Smart Balance Master Research Articles

Sensory Integration for Postural Control in Rheumatoid Arthritis Revealed by Computerized Dynamic Posturography

Rheumatoid arthritis (RA) is a systemic autoimmune disease that impairs mobility. How does sensory information influence postural responses in people with RA? The aim of this study was to evaluate the postural control of people with RA during a sensory organization test, comparing how sensory information influences postural responses in people with rheumatoid arthritis compared with healthy people. Participants were 28 women with rheumatoid arthritis (RA group) and 16 women without any rheumatoid disease (Control group CG). The Sensory Organization Test (SOT) was performed on a Smart Balance Master® (NeuroCom International, Inc., Clackamas, OR, USA) and center of pressure (COP) was measured. SOT conditions: SOT1 (eyes open, fixed support surface and surround; SOT2) eyes closed, fixed support surface and surround; and SOT5) eyes closed, sway-referenced support surface, and fixed surround. To compare the demographic and clinical aspects between groups, independent t-test or Mann-Whitney's U-test were used. Differences were found between groups. Between SOT conditions, for CG and RA, COP was faster for SOT-5 than SOT-1, while SOT-1 and SOT-2 presented similar COP velocity. For SOT-2 and SOT-5, COP was larger for the RA group. For both groups, SOT-1 presented the smallest COP, and SOT-5 showed the largest COP.

A Study Protocol to Evaluate the Effects of Vestibular Training on the Postural Control of Healthy Adults Using Virtual Reality

Postural instability is a common symptom of vestibular dysfunction due to an insult to the vestibular system. Vestibular rehabilitation is effective in decreasing dizziness and visual symptoms, and improving postural control through several mechanisms, including sensory reweighting. As part of the sensory reweighting mechanisms, vestibular activation training with headshake activities influences vestibular reflexes. However, combining challenging vestibular and postural tasks to facilitate more effective rehabilitation outcomes is underutilized. Our research goal is to develop a virtual reality vestibular rehabilitation method for vestibular-postural control in neurological populations with vestibular and/or sensorimotor control impairment. The NeuroCom® SMART Balance Master (Natus Medical Inc., Pleasanton, CA, USA), which was used in a prior study, is expensive and bulky. Hence, a novel study protocol is established in this paper with the detailed objectives and pre-/post-intervention data analysis pipeline (ANOVA, t-test, post hoc analysis, etc.) involving modern off-the-shelf sensors and custom instrumentation (electromyography, electrooculography, video head impulse testing, force plates, and virtual reality headsets). It is expected that the training will significantly decrease vestibuloocular reflex gains and eye movement variability, as well as reweight the somatosensory ratio, finetune postural muscle activation, and consequently improve postural flexibility and produce a faster automatic postural response. The findings may have implications for the future development of vestibular rehabilitation protocols.

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.

The effect of a daytime 60-min nap opportunity on postural control in highly active individuals.

Although napping is commonly used as a strategy to improve numerous physical and cognitive performances, the efficacy of this strategy for improving postural balance has not yet been elucidated. Thus, the aim of this study was to conduct a comprehensive examination of the effect of a 60 min nap opportunity (N60) on different components of postural control. Ten highly active individuals (age = 27 ± 3.5 y, height = 1.75 ± 0.52 m, weight = 66.02 ± 8.63 kg) performed, in a randomized order, two afternoon test sessions following no nap (NN) and N60. Postural balance was assessed using the sensory organisation test (SOT), the unilateral stance test (UST), and the limits of Stability Test performed on NeuroCom® Smart Balance Master. The subjective rating of sleepiness before and after the nap conditions was also assessed. Compared to NN, N60 improved the composite balance score (p < 0.05, ES = 0.75, Δ = 5.3%) and the average and maximum percentage balance in the most challenging postural conditions of the SOT (p < 0.05 for SOT-4 and 5 and p < 0.0005 for SOT-6; ES range between 0.58 and 1.1). This enhanced postural balance in N60 was accompanied with improved visual (p < 0.05; ES = 0.93; Δ = 8.9%) and vestibular (p < 0.05; ES = 0.81; Δ = 10.5%) ratios and a reduced level of sleepiness perception (p < 0.001, ES = 0.87). However, no significant differences were found in any of the UST and LOS components’ scores (p > 0.05). Overall, a 60 min post lunch nap opportunity may be viable for improving static balance, although further work, involving larger samples and more complex motor activities, is warranted.

A new process to measure postural sway using a Kinect depth camera during a Sensory Organisation Test.

Posturography provides quantitative, objective measurements of human balance and postural control for research and clinical use. However, it usually requires access to specialist equipment to measure ground reaction forces, which are not widely available in practice, due to their size or cost. In this study, we propose an alternative approach to posturography. It uses the skeletal output of an inexpensive Kinect depth camera to localise the Centre of Mass (CoM) of an upright individual. We demonstrate a pipeline which is able to measure postural sway directly from CoM trajectories, obtained from tracking the relative position of three key joints. In addition, we present the results of a pilot study that compares this method of measuring postural sway to the output of a NeuroCom SMART Balance Master. 15 healthy individuals (age: 42.3 ± 20.4 yrs, height: 172 ± 11 cm, weight: 75.1 ± 14.2 kg, male = 11), completed 25 Sensory Organisation Test (SOT) on a NeuroCom SMART Balance Master. Simultaneously, the sessions were recorded using custom software developed for this study (CoM path recorder). Postural sway was calculated from the output of both methods and the level of agreement determined, using Bland-Altman plots. Good agreement was found for eyes open tasks with a firm support, the agreement decreased as the SOT tasks became more challenging. The reasons for this discrepancy may lie in the different approaches that each method takes to calculate CoM. This discrepancy warrants further study with a larger cohort, including fall-prone individuals, cross-referenced with a marker-based system. However, this pilot study lays the foundation for the development of a portable device, which could be used to assess postural control, more cost-effectively than existing equipment.

Effect of Vibration Intervention on Balance, Core Stability and Muscle Strength in Martial Arts Athletes

OBJECTIVE: To compare the effects of vibration training(V)and control training(C)on balance, core stability and muscle strength in young martial arts athletes. METHODS: Fourteen athletes were recruited and randomly assigned to two groups:vibration group(V, n=7)and control group(C, n=7). Before and after the 12 weeks training, The SMART Balance Master system was used to measure scores in the limits of stability(LS): reaction time(RT), movement velocity(MVL), end point excursion(EPE), maximum excursion(MXE), and directional control(DCL). The core stability is evaluated by the performance of grade 8 abdominal bridge. Core muscle strength are indirectly evaluated by integrating electromyography (iEMG). Student t-tests were used for data analysis. RESULTS : MVL(1.37 deg/sec, P < 0.01),EPE(10.86%,P < 0.01),MXE(7.00%,P < 0.05),DCL(2.86% ,P < 0.05)in group V were significantly higher after the Vibration Intervention . EPE ( 8.86%,P < 0.01),MXE(4.43%,P < 0.01)in group C were higher after the control training . The percentage range was higher in group V(8.29%)than C(4.50%). No significant differences were found in LS between the groups at 12 weeks of follow up. The full score of grade 8 abdominal bridge was obtained in the vibration group, and the overall Range was higher in group C than group V(P < 0.01). The scoring of core stability also revealed no differences between the groups. In group V left rectus abdominis iEMG value(nearly 100% mV·s ,P < 0.01), left rectus femoris(0.71 mV·s,P<0.05) , left tibialis anterior ( 0.39 mV·s, P<0.05)were higher after 12 weeks training .In group C left rectus femoris ( 0.42 mV·s, P < 0.01), left tibialis anterior ( 0.12 mV·s ,P < 0.05) were higher after 12 weeks training . After 12 weeks training, the iEMG value of left tibialis anterior( 0.63 mV·s ,P < 0.01),right rectus abdominis ( 0.34 mV·s ,P < 0.05) in group V were higher than C. There were no significant differences in the right erector spinae, left Rectus abdominis, left rectus femoris, left erector spinae and left gluteus maximus between group V and C. CONCLUSION: Vibration training improved balance, core stability and muscle strength of movements in young martial arts athletes.

Patellar tendon ultrasonographic properties and lower limb function in rheumatoid arthritis patients

Aim of workThe aim of this work was to investigate patellar tendon (PT) biomechanical properties in rheumatoid arthritis (RA) patients through changes in ultrasonographic tendon properties and its effect on lower limb function.Patients and methodsForty RA patients and 20 healthy participants were included in this study. The physical function was assessed by Health Assessment Questionnaire, the activity of RA by disease activity score 28 and range of motion for all knees by a manual goniometer. RA patients were divided into the following groups: group I comprised patients with low disease activity score 28, who were further subdivided according to the presence of knee flexion deformity into two subgroups (GIA and GIB) and group II patients in the remission stage. Ultrasonography was used for measuring PT elongation and cross-sectional area and quadriceps’ muscle strength was measured. The lower limb function was assessed clinically by 50-foot walk test and smart balance master system through unilateral stance test, step up and over and sit to stand tests.ResultsThere was an increased elongation of PT of all RA groups relative to the control group (P=0.001); no significant difference was found in the PT (cross-sectional area). RA patients showed quadriceps’ muscle strength reduction (P=0.001) and delayed walking time of the 50-foot walk test (P=0.05). Unilateral stance test showed increased center of gravity sway velocity during either eye open or eye closed conditions in RA groups and deterioration in all parameters of step up and over and sit to stand tests (P=0.05–0.001). All physical function evaluation of RA patients showed impairment associated with a reduction of PT stiffness and quadriceps’ strength.ConclusionInflammation of the PT and peritendinous tissues in RA alters its biomechanical properties; this impairs RA patients’ physical and lower limb functions.

Simplified Tai Chi 6-Form Apparatus for Balance in Elderly People with Alzheimer\u2019s Disease

BackgroundPeople with Alzheimer’s disease (AD) can have deteriorated walking and impaired postural-balance control, which increases the risk of falls. Tai chi (TC) can improve fitness and balance in elderly people. To facilitate TC learning, we developed the Simplified Tai Chi 6-Form Apparatus (STC6FA).MethodsThis case-controlled study enrolled 26 elderly people with mild-to-moderate AD. Over 8 weeks, the TC group (TCGr) of 11 elderly people with AD completed a training course for the STC6FA. Another 10 older adults with matched age, height, and severity of dementia were assigned to the control group (CGr). Balance function was measured using a SMART Balance Master (NeuroCom International Inc., OR, USA). The parameters were evaluated three times during the training course, at weeks 0, 4, and 8.ResultsThe balance of both the TCGr and CGr improved significantly. A rhythmic forward–backward shift test revealed more improvement in the TCGr than in the CGr.ConclusionSTC6FA training can improve balance and may reduce backward falls in elderly people with mild-to-moderate AD.

Postural Training using Augmented Visual Feedback and Vestibular Activation in Healthy Adults

Postural Training using Augmented Visual Feedback and Vestibular Activation in Healthy Adults

Effects of distractors on upright balance performance in school-aged children with attention deficit hyperactivity disorder, preliminary study.

IntroductionAttention deficit hyperactivity disorder is a common impairing neuropsychiatric disorder with onset in early childhood. Almost half of the children with attention deficit hyperactivity disorder also experience a variety of motor-related dysfunctions ranging from fine/gross motor control problems to difficulties in maintaining balance.ObjectivesThe main purpose of this study was to investigate the effects of distractors two different auditory distractors namely, relaxing music and white noise on upright balance performance in children with attention deficit hyperactivity disorder.MethodsWe compared upright balance performance and the involvement of different sensory systems in the presence of auditory distractors between school-aged children with attention deficit hyperactivity disorder (n = 26) and typically developing controls (n = 20). Neurocom SMART Balance Master Dynamic Posturography device was used for the sensory organization test. Sensory organization test was repeated three times for each participant in three different test environments.ResultsThe balance scores in the silence environment were lower in the attention deficit hyperactivity disorder group but the differences were not statistically significant. In addition to lower balance scores the visual and vestibular ratios were also lower. Auditory distractors affected the general balance performance positively for both groups. More challenging conditions, using an unstable platform with distorted somatosensory signals were more affected. Relaxing music was more effective in the control group, and white noise was more effective in the attention deficit hyperactivity disorder group and the positive effects of white noise became more apparent in challenging conditions.ConclusionTo the best of our knowledge, this is the first study evaluating balance performance in children with attention deficit hyperactivity disorder under the effects of auditory distractors. Although more studies are needed, our results indicate that auditory distractors may have enhancing effects on upright balance performance in children with attention deficit hyperactivity disorder.

Normobaric Hypoxia Effects on Balance Measured by Computerized Dynamic Posturography.

Following a familiarization trial, 12 males (27.3 ± 7.1 years) completed three sessions in random order on a NeuroCom SMART Balance Master: a sham trial at the ambient altitude of 1500 m and simulated altitudes of 3000 and 5000 m created by a hypoxic generator. The NeuroCom provided composite scores for a sensory organization test of equilibrium and a motor control test to assess the appropriate motor response. Additional information on somatosensory, visual, and vestibular responses was obtained. Each session consisted of 20 minutes of rest followed by the NeuroCom test, then 10 minutes of exercise, and 10 minutes of recovery followed by a second NeuroCom test, all while connected to the hypoxic generator. Mean differences were identified with a two-way (pre/postexercise and altitude condition), repeated-measures analysis of variance. The composite sensory score was significantly lower (p < 0.001) during the 5000 m trial (73.4 ± 12.0) compared to the 1500 m (80.8 ± 7.0) and 3000 m (84.1 ± 5.0) altitudes. The inability to ignore inaccurate visual cues in a situation of visual conflict was the most common sensory error. Motor control was not affected by altitude or exercise. These results suggest that moderate hypoxia does not affect balance, but severe hypoxia significantly reduces equilibrium. Furthermore, it appears that the alterations in equilibrium are primarily from impairments in visual function.

Effects of a Novel Therapeutic Intervention in Patients With Diabetic Peripheral Neuropathy

ObjectiveTo determine the effect of a novel therapeutic intervention called intraneural facilitation on balance measures and a neuropathy scale in patients with diabetic peripheral neuropathy. DesignProspective pre- and posttest, single group clinical trial. SettingOutpatient physical therapy clinic. ParticipantsPatients with diabetic peripheral neuropathy (N=13). InterventionSubjects received 10 sessions of intraneural facilitation. Main Outcome MeasuresThe modified Total Neuropathy Scale, the NeuroCom SMART Balance Master system computerized dynamic posturography (CDP) that includes the Sensory Organization Test (SOT) and the limits of stability (LOS), and the Activities-specific Balance and Confidence (ABC) scale. ResultsSubjects in this study showed significant improvement in the modified Total Neuropathy Scale, SOT, and 1 component in the LOS test (movement velocity). There were no significant differences in the ABC scale or in 4 components of the LOS test, which were reaction time, end point excursion, maximum excursion, and directional control. ConclusionsIntraneural facilitation improved objective balance measures and neuropathy symptoms in patients with diabetic peripheral neuropathy. Further study is needed to determine long-term benefits of this intervention.

Botulinum Toxin Type A Injection May Restore Ankle Strategy Use in Stroke Patients: A Preliminary Report

Introduction: Stroke causes upper motor neuron syndrome, and spasticity of foot ankle complex further leads to equine gait and posture stability disturbance. Botulinum type A (BTX-A) injection has been widely used in treating spasticity, yet few studies report its effect on posture control. This study aimed at applying BTX-A injection in treating ankle-foot complex spasticity and investigating its effect on ankle strategy use with sensory organization test. Material and method: 9 stroke patients and 5 healthy subjects were recruited. BTX-A injection was applied over calf flexor muscle group under electrical stimulation guide. Strategy score (ST) and Composite score were assessed using standard sensory organization test(SOT) with SMART Balance Master. The higher ST and Composite score indicated that the subjects used more ankle strategy. The individual test conditions were as following: EO: eyes open; EC: eyes closed; SV: swayed vision and fixed support; EOSS: eyes open and swayed support; ECSS: eyes closed and swayed support; SVSS: swayed vision and swayed support). For the patient group, SOT was performed before BTX-A injection, and at 4 weeks, 8 weeks and 12 weeks follow up. For control group, the assessments were performed once. Generalized estimating equation was implemented for data analysis, and set p<0.05 as statistical significance.

Impact of Yoga on Postural Stability in Stroke

Deficits in motor capacity following stroke poses a potential threat to postural stability. The purpose of the study was to assess the impact of yoga training on postural alignment, anticipatory postural adjustments, and compensatory postural adjustments in individuals with chronic stroke deficits. This study is a subset analysis from a prospective, randomized control trial using therapeutic yoga. Twenty one individuals with chronic motor deficits from stroke participated in an hour-long group yoga sessions twice a week for 8 weeks focusing on progressively challenging postures, breathing, and meditation in sitting, standing, and supine positions. Postural symmetry, compensatory postural adjustment, and anticipatory postural adjustment from the NeuroCom SMART Balance Master® were used to evaluate changes in postural stability. The Berg Balance Scale was used to evaluate correlations to changes in dynamic balance control. Prior to participation in yoga, significant weight distribution asymmetry was observed during full upright standing. After 8 weeks of yoga training, there were no significant differences in weight distribution between right and left legs at 0 degrees. Subjects demonstrated greater than 50% improvement in symmetry alignment for different standing positions. No significant changes in compensatory or anticipatory postural adjustments were seen following yoga training. Changes in functional BBS scores were significantly correlated to changes in upright standing symmetry. Yoga training may improve postural symmetry enhancing postural control decreasing the risk for falls in individuals with deficits from chronic stroke.

Postural changes associated with ageing on the sensory organization test and the limits of stability in healthy subjects.

Acknowledgement of the age effects on postural control and balance is essential to differentiate between physiological changes and actual pathological alterations of the elderly. The aim of this study is to establish the age-related postural changes recorded by the Computerized Dynamic Posturography. 70 healthy individuals (35 males and 35 females) with an average age of 44.9 years, evenly distributed in seven age groups. We carried out a Sensory Organization Test and Limits of Stability with the Neurocom Smart Balance Master(®) posturography platform. Statistical analysis was undertaken using ANOVA (p<0.05). Increased age-related balance percentage for Condition 4 (p=0.022), reduced usage rate of ankle-strategy for Conditions 3 (p=0.027) and 4 (p=0.05) for the higher age groups were reported. Regarding limits of stability, the following were the results: age-related differences at an early stage, reaction time from 40 to 49 years, velocity of movement, excursion and directional control from 50 to 59 years. Age only affects the balance rate under more complex sensory conditions. For healthy people, ankle strategy is more frequently used than hip strategy; however, the use of hip strategy increases under more difficult sensory conditions. Limits of stability get worse with age, namely after the age of 40-50 years.

Is It Possible to Shorten Examination Time in Posture Control Studies?

Introduction and objectivesThe sensory organisation test (SOT) is the gold-standard test for the study of postural control with posturographic platforms. Three registers of Conditions 3, 4, 5 and 6 are conducted to find an arithmetic mean of the 3, with the time that this entails. The aim of this study was to determine whether a single record for each SOT condition would give us the same information as the arithmetic mean of the 3 recordings used until now. Materials and methods100 healthy individuals who performed a sensory organisation test in the Smart Balance Master® Neurocom platform. For the statistical analysis we used the Wilcoxon test for nonparametric variables and dependent t-student for paired samples for parametric variables (P<.05). ResultsWhen comparing the scores on the first record with the average of the 3 records, we found statistically significant differences for the 4 conditions (P<.05). Comparing the first record to the second record also yielded statistically significant differences in the 4 conditions (P<.05). Upon comparing the second record with the third, however, we found differences in only Condition 5, with the significance being borderline (P=.04). Finally, comparing the average of the first and second record with the average of the 3 records, we also found statistically significant differences for the 4 conditions (P<.05). ConclusionUsing only 1 or 2 records from each of the conditions on the SOT does not give us the same information as the arithmetic average of the 3 records used until now.

Deficits in sensory organization for postural stability in children with Tourette syndrome

Tourette syndrome (TS) is a childhood-onset developmental disorder characterized by involuntary motor and vocal tics. Previous studies have indicated that children with TS demonstrate postural control anomalies when standing. The aim of this study was to compare postural stability under normal and altered sensory conditions in children with TS and healthy control (HC) children. A convenience sample of twelve children with TS (9 boys and 3 girls; 9.4 ± 1.1 yr) and 12 HC age- and gender-matched children (9.2 ± 1.1 yr) participated in this study. The Sensory Organization Test (SOT) was used to assess postural stability under six altered sensory conditions (1. normal vision, fixed support; 2. eyes closed, fixed support; 3. vision sway-referenced, fixed support; 4. normal vision, support sway-referenced; 5. eyes closed, support surface sway-referenced; 6. both vision and support surface sway-referenced) using the SMART Balance Master® 8.2 (NeuroCom® International, Inc, Clackamas, OR, USA). The results showed significant differences between the two groups in conditions 5 and 6 (p=0.003 and 0.002, respectively). The mean composite equilibrium score in children with TS was significantly lower than that of HC children (p<0.000). The results suggested that children with TS had greater difficulty in maintaining postural stability, especially when vestibular information was challenged. The results of this study provide supporting evidence for possible deficits in impaired access to vestibular information and sensorimotor integration of postural control in children with TS.

¿Es posible reducir el tiempo de exploración en los estudios posturográficos?

Introduction and objectivesThe sensory organization test (SOT) is the gold-standard test for the study of postural control with posturographic platforms. Three registers of Conditions 3, 4, 5 and 6 are conducted to find an arithmetic mean of the 3, with the time that this entails. The aim of this study was to determine whether a single record for each SOT condition would give us the same information as the arithmetic mean of the 3 recordings used until now. Materials and methods100 healthy individuals who performed a sensory organisation test in the Smart Balance Master® Neurocom platform. For the statistical analysis we used the Wilcoxon test for nonparametric variables and dependent t-student for paired samples for parametric variables (P<.05). ResultsWhen comparing the scores on the first record with the average of the 3 records, we found statistically significant differences for the 4 conditions (P<0.05). Comparing the first record to the second record also yielded statistically significant differences in the 4 conditions (P<.05). Upon comparing the second record with the third, however, we found differences in only Condition 5, with the significance being borderline (P=.04). Finally, comparing the average of the first and second record with the average of the 3 records, we also found statistically significant differences for the 4 conditions (P<.05). ConclusionUsing only 1 or 2 records from each of the conditions on the SOT does not give us the same information as the arithmetic average of the 3 records used until now.

Use of the SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness.

Dizziness is the third most common complaint among outpatients and the most common complaint in patients aged 75 years or older. It can be incapacitating for patients, affecting both productivity and quality of life. To evaluate the effect of osteopathic manipulative treatment (OMT) for spinal somatic dysfunction in patients with dizziness lasting longer than 3 months. A prospective clinical cohort study that took place in 2011. Department of Physical Therapy laboratory at the Western University of Health Sciences College of Osteopathic Medicine in Pomona, California. Sixteen participants (2 male, 14 female; mean [range] age, 49 [13-75] years) with dizziness lasting at least 3 months (mean duration of symptoms, 84 months) and spinal somatic dysfunction, but no history of known stroke or brain disease, were recruited from the local community and evaluated for postural balance control before, immediately after, and 1 week after OMT. Four osteopathic physicians board certified in neuromusculoskeletal medicine/osteopathic manipulative medicine provided OMT, including muscle energy; high-velocity, low-amplitude; counterstrain; myofascial release; balanced ligamentous release; and cranial OMT techniques. Outcomes were assessed with the SMART Balance Master (NeuroCom), a validated instrument that provides graphic and quantitative analyses of sway and balance, and the Dizziness Handicap Inventory (DHI), a self-assessment inventory designed to assess precipitating physical factors associated with dizziness and functional and emotional consequences of vestibular disease. Paired t tests, performed to assess changes in mean composite scores for all challenge tests, revealed that balance was significantly improved both immediately and 1 week after OMT (both P<.001), with no significant difference between immediate and 1-week post-OMT scores (P=.20). The DHI scores, both total and subscale, improved significantly after OMT (P<.001), and changes in composite and DHI scores were correlated with each other (P=.047). Osteopathic manipulative treatment for spinal somatic dysfunction improved balance in patients with dizziness lasting at least 3 months.

Potential of the smart balance master system to assess standing balance in people with incomplete spinal cord injury

The aim of this study was to investigate the concurrent validity of the Smart Balance Master (SBM) tests in individuals with incomplete spinal cord injury. Correlational study. A total of 32 individuals with an American Spinal Injury Association Impairment Scale D spinal cord injury able to walk 10 m independently, with or without walking assistive devices. Outcome measures obtained from static and dynamic balance tests while standing using the SBM were compared to data obtained from the Berg Balance Scale (BBS) (14 items). No difference in performance between paraplegic and tetraplegic subjects was noted in the SBM tests. No ceiling effect was apparent in the SBM tests. The highest levels of association with the BBS was found for the limits of stability test (-0.416 < R < -0.752, p ≤ 0.05). The limits of stability test also correlated significantly with the majority of the other SBM tests and, except for the weight-shifting test, was completed by all but two participants. The limits of stability test of the SBM system appears to be useful for assessing dynamic standing-balance ability in spinal cord injury subjects and could potentially be used to complement the BBS.