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Comparison of Dizziness Factors for Mild Traumatic Brain Injury Patients with and without Dizziness: A Factor Analysis and Propensity Score Model Study. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:5571319. [PMID: 34055038 PMCID: PMC8131139 DOI: 10.1155/2021/5571319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/20/2021] [Accepted: 04/30/2021] [Indexed: 12/04/2022]
Abstract
Traumatic brain injury (TBI) causes major socioeconomic problems worldwide. In the United States, nearly three-quarters of patients with TBI have mild TBI (mTBI). 32% of these patients may develop dizziness. In this study, we analyzed the factor structure of the traditional Chinese version of the DHI and evaluate the differences in DHI factors between dizziness and nondizziness groups. In total, 315 patients with mTBI, comprising 158 with self-reported dizziness and 157 without dizziness, were recruited from three hospitals. The responses for Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Epworth Sleepiness Scale (ESS), and Pittsburgh Sleep Quality Index (PSQI) demonstrated between-group differences. The Chinese DHI had internal validity and had four factors that differed from the English version (3 aspects). The group effects for the physical subscale remained significantly different even after adjustments in the propensity score model. For the Chinese version, two of four factors remained significantly different in the effects between self-reported dizziness and nondizziness groups. The factors of our Chinese DHI differed from those of the original English version of DHI. After adjustments using the propensity score model, the physical subscale demonstrated significant differences between the self-reported dizziness and nondizziness groups. Only two factors from our Chinese DHI were significantly different; moreover, it contained only three physical, five functional, and three emotional items.
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Patti A, Zangla D, Sahin FN, Cataldi S, Lavanco G, Palma A, Fischietti F. Physical exercise and prevention of falls. Effects of a Pilates training method compared with a general physical activity program: A randomized controlled trial. Medicine (Baltimore) 2021; 100:e25289. [PMID: 33787615 PMCID: PMC8021317 DOI: 10.1097/md.0000000000025289] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/08/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Falls are the leading cause of injury-related mortality and morbidity in the elderly. Physical activity plays a key role in the prevention of falls and stimulates postural control. The aim of this study was to compare a general physical activity program for the elderly with a Pilates program to evaluate the effects on balance and on reducing the risk of falling. MATERIALS AND METHODS Forty-six subjects were enrolled in this study, but only 41 were included in the study. The subjects were divided into 2 groups: Pilates group (P-G) and a group following a nonspecific program of physical activity (Pa-G). Each subject underwent the hand grip test, Berg balance scale test, and posturographic analysis. RESULTS Spearman correlation coefficient showed correlations between the following parameters: BBS versus hand grip test (r = 0.68); BBS versus ellipse surface area (r = -0.75). There were significant differences between groups after the exercise program: both groups showed an improvement in performance but the P-G recorded significantly better results than the Pa-G. DISCUSSION AND CONCLUSIONS This study confirmed that physical activity improves both balance and strength. However, our data show that Pilates has a greater effect on these physical abilities than a general physical activity program.
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Affiliation(s)
- Antonino Patti
- Department of Psychology, Educational Science and Human Movement, University of Palermo
| | - Daniele Zangla
- Department of Psychology, Educational Science and Human Movement, University of Palermo
| | | | - Stefania Cataldi
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, School of Medicine, University of Study of Bari
| | - Gioacchino Lavanco
- Department of Psychology, Educational Science and Human Movement, University of Palermo
| | - Antonio Palma
- Department of Psychology, Educational Science and Human Movement, University of Palermo
| | - Francesco Fischietti
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, School of Medicine, University of Study of Bari
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Balance and Dizziness Disorders in the Elderly: a Review. CURRENT OTORHINOLARYNGOLOGY REPORTS 2020. [DOI: 10.1007/s40136-020-00281-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
The world's population is ageing due to increased hygiene and improved medical care. Dizziness and imbalance frequently affect the elderly and is most common among individuals over the age of 60. In this age group approximately 30% of the population experience these debilitating symptoms at some point. They contribute to falls and frailty, which often result in hospitalization causing tremendous cost for the health care systems, and increased mortality. To make the matters worse balance disorders are often complex. Physicians face the difficulty of diagnosing the patient with the exact disorder especially since each disorder may manifest differently in each patient. In addition, several treatment options exist, however, with a low level of evidence. This chapter summarizes the underlying degenerative processes of the peripheral as well as the central vestibular system, diagnostic tools, the most common balance disorders in the elderly, and possible treatment options of these disorders.
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Balatsouras DG, Koukoutsis G, Fassolis A, Moukos A, Apris A. Benign paroxysmal positional vertigo in the elderly: current insights. Clin Interv Aging 2018; 13:2251-2266. [PMID: 30464434 PMCID: PMC6223343 DOI: 10.2147/cia.s144134] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Balance disorders, unsteadiness, dizziness and vertigo in the elderly are a significant health problem, needing appropriate treatment. One third of elderly patients with vertigo were diagnosed with benign paroxysmal positional vertigo (BPPV), the most common cause of dizziness in both primary care specialist Neurology and Ear Nose Throat settings. BPPV presents a specific paroxysmal positional nystagmus which can be obtained using the appropriate diagnostic positional test and can be treated effectively using specific therapeutic maneuvers. This review presents current insights into the diagnostic, pathogenetic and therapeutic aspects of BPPV in the elderly. BPPV in older patients does not differ significantly from BPPV in younger patients, with regard to pathogenesis, diagnosis and treatment. However, in older patients, its prevalence is higher and it responds less effectively to treatment, having a tendency for recurrence. Specific issues which should be considered in the elderly are: 1) difficulty in obtaining an accurate history; 2) difficulty in performing the diagnostic and therapeutic maneuvers, which should be executed with slow and gentle movements and extremely cautiously to avoid any vascular or orthopedic complications; and 3) the relation between BPPV and falls.
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Affiliation(s)
- D G Balatsouras
- Department of ENT, Tzanion General Hospital of Piraeus, Piraeus, Greece,
| | - G Koukoutsis
- Department of ENT, Tzanion General Hospital of Piraeus, Piraeus, Greece,
| | - A Fassolis
- Department of ENT, Tzanion General Hospital of Piraeus, Piraeus, Greece,
| | - A Moukos
- Department of ENT, Tzanion General Hospital of Piraeus, Piraeus, Greece,
| | - A Apris
- Department of ENT, Nicosia General Hospital, Nicosia, Cyprus
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Jacobson GP, Piker EG, Grantham SL, English LN. Age predicts the absence of caloric-induced vertigo. J Otol 2018; 13:5-9. [PMID: 29937859 PMCID: PMC6002628 DOI: 10.1016/j.joto.2017.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 10/16/2017] [Accepted: 10/26/2017] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The absence of vertigo during the caloric test, despite a robust response, has been suggested to represent a central vestibular system phenomenon. The purpose of this investigation was to determine the prevalence of absent caloric-induced vertigo perception in an unselected group of patients and to assess possible predicting variables. METHODS Prospective investigation of 92 unselected patients who underwent caloric testing. Inclusion criteria were that each patient generate a maximum slow phase velocity (maxSPV) ≥ 15 deg/sec and a caloric asymmetry of ≤10%. Following the caloric, patients were asked, "Did you have any sensation of motion?" RESULTS Results showed 75% of patients reported motion with a mean age of 56.51 years compared to a mean age of 66.55 in the 25% of patients reporting an absence of motion. A logistic regression was performed and the overall model was statistically significant accounting for 29% of the variance in caloric perception. The significant predictor variables were patient age and maxSPV of the caloric response. The effect size for both variables was small with an odds ratio of .9 for maxSPV and 1.06 for age. CONCLUSIONS The current investigation showed that both age and maxSPV of the caloric response were significant predictors of vertigo perception during the caloric exam. However, the association between age and caloric perception is not conclusive. Although there is evidence to suggest that these findings represent age-related changes in the central processing of vestibular system stimulation, there are additional unmeasured factors that influence the perception of caloric-induced vertigo.
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Affiliation(s)
- Gary P. Jacobson
- Department of Hearing and Speech Sciences, Divisions of Audiology and Vestibular Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Erin G. Piker
- Department of Communication Sciences and Disorders, James Madison University, Harrisonburg, VA, USA
| | - Sarah L. Grantham
- Department of Hearing and Speech Sciences, Divisions of Audiology and Vestibular Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lauren N. English
- Department of Hearing and Speech Sciences, Divisions of Audiology and Vestibular Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
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The Neural Correlates of Chronic Symptoms of Vertigo Proneness in Humans. PLoS One 2016; 11:e0152309. [PMID: 27089185 PMCID: PMC4835222 DOI: 10.1371/journal.pone.0152309] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 03/11/2016] [Indexed: 11/19/2022] Open
Abstract
Vestibular signals are of significant importance for variable functions including gaze stabilization, spatial perception, navigation, cognition, and bodily self-consciousness. The vestibular network governs functions that might be impaired in patients affected with vestibular dysfunction. It is currently unclear how different brain regions/networks process vestibular information and integrate the information into a unified spatial percept related to somatosensory awareness and whether people with recurrent balance complaints have a neural signature as a trait affecting their development of chronic symptoms of vertigo. Pivotal evidence points to a vestibular-related brain network in humans that is widely distributed in nature. By using resting state source localized electroencephalography in non-vertiginous state, electrophysiological changes in activity and functional connectivity of 23 patients with balance complaints where chronic symptoms of vertigo and dizziness are among the most common reported complaints are analyzed and compared to healthy subjects. The analyses showed increased alpha2 activity within the posterior cingulate cortex and the precuneues/cuneus and reduced beta3 and gamma activity within the pregenual and subgenual anterior cingulate cortex for the subjects with balance complaints. These electrophysiological variations were correlated with reported chronic symptoms of vertigo intensity. A region of interest analysis found reduced functional connectivity for gamma activity within the vestibular cortex, precuneus, frontal eye field, intra-parietal sulcus, orbitofrontal cortex, and the dorsal anterior cingulate cortex. In addition, there was a positive correlation between chronic symptoms of vertigo intensity and increased alpha-gamma nesting in the left frontal eye field. When compared to healthy subjects, there is evidence of electrophysiological changes in the brain of patients with balance complaints even outside chronic symptoms of vertigo episodes. This suggests that these patients have a neural signature or trait that makes them prone to developing chronic balance problems.
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Fernández L, Breinbauer HA, Delano PH. Vertigo and Dizziness in the Elderly. Front Neurol 2015; 6:144. [PMID: 26167157 PMCID: PMC4481149 DOI: 10.3389/fneur.2015.00144] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 06/12/2015] [Indexed: 11/13/2022] Open
Abstract
The prevalence of vertigo and dizziness in people aged more than 60 years reaches 30%, and due to aging of world population, the number of patients is rapidly increasing. The presence of dizziness in the elderly is a strong predictor of falls, which is the leading cause of accidental death in people older than 65 years. Balance disorders in the elderly constitute a major public health problem, and require an adequate diagnosis and management by trained physicians. In the elderly, common causes of vertigo may manifest differently, as patients tend to report less rotatory vertigo and more non-specific dizziness and instability than younger patients, making diagnosis more complex. In this mini review, age-related degenerative processes that affect balance are presented. Diagnostic and therapeutic approaches oriented to the specific impaired system, including visual, proprioceptive, and vestibular pathways, are proposed. In addition, presbystasis – the loss of vestibular and balance functions associated with aging – benign paroxysmal positional vertigo, and stroke (in acute syndromes) should always be considered.
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Affiliation(s)
- Lara Fernández
- Otolaryngology Department, Clinical Hospital of the University of Chile , Santiago , Chile
| | - Hayo A Breinbauer
- Otolaryngology Department, San Juan de Dios Hospital, University of Chile , Santiago , Chile ; Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo , Santiago , Chile
| | - Paul Hinckley Delano
- Otolaryngology Department, Clinical Hospital of the University of Chile , Santiago , Chile ; Physiology and Biophysics Program, Institute of Biomedical Sciences (ICBM), Medicine Faculty, University of Chile , Santiago , Chile
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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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Tuunainen E, Rasku J, Jäntti P, Pyykkö I. Risk factors of falls in community dwelling active elderly. Auris Nasus Larynx 2013; 41:10-6. [PMID: 23763793 DOI: 10.1016/j.anl.2013.05.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 04/30/2013] [Accepted: 05/10/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To search for measures to describe and relate to accidental falls in community dwelling elderly. METHOD A EuroQol EQ-5D questionnaire based on a patient's otoneurological case history provided a general health related quality of life measure, a fall history for the last 3 months and force platform measures for 96 active elderly from a pensioner organization. RESULTS On average, the elderly experienced 0.3 falls over the preceding three months. A fall was seen to cause a significant deterioration in the quality of life and vertigo and caused fear of falling. The postural instability correlated with falls. Vertigo was present among 42% and was most commonly characterized as episodic and rotatory in factorial analysis items relating to vertigo correlated to falls and balance complaints. Four factors were identified and three of these correlated with falls. Vestibular failure correlated to a fall occurring when a person was rising up; Movement intolerance correlated with falls due to slips and trips, and Near-syncope factor correlated to falls for other reasons. In posturography, the variable measuring critical time describing the memory based "closed loop" control of postural stability carried a risk for accidental fall with an odds ratio of 6. The variable measuring zero crossing velocity showed a high rate of velocity change around the neutral position of stance. CONCLUSION Vertigo and poor postural stability were the major reasons for falls in the active elderly. In ageing, postural control is shifted towards open loop control (visual, proprioception, exteroception and vestibular) instead of closed loop control and is a factor that contributes to a fall.
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Affiliation(s)
- Eeva Tuunainen
- Department of Otolaryngology, University Central Hospital of Tampere and University of Tampere, Medical School, Finland
| | - Jyrki Rasku
- Department of Otolaryngology, University Central Hospital of Tampere and University of Tampere, Medical School, Finland
| | - Pirkko Jäntti
- Department of Geriatric Medicine, Hatanpää City Hospital, Tampere, Finland
| | - Ilmari Pyykkö
- Department of Otolaryngology, University Central Hospital of Tampere and University of Tampere, Medical School, Finland.
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