This research work was supported by NIH grant R01 DC009031. Thanks to Sharon L Congdon, Melody A Fregia, and Nathan Silver for technical support.

The test methodologies described in this study were developed with healthy control subjects and patients with vestibular disorders. Healthy control subjects had no known history of neurologic, otologic, or musculoskeletal disorders. Patients with vestibular disorders had abnormal responses on a battery of objective tests of the vestibular system, including tests of the vestibulo-ocular reflex in darkness, positional tests, and cervical vestibular-evoked myogenic potentials. These studies were approved by the Institutional Review Board for Human Subjects Research at Baylor College of Medicine, Houston, Texas, USA.
NOTE: In a study of 1869, healthy subjects aged 4 to 85 years who were tested at Space Center Houston, a community science education center, subjects were tested with the methodology described in this paper. Participants first removed their shoes but wore socks. Science educators then tested participants on Tandem Walking with eyes closed and on CTSIB on compliant foam with three conditions, each with eyes closed, standing still with the head still, standing still with slow head nodding in pitch (up/down), and standing still with slow head shaking in yaw (right/ left).
1. Patients/research subjects
<ol>
	<li>Ensure that individuals can stand erect, unsupported, for at least 30 s. They must be able to follow the instructions.</li>
</ol>
2. Environment and equipment
<ol>
	<li>Perform the tests in a well-lighted room with a firm surface, e.g., vinyl tile or industrial carpeting. Do not perform these tests on plush carpeting.</li>
	<li>Use a stopwatch, clock with a second hand, or digital timer for CTSIB. No timing device is needed for TW.</li>
	<li>To perform CTSIB, use medium-density, compliant foam which meets the following compliance criterion: PSI = 0.85-0.95. This type of foam is commonly known as temper foam or memory foam. The norms were developed with foam of the following size: 40.64 cm X 45.72 cm X 10 cm. A larger slab of foam may be used if desired, but it is not necessary. 
	&#8203;NOTE: More than one manufacturer makes this foam. Using the foam with the correct compliance characteristics is essential. If another type of foam is used, the published norms will not apply.</li>
</ol>
3. Methodology for CTSIB
<ol>
	<li>Place the foam near a corner of the room or a wall for safety. Have the individual first practice the test on the floor with eyes open to learn the basic movements involved.
	<ol>
		<li>Instruct the individual being tested to stand erect, not touching anything against the legs or back, with feet together, side by side. Ensure that the individual&#39;s arms are crossed at the waist, with each hand holding the contralateral elbow or comfortably crossed at the waist.</li>
		<li>Instruct the individual to look straight ahead. Perform 1-3 test trials for 5-10 s, on the foam, with arms crossed at the waist, feet adjacent, standing erect and looking straight ahead, with nothing touching the legs or back.</li>
		<li>To steady the individual, place a hand on the person&#39;s shoulder while the person looks straight ahead.</li>
		<li>To start the test trial say, &#34;Close your eyes&#34;. Remove the hand from the person&#39;s shoulder, say &#34;Go&#34;, and begin timing the trial for up to 30 s. Perform this trial only once. If the individual appeared frightened, distracted by a noise, or did not understand the instructions, perform a second trial and consider the first trial a training trial. 
		NOTE: The individual will have increased postural sway with eyes closed, which may be a source of concern to the person being tested. Gently advise the individual not to worry about it.</li>
		<li>Dependent measure: Measure the time the individual can maintain the erect posture before making an error, up to 30 s, for each CTSIB condition. 
		&#8203;NOTE: Errors are opening the eyes, moving the arms, taking a step, or leaning against the wall.</li>
	</ol>
	</li>
	<li>Perform Trial 1 with the head stationary. If the person has difficulty on Trial 1 the first time, consider that trial a training trial, and give it a second time. Use the score from the second trial.</li>
	<li>Perform Trial 2 with head nodding (up/down) slowly at 0.3 Hz in time to a real metronome or digital metronome application.
	<ol>
		<li>Prior to starting Trial 2, have the individual stand on the floor with eyes open and practice nodding the head in time to the sound until the maximum upper and lower head movements occur in time to the maximum and minimum sounds on the application so that the individual can move at 0.3 Hz.</li>
		<li>To perform Trial 2, instruct the individual to stand on the foam, with feet adjacent and arms crossed, as in Trial 1.</li>
		<li>Start the sound on the metronome or metronome app before the individual closes his/ her eyes. Then instruct the individual to close his/ her eyes while the hand of the investigator is on the person&#39;s shoulder to steady him/her.</li>
		<li>To begin Trial 2, instruct the individual to nod his/her head (head moves up/ down) in time to the sound when &#34;Go&#34; is heard.</li>
		<li>Remove the hand from the individual&#39;s shoulder, say &#34;Go&#34; and simultaneously start the timer.</li>
		<li>After this trial, allow the individual to rest for a few seconds by stepping off the foam and sitting down if desired.</li>
	</ol>
	</li>
	<li>Perform Trial 3 with the head shaking (left/right) at 0.3 Hz, in time to the sound. Otherwise, use the same procedure for Trial 2.</li>
</ol>
4. Methodology for Tandem Walking
<ol>
	<li>Make sure the room has no obstructions where the individual will walk over a distance of approximately 4.5 m forward and approximately 1 m on either side of the individual. More space can be used but is not required.</li>
	<li>Demonstrate the test for the individual for 3 to 5 steps: Put one foot heel-to-toe in front of the other foot. Repeat for 4 more steps so the individual will know the task.</li>
	<li>Practice trial:
	<ol>
		<li>Instruct the individual to perform a practice trial with eyes open, arms crossed at the waist as for the CTSIB, without wearing shoes but wearing socks for good hygiene.</li>
		<li>Have the individual place one foot directly in front of the other, with no more than 2.4 cm (1 inch) between the front and rear feet. Ensure that the individual performs the practice trial for up to 5 steps. If needed, use more than one practice trial for the individual to understand the motor task.</li>
	</ol>
	</li>
	<li>Test trial: Have the individual stand with arms crossed, feet at a comfortable distance apart, without wearing shoes but wearing socks for good hygiene. Instruct the individual to close his/her eyes and perform 10 heel-to-toe steps, as described in step 4.3, when the investigator says, &#34;Go.&#34;</li>
	<li>Do not time the test.</li>
	<li>Dependent measure: Measure the total number of correct tandem steps performed out of 10 steps, even if the steps are not consecutive. To count incorrect steps, count with the fingers of one hand, the way children use fingers to count. Count the total number of steps aloud, but do not say the number of incorrect steps aloud during the test. 
	&#8203;NOTE: Errors are: opening the eyes, moving the arms, stepping out of line, or stepping too far ahead of the rear foot.</li>
</ol>
5. Scoring for CTSIB and TW
<ol>
	<li>To score the trials, two sources provide data. Use the norms for children and young adults on CTSIB and TW from the paper with those published data9. Also, CTSIB and TW norms for adults aged 21 to 90 are available in the paper with those published data8.</li>
	<li>Compare the individual&#39;s scores to the published data to determine if the scores are normal or abnormal for the individual&#39;s age group and, for CTSIB, for each condition.</li>
</ol>

Implementing Vestibular Disorder Screening Tests

<ol>
	<li>Wilson, V. J., Melvill Jones, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Mammalian Vestibular Physiology. , (1979).</li><li>Bergen, G., Stevens, M. R., Burns, E. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Falls+and+fall+injuries+among+adults+aged+&#8805;65+years-United+States,+2014.">Falls and fall injuries among adults aged &#8805;65 years-United States, 2014.</a> MMWR Morbidity and Mortality Weekly Report. 65 (37), 993-998 (2016).</li><li>Burns, E., Kakara, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Deaths+from+falls+among+persons+aged+&gt;+65+years+-+United+States,+2017+-+2016.">Deaths from falls among persons aged &gt; 65 years - United States, 2017 - 2016.</a> MMWR Morbidity and Mortality Weekly Report. 67 (18), 509-514 (2018).</li><li>Strupp, M., Brandt, T., Dieterich, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Vertigo and Dizziness. , (2023).</li><li>Lanska, D. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Romberg+sign+and+early+instruments+for+measuring+postural+sway.">The Romberg sign and early instruments for measuring postural sway.</a> Seminars in Neurology. 22 (4), 409-418 (2002).</li><li>Horak, F. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+measurement+of+postural+control+in+adults.">Clinical measurement of postural control in adults.</a> Physical Therapy. 67 (12), 1881-1885 (1987).</li><li>Gosselin, G., Fagan, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Foam+pads+properties+and+their+effects+on+posturography+in+participants+of+different+weight.">Foam pads properties and their effects on posturography in participants of different weight.</a> Chiropractic &amp; Manual Therapies. 23 (1), 2 (2015).</li><li>Lin, C. -. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Test-retest+reliability+of+postural+stability+on+two+different+foam+pads.">Test-retest reliability of postural stability on two different foam pads.</a> Journal of Nature and Science. 1 (2), e43 (2015).</li><li>Cohen, H. S., Sangi-Haghpehkar, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Differences+in+responses+on+the+modified+clinical+test+of+sensory+interaction+and+balance+on+medium+firm+and+medium+density+foam+in+healthy+controls+and+patients+with+vestibular+disorders.">Differences in responses on the modified clinical test of sensory interaction and balance on medium firm and medium density foam in healthy controls and patients with vestibular disorders.</a> Biomedicine Hub. 5 (1), 1548-1555 (2020).</li><li>Patel, M., Fransson, P. A., Lush, D., Gomez, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+effect+of+foam+surface+properties+on+postural+stability+assessment+while+standing.">The effect of foam surface properties on postural stability assessment while standing.</a> Gait &amp; Posture. 28 (4), 649-656 (2008).</li><li>Cohen, H. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Tandem+walking+as+a+quick+screening+test+for+vestibular+disorders.">Tandem walking as a quick screening test for vestibular disorders.</a> The Laryngoscope. 128 (7), 1687-1691 (2018).</li><li>Cohen, H. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Screening+for+vestibular+disorders+using+the+modified+clinical+test+of+sensory+interaction+and+balance+and+tandem+walking+with+eyes+closed.">Screening for vestibular disorders using the modified clinical test of sensory interaction and balance and tandem walking with eyes closed.</a> Otology &amp; Neurotology. 40 (5), 658-665 (2019).</li><li>Friello, P., Silver, N., Sangi-Haghpeykar, H., Cohen, H. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Screening+for+balance+in+children+and+adults+in+a+community+science+education+setting:+normative+data,+influence+of+age,+sex,+and+body+mass+index,+and+feasibility.">Screening for balance in children and adults in a community science education setting: normative data, influence of age, sex, and body mass index, and feasibility.</a> PLoS One. 17 (5), e0268030 (2022).</li><li>Bermudez Rey, M. C., Clark, T. K., Merfeld, D. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Balance+screening+of+vestibular+function+in+subjects+aged+4+years+and+older:+a+living+laboratory.">Balance screening of vestibular function in subjects aged 4 years and older: a living laboratory.</a> Frontiers in Neurology. 8, 631 (2017).</li><li>Shumway-Cook, A., Horak, F. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessing+the+influence+of+sensory+interaction+on+balance.">Assessing the influence of sensory interaction on balance.</a> Physical Therapy. 66 (10), 1548-1550 (1986).</li></ol>

The author has nothing to disclose.

These screening tests require minimal or no technology and minimal space. Administration and scoring are quick and easy. Therefore, these screening tests are widely used in healthcare settings by medical providers, occupational therapists, and physical therapists in rehabilitation clinics and epidemiologic screening studies. These tests can be used to screen patients for vestibular disorders and also to screen people with non-vestibular disorders such as presbyastasis. Other balance impairments may also be screened with these tests, but the list of possible disorders is too long to describe here. Clinicians who are trained in the assessment and treatment of various types of vestibular and non-vestibular balance disorders can use these screening tests as part of the clinical toolbox.
The tests have some limitations. These tests can only be used with people who are able to follow the instructions and are able to stand unassisted. Musculoskeletal problems, such as arthritis and joint deformities, amputation of a toe, significant weakness, and incoordination affecting the feet and lower extremities will all affect the test results. Similarly, movement disorders of the nervous system, such as Parkinson&#39;s disease, will affect test results. Musculoskeletal and movement disorders may interfere with the ability to stand long enough to perform the test, to have good enough weight-shifting ability, or even the motor control to perform the tests at all. To be consistent with the normative data, shoes should not be worn, but socks should be worn for good hygiene. Obesity affects the outcome5. The type of compliant foam used for CTSIB affects the outcome. If the test administrator prefers to use a different type of foam, then the test administrator should follow the advice of Shumway-Cook and Horak, the originators of CTSIB, and develop norms on healthy individuals before testing with patients15.
These normed balance tests are useful for screening balance in a wide range of ages. They require minimal equipment and minimal time but provide valid and reliable data for use in a variety of settings. The test administrator should use foam with the correct density characteristics, and individuals should perform the tests without shoes but while wearing socks, with eyes closed. Test sensitivity (to patients) and specificity (to healthy controls) will be improved if both tests are used. Test scores will be influenced by the presence of movement disorders, musculoskeletal disorders, or difficulty following instructions. Therefore, interpret the data with care in the presence of such problems.

Screening the vestibular system, the sensory system with receptors in the inner ear that detect head movement, is notoriously difficult. Due to the presence of the vestibulo-spinal tracts, which project from the vestibular nuclei in the rostral medulla down through cervical, thoracic, and lumbosacral levels of the spinal cord, the head velocity signals generated by the vestibular system influence balance during standing and walking1. For that reason, many people with disorders of the vestibular system have impaired balance and are at risk of falling. For example, 25% of American seniors over the age of 65 years fall every year2, and the death rate from falls in the United States in 2016 ranged from 24.2 to 142.7 per 100,000 people, depending on the state3. Therefore, balance testing is often a component of a clinical assessment or screening for a vestibular impairment and is often used in clinical research4. These tests may also be useful for on-site screening of athletes, post-flight astronauts, military personnel, and other individuals who may show some balance problems. Such individuals might need to be screened near an athletic field, at a landing site, in an emergency field hospital, or some other emergency situation, respectively, before being transported a long distance to comprehensive healthcare facilities for detailed testing.
To screen people for balance disorders, two different kinds of balance testing are often used. Standing still and shifting weight, such as when washing dishes at the kitchen sink, involves somewhat different skills than translating the body through space when walking. Both kinds of balance should be examined. Balance testing is often performed with a narrow base of support to make a test challenging for the individual. For example, testing standing balance with feet close together and eyes closed is based on the Romberg sign, i.e., that patients have a good balance with eyes open but lose their balance with eyes closed1. This test has been sharpened over the years several times until the current modified version of the Romberg, or Clinical Test of Sensory Integration and Balance (CTSIB)4, was more useful for clinical screening than previous tests by being simpler, shorter, and having proven good sensitivity. The current version uses unstable, medium-density, compliant foam on the support surface and has been sharpened even further with head movements. These modifications have been used in recent studies showing age-related normative data on children and adults and also in studies showing that the norms are specific to the foam used7,8,9,10.
Tandem walking (TW), also known as heel-toe walking, is performed on the floor, with the subject wearing socks but not wearing shoes and with eyes closed. Recent studies provide age-related normative data on children and adults11,12,13. Reduced performance on TW and CTSIB may be consistent with a disorder of the vestibular system, although balance tests are not direct tests of the vestibular system. When TW and CTSIB are given together to patients who do not have musculoskeletal deformities or significant neurologic problems, the sensitivity of the tests to vestibular disorders is higher than when only TW or CTSIB is given12.
Using the methodology described in this paper, several studies have been performed with healthy participants. For example, a study of 292 healthy controls and 90 patients with vestibular disorders - as indicated on standard, clinical objective tests of the vestibular system using bi-thermal caloric testing, vestibular evoked myogenic potentials, and Dix-Hallpike testing - showed age-related declines among controls on the CTSIB conditions and TW11,12,13.The sensitivity of the individual tests was moderate for TW7 and CTSIB8, but the sensitivity of the combined battery was &#62; 0.9. In a study of CTSIB at the Museum of Science Boston, healthy participants were able to test themselves on CTSIB on compliant foam with the head still condition14. Age-related changes among children and adults were found by that group, too.
These performance-based screening tests cannot be learned from reading about them in the research papers. This paper aims to inform the reader exactly how to perform these tests.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>10 cm thick, medium density, Sunmate foam</td>
			<td>Dynamic Systems, Leicester, NC, USA;</td>
			<td>sunmatecushions.com</td>
			<td>Either this foam or foam by another manufacturer that has the same compliance characteristics as medium density Sunmate foam will be sufficient. Use a slab of foam large enough for an adult man&#39;s feet, e.g. 40.65 cm X 45.72 cm or larger</td>
		</tr>
		<tr>
			<td>Metronome app</td>
			<td>Any source</td>
			<td>N/A</td>
			<td>Either a real, physical metronome or a metronome app that can provide an auditory cue at 0.3 Hz. 0.3 Hz is the equivalent of 18 beats per minute, but using 20 beats per minute is acceptable if your app only goes that low.</td>
		</tr>
		<tr>
			<td>Stopwatch</td>
			<td>Any source</td>
			<td>N/A</td>
			<td>Any timing device in tenths of seconds will be sufficient</td>
		</tr>
	</tbody>
</table>

screening people on standing balance with romberg testing and walking balance with tandem walking

The goal of this protocol is to inform readers about the exact procedures to use to perform two screening tests for vestibular disorders: tandem walking (TW) with eyes closed, also known as heel-toe walking, and the Clinical Test of Sensory Integration and Balance (CTSIB), which is also known as the modified Romberg. The study describes the steps for performing each test and each of the three CTSIB subtests so that the reader will be able to replicate the test conditions for use in the clinic, in the clinical laboratory, or in any other situation needing valid and reliable screening for balance skill which might be affected by changes in vestibular system function. The procedures detailed here can be easily administered and take less than 1 min per trial. References to published papers with normative data are provided. The representative results section includes examples of data collected with these screening tests.

As with other studies, age-related changes were found on tandem walking and for CTSIB, especially for young children and older adults, although the data for the oldest old may not be reliable due to the small sample size. Figure 1 shows the data for the three conditions of CTSIB. Figure 2 shows the data for eye-closed tandem walking. Young children had reduced scores for both tests compared to children aged 10 and older. Scores declined in the middle- and especially older age. In this particular study, the data for the oldest subjects are unreliable due to small sample sizes.
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/65663/65663fig01.jpg" /> 
Figure 1: Mean CTSIB data by age groups. The data are the time in seconds. (A) CTSIB head still. (B) CTSIB head yaw. (C) CTSIB head pitch. This figure has been modified from the original paper and used with permission from Friello et al.13. <a href="https://www.jove.com/files/ftp_upload/65663/65663fig01large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/65663/65663fig02.jpg" /> 
Figure 2: Median TW data by age groups. The data are the number of correct tandem steps. Ranges were from 1 to 10 but varied by age; refer to Friello et al.13 for details. This figure has been modified from the original paper and used with permission from Friello et al.13. <a href="https://www.jove.com/files/ftp_upload/65663/65663fig02large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>

Watch this Scientific Journal Video about Developing Low-Tech Balance Assessment Methods for Broad-Spectrum Healthcare Applications at JoVE.com

Author Spotlight: Developing Low-Tech Balance Assessment Methods for Broad-Spectrum Healthcare Applications 

This article describes procedures for screening people for standing and walking balance impairments using two normed, rapid, low-tech balance tests.

Screening People on Standing Balance with Romberg Testing and Walking Balance with Tandem Walking

The goal of this protocol is to inform readers about the exact procedures to use to perform two screening tests for vestibular disorders: tandem walking ...

The scientific challenge is to create dependable and effective techniques for measuring balance without relying on a lot of technology. These tests should be applicable for use in field research, small clinics, and for screening patients in places where healthcare technology is limited. It is crucial to test enough healthy individuals across different age ranges, as well as enough patients with vestibular disorders and other balance issues.Recruiting enough people can be challenging, but it's necessary to determine if these tests can effectively screen individuals for various balance problems. Clinicians and investigators can use these tests in sophisticated healthcare environments and also in small clinics, nursing homes, community-based care facilities, mobile labs for population-based epidemiologic studies, and even at landing sites for post-flight astronauts. These data help with clinical decision-making.

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4.2K Views.  Baylor College of Medicine. The scientific challenge is to create dependable and effective techniques for measuring balance without relying on a lot of technology. These tests should be applicable for use in field research, small clinics, and for screening patients in places where healthcare technology is limited. It is crucial to test enough healthy individuals across different age ranges, as well as enough patients with vestibular disorders and other balance issues.Recruiting enough people can be challenging, b...

Video: Author Spotlight: Developing Low-Tech Balance Assessment Methods for Broad-Spectrum Healthcare Applications 

Barnes Maze Testing Strategies with Small and Large Rodent Models

Spatial learning and memory of laboratory rodents is often assessed via navigational ability in mazes, most popular of which are the water and dry-land (Barnes) mazes. Improved performance over sessions or trials is thought to reflect learning and memory of the escape cage/platform location. Considered less stressful than water mazes, the Barnes maze is a relatively simple design of a circular platform top with several holes equally spaced around the perimeter edge. All but one of the holes are false-bottomed or blind-ending, while one leads to an escape cage. Mildly aversive stimuli (e.g.&#160;bright overhead lights) provide motivation to locate the escape cage. Latency to locate the escape cage can be measured during the session; however, additional endpoints typically require video recording. From those video recordings, use of automated tracking software can generate a variety of endpoints that are similar to those produced in water mazes (e.g.&#160;distance traveled, velocity/speed, time spent in the correct quadrant, time spent moving/resting, and confirmation of latency). Type of search strategy (i.e.&#160;random, serial, or direct) can be categorized as well. Barnes maze construction and testing methodologies can differ for small rodents, such as mice, and large rodents, such as rats. For example, while extra-maze cues are effective for rats, smaller wild rodents may require intra-maze cues with a visual barrier around the maze. Appropriate stimuli must be identified which motivate the rodent to locate the escape cage. Both Barnes and water mazes can be time consuming as 4-7 test trials are typically required to detect improved learning and memory performance (e.g.&#160;shorter latencies or path lengths to locate the escape platform or cage) and/or differences between experimental groups. Even so, the Barnes maze is a widely employed behavioral assessment measuring spatial navigational abilities and their potential disruption by genetic, neurobehavioral manipulations, or drug/ toxicant exposure.

The dry-land Barnes maze is widely used to measure spatial navigation ability in response to mildly aversive stimuli. Over consecutive days, performance (e.g.&#160;latency to locate escape cage) of control subjects improves, indicative of normal learning and memory. Differences between rats and mice necessitate apparatus and methodology changes that are detailed here.

Spatial learning and memory of laboratory rodents is often assessed via navigational ability in mazes, most popular of which are the water and dry-land ...

Testing Sensory and Multisensory Function in Children with Autism Spectrum Disorder

In addition to impairments in social communication and the presence of restricted interests and repetitive behaviors, deficits in sensory processing are now recognized as a core symptom in autism spectrum disorder (ASD). Our ability to perceive and interact with the external world is rooted in sensory processing. For example, listening to a conversation entails processing the auditory cues coming from the speaker (speech content, prosody, syntax) as well as the associated visual information (facial expressions, gestures). Collectively, the &#8220;integration&#8221; of these multisensory (i.e., combined audiovisual) pieces of information results in better comprehension. Such multisensory integration has been shown to be strongly dependent upon the temporal relationship of the paired stimuli. Thus, stimuli that occur in close temporal proximity are highly likely to result in behavioral and perceptual benefits &#8211; gains believed to be reflective of the perceptual system&#39;s judgment of the likelihood that these two stimuli came from the same source. Changes in this temporal integration are expected to strongly alter perceptual processes, and are likely to diminish the ability to accurately perceive and interact with our world. Here, a battery of tasks designed to characterize various aspects of sensory and multisensory temporal processing in children with ASD is described. In addition to its utility in autism, this battery has great potential for characterizing changes in sensory function in other clinical populations, as well as being used to examine changes in these processes across the lifespan.

We describe how to implement a battery of behavioral tasks to examine the processing and integration of sensory stimuli in children with ASD. The goal is to characterize individual differences in temporal processing of simple auditory and visual stimuli and relate these to higher order perceptual skills like speech perception.

In addition to impairments in social communication and the presence of restricted interests and repetitive behaviors, deficits in sensory processing are ...

Experimental Research Examining How People Can Cope with Uncertainty Through Soft Haptic Sensations

Human beings are constantly surrounded by uncertainty and change. The question arises how people cope with such uncertainty. To date, most research has focused on the cognitive strategies people adopt to deal with uncertainty. However, especially when uncertainty is due to unpredictable societal events (e.g., economical crises, political revolutions, terrorism threats) of which one is unable to judge the impact on one&#8217;s future live, cognitive strategies (like seeking additional information) is likely to fail to combat uncertainty. Instead, the current paper discusses a method demonstrating that people might deal with uncertainty experientially through soft haptic sensations. More specifically, because touching something soft creates a feeling of comfort and security, people prefer objects with softer as compared to harder properties when feeling uncertain. Seeking for softness is a highly efficient and effective tool to deal with uncertainty as our hands are available at all times. This protocol describes a set of methods demonstrating 1) how environmental (un)certainty can be situationally activated with an experiential priming procedure, 2) that the quality of the softness experience (what type of softness and how it is experienced) matters and 3) how uncertainty can be reduced using different methods.

To date research has focused on cognitive strategies people adopt to cope with uncertainty. This research examines instead an experiential way of dealing with uncertainty and introduces a set of experimental methods showing how the experience of haptic softness can serve as a tool to deal with uncertainty.

Human beings are constantly surrounded by uncertainty and change. The question arises how people cope with such uncertainty. To date, most research has ...

Exploring the Use of Isolated Expressions and Film Clips to Evaluate Emotion Recognition by People with Traumatic Brain Injury

The current study presented 60 people with traumatic brain injury (TBI) and 60 controls with isolated facial emotion expressions, isolated vocal emotion expressions, and multimodal (i.e., film clips) stimuli that included contextual cues. All stimuli were presented via computer. Participants were required to indicate how the person in each stimulus was feeling using a forced-choice format. Additionally, for the film clips, participants had to indicate how they felt in response to the stimulus, and the level of intensity with which they experienced that emotion.

This paper describes how to implement a battery of behavioral tasks to examine emotion recognition of isolated facial and vocal emotion expressions, and a novel task using commercial television and film clips to assess multimodal emotion recognition that includes contextual cues.

The current study presented 60 people with traumatic brain injury (TBI) and 60 controls with isolated facial emotion expressions, isolated vocal emotion ...

Substantiating Appropriate Motion Capture Techniques for the Assessment of Nordic Walking Gait and Posture in Older Adults

Nordic walking (NW) has become a safe and simple form of exercise in recent years, and in studying this gait pattern, various data collection techniques have been employed, each with positives and negatives. The aim was to determine the effect of NW on older adult gait and posture and to determine optimal use of different data collection systems in both short and long duration analysis. Gait and posture during NW and normal walking were assessed in 17 healthy older adults (age: 69 &#177; 7.3). Participants performed two trials of 6 Minute Walk Tests (6MWT) (1 with poles (WP) and 1 without poles (NP)) and 6 trials of a 5m walk (3 WP and 3 NP). Motion was recorded using two systems, a 6-sensor accelerometry system and an 8-camera 3-dimensional motion capture system, in order to quantify spatial-temporal, kinematic, and kinetic parameters.
With both systems, participants demonstrated increased stride length and double support and decreased gait speed and cadence WP compared to NP (p &#60;0.05). Also, with motion capture, larger single support time was found WP (p &#60;0.05). With 3-D capture, smaller hip power generation and moments of force were found at heel contact and pre-swing as well as smaller knee power absorption at heel contact, pre-swing, and terminal swing WP compared to NP, when assessed over one cycle (p &#60;0.05). Also, WP yielded smaller moments of force at heel contact and terminal swing along with larger moments at mid-stance of a gait cycle (p &#60;0.05). No changes were found for posture.
NW seems appropriate for promoting a normal gait pattern in older adults. Three-dimensional motion capture should primarily be used during short duration gait analysis (i.e. single gait cycle), while accelerometry systems should be primarily employed in instances requiring longer duration analysis such as during the 6MWT.

The aim was to substantiate optimal use of data collection techniques for Nordic walking gait and posture analysis. Three-dimensional motion capture should be used during short duration analysis (i.e. single gait cycle), while accelerometry should be employed for longer duration analysis (i.e. repeated cycles) like a 6 Minute Walk Test.

Nordic walking (NW) has become a safe and simple form of exercise in recent years, and in studying this gait pattern, various data collection techniques ...

Reversible Cooling-induced Deactivations to Study Cortical Contributions to Obstacle Memory in the Walking Cat

On complex, naturalistic terrain, sensory information about an environmental obstacle can be used to rapidly adjust locomotor movements for avoidance. For example, in the cat, visual information about an impending obstacle can modulate stepping for avoidance. Locomotor adaptation can also occur independent of vision, as sudden tactile inputs to the leg by an expected obstacle can modify the stepping of all four legs for avoidance. Such complex locomotor coordination involves supraspinal structures, such as the parietal cortex. This protocol describes the use of reversible, cooling-induced cortical deactivation to assess parietal cortex contributions to memory-guided obstacle locomotion in the cat. Small cooling loops, known as cryoloops, are specially shaped to deactivate discrete regions of interest to assess their contributions to an overt behavior. Such methods have been used to elucidate the role of parietal area 5 in memory-guided obstacle avoidance in the cat.

Complex locomotion in naturalistic environments requiring careful coordination of the limbs involves regions of the parietal cortex. The following protocol describes the use of reversible cooling-induced deactivation to demonstrate the role of parietal area 5 in memory-guided obstacle avoidance in the walking cat.

On complex, naturalistic terrain, sensory information about an environmental obstacle can be used to rapidly adjust locomotor movements for avoidance. For ...

A Vibrotactile Feedback Device for Seated Balance Assessment and Training

Postural perturbations, motion tracking, and sensory feedback are modern techniques used to challenge, assess, and train upright sitting, respectively. The goal of the developed protocol is to construct and operate a sitting platform that can be passively destabilized while an inertial measurement unit quantifies its motion and vibrating elements deliver tactile feedback to the user. Interchangeable seat attachments alter the stability level of the device to safely challenge sitting balance. A built-in microcontroller allows fine-tuning of the feedback parameters to augment sensory function. Posturographic measures, typical of balance assessment protocols, summarize the motion signals acquired during timed balance trials. No dynamic sitting protocol to date provides variable challenge, quantification, and sensory feedback free of laboratory constraints. Our results demonstrate that non-disabled users of the device exhibit significant changes in posturographic measures when balance difficulty is altered or vibrational feedback provided. The portable, versatile device has potential applications in rehabilitation (following skeletal, muscular, or neurological injury), training (for sports or spatial awareness), entertainment (via virtual or augmented reality), and research (of sitting-related disorders).

A sitting platform has been developed and assembled that passively destabilizes sitting posture in humans. During the user&#39;s stabilizing task, an inertial measurement unit records the device&#39;s motion, and vibrating elements deliver performance-based feedback to the seat. The portable, versatile device may be used in rehabilitation, assessment, and training paradigms.

Postural perturbations, motion tracking, and sensory feedback are modern techniques used to challenge, assess, and train upright sitting, respectively. ...

Using a Real-Time Locating System to Measure Walking Activity Associated with Wandering Behaviors Among Institutionalized Older Adults

A real-time locating system (RTLS) can be used to track the walking activity of institutionalized older adults in long-term care who are at risk for wandering behaviors. The benefits of a RTLS are objective and continuous measurements of activity. Self-report methods of activity, especially wandering, by health care staff are vulnerable to floor effects and recall bias, and continuous clinical or research observation over the long-term can be time-consuming and expensive. Health care staff also fail to recognize the onset and/or duration of wandering behaviors, which are associated with a variety of adverse health outcomes in this population but amenable to intervention. RTLS technologies can measure the walking activity of institutionalized residents with cognitive impairment over time with a high degree of accuracy. This is particularly useful for the study of wandering, defined as walking for at least 60 seconds with few (if any) breaks in activity. Wandering is associated with disease progression, hospitalizations, falls and death. Previous work suggests older adults with poor balance ability and high sustained walking activity may be particularly susceptible to poor health outcomes. RTLS&#39;s are used to assess cognitive impairment and factors associated with gait and balance; however, supplemental paper and pencil gait/balance tools may be used to further refine risk profiles. This project discusses the use of a RTLS to measure walking activity and also gait quality and balance ability measures on this population.

This paper discusses the use of a continuous and objective real-time locating system to measure walking activity associated with wandering behaviors, focusing on older adults with cognitive impairment. Walking activity is measured by walking distance, sustained walking distance, and sustained gait speed. Also assessed are gait quality and balance ability.

A real-time locating system (RTLS) can be used to track the walking activity of institutionalized older adults in long-term care who are at risk for ...

Measuring the Switch Cost of Smartphone Use While Walking

This paper presents a study protocol to measure the task-switching cost of using a smartphone while walking. This method involves having participants walk on a treadmill under two experimental conditions: a control condition (i.e., simply walking) and a multitasking condition (i.e., texting while walking). During these conditions, the participants must switch between the tasks related to the experimental condition and a direction determining task. This direction task is done with a point-light walker figure, seemingly walking towards the left or the right of the participant. Performance on the direction task represents the participant&#8217;s task-switching costs. There were two performance measures: 1) correct identification of the direction and 2) response time. EEG data are recorded in order to measure the alpha oscillations and cognitive engagement occurring during the task switch. This method is limited in its ecological validity: pedestrian environments have many stimuli occurring simultaneously and competing for attention. Nonetheless, this method is appropriate for pinpointing task-switching costs. The EEG data allow the study of the underlying mechanisms in the brain that are related to differing task-switching costs. This design allows the comparison between task switching when doing one task at a time, as compared to task switching when multitasking, prior to the stimulus presentation. This allows understanding and pinpointing both the behavioral and neurophysiological impact of these two different task-switching conditions. Furthermore, by correlating the task-switching costs with the brain activity, we can learn more about what causes these behavioral effects. This protocol is an appropriate base for studying the switching cost of different smartphone uses. Different tasks, questionnaires, and other measures can be added to it in order to understand the different factors involved in the task-switching cost of smartphone use while walking.

This study design measures the task-switching cost of using a smartphone while walking. Participants undergo two experimental conditions: a control condition (walking) and a multitasking condition (texting while walking). Participants switch between these tasks and a direction determining task. EEG data as well as behavioral measures are recorded.

This paper presents a study protocol to measure the task-switching cost of using a smartphone while walking. This method involves having participants walk ...

A Modified Lean and Release Technique to Emphasize Response Inhibition and Action Selection in Reactive Balance

Assessment of reactive balance traditionally imposes some type of perturbation to upright stance or gait followed by measurement of the resultant corrective behavior. These measures include muscle responses, limb movements, ground reaction forces, and even direct neurophysiological measures such as electroencephalography. Using this approach, researchers and clinicians can infer some basic principles regarding how the nervous system controls balance to avoid a fall. One limitation with the way in which these assessments are currently used is that they heavily emphasize reflexive actions without any need to revise automatic postural reactions. Such an exclusive focus on these highly stereotypical reactions would fail to adequately address how we can modify these reactions should the need arise (e.g., avoiding an obstacle with a recovery step). This would appear to be a glaring omission when one considers the enormous complexity of the environments we face daily. Overall, the status quo when evaluating the neural control of balance fails to truly expose how higher brain resources contribute to preventing falls in complex settings. The present protocol offers a way to require suppression of automatic, but inappropriate corrective balance reactions, and force a selection among alternative action choices to successfully recover balance following postural perturbation.

Here we offer a protocol that allows the user to selectively change affordances and/or constraints on movements that are relevant for recovering balance after postural perturbation.