title: Vestibular deficits leading to disequilibrium and falls in ambulatory amyotrophic lateral sclerosis.
abstract: OBJECTIVE
  To assess vestibular deficits in response to disequilibrium in ambulatory individuals with amyotrophic lateral sclerosis (ambALS).
  
  
  METHODS
  All participants completed standard protocols for the Sensory Organization Test (SOT) by computerized dynamic posturography.
  
  
  METHODS
  Multidisciplinary amyotrophic lateral sclerosis clinic at an academic medical center.
  
  
  METHODS
  Study participants (N=34) consisted of ambALS (n=19) and healthy controls (HC) (n=15).
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Equilibrium scores (ESs) obtained from averaged sway amplitude in condition 5 (ES5) and condition 6 (ES6) of the SOT.
  
  
  RESULTS
  In conditions of altered somatosensory information with vision absent or vision sway-referenced, the mean ± SD scores for ambALS (ES5=51.4±22.5; ES6=50.8±22.1) were lower than those for HC (ES5=65.4±11.7, P≤.03; ES6=58.9±12.5, P>.05). Seven ambALS (37%) experienced a total of 19 falls during the sway-referenced support test conditions. There were no falls in the HC.
  
  
  CONCLUSIONS
  Nearly 37% of ambALS with normal clinical balance testing have decreased ability to use the vestibular input and required increased reliance on visual input for postural orientation to sustain equilibrium. The mechanism of this alteration in sensory preference is not completely clear. Extrapyramidal involvement early in ALS may be indicated.
authors.affiliation: Carolinas Neuromuscular/Amyotrophic Lateral Sclerosis-Muscular Dystrophy Association Center, Carolinas HealthCare System, Neurosciences Institute, Department of Neurology, Carolinas Medical Center-Main, North Charlotte, NC; Department of Kinesiology, College of Health and Human Services, University of North Carolina-Charlotte, Charlotte, NC. Electronic address: Mohammed.Sanjak@carolinashealthcare.org.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Sanjak
authors.affiliation: Carolinas Rehabilitation, Carolinas HealthCare System, Department of Physical Medicine and Rehabilitation, Carolinas Medical Center-Main, Charlotte, NC.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Hirsch
authors.affiliation: Carolinas Neuromuscular/Amyotrophic Lateral Sclerosis-Muscular Dystrophy Association Center, Carolinas HealthCare System, Neurosciences Institute, Department of Neurology, Carolinas Medical Center-Main, North Charlotte, NC; University of North Carolina School of Medicine-Charlotte Campus, Charlotte, NC.
authors.forename: Elena K
authors.initials: EK
authors.lastname: Bravver
authors.affiliation: Carolinas Rehabilitation, Carolinas HealthCare System, Department of Physical Medicine and Rehabilitation, Carolinas Medical Center-Main, Charlotte, NC; University of North Carolina School of Medicine-Charlotte Campus, Charlotte, NC.
authors.forename: William L
authors.initials: WL
authors.lastname: Bockenek
authors.affiliation: Dickson Advanced Analytics, Carolinas HealthCare System, Department of Biostatistics, Carolinas Medical Center-Main, Charlotte, NC.
authors.forename: H James
authors.initials: HJ
authors.lastname: Norton
authors.affiliation: Carolinas Neuromuscular/Amyotrophic Lateral Sclerosis-Muscular Dystrophy Association Center, Carolinas HealthCare System, Neurosciences Institute, Department of Neurology, Carolinas Medical Center-Main, North Charlotte, NC; University of North Carolina School of Medicine-Charlotte Campus, Charlotte, NC.
authors.forename: Benjamin Rix
authors.initials: BR
authors.lastname: Brooks
mesh_terms: D000058:Accidental Falls; D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000150:complications / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D004856:Postural Balance / Q000502:physiology*; D011434:Proprioception / Q000502:physiology*; D015837:Vestibular Diseases / Q000150:complications / Q000503:physiopathology*; D014796:Visual Perception / Q000502:physiology; D016138:Walking
keywords: Accidental falls; Amyotrophic lateral sclerosis; Loss of balance; Postural equilibrium; Rehabilitation; Sensory disorders