Deborah S. Nichols

Sitting balance: Its relation to function in individuals with hemiparesis

OBJECTIVES To evaluate test-retest reliability of sitting balance measures in healthy subjects and individuals with hemiparesis secondary to stroke, to evaluate the ability of the balance measures and Functional Independence Measure (FIM) to document changes over time, and to compare changes in the balance measures and FIM to each other. METHOD Six nonpatient subjects were evaluated for test-retest reliability. Fourteen subjects with hemiparesis were tested every 2 weeks during their hospitalization on their ability to lean to either side, lean forward, and maintain a symmetrical posture. Maximum displacement was recorded using the Balance System. FIM scores were obtained for each testing session. RESULTS Test-retest reliability for nonpatient subjects was high and for patients was moderate to high. Leaning forward and to the paretic side showed the greatest number of correlations with the FIM scores. All of the FIM scales and the forward lean measure documented progress. CONCLUSIONS The protocol developed to test sitting balance, using the Balance System, seems appropriate for use with patient populations. The ability to lean maximally to either side or forward or sit symmetrically is not strongly related to function.

Opiate and serotonergic mechanisms of stimulation-produced analgesia within the periaqueductal gray

These studies investigated the distribution of analgesia-producing sites within the periaqueductal gray (PAG), and their potential reversal by naloxone and methysergide. The PAG is not differentiable in its ability to elicit stimulation-produced analgesia (SPA) until the point of stimulation is caudal to the dorsal raphe nucleus, where analgesia was not obtained. Naloxone, however, was found to have a differential effect at specific loci, significantly reducing SPA from ventral but not dorsal sites. In contrast, methysergide was effective in reversing analgesia both at ventral and dorsal sites. The site of stimulation was critical to whether motor effects were elicited: Motor effects accompanied by analgesia were most often produced rostrally, while motor effects without analgesia were most frequently produced in the middle PAG. Null effects for both motor activity and analgesia were obtained from caudal PAG sites.

Effects of vestibular rehabilitation and social reinforcement on recovery following ablative vestibular surgery

This study investigated the relative effects of vestibular rehabilitation (VR) and social reinforcement (SR) on recovery following ablative vestibular surgery. Twenty‐four subjects were randomly assigned to three treatment groups of either VR with SR, VR without SR, or general range of motion (ROM) exercises with SR. Outcome measures included equilibrium scores in dynamic posturography, asymmetry index in rotation testing, motion sensitivity quotient (MSQ), and dizziness handicap inventory (DHI). A multiple comparison of the overall outcome measures showed no significant differences in group performance over an 8‐week period. When individual outcome measures were compared, MSQ and DHI results at the end of the 8‐week treatment period revealed less motion sensitivity and dizziness handicap in groups who received VR, with or without SR, as compared with the group who received ROM exercises. These results suggest that after a vestibular injury most patients can effectively utilize central compensation mechanisms to recover from such an injury, regardless of the type of therapeutic intervention used. On the other hand, the reduction in motion sensitivity and dizziness handicap for patients who received VR could indicate a more rapid and complete recovery for these patients. This investigation is continuing as a long‐term follow‐up study to determine whether there are any long‐term benefits in participating in a VR program.

Childhood Imbalance and Chronic Otitis Media With Effusion: Effect of Tympanostomy Tube Insertion on Standardized Tests of Balance and Locomotion

The goal of this study was to investigate the role of chronic otitis media with effusion as a cause of childhood imbalance. Nineteen 4‐ to 6‐year‐old children with chronic otitis media with effusion and 14 matched control children underwent a series of laboratory tests, including two standardized tests of balance and locomotion: the Peabody Developmental Motor Scales (PDMS) and the Bruininks‐Oseretsky Test of Motor Proficiency (BOTMP). The children in the chronic otitis media with effusion group underwent tympanostomy tube insertion. Both groups underwent the same battery of tests within 6 to 8 weeks of initial testing. Analysis of variance for the PDMS and BOTMP demonstrated significantly lower performance in the balance subscales for the otitis group before (P < .01). Both otitis and control groups improved when retested. The improvement was greater and approaching significance in the otitis group on the PDMS and BOTMP (P = .056 and .097, respectively). It is concluded that chronic otitis media with effusion significantly affects balance and coordination skills in 4‐ to 6‐year‐old children. These skills improve after tympanostomy tube insertion at a rate greater than that of the control group.

Stimulation-produced analgesia and its cross-tolerance between dorsal and ventral PAG loci

&NA; This study explored the development of tolerance to brain stimulation‐produced analgesia in both dorsal and ventral periaqueductal gray (PAG) sites and the development of cross‐tolerance between naloxone‐reversible and non‐reversible sites. Cross‐tolerance was produced from non‐naloxone‐reversible sites to naloxone‐reversible sites (NNR‐NR) and from naloxone‐reversible sites to non‐naloxone‐reversible sites (NR‐NNR). The following conclusions can be drawn from the present study: (1) the descending pain inhibitory systems within the PAG do not operate in isolation of each other since cross‐tolerance to chronic stimulation can be produced between systems; (2) the interaction between the two systems is apparently bi‐directional in that cross‐tolerance was produced from naloxone‐reversible to non‐reversible sites and vice versa; and (3) the interaction may be the result of a co‐activation of opioid and non‐opioid systems produced by electrical stimulation or by a co‐utilization of a common neuronal substrate. It is speculated that serotonin is a neurotransmitter involved in the mechanism of convergence.

Veranderingen in de gemiddelde lokalisatie van het lichaamszwaartepunt tijdens onderzoek naar het evenwicht bij jong- volwassenen

Het is momenteel mogelijk om met behulp van een commercieel verkrijgbaar krachtenplatform een analyse te maken van de balans in stand. De auteurs zijn van mening dat eerst gegevens over de balans van groepen niet-patienten moeten worden verzameld en geanalyseerd, alvorens geschikte meet- en behandelprotocollen voor patientengroepen kunnen worden ontwikkeld.