Foudriat B A, Di Fabio R P, Anderson J H
Department of Physical Medicine & Rehabilitation, University of Minnesota, Minneapolis.
Int J Pediatr Otorhinolaryngol. 1993 Oct;27(3):255-71. doi: 10.1016/0165-5876(93)90231-q.
The effect of altered sensory environments on balance was studied in 82 healthy children between 3 and 6 years of age. The purpose was to obtain normative measurements of postural stability during early stages of development for use in clinical posturography. Subjects were tested in three visual conditions (eyes open, blind-folded, and sway-referenced visual enclosure) during stance on either a fixed or sway-referenced force platform (EquiTest). During sway-referenced conditions, spontaneous changes in the subject's center of force (COF) drove rotational displacements of the platform and/or visual surround. The gain of platform/COF or surround/COF displacement was altered from 0.00 to 1.5. An equilibrium score (ES) was calculated based on the amount of postural sway compared to the maximum sway possible without falling. A higher ES reflected greater postural stability. An improvement in postural stability was observed between 4 and 5 years of development when the sensory environment was fixed (sway referenced gain = 0.0). In a dynamic sensory environment, however, age-related improvements in postural stability were not uniform and depended upon the specific sensory condition. For example, while 6 year olds generally showed the greatest postural stability of any age group, all ages showed statistically equivalent equilibrium scores during stance on a compliant surface with eyes closed, at all sway gains. The ability to ignore misleading sensory inputs to maintain balance was observed at 3 years of age; 76% of the 3 year olds (n = 16) were able to maintain stance in altered sensory environments at the 1.0 sway gain. In addition, postural stability was greater when visual inputs were sway-referenced compared to conditions that manipulated the support surface compliance. These data suggest that the predominance of visual-vestibular control of balance gives way to a somatosensory-vestibular dependence by age 3, but that the transition to adult-like balance responses is not complete for all sensory conditions even by age 6. The use of posturography to enhance the assessment of pediatric vestibular and sensory integration deficits is discussed.
对82名3至6岁的健康儿童进行了研究，以探讨改变的感觉环境对平衡的影响。目的是获取发育早期姿势稳定性的规范性测量数据，用于临床姿势描记法。受试者在固定或摆动参考力平台（EquiTest）上站立时，于三种视觉条件下（睁眼、蒙眼和摆动参考视觉罩）接受测试。在摆动参考条件下，受试者力中心（COF）的自发变化驱动平台和/或视觉环境的旋转位移。平台/COF或环境/COF位移的增益从0.00改变至1.5。根据与不摔倒时最大摆动相比的姿势摆动量计算平衡分数（ES）。较高的ES反映出更大的姿势稳定性。当感觉环境固定时（摆动参考增益 = 0.0），在4至5岁的发育阶段观察到姿势稳定性有所改善。然而，在动态感觉环境中，姿势稳定性的年龄相关改善并不一致，且取决于特定的感觉条件。例如，虽然6岁儿童在所有年龄组中通常表现出最大的姿势稳定性，但在所有摆动增益下，所有年龄组在闭眼站在顺应性表面时的平衡分数在统计学上相当。3岁时就观察到了忽略误导性感觉输入以维持平衡的能力；16名3岁儿童中有76%（n = 16）能够在1.0摆动增益的改变感觉环境中保持站立姿势。此外，与操纵支撑表面顺应性的条件相比，当视觉输入为摆动参考时，姿势稳定性更高。这些数据表明，3岁时视觉 -前庭对平衡的控制优势让位于体感 -前庭依赖，但即使到6岁，向成人样平衡反应的转变在所有感觉条件下也未完成。文中还讨论了使用姿势描记法加强对儿童前庭和感觉整合缺陷评估的问题。
