Posture examination and Posturography

Prof. R. BONIVER Royal Belgian Society for ear, nose, throat, head and neck surgery meeting 02-12-2011

It is important to differenciate posture examination and posturography

The goal of a posture exam is to identify what postural deviations exist, but not to identify why they exist (at least not during the posture exam). Therefore, the posture exam is a screening exam that assists you in determining specific areas that you may need to examine further.

Associations can exist between postural deviations & impairments, such as 1) Hamstring tightness & lumbar hypolordosis 2) Hip flexor tightness & lumbar hyperlordosis 3) Standing foot asymmetry or pelvic asymmetry and leg length difference 4) Pectoral tightness and forward shoulders and the lis goes on.

However, one can NEVER assume that everyone with hypolordosis has tight hams, etc When clinicians do a posture exam & see a deviation, they (and the patient) typically want to know why it exists. They can only find the answer by doing, additional detailed examination. The problem occurs when PTs are satisfied with shear speculation about the cause of poor posture, assume it to be truth, and never examine further.

a)

Anterior view. The patient faces you with the plumb line dividing his body into right and left halves.

b) Lateral view. Observe the lateral view from both the left and right sides so you can see any imbalances between the two. c) Posterior view. This view includes some of the same items observed in the anterior view but should not be eliminated since it also reveals other factors such as foot arch positions, knee fossa alignment, scoliosis, and scapula theight. The plumb line bisects the body as indicated in the posterior view checklist.

The examination process always includes comparison of left and right corresponding segments, because normal is often solely determined by comparison to the contralateral side. Normal for one person may not be normal for another person. For example, a gymnast will have much greater excursion in a straight leg raise than a baseball player, and a pitcher will have more glenohumeral lateral rotation than a first baseman. Each athlete must be compared only to herself and not to others.

Posturography
Posturography is a general term that covers all the techniques to quantify postural control in upright stance in either static or dynamic conditions.

STATIC POSTUROGRAPHY our results

We use static posturography examination since 1980. In 1989, at the Neurootological and Equilibrium Society (N.E.S.), we present a communication concerning the interest of static posturography in otoneurology in a study of 130 patients. We published The Interest of static posturography in whiplash injuries in the Proceeding of the N.E.S. in 1991.

STATIC POSTUROGRAPHY our results

In these studies we analyse :
- the surface of the displacement area - the total distance covered by the center of gravity

In three positions :
1) opened eyes 2) closed eyes 3) closed eyes with neck loading position

STATIC POSTUROGRAPHY our results

The Romberg quotients defined by Marcel Norre were calculated
closed eyes surface QR1 = opened eyes surface

QR2 =

closed eyes surface with neck loading opened eyes surface

OUR CONCLUSIONS
According to our results it appears that the main interest of posturography is - to appreciate the processus of rehabilitation in patients that complain of dizziness with vestibular proofs demonstration a compensated labyrinthic lesion. - to demonstrate mainly in the postcommotionnal syndrome the exageration of the symptoms described by the patient : that is interesting for a medicolegal point of view. - to proof in some cases the relation between whiplash injury and dizziness sensation without labyrinthic pathology. We aggree with Marcel Norre when he says that posturography is a complementary technique to the ENG examination. It is a other element in our battery of otoneurological diagnosis tests.

Static Posture
Normalized data were proposed in 1985 by Association Franaise de Posturologie and further modified and analysed every year, by the European Society for clinical evaluation of Balance Disorders founded in Nancy by Prof. Philippe Perrin.

Place de l'examen de la posture dans l'valuation du dommage corporel.

Revue Belge du dommage corporel et de Mdecine Lgale 2005, 32, 33-43 http://vertigoanddizziness.blogspot.com

Dynamic Posturography

Computerized Dynamic Posturography

CAUTION
Journal of Vestibular Research 21 (2011) 117-125 DOI 10.3233/VES-2011-0397 IOS Press

Stocktaking on the development of posturography for clinical use

Herman Kingma, Grome C. Gauchard, Catherine de Waele, Christian van Nechel, Alexandre Bisdorff, Alain Yelnik, Mans Magnusson and Philippe P. Perrin

This report identifies fundamental problems to be addressed in order to build relevant clinical tests of human balance while standing. The stated purpose of these tests is identification of lesion site and/or definition of functional balance deficits in a specific patient. During a recent consensus meeting (ESCEBD), 60 researchers and experienced clinical users of posturography (14 European countries, 9 different disciplines) inventoried and critically analyzed the various methodologies of posturography currently used for clinical evaluation. To complement posturography, alternative methods of assessment of balance control were considered. The indications for the clinical use of posturography were defined as well as recommendations regarding measurement parameters, type of perturbations and signal analysis techniques to improve assessment of balance control.

Consensus was reached that a force platform cannot be considered as a technique which is sufficient on its own to perform a clinically relevant test for the assessment of neuro-otological and musculo-skeletal conditions, evaluation of compensation or treatment (rehabilitation) or prediction of falls. It should be supported by complementary methods, such a segment motion analysis, body-fixed 2D or 3D accelerometer-gyroscope or electromyography. At present, no generally applicable posturography test is available with reasonable sensitivity and specificity for the diagnosis of balance disorders. Perturbation techniques are most likely needed to enhance the diagnostic yield of posturography.