Abstract/Text: To characterize clinical features of those patients who showed an absence of vestibular evoked myogenic potential (VEMP) responses in the presence of normal caloric responses bilaterally, we reviewed clinical records of 1,887 consecutive outpatients who complained of balance problems, and identified three patients, who showed absent VEMPs in the presence of normal caloric responses bilaterally with unknown causes. All three patients had episodes of recurrent vertigo without spontaneous, gaze-evoked, or positional nystagmus at the time of examination. They complained of oscillopsia while moving their body or head and showed positive Romberg's signs. Drawing on these cases, we underscore the importance of examining the function of the inferior vestibular nerve system, even with no nystagmus and normal caloric findings, in patients complaining of dizziness or oscillopsia during locomotion.

Abstract/Text: One hundred and twenty-five people aged 65 and over in the Birmingham area who fell at home were followed up for one year after the fall had been reported by the general practitioner. They were compared with 125 control subjects matched for age and sex and drawn from the same doctors' lists. Two months after the fall, one control and 11 fallers had died. One year after the fall, eight controls and 32 fallers had died. The main factor associated with increased mortality was impaired mobility before the index fall.

Abstract/Text: OBJECTIVES: Simple tests to detect peripheral vestibulopathy might be practically useful before conducting elaborate examinations. The purpose of this study was to assess the diagnostic accuracy of foam posturography for peripheral vestibulopathy, with emphasis on visual and somatosensory dependence.
METHODS: Two-legged stance tasks were conducted in patients with unilateral (n=68) and bilateral (n=16) vestibulopathy and healthy controls (n=66), under four conditions; eyes open with and without the foam rubber, and eyes closed with and without the foam rubber.
RESULTS: The values of six parameters; the velocity of movement of the center of pressure (COP) and envelopment area tracing by the movement of the COP in eyes closed/foam rubber, the Romberg's ratios of velocity and area with foam rubber, and the foam ratios (ratios of a measured parameter with to without the foam rubber), of velocity and area in eyes closed, were significantly higher in unilateral and bilateral vestibulopathy compared with the control (p<0.001). The area under the receiver operating characteristic curve for the Romberg's ratio of velocity with the foam rubber was the largest.
CONCLUSIONS: Foam posturography detected high levels of visual and somatosensory dependence in patients with vestibulopathy.
SIGNIFICANCE: Foam posturography is useful for preliminary assessment of possible peripheral vestibulopathy.

Abstract/Text: Following a lesion in the vestibular system visual, proprioceptive and residual vestibular information is integrated by the brain, to enable a patient to attain equilibrium. The basis of vestibular rehabilitation is to encourage these adaptive and compensatory mechanisms. Another form of rehabilitation is to provide some form of mechanical aid, and walking sticks are often used for this purpose in patients with balance disorders. There are no reported studies objectively assessing the use of walking sticks in patients with balance disorders. In this study we used the Sway Weigh balance platform (Raymar) to determine the efficacy of a walking stick in 25 patients with peripheral vestibular balance disorders. Patients were tested with their eyes opened and eyes closed whilst they were standing on a flat surface and on an air-filled bed (to alter limb proprioception) on the Sway Weigh balance platform. All the tests were carried out with, and without, a walking stick. The results demonstrate that a walking stick significantly reduces lateral body sway in patients with peripheral vestibular balance disorders.