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D’Silva LJ, Phongsavath T, Partington K, Pickle NT, Marschner K, Zehnbauer TP, Rossi M, Skop K, Roos PE. A gaming app developed for vestibular rehabilitation improves the accuracy of performance and engagement with exercises. Front Med (Lausanne) 2023; 10:1269874. [PMID: 38076248 PMCID: PMC10704144 DOI: 10.3389/fmed.2023.1269874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/06/2023] [Indexed: 02/12/2024] Open
Abstract
Introduction Vestibular hypofunction is associated with dizziness, imbalance, and blurred vision with head movement. Vestibular rehabilitation is the gold standard recommendation to decrease symptoms and improve postural stability. The Clinical Practice Guidelines for vestibular hypofunction suggest home exercises 3-5 times daily, but patient adherence is a problem, with compliance rates often below 50%. Methods An app was developed to increase engagement with home exercises by providing exercises as games. This study compared the accuracy of exercise performance in a one-time session using the app versus no-app and gathered participant feedback on using the app for vestibulo-ocular reflex (VOR) and balance exercises. The app was tested with 40 adults (20 women), mean age of 67 ± 5.7 years, with symptomatic unilateral or bilateral vestibular hypofunction. Participants completed VOR exercises in pitch and yaw planes, weight-shift, and single-leg balance exercises using an inertial motion unit to move the character on the tablet screen. Participants were randomly assigned to begin the exercises with or without the app. Results Results show that during VOR exercises, participants achieved the prescribed frequency of head motion for the yaw plane (p ≤ 0.001) and reduced variability of head movement frequency in both the yaw (p ≤ 0.001) and pitch plane (p ≤ 0.001) in the app compared to the no-app condition. During weight-shifting exercises, a larger range of body motion was noted in the anteroposterior and mediolateral directions in the app compared to the no-app condition (p < 0.05). During single-leg balance exercises, pelvic motion was lower in the app versus no-app condition (p = 0.02). Participants modified their exercise performance and corrected their mistakes to a greater extent when they used the app during the VOR exercises. Participants agreed that they felt motivated while playing the games (97%) and felt motivated by the trophies (92%). They agreed that the app would help them perform the exercises at home (95%), improve their rehab performance (95%) and that it was fun to do the exercises using the app (93%). Discussion The results of this study show that technology that is interactive and provides feedback can be used to increase accuracy and engagement with exercises.
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Affiliation(s)
- Linda J. D’Silva
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas, MO, United States
| | - Tarah Phongsavath
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas, MO, United States
| | - Kelly Partington
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas, MO, United States
| | - Nathan T. Pickle
- Biomedical, Energy and Materials, CFD Research Corporation, Huntsville, AL, United States
| | - Katherine Marschner
- Biomedical, Energy and Materials, CFD Research Corporation, Huntsville, AL, United States
| | - Timothy P. Zehnbauer
- Biomedical, Energy and Materials, CFD Research Corporation, Huntsville, AL, United States
| | - Michael Rossi
- Biomedical, Energy and Materials, CFD Research Corporation, Huntsville, AL, United States
| | - Karen Skop
- Physical Medicine and Rehabilitation Services, Department of Physical Therapy, James A. Haley Veterans’ Hospital, Tampa, FL, United States
- School of Physical Therapy, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Paulien E. Roos
- Biomedical, Energy and Materials, CFD Research Corporation, Huntsville, AL, United States
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Yesantharao LV, Rosenberg P, Oh E, Leoutsakos J, Munro CA, Agrawal Y. Vestibular therapy to reduce falls in people with Alzheimer's disease: study protocol for a pilot randomized controlled trial. Pilot Feasibility Stud 2022; 8:167. [PMID: 35918757 PMCID: PMC9344717 DOI: 10.1186/s40814-022-01133-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 07/20/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Falls are highly common in patients with Alzheimer's disease (AD); around two-thirds of AD patients fall annually. Fall events are major drivers of injury, early institutionalization, and shorter survival. Balance and mobility impairment are among the most important fall risk factors in AD patients. Vestibular therapy (VT) is an effective rehabilitation intervention in improving balance and fall risk through vestibular function, but not often used in AD. We want to evaluate the feasibility of using VT to reduce falls and improve balance function in patients with AD and drive use of an existing, potentially beneficial therapy in a patient population whose high level of vestibular deficits is currently unaddressed. METHODS The proposed pilot clinical trial will be a parallel-group randomized controlled trial. Patients with a diagnosis of mild-moderate AD, age ≥ 60, and the presence of a caregiver will be recruited from the Johns Hopkins Memory and Alzheimer's Treatment Center. Eligible patients will be offered vestibular testing. Patients with vestibular loss will be offered participation in the VT trial. One-hundred AD patients with vestibular loss will be enrolled and randomized 1:1 into the control and intervention arms of the trial. All patients will undergo baseline balance and cognitive assessment, followed by 8 weeks of active control therapy or VT, consisting of ~25-min office sessions with a vestibular therapist. Patients will be tracked for falls and undergo follow-up balance and cognitive assessment at 8 and 52 weeks (1 year) to assess the potential short-term and longer-term effects, respectively, of VT on balance and cognition. The main outcomes of this trial are falls, balance (using the Berg Balance Scale and the Timed Up and Go test), and cognition (using the clock drawing test, the Card Rotations test, the Money Road Map test, and the triangle completion task). DISCUSSION As the population ages and the number of individuals with AD in the US grows to a projected 14 million in 2050, managing falls in AD will continue to grow as a critical public health concern; this trial assesses feasibility of a potential solution. TRIAL REGISTRATION ClinicalTrial.Gov identifier - NCT03799991 . Registered 01 August 2019.
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Affiliation(s)
- Lekha V Yesantharao
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Paul Rosenberg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Esther Oh
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Jeannie Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Cynthia A Munro
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Yuri Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.
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Zhang S, Liu D, Tian E, Wang J, Guo Z, Kong W. Central vestibular dysfunction: don't forget vestibular rehabilitation. Expert Rev Neurother 2022; 22:669-680. [PMID: 35912850 DOI: 10.1080/14737175.2022.2106129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Vestibular rehabilitation (VR) is now a subject of active studies and has been shown to be effective for multiple vestibular disorders, peripheral or central. VR is a physical therapy that helps train the central nervous system to compensate for vestibular dysfunction. There is moderate to strong evidence that VR is safe and effective for the management of peripheral vestibular dysfunction. Nonetheless, the studies on how VR works on central vestibular dysfunction remains scanty. AREAS COVERED This article addressed the rehabilitation strategies and possible mechanisms, including how central vestibular function might improve upon rehabilitation. In addition, it provides some examples concerning the effect of VR on central vestibular dysfunction. EXPERT OPINION VR works on the vestibular system through repetition of specific physical exercises that activate central neuroplastic mechanisms to achieve adaptive compensation of the impaired functions. VR has become a mainstay in the management of patients with dizziness and balance dysfunction. Individualized VR programs are a safe and effective treatment option for a large percentage of patients with central vestibular disease reporting imbalance and dizziness. Exploration of various treatment strategies and possible mechanisms will help develop the best and personalized VR treatment for patients with central vestibular dysfunction.
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Affiliation(s)
- Sulin Zhang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China.,Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - Dan Liu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - E Tian
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - Jun Wang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - Zhaoqi Guo
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - Weijia Kong
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China.,Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China.,Key Laboratory of Neurological Disorders of Education Ministry, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei, China
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Amouei S, Selk Ghafari A, Zabihollah A, Mohammadi Moghaddam S, Mohammadi Laal Abadi Z. Multi-Sensory Balance Board for Children with SPD & ADHD Disorders. J Biomed Phys Eng 2021; 11:761-768. [PMID: 34904073 PMCID: PMC8649158 DOI: 10.31661/jbpe.v0i0.2101-1265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/20/2021] [Indexed: 11/16/2022]
Abstract
Nowadays, as technology grows, human life formation changes every second. These changes sometimes create harmful habits and affect our lifestyle, which unfortunately bring various diseases and disorders. ADHD (Attention Deficit Hyperactivity Disorder) & SPD (Sensory Processing Disorder) are common disorders in children. By giving children the right treatment at the younger ages, we can help them overcome their disabilities and not face any symptoms in their adulthood. The multi-sensory balance board is designed and developed to help medics diagnose the disorders in patients at early stages and monitor the treatment progress. The balance board uses multiple sensors to detect common human senses, visual, auditory, balance, and tactile sensing. Due to the safety issues for children during the COVID-19 pandemic, the balance board has been clinically tested for adults with stroke disorder. The research has concluded that it provides a fast low-cost with reliable results to diagnose the disorders in patients.
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Affiliation(s)
- Shila Amouei
- MSc, Department of Mechanics & Mechatronics Engineering, Sharif University of Technology (Kish Campus), Kish, Iran
| | - Ali Selk Ghafari
- PhD, Department of Mechanics & Mechatronics Engineering, Sharif University of Technology (Kish Campus), Kish, Iran
| | - Abolghasem Zabihollah
- PhD, Department of Mechanics & Mechatronics Engineering, Sharif University of Technology (Kish Campus), Kish, Iran
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Rehman Y, Kirsch J, Bhatia S, Johnston R, Bingham J, Senger B, Swogger S, Snider KT. Impact of osteopathic manipulative techniques on the management of dizziness caused by neuro-otologic disorders: Protocol for systematic review and meta-analysis. INT J OSTEOPATH MED 2021. [DOI: 10.1016/j.ijosm.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Xavier F, Chouin E, Montava M, Tighilet B, Lavieille JP, Chabbert C. Status of rehabilitation of the dizzy patient in France: focus on vestibular physiotherapy. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2021. [DOI: 10.1080/21679169.2021.1969427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Frédéric Xavier
- Laboratoire de Neurosciences Cognitives, LNC UMR 7291; Unit GDR2074 CNRS, Team Pathophysiology and Therapy of Vestibular Disorders, Aix Marseille Université-CNRS, Marseille, France
| | - Emmanuelle Chouin
- Laboratoire de Neurosciences Cognitives, LNC UMR 7291; Unit GDR2074 CNRS, Team Pathophysiology and Therapy of Vestibular Disorders, Aix Marseille Université-CNRS, Marseille, France
| | - Marion Montava
- Assistance Publique des Hôpitaux de Marseille, Otorhinolaryngology and Head Neck Surgery Department, Conception University Hospital, Marseille, France
- Aix Marseille Univ, CNRS UMR 7051, INP, Institut NeuroPhysiopathologie, Marseille, France
| | - Brahim Tighilet
- Laboratoire de Neurosciences Cognitives, LNC UMR 7291; Unit GDR2074 CNRS, Team Pathophysiology and Therapy of Vestibular Disorders, Aix Marseille Université-CNRS, Marseille, France
| | - Jean-Pierre Lavieille
- Laboratoire de Neurosciences Cognitives, LNC UMR 7291; Unit GDR2074 CNRS, Team Pathophysiology and Therapy of Vestibular Disorders, Aix Marseille Université-CNRS, Marseille, France
- Assistance Publique des Hôpitaux de Marseille, Otorhinolaryngology and Head Neck Surgery Department, Conception University Hospital, Marseille, France
| | - Christian Chabbert
- Laboratoire de Neurosciences Cognitives, LNC UMR 7291; Unit GDR2074 CNRS, Team Pathophysiology and Therapy of Vestibular Disorders, Aix Marseille Université-CNRS, Marseille, France
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Samartsev IN, Zhivolupov SA. [The significance of neuroplastic mechanisms in compensation of statodynamic impairments during vestibular disorders]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:165-172. [PMID: 34184494 DOI: 10.17116/jnevro2021121051165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The process of balance restoration in patients with the vestibular disorders is known as «vestibular compensation». It is obvious nowadays that this phenomenon is very complex and is associated with the deep brain neuroplastic changes involving reinnervation, habituation and adaptation. The research of the last decades has shown some fundamental physiologic mechanisms that form the basis of neuroplasticity, establish the staging of ongoing transformations and analyze the opportunity to improve and/or accelerate vestibular compensation with the help of vestibular rehabilitation and contemporary medications such as betaserc long.
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Affiliation(s)
- I N Samartsev
- Kirov Military Medical Academy, St. Petersburg, Russia
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Abstract
OBJECTIVES Thanks to the advantages of hearing-in-noise and spatial orientation, currently bilateral cochlear implantation (CI) became popular for patients with profound hearing loss. The aim of this study was to investigate vestibular function in bilateral simultaneous CI recipients. STUDY DESIGN Retrospective analysis. SETTING University hospital. PATIENTS Sixteen patients with profound hearing loss were included. INTERVENTIONS Bilateral simultaneous CI with flexible electrode using round window approach. MAIN OUTCOME MEASURES Vestibular function was evaluated using both objective and subjective measures in the subjects preoperatively and 4 months postoperatively. Differences were analyzed preoperatively and postoperatively. RESULTS Preoperative vestibular tests revealed that 8 subjects (50%) had abnormal caloric test results, 11 ears (34.4%) had abnormal ocular vestibular-evoked myogenic potential results, 6 ears (18.8%) had abnormal cervical vestibular-evoked myogenic potential results, 7 ears (21.9%) in the anterior semicircular canal, and 6 ears (18.8%) in the posterior semicircular canal had gain loss. However, surgery significantly decreased the sums of the maximal slow-phase velocities evidenced by caloric test (p ‹ 0.05). Cervical vestibular-evoked myogenic potential abnormal rate significantly increased to 53.1% after surgery (p ‹ 0.05). The postoperative changes regarding ocular vestibular-evoked myogenic potential, video head impulse test (vHIT), and Dizziness Handicap Inventory (DHI) were not significant among all the patients. Patients diagnosed as large vestibular aqueduct syndrome showed significantly higher DHI scores than others (p ‹ 0.05). Spearman's correlation analysis revealed that DHI moderately correlated with the dysfunction of semicircular canals evidenced by vHIT (r = 0.702; p < 0.001), weakly correlated with caloric (r = 0.352; p = 0.048). However, no correlation was found between DHI and VEMPs. The monosyllabic and disyllabic word recognition score significantly improved from 0 to 60.4 ± 14.3% (p < 0.05) and from 0 to 63.3 ± 14.5% (p < 0.05) respectively. There was no correlation between the improvement of word recognition score and the change of vestibular tests. CONCLUSION The study showed preservation of utricle function, vestibular function at high frequency after bilateral simultaneous CI. However, operation significantly affected vestibular function at low frequency and saccule function. Patients with large vestibular aqueduct syndrome showed dramatically higher DHI scores than others. DHI moderately correlated with vHIT and weakly correlated with caloric.
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Vestibular rehabilitation therapy in combination with transcranial direct current stimulation (tDCS) for treatment of chronic vestibular dysfunction in the elderly: a double-blind randomized controlled trial. Braz J Otorhinolaryngol 2020; 88:758-766. [PMID: 33339758 PMCID: PMC9483938 DOI: 10.1016/j.bjorl.2020.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/10/2020] [Accepted: 11/02/2020] [Indexed: 01/21/2023] Open
Abstract
Introduction Dizziness and imbalance are common dysfunctions in the elderly. Vestibular rehabilitation therapy is an effective method to alleviate chronic dizziness in patients with vestibular dysfunction. Transcranial direct current stimulation has reportedly improved balance function in patients with vestibular dysfunction. Objective This study was conducted to investigate the therapeutic efficacy of vestibular rehabilitation combined with transcranial direct current stimulation in elderly patients with vestibular dysfunction. Methods In a double-blinded randomized controlled trial, 36 elderly patients with chronic vestibular dysfunction were randomly assigned to either vestibular rehabilitation and transcranial direct current stimulation (n = 18) or vestibular rehabilitation alone (n = 18) group. The transcranial stimulation protocol consisted of multisession bifrontal electrical stimulation of the dorsolateral prefrontal cortex (2 mA intensity and 20 min duration), followed by rehabilitation exercises. The vestibular rehabilitation protocol consisted of habituation and adaptation exercises combined with gait exercises during a three week period. The primary outcome of this study was the dizziness handicap inventory score, and the secondary outcomes were activities-specific balance confidence and Beck anxiety inventory scores. Results For the dizziness handicap score, the repeated-measures analysis of variance showed a significant main effect of “time”, “stimulation” and stimulation × time interaction effect. There was a significant reduction in the overall dizziness handicap score with “time” for both the groups, which was more pronounced in the vestibular rehabilitation and electrical stimulation group. In terms of activities-specific balance confidence change scores, we found a significant main effect of “time” and “stimulation” main factors, but this effect for stimulation × time interaction was not significant. For the Beck anxiety score, we observed a significant main effect of “time”, but no evidence for the main effect of the “stimulation” factor. Conclusion Bifrontal transcranial direct current stimulation in combination with vestibular rehabilitation therapy is a promising approach to improve chronic vestibular symptoms in the elderly.
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Żurawski AŁ, Kiebzak WP, Kowalski IM, Śliwiński G, Śliwiński Z. Evaluation of the association between postural control and sagittal curvature of the spine. PLoS One 2020; 15:e0241228. [PMID: 33108407 PMCID: PMC7591056 DOI: 10.1371/journal.pone.0241228] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 10/09/2020] [Indexed: 12/04/2022] Open
Abstract
Introduction Balance is key to controlling body posture. Balance is typically assessed by measures of the body’s vertical orientation, obtained by balancing out the forces acting on different body segments. The ability to maintain balance is assessed by evaluating centre of pressure (CoP) displacement; such assessments are typically used to evaluate responses to a treatment process. Purpose of study This study evaluated the efficiency of compensatory reactions in children according to the extent of thoracic kyphosis and lumbar lordosis. Materials and method The study enrolled 312 children aged 8‒12 years, including 211 patients with postural disorders: thoracic kyphosis outside the 47‒50-degree range and lordosis outside the 38‒42-degree range (study group). A control group was also recruited and comprised 101 children without postural disorders. The DIERS formetric 4D system was used to assess posture and CoP displacement. Results Children in the study group showed a significantly greater range of CoP displacement than children in the control group. The kyphosis angle correlated with the maximum CoP displacement in the coronal plane and the maximum CoP displacement in the sagittal plane during gait. The kyphosis angle also correlated with the maximum CoP displacement back in the static test. The size of the lordosis angle correlated with the maximum displacement of CoP in the coronary plane during gait, and with the maximum displacement of CoP toward the left, forward, and backward in the static test. The correlation coefficient of the lordosis angle with displacement of the CoP in the sagittal plane was 0.999. Conclusions
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Affiliation(s)
- Arkadiusz Łukaz Żurawski
- Institute of Health Sciences, Collegium Medicum, The Jan Kochanowski University, Kielce, Poland
- Świętokrzyskie Centre for Paediatrics, Provincial Integrated Hospital, Kielce, Poland
- * E-mail:
| | - Wojciech Piotr Kiebzak
- Institute of Health Sciences, Collegium Medicum, The Jan Kochanowski University, Kielce, Poland
- Świętokrzyskie Centre for Paediatrics, Provincial Integrated Hospital, Kielce, Poland
| | | | - Grzegorz Śliwiński
- Institute of Health Sciences, Collegium Medicum, The Jan Kochanowski University, Kielce, Poland
- Institute of Biomedical Engineering, TU Dresden, Dresden, Germany
| | - Zbigniew Śliwiński
- Institute of Health Sciences, Collegium Medicum, The Jan Kochanowski University, Kielce, Poland
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Zhu CT, Zhao XQ, Ju Y, Wang Y, Chen MM, Cui Y. Clinical Characteristics and Risk Factors for the Recurrence of Benign Paroxysmal Positional Vertigo. Front Neurol 2019; 10:1190. [PMID: 31798518 PMCID: PMC6863975 DOI: 10.3389/fneur.2019.01190] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 10/25/2019] [Indexed: 11/13/2022] Open
Abstract
Benign paroxysmal positional vertigo (BPPV) manifests itself as a paroxysm of vertigo and nystagmus lasting several seconds, which is self-limiting. The clinical characteristics and risk factors for the recurrence of BPPV in different ages have not yet been investigated. Materials and Methods: A retrospective observational study was conducted in the Department of Neurology in Beijing Tiantan Hospital from July 2009 to June 2015. The study included 1,012 patients aged 18–93 years. All patients received the definitive diagnosis and canalith repositioning maneuvers treatment and finally accomplished follow-up. Demographic variables, potential recurrence risk factors, neurological examination, and laboratory indexes were assessed. Data Analyses: The t-test or chi-squared test was first performed for group comparison, then logistic regression analysis was used to investigate the risk factors of BPPV recurrence. Results: The 1-year recurrence rates of BPPV patients after reposition maneuvers were, respectively, 22.79% (aged 18–45 years), 23.92% (aged 45–60 years), 28.89% (over 60 years). The recurrence rates among the three groups have no statistically significant difference. Logistic regression analysis shows that women BPPV patients have more recurrence risks than do men. Ménière's disease (odds ratio = 6.009, 95% confidence interval: 2.489–14.507, p < 0.001), hypertension (odds ratio = 1.510, 95% confidence interval: 1.095–2.084, p = 0.012), migraine (odds ratio = 2.534, 95% confidence interval: 1.164–5.516, p = 0.019), and hyperlipemia (odds ratio = 1.419, 95% confidence interval: 1.024–1.968, p = 0.036) were risk factors for the recurrence of BPPV in patients. Conclusion: We conclude that Ménière's disease, hypertension, migraine, and hyperlipemia may be independent risk factors for the recurrence of BPPV in patients, but aging does not increase the recurrence risk.
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Affiliation(s)
- Cui Ting Zhu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Xing Qquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Yi Ju
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Yan Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Mei Mei Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Yu Cui
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
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Affiliation(s)
- René Handschu
- Neurologische Klinik, Kliniken des Landkreises Neumarkt i. d. OPf., Neumarkt i. d. OPf., Deutschland. .,Klinikum Neumarkt i. d. OPf, Akademisches Lehrkrankenhaus der Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberger Str. 12, D-92318, Neumarkt i. d. OPf., Deutschland.
| | - Astrid Täuber
- Neurologische Klinik, Kliniken des Landkreises Neumarkt i. d. OPf., Neumarkt i. d. OPf., Deutschland
| | - Alexander Schuh
- Muskuloskelettales Zentrum, Kliniken des Landkreises Neumarkt i. d. OPf., Neumarkt i. d. OPf., Deutschland
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Trivedi V, Bang JW, Parra C, Colbert MK, O'Connell C, Arshad A, Faiq MA, Conner IP, Redfern MS, Wollstein G, Schuman JS, Cham R, Chan KC. Widespread brain reorganization perturbs visuomotor coordination in early glaucoma. Sci Rep 2019; 9:14168. [PMID: 31578409 PMCID: PMC6775162 DOI: 10.1038/s41598-019-50793-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 09/19/2019] [Indexed: 11/09/2022] Open
Abstract
Glaucoma is the world's leading cause of irreversible blindness, and falls are a major public health concern in glaucoma patients. Although recent evidence suggests the involvements of the brain toward advanced glaucoma stages, the early brain changes and their clinical and behavioral consequences remain poorly described. This study aims to determine how glaucoma may impair the brain structurally and functionally within and beyond the visual pathway in the early stages, and whether these changes can explain visuomotor impairments in glaucoma. Using multi-parametric magnetic resonance imaging, glaucoma patients presented compromised white matter integrity along the central visual pathway and around the supramarginal gyrus, as well as reduced functional connectivity between the supramarginal gyrus and the visual occipital and superior sensorimotor areas when compared to healthy controls. Furthermore, decreased functional connectivity between the supramarginal gyrus and the visual brain network may negatively impact postural control measured with dynamic posturography in glaucoma patients. Taken together, this study demonstrates that widespread structural and functional brain reorganization is taking place in areas associated with visuomotor coordination in early glaucoma. These results implicate an important central mechanism by which glaucoma patients may be susceptible to visual impairments and increased risk of falls.
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Affiliation(s)
- Vivek Trivedi
- Department of Ophthalmology, New York University (NYU) School of Medicine, NYU Langone Health, New York, NY, USA
| | - Ji Won Bang
- Department of Ophthalmology, New York University (NYU) School of Medicine, NYU Langone Health, New York, NY, USA
| | - Carlos Parra
- Department of Ophthalmology, New York University (NYU) School of Medicine, NYU Langone Health, New York, NY, USA
| | - Max K Colbert
- Department of Ophthalmology, New York University (NYU) School of Medicine, NYU Langone Health, New York, NY, USA
| | - Caitlin O'Connell
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Kinesiology, East Carolina University, Greenville, NC, USA
| | - Ahmel Arshad
- Department of Ophthalmology, New York University (NYU) School of Medicine, NYU Langone Health, New York, NY, USA
| | - Muneeb A Faiq
- Department of Ophthalmology, New York University (NYU) School of Medicine, NYU Langone Health, New York, NY, USA
| | - Ian P Conner
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Ophthalmology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mark S Redfern
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gadi Wollstein
- Department of Ophthalmology, New York University (NYU) School of Medicine, NYU Langone Health, New York, NY, USA.,Center for Neural Science, Faculty of Arts and Science, New York University, New York, NY, USA
| | - Joel S Schuman
- Department of Ophthalmology, New York University (NYU) School of Medicine, NYU Langone Health, New York, NY, USA.,Neuroscience Institute, New York University (NYU) School of Medicine, NYU Langone Health, New York, NY, USA.,Center for Neural Science, Faculty of Arts and Science, New York University, New York, NY, USA
| | - Rakie Cham
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Ophthalmology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kevin C Chan
- Department of Ophthalmology, New York University (NYU) School of Medicine, NYU Langone Health, New York, NY, USA. .,Department of Radiology, New York University (NYU) School of Medicine, NYU Langone Health, New York, NY, USA. .,Neuroscience Institute, New York University (NYU) School of Medicine, NYU Langone Health, New York, NY, USA. .,Center for Neural Science, Faculty of Arts and Science, New York University, New York, NY, USA.
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Lopes AL, Lemos SMA, Figueiredo PHS, Santos JN. Impact of lian gong on the quality of life of individuals with dizziness in primary care. Rev Saude Publica 2019; 53:73. [PMID: 31553377 PMCID: PMC6752643 DOI: 10.11606/s1518-8787.2019053001234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 11/10/2018] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To assess the effects of the lian gong practice as a rehabilitation strategy in primary health care on the quality of life and functional capacity of people with dizziness. METHODS Randomized controlled clinical trial. Thirty-six people, who were complaining of dizziness or vertigo without the presence of central signs and were referred by the physician of primary health care participated in the study. The individuals were randomly allocated to the three experimental conditions: lian gong group (n = 11), vestibular rehabilitation group (n = 11) and control group (n = 14). The interventions were weekly, in group, with duration of 12 sessions. The participants were evaluated before and after the intervention regarding quality of life by the 36-Item Short Form Health Survey and the functional capacity by the Short Physical Performance Battery. RESULTS The scores of all domains of the Short Form Health Survey increased after intervention in the lian gong group. This variation was higher than that observed in the control group for the domains functional capacity, limitation by physical aspects and general health status, and also higher than that found after the intervention in the Vestibular Rehabilitation Group regarding pain. No differences were found in the Short Physical Performance Battery. CONCLUSIONS Based on the results presented, lian gong improves the quality of life of individuals with dizziness, without altering the functional capacity.
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Affiliation(s)
- Aline Lamas Lopes
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Fonoaudiológicas. Belo Horizonte, MG, Brasil
| | - Stela Maris Aguiar Lemos
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Fonoaudiológicas. Belo Horizonte, MG, Brasil.,Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento de Fonoaudiologia. Belo Horizonte, MG, Brasil
| | - Pedro Henrique Scheidt Figueiredo
- Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Faculdade de Ciências Biológicas e da Saúde, Departamento de Fisioterapia. Diamantina, MG, Brasil
| | - Juliana Nunes Santos
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Fonoaudiológicas. Belo Horizonte, MG, Brasil.,Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Faculdade de Ciências Biológicas e da Saúde, Departamento de Fisioterapia. Diamantina, MG, Brasil
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15
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Cortés-Amador S, Carrasco JJ, Sempere-Rubio N, Igual-Camacho C, Villaplana-Torres LA, Pérez-Alenda S. Effects of a vestibular physiotherapy protocol on adults with intellectual disability in the prevention of falls: A multi-centre clinical trial. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2018; 32:359-367. [DOI: 10.1111/jar.12531] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 06/04/2018] [Accepted: 08/28/2018] [Indexed: 11/27/2022]
Affiliation(s)
| | - Juan J. Carrasco
- Department of Physiotherapy; University of Valencia; Valencia Spain
- Intelligent Data Analysis Laboratory; University of Valencia; Valencia Spain
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Kundakci B, Sultana A, Taylor AJ, Alshehri MA. The effectiveness of exercise-based vestibular rehabilitation in adult patients with chronic dizziness: A systematic review. F1000Res 2018; 7:276. [PMID: 29862019 PMCID: PMC5954334 DOI: 10.12688/f1000research.14089.1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2018] [Indexed: 01/30/2023] Open
Abstract
Background: Dizziness is a non-specific term used by patients to describe several symptoms ranging from true vertigo, light headedness, disorientation or sense of imbalance. Vestibular rehabilitation (VR) is a specific form of exercise-based therapy programme aimed at alleviating the primary and secondary problems of a vestibular pathology. The aim of this study was to investigate the effectiveness of exercise-based vestibular rehabilitation in adult patients with chronic dizziness. Methods: The following five databases were searched: the Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Library), MEDLINE, PubMed, the Physiotherapy Evidence Database (PEDro) and Scopus (Elsevier). Two investigators independently reviewed all articles and a systematic review of literature was performed using the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The articles were included if they met the following inclusion criteria: (1) randomised controlled trial, (2) people with chronic dizziness, (3) adults aged 18 or over, (4) exercise-based VR, (5) VR exercises compared with sham or usual care, non-treatment or placebo and (6) only studies published full text in English. Results: The initial search identified 304 articles, four of which met the criteria for analysis. All studies involved some form of vestibular rehabilitation, including vestibular compensation, vestibular adaptation and substitution exercises. These exercises were compared with usual medical care (three studies) or placebo eye exercise (one study). The Vertigo Symptom Scale was the most commonly used outcome measure to assess subjective perception of symptoms of dizziness (three studies). According to the PEDro scale, three studies were considered to be of high quality, and one was rated as fair. Conclusions: This review suggests that exercise-based vestibular rehabilitation shows benefits for adult patients with chronic dizziness with regard to improvement in the vertigo symptom scale, fall risk, balance and emotional status.
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Affiliation(s)
- Burak Kundakci
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, Nottinghamshire, NG7 2RD, UK.,Physiotherapy and Rehabilitation, Faculty of Health Sciences, Ordu University , Ordu, Turkey
| | - Anjum Sultana
- Division of Physiotherapy, School of Health Sciences, University of Nottingham, Nottingham, Nottinghamshire , NG7 2RD, UK
| | - Alan J Taylor
- Division of Physiotherapy, School of Health Sciences, University of Nottingham, Nottingham, Nottinghamshire , NG7 2RD, UK
| | - Mansour Abdullah Alshehri
- Physiotherapy Department, Faculty of Applied Medical Sciences, Umm-Al-Qura University, Mecca, 21421, Saudi Arabia
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Ribeiro KF, Oliveira BS, Freitas RV, Ferreira LM, Deshpande N, Guerra RO. Effectiveness of Otolith Repositioning Maneuvers and Vestibular Rehabilitation exercises in elderly people with Benign Paroxysmal Positional Vertigo: a systematic review. Braz J Otorhinolaryngol 2017; 84:S1808-8694(17)30102-7. [PMID: 28716503 PMCID: PMC9442809 DOI: 10.1016/j.bjorl.2017.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 05/20/2017] [Accepted: 06/02/2017] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Benign Paroxysmal Positional Vertigo is highly prevalent in elderly people. This condition is related to vertigo, hearing loss, tinnitus, poor balance, gait disturbance, and an increase in risk of falls, leading to postural changes and quality of life decreasing. OBJECTIVE To evaluate the outcomes obtained by clinical trials on the effectiveness of Otolith Repositioning Maneuver and Vestibular Rehabilitation exercises in the treatment of Benign Paroxysmal Positional Vertigo in elderly. METHODS The literature research was performed using PubMed, Scopus, Web of Science and PEDro databases, and included randomized controlled clinical trials in English, Spanish and Portuguese, published during January 2000 to August 2016. The methodological quality of the studies was assessed by PEDro score and the outcomes analysis was done by critical revision of content. RESULTS Six studies were fully reviewed. The average age of participants ranged between 67.2 and 74.5 years. The articles were classified from 2 to 7/10 through the PEDro score. The main outcome measures analyzed were vertigo, positional nystagmus and postural balance. Additionally, the number of maneuvers necessary for remission of the symptoms, the quality of life, and the functionality were also assessed. The majority of the clinical trials used Otolith Repositioning Maneuver (n=5) and 3 articles performed Vestibular Rehabilitation exercises in addition to Otolith Repositioning Maneuver or pharmacotherapy. One study showed that the addition of movement restrictions after maneuver did not influence the outcomes. CONCLUSION There was a trend of improvement in Benign Paroxysmal Positional Vertigo symptomatology in elderly patients who underwent Otolith Repositioning Maneuver. There is sparse evidence from methodologically robust clinical trials that examined the effects of Otolith Repositioning Maneuver and Vestibular Rehabilitation exercises for treating Benign Paroxysmal Positional Vertigo in the elderly. Randomized controlled clinical trials with comprehensive assessment of symptoms, quality of life, function and long-term follow up are warranted.
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Affiliation(s)
- Karyna Figueiredo Ribeiro
- Universidade Federal do Rio Grande do Norte (UFRN), Programa de Pós-Graduação em Ciências da Saúde, Natal, RN, Brazil; Universidade Federal do Rio Grande do Norte (UFRN), Departamento de Fisioterapia, Natal, RN, Brazil.
| | - Bruna Steffeni Oliveira
- Universidade Federal do Rio Grande do Norte (UFRN), Departamento de Fisioterapia, Natal, RN, Brazil
| | - Raysa V Freitas
- Universidade Federal do Rio Grande do Norte (UFRN), Departamento de Fisioterapia, Natal, RN, Brazil
| | - Lidiane M Ferreira
- Universidade Federal do Rio Grande do Norte (UFRN), Programa de Pós-Graduação em Saúde Pública, Natal, RN, Brazil
| | - Nandini Deshpande
- Queen's University, Faculty of Health Sciences, School of Rehabilitation Therapy, Kingston, Canada
| | - Ricardo O Guerra
- Universidade Federal do Rio Grande do Norte (UFRN), Programa de Pós-Graduação em Ciências da Saúde, Natal, RN, Brazil; Universidade Federal do Rio Grande do Norte (UFRN), Programa de Pós-Graduação em Fisioterapia, Natal, RN, Brazil
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18
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Effects of vestibular rehabilitation in the elderly: a systematic review. Aging Clin Exp Res 2016; 28:599-606. [PMID: 26511625 DOI: 10.1007/s40520-015-0479-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 10/12/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Aging is characterized by gradual physiological changes in body systems. Changes in the vestibular system can occur and cause dizziness, vertigo and imbalance, symptoms that are common in the elderly. Vestibular rehabilitation is a therapeutic resource that has been widely used to improve this condition. AIMS To complete a systematic review of the effects of vestibular rehabilitation on the elderly. METHODS A search for relevant publications was conducted in SCIELO, PUBMED, MEDLINE, COCHRANE and LILACS databases. Clinical trials and cohort studies that were written in the English language and published over the course of the last 10 years were selected. The methodological quality of the studies was assessed using the PEDro scale. A critical analysis of the studies was composed. RESULTS Eight studies that involved subjects who were over the age of 60 were selected for inclusion in the systematic review. The most common vestibular dysfunction identified was complaints about dizziness and imbalance. The Dizziness Handicap Inventory was the most frequently used assessment instrument, and the treatment protocol that prevailed was that suggested by Cawthorne and Cooksey. DISCUSSION The PEDro scale showed that only one article was of an acceptable methodological quality and presented satisfactory outcome measures. This was due, in part, to a lack of a hidden randomization, masking of the subject, evaluators and therapists, and lack of outcome measures, which can reduce the quality of the evidence presented in this study. CONCLUSION Clinical trials indicate that vestibular rehabilitation represents an effective means of treating elderly patients with vestibular disorders; however, evidence of its effectiveness remains lacking.
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Abbott J, Tomassen S, Lane L, Bishop K, Thomas N. Assessment for benign paroxysmal positional vertigo in medical patients admitted with falls in a district general hospital. Clin Med (Lond) 2016; 16:335-8. [PMID: 27481376 PMCID: PMC6280209 DOI: 10.7861/clinmedicine.16-4-335] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Having benign paroxysmal positional vertigo (BPPV) puts patients at a significantly higher risk of falling. It is poorly recognised and diagnosis is frequently delayed. BPPV has been studied in outpatient settings, but there have been no studies looking at the prevalence in patients admitted with falls. This study aims to establish how common BPPV is in these patients.For a 4-month period, patients admitted on an unselected medical take were screened for an admission precipitated by a fall. Patients who consented were assessed for BPPV using the Dix-Hallpike manoeuvre. Patients who tested positive were treated using the Epley manoeuvre. The assessments were carried out by specialist physiotherapists who were experienced at assessing and diagnosing patients with peripheral vestibular disorders. Out of the 111 patients initially identified, 37 (33%) were considered to be appropriate and consented to be part of the study. Of these, 20 patients (54%) had a positive Dix-Hallpike manoeuvre.Of the patients included in the study, over half tested positive for BPPV. This merits further study. Potentially, there is a proportion of patients admitted with falls who have an easily treatable contributing factor that is not being identified with standard practice.
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20
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Ribeiro KMOBD, Freitas RVDM, Ferreira LMDBM, Deshpande N, Guerra RO. Effects of balance Vestibular Rehabilitation Therapy in elderly with Benign Paroxysmal Positional Vertigo: a randomized controlled trial. Disabil Rehabil 2016; 39:1198-1206. [DOI: 10.1080/09638288.2016.1190870] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Karyna Myrelly Oliveira Bezerra de Ribeiro
- Post-Graduation Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | | | - Nandini Deshpande
- Faculty of Health Sciences, School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Ricardo Oliveira Guerra
- Post-Graduation Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
- Post-Graduation Program of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
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21
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Ribeiro KMOBDF, Ferreira LMDBM, Freitas RVDM, Silva CND, Deshpande N, Guerra RO. "Positive to Negative" Dix-Hallpike test and Benign Paroxysmal Positional Vertigo recurrence in elderly undergoing Canalith Repositioning Maneuver and Vestibular Rehabilitation. Int Arch Otorhinolaryngol 2016; 20:344-352. [PMID: 27746838 PMCID: PMC5063735 DOI: 10.1055/s-0036-1572528] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/15/2015] [Indexed: 11/06/2022] Open
Abstract
Introduction Benign Paroxysmal Positional Vertigo is the most common cause of dizziness in elderly people. Recent studies have shown that the elderly present higher Benign Paroxysmal Positional Vertigo recurrence and that vertiginous symptomatology remission varies according to comorbidities and the therapeutic techniques applied. Objective To assess the short-term effectiveness of Vestibular Rehabilitation in addition to Canalith Repositioning Maneuver on positive to negative Dix-Hallpike test, on recurrence and number of maneuvers to achieve a negative test in elderly patients with chronic Benign Paroxysmal Positional Vertigo. Methods In this randomized controlled trial, 7 older adults (median age: 69 years, range 65–78) underwent Canalith Repositioning Maneuver and Vestibular Rehabilitation for thirteen weeks. Seven older adults (median age: 73 years, range 65–76) in the control group received only Canalith Repositioning Maneuver. The participants were assessed at baseline (T0), one (T1), five (T5), nine (T9), and thirteen weeks (T13). We assessed the differences between the groups by Mann-Whitney and Fisher exact tests, and used the Friedman and Wilcoxon tests to determine the intragroup differences. Results No significant differences were found between groups for the positive to negative Dix-Hallpike test, recurrence, and number of maneuvers to achieve a negative test. The number of maneuvers to achieve negative Dix-Hallpike test was lower in intragroup comparisons in the experimental group. Conclusion The findings suggest that additional Vestibular Rehabilitation did not influence the positive to negative Dix-Hallpike test, recurrence, or number of maneuvers to achieve a negative test in elderly patients with chronic Benign Paroxysmal Positional Vertigo.
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Affiliation(s)
| | | | | | - Camila Nicácio da Silva
- Department of Physiotherapy, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Nandini Deshpande
- Faculty of Health Sciences, School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Ricardo Oliveira Guerra
- Department of Physiotherapy, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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23
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Ferreira LMDBM, Ribeiro KMOBDF, Lima KCD. Prevalência de vestibulopatia em idosos institucionalizados de Natal - RN - Brasil. REVISTA CEFAC 2015. [DOI: 10.1590/1982-021620151752815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo: OBJETIVO: aferir a prevalência de vestibulopatia e seus fatores associadosem idosos institucionalizados por meio do exame clínico de cabeceira. MÉTODOS: trata-se de um estudo transversal realizado nas 12 Instituições de longa permanência para idosos de Natal-Brasil, regulamentadas pela Vigilância Sanitária. Foram eleitos os idosos com bom nível cognitivo e capazes de deambular, totalizando 115 indivíduos. Os idosos foram questionados sobre a presença de tontura no último ano, e quando a resposta era positiva, eram submetidos a questionário e exame físico específico para diagnóstico de vestibulopatia, segundo o protocolo de Johnson e Lalwani (2004). Para a análise estatística, utilizou-se o teste do Qui-quadrado ou exato de Fisher para um nível de significância de 5% e cálculo da razão de prevalência. RESULTADOS: a prevalência de vestibulopatia foi de 10,56%e foram associados a osteoartrose e o etilismo. CONCLUSÃO: a vestibulopatia apresenta baixa prevalência nos idosos institucionalizados de Natal-Brasil.
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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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Alrwaily M, Whitney S, Holmberg J. A physical therapist classification system for persons with complaints of dizziness and balance dysfunction. PHYSICAL THERAPY REVIEWS 2015. [DOI: 10.1179/1743288x15y.0000000004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Computer-assisted training as a complement in rehabilitation of patients with chronic vestibular dizziness--a randomized controlled trial. Arch Phys Med Rehabil 2014; 96:395-401. [PMID: 25450134 DOI: 10.1016/j.apmr.2014.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 09/24/2014] [Accepted: 10/08/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To compare a computer-assisted home exercise program with conservative home-training following printed instructions in the rehabilitation of elderly patients with vestibular dysfunction. DESIGN Single-blind, randomized, controlled trial. SETTING Geriatric department of a university hospital. PARTICIPANTS Patients with chronic dizziness due to vestibular dysfunction (N=63) were randomly assigned to either rehabilitation in the clinic followed by computer-assisted home exercises (intervention group: n=32) or rehabilitation in the clinic followed by home exercises according to printed instructions (control group: n=31). INTERVENTIONS Patients in the intervention group received assisted rehabilitation by a computer program. MAIN OUTCOME MEASURES Measurements at baseline and at 8 and 16 weeks were compared. These included the One Leg Stand Test, Dynamic Gait Index, Chair Stand Test, Motion Sensitivity Test, Short Form-12, Dizziness Handicap Inventory, and visual analog scale. RESULTS Both groups improved significantly during 16 weeks of rehabilitation. However, neither t tests nor repeated-measures analysis of variance demonstrated any significant differences between the 2 groups. The overall compliance rate to computer program exercises during 16 weeks was 57%. CONCLUSIONS A computer-assisted program to support the home training of elderly patients with vestibular dysfunction did not improve rehabilitation more than did printed instructions.
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Soto-Varela A, Faraldo-García A, Rossi-Izquierdo M, Lirola-Delgado A, Vaamonde-Sánchez-Andrade I, del-Río-Valeiras M, Gayoso-Diz P, Santos-Pérez S. Can we predict the risk of falls in elderly patients with instability? Auris Nasus Larynx 2014; 42:8-14. [PMID: 25194853 DOI: 10.1016/j.anl.2014.06.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 06/03/2014] [Accepted: 06/13/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The aim of this study is to determine whether clinical and instrumental examination of balance can predict the risk of falls in elderly patients with instability. METHODS STUDY DESIGN It is a case control study, with cases defined by falls in the last year, developed in a third level university hospital. PATIENTS Seventy patients aged 65 years or more who met at least one of the following inclusion criteria: (a) at least one fall in the last year; (b) spend more than 15s during the timed up and go test (TUG); (c) a score of less than 68% average balance in the sensory organisation test (SOT) of the computerised dynamic posturography (CDP); or (d) at least one fall in the CDP-SOT. INTERVENTION TUG test, CDP-SOT, CDP centre of gravity balancing (CG) and limits of stability (LOS), Dizziness Handicap Inventory (DHI) test and short FES-I test. MAIN OUTCOME MEASURES Number of steps and time (TUG), average balance and use of sensorial information (CDP-SOT), speed and directional control (CDP-CG and LOS), DHI score and short FES-I score. RESULTS Comparing subjects without falls (non-fallers) vs subjects with at least one fall (fallers) in the last year, fallers obtain worse scores than non-fallers in condition 2 (p=0.043) and use of somatosensory information (p=0.039). Comparing subjects with five falls or less (non-multiple-fallers) vs subjects with more than five falls (multiple-fallers), multiple-fallers obtain worse scores than non-multiple-fallers in overall balance (p=0.023), condition 6 (p=0.036), directional control (swaying (p=0.006) and LOS (p=0.023)) and short FES-I score (p=0.007). CONCLUSION The three most useful parameters for identifying unstable elderly patients at particularly high risk of repeated falls are mean balance in the CDP SOT, directional control of CDP LOS and short FES-I score.
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Affiliation(s)
- Andrés Soto-Varela
- Division of Neurotology, Department of Otorhinolaryngology, Complexo Hospitalario Universitario, Santiago de Compostela, Spain; Department of Dermatology and Otorhinolaryngology, University of Santiago de Compostela, Spain.
| | - Ana Faraldo-García
- Department of Otorhinolaryngology, Complexo Hospitalario Universitario, Santiago de Compostela, Spain
| | | | - Antonio Lirola-Delgado
- Department of Otorhinolaryngology, Complexo Hospitalario Universitario, Santiago de Compostela, Spain
| | | | - María del-Río-Valeiras
- Department of Otorhinolaryngology, Complexo Hospitalario Universitario, Santiago de Compostela, Spain
| | - Pilar Gayoso-Diz
- Clinical Epidemiology Unit, Hospital Clínico Universitario, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain
| | - Sofía Santos-Pérez
- Division of Neurotology, Department of Otorhinolaryngology, Complexo Hospitalario Universitario, Santiago de Compostela, Spain; Department of Dermatology and Otorhinolaryngology, University of Santiago de Compostela, Spain
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Ferreira LMDBM, Ribeiro KMOBDF, Pestana ALDS, Lima KCD. Prevalência de tontura na terceira idade. REVISTA CEFAC 2014. [DOI: 10.1590/1982-021620142913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objetivo aferir a prevalência de tontura em idosos participantes de um grupo de convivência do Sistema Único de Saúde localizado em centro de especialidades e assistência à saúde do idoso no município de Natal-RN. Métodos estudo prospectivo. Para estatística, utilizou-se análise descritiva dos dados. Resultados foram entrevistados 50 idosos, com idades entre 60 e 88 anos. A prevalência de tontura nesta população foi de 74%. Destes, 35,1% apresentavam apenas vertigem; 13,5% apresentavam vertigem associada a outro tipo de tontura; 24,3% apresentavam desequilíbrio; 8,1% flutuação; 16,2% pré-síncope; e 2,7% flutuação e pré-síncope. Em relação à duração da tontura, 48,6% tinham duração de segundos. Quanto à presença de sintomas otoneurológicos associados, 48,64% referiram sintomas neurovegetativos, 56,8% tinham zumbido, 56,8% apresentavam hipoacusia e 43,2% apresentavam plenitude aural. Referente a outras alterações, 10,8% não usava óculos; 2,7% usavam aparelho auditivo e 8,1% usavam bengalas, 48% tinham 2 ou mais doenças associadas e 40% faziam uso de 3 ou mais medicamentos ao dia. Comparando-se os pacientes com tontura e os sem tontura, achou-se RP de 0,947 para número de comorbidades e 0,971 para número de medicamentos. Na comparação entre idosos com vertigem e outros tipos de tontura, achou-se RP de 1,197 para zumbido, 1,050 para plenitude aural, 2,111 para sintomas neurovegetativos, 0,480 para duração da tontura, 0,528 para número de comorbidades e 0,758 para número de medicamentos. Conclusão conclui-se que a tontura é um sintoma bastante prevalente no idoso da comunidade assim como a presença de co-morbidades e uso de vários medicamentos.
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Affiliation(s)
| | | | | | - Kenio Costa de Lima
- Departamento de Odontologia da Universidade Federal do Rio Grande do Norte - UFRN, Brasil
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Iwasaki S, Yamasoba T. Dizziness and Imbalance in the Elderly: Age-related Decline in the Vestibular System. Aging Dis 2014; 6:38-47. [PMID: 25657851 DOI: 10.14336/ad.2014.0128] [Citation(s) in RCA: 156] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 01/27/2014] [Accepted: 01/28/2014] [Indexed: 01/30/2023] Open
Abstract
Dizziness and imbalance are amongst the most common complaints in older people, and are a growing public health concern since they put older people at a significantly higher risk of falling. Although the causes of dizziness in older people are multifactorial, peripheral vestibular dysfunction is one of the most frequent causes. Benign paroxysmal positional vertigo is the most frequent form of vestibular dysfunction in the elderly, followed by Meniere's disease. Every factor associated with the maintenance of postural stability deteriorates during aging. Age-related deterioration of peripheral vestibular function has been demonstrated through quantitative measurements of the vestibulo-ocular reflex with rotational testing and of the vestibulo-collic reflex with testing of vestibular evoked myogenic potentials. Age-related decline of vestibular function has been shown to correlate with the age-related decrease in the number of vestibular hair cells and neurons. The mechanism of age-related cellular loss in the vestibular endorgan is unclear, but it is thought that genetic predisposition and cumulative effect of oxidative stress may both play an important role. Since the causes of dizziness in older people are multi-factorial, management of this disease should be customized according to the etiologies of each individual. Vestibular rehabilitation is found to be effective in treating both unilateral and bilateral vestibular dysfunction. Various prosthetic devices have also been developed to improve postural balance in older people. Although there have been no medical treatments improving age-related vestibular dysfunction, new medical treatments such as mitochondrial antioxidants or caloric restriction, which have been effective in preventing age-related hearing loss, should be ienvestigated in the future.
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Affiliation(s)
- Shinichi Iwasaki
- Department of Otolaryngology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
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Correlating the Head Shake–Sensory Organizing Test With Dizziness Handicap Inventory in Compensation After Vestibular Neuritis. Otol Neurotol 2012; 33:211-4. [DOI: 10.1097/mao.0b013e318241c0a6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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