Posture Congres de Bruxelles Decembre 2011

8/3/2019 Posture Congres de Bruxelles Decembre 2011

1/28

Posture examination and

Posturography

Prof. R. BONIVER

Royal Belgian Society for ear, nose, throat,head and neck surgery meeting

02-12-2011


2/28

It is important to differenciate posture examination

and posturography


3/28

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.


4/28

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.


5/28

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.


6/28

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 viewincludes 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, kneefossa alignment, scoliosis,

and scapula theight. The

plumb line bisects the body

as indicated in the posterior

view checklist.


7/28

The examination process always includes comparison ofleft 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 ina 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.


8/28

To see a program of posture analysis consult :

http://en.mcsinnovation.com

Video : Podia XP


9/28

PosturographyPosturography is a general term that covers all the

techniques to quantify postural control in upright stance

in either static or dynamic conditions.


10/28

To see an application of the use of nintendo

platform for posturography consult on youtube :

www.youtube.com/watch?

v=PHVz

LUmkFDE


11/28


12/28

STATIC POSTUROGRAPHY

our resultsWe use static posturography examination since

1980.

In 1989, at the Neurootological and EquilibriumSociety (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.


13/28


our resultsIn 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


14/28


our resultsThe Romberg quotients defined by Marcel Norre

were calculated

QR1 =closed eyes surface

opened eyes surface

QR2 =closed eyes surface with neck loading

opened eyes surface


15/28

OUR CONCLUSIONS

According to our results it appears that the main interest ofposturography 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 injuryand 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.


16/28

Static PostureNormalized data were proposed in 1985

by Association Franaise de

Posturologie and further modified andanalysed every year, by the European

Society for clinical evaluation of Balance

Disorders founded in Nancy byProf. Philippe Perrin.


17/28


18/28

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


19/28


20/28

Dynamic Posturography


21/28


22/28


23/28

Computerized Dynamic

Posturography

To see a demonstration, see on youtube :

www.youtube.com/watch?

v=HT1xe4JaV7

w


24/28


25/28


26/28

CAUT

ION

Stocktaking on the development of

posturography for clinical use

Journal of Vestibular Research 21 (2011) 117-125

DOI 10.3233/VES-2011-0397

IOS Press

Herman Kingma, Grome C. Gauchard, Catherine de Waele,

Christian van Nechel, Alexandre Bisdorff, Alain Yelnik,

Mans Magnusson and Philippe P. Perrin


27/28

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 differentdisciplines) 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 ofposturography were defined as well as

recommendations regarding measurement parameters,

type of perturbations and signal analysis techniques to

improve assessment of balance control.


28/28

Consensus was reached that a force platform cannot be

considered as a technique which is sufficient on its own toperform 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.

Documents

Posture Congres de Bruxelles Decembre 2011