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At least 19 recordsLinked to original sources

PubMed1997

[Is indirect posturography using force plates equivalent to direct posturography by movement analysis? A physical observation].

Piezoelectric force plates are accurate and convenient aids for the monitoring of coordination in erect humans. However, the results obtained with such "indirect" posturographic measurements should not be "over-interpreted". The information on the spatial location of the centre of pressure (CoP) provided by the force plate permits conclusions to be drawn about the regulation of the "sway" of the centre of gravity (CoG) only when other information on the acceleration situation of the body is available. Otherwise the systematic error of the measurement exceeds the amount of the true "sway" even for physiological cyclic movement frequencies of 0.5 Hz or more.

Biomechanical Phenomena↗

PubMed1994

Posturography: uses and limitations.

The field of posturography has been advanced by the development of computerized dynamic posturography, wherein a force platform has been combined with visual stimuli as a means of determining the relative importance of the various sensory inputs critical for balance, namely vision, somatosensation and vestibular sensation. When compared with other tests currently available for the assessment of vestibular function, computerized dynamic posturography is unique in that it assesses 'balance' rather than attempting to assess peripheral or central vestibular function more directly. This discussion focuses on the device manufactured by NeuroCom International, marketed under the trade name Equitest. The sensory organization portion of the test has been shown to be most useful in the assessment of patients with suspected vestibular disorders. This chapter reviews the current status of computerized dynamic posturography based on published material. The vestibular pattern on computerized dynamic posturography has been observed in patients with ongoing vestibulospinal deficits. Another pattern has been labelled 'surface dependence' or 'combined visual-vestibular deficit'. Data suggest that 2-3 weeks after loss of unilateral peripheral vestibular function, most patients lose their vestibular pattern. Thus, posturography can provide valuable information regarding the status of compensation for a peripheral vestibular deficit. Results from computerized dynamic posturography may disagree with those from other vestibular laboratory testing, which suggests that posturography tests a different aspect of vestibular function than that assessed by electronystagmography and rotational testing. Computerized dynamic posturography does not provide localizing or lateralizing information, nor any information regarding aetiology; it does provide functional information regarding how well an individual can use their balance and an indication of the importance of a patient's balance disturbance on their activities of daily living. Also, computerized dynamic posturography provides a functional measure that is helpful in predicting the benefit that patients may expect to receive from therapeutic intervention with physical therapy.

Humans↗

PubMed1995

Sensitivity and specificity of platform posturography for identifying patients with vestibular dysfunction.

Sensitive and specific measures are needed to identify patients with vestibular impairments. The purpose of this clinical perspective is to describe the sensitivity and specificity of dynamic and static platform posturography for detecting vestibular disorders. The sensory organization test (SOT) of dynamic posturography (EquiTest), the motor "perturbation" test, and Romberg's tests on a static (fixed) force platform each had over 90% specificity. This finding means that nearly all of the subjects who should have tested negative, did test negative on each type of assessment. The sensitivity of the SOT was evaluated across five studies involving a total of 836 patients with peripheral vestibular deficits (PVDs). Abnormalities in the SOT were detected in only 40% (n = 338) of the cases. Static platform posturography sensitivity was evaluated across six studies involving a total of 571 patients with PVDs, and abnormalities were detected in 53% (n = 302) of these cases. Tests of spontaneous and positional nystagmus and the horizontal component of the vestibuloocular reflex (VOR), by comparison, detected PVDs in 48% of 798 patients with suspected vestibular impairment. For patients with vestibular deficits associated with central nervous system disease, a total of 389 cases were identified in five studies and SOT abnormalities were found in 54% (n = 209) of these cases. The motor perturbation test was abnormal in 35% (n = 41) of 119 patients with central vestibular disease. In conclusion, the sensitivity of static posturography appeared to be slightly better than that of dynamic posturography for detecting PVDs, but the level of sensitivity for each posturography test, as well as for tests of horizontal VOR function, was considered to be low. Combining either type of posturography with other tests of vestibular function, however, increased the overall sensitivity of detecting vestibular deficits to 61% to 89%. It was concluded that dynamic and static platform posturography as well as tests of VOR function lack adequate sensitivity to detect vestibular impairment when applied in isolation. Posturography appears to detect vestibular deficits in some patients who had normal VOR assessments and, therefore, provides supplemental rather than redundant information about vestibular dysfunction.

Adult↗

PubMed2002

Can posturography identify informed malingerers?

OBJECTIVE: This study evaluated whether information about computed dynamic posturography given to subjects instructed to feign vestibular impairment (malingerers) improved their attempts to display test patterns consistent with vestibular weakness. STUDY DESIGN: The study design was prospective, with blinded scoring of tests. SETTING: The study was conducted at a university hospital. PATIENTS: Sixty volunteer subjects, 20 to 59 years old, were randomly assigned to one of two equal groups: naïve subjects and subjects informed about computed dynamic posturography. INTERVENTIONS: Computed dynamic posturography was performed twice. First, subjects were instructed to feign a vestibular weakness. Second, subjects were instructed to perform the test normally. One group was given additional information about computed dynamic posturography before the first test (informed faking). MAIN OUTCOME MEASURES: The computed dynamic posturography test summaries were scored as normal, aphysiologic, or vestibular by two methods: the scoring method published by Cevette et al. in 1995 and blinded clinical scoring. The computed dynamic posturography test summaries of patients referred for vestibular disorders were included with the test summaries collected from subjects during scoring. These additional tests of possible "true" vestibular disorder allowed evaluation of scoring accuracy. RESULTS: The scoring method of Cevette et al. classified about one-third of the test results of feigned vestibular weakness as either normal (16.7%) or vestibular weakness (18.3%). The remaining two thirds of the test results of feigned vestibular weakness were classified as aphysiologic (65.0%). Blinded clinical scoring gave similar figures. Additional information about computed dynamic posturography did not increase the number of feigned test results scored as a vestibular weakness. CONCLUSION: When additional information about computed dynamic posturography was provided, the subjects did not improve their ability to feign vestibular weakness. This investigation supports the use of scoring computed dynamic posturography results by the formulae of Cevette et al. in separating aphysiologic behavior from vestibular impairment.

Adult↗

PubMed2002

A comparison of electronystagmography results with posturography findings from the BalanceTrak 500.

OBJECTIVE: To determine a correlation between conventional electronystagmography findings with results obtained from BalanceTrak 500 posturography assessment. STUDY DESIGN: Individuals with a variety of dizziness and balance disorder symptoms were tested with both electronystagmography (ocular motor studies, positional/positioning testing, caloric testing) and computer posturography using the BalanceTrak 500. SETTING: Tertiary referral center. PATIENTS: Urban/rural midwesterners referred for dizziness and balance dysfunction symptoms. INTERVENTION: Results of both testing modalities were sent to referring physicians. OUTCOME MEASURES: Electronystagmography and posturography results. RESULTS: When electronystagmography results were compared with BalanceTrak findings, a majority of patients whose electronystagmography findings indicated central and mixed causes, or peripheral lesions other than benign paroxysmal positional vertigo, had abnormal findings on posturography. Specifically, tests similar to the Balance Master Sensory Organization Tests 4 and 5 and a new test, Limits of Stability, presented the most difficulty for these individuals. Patients with normal electronystagmography findings and those with benign paroxysmal positional vertigo had mixed results on posturography. The results for specific individual electronystagmography tests were compared with those of posturography tests. No correlation was noted among any of the electronystagmography results and posturography findings. Furthermore, no correlation was observed between posturography and the causes of dizziness. CONCLUSION: For many patients with dizziness and/or balance dysfunctions, posturography can provide additional information to that obtained with electronystagmography. This is especially apparent in individuals who have these symptoms but have normal or borderline normal electronystagmography findings.

Dizziness↗

PubMed2002

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↗

PubMed1996

Meta-analysis of the sensitivity and specificity of platform posturography.

OBJECTIVE: To compare the sensitivity and specificity of platform posturography with other vestibular tests for patients with peripheral vestibular deficits (PVD), Meniere's disease, benign paroxysmal positional vertigo (BPPV), and central nervous system-vestibular impairment (CNS). DATA SOURCES: A computed search was conducted using the Index Medicus database (1966-1994) and Current Contents Science Editions. STUDY SELECTION: Studies were selected for analysis if the article addressed the sensitivity and/or specificity of platform posturography, compared posturography with another objective test of vestibular function, identified the basis for abnormal test results, and reported the data with sufficient detail to calculate an effect size from a 2 x 2 contingency table. DATA EXTRACTION: A count of the normal and abnormal test results for posturography and the criterion standard were retrieved from each article, analyzed using a chi 2 statistic, and converted to an effect size. A positive effect size indicated that posturography identified abnormalities in patients who had normal tests on the criterion standard. DATA SYNTHESIS: Sensitivity and specificity of posturography were about 50%. The overall effect size was small (0.13) but positive. The diagnostic category had a significant influence on the predictive value of abnormal results (73% for Meniere's disease and BPPV, compared with 41% for PVD, and 44% for mixed CNS and PVD (F2,12 = 5.26, P = .02) and on the magnitude of the effect size (0.41 for mixed CNS and PVD compared with 0.22 for Meniere's disease and BPPV, and -0.10 for PVD (F2,12 = 13.95, P = .001). CONCLUSIONS: Platform posturography provides a measurable supplement to the standard vestibular examination. The enhancement was most notable when the target population included patients with CNS deficits.

Abstracting and Indexing↗

PubMed1999

Posturography does not test vestibulospinal function.

The clinical usefulness of posturography is unknown, despite its costing more than +500 per test in some areas of the United States, including Boston. We cross-sectionally and prospectively studied blinded vestibulo-ocular and vestibulospinal tests from 29 stable patients with chronic vestibular hypofunction; 22 patients were affected bilaterally (BVH), and 7 were affected unilaterally (UVH). Vestibulo-ocular function was assessed by electronystagmographic caloric stimulation and sinusoidal vertical axis rotation gains at 0.05 Hz. Vestibulospinal function was assessed by moving-platform and visualsurround posturography sensory organization tests (SOTs), paced and free gait in a gait laboratory, and clinical tests of timed gait and standing. Posturography SOT moving-platform tests 4 through 6, designed to assess vestibular function, correlated significantly (r < or = 0.72, P > or = 0.01) with vestibulo-ocular tests in 5 of 6 comparisons among BVH patients. Posturography SOT results, however, correlated poorly with other vestibulospinal measures: correlations were statistically significant for only 7 of 18 comparisons with clinical balance and gait function (r < or = 0.69, P > or = 0.01) and with 2 of 12 comparisons for gait laboratory dynamic stability measures (r < or = 0.55, P > or = 0.01) among the BVH patients. When both the platform and visual surround moved (SOT 6), however, correlations were statistically significant with static standing clinical measures (r = 0.51 to 0.69, P < 0.01) and with whole-body maximum moment arm during paced gait (r = 0.55, P < 0.01). Posturography scores for the UVH patients did not significantly correlate with any vestibulo-ocular or other vestibulospinal measures. These data indicate that among patients with BVH posturography SOT scores relate at best modestly with accepted measure of vestibulo-ocular function, less well with clinical measures of balance control, and poorly with dynamic gait-performance measures. We conclude that posturography SOT does not assess vestibulospinal function.

Adult↗

PubMed1995

Role of posturography in the management of vestibular patients.

Computerized dynamic posturography uses a force platform that can both translate and rotate. When combined with visual stimuli, it can be used to determine the relative importance of the various sensory inputs critical for balance, namely vision, somatosensation, and vestibular sensation. Studies to date have shown several patterns of abnormalities on posturography, the best recognized being the vestibular pattern. Many patients with a high suspicion of having a peripheral vestibular abnormality (based on other information) have such a pattern. Moreover, few normal subjects have such abnormalities. Although computerized dynamic posturography does not help in localizing a lesion or determining its etiology, such testing does provide a functional measure that can be helpful in understanding a patient's ability to properly use vestibular system information. Posturography is helpful in the management of patients with suspected vestibular disorders. In addition to suggesting the presence of a vestibular system abnormality, particularly an uncompensated peripheral vestibular deficit, a bilateral peripheral vestibular deficit, or a central vestibular abnormality, computerized dynamic posturography may help guide the clinician regarding choice of treatment and counseling of patients. Further studies are required to determine the ultimate role of computerized dynamic posturography in the management of patients with vestibular disorders.

Humans↗

PubMed1995

Posturography and balance problems in older people.

OBJECTIVE: To determine which measurements and test conditions on posturography are most useful for identifying balance problems in older people. SUBJECTS: Two samples of 70 community-dwelling older subjects (> 75 years). One group (controls) considered their balance normal for their age, and the other (patients) complained of imbalance. MEASUREMENTS: Velocity of sway on static (with and without foam) and dynamic posturography, Tinetti gait and balance score, self-reported fear of falling, and number and circumstances of falls. RESULTS: Mean sway velocity was significantly increased in patients compared with controls. The greatest difference between patients and controls occurred with measures of anterior-posterior sway velocity during angular tilt of the platform. Sway velocity was not significantly increased in patients or controls who reported falls compared with those who did not report falls. Even when comparing those who fell as a result of loss of balance with those who fell because of trips or slips, there was no significant difference in sway velocity. By contrast, those who reported fear of falling (patients and controls) had significantly increased sway velocity compared with those who did not report fear of falling. CONCLUSION: On average, velocity of sway (particularly in the anterior-posterior direction) is higher in older subjects who complain of imbalance compared with age-matched controls, and the difference is greater with dynamic posturography than with static posturography. However, the posturography data provided little information about the cause of the imbalance and did not correlate with the frequency of reported falls.

Accidental Falls↗

PubMed1995

Vestibular and sensory interaction deficits assessed by dynamic platform posturography in patients with multiple sclerosis.

Vestibular impairments have not been routinely identified in patients with multiple sclerosis (MS), because of the confounding effects of deficits in other neural systems. In this study, 35 patients with MS were evaluated by means of a systematic alteration of the sensory environment (dynamic posturography) in order to identify those patients who became unstable when vestibular inputs were needed to maintain stance. Subjects were assigned to either a high-function (HF) or a low-function (LF) group on the basis of a functional status assessment score obtained prior to the posturography test. For the HF group, 30% (7/23) had abnormal posturography scores. Of those subjects, 3 had a vestibular dysfunction pattern or a somatosensory-vestibular impairment. In contrast, 58% of the LF group (7/12) had abnormal posturography scores. Nearly all of these LF patients (6/7) had a vestibular dysfunction pattern or a combined visual-vestibular or somatosensory-vestibular impairment. Posturography might serve as one method to evaluate the functional consequences of a vestibular deficit in patients with MS.

Adult↗

PubMed1991

Abstinent chronic alcoholics investigated by dynamic posturography, ocular smooth pursuit and visual suppression.

Eleven male chronic alcoholic volunteers aged 44-65 years (mean 57 years) were investigated by dynamic posturography, ocular smooth pursuit and visual suppression of the vestibulo-ocular reflex (VOR). Their drinking time ranged from 8-30 years (mean 20 years) and they had been abstinent for the last 1-20 years (mean 7 years). Ocular smooth pursuit showed abnormalities in 8/11. Abnormalities were found in 5/11 in the visual suppression of the VOR. The results of dynamic posturography tests were compared to an age-matched reference material. Dynamic posturography (EquiTest) comprises a sensory organization (SO) part in which the support surface and visual surround are either stable or referenced to the patient's sway, with eyes open or closed. In the SO part the chronic alcoholics had lower equilibrium scores in all test conditions, and the differences were significant in 4 tests out of 6. In a movement coordination part the platform makes active movements, the latencies to which were significantly prolonged in the 2 larger of the 3 translational amplitudes. Adaptation to repeated tilting of the platform was estimated to be pathological in 4/10, compared to none of the controls. The abnormal pattern found in dynamic posturography correlates well with the pathology in ocular smooth pursuit and visual suppression tests, suggested to be due to alcohol induced cerebellar lesions. It is concluded that dynamic posturography is a valuable test for assessing dysequilibrium in chronic alcoholics, even abstinent.

Adult↗

PubMed1993

Evaluation of vestibular function by dynamic posturography and other equilibrium examinations.

We evaluated the significance of dynamic posturography (EquiTest) in vestibular function assessment by comparing it with our routine equilibrium examinations comprised of nystagmographic data and other postural tests. Fifty-two patients with unilateral peripheral vestibular disorders were examined. Differences in test results between pendular rotation test and dynamic posturography were found in 23 out of 52 (44%) patients with unilateral peripheral vestibular disorders. In 5 patients, no abnormality of vestibular function could be detected by means of a three-test battery (spontaneous and positional nystagmus and pendular rotation test) used for evaluating vestibular compensation. In spite of these results, the patients complained of vertigo of dizziness and showed abnormal results in dynamic posturography. Dynamic posturography was superior to other postural tests in the detection of pathology corresponding with the patients' complaints. From these results, dynamic posturography (EquiTest) appeared to provide new information about such conditions of vestibular patients which other equilibrium examinations have not heretofore been able to detect.

Adult↗

PubMedDate not supplied

Effects of balance training in elderly evaluated by clinical tests and dynamic posturography.

All persons aged 70 through 75 years (N = 457) in a Swedish community were invited to participate in a 9 week balance training study. Out of 55 interested subjects, 15 were chosen at random for a study group; 15 matched controls were also selected. Before and after the investigation period the balance function was assessed by clinical balance tests and dynamic posturography. In the clinical balance tests, the training group significantly improved their balance standing on one leg with eyes closed as well as standing on one leg while shaking the head; they also walked 15 m back and forth faster. In the dynamic posturography the training group significantly improved their equilibrium scores in the 3 most difficult test conditions. The results of the control group were unchanged except for one test condition in the dynamic posturography. The differences in one-leg standing with head shaking, walking 2 x 15 m, and the equilibrium score using sway-referenced platform in dynamic posturography were proved to be attributable to the training. The first investigation in all 29 subjects formed normative dynamic posturography data for the age group 70 through 75 years. The normative posturographic data of this age group differed from previously obtained data in the age groups 20 through 59 and 60 through 69 years. It is concluded that elderly may improve their balance by regular balance training exercises for as short a period as 9 weeks. This might prove to be of great value in improving balance and thereby preventing accidental falls and subsequent fractures in elderly.

Aged↗

PubMed1998

Posturography changes do not predict functional performance changes.

OBJECTIVE: Essentially no data exist to assess the utility of posturography, a frequently used test of standing balance in measuring change. The authors examined 1) how changes in posturography relate to functional balance changes as measured in the clinic and gait laboratory and 2) posturography's role and value in assessing patients with vestibular dysfunction. STUDY DESIGN: A correlational research design was used. SETTING: This study was conducted at a large, urban U.S. tertiary referral hospital. PATIENTS: Thirty-seven subjects (22 females and 15 males) with peripheral vestibular hypofunction and stable symptoms participated. Patients with central nervous system pathology were excluded from this study. INTERVENTIONS AND MAIN OUTCOME MEASURES: Subjects were tested before and after 6-8 weeks of vestibular rehabilitation with Equitest posturography sensory organization test (SOT), with timed quasistatic bilateral standing in tandem, on foam, and one leg; and with functional balance measures including gait velocity, a modified Timed Up & Go, gait with head rotation, gait with eyes closed, and tandem gait. RESULTS: Changes in SOT were not predictive of, nor often even directly correlated with, changes in quasistatic standing or functional performance. CONCLUSIONS: These data suggest that posturography SOT alone is not a useful tool to assess balance and functional changes in patients with vestibular hypofunction.

Female↗

PubMed2000

Computerized posturography analysis of progressive supranuclear palsy: a case-control comparison with Parkinson's disease and healthy controls.

BACKGROUND: Progressive supranuclear palsy (PSP) is a neurodegenerative disorder that is frequently mistaken for Parkinson's disease (PD) in its early stages. OBJECTIVE: To compare balance measures using computerized posturography in patients with early PSP and early PD. METHODS: We performed computerized posturography (SMART Balance Master; NeuroCom International, Inc, Clackamas, Ore) in 20 patients with clinically diagnosed mild to moderate PSP (ambulatory) and compared results with those from 20 patients with PD of similar age and disease duration who were not receiving medications, and from 20 healthy age- and sex-matched controls. Sensory organization testing (SOT), limits of stability (LOS), and toes-up perturbations (4 degrees at 50 degrees per second) were tested while receiving and not receiving a combination of oral carbidopa (25 mg) and levodopa (250 mg) in the PSP group. Clinical assessment included Unified Parkinson's Disease Rating Scale, Performance-oriented assessments, and functional reach. RESULTS: When compared with the PD and control groups, total LOS time (P < .001) and path sway (P < .001) were significantly prolonged in PSP. Total SOT showed significantly worse scores in PSP compared with PD and control groups (F(2,57) = 29.6; P < .001). Univariate follow-up tests comparing PSP and PD showed differences in the following conditions: eyes open and visual sway (P = .003), eyes open and platform sway (P = .003), eyes closed and platform sway (P < .001), and eyes open and platform and visual sway (P < .001). Medium- and long-latency responses to perturbation were similar, but a larger number in the PSP group lacked short-latency responses (chi(2) = 11.3; P = .002). Levodopa administration did not significantly improve any aspect of posturography testing in PSP. In differentiating PSP from PD, LOS time and SOT condition of eyes open and platform and visual sway were nearly 100% sensitive and 100% specific (canonical correlation, 0.91). CONCLUSIONS: Computerized posturography testing reliably differentiated early PSP from early PD and age-matched controls. The PSP group demonstrated severely contracted limits of stability with probable deficits in motor programming. Results of SOT in PSP suggested a vestibular pattern and overreliance on visual cues, even when incorrect. The absence of short-latency responses (monosynaptic reflex arch) suggests an additional disturbance in the spinal cord or peripheral nervous system. Arch Neurol. 2000;57:1464-1469

Aged↗

PubMedDate not supplied

Chronic toxic encephalopathy investigated using dynamic posturography.

Seven male patients previously exposed to industrial solvents and diagnosed with chronic toxic encephalopathy (aged 38 to 69 years; mean age, 56 years) were investigated by dynamic posturography and compared with healthy, age-matched male control patients. Dynamic posturography comprises two phases: a sensory organization (SO) phase, in which the support surface and visual surround are either stable or referenced to the patient's sway, with eyes open or closed, and a movement coordination (MC) phase, in which the platform makes active movements. In SO testing, the patient group showed significantly impaired equilibrium performance compared with the control group in most test conditions. The MC test revealed no differences between groups. A relationship was found between the equilibrium score resulting from SO testing with stable support and visual surround and the sway area of the confidence ellipse elicited 3 years previously by static posturography with eyes open. We conclude that patients with chronic toxic encephalopathy have impaired equilibrium, as demonstrated by dynamic posturography testing.

Adult↗

PubMed2004

[Sensory interaction in posturography].

OBJECTIVE: The aim of this work is to show the results obtained with a dynamic posturography on a stabilometric platform and to create relative parameters of study. MATERIAL AND METHODS: The study was performed on 127 patients with dizziness of a peripheral vestibular origin and the results analyzed in a dynamic posturography under six conditions of stimulation. RESULTS: The values obtained under the studied conditions of dynamic posturography are significantly different when the conditions of test increases sensorial conflicts. We could create 15 news relatives parameters which are in normal distribution. CONCLUSIONS: Dynamic posturography over stabilometric platform could be considered as a good test in the evaluation of vertiginous patients. Different stimulations introduce more sensibility to the test.

Female↗