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Objective: Foam pads are commonly used devices in the clinics and laboratories to assess postural control. However, no reliability data are presently available to support the use of one type of foam over another. The purpose of this study was to evaluate the test-rest reliability of postural sway parameters while using two different types of foam that are commonly used and to determine which type of foam is optimal for providing a consistent and effective perturbation., Design: Test-retest reliability., Setting: Clinical setting., Participants: Ten healthy young subjects were recruited., Main Outcome Measures: The Balance Accelerometry Measure device was used to collect postural sway for 90 seconds with eyes open and closed on three different surface conditions (firm, Airex foam and Neurocom foam). Intraclass correlation coefficients were used to determine test-retest reliability., Results: Eyes open and eyes closed on a firm surface showed fair to good reliability for the path length value (ICC (3,1) = 0.61-0.64, p <0.05). Eyes open and eyes closed on the Airex pad showed fair to excellent reliability for the path length value (ICC (3,1) = 0.41-0.81, p >0.05 with eyes open and eyes closed). Eyes open and eyes closed on the Neurocom foam showed fair to good reliability for the path length value (ICC (3,1)= 0.29-0.45, p >0.05)., Conclusions: The Airex and Neurocom foam pads both provide fair to good reliability. The Airex foam had higher reliability scores with eyes closed than the Neurocom foam pad. Both foam pads appear to produce repeatable findings.

Objective: Development of an easy to administer, low-cost test of vestibular function., Methods: Members of the NIH Toolbox Sensory Domain Vestibular, Vision, and Motor subdomain teams collaborated to identify 2 tests: 1) Dynamic Visual Acuity (DVA), and 2) the Balance Accelerometry Measure (BAM). Extensive work was completed to identify and develop appropriate software and hardware. More than 300 subjects between the ages of 3 and 85 years, with and without vestibular dysfunction, were recruited and tested. Currently accepted gold standard measures of static visual acuity, vestibular function, dynamic visual acuity, and balance were performed to determine validity. Repeat testing was performed to examine reliability., Results: The DVA and BAM tests are affordable and appropriate for use for individuals 3 through 85 years of age. The DVA had fair to good reliability (0.41-0.94) and sensitivity and specificity (50%-73%), depending on age and optotype chosen. The BAM test was moderately correlated with center of pressure (r = 0.42-0.48) and dynamic posturography (r = -0.48), depending on age and test condition. Both tests differentiated those with and without vestibular impairment and the young from the old. Each test was reliable., Conclusion: The newly created DVA test provides a valid measure of visual acuity with the head still and moving quickly. The novel BAM is a valid measure of balance. Both tests are sensitive to age-related changes and are able to screen for impairment of the vestibular system.

Background: Accelerometers are being used to assess postural control in adults, but there is little to support their reliability and validity., Objective: To estimate the test-retest reliability of the balance accelerometry measure (BAM) and to describe the known-groups validity of the BAM composite score., Methods: Two measures of standing postural sway were taken across six sensory (vision/stance surface) and motor stance (feet together or tandem) positions from eighteen patients with vestibular disorders and 84 healthy subjects. Test-retest reliability for postural sway was estimated across all conditions using intraclass correlation coefficient (ICC). A composite measure of sway standardized to young healthy subjects on eyes open firm surface stance was compared between groups., Results: Test-retest reliability of postural sway was good (ICC ⩾ 0.74) under all sensory conditions except eyes closed/tandem stance, which was slight to poor. Analysis of the receiver operating characteristic curve for composite scores indicated significant accuracy at identification of subjects in the vestibular/balance disorder groups. Composite standard scores equal or greater than 21.1 identified subjects with vestibular disorders with an accuracy of 72% sensitivity and 68% specificity., Conclusion: The BAM displays good-excellent reliability for five of six sensory-motor conditions. The composite score appears to differentiate healthy from subjects with vestibular disorders.

Accelerometry (ACC) shows promise as an easily implemented clinical measure of balance. The purpose of the study was to estimate test-retest reliability of ACC measures and determine the relationship between ACC measured at the pelvis and underfoot center of pressure (COP) measures during sensory organization test (SOT) conditions. Eighty-one subjects were recruited from the community with no known orthopedic or vestibular deficits (19-85 years). Subjects completed three consecutive, ninety second trials for each of the six SOT conditions, while wearing the accelerometer. ACC and COP time series were described by calculating the normalized path length, root mean square (RMS), and peak-to-peak values. The test-retest reliability of the three measures within each SOT condition was estimated over three trials using the intraclass correlation coefficient. ACC and COP test-retest reliability were similar, ranging from 0.63 to 0.80 using ACC and 0.42 to 0.81 using COP for the measure of normalized path length. Linear regression between ACC and COP measures showed significant correlation under almost every SOT condition using both single and average measures across trials. The degree of association between COP and ACC was equivalent when using the first trial or the 3-trial average, suggesting that one trial may be sufficient. The use of accelerometry may have value in estimating balance function and minimizing clinical evaluation time., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Potassium bromide is still in use for the treatment of multidrug-resistant seizures. It is a known cause of severe drug-induced skin disorders. The clinical presentation of bromoderma may be similar to that of pyoderma gangrenosum when occurring with a single lesion. The case of a young girl with a single vegetating plaque of bromoderma on the leg is reported. The presence of pustules at the periphery of the plaque provides the clinical clue to the diagnosis.

The present study investigated the effect of optic flow periodicity on postural sway. Head and center-of-pressure (COP) displacements in response to an oscillating full-field bullseye-and-checkerboard pattern were recorded in six healthy adults. Scene movement was driven by one of five signals: (1) 0.1 Hz sinusoid, (2) 0.3 Hz sinusoid, (3) 0.5 Hz sinusoid, (4) the periodic sum of these three sinusoids (PSUM), or (5) a non-periodic counterpart (NPSUM = 0.1+ pi/10 + 0.5 Hz). Sway response power at the various stimulus frequencies were compared: (1) among the three pure sinusoidal groups; and (2) between the two sum-of-sinusoid groups. Head and COP responses displayed similar spectral content, though sway magnitude was larger for the head. Sway responses to the moving scenes were significantly larger than those observed during quiet stance. Each sinusoidal moving scene evoked a strong response at the stimulus frequency, as well as increased sway at non-stimulus frequencies, primarily below 0.2 Hz. For the sum-of-sinusoids stimuli, both PSUM and NPSUM signals elicited sway responses at each of their component frequencies. The amplitudes of these responses were similar to one another at 0.1 and 0.3 Hz, but significantly different at 0.5 Hz, with PSUM responses on average four times larger than those for NPSUM. These findings indicate that spectrally similar periodic and non-periodic stimuli elicit quantitatively different sway responses. The observed behaviors may be due to postural sensitivity to the predictability of visual motion, or due to other nonlinear and/or time-varying mechanisms in the postural control system.