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Haciabbasoğlu R, Araci A, Günizi H. Are Telerehabilitation Exercise Practices Effective in Patients Diagnosed with Benign Paroxysmal Positional Vertigo? Indian J Otolaryngol Head Neck Surg 2023; 75:557-567. [PMID: 37200900 PMCID: PMC10016185 DOI: 10.1007/s12070-023-03631-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/23/2023] [Indexed: 03/17/2023] Open
Abstract
The aim of this study was to investigate the effectiveness of classical Vestibular Rehabilitation Exercises (Control Group-CG) given as home exercise program and VR + balance exercises (Experimental Group-EG) applied with telerehabilitation method on patients with Benign Paroxysmal Positional Vertigo (BPPV). Material and Methods: The patients were randomly divided into 2 therapy groups in the ALKU Hospital (CG; 21 patients, and EG;22 patients). Pre- and post-test experimental design was adopted and a six-week training was offered. The participants' balance ability (Romberg, tandem and semi-tandem tests), vertigo severity (Vertigo Symptom Scale-VSS, VAS), vertigo-related disability level (Dizziness Handicap Inventory-DHI), anxiety (Beck Anxiety Inventory-BAI) and quality of life (Vertigo Dizziness Imbalance Questionnaire-VDI) were assessed. Regarding the balance ability, findings in tandem and semi-tandem tests were significantly increased in the EG compared to CG (p < 0.05). According to VAS, the severity of dizziness decreased significantly compared to the CG (p < 0.05). Regarding the DHI score, symptoms of vertigo were reduced considerably after the treatment compared to the CG (p < 0.05). A significant improvement was observed in the quality of life of the EG group according to VDI scoring (p < 0.05). Although gains were observed in both groups, it was observed that the EG group obtained more effective improvement in the severity of vertigo, disability level due to vertigo, and quality of life compared to the home exercise group.These results confirmed the hypothesis that EG applications are effective and clinically applicable in patients with BPPV.
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Affiliation(s)
- Reyyan Haciabbasoğlu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Üsküdar University, Istanbul, Turkey
| | - Ayça Araci
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Alanya Alaaddin keykubat University (ALKU), Kestel mh. Cimento cd no:80, Alanya, Antalya Turkey
| | - Hüseyin Günizi
- Department of Otolaryngology, Faculty of Medicine, Alanya Alaaddin Keykubat University, Alanya, Turkey
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Xiang L, Bansal S, Wu AY, Roberts TL. Pathway of care for visual and vestibular rehabilitation after mild traumatic brain injury: a critical review. Brain Inj 2022; 36:911-920. [PMID: 35918848 PMCID: PMC10134507 DOI: 10.1080/02699052.2022.2105399] [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: 11/02/2022]
Abstract
PRIMARY OBJECTIVE To review the pathway to care for treatment and management of patients receiving visual and vestibular rehabilitation after mild traumatic brain injury (mTBI). METHODS & PROCEDURES English scientific peer-reviewed articles from PubMed, CINAHL, Embase, and PsycINFO between 2000 and 2020 were first screened by title and abstract, then those selected underwent full-text review and analysis. MAIN OUTCOMES & RESULTS The database search yielded 1640 results and after title and abstract review, 75 articles were selected for full-text screening, from which 8 were included in the qualitative synthesis. Current evidence includes a limited number of retrospective cohort studies and case studies. CONCLUSIONS Many patients with visual and vestibular deficits following mTBI do not receive rehabilitation services until months following their injury as there is no standardized pathway to care for patients for visual and vestibular rehabilitation. Barriers to establishing a standardized pathway are the lack of natural history data for visual and vestibular function following mTBI and the lack of randomized clinical trials establishing the efficacy of rehabilitation in patients following mTBI.
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Affiliation(s)
- Lucille Xiang
- School of Physical and Occupational Therapy, McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada.,School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Surbhi Bansal
- Spencer Center for Vision Research, Byers Eye Institute at Stanford University, Palo Alto, California, USA
| | - Albert Y Wu
- Spencer Center for Vision Research, Byers Eye Institute at Stanford University, Palo Alto, California, USA
| | - Tawna L Roberts
- Spencer Center for Vision Research, Byers Eye Institute at Stanford University, Palo Alto, California, USA
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Scarano S, Sansone VA, Ferrari Aggradi CR, Carraro E, Tesio L, Amadei M, Rota V, Zanolini A, Caronni A. Balance impairment in myotonic dystrophy type 1: Dynamic posturography suggests the coexistence of a proprioceptive and vestibular deficit. Front Hum Neurosci 2022; 16:925299. [PMID: 35967003 PMCID: PMC9367988 DOI: 10.3389/fnhum.2022.925299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/13/2022] [Indexed: 11/25/2022] Open
Abstract
Falls are frequent in Myotonic Dystrophy type 1 (DM1), but the pathophysiology of the balance impairment needs further exploration in this disease. The current work aims to provide a richer understanding of DM1 imbalance. Standing balance in 16 patients and 40 controls was tested in two posturographic tests (EquiTest™). In the Sensory Organization Test (SOT), standstill balance was challenged by combining visual (eyes open vs. closed) and environmental conditions (fixed vs. sway-tuned platform and/or visual surround). In the “react” test, reflexes induced by sudden shifts in the support base were studied. Oscillations of the body centre of mass (COM) were measured. In the SOT, COM sway was larger in patients than controls in any condition, including firm support with eyes open (quiet standing). On sway-tuned support, COM oscillations when standing with closed eyes were larger in patients than controls even after taking into account the oscillations with eyes open. In the “react” paradigm, balance reflexes were delayed in patients. Results in both experimental paradigms (i.e., SOT and react test) are consistent with leg muscle weakness. This, however, is not a sufficient explanation. The SOT test highlighted that patients rely on vision more than controls to maintain static balance. Consistently enough, evidence is provided that an impairment of proprioceptive and vestibular systems contributes to falls in DM1. Rehabilitation programs targeted at reweighting sensory systems may be designed to improve safe mobility in DM1.
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Affiliation(s)
- Stefano Scarano
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Milan, Italy
| | - Valeria Ada Sansone
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- NEuroMuscular Omnicentre, Fondazione Serena Onlus, Milan, Italy
| | | | - Elena Carraro
- NEuroMuscular Omnicentre, Fondazione Serena Onlus, Milan, Italy
| | - Luigi Tesio
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Milan, Italy
| | - Maurizio Amadei
- Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Milan, Italy
| | - Viviana Rota
- Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Milan, Italy
| | - Alice Zanolini
- NEuroMuscular Omnicentre, Fondazione Serena Onlus, Milan, Italy
| | - Antonio Caronni
- Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Milan, Italy
- *Correspondence: Antonio Caronni,
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Allen JW, Trofimova A, Ahluwalia V, Smith JL, Abidi SA, Peters MAK, Rajananda S, Hurtado JE, Gore RK. Altered Processing of Complex Visual Stimuli in Patients with Postconcussive Visual Motion Sensitivity. AJNR Am J Neuroradiol 2021; 42:930-937. [PMID: 33574098 DOI: 10.3174/ajnr.a7007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/16/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Vestibular symptoms are common after concussion. Vestibular Ocular Motor Screening identifies vestibular impairment, including postconcussive visual motion sensitivity, though the underlying functional brain alterations are not defined. We hypothesized that alterations in multisensory processing are responsible for postconcussive visual motion sensitivity, are detectable on fMRI, and correlate with symptom severity. MATERIALS AND METHODS Twelve patients with subacute postconcussive visual motion sensitivity and 10 healthy control subjects underwent vestibular testing and a novel fMRI visual-vestibular paradigm including 30-second "neutral" or "provocative" videos. The presence of symptoms/intensity was rated immediately after each video. fMRI group-level analysis was performed for a "provocative-neutral" condition. Z-statistic images were nonparametrically thresholded using clusters determined by Z > 2.3 and a corrected cluster significance threshold of P = .05. Symptoms assessed on Vestibular Ocular Motor Screening were correlated with fMRI mean parameter estimates using Pearson correlation coefficients. RESULTS Subjects with postconcussive visual motion sensitivity had significantly more Vestibular Ocular Motor Screening abnormalities and increased symptoms while viewing provocative videos. While robust mean activation in the primary and secondary visual areas, the parietal lobe, parietoinsular vestibular cortex, and cingulate gyrus was seen in both groups, selective increased activation was seen in subjects with postconcussive visual motion sensitivity in the primary vestibular/adjacent cortex and inferior frontal gyrus, which are putative multisensory visual-vestibular processing centers. Moderate-to-strong correlations were found between Vestibular Ocular Motor Screening scores and fMRI activation in the left frontal eye field, left middle temporal visual area, and right posterior hippocampus. CONCLUSIONS Increased fMRI brain activation in visual-vestibular multisensory processing regions is selectively seen in patients with postconcussive visual motion sensitivity and is correlated with Vestibular Ocular Motor Screening symptom severity, suggesting that increased visual input weighting into the vestibular network may underlie postconcussive visual motion sensitivity.
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Affiliation(s)
- J W Allen
- From the Department of Radiology and Imaging Sciences (J.W.A., A.T., J.L.S.), Emory University, Atlanta, Georgia
- Department of Neurology (J.W.A.), Emory University, Atlanta, Georgia
- Wallace H. Coulter Department of Biomedical Engineering (J.W.A., R.K.G.), Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | - A Trofimova
- From the Department of Radiology and Imaging Sciences (J.W.A., A.T., J.L.S.), Emory University, Atlanta, Georgia
| | - V Ahluwalia
- Georgia State University/Georgia Tech Center for Advanced Brain Imaging (V.A.), Atlanta, Georgia
| | - J L Smith
- From the Department of Radiology and Imaging Sciences (J.W.A., A.T., J.L.S.), Emory University, Atlanta, Georgia
| | - S A Abidi
- School of Medicine (S.A.A.), Emory University, Atlanta, Georgia
| | - M A K Peters
- Department of Bioengineering (M.A.K.P., S.R.), University of California, Riverside, Riverside, California
| | - S Rajananda
- Department of Bioengineering (M.A.K.P., S.R.), University of California, Riverside, Riverside, California
| | | | - R K Gore
- Wallace H. Coulter Department of Biomedical Engineering (J.W.A., R.K.G.), Georgia Institute of Technology and Emory University, Atlanta, Georgia
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Trofimova A, Smith JL, Ahluwalia V, Hurtado J, Gore RK, Allen JW. Alterations in Resting-State Functional Brain Connectivity and Correlations with Vestibular/Ocular-Motor Screening Measures in Postconcussion Vestibular Dysfunction. J Neuroimaging 2021; 31:277-286. [PMID: 33476477 DOI: 10.1111/jon.12834] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/31/2020] [Accepted: 12/31/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE Vestibular symptoms after concussion are common and associated with protracted recovery. The purpose of this study is to define resting-state functional MRI (rs-fMRI) brain connectivity alterations in patients with postconcussion vestibular dysfunction (PCVD) and correlations between rs-fMRI connectivity and symptoms provoked during Vestibular/Ocular-Motor Screening (VOMS) assessment. METHODS Prospective IRB approved study. STUDY GROUP 12 subjects with subacute PCVD (2-10 weeks); control group: 10 age-matched subjects without history of concussion or vestibular impairment. Both groups underwent clinical vestibular assessment. rs-fMRI was acquired on 3.0T Siemens Trio with a 12-channel head coil. rs-fMRI data analysis included independent component analysis-based functional connectivity group differences, graph theory analysis, and ROI-to-ROI connectivity correlation analysis with VOMS clinical derivatives. Group difference maps between resting-state networks were calculated using dual regression method and corrected for multiple comparisons. Correlation analysis between ROI-to-ROI rs-fMRI brain activation and VOMS assessment ratings was performed using Pearson correlation coefficient, with a significance threshold of P ≤ .05. RESULTS Compared to controls, PCVD group demonstrated significantly increased rs-fMRI connectivity between the default-mode network and right middle frontal gyrus and right postcentral gyrus; and between a vestibular-sensorimotor network and right prefrontal cortex. Significant positive correlations were found between clinical derivative VOMS scores and components of the vestibular, visual networks, and multisensory processing cortical representations. CONCLUSION Altered rs-fMRI brain connectivity with increased connectivity of visual input, multisensory processing, and spatial memory in PCVD is correlative with clinical derivative VOMS scores, suggesting maladaptive brain plasticity underlying vestibular symptomatology.
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Affiliation(s)
- Anna Trofimova
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
| | - Jeremy L Smith
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
| | - Vishwadeep Ahluwalia
- Georgia Statue University/Georgia Tech Center for Advanced Brain Imaging, Atlanta, GA
| | | | - Russell K Gore
- Shepherd Center, Atlanta, GA.,Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA
| | - Jason W Allen
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA.,Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA.,Department of Neurology, Emory University, Atlanta, GA
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