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Posturography

What is it?​

At Plasticity®, we utilize the Comprehensive Assessment of Postural Systems (CAPS®) technology. It is an essential posturography tool combining user friendly, yet powerful software, with a self-leveling, three-component force platform that has an accuracy of 0.1 mm and precision and resolution of 0.05 mm, as assessed by the International Society for Posture and Gait Research (ISPGR) (1). The sensitivity of the CAPS® technology makes it one of the most sensitive tools to measure balance and stability (16).

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Why is it important?

Control of balance involves complex and inter-connected physiologic pathways for the purpose maintaining posture, facilitating appropriate movements, and restoring equilibrium (2,3). These tasks are achieved by the coordination of multiple body systems including vestibular (detection of angular and linear translations or accelerations), visual (visual representation of the world around you), and proprioceptive (perception of spatial orientation via muscle and joint positioning), all integrating in the brainstem (2-7), an important area of the brain that also has associations with the coordination of eye movements and regulation of autonomic functions (3).

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How does it work?

CAPS® allows a subject to be tested both statically and dynamically through a series of 10, 25-second tests. Static tests are completed on a solid surface with the subject’s eyes open, eyes closed, and eyes closed with mathematical calculations. Dynamic tests are completed on a perturbed surface, or foam pad, including the same tests already mentioned, as well as, eyes closed with the head in different positions. The completion of each test is recorded, and the subject is given an overall stability score compared against normative data for their age, height, and weight.

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How does it help?

Manipulating the subject’s sensory environment by decreasing visual (eyes closed), proprioceptive (perturbed surface) and vestibular (head in different positions) feedback, in addition to introducing a secondary task (mathematical calculations), gives insight to how each system is contributing the subject’s overall balance and stability (8), as well as the ability of those systems to process the available sensory information and recalibrate accordingly (9), potentially revealing underlying sensorimotor mechanisms contributing to balance disorders (10).

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​Although specific stability scores do not directly correlate to any disease or dysfunction, the subject’s performance can be assessed based on sway patterns, center of pressure changes, response latencies, etc. reflecting what systems or parts of the brain may not be functioning optimally, such as seen in concussion, traumatic brain injury (11), peripheral neuropathies, multiple sclerosis (12), Parkinson’s Disease and other neurodegenerative diseases, stroke, vestibular disorders, aging (13-15), and many other different conditions that impact neurological function.

References

  1. Scoppa F, Capra R, Gallamini M, Shiffer R. Clinical stabilometry standardization: Basic definitions - acquisition interval - sampling frequency. Gait Posture. 2013;37:290-2.

  2. Horak FB. Clinical assessment of balance disorders. Gait & Posture. 1997;6:76–84.

  3. Uchino, Y., & Kushiro, K. (2011).  Differences between otolith-and semicircular canal-activated neural circuitry in the vestibular system. Neurosci Res,7 (14), 315-327.

  4. Macpherson J, Horak FB. Postural Control, Chapter 9 in Eric Kandell and Schwartz. Neuroscience. 2009.

  5. Chandrasekhar, Sujana S. The assessment of balance and dizziness in the TBI patient. NeuroRehabilitation 32 (2013) 445-454.

  6. Cronin, Thomas., Arshad, Qadeer., and Seemungal, Barry M. Vestibular deficits in neurodegenerative disorders: balance, dizziness, and spatial disorientation. Frontiers in neurology. 26 October 2017.

  7. Visser JE, Carpenter MG, van der KH, Bloem BR. The clinical utility of posturography. Clin.Neurophysiol. 2008;119:2424–2436.  [PubMed]

  8. Visser JE, Carpenter MG, van der KH, Bloem BR. The clinical utility of posturography. Clin.Neurophysiol. 2008;119:2424–2436.  [PubMed]

  9. Nashner LM, Black FO, Wall C., 3rd Adaptation to altered support and visual conditions during stance: patients with vestibular deficits. J Neurosci. 1982 May;2(5):536–44.  [PubMed]

  10. Mancini, M., & Horak, F. B. (2010). The relevance of clinical balance assessment tools to differentiate balance deficits. European Journal of Physical and Rehabilitation Medicine, 46(2), 239–248.

  11. Cherer, M. , & Shubert, M. C. (2009). Traumatic brain injury and vestibular pathology as a comorbidity after blast exposure. Physical Therapy, 89 (9), 980-992

  12. Dickstein R, Shupert CL, Horak FB. Fingertip touch improves postural stability in patients with peripheral neuropathy. Gait & Posture. 2003;14(3):238–247.  [PubMed]

  13. Prieto TE, Myklebust JB, Hoffmann RG, Lovett EG, Myklebust BM. Measures of postural steadiness: differences between healthy young and elderly adults. IEEE Trans.Biomed.Eng. 1996;43:956–966.  [PubMed]

  14. de Haart M, Geurts AC, Huidekoper SC, Fasotti L, van LJ. Recovery of standing balance in postacute stroke patients: a rehabilitation cohort study. Arch.Phys.Med.Rehabil. 2004;85:886–895.[PubMed]

  15. Dozza M, Chiari L, Horak FB. Audio-biofeedback improves balance in patients with bilateral vestibular loss. Arch.Phys.Med.Rehabil. 2005;86:1401–1403.  [PubMed]

  16. Pagnacco, G., Oggero, E., & Wright, C.H. (2011). Biomedical instruments versus toys:a preliminary comparison of force platforms and the nintendo wii balance board - biomed 2011. Biomedical sciences instrumentation, 47, 12-7.

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