Narcotic Nitrogen Effects Persist after a Simulated Deep Dive.

Background and Objectives: Scuba divers often experience persistent inert gas narcosis (IGN) even after surfacing. This study aimed to test the hypothesis that breathing oxygen (O2) before surfacing can reduce postdive IGN. Materials and Methods: A group of 58 experienced divers underwent a 5 min dive at a depth of 50 m in a multi-place hyperbaric chamber. They were decompressed using air (air group). Another group of 28 divers (O2 group) breathed 100% O2 during the end of decompression. Prior to and after the dive, all participants performed the Sharpened Romberg test (SRT) and a modified tweezers test. Results: In the air group, the number of positive SRT results increased postdive (47% vs. 67%), indicating a greater impairment in the vestibular system (Cohen's d = 0.41). In the O2 group, the percentage of positive SRT results remained constant at 68% both before and after the dive. In terms of the modified tweezers test, the air group showed no significant change in the number of picked beads (40 ± 9 vs. 39 ± 7), while the O2 group demonstrated an increase (36 ± 7 vs. 44 ± 10) (Cohen's d = 0.34). Conclusion: The results reveal that the SRT revealed a negative effect of nitrogen (N2) on the vestibular system in the air group. The increased number of beads picked in the O2 group can be attributed to the learning effect, which was hindered in the air group. Consistent with our hypothesis, breathing O2 during decompression appears to reduce postdive IGN.

Vestibular Sensory Conflict During Postural Control, Freezing of Gait, and Falls in Parkinson's Disease.

BACKGROUND: The vestibular system has been implicated in the pathophysiology of episodic motor impairments in Parkinson's disease (PD), but specific evidence remains lacking. OBJECTIVE: We investigated the relationship between the presence of freezing of gait and falls and postural failure during the performance on Romberg test condition 4 in patients with PD. METHODS: Modified Romberg sensory conflict test, fall, and freezing-of-gait assessments were performed in 92 patients with PD (70 males/22 females; mean age, 67.6 ± 7.4 years; Hoehn and Yahr stage, 2.4 ± 0.6; mean Montreal Cognitive Assessment, 26.4 ± 2.8). RESULTS: Failure during Romberg condition 4 was present in 33 patients (35.9%). Patients who failed the Romberg condition 4 were older and had more severe motor and cognitive impairments than those without. About 84.6% of all patients with freezing of gait had failure during Romberg condition 4, whereas 13.4% of patients with freezing of gait had normal performance (χ2  = 15.6; P < 0.0001). Multiple logistic regression analysis showed that the regressor effect of Romberg condition 4 test failure for the presence of freezing of gait (Wald χ2  = 5.0; P = 0.026) remained significant after accounting for the degree of severity of parkinsonian motor ratings (Wald χ2  = 6.2; P = 0.013), age (Wald χ2  = 0.3; P = 0.59), and cognition (Wald χ2  = 0.3; P = 0.75; total model: Wald χ2  = 16.1; P < 0.0001). Patients with PD who failed the Romberg condition 4 (45.5%) did not have a statistically significant difference in frequency of patients with falls compared with patients with PD without abnormal performance (30.5%; χ2  = 2.1; P = 0.15). CONCLUSIONS: The presence of deficient vestibular processing may have specific pathophysiological relevance for freezing of gait, but not falls, in PD. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Vestibular contributions to the Romberg test: Testing semicircular canal and otolith function.

Normal stance relies on three sensory inputs: vision, proprioception and vestibular function. The Romberg test, trying to stand with feet together and eyes closed, is familiar to every medical student as a test of distal proprioceptive impairment. It remains the best known of Romberg's many remarkable contributions to clinical neurology. In Romberg's time almost nothing was known about the function of the vestibular system. We now know that standing with the eyes closed on a compliant rather than a firm surface is more a test of vestibular than proprioceptive function. Peripheral vestibular function tests in clinical use today all rely on measurements of oligosynaptic brainstem reflexes. Short-latency eye rotations in response to rapid, brief head rotations (head impulses) give an accurate, robust and reproducible measure of the function of any and each of the six semicircular canals. Short-latency evoked potentials from sternomastoid and inferior oblique muscles in response to loud clicks or skull taps (vestibular evoked myogenic potentials) give an accurate and reproducible measure of the function of each and any of the four otolith organs. In the present paper, we briefly review what is now known about the anatomy and physiology of the peripheral receptors and brainstem pathways mediating these reflexes and examine how this knowledge can help interpret the Romberg test.

What is actually happening inside the "cone of economy": compensatory mechanisms during a dynamic balance test.

STUDY DESIGN: A nonrandomized, prospective, concurrent control cohort study. OBJECTIVE: To further develop cone of economy (CoE) measurements by identifying compensatory mechanisms at the extremes of the CoE and comparing balance control strategies in a group of adult degenerative scoliosis (ADS) patients with non-scoliotic controls. The CoE concept was first proposed by Dubousset and is frequently referred to when assessing balance in spinal deformity patients. Recently, a method that quantifies the CoE of individual patients through 3D video kinematic and electromyography data was developed. However, this method lacks measurements that describe the motor control strategies utilized by spinal disorder patients to maintain balance. PATIENT SAMPLE: Twenty ADS patients and 15 non-scoliotic controls. METHODS: All test subjects were fitted with a full body marker set. Each subject performed a series of functional balance tests (Romberg's with eyes opened) while being recorded in a human motion capture system. Three-dimensional CoE dimensions, range of sway (RoS), overall sway and lower extremity and trunk range of motion (RoM) were measured and analyzed. RESULTS: Patients with ADS demonstrated greater overall sway and RoS in the sagittal and coronal planes compared to controls. Moreover, ADS patients presented with more hip flexion and trunk flexion at maximal points of sway and more ankle, knee, hip and trunk RoM when swaying in comparison with controls. CONCLUSIONS: ADS patients have larger CoE dimensions and increased sway when compared to non-scoliotic controls. ADS patients rely on a hip balance control "strategy" and lower extremity RoM to maintain balance, which differed from control subjects. Unlike prior attempts to define compensatory mechanisms in ADS patients, the described technique utilizes dynamic, three-dimensional measurements to define what is occurring within the CoE. By expanding on prior CoE measurements, we were able to define a unique dynamic balance control strategy for each patient.

Quantification of Axial Abnormality Due to Cerebellar Ataxia with Inertial Measurements.

Cerebellar Ataxia (CA) leads to deficiencies in muscle movement and lack of coordination that is often manifested as gait and balance disabilities. Conventional CA clinical assessments are subjective, cumbersome and provide less insight into the functional capabilities of patients. This cross-sectional study investigates the use of wearable inertial sensors strategically positioned on the front-chest and upper-back locations during the Romberg and Trunk tests for objective assessment of human postural balance due to CA. The primary aim of this paper is to quantify the performance of postural stability of 34 patients diagnosed with CA and 22 healthy subjects as controls. Several forms of entropy descriptions were considered to uncover characteristics of movements intrinsic to CA. Indeed, correlation with clinical observation is vital in ascertaining the validity of the inertial measurements in addition to capturing unique features of movements not typically observed by the practicing clinician. Both of these aspects form an integral part of the underlying objective assessment scheme. Uncertainty in the velocity contained a significant level of information with respect to truncal instability and, based on an extensive clustering and discrimination analysis, fuzzy entropy was identified as an effective measure in characterising the underlying disability. Front-chest measurements demonstrated a strong correlation with clinical assessments while the upper-back measurements performed better in classifying the two cohorts, inferring that the standard clinical assessments are relatively influenced by the frontal observations. The Romberg test was confirmed to be an effective test of neurological diagnosis as well as a potential candidate for objective assessment resulting in a significant correlation with the clinical assessments. In contrast, the Trunk test is observed to be relatively less informative.

Inertial Measurement Unit-Based Romberg Test for Assessing Adults With Vestibular Hypofunction.

This work aims to explore the utility of wearable inertial measurement units (IMUs) for quantifying movement in Romberg tests and investigate the extent of movement in adults with vestibular hypofunction (VH). A cross-sectional study was conducted at an academic tertiary medical center between March 2021 and April 2022. Adults diagnosed with unilateral vestibular hypofunction (UVH) or bilateral vestibular hypofunction (BVH) were enrolled in the VH group. Healthy controls (HCs) were recruited from community or outpatient clinics. The IMU-based instrumented Romberg and tandem Romberg tests on the floor were applied to both groups. The primary outcomes were kinematic body metrics (maximum acceleration [ACC], mean ACC, root mean square [RMS] of ACC, and mean sway velocity [MV]) along the medio-lateral (ML), cranio-caudal (CC), and antero-posterior (AP) axes. A total of 31 VH participants (mean age, 33.48 [SD 7.68] years; 19 [61%] female) and 31 HCs (mean age, 30.65 [SD 5.89] years; 18 [58%] female) were recruited. During the eyes-closed portion of the Romberg test, VH participants demonstrated significantly higher maximum ACC and increased RMS of ACC in head movement, as well as higher maximum ACC in pelvic movement along the ML axis. In the same test condition, individuals with BVH exhibited notably higher maximum ACC and RMS of ACC along the ML axis in head and pelvic movements compared with HCs. Additionally, BVH participants exhibited markedly increased maximum ACC along the ML axis in head movement during the eyes-open portion of the tandem Romberg test. Conversely, no significant differences were found between UVH participants and HCs in the assessed parameters. The instrumented Romberg and tandem Romberg tests characterized the kinematic differences in head, pelvis, and ankle movement between VH and healthy adults. The findings suggest that these kinematic body metrics can be useful for screening BVH and can provide goals for vestibular rehabilitation.

Romberg's test revisited: Changes in classical and advanced sway metrics in patients with pure sensory neuropathy.

OBJECTIVES: The Romberg test, undoubtedly a classical and well-established method in physical neurological assessment of patients with sensory ataxia, has long been suspected to be prone to several limitations. Here, we quantified upright stance before and after visual deprivation in a selected cohort of patients with pure sensory neuropathy. METHODS: Static balance was assessed in sensory neuropathy patients during quiet stance on a force platform under different visual and proprioceptive feedback conditions. Sural nerve neurography was employed to evaluate the severity of peripheral neuropathy. Conventional and advanced postural sway metrics were investigated to draw a quantitative analogy to the clinical Romberg test. RESULTS: Posturographic analyses showed that patients displayed Romberg and vestibular Romberg quotient values around 2, indicating an approximately twofold increase in body sway in the absence of vision. However, the diagnostic discrimination ability between patients and controls was only modest. Even less impactful were the diagnostic contributions of frequency domain and non-linear sway analyses. This was primarily attributed to the heightened body sway exhibited by patients with sensory neuropathy under 'eyes open' conditions, diminishing the contrast with the 'eyes closed' condition as assessed in the classical Romberg test. CONCLUSION: We conclude that the Romberg test, even in its quantitative form with the aid of an apparatus, had an unsatisfactory classification value in terms of distinguishing patients from healthy controls. Instead, it should be interpreted within the comprehensive context of the broader neurological examination and the electrodiagnosis of peripheral nerve function.

Sarcopenia in older adults is associated with static postural control, fear of falling and fall risk: A study of Romberg test.

BACKGROUND: As a geriatric syndrome, sarcopenia may exacerbate static postural control and increase fall risk among older adults. The Romberg test, a simple method to assess static postural control, has the potential to predict fall, but has rarely been used to assess static postural control and fall risk in sarcopenic older adults. RESEARCH QUESTION: How does sarcopenia increase fall risk by affecting static postural control? METHODS: Forty-four older adults performed the Romberg test and were included for analyses. Romberg parameters, including Center of Pressure (CoP), Center of Mass (CoM) and Displacement Angle (DA), were collected under eyes-open/eyes-closed conditions. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 criteria. Fall risk was assessed using the Morse Elderly Fall Risk Assessment Scale (MFS), and fear of falling was evaluated using the Falls Efficacy Scale-International (FES-I). Multivariate linear regression models were conducted to examine the associations of sarcopenia with Romberg test parameters, fear of falling, and fall risk. RESULTS: Sarcopenic older adults had higher scores of both fear of falling and fall risk (P<0.001 and =0.006, respectively), and worse static postural control parameters (P values ranging from <0.001-0.043) than healthy controls, demonstrated by the multivariate linear regression models. Most of the Romberg test parameters were significantly associated with fear of falling score, especially under eyes-closed condition, and fear of falling was further associated with higher fall risk score (ß=0.90, P=0.001). Meanwhile, the presence of sarcopenia also significantly increased fall risk score (ß=10.0, P<0.001). SIGNIFICANCE: Sarcopenia may increase fall risk in older adults via worsen static postural control ability and increase fear of falling. Paying attention and making efforts to prevent sarcopenia may help to alleviate postural control dysfunction, decrease fear of falling, so as to reduce fall risk and prevent severe injuries caused by fall accidents.

Balance Problem in Individuals with Normal Hearing Across Age Groups - A Behavioural Study.

Purpose: This study was done to find the hidden balance problem in individuals across age groups using perceptual measure (Dizziness Index of Impairment in Activities of Daily Living Scale questionnaire, DII-ADL) and vestibulospinal-cerebellar function tests (Sharpened Romberg test, Fukuda stepping test, Tandem gait test, and Finger-to-nose test). Methods: A total of 150 individuals in three age groups, young adults (20-40 years), middle-aged adults (40-60 years), and older adults (> 60 years) were considered. All the individuals had normal hearing sensitivity with no reported perceptual balance issues. DII-ADL questionnaire, Sharpened Romberg test, Fukuda stepping test, Tandem gait test, and Finger-to-nose test were administered to all the participants. Results: Balance disturbances were observed in all three age groups. The symptoms and test findings showed increased abnormality with the increase in age. DII-ADL questionnaire suggests older adults have more difficulty performing activities of daily living than young and middle-aged adults. The sharpened Romberg test result showed a moderate negative correlation and the Fukuda stepping test showed a moderate positive correlation with the sections of the DII-ADL questionnaire. Conclusion: Individuals of any age can have difficulty performing activities of daily living even though they do not have evident balance disorder perceptually. Thus there is a need to spread awareness among professionals and emphasize the need for screening individuals across age groups for balance disturbances. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-022-03459-6.

Effect of Coronavirus 19 on Maintaining Balance in Skilled Athletes.

Preliminary studies have reported that motor control is negatively impacted following an infection of COVID-19. The purpose of this study was to evaluate the effect of COVID-19 on maintaining balance in highly skilled athletes. As part of a larger investigation that was initiated in 2019, twelve professional handball players were recruited to participate in a study that was designed to measure static balance performance. Following the initial pre-test, six participants (body height 184.8 ± 4.7 cm; body weight 85.5 ± 3.3 kg; age 21.3 ± 1.2 years) were infected with COVID-19. The remaining six participants (body height 188.7 ± 2.6 cm; body weight 92.3 ± 3.7 kg; age 26.3 ± 3.3 years) never tested positive for COVID-19 and were presumably not infected with the virus. The experimental design required all the participants to complete an initial balance assessment (pre-test) and a later balance assessment (post-test). To fully analyze our data, we conducted a 2 (condition: COVID, no-COVID) X 2 (test: pre-test, post-test) ANOVA with repeated measures on the second factor. Our analysis revealed that the skilled athletes who contracted COVID-19 had a significant decrease in balance performance from the pre-test that occurred prior to being infected with COVID-19 relative to the post-test that occurred following the COVID-19 infection. Additionally, the skilled athletes who were not infected with COVID-19 did not demonstrate the same deterioration in balance performance in the same period. This study highlights the impact COVID-19 has on static balance performance in a group of highly skilled handball players. Longitudinal studies are needed to fully understand the lasting impacts COVID-19 has on motor behavior.

Revisiting the Instrumented Romberg Test: Can Today's Technology Offer a Risk-of-Fall Screening Device for Senior Citizens? An Experience-Based Approach.

Risk of fall (ROF) is a worldwide major concern for its prevalence and consequent dramatic outcomes in the elderly population. The growing age-related risk appears to be associated with increasing motor, sensory, and cognitive problems in the elderly population. There is a consensus on the need to screen for these balance dysfunctions, but the available methods are largely based on subjectively assessed performances. The instrumented Romberg test using a force plate represents a validated assessment process for the evaluation of balance performances. The purpose of this study is to propose an innovative instrumental method to identify balance deficits, assess their severity, and give an automated indication of the most likely etiology. The proposed new method was applied to the instrumented Romberg test, using force plate data recorded in a cohort of 551 females aged >65 participating in adapted physical activity courses. The method allowed us to identify 145 dysfunctional subjects and to determine the likely origin of their deficit: 21 central, 5 vestibular, 9 visual, 59 proprioceptive (musculoskeletal etiology), and 51 functional. Based on the preliminary findings of the study, this test could be an efficient and cost-effective mass screening tool for identifying subjects at risk of fall, since the procedure proves to be rapid, non-invasive, and apparently devoid of any contraindications.

Balance Testing in Multiple Sclerosis-Improving Neurological Assessment With Static Posturography?

Background: Balance problems can severely limit the quality of life for people with Multiple Sclerosis (pwMS) already in the early stages of the disease. PwMS are usually assessed with the Expanded Disability Status Scale (EDSS), which includes a Romberg test for assessing balance. As the EDSS assessments are subjective to the examining neurologist, the postural stability of pwMS could be objectively quantified by implementing static posturography to detect balance problems and address preventive medical care. Methods: In this cross-sectional study, we added static posturography to the neurological EDSS examination in pwMS and healthy subjects to determine how this technique could supply additional information during the evaluation of the cerebellar functional system of the neurostatus EDSS as clinical outcome already in early disease stages. Static posturography was performed with subjects standing on a force platform while outcome variables such as delineated area, average speed and average sway were obtained. Unpaired t-test as well as (Welch's) analysis of variance (ANOVA) with pairwise post-hoc comparisons according to Games-Howell were used. Spearman rank correlations were implemented to study associations of balance outcomes with EDSS-associated outcomes. Results: A total of 99 pwMS (mean age: 35.01 years; EDSS median: 2.0, 68.69% females) and 30 healthy subjects (mean age: 34.03 years; 70% females) were enrolled. PwMS had worse performances in the three evaluated balance parameters than the healthy group (all p < 0.001). Even patients without postural instability as documented in the Romberg test score of the EDSS assessment showed significantly worse outcome regarding the delineated area [+1.97 cm2, 95%-CI (0.61-3.34); p = 0.002] vs. healthy controls. Similar results were observed for the comparison between pwMS with normal cerebellar function EDSS-systems and healthy subjects. There were significant correlations with the EDSS, cerebellar function score and Romberg test for the delineated area and average speed (r's ranging from 0.330 to 0.537, p < 0.001). Conclusions: Static posturography can complement neurological assessment of EDSS as an objective and quantitative test, especially for MS patients in early stages of the disease.

Diagnostic Balance Tests for Assessing Risk of Falls and Distinguishing Older Adult Fallers and Non-Fallers: A Systematic Review with Meta-Analysis.

Falls are a major cause of injury and morbidity in older adults. To reduce the incidence of falls, a systematic assessment of the risk of falling is of paramount importance. The purpose of this systematic review was to provide a comprehensive comparison of the diagnostic balance tests used to predict falls and for distinguishing older adults with and without a history of falls. We conducted a systematic review of the studies in which instrumented (force plate body sway assessment) or other non-instrumented balance tests were used. We analyzed the data from 19 prospective and 48 retrospective/case-control studies. Among the non-instrumented tests, the single-leg stance test appears to be the most promising for discrimination between fallers and non-fallers. In terms of body sway measures, the center-of-pressure area was most consistently associated with falls. No evidence was found for increased benefit of the body sway test when cognitive tasks were added, or the vision was eliminated. While our analyses are limited due to the unbalanced representation of different test and outcome measures across studies, we can recommend the single-leg test for the assessment of the risk of falling, and the measurements of body sway for a more comprehensive assessment.

Vitamin D Supplementation Improves the Effects of the Rehabilitation Program on Balance and Pressure Distribution in Patients after Anterior Cervical Interbody Fusion-Randomized Control Trial.

STUDY DESIGN: A double-blinded, randomized controlled trial. BACKGROUND: Surgery is effective in reducing pain intensity in patients with cervical disc disease. However, functional measurements demonstrated that the results have been not satisfactory enough. Thus, rehabilitation programs combined with the supplementation of vitamin D could play an essential role. METHODS: The study recruited 30 patients, aged 20 to 70 years, selected for anterior cervical interbody fusion (ACIF). The patients were randomly divided into the placebo (Pl) and vitamin D (3200 IU D3/day) supplemented groups. The functional tests limits of stability (LOS), risk of falls (RFT), postural stability (PST), Romberg test, and foot pressure distribution were performed before supplementation (BS-week 0), five weeks after supplementation (AS-week 5), four weeks after surgery (BSVR-week 9), and 10 weeks after supervising rehabilitation (ASVR-week 19). RESULTS: The concentration of 25(OH)D3 in the serum, after five weeks of supplementation, was significantly increased, while the Pl group maintained the same. The RFT was significantly reduced after five weeks of vitamin D supplementation. Moreover, a further significant decrease was observed following rehabilitation. In the Pl group, no changes in the RFT were observed. The overall postural stability index (OSI), LOS, and the outcomes of the Romberg test significantly improved in both groups; however, the effects on the OSI were more pronounced in the D3 group at the end of the rehabilitation program. CONCLUSIONS: Our data suggest that vitamin D supplementation positively affected the rehabilitation program in patients implemented four weeks after ACIF by reducing the risk of falls and improving postural stability.

Clinical predictors of symptom resolution for children and adolescents with sport-related concussion.

OBJECTIVE: The goal of this study was to determine which variables assessed during an initial clinical evaluation for concussion are independently associated with time until symptom resolution among pediatric patients. METHODS: Data collected from a prospective clinical registry of pediatric patients with concussion were analyzed. The primary outcome variable was time from injury until symptom resolution. Predictor variables assessed within 10 days after injury included preinjury factors, Health and Behavior Inventory scores, headache severity, and balance, vestibular, and oculomotor test performances. The researchers used univariate Cox proportional models to identify potential predictors of symptom resolution time and constructed a multivariate Cox proportional hazards model in which total duration of concussion symptoms remained the outcome variable. RESULTS: The sample consisted of 351 patients (33% female, mean age 14.6 ± 2.2 years, evaluated 5.6 ± 2.6 days after concussion). Univariate Cox proportional hazards models indicated that several variables were associated with a longer duration of symptoms, including headache severity (hazard ratio [HR] 0.90 [95% CI 0.85-0.96]), headache frequency (HR 0.83 [95% CI 0.71-0.96]), confusion (HR 0.79 [95% CI 0.69-0.92]), forgetfulness (HR 0.79 [95% CI 0.68-0.92]), attention difficulties (HR 0.83 [95% CI 0.72-0.96]), trouble remembering (HR 0.84 [95% CI 0.72-0.98]), getting tired often (HR 0.86 [95% CI 0.76-0.97]), getting tired easily (HR 0.86 [95% CI 0.76-0.98]), dizziness (HR 0.86 [95% CI 0.75-0.99]), and abnormal performance on the Romberg test (HR 0.59 [95% CI 0.40-0.85]). A multivariate Cox proportional hazards model indicated that an abnormal performance on the Romberg test was independently associated with a longer duration of symptoms (HR 0.65 [95% CI 0.44-0.98]; p = 0.038). CONCLUSIONS: For children and adolescents evaluated within 10 days after receiving a concussion, abnormal performance on the Romberg test was independently associated with a longer duration of symptoms during recovery. In line with findings of other recent studies investigating predictors of symptom resolution, postural stability tests may provide useful prognostic information for sports medicine clinicians.

Relationship between the Romberg test and the Wii Fit basic balance test and cognition in athletes with concussion.

BACKGROUND: Approximately 30% of individuals with a sport-related concussion present with postural instability. Multiple clinical balance tests exist to diagnose postural instability; yet little is known about the potential relationship between these type of postural assessments and cognition post-concussion. AIM: The purpose of the current study was to assess the relationship between the Romberg test, the Wii Fit basic balance test (WBBT), and the composite scores on the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) test in a sample of athletes with concussions. METHODS: Fifty five post-concussed athletes (40 males) completed the Romberg test (RT) (-/+), the WBBT, and ImPACT test. WBBT performance was operationalized as the number of successfully completed trials (of 5 trials of increasing difficulty) within 30 seconds. Pearson's and point-biserial correlations examined univariate associations among the variables. RESULTS: The RT and WBBT were not significantly related (r = - 0.029, p = 0.832). The RT weakly correlated with ImPACT impairment scores (r = 0.26, p = 0.041), whereas WBBT the number of trials did not (r = - 0.20, p = 0.155). The RT scores were significantly correlated with ImPACT Visual Processing Speed Score (r = 0.27, p = 0.036) and Reaction Time score (r = 0.34, p = 0.006). In contrast, WBBT trials were significantly correlated with the ImPACT Visual Memory Score (r = - 0.41, p = 0.003). CONCLUSIONS: These results suggest that the WBBT and RT assess unique aspects of postural control. The RT may relate directly to single sensory cognitive and motor processing, while the WBBT may relate to multi-sensory visually driven cognitive and motor processing. RELEVANCE FOR PATIENTS: Clinical balance tests could point to different cognitive impairments post-concussion.

Bedside examination.

In most dizzy patients a limited selection of bedside tests, together with the history, is adequate to establish a differential diagnosis and select the next diagnostic and therapeutic procedures. A set of basic bedside tests that should be applied in every patient with vertigo or imbalance allows identifying: (1) patients who need immediate referral for further assessment and treatment; (2) patients with nonthreatening disorders for which treatment can be started without more detailed testing; (3) patients with benign paroxysmal vertigo, in whom a detailed work-up is not required and who can immediately be treated with an appropriate particle-repositioning maneuver; and (4) patients who need a comprehensive neuro-otologic and neurologic work-up. Additional neuro-otologic bedside tests help to further refine the differential diagnosis.

Reliability and validity evidence of multiple balance assessments in athletes with a concussion.

CONTEXT: An estimated 300 000 sport-related concussion injuries occur in the United States annually. Approximately 30% of individuals with concussions experience balance disturbances. Common methods of balance assessment include the Clinical Test of Sensory Organization and Balance (CTSIB), the Sensory Organization Test (SOT), the Balance Error Scoring System (BESS), and the Romberg test; however, the National Collegiate Athletic Association recommended the Wii Fit as an alternative measure of balance in athletes with a concussion. A central concern regarding the implementation of the Wii Fit is whether it is reliable and valid for measuring balance disturbance in athletes with concussion. OBJECTIVE: To examine the reliability and validity evidence for the CTSIB, SOT, BESS, Romberg test, and Wii Fit for detecting balance disturbance in athletes with a concussion. DATA SOURCES: Literature considered for review included publications with reliability and validity data for the assessments of balance (CTSIB, SOT, BESS, Romberg test, and Wii Fit) from PubMed, PsycINFO, and CINAHL. DATA EXTRACTION: We identified 63 relevant articles for consideration in the review. Of the 63 articles, 28 were considered appropriate for inclusion and 35 were excluded. DATA SYNTHESIS: No current reliability or validity information supports the use of the CTSIB, SOT, Romberg test, or Wii Fit for balance assessment in athletes with a concussion. The BESS demonstrated moderate to high reliability (interclass correlation coefficient = 0.87) and low to moderate validity (sensitivity = 34%, specificity = 87%). However, the Romberg test and Wii Fit have been shown to be reliable tools in the assessment of balance in Parkinson patients. CONCLUSIONS: The BESS can evaluate balance problems after a concussion. However, it lacks the ability to detect balance problems after the third day of recovery. Further investigation is needed to establish the use of the CTSIB, SOT, Romberg test, and Wii Fit for assessing balance in athletes with concussions.

Investigation of changes in psycho-physiological parameters evoked by short duration, intensive physical stress.

The aim of our study was to investigate changes in psycho-physiological parameters evoked by short duration, intensive physical stress on university students practicing judo at different intensities and timely manner. Stability of posture, muscle strength (hand force exertions), attention concentration (choice reaction time), cardiac parameters, (ECG, heart rate, heart rate variability), and oxygen saturation were measured, cardiac state and stress index were computed before and after the physical stress. The actual psychic state of the subjects was evaluated using the Spielberger's STPI-H Y-1 test which determined anxiety, curiosity, anger and depression level. Analysis of psychometric and physiologic parameters indicated significant correlations, among others, between force and cardiac stress (-), force and depression (-), anxiety and errors in actions (+), cardiac state and errors in action (-), cardiac state and depression (-). Paired samples tests showed the influence of intensive physical stress within groups of students, and independent samples tests made it possible to evaluate the power of medical and sport students, performing physical training at a significantly higher level than it is usual among the medical students. Our results proved that higher level physical training influences the psychic state advantageously, limits increases in cardiac stress level, and decreases susceptibility to anxiety and depression.