Di Fabio R P
Department of Physical Medicine and Rehabilitation, University of Minnesota, Minneapolis 55455.
Phys Ther. 1995 Apr;75(4):290-305. doi: 10.1093/ptj/75.4.290.
Sensitive and specific measures are needed to identify patients with vestibular impairments. The purpose of this clinical perspective is to describe the sensitivity and specificity of dynamic and static platform posturography for detecting vestibular disorders. The sensory organization test (SOT) of dynamic posturography (EquiTest), the motor "perturbation" test, and Romberg's tests on a static (fixed) force platform each had over 90% specificity. This finding means that nearly all of the subjects who should have tested negative, did test negative on each type of assessment. The sensitivity of the SOT was evaluated across five studies involving a total of 836 patients with peripheral vestibular deficits (PVDs). Abnormalities in the SOT were detected in only 40% (n = 338) of the cases. Static platform posturography sensitivity was evaluated across six studies involving a total of 571 patients with PVDs, and abnormalities were detected in 53% (n = 302) of these cases. Tests of spontaneous and positional nystagmus and the horizontal component of the vestibuloocular reflex (VOR), by comparison, detected PVDs in 48% of 798 patients with suspected vestibular impairment. For patients with vestibular deficits associated with central nervous system disease, a total of 389 cases were identified in five studies and SOT abnormalities were found in 54% (n = 209) of these cases. The motor perturbation test was abnormal in 35% (n = 41) of 119 patients with central vestibular disease. In conclusion, the sensitivity of static posturography appeared to be slightly better than that of dynamic posturography for detecting PVDs, but the level of sensitivity for each posturography test, as well as for tests of horizontal VOR function, was considered to be low. Combining either type of posturography with other tests of vestibular function, however, increased the overall sensitivity of detecting vestibular deficits to 61% to 89%. It was concluded that dynamic and static platform posturography as well as tests of VOR function lack adequate sensitivity to detect vestibular impairment when applied in isolation. Posturography appears to detect vestibular deficits in some patients who had normal VOR assessments and, therefore, provides supplemental rather than redundant information about vestibular dysfunction.
需要灵敏且特异的措施来识别前庭功能受损的患者。本临床观点的目的是描述动态和静态平台姿势描记法在检测前庭疾病方面的敏感性和特异性。动态姿势描记法（EquiTest）的感觉组织测试（SOT）、运动“扰动”测试以及在静态（固定）测力平台上进行的罗姆伯格测试，每种测试的特异性均超过90%。这一发现意味着几乎所有本应检测为阴性的受试者，在每种评估类型中检测结果均为阴性。在涉及总共836例周围性前庭缺陷（PVD）患者的五项研究中评估了SOT的敏感性。仅在40%（n = 338）的病例中检测到SOT异常。在涉及总共571例PVD患者的六项研究中评估了静态平台姿势描记法的敏感性，其中53%（n = 302）的病例检测到异常。相比之下，在798例疑似前庭功能受损的患者中，自发性和位置性眼球震颤测试以及前庭眼反射（VOR）水平分量测试在48%的患者中检测到PVD。在五项研究中总共识别出389例与中枢神经系统疾病相关的前庭缺陷患者，其中54%（n = 209）的病例发现SOT异常。在119例中枢性前庭疾病患者中，35%（n = 41）的患者运动扰动测试结果异常。总之，在检测PVD方面，静态姿势描记法的敏感性似乎略高于动态姿势描记法，但每种姿势描记法测试以及水平VOR功能测试的敏感性水平都被认为较低。然而，将任何一种姿势描记法与其他前庭功能测试相结合，可将检测前庭缺陷的总体敏感性提高到61%至89%。得出的结论是，动态和静态平台姿势描记法以及VOR功能测试单独应用时，缺乏足够的敏感性来检测前庭功能受损。姿势描记法似乎能在一些VOR评估正常的患者中检测到前庭缺陷，因此，它提供的是关于前庭功能障碍的补充信息而非冗余信息。
