Head and Trunk Movement Responses in Healthy Children to Induced Versus Self-Induced Lateral Tilt

The purpose of our study was to determine head and trunk movement responses that occur in healthy 7-year-old children during induced and self-induced lateral tilt. Twenty subjects, while tailor sitting on a tiltboard, participated in three trials of both induced and self-induced left and right lateral displacements. Measurements of neck and trunk lateral flexion; trunk counterrotation; and neck, trunk, and body anterior-posterior movement were obtained from slide transparencies made at three stages of tilt (original position, initial tilt, and full tilt). For each subject in the two test conditions, changes in these measurements between the stages of tilt were determined and compared. Based on the results of multivariate analysis of variance procedures, we concluded that 1) a significant difference in trunk counterrotation existed between the two types of tilt, with the greatest degree of couriterrotation occurring with induced displacement; 2) no significant difference existed in neck or trunk lateral flexion; and 3) no significant differences existed in neck, trunk, or body anterior-posterior movement between tilts. We also found that a wide variability of response existed among the children over the three testing trials. Clinical application of our results suggests that different and unique motor programs exist for automatic and willed balance responses. These differences should be considered when planning treatment strategies

Differences in Symptoms among Adults with Canal versus Otolith Vestibular Dysfunction: A Preliminary Report

Despite the importance of symptomatology in the diagnosis of vestibular dysfunction, the qualitative nature of the symptoms related to semicircular canal (canal) versus otolith dysfunction is not fully understood. The purpose of this study was to compare symptoms, and their severity, in individuals with canal versus otolith peripheral vestibular dysfunction. A subjective tool, the Descriptive Symptom Index (DSI), was developed to enable categorization of symptoms as rotary, linear, imbalance or falls, and nondistinct. Fourteen adults were recruited and grouped based on vestibular function testing: canal only dysfunction, otolith only dysfunction, or canal and otolith dysfunction. Also, the Dizziness Handicap Inventory (DHI) was used to grade the severity of perceived limitations due to symptoms. The DSI was reliable and differentiated those with canal (rotary symptoms) versus otolith (linear symptoms) dysfunction. Most individuals with otolith only dysfunction did not report rotary symptoms. DHI scores were significantly higher in those with otolith dysfunction, regardless of canal functional status. All who experienced falls had otolith dysfunction and none had canal only dysfunction. Results support the importance of using linear and rotary descriptors of perceived disorientation as part of diagnosing vestibular dysfunction

Central Somatosensory Changes and Altered Muscle Synergies in Subjects with Anterior Cruciate Ligament Deficiency

To clarify the mechanisms of compensation in subjects with anterior cruciate ligament deficiency (ACL-D), we examined proprioception, quadriceps strength, somatosensory evoked potentials (SEPs) and muscle responses during gait in varied combinations of speed and incline. Seventeen subjects with ACL-D were grouped by functional level and report of giving way. Seven subjects without ACL-D served as a control sample for muscle response measures. ACL-D subjects with quadriceps weakness experienced giving way and could not resume sport activities. Those without weakness fell into one of two groups: (1) copers, who had full return to previous activity and no giving way despite proprioceptive loss and altered SEPs, and (2) adapters, who were unable to return to previous activity level and experienced giving way despite neither proprioceptive loss or altered SEPs. The unique muscle pattern in copers during inclined fast walking included larger and earlier hamstring activation. These results suggest that in individuals with ACL-D without a strength deficit, altered SEPs and altered neuromuscular patterns are the factors that enable resumption of pre-injury functional levels. Loss of proprioception may drive the central changes, which in turn drives the development of altered muscle patterns

Differences in Symptoms among Adults with Canal versus Otolith Vestibular Dysfunction: A Preliminary Report

Despite the importance of symptomatology in the diagnosis of vestibular dysfunction, the qualitative nature of the symptoms related to semicircular canal (canal) versus otolith dysfunction is not fully understood. The purpose of this study was to compare symptoms, and their severity, in individuals with canal versus otolith peripheral vestibular dysfunction. A subjective tool, the Descriptive Symptom Index (DSI), was developed to enable categorization of symptoms as rotary, linear, imbalance or falls, and nondistinct. Fourteen adults were recruited and grouped based on vestibular function testing: canal only dysfunction, otolith only dysfunction, or canal and otolith dysfunction. Also, the Dizziness Handicap Inventory (DHI) was used to grade the severity of perceived limitations due to symptoms. The DSI was reliable and differentiated those with canal (rotary symptoms) versus otolith (linear symptoms) dysfunction. Most individuals with otolith only dysfunction did not report rotary symptoms. DHI scores were significantly higher in those with otolith dysfunction, regardless of canal functional status. All who experienced falls had otolith dysfunction and none had canal only dysfunction. Results support the importance of using linear and rotary descriptors of perceived disorientation as part of diagnosing vestibular dysfunction

Visual-Vestibular Habituation and Balance Training for Motion Sickness

Background and Purpose. This case report describes physical therapy for motion sickness in a 34-year-old woman. The purpose of the report is twofold: (1) to provide an overview of the literature regarding motion sickness syndrome, causal factors, and rationale for treatment and (2) to describe the evaluation and treatment of a patient with motion sickness. Case Description and Outcomes. The patient initially had moderate to severe visually induced motion sickness, which affected her functional abilities and prevented her from working. Following 10 weeks of a primarily home-based program of visualvestibular habituation and balance training, her symptoms were alleviated and she could resume all work-related activities. Discussion. Although motion sickness affects nearly one third of all people who travel by land, sea, or air, little documentation exists regarding prevention or management

Normative scores for the NIH Toolbox dynamic visual acuity test from 3 to 85 years

As part of the National Institutes of HealthToolbox initiative, a computerized test of dynamic visual acuity (cDVA) was developed and validated as an easy-to-administer, cost- and timeefficient test of vestibular and visual function. To establish normative reference values, 3,992 individuals, aged 3–85 years, without vestibular pathology underwent cDVA testing at multiple clinical research testing facilities across the United States. Test scores were stratified by sociodemographic characteristics. cDVA was worse in males (p \u3c0.001) and those subjects 50 years or older, while there was no difference in dynamic visual acuity across age groups binned from 3 to 49 years. Furthermore, we used these normative cDVA data as a criterion reference to compare both the long (validated) and short versions of the test. Both versions can distinguish between those with and without vestibular pathology (p D0.0002 long; p D0.0025 short). The intraclass correlation coefficient between longand short-cDVA tests was 0.86

Normative scores for the NIH Toolbox dynamic visual acuity test from 3 to 85 years

As part of the National Institutes of HealthToolbox initiative, a computerized test of dynamic visual acuity (cDVA) was developed and validated as an easy-to-administer, cost- and timeefficient test of vestibular and visual function. To establish normative reference values, 3,992 individuals, aged 3–85 years, without vestibular pathology underwent cDVA testing at multiple clinical research testing facilities across the United States. Test scores were stratified by sociodemographic characteristics. cDVA was worse in males (p \u3c0.001) and those subjects 50 years or older, while there was no difference in dynamic visual acuity across age groups binned from 3 to 49 years. Furthermore, we used these normative cDVA data as a criterion reference to compare both the long (validated) and short versions of the test. Both versions can distinguish between those with and without vestibular pathology (p D0.0002 long; p D0.0025 short). The intraclass correlation coefficient between longand short-cDVA tests was 0.86

New portable tool to screen vestibular and visual function—National Institutes of Health Toolbox initiative

As part of the National Institutes of Health Toolbox initiative, we developed a low-cost, easy-to-administer, and time-efficient test of vestibular and visual function. A computerized test of dynamic visual acuity (cDVA) was used to measure the difference in visual acuity between head still and moving in yaw. Participants included 318 individuals, aged 3 to 85 years (301 without and 17 with vestibular pathology). Adults used Early Treatment of Diabetic Retinopathy Study (ETDRS) optotypes; children used ETDRS, Lea, and HOTV optotypes. Bithermal calorics, rotational chair, and light box testing were used to validate the cDVA. Analysis revealed that the cDVA test is reliable for static (intraclass correlation coefficient [ICC] \u3e/= 0.64) and dynamic (ICC \u3e/= 0.43–0.75) visual acuity. Children younger than 6 years old were more likely to complete cDVA with Lea optotypes, but reliability and correlation with ETDRS was better using HOTV optotypes. The high correlation between static acuity and light box test scores (r = 0.795), significant difference of cDVA scores between those with and without pathology (