Dissertation
Dissertation > Medicine, health > Surgery > Orthopaedic Surgery ( movement system diseases,orthopedic surgery ) > Bone diseases > Spine and back disorders

Body center of gravity test system diagnostics clinical study of cervical vertigo

Author HuangAYong
Tutor ZhouWei
School China Academy of Traditional Chinese Medicine
Course Traditional Chinese Medicine
Keywords cervical vertigo quantitative analysis diagnosis static posturography pressure
CLC R681.5
Type Master's thesis
Year 2006
Downloads 86
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Study background:Cervical vertigo, clinically common in orthopedics, is referred to dizziness caused by the functional or organic changes of cervical vertebra and its ambient soft tissue such as articular capsules, ligaments, muscles, nerves, and blood vessel so on. Domestic and foreign scholars reported high attack rate of cervical vertigo. In recent years ,with the changes of people’s life style, we discover that the attack rate of cervical vertigo in young people has been on the rise gradually ,too.Cervical vertigo corresponds to dizziness in traditional Chinese medicine(abbreviated for TCM).The four physical examinations of TCM, particularly interrogation, play an important role in the diagnosis and treatment of dizziness, which involve in the factor of provocation and aggravation, and in the prognosis of disease so on. Symptoms are the results of pathological change of disease. However these changes are complicated and lack of objective signs. The symptom of dizziness like pain, numbness and turg which the patients alone can feel;can be acquired only by interrogation. To quantify partial content of the interrogation of TCM, we conducted the qualitative and quantitative analysis of the movement of center of gravity in subjects.The symptom of dizziness is extremely common in the visiting patients, which is indispensable in the diagnosis of the patients with cervical vertigo. However, it’s an subjective symptom, not only involving in pathophysiological and psychogenic problems, but also psychology, physiology, behaviour and cognitioa As yet, there hasn’t been definite diagnostic criteria of cervical vertigo. In the past, clinical diagnosis of it was limited to case history, medical check-up and so on. Moreover, these methods lacked objectivity. Later, with the development of diagnostics unit, imageology such as X-ray of cervical vertebra, TCD, vertebral arteriography has been widely used in diagnosis of cervical vertigo. Although these methods are objective, some of them even increase patients’ suffering. Clinically, we often discover that symptoms of some patients with cervical vertigo are obvious .However, the results of imaging aren’t apparent or essentially normal. At present, the reason hasn’t been interpreted clearly. Therefore, how to make the diagnosis of cervical vertigo indexing and quantization hasn’t been resolved.The patients with cervical vertigo are chiefly personnel of long-term bowing his or her head, who invariably have the history of chronic strain of cervical vertebrae. We find that dizziness is most frequent complaint in the patients, The character of it is chiefly stupor sensation. Some patients have rotation feeling. Because dizziness is a kind of spatial disorientation, it can lead to degression of different degrees in posture control. But the objective evidence is scanty.For the past few years, in the biomechanics field of sports medicine, rehabilitation department and HNO, posturography has been used to reflect equilibrium dysfunction of. the patients.Although we read some reports about posturography of health adult in domestic scholars, there hasn’t been unified standard of its index value. The analysis of posturography of thepatients with cervical vertigo has been seldom reported. And posturography pattern has been seldom classified.The static posturography of normal control and patients with cervical vertigo were quantitatively measured respectively in the states of opened and closed eyes In contrast to current diagnosis method of patients with cervical vertigo, the accuracy, reliability and clinical benefit of diagnosing cervical vertigo with biomechanical measurement of static posturography in the states of opened and closed eyes were evaluated with sensitivity, specificity, Youden’s index ,coincidence, Kappa value, negative and positive predictive value, negative and positive likelihood ratio. The aim was to provide quantitatively biomechanical indexes for the diagnosis of cervical vertigo. Contents and methods l.The manufacturing of computerized static posturography systemThe computerized posturography system was manufactured by the Biomechanics Room of Traumatology Institute of China Academy Of Traditional Chinese Science. The hardware system was made of tablet-type force-platform, amplifying circuit board, wave filter, A/D translator and computer. The software which matched hardware was compiled by Biomechanics Room. It was chiefly composed of graphic display, data acquisition, data storage and playback so on.1.1 Contents1.1.1 the manufacturing, standardization and the linearity analysis of of every force transducer.1.1.2 the error analysis of the system1.1.3 the reproducibility analysis of the system1.2 Methods1.2.1 The different standard loads were exerted to the four force transducers respectively to some extent, and the corresponding output voltages were obtained. Then we used the respective output voltage, which was viewed as independent variable, and the corresponding load , which was viewed as dependent variable to obtain the standardization cofficient.1.2.2 The analysis of the systemic noise was studied by simulating testing step ten times with an fixed-weight(32kgs) object put on the center of test board. The evaluation criterion was the ratio between systemic noise and ultimate range.1.2.3 The same person(altogether four persons) was tested three times in the morning, afternoon and evening with static posturography And the subsequent four days in the same time was replicated testing.The aim was to discover whether there was difference between different testing time.2.The biomechanical quantitative study of static posturography with health adults 2.1 Study contents2.1 .lTo obtain the normal range of every index, we respectively measured the parameter value of every index in the states of pened and closed eyes in health adults1.2 The dependability analysis between every index and his or her height, weight, et al.2.2 Study methods2.2.1 testing methodsSubjects were tested in the statesof open and closed eyes with static posturography, which approximately lasted 15 seconds each testing, one minute for an interval. To reduced the systemic error, we tested every subject three times, and the mean value of some index was viewed as the index value After the end of testing, the graphic type and index values of the static posturography could be displayed on the test screen if we call out the original data file.2.2.2 Measurement indexes:L-x represented maximum of the pathway which center of gravity covered in right-left direction;L-y represented maximum of the pathway which center of gravity covered in right-left direction;A-box representewd the rectangle area of the pathway which center of gravity covered in right-left and forward backward direction;Length represented the total length which center of gravity covered..2.2.3 The static posturography of health adultsTo obtain the normal parameters of every index , we conducted the static posturography in the states of open and closed eyes with 101 health adults. Those subjects were subgrouped by gender and four age stages(namely,20-29;30-39;40-49;above50) to find whether there was relationship between different gender and age stages. 3.The computerized static posturography of patients with cervical vertigo3.1 study contents3.1.1 To obtain the parameter values and graphic type of case group, we conducted the static posturography in the states of opened and closed eyes respectively with 75 patients with cervical vertigo.3.1.2 To obtain the parameter values and graphic type of normal control, we conducted the static posturography in the states of opened and closed eyes respectively with 86 health adults.3.1.3 The concordance evaluation of two methods of diagnosis of cervical vertigo, namely, static postrography and current diagnostic methods.3.2 study methods3.2.1 Subjects:75 patients consistent with the terms of cervical vertigo;86 normal control consistent with the qualification of health adults.3.2.2 testing methods: the same as the methods in "2.2.2"3.2.3 the judgement of health adults and patients with cervical vertigoAccording to the range of normal values in the states of opened and closed eyes, we diagnosed 86 health adults and 75 patients with cervical vertigo once again. And we compared the diagnostic results of static posturography with those of current methods of diagnosing cervical vertigo.In contrast to current methods of diagnosing cervical vertigo, the clinical value ofstatic posturography was evaluated.Resultsl.the manufacturing of computerized static posturography system1.1 The linear correlation of the pressure in every sensor was excellent1.2 The noise error was tiny:the transverse noise error was(0.29 ±0. 14) %;the vertical noise error was(0.41±0.21)%.1.3 The reproducibility of the system was good. There was no significant difference between different testing times and testing time.2.Biomechanical quantitative study of static posturography in healthy adults2.1 The correlation analysis of every index value showed that there wasn’t evident correlation between height, weight and BMI(body mass index) regardless of opened and closed eyes.2.2 The range of normal values in normal subjectsIn the opened-eyes state: L-x<8.00mm;L-y<17.03mm;A-box<l04.40mm2;Length<64.80mm;In the closed-eyes state : L-x<9.01mm;L-y<21.85mm;A-box<l62.42mm2;Length<l 11.20mm;2.3 There was extremely significant difference between the index values of opened and closed eyes, showing the values of opened-eyes state were less than those of closed-eyes state.2.4 There was no significant difference between males and females regardless of the state of opened or closed eyes.3. the evaluation study of the diagnosis of cervical vertigo with the computerized static posturography3.1 The sensitivity in the state of opened eyes was 51.4%;specificity was 87.2%;Youden index was 36.5%,agreement rate for observation was 70.9%. Kappa value equaled 0.397;positive and negative predictive value were respectively 77.1% and 87.2%;the positive and negative likelihood rate were respectively 4.018 and 0.557.3.2 The sensitivity in the state of closed eyes was 76.0%;specificity was 93.0%;agreement rate for observation was 82.9%. Kappa value equaled 0.653;positive and negative predictive value were respectively 84.6% and 88.4%;the positive and negative likelihood rate were respectively 6.569 and 0.267.3.3 We got six patterns of postural sway, namely, centripetal, diffuse, right-left, multicentric and skew patterns.In the state of opened eyes, the results of the health adults were as follows: foreword-backward pattern accounted for 65 percent, diffuse pattern for 9 percent;multicentric pattern for 8 percent;right-left pattern for 2 percent;centripetal for 14 percent;skew patterns for 2 percent. However, the results of the patients with cervical vertigo were as follows: foreword-backward pattern accounted for 35 percent, diffuse pattern for 47 percent;multicentric pattern for 5 percent;right-left pattern for 1 percent;centripetal for 4 percent;skew patterns for 8percent.In the state of closed eyes, the results of the health adults were as follows: foreword-backward pattern accounted for 68 percent, diffuse pattern for 14 percent;multicentric pattern for 13 percent;right-left pattern for 0 percent;centripetal for 2 percent;skew patterns for 3percent. However, the results of the patients with cervical vertigo were as follows: foreword-backward pattern accounted for 21 percent, diffuse pattern for 66 percent;multicentric pattern for 0 percent;right-left pattern for 1 percent;centripetal for 0 percent;skew patterns for 12 percent.Therefore, foreword-backward pattern was the most prominent figure pattern in the normal subjects. However, diffuse pattern was the most prominent figure pattern in the patients with cervical vertigo. Conclusion 1 .The computerized static posturography could be used to clinical testing, whose reproducibilityand stability were good.2. Foreword-backward pattern was the most prominent figure pattern in the normal subjects.However, diffuse pattern was the most prominent figure pattern in the patients with cervicalvertigo.3.The index values of the patients with cervical vertigo were obviously greater than the healthadults regardless of open or closed eyes.4.The computerized static posturography could achieve the basic requirements of diagnosingcervical vertigo, whose validity, reliability and clinical application effect were good.transducer

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