Differentiating Malingering Balance Disorder Patients from Healthy Controls, Compensated Unilateral Vestibular Loss, and Whiplash Patients Using Stance and Gait Posturography

Abstract

Differentiating balance disorder patients who are malingering from those with organic balance disorders is difficult and costly. We used trunk sway measured during several stance and gait tasks in 18 patients suspected of malingering in order to differentiate these from 20 patients who had suffered unilateral vestibular loss 3 months earlier, 20 patients with documented whiplash injuries, and 34 healthy controls. Classification results ranged from 72 to 96% and were equally accurate for task or criteria variables based on 90% sway values. The tasks yielding the best discrimination were: standing with eyes closed on a foam and firm surface; standing with eyes open on a firm surface; standing on 1 leg; and walking tandem steps. The criteria yielding the best discrimination were: standing with eyes open on a firm surface; the difference between standing with eyes closed on foam and firm surfaces; the difference between walking tandem steps and standing on 1 leg with eyes open; and the difference between roll and pitch velocity when walking 8 tandem steps. We conclude that discriminating suspected malingering balance disorder patients is possible using variables or criteria based on objective measures of trunk sway during several stance and gait tasks.

An Attempt of Early Detection of Poor Outcome after Whiplash

“…On the motor side, reduced cervical mobility, disturbed kinesthesia and altered neck muscles activity are often present at the acute stage and they persist over time in the moderate/severe whiplash groups of patients ( 13 ). Several reviews also point to dysfunctions of postural control in CWP ( 14 – 16 ). On the sensory side, within 1 week of their trauma, 40% of acute whiplash patients (AWP) report dizziness and 10% of them develop later otological symptoms, such as tinnitus, deafness, and vertigo ( 17 ).…”

Trunk sway in patients with and without, mild traumatic brain injury after whiplash injury

“…Because only the emotional category of the DHI was higher in the MTBI patients, compared to no-MTBI patients, we must note the limitations in obtaining objective measures due to the complex combination of pain, dizziness and neuropsychological symptoms in patients with MTBI and WAD [28]. These complexities make it difficult for caregivers to distinguish between somatic complaints, hysteric exaggeration [27], and lack of effort [29]. Nonetheless, the finding of increased sway with MTBI suggests that there is subtle cerebral damage in WAD patients with MTBI leading to greater balance deficits as compared to whiplash patients without MTBI.…”

Recurrence quantification analysis of gait in normal and hypovestibular subjects

“…However, quantification of dynamic stability during locomotion represents a great challenge since classic analysis measurements such as the amplitude of trunk oscillations or interstep variability of angular motion during normal walking often fail to discriminate clearly between normal and pathological gait. In effect, often specific walking conditions are needed to identify pathological features [7,15]. Therefore, developing new complementary methods may help assessing walking performance and rehabilitation outcome in patients with different balance disorders.…”