Balance Control Near the Limit of Stability in Various Sensory Conditions in Healthy Subjects and Patients Suffering from Vertigo or Balance Disorders: Impact of Sensory Input on Balance Control

Abstract

The large inter-individual variability within the normal population, the limited reproducibility due to habituation or fatigue, and the impact of instruction and the subject's motivation, all constitute a major problem in posturography. These aspects hinder reliable evaluation of the changes in balance control in the case of disease and complicate objectivation of the impact of therapy and sensory input on balance control. In this study, we examine whether measurement of balance control near individualized limits of stability and under very challenging sensory conditions might reduce inter- and intra-individual variability compared to the well-known Sensory Organization Test (SOT). To do so, subjects balance on a platform on which instability increases automatically until body orientation or body sway velocity surpasses a safety limit. The maximum tolerated platform instability is then used as a measure for balance control under 10 different sensory conditions. Ninety-seven healthy subjects and 107 patients suffering from chronic dizziness (whiplash syndrome (n=25), Meniere's disease (n=28), acute (n=28) or gradual (n=26) peripheral function loss) were tested. In both healthy subjects and patients this approach resulted in a low intra-individual variability (<14.5%). In healthy subjects and patients, balance control was maximally affected by closure of the eyes and by vibration of the Achilles' tendons. The other perturbation techniques applied (sway referenced vision or platform, cooling of the foot soles) were less effective. Combining perturbation techniques reduced balance control even more, but the effect was less than the linear summation of the effect induced by the techniques applied separately. The group averages of healthy subjects show that vision contributed maximum 37%, propriocepsis minimum 26% and labyrinths maximum 44% to balance control in healthy subjects. However, a large inter-individual variability was observed. Balance control of each patient group was less than in healthy subjects in all sensory conditions. Similar to healthy subjects, patients also show a large inter-individual variability, which results in a low sensitivity of the test. With the exception of some minor differences between Whiplash and Meniere patients, balance control did not differ between the four patient groups. This points to a low specificity of the test. Balance control was not correlated with the outcome of the standard vestibular examination. This study strengthens our notion that the contribution of the sensory inputs to balance control differs considerably per individual and may simply be due to differences in the vestibular function related to the specific pathology, but also to differences in motor learning strategies in relation to daily life requirements. It is difficult to provide clinically relevant normative data. We conclude that, like the SOT, the current test is merely a functional test of balance with limited diagnostic value.