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WO1990006082A1 - Analyse des reponses de posture - Google Patents

Analyse des reponses de posture Download PDF

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Publication number
WO1990006082A1
WO1990006082A1 PCT/US1989/005415 US8905415W WO9006082A1 WO 1990006082 A1 WO1990006082 A1 WO 1990006082A1 US 8905415 W US8905415 W US 8905415W WO 9006082 A1 WO9006082 A1 WO 9006082A1
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WIPO (PCT)
Prior art keywords
displacement
function
subject
equilibrium
stability
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PCT/US1989/005415
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English (en)
Inventor
Lewis M. Nashner
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Neurocom International Inc
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Neurocom International Inc
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Publication of WO1990006082A1 publication Critical patent/WO1990006082A1/fr
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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/103—Measuring devices for testing the shape, pattern, colour, size or movement of the body or parts thereof, for diagnostic purposes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/40—Detecting, measuring or recording for evaluating the nervous system
    • A61B5/4005—Detecting, measuring or recording for evaluating the nervous system for evaluating the sensory system
    • A61B5/4023—Evaluating sense of balance

Definitions

  • This invention relates generally to methods and devices for the detection of balance disorders, and specifically to methods and devices for numerical and graphical analysis of postural movement response data obtained from subjects while they maintain positions in equilibrium under a variety of conditions.
  • the present experimental and clinical art includes a large number of methods and devices for measuring the forces and body segment motions associated with the postural movements produced by subjects as they maintain assumed positions in equilibrium. Measurement methods include the incorporation of force transducing devices into the surface supporting an assumed posture (see, for example, Nashner, "A Model Describing Vestibular Detection of Body Sway Motion," Acta Otolaryn ⁇ Stockh.
  • the methods for analyzing the resulting force and motion data available in the present experimental and clinical art vary with the type of measurement used.
  • force measuring surfaces When force measuring surfaces are used, the distribution of forces on the surface can be analyzed to determine the locations of the centers of force for each foot separately and for the two feet together, and to relate these quantities to the position of the center of gravity of the body above the surface (Gurfinkel, "Physical Foundations of the Stabilography, "Agressologie 14G:9-14).
  • potentiometric and optical methods are used to measure the position changes of specific points on the body, geometric calculations are used to determine the linear motions of body parts and the angular orientations of body parts relative to one another and to the gravitational vertical.
  • inertial motion transducers The analysis of information from inertial motion transducers is similar to that used with the position measuring devices, except that an additional step is necessary to numerically integrate the velocity and acceleration information to determine the position of specific body parts (for example, Nashner, Shupert, Horak, "Head-trunk Coordination in the Standing Posture,” in “Vestibulospinal Control of Posture and Locomotion,” Progress in Brain Research, Vol 76, pp. 243-51, Elsevier, Amsterdam, 1988).
  • the present art contains descriptions of additional methods and devices for analyzing body movement responses with the purpose of understanding the underlying physiological mechanisms of posture and equilibrium control.
  • Fourier transforms of center of force position and body center of mass position information are used to determine the amplitude of power contained in the body movement signals as a function of the frequency of the body movements (for example, Bensel, Dzendolet, "Power Spectral Density Analysis of the Standing of Males,” Perception and Psychophysics 4:285- 87, 1968; Yoneda, Tokumasu, "Frequency Analysis of Body Sway in the Upright Posture, Acta Otolaryngol. Stockh. 102:87-92, 1986) . differences in the power spectra of sway with changes in task conditions and disease states are thought to reflect changes in the underlying physiological control mechanisms.
  • support surface inputs somatosensory and proprioceptive inputs derived from the forces and motions of contact with the support surface
  • support surface inputs are among the most sensitive and fast acting of the postural input systems (for example, Diener, Dichgans, Guschlbaure, Mau, "The Significance of Proprioception on Postural Stabilization as Assessed by Ischemia," Brain Research 296:103-109, 1984).
  • the sway displacement scores of a group of patients with dizziness were then compared to the normal data base of scores to determine the effectiveness of a postural stability test distinguishing between normals and patients with dizziness (Wall, Black, Postural stability and rotational tests: their effectiveness for screening dizzy patients, Acta Otolaryngol. Stockh. 95:235-46, 1983) .
  • This present invention provides a method for assessing the stability of a subject who is actively maintaining a position in equilibrium on a support surface.
  • the subject is placed on a support surface, and assumes a position in equilibrium thereon.
  • Figure 1 shows a schematic block diagram of the components of one possible embodiment of an apparatus in accordance with the present invention.
  • Figure 2 shows the single inverted pendulum mathematical model used for calculating the limits of stability for the erect standing position.
  • Figure 3A and 3B show example two-dimensional plots of a stability limit function and a displacement function of a possible embodiment of a display according the present invention.
  • the present invention is designed to provide sensitive and reliable information regarding the extent of possible balance disorder and of the possible involvement of individual sensory input systems.
  • One specific application of the invention is to determine the relative contribution of vestibular system utricular otolith and semicircular canal abnormalities to the balance disorder.
  • the methods and devices described in this invention can be used to provide medical practitioners with assessment information helpful in diagnosing patients with balance and movement deficits, and with complaints of dysequilibrium, vertigo, and/or motion sickness.
  • the present invention provides new methods and devices for analyzing and displaying postural movement response data obtained during the assessment of a subject's ability to maintain an assumed position in equilibrium using test means available in the present art.
  • the methods and devices provided by my present invention perform the following functions: (1) analyze movement response data in terms of the biomechanical constraints on a subject's ability to move the body while maintaining a position in equilibrium and in terms of the sensory constraints on a subject's ability to sense displacements from an assumed equilibrium position, (2) compare the results of analysis to a normal data base of analyzed results, and (3) display the results in a format that facilitates interpretation by clinicians.
  • the subject to be tested performs an active posture control task by assuming a position in equilibrium on a support surface.
  • a quantity related to the displacement of the subject from the assumed equilibrium position is measured over an interval of time I call a trial.
  • a quantity I call the displacement function is calculated which characterizes the amplitude of the subject's displacement as a function of the frequency of displacement during the trial.
  • a quantity I call the stability limit function is calculated which characterizes, as a function of the displacement frequency, the maximum displacement of the body from the assumed equilibrium position that is possible without the subject losing balance or requiring additional external support.
  • the stability limit function is determined using a mathematical description of the body biomechanics as described in the prior art and knowledge of the subject's height, body mass, and foot length.
  • a quantity I call the stability margin function is calculated which characterizes, as a function of the displacement frequency, the difference between the measured displacement and the stability limit.
  • the equilibrium of the subject being tested is stability margin differs from a "normal stability margin function" according to a statistical test of difference.
  • the normal stability margin function is defined by referring to a data base which, for example, can be determined by repeating the first four steps on a group of other subjects judged normal by accepted clinical methods and then calculating on a statistical basis the normal distribution of displacement and stability margin functions.
  • the subject to be tested performs an active posture control task by assuming a position in equilibrium on a support surface.
  • a quantity I call the displacement function is calculated which characterizes the amplitude of the subject's displacement as a function of the frequency of displacement during the trial.
  • a quantity related to the displacement of the subject from the assumed equilibrium position is measured over an interval of time I call a trial.
  • a quantity I call the displacement function is calculated which characterizes the amplitude of the subject's displacement as a function of the frequency of displacement during the trial.
  • a quantity I call the designated sense threshold function is calculated for each of the senses to be assessed.
  • Each designated sense threshold function characterizes, as a function of the displacement frequency, the smallest amplitude of displacement from the assumed equilibrium position that can be detected by the sense.
  • the designated sense threshold function is calculated from knowledge of the threshold and dynamic properties of the sense as described in the prior experimental art.
  • a quantity I call the designated sense margin function is calculated by determining, for each displacement frequency, the difference between the displacement function and the designated sense margin function.
  • a designated sense is judged abnormal at those frequencies of displacement at which the designated sense margin function differs from a "normal designated sense margin function" for that sense according to a statistical test of difference.
  • this normal designated sense margin function is defined by referring to a data base which, for example, could be generated by repeating the first five steps on a group of other subjects judged normal by accepted clinical methods and then calculating on a statistical basis normal distributions for the displacement and designated sense margin functions.
  • Assessing Stability of Eguilibrium Positions In a preferred embodiment of my present invention, the EquiTest system manufactured by NeuroCom international Inc. of Portland Oregon creates the test environments in which a subject is placed in a position in eguilibrium, measures the subjects displacements from the assumed equilibrium position, and stores the resulting data for later analysis.
  • a subject 11 assumes an erect standing position in equilibrium on a support surface 12, within which are imbedded measurement means for measuring the distribution of surface reaction forces between the subject's feet and the support surface.
  • Displacement measurement means 13 measures displacements of the subject from the assumed equilibrium position.
  • Support surface movement means 14 moves the support surface in accordance with movement commands from the computing/electronic interface means 18.
  • a visual enclosure 15 surrounds the subject's field of view.
  • Visual enclosure moving means 16 moves the visual enclosure in accordance with movement commands from the computing/electronic interface means.
  • the system includes a data entry means 17 by which an operator can enter data related to the characteristics of body motions and sensory input systems.
  • the computing/electronic interface means 18 executes a trial in accordance with a predetermined protocol, calculating functional quantities related to measurement data from the displacement measure means 13, issuing movement commands to the support surface and visual enclosure movement means 14 and 16, calculating functional quantities related to the designated sense threshold, designated sense margin, stability limit, stability margin, calculating normal distributions of these functions, and generating displays of these functions to be transmitted to the display means 19.
  • Display means 19 displays the displacement, designated sense threshold, stability limit, and other functional quantities calculated by the computing means.
  • the first EquiTest system consists of two force measuring support surfaces (forceplates) for measuring the forces exerted by each of the subject's feet and a visual enclosure surrounding the subject's field of view.
  • the forceplate support surface is rotatable about an axis approximately 2 inches above the surface.
  • the visual enclosure is rotatable about an axis also locates above the support surface. Rotational positions of the support surface and enclosure are controlled by separate electrical position servomotors.
  • An electronic interface transmits rotational position commands from a computer to the support surface and visual enclosure servomotors.
  • An electronic interface transmits rotational position commands from a computer to the support surface and visual enclosure servomotors and transmits force response data from the forceplate to the computer.
  • a computer receives and stores force data from the electronic interface, performs mathematical calculations of the force data, and calculates rotational position commands for transmission to the electronic interface.
  • a computer program implements the test protocols, controls the actions of the three position servomotors, controls the actions of the three position servomotors, and analyzes the resulting force transducer data in terms of prescribed methods.
  • Eliminating Accurate Orientation Information To perform an EquiTest assessment, the subject assumes an erect standing position of the support surface. In a preferred protocol of the EquiTest system, the subject's ability to maintain stability in the antero-posterior plane of motion is assessed by aligning the subject's ankle joints, so as to be co-linear with the support surface rotation axis. During standing, force signals from the forceplate are transmitted to the computer. The computer uses programmed mathematical algorithms to calculate on a continuous basis, among other quantities, a quantity related to the antero-posterior angular displacements of the subject's body center of mass in relation to the center of support and then stores the resulting data in computer memory for later analysis.
  • the subject's anetero-posterior angular displacements from the erect standing position are monitored during a series of six 20-second test trials.
  • the six trials consist of the following conditions: (1) fixing the support surface and visual enclosure with subject's eyes open allow accurate visual and support surface somatosensory orientation information, (2) fixing the support surface with the subject's eyes closed allow accurate support surface somatosensory orientation information while eliminating all visual information, (3) fixing the support surface allows accurate support surface somatosensory orientation information while rotating the visual enclosure in direct relation to the measured antero-posterior angular displacements with the subject's eyes open eliminates orientationally accurate visual information, (4) rotating the support surface in direct relation to the measured antero- posterior angular displacements of the subject eliminates orientationally accurate support surface somatosensory information while fixing the visual enclosure with the subject's eyes open allows accurate visual orientation information, (5) rotating the support surface in direct relation to the measure antero-posterior angular displacements of
  • the sensory organization test can also be administered to assess the lateral plane angular displacements of the subject's body center of mass and to eliminate orientationally accurate support surface somatosensory and visual orientation information in the lateral plane of motion.
  • the subject assuming an erect standing position on the EquiTest forceplate surface so that a line passing through the two ankle joints is aligned perpendicular to the surface and enclosure rotation axes.
  • the computer uses programmed mathematical algorithms to calculate on a continuous basis, among other quantities, a quantity related to the lateral plane angular displacements of the subject's body center of mass in relation to the center of support and then stores the resulting data in computer memory for later analysis.
  • the 6 20-second trials described for the antero-posterior assessment protocol are repeated, except now the support surface and visual enclosure are rotated in direct relation to the measure lateral plane angular displacements of the subject's body center of mass.
  • the NeuroCom International, Inc. EquiTest chair accessory is used to assess a subject's ability to maintain stability in the antero-posterior plane of motion while assuming a seated position in equilibrium.
  • the subject assumes a seated position in equilibrium on a chair surface which is rotatable about an axis approximately co-linear with the hip joints.
  • the subject's field of view is surrounded by an enclosure rotatable about a second axis also approximately co-linear with the subjects hip joints.
  • An angular rate sensory attached to the upper back measures the antero-posterior angular velocity of displacement of the subject's body. Numerical integration of the angular velocity signal is used to determine the angular displacement of the upper body.
  • the EquiTest and chair accessory system performs a series of six 20-second test trials identical to those described for the erect standing sensory organization test.
  • the support surface of the chair and visual enclosure are rotated in direct relation to the measure antero-posterior plane angular displacements of the subject's upper body.
  • a second protocol of the seated sensory organization test assesses the ability of the subject to maintain stability in the lateral plane of motion is assessed while assuming a seated position in equilibrium.
  • the subject assumes a seated position in equilibrium on the EquiTest chair accessory with the subject positioned such that a line passing through the two hip joints lies perpendicular to the support surface and visual enclosure rotation axes.
  • An angular rate sensory attached to the upper back measures the lateral plane angular velocity of displacement of the subject's upper body.
  • the series of six 20 second trials identical to those described for the erect standing protocol is repeated, except now the support surface of the chair and visual enclosure are rotated in direct relation to the measured lateral plan angular displacements of the subject's upper body.
  • orientationally accurate information from support surface somatosensory inputs can be selectively reduced or eliminated by placing the subject on a surface which is complient to the support surface.
  • Accurate orientation information from support surface somatosensory inputs in both antero-posterior and lateral planes of motions can be simultaneously reduced or eliminated by placing the subject on complient foam rubber surface or on a flexible container such as a large rubber bag filled with a complient fluid such as air or water.
  • a complient fluid such as air or water.
  • Support surface somatosensory information in the antero- posterior plane of motion can be selectively reduced or eliminated by placing the subject on a support surface rotatable about an axis co-linear with the ankle joints and making the surface rotationally complient to the antero- posterior plane torsional forces exerted about the ankle joints.
  • support surface somatosensory information in the lateral plane of motion can be selectively reduced or eliminated by placing the subject on a support surface rotatable about an axis perpendicular to a line passing through the two ankle joints and making the surface rotationally complient to the lateral plane torsional forces exerted about the ankle joints.
  • Calculating the Displacement Function Several analytical and computational methods are described within the prior art to calculate information regarding the amplitude of subject's angular displacement from an assumed equilibrium position relative to the rate of angular displacement using the measurement data provided by the EquiTest sensory organization test protocols.
  • a functional quantity relating the amplitude of a subject's angular displacement from an assumed equilibrium position to the frequency of the subject's angular displacement can be calculated by performing a Fourier transform on the displacement data received during each 20- second test.
  • a second method would be to perform a time derivative of the angular displacement data received during each 20-second test to determine the velocity of sway displacement as a function of the sway amplitude.
  • Computer programs to perform Fourier transforms and time derivatives are commercially available; for example, in the "Assist" program sold by MacMillan, Inc. of New York City, New York.
  • the stability limits for angular displacement of the body center of mass about the ankle joints are determined by imposing a mechanical constraint on the maximum ankle torque available to resist the destabilizing affects of gravity and body angular momentum about the ankle joints.
  • the mechanical constraint on the maximum ankle torque in the lateral plane of motion is determined from knowledge of the total body mass, the height of the center of body mass above the ankle joints, and the lateral plane width of the contact surface between the feet and the support surface.
  • the configuration of the support surface affects the stability limit function for a given assumed position in equilibrium.
  • the maximum possible ankle torque in the antero-posterior plane of motion is reduced.
  • the maximum possible ankle torque in the lateral plane of motion is reduced.
  • ankle torque constraints are similar to those described for the single inverted pendulum model.
  • Hip torque constraints can be based either on empirical observations of maximum hip joint accelerations in relation to trunk length and mass or on theoretical calculations of maximum hip muscle strengths and contractile speeds in relation to trunk length and mass.
  • Mathematical methods similar to those described for the erect standing position in eguilibrium can be used to determine the stability limits for angular displacements of the body from assumed equilibrium positions other than erect standing.
  • antero-posterior angular displacements of the upper body about the hip joints can be described in terms of a single inverted pendulum model.
  • the maximum torque that can be exerted about the hip joints is derived from knowledge of upper body total mass, height of upper body center of mass above the hip joints, and the antero-posterior length or lateral width of the contact surface between the buttocks and upper legs and the support surface.
  • maximum antero-posterior and lateral plane hip torques are then used to calculate the maximum antero- posterior and lateral plane angular displacement amplitudes of the upper body as functions of the upper body angular displacement frequencies and velocities.
  • the identical method is used to calculate the erect standing antero-posterior plane canal and otolith thresholds as functions of the frequency of antero-posterior plane displacements.
  • the mathematical formulation developed by me in my 1971 publication can also be used to determine the angular displacement thresholds for the canals and otoliths as functions of the velocity of angular displacements.
  • the body begins displacement at a constant angular velocity from the erect standing position.
  • angular accelerations to the canals are identical to those of the center of body mass, while the angular tilt of the head is identical to that of the center of mass.
  • the dynamical and threshold models of the canals and otoliths will then predict the angular displacement of the body center of mass at which the motion will first be detected.
  • a separate functional relation for each of the canals and otoliths is defined which describes the angular displacement amplitude at which motion is first detected as a function of the angular displacement velocity.
  • otolith and canal threshold functions for lateral displacement from the erect standing position can be determined with methods similar to those used for the antero-posterior plane of motion.
  • the same mathematical formulations for describing canal and otolith detection can be used for antero-posterior and lateral planes of motion, because the experimental observations used to develop the dynamic and threshold models of the canals and otoliths found that detection characteristics were similar in both antero-posterior and lateral planes of motion.
  • Other preferred embodiments of the present invention may use more complex biomechanical models to calculate the canal and otolith threshold functions for sensing displacements of the body center of mass from the erect standing position.
  • the combined effects of ankle and hip joint motions on angular and linear acceleration inputs to the canals and otoliths can be taken into account using a double inverted pendulum model of body motion. If the combined effects of ankle, hip and neck rotations on the canal and otolith threshold functions is desired, a triple inverted pendulum model using the ankle, hip and neck joints may be used.
  • a single inverted pendulum model for describing angular displacements of the upper body about the hip joints can be used to determine the antero-posterior and lateral plane angular threshold functions for canal and otolith detection of displacements from the seated eguilibrium position.
  • the rotational motion inputs to the canals are identical to the angular tilt displacement of the upper body.
  • calculations are identical to those described for the erect standing position.
  • Figure 3A shows an example of two-dimensional plots of a stability limit function and a displacement function of a possible embodiment of a display according to the present invention.
  • the vertical axis of the plot shows the displacement angle.
  • the horizontal axis of the plot shows the displacement angle.
  • the horizontal axis shows the displacement frequency.
  • Trace 31a shows the stability limit angle as a function of frequency for the erect standing position.
  • Trace 32a shows a possible displacement function of a patient who is unstable at frequencies between 0.4 and 0.6 Hz.
  • Fig. 3B uses the same graphical format.
  • Trace 31b again shows the stability limit angle as a frequency for the erect standing position.
  • Trace 32b shows a possible designated sense threshold displacement angle as a function of the displacement frequency.
  • the displacement sense margin function determined by calculating the difference between the displacement function and the designated sense threshold function is large for frequencies between 0.4 and 0.6 Hz, indicating that the designated sense is abnormal in this frequency range.
  • a number of computer programs are commercially available for generating two-dimensional plots of the functional relation between two variables from either one of a table of numbers relating the two variables or a' mathematical equation relating the two variables.
  • the "Assist" program sold by MacMillian Co of New York is one such computer program.
  • the two-dimensional plots may be generated by computer and then printed in hard copy form by a computer-driven printing or plotting device.
  • the functional relations may be displayed in terms of numerical data.

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Abstract

Procédé et appareil permettant d'évaluer la stabilité d'un sujet recherchant activement à maintenir une position d'équilibre sur une surface portante (12). On mesure (13) l'amplitude de déplacement du sujet par rapport à la position supposée d'équilibre en fonction de la vitesse dudit déplacement. On calcule (18) ensuite, pour chaque vitesse de déplacement, l'amplitude de déplacement maximum possible par rapport à la position supposée d'équilibre. On compare (18) enfin la différence entre ces deux calculs avec une base de données déterminant les réponses normales du point de vue clinique.
PCT/US1989/005415 1988-11-30 1989-11-30 Analyse des reponses de posture Ceased WO1990006082A1 (fr)

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Cited By (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5551445A (en) * 1982-08-16 1996-09-03 Neurocom International, Inc. Apparatus and method for movement coordination analysis
WO2004014230A1 (fr) 2002-08-09 2004-02-19 Matsushita Electric Industrial Co., Ltd. Dispositif d'analyse d'un etat d'equilibre
US9183756B2 (en) 2007-11-26 2015-11-10 Ultrathera Technologies, Inc. Vestibular stimulation systems and methods of use
AU2018201685B1 (en) * 2017-07-07 2018-10-25 Tata Consultancy Services Limited Method and system for postural stability assessment
EP3376414A4 (fr) * 2015-11-13 2019-04-24 Innomotion Incorporation (Shanghai) Système et procédé de détection de déplacement d'articulation, et procédé et système d'évaluation dynamique pour une articulation de genou

Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4738269A (en) * 1982-08-16 1988-04-19 Nashner Lewis M Apparatus and method for sensory integration and muscular coordination analysis
US4830024A (en) * 1982-08-16 1989-05-16 Nashner Lewis M Apparatus and method for determining the presence of vestibular perilymph fistulae and other abnormal coupling between the air-filled middle ear and the fluid-filled inner ear

Patent Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4738269A (en) * 1982-08-16 1988-04-19 Nashner Lewis M Apparatus and method for sensory integration and muscular coordination analysis
US4830024A (en) * 1982-08-16 1989-05-16 Nashner Lewis M Apparatus and method for determining the presence of vestibular perilymph fistulae and other abnormal coupling between the air-filled middle ear and the fluid-filled inner ear

Cited By (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5551445A (en) * 1982-08-16 1996-09-03 Neurocom International, Inc. Apparatus and method for movement coordination analysis
USRE40427E1 (en) 1982-08-16 2008-07-08 Neurocom International, Inc. Apparatus and method for movement coordination analysis
WO2004014230A1 (fr) 2002-08-09 2004-02-19 Matsushita Electric Industrial Co., Ltd. Dispositif d'analyse d'un etat d'equilibre
EP1527734A4 (fr) * 2002-08-09 2009-04-15 Panasonic Corp Dispositif d'analyse d'un etat d'equilibre
US9183756B2 (en) 2007-11-26 2015-11-10 Ultrathera Technologies, Inc. Vestibular stimulation systems and methods of use
EP3376414A4 (fr) * 2015-11-13 2019-04-24 Innomotion Incorporation (Shanghai) Système et procédé de détection de déplacement d'articulation, et procédé et système d'évaluation dynamique pour une articulation de genou
AU2018201685B1 (en) * 2017-07-07 2018-10-25 Tata Consultancy Services Limited Method and system for postural stability assessment

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