability between patients with type 2 diabetes mellitus and patients with peripheral vertigo using computerized posturography. Methods:Participants were divided into the control group （52 cases）, the type 2 diabetes mellitus group （T2DM） （45 cases）, and the peripheral vertigo group （PV） （47 cases）. All participants were examined under six conditions by computerized posturography: The sensory organization test, a part of computerized dynamic posturography, was used to assess the abilities of vision, somatosensory and vestibular systems in maintaining postural stability. Results:The scores of statokinesiogram （SKG） of the T2DM group in condition 1 （standing on static platform with eye open）, condition 4（standing on foam platform with eyes open） and condition 6（standing on foam platform with servo-controlled vision） were significantly greater than that in the vertigo group （P<0.01）. The visual scores in the T2DM group were lower than those of the PV group（P<0.01） in the anteroposterior and lateral directions. Conclusion:Patients with type 2 diabetes and peripheral vertigo have a decreased ability to maintain balance in the upright position. Patients with type 2 diabetes have a poorer ability to maintain balance with visual systems than patients with peripheral vertigo.

Association of posturography with clinical measures in balance rehabilitation of ataxic patients.

The assessment of balance includes posturography measures and clinical balance tests in individuals with ataxia. Although both advantages and disadvantages of these assessments have been stated, no relationship between them in individuals with ataxia has been shown in the literature. The aim of this cross-sectional study was to investigate the relationships between commonly used clinical balance tests and posturography measures in ataxic individuals. The study included a total of 42 patients (mean age: 33.90 ± 8.75 years) with different diagnoses causing ataxia. The sensory organization test (SOT), limits of stability (LOS), unilateral stance and rhythmic weight shift (RWS) tests in computerized dynamic posturography and the clinical balance tests of Berg Balance Scale (BBS), International Cooperative Ataxia Rating Scale (ICARS) and timed up and go (TUG) test were used to assess balance. The Spearman correlation test was used to evaluate the relationships between the clinical balance tests and posturography variables. Moderate and strong correlations were found between the ICARS, BBS and TUG scores and Unilateral Stance sway velocity, directional control parameter of RWS and LOS (P < 0.01-0.05). The ICARS and BBS scores were correlated with the SOT-Composite Equilibrium Score (P < 0.01-0.05). The results of this study suggest the use of both posturography and clinical balance tests in the rehabilitation of ataxic individuals with mild-moderate balance impairment, because posturography variables determine the underlying cause of imbalance and clinical tests evaluate balance in functional activities.

The Management of Balance and Proprioception Discrepancies for a Patient with Cervicogenic Headache: A Case Report

Introduction: Previous research studies have established a link between cervical dysfunction, proprioception, and balance deficits in patients with cervicogenic headache. However, no current research exists to determine if the implementation of a balance program for these patients has any effect on their balance and proprioception capabilities. This case study aimed to identify if significant changes can be made the overall balance of a patient with cervicogenic headache as measured by the NeuroCom Sensory Organization Test. Case Description: The patient was a 50-year-old female, who had been suffering from long term cervicogenic headaches with increasing frequency and intensity for 6 months. Outcomes: The patient was seen for six visits over six weeks for balance training in addition to traditional physical therapy interventions including manual therapy and therapeutic exercise. After 6 sessions the patient made an overall improvement in balance (+7.9%) measured via the NeuroCom Sensory Organization Test and clinically significant improvements in reported pain via the Headache Disability Index (91.6%), Neck Disability Index (63.6%) and the Visual Analog Scale (2.5 points). Discussion: This case report demonstrates when balance training is added to standard manual therapy interventions for the management of cervicogenic headache you can successfully improve overall balance control measured with the NeuroCom Sensory Organization Test. Further research is necessary to further validate balance programming as a key intervention strategy for the general population with cervicogenic headache and guide decision-making for these patients.

Chronic Effects of Breaching Blast Exposure on Sensory Organization and Postural Limits of Stability.

The goal of this effort to investigate if experienced breachers, professionals with a career history of exposure to repeated low-level blasts, exhibited postural instability. Postural data were examined using traditional tests of means and compared to normative data. Breachers had significantly lower NeuroCom Sensory Organization Test (SOT) visual scores (within normative limits), prolonged Limits of Stability (LOS) test reaction time (30% of breachers and 7% of controls testing abnormal), and slower LOS movement velocity (21% of breachers and 0% of controls testing abnormal) compared to controls. Our LOS test findings are like those previously reported for students in the military breacher training course and seem to indicate that while acute effects of blasts on sensory control of balance fade away, effects on postural LOS persist over time.

Population Receptive Field Characteristics in the between- and Within-Digit Dimensions of the Undominant Hand in the Primary Somatosensory Cortex

Somatotopy is an important guiding principle for sensory fiber organization in the primary somatosensory cortex (S1), which reflects tactile information processing and is associated with disease-related reorganization. However, it is difficult to measure the neuronal encoding scheme in S1 in vivo in normal participants. Here, we investigated the somatotopic map of the undominant hand using a Bayesian population receptive field (pRF) model. The model was established in hand space with between- and within-digit dimensions. In the between-digit dimension, orderly representation was found, which had low variability across participants. The pRF shape tended to be elliptical for digits with high spatial acuity, for which the long axis was along the within-digit dimension. In addition, the pRF width showed different change trends in the 2 dimensions across digits. These results provide new insights into the neural mechanisms in S1, allowing for in-depth investigation of somatosensory information processing and disease-related reorganization.

Sensory organization for postural control in children with strabismus-A systematic review and meta-analysis.

Postural control requires the interaction of somatosensory, vestibular and visual systems to prevent disequilibrium. Children with strabismus have an impaired visual input which can lead to postural control deficits. Does strabismus affect sensory organization for postural control in children? A systematic comprehensive search of multiple electronic databases for relevant articles was performed using a predetermined search strategy. Peer-reviewed journal publications that assessed sensory organization and postural performance in children with strabismus were included in this review. Methodological quality of the articles was evaluated using the modified Downs and Black quality assessment tool. A total of 10 articles were included in this review. Eight of the 10 articles reviewed were included in the meta-analysis. Meta-analysis for Centre of Pressure CoP velocity (n = 3) (eyes open, stable support), was statistically significant (P = 0.01) in favor of controls over children with strabismus (MD, 3.08; 95 % CI -0.66, 5.51). Meta-analysis for CoP surface area (n = 5) (eyes open, stable support) was also statistically significant (P < 0.001) in favor of the control group (MD, 130.14; 95 % CI 70.01, 190.260). Meta-analysis with standardized mean difference (n = 6) for eyes open vs closed, stable support was statistically significant (P = 0.02) in favor of eyes open (MD, -0.94; 95 % CI, -1.74, -0.15). Overall, there was a high level of heterogeneity throughout the studies. This is the first systematic review of its kind to collate and synthesize evidence on the effect of strabismus on postural control in children. This review suggests that postural control performance in children with strabismus is inferior to that of age-matched control children. Further investigation is needed to understand the influence of the three sensory systems.

Feasibility and Preliminary Effects of a 1-Week Vestibular Rehabilitation Day Camp in Children with Developmental Coordination Disorder

Aim This pilot study investigated the feasibility and preliminary effects of an intensive 1-week day camp program for children with Developmental Coordination Disorder (DCD) that focused on vestibular rehabilitation. Methods Ten participants (6-10 years) were assessed twice pre-intervention, post intervention, and at 8-week follow-up. Videonystagmography, Video Head Impulse Tests (vHIT), and Modified Emory Clinical Vestibular Chair Test (m-ECVCT) test were assessed at baseline. Outcomes measures were gaze stability (Dynamic Visual Acuity; DVA), functional gait (Functional Gait Assessment; FGA), balance (Sensory Organization Test), motor function (Bruininks-Oseretsky Test), and participation (Miller Function and Participation). Results No abnormal results were detected from the videonystagmography, vHIT and m-ECVCT. There was a 100% attendance rate at the camp and assessment sessions. FGA scores significantly improved following intervention and changes were maintained at follow-up. The number of children with abnormal DVA scores decreased from 3 to 1 to 0 between pre-intervention, post-intervention, and follow-up. There were no significant changes in any of the other outcomes following intervention. Conclusions Intensive vestibular rehabilitation delivered in a day camp format is feasible and show positive preliminary effects on functional gait and dynamic visual acuity in children with DCD.

Dizziness and Balance Disorders in a Traumatic Brain Injury Population: Current Clinical Approaches

Balance deficits are frequently observed in traumatic brain injuries (TBIs). This review seeks to explore the components of the balance system affected by TBIs and current interventions used to address the underlying impairments. TBIs result in a wide range of impairments often including imbalance and dizziness. The trauma can result in mechanical issues, benign paroxysmal positional vertigo (BPPV), or central processing issues through damage to the vestibular nucleus and pathways. Both issues can be addressed through physical therapy. BPPV treatment involves using a series of positions to move the otoconia from the canal to the vestibules, whereas treatments for central processing issues involve improving sensory organization using exercises based on the system affected or teaching compensatory strategies. Balance impairments are a common issue after TBI. Physical therapy can be used to treat these impairments, to reduce fall risk, to improve functional independence, and to improve quality of life.

Examining the Relationship Between Conventional Outcomes and Immersive Balance Task Performance in Service Members With Mild Traumatic Brain Injury.

Mild traumatic brain injury (mTBI) is associated with significant financial cost and reduced military readiness and impacts quality of life for active duty service members (SMs). Post-concussive symptoms can include vestibular impairments, such as chronic dizziness and postural instability, which can be compounded by psychological comorbidities like PTSD. Comprehensive vestibular evaluations are required to assess symptoms and guide clinical decision-making. At the National Intrepid Center of Excellence (NICoE), in addition to traditional vestibular assessments, clinicians can also leverage virtual environments (VEs) in the Computer-Assisted Rehabilitation Environment (CAREN) to further evaluate balance. The objective of this study was to examine the relationship between conventional outcomes and VE performance on immersive balance tasks in the CAREN, determine whether VE performance could predict conventional outcomes, and explore the impact of PTSD. This retrospective analysis included 112 SMs from the NICoE Intensive Outpatient Program who provided informed consent for their clinical data to be used for research purposes. All had a history of mTBI, underwent vestibular evaluations, and completed immersive balance tasks on the CAREN. Conventional outcomes included the Sensory Organization Test (SOT), Functional Gait Assessment (FGA), Activities Balance Confidence (ABC) Scale, and Dizziness Handicap Inventory (DHI). The PTSD Checklist-Military Version was added to account for behavioral symptoms. Computer-Assisted Rehabilitation Environment outcomes included total time to complete the Balance Cubes VE, with the platform static (BC-Static) and with random platform motion (BC-PM) as well as composite scores for the Shark Hunt VE, with (SH-Recall) and without a recall task (SH-Standard). Statistical analyses included independent t-tests to determine group differences, Pearson's correlations to examine relationships between conventional outcomes and VE performance, and binary logistic regressions to determine if VE performance predicted conventional outcomes based on clinically relevant cutoffs. SMs who took less time to complete BC-Static had better overall balance, indicated by higher ABC, SOT, and FGA scores (P <.001). Those with greater self-reported dizziness, higher DHI scores, took longer to complete BC-Static (P < .05). FGA and SOT, objective gait and balance, were similarly correlated to BC-PM performance (P <.001). SMs with higher SOT scores, better balance, also tended to have higher SH-Standard scores (P <.1). SMs, who were above normative SOT, FGA, and ABC cutoffs, completed BC-Static significantly faster than those below (P <.05). This remained true for BC-PM but was only significant for SOT (P = .004). Performance on BC-Static, BC-PM, and SH-Standard was significant predictors of SOT score. For SMs with comorbid mTBI and PTSD, increased functional disability was observed in conventional outcomes and diminished VE performance was noted. Objective balance and gait, SOT and FGA, demonstrated the strongest relationships to immersive VE performance in the CAREN. Our findings suggest that these immersive balance tasks may be effective as an adjunct assessment to examine balance. Future work will focus on moving these VEs from the CAREN to a portable system, which could be more readily utilized in a variety of clinical settings, increasing accessibility.

Discovery of a body-wide photosensory array that matures in an adult-like animal and mediates eye–brain-independent movement and arousal

The ability to respond to light has profoundly shaped life. Animals with eyes overwhelmingly rely on their visual circuits for mediating light-induced coordinated movements. Building on previously reported behaviors, we report the discovery of an organized, eye-independent (extraocular), body-wide photosensory framework that allows even a head-removed animal to move like an intact animal. Despite possessing sensitive cerebral eyes and a centralized brain that controls most behaviors, head-removed planarians show acute, coordinated ultraviolet-A (UV-A) aversive phototaxis. We find this eye-brain-independent phototaxis is mediated by two noncanonical rhabdomeric opsins, the first known function for this newly classified opsin-clade. We uncover a unique array of dual-opsin-expressing photoreceptor cells that line the periphery of animal body, are proximal to a body-wide nerve net, and mediate UV-A phototaxis by engaging multiple modes of locomotion. Unlike embryonically developing cerebral eyes that are functional when animals hatch, the body-wide photosensory array matures postembryonically in "adult-like animals." Notably, apart from head-removed phototaxis, the body-wide, extraocular sensory organization also impacts physiology of intact animals. Low-dose UV-A, but not visible light (ocular-stimulus), is able to arouse intact worms that have naturally cycled to an inactive/rest-like state. This wavelength selective, low-light arousal of resting animals is noncanonical-opsin dependent but eye independent. Our discovery of an autonomous, multifunctional, late-maturing, organized body-wide photosensory system establishes a paradigm in sensory biology and evolution of light sensing.

Age-related Patterns of Vestibular Dysfunction in Dizziness and Imbalance: A Review of Vestibular Testing Results Among 1,116 Patients.

To characterize differences in vestibular testing results among patients presenting with balance-related complaints; to stratify patterns of testing abnormalities by age. Retrospective chart review. Academic Balance Center at a Tertiary Referral Center. All patients who underwent vestibular testing in a 1-year period from 2017 to 2018. Balance function test results. We reviewed 1,116 patients with age ranging from 11 to 94 years, including 521 patients ≥60 years. Most patients had at least 1 abnormal result, with only 21% of patients ≥60 years and 43% of patients <60 years yielding no test abnormalities (p < 0.001). Among 754 individuals with abnormal testing results, caloric testing did not show any significant difference between age groups. Patients ≥60 years of age were more likely to demonstrate abnormalities on saccadic and horizontal tracking eye movements (p < 0.01; sacc 20.8% vs 6.3%; HT 9.2% vs 4.7%), as well as positional and Dix-Hallpike testing with videonystagmography (p < 0.001; pos 52.3% vs 37.5%, DH 14.4% vs 6.8%). On computerized dynamic posturography, there were significantly more abnormal composite scores in the older group for both sensory organization and motor control testing (p < 0.001; SOT 31.8% vs 8.8%, MCT 7.6% vs 1.8%). Among patients presenting balance-related complaints, a majority demonstrate at least one abnormality on vestibular testing. While caloric abnormalities occur across the life span, patients ≥60 years of age are more likely to have abnormal results in random saccades, positional, Dix-Hallpike testing, and posturography, with greater effect sizes in tests of central function. While the causes of imbalance and vertigo remain multifactorial, vestibular dysfunction can be considered a major contributor to balance dysfunction in the elderly population and should be thoroughly evaluated.

Baduanjin Qigong Improves Balance, Leg Strength, and Mobility in Individuals With Chronic Stroke: A Randomized Controlled Study

Background Effective and sustainable exercise training methods for improving balance poststroke are needed. Objective To evaluate the effect of Baduanjin Qigong for improving balance after stroke. Methods This was a single-blinded randomized controlled study in which only the assessor was blinded. Fifty-eight people with chronic stroke (mean age: 62.5 ± 11.8 years) were randomly assigned to the experimental (n = 29) or control group (n = 29). The experimental group underwent 8 weeks of supervised Baduanjin training (3 sessions per week). This was followed by home-based practice of the same exercises 3 days a week for another 8 weeks. The control group underwent 2 sessions of supervised conventional fitness training in the first week, followed by home-based exercise practice 3 days a week until the end of week 16. All outcomes were measured at baseline, week 8, and week 16. Results Significantly greater improvements in the Mini-Balance Evaluation Systems Test (Mini-BESTest), composite equilibrium score (Sensory Organization Test), 5 Times Sit to Stand, and Timed Up and Go test were detected at week 8 in the experimental group than in the control group (P < .017). Further improvement in the Mini-BESTest was observed from week 8 to 16 in the experimental group (P < .001). Other outcomes (Limit of Stability, Fall-Efficacy Scale, Modified Barthel Index, Stroke-Specific Quality of Life) showed no significant results. Conclusion Baduanjin is effective in improving balance, leg strength, and mobility and is a safe and sustainable form of home-based exercise for people with chronic stroke.