The clinical use of dynamic posturography in the elderly

We provide an overview of the clinical uses of dynamic posturography. Although the equipment described to perform this testing is expensive, the concepts, especially those for sensory organization, can be applied for +20.00. To apply the six sensory organization conditions, one merely needs some way to disrupt proprioceptive information by maintaining ankle angle and providing for visual conflict stimuli. We found that proprioceptive information can be disrupted easily by asking the patient to stand on a thick (4-inch) dense piece of foam rubber like that used in cushions for furniture. Visual stabilization conflict can be provided by having the patient wear a 19- to 20-inch Japanese lantern with a head-mounting system in the center so that the patient's movements do not reflect themselves in relative movements to the visual environment. With use of these two simple tools, the six sensory organization tests can be approximated in a clinical situation in a short time and can provide some relative information about a patient's postural control capabilities. With minor additional work, a quantitative measure of output that gives indications of the amount of anterior-posterior sway also can be provided. For elderly patients with a variety of problems ranging from general unsteadiness to frank vertigo, the risk of falling can be devastating, and it is important to provide a thorough investigation of the total balance system. The systematic investigation, qualitatively or quantitatively, of integration of sensory input and motor outputs provides a dimension that typically has been lacking in the routine "dizzy patient workup" for all ages but especially for elderly patients. Therefore, the application of the postural maintenance theory with the above-described procedures or variations in these procedures appears to have a great deal of clinical relevance in the evaluation of patients with gait and balance disorders. These types of evaluations represent an adjunct or addition to the evaluation of the vestibular system and the vestibulo-ocular reflexes and by no means should be considered a substitute for that traditional evaluation. It is the combination of information that can provide the clinician with a more global picture of the entire balance system and its functional capabilities.