Search

Objective: Whiplash is an acceleration-deceleration mechanism of energy transfer to the neck that may result from a rearend or side impact, predominantly in motor vehicle accidents but also from other mishaps. Vertigo and dizziness after whiplash injury are the most frequent, persistent and disabling symptoms, even in the absence of anatomical and cervical spine damage. Vestibular disturbances in whiplash patients have been widely investigated; nevertheless, physiopathology of vertigo and dizziness still remains an unsolved problem. The aim of our study was to demonstrate that cVEMPs (cervical Vestibular Evoked Myogenic Potentials) represent a valid and non-invasive technique able to investigate vestibular function, in particular the vestibulo-collic refl ex and macular function. Study design: We examined 25 patients affected by disabling post-whiplash injury by means of audiovestibular tests: audiometric and impedance tests, nystagmus evaluation, caloric test, dynamic posturography and cervical VEMPs. Data obtained were compared with those of a normal control group. Results: Audiological tests, impedance tests, nystagmus evaluation, and caloric tests were normal in all patients. Comparison of dynamic posturography values obtained in whiplash patients and in the normal control group demonstrated signifi cant differences in the Composite Equilibrium Score and Visual Component. Finally, cVEMPs were bilaterally absent in 72% of patients, unilaterally absent in 16% and present in 12%. C onclusions: Based upon neurophysiological evidence and our results, we can hypothesize that a concussion of the macular receptors takes place and that the maculae are more sensitive than the ampulla or cochlea receptor to this kind of injury. We conclude that cervical VEMPs represent a valid and non-invasive technique to evaluate disability after whiplash injury.

Objective: Whiplash is an acceleration-deceleration mechanism of energy transfer to the neck that may result from a rearend or side impact, predominantly in motor vehicle accidents but also from other mishaps. Vertigo and dizziness after whiplash injury are the most frequent, persistent and disabling symptoms, even in the absence of anatomical and cervical spine damage. Vestibular disturbances in whiplash patients have been widely investigated; nevertheless, physiopathology of vertigo and dizziness still remains an unsolved problem. The aim of our study was to demonstrate that cVEMPs (cervical Vestibular Evoked Myogenic Potentials) represent a valid and non-invasive technique able to investigate vestibular function, in particular the vestibulo-collic refl ex and macular function. Study design: We examined 25 patients affected by disabling post-whiplash injury by means of audiovestibular tests: audiometric and impedance tests, nystagmus evaluation, caloric test, dynamic posturography and cervical VEMPs. Data obtained were compared with those of a normal control group. Results: Audiological tests, impedance tests, nystagmus evaluation, and caloric tests were normal in all patients. Comparison of dynamic posturography values obtained in whiplash patients and in the normal control group demonstrated signifi cant differences in the Composite Equilibrium Score and Visual Component. Finally, cVEMPs were bilaterally absent in 72% of patients, unilaterally absent in 16% and present in 12%. C onclusions: Based upon neurophysiological evidence and our results, we can hypothesize that a concussion of the macular receptors takes place and that the maculae are more sensitive than the ampulla or cochlea receptor to this kind of injury. We conclude that cervical VEMPs represent a valid and non-invasive technique to evaluate disability after whiplash injury.

[Truncated abstract] One of the classical and more debilitating symptoms of Parkinson's disease is postural instability. As a result of this impairment in balance, patients with Parkinson's disease experience restricted mobility, are prone to falls, display a reduced capacity to perform activities of daily living and have a reduced quality of life. This thesis reviews our current knowledge of Parkinson's disease in the context of the mechanisms regulating postural control and how impairments to these lead to postural instability. The thesis then examines the characteristics and assessment of patients with Parkinson's disease, with a history of falls or near falls compared to non-fallers and controls. Our first objective was to explore the circumstances surrounding fall and near fall events in a cohort of 130 patients with idiopathic Parkinson's disease using an approach based on a 16-item questionnaire. This survey – the largest of its kind undertaken to date – showed that over 50% of patients experienced one or more falls over the previous two years with over 80% experiencing near falls over the same period. Our study suggests that fear of falling is more prevalent in patients than previously thought and that a fear of falling, restrictions on activities and reduced participation in exercise correlate with falling and the number of falls experienced. From this initial cohort of patients, a smaller cohort of 48 patients was selected comprising two sub-groups, fallers and non-fallers. These were used to address the question of whether a multi-dimensional approach to assessing postural instability based on a combination of established clinical and functional measures, provides a more accurate and quantifiable assessment of an individual's balance and mobility compared to any single methodology. Fallers had longer disease duration compared to non-fallers but importantly could be discriminated from non-fallers by most of the individual assessment methodologi, To explore this issue further, we used posturography – a technique widely recognised as superior to established clinical and functional measures of postural stability in terms of its quantifiability and reproducibility – to measure and quantify balance in fallers and non-fallers with Parkinson's disease compared to controls. Of the static posturographic variables measured, only two differed significantly between fallers and controls. By contrast, several of the dynamic posturographic variables differed significantly between the groups (viz. fallers, non-fallers and controls). A correlation analysis showed significant correlations between the static and dynamic posturographic measures and clinical and functional measures. Consistent with the fact that the postural instability associated with Parkinson's disease represents a continuum from slightly impaired balance through to functional impairment typified by falls and near falls, our findings suggest that using a combination of clinical and functional measures of balance and mobility coupled with posturography provides the best approach to assessing subtle changes in balance in patients, particularly in a research setting..., Thesis (Ph.D.)--University of Western Australia, 2013

Background: Today there is limited knowledge of postural control and remaining dizziness after anterior cervical decompression and fusion (ACDF). Objective: The purpose of the present study was to compare the results from dynamic posturography (sensory organization test (SOT) 1–6 and SOT 1–2 in flexed and extended neck position, respectively) in patients with cervical disc disease with healthy controls and with patients with a previous whiplash-associated disorder (WAD). Another purpose was to investigate which objective and/or subjective factors that were related to the outcome on SOT 5 and SOT 6 in patients after ACDF. Design: Fifteen patients, half with self-perceived dizziness, who had undergone ACDF with cervical carbon fibre intervertebral fusion cage, were consecutively included in the study. Background data, active range of motion of the neck, neck and hand strength, neck muscle endurance and subjective variables were used in a multiple regression model to find the strongest factor of a good postural performance. Results: Not only WAD patients but also a major part of ACDF patients had dizziness and impaired postural control. Male patients without dizziness, with a low pain and disability level had the best results on dynamic posturography. Conclusions: Many patients with cervical disc disease had remaining disability due to postural control and are in need of specific physiotherapy after ACDF.

Objectives: This study has two aims. First, we analyze the results of dynamic computerized posturography (Equitest) achieved by patients who have undergone acoustic neuroma removal or vestibular neurotomy. The examination is performed during the preoperative assessment and at several postoperative consultations. Secondly, after analyzing the results, we evaluate the interest of this type of examination for such patients during preoperative assessment and postoperative follow-up. Patients: 25 patients underwent acoustic neuroma removal and 8 vestibular neurotomy from June 1996 until September 1997. All patients included in the study underwent dynamic posturography follow-up, The schema proposed was an examination before surgery and then 10 days and 1 and 3 months after the operation. Not all patients underwent all examinations tit is a retrospective study). Method: Retrospective case review, Results: 50% of the patients (n = 8) who underwent vestibular neurotomy achieved a normal score at the sensory organisation test(SOT) of the Equitest within the first 6 postoperative weeks. 60% of the patients (n = 25) undergoing acoustic neuroma removal developed a central vestibular compensation 3 months after surgery. Two patients developed an inadequate balance strategy with excessive visual dependence detected by the SOT. Conclusions: According to our experience, the SOT is a useful examination during the follow-up period of patients who have undergone neurootologic surgery, it provides information about the progress of postoperative central vestibular compensation. The dynamic posturography also detects inadequate balance strategies, therefore, allowing a personalized vestibular reeducation adapted to each patient.