Evaluation of Hearing Sensitivity in Young Adults With Normal Hearing Using a 40-Hz Auditory Steady-State Response With CE-Chirp

Purpose

The present study aimed to measure hearing sensitivity in young adults with normal hearing using a 40-Hz auditory steady-state response with CE-Chirp and to evaluate the speed and accuracy of this method.

Method

Twelve young adults (1 man, 11 women; mean age = 22.1 ± 3.1 years) each completed two auditory steady-state response measurement sessions with CE-Chirp. The difference score was calculated at each of the four pure-tone frequencies. The measurement time and residual noise level in all stimulus levels were also determined.

Results

The difference scores across the 4 frequencies ranged within ±10 dB (1st: 58% to 71%, 2nd: 54% to 79%), within 20 dB (1st: 79% to 96%, 2nd: 79% to 100%), and ≥ 30 dB (1st: 4% to 17%, 2nd: 0% to 17%). The measurement times for both ears were approximately 20 min in both sessions. There was a significant correlation between the measurement time and the mean residual noise level for pooled frequencies in all stimulus levels (p = .0001249, r = .70). The measurement time was reduced by approximately 50% from conventional auditory steady-state response measurement.

Conclusion

The results of this preliminary study support the use of this technology as a rapid and accurate method for behavioral auditory threshold evaluation.

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Considerations for Pediatric Cochlear Implant Recipients With Unilateral or Asymmetric Hearing Loss: Assessment, Device Fitting, and Habilitation

Purpose

The purpose of this clinical report is to present case studies of children who are nontraditional candidates for cochlear implantation because they have significant residual hearing in 1 ear and to describe outcomes and considerations for their audiological management and habilitation.

Method

Case information is presented for 5 children with profound hearing loss in 1 ear and normal or mild-to-moderate hearing loss in the opposite ear and who have undergone unilateral cochlear implantation. Pre- and postoperative assessments were performed per typical clinic routines with modifications described. Postimplant habilitation was customized for each recipient using a combination of traditional methods, newer technologies, and commercial materials.

Results

The 5 children included in this report are consistent users of their cochlear implants and demonstrate speech recognition in the implanted ear when isolated from the better hearing ear.

Conclusions

Candidacy criteria for cochlear implantation are evolving. Children with single-sided deafness or asymmetric hearing loss who have traditionally not been considered candidates for cochlear implantation should be evaluated on a case-by-case basis. Audiological management of these recipients is not vastly different compared with children who are traditional cochlear implant recipients. Assessment and habilitation techniques must be modified to isolate the implanted ear to obtain accurate results and to provide meaningful therapeutic intervention.

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Service Delivery to Children With Mild Hearing Loss: Current Practice Patterns and Parent Perceptions

Purpose

This study investigates clinical practice patterns and parent perception of intervention for children with mild hearing loss (HL).

Method

Ages at and delays between service delivery steps (first diagnostic evaluation, confirmation of HL, hearing aid [HA] fitting, entry into early intervention) were investigated for 113 children with mild HL. Comparisons were made to children with moderate-to-severe HL. Parents of children with mild HL reported reasons for delays and their perceptions of intervention and amplification for their children.

Results

Seventy-four percent of children with mild HL were identified through the newborn hearing screen; 26% were identified later due to passing or not receiving a newborn hearing screen. Ninety-four percent of children with mild HL were fit with HAs, albeit at significantly later ages than children with moderate-to-severe HL. Most parents indicated that their children benefited from HA use, but some parents expressed ambivalence toward the amount of benefit.

Conclusions

Audiologists appear to be moving toward regularly providing amplification for children with mild HL. However, delays in HA fittings indicate that further educating professionals and parents about the benefits of early amplification and intervention is warranted to encourage timely fitting and consistent use of HAs.

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Evaluation of Hearing Sensitivity in Young Adults With Normal Hearing Using a 40-Hz Auditory Steady-State Response With CE-Chirp

Purpose

The present study aimed to measure hearing sensitivity in young adults with normal hearing using a 40-Hz auditory steady-state response with CE-Chirp and to evaluate the speed and accuracy of this method.

Method

Twelve young adults (1 man, 11 women; mean age = 22.1 ± 3.1 years) each completed two auditory steady-state response measurement sessions with CE-Chirp. The difference score was calculated at each of the four pure-tone frequencies. The measurement time and residual noise level in all stimulus levels were also determined.

Results

The difference scores across the 4 frequencies ranged within ±10 dB (1st: 58% to 71%, 2nd: 54% to 79%), within 20 dB (1st: 79% to 96%, 2nd: 79% to 100%), and ≥ 30 dB (1st: 4% to 17%, 2nd: 0% to 17%). The measurement times for both ears were approximately 20 min in both sessions. There was a significant correlation between the measurement time and the mean residual noise level for pooled frequencies in all stimulus levels (p = .0001249, r = .70). The measurement time was reduced by approximately 50% from conventional auditory steady-state response measurement.

Conclusion

The results of this preliminary study support the use of this technology as a rapid and accurate method for behavioral auditory threshold evaluation.

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Considerations for Pediatric Cochlear Implant Recipients With Unilateral or Asymmetric Hearing Loss: Assessment, Device Fitting, and Habilitation

Purpose

The purpose of this clinical report is to present case studies of children who are nontraditional candidates for cochlear implantation because they have significant residual hearing in 1 ear and to describe outcomes and considerations for their audiological management and habilitation.

Method

Case information is presented for 5 children with profound hearing loss in 1 ear and normal or mild-to-moderate hearing loss in the opposite ear and who have undergone unilateral cochlear implantation. Pre- and postoperative assessments were performed per typical clinic routines with modifications described. Postimplant habilitation was customized for each recipient using a combination of traditional methods, newer technologies, and commercial materials.

Results

The 5 children included in this report are consistent users of their cochlear implants and demonstrate speech recognition in the implanted ear when isolated from the better hearing ear.

Conclusions

Candidacy criteria for cochlear implantation are evolving. Children with single-sided deafness or asymmetric hearing loss who have traditionally not been considered candidates for cochlear implantation should be evaluated on a case-by-case basis. Audiological management of these recipients is not vastly different compared with children who are traditional cochlear implant recipients. Assessment and habilitation techniques must be modified to isolate the implanted ear to obtain accurate results and to provide meaningful therapeutic intervention.

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Service Delivery to Children With Mild Hearing Loss: Current Practice Patterns and Parent Perceptions

Purpose

This study investigates clinical practice patterns and parent perception of intervention for children with mild hearing loss (HL).

Method

Ages at and delays between service delivery steps (first diagnostic evaluation, confirmation of HL, hearing aid [HA] fitting, entry into early intervention) were investigated for 113 children with mild HL. Comparisons were made to children with moderate-to-severe HL. Parents of children with mild HL reported reasons for delays and their perceptions of intervention and amplification for their children.

Results

Seventy-four percent of children with mild HL were identified through the newborn hearing screen; 26% were identified later due to passing or not receiving a newborn hearing screen. Ninety-four percent of children with mild HL were fit with HAs, albeit at significantly later ages than children with moderate-to-severe HL. Most parents indicated that their children benefited from HA use, but some parents expressed ambivalence toward the amount of benefit.

Conclusions

Audiologists appear to be moving toward regularly providing amplification for children with mild HL. However, delays in HA fittings indicate that further educating professionals and parents about the benefits of early amplification and intervention is warranted to encourage timely fitting and consistent use of HAs.

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Evaluation of Hearing Sensitivity in Young Adults With Normal Hearing Using a 40-Hz Auditory Steady-State Response With CE-Chirp

Purpose

The present study aimed to measure hearing sensitivity in young adults with normal hearing using a 40-Hz auditory steady-state response with CE-Chirp and to evaluate the speed and accuracy of this method.

Method

Twelve young adults (1 man, 11 women; mean age = 22.1 ± 3.1 years) each completed two auditory steady-state response measurement sessions with CE-Chirp. The difference score was calculated at each of the four pure-tone frequencies. The measurement time and residual noise level in all stimulus levels were also determined.

Results

The difference scores across the 4 frequencies ranged within ±10 dB (1st: 58% to 71%, 2nd: 54% to 79%), within 20 dB (1st: 79% to 96%, 2nd: 79% to 100%), and ≥ 30 dB (1st: 4% to 17%, 2nd: 0% to 17%). The measurement times for both ears were approximately 20 min in both sessions. There was a significant correlation between the measurement time and the mean residual noise level for pooled frequencies in all stimulus levels (p = .0001249, r = .70). The measurement time was reduced by approximately 50% from conventional auditory steady-state response measurement.

Conclusion

The results of this preliminary study support the use of this technology as a rapid and accurate method for behavioral auditory threshold evaluation.

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Considerations for Pediatric Cochlear Implant Recipients With Unilateral or Asymmetric Hearing Loss: Assessment, Device Fitting, and Habilitation

Purpose

The purpose of this clinical report is to present case studies of children who are nontraditional candidates for cochlear implantation because they have significant residual hearing in 1 ear and to describe outcomes and considerations for their audiological management and habilitation.

Method

Case information is presented for 5 children with profound hearing loss in 1 ear and normal or mild-to-moderate hearing loss in the opposite ear and who have undergone unilateral cochlear implantation. Pre- and postoperative assessments were performed per typical clinic routines with modifications described. Postimplant habilitation was customized for each recipient using a combination of traditional methods, newer technologies, and commercial materials.

Results

The 5 children included in this report are consistent users of their cochlear implants and demonstrate speech recognition in the implanted ear when isolated from the better hearing ear.

Conclusions

Candidacy criteria for cochlear implantation are evolving. Children with single-sided deafness or asymmetric hearing loss who have traditionally not been considered candidates for cochlear implantation should be evaluated on a case-by-case basis. Audiological management of these recipients is not vastly different compared with children who are traditional cochlear implant recipients. Assessment and habilitation techniques must be modified to isolate the implanted ear to obtain accurate results and to provide meaningful therapeutic intervention.

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Service Delivery to Children With Mild Hearing Loss: Current Practice Patterns and Parent Perceptions

Purpose

This study investigates clinical practice patterns and parent perception of intervention for children with mild hearing loss (HL).

Method

Ages at and delays between service delivery steps (first diagnostic evaluation, confirmation of HL, hearing aid [HA] fitting, entry into early intervention) were investigated for 113 children with mild HL. Comparisons were made to children with moderate-to-severe HL. Parents of children with mild HL reported reasons for delays and their perceptions of intervention and amplification for their children.

Results

Seventy-four percent of children with mild HL were identified through the newborn hearing screen; 26% were identified later due to passing or not receiving a newborn hearing screen. Ninety-four percent of children with mild HL were fit with HAs, albeit at significantly later ages than children with moderate-to-severe HL. Most parents indicated that their children benefited from HA use, but some parents expressed ambivalence toward the amount of benefit.

Conclusions

Audiologists appear to be moving toward regularly providing amplification for children with mild HL. However, delays in HA fittings indicate that further educating professionals and parents about the benefits of early amplification and intervention is warranted to encourage timely fitting and consistent use of HAs.

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Schumann Frequenzgenerator

The Schumann resonator, which is also called the Schumann Frequenzgenerator, is a machine that generates a magnetic pulse at the same frequency of the Earth’s. The Earth’s magnetic pulse frequency was discovered in 1953 by Professor Schumann of the University of Munich. He was able to apply that frequency to solve problems that were experienced by some of the earliest astronauts. Today, the Shumann resonator is used by people on solid land who are experiencing troubling symptoms that impact their quality of life.

History of the Schumann Frequenzgenerator
In 1954, Schumann’s successor, a Dr. Herbert Konig, confirmed that the Earth’s magnetic frequency is 7.83 Hz. In later years, other medical researchers and scientists found that human brain waves operate at the same frequency as the Earth’s magnetic pulse. Today, it is possible to buy a portable Shumann resonator to plug into your car or use in your home in order to restore these natural pulses into your life.

How the Schumann Frequenzgenerator Works
The Shumann resonator uses electricity to vibrate magnets, which then pulse at the frequency of 7.83 Hz. It can also be set to include a 10.2 Hz frequency. These natural frequencies are thought to be the optimal levels that allow for healthy functioning of biological tissues and structures in the brain, such as the hippocampus.

Who May Use a Schumann Frequenzgenerator
You may benefit from the use of a Schumann resonator if you have been feeling out of sorts, especially if you spend a lot of time surrounded by other signals. This includes signals that come from cell phones, radios, TVs, cell phone towers, electrical lines and heavily trafficked roads. The Schumann resonator may benefit you if you have vague, waxing and waning symptoms such as low libido, restlessness, low energy, irritability, headaches and a sense of fatigue when in your home, at work or in your car.

Benefits of Using the Schumann Frequenzgenerator
Using the Schumann resonator at home, at work or in your car may help you to experience a sense of calm and reduced tension. Setting up the Schumann resonator in your bedroom and using it at night may help to reduce problems such as bad dreams, sleeplessness and sleep that is not restful. Many people find that the Schumann resonator helps to reduce brain fog and feelings of sadness, irritability, depression or apathy. You may also notice a boost in digestive system functioning.

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Corrigendum.

Related Articles

Corrigendum.

Int J Audiol. 2017 Mar 11;:1

Authors:

PMID: 28285558 [PubMed - as supplied by publisher]

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Novel Mutations and Mutation Combinations of TMPRSS3 Cause Various Phenotypes in One Chinese Family with Autosomal Recessive Hearing Impairment.

Related Articles

Novel Mutations and Mutation Combinations of TMPRSS3 Cause Various Phenotypes in One Chinese Family with Autosomal Recessive Hearing Impairment.

Biomed Res Int. 2017;2017:4707315

Authors: Gao X, Yuan YY, Wang GJ, Xu JC, Su Y, Lin X, Dai P

Abstract
Autosomal recessive hearing impairment with postlingual onset is rare. Exceptions are caused by mutations in the TMPRSS3 gene, which can lead to prelingual (DFNB10) as well as postlingual deafness (DFNB8). TMPRSS3 mutations can be classified as mild or severe, and the phenotype is dependent on the combination of TMPRSS3 mutations. The combination of two severe mutations leads to profound hearing impairment with a prelingual onset, whereas severe mutations in combination with milder TMPRSS3 mutations lead to a milder phenotype with postlingual onset. We characterized a Chinese family (number FH1523) with not only prelingual but also postlingual hearing impairment. Three mutations in TMPRSS3, one novel mutation c.36delC [p.(Phe13Serfs⁎12)], and two previously reported pathogenic mutations, c.916G>A (p.Ala306Thr) and c.316C>T (p.Arg106Cys), were identified. Compound heterozygous mutations of p.(Phe13Serfs⁎12) and p.Ala306Thr manifest as prelingual, profound hearing impairment in the patient (IV: 1), whereas the combination of p.Arg106Cys and p.Ala306Thr manifests as postlingual, milder hearing impairment in the patient (II: 2, II: 3, II: 5), suggesting that p.Arg106Cys mutation has a milder effect than p.(Phe13Serfs⁎12). We concluded that different combinations of TMPRSS3 mutations led to different hearing impairment phenotypes (DFNB8/DFNB10) in this family.

PMID: 28246597 [PubMed - indexed for MEDLINE]

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Hearing devices for children with unilateral hearing loss: Patient- and parent-reported perspectives.

Related Articles

Hearing devices for children with unilateral hearing loss: Patient- and parent-reported perspectives.

Int J Pediatr Otorhinolaryngol. 2016 Nov;90:43-48

Authors: Purcell PL, Jones-Goodrich R, Wisneski M, Edwards TC, Sie KC

Abstract
OBJECTIVE: Management of children with unilateral hearing loss is not standardized. The primary goal of this study was to elicit patient- and parent-reported perspectives regarding usage of hearing devices in pediatric UHL and to suggest a basic algorithmic approach to management.
METHODS: Our tertiary care center recruited families of youth ages 5-19 years with unilateral hearing loss from January 2014 through October 2015. Parents of all youths completed a 36-item survey, and some youth ages 11-19 years participated in hour-long interviews. We assessed patterns of hearing device usage among participants, and performed qualitative data analysis to understand factors considered by youths when deciding whether or not to use a hearing device.
RESULTS: Survey information was collected for 50 patients. Distribution of hearing loss severity in affected ear was mild 14%, moderate 26%, severe 22%, and profound 38%. The majority of children had sensorineural hearing loss (57%), followed by mixed (32%), and then conductive (11%). 34 children (68%) had tried a hearing device; 20 continued to use the device. Retention rates were similar among children with different degrees of hearing loss: mild 66%, moderate 50%, severe 60%, profound 64%. Sixteen children tried a wireless contralateral routing of signal (CROS) device, and 15 tried a behind-the-ear (BTE) hearing aid. Retention rates for CROS and BTE devices were 69% and 47%, respectively. The most common reason for cessation of use was discomfort, followed by lack of benefit.
CONCLUSION: A majority of children with unilateral hearing loss who tried a hearing device continued to use it, and retention rates were similar across all degrees of hearing loss. These findings suggest that personal hearing devices should be included in management protocols.

PMID: 27729150 [PubMed - indexed for MEDLINE]

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Follow-up in newborn hearing screening - A systematic review.

Related Articles

Follow-up in newborn hearing screening - A systematic review.

Int J Pediatr Otorhinolaryngol. 2016 Nov;90:29-36

Authors: Ravi R, Gunjawate DR, Yerraguntla K, Lewis LE, Driscoll C, Rajashekhar B

Abstract
INTRODUCTION: The quality and efficiency of newborn hearing screening programs (NHS) rely heavily on appropriate follow-up. The Joint Committee on Infant Hearing recommends a follow-up rate of more than 95% of infants who fail the initial hearing screening. However, a 70% benchmark is considered to be more feasible. This high loss to follow-up (LTF) rate acts as a threat to the overall success of NHS programs. The objective of the study was to identify and examine the reported rates of LTF, attributed reasons for LTF and strategies undertaken to reduce LTF.
METHODS: Using a systematic search, articles published between 2005 to December 2015 were identified from PubMed/Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Educational Resources Information Center (ERIC), Scopus, Ovid, ProQuest, and Cochrane Library. To be included in the review, the study should be exploring the loss to follow-up or drop-out rate in newborn hearing screening programs and be published in an indexed peer-reviewed journal in the English language. The main outcome measures were overall rate of LTF, factors leading to LTF and measures adopted to overcome LTF.
RESULTS: 53 articles were short-listed for data extraction. Out of these, 27 were single-centre studies, 19 were multi-centre, 3 compared multiple databases, and 4 used survey-based methods. Overall LTF rates of 20% in single-centre and 21% in multiple-centre studies were observed. Educational disparity and lack of adequate knowledge among parents were associated with LTF. The most commonly used strategy to overcome LTF suggested by studies was the use of an adequate data management system.
CONCLUSION: This review is a novel attempt to explore the LTF among NHS studies, reasons for LTF and strategies to reduce LTF. This review can act as a basis for planning and execution of effective NHS programs.

PMID: 27729148 [PubMed - indexed for MEDLINE]

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Level of emotion comprehension in children with mid to long term cochlear implant use: How basic and more complex emotion recognition relates to language and age at implantation.

Related Articles

Level of emotion comprehension in children with mid to long term cochlear implant use: How basic and more complex emotion recognition relates to language and age at implantation.

Int J Pediatr Otorhinolaryngol. 2016 Aug;87:219-32

Authors: Mancini P, Giallini I, Prosperini L, D'alessandro HD, Guerzoni L, Murri A, Cuda D, Ruoppolo G, De Vincentiis M, Nicastri M

Abstract
OBJECTIVES: The current study was designed with three main aims: To document the level of emotional comprehension skills, from basic to more complex ones, reached by a wide sample of cochlear implant (CI) deaf children with at least 36 months of device use; To investigate subjective and audiological factors that can affect their emotional development; To identify, if present, a "critical age", in which early intervention might positively affect adequate emotional competence development.
DESIGN: This is an observational cohort study. Children with congenital severe/profound deafness were selected based on: aged by 4-11 years, minimum of 36 months of CI use, Italian as the primary language in the family; normal cognitive level and absence of associated disorders or socio-economic difficulties. Audiological characteristics and language development were assessed throughout standardized tests, to measure speech perception in quiet, lexical comprehension and production. The development of emotions' understanding was assessed using the Test of Emotion Comprehension (TEC) of Pons and Harris, a hierarchical developmental model, where emotion comprehension is organized in 3 Stages (external, mental and reflective). Statistical analysis was accomplished via the Spearman Rank Correlation Coefficient, to study the relationship between the personal and audiological characteristics; a multivariate linear regression analysis was carried out to find which variables were better associated with the standardized TEC values; a chi-squared test with Yate's continuity correction and Mann-Whitney U test were used to account for differences between continuous variables and proportions.
RESULTS: 72 children (40 females, 32 males) with a mean age of 8.1 years were included. At TEC score, 57 children showed normal range performances (79.17% of recipients) and 15 fell below average (20.83% of recipients). The 16.63% of older subjects (range of age 8-12 years) didn't master the Stage 3 (reflective), which is normally acquired by 8 years of age and failed 2 or all the 3 items of this component. Subjects implanted within 18 months of age had better emotion comprehension skills. TEC results were also positively correlated with an early diagnosis, a longer implant use, better auditory skills and higher scores on lexical and morphosintactic tests. On the contrary, it was negatively correlated with the presence of siblings and the order of birth. The gender, the side and the severity of deafness, type of implant and strategy were not correlated.
CONCLUSIONS: Early implanted children have more chance to develop adequate emotion comprehension, especially when the complex aspects are included, due to the very strong link between listening and language skills and emotional development. Furthermore, longer CI auditory experience along with early intervention allows an adequate communication development which positively influences the acquisition of such competencies.

PMID: 27368475 [PubMed - indexed for MEDLINE]

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Corrigendum.

Related Articles

Corrigendum.

Int J Audiol. 2017 Mar 11;:1

Authors:

PMID: 28285558 [PubMed - as supplied by publisher]

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Corrigendum.

Related Articles

Corrigendum.

Int J Audiol. 2017 Mar 11;:1

Authors:

PMID: 28285558 [PubMed - as supplied by publisher]

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Corrigendum.

Related Articles

Corrigendum.

Int J Audiol. 2017 Mar 11;:1

Authors:

PMID: 28285558 [PubMed - as supplied by publisher]

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The Romberg ratio in people with multiple sclerosis

Publication date: Available online 14 March 2017
Source:Gait & Posture
Author(s): Alon Kalron
Postural control relies on the integration of inputs from the visual, somatosensory and vestibular systems which are frequently impaired in people with Multiple Sclerosis (PwMS). In this situation, examining the Romberg ratio can be useful. This parameter can be interpreted as a gross indicator of a vestibular and proprioceptive contribution to postural control. Therefore, the primary objective of the current study was to examine whether the Romberg ratio differs between MS fallers, non-fallers and neurological disability levels. In addition, we clarified the association between the Romberg ratio values with validated gait and the balance tests in PwMS. Romberg ratio values were calculated according to the sway rate, total sway area and center of pressure (CoP) path length. The patient group included 542 PwMS (337 women) with a mean age of 42.3 (S.D=13.8). In terms of fall status, significant differences were observed between the faller (n=287) and non-faller (n=255) groups solely in terms of the Romberg ratio-ellipse sway area: 2.76 (S.D=2.46) vs. 2.24 (S.D=2.01), P-Value=0.01. A significant increase in the Romberg ratio was found between the severe group (n=50), the very mild (n=245), mild (n=186) and moderate (n=61) groups for each of the three Romberg ratio quotients. Significant weak correlation scores were found between the Romberg ratio-ellipse sway area and all walking and balance outcome measures; the Pearson's rho ranged from 0.172 to 0.270. The present data suggest that an elevated Romberg ratio quotient, especially according to the sway area, is an indicator of poor walking and balance capabilities in PwMS.



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Combined versus individual effects of a valgus knee brace and lateral wedge foot orthotic during stair use in patients with knee osteoarthritis

Publication date: May 2017
Source:Gait & Posture, Volume 54
Author(s): Rebecca Moyer, Trevor Birmingham, Colin Dombroski, Robert Walsh, J. Robert Giffin
The aim of this study was to investigate the combined and individual biomechanical effects of a valgus knee brace and a lateral wedge foot orthotic during stair ascent and descent in patients with knee osteoarthritis (OA). Thirty-five patients with varus alignment and medial knee OA were prescribed a custom valgus knee brace and lateral wedge foot orthotic. Knee angles and moments in the frontal and sagittal planes were determined from 3D gait analysis completed under four randomized conditions: (1) control (no knee brace or foot orthotic), (2) knee brace, (3) foot orthotic, and (4) combined knee brace and foot orthotic. Additional measures included the vertical ground reaction force, trunk lean, toe out and gait speed. During the combined use of a knee brace and foot orthotic, significant decreases in the knee adduction angle (2.17, 95%CI: 0.50-3.84, p=0.013) and 2nd peak EKAM (0.35, 95%CI: 0.17–0.52, p<0.001) were observed during stair descent; and significant increases in the EKFM were observed during stair ascent (0.54, 95%CI: 0.30–0.78, p<0.001) and descent (1stpk: 0.48, 95%CI: 0.15-0.80, p=0.005; 2ndpk: 0.55, 95%CI: 0.34–0.76, p<0.001). Fewer gait compensations were observed between conditions during stair descent compared to ascent, except for toe out. Findings suggest greater effects on gait when both knee brace and foot orthotic are used together, resulting in a more normal gait pattern. However, whether or not a true change in knee joint load can be inferred when using these orthoses remains unclear. Further research is required to determine the clinical importance of the observed changes.



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The Romberg ratio in people with multiple sclerosis

Publication date: Available online 14 March 2017
Source:Gait & Posture
Author(s): Alon Kalron
Postural control relies on the integration of inputs from the visual, somatosensory and vestibular systems which are frequently impaired in people with Multiple Sclerosis (PwMS). In this situation, examining the Romberg ratio can be useful. This parameter can be interpreted as a gross indicator of a vestibular and proprioceptive contribution to postural control. Therefore, the primary objective of the current study was to examine whether the Romberg ratio differs between MS fallers, non-fallers and neurological disability levels. In addition, we clarified the association between the Romberg ratio values with validated gait and the balance tests in PwMS. Romberg ratio values were calculated according to the sway rate, total sway area and center of pressure (CoP) path length. The patient group included 542 PwMS (337 women) with a mean age of 42.3 (S.D=13.8). In terms of fall status, significant differences were observed between the faller (n=287) and non-faller (n=255) groups solely in terms of the Romberg ratio-ellipse sway area: 2.76 (S.D=2.46) vs. 2.24 (S.D=2.01), P-Value=0.01. A significant increase in the Romberg ratio was found between the severe group (n=50), the very mild (n=245), mild (n=186) and moderate (n=61) groups for each of the three Romberg ratio quotients. Significant weak correlation scores were found between the Romberg ratio-ellipse sway area and all walking and balance outcome measures; the Pearson's rho ranged from 0.172 to 0.270. The present data suggest that an elevated Romberg ratio quotient, especially according to the sway area, is an indicator of poor walking and balance capabilities in PwMS.



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Combined versus individual effects of a valgus knee brace and lateral wedge foot orthotic during stair use in patients with knee osteoarthritis

Publication date: May 2017
Source:Gait & Posture, Volume 54
Author(s): Rebecca Moyer, Trevor Birmingham, Colin Dombroski, Robert Walsh, J. Robert Giffin
The aim of this study was to investigate the combined and individual biomechanical effects of a valgus knee brace and a lateral wedge foot orthotic during stair ascent and descent in patients with knee osteoarthritis (OA). Thirty-five patients with varus alignment and medial knee OA were prescribed a custom valgus knee brace and lateral wedge foot orthotic. Knee angles and moments in the frontal and sagittal planes were determined from 3D gait analysis completed under four randomized conditions: (1) control (no knee brace or foot orthotic), (2) knee brace, (3) foot orthotic, and (4) combined knee brace and foot orthotic. Additional measures included the vertical ground reaction force, trunk lean, toe out and gait speed. During the combined use of a knee brace and foot orthotic, significant decreases in the knee adduction angle (2.17, 95%CI: 0.50-3.84, p=0.013) and 2nd peak EKAM (0.35, 95%CI: 0.17–0.52, p<0.001) were observed during stair descent; and significant increases in the EKFM were observed during stair ascent (0.54, 95%CI: 0.30–0.78, p<0.001) and descent (1stpk: 0.48, 95%CI: 0.15-0.80, p=0.005; 2ndpk: 0.55, 95%CI: 0.34–0.76, p<0.001). Fewer gait compensations were observed between conditions during stair descent compared to ascent, except for toe out. Findings suggest greater effects on gait when both knee brace and foot orthotic are used together, resulting in a more normal gait pattern. However, whether or not a true change in knee joint load can be inferred when using these orthoses remains unclear. Further research is required to determine the clinical importance of the observed changes.



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The Romberg ratio in people with multiple sclerosis

Publication date: Available online 14 March 2017
Source:Gait & Posture
Author(s): Alon Kalron
Postural control relies on the integration of inputs from the visual, somatosensory and vestibular systems which are frequently impaired in people with Multiple Sclerosis (PwMS). In this situation, examining the Romberg ratio can be useful. This parameter can be interpreted as a gross indicator of a vestibular and proprioceptive contribution to postural control. Therefore, the primary objective of the current study was to examine whether the Romberg ratio differs between MS fallers, non-fallers and neurological disability levels. In addition, we clarified the association between the Romberg ratio values with validated gait and the balance tests in PwMS. Romberg ratio values were calculated according to the sway rate, total sway area and center of pressure (CoP) path length. The patient group included 542 PwMS (337 women) with a mean age of 42.3 (S.D=13.8). In terms of fall status, significant differences were observed between the faller (n=287) and non-faller (n=255) groups solely in terms of the Romberg ratio-ellipse sway area: 2.76 (S.D=2.46) vs. 2.24 (S.D=2.01), P-Value=0.01. A significant increase in the Romberg ratio was found between the severe group (n=50), the very mild (n=245), mild (n=186) and moderate (n=61) groups for each of the three Romberg ratio quotients. Significant weak correlation scores were found between the Romberg ratio-ellipse sway area and all walking and balance outcome measures; the Pearson's rho ranged from 0.172 to 0.270. The present data suggest that an elevated Romberg ratio quotient, especially according to the sway area, is an indicator of poor walking and balance capabilities in PwMS.



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Combined versus individual effects of a valgus knee brace and lateral wedge foot orthotic during stair use in patients with knee osteoarthritis

Publication date: May 2017
Source:Gait & Posture, Volume 54
Author(s): Rebecca Moyer, Trevor Birmingham, Colin Dombroski, Robert Walsh, J. Robert Giffin
The aim of this study was to investigate the combined and individual biomechanical effects of a valgus knee brace and a lateral wedge foot orthotic during stair ascent and descent in patients with knee osteoarthritis (OA). Thirty-five patients with varus alignment and medial knee OA were prescribed a custom valgus knee brace and lateral wedge foot orthotic. Knee angles and moments in the frontal and sagittal planes were determined from 3D gait analysis completed under four randomized conditions: (1) control (no knee brace or foot orthotic), (2) knee brace, (3) foot orthotic, and (4) combined knee brace and foot orthotic. Additional measures included the vertical ground reaction force, trunk lean, toe out and gait speed. During the combined use of a knee brace and foot orthotic, significant decreases in the knee adduction angle (2.17, 95%CI: 0.50-3.84, p=0.013) and 2nd peak EKAM (0.35, 95%CI: 0.17–0.52, p<0.001) were observed during stair descent; and significant increases in the EKFM were observed during stair ascent (0.54, 95%CI: 0.30–0.78, p<0.001) and descent (1stpk: 0.48, 95%CI: 0.15-0.80, p=0.005; 2ndpk: 0.55, 95%CI: 0.34–0.76, p<0.001). Fewer gait compensations were observed between conditions during stair descent compared to ascent, except for toe out. Findings suggest greater effects on gait when both knee brace and foot orthotic are used together, resulting in a more normal gait pattern. However, whether or not a true change in knee joint load can be inferred when using these orthoses remains unclear. Further research is required to determine the clinical importance of the observed changes.



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