computerized-dynamic-posturography-for-postural-control-assessment

Computerized Dynamic Posturography for Postural Control Assessment in Patients with Intermittent Claudication

Computerized dynamic posturography with the EquiTest is an objective technique for measuring postural strategies under challenging static and dynamic ...

Hull And East Yorkshire Hospitals

Addenbrookes Hospital

Quality of life (QoL) is a crucial outcome measure in patients with lower limb ischemia (LLI). The Short Form 36 (SF36) has been proposed as the gold standard instrument for generic QoL analysis in patients with LLI. The Short Form 8 (SF8) was developed from the SF36 and we aim to compare these two instruments in terms of validity, reliability, and responsiveness.

Quality of life in patients with lower limb ischemia; revised suggestions for analysis.

Nurse-led assessment/management of risk factors is effective in many chronic medical conditions. We aimed to evaluate whether this finding was true for patients with intermittent claudication and to analyze its impact on patient-reported quality of life and predicted mortality due to coronary heart disease. We prospectively studied a series of 78 patients (51 men; median age, 65 years [IQR: 56-74 years]), diagnosed with intermittent claudication and referred to a nurse-led risk assessment/management clinic (NLC) from a consultant-led vascular surgical clinic. The NLC used clinical care pathways to manage antiplatelet medication, smoking cessation, hyperlipidemia, hypertension, and diabetes and to provide exercise advice. All patients were reassessed at a 3 months. Medication compliance, smoking status, fasting lipid profiles, blood pressure, and HbA1c were recorded. Disease-specific quality of life was assessed using King's College VascuQoL and predicted cardiac morbidity and mortality were calculated using the PROCAM and Framingham risk scores. We found that NLC enrollment produced an antiplatelet and a statin compliance of 100%, a smoking cessation rate of 17% (9 patients) and significant improvements in total cholesterol (median, 5.2-4.5 mmol/l), LDL (median, 3.1-2.5 mmol/l) and triglyceride (median, 1.7-1.4 mmol/l) levels. Significant disease-specific quality of life improvements and significant reduction in both the PROCAM (14% to 10%) and Framingham (14% to 11%) coronary risk scores were observed. Providing care at NLCs for claudicants is effective in assessing and managing risk factors, improves disease-specific quality of life and reduces predicted morbidity and mortality due to coronary heart disease.

Nurse-led risk assessment/management clinics reduce predicted cardiac morbidity and mortality in claudicants.

Intermittent claudication has been associated with impaired gait and balance. The study aim was to compare gait adaptations over time between claudicants classified with good versus poor balance. Kinematic data were collected from 24 claudicants during continuous walking. Balance was assessed using; Timed Up and Go test (TUG), and Sensory Organisation (SOT) and Motor Control (MCT) Tests using NeuroCom Equitest®. 'Good balance' (GB) was operationally defined as those claudicants achieving normal scores on at least 2 of 3 tests whereas 'poor balance' (PB) claudicants achieved normal scores on 0 or 1 test. Temporal-spatial and sagittal plane joint kinematics were analysed at three time intervals; 'no pain' (prior to onset), 'initial pain' and 'maximal pain' (unable to continue walking). A two-way mixed design ANOVA was performed. Claudicants demonstrated a significant decrease in walking speed, step frequency and increased time in double support (p<0.05). Inter-group analysis showed no differences between GB and PB on any temporal-spatial or kinematic parameters (p>0.05). There was no significant time and group interaction for any temporal-spatial or kinematic variable except hip flexion. GB claudicants demonstrated increased hip flexion as pain progressed but this adaptive strategy was not seen in PB claudicants. Claudicants make adaptations to walking by slowing (down) when in pain. Differences between GB and PB were not seen in temporal-spatial or ankle, knee and pelvic kinematic gait parameters. However adaptation to pain in GB claudicants involved a hip strategy, not seen in PB claudicants.

Kinematic adaptations to ischemic pain in claudicants during continuous walking.

One-third of all elderly patients fall each year and impaired balance has been recognized as a specific risk factor. Intermittent claudication is common among the elderly population, affecting approximately 5% of the population over the age of 50. The aim of this proof-of-concept study was to assess the prevalence of impaired balance among elderly claudicants and to assess each patient's insight into their own risk of falling. A total of 58 claudicants (45 men), median age of 70 (interquartile range = 65-73) years, underwent objective balance assessment by using computerized dynamic posturography. As compared with 195 (5%) historic controls, 24 (41%) of the claudicants demonstrated abnormal balance when the Sensory Organization Test (SOT) was used. Vestibular dysfunction occurred in 52% of the claudicants. Abnormalities including somatosensory (22%), visual function (17%), and preferential reliance on inaccurate visual cues (17%) occurred less often. Prolonged Motor Control Test latency times were uncommon (n = 13) and were in most cases evenly distributed between those with normal (n = 7) and abnormal (n = 6) composite SOT scores. There was a significant difference in history of falling between claudicants with abnormal and normal SOT scores (p = 0.003), with a higher number of patients with abnormal SOT having experienced falling in the past year. However, no correlation between fear of falling and composite SOT score was found (Spearman rank correlation, r = 0.124; p = 0.381). Impaired balance, particularly secondary to vestibular problems, is very common among claudicants and may predispose to a high incidence of falls. Claudicants with abnormal balance are more likely to have a history of falls but not a fear of falling, thus potentially rendering these patients to be at a greater risk.

Computerized dynamic posturography in the objective assessment of balance in patients with intermittent claudication.

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Images in vascular medicine. Delayed Horner's syndrome as a presenting symptom of traumatic internal carotid artery dissection and pseudoaneurysm.

We assessed the quality and readability of patient information for abdominal aortic aneurysms (AAAs) on the World Wide Web, as accessed from the United Kingdom.

Quality and readability of online patient information for abdominal aortic aneurysms.

The management of peripheral arterial disease with intermittent claudication includes angioplasty, pharmaceutical therapy, risk factor modification and exercise therapy. Supervised exercise programmes are used sporadically but may improve the distance that an individual with claudication can walk. The purpose of this study was to evaluate the effectiveness of a 3-month supervised exercise programme on improving gait parameters in patients with intermittent claudication.

The effect of a 3-month supervised exercise programme on gait parameters of patients with peripheral arterial disease and intermittent claudication.

Background: In the era of Abdominal Aortic Aneurysm (AAA) screening, pharmacotherapies to attenuate AAA growth are sought. HMG Co-A reductase inhibitors (statins) have pleiotropic actions independent of their lipid lowering effects and have been suggested as potential treatment for small AAAs. We systematically review the clinical evidence for this effect. Methods: Medline, EMBASE and the Cochrane Central Register of Controlled Trials (1950-2011) were searched for studies reporting data on the role of statin therapy on AAA growth rate. No language restrictions were placed on the search. References of retrieved articles and pertinent journals were hand searched. Included studies were reviewed by 2 independent observers. The search retrieved 164 papers, 100 were irrelevant based on their title, 47 were reviews and 1 was a letter. 8 studies were excluded based on review of their abstract leaving 8 for inclusion in the study. Results: Eight observational clinical studies with a total of 4,466 patients were reviewed. Four studies demonstrated reduced AAA expansion in statin users while 4 studies failed to demonstrate this effect. The method of determining AAA growth rates varied significantly between the studies and the ability of many studies to control for misclassification bias was poor. Conclusions: The claim that statins attenuate AAA growth remains questionable. Further prospective studies with stringent identification and verification of statin usage and a standardised method of estimating AAA growth rates are required. Statin type and dose also merit consideration.

Statins: The Holy Grail of Abdominal Aortic Aneurysm (AAA) Growth Attenuation? A Systematic Review of the Literature.

To determine whether increasing claudication severity is associated with impaired balance and physical functional ability.

Balance impairment, physical ability, and its link with disease severity in patients with intermittent claudication.

Regarding "Quality of vascular surgery web sites on the internet".

The aim of this study was to identify whether revascularization by percutaneous transluminal angioplasty (PTA) for patients with intermittent claudication improved measures of functional performance including balance.

Percutaneous transluminal angioplasty results in improved physical function but not balance in patients with intermittent claudication.

Recreational drug use is a recognized cause of a number of acute vascular events. Cocaine is associated with a number of cardiovascular diseases, including myocardial ischemia, arrhythmias, and aortic dissection. Cutting agents are commonly used to dilute the amount of cocaine required to enhance the profits of the seller. Such cutting agents themselves often provoke acute vascular disease. We present the case of a 34-year-old female presenting with profound ischemia affecting all four limbs secondary to cocaine inhalation.

Article	Year
Quality of life in patients with lower limb ischemia; revised suggestions for analysis. Journal of vascular surgery\| PubMed ID: 18945581	2009
Nurse-led risk assessment/management clinics reduce predicted cardiac morbidity and mortality in claudicants. Journal of vascular nursing : official publication of the Society for Peripheral Vascular Nursing\| PubMed ID: 19022170	2008
Kinematic adaptations to ischemic pain in claudicants during continuous walking. Gait & posture\| PubMed ID: 20678939	2010
Computerized dynamic posturography in the objective assessment of balance in patients with intermittent claudication. Annals of vascular surgery\| PubMed ID: 20889294	2011
Internal iliac artery pseudoaneurysm in an infant following bone marrow trephine biopsy. British journal of haematology\| PubMed ID: 21391970	2011
Images in vascular medicine. Delayed Horner's syndrome as a presenting symptom of traumatic internal carotid artery dissection and pseudoaneurysm. Vascular medicine (London, England)\| PubMed ID: 21511675	2011
Quality and readability of online patient information for abdominal aortic aneurysms. Journal of vascular surgery\| PubMed ID: 22521801	2012
The effect of a 3-month supervised exercise programme on gait parameters of patients with peripheral arterial disease and intermittent claudication. Clinical biomechanics (Bristol, Avon)\| PubMed ID: 22663776	2012
Statins: The Holy Grail of Abdominal Aortic Aneurysm (AAA) Growth Attenuation? A Systematic Review of the Literature. Current vascular pharmacology\| PubMed ID: 22724473	2012
Balance impairment, physical ability, and its link with disease severity in patients with intermittent claudication. Annals of vascular surgery\| PubMed ID: 23084732	2013
Regarding "Quality of vascular surgery web sites on the internet". Journal of vascular surgery\| PubMed ID: 23535046	2013
Percutaneous transluminal angioplasty results in improved physical function but not balance in patients with intermittent claudication. Journal of vascular surgery\| PubMed ID: 23880550	2013
Profound acute limb ischemia affecting all four limbs following cocaine inhalation. Journal of vascular surgery\| PubMed ID: 24176631	2013

Patrick A Coughlin

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