Balance performance, falls-efficacy and social participation in patients with type 2 diabetes mellitus with and without vestibular dysfunction.

Background: The performance of balance is an important factor to perform activities. The complications of type 2 diabetes mellitus (T2DM), especially vestibular dysfunction (VD), could decrease balance performance and falls-efficacy (FE) which consequently impacts social participation and quality of life (QoL). Purpose: This study aimed to compare balance performance, FE, social participation and QoL between individuals with T2DM with and without VD. Methods: The participants comprised 161 T2DM with VD and 161 without VD. Three clinical tests used for confirming VD included the Head Impulse Test (HIT), the Dix Hallpike Test (DHT) and the Supine Roll Test (SRT). The scores of static and dynamic balances, FE, social participation and QoL were compared between groups. Results: The balance performance, FE, social participation and QoL were lower in the group with VD. The number of patients who had severe social restriction was higher in T2DM with VD than without VD (58.4% vs 48.4%). Moreover, all domains of QoL (physical, psychological, social relationships and environmental) were lower in T2DM with VD than without VD. Conclusion: The presence of VD in T2DM patients was associated with decreased physical balance performances and increased social and QoL disengagement. Comprehensive management related to balance and FE, as well as the monitoring to support social participation and QoL, should be emphasized in patients with T2DM with VD.

Introduction to the assessment and management of persistent postural-perceptual dizziness.

OBJECTIVE: Persistent postural-perceptual dizziness classifies patients with chronic dizziness, often triggered by an acute episode of vestibular dysfunction or threat to balance. Unsteadiness and spatial disorientation vary in intensity but persist for over three months, exacerbated by complex visual environments. METHOD: Literature suggests diagnosis relies on a clinical history of persistent subjective dizziness and normal vestibular and neurological examination findings. Behavioural diagnostic biomarkers have been proposed, to facilitate diagnosis. RESULTS: Research has focused on understanding the neural mechanisms that underpin this perceptual disorder, with imaging data supporting altered connectivity between neural brain networks that process vision, motion and emotion. Behavioural research identified the perceptual and motor responses to a heightened perception of imbalance. CONCLUSION: Management utilises head and body motion detection, and downregulation of visual motion excitability, reducing postural hypervigilance and anxiety. Combinations of physical and cognitive therapies, with antidepressant medications, help if the condition is associated with mood disorder.

Estimated Vestibulogram (EVEST) for Effective Vestibular Assessment.

BACKGROUND: The availability and development of methods testing the vestibuloocular reflex (VOR) brought a broader view into the lateral semicircular canal (L-SCC) function. However, the higher number of evaluated parameters makes more difficult the specialist's diagnose-making process. PURPOSE: To provide medical specialists, a new diagnostic-graphic tool, Estimated Vestibulogram- EVEST, enabling a quick and easy-to-read visualization and comparison of the VOR test results within the L-SCC. METHODS: The development of EVEST involved 148 participants, including 49 healthy volunteers (28 female and 21 male) and 99 (58 female and 41 male) patients affected by different degrees of peripheral vestibular deficit. The corresponding L-SCC VOR test results, from patients meeting the diagnostic criteria, were used to create the EVEST. RESULTS: Based on the test results, we depicted and calculated the EVEST vestibular function asymmetry (VFA) in all the groups. To assess a feasibility of EVEST to describe a vestibular function deficit, we calculated sensitivity and specificity of VFA using a receiver operating characteristic curve (ROC) and compared it to single tests. In all the tests, we determined the cutoff value as the point with the highest sensitivity and specificity. For discrimination of any vestibular deficit, the VFA with cutoff 6.5% was more sensitive (91%) and specific (98%) than single tests. Results showed that EVEST is a beneficial graphic tool for quick multifrequency comparison and diagnosis of different types of the peripheral vestibular loss. CONCLUSIONS: EVEST can help to easily evaluate various types of peripheral vestibular lesion.

Assessment of sleep quality in fibromyalgia syndrome and its effect on postural balance and functional status.

BACKGROUND: Patients with fibromyalgia syndrome (FMS) often have sleep problems and balance disorders. OBJECTIVE: The aim of the study was to examine sleep quality and balance disorders and the relationship between sleep quality and balance, functional status and the frequency of falls in patients with FMS. METHODS: Fifty women with FMS and 50 healthy women were included in the study. Sleep quality was assessed with the numeric rating scale (NRS) and the Pittsburgh Sleep Quality Index (PSQI) and balance and balance self-confidence were assessed with the Berg Balance Scale (BBS) and Activities-Specific Balance Confidence (ABC) Scale, respectively. Functional status and symptom severity of patients were assessed with the Fibromyalgia Impact Questionnaire (FIQ) and the Symptom Impact Questionnaire (SIQR). The number of falls in the last six months were recorded. RESULTS: In the patient group, sleep quality scores were significantly higher, and BBS and ABC scores were significantly lower than the control group. NRS scores were significantly correlated with the BBS, FIQ, and SIQR scores, and the PSQI scores were significantly correlated with the BBS and ABC scores and the number of falls in FMS. CONCLUSION: This study showed that the prevalence of sleep and balance disorders is higher in FMS patients. A relationship was reported between the sleep quality and balance and functional status and frequency of falls.

The feasibility, validity and reliability of a child friendly vestibular assessment in infants and children candidates to cochlear implant.

OBJECTIVES: The pediatric vestibular assessment has developed significantly in the past two decades, especially in terms of assessment of cochlear implant (CI) candidates. Different methods and test protocols have been applied, however without a general consensus. We present here the feasibility, validity and reliability of a child friendly vestibular testing in use at our department for the assessment of pediatric CI candidates. METHODS: The test battery consisted of head impulse test (HIT), video head impulse test (vHIT), cervical evoked myogenic potentials (cVEMP) and mini ice water caloric test (mIWC), all adapted from previous methods, mentioned in literature. We defined specific criteria for test feasibility, for test validity and test positivity (i.e. indicating vestibular insufficiency). The reliability of the whole protocol was assessed with test agreement analysis. RESULTS: Complete data from 35 children, all CI candidates, age ranging 4-79 months (67% under 2 years) and recruited over two years, were obtained. All but one child could complete at least one test with valid responses bilaterally, with the best compliance for HIT (97,1%) and least for cVEMP (68,6%). Feasibility did not appear to be affected by age or hearing loss etiology. Among the valid responses there was a substantial test agreement between HIT and vHIT, moderate agreement between vHIT/HIT and mIWC and no apparent agreement between the canal tests and cVEMP. Simple clinical guidelines were introduced to solve the tests' disagreement and to improve the protocol reliability: a) a pathological response had to be confirmed in at least two different canal tests and in at least three cVEMP trials; b) a canal/otolith disagreement was interpreted as a partial vestibular loss to be opposed to a complete vestibular insufficiency. CONCLUSIONS: The search for vestibular insufficiency in infants and young children can be attained with an opportunely adapted vestibular assessment, such the test battery proposed here. That assessment resulted easy to conduct and to interpret in a representative sample of CI candidates in preschool age, the most of whom were younger than 2 years. This method appears to particularly suit the demands of a vestibular assessment in young children CI candidates.

Reliability and Concurrent Validity of Life Space Assessment in Individuals With Vestibular Disorders.

BACKGROUND AND PURPOSE: The Life Space Assessment (LSA) is a self-report measure that allows clinicians to determine how often someone moves around in his or her environment with or without assistance. Presently, there are no reliable and valid measures that capture all 3 aspects of mobility (ie, mobility frequency, distance, and assistance needed) for individuals with vestibular disorders. The purpose of this study was to describe life space and to determine the reliability and concurrent validity of the LSA as a tool to measure mobility and function in individuals with balance and vestibular disorders. METHODS: One hundred twenty-eight participants (mean age of 55 ± 16.7 years) experiencing dizziness or imbalance who were seeking the care of an otoneurologist were recruited. Participants completed the LSA, Dizziness Handicap Inventory (DHI), and the 12-Item Short Form Health Survey (SF-12). RESULTS: The mean LSA score of the sample was 75/120 ± 30. The LSA demonstrated excellent test-retest reliability (intraclass correlation coefficient = 0.91). The LSA was negatively correlated with the DHI total score (ρ = -0.326, P < 0.01), DHI physical subscore (ρ = -0.229, P = 0.02), DHI functional subscore (ρ = -0.406, P < 0.01), and DHI emotional subscore (ρ = -0.282, P < 0.01). The LSA was positively correlated with both the physical (ρ = 0.422, P < 0.01) and mental (ρ = 0.362, P < 0.01) composite scores of the SF-12. DISCUSSION AND CONCLUSIONS: Similar to the findings in community-dwelling older adults, the LSA demonstrated excellent test-retest and internal consistency in individuals with vestibular disorders. The LSA is a valid and reliable tool for measuring mobility and function in individuals with vestibular disorders.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A317).

Observational Gait Assessment Scales in Patients with Walking Disorders: Systematic Review.

OBJECTIVE: To compile and analyze the characteristics and methodological quality of observational gait assessment scales validated to date. METHODS: PubMed, Scopus, the Cochrane Library, Physiotherapy Evidence Database, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Dialnet, Spanish Medical Index, and Nursing, Physiotherapy, and Podiatry databases were searched up to August 2019. The main inclusion criteria were validated tools based on a conceptual framework developed to evaluate gait, validation design studies of observational scales in their entirety, and articles written in English or Spanish. Evaluators extracted descriptive information of the scales and the metric properties of the studies, which were further analyzed with Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) and COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN checklist). RESULTS: Eighteen articles based on 14 scales were included. The populations were neurological patients (72.22%), musculoskeletal disorders (11.11%), and other areas such as vestibular disorders (11.11%). The most addressed items were orthopedic aids (64.29%); phases of the gait cycle and kinematics of the leg and trunk (57.14% each one); and spatial and temporal parameters (50%). All studies analyzed criterion validity, and five included content or structural validity (27.78%). Fifteen articles considered reliability (83.33%). Regarding the seven-item scale QUADAS-2, five studies obtained six results on "low" risk of bias or "low" concerns regarding applicability. Nine articles obtained at least a "fair" result on COSMIN checklist. CONCLUSIONS: A necessary compilation of the observational gait assessment scales validated to date was conducted. Besides, their characteristics and methodological quality were analyzed. Most scales were applied in neurological signs. The most approached topics were orthopedic aids, phases of the gait cycle, and kinematics of the leg and trunk. The scale that demonstrated a higher methodological quality was Visual Gait Assessment Scale, followed by CHAGS, Salford Gait Tool, and Edinburgh Visual Gait Score.

Balance Assessment in Traumatic Brain Injury: A Comparison of the Sensory Organization and Limits of Stability Tests.

Balance problems are common after a traumatic brain injury (TBI). Symptoms of dizziness, unsteadiness, or imbalance have been most frequently attributed to sensory organization problems involving the use of visual, proprioceptive, and/or vestibular information for postural control. These problems can be assessed with the Sensory Organization Test (SOT). However, as head trauma can affect any brain region, areas responsible for voluntary control of movements involved in dynamic balance tasks, such as the motor cortex and its projections, could also be compromised, which would likely affect one's limits of stability. The Limits of Stability (LOS) balance test has received little attention in TBI. In the present study, we compared the prevalence of SOT versus LOS abnormalities in a cohort of 48 patients, the majority classified as having mild or moderate chronic TBI. Compared with a normative database provided by the balance testing manufacturer, a larger portion of our cohort presented abnormalities in the LOS test. Dizziness Handicap Inventory (DHI) results indicated mild disability, with the five activities most frequently endorsed as problematic being: looking up, performing quick head movements, performing ambitious such as sports or dancing activities, feeling frustrated, and performing strenuous house/yard work. Although regression analysis revealed that both tests significantly predicted subjective scores on the DHI, more LOS than SOT testing variables were important predictors of DHI results indicating disability. These results suggest that the LOS test is an informative tool that should be included in any objective balance evaluations that screen TBI patients with balance complaints.

Surgery-free video-oculography in mouse models: enabling quantitative and short-interval longitudinal assessment of vestibular function.

Vestibulo-ocular reflex (VOR) responding to acceleration stimuli is originated from the vestibular apparatuses and thus widely used as an in vivo indicator of the vestibular function. We have developed a vestibular function testing (VFT) system that allows to evaluate VOR response with improved efficiency. The previously required surgical procedure has been avoided by using a newly designed animal-immobility setup. The efficacy of our VFT system was demonstrated on the mice with vestibular abnormalities caused by either genetic mutations (Lhfpl5-/- or Cdh23-/-) or applied vestibulotoxicant (3,3'-iminodipropionitrile, IDPN). Daily longitudinal inspection of the VOR response in the IDPN-administered mice gives the first VOR-based daily-progression profile of the vestibular impairment. The capability of VOR in quantifying the severity of toxicant-induced vestibular deficits has been also demonstrated. The acquired VOR-measurement results were validated against the corresponding behavioral-test results. Further validation against immunofluorescence microscopy was applied to the VOR data obtained from the IDPN-administered mice. We conclude that the improved efficiency of our surgery-free VFT system, firstly, enables the characterization of VOR temporal dynamics and quantification of vestibular-impairment severity that may reveal useful information in toxicological and/or pharmaceutical studies; and, secondly, confers our system promising potential to serve as a high-throughput screener for identifying genes and drugs that affect vestibular function.

Assessment of vestibular function in elderly patients.

PURPOSE OF REVIEW: Individuals over the age of 60 are at an increased risk of falls, even if they do not have an isolated dysfunction of the vestibular system. The aim of this article is to review the various vestibular testing currently available and its usefulness in determining the presence of vestibular dysfunction in the elderly population. The primary vestibular tests to be reviewed include: balance function testing, vestibular evoked myogenic potentials (VEMPs), and video head impulse testing (vHIT). RECENT FINDINGS: Balance function testing is important as it evaluates the integration of vestibular information along with sensory and visual information, which may also be impaired. VEMP testing provides a small diagnostic yield as most elderly patients have absent or reduced responses. vHIT gain is reduced in this population, but will still be within the normal range for individuals with normal balance function. SUMMARY: The combination of various vestibular tests provides complimentary information instead of redundant information on the patient's balance function. Each test evaluates various aspects of the vestibular system which are all needed to determine stable balance in the elderly population.

Japanese standard for clinical stabilometry assessment: Current status and future directions.

Stabilometry is a useful tool for examining patients with functional disorders of the vestibular system. However, measurement techniques and devices vary by country. Therefore, international standardization of stabilometry is mandatory to validate the exchange of important findings. This was advocated at the 1983 Posturography Meeting in Kyoto but has not been adopted worldwide, and each country has continued to use unique regional measurement methods. In Japan, stabilometry has widespread application in medical practice in conjunction with research into its applications. With a goal of international standardization, we present details of stabilometry measurement methods and their application in Japan, together with a brief history and potential future directions of stabilometry.

Vestibular migraine screening in a migraine-diagnosed patient population, and assessment of vestibulocochlear function.

OBJECTIVE: The primary aim of this study is to do a vestibular migraine scan in a population of patients with migraine diagnosis using the most recent standardized diagnosis criterion which is International Classification of Headache Disorders (ICHD) 3 Beta and to identify the epidemiological data. The second part of the study involves performing several vestibulocochlear tests on patients who received vestibular migraine (VM) diagnosis to collect data that may be important for diagnostic purposes by comparing the patients with normal population when necessary. DESIGN: Blind, cross-sectional study. SETTING: Tertiary referral hospital. PARTICIPANTS: One hundred patients were scanned for VM using ICHD 3 Beta guideline. MAIN OUTCOME MEASURES: In order to evaluate the vestibulocochlear functions of the patients with VM diagnosis, audiometry, tympanometry, electrocochleography (EcochG), computerized dynamic posturography (CDP) and video head impulse test (vHIT) were performed; besides in order to evaluate the significance of the results of the tests, second group was formed with migraine patients without any vestibular complaints and control group was formed from healthy population when needed. RESULTS: VM prevalence was determined to be 21% in migraine patients which is much higher than stated in current literature. No significant difference was observed between migraine and VM patients with respect to audiometric and tympanometric measurements. According to the CDP results, balance defects were present in VM patients, even during attack-free periods. EcochG data suggests average SP/AP scores of VM patients are significantly higher than migraine patients. Furthermore, the number of patients who exceeded a limit value of 0.4 or 0.5 in SP/AP scores was significantly higher in VM patients than in migraine patients. Also vHIT results show that nearly half the VM patients, which is a significant ratio, have saccadic movements and this is thought to be compatible with peripheral vestibular involvement. CONCLUSION: Our results suggest VM disease is more common than previously thought. We believe that further EcochG-based studies would shed light on the controversial topic on the intersection and disjunction sets of MD and VM diseases. Although the results of the present study are compatible with peripheral vestibular effects, it is not possible to rule out another central mechanism at some other level.

The Activities-specific Balance Confidence scale: reliability and validity in Spanish patients with vestibular disorders.

PURPOSE: To examine the reliability and validity of the Spanish version of the Activities-specific Balance Confidence scale (ABC-S), and its ability to discriminate between patients with and without a history of falls among a Spanish population with vestibular disorders. METHOD: A total of 84 participants completed the ABC-S. Internal consistency, test-retest reliability and construct validity (exploratory factor analysis) were analysed. Concurrent validity was evaluated using the 12-item Short Form Health Survey (SF-12) and the Dizziness Handicap Inventory (DHI). To determine the accuracy of the ABC total score in discriminating patients with and without a history of falls, a receiver operating characteristic (ROC) curve analysis was performed. RESULTS: The ABC-S showed excellent internal consistency (Cronbach's α = 0.916) and substantial test-retest reliability (ICC = 0.86, 95% CI: 0.74-0.93), with standard error and minimal detectable change values of 8.64 and 16.94, respectively. Factor analyses suggested a three-factor structure (explained variance was 62.24%). The ABC total score significantly correlated with the physical component summary score of the SF-12 and with the DHI-P, DHI-E, DHI-F and DHI total scores (p < 0.001). The ABC-S was significantly able to discriminate between participants with and without a history of falls (p < 0.006). CONCLUSIONS: The ABC-S is a valid and reliable instrument, suitable to assess balance confidence in Spanish patients with vestibular disorders. Implications for Rehabilitation The Spanish version of the ABC scale is a valid and reliable measure of balance confidence in patients with vestibular disorders. In persons with vestibular disorders, the Spanish version of the ABC scale has shown the ability to discriminate between patients with and without a history of falls in the last year.

[The application of subjective visual gravity in assessment of vestibular compensation: a pilot study].

OBJECTIVE: To discuss the characteristics of subjective visual gravity (subjective visual vertical/horizontal, SVV/SVH) and assess its clinical application for peripheral unilateral vestibular compensation. METHODS: 69 cases of acute peripheral unilateral vestibular dysfunction patients (case group) accepted SVV/SVH, spontaneous nystagmus (SN), caloric test (CT) and other vestibular function tests. 49 healthy people (control group) accepted SVV/SVH only. SVV/SVH, SN and unilateral weakness (UW) were selected as for the observation indicators. The correlations between SVV/SVH, SN, UW and courses were investigated respectively, as well as the characteristic of SVV/SVH, SN in period of vestibular compensation. RESULTS: Among case group SVV, SVH positive in 42 patients(60.9%) and 44 patients(63.8%), the absolute values of the skew angle were in the range between 2.1°-20.0°, 2.1°-22.2°. Skew angles of SVV/SVH in control were in the range between -1.5°-2.0° and -2.0°-1.6°, and had no statistical significance with case group(t=5.336 and 5.864, P<0.05). SN-positive 28 cases (40.6%), the range of intensities at 2.4°-17.1°; UW-positive 50 cases (72.5%). In case group, positive correlation between SVV and SVH(r=0.948, P=0.00), negatively correlated between SVV/SVH and SN respectively(r values were -0.720, -0.733, P values were 0.00), no correlation between the skew angle of SVV/SVH, strength of SN and UW value(r values were 0.191, 0.189, and 0.179, P>0.05), there was no correlation between the absolute value of SVV, SVH, SN, UW with the duration (rs values were -0.075, -0.065, -0.212, and 0.126, P>0.05). CONCLUSION: Subjective visual gravity can be used not only to assess the range of unilateral peripheral vestibular dysfunction, but also help assess the static compensatory of otolithic, guidance and assessment of vestibular rehabilitation.

Assessment of D-methionine protecting cisplatin-induced otolith toxicity by vestibular-evoked myogenic potential tests, ATPase activities and oxidative state in guinea pigs.

To date, inadequate study has been devoted to the toxic vestibular effects caused by cisplatin. In addition, no electrophysiological examination has been conducted to assess cisplatin-induced otolith toxicity. The purposes of this study are thus two-fold: 1) to determine whether cervical vestibular-evoked myogenic potentials (VEMPs) and ocular VEMPs are practical electrophysiological methods of testing for cisplatin-induced otolith toxicity and 2) to examine if D-methionine (D-met) pre-injection would protect the otolith organs against cisplatin-induced changes in enzyme activities and/or oxidative status. Guinea pigs were intraperitoneally treated once daily with the following injections for seven consecutive days: sterile 0.9% saline control, cisplatin (5 mg/kg) only, D-met (300 mg/kg) only, or a combination of d-met (300 mg/kg) and cisplatin (5 mg/kg), respectively, with a 30 minute window in between. Each animal underwent the oVEMP and cVEMP tests before and after treatment. The changes in the biochemistry of the otolith organs, including membranous Na(+), K(+)-ATPase and Ca(2+)-ATPase, lipid peroxidation (LPO) levels and nitric oxide (NO) levels, were also evaluated. In the cisplatin-only treated guinea pigs, the mean amplitudes of the oVEMP tests were significantly (p<0.05) decreased when compared to the other three groups. In guinea pigs receiving both D-met and cisplatin, the amplitudes of their oVEMP tests were significantly larger (p<0.05) than those of the cisplatin-only group, but smaller (p<0.05) than those of the saline control or D-met-only group. However, no significant difference of the amplitudes of cVEMP tests was noted among the four groups. In comparison with the other three groups, the cisplatin-only group had the lowest (ps<0.05) mean Na(+), K(+)-ATPase and Ca(2+)-ATPase, and the highest (ps<0.05) LPO and NO levels. The oVEMP tests were feasible for the evaluation of cisplatin-related otolith dysfunction. D-Met attenuated the reduced ATPase activities and increased oxidative stress induced by cisplatin toxicity in the otolith organs.

Assessment of the Clinical Utility of Cervical and Ocular Vestibular Evoked Myogenic Potential Testing in Elderly Patients.

OBJECTIVES: To assess whether patient age or sex was predictive of a bilaterally absent cervical or ocular vestibular evoked myogenic potential (cVEMP or oVEMP). STUDY DESIGN: Retrospective case review. SETTING: Tertiary center. PATIENTS: Patients presenting with normal vestibular tests (i.e. normal caloric and rotational chair) who underwent cVEMP and/or oVEMP testing. Patients with conductive hearing loss were excluded as were those with unilaterally abnormal VEMP results because they presented with evidence of a possible unilateral vestibular impairment. A total of 895 patients met criteria for cVEMPs and 297 for oVEMPs. MAIN OUTCOME MEASURES: The presence or absence of cVEMP and oVEMP responses elicited with a 500-Hz 125-dB pSPL air conduction stimulus. RESULTS: A logistic regression was performed including odd ratios and confidence intervals. Compared with adults in their 20s, the odds of bilaterally absent cVEMP responses are 6 times greater for patients in their 50s and 60s and over 22 times greater for patients in their 70s and 80s. A bilaterally absent oVEMP response is 6 times more likely for patients in their 40s, 50s, and 60 and 13 times greater for patients in their 70s. CONCLUSIONS: VEMPs in response to air conduction stimuli are bilaterally absent in a large percentage of older patients complaining of dizziness who otherwise have normal vestibular and auditory testing for their age. In combination with other abnormal vestibular findings, an absence of VEMP responses may be of value. However, the functional consequence of an isolated bilaterally absent VEMP is not known and may provide minimal information to an older patient's diagnostic picture. In cases where the response is bilaterally absent, a more intense AC stimulus should be used or bone conducted vibration should be considered.

Evidence for the validity of the modified dynamic gait index across diagnostic groups.

BACKGROUND: The modified Dynamic Gait Index (mDGI) measures the capacity to adapt gait to complex tasks utilizing 8 tasks and 3 facets of performance. The measurement stability of the mDGI in specific diagnostic groups is unknown. OBJECTIVE: This study examined the psychometric properties of the mDGI in 5 diagnostic groups. DESIGN: This was a cross-sectional, descriptive study. METHODS: A total of 794 participants were included in the study: 140 controls, 239 with stroke, 140 with vestibular dysfunction, 100 with traumatic brain injury, 91 with gait abnormality, and 84 with Parkinson disease. Differential item functioning analysis was used to examine the comparability of scores across diagnoses. Internal consistency was computed using Cronbach alpha. Factor analysis was used to examine the factor loadings for the 3 performance facet scores. Minimal detectable change at the 95% confidence level (MDC95%) was calculated for each of the groups. RESULTS: Less than 5% of comparisons demonstrated moderate to large differential item functioning, suggesting that item scores had the same order of difficulty for individuals in all 5 diagnostic groups. For all 5 patient groups, 3 factors had eigenvalues >1.0 and explained 80% of the variability in scores, supporting the importance of characterizing mobility performance with respect to time, level of assistance, and gait pattern. LIMITATIONS: There were uneven sample sizes in the 6 groups. CONCLUSIONS: The strength of the psychometric properties of the mDGI across the 5 diagnostic groups further supports the validity and usefulness of scores for clinical and research purposes. In addition, the meaning of a score from the mDGI, regardless of whether at the task, performance facet, or total score level, was comparable across the 5 diagnostic groups, suggesting that the mDGI measured mobility function independent of medical diagnosis.

Assessment of oculomotor control and balance post-concussion: a preliminary study for a novel approach to concussion management.

PRIMARY OBJECTIVE: Balance disturbances occur in ∼30% of concussion injuries, with vestibular dysfunction reported as the main contributor. However, few have studied oculomotor control post-concussion to assess vestibular dysfunction. RESEARCH DESIGN: The current research measured the differences in oculomotor control between athletes post-concussion (PC) and athletes without concussion (NC) during an active balance control task. METHODS: Nine PC and nine NC athletes wore a monocular eye tracking device, while balance tests were performed using the Nintendo WiiFit® soccer heading game. Average game scores, eye deviations from centre (Gaze Deviations) and gaze fixation (Percentage Time on Centre) were measured. RESULTS: PC made significantly greater Gaze Deviations from centre compared to NC (p < 0.001), however Percentage Time on Centre and game scores were not significantly different between groups. Correlations between gaze and balance within groups revealed a significant positive correlation in NC, while a significant negative correlation in PC. CONCLUSIONS: Results from this exploratory examination of oculomotor behaviour post-concussion revealed significant differences in gaze stability between athletes with a concussion and those without, suggesting vestibular involvement post-concussion. Assessment of oculomotor control during balance activities may provide further insight into dysfunction of the vestibular system following a concussion injury.

Hacia un nuevo VIII par: alternativas de baja complejidad / Towards a new vestibular assessment: low complexity alternatives

Introducción: El examen funcional del VIII par, mediante la prueba calórica permite conocer la función del canal semicircular horizontal, dejando de lado la evaluación de otras estructuras como el complejo utrículo-sacular. Objetivo: Evaluar el rendimiento diagnóstico de pruebas vestibulares de bajo costo y complejidad cefálico para suplir esta falencia. Material y método: En 34 pacientes con indicación de estudio funcional de VIII par se realizaron, además de las pruebas tradicionales, el test visual subjetivo vertical mediante prueba del balde, la prueba de impulso cefálico a ojo desnudo, y la aplicación del cuestionario de sintomatología "Dizziness Handicap Inventory". Resultados: Considerando el VIII par clásico como patrón de oro, se encuentra evidencia objetiva de patología en 50% de la muestra. Con la incorporación de los nuevos exámenes esta cifra aumenta a 85%. Se realizó análisis de discrepancia sobre pacientes con resultados normales en el estudio tradicional, pero anormal según los nuevos exámenes. El 100% de dicho grupo presenta una puntuación patológica en el cuestionario de síntomas. Más aún, los valores de desviación de verticalidad correlacionaron fuertemente con la puntuación de sintomatología (r =0,79; p =0,002). Conclusiones: El análisis de discrepancia sugiere que los nuevos exámenes son confiables en identificar patología en el estudio. Incluir en el estudio tradicional del VIII par pruebas de baja complejidad y corta duración (menos de 5 minutos en su conjunto) podría aumentar el rendimiento diagnóstico del estudio del equilibrio en hasta 35%.

Introduction: Traditionally, the assessment of vestibular function is based on the caloric test. This procedure assesses mainly the horizontal semicircular canal function, leaving other vestibular structures aside, such as the utricule-saccule complex. Aim: To assess the diagnostic performance low complexity tests to compensate for these issues. Material and methods: 34 patients with indication for vestibular assessment were recruited. In addition to traditional testing (caloric test and postural provocation maneuvers), the mentioned Subjective Visual Vertical and Head Impulse tests were applied alongside the Dizziness Handicap Inventory for vestibular symptoms. Results: Considering caloric testing and Dix-Hallpike maneuvers as gold standard, 50% of the sample presented an objective cause of their symptomatology. When including the new test, this value increases to 85%. A discrepancy analysis was conducted on the group with normal traditional tests and abnormal new tests. 100% of this group showed symptoms score above pathological levels. Furthermore, there was a strong relationship between deviation on the Visual Vertical test and symptomatology (r =0,79; p =0,002). Conclusion: The discrepancy analysis suggests that the new tests are reliable in determining pathology on this study. It these test are included to traditional testing, diagnostic performance may increase up to 35%.