Journal of vestibular research : equilibrium & orientation, 2010
Electronystagmography (ENG) testing has been supplanted by newer techniques of measuring eye move... more Electronystagmography (ENG) testing has been supplanted by newer techniques of measuring eye movement with infrared cameras (VNG). Most techniques of quantifying caloric induced nystagmus measure the slow phase velocity in some manner. Although our analysis is carried out by very experienced assessors, some systems have computer algorithms that have been "taught" to locate and quantify maximum responses. We wondered what differences in measurement might show up when measuring calorics using different techniques and systems, the relevance of this being that if there was a change in slow phase velocity between ENG and VNG testing when measuring caloric response, then normative data would have to be changed. There are also some subjective but important aspects of ENG interpretation which comment on the nature of the response (e.g. responses which might be "sporadic" or "scant"). Our experiment compared caloric responses in 100 patients analyzed four differ...
Objectif: Supporter l'hypothèse que le syndrome connu sous le nom de visual vestibular misma... more Objectif: Supporter l'hypothèse que le syndrome connu sous le nom de visual vestibular mismatch (VVM) peut être induit par une pathologie vestibulaire périphérique. Devis: Etude rétrospective de dossiers avec questionnaire prospectif. Localisation: Clinique externe de soins ...
BackgroundOtolithic function is poorly understood, but vestibular-evoked myogenic potential testi... more BackgroundOtolithic function is poorly understood, but vestibular-evoked myogenic potential testing has allowed the documentation of pathology in patients who complain of imbalance.MethodsSeventy-four patients with traumatic and non-traumatic vestibular disease were sequentially assessed at a tertiary referral neuro-otology unit in a teaching hospital. A detailed history of all patients was taken and standard vestibular assessment was conducted using the technique described in the companion paper. The results of both groups of patients were analysed and the rate of abnormalities was assessed.ResultsThere was a high rate of abnormalities, including bilateral pathology, in a significant number of patients. Many patients in both groups inexplicably failed to recover.ConclusionVestibular-evoked myogenic potentials are helpful in documenting pathology, including bilateral pathology, which is outlined in the literature as being exceedingly difficult to compensate for.
Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale, 2008
Tandem walking testing is a "standard" clinical technique for assessing balance and gai... more Tandem walking testing is a "standard" clinical technique for assessing balance and gait, but it is not a standardized test. We wished to develop a protocol by which we could measure sway during tandem walking at a patient's preferred cadence and at an altered cadence, which might be more challenging. Fifteen patients with vestibular complaints were evaluated with standard tandem walking testing while wearing the Swaystar belt-mounted accelerometer and were also assessed in the same way with tandem walking at two altered cadences. We measured tandem walking sway amplitude and sway velocity with eyes open in both pitch and roll planes at a patient's preferred cadence, at 75% of their preferred cadence, and at 125% of their preferred cadence. We measured total sway amplitude and sway velocity in pitch and roll planes during tandem walking with eyes open while wearing Swaystar to see if there was any increase in sway at nonpreferred cadences. There was no correlation ...
Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale, 2008
We used two balance assessment devices, computerized dynamic posturography (CDP) and Swaystar tra... more We used two balance assessment devices, computerized dynamic posturography (CDP) and Swaystar transducers to detect subtle balance system deficits in nine subjects who had ingested minimal amounts of alcohol. Nine subjects were evaluated with both modalities before, and repetitively after, ingesting a small amount of alcohol. We measured condition 5 (sway referenced platform; eyes closed) on CDP and tandem walking with eyes closed while wearing Swaystar to see if either test could detect a balance deficit. We measured total sway amplitude with eyes closed in pitch and roll planes during tandem walking with Swaystar, and static balance scores of CDP sensory organization testing condition 5 before and after alcohol ingestion at 20 min intervals. Although there was no detectable deficit measurable by CDP, eight of our nine subjects showed increased dynamic sway as measured by Swaystar, after alcohol ingestion. Total sway was significantly greater (p=.05) after alcohol ingestion. It is ...
Previous studies have demonstrated that sedatives and antiemetics commonly used by patients suppr... more Previous studies have demonstrated that sedatives and antiemetics commonly used by patients suppress the vestibulo-ocular reflexes during electronystagmography, making it more difficult to quantify function in such patients. The effects of these medications on computerized dynamic posturography (CDP) have not been studied, and the influences, if any, on the vestibulospinal reflexes are not known. We aimed to study the influence, if any, of dimenhydrinate on CDP performance. A double-blinded study using a randomized protocol to compare the effects of dimenhydrinate and placebo on CDP performance in normal subjects. A tertiary/quaternary care facility using a standardized CDP assessment protocol. After a CDP training session (one assessment) to rule out any learning effect, 10 subjects underwent CDP assessment on 2 separate days after ingestion of either a standard single dose of dimenhydrinate or placebo. Pre- and post-medication CDP performance was measured using Sensory Organizatio...
Subtle complaints of visual-vestibular mismatch may not be elicited in an initial history-taking.... more Subtle complaints of visual-vestibular mismatch may not be elicited in an initial history-taking. Clinicians must be familiar with the nature of these complaints when assessing whiplash patients because other injuries may predominate and patients do not volunteer these more subtle complaints, which may be persisting and sometimes debilitating. A retrospective case review was performed. The study was conducted at a tertiary/quaternary referral clinic. Patients with whiplash, mild head injury, or both were referred for assessment of symptoms persisting for at least 2 years after their injury. A full history; otolaryngologic examination; including assessment of eye movements, corneal reflexes, and gait; investigation including electronystagmography and computerized dynamic posturography; and history-taking and detailed recording of related complaints were performed immediately before diagnostic workup. Many patients had more subtle complaints, which we now recognize as indicative of ve...
Pelizaeus-Merzbacher disease is a rare sex-linked recessive neurological disorder. It presents wi... more Pelizaeus-Merzbacher disease is a rare sex-linked recessive neurological disorder. It presents with a slowly progressive neurological deterioration. It is liable to be misdiagnosed as cerebral palsy. A family history of similar disease is a clue to the diagnosis. A patient with this condition has been followed over many years. Nystagmus was noted to be present shortly after birth. Audiovestibular investigations were performed. All tests of peripheral hearing were normal. ABR indicated abnormal brainstem conduction. Several electronystagmographic abnormalities were present. These were of a central type. They included failure of fixation suppression, poor smooth pursuit, and impaired performance of optokinetic nystagmus at high stripe speeds. During caloric-induced nystagmus an excessively prolonged slow phase of nystagmus with wide eye excursions was seen. We have not seen this feature in any other diseases and we suggest it may be specific for this syndrome.
The Arnold-Chiari malformation (ACM) is a rare congenital condition in which there is a downward ... more The Arnold-Chiari malformation (ACM) is a rare congenital condition in which there is a downward displacement of the cerebellum through the foramen magnum. Patients with this condition frequently develop symptoms of ataxia, imbalance, or vertigo. As a result the patient is often referred to an otolaryngologist. Such a case is reported. A patient presented with imbalance, had downbeating nystagmus on down gaze, and had other eye movement abnormalities recorded on electronystagmography (ENG) which were strongly suggestive of central pathology. Although her computerized tomography (CT) scan was normal, the eye findings and neurological evaluation were strongly suggestive of an ACM. A repeat CT scan with intrathecal metrizamide was abnormal. A definite diagnosis of ACM was confirmed using the new investigative technique of magnetic resonance imaging (MRI).
To analyze a newly defined group of Computerized Dynamic Posturography abnormalities and to deter... more To analyze a newly defined group of Computerized Dynamic Posturography abnormalities and to determine if these patients' abnormalities are of vestibular origin. Analysis of results drawn from our larger study of two groups of sequentially referred patients complaining of dizziness and/or imbalance. A tertiary and quaternary care ambulatory referral centre. Two groups of patients were studied. One was a group of patients who had suffered work-related head trauma and had subsequent complaints of dizziness and/or imbalance. The other was a group of patients referred for dizziness and/or imbalance who had no history of head trauma, work related injury. or litigation procedures. Standard vestibular assessment including Computerized Dynamic Posturography was carried out on all patients. CDP results of all patients were reanalyzed and all results were pulled which were abnormal on at least 5 of 6 sensory conditions. All results were analyzed using a quantitative method of detecting malingering and also using our newly developed nine point subjective/objective criteria scale. While the standardized formulae categorized most of these results as "aphysiologic," our nine-point protocol showed most of the patients to be legitimate. These results represent a legitimate subgroup of vestibular patients that we feel have been more or less unrecognized, many of whom are incapacitated by imbalance and disorientation. These results also are helpful in measuring safety of these patients in the workplace.
To define and investigate the symptom set known as visual-vestibular mismatch and analyze its nat... more To define and investigate the symptom set known as visual-vestibular mismatch and analyze its nature and occurrence in two groups of patients referred for dizziness. Prospective study of two groups of sequentially referred patients complaining of dizziness, imbalance, or both. A tertiary and quaternary care ambulatory referral center. Two groups of patients were studied. One was a group of patients who had suffered work-related head trauma and had subsequent complaints of dizziness and/or imbalance. The other was a group of patients referred for dizziness and/or imbalance who had no history of head trauma, work-related injury, or litigation procedures. Standard vestibular assessment including computerized dynamic posturography was carried out on all patients. A series of questions was designed to quantify patients' complaints of symptoms of visual-vestibular mismatch, and patients were scored according to their yes/no answers to the five questions. Results of traditional vestibular tests were correlated with the answers to the questions. Computerized dynamic posturography and electronystagmography results were compared between both symptomatic and nonsymptomatic patients and also between patients who had traumatic and nontraumatic causes of their symptoms. We found no correlation between test results and the presence of visual-vestibular mismatch symptomatology. There does seem to be a connection between the presence of motion sickness symptomatology and the development of visual-vestibular mismatch symptoms. Although visual-vestibular mismatch is of vestibular origin, it is discernible only after obtaining a careful history. It is a genuine symptom set of vestibular origin, and there is a certain group of patients who are more sensitive to this symptom set and who are often debilitated by its presence.
The study was conducted to determine if Swaystar (University Hospital, Basel), a device that meas... more The study was conducted to determine if Swaystar (University Hospital, Basel), a device that measures trunk sway, could be used in the office to detect abnormalities in patients who had vestibular abnormalities. Prospective study design. Patients were referred to our tertiary and quaternary care dizziness clinic. We measured total sway amplitudes using Swaystar during tandem walking of 18 patients referred sequentially who were identified as abnormal by caloric testing. These patients were compared with age- and sex-matched subjects from our normative Swaystar databank. We measured total sway amplitude in pitch and roll planes with Swaystar during tandem walking testing with eyes open and eyes closed. Patients with caloric abnormalities had significantly higher total sway than the age- and sex-matched normals from our normative databank. Swaystar is sensitive to measuring increased sway amplitude in patients with balance system deficits (as documented by caloric abnormalities) whether the patient is unstable in the pitch plane, roll plane, or both.
To develop and use a set of criteria using computerized dynamic posturography results to detect a... more To develop and use a set of criteria using computerized dynamic posturography results to detect aphysiologic behavior in patients with complaints of imbalance, and to compare the efficacy of this system with present quantitative techniques and with subjective methods of evaluating malingerers. Prospective study of two groups of sequentially referred patients complaining of dizziness and/or imbalance. A tertiary and quaternary care ambulatory referral center. Two groups of patients were studied. One was a group of patients who had suffered work-related head trauma and had subsequent complaints of dizziness and/or imbalance. The other was a group of patients referred for dizziness and/or imbalance who had no history of head trauma, work-related injury, or litigation procedures. Standard vestibular assessment including computerized dynamic posturography was carried out on all patients. All patients in both groups were scored for aphysiologic behavior using a quantified formula that has been used to detect malingerers, an analysis criterion using different aspects of computerized dynamic posturography performance that has been used for some time, and our newly developed nine-point scoring method. Results of all three methods were compared to determine the effectiveness of each one in detecting malingering behavior. Our nine-point protocol was effective in assessing patients in a consistent manner. Assessment using the quantitative formula in the literature raised suspicions of malingering in many patients with no known ulterior motives, some of whom had documented vestibular disease. Our criteria also evaluate other aspects of performance not evaluated by the presently used techniques. Our newly developed criteria are effective at evaluating the medicolegal patients from both the quantitative and qualitative viewpoints, and provide a more thorough assessment than has previously been available.
To evaluate the effectiveness of tandem Romberg and tandem walking testing at detecting vestibula... more To evaluate the effectiveness of tandem Romberg and tandem walking testing at detecting vestibular disease and to increase the difficulty of these standard screening assessments in an attempt to try and make them more effective in the clinical office setting. A prospective study in a tertiary and quaternary care neuro-otology clinic comparing performance on tandem Romberg and tandem walking between patients with vestibular disease and controls matched for age and sex. Making the tandem Romberg test and tandem walking tests more difficult for patients was not helpful because it also made the tests more difficult to perform for controls with no symptoms of vestibular disease. When comparing a young and an old cohort, there was a significant difference in performance. Our techniques of sharpening and sensitizing tandem Romberg and tandem walking tests were not useful at delineating vestibular disease, and age itself may be a confound that mimics the effects of balance system disease. The tandem Romberg and tandem walking tests, despite being in widespread clinical use as office screening tests, may not be effective at determining the presence of newly developed vestibular disease.
To determine whether the presence of back pain and its related disabilities are determinants of b... more To determine whether the presence of back pain and its related disabilities are determinants of balance and functional mobility in a group of women with osteoporosis, we carried out a cross-sectional analysis of 93 community-dwelling women with osteoporosis between the ages of 65 and 75 years old. We assessed health history, anthropometrics, self-report of current physical activity level and self-report of back pain (intensity and pain-related disabilities). Balance was measured by computerized dynamic posturography and functional mobility was assessed by timed figure-ofeight test. The prevalence of back pain was high (75%) in this cohort of older women with osteoporosis. Age was the major determinant of both balance and functional mobility and accounted for 9% and 14% of the variance, respectively. After accounting for age, back pain explained an additional 9% of the variance in balance and 13% of the variance in functional mobility. The high prevalence of back pain demonstrates the importance of pain management in the treatment of osteoporosis. Furthermore, the finding of self-reported back pain as a determinant of both balance and functional mobility suggests that this measure may deserve attention when screening women with osteoporosis for fracture risk. Prospective studies are needed to determine whether pain management will improve balance and functional mobility.
Journal of vestibular research : equilibrium & orientation, 2010
Electronystagmography (ENG) testing has been supplanted by newer techniques of measuring eye move... more Electronystagmography (ENG) testing has been supplanted by newer techniques of measuring eye movement with infrared cameras (VNG). Most techniques of quantifying caloric induced nystagmus measure the slow phase velocity in some manner. Although our analysis is carried out by very experienced assessors, some systems have computer algorithms that have been "taught" to locate and quantify maximum responses. We wondered what differences in measurement might show up when measuring calorics using different techniques and systems, the relevance of this being that if there was a change in slow phase velocity between ENG and VNG testing when measuring caloric response, then normative data would have to be changed. There are also some subjective but important aspects of ENG interpretation which comment on the nature of the response (e.g. responses which might be "sporadic" or "scant"). Our experiment compared caloric responses in 100 patients analyzed four differ...
Objectif: Supporter l'hypothèse que le syndrome connu sous le nom de visual vestibular misma... more Objectif: Supporter l'hypothèse que le syndrome connu sous le nom de visual vestibular mismatch (VVM) peut être induit par une pathologie vestibulaire périphérique. Devis: Etude rétrospective de dossiers avec questionnaire prospectif. Localisation: Clinique externe de soins ...
BackgroundOtolithic function is poorly understood, but vestibular-evoked myogenic potential testi... more BackgroundOtolithic function is poorly understood, but vestibular-evoked myogenic potential testing has allowed the documentation of pathology in patients who complain of imbalance.MethodsSeventy-four patients with traumatic and non-traumatic vestibular disease were sequentially assessed at a tertiary referral neuro-otology unit in a teaching hospital. A detailed history of all patients was taken and standard vestibular assessment was conducted using the technique described in the companion paper. The results of both groups of patients were analysed and the rate of abnormalities was assessed.ResultsThere was a high rate of abnormalities, including bilateral pathology, in a significant number of patients. Many patients in both groups inexplicably failed to recover.ConclusionVestibular-evoked myogenic potentials are helpful in documenting pathology, including bilateral pathology, which is outlined in the literature as being exceedingly difficult to compensate for.
Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale, 2008
Tandem walking testing is a "standard" clinical technique for assessing balance and gai... more Tandem walking testing is a "standard" clinical technique for assessing balance and gait, but it is not a standardized test. We wished to develop a protocol by which we could measure sway during tandem walking at a patient's preferred cadence and at an altered cadence, which might be more challenging. Fifteen patients with vestibular complaints were evaluated with standard tandem walking testing while wearing the Swaystar belt-mounted accelerometer and were also assessed in the same way with tandem walking at two altered cadences. We measured tandem walking sway amplitude and sway velocity with eyes open in both pitch and roll planes at a patient's preferred cadence, at 75% of their preferred cadence, and at 125% of their preferred cadence. We measured total sway amplitude and sway velocity in pitch and roll planes during tandem walking with eyes open while wearing Swaystar to see if there was any increase in sway at nonpreferred cadences. There was no correlation ...
Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale, 2008
We used two balance assessment devices, computerized dynamic posturography (CDP) and Swaystar tra... more We used two balance assessment devices, computerized dynamic posturography (CDP) and Swaystar transducers to detect subtle balance system deficits in nine subjects who had ingested minimal amounts of alcohol. Nine subjects were evaluated with both modalities before, and repetitively after, ingesting a small amount of alcohol. We measured condition 5 (sway referenced platform; eyes closed) on CDP and tandem walking with eyes closed while wearing Swaystar to see if either test could detect a balance deficit. We measured total sway amplitude with eyes closed in pitch and roll planes during tandem walking with Swaystar, and static balance scores of CDP sensory organization testing condition 5 before and after alcohol ingestion at 20 min intervals. Although there was no detectable deficit measurable by CDP, eight of our nine subjects showed increased dynamic sway as measured by Swaystar, after alcohol ingestion. Total sway was significantly greater (p=.05) after alcohol ingestion. It is ...
Previous studies have demonstrated that sedatives and antiemetics commonly used by patients suppr... more Previous studies have demonstrated that sedatives and antiemetics commonly used by patients suppress the vestibulo-ocular reflexes during electronystagmography, making it more difficult to quantify function in such patients. The effects of these medications on computerized dynamic posturography (CDP) have not been studied, and the influences, if any, on the vestibulospinal reflexes are not known. We aimed to study the influence, if any, of dimenhydrinate on CDP performance. A double-blinded study using a randomized protocol to compare the effects of dimenhydrinate and placebo on CDP performance in normal subjects. A tertiary/quaternary care facility using a standardized CDP assessment protocol. After a CDP training session (one assessment) to rule out any learning effect, 10 subjects underwent CDP assessment on 2 separate days after ingestion of either a standard single dose of dimenhydrinate or placebo. Pre- and post-medication CDP performance was measured using Sensory Organizatio...
Subtle complaints of visual-vestibular mismatch may not be elicited in an initial history-taking.... more Subtle complaints of visual-vestibular mismatch may not be elicited in an initial history-taking. Clinicians must be familiar with the nature of these complaints when assessing whiplash patients because other injuries may predominate and patients do not volunteer these more subtle complaints, which may be persisting and sometimes debilitating. A retrospective case review was performed. The study was conducted at a tertiary/quaternary referral clinic. Patients with whiplash, mild head injury, or both were referred for assessment of symptoms persisting for at least 2 years after their injury. A full history; otolaryngologic examination; including assessment of eye movements, corneal reflexes, and gait; investigation including electronystagmography and computerized dynamic posturography; and history-taking and detailed recording of related complaints were performed immediately before diagnostic workup. Many patients had more subtle complaints, which we now recognize as indicative of ve...
Pelizaeus-Merzbacher disease is a rare sex-linked recessive neurological disorder. It presents wi... more Pelizaeus-Merzbacher disease is a rare sex-linked recessive neurological disorder. It presents with a slowly progressive neurological deterioration. It is liable to be misdiagnosed as cerebral palsy. A family history of similar disease is a clue to the diagnosis. A patient with this condition has been followed over many years. Nystagmus was noted to be present shortly after birth. Audiovestibular investigations were performed. All tests of peripheral hearing were normal. ABR indicated abnormal brainstem conduction. Several electronystagmographic abnormalities were present. These were of a central type. They included failure of fixation suppression, poor smooth pursuit, and impaired performance of optokinetic nystagmus at high stripe speeds. During caloric-induced nystagmus an excessively prolonged slow phase of nystagmus with wide eye excursions was seen. We have not seen this feature in any other diseases and we suggest it may be specific for this syndrome.
The Arnold-Chiari malformation (ACM) is a rare congenital condition in which there is a downward ... more The Arnold-Chiari malformation (ACM) is a rare congenital condition in which there is a downward displacement of the cerebellum through the foramen magnum. Patients with this condition frequently develop symptoms of ataxia, imbalance, or vertigo. As a result the patient is often referred to an otolaryngologist. Such a case is reported. A patient presented with imbalance, had downbeating nystagmus on down gaze, and had other eye movement abnormalities recorded on electronystagmography (ENG) which were strongly suggestive of central pathology. Although her computerized tomography (CT) scan was normal, the eye findings and neurological evaluation were strongly suggestive of an ACM. A repeat CT scan with intrathecal metrizamide was abnormal. A definite diagnosis of ACM was confirmed using the new investigative technique of magnetic resonance imaging (MRI).
To analyze a newly defined group of Computerized Dynamic Posturography abnormalities and to deter... more To analyze a newly defined group of Computerized Dynamic Posturography abnormalities and to determine if these patients' abnormalities are of vestibular origin. Analysis of results drawn from our larger study of two groups of sequentially referred patients complaining of dizziness and/or imbalance. A tertiary and quaternary care ambulatory referral centre. Two groups of patients were studied. One was a group of patients who had suffered work-related head trauma and had subsequent complaints of dizziness and/or imbalance. The other was a group of patients referred for dizziness and/or imbalance who had no history of head trauma, work related injury. or litigation procedures. Standard vestibular assessment including Computerized Dynamic Posturography was carried out on all patients. CDP results of all patients were reanalyzed and all results were pulled which were abnormal on at least 5 of 6 sensory conditions. All results were analyzed using a quantitative method of detecting malingering and also using our newly developed nine point subjective/objective criteria scale. While the standardized formulae categorized most of these results as "aphysiologic," our nine-point protocol showed most of the patients to be legitimate. These results represent a legitimate subgroup of vestibular patients that we feel have been more or less unrecognized, many of whom are incapacitated by imbalance and disorientation. These results also are helpful in measuring safety of these patients in the workplace.
To define and investigate the symptom set known as visual-vestibular mismatch and analyze its nat... more To define and investigate the symptom set known as visual-vestibular mismatch and analyze its nature and occurrence in two groups of patients referred for dizziness. Prospective study of two groups of sequentially referred patients complaining of dizziness, imbalance, or both. A tertiary and quaternary care ambulatory referral center. Two groups of patients were studied. One was a group of patients who had suffered work-related head trauma and had subsequent complaints of dizziness and/or imbalance. The other was a group of patients referred for dizziness and/or imbalance who had no history of head trauma, work-related injury, or litigation procedures. Standard vestibular assessment including computerized dynamic posturography was carried out on all patients. A series of questions was designed to quantify patients' complaints of symptoms of visual-vestibular mismatch, and patients were scored according to their yes/no answers to the five questions. Results of traditional vestibular tests were correlated with the answers to the questions. Computerized dynamic posturography and electronystagmography results were compared between both symptomatic and nonsymptomatic patients and also between patients who had traumatic and nontraumatic causes of their symptoms. We found no correlation between test results and the presence of visual-vestibular mismatch symptomatology. There does seem to be a connection between the presence of motion sickness symptomatology and the development of visual-vestibular mismatch symptoms. Although visual-vestibular mismatch is of vestibular origin, it is discernible only after obtaining a careful history. It is a genuine symptom set of vestibular origin, and there is a certain group of patients who are more sensitive to this symptom set and who are often debilitated by its presence.
The study was conducted to determine if Swaystar (University Hospital, Basel), a device that meas... more The study was conducted to determine if Swaystar (University Hospital, Basel), a device that measures trunk sway, could be used in the office to detect abnormalities in patients who had vestibular abnormalities. Prospective study design. Patients were referred to our tertiary and quaternary care dizziness clinic. We measured total sway amplitudes using Swaystar during tandem walking of 18 patients referred sequentially who were identified as abnormal by caloric testing. These patients were compared with age- and sex-matched subjects from our normative Swaystar databank. We measured total sway amplitude in pitch and roll planes with Swaystar during tandem walking testing with eyes open and eyes closed. Patients with caloric abnormalities had significantly higher total sway than the age- and sex-matched normals from our normative databank. Swaystar is sensitive to measuring increased sway amplitude in patients with balance system deficits (as documented by caloric abnormalities) whether the patient is unstable in the pitch plane, roll plane, or both.
To develop and use a set of criteria using computerized dynamic posturography results to detect a... more To develop and use a set of criteria using computerized dynamic posturography results to detect aphysiologic behavior in patients with complaints of imbalance, and to compare the efficacy of this system with present quantitative techniques and with subjective methods of evaluating malingerers. Prospective study of two groups of sequentially referred patients complaining of dizziness and/or imbalance. A tertiary and quaternary care ambulatory referral center. Two groups of patients were studied. One was a group of patients who had suffered work-related head trauma and had subsequent complaints of dizziness and/or imbalance. The other was a group of patients referred for dizziness and/or imbalance who had no history of head trauma, work-related injury, or litigation procedures. Standard vestibular assessment including computerized dynamic posturography was carried out on all patients. All patients in both groups were scored for aphysiologic behavior using a quantified formula that has been used to detect malingerers, an analysis criterion using different aspects of computerized dynamic posturography performance that has been used for some time, and our newly developed nine-point scoring method. Results of all three methods were compared to determine the effectiveness of each one in detecting malingering behavior. Our nine-point protocol was effective in assessing patients in a consistent manner. Assessment using the quantitative formula in the literature raised suspicions of malingering in many patients with no known ulterior motives, some of whom had documented vestibular disease. Our criteria also evaluate other aspects of performance not evaluated by the presently used techniques. Our newly developed criteria are effective at evaluating the medicolegal patients from both the quantitative and qualitative viewpoints, and provide a more thorough assessment than has previously been available.
To evaluate the effectiveness of tandem Romberg and tandem walking testing at detecting vestibula... more To evaluate the effectiveness of tandem Romberg and tandem walking testing at detecting vestibular disease and to increase the difficulty of these standard screening assessments in an attempt to try and make them more effective in the clinical office setting. A prospective study in a tertiary and quaternary care neuro-otology clinic comparing performance on tandem Romberg and tandem walking between patients with vestibular disease and controls matched for age and sex. Making the tandem Romberg test and tandem walking tests more difficult for patients was not helpful because it also made the tests more difficult to perform for controls with no symptoms of vestibular disease. When comparing a young and an old cohort, there was a significant difference in performance. Our techniques of sharpening and sensitizing tandem Romberg and tandem walking tests were not useful at delineating vestibular disease, and age itself may be a confound that mimics the effects of balance system disease. The tandem Romberg and tandem walking tests, despite being in widespread clinical use as office screening tests, may not be effective at determining the presence of newly developed vestibular disease.
To determine whether the presence of back pain and its related disabilities are determinants of b... more To determine whether the presence of back pain and its related disabilities are determinants of balance and functional mobility in a group of women with osteoporosis, we carried out a cross-sectional analysis of 93 community-dwelling women with osteoporosis between the ages of 65 and 75 years old. We assessed health history, anthropometrics, self-report of current physical activity level and self-report of back pain (intensity and pain-related disabilities). Balance was measured by computerized dynamic posturography and functional mobility was assessed by timed figure-ofeight test. The prevalence of back pain was high (75%) in this cohort of older women with osteoporosis. Age was the major determinant of both balance and functional mobility and accounted for 9% and 14% of the variance, respectively. After accounting for age, back pain explained an additional 9% of the variance in balance and 13% of the variance in functional mobility. The high prevalence of back pain demonstrates the importance of pain management in the treatment of osteoporosis. Furthermore, the finding of self-reported back pain as a determinant of both balance and functional mobility suggests that this measure may deserve attention when screening women with osteoporosis for fracture risk. Prospective studies are needed to determine whether pain management will improve balance and functional mobility.
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