Individual Patient Data Meta-Analysis Estimates the Minimal Detectable Change of the Geriatric Depression Scale-15.

OBJECTIVE: To use individual participant data meta-analysis (IPDMA) to estimate the minimal detectable change (MDC) of the Geriatric Depression Scale-15 (GDS-15) and to examine whether MDC may differ based on participant characteristics and study-level variables. STUDY DESIGN AND SETTING: This was a secondary analysis of data from an IPDMA on the depression screening accuracy of the GDS. Datasets from studies published in any language were eligible for the present study if they included GDS-15 scores for participants aged 60 or older. MDC of the GDS-15 was estimated via random-effects meta-analysis using 2.77 (MDC95) and 1.41 (MDC67) standard errors of measurement (SEM). Subgroup analyses were used to evaluate differences in MDC by participant age and sex. Meta-regression was conducted to assess for differences based on study-level variables, including mean age, proportion male, proportion with major depression, and recruitment setting. RESULTS: 5,876 participants (mean age 76 years, 40% male, 11% with major depression) from 21 studies were included. The MDC95 was 3.81 points (95% confidence interval [CI] 3.59, 4.04), and MDC67 was 1.95 (95% CI 1.83, 2.03). The difference in MDC95 was 0.26 points (95% CI 0.04, 0.48) between ≥ 80-year-olds and < 80-year-olds; MDC95 was similar for females and males (0.05, 95% CI -0.12, 0.22). The MDC95 increased by 0.29 points (95% CI 0.17, 0.41) per 10% increase in proportion of participants with major depression; mean age had a small association (0.04 points, 95% CI 0.00 to 0.09) with MDC95, but sex and recruitment setting were not significantly associated. CONCLUSIONS: The MDC95 was 3.81 points and MDC67 was 1.95 points. MDC95 increased with the proportion of participants with major depression. Results can be used to evaluate individual changes in depression symptoms and as a threshold for assessing minimal clinical important difference estimates.

Portable technology for postural control measurement: Comparing head position with center of pressure data.

BACKGROUND: Standing is a basic human function that healthy adults take for granted, yet it is a complex perceptual-motor process that requires sensation of position and motion from the sensory systems. OBJECTIVE: We assessed agreement between center of pressure data from a laboratory force-platform and head position data from an HTC Vive head-mounted display (HMD) for the evaluation of standing postural control. We investigated the impact of different statistical choices when assessing the relationship between two measurements. Specifically: 1) How does correlation and agreement statistics relate before and after logarithmic transformation? 2) Is there systemic or proportional bias between the force-platform and HMD measurements? METHODS: We tested 37 adults (26 controls, 11 with unilateral vestibular hypofunction) standing on foam, observing a static or dynamic visual scene projected from the HMD. We quantified anterior-posterior and medio-lateral sway via Directional Path, Root Mean Square Velocity, Variance, and Power Spectral Density (PSD) from a force-platform and the HMD. RESULTS: Intra-class correlations (ICCs) were moderate-to-good for the non-transformed data and good-to-excellent after logarithmic transformation for all outcomes except for PSD above 1 Hz. Correlations were higher than ICCs. Bland-Altman plots indicated proportional bias but not after logarithmic transformation. CONCLUSIONS: Both devices correlated linearly, and measure people's postural responses but cannot be used interchangeably, mostly because they appear to diverge with larger sway as evident on Bland-Altman plots of non-transformed data. Agreement between devices was excellent for low frequency movement but poor for high frequency small corrective movements.

Comparison of Patient Health Questionnaire-9, Edinburgh Postnatal Depression Scale and Hospital Anxiety and Depression - Depression subscale scores by administration mode: An individual participant data differential item functioning meta-analysis.

Administration mode of patient-reported outcome measures (PROMs) may influence responses. We assessed if Patient Health Questionnaire-9 (PHQ-9), Edinburgh Postnatal Depression Scale (EPDS) and Hospital Anxiety and Depression Scale - Depression subscale (HADS-D) item responses and scores were associated with administration mode. We compared (1) self-administration versus interview-administration; within self-administration (2) research or medical setting versus private; and (3) pen-and-paper versus electronic; and within interview-administration (4) in-person versus phone. We analysed individual participant data meta-analysis datasets with item-level data for the PHQ-9 (N = 34,529), EPDS (N = 16,813), and HADS-D (N = 16,768). We used multiple indicator multiple cause models to assess differential item functioning (DIF) by administration mode. We found statistically significant DIF for most items on all measures due to large samples, but influence on total scores was negligible. In 10 comparisons conducted across the PHQ-9, EPDS, and HADS-D, Pearson's correlations and intraclass correlation coefficients between latent depression symptom scores from models that did or did not account for DIF were between 0.995 and 1.000. Total PHQ-9, EPDS, and HADS-D scores did not differ materially across administration modes. Researcher and clinicians who evaluate depression symptoms with these questionnaires can select administration methods based on patient preferences, feasibility, or cost.

A Picture May Be Worth 1,000 Words, but Is It Worth a Letter? Examining Whether the Choice of Label Affects the Perception of Speech Sounds.

PURPOSE: Researchers often use identification or goodness rating tasks to assess speech perception for different populations. These tasks provide useful information about a listener's willingness to accept a range of acoustically variable stimuli as belonging to the same category and also about assessing how stimuli that are labeled the same may not be perceived as equally good versions of a particular speech sound. Many methodological aspects of these simple tasks have been tested, but one aspect that has not is the choice of label. In this study, we examine response patterns to images versus letters, as studies with different populations (children vs. adults) or different methods (typical behavioral study vs. visual world paradigm) may vary in the type of label used. METHOD: Eighty-one adult listeners completed phoneme identification and goodness ratings tasks with either images of response options (a picture of a bear and a picture of a pear) or with letter labels (a capital B and P). RESULTS: The results suggest that choice of label does not alter performance within the tasks studied here. In addition, the results did show the expected finding that the slope of the response curve is steeper in an identification task than in a goodness rating task. CONCLUSION: These results suggest that it is possible to compare across studies that use different response options, a benefit to research and practice because letter labels can be used for nonimageable words and nonwords, whereas images may be best used for participants who are younger or have poorer reading skills.

The association of resilience and positive mental health in systemic sclerosis: A Scleroderma Patient-centered Intervention Network (SPIN) cohort cross-sectional study.

OBJECTIVE: A previous study using Scleroderma Patient-centered Intervention Network (SPIN) Cohort data identified five classes of people with systemic sclerosis (also known as scleroderma) based on patient-reported somatic (fatigue, pain, sleep) and mental health (anxiety, depression) symptoms and compared indicators of disease severity between classes. Across four classes ("low", "normal", "high", "very high"), there were progressively worse somatic and mental health outcomes and greater disease severity. The fifth ("high/low") class, however, was characterized by high disease severity, fatigue, pain, and sleep but low mental health symptoms. We evaluated resilience across classes and compared resilience between classes. METHODS: Cross-sectional study. SPIN Cohort participants completed the 10-item Connor-Davidson-Resilience Scale (CD-RISC) and PROMIS v2.0 domains between August 2022 and January 2023. We used latent profile modeling to identify five classes as in the previous study and multiple linear regression to compare resilience levels across classes, controlling for sociodemographic and disease variables. RESULTS: Mean CD-RISC score (N = 1054 participants) was 27.7 (standard deviation = 7.3). Resilience decreased progressively across "low" to "normal" to "high" to "very high" classes (mean 4.7 points per step). Based on multiple regression, the "high/low" class exhibited higher resilience scores than the "high" class (6.0 points, 95% confidence interval [CI] 4.9 to 7.1 points; standardized mean difference = 0.83, 95% CI 0.67 to 0.98). CONCLUSIONS: People with worse disease severity and patient-reported outcomes reported substantially lower resilience, except a class of people with high disease severity, fatigue, pain, and sleep disturbance but positive mental health and high resilience.

Type of auditory cues and apparatus influence how healthy young adults integrate sounds for dynamic balance.

It is unclear whether the brain handles auditory cues similarly to visual cues for balance. We investigated the influence of headphones and loudspeaker reproduction of sounds on dynamic balance performance when an individual is facing a cognitive challenge. Twenty participants (16 females, aged 19-36) were asked to avoid a ball according to a specific visual rule. Visuals were projected from the HTC Vive head-mounted display in an acoustically controlled space. We varied the environment by adding congruent sounds (sounds coincide with the visual rule) or incongruent sounds (sounds may or may not coincide with the visual rule) as well as creating a multimodal (visual and congruent sounds) vs. unimodal (visual or congruent sounds only) display of stimuli. Sounds were played over headphones or loudspeakers. We quantified reaction time (RT) and accuracy (choosing the correct direction to move) by capturing the head movement. We found that in the absence of sounds, RT was slower with headphones compared to loudspeakers, but the introduction of either congruent or incongruent sounds resulted in faster movements with headphones such that RT was no longer different between apparatus. Participants used congruent sounds to improve accuracy but disregarded incongruent sounds. This suggests that selective attention may explain how sounds are incorporated into dynamic balance performance in healthy young adults. Participants leveraged sounds played over loudspeakers, but not over headphones, to enhance accuracy in a unimodal dark environment. This may be explained by the natural listening conditions created by loudspeakers where sounds may be perceived as externalized.

Incidence, Complications, and Long-term Outcomes of Gender-affirming Phalloplasty: Analysis of a Large Statewide Population-based Dataset.

OBJECTIVE: To evaluate the incidence of gender-affirming phalloplasty and postoperative complications in a large population-based dataset. METHODS: Retrospective cohort study was done using the California Department of Health Care Access and Information datasets which include patient-level data from all licensed hospitals, emergency departments, and ambulatory surgery facilities in California. Adult patients 18 years or older undergoing gender-affirming phalloplasty in California from January 1, 2009 to December 31, 2019 were included. We examined phalloplasty-related complications using International Classification of Disease diagnosis and procedure codes and Current Procedural Terminology codes. Unique record linkage number identifiers were used to follow patients longitudinally. Statistical analysis included Kaplan-Meier survival analysis and Cox proportional hazards analysis. RESULTS: We identified 766 patients who underwent gender-affirming phalloplasty in 23 facilities. Of 475 patients with record linkage numbers, 253 (55.3%) had subsequent re-presentations to the inpatient, emergency department, and ambulatory surgery settings related to phalloplasty complications. Survival analysis indicated that 50% of patients re-presented by 1year post-phalloplasty. Asian/Pacific Islander patients had lower risk of complications, and California residents had higher risk of complications. CONCLUSION: This population-based study confirms that gender-affirming phalloplasty has a high complication rate, and demonstrates for the first time an association with high rates of return to hospitals, emergency departments, and ambulatory surgery centers. These findings provide additional higher-level evidence that may aid patient counseling, shared surgical decision-making, and institutional and government policy.

Examining the Relationship Between Multiple Tests of Receptive Vocabulary.

PURPOSE: Numerous tasks have been developed to measure receptive vocabulary, many of which were designed to be administered in person with a trained researcher or clinician. The purpose of the current study is to compare a common, in-person test of vocabulary with other vocabulary assessments that can be self-administered. METHOD: Fifty-three participants completed the Peabody Picture Vocabulary Test (PPVT) via online video call to mimic in-person administration, as well as four additional fully automated, self-administered measures of receptive vocabulary. Participants also completed three control tasks that do not measure receptive vocabulary. RESULTS: Pearson correlations indicated moderate correlations among most of the receptive vocabulary measures (approximately r = .50-.70). As expected, the control tasks revealed only weak correlations to the vocabulary measures. However, subsets of items of the four self-administered measures of receptive vocabulary achieved high correlations with the PPVT (r > .80). These subsets were found through a repeated resampling approach. CONCLUSIONS: Measures of receptive vocabulary differ in which items are included and in the assessment task (e.g., lexical decision, picture matching, synonym matching). The results of the current study suggest that several self-administered tasks are able to achieve high correlations with the PPVT when a subset of items are scored, rather than the full set of items. These data provide evidence that subsets of items on one behavioral assessment can more highly correlate to another measure. In practical terms, these data demonstrate that self-administered, automated measures of receptive vocabulary can be used as reasonable substitutes of at least one test (PPVT) that requires human interaction. That several of the fully automated measures resulted in high correlations with the PPVT suggests that different tasks could be selected depending on the needs of the researcher. It is important to note the aim was not to establish clinical relevance of these measures, but establish whether researchers could use an experimental task of receptive vocabulary that probes a similar construct to what is captured by the PPVT, and use these measures of individual differences.

Measurement equivalence of the English and French versions of the self-efficacy to manage chronic disease scale: a Scleroderma Patient-Centered Intervention Network (SPIN) study.

PURPOSE: The Self-Efficacy to Manage Chronic Disease (SEMCD) scale is widely used, including in systemic sclerosis (SSc). The SEMCD has been validated in SSc, but the metric equivalence of the English and French versions has not been assessed (i.e., whether psychometric properties are equivalent across English and French). METHODS: Participants were adults from the Scleroderma Patient-Centered Intervention Network (SPIN) Cohort (N = 2159) who completed baseline measures in English (n = 1473) or French (n = 686) between May 2014 to July 2020. Analyses assessed internal consistency reliability via Cronbach's alpha and McDonald's omega, convergent validity via Pearson's correlations, structural validity via confirmatory factor analysis (CFA), and differential item functioning via the Multiple-Indicator Multiple-Cause (MIMIC) model. RESULTS: Internal consistency reliability was high in English (α = .93, ω = .93) and French (α = .92, ω = .93). All correlations between the SEMCD and measures of health outcomes were moderate to large, statistically significant, and in the hypothesized direction in both languages. The CFA demonstrated that the one-factor model of self-efficacy, overall, fit reasonably well (CFI = .96, TLI = .93, SRMR = .03, RMSEA = .14). Standardized factor loadings were large (.76 to .88). Three items displayed statistically significant uniform DIF and all six displayed nonuniform DIF; all DIF was of minimal magnitude. Comparison of unadjusted and DIF-adjusted models indicated that DIF did not meaningfully impact total score (ICC = 0.999, r = 0.999). CONCLUSION: Scores from English- and French-speaking adults with SSc can be combined for analysis or compared.

Weighting of visual and auditory inputs in dancers with and without previous ankle injury.

Elite dance requires highly controlled balance performance in dynamic visual and auditory environments characterized by the use of stage lighting and music. Perturbing visual input is known to influence balance in dancers, but the effects of sounds have not been clearly established. Ankle inversion injuries are common in dancers and may also play a role in dancers' ability to respond to sensory perturbations. The aims of this study were to identify changes in static balance in response to visual or auditory perturbation in elite collegiate dancers with and without a history of ankle injury, and to describe coupling of measurements obtained from the waist and head during balance. Thirty-seven dancers: 22 controls and 15 with a history of ankle sprain, performed single-leg balance under static and dynamic visual and auditory conditions. Dancers demonstrated increased waist sway when viewing a dynamic visual scene and when presented with moving sounds and increased head sway with dynamic visuals. These results did not vary by history of ankle sprain. While dancers appear to dampen the impact of waist sway on head motion during single leg stance, even highly trained dancers may experience challenges controlling balance under perturbing visual and auditory conditions like those present during stage performance.

Contextual sensory integration training vs. traditional vestibular rehabilitation: a pilot randomized controlled trial.

BACKGROUND: We created a clinical virtual reality application for vestibular rehabilitation. Our app targets contextual sensory integration (C.S.I.) where patients are immersed in safe, increasingly challenging environments while practicing various tasks (e.g., turning, walking). The purpose of this pilot study was to establish the feasibility of a randomized controlled trial comparing C.S.I. training to traditional vestibular rehabilitation. METHODS: Thirty patients with vestibular dysfunction completed the Dizziness Handicap Inventory (DHI), Activities-Specific Balance Confidence Scale (ABC), Visual Vertigo Analog Scale (VVAS), Functional Gait Assessment (FGA), Timed-Up-and-Go (TUG), and Four-Square Step Test (FSST). Following initial assessment, the patients were randomized into 8 weeks (once per week in clinic + home exercise program) of traditional vestibular rehabilitation or C.S.I. training. Six patients had to stop participation due to the covid-19 pandemic, 6 dropped out for other reasons (3 from each group). Ten patients in the traditional group and 8 in the C.S.I group completed the study. We applied an intention to treat analysis. RESULTS: Following intervention, we observed a significant main effect of time with no main effect of group or group by time interaction for the DHI (mean difference - 18.703, 95% CI [-28.235, -9.172], p = 0.0002), ABC (8.556, [0.938, 16.174], p = 0.028), VVAS, (-13.603, [-25.634, -1.573], p = 0.027) and the FGA (6.405, [4.474, 8.335], p < 0.0001). No changes were observed for TUG and FSST. CONCLUSION: Patients' symptoms and function improved following either vestibular rehabilitation method. C.S.I training appeared comparable but not superior to traditional rehabilitation. TRIAL REGISTRATION: This study (NCT04268745) was registered on clincaltrials.gov and can be found at https://clinicaltrials.gov/ct2/show/NCT04268745 .

Differential Item Functioning on the Cochin Hand Function Scale Among People With Systemic Sclerosis by Language, Sex, and Disease Subtype: A Scleroderma Patient-Centered Intervention Network (SPIN) Cohort Study.

OBJECTIVE: To evaluate the degree that the Cochin Hand Function Scale (CHFS) generates scores that are comparable across language, sex, and disease subtype. METHODS: We included participants enrolled in the Scleroderma Patient-centered Intervention Network (SPIN) Cohort who completed the CHFS at their baseline assessment between April 2014 and September 2020. Confirmatory factor analysis (CFA) was used to test unidimensionality, and multiple indicator multiple cause (MIMIC) models were used for differential item functioning (DIF) analysis based on language, sex, and disease subtype. Both intraclass correlation coefficient (ICC) and Pearson's correlation were calculated using factor scores obtained from unadjusted and DIF-adjusted MIMIC models to evaluate agreement and correlation between scores. RESULTS: A total of 2,155 participants were included. CFA with covarying error terms supported a good fit of the model (χ2 [127] = 1,754.671; P < 0.001; Tucker-Lewis index = 0.985; comparative fit index = 0.987; root mean square error of approximation = 0.077). Nine items displayed statistically significant DIF for language of administration, 10 items for sex, and 10 items for disease subtype. However, the overall impact of DIF was negligible when comparing factor scores that did and did not account for DIF (ICC = 0.999; r = 0.999). CONCLUSION: The CHFS has score comparability in systemic sclerosis regardless of participants' language, sex, and disease subtype.

Validity, Reliability, and Differential Item Functioning of English and French Versions of the 10-Item Connor-Davidson Resilience Scale in Systemic Sclerosis: A Scleroderma Patient-Centered Intervention Network Cohort Study.

OBJECTIVE: Some individuals with systemic sclerosis (SSc) report positive mental health, despite severe disease manifestations, which may be associated with resilience, but no resilience measure has been validated in SSc. This study was undertaken to assess the validity, reliability, and differential item functioning (DIF) between English- and French-language versions of the 10-item Connor-Davidson Resilience Scale (CD-RISC-10) in SSc. METHODS: Eligible participants were enrolled in the Scleroderma Patient-centered Intervention Network Cohort and completed the CD-RISC-10 between August 2022 and January 2023. We used confirmatory factor analysis (CFA) to evaluate the CD-RISC-10 factor structure and conducted DIF analysis across languages with Multiple Indicators Multiple Causes models. We tested convergent validity with another measure of resilience and measures of self-esteem and depression and anxiety symptoms. We assessed internal consistency and test-retest reliability using Cronbach's alpha and intraclass correlation coefficient (ICC). RESULTS: A total of 962 participants were included in this analysis. CFA supported a single-factor structure (Tucker-Lewis index = 0.99, comparative fit index = 0.99, root mean square error of approximation = 0.08 [90% confidence interval (90% CI) 0.07, 0.09]). We found no meaningful DIF. Internal consistency was high (α = 0.93 [95% CI 0.92, 0.94]), and we found that correlations with other measures of psychological functioning were moderate to large (|r| = 0.57-0.78) and confirmed study hypotheses. The scale showed good 1-2-week test-retest reliability (ICC 0.80 [95% CI 0.75, 0.85]) in a subsample of 230 participants. CONCLUSION: The CD-RISC-10 is a valid and reliable measure of resilience in SSc, with score comparability across English and French versions.

Decrease in head sway as a measure of sensory integration following vestibular rehabilitation: A randomized controlled trial.

OBJECTIVE: The purpose of this study was to determine the extent to which sensory integration strategies via head sway, derived from a Head-Mounted Display (HMD), change in people with vestibular disorders following vestibular rehabilitation. DESIGN: Randomized Controlled TrialSetting:Vestibular Rehabilitation ClinicParticipants:Thirty participants with vestibular dysfunction and 21 age-matched controls. MAIN OUTCOME MEASURES: Participants experienced two levels of visual surround (static or moving 'stars', front to back at 0.2 Hz, 32 mm) and white noise (none or rhythmic) while their head sway was recorded via the HTC Vive. We quantified head sway via Directional Path (DP) and Root Mean Square Velocity (RMSV) in 5 directions: anterior-posterior, medio-lateral, pitch, yaw, and roll and Power Spectral Density in low (PSD 1), medium (PSD 2) and high (PSD 3) frequencies in the anterior-posterior direction. INTERVENTIONS: Participants performed the assessment prior to being randomized into 8-weeks of contextual sensory integration training in virtual reality or traditional vestibular rehabilitation and once again following completion of the intervention. Controls performed the assessment once. Twelve participants dropped out, half due to covid lock-down. We applied an intention to treat analysis. RESULTS: We observed significant increases in AP DP, RMSV and all PSDs with change in visual level. Both intervention groups significantly decreased medio-lateral, pitch and roll DP and RMSV and anterior-posterior PSD 2 with no group differences. Vestibular participants were significantly higher than controls on all outcomes pre rehabilitation. Post rehabilitation they were only significantly higher on PSD 2. Sound was not a significant predictor of head sway in this protocol. CONCLUSIONS: Head sway decreased following vestibular rehabilitation regardless of visual load or type of intervention applied. This change was measured via head kinematics derived from a portable HMD which can serve as a sensitive in-clinic assessment for tracking improvement over time.

Differing postural control patterns in individuals with bilateral and unilateral hearing loss.

OBJECTIVES: Hearing loss (HL) is associated with imbalance and increased fall risk. The mechanism underlying this relationship and differences across types of hearing loss remains unclear. Head mounted displays (HMD) can shed light on postural control mechanisms via an analysis of head sway. PURPOSE: The purpose of this study was to evaluate head sway in response to sensory perturbations in individuals with bilateral (BHL) or unilateral hearing loss (UHL) and compare them to controls. MATERIALS AND METHODS: We recruited 36 controls, 23 individuals with UHL and 14 with BHL. An HMD (HTC Vive) measured head sway while participants stood on the floor, hips-width apart. Stimuli included two levels of visuals and sound. Root Mean Square Velocity (RMSV) and Power Spectral Density (PSD) were used to quantify head sway. RESULTS: Adjusting for age, individuals with BHL had significantly higher anterior-posterior and medio-lateral RMSV than controls and individuals with UHL. Individuals with UHL demonstrated significantly lower response to visual perturbations in RMSV AP and in all 3 frequency segments of PSD compared to controls. Individuals with UHL showed significantly lower movements at high frequencies compared to controls. Sounds or severity of HL did not impact head sway. CONCLUSIONS: Individuals with BHL demonstrated increased sway with visual perturbations and should be clinically assessed for balance performance and fall risk. Individuals with UHL exhibited reduced responses to visual stimuli compared with controls, which may reflect conscious movement processing. Additional studies are needed to further understand the mechanistic relationship between hearing loss and imbalance.

Insight into postural control in unilateral sensorineural hearing loss and vestibular hypofunction.

This pilot study aimed to identify postural strategies in response to sensory perturbations (visual, auditory, somatosensory) in adults with and without sensory loss. We tested people with unilateral peripheral vestibular hypofunction (N = 12, mean age 62 range 23-78), or with Unilateral Sensorineural Hearing Loss (USNHL, N = 9, 48, 22-82), or healthy controls (N = 21, 52, 28-80). Postural sway and head kinematics parameters (Directional Path in the anterior-posterior and medio-lateral directions (sway & head); pitch, yaw and roll (head) were analyzed in response to 2 levels of auditory (none, rhythmic sounds via headphones), visual (static, dynamic) and somatosensory cues (floor, foam) within a simulated, virtual 3-wall display of stars. We found no differences with the rhythmic auditory cues. The effect of foam was magnified in the vestibular group compared with controls for anterior-posterior and medio-lateral postural sway, and all head direction except for medio-lateral. The vestibular group had significantly larger anterior-posterior and medio-lateral postural sway and head movement on the static scene compared with controls. Differences in pitch, yaw and roll emerged between vestibular and controls only with sensory perturbations. The USNHL group did not increase their postural sway and head movement with the increased visual load as much as controls did, particularly when standing on the foam. They did not increase their medio-lateral sway with the foam as much as controls did. These findings suggest that individuals with USNHL employ a compensatory strategy of conscious control of balance, the functional implications of which need to be tested in future research.