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Treatment of vertigo and postural instability using visual illusions. The Journal of Laryngology & Otology 2014; 128:1005-7. [DOI: 10.1017/s0022215114002254] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackground:Ototoxicity caused by medication can lead to debilitating symptoms such as dizziness, vertigo and postural instability. There is no current ‘gold standard’ treatment available.Case report:A 79-year-old male, with bilateral loss of vestibular function caused by gentamicin toxicity after surgery for prosthetic valve endocarditis, complained of dizziness, difficulty in walking and an increased risk of falling. Physical examination showed a positive head thrust test suggesting bilateral loss of vestibular function.Results:The patient underwent a specific motion-based virtual reality enhanced protocol for peripheral vestibular disease. He showed a great improvement, with a 50 per cent reduction in his Dizziness Handicap Inventory score.Conclusion:Computer-aided rehabilitation programmes might represent an important advance in gait and posture training.
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Mucha A, Collins MW, Elbin R, Furman JM, Troutman-Enseki C, DeWolf RM, Marchetti G, Kontos AP. A Brief Vestibular/Ocular Motor Screening (VOMS) assessment to evaluate concussions: preliminary findings. Am J Sports Med 2014; 42:2479-86. [PMID: 25106780 PMCID: PMC4209316 DOI: 10.1177/0363546514543775] [Citation(s) in RCA: 484] [Impact Index Per Article: 48.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Vestibular and ocular motor impairments and symptoms have been documented in patients with sport-related concussions. However, there is no current brief clinical screen to assess and monitor these issues. PURPOSE To describe and provide initial data for the internal consistency and validity of a brief clinical screening tool for vestibular and ocular motor impairments and symptoms after sport-related concussions. STUDY DESIGN Cross-sectional study; Level of evidence, 2. METHODS Sixty-four patients, aged 13.9 ± 2.5 years and seen approximately 5.5 ± 4.0 days after a sport-related concussion, and 78 controls were administered the Vestibular/Ocular Motor Screening (VOMS) assessment, which included 5 domains: (1) smooth pursuit, (2) horizontal and vertical saccades, (3) near point of convergence (NPC) distance, (4) horizontal vestibular ocular reflex (VOR), and (5) visual motion sensitivity (VMS). Participants were also administered the Post-Concussion Symptom Scale (PCSS). RESULTS Sixty-one percent of patients reported symptom provocation after at least 1 VOMS item. All VOMS items were positively correlated to the PCSS total symptom score. The VOR (odds ratio [OR], 3.89; P < .001) and VMS (OR, 3.37; P < .01) components of the VOMS were most predictive of being in the concussed group. An NPC distance ≥5 cm and any VOMS item symptom score ≥2 resulted in an increase in the probability of correctly identifying concussed patients of 38% and 50%, respectively. Receiver operating characteristic curves supported a model including the VOR, VMS, NPC distance, and ln(age) that resulted in a high predicted probability (area under the curve = 0.89) for identifying concussed patients. CONCLUSION The VOMS demonstrated internal consistency as well as sensitivity in identifying patients with concussions. The current findings provide preliminary support for the utility of the VOMS as a brief vestibular/ocular motor screen after sport-related concussions. The VOMS may augment current assessment tools and may serve as a single component of a comprehensive approach to the assessment of concussions.
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Affiliation(s)
| | | | | | | | | | | | | | - Anthony P. Kontos
- Address correspondence to: Anthony P. Kontos, PhD, UPMC Sports Medicine Concussion Program, University of Pittsburgh Medical Center, 3200 South Water Street, Pittsburgh, PA 15203, USA,
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Whitney SL, Sparto PJ, Alahmari K, Redfern MS, Furman JM. The use of virtual reality for people with balance and vestibular disorders: the Pittsburgh experience. PHYSICAL THERAPY REVIEWS 2014. [DOI: 10.1179/108331909x12488667117294] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Marquer A, Barbieri G, Pérennou D. The assessment and treatment of postural disorders in cerebellar ataxia: a systematic review. Ann Phys Rehabil Med 2014; 57:67-78. [PMID: 24582474 DOI: 10.1016/j.rehab.2014.01.002] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 12/31/2013] [Accepted: 01/14/2014] [Indexed: 12/16/2022]
Abstract
Gait and balance disorders are often major causes of handicap in patients with cerebellar ataxia. Although it was thought that postural and balance disorders in cerebellar ataxia were not treatable, recent studies have demonstrated the beneficial effects of rehabilitation programs. This article is the first systematic review on the treatment of postural disorders in cerebellar ataxia. Nineteen articles were selected, of which three were randomized, controlled trials. Various aetiologies of cerebellar ataxia were studied: five studies assessed patients with multiple sclerosis, four assessed patients with degenerative ataxia, two assessed stroke patients and eight assessed patients with various aetiologies. Accurate assessment of postural disorders in cerebellar ataxia is very important in both clinical trials and clinical practice. The Scale for the Assessment and Rating of Ataxia (SARA) is a simple, validated measurement tool, for which 18 of the 40 points are related to postural disorders. This scale is useful for monitoring ataxic patients with postural disorders. There is now moderate level evidence that rehabilitation is efficient to improve postural capacities of patients with cerebellar ataxia - particularly in patients with degenerative ataxia or multiple sclerosis. Intensive rehabilitation programs with balance and coordination exercises are necessary. Although techniques such as virtual reality, biofeedback, treadmill exercises with supported bodyweight and torso weighting appear to be of value, their specific efficacy has to be further investigated. Drugs have only been studied in degenerative ataxia, and the level of evidence is low. There is now a need for large, randomized, controlled trials testing rehabilitation programs suited to postural and gait disorders of patients with cerebellar ataxia.
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Affiliation(s)
- A Marquer
- UJF-Grenoble 1, UMR CNRS 5525 TIMC-IMAG, clinique MPR, CHU de Grenoble, 38041 Grenoble, France.
| | - G Barbieri
- UJF-Grenoble 1, UMR CNRS 5525 TIMC-IMAG, clinique MPR, CHU de Grenoble, 38041 Grenoble, France
| | - D Pérennou
- UJF-Grenoble 1, UMR CNRS 5525 TIMC-IMAG, clinique MPR, CHU de Grenoble, 38041 Grenoble, France
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Abstract
PURPOSE To describe the performance of high school adolescents during common functional gait and balance measures used in vestibular physical therapy. METHODS A cross-sectional study of 91 participants determined their performance on the Activities-specific Balance Confidence (ABC) scale, Dynamic Gait Index, Functional Gait Assessment, Timed "Up and Go" (TUG), Five Times Sit to Stand (FTSTS) test, tests of gait speed (GS), and the Balance Error Scoring System. In a subset of this sample, GS, TUG, and the FTSTS were repeated twice to examine test-retest reliability. RESULTS The measures of GS, TUG, and FTSTS were normally distributed. The Activities-specific Balance Confidence, Dynamic Gait Index, and Functional Gait Assessment exhibited a ceiling effect. The timed measures exhibited moderate to good reliability. CONCLUSIONS These performance scores may provide end points for discharge from vestibular physical therapy. However, clinicians should be aware of the ceiling effect exhibited by some measures.
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Deveze A, Bernard-Demanze L, Xavier F, Lavieille JP, Elziere M. Vestibular compensation and vestibular rehabilitation. Current concepts and new trends. Neurophysiol Clin 2014; 44:49-57. [DOI: 10.1016/j.neucli.2013.10.138] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 10/18/2013] [Accepted: 10/18/2013] [Indexed: 10/26/2022] Open
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Marioni G, Fermo S, Lionello M, Fasanaro E, Giacomelli L, Zanon S, Staffieri C, Dall'Igna F, Manzato E, Staffieri A. Vestibular rehabilitation in elderly patients with central vestibular dysfunction: a prospective, randomized pilot study. AGE (DORDRECHT, NETHERLANDS) 2013; 35:2315-2327. [PMID: 23179254 PMCID: PMC3825000 DOI: 10.1007/s11357-012-9494-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 11/09/2012] [Indexed: 05/27/2023]
Abstract
For the vestibular system, aging is associated with degenerated otoconia and loss of hair cells, vestibular afferents, and cells in the vestibular nuclei. Further neurodegenerative processes involve cortical, extrapyramidal motor, and cerebellar structures. Dizziness is quite common in the elderly, limiting their mobility and activities. The role of vestibular rehabilitation in these patients is controversial. The present prospective, randomized, preliminary investigation aimed to compare the effect of a 6-week posturography-assisted vestibular rehabilitation protocol (30 min a week) combined with a home-based exercise program (group A, 14 randomly assigned elderly patients) with the same home-based exercise program alone (group B, 14 randomly assigned elderly patients) for treating dizziness due to central vestibular dysfunction in elderly patients. The outcomes were analyzed using the 25-item Dizziness Handicap Inventory (DHI) and computerized posturography. After rehabilitation, group A scored significantly better in the DHI for the functional (p = 0.0016) and emotional (p = 0.01) domains and total score (p = 0.001); only the emotional domain improved significantly in group B (p = 0.038). Group A improved significantly in some posturographic parameters in the motor tests (reaction time, movement velocity, and endpoint excursion), while group B experienced more limited improvements. Our preliminary results with a program of posturography-assisted vestibular rehabilitation, and home-based exercises are more promising than with home-based exercises alone. A new study on a larger series of elderly patients with central vestibular dysfunctions is currently underway at Padova University, considering the effect of a protocol involving rehabilitation with computerized posturography alone and the relationship between outcomes and the duration of rehabilitation programs.
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Affiliation(s)
- Gino Marioni
- Department of Neurosciences, Otolaryngology Section, University of Padova, Via Giustiniani 2, 35128, Padova, Italy,
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Winser SJ, Hale L, Claydon LS, Smith C. Outcome measures for the assessment of balance and posture control in cerebellar ataxia. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/1743288x13y.0000000065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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The effectiveness of allied health care in patients with ataxia: a systematic review. J Neurol 2013; 261:251-8. [DOI: 10.1007/s00415-013-6910-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 03/28/2013] [Accepted: 03/29/2013] [Indexed: 11/26/2022]
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Bechly KE, Carender WJ, Myles JD, Sienko KH. Determining the preferred modality for real-time biofeedback during balance training. Gait Posture 2013; 37:391-6. [PMID: 23022157 DOI: 10.1016/j.gaitpost.2012.08.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 08/09/2012] [Accepted: 08/13/2012] [Indexed: 02/02/2023]
Abstract
Vestibular rehabilitation therapy has been shown to improve balance and gait stability in individuals with vestibular deficits. However, patient compliance with prescribed home exercise programs is variable. Real-time feedback of exercise performance can potentially improve exercise execution, exercise motivation, and rehabilitation outcomes. The goal of this study is to directly compare the effects of visual and vibrotactile feedback on postural performance to inform the selection of a feedback modality for inclusion in a home-based balance rehabilitation device. Eight subjects (46.6±10.6years) with peripheral vestibular deficits and eight age-matched control subjects (45.3±11.1years) participated in the study. Subjects performed eyes-open tandem Romberg stance trials with (vibrotactile, discrete visual, continuous visual, and multimodal) and without (baseline) feedback. Main outcome measures included medial-lateral (M/L) and anterior-posterior mean and standard deviation of body tilt, percent time spent within a no-feedback zone, and mean score on a comparative ranking survey. Both groups improved performance for each feedback modality compared to baseline, with no significant differences in performance observed among vibrotactile, discrete visual, or multimodal feedback for either group. Subjects with vestibular deficits performed best with continuous visual feedback and ranked it highest. Although the control subjects performed best with continuous visual feedback in terms of mean M/L tilt, they ranked it lowest. Despite the observed improvements, continuous visual feedback involves tracking a moving target, which was noted to induce dizziness in some subjects with vestibular deficits and cannot be used during exercises in which head position is actively changed or during eyes-closed conditions.
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Affiliation(s)
- Kelli E Bechly
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, United States
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63
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Walak J, Szczepanik M, Woszczak M, Józefowicz-Korczyńska M. [Impact of physiotherapy on quality of life improvement in patients with central vestibular system dysfunction]. Otolaryngol Pol 2013; 67:11-7. [PMID: 23374658 DOI: 10.1016/j.otpol.2012.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 08/26/2012] [Accepted: 09/03/2012] [Indexed: 10/27/2022]
Abstract
UNLABELLED THE AIM of the study was to evaluate the impact of physiotherapy on balance stability and quality of life improvement in patients with central vestibular system dysfunction. MATERIAL AND METHODS The study was conducted on 31 patients (23 females, 8 males) with vertigo/dizziness and unsteadiness diagnosed for central vestibular system impairment based on videonystagraphy examinations, in ENT Department Medical University of Lodz between 2010-2011 years. Patients' history of diseases were collected. The physiotherapeutic programme was individually introduced during four weeks (five time a week). The intervention included balance training and habituation exercises. At baseline and after patients were evaluated therapy with WHO Quality of Life-BREF (WHOQOL-BREF) and Dizzeness Handicap Inventory (DHI) self-assessment scales. Clinical examination with Romberg and stand one leg tests (eyes opened and closed) was performed. RESULTS After therapy statistically significant differences in total DHI score (p<0.005) and 3 subscales: physical, emotional, functional (p<0.05) and WHOQOL-BREF only physical subscale (p<0.05) compared baseline were found. There were no statistical differences between psychological, social relationships and environment subscales. In clinical evaluation significant reduction of unsteadiness in Romberg test (p<0.05) and in stand one leg tests eyes opened and closed tests (p<0.05) were found. CONCLUSION In patients with central vestibular system impairment after physical therapy betterment in clinical examination and some subjective self-assessment scales were observed. Lack of significant improvement in psychological, social relationships and environment domain in WHOQOL-BREF subscale indicated that these patients may need more psychological support or extensions in physiotherapy.
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Abstract
This chapter addresses the important and undertreated problem of balance disorders. The chapter has a simplified summary of the physiology of balance problems in order to set the scene. The issue of assessment is next addressed with discussion of important tests including the Berg Balance Scale and the Get Up and Go Test, and others. Posturography is discussed as well as assessment of the gravitional vertical. The assessment of vestibular function is of key importance and discussed in some detail. The focus of the chapter is on balance rehabilitation. Re-training of postural alignment and of sensory strategies are key but adaptation of the environment and re-training of cognitive strategies are also helpful in individual cases. Vestibular exercises can also be used. The chapter then critically analyses the efficacy of these treatments in specific balance disorders such as in stroke, Parkinson disease, polyneuropathies, multiple sclerosis, and vestibular disorders. Overall, there is a growing body of evidence that balance rehabilitation improves symptoms, function, and quality of life for those troubled by these disabling problems.
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Vestibular rehabilitation strategies and factors that affect the outcome. Eur Arch Otorhinolaryngol 2012; 269:2309-16. [PMID: 22526580 DOI: 10.1007/s00405-012-2019-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 03/27/2012] [Indexed: 12/20/2022]
Abstract
Ever since the introduction of Cawthorne-Cooksey exercises, vestibular rehabilitation (VR) has been gaining popularity in the treatment of the dizzy patient. Numerous studies support the effectiveness of VR in improving balance/walking skills, eye-head coordination and the quality of life of the patient. Different rehabilitation protocols have been used to treat patients with peripheral and central vestibular disorders. Assessment of the patients' progress is based on the patients' selfperception of dizziness and their functional skills. Factors such as age, medication, time of onset of vertigo and home based VR have been evaluated on their effect on the rehabilitation's outcome. The aim of this review is to evaluate rehabilitation strategies and discuss the factors that affect the outcome.
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Badke MB, Sherman J, Boyne P, Page S, Dunning K. Tongue-based biofeedback for balance in stroke: results of an 8-week pilot study. Arch Phys Med Rehabil 2011; 92:1364-70. [PMID: 21878206 DOI: 10.1016/j.apmr.2011.03.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 03/23/2011] [Accepted: 03/29/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To assess balance recovery and quality of life after tongue-placed electrotactile biofeedback training in patients with stroke. DESIGN Prospective multicenter research design. SETTING Outpatient rehabilitation clinics. PARTICIPANTS Patients (N=29) with chronic stroke. INTERVENTIONS Patients were administered 1 week of therapy plus 7 weeks of home exercise using a novel tongue based biofeedback balance device. MAIN OUTCOME MEASURES The Berg Balance Scale (BBS), Timed Up and Go (TUG), Activities-Specific Balance Confidence (ABC) Scale, Dynamic Gait Index (DGI), and Stroke Impact Scale (SIS) were performed before and after the intervention on all subjects. RESULTS There were statistically and clinically significant improvements from baseline to posttest in results for the BBS, DGI, TUG, ABC Scale, and some SIS domains (Mobility, Activities of Daily Living/Instrumental Activities of Daily Living, Social, Physical, Recovery domains). Average BBS score increased from 35.9 to 41.6 (P<.001), and DGI score, from 11.1 to 13.7 (P<.001). Time to complete the TUG decreased from 24.7 to 20.7 seconds (P=.002). Including the BBS, DGI, TUG, and ABC Scale, 27 subjects improved beyond the minimal detectable change with 95% certainty (MDC-95) or minimal clinically important difference (MCID) in at least 1 outcome and 3 subjects improved beyond the MDC-95 or MCID in all outcomes. CONCLUSIONS Electrotactile biofeedback seems to be a promising integrative method to balance training. A future randomized controlled study is needed.
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Affiliation(s)
- Mary Beth Badke
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI, USA.
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Postconcussion Syndrome: A Physiatrist's Approach. PM R 2011; 3:S396-405. [DOI: 10.1016/j.pmrj.2011.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 07/29/2011] [Indexed: 01/11/2023]
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Naber CM, Water-Schmeder O, Bohrer PS, Matonak K, Bernstein AL, Merchant MA. Interdisciplinary treatment for vestibular dysfunction: the effectiveness of mindfulness, cognitive-behavioral techniques, and vestibular rehabilitation. Otolaryngol Head Neck Surg 2011; 145:117-24. [PMID: 21493331 DOI: 10.1177/0194599811399371] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To investigate whether an interdisciplinary program for vestibular patients improved health outcomes and health care utilization. STUDY DESIGN Case series with chart review. SETTING Outpatient neurotology clinic. SUBJECTS AND METHODS Patients (N = 167) with dizziness attended an interdisciplinary neurotology clinic; 129 were offered group treatment. After an introductory session, group treatment included 5 sessions incorporating mindfulness, cognitive-behavioral techniques, and vestibular rehabilitation. Physical and emotional functioning, depression,anxiety, dizziness, impairment, coping, skill use, and patient satisfaction were measured with rating scales pre- and post-group treatment. Data from 51 patients (male/female = 14/37; age range, 25-82 years) were analyzed with paired t tests or nonparametric tests. Logistic regression analyzed predictors of outcome and utilization for 116 patients (male/female = 81/35; age range, 11-86 years) attending the interdisciplinary clinic, introductory session, and/or group. RESULTS After group treatment, patients reported better mood (P = .0482); better physical (P = .0006) and mental (P = .0183) health; better functionality, coping, and skill use (Ps< .0001); less impairment (P < .0001); and fewer limitations from dizziness (P < .0001). Higher pretreatment levels of depression (P = .0216), poorer initial mental (P = .0164) or physical (P = .0059) health, and peripheral diagnosis (P = .0220) predicted better outcome. Group treatment decreased utilization more than the interdisciplinary clinic with (P = .0183) or without (P = .0196) the introductory session; 78% of patients with any level of participation showed less utilization. Clinic patients had fewer radiology procedures than group patients (P = .0365). Patients were highly satisfied with the program and found it more effective than previous treatment. CONCLUSION Interdisciplinary treatment improves patient coping, functionality, and satisfaction and decreases overall health care utilization in vestibular patients.
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Affiliation(s)
- Christine M Naber
- Department of Neurology, Kaiser Permanente, Santa Rosa, California USA.
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Abstract
This series of articles for rehabilitation in practice aims to cover a knowledge element of the rehabilitation medicine curriculum. Nevertheless they are intended to be of interest to a multidisciplinary audience. The competency addressed in this article is 'The trainee consistently demonstrates a knowledge of management approaches for specific impairments including spasticity, ataxia.'
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Affiliation(s)
- Jon Marsden
- School of Health Professions, Peninsula Allied Health Centre, Derriford Road, University of Plymouth, PL6 8BH, UK.
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Stasny BM, Newton RA, Viggiano LoCascio L, Bedio N, Lauke C, Conroy M, Thompson A, Vakhnenko L, Polidoro C. The ABC Scale and Fall Risk: A Systematic Review. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2011. [DOI: 10.3109/02703181.2011.572249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Rossi-Izquierdo M, Santos-Pérez S, Soto-Varela A. What is the most effective vestibular rehabilitation technique in patients with unilateral peripheral vestibular disorders? Eur Arch Otorhinolaryngol 2011; 268:1569-74. [PMID: 21340557 DOI: 10.1007/s00405-011-1532-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 02/07/2011] [Indexed: 12/30/2022]
Abstract
Vestibular rehabilitation has been found to be effective and safe in patients with instability. There is insufficient evidence, however, for distinguishing between the efficacies of different rehabilitation techniques. The objective of this study is to verify whether there are differences between two instrumental vestibular rehabilitation techniques, computerised dynamic posturography (CDP) and optokinetic stimulation (OKN), in order to establish the optimal strategy for each patient. We conducted a prospective, comparative study of the two techniques (CDP and OKN) in patients with instability due to chronic unilateral peripheral vestibular disorder. We randomly included 12 patients in each group, performing the evaluation with the Dizziness Handicap Inventory and the CDP with the sensorial organisation test (SOT), rhythmic weight shift and limits of stability (LOS). We found a statistically significant improvement in both groups in average balance score according to the SOT. In the OKN group, however, improvement was greater in visual preference. The CDP group showed greater benefits in the visual and vestibular input and LOS. Patients with poor vestibular and visual input or with reduced LOS will benefit more from an exercise protocol with CDP. Patients with poor visual preference, however, are ideal candidates for rehabilitation with OKN.
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Affiliation(s)
- Marcos Rossi-Izquierdo
- Department of Otolaryngology, University Hospital Lucus Augusti, San Cibrao s/n, 27003, Lugo, Spain.
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Abstract
PURPOSE OF REVIEW This review discusses the demographics of dizziness in the older person, the evaluation of the older dizzy patient and how the treatment of dizziness in older patients differs from that in younger individuals. RECENT FINDINGS Seven percent of all visits to primary care physicians for patients older than 65 years of age are for dizziness, and dizziness is the most common complaint for patients older than 75 years. In a German study, the 12-month prevalence of vertigo in the general population was 5% with an incidence of 1.4% in adults overall. For individuals aged 60-69 the 12-month prevalence was found to be 7.2% and in individuals 70 years of age or older 8.9%. Data from the United States National Health and Nutrition Examination Surveys indicated that the prevalence of vestibular dysfunction for individuals in the seventh decade of life, eighth decade of life, and older was 49.4, 68.7, and 84.8 percent, respectively. Only subtle age effects are seen on caloric and rotational testing whereas vestibular evoked myogenic potentials (VEMPs) change somewhat with age. Particle repositioning for benign paroxysmal positional vertigo combined with vestibular rehabilitation is more effective than only performing the repositioning maneuver. Tai Chi appears to be an effective intervention for older adults at risk for falling. SUMMARY When caring for an older dizzy patient always assess medication use, perform a Dix-Hallpike maneuver, obtain orthostatic vital signs, discuss fall risk precautions, and consider referral for vestibular rehabilitation.
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Abstract
The use of vestibular rehabilitation for persons with balance and vestibular disorders is used to improve function and decrease dizziness symptoms. Principles of a vestibular rehabilitation program are described including common exercises and outcome measures used to report change. A review of negative and positive predictive factors related to recovery is also provided.
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Affiliation(s)
- Susan L Whitney
- Department of Physical Therapy and Otolaryngology, University of Pittsburgh, Pittsburgh, PA 15262, USA.
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Nardone A, Godi M, Artuso A, Schieppati M. Balance Rehabilitation by Moving Platform and Exercises in Patients With Neuropathy or Vestibular Deficit. Arch Phys Med Rehabil 2010; 91:1869-77. [DOI: 10.1016/j.apmr.2010.09.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Revised: 08/13/2010] [Accepted: 09/09/2010] [Indexed: 11/30/2022]
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Abstract
BACKGROUND AND PURPOSE Management of dizziness and balance dysfunction is a major challenge after concussion. The purpose of this study was to examine the effect of vestibular rehabilitation in reducing dizziness and to improve gait and balance function in people after concussion. METHODS A retrospective chart review of 114 patients (67 children aged 18 years and younger [mean, 16 years; range, 8-18 years]; 47 adults older than 18 years [mean, 41 years; range, 19-73 years]) referred for vestibular rehabilitation after concussion was performed. At the time of initial evaluation and discharge, recordings were made of outcome measures of self-report (eg, dizziness severity, Activities-specific Balance Confidence Scale, and Dizziness Handicap Inventory) and gait and balance performance (eg, Dynamic Gait Index, gait speed, and the Sensory Organization Test). A mixed-factor repeated-measures analysis of variance was used to test whether there was an effect of vestibular rehabilitation therapy and age on the outcome measures. RESULTS The median length of time between concussion and initial evaluation was 61 days. Of the 114 patients who were referred, 84 returned for at least 1 visit. In these patients, improvements were observed in all self-report, gait, and balance performance measures at the time of discharge (P < .05). Children improved by a greater amount in dizziness severity (P = .005) and conditions 1 (eyes open, fixed support) and 2 (eyes closed, fixed support) of the Sensory Organization Test (P < .025). DISCUSSION Vestibular rehabilitation may reduce dizziness and improve gait and balance function after concussion. For most measures, the improvement did not depend on age, indicating that vestibular rehabilitation may equally benefit both children and adults. CONCLUSIONS Vestibular rehabilitation should be considered in the management of individuals post concussion who have dizziness and gait and balance dysfunction that do not resolve with rest.
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A Case-Oriented Approach Exploring the Relationship Between Visual and Vestibular Disturbances and Problems of Higher-Level Mobility in Persons With Traumatic Brain Injury. J Head Trauma Rehabil 2010; 25:193-205. [DOI: 10.1097/htr.0b013e3181dc82fa] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Whitney SL, Marchetti GF, Pritcher M, Furman JM. Gaze stabilization and gait performance in vestibular dysfunction. Gait Posture 2009; 29:194-8. [PMID: 18815040 PMCID: PMC4879829 DOI: 10.1016/j.gaitpost.2008.08.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Revised: 07/21/2008] [Accepted: 08/02/2008] [Indexed: 02/02/2023]
Abstract
BACKGROUND The gaze stability test (GST) quantifies the ability of a person to recognize a target projected on a personal computer monitor during active head movement. PURPOSE The purpose of this study was to determine if there was a relationship between clinical measures of walking performance and the GST in patients with vestibular disorders and in healthy subjects. We hypothesized that impairment of the ability to keep objects in focus during active head movement would be correlated with walking performance. SUBJECTS Twenty older asymptomatic adults acted as controls and 12 patients with either unilateral or bilateral vestibular disease participated. METHODS The GST quantifies the maximum velocity that a person can move their head in the pitch and yaw planes while retaining the ability to read an optotype that is momentarily projected onto a computer screen. Subjects were scored while performing the Dynamic Gait Index (DGI) and the Timed "Up & Go" (TUG) tests. RESULTS Walking performance on the DGI and TUG were significantly associated with GST results in subjects with vestibular disorders, but not in control subjects. Abnormalities of gait could be identified by GST cutoff values of 65 degrees s(-1) in the pitch plane and 63 degrees s(-1) in the yaw plane. DISCUSSION/CONCLUSION In older subjects with vestibular disorders, gaze stability, as assessed by the GST, is associated with reduced test scores on measures of gait performance.
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Affiliation(s)
- Susan L. Whitney
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA,Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA,Corresponding author: Susan L. Whitney: University of Pittsburgh, Department of Physical Therapy, 6035 Forbes Tower, Pittsburgh, PA 15260, USA. Fax: +1 412 647 1449
| | - Gregory F. Marchetti
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA,Department of Physical Therapy, Duquesne University, Pittsburgh, PA, USA
| | | | - Joseph M. Furman
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA,Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA
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Martin CL, Tan D, Bragge P, Bialocerkowski A. Effectiveness of physiotherapy for adults with cerebellar dysfunction: a systematic review. Clin Rehabil 2009; 23:15-26. [DOI: 10.1177/0269215508097853] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To systematically review the literature investigating the effectiveness of physiotherapy in adults with cerebellar dysfunction and to document treatment strategies currently employed in the physiotherapy management of this patient population. Data sources: Eight electronic databases were searched to source English-language studies published up to December 2007. Secondary searching of reference lists was also undertaken. Review methods: Studies were included if they used a quantitative research design to investigate the effect of physiotherapy on adults with diagnosed cerebellar dysfunction. Three reviewers were involved in study selection. Eligible studies were assessed for methodological quality. Data pertaining to the participants, interventions received, outcomes measured, and the effectiveness of the intervention were systematically extracted and synthesised in a narrative format. Results: Nine studies were included in the review. The majority of the studies (n = 7) were case studies or case series. The median quality score was 8/16 (range 4—10). The studies were heterogeneous in terms of patient characteristics, interventions received and outcomes measured. All studies reported positive effects of physiotherapy over a range of outcomes measured, in particular balance, gait and function. Conclusion: There is some evidence that supports the effectiveness of physiotherapy in adults with cerebellar dysfunction. However, these results need to be interpreted with caution due to the low volume, quality and clinical applicability of this evidence. There is a need for further high-quality research in this area.
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Affiliation(s)
- CL Martin
- School of Physiotherapy and Rehabilitation Sciences Research Centre, The University of Melbourne,
| | - D. Tan
- School of Physiotherapy, The University of Melbourne and Department of Physiotherapy, Singapore General Hospital, Singapore
| | - P. Bragge
- School of Physiotherapy, The University of Melbourne
| | - A. Bialocerkowski
- School of Physiotherapy and Rehabilitation Sciences Research Centre, The University of Melbourne, Melbourne, Australia
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Bases physiopathologiques et pratiques de la rééducation vestibulaire. ACTA ACUST UNITED AC 2008; 125:273-81. [DOI: 10.1016/j.aorl.2008.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Accepted: 06/17/2008] [Indexed: 11/24/2022]
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Moreira Bittar RS, Bovino Pedalini ME, Oiticica Ramalho J, Yoshimura R. Critical analysis of vestibular rehabilitation outcome according to dizziness etiology. Braz J Otorhinolaryngol 2008; 73:760-764. [PMID: 18278222 PMCID: PMC9450678 DOI: 10.1016/s1808-8694(15)31172-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2006] [Accepted: 11/18/2006] [Indexed: 12/03/2022] Open
Abstract
Summary Vestibular rehabilitation (VR) is an excellent therapy for dizziness patients. However, despite well managed, sometimes results are not suitable. Aim evaluate VR outcome between patients according to dizziness etiology. Study design: Retrospective review of medical records. Method: Patients' records were analyzed between January 2002 and December 2004. As for inclusion criteria, patients should have had finished VR therapy and an established diagnosis. Patients were included in three VR outcome groups and compared according to etiology. Results according to VR outcome 13 patients had no improvement, 24 had partial improvement and 22 complete improvement. The main etiologies were cervical syndrome, trauma, metabolic disorders, central nervous system disorders, anxiety and mood disorders, autoimmune disease and orthostatic intolerance. Patients with metabolic disorders showed better VR outcome than the others. Conclusion VR therapy combined with clinical etiology treatment is an excellent approach for dizziness patients.
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Affiliation(s)
| | | | | | - Ricardo Yoshimura
- MD. Otorhinolaryngologist. Student of the Specialization course in Neurotology - FMUSP; Disciplina de Clinica Otorrinolaringológica do Hospital das Clínicas da FMUSP
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Abstract
Vertigo is a common balance deregulation symptom among elders. Its etiology may be peripheral vestibular disease or a central vestibular disorder. Symptom onset, severity, and duration are distinguishing characteristics. The majority of peripheral vestibular disorders include benign paroxysmal positional vertigo, vestibular neuronitis, Meniere's disease, and perilymph fistula. Medication regimen review is necessary to identify possible drug-induced etiology. Treatment options include pharmacotherapy, canalith repositioning procedures, surgery, vestibular rehabilitation therapy, and dietary interventions.
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Affiliation(s)
- Guido R Zanni
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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