Name: Video: Methodology for Performing Balance Tests for Screening People with Balance Impairment
Uploaded: 2023-09-01T14:00:00
Duration: 5 min 22 s
Description: 643 Views. Methodology for Performing Balance Tests for Screening People with Balance Impairment

methodology for performing balance tests for screening people with balance impairment

Implementing Vestibular Disorder Screening Tests

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.

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

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

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Methodology for Performing Balance Tests for Screening People with Balance Impairment

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643 Views. Methodology for Performing Balance Tests for Screening People with Balance Impairment

Video: Methodology for Performing Balance Tests for Screening People with Balance Impairment

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.

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

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 ...