Comparison. Dynamic Gait Index (DGI)Results with. Patients with vestibular Hypofunction Youssef Koaik MPT

Transcription

1 Comparison of Dynamic Gait Index (DGI)Results with Static ti Stabilometry t (SATEL) on Patients with vestibular Hypofunction Youssef Koaik MPT

2 Balance

3 Postural Control In order ode to possess normal postural control o it is necessary to have: Functioning sensors and afferent pathways Adequate neuromuscular output Intact musculoskeletal system The postural control system is also affected by age, reaching an optimum in early adult life and deteriorating from approximately the age of 50 (Prieto et al 1996)

4 Vestibular Rehabilitation Vestibular rehabilitation ti (VR) has become one of the most widely used treatments for bl balance disorders d Patients with deficits affecting the peripheral or central vestibular system are considered for VR

5 Vestibular assessment Several objective Clinical and instrumental assessments of the vestibulo ocular reflex (VOR) vestibulo spinal reflex (VSR) Subjective measures consist of general questionnaires on quality of life (QOL) and specific questionnaires on the handicap and disability caused by dizziness

6 Vestibulo Spinal Reflex The VSR is studied d by means of static, ti dynamic stabilometry and/or by Dynamic Gait Index (DGI) tests t

7 Material and Methods The aim of this study is to investigate i possible correlations between the findings of the tests done on the posturographic, and the dynamic gait index (DGI), scores

8 Between January 2009 and February 2010, 21 patients (8 females, 13 males) mean age 66 years; SD 11.9 years) with imbalance and/ or vertigo referred to our department for vestibular rehabilitation classified as per referred physician diagnosis as follows Diagnosis Nb of Pts (21) Diagnosis Nb of Pts Acoustic Neuroma 1 Chronic B V 1 Chronic imbalance 2 Chronic U V 1 Dead Ear 2 Meniere comp 5 Perilymph fistula, 1 Uknown, 2 Ototoxicity, 1 Vascular, 1 Chronic imbalance, 2 Acoustic Neuroma, 1 Chronic B V, 1 Neuritis 4 Ototoxicity 1 Neuritis, 4 Perilymph fistula 1 Meniere comp, 5 Chronic U V, 1 Dead Ear, 2 Uknown 2 Vascular 1 Total 21 Acoustic Neuroma Chronic B V Chronic imbalance Chronic U V Dead Ear Meniere comp Neuritis Ototoxicity Perilymph fistula Uknown Vascular

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10 Assessment of the 21 patients Pti Patients t were assessed following a special il assessment prepared for vestibular impaired people. The assessment includes, among many tests, DGI (dynamic Gait Index), static posturography.

11 Static Stabilometry Force platform ltf (Satel platform, ltf 40 Hz signal acquisition) Data entry Tested under four different sensory conditions: 1 standing with EO on a firm surface 2 standing with EC on a firm surface 3 standing with iheo on a foam surface 4 standing with EC on a foam surface

12 Static Stabilometry (cont..) The system analyzed ay the subject's s functional balance a control to quantify the average sway on X (left right sways) the average on Y (left right sways) the area the COP occupied idover the time of test, the length that the COP travels over the test time Also thesystem quantified theaverage velocity (mm/sec) of the sway during each of the four conditions as well as the Romberg quotient when possible The software was giving the limits of a normal test and showed abnormal results in red

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14 Dynamic Gait Index 8 tasks to be performed Each scored between zero and three Maximum possible score of 24 A score of 19 or less indicates an increased risk of falling in older adults and in patients with vestibular disorders (Cohen and al. 2003)

15 Dynamic Gait Index (cont..) 1 Gait level surface 2 Change in speed 3 Gait with horizontal head turns 4 Gait with vertical head turns 5 Gait Gitand pivot tturn 6 Step over obstacle 7 Step around obstacles 8 Steps

16 Dynamic Gait Index (cont..) Explanations and demonstrations ti about tthe tests were given to patients in prior to performance, the tests t were done in a corridor of 35 m long and 2 m large well lighted for the 5 first tasks ; and in the department Gym for the 3 last tasks, all patients t tests t were supervised dby the same therapist

17 Results patients AV X Av Y Length Area DGI P P P P P P P P P P P P P P P P P P P P P

18 Categorization In order to unify the parameters and as a ti trial to compare the results of the DGI to the results of the SATEL, a kind of categorization ti of the abnormalities was done We put as hypothesis 4 categories of patients, in both DGI and SATEL tests, according to how far from normal limits they are

19 Categorization of DGI 24 is the max score, bl below 19 is when patient t has a risk of fall Normal population (CD1) 24 to =5 CD2 18 to 13 (18 5) CD3 12 to 7 (12 5) CD4 6

20 Categorization on X Starting from the origin (average=1.1), double, triple and quadruple of the normal length were designating the CX2, CX3 and CX4 CAT I -9.6 to 11.7 CAT II to -9.5 or 11.8 to 22.4 CAT III -31 to or 22.5 to 33.1 CAT IV to or 33.2 to 44

21 Categorization on Y Starting from the origin (average=-1.5), double, triple and quadruple of the normal length were designating the CY2, CY3 and 4 CAT I -1.5 to -57 CAT II to-84.4 or -1.5 to 25.0 CAT III to -111 or 26 to 53.4 CAT IV to or 53.5 to 81.0

22 Categorization of lengths = 292 GL2 = = 891 GL3 = (292x2) =1183 GL CAT I 307 to599 CAT II 600 to 891 CAT III 892to1183 CAT IV 1184

23 Categorization of Areas 91 = π (3.5) = π (8.17) 2 Difference of rays = = 4.67 CA2: 518 = π [ ] 2 CA3: 960= π [ ] 67] 2 CA4: 1540=π [ ] 2

24 Categorization of the results The results of the assessments of 21 patients on DGI and on SATEL (solid floor/eyes /y opened) were as follow pts AV X category Av Y category Length category Area category DGI category P1 1 I 27.1 I 428 I 129 I 18 II P II 44.7 I 1054 III 1171 IV 6 IV P3 7.9 I 35.6 I 712 II 186 I 18 II P4 6.1 I 47.7 I 1603 IV 900 IV 15 II P I 31.1 I 2833 IV 9142 IV 14 II P6 9.1 I 36.8 I 503 I 340 II 21 I P7 3.8 I 39 I 428 I 408 II 21 I P8 2.9 I 33.6 I 416 I 435 II 22 I P9 0 I 21.7 I 397 I 164 I 19 I P I 2.5 II 422 I 372 II 16 II P II 44.5 I 389 I 228 II 18 II P I 48.3 I 1018 III 244 II 18 II P I 24.7 I 490 I 293 II 24 I P II 21.4 I 6557 IV 4881 IV 6 IV P II 41.8 I 655 II 176 I 11 III P III 45.8 I 356 I 167 I 21 I P I 45.9 I 528 I 203 I 12 I P18 7 I 33.5 I 372 I 116 I 15 II P II 21.3 I 601 II 126 I 18 II P I 46.4 I 400 I 101 I 19 I P I 30.8 I 789 II 221 II 12 III S D Av

25 Comparing Av on X with DGI

26 Comparing Av on Y with DGI

27 Comparing Av length to DGI categories

28 Comparing Av Area to DGI categories

29 Comparing category classification results of different tests

30 Comparing the DGI to the 4 components of SATEL

31 Results All The Patient, except one, showed normal value for the Average on Y, which is compatible with vestibular impaired patients (they usually have lateral imbalance rather than anteroposterior imbalance When comparing category thefindings findings, visual similarity could be seen between DGI and SATEl (Av X), more for the Length and Area, but not with SATEL (Av Y)

32 Discussion These results, although retrieved from a relatively small number of patients to be statistically significant, showed that DGI as dynamic test for the patients with vestibular hypofunction can be correlated with the SATEL results as static tests on the same patients (except for ant post swaying). Some patients (P2 and P14) can have acceptable to good static balance (when tested on SATEL) but the risk of fall during daily dil activities iti remains function of the DGI evaluation results To have significance of these results, larger number of patients is needed

33 THANK YOU