Search Results (20)

Background and Objectives: Virtual reality (VR)-based interventions provide immersive and interactive environments that can enhance motor learning and deliver real-time feedback, offering potential advantages over conventional therapies. This systematic review evaluated the impact of non-immersive and immersive VR exergaming interventions versus conventional therapy on balance in Parkinson’s disease (PD) through a detailed analysis of randomized controlled trials (RCTs). Materials and Methods: A comprehensive search was conducted across the PubMed, Lilacs, IBECS, CENTRAL, Web of Science (WOS), EBSCOHost, and SciELO databases. Article selection and duplicate removal were managed using Rayyan QCRI. The quality of the evidence was assessed using the GRADE system. Results: From an initial screening of 100 studies, 58 underwent title and abstract screening. After full-text evaluation, 11 RCTs met the inclusion criteria, involving 518 participants with PD (average age: 67.3 years; 67.95% men). The balance outcomes were primarily measured using the Berg balance scale (BBS), employed in most studies (n = 9). The pooled analysis demonstrated a significant improvement in the balance scores for the experimental groups compared to the controls, with a standardized mean difference (SMD) of 0.58 [95% CI: 0.07, 1.09, p = 0.03]. However, the heterogeneity was substantial (I² = 77%). The analysis of the six-minute walking test (6 MWT), as another outcome of four articles, revealed a mean difference of 32.99 m [95% CI: −8.02, 74.00], but the effect was not statistically significant (p = 0.11). The heterogeneity for this outcome was moderate (I² = 41%), indicating some variability across studies. Alternative tools, such as the Tinetti Performance-Oriented Mobility Assessment (POMA) scale, the UPDRS III, and the sensory organization test (SOT), were also evaluated where possible. Conclusions: VR-based interventions offer promise for improving balance in Parkinson’s disease, enhancing rehabilitation engagement. Their integration into clinical practice could complement conventional therapy. However, further research is needed to optimize protocols, standardize parameters, and maximize their impact on mobility, independence, and quality of life. Full article

Background: Nowadays, not only is a high, long life expectancy desired, but also longevity with quality. Quality of life in adulthood is a multidimensional construct related to the perception of one’s own health, psychological and socio-emotional factors, functionality for daily activities, and body composition. Objective: This study evaluates the effects of physical activity level (PAL), strength, balance, and body composition on perceived health in healthy adults. Methods: An observational, cross-sectional study with consecutive, non-probabilistic inclusion of cases was conducted. Body fat percentage (BFP) was measured by DXA. Physical activity level was assessed using accelerometry. The strength index (S_Index) was estimated using dynamometry. Postural control was assessed through posturography. The composite equilibrium score from the Sensory Organization Test (SOT_CES) was conducted to measure postural stability under various sensory conditions using dynamic posturography. Perceived health was calculated using the SF36 questionnaire, which detects health states, both positive and negative. A linear regression model was generated between each domain of SF36 with SOT_CES, BFP, PAL, and S_Index. Results: A total of 64 males with a mean age of 55 ± 5 years and a mean body mass index of 27 ± 4 kg/m² were recruited. Results showed a negative correlation between physical function (ß = −0.7; t = −3.163; p = 0.003; R² = 23.7%) and general health (ß = −0.227; t = −3.425; p = 0.001; R² = 17.4%) with BFP. Also, it showed a negative correlation between physical function (ß = 0.047; t = −2.643; p = 0.011; R² = 17.5%) and general health (ß = 0.016; t = −3.044; p = 0.004; R² = 14.6%) with S_Index. On the other hand, no relation was observed between SF36 and SOT_CES. Finally, only the emotional role showed a positive correlation (ß = −0.02; t = −2.629; p = 0.011; R² = 23.1%) with PAL. Conclusion: A lower BFP and higher S_Index are associated with increased physical function and general health. Also, the higher the PAL, the greater the emotional health. On the other hand, no relation was observed between SF36 and the balance detected from SOT_CES. Full article

Background/Objectives: Ocular proprioception is implicated in balance control and heterophoria is associated with abnormal posture, though previous research focused mainly on the role of vertical phoria and the use of vertical prisms. This study aims to evaluate whether ocular misalignment and prismatic correction of horizontal phoria affect posture. Methods: Sixty-nine (N = 69) young healthy subjects were included and equally divided by horizontal distance phoria: orthophoria (n = 23), esophoria (n = 23) and exophoria (n = 23). A prism of low power (two-diopter) was placed base out on the non-dominant eye, reducing misalignment in esophorics and increasing it in exophorics more than in orthophorics. Dynamic computerized posturography was performed with the sensory organization test protocol (SOT) of the EquiTest^® NeuroCom^® version 8 platform both without and with prism, always maintaining subjects unaware of prism use. A mixed model for repeated measures analysis of variance was run to evaluate the main effect of prism and the interaction effect of prism with baseline phoria. Results: Composite movement strategy score without prism was 88.1 ± 2.8% (ankle-dominant strategy) and slightly increased to 89.0 ± 3.1% with prism insertion (p = 0.004), further shifting toward ankle strategy. Composite equilibrium score without prism was 80.3 ± 6.5% and remained stable with prism insertion (81.3 ± 8.2%, p = 0.117), medio-lateral and antero-posterior projection of center of gravity did not displace significantly under prism insertion (p = 0.652 and p = 0.270, respectively). At baseline, posturographic parameters were statistically independent of individual phoria, and no significant interaction between prism insertion and individual phoria was documented for any parameters (p > 0.05 for all). Secondary analysis and pairwise comparisons confirmed that the effect of prism was strongly selective on condition SOT 5 (eyes-closed, platform sway-referenced) with improvement of equilibrium (70.4 ± 9.7% with prism vs. 65.7 ± 11.6% without) and more use of ankle strategy (81.6 ± 5.3% with prism vs. 78.2 ± 6.0% without), without any interaction of phoria and ocular dominance, while the other conditions were comparable with and without prism. Conclusions: A two-diopter prism base out on the non-dominant eye induces the body to use the ankle joint more independently of individual phoria, suggesting a small improvement in postural control, while maintaining oscillations of the center of gravity unaltered. Prism seems to enhance the function of vestibular system selectively. Phoria adjustments with prismatic correction enable intervention in postural behavior. Extraocular muscles could act as proprioceptors influencing postural stability. Full article

Background/Objectives: Subthalamic nucleus deep brain stimulation (STN-DBS) is a standard treatment for motor complications in Parkinson’s disease (PD). Its impact on axial symptoms is still not fully understood. This study aimed to quantitatively evaluate the effect of frequency changes within the therapeutic window on postural control performances of individuals with PD who underwent bilateral STN-DBS. Methods: Postural control was assessed using Computerized Dynamic Posturography with randomized DBS frequency parameters, low (60 Hz), high (130 Hz), and very high (180 Hz), across six sensory organization test (SOT) conditions. Results: Twenty PD participants with a mean age of 61.2 ± 10.1 years were included. There were no differences in equilibrium scores of SOT conditions between 60, 130, and 180 Hz frequencies (p > 0.05), except the SOT6 score (p = 0.003), where 60 Hz showed better equilibrium performance in SOT6, indicating an advantage in postural control when visual cues are disturbed. Discussion: Low-frequency settings (60 Hz) in STN-DBS may benefit those who rely heavily on visual cues while ineffectively using somatosensory and vestibular inputs. Conclusions: A tailored approach to the DBS frequency setting could optimize postural stability and reduce fall risk in these patients. Future research is needed to explore these mechanisms to enhance therapeutic strategies. Full article

The purpose of this study is to investigate the effect of task constraints on the neurobiological systems while maintaining postural control under various sensory feedback manipulations in individuals with and without Chronic Ankle Instability (CAI). Forty-two physically active individuals, with and without CAI, were enrolled in a case-control study conducted at a biomechanics research laboratory. All participants underwent the Sensory Organization Test (SOT), which assesses individuals’ ability to integrate somatosensory, visual, and vestibular feedback to maintain postural control in double-, uninjured-, and injured-limb stances under six different conditions in which variations in the sway-referenced support surface (platform) and visual surroundings, with and without vision, are manipulated to affect somatosensory and visual feedback. Center-of-Pressure (COP) path length was computed from raw data collected during trials of each SOT condition. Sample Entropy (SampEN) values were extracted from the COP path length time series to examine neurobiological systems complexity, with lower SampEN values indicating more predictable and periodic (rigid) neurobiological systems, while higher SampEN values indicate more unpredictable and random systems. The results show that specific task constraints affect the neurobiological systems. Specifically, individuals with CAI demonstrated reduced complexity (decreased SampEN values) in the neurobiological systems during the uninjured-limb stance when all sensory feedback was intact and during both uninjured- and injured-limb stances when they were forced to rely on vestibular feedback. These results highlight the interplay between sensory feedback and task constraints in individuals with CAI and suggest potential adaptations in the neurobiological systems involved in postural control. Full article

Background: The aim of the study was to demonstrate the influence of virtual reality (VR) exposure on postural stability and determine the mechanism of this influence. Methods: Twenty-six male participants aged 21–23 years were included, who underwent postural stability assessment twice before and after a few minute of single VR exposure. The VR projection was a computer-generated simulation of the surrounding scenery. Postural stability was assessed using the Sensory Organization Test (SOT), using Computerized Dynamic Posturography (CDP). Results: The findings indicated that VR exposure affects the visual and vestibular systems. Significant differences (p < 0.05) in results before and after VR exposure were observed in tests on an unstable surface. It was confirmed that VR exposure has a positive influence on postural stability, attributed to an increase in the sensory weight of the vestibular system. Partial evidence suggested that the reduction in vestibulo-ocular reflex (VOR) reinforcement may result in an adaptive shift to the optokinetic reflex (OKR). Conclusions: By modifying the process of environmental perception through artificial sensory simulation, the influence of VR on postural stability has been demonstrated. The validity of this type of research is determined by the effectiveness of VR techniques in the field of vestibular rehabilitation. Full article

The aim of this study was to determine the effects of maximal exercise and maximal exercise under hypoxic conditions on balance, the strategies of the balance-maintenance process and its sensory organization. A total of 60 men were randomly allocated to three experimental groups and a control group. All participants completed the sensory organization test for assessing balance. Participants in the experimental groups performed the same test after an hour of normobaric hypoxia (the first group), after supramaximal exercise (the second group) and after supramaximal exercise combined with 60 min of hypoxia exposure (the third group). The control group performed the test after 60 min of passive rest. Normobaric hypoxia conditions corresponded to an altitude of 2950 m (FIO₂ 15%). Physical effort in normoxia and hypoxia significantly impaired the participants’ stability on a stable platform with eyes open (η² = 0.711, p = 0.001; η² = 0.583, p = 0.001, respectively). On an unstable platform, a significant improvement in stability indices was observed in the group undertaking the exercise in hypoxia (p = 0.04, η² = 0.249). The experimental conditions increased the role of hip strategies in maintaining balance in the experimental groups during trials requiring somatosensory information. An analysis of sensory organization shows that maximal effort in hypoxia increases the role of somatosensory (p = 0.002, η² = 0.69) and vestibular (p = 0.02, η² = 0.34) information, whereas hypoxia alone increases reliance on visual (p = 0.03, η² = 0.38) and vestibular (p = 0.02, η² = 0.36) information. This study indicates that individuals have poorer stability after maximal exercise, which may cause difficulties in engaging in some dynamic forms of activity, especially those with a large number of visual stimuli. Full article

Patients with bilateral vestibulopathy (BVP) suffer from postural imbalance during daily life conditions, which in turn leads to a high frequency of falls. Unfortunately, vestibular rehabilitation has only modest and somewhat inconsistent effects in this patient group. Approximately 50% of BVP patients show an improved postural control after conventional vestibular rehabilitation training. New and more promising approaches are required. The individualized vibrotactile neurofeedback training (IVNT) in stance and gait conditions has already been described as highly effective in patients with various vestibular disorders. The purpose of the present multicenter study was to determine the efficacy of the IVNT in improving balance, reducing self-perceived disability, and improving gait in patients with confirmed BVP. In total, 22 patients performed the IVNT with the Vertiguard^® system for 10 daily sessions. The dizziness handicap inventory (DHI), the stance stability score of the sensory organization test (SOT) and the score for everyday life mobility in stance and gait tasks (SBDT) were obtained immediately before and after the rehabilitation training period, as well as 3 and 12 months later. All measures improved significantly after the IVNT. Between 77.3% and 94.4% of patients showed an individual benefit (depending on outcome measure). The effect was not significantly reduced within the follow-up period of 12 months. The results demonstrate a high efficacy of the IVNT for vestibular rehabilitation in BVP patients. Full article

Chiari Malformation Type I (CM1) is a neurological condition in which the cerebellar tonsils extend past the foramen magnum. While many studies have reported dizziness symptoms in patients with CM1, the prevalence of peripheral labyrinthine lesions is largely unknown. This study aimed to comprehensively describe the audiovestibular phenotype in a cohort of patients with CM1 expressly referred for dizziness. Twenty-four patients with CM1 and a complaint of dizziness/vertigo were evaluated. Hearing and auditory brainstem tract function were essentially normal. While vestibular abnormalities were most prevalent during rotational testing (33%), abnormal functional balance was the most common finding (40%). Patients with CM1 had a greater likelihood of exhibiting an abnormal sensory organization test (SOT) postural stability score for fixed platform conditions, and for the somatosensory analysis score. While no significant associations were identified between tonsillar ectopia extent and any vestibular/balance outcome measure, a significant negative association was identified between neck pain and the somatosensory sensory analysis score. Abnormal functional balance in the somatosensory domain was remarkable, with poorer scores associated with neck pain. An isolated peripheral vestibulopathy was present in only 8% of patients. Despite the low prevalence of vestibulopathy, vestibular/balance assessment is warranted to identify patients who may benefit from referral to specialized medical disciplines. Full article

Rheumatoid arthritis (RA) is a systemic autoimmune disease that impairs mobility. How does sensory information influence postural responses in people with RA? The aim of this study was to evaluate the postural control of people with RA during a sensory organization test, comparing how sensory information influences postural responses in people with rheumatoid arthritis compared with healthy people. Participants were 28 women with rheumatoid arthritis (RA group) and 16 women without any rheumatoid disease (Control group CG). The Sensory Organization Test (SOT) was performed on a Smart Balance Master^® (NeuroCom International, Inc., Clackamas, OR, USA) and center of pressure (COP) was measured. SOT conditions: SOT1 (eyes open, fixed support surface and surround; SOT2) eyes closed, fixed support surface and surround; and SOT5) eyes closed, sway-referenced support surface, and fixed surround. To compare the demographic and clinical aspects between groups, independent t-test or Mann–Whitney’s U-test were used. Differences were found between groups. Between SOT conditions, for CG and RA, COP was faster for SOT-5 than SOT-1, while SOT-1 and SOT-2 presented similar COP velocity. For SOT-2 and SOT-5, COP was larger for the RA group. For both groups, SOT-1 presented the smallest COP, and SOT-5 showed the largest COP. Full article

Balance disorders are caused by several factors related to functionality deficits in one or multiple sensory systems such as vision, vestibular, and somatosensory systems. Patients usually have difficulty explaining their dizziness, often using ambiguous words to describe their symptoms. A common practice by clinicians is to objectively evaluate the patient’s dizziness by applying the Sensory Organization Test (SOT), which measures the contribution of each sensory system (vestibular, visual, somatosensory). The SOT protocol can record up to 2000 measurements in 20 s to generate the Equilibrium Score (EQS) with its five load sensors. EQS is an indicator that reflects how well a patient can maintain balance. However, its calculation only considers two instances from these 2000 measurements that reflect the maximum anterior and posterior sway angle during the test performance; therefore, there is an opportunity to perform further analysis. This article aims to use the Centre of Pressure (COP) time series generated by the SOT and describes a methodology to pre-process and reduce the dimensionality of this raw data and use it as an input for machine learning algorithms to diagnose patients with balance disorder impairments. After applying this methodology to data from 475 patients, the logistic regression model (LR) produced the highest f1-score with 76.47%, and the support vector machine (SVM) performed almost as well, with an f1-score of 76.19%. Full article

Background: Although fall prevention in patients after stroke is crucial, the clinical validity of fall risk assessment tools is underresearched in this population. The study aim was to determine the cut-off scores and clinical validity of the Sensory Organization Test (SOT), the Berg Balance Scale (BBS), and the Fall Efficacy Scale–International (FES-I) in patients after stroke. Methods: In this prospective cross-sectional study, we analyzed data for patients admitted to a rehabilitation unit after stroke from 2018 through 2021. Participants underwent SOT, BBS, and FES-I pre-discharge, and the fall incidence was recorded for 6 months. We used an area under the receiver operating characteristic curve (AUC) to calculate predictive values. Results: Of 84 included patients (median age 68.5 (interquartile range 67–71) years), 32 (38.1%) suffered a fall. All three tests were significantly predictive of fall risk. Optimal cut-off scores were 60 points for SOT (AUC 0.686), 35 and 42 points for BBS (AUC 0.661 and 0.618, respectively), and 27 and 29 points for FES-I (AUC 0.685 and 0.677, respectively). Conclusions: Optimal cut-off scores for SOT, BBS, and FES-I were determined for patients at risk for falls after a stroke, which all three tools classified with a good discriminatory ability. Full article

Lack of sleep is a factor that disrupts the receptors’ reception of information from the environment and contributes to the emergence of problems with maintaining balance. The main aim of the study was to determine whether sleep disorders affect postural stability in young men. The study participants were 76 male students who were divided into groups with good and poor sleep quality. The division was made based on the results obtained from the questionnaire of the Pittsburgh Sleep Quality Index (PSQI). In each group, postural stability had been tested using three main tests: Sensory Organization Test (SOT); Motor Control Test (MCT); and Adaptation Test (ADT). The results of the analysis show that the obtained results differ in the examined groups under the SOT test. Different values of the tested parameters were noted among people with poor sleep quality and compared with the values of those who sleep well, which translates into a difference in the ability to maintain balance. The greatest impact is observed when using visual and a vestibular system to maintain a stable posture. It was confirmed that the lack of sleep significantly disturbs postural stability. Full article

Objective: The skull vibration-induced-nystagmus test (SVINT) is a noninvasive and effective screening tool for the function of the otolith and canal structures in children. It can instantaneously assess vestibular asymmetry. This study aimed to analyze the SVINT results of healthy children vs. children with hearing loss (HL) and to correlate it with sensory organization test (SOT) results as a functional balance evaluation tool. Design: This case-controlled study compared the results of SVINT to the results of the SOT of the computerized dynamic posturography (CDP) in a control group of 120 healthy normal-hearing children (i.e., NH group) vs. hearing loss (HL) group of 60 children, including 30 children with hearing aids (HAs) and 30 children with a unilateral cochlear implant (CI). The SVINT results were compared to the caloric test (CaT) and video head impulse test (vHIT) and associated with SOT scores. Results: Thirty-one children in the HL group had normal SVINT and normal SOT results. A total of 21 children in the HL group had SVINT-negative and abnormal results in the SOT (possibly due to bilateral vestibular loss (BVL)). Eight children in the HL group had positive SVINT and abnormal SOT results. However, none of the children had only positive SVINT with normal SOT findings. Moreover, 52% of children had a normal result on both the SOT and CaT, whereas 27% had abnormal results on both tests (17% bilateral weakness and 10% unilateral), and 22% had the only result of the SOT suggesting a functional abnormality. Similarly, when associating the result to vHIT, 51% had normal results on both tests, and 25% had abnormal results (13% bilateral and 12% unilateral weakness). Conclusions: SVINT findings can be correlated with SOT findings in the case of the unilateral vestibular lesion (UVL), which adds a diagnostic value in these pediatric cases but may differ in the case of the bilateral vestibular lesion (BVL). However, SVINT findings need to be cautiously interpreted in light of other test findings such as the SOT, CaT, and vHIT. Full article

Background: Postural strategies such as ankle, hip, or combined ankle-hip strategies are used to maintain optimal postural stability, which can be influenced by the footwear type and physiological workload. Purpose: This paper reports previously unreported postural strategy scores during the six conditions of the sensory organization test (SOT). Methods: Fourteen healthy males (age: 23.6 ± 1.2 years; height: 181 ± 5.3 cm; mass: 89.2 ± 14.6 kg) were tested for postural strategy adopted during SOT in three types of occupational footwear (steel-toed work boot, tactical work boot, low-top work shoe) every 30 min during a 4-h simulated occupational workload. Postural strategy scores were analyzed using repeated measures analysis of variance at 0.05 alpha level. Results: Significant differences among postural strategy scores were only evident between SOT conditions, and but not between footwear type or the workload. Conclusions: Findings indicate that occupational footwear and occupational workload did not cause a significant change in reliance on postural strategies. The significant changes in postural strategy scores were due to the availability of accurate and/or conflicting sensory feedback during SOT conditions. In SOT conditions where all three types of sensory feedback was available, the ankle strategy was predominantly adopted, while more reliance on hip strategy occurred in conditions with absent or conflicting sensory feedback. Full article