The role of instrumental assessment of balance in clinical decision making.

This review addresses the issue whether instrumental evaluations of balance may be helpful in orienting the clinical decision regarding balance rehabilitation. The aptitude of instrumental assessment of balance in supporting decision making in patients with balance disorders connected with ageing and with neurological diseases is considered. Among instrumental evaluations, recording of body sway during quiet stance and dynamic conditions are described, together with manoeuvres for recording postural reactions to predictable or unpredictable postural perturbations. The posturography patterns encountered in elderly subjects and patients affected by Parkinson's disease, spasticity, peripheral neuropathy, cerebellar diseases, vestibular deficit and neck disorders are presented and discussed. Findings from instrumental assessments of balance are helpful in understanding the pathophysiology of balance disorders, in screening for balance disorders, and in evaluating the natural progression of the disease or the response to therapy, be it physical or pharmacological. Conversely, as far as the prediction of the risk of falling in one individual patient is concerned, the various posturography tests do not produce consistent results.