Usefulness of some current balance tests for identifying individuals with disequilibrium due to vestibular impairments. J Vestib Res 18(5-6):295-303, 0957-4271; 0957-4271

Bobby R. Alford Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA.
Journal of Vestibular Research (Impact Factor: 1.19). 02/2008; 18(5-6):295-303.
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The goal of this study was to determine which of several clinical balance tests best identifies patients with vestibular disorders. We compared the scores of normals and patients on the Berg Balance Scale (Berg), Dynamic Gait Index (DGI), Timed Up and Go (TUG), Computerized Dynamic Posturography Sensory Organization Test (SOT), and a new obstacle avoidance test: the Functional Mobility Test (FMT). The study was performed in an out-patient balance laboratory at a tertiary care center. Subjects were 40 normal adults, and 40 adults with vestibular impairments. The main outcome measures were the sensitivity of tests to patients and specificity to normals. When adjusted for age the Berg, TUG, DGI and FMT had moderate sensitivity and specificity. SOT had moderately high sensitivity and specificity. SOT and FMT, combined, had high sensitivity and moderate specificity. Therefore, the kinds of tests of standing and walking balance that clinicians may use to screen patients for falling are not as good for screening for vestibular disorders as SOT. SOT combined with FMT is better. When screening patients for vestibular disorders, when objective diagnostic tests of the vestibular system, itself, are unavailable, tests of both standing and walking balance, together, give the most information about community-dwelling patients. These tests may also indicate the presence of sub-clinical balance problems in community-dwelling, asymptomatic adults.

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Available from: Helen S Cohen, Sep 04, 2014
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    • "Older adults perform worse than younger adults on such tasks [3] [4] [19] and normals undergoing sensorimotor adaptation perform more poorly than their pre-adaption scores on obstacle avoidance [5] [10] [11]. Our previous work with normals and patients who have vestibular impairments has shown that an obstacle avoidance task is almost as sensitive to vestibular impairments as computerized dynamic posturography and the two tests, combined, are very sensitive [6]. The obstacle avoidance task had sensitivity of 78, i.e. 78% of patients were correctly classified , and specificity of 80, i.e. 80% of normals were correctly classified. "
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    ABSTRACT: The currently approved objective clinical measure of standing balance in astronauts after space flight is the Sensory Organization Test battery of computerized dynamic posturography. No tests of walking balance are currently approved for standard clinical testing of astronauts. This study determined the sensitivity and specificity of standing and walking balance tests for astronauts before and after long-duration space flight. Astronauts were tested on an obstacle avoidance test known as the Functional Mobility Test (FMT) and on the Sensory Organization Test using sway-referenced support surface motion with eyes closed (SOT 5) before and six months after (n=15) space flight on the International Space Station. They were tested two to seven days after landing. Scores on SOT tests decreased and scores on FMT increased significantly from pre- to post-flight. In other words, post-flight scores were worse than pre-flight scores. SOT and FMT scores were not significantly related. ROC analyses indicated supra-clinical cut-points for SOT 5 and for FMT. The standard clinical cut-point for SOT 5 had low sensitivity to post-flight astronauts. Higher cut-points increased sensitivity to post-flight astronauts but decreased specificity to pre-flight astronauts. Using an FMT cut-point that was moderately highly sensitive and highly specific plus SOT 5 at the standard clinical cut-point was no more sensitive than SOT 5, alone. FMT plus SOT 5 at higher cut-points was more specific and more sensitive. The total correctly classified was highest for FMT, alone, and for FMT plus SOT 5 at the highest cut-point. These findings indicate that standard clinical comparisons are not useful for identifying problems. Testing both standing and walking balance will be more likely to identify balance deficits.
    Full-text · Article · Nov 2012 · Journal of Vestibular Research
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    • "other machine-based techniques in vestibulology are divided. Prevailing opinion is that both posturography techniques (SCPG and DCPG) are beneficial especially for the quantitative assessment of postural balance [2] [6] [7]. Posturography is deemed a suitable complement to standard vestibular examinations, especially in patients with CNS pathology and is useful for evaluating susceptibility to falling [8] [9] [10]. "
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    ABSTRACT: Posturography is a general term for techniques used to measure postural stability on static or dynamic measuring platforms. The principle of static computerised posturography (SCPG) is the detection of the centre of foot pressure (CFP) in upright stance on a posturography platform. Our communication deals with the importance of SCPG in differential topodiagnosis of vestibular syndromes in neurology. The set of examinations and evaluations carried out was divided among a control group of healthy subjects (77), a group of subjects with peripheral vestibular disorder (159), and a group of subjects with a non-peripheral balance disorder (82). Results obtained through the measurements were evaluated using descriptive statistics procedures and basic numerical and graphic statistical characteristics of the given groups. Our observations demonstrate that posturography is a valuable auxiliary test for balance disorders, especially given the lack of more suitable tests. According to our results, SCPG can be used for a rough differential topodiagnosis of balance disorders in neurology. © Versita Sp. z o.o. Keywords: Static and dynamic computerised posturography • Differential diagnosis • Central and peripheral vestibular dysfunction
    Full-text · Article · Jun 2012 · Central European Journal of Medicine
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    • ", tandem gait [47], walking with simultaneous head rotations, obstacle avoidance [29] [96] [114], Timed Up and Go [103]. 3) Path integration: veering task [21] [26]. "
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    ABSTRACT: The Barany Society Ad Hoc Committee on Vestibular Rehabilitation Therapy has developed guidelines for developing educational programs for continuing education. These guidelines may be useful to individual therapists who seek to learn about vestibular rehabilitation or who seek to improve their knowledge bases. These guidelines may also be useful to professional organizations or therapists who provide continuing education in vestibular rehabilitation. We recommend a thorough background in basic vestibular science as well as an understating of current objective diagnostic testing and diagnoses, understanding of common tests used by therapists to assess postural control, vertigo and ability to perform activities of daily living. We recommend that therapists be familiar with the evidence supporting efficacy of available treatments as well as with limitations in the current research.
    Full-text · Article · Jan 2011 · Journal of Vestibular Research
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