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Characteristics of body sway in patients with peripheral vestibular disorders.

Measuring the movement of the body's center of gravity during standing with the eyes open and with the eyes closed, proved to be a useful test in vestibular investigation. 30 patients with peripheral vestibular disorders were tested using a static sensonograph and a digital computer. Three types of locus patterns, the lateral deviation of the averaged position and two types of frequency spectral patterns obtained from the movement of the center of gravity were the characteristics of the body sway in the patients with peripheral vestibular disorders.

Humans↗

The vestibulospinal system and postural regulation in man.

Upright posture in humans represents a giant step phylogenetically speaking. But upright posture demands refined mechanisms for static and dynamic postural equilibrium that are initiated by the concurrence of visual and proprioceptive impulses from the muscles of the legs and the labyrinth. The static labyrinth and Deiter's nucleus via the LVST seem to be the main centers responsible for static equilibrium. Its basic neurophysiological mechanism has been analyzed by the study of stretch reflexes, which permits a semiquantitative evaluation of the function of the static labyrinth. The cerebellum appears as the main control center of the proprioceptive system in relation to dynamic equilibrium.

Cerebellum↗

Measuring physical impairment and disability with the Chedoke-McMaster Stroke Assessment.

BACKGROUND AND PURPOSE: The Chedoke-McMaster Stroke Assessment measures the physical impairments and disabilities that impact on the lives of individuals with stroke. This measure has three overall purposes: 1) to stage motor recovery to classify individuals in terms of clinical characteristics, 2) to predict rehabilitation outcomes, and 3) to measure clinically important change in physical function. This study was carried out to evaluate the ability of this measure to yield reliable and valid results. METHODS: Thirty-two subjects from a stroke rehabilitation treatment unit were assessed by research and treating physical therapists using multiple measures on multiple occasions. The measure's three purposes dictated the study objectives and design. RESULTS: Intrarater, interrater, and test-retest reliabilities of the impairment and disability inventories were estimated. Reliability coefficients for the total scores ranged from 0.97 to 0.99. Construct and concurrent validities were studied by examining the correlations between this and other measures. A priori hypothetical constructs stated that these correlations should exceed 0.60. These constructs were confirmed; the impairment inventory total score was found to correlate with the Fugl-Meyer Test (r = 0.95, p < 0.001) and the disability inventory with the Functional Independence Measure (r = 0.79, p < 0.05). Additional study hypotheses were also substantiated. CONCLUSIONS: This study confirms that the Chedoke-McMaster Stroke Assessment yields both reliable and valid results. With the evaluation study now completed, the Chedoke-McMaster Stroke Assessment can be used with confidence as both a clinical and a research tool that can discriminate among subjects and evaluate patient outcomes.

Adolescent↗

Validation of a standardized assessment of postural control in stroke patients: the Postural Assessment Scale for Stroke Patients (PASS).

BACKGROUND AND PURPOSE: Few clinical tools available for assessment of postural abilities are specifically designed for stroke patients. Most have major floor or ceiling effects, and their metrological properties are not always completely known. METHODS: The Postural Assessment Scale for Stroke patients (PASS), adapted from the BL Motor Assessment, was elaborated in concordance with 3 main ideas: (1) the ability to maintain a given posture and to ensure equilibrium in changing position both must be assessed; (2) the scale should be applicable for all patients, even those with very poor postural performance; and (3) it should contain items with increasing difficulty. This new scale has been validated in 70 patients tested on the 30th and 90th days after stroke onset. RESULTS: Normative data obtained in 30 age-matched healthy subjects are presented. The PASS meets the following requirements: (1) good construct validity: high correlation with concomitant Functional Independence Measure (FIM) scores (r=0.73, P=10(-6)), with lower-limb motricity scores (r=0.78, P<10(-6)), and with an instrumental measure of postural stabilization (r=0.48, P<10(-2)); (2) excellent predictive validity: high correlation between PASS scores on the 30th day and FIM scores on the 90th day (r=0.75, P<10(-6)); (3) high internal consistency (Cronbach alpha-coefficient=0.95); and (4) high interrater and test-retest reliabilities (average kappa=0.88 and 0.72). CONCLUSIONS: Our results confirm that the PASS is one of the most valid and reliable clinical assessments of postural control in stroke patients during the first 3 months after stroke.

Cerebrovascular Disorders↗

Using posturography to detect unsteadiness in 13 patients with peripheral neuropathy: a pilot study.

Our aims were to use posturography to see if sway pattern differed between patients with large-fiber peripheral neuropathy and normal control subjects and, if it did, to compare posturography with conventional electromyography (EMG) as screening tools for large-fiber peripheral neuropathy. Thirteen patients who came to our neurophysiology laboratory with a preliminary diagnosis of peripheral neuropathy (made by their referring physicians) were compared with 7 nonmatched control subjects. All subjects received a neurologic examination and underwent posturography and conventional EMG. Results of posturography and conventional EMG were compared. Posturography showed abnormal sway patterns only in patients who had EMG abnormalities consistent with large-fiber peripheral neuropathy. These sway patterns differed significantly from those of the control subjects. Posturography seems to be a useful and well-tolerated screening test for patients with a history suggestive of peripheral neuropathy, and results of posturography agree with those of conventional EMG. Moreover, posturography directly measures increased sway in these patients and may be used as a more direct screen for risk of falls in this population.

Electromyography↗