Balance and Mobility Disorders

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NeuroCom®, a division of Natus®, is a specialist in balance and mobility, and for the effective assessment and treatment of chronic dizziness, balance and mobility disorders. NeuroCom's mission is to advance healthcare in the areas of chronic balance, dizziness, and vestibular disorders, and other balance dysfunction and mobility problems related to neurological conditions and diseases, aging, and injuries.

 What are balance disorders?

Balance is vital to normal everyday life activities such as getting out of a chair and walking, bending over to put your shoes on, washing your hair, driving a car or going grocery shopping. Just about everything you do in your daily life, whether for work or leisure requires balance control, and most of the time you don't have to think about it. If balance problems develop, though, they can cause profound disruptions in your daily life. In addition to increased risk for falls, balance disorders can shorten your attention span, disrupt normal sleep patterns, and/or cause excessive fatigue.

The balance control process

Ability to maintain balance is a complex process that depends on three major components:

  • your sensory systems for accurate information about your body's position relative to your environment
  • your brain's ability to process this information; and
  • your muscles and joints for coordinating the movements required to maintain balance. The sensory systems include your sense of touch (feet, ankles, joints), your vision and your inner ear motion sensors.

Loss of balance control

In a normal healthy individual our senses of touch (feet, ankles, joints), sight (eyes) and inner ear motion sensors work together in harmony with the brain. A person with a balance disorder, however, may have a problem in any one of these systems, or in multiple systems. In some individuals, one or more of the senses are missing and the person does not realize they are losing their balance. In other people, the brain gets confused and creates an inaccurate sense of falling when in fact the person is in balance.

Dizziness among older adults can be caused by a collection of subtle degenerative or infectious processes or injuries that in combination result in a balance problem.

Some individuals experiencing balance problems have an obvious medical diagnosis such as diabetes, Parkinson's disease, or even a stroke that are primary sources of the problem. In other individuals with balance difficulties, the cause can even be subtle undetected forms of these diseases. A history of injuries, such as concussions, ear infections, or serious sprains or fractures, may contribute to a loss of balance control over time.

In addition, various combinations of medications, both prescription and over the counter, can be detrimental to our senses or brain and cause either temporary or permanent damage.

Identifying and treating balance disorders

Because of the complexity of balance control, not all balance problems are the same. Because of the wide variety of balance problems, determining the cause of a balance disorder and what treatment options are the most appropriate can be difficult. In the last twenty years, however, there have been significant advances in evaluation and treatment approaches to balance disorders that have proven to be highly effective and offer relief to those suffering from imbalance or dizziness.

NeuroCom, an FDA-registered medical manufacturing company based in Oregon, has a complete range of balance solutions from simple, easy-to-use screeners to clinical research systems used in universities and medical centers.

NeuroCom, through its use of innovative force plate technology and advanced computer software has solutions that are used in diverse fields such as neurology, orthopedics, vestibular rehabilitation, sports medicine and community fall prevention for older adults.

NeuroCom Balance Master® Family

The NeuroCom Balance Master® family of products provide objective assessment and retraining of the sensory and voluntary motor control of balance. With visual biofeedback on either a stable or unstable support surface and in a stable or dynamic visual environment, the clinician can assess patients performing tasks ranging from essential daily living activities through high-level athletic skills. The objective data aids in the design of effective treatment and/or training programs focused on the specific sensory and motor components underlying a patient's functional limitations.

The Balance Manager Family of Products include the following models:

  • SMART EquiTest® (CDP)
  • SMART Balance Master®
  • EquiTest® (CDP)
  • PRO Balance Master®
  • Balance Master®
  • Basic Balance Master®
  • VSR™

SMART Balance Master®

SMART Balance Master®

The SMART Balance Master® utilizes a dynamic force plate with rotation capabilities to quantify the vertical forces exerted through the patient's feet to measure center of gravity position and postural control; and a dynamic visual surround to measure the patient’s use of visual information to maintain balance.

It provides assessment and retraining capabilities with visual biofeedback on either a stable or unstable support surface and in a stable or dynamic visual environment.









Objective Assessment Protocols

The interactive technology and clinically proven protocols allow the clinician to objectively and systematically assess sensory and voluntary motor components of balance control. The objective data helps the clinician accurately identify underlying impairments for more effective treatment planning.

The SMART Balance Master includes the following standardized assessment protocols:

  1. 1. The Sensory Organization Test (SOT) protocol objectively identifies abnormalities in the patient's use of the three sensory systems that contribute to postural control: somatosensory, visual and vestibular. During the SOT, useful information delivered to the patient's eyes, feet and joints is effectively eliminated through calibrated "sway referencing" of the support surface and/or visual surround, which tilt to directly follow the patient's anteroposterior body sway. By controlling the usefulness of the sensory (visual and proprioceptive) information through sway referencing and/or eyes open/closed conditions, the SOT protocol systematically eliminates useful visual and/or support surface information and creates sensory conflict situations. These conditions isolate vestibular balance control, as well as stress the adaptive responses of the central nervous system.
  2. The Adaptation Test (ADT) assesses a patient's ability to minimize sway when exposed to surface irregularities and unexpected changes in support surface inclination. Sequences of platform rotations in the toes-up or toes-down direction elicit automatic motor responses. For each platform rotation trial, a sway energy score quantifies the magnitude of the force response required to overcome induced postural instability.Adaptation Test (ADT)
  3. The Limits of Stability (LOS) test quantifies the maximum distance a person can intentionally displace their Center of Gravity (COG), i.e. lean their body in a given direction without losing balance, stepping, or reaching for assistance. The measured parameters are reaction time, COG movement velocity, directional control, end point excursion, and maximum excursion.
  4. The Rhythmic Weight Shift (RWS) test quantifies the patient's ability to rhythmically move their Center of Gravity (COG) from left to right (lateral) and forward to backward (anterior/posterior) between two targets at three distinct speeds: slow, medium, and fast.
  5. The Weight Bearing Squat (WBS) test, in which the patient is instructed to maintain equal weight on the two legs while standing erect and then squatting in three positions of knee flexion. The percentage of body weight borne by each leg is measured with the patient standing at 0º (erect), 30º, 60º, and 90º of knee flexion.Weight Bearing Squat
  6. The Unilateral Stance (US) test quantifies postural sway velocity with the patient standing on either the right or left foot on the forceplate, with eyes open and with eyes closed. The length of each trial is ten seconds. The US test is highly sensitive, but not specific because a large number of independent factors can impact performance. A partial list of these factors includes lower extremity strength and weight bearing control, sensory balance control, movement strategies, and prior practice with the task.

inVision™ package

The inVision™ package from NeuroCom®, quantifies a patient's ability to maintain visual acuity and stable gaze while actively moving the head. The inVision™ package includes:inVision™

  • Dynamic Visual Acuity (DVA) Test Quantifies the impact of vestibular ocular reflex (VOR) system impairment on a patient's ability to perceive objects accurately while moving the head at a given velocity on a given axis.
  • Gaze Stabilization Test (GST) Quantifies the range of head movement velocities on a given axis over which a patient is able to maintain an acceptable level of visual acuity.