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.

Keywords:
Malingering balance disorder, Unilateral vestibular loss, Whiplash patients, Stance and gait posturography
1.
Adkin AL, Bloem BR, Allum JHJ: Trunk sway measurements during stance and gait tasks in Parkinson’s disease. Gait Posture 2005;22:240–249.
2.
Allum JHJ, Adkin AL: Improvements in trunk sway observed for stance and gait tasks during recovery from an acute unilateral peripheral vestibular deficit. Audiol Neurootol 2003;8:286–302.
3.
Allum JHJ, Bloem BR, Carpenter MG, Honegger F: Differential diagnosis of propioceptive and vestibular deficits using dynamic support-surface posturography. Gait Posture 2001;14:217–226.
4.
Allum JHJ, Carpenter MG: A speedy solution for balance and gait analysis: angular velocity measured at the centre of body mass. Curr Opin Neurol 2005;18:15–21.
5.
Allum JHJ, Huwiler M, Honegger F: Identifying cases of non-organic vertigo using dynamic posturography. Gait Posture 1996;4:52–61.
6.
Allum JHJ, Shepard NT: An overview of the clinical use of dynamic posturography in the differential diagnosis of balance disorders. J Vestib Res 1999;9:223–252.
7.
Allum JHJ, Zamani F, Adkin AL, Ernst A: Differences between trunk sway characteristics on a foam support surface and on the Equitest® ankle-sway-referenced support surface. Gait Posture 2002;16:264–270.
8.
Binder LM, Rohling ML: Money matters: a meta-analytic review of the effects of financial incentives on recovery after closed-head injury. Am J Psychiatry 1996;153:7–10.
9.
Cevette MJ, Puetz B, Marion MS, Wertz ML, Muenter MD: Aphysiologic performance on dynamic posturography. Otolaryngol Head Neck Surg 1995;112:676–688.
10.
Colebatch JG, Halmagyi GM, Skuse NF: Myogenic potentials generated by click-evoked vestibulocollic reflex. J Neurol Neurosurg Psychiatry 1994;57:190–197.
11.
Committee of European Assurances (CEA): Frequency of deficits and case costs after minor damage to the cervical-spinal column. CERE DOC 2004.
12.
Endo K, Suzuki H, Yamamoto K: Consciously postural sway and cervical vertigo after whiplash injury. Spine 2008;33:539–542.
13.
Gianoli G, McWilliams S, Soileau J, Belafsky P: Posturographic performance in patients with the potential for secondary gain. Otolaryngol Head Neck Surg 2000;122:11–18.
14.
Goebel JA, Sataloff RT, Hanson JM, Nashner LM, Hirshout DS, Sokolow CC: Posturographic evidence of nonorganic sway patterns in normal subjects, patients, and suspected malingerers. Otolaryngagol Head Neck Surg 1997;117:293–232.
15.
Hain TC: Treatment of vertigo. Neurologist 1995;1:125–133.
16.
Hamid MA: New tests of vestibular function; in Meyers EN, et al (eds): Advances in Otolaryngology-Head and Neck Surgery. Chicago, Year Book Medical Publishers, 1990, vol 5, pp 15–38.
17.
Hegeman J, Shapkova EY, Honegger F, Allum JHJ: Effect of age and height on trunk sway during stance and gait. J Vestib Res 2007;17:75–87.
18.
Holmberg J, Tjernström F, Karlberg M, Fransson PA, Magnusson M: Reduced postural differences between phobic postural vertigo patients and healthy subjects during a postural threat. J Neurol 2009;256:1258–1262.
19.
Horlings CGC, Küng UM, Bloem BR, Honegger F, Van Alfen N, Van Engelen BGM, Allum JHJ: Identifying deficits in balance control following vestibular or proprioceptive loss using posturographic analysis of stance tasks. Clin Neurophysiol 2008;119:2338–2346.
20.
Johansson R, Magnusson M, Fransson PA, Karlberg M: Discrimination between patients with acoustic neuroma and with peripheral vestibular lesion by human posture dynamics. Acta Otolaryngol 1994;114:479–483.
21.
Karlberg M, Johansson R, Magnusson M, Fransson PA: Dizziness of suspected cervical origin distinguished by posturographic assessment of human postural dynamics. J Vestib Res 1996;6:37–47.
22.
Krempl GA, Dobie RA: Evaluation of posturography in the detection of malingering subjects. Am J Otol 1998;19:619–627.
23.
Mallison AI, Longridge NS: A new set of criteria for evaluating malingering in work-related vestibular injury. Otol Neurotol 2005;26:686–690.
24.
Morgan SS, Beck WG, Dobie RA: Can posturography identify informed malingerers? Otol Neurotol 2002;23:214–217.
25.
Nedzelski JM, Barber HO, McIlmoyl L: Diagnosis in a dizziness unit. J Otolaryngol 1986;15:101–104.
26.
Pearce JMS: The myth of chronic whiplash injury. Spinal Cord 1999;27:741–748.
27.
Querner V, Krafczyk S, Dieterich M, Brandt T: Patients with somatoform phobic postural vertigo: the more difficult the balance task, the better the balance performance. Neurosc Lett 2000;285:21–24.
28.
Rey-Martinez J, Rama-Lopez J, Pérez-Fernandez N: Posturographic examination of malingering patients. Acta Otorrinolaringol Esp 2007;58:202–207.
29.
Shumway-Cook A, Horak FB: Assessing the influence of sensory interaction on balance. Phys Ther 1986;66:1548–1550.
30.
Sjöström H, Allum JHJ, Carpenter MG, Adkin AL, Honegger F, Ettlin T: Trunk sway measurers of postural stability during clinical balance tests in patients with chronic whiplash injury symptoms. Spine 2003;28:1725–1734.
31.
Tinetti ME: Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc 1986;34:119–126.
32.
Weber PC, Cass SP: Clinical assessment of postural stability. Am J Otol 1993;14:566–569.
© 2009 S. Karger AG, Basel
2009
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.