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CONTEXT: There is a paucity of research assessing the efficacy of osteopathic manipulative treatment (OMT) in patients with vertigo. OBJECTIVE: To assess the feasibility of conducting a randomized, controlled trial comparing OMT and vestibular rehabilitation therapy (VRT), alone or in combination, in patients with vertigo and somatic dysfunction. METHODS: Volunteers with vertigo who were also diagnosed with somatic dysfunction (SD) were prospectively enrolled in a blinded, randomized, controlled cohort comparative effectiveness study and assigned to 1 of 4 groups: OMT alone, VRT alone, a combination of OMT and VRT (OMT/VRT), or a nonintervention control group. Participants between 18 and 79 years of age were included if they had experienced symptoms of vertigo for at least 3 months' duration, demonstrated somatic dysfunction, and could participate in computerized dynamic posturography (CDP) testing, tolerate manual therapy and exercises, and communicate effectively in English or Spanish. A total of 3 treatments lasting 45 minutes each were administered 1 week apart to each participant. OMT in this study consisted of counterstrain, myofascial release, balanced ligamentous tension, soft tissue, HVLA, and articulatory techniques. Comparisons were made between composite scores (CS) assessed with computerized dynamic posturography (CDP), dizziness handicap inventory (DHI), optometric evaluation, and osteopathic structural examinations collected before the first treatment, after the third/final treatment, and 3 months after the final treatment. (ClinicalTrials.gov number NCT01529151). RESULTS: A total of 23 patients were included in the study: 7 in the OMT group, 5 in the VRT group, 6 in the OMT/VRT group, and 5 in the control group. The OMT/VRT group demonstrated significant improvement in DHI score (P=0.0284) and CS (P=0.0475) between pre- and 3-month posttreatment measures. For total severity, improvements were significant in the OMT group both from pretreatment to immediate posttreatment measures (P=0.0114) and from pretreatment to 3-month posttreatment measures (P=0.0233). There was a statistical difference between the OMT and control groups from pretreatment to 3-month posttreatment DHI scores (P=0.0332). Also, there was a statistical difference in DHI score between VRT and control from pre- to 3-month posttreatment scores (P=0.0338). OMT/VRT statistically and clinically improved visual acuity in patients' right eyes from pre- to posttreatment (P=0.0325). In all participants, vergence dysfunction was prevalent (5; 21.7%) in addition to vertical heterophoria (15; 65.2%). CONCLUSION: A combination of OMT and VRT significantly reduced vertigo and improved balance 3 months after treatment (P<0.05). There was a high prevalence in vergence and vertical heterophoria, which are not typical screening measurements used by physical therapists and physicians to assess vertigo patients. With a small sample size, this study demonstrated the feasibility of an interdisciplinary team evaluating and treating patients with vertigo in a community setting. A larger study is needed to assess the efficacy of OMT/VRT in vertigo patients.

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SIGNIFICANCE: Our study revealed that children with sensory processing disorder (SPD) exhibit deficient saccades and pursuits compared with typically developing (TD) children. Optometrists have a key role in caring for patients with SPD. Optometrists are paramount in identifying, coordinating care for, and treating these children. PURPOSE: Children with SPD exhibit poor neurological processes, which can affect oculomotor performance. The study aims are to investigate differences in oculomotor skills using the Northeastern State University College of Optometry (NSUCO) oculomotor testing in children with SPD as compared with TD children, to explore effects of age and sex of children in each group on oculomotor performance, and to compare our results to test normative values for both TD and SPD groups. METHODS: One hundred fifty children aged 7 to 11 years were recruited from surrounding community. The Short Sensory Profile (SSP) was used to assign the children into two groups. Of the eligible children recruited, 60 were TD (SSP ≥155) and 68 had SPD (SSP ≤141). Children were excluded if they reported blindness, strabismus, deafness, ocular disease, fractures within 6 months, or physical disabilities. Gait, balance, and visual skills of all children were assessed. Visual skill evaluation included select visual efficiency and visual processing testing. The NSUCO test was included as part of the visual efficiency evaluation. RESULTS: Results showed that children with SPD demonstrate decreased oculomotor skills on all tests compared with TD children. For the SPD group, boys scored significantly poorer than did girls in head and body movement with saccades and pursuits. Overall, TD group scores confirm the established test norms. CONCLUSIONS: Because of significant differences in oculomotor function in children with SPD and the increasing number of children with neurosensory disorders, optometrists should consider NSUCO testing on all pediatric patients and particularly in children with SPD.

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OBJECTIVE: To characterize the gait of small-breed dogs walked on a pressure walkway by handlers moving at a metronome-set tempo and to determine the influence of handler and leash side on gait characteristics. DESIGN: Prospective study. ANIMALS: 5 healthy adult small-breed dogs weighing < 11.4 kg (25 lb). PROCEDURES: Dogs were walked by each of 5 handlers moving at a metronome-set tempo (100 beats/min). Velocity, cadence, stance time, number of activated sensors, total pressure index (TPI), left or right hind reach, and symmetry indices were obtained with the leash on the left and right sides of each dog for each handler. RESULTS: Coefficients of variation for TPI and stance time approximated 30%, whereas coefficients of variation for symmetry indices remained < 20%. Changing handlers and leash side did not influence hind limb variables. Changing handlers influenced the TPI of the forelimbs, inducing changes of up to 8%. Leash side accounted for 12% and 14% of the variation in symmetry indices of TPI and number of sensors activated between forelimbs, respectively (mean alterations for recorded variables, 9%). CONCLUSIONS AND CLINICAL RELEVANCE: Symmetry indices appeared to vary less than variables obtained for individual dog limbs, and it may therefore be advantageous to determine those indices during large trials. Handlers or leash side may be changed in studies focusing on dogs' hind limbs without affecting results. Use of symmetry indices is recommended in forelimb studies requiring multiple handlers. Pressure walkway analyses of the forelimbs should include equal distribution of left- and right-sided leash-led trials, given that small-breed dogs tended to shift weight toward the forelimb opposite the leash.

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PURPOSE: To examine the capability and performance of children with sensory processing disorders (SPD) compared with children who are developing typically and those with physical disabilities (PD). METHODS: Participants included parents/caregivers of 81 children ranging in age from 1 to 7.3 years; 57% were boys. The child's therapist interviewed the parents using the Pediatric Evaluation of Disability Inventory (PEDI) to measure functional performance. RESULTS: Children with SPD demonstrated significant differences from children in the other groups in functional skills and caregiver assistance within 3 domains (self-care, mobility, social function). CONCLUSIONS: The PEDI can be used to (1) identify functional delays in young children with SPD, which can affect participation in age-appropriate self-care, mobility, and social skills, and (2) determine appropriate referrals for early intervention.

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UNLABELLED: Patients in an inpatient rehabilitation facility (IRF) are at increased fall risk. However, little IRF research has focused on fall risk. PURPOSE: The purpose of this study was to retrospectively examine differences between 35 patients who fell and 35 who did not during their IRF stay . METHOD: The following admission data were compared: age, gender, diagnosis, Morse Fall Scale score, and 18 Functional Independence Measure (FIM) scores. Independent t-tests were conducted for age and FIM scores, Mann-Whitney test was conducted for Morse scores, and chi-square tests were conducted for gender and diagnosis to examine differences between fallers and nonfallers. FINDINGS: There were no significant differences between groups for age, gender, diagnosis, or Morse scores. However, there were significant differences for 12 FIM items, and FIM Motor, Cognitive, and Total scores. FINDINGS: The results suggest that the Morse Scale may not be the most appropriate tool for assessing fall risk in an IRF. CONCLUSIONS AND CLINICAL RELEVANCE: Decisions about fall risk should consider admission FIM scores.

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OBJECTIVE: To determine if specific birth factors can be used to predict a subsequent disability and severity level in self-care, mobility and social function as measured by the Paediatric Evaluation of Disability Inventory (PEDI). DESIGN: This cross-sectional study design used retrospective data from birth records and concurrent data from PEDI scores. METHOD: Sixty children (20 per group) were selected representing groups consistent with typical development, sensory processing disorders or physical disability. Mean age was 56 months; there were 32 males. Information extracted from birth records was compared to PEDI scores. RESULTS: Univariate ANOVA showed differences among groups for PEDI scores (p < 0.001) and birth factors (p < 0.001). A forward logistic regression analysis revealed gestational age and 5-minute Apgar scores as potential predictors of PEDI scores. CONCLUSION: Findings indicated that two birth factors were related to later functional performance, but only in children with sensory processing deficits.

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