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Vestibular dysfunction was linked to moderate-to-severe obstructive sleep apnea syndrome (OSAS) patients in literature. However, due to a lack of knowledge among valid and recent implementations conceived to study postural control on static posturography (SP) and vestibulo-ocular reflex (VOR) gain under physiological conditions (video Head Impulse Test; vHIT), the aim of this work was to integrate (i) VOR changes via vHIT implementation, (ii) postural arrangement by studying both classical parameters and frequency spectra (PS) and (iii) correlation between these findings, polygraphic (PG) and subjective scores along Dizziness Handicap Inventory (DHI) and Epworth Sleepiness Scale (ESS). Thus, 32 moderate-to-severe OSAS patients and 32 healthy subjects - studied by using PG, DHI and ESS - underwent vHIT and SP posturographic assessment. Analysis of variance was performed to disclose between-group effects and correlation analysis was implemented between otoneurological, PG, DHI and ESS values. OSAS group demonstrated a significant decay of VOR gain and an increase in both frequency spectra PS values, especially within the low-frequency interval, and in classical posturographic SP parameters. Further, positive and negative correlations between mean SaO 2 and gain and low frequency interval spectra PS were found, respectively. Strengthening previous hypothesis related to brainstem chronic hypoxemia phenomena affecting vestibular network, implementation of these data could generate future attentions (i) for screening under physiological conditions postural and vestibular detriments in OSAS subjects, especially exposed at risk settings, and (ii) among PG parameters, such as mean SaO 2 , to propose further reliable tools in monitoring postural and vestibular decay in these patients demonstrating PG parameters detriments., (© 2017 European Sleep Research Society.)

Previous studies have investigated the relationship between muscular tension, body posture, and voice quality. The aim of this paper is to study the postural pattern during voice production in healthy subjects compared with patients affected by voice disorders and in the same patients before and after vocal treatment by means of static posturography. Classic posturographic variables and spectral frequency analysis of body sway have been measured. Posturographic values in patients before vocal treatment and controls were within normal ranges but not homogeneous. Body sway significantly decreased during voice production in patients after voice training. Spectral frequency analysis of body sway showed a significantly decreased body sway at middle frequencies on the anteroposterior (y) plane during voice production after voice training. Our results would suggest that in patients affected by voice disorders rehabilitative treatment may cause an improvement of the body proprioceptive scheme and this improvement might be useful to evaluate the proper (ongoing) treatment.

Sound-evoked activation of the vestibular system has been suggested for a long time, and myogenic potentials have been recorded at the level of different muscular groups while a high intensity sound was applied. The aim of this study was to analyse sound-evoked postural responses in normal subjects and to correlate them with the activation of the vestibular system. Body sway was measured by posturography and elaborated through spectral frequency analysis in 40 healthy volunteers in the basal condition and after applying a sound stimulus monoaurally. Spectral frequency analysis results showed a significant increase, in presence of stimulus, of body sway at low and middle frequencies only on the lateral plane and in the closed-eyes condition. As it seems that these frequency ranges are mainly under vestibular control, our results suggest that sound activates specifically the vestibular system, and posturography during sound stimulation represents an alternative approach to assess vestibular function.

Patients with an acute unilateral vestibular lesion show an impaired balance control. The initial presentation is vertigo followed by postural instability; but with time, the global balance functions can be completely restored by a process called vestibular compensation. The aim of our study was to evaluate short and long-term variations of postural parameters in 20 patients affected by vestibular neuritis (VN), and to compare these patients to 20 normal individuals using computerized static posturography (CSP) along with patient feedback throughout the spectral frequency analysis. This analysis showed in patients with no residual dizziness a frequency shift of body sway from low to middle frequencies as a probable expression of the compensatory strategies used by the central nervous system. On the other hand, patients with persistence of postural instability did not show any frequency shift. Our results seem to provide an early index of a proper occurring compensation so that we can adjust therapeutic protocols according to each patient's functional modifications.

Benign paroxysmal positional vertigo (BPPV) is a disorder in which patients suffer from acute rotatory vertigo due to the presence of free otoconial debris migrating into one or more semicircular canals during head movements and resulting in abnormal stimulation of the ampullary crest. A prolonged loss of equilibrium of unclear origin is also present. Static posturography is a useful tool for the study of postural control systems and their role in these abnormalities. The aim of the present study was to evaluate the frequency of body sway and long-term instability of BPPV patients by posturography frequency analysis. Twenty patients with canalithiasis of the posterior semicircular canal and 20 normal controls were subjected to static posturography. Informed consent was obtained from all subjects. Patients were tested 1 h after diagnosis, and 3 days and 12 weeks after the characteristic Epley repositioning maneuver. Patients with BPPV showed significantly increased body sway both on lateral (X) and anteroposterior (Y) planes compared to normal subjects. Corporal oscillation with a broad-frequency spectrum was observed in both closed and open eye tests. The repositioning maneuver decreased the X plane body sway, while the anteroposterior sway was unchanged. Twelve weeks after treatment, a normalization of the anteroposterior sway was observed. Results of this study suggest that the long-term postural disturbance associated with BPPV differs from the acute disequilibrium that subsides after canalith repositioning: the former is a sagittal plane/broad spectrum body sway, while the latter is primarily a frontal plane/low frequency sway. The Epley maneuver was shown to reduce frontal sway, a postural abnormality that might therefore be linked to posterior semicircular canal function. Conversely, the observed sagittal body sway was only partially relieved by the restoration of canal function, and therefore, may be more related to the chronic dizziness observed in these patients., (Copyright 2002 S. Karger AG, Basel)

To evaluate posturography measurements, and their association with other clinical tests used for cervicogenic dizziness diagnosis, in a cohort of subjects suffering from cervicogenic dizziness, compared with healthy subjects. Ninety-three cervicogenic dizziness patients and 98 age- and gender-matched healthy subjects underwent video-Head impulse test, posturography testing, evaluation of cervical spine movements by means of cervical range of motion goniometer and self-report and performance measures, including Dizziness Handicap Inventory, Neck Disability Index, Neck Pain Intensity, Tampa Scale for Kinesiophobia and Hospital Anxiety and Depression Scale. Cervicogenic dizziness patients demonstrated significant increases in classical posturography parameters (i.e., surface and length) and in power spectra values within middle and high-frequency interval depicting balance control alterations especially due to proprioceptive integration changes. Furthermore, decreases in degrees of cervical range of motion and increases of self-report and performance measures – highlighting significant complaints of subjective feeling of dizziness – were found in these patients when compared with healthy subjects. Multiple correlations were found between posturography testing and cervical range of motion and Dizziness Handicap Inventory as well as between different self-report and performance measures in cervicogenic dizziness patients. The implementation of posturography – including power spectra analysis - coupled with appropriate exclusion of other disorders, may represent a useful tool in improving cervicogenic dizziness assessment in terms of cost, time consumption and correlation with other measurements. Uncertainties in diagnostic assessment of cervicogenic dizziness reflect doubts regarding the causes underpinning the symptoms of imbalance, unsteadiness, and disorientation. Posturography measurement is a low-cost, time-sparing technique and its implementations have proven to be useful in detecting significant alterations in body sway during perturbating situations. Implementation of power spectra analysis on posturography testing may represent a useful tool in improving cervicogenic dizziness assessment also in terms of rehabilitative treatment follow-up. [ABSTRACT FROM AUTHOR]

Individuals have to reweight the respective contribution of the different sources of sensorial information for regulating posture and balance, especially during fine task execution. Given the evidences indicating strategy during swing performance as associated with prioritization of task-relevant visuospatial information for skill execution, the aim of the present work is to assess differences in visual dependency (VD) and postural control in a population of expert (EXP) and non-expert (NEXP) golfers when compared with healthy subjects (HC) and to discover possible relationships between these outcomes and swing performance. Thus, 15 golfers (EXP = 7; NEXP = 8) and 32 matched HC underwent otoneurological testing including video Head Impulse Test, posturography and Rod and Disk Test (RDT). Golf players also underwent a swing session procedure, which performance was measured by means of the Flightscope X2 Doppler-radar launch monitor system. EXP subjects demonstrated significant (p < 0.05) lower values in i) counter-clockwise (CCW) and clockwise (CW) dynamic conditions when compared with both NEXP and HC subjects RDT outcome measures and ii) surface and length posturography values as compared with HC subjects. When treating golf players outcomes as 'a continuum', CCW and CW scores were found to positively correlate with both lateral distance and horizontal launch angle and to negatively correlate with spin rpm. In conclusion, the present study suggests that the high-level of visual-independency demonstrated by EXP subjects may be functionally related in expert golfers to an effective motor strategy preferentially not referring to an inappropriate reliance on visual input. [ABSTRACT FROM AUTHOR]

Objective: To investigate the long-term effects of adding virtual reality–based home exercises to vestibular rehabilitation in people with unilateral vestibular hypofunction. Design: Follow-up otoneurological examination in two randomized groups following a previous one-month trial. Setting: Tertiary rehabilitation center. Subjects: A total of 47 patients with unilateral vestibular hypofunction, one group (n = 24) undergoing conventional vestibular rehabilitation and the other one (n = 23) implementing, in addition, head-mounted gaming home exercises, 20 minutes per day for one month. Interventions: One year after completing rehabilitation, patients underwent testing with static posturography, video head impulse test, self-report questionnaires, and a performance measure. Main measures: Vestibulo-ocular reflex gain, posturographic parameters such as length, surface, and fast Fourier transform power spectra, self-report, and gait performance measure scores. Results: Vestibulo-ocular reflex gain was significantly better with respect to pretreatment in both groups. The mixed-method group showed significantly higher gain scores: mean (standard deviation (SD)) at 12 months was 0.71 (0.04), versus 0.64 (0.03) for the vestibular rehabilitation–only group (P < 0.001). Accordingly, some classical posturography scores such as surface with eyes open and length with eyes closed and low-frequency power spectra were significantly different between groups, with the virtual reality group showing improvement (P < 0.001). Self-report measures were significantly better in both groups compared to pretreatment, with significant improvement in the mixed-method group as compared to conventional rehabilitation alone: Dizziness Handicap Inventory mean total score was 24.34 (2.8) versus 35.73 (5.88) with a P-value <0.001. Conclusion: Results suggest that head-mounted gaming home exercises are a viable, effective, additional measure to improve long-term vestibular rehabilitation outcomes. [ABSTRACT FROM AUTHOR]

• Vestibular deficits and cognitive decline share many central pathways. • Degree of cognitive decline may limit vestibular rehabilitation outcomes. • Implementation of head-mounted displays may support vestibular rehabilitation. Due to the gap in the knowledge in the field of vestibular rehabilitation the purpose of this randomized study is to highlight the outcomes of head-mounted display (HMD) implementation in older adults and patients with mild cognitive impairment (MCI), suffering from unilateral vestibular hypofunction (UVH). Vestibulo-ocular reflex (VOR) gain, postural sway examination and dizziness-related and quality of life scores were collected in 12 UVH elderly and 12 UVH subjects suffering from MCI only undergoing vestibular rehabilitation and in 11 UVH elderly and 12 UVH subjects suffering from MCI undergoing a home-based HMD + vestibular rehabilitation protocol. Although the within-subjects analysis found in all groups a significant (p < 0.05) improvement in posturography parameters and dizziness-related and quality of life scores and no changes in VOR gain, implementation of HMD demonstrated a significant (p < 0.05) increase in post-treatment between-group comparisons in the same tests and VOR gain with respect to those older adults and participants with MCI only undergoing vestibular rehabilitation. Positive correlations were discovered between Mini-Mental Score Exam values and pre-/post-treatment differences in (i) power spectra values in the low-frequency interval (r = 0.72) and in (ii) Dynamic Gait Index scores (r = 0.76). This study demonstrates that the implementation of a home-based virtual reality protocol may be a safe option in order to ameliorate VOR, postural control and the quality of life also in the vestibular impaired patients in whom the presence of cognitive decline could hinder the achievement of the goal of rehabilitation. [ABSTRACT FROM AUTHOR]

Several studies have investigated the possible influence of temporomandibular disorders (TMD) on body posture and whether cervical spine disorders, such as cervicogenic dizziness (CGD) could play an additional role in affecting static balance. The purpose of this study was to analyze static postural behavior by means of static posturography, in patients affected by either TMD or CGD alone or by both conditions, and to compare findings with a group of healthy subjects. Significant changes in posturographic parameters were found among the three groups of patients and when compared with controls. When the three study groups were compared to each other, subjects affected by a combination of TMD and CGD showed worse postural performances with respect to subjects affected by CGD or TMD alone. Correlations with self-perceived dizziness, anxiety, depression and jaw functionality, investigated by means of validated questionnaires, were found among all patient groups. These results provide new evidences for the presence of static balance alterations in patients suffering from TMD with and without associated cervical spine impairment, by using a reliable diagnostic technique. Further studies are needed in order to identify any causal relation between these two disorders. [ABSTRACT FROM AUTHOR]