Development of a ground-based sensorimotor disorientation analog to replicate astronaut postflight experience.

The perceptual and motor coordination problems experienced following return from spaceflight reflect the sensory adaptation to altered gravity. The purpose of this study was to develop a ground-based analog that replicates similar sensorimotor impairment using a standard measures test battery and subjective feedback from experienced crewmembers. This Sensorimotor Disorientation Analog (SDA) included varying levels of sensorimotor disorientation through combined vestibular, visual, and proprioceptive disruptions. The SDA was evaluated on five previously flown astronauts to compare with their postflight experience and functional motor performance immediately (Return (R)+0 days) and +24 h (R+1) after landing. The SDA consisted of galvanic vestibular stimulation (GVS), visual disruption goggles, and a weighted suit to alter proprioceptive feedback and replicate perceived heaviness postflight. Astronauts reported that GVS alone replicated ∼50-90% of their postflight performance with the weighted suit fine-tuning the experience to replicate an additional 10%-40% of their experience. Astronauts did not report feeling that the disruption goggles represented either the visual disruptions or illusory sensations that they experienced, nor did they impact motor performance in postflight tasks similarly. Based on these results, we recommend an SDA including the GVS and the weighted suit. These results provide a more realistic and portable SDA framework to provide transient spaceflight-relevant sensorimotor disruptions for use in countermeasure testing and as a pre-flight training tool.

Developing Proprioceptive Countermeasures to Mitigate Postural and Locomotor Control Deficits After Long-Duration Spaceflight.

Astronauts experience post-flight disturbances in postural and locomotor control due to sensorimotor adaptations during spaceflight. These alterations may have adverse consequences if a rapid egress is required after landing. Although current exercise protocols can effectively mitigate cardiovascular and muscular deconditioning, the benefits to post-flight sensorimotor dysfunction are limited. Furthermore, some exercise capabilities like treadmill running are currently not feasible on exploration spaceflight vehicles. Thus, new in-flight operational countermeasures are needed to mitigate postural and locomotor control deficits after exploration missions. Data from spaceflight and from analog studies collectively suggest that body unloading decreases the utilization of proprioceptive input, and this adaptation strongly contributes to balance dysfunction after spaceflight. For example, on return to Earth, an astronaut's vestibular input may be compromised by adaptation to microgravity, but their proprioceptive input is compromised by body unloading. Since proprioceptive and tactile input are important for maintaining postural control, keeping these systems tuned to respond to upright balance challenges during flight may improve functional task performance after flight through dynamic reweighting of sensory input. Novel approaches are needed to compensate for the challenges of balance training in microgravity and must be tested in a body unloading environment such as head down bed rest. Here, we review insights from the literature and provide observations from our laboratory that could inform the development of an in-flight proprioceptive countermeasure.

Vestibular and Cardiovascular Responses After Long-Duration Spaceflight.

BACKGROUND: The vestibulo-sympathetic reflex operates during orthostatically challenging movements to initiate cardiovascular responses in advance of a baroreceptor-mediated response. The objective of this study was to determine whether there was an association between changes in vestibular function and cardiovascular responses during a prone-to-stand movement in astronauts after return from long-duration spaceflight.METHODS: Thirteen crewmembers who participated in International Space Station missions were tested before spaceflight and 1 d after landing. Vestibular function was evaluated by computerized dynamic posturography while their head was erect and while they performed dynamic head tilts. Heart rate and mean arterial blood pressure were measured while the subjects were in prone and standing positions.RESULTS: The 21.4% increase in the astronauts' heart rate during the prone to stand maneuver after spaceflight correlated significantly with their spaceflight-induced 48.7% decrease in postural stability during dynamic head tilts. The larger mean arterial pressure in the prone position after spaceflight compared to preflight (+7%) also correlated with the postflight decrease in postural stability during dynamic head tilts.CONCLUSION: These results indicate that an appropriate vestibular function is important to evoke optimum vestibulo-sympathetic response during orthostatically challenging voluntary movements performed after spaceflight. They also suggest that there may be a greater need to generate an anticipatory cardiovascular response after spaceflight.Deshpande N, Laurie SS, Lee SMC, Miller CA, Mulavara AP, Peters BT,Reschke MF, Stenger MB, Taylor LC, Wood SJ, Clément GR, Bloomberg JJ. Vestibular and cardiovascular responses after long-duration spaceflight. Aerosp Med Hum Perform. 2020; 91(8):621-627.

Screening for Vestibular Disorders Using the Modified Clinical Test of Sensory Interaction and Balance and Tandem Walking With Eyes Closed.

OBJECTIVES: Determine accurate cut-points and optimal combinations of screening tests of balance to detect patients with vestibular disorders. STUDY DESIGN: Case-control study. SETTING: Out-patient tertiary care. SUBJECTS AND METHODS: Community-dwelling adults, without known neurological deficits or significant musculoskeletal disorders, including patients with vestibular disorders and healthy controls without vestibular disorders were tested while standing on medium density compliant foam with feet together and eyes closed under three head movement conditions, head stationary, and head moving in yaw and pitch at 0.33 Hz, for up to 30 seconds per trial. Dependent measures were trial duration, number of head movements during head movement trials, trunk kinematic measures, and number of correct tandem steps during tandem walking trials. RESULTS: Receiver operator characteristics (ROC), sensitivity and specificity, and specific cut-points were calculated. Individual tests had moderate ROC values, from 0.67 to 0.84. ROC values were higher in the head moving trials than the head stationary trial and best for subjects aged 40 to 79. Using combined analyses of two or more tests, including published data on tandem walking, ROC values were higher, 0.80 to 0.90. Age- and sex-related performance differences were found. CONCLUSION: Balance skills in standing and walking differ, so testing both skills is optimal and increases the likelihood of finding a deficit. Patients should be compared to age-appropriate norms. Kinematics and number of head movements were not very useful. This combined set of rapid, low-tech balance tests is useful in an initial approach to screening patients who may have vestibular disorders.

Functional Task and Balance Performance in Bed Rest Subjects and Astronauts.

INTRODUCTION: The purpose of this study was to determine how short- and long-duration spaceflight affects astronauts' performance on functional tests that challenge the balance control system (Seated Egress and Walk; Object Translation; Recovery from Fall/Stand; and Jump Down) and on clinical tests of balance function (Computerized Dynamic Posturography and Tandem Walk). In addition, we examined how exercise affects functional performance after long-term axial body unloading during 70 d of bed rest at 6° head-down tilt. METHODS: Data were collected twice during the 2-mo period before spaceflight or during the 2-wk period before bed rest, and four times after flight or bed rest: on the day of landing or the day bed rest ended, 1 d and 6 d later, and a final session 12 d after bed rest or 30 d after spaceflight. RESULTS: For bed rest subjects, long-term axial unloading alone caused functional performance deficits immediately after bed rest. However, the addition of an exercise regimen did not significantly improve median functional performance immediately after this axial unloading. For spaceflight subjects, the length of the space mission was directly related to the severity of functional performance deficits within 1 d of landing and during the subsequent recovery period after flight. DISCUSSION: The performance data suggest that an additional sensorimotor-based countermeasure may be necessary to maintain functional performance at preflight levels immediately after spaceflight.Miller CA, Kofman IS, Brady RR, May-Phillips TR, Batson CD, Lawrence EL, Taylor LC, Peters BT, Mulavara AP, Feiveson AH, Reschke MF, Bloomberg JJ. Functional task and balance performance in bed rest subjects and astronauts. Aerosp Med Hum Perform. 2018; 89(9):805-815.

Physiological and Functional Alterations after Spaceflight and Bed Rest.

INTRODUCTION: Exposure to microgravity causes alterations in multiple physiological systems, potentially impacting the ability of astronauts to perform critical mission tasks. The goal of this study was to determine the effects of spaceflight on functional task performance and to identify the key physiological factors contributing to their deficits. METHODS: A test battery comprised of seven functional tests and 15 physiological measures was used to investigate the sensorimotor, cardiovascular, and neuromuscular adaptations to spaceflight. Astronauts were tested before and after 6-month spaceflights. Subjects were also tested before and after 70 d of 6° head-down bed rest, a spaceflight analog, to examine the role of axial body unloading on the spaceflight results. These subjects included control and exercise groups to examine the effects of exercise during bed rest. RESULTS: Spaceflight subjects showed the greatest decrement in performance during functional tasks that required the greatest demand for dynamic control of postural equilibrium which was paralleled by similar decrements in sensorimotor tests that assessed postural and dynamic gait control. Other changes included reduced lower limb muscle performance and increased HR to maintain blood pressure. Exercise performed during bed rest prevented detrimental change in neuromuscular and cardiovascular function; however, both bed rest groups experienced functional and balance deficits similar to spaceflight subjects. CONCLUSION: Bed rest data indicate that body support unloading experienced during spaceflight contributes to postflight postural control dysfunction. Further, the bed rest results in the exercise group of subjects confirm that resistance and aerobic exercises performed during spaceflight can play an integral role in maintaining neuromuscular and cardiovascular functions, which can help in reducing decrements in functional performance. These results indicate that a countermeasure to mitigate postflight postural control dysfunction is required to maintain functional performance.

Tandem walking as a quick screening test for vestibular disorders.

OBJECTIVES/HYPOTHESIS: Although many screening tests of balance are available, few of them have been well validated for clinical or research uses. The goal of this study was to test an updated version of an old test, Tandem Walking, to determine how useful it is for screening patients with vestibular disorders. STUDY DESIGN: Case-control study. METHODS: Subjects were 90 adult patients with vestibular disorders and 292 healthy adult controls. They were tested on the number of correct tandem steps they could perform with arms crossed and eyes closed in a series of 10 steps. Correct steps could be nonconsecutive. Subjects were given one practice trial with eyes open and three experimental trials with eyes closed. RESULTS: Receiver operating characteristic (ROC), and sensitivity and specificity were calculated. ROC values, sensitivity, and specificity were, at best, only moderate, no matter how the age range was cut. Even for subjects in the age group with the highest ROC value (i.e., age less than 50 years), ROC = 0.8, sensitivity = 0.77, and specificity = 0.72. CONCLUSIONS: These results indicate that 23% of patients will not be identified. Therefore, we recommend that if this test is used for screening patients in the clinic or healthy volunteers, the result should be interpreted with care. LEVEL OF EVIDENCE: 3b. Laryngoscope, 128:1687-1691, 2018.

Utility of quick oculomotor tests for screening the vestibular system in the subacute and chronic populations.

OBJECTIVE: The goal of this study was to determine the sensitivity and specificity of some widely used, easily administered clinical tests. BACKGROUND: Simple tests of oculomotor function have become widely used for clinical screening of patients suspected of having vestibular disorders despite a paucity of evidence showing good statistical support for their use in this highly variable population. METHODS: Healthy controls with no history of otologic or neurologic disorders (n = 291) were compared to patients with known vestibular disorders (n = 62). All subjects performed passive and active head shaking, un-instrumented head impulse tests (HT), and video head impulse tests (vHIT) recorded with infrared video-oculography. RESULTS: For both passive and active head shaking, using presence/absence of vertigo and of nystagmus, sensitivity was low (<0.40). Sensitivity of presence/absence of saccades on HT was even lower (<0.15). On vHIT, gains were all approximately = 1.0, so sensitivity was very low (approximately 0.15-0.35). Sensitivity and specificity for presence/absence of saccades were moderately poor (less than 0.70). CONCLUSION: None of these tests are adequate for screening patients in the out-patient clinic for vestibular disorders or for screening people in epidemiologic studies to determine the prevalence of vestibular disorders.

Assessing Somatosensory Utilization during Unipedal Postural Control.

Multisensory-visual, vestibular and somatosensory information is integrated for appropriate postural control. The primary goal of this study was to assess somatosensory utilization during a functional motor task of unipedal postural control, in normal healthy adults. Assessing individual bias in the utilization of individual sensory contributions during postural control may help customization of rehabilitation protocols. In this study, a test paradigm of unipedal stance control in supine orientation with and without vision was assessed. Postural control in this test paradigm was hypothesized to utilize predominantly contributions of somatosensory information from the feet and ankle joint, with minimal vestibular input. Fourteen healthy subjects "stood" supine on their dominant leg while strapped to a backpack frame that was freely moving on air-bearings, to remove available otolith tilt cues with respect to gravity that influences postural control when standing upright. The backpack was attached through a cable to a pneumatic cylinder that provided a gravity-like load. Subjects performed three trials each with Eyes-open (EO) and Eyes-closed (EC) while loaded with 60% body weight. There was no difference in unipedal stance time (UST) across the two conditions with EC condition challenging the postural control system greater than the EO condition. Stabilogram-diffusion analysis (SDA) indicated that the critical mean square displacement was significantly different between the two conditions. Vestibular cues, both in terms of magnitude and the duration for which relevant information was available for postural control in this test paradigm, were minimized. These results support our hypothesis that maintaining unipedal stance in supine orientation without vision, minimizes vestibular contribution and thus predominantly utilizes somatosensory information for postural control.

Enhancing astronaut performance using sensorimotor adaptability training.

Astronauts experience disturbances in balance and gait function when they return to Earth. The highly plastic human brain enables individuals to modify their behavior to match the prevailing environment. Subjects participating in specially designed variable sensory challenge training programs can enhance their ability to rapidly adapt to novel sensory situations. This is useful in our application because we aim to train astronauts to rapidly formulate effective strategies to cope with the balance and locomotor challenges associated with new gravitational environments-enhancing their ability to "learn to learn." We do this by coupling various combinations of sensorimotor challenges with treadmill walking. A unique training system has been developed that is comprised of a treadmill mounted on a motion base to produce movement of the support surface during walking. This system provides challenges to gait stability. Additional sensory variation and challenge are imposed with a virtual visual scene that presents subjects with various combinations of discordant visual information during treadmill walking. This experience allows them to practice resolving challenging and conflicting novel sensory information to improve their ability to adapt rapidly. Information obtained from this work will inform the design of the next generation of sensorimotor countermeasures for astronauts.

Using low levels of stochastic vestibular stimulation to improve locomotor stability.

Low levels of bipolar binaural white noise based imperceptible stochastic electrical stimulation to the vestibular system (stochastic vestibular stimulation, SVS) have been shown to improve stability during balance tasks in normal, healthy subjects by facilitating enhanced information transfer using stochastic resonance (SR) principles. We hypothesize that detection of time-critical sub-threshold sensory signals using low levels of bipolar binaural SVS based on SR principles will help improve stability of walking during support surface perturbations. In the current study 13 healthy subjects were exposed to short continuous support surface perturbations for 60 s while walking on a treadmill and simultaneously viewing perceptually matched linear optic flow. Low levels of bipolar binaural white noise based SVS were applied to the vestibular organs. Multiple trials of the treadmill locomotion test were performed with stimulation current levels varying in the range of 0-1500 µA, randomized across trials. The results show that subjects significantly improved their walking stability during support surface perturbations at stimulation levels with peak amplitude predominantly in the range of 100-500 µA consistent with the SR phenomenon. Additionally, objective perceptual motion thresholds were measured separately as estimates of internal noise while subjects sat on a chair with their eyes closed and received 1 Hz bipolar binaural sinusoidal electrical stimuli. The optimal improvement in walking stability was achieved on average with peak stimulation amplitudes of approximately 35% of perceptual motion threshold. This study shows the effectiveness of using low imperceptible levels of SVS to improve dynamic stability during walking on a laterally oscillating treadmill via the SR phenomenon.

Individual predictors of sensorimotor adaptability.

There are large individual variations in strategies and rates of sensorimotor adaptation to spaceflight. This is seen in both the magnitude of performance disruptions when crewmembers are first exposed to microgravity, and in the rate of re-adaptation when they return to Earth's gravitational environment. Understanding the sources of this variation can lead to a better understanding of the processes underlying adaptation, as well as provide insight into potential routes for facilitating performance of "slow adapters". Here we review the literature on brain, behavioral, and genetic predictors of motor learning, recovery of motor function following neural insult, and sensorimotor adaptation. For example, recent studies have identified specific genetic polymorphisms that are associated with faster adaptation on manual joystick tasks and faster recovery of function following a stroke. Moreover, the extent of recruitment of specific brain regions during learning and adaptation has been shown to be predictive of the magnitude of subsequent learning. We close with suggestions for forward work aimed at identifying predictors of spaceflight adaptation success. Identification of "slow adapters" prior to spaceflight exposure would allow for more targeted preflight training and/or provision of booster training and adaptation adjuncts during spaceflight.

Screening people in the waiting room for vestibular impairments.

OBJECTIVE: Primary care physicians need good screening tests of the vestibular system to help them determine whether patients who complain of dizziness should be evaluated for vestibular disorders. The goal of this study was to determine whether current, widely used screening tests of the vestibular system predict subsequent performance on objective diagnostic tests of the vestibular system (ENG). METHODS: Of 300 subjects who were recruited from the waiting room of a primary care clinic and were screened there, 69 subjects subsequently volunteered for ENGs in the otolaryngology department. The screening study included age, history of vertigo, head impulse tests, Dix-Hallpike maneuvers, and the Clinical Test of Sensory Integration and Balance with the head still and the head pitching at 0.33 Hz. The ENG included Dix-Hallpike maneuvers, vestibular-evoked myogenic potentials, bithermal water caloric tests, and low-frequency sinusoids in the rotatory chair in darkness. RESULTS: The scores on the screening were related to the total ENG, but odds ratios were not significant for some variables, probably because of the small sample size. CONCLUSIONS: A larger sample may have yielded stronger results, but in general the high odds ratios suggest a relation between the ENG score and Dix-Hallpike responses and between the ENG scores and some Clinical Test of Sensory Integration and Balance responses.

Standing balance tests for screening people with vestibular impairments.

OBJECTIVES/HYPOTHESIS: To improve the test standards for a version of the Romberg test and to determine whether measuring kinematic variables improved its utility for screening. STUDY DESIGN: Healthy controls and patients with benign paroxysmal positional vertigo, postoperative acoustic neuroma resection, and chronic peripheral unilateral weakness were compared. METHODS: Subjects wore Bluetooth-enabled inertial motion units while standing on the floor or medium-density, compliant foam, with eyes open or closed, with head still or moving in pitch or yaw. Dependent measures were time to perform each test condition, number of head movements made, and kinematic variables. RESULTS: Patients and controls did not differ significantly with eyes open or with eyes closed while on the floor. With eyes closed, on foam, some significant differences were found between patients and controls, especially for subjects older than 59 years. Head movement conditions were more challenging than with the head still. Significantly fewer patients than controls could make enough head movements to obtain kinematic measures. Kinematics indicated that lateral balance control is significantly reduced in these patients compared to controls. Receiver operator characteristics and sensitivity/specificity analyses showed moderately good differences with older subjects. CONCLUSIONS: Tests on foam with eyes closed, with head still or moving, may be useful as part of a screening battery for vestibular impairments, especially for older people. LEVEL OF EVIDENCE: 3b.

Dynamic visual acuity (DVA) during locomotion for targets at near and far distances: effects of aging, walking speed and head-trunk coupling.

This study examined effects of aging, head-trunk coupling (HTcoupling) and walking speed on dynamic visual acuity (DVA) at near and far viewing distances. Ten healthy participants were recruited in 3 groups; young: 20-33 years, Older1: 65-74 years, Older2: 75-85 years. The binocular DVA was measured while walking on a treadmill at 0.75 and 1.5 m/s speeds. The optotype display was placed at 0.5 m for NearDVA and at 3.0 m for FarDVA. On randomly selected trials, HTcoupling was achieved by using a collar. A mix-factor ANOVA (age-group x HTcoupling x speed) was performed separately for the Near and FarDVA. NearDVA declined with HTcoupling (p=0.021). Additionally, NearDVA worsened at the faster speed (p< 0.001). At 1.5 m/s speed the differences between Young and Older2 groups were significant (p=0.012) and those between Older1 and Older2 were marginal (p=0.085). FarDVA declined at the faster speed (p< 0.001) with no effect of HTcoupling or age-group. NearDVA is more sensitive to normal aging process. These age-related deficits become more apparent at higher walking speeds. Effect of HTcoupling on NearDVA suggests a possible additive effect of insufficient dampening of the vertical movement of the overall head-trunk complex and inability of the linear vestibulo-ocular reflex to compensate for the consequent high discrepancy.

Sharpening the tandem walking test for screening peripheral neuropathy.

OBJECTIVE: Few tests of functional motor behavior are useful for rapidly screening people for lower extremity peripheral neuropathy. The goal of this study was to improve the widely used tandem walking (TW) test. METHODS: We tested "normal" (control) adult and ambulatory patients with peripheral neuropathy (PN) with their eyes open and eyes closed while they performed TW on industrial carpeting in sock-covered feet. Each subject wore a torso-mounted inertial motion unit to measure kinematic data. The data of subjects with PN also were compared with historical data on patients with vestibular impairments. RESULTS: The normal and PN groups differed significantly on TW and on the number of steps completed. PN and vestibular impairments data also differed significantly on both visual conditions. Kinematic data showed that patients with PN were more unstable than normal patients in the group. For the number of steps taken during the eyes open condition, receiver operating characteristic (ROC) values were only 0.81 and for the number of steps taken during the eyes closed condition, ROC values were 0.88. Although not optimal, this ROC value is better. Sensitivity and specificity at a cutoff of two steps were 0.81 and 0.92, respectively, and at a cutoff of three steps were 0.86 and 0.75, respectively. ROC values for kinematic data were <0.8, and when combined with the ROC value for the number of steps, the total ROC value did not improve appreciably. CONCLUSIONS: Although not ideal for screening patients who may have PN, counting the number of steps during TW is a quick and useful clinical test. TW is most sensitive to patients with PN when they are tested with eyes closed.

Adaptation in locomotor stability, cognition, and metabolic cost during sensory discordance.

BACKGROUND: Locomotor instability may affect planetary extravehicular activities during the initial adaptation to the new gravitational environment. The goal of this study was to quantify the locomotor, cognitive, and metabolic effects of exposure to a discordant sensory environment. METHODS: A treadmill mounted on a 6-degree-of-freedom motion base was used to present 15 healthy subjects with a destabilizing support surface while they walked. Dependent measures of locomotor stability, cognitive load, and metabolic cost were stride frequency (SF), reaction time (RT), and the volume of oxygen consumed (Vo2), respectively. Subjects completed an 8-min baseline walk followed by 20 min of walking with a continuous, sinusoidal, laterally oscillating support-surface perturbation. Data for minutes 1, 7, 13, and 20 of the support-surface perturbation period were compared with the baseline. RESULTS: SF, RT, and Vo2 were significantly greater during support-surface motion than during the baseline walking condition and showed a trend toward recovery to baseline levels during the perturbation period. Results demonstrated that adaptation to walking in a discordant sensory environment has quantifiable and significant costs in SF, RT, and Vo2 as shown by mean increases of 9%, 20%, and 4%, respectively, collected during the first minute of exposure. By the fourth minute of exposure, mean Vo2 consumption had increased to 20% over its baseline. DISCUSSION: We believe that preflight sensorimotor adaptation training paradigms will impart gains in stability and the ability to multitask, and might increase productive mission time by extending work time in extravehicular activity suits where metabolic expenditure is a limiting factor.

New analyses of the sensory organization test compared to the clinical test of sensory integration and balance in patients with benign paroxysmal positional vertigo.

OBJECTIVES/HYPOTHESIS: To determine whether the Sensory Organization Test (SOT) of the computerized dynamic posturography battery or the Clinical Test of Sensory Integration and Balance (CTSIB) is more likely to indicate balance disorders in people with benign paroxysmal positional vertigo (BPPV). STUDY DESIGN: Normal controls were compared to patients with unilateral BPPV of the posterior semicircular canal. METHODS: Subjects performed tests with eyes open or closed on stable and unstable surfaces, with head still or with head moving at 0.33 Hz in pitch or yaw. Dependent variables were the percent time of the standard duration each subject could perform the task, the number of head motions made, and kinematic variables measured with head- and torso-mounted inertial motion units. RESULTS: Because equilibrium scores of control subjects improved significantly over repeated trials on SOT, patients were given only one trial per condition. For percent time between-group differences were found on CTSIB with eyes closed, on foam, head moving in yaw showing significantly reduced performance by BPPV subjects compared to controls. Compared to controls, patients made significantly fewer head movements on CTSIB, eyes closed, on foam, head still, in pitch and yaw. Kinematic data also differed between the groups on tests with eyes closed and unstable surfaces with different head movement combinations, indicating increased instability in BPPV patients. CONCLUSIONS: For screening, CTSIB with head movements is more likely than SOT to indicate balance deficits, especially when dependent measures include percent time as well as head movement counts and kinematic measures.

Effects of distance and duration on vertical dynamic visual acuity in screening healthy adults and people with vestibular disorders.

BACKGROUND: Dynamic visual acuity (DVA) testing may be a useful, indirect indicator of vestibulo-ocular reflex function. Previous evidence shows that acuity for 2 m targets differs little between patients and normals using a 75 ms display duration and that healthy subjects do not differ in acuity when standing and walking while viewing a far target but they do differ when viewing a near target. OBJECTIVE: Improve the protocol of a screening tool by testing the hypothesis that healthy control subjects and patients and with unilateral peripheral vestibular weakness differ on DVA when viewing far targets while seated. METHODS: Controls and patients were tested while they were seated in a chair that oscillated vertically at 2 Hz. They viewed a computer screen 4 m away, while stationary and while moving, with viewing times of either 75 ms or 500 ms. RESULTS: The amount of change between static and dynamic conditions did not differ significantly between patients and controls for the 75 ms condition but controls had lower difference scores than patients when using the 500 ms duration. The ROC value was low, 0.68. Compared to historical data using the 75 ms duration at a distance of 2 m, subjects in both diagnostic groups had better visual acuity at the 75 ms/4 m distance. CONCLUSIONS: These results suggest that using the longer duration is better for differentiating patients from healthy controls and they support previous evidence showing that near target viewing is more challenging.

Tests of walking balance for screening vestibular disorders.

Few reliable tests are available for screening people rapidly for vestibular disorders although such tests would be useful for a variety of testing situations. Balance testing is widely performed but of unknown value for screening. The goal of this study was to determine the value of tests of walking balance for screening people with vestibular impairments. We tested three groups of patients with known vestibular impairments: benign paroxysmal positional vertigo, unilateral vestibular weakness, and post-acoustic neuroma resection. We compared them to normal subjects. All subjects were independently ambulatory without gait aids. Subjects were tested on tandem walking (TW) with eyes open and eyes closed for 10 steps, walking with no additional head motions and with augmented head rotations in yaw for 7 m (WwHT), and an obstacle avoidance task, the Functional Mobility Test (FMT). Subjects wore a 3-D motion sensor centered at mid-torso to capture kinematic measures. Patients and normals differed significantly on some behavioral measures, such as the number of steps to perform TW, and on some but not all kinematic measures. ROC analyses, however, were at best only moderate, and failed to find strong differences and cut-points that would differentiate the groups. These findings suggest that although patients and normals differ in performance of these tests in some interesting ways the groups are not sufficiently different on these tests for easy use as screening tests to differentiate the populations.