Vestibular assessment with Balance Quest: Normative data for children and young adults

The purpose of this study was to examine whether whole-body vibration (WBV) training results in short-term performance improvements in flexibility, strength and balance tests in comparison to an equivalent exercise program performed without vibration. Eleven elite rhythmic gymnasts completed a WBV trial, and a control, resistance training trial without vibration (NWBV). The vibration trial consisted of eccentric and concentric squatting exercises on a vibration platform that was turned on, whereas the NWBV involved the same training protocol with the platform turned off. Balance was assessed using the Rhythmic Weight Shift (RWS) based on the EquiTest Dynamic Posturography system; flexibility was measured using the sit & reach test, and lower limb explosive strength was evaluated using standard exercises (squat jump, counter movement jump, single leg squat). All measurements were performed before (pre) immediately after the training program (post 1), and 15 minutes after the end of the program (post 15). Data were analyzed using repeated measures ANOVA was used with condition (WBV-NWBV) as the primary factor and time (pre, post 1, post 15) as the nested within subjects factor, followed by post-hoc pairwise comparison with Bonferroni corrections. Results confirmed the hypothesis of the superiority of WBV training, especially in the post 15 measurement, in all flexibility and strength measures, as well as in a number of balance tests.

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Objectives: This study aimed (1) to identify the developmental status of balance and sensory functions in young adolescents as compared to adults and, (2) to explore the effect of Taekwondo (TKD) training on the development of balance and sensory systems in young adolescents. Design: Cross-sectional controlled trial. Methods: Sixty-six participants including 42 adolescents (21 TKD practitioners, 21 non-TKD practitioners) and 24 adults were tested. The sway velocity of centre of gravity was recorded during standing on the non-dominant leg on a Smart Equitest ® system. The somatosensory, vestibular and visual ratios were also measured with the machine. Results: Adult participants swayed slower than both TKD and non-TKD adolescent groups during single leg stance with eyes open (p = 0.007 and p < 0.001, respectively). The TKD adolescent group, in turn, swayed slower than the non-TKD adolescent group (p < 0.001). Adult participants had better visual ratio than both TKD and non-TKD adolescents (p = 0.001 and p < 0.001, respectively) while there was no difference between the TKD and non-TKD adolescents (p = 0.164). For the vestibular ratio, there was no significant difference between adult participants and TKD adolescents (p = 0.432). Adolescents who did not practice TKD showed significantly lower vestibular ratio than TKD adolescents and adults (p = 0.003 and p < 0.001, respectively). In addition, there was no significant difference in the somatosensory ratio among the 3 participant groups (p = 0.711). Conclusions: Participation in TKD appears to speed up the development of postural control and vestibular function in adolescents. Clinicians might advocate TKD exercise as a therapeutic intervention for young people with balance or vestibular dysfunctions.

Three main issues have to be addressed by the examination of a patient complaining from balance disorders: physiopathology and aetiology, severity and consequences, and evolution. A precise clinical analysis must be then conducted, including close anamnesis and clinical examination, with scale measurements depending on the objectives. Daily consequences can be assessed by the Dizziness Handicap Inventory, which considers a large field of daily activities. The International Classification of Functioning evaluates activities and participation, influence of environmental factors, and quality of life. Then, patient’s examination aims at objectifying and measuring the balance disorder. Quantified measurement is possible even in a simple doctor’s office. Clinical scales for balance assessment should be used for a standardized assessment and to allow comparison of different subjects. Although the Tinetti test is the most-widely used in older people, it is quite approximate. The Berg Balance Scale has also been first validated in older people, it is rather easy to use, but uncertainty between two close scores is frequent. The Timed Up-and-Go Test is the simplest one and probably the most reliable. The Unipodal Stance Testing is also a simple test and a good predictor of fall. The Functional Ambulation Classification focuses attention on the physical support needed by the patient during walking. The Postural Assessment Scale for Stroke Patients (PASS) is easy to use after a recent stroke. Instrumental analysis by means of static and dynamic platforms, often coupled together with accelerometers or video, can be used to complete the clinical examination. Its main interest is to contribute to give insight into physiologic and pathologic mechanisms underlying the postural trouble.

Trois questions principales se posent à l’examinateur d’un patient se plaignant de troubles de l’équilibre : la physiopathologie et l’étiologie de ce trouble, sa sévérité et ses conséquences et enfin son évolutivité. Une analyse clinique rigoureuse doit être conduite, incluant un interrogatoire précis et l’examen clinique, aidé d’échelles d’évaluation selon les objectifs poursuivis. Les conséquences quotidiennes peuvent être évaluées par la "Dizziness Handicap Inventory" qui balaie un large champ des activités quotidiennes. Sur la base de la Classification internationale de fonctionnement, les activités et la participation à la vie sociale peuvent être évaluées ainsi que l’influence des facteurs environnementaux et la qualité de vie. L’examen lui même a pour but d’objectiver et de mesurer le trouble de l’équilibre. L’évaluation quantifiée est possible au cours d’une simple consultation médicale. Les échelles cliniques d’évaluation de l’équilibre doivent être utilisées pour une évaluation standardisée et permettre ainsi la comparaison de différents sujets entre eux. Bien que le test de Tinetti soit le plus couramment utilisé chez le sujet âgé, il est approximatif. La Berg Balance Scale, également validée chez les personnes âgées, est d’usage plus facile, mais des hésitations entre deux scores proches sont fréquentes. Le Timed « Up and Go Test » est le plus simple et sans doute le plus fiable. Le test de station unipodale est également un test simple et un bon indicateur de risque de chute. La « Functionnal Ambulation Classification » tient particulièrement compte du support physique dont le patient a besoin pendant la marche, aide technique ou aide humaine. La « Postural Assessment Scale for Stroke Patients » est adaptée à l’examen de l’équilibre après accident vasculaire cérébral récent. L’analyse instrumentale au moyen d’une plateforme d’équilibre statique ou dynamique, souvent associée à une analyse par accéléromètres ou caméra vidéo peut être utilisée pour compléter l’examen clinique. L’intérêt principal est de contribuer à une meilleure connaissance de la physiologie et des mécanismes pathologiques expliquant le trouble d’équilibre.

The purpose of the present prospective study was to obtain normative data for Equitest computerized dynamic posturography (CDP) in children and young adults and to observe the balance maturation process.

Equilibrium pattern and SOT of 195 healthy children aged from 6 to 14 years were compared to those of 64 young adults aged 20 years, using Equitest.

The mean stability scores for children progressively improve with age and are significantly lower than those of young adults. Furthermore, sensory organization scores were lower in children compared to young adults, whereas visual preference scores were similar for the whole studied groups.

According to previous literature, it may be stressed that due to a presumed incomplete development of vestibular system and central nervous system integration, children unlike young adults have lower equilibrium scores, especially when visual information was not available or was incorrect. Our results confirm previous ones obtained in children and young adults with Equitest CDP. This study also provides Equitest data for these age groups, which complete those that have been previously reported.