TY - JOUR
T1 - Screening for Vestibular Disorders Using the Modified Clinical Test of Sensory Interaction and Balance and Tandem Walking With Eyes Closed
AU - Cohen, Helen S.
AU - Mulavara, Ajitkumar P.
AU - Stitz, Jasmine
AU - Sangi-Haghpeykar, Haleh
AU - Williams, Susan P.
AU - Peters, Brian T.
AU - Bloomberg, Jacob J.
N1 - Funding Information:
Address correspondence and reprint requests to Helen S. Cohen, EdD, Department of Otolaryngology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030; e-mail: [email protected] Funding/Support: NIH grant 2R01DC009031 (HSC), National Space Biomedical Research Institute through NASA NCC 9-58 (A.P.M., J.J.B.), and a fellowship from the Austria Marshall Plan Foundation (J.S.). The authors disclose no conflicts of interest.
Publisher Copyright:
© 2019, Otology & Neurotology, Inc.
PY - 2019/6/1
Y1 - 2019/6/1
N2 - OBJECTIVES: Determine accurate cut-points and optimal combinations of screening tests of balance to detect patients with vestibular disorders. STUDY DESIGN: Case-control study. SETTING: Out-patient tertiary care. SUBJECTS AND METHODS: Community-dwelling adults, without known neurological deficits or significant musculoskeletal disorders, including patients with vestibular disorders and healthy controls without vestibular disorders were tested while standing on medium density compliant foam with feet together and eyes closed under three head movement conditions, head stationary, and head moving in yaw and pitch at 0.33 Hz, for up to 30 seconds per trial. Dependent measures were trial duration, number of head movements during head movement trials, trunk kinematic measures, and number of correct tandem steps during tandem walking trials. RESULTS: Receiver operator characteristics (ROC), sensitivity and specificity, and specific cut-points were calculated. Individual tests had moderate ROC values, from 0.67 to 0.84. ROC values were higher in the head moving trials than the head stationary trial and best for subjects aged 40 to 79. Using combined analyses of two or more tests, including published data on tandem walking, ROC values were higher, 0.80 to 0.90. Age- and sex-related performance differences were found. CONCLUSION: Balance skills in standing and walking differ, so testing both skills is optimal and increases the likelihood of finding a deficit. Patients should be compared to age-appropriate norms. Kinematics and number of head movements were not very useful. This combined set of rapid, low-tech balance tests is useful in an initial approach to screening patients who may have vestibular disorders.
AB - OBJECTIVES: Determine accurate cut-points and optimal combinations of screening tests of balance to detect patients with vestibular disorders. STUDY DESIGN: Case-control study. SETTING: Out-patient tertiary care. SUBJECTS AND METHODS: Community-dwelling adults, without known neurological deficits or significant musculoskeletal disorders, including patients with vestibular disorders and healthy controls without vestibular disorders were tested while standing on medium density compliant foam with feet together and eyes closed under three head movement conditions, head stationary, and head moving in yaw and pitch at 0.33 Hz, for up to 30 seconds per trial. Dependent measures were trial duration, number of head movements during head movement trials, trunk kinematic measures, and number of correct tandem steps during tandem walking trials. RESULTS: Receiver operator characteristics (ROC), sensitivity and specificity, and specific cut-points were calculated. Individual tests had moderate ROC values, from 0.67 to 0.84. ROC values were higher in the head moving trials than the head stationary trial and best for subjects aged 40 to 79. Using combined analyses of two or more tests, including published data on tandem walking, ROC values were higher, 0.80 to 0.90. Age- and sex-related performance differences were found. CONCLUSION: Balance skills in standing and walking differ, so testing both skills is optimal and increases the likelihood of finding a deficit. Patients should be compared to age-appropriate norms. Kinematics and number of head movements were not very useful. This combined set of rapid, low-tech balance tests is useful in an initial approach to screening patients who may have vestibular disorders.
KW - Aging
KW - Balance evaluation
KW - Postural control
KW - Romberg
KW - Screening
KW - Vestibular
KW - Head Movements
KW - Humans
KW - Middle Aged
KW - Male
KW - Case-Control Studies
KW - Biomechanical Phenomena/physiology
KW - Walking
KW - Sensitivity and Specificity
KW - Adult
KW - Female
KW - Aged
KW - Vestibular Diseases/diagnosis
KW - Neurologic Examination/methods
KW - Postural Balance
UR - http://www.scopus.com/inward/record.url?scp=85066061108&partnerID=8YFLogxK
U2 - 10.1097/MAO.0000000000002173
DO - 10.1097/MAO.0000000000002173
M3 - Article
C2 - 31083095
AN - SCOPUS:85066061108
SN - 1531-7129
VL - 40
SP - 658
EP - 665
JO - Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology
JF - Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology
IS - 5
ER -