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Webster KE, Kamo T, Smith L, Harrington-Benton NA, Judd O, Kaski D, Maarsingh OR, MacKeith S, Ray J, Van Vugt VA, Burton MJ. Non-pharmacological interventions for persistent postural-perceptual dizziness (PPPD). Cochrane Database Syst Rev 2023; 3:CD015333. [PMID: 36912784 PMCID: PMC10011873 DOI: 10.1002/14651858.cd015333.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
BACKGROUND Persistent postural-perceptual dizziness (PPPD) is a chronic balance disorder, which is characterised by subjective unsteadiness or dizziness that is worse on standing and with visual stimulation. The condition was only recently defined and therefore the prevalence is currently unknown. However, it is likely to include a considerable number of people with chronic balance problems. The symptoms can be debilitating and have a profound impact on quality of life. At present, little is known about the optimal way to treat this condition. A variety of medications may be used, as well as other treatments, such as vestibular rehabilitation. OBJECTIVES: To assess the benefits and harms of non-pharmacological interventions for persistent postural-perceptual dizziness (PPPD). SEARCH METHODS: The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 21 November 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs in adults with PPPD, which compared any non-pharmacological intervention with either placebo or no treatment. We excluded studies that did not use the Bárány Society criteria to diagnose PPPD, and studies that followed up participants for less than three months. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were: 1) improvement in vestibular symptoms (assessed as a dichotomous outcome - improved or not improved), 2) change in vestibular symptoms (assessed as a continuous outcome, with a score on a numerical scale) and 3) serious adverse events. Our secondary outcomes were: 4) disease-specific health-related quality of life, 5) generic health-related quality of life and 6) other adverse effects. We considered outcomes reported at three time points: 3 to < 6 months, 6 to ≤ 12 months and > 12 months. We planned to use GRADE to assess the certainty of evidence for each outcome. MAIN RESULTS: Few randomised controlled trials have been conducted to assess the efficacy of different treatments for PPPD compared to no treatment (or placebo). Of the few studies we identified, only one followed up participants for at least three months, therefore most were not eligible for inclusion in this review. We identified one study from South Korea that compared the use of transcranial direct current stimulation to a sham procedure in 24 people with PPPD. This is a technique that involves electrical stimulation of the brain with a weak current, through electrodes that are placed onto the scalp. This study provided some information on the occurrence of adverse effects, and also on disease-specific quality of life at three months of follow-up. The other outcomes of interest in this review were not assessed. As this is a single, small study we cannot draw any meaningful conclusions from the numeric results. AUTHORS' CONCLUSIONS: Further work is necessary to determine whether any non-pharmacological interventions may be effective for the treatment of PPPD and to assess whether they are associated with any potential harms. As this is a chronic disease, future trials should follow up participants for a sufficient period of time to assess whether there is a persisting impact on the severity of the disease, rather than only observing short-term effects.
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Affiliation(s)
- Katie E Webster
- Cochrane ENT, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Tomohiko Kamo
- Department of Physical Therapy, Faculty of Rehabilitation, Gunma Paz University, Gunma, Japan
| | - Laura Smith
- School of Psychology, University of Kent, Canterbury, UK
| | | | - Owen Judd
- ENT Department, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Diego Kaski
- National Hospital for Neurology and Neurosurgery, London, UK
| | - Otto R Maarsingh
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Samuel MacKeith
- ENT Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Vincent A Van Vugt
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
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Yasuda K, Saichi K, Iwata H. Haptic-Based Perception-Empathy Biofeedback Enhances Postural Motor Learning During High-Cognitive Load Task in Healthy Older Adults. Front Med (Lausanne) 2018; 5:149. [PMID: 29868597 PMCID: PMC5964210 DOI: 10.3389/fmed.2018.00149] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 05/01/2018] [Indexed: 11/13/2022] Open
Abstract
Falls and fall-induced injuries are major global public health problems, and sensory input impairment in older adults results in significant limitations in feedback-type postural control. A haptic-based biofeedback (BF) system can be used for augmenting somatosensory input in older adults, and the application of this BF system can increase the objectivity of the feedback and encourage comparison with that provided by a trainer. Nevertheless, an optimal BF system that focuses on interpersonal feedback for balance training in older adults has not been proposed. Thus, we proposed a haptic-based perception-empathy BF system that provides information regarding the older adult's center-of-foot pressure pattern to the trainee and trainer for refining the motor learning effect. The first objective of this study was to examine the effect of this balance training regimen in healthy older adults performing a postural learning task. Second, this study aimed to determine whether BF training required high cognitive load to clarify its practicability in real-life settings. Twenty older adults were assigned to two groups: BF and control groups. Participants in both groups tried balance training in the single-leg stance while performing a cognitive task (i.e., serial subtraction task). Retention was tested 24 h later. Testing comprised balance performance measures (i.e., 95% confidence ellipse area and mean velocity of sway) and dual-task performance (number of responses and correct answers). Measurements of postural control using a force plate revealed that the stability of the single-leg stance was significantly lower in the BF group than in the control group during the balance task. The BF group retained the improvement in the 95% confidence ellipse area 24 h after the retention test. Results of dual-task performance during the balance task were not different between the two groups. These results confirmed the potential benefit of the proposed balance training regimen in designing successful motor learning programs for preventing falls in older adults.
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Affiliation(s)
- Kazuhiro Yasuda
- Research Institute for Science and Engineering, Waseda University, Tokyo, Japan
| | - Kenta Saichi
- Graduate School of Creative Science and Engineering, Waseda University, Tokyo, Japan
| | - Hiroyasu Iwata
- Graduate School of Creative Science and Engineering, Waseda University, Tokyo, Japan
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Schwesig R, Hollstein L, Plontke SK, Delank KS, Fieseler G, Rahne T. Comparison of intraobserver single-task reliabilities of the Interactive Balance System (IBS) and Vertiguard in asymptomatic subjects. Somatosens Mot Res 2016; 34:9-14. [PMID: 27915498 DOI: 10.1080/08990220.2016.1260541] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The intraobserver reliabilities of the Interactive Balance System (IBS) and Vertiguard were compared in 30 asymptomatic volunteers. Relative reliability for all IBS single tasks and parameters in the IBS was excellent (intraclass correlation coefficient, ICC ≥0.75). The ICC values ranged from 0.78 to 0.89. The ICC values of the Vertiguard system ranged from 0 to 0.75. The cumulative measure of injury risk of the Vertiguard system was highly reliable.
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Affiliation(s)
- René Schwesig
- a Department of Orthopedic and Trauma Surgery , Martin-Luther-University Halle-Wittenberg , Halle (Saale) , Germany
| | - Lisa Hollstein
- b Department of Otorhinolaryngology, Head and Neck Surgery , Martin-Luther-University Halle-Wittenberg , Halle (Saale) , Germany
| | - Stefan K Plontke
- b Department of Otorhinolaryngology, Head and Neck Surgery , Martin-Luther-University Halle-Wittenberg , Halle (Saale) , Germany
| | - Karl-Stefan Delank
- a Department of Orthopedic and Trauma Surgery , Martin-Luther-University Halle-Wittenberg , Halle (Saale) , Germany
| | - Georg Fieseler
- c Helios Clinic Warburg, Division for Shoulder Surgery and Sports Medicine , Warburg , Germany
| | - Torsten Rahne
- b Department of Otorhinolaryngology, Head and Neck Surgery , Martin-Luther-University Halle-Wittenberg , Halle (Saale) , Germany
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Lim SB, Horslen BC, Davis JR, Allum JHJ, Carpenter MG. Benefits of multi-session balance and gait training with multi-modal biofeedback in healthy older adults. Gait Posture 2016; 47:10-7. [PMID: 27264396 DOI: 10.1016/j.gaitpost.2016.03.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 03/18/2016] [Accepted: 03/23/2016] [Indexed: 02/02/2023]
Abstract
Real-time balance-relevant biofeedback from a wearable sensor can improve balance in many patient populations, however, it is unknown if balance training with biofeedback has lasting benefits for healthy older adults once training is completed and biofeedback removed. This study was designed to determine if multi-session balance training with and without biofeedback leads to changes in balance performance in healthy older adults; and if changes persist after training. 36 participants (age 60-88) were randomly divided into two groups. Both groups trained on seven stance and gait tasks for 2 consecutive weeks (3×/week) while trunk angular sway and task duration were monitored. One group received real-time multi-modal biofeedback of trunk sway and a control group trained without biofeedback. Training effects were assessed at the last training session, with biofeedback available to the feedback group. Post-training effects (without biofeedback) were assessed immediately after, 1-week, and 1-month post-training. Both groups demonstrated training effects; participants swayed less when standing on foam with eyes closed (EC), maintained tandem-stance EC longer, and completed 8 tandem-steps EC faster and with less sway at the last training session. Changes in sway and duration, indicative of faster walking, were also observed after training for other gait tasks. While changes in walking speed persisted post-training, few other post-training effects were observed. These data suggest there is little added benefit to balance training with biofeedback, beyond training without, in healthy older adults. However, transient use of wearable balance biofeedback systems as balance aides remains beneficial for challenging balance situations and some clinical populations.
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Affiliation(s)
- Shannon B Lim
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Brian C Horslen
- School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - Justin R Davis
- School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - John H J Allum
- Department of ORL, University Hospital, Basel, Switzerland
| | - Mark G Carpenter
- School of Kinesiology, University of British Columbia, Vancouver, Canada; International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada.
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Müller B, Volk GF, Guntinas-Lichius O. [Rehabilitation of facial palsy and vertigo in patients with vestibular schwannoma]. HNO 2016; 65:724-734. [PMID: 27072637 DOI: 10.1007/s00106-016-0125-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Facial palsy and vertigo, as symptoms of vestibular schwannoma (VS) or consequences of its therapy, have a significant impact on patients' quality of life. OBJECTIVE This review analyzed current literature on the topic and deduced recommendations for rehabilitation of facial palsy and vertigo. METHODS The present review describes a PubMed-based search of the literature of the past 10 years. RESULTS There is no evidence-based drug therapy for the treatment of acute facial palsy after VS surgery. Several surgical procedures for facial nerve reconstruction, muscle transfer, and static techniques have been established. Physiotherapeutic movement therapy, optimally with biofeedback, seems to improve facial function in patients with post-paralytic syndrome. Botulinum toxin injections are the method of choice for synkinesis treatment. For treatment of acute and chronic vertigo in patients with VS, the same antivertiginous drugs as for other vertigo patients are used. If the patient shows retained vestibular stimulation function, preoperative intratympanic gentamycin therapy followed by compensation training is a promising approach to decreasing postoperative vertigo. Good vestibular rehabilitation comprises intensive and regular movement training, preferably with real-time feedback and therapy control. CONCLUSION There are several conservative, surgical, or combined conservative-surgical treatment options for individualized facial nerve rehabilitation of VS patients, as confirmed by clinical studies. In cases of acute vertigo, standard antivertiginous pharmacotherapy is indicated. In cases of acute and also of chronic vertigo, intensive balance and movement training relieves complaints.
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Affiliation(s)
- B Müller
- Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Universitätsklinikum Jena, Lessingstraße 2, 07740, Jena, Deutschland
| | - G F Volk
- Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Universitätsklinikum Jena, Lessingstraße 2, 07740, Jena, Deutschland
| | - O Guntinas-Lichius
- Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Universitätsklinikum Jena, Lessingstraße 2, 07740, Jena, Deutschland.
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Brugnera C, Bittar RSM, Greters ME, Basta D. Effects of vibrotactile vestibular substitution on vestibular rehabilitation - preliminary study. Braz J Otorhinolaryngol 2015; 81:616-21. [PMID: 26480904 PMCID: PMC9442680 DOI: 10.1016/j.bjorl.2015.08.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 10/21/2014] [Indexed: 11/11/2022] Open
Abstract
Introduction Some patients with severe impairment of body balance do not obtain adequate improvement from vestibular rehabilitation (VR). Objective To evaluate the effectiveness of Vertiguard™ biofeedback equipment as a sensory substitution (SS) of the vestibular system in patients who did not obtain sufficient improvement from VR. Methods This was a randomized prospective clinical study. Thirteen patients without satisfactory response to conventional VR were randomized into a study group (SG), which received the vibrotactile stimulus from Vertiguard™ for ten days, and a control group (CG), which used equipment without the stimulus. For pre- and post-treatment assessment, the Sensory Organization Test (SOT) protocol of the Computerized Dynamic Posturography (CDP) and two scales of balance self-perception, Activities-specific Balance Confidence (ABC) and Dizziness Handicap Inventory (DHI), were used. Results After treatment, only the SG showed statistically significant improvement in C5 (p = 0.007) and C6 (p = 0.01). On the ABC scale, there was a significant difference in the SG (p = 0.04). The DHI showed a significant difference in CG and SG with regard to the physical aspect, and only in the SG for the functional aspect (p = 0.04). Conclusion The present findings show that sensory substitution using the vibrotactile stimulus of the Vertiguard™ system helped with the integration of neural networks involved in maintaining posture, improving the strategies used in the recovery of body balance.
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Affiliation(s)
- Cibele Brugnera
- Otoneurology Outpatient Clinic, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil.
| | | | - Mário Edvin Greters
- Hospital Celso Pierro, Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas, SP, Brazil
| | - Dietmar Basta
- Hospital Charité, Berlin University, Berlin, Germany
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Lin CC, Whitney SL, Loughlin PJ, Furman JM, Redfern MS, Sienko KH, Sparto PJ. The effect of age on postural and cognitive task performance while using vibrotactile feedback. J Neurophysiol 2015; 113:2127-36. [PMID: 25589585 DOI: 10.1152/jn.00083.2014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 01/09/2015] [Indexed: 02/08/2023] Open
Abstract
Vibrotactile feedback (VTF) has been shown to improve balance performance in healthy people and people with vestibular disorders in a single-task experimental condition. It is unclear how age-related changes in balance affect the ability to use VTF and if there are different attentional requirements for old and young adults when using VTF. Twenty younger and 20 older subjects participated in this two-visit study to examine the effect of age, VTF, sensory condition, cognitive task, duration of time, and visit on postural and cognitive performance. Postural performance outcome measures included root mean square of center of pressure (COP) and trunk tilt, and cognitive performance was assessed using the reaction time (RT) from an auditory choice RT task. The results showed that compared with younger adults, older adults had an increase in COP in fixed platform conditions when using VTF, although they were able to reduce COP during sway-referenced platform conditions. Older adults also did not benefit fully from using VTF in their first session. The RTs for the secondary cognitive tasks increased significantly while using the VTF in both younger and older adults. Older adults had a larger increase compared with younger adults, suggesting that greater attentional demands were required in older adults when using VTF information. Future training protocols for VTF should take into consideration the effect of aging.
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Affiliation(s)
- Chia-Cheng Lin
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Physical Therapy, East Carolina University, Greenville, North Carolina; and
| | - Susan L Whitney
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Patrick J Loughlin
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Joseph M Furman
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mark S Redfern
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kathleen H Sienko
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan; Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
| | - Patrick J Sparto
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania
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Horowitz S. Neurofeedback Therapy in Clinical Applications and for Cognitive Enhancement. ACTA ACUST UNITED AC 2012. [DOI: 10.1089/act.2012.18503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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