前庭脊髓反射功能临床研究及前庭康复治疗
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摘要
实验一:单侧前庭功能低下患者计时平衡试验及静态姿势描记
目的观察单侧前庭功能低下(unilateral vestibular hypofunction, UVH)患者的计时平衡试验和静态姿势描记(static posturography, SPG),探讨两种方法的临床应用价值。
方法65例UVH患者和92例健康者进行如下静态直立试验:①标准Romberg试验;②双脚平行分开直立试验;③强化Romberg试验(踵趾足位站立);④单足直立试验。每种测试条件下分别睁眼和闭眼站立,用秒表记录①~④试验中维持平衡的时间,同时用SPG记录①、②条件下的身体晃动平均速度(sway velocity, SV)。
结果①计时平衡试验:UVH组采取踵趾位和单足站立时,维持平衡时间较对照组降低,差异均有极显著性意义(P值均<0.001);②SPG:采用标准Romberg位和双脚分开站立,UVH组和对照组相比,睁眼时两组SV差异无显著性意义(P值分别是0.118和0.110)。而闭眼时,两组间差异均有统计学意义(P值均<0.001);③对于UVH组和对照组,无论睁眼或闭眼,采用双脚分开站立时,SV均较标准Romberg位时降低,差异有显著性意义(P值均<0.05),或极显著性意义(P值<0.001);④两组受试者踵趾位和单足站立时的各计时结果与其标准Romberg站立和双足分开站立时的各SV间未发现有相关性(P值均大于0.05)。
结论评估UVH患者平衡功能时,踵趾位和单足直立计时平衡试验是对SPG试验的补充,两种方法可在临床中结合应用;进行SPG试验时,应考虑足位因素对测试结果的影响。
实验二:正常人直立于不同厚度海绵垫时的姿势特征
目的探讨正常人直立于不同厚度海绵垫时的静态姿势特征。
方法30名正常人分别站立于坚硬平板以及不同厚度的中等密度海绵垫上,海绵块数依次从1块到5块,每块厚度4.7cm。每种站立面条件下,睁眼和闭眼各站立30秒,应用姿势描记仪记录人体姿势稳定性参数,包括:总轨迹长、单位轨迹长即平均速度、单位面积轨迹长、外周面积、实效值面积、矩形面积。
结果(1)所有参数在睁眼和闭眼条件下均有随海绵垫厚度增加而变化趋势(P <0.0001),除单位面积轨迹长呈减少趋势外,其余参数均为增加趋势;(2)比较各参数在不同海绵块数之间的差异,大部分差异有显著性(P<0.05)或极显著性意义(P<0.01),出现无显著性意义(P>0.05)的情况有:①总轨迹长和平均速度:睁眼及闭眼时,4-5块之间;②单位面积轨迹长:睁眼时,0-1、1-3、2-3、3-4、4-5块之间;闭眼时,3-4、3-5、4-5块之间;③外周面积:睁眼时2-3、3-4、4-5块之间;闭眼时,3-4、3-5、4-5块之间;④实效值面积和矩形面积:睁眼时2-3、4-5块之间;闭眼时,3-4、3-5、4-5块之间。
结论人体站立于不同厚度海绵垫时,诸多静态平衡参数中,总轨迹长和平均速度的稳定性和敏感性均优于其它参数,是较理想的描述姿势稳定性的指标;应用海绵垫对直立人体本体觉进行干扰时,应考虑海绵垫厚度对结果的影响,选择适宜的厚度,以提高其临床应用价值。
实验三:海绵厚度对眩晕患者mCTSIB不同测试参数的影响
目的通过眩晕患者在不同厚度海绵垫上进行感觉相互作用和平衡的临床改良试验(modified clinical test of sensory interaction and balance, mCTSIB),探讨本体感觉不同减弱程度对该试验的影响以及不同观测指标对海绵垫厚度变化的敏感性。
方法33名眩晕患者站立于姿势描记仪进行mCTSIB,足底站立平面依次是坚硬平板和不同厚度的中等密度海绵垫(分别是1到5块,每块厚度4.7cm),睁眼和闭眼条件下各站立30秒。记录:①倾倒的发生;②维持平衡的站立时间;③未发生倾倒时,姿势图仪记录人体重心晃动的平均速度(sway velocity, SV)。
结果①睁眼时无倾倒发生,对于闭眼时不同海绵垫块数下倾倒发生例数,第1块与第2、3、4、5块之间的差异有统计学意义(P<0.001),而后四块之间差异无显著性意义(P>0.5);②维持平衡时间:睁眼时各厚度海绵垫之间差异无显著性意义。闭眼时,站立时间随着海绵垫块数的增加有减少趋势,二者呈负相关(r=-0.3557,P<0.0001),但第0、1块间(F=3.64,P=0.0653)、第2、3块间(F=0.27,P=0.6102)、第4、5块间(F=0.14,P=0.7084)差异无显著性意义,其余块数之间有统计学差异(P<0.05);③睁眼和闭眼时,随着海绵垫块数的增加,SV有增加的趋势。海绵垫块数分别为0,1,2,3,4时SV值两两之间比较均有统计学差异(P<0.0001),第5块与块数为0,1,2,3时的SV值之间差异有显著性意义(P<0.001),但与第4块间没有统计学差异(P睁眼=0.0503,P闭眼=0.3422);海绵垫的块数与闭眼时SV之间呈正相关(r=0.67765,P<0.0001)。从相关系数绝对值分析,闭眼时SV对海绵厚度变化较站立时间敏感。
结论不同厚度海绵垫对眩晕患者mCTSIB结果有影响;定量测量身体重心晃动速度可较敏感地反映眩晕患者在不同本体感觉减弱程度下的姿势平衡特征,其次是计时平衡测量。
实验四:感觉相互作用和平衡的临床改良试验的临床应用
目的探讨海绵垫干扰本体觉结合定量测量姿势平衡的方法在正常人及眩晕患者中的应用,并分析正常人和眩晕患者姿势平衡中的感觉相互作用机制。
方法各106例正常人和眩晕患者进行海绵姿势描记(foam posturography, FPG)检查,受试者站立以下四种感觉条件下,T1:睁眼站立于坚硬平板;T2:闭眼战立于坚硬平板;T3:睁眼站立于海绵;T4:闭眼站立于海绵。对各站立条件下人体站立时足底压力中心的晃动速度(sway velocity, SV)进行定量测量。如有跌倒则记录不同感觉条件瞎跌倒发生的例数。同时对眩晕患者进行视频眼震图仪(videonystagmography, VNG)检查。
结果(1)对正常人而言:①在视觉或/和本体觉受到干扰时,SV均增加,其差异有极显著性意义(P<0.0001);②当本体觉未被干扰及被干扰时,视觉条件的变化引起SV增加程度分别是(12.12±6.19)和(30.58±9.69)%;当视觉条件未被干扰及被干扰时,本体觉变化导致的SV增加程度分别是(18.31±6.56)和(36.25±8.90)%;而当视觉和本体觉同时受到干扰时,SV增加程度是(46.21±8.67)%;③在姿势平衡中起作用较大的是前庭觉,其次是本体觉和视觉,三者呈非线形关系。(2)对患者而言:①在前庭末梢和中枢性病变中,VNG的异常率分别是67.74%和22.73%,两种病变中的VNG差异有显著性意义(χ2=20.867,P<0.001);②同时以SV异常和跌倒为参数分析FPG异常率,在前庭末梢和中枢性病变中分别为58.06%和40.91%,两种病变中的VNG差异无显著性意义(χ2=3.031,P=0.082);③只以跌倒为参数,在前庭末梢和中枢性病变中分别为45.16%和27.27%,两种病变中的VNG差异无显著性意义(χ2=3.505,P=0.061);④进一步分析106例患者感觉整合试验结果异常的分布,发现根据出现结果异常的感觉条件,共分为四种类型:A:只有T4异常;B:T2+T4异常;C:T3+T4异常;D:T2+T3+T4异常。四种感觉整合异常模式在末梢和中枢性眩晕患者中的构成比差异并无统计学意义(χ2=2.838, P=0.417)。
结论①利用海绵垫干扰本体觉,结合姿势描记可以记录不同感觉条件下姿势稳定性,并可定量分析视觉、本体觉和前庭觉在姿势平衡中的整合作用;②人体维持平衡过程中,应用三种外周感觉的姿势策略差异较大。当一种或两种外周感觉信息被干扰时,中枢神经系统为维持姿势稳定,存在复杂的感觉整合机制;③海绵姿势描记的异常和感觉整合的异常分类并不能做为鉴别前庭末梢和前庭中枢疾病的方法。但该方法可以初步了解眩晕患者在姿势平衡中应用的不同平衡策略,可望用以指导患者进行个性化庭康复治疗。
实验五:头部后仰对正常人姿势稳定性的影响
目的探讨头部后仰对正常人姿势稳定性的影响。
方法34名健康青年人进行四种站立条件下的姿势描记仪检查,分别为:①站立于坚硬平板、头部直立;②坚硬平板、头部后仰50~55°;③海绵垫、头部直立;④海绵垫、头部后仰50~55°。每种条件下分别测试睁眼和闭眼时的姿势稳定性,采用身体重心晃动速度(sway velocity, SV)为研究参数。
结果①头部直立时,站立海绵垫时与站立坚硬平板下身体重心SV比较,睁眼时(t=15.484,P<0.001)和闭眼时(t=19.302,P<0.001)均有显著增加。②睁眼时,在两种站立平面上,头部直立和后仰时SV间比较差异无显著性意义(坚硬平板和海绵垫平面上的P值分别是0.083和0.616);而闭眼时,无论站立平面条件如何,头部后仰时SV均显著高于头部处于直立位时(P值均小于0.001);③就闭眼时头部后仰引起的SV增加程度而言,站立海绵垫时的增加程度高于站立于坚硬平板上(t=5.757,P<0.001)。
结论正常青年人闭眼同时头部后仰可使姿势稳定性降低,且头部后仰可能使机体对本体觉的依赖增加。
实验六:本体觉在头部后仰姿势平衡中的作用
目的探讨正常青年进行感觉相互作用试验时,不同本体觉干扰程度对头部后仰姿势平衡的影响。
方法42名健康青年人进行六种条件下的姿势图仪检查,分别为:①站立于坚硬平板、头部直立;②坚硬平板、头部后仰;③两层海绵垫、头部直立;④两层海绵垫、头部后仰;⑤四层海绵垫、头部直立;⑥四层海绵垫、头部后仰。每层海绵垫的厚度为4.7 cm,头部后仰的角度是50°～55°。每种条件下分别测试睁眼和闭眼时的姿势稳定性。采用身体重心晃动速度(sway velocity, SV)和外周面积(sway area, SA)为研究参数,并比较不同站立平面下头部后仰产生的身体晃动增加比率(body-sway increase ratio, BIR)。
结果①不同站立条件下头部直立和后仰时重心晃动的SV和SA比较结果均表明,无论站立平面条件如何,睁眼时头部直立和后仰时重心晃动的差异无显著性意义;而闭眼时头部后仰时重心晃动SA和SV均高于头部处于直立位,差异有极显著性意义。②对于闭眼时不同站立条件下的BIR, SA和SV的结果表明:对于站立于坚硬平板和2层海绵上,闭眼时头部后仰导致的BIR而言,差异没有显著性意义;而站立于4层海绵上,闭眼时头部后仰产生的BIR显著高于前两种站立平面的BIR。
结论正常人进行感觉相互作用试验时,睁眼时头部后仰不能使姿势稳定性降低,闭眼时头部后仰对姿势稳定性的影响倚赖于本体觉受到干扰程度。对本体觉干扰程度越大,姿势稳定性降低程度越大。人体闭眼头部后仰时,为维持平衡,对本体觉的依赖增加。
实验七:单侧外周前庭病变患者头部后仰导致的姿势稳定性改变
目的探讨应用海绵干扰本体觉条件下,头部后仰对单侧外周前庭病变(unilateral peripheral vestibular disorder, uPVD)患者姿势稳定性的影响。
方法28名uPVD患者进行四种站立条件下的姿势描记仪检查,分别为:①站立于坚硬平板、头部直立;②坚硬平板、头部后仰50~55°;③海绵垫、头部直立;④海绵垫、头部后仰50~55°。每种条件下分别测试睁眼和闭眼时的姿势稳定性,采用身体直立时足底压力中心的晃动速度(sway velocity, SV)为研究参数。
结果①站立坚硬平板测试时均无跌倒发生。睁眼时,头部后仰与直立时比较,SV差异无显著性意义(t=0.043,P=0.966);而闭眼时,不同头位间SV差异有显著性意义(t=4.735,P<0.001);②站立海绵垫时,睁眼条件下,所有测试者均无跌倒,头部后仰与直立时比较,SV差异无显著性意义(t=1.113,P=0.275);③站立海绵垫时,闭眼条件下,头部直立时有4名患者在三次测试中均跌倒。头部后仰时有6名患者在3次测试中均跌倒,有2名患者在第1次测试中跌倒(第2次未跌倒)。不同头位间SV差异有显著性意义(t=3.015,P=0.007);两种头位下,跌倒次数比较无显著性差异(χ2=1.693,P=0.193);④就闭眼时头部后仰引起的SV增加程度而言,站立海绵上与站立于坚硬平板上间无统计学差异(t=2.036,P=0.055)。
结论uPVD患者闭眼时头部后仰可使姿势稳定性降低,这种降低发生条件与正常人有一致性。提示头部后仰姿势描记可能不是鉴别区分已代偿uPVD患者和正常人平衡能力的理想方法。
实验八:耳石复位治疗对良性阵发性位置性眩晕患者姿势稳定性的影响
目的探讨耳石复位治疗(canal repositioning procedure, CRP)对后半规管良性阵发性位置性眩晕(benign paroxysmal positional vertigo , BPPV)患者姿势稳定性的影响。
方法25名确诊为后半规管BPPV患者在CRP前后进行四种感觉条件下的姿势稳定性测量,分别是:(T1)坚硬平板、睁眼;(T2)坚硬平板、闭眼;(T3)海绵平面、睁眼;(T4)海绵平面、闭眼。并与配对的25名正常人姿势稳定性比较。采用身体直立时足底压力中心的晃动速度(sway velocity, SV)为研究参数。
结果①CRP前BPPV组身体晃动SV均较正常组增加,差异有统计学意义(P<0.05或P<0.001);②BPPV组除T1外(P=0.083),CRP后身体晃动SV较治疗前降低,差异间有统计学意义(P<0.05或P<0.001);③BPPV组CRP后的姿势稳定性与正常组间,站立坚硬平板上的SV间比较,差异无显著性意义(P睁眼=0.178;P闭眼=0.055);而站立海绵上的SV间比较,差异有显著性意义(P睁眼=0.004;P闭眼=0.029)。
结论后半规管BPPV患者的姿势稳定性可降低,CRP可使其姿势平衡得到一定程度的提高,但与正常人仍有一定差异。
PartⅠThe timed balance test and static posturography in the patients with unilateral vestibular hypofunction
Objective To investigate the balance function of the patients with unilateral vestibular hypofunction (UVH) by timed balance tests and static posturography (SPG).
Methods 65 subjects with UVH and 92 healthy adults were taken the timed balance tests under differential stance including①standard Romberg test,②feet apart stance test,③tandem stance (TS) and④unilateral standing (US) tests with eye open (EO) and eye closed (EC). The average timing that subjects kept balance before falling under different standing conditions was recorded by stopwatch. The body sway velocity (SV) during the test①and②were also recorded by the SPG.
Results The time of keeping balance under TS and US with EO and EC in the UVH group is decreased (P<0.001) compared with the control group. The SV under standard Romberg test and foot apart stance with EO was not different between the UVH group and control group (P-value was 0.118 and 0.110 for the two test respectively), and the difference was significant while with EC condition (P<0.001). For two groups, the SV under foot apart was decreased than under standard Romberg test with EO and EC (P<0.05 or P<0.001). The timed results under both TS and US and SV under both the standard Romberg test and the feet apart stance did not correlated for the two groups.
Conclusions According to clinical assessment of balance function in UVH, the tandem stance test and unilateral stance test could provide the additional information to the SPG measurement. The effect of foot position on the results of SPG should been considered in clinic.
PartⅡPostural characteristics of healthy subjects under different thickness of foam
Objective To investigate the effects of different thickness of foam on the postural control of standing in healthy subjects.
Methods 30 healthy adult subjects(11 males,19 females)were taken into examination of computerized posturography measurement under different surface conditions including the firm surface and 1 to 5 layer foams of medium density with 4.7cm high respectively in stance of feet together with eye open (EO) and eye closed (EC) for 30 seconds. The following time-dominated parameters regarding to the center of pressure (COP) movement were used to evaluate the postural stability: whole path length (WPL), unit path length (UPL) which means the sway velocity of the COP movement, unit area path length (UAPL), circumference area (CA), effective value area (EVA) and rectangle areas (RA).
Results All parameters have the increased tendency when the layer of foam is added with both eye open and closed conditions except the UAPL, which has a decreased tendency. The parameters under differential layer foam were significance(P<0.05)except the following conditions:①WPL and UPL under layer 4 to 5 with EO and EC;②UAPL under layer 0 to 1, layer 1 to 3, layer 2 to 3, layer 3 to 4, layer 4 to 5 with EO, layer 3 to 4, layer 3 to 5 and layer 4 to 5 with EC,③CA under layer 2 to 3, layer 3 to 4, layer 4 to 5 with EO, layer 3 to 4, layer 3 to 5, layer 4 to 5 with EC;④RA and EVA under layer 2 to 3, layer 4 to 5 with EO, layer 3 to 4, layer 3 to 5, layer 4 to 5 with EC.
Conclusions The whole path and velocity of movement of COP is the stable and sensitivity parameters to evaluate the postural stability under foam by the posturography. It is important that the thickness of foam should be considered for interrupting the proprioception during the sensory interaction test in clinical.
PartⅢThe modified clinical test of sensory interaction and balance under difference surface conditions in patients with vertigo
Objective To investigate the influence of different surface condition on the modified clinical test of sensory interaction and balance (mCTSIB) in the patients with vertigo.
Method 33 patients with vertigo were taken into examination of computerized posturography measurement under different surface conditions such as the hard surface and 1 to 5 layer foams of medium density with 4.7cm high respectively in stance of feet together with eye open and eye closed for 30 seconds. The interval between two trials was 2 to 3 minutes for enough relaxation. The time-dominated parameter of unit path length (UPL), which means the average sway velocity(SV) of the center of pressure (COP) movement with different surface conditions were used for the analysis. The timing that subjects keeping balance without falling was recorded.
Results①The SV has the increased tendency when the layer of foam was added with both eye open and closed conditions. The difference of the SV between the hard surface and 1 to 4 layer foam respectively are significanc(eP<0.0001)with eye open and closed. The SV has not different while standing in the 4th and 5th layer foam with both eye open and closed because the P value were 0.0503 and 0.3422 for this two conditions respectively. The SV with eye closed and the thickness of foam was negative correlation(r=0.67765,P<0.0001).②The timing that subjects keeping balance without falling has the decreased tendency when the layer of foam was added with eye closed. The timing and the thickness of foam was negative correlation(r=-0.35565,P<0.0001). According to the absolute value of the correlate coefficients, the SV was sensitive to the change of thickness of foam than the timing with eye closed. The SV and timing in eye closed condition was negative correlation(r=-0.40137,P<0.0001).③According to the case of fall under different thick foam with eye close, there are significant differences(P<0.001)between the 1 layer and the 2 to 5 layer, while the cases of fall under 2 to 5 layer are not statistical difference(P>0.5).
Conclusions The different thick foam can affect the results of mCTSIB including the SV with both eye conditions and timing with eye close. Through quantitative measurement the sensory interaction in patients with vertigo.
PartⅣThe application of mCTSIB in the clinical
Objective To investigate the application of foam posturography (FPG) in the normal subjects and patients with vertigo. The mechanisms of sensory interaction in the postural control in the normal and patients with vertigo were also discussed.
Methods 106 normal subjects and patients with vertigo individually were taken the computerized posturography under the firm surface and foam surface with eye open and eye closed for 30 seconds respectively. The standing foam surface was to interrupt the somatosensory and closing eyes was to interrupt the visual input in the postural stability. The sway velocity (SV) of body under different sensory conflict condition was recorded as parameter of postural stability and the effect of organization between the vestibular, visions and somatosensory was analyzed quantitatively. The patients with vertigo were also taken the videonystagmography (VNG).
Results (1) For the normal subjects,①the SV decreased when the visual cue or/and somatosensory cue be interrupted (P<0.0001).②The decreased degrees of SV induced by the change of visual cue were (12.12±6.1)and (30.58±9.69)% when the somatosensory cue be interrupted or not. The decreased degrees of SV induced by the change of somatosensory cue were (18.31±6.56)and (36.25±8.90)% when the visual cue be interrupted or not. The decreased degrees of SV induced by the change of both somatosensory and visual cue were (46.21±8.67)%.③The most important sensory input for keeping balance is vestibular cue and following by the somatosensory and visual cues and the relationship among these three sensory is non-line. (2) For the patients with vertigo,①The abnormality rate of VNG in the vestibular periphery and central disorder was 67.74% and 22.73%, which has a significant difference between this two kind disorders (χ~2=20.867,P<0.001).②When the abnormality of FPG was assessed by the falling and SV, the abnormality rate of FPG in the vestibular periphery and central disorder was 58.06% and 40.91%, which has not a significant difference between this two kind disorders(χ~2=3.031,P=0.082).③When the abnormality of FPG was assessed only by the falling, the abnormality rate of FPG in the vestibular periphery and central disorder was 45.16% and 27.27%, which has not a significant difference between this two kind disorders (χ~2=3.505,P=0.061).④There were four types abnormality of sensory organization including the only T4 abnormality, T2+T4 abnormality, T3+T4 abnormality and T2+T3+T4 abnormality. The difference of constituent ratio of this four types abnormality between the peripheral and centeral vertigo disorder was not significant (χ~2=2.838, P=0.417).
Conclusions Through recording the postural stability quantitatively under different conditions of sensory conflict induced by standing foam surface or closing eyes, it is possible to evaluate the sensory organization of the three kinds of sensory input including the visual, somatosensory, and vestibular input in postural control. It exist the various balance strategy for keeping postural stability under sensory conflict in normal subjects. When one or two sensory input was interrupted in the static balance, the center nervous system has a complicated mechanism of sensory organization to keep balance even in the normal subject. The abnormality of the FPG and the categorization of abnormality of sensory interaction could not differentiate the vestibular periphery and central disorder. But this method can assess the posture control strategy of the patients with vertigo, and the results about the sensory interaction can guide the vestibular rehabilitation therapy in the patients with vertigo.
PartⅤThe effect of the head extension on the postural stability in the normal subjects
Objective To investigate the effect of head extension on the postural stability in the healthy young subjects.
Methods 34 healthy young subjects were taken in the posturography including four conditions, such as (1) firm surface and head erected; (2) firm surface and head extension; (3) foam surface and head erected; (4) foam surface and head extension. Each condition was tested under eye open and closed. The body sway velocity (SV) was analyzed.
Results (1) SV under foam surface was greater than those under firm surface with EO (t=15.484,P<0.001) and EC (t=19.302,P<0.001) when the head was in the erected position. (2) The difference of SV between the head erect and head extension was not significance without the surface is firm or foam when the eye was open. While under eye close condition, The SV with head extension was greater than that with head erect under two surface conditions. (3) The body sway increase ratio under foam surface was greater than that under firm surface when the head was put in the extension with eye close (t=5.757, P<0.001).
Conclusion: The postural stability decreased when the head is put in extended orientation in static standing with eye closed in normal individuals. Head extension may increases the reliance on the proprioceptive input.
PartⅥEffect of somatosensory input in postural stability with head extension
Objective To investigate the role of somatosensory in the postural stability during the head extension in healthy young subjects.
Methods 42 healthy young subjects were taken the posturography under six conditions that the standing surfaces were firm and foam of two kind height while the head put in upright and extension. The postural stability was recorded as sway velocity (SV) and sway area (SA) under eye open (EO) and eye closed (EC) respectively. The body-sway increase ratio when the head put extended orientation between differential surfaces was also analyzed.
Results (1) For the SA and SV between the head-erected and head-extension under differential surface and visual condition, the body sway was not significant difference with EO under all surface, while the body sway under head-extension were greater than that under head-erected with EC under three kinds of surface. (2) For the BIR under differential standing surface with EC, the difference between the firm surface and 2 layer foams were not significance for the SA and SV, while the BIR under 4 layer foams was great than those under firm and 2 layer foams standing surface for the SA and SV.
Conclusion The head extension increases the reliance on the proprioceptive input. While the head put in the extension orientation, the greater interruption for the proprioceptive input, the worse postural stability.
PartⅦPostural instability induced by the head extension in the patients with unilateral peripheral vestibular disorder
Objective To investigate the postural instability induced by the differential head orientation while interrupting the proprioceptive input with standing foam in the unilateral peripheral vestibular disorder (uPVD).
Methods 28 patients with uPVD were taken in the posturography including four conditions, such as (1) firm surface and head erected; (2) firm surface and head extension; (3) foam surface and head erected; (4) foam surface and head extension. Each condition was tested under eye open and closed. The body sway velocity (SV) was analyzed.
Results (1) There were not falling in the test of standing on the firm surface. The SV had not significant different between the head erect and head extension with eyes open (t=0.043, P=0.966), while there were significant difference with eyes closed (t=4.735, P<0.001). (2) There were not falling in the test of standing on the firm surface with eyes open, and the SV did not showed difference between two head position (t=1.113, P=0.275). (3) In the foam standing with eyes closed, there were 4 cases of falling when the head was erect. While in the head extension, there were 6 cases of falling in three trials and 2 cases in the one trial. The SV showed significant difference between two head position (t=3.015, P=0.007). The difference of falling cases between head erect and head extension was not significant (χ~2=1.693, P=0.193). (4) For the body sway increase ratio induced by the head extension with eyes closed, there was not significant difference between the firm and foam surface (t=2.036, P=0.055).
Conclusions The postural stability decreased with the eyes closed in the patients with uPVD, which was consisted with that of the normal subjects. It indicated that the posturography with the head extension may not an ideal method to differentiate the compensated patients with uPVD from the normal subjects.
PartⅧEffect of canal repositioning procedure on the postural stability in patients with benign paroxysmal positional vertigo
Objective To investigate the effect of canal repositioning procedure (CRP) on the postural stability in patients with benign paroxysmal positional vertigo of the posterior canal (BPPV-PC) of the posterior semicircular canal.
Methods 25 patients with BPPV-PC were taken the posturography before and after the CRP. The posturography test including four conditions, such as (1) firm surface with eyes open (EO); (2) firm surface with eyes closed (EC); (3) foam surface with EO; (4) foam surface with EO. The body sway velocity (SV) recorded by the posturography was analyzed as parameter of postural stability. The postural stability of the patients with BPPV-PC was compared with the matched control group.
Results①The SV of the BPPV-PC patients before the CRP was greater than that of control group (P<0.05 or P<0.001).②For the BPPV-PC patients, the SV showed decrease after the CRP except that test condition 1 (firm surface with EO).③There were not differences of the SV between the BPPV-PC patients after the CRP and the control group in the test with the firm surface (PEO=0.178, PEC=0.055), while there were still differences in the test with foam surface (PEO=0.004, PEC=0.029).
Conclusions A deficit of postural stability was presented in the patients with BPPV-PC decreased. Treatment of BPPV-PC by the CRP can result in improved postural stability in the patients with BPPV-PC, but there was still somewhat difference compared with the normal subjects.
目的观察单侧前庭功能低下(unilateral vestibular hypofunction, UVH)患者的计时平衡试验和静态姿势描记(static posturography, SPG),探讨两种方法的临床应用价值。
方法65例UVH患者和92例健康者进行如下静态直立试验:①标准Romberg试验;②双脚平行分开直立试验;③强化Romberg试验(踵趾足位站立);④单足直立试验。每种测试条件下分别睁眼和闭眼站立,用秒表记录①~④试验中维持平衡的时间,同时用SPG记录①、②条件下的身体晃动平均速度(sway velocity, SV)。
结果①计时平衡试验:UVH组采取踵趾位和单足站立时,维持平衡时间较对照组降低,差异均有极显著性意义(P值均<0.001);②SPG:采用标准Romberg位和双脚分开站立,UVH组和对照组相比,睁眼时两组SV差异无显著性意义(P值分别是0.118和0.110)。而闭眼时,两组间差异均有统计学意义(P值均<0.001);③对于UVH组和对照组,无论睁眼或闭眼,采用双脚分开站立时,SV均较标准Romberg位时降低,差异有显著性意义(P值均<0.05),或极显著性意义(P值<0.001);④两组受试者踵趾位和单足站立时的各计时结果与其标准Romberg站立和双足分开站立时的各SV间未发现有相关性(P值均大于0.05)。
结论评估UVH患者平衡功能时,踵趾位和单足直立计时平衡试验是对SPG试验的补充,两种方法可在临床中结合应用;进行SPG试验时,应考虑足位因素对测试结果的影响。
实验二:正常人直立于不同厚度海绵垫时的姿势特征
目的探讨正常人直立于不同厚度海绵垫时的静态姿势特征。
方法30名正常人分别站立于坚硬平板以及不同厚度的中等密度海绵垫上,海绵块数依次从1块到5块,每块厚度4.7cm。每种站立面条件下,睁眼和闭眼各站立30秒,应用姿势描记仪记录人体姿势稳定性参数,包括:总轨迹长、单位轨迹长即平均速度、单位面积轨迹长、外周面积、实效值面积、矩形面积。
结果(1)所有参数在睁眼和闭眼条件下均有随海绵垫厚度增加而变化趋势(P <0.0001),除单位面积轨迹长呈减少趋势外,其余参数均为增加趋势;(2)比较各参数在不同海绵块数之间的差异,大部分差异有显著性(P<0.05)或极显著性意义(P<0.01),出现无显著性意义(P>0.05)的情况有:①总轨迹长和平均速度:睁眼及闭眼时,4-5块之间;②单位面积轨迹长:睁眼时,0-1、1-3、2-3、3-4、4-5块之间;闭眼时,3-4、3-5、4-5块之间;③外周面积:睁眼时2-3、3-4、4-5块之间;闭眼时,3-4、3-5、4-5块之间;④实效值面积和矩形面积:睁眼时2-3、4-5块之间;闭眼时,3-4、3-5、4-5块之间。
结论人体站立于不同厚度海绵垫时,诸多静态平衡参数中,总轨迹长和平均速度的稳定性和敏感性均优于其它参数,是较理想的描述姿势稳定性的指标;应用海绵垫对直立人体本体觉进行干扰时,应考虑海绵垫厚度对结果的影响,选择适宜的厚度,以提高其临床应用价值。
实验三:海绵厚度对眩晕患者mCTSIB不同测试参数的影响
目的通过眩晕患者在不同厚度海绵垫上进行感觉相互作用和平衡的临床改良试验(modified clinical test of sensory interaction and balance, mCTSIB),探讨本体感觉不同减弱程度对该试验的影响以及不同观测指标对海绵垫厚度变化的敏感性。
方法33名眩晕患者站立于姿势描记仪进行mCTSIB,足底站立平面依次是坚硬平板和不同厚度的中等密度海绵垫(分别是1到5块,每块厚度4.7cm),睁眼和闭眼条件下各站立30秒。记录:①倾倒的发生;②维持平衡的站立时间;③未发生倾倒时,姿势图仪记录人体重心晃动的平均速度(sway velocity, SV)。
结果①睁眼时无倾倒发生,对于闭眼时不同海绵垫块数下倾倒发生例数,第1块与第2、3、4、5块之间的差异有统计学意义(P<0.001),而后四块之间差异无显著性意义(P>0.5);②维持平衡时间:睁眼时各厚度海绵垫之间差异无显著性意义。闭眼时,站立时间随着海绵垫块数的增加有减少趋势,二者呈负相关(r=-0.3557,P<0.0001),但第0、1块间(F=3.64,P=0.0653)、第2、3块间(F=0.27,P=0.6102)、第4、5块间(F=0.14,P=0.7084)差异无显著性意义,其余块数之间有统计学差异(P<0.05);③睁眼和闭眼时,随着海绵垫块数的增加,SV有增加的趋势。海绵垫块数分别为0,1,2,3,4时SV值两两之间比较均有统计学差异(P<0.0001),第5块与块数为0,1,2,3时的SV值之间差异有显著性意义(P<0.001),但与第4块间没有统计学差异(P睁眼=0.0503,P闭眼=0.3422);海绵垫的块数与闭眼时SV之间呈正相关(r=0.67765,P<0.0001)。从相关系数绝对值分析,闭眼时SV对海绵厚度变化较站立时间敏感。
结论不同厚度海绵垫对眩晕患者mCTSIB结果有影响;定量测量身体重心晃动速度可较敏感地反映眩晕患者在不同本体感觉减弱程度下的姿势平衡特征,其次是计时平衡测量。
实验四:感觉相互作用和平衡的临床改良试验的临床应用
目的探讨海绵垫干扰本体觉结合定量测量姿势平衡的方法在正常人及眩晕患者中的应用,并分析正常人和眩晕患者姿势平衡中的感觉相互作用机制。
方法各106例正常人和眩晕患者进行海绵姿势描记(foam posturography, FPG)检查,受试者站立以下四种感觉条件下,T1:睁眼站立于坚硬平板;T2:闭眼战立于坚硬平板;T3:睁眼站立于海绵;T4:闭眼站立于海绵。对各站立条件下人体站立时足底压力中心的晃动速度(sway velocity, SV)进行定量测量。如有跌倒则记录不同感觉条件瞎跌倒发生的例数。同时对眩晕患者进行视频眼震图仪(videonystagmography, VNG)检查。
结果(1)对正常人而言:①在视觉或/和本体觉受到干扰时,SV均增加,其差异有极显著性意义(P<0.0001);②当本体觉未被干扰及被干扰时,视觉条件的变化引起SV增加程度分别是(12.12±6.19)和(30.58±9.69)%;当视觉条件未被干扰及被干扰时,本体觉变化导致的SV增加程度分别是(18.31±6.56)和(36.25±8.90)%;而当视觉和本体觉同时受到干扰时,SV增加程度是(46.21±8.67)%;③在姿势平衡中起作用较大的是前庭觉,其次是本体觉和视觉,三者呈非线形关系。(2)对患者而言:①在前庭末梢和中枢性病变中,VNG的异常率分别是67.74%和22.73%,两种病变中的VNG差异有显著性意义(χ2=20.867,P<0.001);②同时以SV异常和跌倒为参数分析FPG异常率,在前庭末梢和中枢性病变中分别为58.06%和40.91%,两种病变中的VNG差异无显著性意义(χ2=3.031,P=0.082);③只以跌倒为参数,在前庭末梢和中枢性病变中分别为45.16%和27.27%,两种病变中的VNG差异无显著性意义(χ2=3.505,P=0.061);④进一步分析106例患者感觉整合试验结果异常的分布,发现根据出现结果异常的感觉条件,共分为四种类型:A:只有T4异常;B:T2+T4异常;C:T3+T4异常;D:T2+T3+T4异常。四种感觉整合异常模式在末梢和中枢性眩晕患者中的构成比差异并无统计学意义(χ2=2.838, P=0.417)。
结论①利用海绵垫干扰本体觉,结合姿势描记可以记录不同感觉条件下姿势稳定性,并可定量分析视觉、本体觉和前庭觉在姿势平衡中的整合作用;②人体维持平衡过程中,应用三种外周感觉的姿势策略差异较大。当一种或两种外周感觉信息被干扰时,中枢神经系统为维持姿势稳定,存在复杂的感觉整合机制;③海绵姿势描记的异常和感觉整合的异常分类并不能做为鉴别前庭末梢和前庭中枢疾病的方法。但该方法可以初步了解眩晕患者在姿势平衡中应用的不同平衡策略,可望用以指导患者进行个性化庭康复治疗。
实验五:头部后仰对正常人姿势稳定性的影响
目的探讨头部后仰对正常人姿势稳定性的影响。
方法34名健康青年人进行四种站立条件下的姿势描记仪检查,分别为:①站立于坚硬平板、头部直立;②坚硬平板、头部后仰50~55°;③海绵垫、头部直立;④海绵垫、头部后仰50~55°。每种条件下分别测试睁眼和闭眼时的姿势稳定性,采用身体重心晃动速度(sway velocity, SV)为研究参数。
结果①头部直立时,站立海绵垫时与站立坚硬平板下身体重心SV比较,睁眼时(t=15.484,P<0.001)和闭眼时(t=19.302,P<0.001)均有显著增加。②睁眼时,在两种站立平面上,头部直立和后仰时SV间比较差异无显著性意义(坚硬平板和海绵垫平面上的P值分别是0.083和0.616);而闭眼时,无论站立平面条件如何,头部后仰时SV均显著高于头部处于直立位时(P值均小于0.001);③就闭眼时头部后仰引起的SV增加程度而言,站立海绵垫时的增加程度高于站立于坚硬平板上(t=5.757,P<0.001)。
结论正常青年人闭眼同时头部后仰可使姿势稳定性降低,且头部后仰可能使机体对本体觉的依赖增加。
实验六:本体觉在头部后仰姿势平衡中的作用
目的探讨正常青年进行感觉相互作用试验时,不同本体觉干扰程度对头部后仰姿势平衡的影响。
方法42名健康青年人进行六种条件下的姿势图仪检查,分别为:①站立于坚硬平板、头部直立;②坚硬平板、头部后仰;③两层海绵垫、头部直立;④两层海绵垫、头部后仰;⑤四层海绵垫、头部直立;⑥四层海绵垫、头部后仰。每层海绵垫的厚度为4.7 cm,头部后仰的角度是50°～55°。每种条件下分别测试睁眼和闭眼时的姿势稳定性。采用身体重心晃动速度(sway velocity, SV)和外周面积(sway area, SA)为研究参数,并比较不同站立平面下头部后仰产生的身体晃动增加比率(body-sway increase ratio, BIR)。
结果①不同站立条件下头部直立和后仰时重心晃动的SV和SA比较结果均表明,无论站立平面条件如何,睁眼时头部直立和后仰时重心晃动的差异无显著性意义;而闭眼时头部后仰时重心晃动SA和SV均高于头部处于直立位,差异有极显著性意义。②对于闭眼时不同站立条件下的BIR, SA和SV的结果表明:对于站立于坚硬平板和2层海绵上,闭眼时头部后仰导致的BIR而言,差异没有显著性意义;而站立于4层海绵上,闭眼时头部后仰产生的BIR显著高于前两种站立平面的BIR。
结论正常人进行感觉相互作用试验时,睁眼时头部后仰不能使姿势稳定性降低,闭眼时头部后仰对姿势稳定性的影响倚赖于本体觉受到干扰程度。对本体觉干扰程度越大,姿势稳定性降低程度越大。人体闭眼头部后仰时,为维持平衡,对本体觉的依赖增加。
实验七:单侧外周前庭病变患者头部后仰导致的姿势稳定性改变
目的探讨应用海绵干扰本体觉条件下,头部后仰对单侧外周前庭病变(unilateral peripheral vestibular disorder, uPVD)患者姿势稳定性的影响。
方法28名uPVD患者进行四种站立条件下的姿势描记仪检查,分别为:①站立于坚硬平板、头部直立;②坚硬平板、头部后仰50~55°;③海绵垫、头部直立;④海绵垫、头部后仰50~55°。每种条件下分别测试睁眼和闭眼时的姿势稳定性,采用身体直立时足底压力中心的晃动速度(sway velocity, SV)为研究参数。
结果①站立坚硬平板测试时均无跌倒发生。睁眼时,头部后仰与直立时比较,SV差异无显著性意义(t=0.043,P=0.966);而闭眼时,不同头位间SV差异有显著性意义(t=4.735,P<0.001);②站立海绵垫时,睁眼条件下,所有测试者均无跌倒,头部后仰与直立时比较,SV差异无显著性意义(t=1.113,P=0.275);③站立海绵垫时,闭眼条件下,头部直立时有4名患者在三次测试中均跌倒。头部后仰时有6名患者在3次测试中均跌倒,有2名患者在第1次测试中跌倒(第2次未跌倒)。不同头位间SV差异有显著性意义(t=3.015,P=0.007);两种头位下,跌倒次数比较无显著性差异(χ2=1.693,P=0.193);④就闭眼时头部后仰引起的SV增加程度而言,站立海绵上与站立于坚硬平板上间无统计学差异(t=2.036,P=0.055)。
结论uPVD患者闭眼时头部后仰可使姿势稳定性降低,这种降低发生条件与正常人有一致性。提示头部后仰姿势描记可能不是鉴别区分已代偿uPVD患者和正常人平衡能力的理想方法。
实验八:耳石复位治疗对良性阵发性位置性眩晕患者姿势稳定性的影响
目的探讨耳石复位治疗(canal repositioning procedure, CRP)对后半规管良性阵发性位置性眩晕(benign paroxysmal positional vertigo , BPPV)患者姿势稳定性的影响。
方法25名确诊为后半规管BPPV患者在CRP前后进行四种感觉条件下的姿势稳定性测量,分别是:(T1)坚硬平板、睁眼;(T2)坚硬平板、闭眼;(T3)海绵平面、睁眼;(T4)海绵平面、闭眼。并与配对的25名正常人姿势稳定性比较。采用身体直立时足底压力中心的晃动速度(sway velocity, SV)为研究参数。
结果①CRP前BPPV组身体晃动SV均较正常组增加,差异有统计学意义(P<0.05或P<0.001);②BPPV组除T1外(P=0.083),CRP后身体晃动SV较治疗前降低,差异间有统计学意义(P<0.05或P<0.001);③BPPV组CRP后的姿势稳定性与正常组间,站立坚硬平板上的SV间比较,差异无显著性意义(P睁眼=0.178;P闭眼=0.055);而站立海绵上的SV间比较,差异有显著性意义(P睁眼=0.004;P闭眼=0.029)。
结论后半规管BPPV患者的姿势稳定性可降低,CRP可使其姿势平衡得到一定程度的提高,但与正常人仍有一定差异。
PartⅠThe timed balance test and static posturography in the patients with unilateral vestibular hypofunction
Objective To investigate the balance function of the patients with unilateral vestibular hypofunction (UVH) by timed balance tests and static posturography (SPG).
Methods 65 subjects with UVH and 92 healthy adults were taken the timed balance tests under differential stance including①standard Romberg test,②feet apart stance test,③tandem stance (TS) and④unilateral standing (US) tests with eye open (EO) and eye closed (EC). The average timing that subjects kept balance before falling under different standing conditions was recorded by stopwatch. The body sway velocity (SV) during the test①and②were also recorded by the SPG.
Results The time of keeping balance under TS and US with EO and EC in the UVH group is decreased (P<0.001) compared with the control group. The SV under standard Romberg test and foot apart stance with EO was not different between the UVH group and control group (P-value was 0.118 and 0.110 for the two test respectively), and the difference was significant while with EC condition (P<0.001). For two groups, the SV under foot apart was decreased than under standard Romberg test with EO and EC (P<0.05 or P<0.001). The timed results under both TS and US and SV under both the standard Romberg test and the feet apart stance did not correlated for the two groups.
Conclusions According to clinical assessment of balance function in UVH, the tandem stance test and unilateral stance test could provide the additional information to the SPG measurement. The effect of foot position on the results of SPG should been considered in clinic.
PartⅡPostural characteristics of healthy subjects under different thickness of foam
Objective To investigate the effects of different thickness of foam on the postural control of standing in healthy subjects.
Methods 30 healthy adult subjects(11 males,19 females)were taken into examination of computerized posturography measurement under different surface conditions including the firm surface and 1 to 5 layer foams of medium density with 4.7cm high respectively in stance of feet together with eye open (EO) and eye closed (EC) for 30 seconds. The following time-dominated parameters regarding to the center of pressure (COP) movement were used to evaluate the postural stability: whole path length (WPL), unit path length (UPL) which means the sway velocity of the COP movement, unit area path length (UAPL), circumference area (CA), effective value area (EVA) and rectangle areas (RA).
Results All parameters have the increased tendency when the layer of foam is added with both eye open and closed conditions except the UAPL, which has a decreased tendency. The parameters under differential layer foam were significance(P<0.05)except the following conditions:①WPL and UPL under layer 4 to 5 with EO and EC;②UAPL under layer 0 to 1, layer 1 to 3, layer 2 to 3, layer 3 to 4, layer 4 to 5 with EO, layer 3 to 4, layer 3 to 5 and layer 4 to 5 with EC,③CA under layer 2 to 3, layer 3 to 4, layer 4 to 5 with EO, layer 3 to 4, layer 3 to 5, layer 4 to 5 with EC;④RA and EVA under layer 2 to 3, layer 4 to 5 with EO, layer 3 to 4, layer 3 to 5, layer 4 to 5 with EC.
Conclusions The whole path and velocity of movement of COP is the stable and sensitivity parameters to evaluate the postural stability under foam by the posturography. It is important that the thickness of foam should be considered for interrupting the proprioception during the sensory interaction test in clinical.
PartⅢThe modified clinical test of sensory interaction and balance under difference surface conditions in patients with vertigo
Objective To investigate the influence of different surface condition on the modified clinical test of sensory interaction and balance (mCTSIB) in the patients with vertigo.
Method 33 patients with vertigo were taken into examination of computerized posturography measurement under different surface conditions such as the hard surface and 1 to 5 layer foams of medium density with 4.7cm high respectively in stance of feet together with eye open and eye closed for 30 seconds. The interval between two trials was 2 to 3 minutes for enough relaxation. The time-dominated parameter of unit path length (UPL), which means the average sway velocity(SV) of the center of pressure (COP) movement with different surface conditions were used for the analysis. The timing that subjects keeping balance without falling was recorded.
Results①The SV has the increased tendency when the layer of foam was added with both eye open and closed conditions. The difference of the SV between the hard surface and 1 to 4 layer foam respectively are significanc(eP<0.0001)with eye open and closed. The SV has not different while standing in the 4th and 5th layer foam with both eye open and closed because the P value were 0.0503 and 0.3422 for this two conditions respectively. The SV with eye closed and the thickness of foam was negative correlation(r=0.67765,P<0.0001).②The timing that subjects keeping balance without falling has the decreased tendency when the layer of foam was added with eye closed. The timing and the thickness of foam was negative correlation(r=-0.35565,P<0.0001). According to the absolute value of the correlate coefficients, the SV was sensitive to the change of thickness of foam than the timing with eye closed. The SV and timing in eye closed condition was negative correlation(r=-0.40137,P<0.0001).③According to the case of fall under different thick foam with eye close, there are significant differences(P<0.001)between the 1 layer and the 2 to 5 layer, while the cases of fall under 2 to 5 layer are not statistical difference(P>0.5).
Conclusions The different thick foam can affect the results of mCTSIB including the SV with both eye conditions and timing with eye close. Through quantitative measurement the sensory interaction in patients with vertigo.
PartⅣThe application of mCTSIB in the clinical
Objective To investigate the application of foam posturography (FPG) in the normal subjects and patients with vertigo. The mechanisms of sensory interaction in the postural control in the normal and patients with vertigo were also discussed.
Methods 106 normal subjects and patients with vertigo individually were taken the computerized posturography under the firm surface and foam surface with eye open and eye closed for 30 seconds respectively. The standing foam surface was to interrupt the somatosensory and closing eyes was to interrupt the visual input in the postural stability. The sway velocity (SV) of body under different sensory conflict condition was recorded as parameter of postural stability and the effect of organization between the vestibular, visions and somatosensory was analyzed quantitatively. The patients with vertigo were also taken the videonystagmography (VNG).
Results (1) For the normal subjects,①the SV decreased when the visual cue or/and somatosensory cue be interrupted (P<0.0001).②The decreased degrees of SV induced by the change of visual cue were (12.12±6.1)and (30.58±9.69)% when the somatosensory cue be interrupted or not. The decreased degrees of SV induced by the change of somatosensory cue were (18.31±6.56)and (36.25±8.90)% when the visual cue be interrupted or not. The decreased degrees of SV induced by the change of both somatosensory and visual cue were (46.21±8.67)%.③The most important sensory input for keeping balance is vestibular cue and following by the somatosensory and visual cues and the relationship among these three sensory is non-line. (2) For the patients with vertigo,①The abnormality rate of VNG in the vestibular periphery and central disorder was 67.74% and 22.73%, which has a significant difference between this two kind disorders (χ~2=20.867,P<0.001).②When the abnormality of FPG was assessed by the falling and SV, the abnormality rate of FPG in the vestibular periphery and central disorder was 58.06% and 40.91%, which has not a significant difference between this two kind disorders(χ~2=3.031,P=0.082).③When the abnormality of FPG was assessed only by the falling, the abnormality rate of FPG in the vestibular periphery and central disorder was 45.16% and 27.27%, which has not a significant difference between this two kind disorders (χ~2=3.505,P=0.061).④There were four types abnormality of sensory organization including the only T4 abnormality, T2+T4 abnormality, T3+T4 abnormality and T2+T3+T4 abnormality. The difference of constituent ratio of this four types abnormality between the peripheral and centeral vertigo disorder was not significant (χ~2=2.838, P=0.417).
Conclusions Through recording the postural stability quantitatively under different conditions of sensory conflict induced by standing foam surface or closing eyes, it is possible to evaluate the sensory organization of the three kinds of sensory input including the visual, somatosensory, and vestibular input in postural control. It exist the various balance strategy for keeping postural stability under sensory conflict in normal subjects. When one or two sensory input was interrupted in the static balance, the center nervous system has a complicated mechanism of sensory organization to keep balance even in the normal subject. The abnormality of the FPG and the categorization of abnormality of sensory interaction could not differentiate the vestibular periphery and central disorder. But this method can assess the posture control strategy of the patients with vertigo, and the results about the sensory interaction can guide the vestibular rehabilitation therapy in the patients with vertigo.
PartⅤThe effect of the head extension on the postural stability in the normal subjects
Objective To investigate the effect of head extension on the postural stability in the healthy young subjects.
Methods 34 healthy young subjects were taken in the posturography including four conditions, such as (1) firm surface and head erected; (2) firm surface and head extension; (3) foam surface and head erected; (4) foam surface and head extension. Each condition was tested under eye open and closed. The body sway velocity (SV) was analyzed.
Results (1) SV under foam surface was greater than those under firm surface with EO (t=15.484,P<0.001) and EC (t=19.302,P<0.001) when the head was in the erected position. (2) The difference of SV between the head erect and head extension was not significance without the surface is firm or foam when the eye was open. While under eye close condition, The SV with head extension was greater than that with head erect under two surface conditions. (3) The body sway increase ratio under foam surface was greater than that under firm surface when the head was put in the extension with eye close (t=5.757, P<0.001).
Conclusion: The postural stability decreased when the head is put in extended orientation in static standing with eye closed in normal individuals. Head extension may increases the reliance on the proprioceptive input.
PartⅥEffect of somatosensory input in postural stability with head extension
Objective To investigate the role of somatosensory in the postural stability during the head extension in healthy young subjects.
Methods 42 healthy young subjects were taken the posturography under six conditions that the standing surfaces were firm and foam of two kind height while the head put in upright and extension. The postural stability was recorded as sway velocity (SV) and sway area (SA) under eye open (EO) and eye closed (EC) respectively. The body-sway increase ratio when the head put extended orientation between differential surfaces was also analyzed.
Results (1) For the SA and SV between the head-erected and head-extension under differential surface and visual condition, the body sway was not significant difference with EO under all surface, while the body sway under head-extension were greater than that under head-erected with EC under three kinds of surface. (2) For the BIR under differential standing surface with EC, the difference between the firm surface and 2 layer foams were not significance for the SA and SV, while the BIR under 4 layer foams was great than those under firm and 2 layer foams standing surface for the SA and SV.
Conclusion The head extension increases the reliance on the proprioceptive input. While the head put in the extension orientation, the greater interruption for the proprioceptive input, the worse postural stability.
PartⅦPostural instability induced by the head extension in the patients with unilateral peripheral vestibular disorder
Objective To investigate the postural instability induced by the differential head orientation while interrupting the proprioceptive input with standing foam in the unilateral peripheral vestibular disorder (uPVD).
Methods 28 patients with uPVD were taken in the posturography including four conditions, such as (1) firm surface and head erected; (2) firm surface and head extension; (3) foam surface and head erected; (4) foam surface and head extension. Each condition was tested under eye open and closed. The body sway velocity (SV) was analyzed.
Results (1) There were not falling in the test of standing on the firm surface. The SV had not significant different between the head erect and head extension with eyes open (t=0.043, P=0.966), while there were significant difference with eyes closed (t=4.735, P<0.001). (2) There were not falling in the test of standing on the firm surface with eyes open, and the SV did not showed difference between two head position (t=1.113, P=0.275). (3) In the foam standing with eyes closed, there were 4 cases of falling when the head was erect. While in the head extension, there were 6 cases of falling in three trials and 2 cases in the one trial. The SV showed significant difference between two head position (t=3.015, P=0.007). The difference of falling cases between head erect and head extension was not significant (χ~2=1.693, P=0.193). (4) For the body sway increase ratio induced by the head extension with eyes closed, there was not significant difference between the firm and foam surface (t=2.036, P=0.055).
Conclusions The postural stability decreased with the eyes closed in the patients with uPVD, which was consisted with that of the normal subjects. It indicated that the posturography with the head extension may not an ideal method to differentiate the compensated patients with uPVD from the normal subjects.
PartⅧEffect of canal repositioning procedure on the postural stability in patients with benign paroxysmal positional vertigo
Objective To investigate the effect of canal repositioning procedure (CRP) on the postural stability in patients with benign paroxysmal positional vertigo of the posterior canal (BPPV-PC) of the posterior semicircular canal.
Methods 25 patients with BPPV-PC were taken the posturography before and after the CRP. The posturography test including four conditions, such as (1) firm surface with eyes open (EO); (2) firm surface with eyes closed (EC); (3) foam surface with EO; (4) foam surface with EO. The body sway velocity (SV) recorded by the posturography was analyzed as parameter of postural stability. The postural stability of the patients with BPPV-PC was compared with the matched control group.
Results①The SV of the BPPV-PC patients before the CRP was greater than that of control group (P<0.05 or P<0.001).②For the BPPV-PC patients, the SV showed decrease after the CRP except that test condition 1 (firm surface with EO).③There were not differences of the SV between the BPPV-PC patients after the CRP and the control group in the test with the firm surface (PEO=0.178, PEC=0.055), while there were still differences in the test with foam surface (PEO=0.004, PEC=0.029).
Conclusions A deficit of postural stability was presented in the patients with BPPV-PC decreased. Treatment of BPPV-PC by the CRP can result in improved postural stability in the patients with BPPV-PC, but there was still somewhat difference compared with the normal subjects.
引文
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