1
|
Yap J, Palmer G, Graving K, Stone S, Gane EM. Vestibular Rehabilitation: Improving Symptomatic and Functional Outcomes of Persons With Vestibular Schwannoma: A Systematic Review. Phys Ther 2024; 104:pzae085. [PMID: 38982735 PMCID: PMC11450271 DOI: 10.1093/ptj/pzae085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 01/30/2024] [Accepted: 07/07/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVE Persons with vestibular schwannoma suffer from dizziness, imbalance, and decreased function leading to reduced quality of life. Other forms of peripheral vestibular hypofunction show improvements in these signs and symptoms with vestibular rehabilitation; however, the efficacy of this intervention for those with vestibular schwannoma is unknown. Therefore, the aim of this systematic review was to determine the effect of vestibular physical therapy on subjective and objective measures of vestibular symptoms and function in people with vestibular schwannoma. METHODS Four electronic databases were searched: PubMed, CINAHL, EMBASE, and Cochrane. Included studies were experimental or observational in design and featured patients with vestibular schwannoma who had undergone vestibular physical therapy. Screening and quality assessment was completed independently by 2 researchers. Risk of bias was assessed with a tool appropriate for study design (eg, Cochrane Risk of Bias 2.0 tool for randomized trials). The Grading of Recommendations Assessment, Development and Evaluation approach was used to synthesize findings. RESULTS Twenty-three studies were included. Overall, the effect of vestibular physical therapy for patients with vestibular schwannoma was uncertain. Outcomes of dizziness, static and dynamic balance, and vestibular function all showed very low certainty on the Grading of Recommendations Assessment, Development and Evaluation assessment. Multimodal physical therapist interventions consistent with clinical practice guidelines (eg, gaze stability, habituation, balance training, gait training) demonstrated potential for improvement in dizziness, balance, and vestibular function, respectively. Results were mostly insignificant when a single modality was used. CONCLUSION There may be benefit in multimodal vestibular physical therapy for people with vestibular schwannoma to improve symptoms and function. More high-quality studies specific to vestibular schwannoma prehabilitation and rehabilitation are needed to increase the certainty in the evidence. IMPACT Physical therapists are encouraged to use multimodal vestibular rehabilitation for vestibular schwannoma in clinical practice in line with clinical guidelines for peripheral vestibular hypofunction.
Collapse
Affiliation(s)
- Jayden Yap
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
- Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Gretta Palmer
- Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Kate Graving
- Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Shona Stone
- Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Elise M Gane
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
- Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Queensland, Australia
| |
Collapse
|
2
|
Kunelskay NL, Ivanova GE, Baybakova EV, Guseva AL, Parfenov VA, Zamergrad MV, Zaitseva OV, Melnikov OA, Shmonin AA, Maltseva MN. [Vestibular rehabilitation for peripheral vestibular hypofunction: an interdisciplinary consensus]. Vestn Otorinolaringol 2024; 89:52-63. [PMID: 38506027 DOI: 10.17116/otorino20248901152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
The literature review presents approaches to the management of patients with vestibular disorders. The principles of organization of vestibular rehabilitation in peripheral vestibular hypofunction, indications for appointment, factors influencing its implementation, technique, methods of evaluating effectiveness are considered in detail. Attention is drawn to the fact that the selection of exercises and the duration of vestibular rehabilitation is carried out individually and depends on many factors, including the nature of vestibular deficiency and the specific characteristics of the patient. The possibilities of using additional pharmacological therapy with histamine preparations, which can accelerate the onset of vestibular compensation, are shown. It is noted that vestibular rehabilitation is a safe and effective method of treating peripheral vestibular hypofunction and should be recommended to patients of all ages with vestibular disorders leading to limited social and physical activity.
Collapse
Affiliation(s)
- N L Kunelskay
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - G E Ivanova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - E V Baybakova
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - A L Guseva
- Pirogov Russian National Research Medical University, Moscow, Russia
- Pirogov Municipal Clinical Hospital No. 1, Moscow, Russia
| | - V A Parfenov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - M V Zamergrad
- Pirogov Russian National Research Medical University, Moscow, Russia
- Russian Medical Academy for Continuous Professional Education, Moscow, Russia
| | - O V Zaitseva
- National Medical Research Center for Otorhinolaryngology of the FMBA of Russia, Moscow, Russia
| | | | - A A Shmonin
- Pavlov First St. Petersburg State Medical University, St. Petersburg, Russia
| | - M N Maltseva
- Pavlov First St. Petersburg State Medical University, St. Petersburg, Russia
| |
Collapse
|
3
|
Kriz M, Conover S, Cameron N, Conover M, Simon J, Prueter J, Samy R, Backous D. Comparing in-clinic versus telehealth for vestibular physical therapy. J Vestib Res 2024; 34:215-222. [PMID: 38905068 DOI: 10.3233/ves-220094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2024]
Abstract
BACKGROUND Vestibular rehabilitation (VR) is a commonly employed treatment method for disorders of dizziness and imbalance. Access to a clinic for rehabilitation appointments can be challenging for a person experiencing dizziness. Telehealth may offer a comparable alternative to clinic-based VR for some patients. OBJECTIVE The objective of this study was to determine the efficacy of telehealth-based VR compared to traditional clinic-based VR, as measured with the Dizziness Handicapped Inventory (DHI) in a retrospective sample of patients with vestibular conditions. METHODS This is a retrospective, multi-institutional review from May 2020 to January 2021. Three study groups were analyzed: a telehealth group, a hybrid group, and a clinic based control group. Treatment efficacy was measured using the DHI. A repeated measures ANCOVA was performed to compare changes between the groups and across timepoints. RESULTS The repeated measures ANCOVA was not significant for the interaction of groups (control, telehealth, and hybrid) by time (pre and post) (p > 0.05). However, there was a significant main effect for time (pre and post) (p < 0.05). Specifically, all groups improved DHI scores from pre to post treatment with mean differences of control: 31.85 points, telehealth: 18.75 points, and hybrid: 21.45 points. CONCLUSION Findings showed that in-clinic, telehealth, and hybrid groups demonstrated a decrease in DHI scores, indicating self-reported improvements in the impact of dizziness on daily life. Continued research is recommended to explore the efficacy of using telehealth in assessing and treating vestibular conditions.
Collapse
Affiliation(s)
- Morgan Kriz
- Vestibular Therapy Specialists, Seattle, WA, USA
| | - Sarah Conover
- Sarah Conover and Associates, LLC, Troy, OH, USA
- Xcel Sports Medicine, Vandalia, OH, USA
| | - Nicholas Cameron
- Department of Otolaryngology - Head and Neck Surgery, Kettering Health Dayton, Dayton, OH, USA
| | - Meg Conover
- Doctors Hospital Family Medicine, Columbus, OH, USA
| | - Janet Simon
- College of Applied Health Sciences and Wellness, Ohio University, Athens, OH, USA
| | - James Prueter
- Department of Otolaryngology - Head and Neck Surgery, Southwest Ohio ENT, Dayton, OH, USA
| | - Ravi Samy
- Department of Otolaryngology - Head and Neck Surgery, Lehigh Valley Health Network, Allentown, PA, USA
| | - Douglas Backous
- Department of Otolaryngology - Head and Neck Surgery, Puget Sound ENT, Edmonds, WA, USA
| |
Collapse
|
4
|
Kamo T, Ogihara H, Azami M, Momosaki R, Fushiki H. Effects of Early Vestibular Rehabilitation in Patients With Acute Vestibular Disorder: A Systematic Review and Meta-Analysis. Otol Neurotol 2023; 44:e641-e647. [PMID: 37641214 DOI: 10.1097/mao.0000000000004006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
OBJECTIVES To investigate the effect of early vestibular rehabilitation on physical function and dizziness in patients with acute vestibular disorders. DATABASES REVIEWED The electronic databases examined included PubMed (MEDLINE), Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE (via Dialog), and PEDro. METHODS The inclusion criteria in terms of the study participants were patients 20 years and older with an acute unilateral peripheral vestibular disorder. We included individual randomized controlled trials (RCTs), cluster-RCTs, quasi-RCTs, and crossover trials. The outcomes were gait, balance (eyes open, eyes close), activities of daily living, dizziness, and vestibular function. Early vestibular rehabilitation was defined as rehabilitation within 14 days of vestibular disorder onset or surgery. Main outcome measures were gait, balance (eyes open, eyes close), activities of daily living, dizziness, and vestibular function. RESULTS Twelve trials involving 542 participants were included. Early vestibular rehabilitation improved the Dizziness Handicap Inventory by -7.18 (95% confidence interval [CI], -10.48 to -3.88), balance during eyes close by -1.40 (95% CI, -2.42 to -0.39), and dizziness by -1.47 (95% CI, -2.74 to -0.21) compared with no intervention or placebo. CONCLUSION The present study demonstrated that early vestibular rehabilitation improved the Dizziness Handicap Inventory, balance (eyes close), and subjective dizziness in a patient with acute vestibular disorders. This result indicates that early vestibular rehabilitation can promote vestibular compensation.
Collapse
Affiliation(s)
| | | | | | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Mie, Japan
| | - Hiroaki Fushiki
- Otolaryngology, Mejiro University Ear Institute Clinic, Saitama
| |
Collapse
|
5
|
Warutkar VB, Samal S, Koul P. Impact of Vestibular and Balance Rehabilitation Therapy Along With Conventional Physiotherapy in a Case of Vestibular Schwannoma With CP Angle Tumor: A Case Report. Cureus 2023; 15:e45224. [PMID: 37842422 PMCID: PMC10576441 DOI: 10.7759/cureus.45224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 09/14/2023] [Indexed: 10/17/2023] Open
Abstract
Vestibular Schwannoma forms in Schwann cells which cover the vestibular nerve, often in the internal auditory canal. Symptoms were likely present before the excision of the tumor. After the excision of the tumor, symptoms may include, hearing defects, tinnitus, facial muscle abnormalities, headache, and balance impairments. This case report is of a female patient with vestibular schwannoma, who had a few above-mentioned symptoms after the surgery. Her physiotherapy protocol included Vestibular and Balance Rehabilitation Therapy along with Conventional Physiotherapy. Also, facial proprioceptive neuromuscular facilitation (PNF) was a part of her treatment. The outcome measures used to rule out the results were the motion sensitivity quotient (MSQ) and the Berg balance scale (BBS). Improvement of symptoms is likely related to the excision of the tumor and the therapy program. The person's balance and coordination improved as a result of the rehabilitation protocol, and she was able to do her regular tasks with minimal assistance. Her standard of living was also enhanced.
Collapse
Affiliation(s)
| | - Snehal Samal
- Neuro Physiotherapy, Ravi Nair Physiotherapy College, Wardha, IND
| | - Prishita Koul
- Neuro Physiotherapy, Ravi Nair Physiotherapy College, Wardha, IND
| |
Collapse
|
6
|
Kiliç G, Çelikyurt C, Algun ZC. The Effect of Vestibular Rehabilitation on Balance and Quality of Life in Patients with Bilateral Vestibular Hypofunction. Indian J Otolaryngol Head Neck Surg 2023; 75:2091-2099. [PMID: 37636755 PMCID: PMC10447320 DOI: 10.1007/s12070-023-03788-0] [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: 03/16/2022] [Accepted: 04/07/2023] [Indexed: 08/29/2023] Open
Abstract
This study aims to investigate the effectiveness of vestibular rehabilitation on balance, dynamic visual acuity, and quality of life in patients with bilateral vestibular hypofunction (BVH). 20 patients diagnosed by videonystagmography were included in the study. Balance tests, Visual Analogue Scale (VAS), testing of Dynamic Visual Acuity (DVA), Dizziness Handicap Inventory (DHI), Computer-modified Clinical Test of Sensory Interaction in Balance (m-CTSIB), and Limits of Stability Test were applied before and 3 and 6 months after the treatment. Physiotherapy sessions were given at two-week intervals. According to the development of the patients, they were asked to perform a home exercise program with 10 repetitions 3 times a day. After 6 months of vestibular rehabilitation, improvements in balance and quality of life parameters were observed in the patients. VAS, DVA, DHI, all static balance parameters except Romberg, Semi-tandem eyes open were significant (p < 0.005). In computerized M-CTSIB, while no significant results were obtained on the hard surface with the eyes open (p = 0.126), statistically significant improvement was observed on the hard surface with the eyes closed and on a foam surface with eyes open and close. LOS results showed significant improvement in velocity, reaching the endpoint, and maximal deviation in all directions except the right posterior. While significant results were found in the right, posterior, left anterior, and left posterior directions in the reaction time section, there was no statistical significance in any of the direct control sections (p < 0.005). Trial registration number: NCT05231109, Date of registration:27/01/2022 (Retrospectively registered).
Collapse
Affiliation(s)
- Gamze Kiliç
- Department of Physiotherapy and Rehabilitation, Istanbul Medipol University, Kavacık South Campus, Beykoz, 34815 Istanbul, Turkey
| | - Cengiz Çelikyurt
- Clinic of Otolaryngology, Istanbul Günesli Erdem Hospital, Istanbul, Turkey
| | - Zeliha Candan Algun
- Department of Physiotherapy and Rehabilitation, Istanbul Medipol University, Kavacık South Campus, Beykoz, 34815 Istanbul, Turkey
| |
Collapse
|
7
|
Pisani D, Gioacchini FM, Chiarella G, Astorina A, Ricciardiello F, Scarpa A, Re M, Viola P. Vestibular Impairment in Patients with Vestibular Schwannoma: A Journey through the Pitfalls of Current Literature. Audiol Res 2023; 13:285-303. [PMID: 37102775 PMCID: PMC10135541 DOI: 10.3390/audiolres13020025] [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: 02/27/2023] [Revised: 03/17/2023] [Accepted: 04/06/2023] [Indexed: 04/28/2023] Open
Abstract
Vestibular Schwannoma is the most common tumour of Ponto Cerebellar Angle and is capable of strongly impacting the patient's quality of life. In recent decades, the proposals for the management of the disease have multiplied, just as the diagnostic capacity has improved. While in the past, the primary objective was the preservation of the facial function, and subsequently also of the auditory function, the attention to the vestibular symptomatology, which appears to be one of the main indicators of deterioration of quality of life, is still unsatisfactory. Many authors have tried to provide guidance on the best possible management strategy, but a universally recognized guideline is still lacking. This article offers an overview of the disease and the proposals which have advanced in the last twenty years, evaluating their qualities and defects in a critical reading.
Collapse
Affiliation(s)
- Davide Pisani
- Unit of Audiology, Regional Centre of Cochlear Implants and ENT Diseases, Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy
| | - Federico Maria Gioacchini
- Ear, Nose, and Throat Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Via Conca 71, 60020 Ancona, Italy
| | - Giuseppe Chiarella
- Unit of Audiology, Regional Centre of Cochlear Implants and ENT Diseases, Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy
| | - Alessia Astorina
- Unit of Audiology, Regional Centre of Cochlear Implants and ENT Diseases, Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy
| | | | - Alfonso Scarpa
- Department of Medicine and Surgery, University of Salerno, 84084 Salerno, Italy
| | - Massimo Re
- Ear, Nose, and Throat Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Via Conca 71, 60020 Ancona, Italy
| | - Pasquale Viola
- Unit of Audiology, Regional Centre of Cochlear Implants and ENT Diseases, Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy
| |
Collapse
|
8
|
Kemper M, Paliege K, Zahnert T. [Vestibular schwannomas - baseline and progress diagnostics]. Laryngorhinootologie 2022; 101:518-538. [PMID: 35724922 DOI: 10.1055/a-1739-6662] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Vestibular (vestibulocochlear) schwannomas are rare, benign schwannomas of the cerebellopontine angle, the internal auditory canal, or the inner ear. They can occur with or without clinical symptoms. The most common symptoms are unilateral or side-differentiated hearing loss with or without tinnitus and balance disorders. Initial symptomatology is nonspecific in the basic functional diagnosis, raising the question of when a hearing or balance disorder should be thought of as a differential diagnosis of vestibular schwannoma and what diagnostic pathway is appropriate. This concerns not only the confirmation of the diagnosis and the recording of all dysfunctions of the involved cranial nerves in the initial basic diagnostics, but also the procedure in the course and follow-up diagnostics - especially in patients who are subject to an observation strategy. Today, imaging alone is no longer sufficient for differentiated and individualized patient counseling. Due to the increasing detection of smaller tumors on MRI and the growing proportion of nearly asymptomatic patients, a shift in thinking from pure imaging monitoring to a detailed analysis of auditory and vestibular function is timely. In this educational article, diagnostic pathways for a sufficient patient consultation will be compiled. Ultimately, functional examination techniques from follow-up and progression diagnostics will also be included.
Collapse
Affiliation(s)
- Max Kemper
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Carl Gustav Carus, Dresden
| | | | | |
Collapse
|
9
|
Alyahya D, Kashoo FZ. Perception, knowledge, and attitude of medical doctors in Saudi Arabia about the role of physiotherapists in vestibular rehabilitation: a cross-sectional survey. PeerJ 2022; 10:e13035. [PMID: 35282282 PMCID: PMC8908887 DOI: 10.7717/peerj.13035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/08/2022] [Indexed: 01/11/2023] Open
Abstract
Objectives There is compelling scientific evidence about the role of physiotherapists in vestibular rehabilitation. However, patients with vestibular-associated dizziness and balance disturbances are seldom referred to physiotherapists in Saudi Arabia. Therefore, this study aims to achieve insight into perceptions, knowledge, attitudes, and referral practices among Saudi Arabian medical doctors relating to the role of physiotherapists in vestibular rehabilitation. Methods A sample of 381 medical doctors practicing in Saudi Arabia participated in this nationwide cross-sectional study. The sample was obtained from 226 hospitals across 13 provinces of Saudi Arabia by stratified sampling method. The 23-item questionnaire developed by a team of experts was emailed to medical doctors practicing in various hospitals across Saudi Arabia. Results Out of 1,231 medical doctors invited, 381 medical doctors responded, giving a response rate of 30.9%. One hundred ninety-three (50.6%) medical doctors reported managing patients with vestibular rehabilitation. The most preferred specialist for managing patients with vestibular disorders was an Ear Nose Throat (ENT) specialist (n = 173, 89.6%). Related Sample Cochran's Q test showed statistically significant difference between preferred specialist for managing patients with vestibular disorders (ENT specialists, physiotherapists, nurses, occupational therapists and audiologists) (χ2(4) = 482.476, p = 0.001). Out of 193 medical doctors, 153 (79.2%) reported no role of the physiotherapist in vestibular rehabilitation. One hundred forty-five (75.1%) of medical doctors reported that they were not aware of the role of physiotherapists in vestibular rehabilitation. Only 27 (15.5%) medical doctors reported referring patients with vestibular disorders to physiotherapists. Conclusion The study reports that physiotherapy services are underutilized in vestibular rehabilitation due to limited referral from Saudi Arabian medical doctors. Therefore, there is a need to increase the awareness among Saudi Arabian doctors about the physiotherapist's role in vestibular rehabilitation.
Collapse
|
10
|
DSilva LJ, Skop KM, Pickle NT, Marschner K, Zehnbauer TP, Rossi M, Roos PE. Use of Stakeholder Feedback to Develop an App for Vestibular Rehabilitation–Input From Clinicians and Healthy Older Adults. Front Neurol 2022; 13:836571. [PMID: 35280295 PMCID: PMC8907890 DOI: 10.3389/fneur.2022.836571] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/20/2022] [Indexed: 12/02/2022] Open
Abstract
Close to half people over 60 years of age experience vestibular dysfunction. Although vestibular rehabilitation has been proven effective in reducing dizziness and falls in older adults, adherence to exercise programs is a major issue and reported to be below 50%. Therefore, this research aimed to develop an app with gaming elements to improve adherence to exercises that are part of vestibular rehabilitation, and to provide feedback to increase the accuracy during exercise performance. A clinician-informed design was used where five physical therapists were asked identical questions about the exercises they would like to see in the app, including their duration and frequency. Games were developed to train the vestibulo-ocular (VOR) reflex using VOR and gaze shifting exercises; and to train the vestibulo-spinal system using weight shifting and balance exercises. The games were designed to progress from simple to more complex visuals. The games were controlled by an Inertial Measurement Unit placed on the head or anterior waist. The app was tested on ten healthy females (69.1 ± 5.1 years) with no prior history of vestibular dysfunction or complaints of dizziness. Participants completed gaze stabilization and balance exercises using the app and provided feedback on the user interface, ease of use, usefulness and enjoyment using standardized questionnaires and changes they would like to see in the form of open-ended questions. In general, participants reported that they found the app easy to use, the user interface was friendly, and they enjoyed playing the games due to the graphics and colors. They reported that the feedback provided during the exercise session helped them recognize their mistakes and motivated them to do better. However, some elements of the app were frustrating due to incomplete instructions and inability to distinguish game objects due to insufficient contrast. Feedback received will be implemented in a revised version which will be trialed in older adults with dizziness due to vestibular hypofunction. We have demonstrated that the “Vestibular AppTM” created for rehabilitation with gaming elements was found to be enjoyable, useful, and easy to use by healthy older adults. In the long term, the app may increase adherence to vestibular rehabilitation.
Collapse
Affiliation(s)
- Linda J. DSilva
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, United States
| | - Karen M. Skop
- Physical Medicine and Rehabilitation Services, Department of Physical Therapy, James A. Haley Veterans' Hospital, Morsani College of Medicine, University of South Florida, School of Physical Therapy, Tampa, FL, United States
| | - Nathan T. Pickle
- Biomedical and Data Sciences Division, CFD Research Corporation, Huntsville, AL, United States
| | - Katherine Marschner
- Biomedical and Data Sciences Division, CFD Research Corporation, Huntsville, AL, United States
| | - Timothy P. Zehnbauer
- Biomedical and Data Sciences Division, CFD Research Corporation, Huntsville, AL, United States
| | - Michael Rossi
- Biomedical and Data Sciences Division, CFD Research Corporation, Huntsville, AL, United States
| | - Paulien E. Roos
- Biomedical and Data Sciences Division, CFD Research Corporation, Huntsville, AL, United States
- *Correspondence: Paulien E. Roos
| |
Collapse
|
11
|
Cole KR, Goodman K, Volland L. Reporting of exercise dose and dosage and outcome measures for gaze stabilisation in the literature: a scoping review. BMJ Open 2022; 12:e049560. [PMID: 35121596 PMCID: PMC8819788 DOI: 10.1136/bmjopen-2021-049560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The concept of this review is to examine and quantify the reporting of parameters of dose (duration, speed, head excursion) and dosage (daily and weekly frequency, duration) for gaze stabilisation exercises and to report on outcome measures used to assess change in gaze stabilisation following intervention. This review includes any population completing gaze stabilisation exercises. DESIGN Scoping review. METHODS We searched key terms in the following databases: PubMed, CINAHL, Scopus and Cochrane. Two researchers reviewed titles, abstracts and full-text articles for inclusion. Data retrieved included: patient diagnosis, specific interventions provided, dose and dosage of gaze stabilisation interventions and outcome measures. RESULTS From the initial 1609 results, 138 studies were included. Data extraction revealed that only 13 studies (9.4%) reported all parameters of dose and dosage. Most studies used other interventions in addition to gaze stabilisation exercises. Half of the studies did not use a clinical or instrumented outcome measure of gaze stability, using only patient-reported outcome measures. Clinical tests of gaze stability were used in 21.1% of studies, and instrumented measures of gaze stability were used in 14.7% of studies. CONCLUSIONS Full reporting of the dose and dosage of gaze stabilisation interventions is infrequent, impairing the ability to translate current evidence into clinical care. Most studies did not use a clinical or instrumented measure of gaze stabilisation as outcome measures, questioning the validity of intervention effects. Improved reporting and use of outcome measures are necessary to establish optimal intervention parameters for those with gaze stability impairments.
Collapse
Affiliation(s)
- Keith R Cole
- Health, Human Function, and Rehabilitation Science, The George Washington University, Washington, DC, USA
| | - Karen Goodman
- Health, Human Function, and Rehabilitation Science, The George Washington University, Washington, DC, USA
| | - Lena Volland
- Department of Clinical Research and Leadership, The George Washington University, Washington, DC, USA
| |
Collapse
|
12
|
Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Updated Clinical Practice Guideline From the Academy of Neurologic Physical Therapy of the American Physical Therapy Association. J Neurol Phys Ther 2021; 46:118-177. [PMID: 34864777 PMCID: PMC8920012 DOI: 10.1097/npt.0000000000000382] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Uncompensated vestibular hypofunction can result in symptoms of dizziness, imbalance, and/or oscillopsia, gaze and gait instability, and impaired navigation and spatial orientation; thus, may negatively impact an individual's quality of life, ability to perform activities of daily living, drive, and work. It is estimated that one-third of adults in the United States have vestibular dysfunction and the incidence increases with age. There is strong evidence supporting vestibular physical therapy for reducing symptoms, improving gaze and postural stability, and improving function in individuals with vestibular hypofunction. The purpose of this revised clinical practice guideline is to improve quality of care and outcomes for individuals with acute, subacute, and chronic unilateral and bilateral vestibular hypofunction by providing evidence-based recommendations regarding appropriate exercises. Methods: These guidelines are a revision of the 2016 guidelines and involved a systematic review of the literature published since 2015 through June 2020 across 6 databases. Article types included meta-analyses, systematic reviews, randomized controlled trials, cohort studies, case-control series, and case series for human subjects, published in English. Sixty-seven articles were identified as relevant to this clinical practice guideline and critically appraised for level of evidence. Results: Based on strong evidence, clinicians should offer vestibular rehabilitation to adults with unilateral and bilateral vestibular hypofunction who present with impairments, activity limitations, and participation restrictions related to the vestibular deficit. Based on strong evidence and a preponderance of harm over benefit, clinicians should not include voluntary saccadic or smooth-pursuit eye movements in isolation (ie, without head movement) to promote gaze stability. Based on moderate to strong evidence, clinicians may offer specific exercise techniques to target identified activity limitations and participation restrictions, including virtual reality or augmented sensory feedback. Based on strong evidence and in consideration of patient preference, clinicians should offer supervised vestibular rehabilitation. Based on moderate to weak evidence, clinicians may prescribe weekly clinic visits plus a home exercise program of gaze stabilization exercises consisting of a minimum of: (1) 3 times per day for a total of at least 12 minutes daily for individuals with acute/subacute unilateral vestibular hypofunction; (2) 3 to 5 times per day for a total of at least 20 minutes daily for 4 to 6 weeks for individuals with chronic unilateral vestibular hypofunction; (3) 3 to 5 times per day for a total of 20 to 40 minutes daily for approximately 5 to 7 weeks for individuals with bilateral vestibular hypofunction. Based on moderate evidence, clinicians may prescribe static and dynamic balance exercises for a minimum of 20 minutes daily for at least 4 to 6 weeks for individuals with chronic unilateral vestibular hypofunction and, based on expert opinion, for a minimum of 6 to 9 weeks for individuals with bilateral vestibular hypofunction. Based on moderate evidence, clinicians may use achievement of primary goals, resolution of symptoms, normalized balance and vestibular function, or plateau in progress as reasons for stopping therapy. Based on moderate to strong evidence, clinicians may evaluate factors, including time from onset of symptoms, comorbidities, cognitive function, and use of medication that could modify rehabilitation outcomes. Discussion: Recent evidence supports the original recommendations from the 2016 guidelines. There is strong evidence that vestibular physical therapy provides a clear and substantial benefit to individuals with unilateral and bilateral vestibular hypofunction. Limitations: The focus of the guideline was on peripheral vestibular hypofunction; thus, the recommendations of the guideline may not apply to individuals with central vestibular disorders. One criterion for study inclusion was that vestibular hypofunction was determined based on objective vestibular function tests. This guideline may not apply to individuals who report symptoms of dizziness, imbalance, and/or oscillopsia without a diagnosis of vestibular hypofunction. Disclaimer: These recommendations are intended as a guide to optimize rehabilitation outcomes for individuals undergoing vestibular physical therapy. The contents of this guideline were developed with support from the American Physical Therapy Association and the Academy of Neurologic Physical Therapy using a rigorous review process. The authors declared no conflict of interest and maintained editorial independence. Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A369).
Collapse
|
13
|
Said M, Lee J, Moshtaghi O, Saliba J, Richardson AJW, Ngo V, Mehranpour P, Schwartz MS, Friedman RA. The Relationship Between the Functional Gait Assessment and Quality-of-Life Data in Patients Undergoing Vestibular Schwannoma Resection. Otol Neurotol 2021; 42:1074-1080. [PMID: 33741817 DOI: 10.1097/mao.0000000000003137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine the relationship between the Functional Gait Assessment (FGA) and quality of life (QOL) measurements relating to balance before and after vestibular schwannoma (VS) resection and to assess the role of preoperative FGA in predicting postoperative QOL. STUDY DESIGN A prospective clinical study of adult patients undergoing VS resection between September 2018 and December 2019. FGA was administered 1 week before and after surgery. Dizziness Handicap Inventory (DHI) and Penn Acoustic Neuroma Quality of Life (PANQOL) were administered preoperatively and at 3 months postoperatively. SETTING Single tertiary center. PATIENTS Patients (age ≥ 18 years old) with VS undergoing microsurgical resection. Excluded were patient with previous surgery or radiation. INTERVENTION VS resection. MAIN OUTCOMES AND MEASURES Primary outcome: correlation between FGA and QOL surveys. Secondary outcome: correlation between preoperative measurements of balance and postoperative PANQOL. RESULTS One hundred thirty-eight patients were analyzed (mean age: 48 years old, 65.9% female). The translabyrinthine approach was most commonly performed. Under multivariate analysis, preoperative FGA significantly correlated with preoperative PANQOL balance score (p < 0.0001), preoperative PANQOL total score (p = 0.0002), and preoperative DHI (p < 0.0001). However, postoperative FGA did not significantly correlate with postoperative PANQOL balance or total scores (p = 0.446 and p = 0.4, respectively), or postoperative DHI (p = 0.3). Univariate analysis demonstrated that preoperative DHI and preoperative FGA were predictive of changes in postoperative PANQOL balance and total scores. However under multivariate analysis, preoperative FGA did not predict changes in postoperative PANQOL balance or total score (p = 0.24; p = 0.28, respectively). Preoperative DHI remained predictive of changes in postoperative PANQOL balance (p = 0.03) score but not of postoperative PANQOL total score (p = 0.37). CONCLUSIONS Although FGA and QOL data significantly correlated in the preoperative setting, our results did not suggest that preoperative FGA can be used to determine postoperative QOL. Additionally, the lack of correlation between FGA and QOL measurements in the acute postoperative setting suggests that further research is needed to determine contributors to postoperative QOL.
Collapse
Affiliation(s)
- Mena Said
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California-San Diego, San Diego, California, USA
| | - Jason Lee
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California-San Diego, San Diego, California, USA
| | - Omid Moshtaghi
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California-San Diego, San Diego, California, USA
| | - Joe Saliba
- Division of Otolaryngology-Head and Neck Surgery, University of Montreal, Montreal, Canada
| | | | - Victoria Ngo
- University of California Davis Health, Sacramento, California, USA
| | - Pasha Mehranpour
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California-San Diego, San Diego, California, USA
| | - Marc S Schwartz
- Division of Neurosurgery, Department of Surgery, University of California-San Diego, San Diego, California, USA
| | - Rick A Friedman
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California-San Diego, San Diego, California, USA
| |
Collapse
|
14
|
Carender WJ, Grzesiak M, Telian SA. Vestibular Physical Therapy and Fall Risk Assessment. Otolaryngol Clin North Am 2021; 54:1015-1036. [PMID: 34304897 DOI: 10.1016/j.otc.2021.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Vestibular physical therapy (VPT) is a specialized form of evidence-based therapy designed to alleviate primary (vertigo, dizziness, imbalance, gait instability, falls) and secondary (deconditioning, cervical muscle tension, anxiety, poor quality of life, fear of falling/fear avoidance behavior) symptoms related to vestibular disorders. This article provides an overview of VPT, highlighting various exercise modalities used to treat a variety of vestibular disorders. Patient safety and fall prevention are paramount; therefore, fall risk assessment and treatment are also addressed.
Collapse
Affiliation(s)
- Wendy J Carender
- Department of Otolaryngology-Head & Neck Surgery, Michigan Medicine, University of Michigan, Michigan Balance Vestibular Testing and Rehabilitation, Med Inn Building, Room C166A, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5816, USA.
| | - Melissa Grzesiak
- Department of Otolaryngology-Head & Neck Surgery, Michigan Medicine, University of Michigan, Michigan Balance Vestibular Testing and Rehabilitation, Med Inn Building, Room C166A, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5816, USA
| | - Steven A Telian
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan, 1500 East Medical Center Drive, TC 1904L, Ann Arbor, MI 48109-5312, USA
| |
Collapse
|
15
|
Wang L, Zobeiri OA, Millar JL, Schubert MC, Cullen KE. Head movement kinematics are altered during gaze stability exercises in vestibular schwannoma patients. Sci Rep 2021; 11:7139. [PMID: 33785796 PMCID: PMC8010068 DOI: 10.1038/s41598-021-86533-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 03/17/2021] [Indexed: 12/17/2022] Open
Abstract
Gaze stability is the ability of the eyes to fixate a stable point when the head is moving in space. Because gaze stability is impaired in peripheral vestibular loss patients, gaze stabilization exercises are often prescribed to facilitate compensation. However, both the assessment and prescription of these exercises are subjective. Accordingly, here we quantified head motion kinematics in patients with vestibular loss while they performed the standard of care gaze stability exercises, both before and after surgical deafferentation. We also correlate the head kinematic data with standard clinical outcome measures. Using inertial measurement units, we quantified head movements in patients as they transitioned through these two vestibular states characterized by different levels of peripheral damage. Comparison with age-matched healthy control subjects revealed that the same kinematic measurements were significantly abnormal in patients both pre- and post-surgery. Regardless of direction, patients took a longer time to move their heads during the exercises. Interestingly, these changes in kinematics suggest a strategy that existed preoperatively and remained symmetric after surgery although the patients then had complete unilateral vestibular loss. Further, we found that this kinematic assessment was a good predictor of clinical outcomes, and that pre-surgery clinical measures could predict post-surgery head kinematics. Thus, together, our results provide the first experimental evidence that patients show significant changes in head kinematics during gaze stability exercises, even prior to surgery. This suggests that early changes in head kinematic strategy due to significant but incomplete vestibular loss are already maladaptive as compared to controls.
Collapse
Affiliation(s)
- Lin Wang
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, USA
| | - Omid A Zobeiri
- Department of Biomedical Engineering, McGill University, Montreal, QC, Canada
| | - Jennifer L Millar
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Michael C Schubert
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, USA.,Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Kathleen E Cullen
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, USA. .,Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, USA. .,Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, USA. .,Kavli Neuroscience Discovery Institute, Johns Hopkins University, Baltimore, USA.
| |
Collapse
|
16
|
Ermiş E, Anschuetz L, Leiser D, Poel R, Raabe A, Manser P, Aebersold DM, Caversaccio M, Mantokoudis G, Abu-Isa J, Wagner F, Herrmann E. Vestibular dose correlates with dizziness after radiosurgery for the treatment of vestibular schwannoma. Radiat Oncol 2021; 16:61. [PMID: 33771181 PMCID: PMC7995572 DOI: 10.1186/s13014-021-01793-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 03/18/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Stereotactic radiosurgery (SRS) has been recognized as a first-line treatment option for small to moderate sized vestibular schwannoma (VS). Our aim is to evaluate the impact of SRS doses and other patient and disease characteristics on vestibular function in patients with VS. METHODS Data on VS patients treated with single-fraction SRS to 12 Gy were retrospectively reviewed. No dose constraints were given to the vestibule during optimization in treatment planning. Patient and tumor characteristics, pre- and post-SRS vestibular examination results and patient-reported dizziness were assessed from patient records. RESULTS Fifty-three patients were analyzed. Median follow-up was 32 months (range, 6-79). The median minimum, mean and maximum vestibular doses were 2.6 ± 1.6 Gy, 6.7 ± 2.8 Gy, and 11 ± 3.6 Gy, respectively. On univariate analysis, Koos grade (p = 0.04; OR: 3.45; 95% CI 1.01-11.81), tumor volume (median 6.1 cm3; range, 0.8-38; p = 0.01; OR: 4.85; 95% CI 1.43-16.49), presence of pre-SRS dizziness (p = 0.02; OR: 3.98; 95% CI 1.19-13.24) and minimum vestibular dose (p = 0.033; OR: 1.55; 95% CI 1.03-2.32) showed a significant association with patient-reported dizziness. On multivariate analysis, minimum vestibular dose remained significant (p = 0.02; OR: 1.75; 95% CI 1.05-2.89). Patients with improved caloric function had received significantly lower mean (1.5 ± 0.7 Gy, p = 0.01) and maximum doses (4 ± 1.5 Gy, p = 0.01) to the vestibule. CONCLUSIONS Our results reveal that 5 Gy and above minimum vestibular doses significantly worsened dizziness. Additionally, mean and maximum doses received by the vestibule were significantly lower in patients who had improved caloric function. Further investigations are needed to determine dose-volume parameters and their effects on vestibular toxicity.
Collapse
Affiliation(s)
- Ekin Ermiş
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Lukas Anschuetz
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dominic Leiser
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Robert Poel
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Andreas Raabe
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Peter Manser
- Division of Medical Radiation Physics, Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel M Aebersold
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Marco Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Janine Abu-Isa
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Franca Wagner
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Evelyn Herrmann
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland.
- Department of Radiation Oncology, Hôpital Riviera-Chablais, Rennaz, Switzerland.
| |
Collapse
|
17
|
Lacour M, Thiry A, Tardivet L. Two conditions to fully recover dynamic canal function in unilateral peripheral vestibular hypofunction patients. J Vestib Res 2021; 31:407-421. [PMID: 33749626 DOI: 10.3233/ves-201557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The crucial role of early vestibular rehabilitation (VR) to recover a dynamic semicircular canal function was recently highlighted in patients with unilateral vestibular hypofunction (UVH). However, wide inter-individual differences were observed, suggesting that parameters other than early rehabilitation are involved. OBJECTIVE The aim of the study was to determine to what extent the degree of vestibular loss assessed by the angular vestibulo-ocular reflex (aVOR) gain could be an additional parameter interfering with rehabilitation in the recovery process. And to examine whether different VR protocols have the same effectiveness with regard to the aVOR recovery. METHODS The aVOR gain and the percentage of compensatory saccades were recorded in 81 UVH patients with the passive head impulse test before and after early VR (first two weeks after vertigo onset: N = 43) or late VR (third to sixth week after onset: N = 38) performed twice a week for four weeks. VR was performed either with the unidirectional rotation paradigm or gaze stability exercises. Supplementary outcomes were the dizziness handicap inventory (DHI) score, and the static and dynamic subjective visual vertical. RESULTS The cluster analysis differentiated two distinct populations of UVH patients with pre-rehab aVOR gain values on the hypofunction side below 0.20 (N = 42) or above 0.20 (N = 39). The mean gain values were respectively 0.07±0.05 and 0.34±0.12 for the lateral canal (p < 0.0001), 0.09±0.06 and 0.44±0.19 for the anterior canal (p < 0.0001). Patients with aVOR gains above 0.20 and early rehab fully recovered dynamic horizontal canal function (0.84±0.14) and showed very few compensatory saccades (18.7% ±20.1%) while those with gains below 0.20 and late rehab did not improve their aVOR gain value (0.16±0.09) and showed compensatory saccades only (82.9% ±23.7%). Similar results were found for the anterior canal function. Recovery of the dynamic function of the lateral canal was found with both VR protocols while it was observed with the gaze stability exercises only for the anterior canal. All the patients reduced their DHI score, normalized their static SVV, and exhibited uncompensated dynamic SVV. CONCLUSIONS Early rehab is a necessary but not sufficient condition to fully recover dynamic canal function. The degree of vestibular loss plays a crucial role too, and to be effective rehabilitation protocols must be carried out in the plane of the semicircular canals.
Collapse
Affiliation(s)
- Michel Lacour
- Neurosciences Department, Aix-Marseille University, CNRS, Marseille, France
| | - Alain Thiry
- Physiotherapist, Bd Dubouchage, Nice, France
| | - Laurent Tardivet
- Otorhinolaryngology Department, CHU Nice, Voie Romaine, Nice, France
| |
Collapse
|
18
|
Grove CR, Whitney SL, Hetzel SJ, Heiderscheit BC, Pyle GM. Effect of Repetitive Administration of a Next-generation Sensory Organization Test in Adults With and Without Vestibular Dysfunction. Otol Neurotol 2021; 42:e363-e370. [PMID: 33165160 PMCID: PMC8205109 DOI: 10.1097/mao.0000000000002950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
HYPOTHESIS The overall aim was to assess the effects of repetitive testing on performance on a next-generation Sensory Organization Test (NG-SOT). BACKGROUND The psychometric properties of sensory organization assessment with a next-generation posturography device are not fully characterized. Thus, a better understanding of the reliability of the NG-SOT is required to support its use as an outcome measure. METHODS Forty adults (20 vestibular-impaired) participated. Test-retest reliability was determined using the interclass correlation coefficient [ICC (3,1)] for the composite, somatosensory, vision, vestibular, and visual preference scores. Learning effects were assessed by analyzing the change in the composite score over time. RESULTS Analyzing the NG-SOT scores across all participants produced the following interclass correlation coefficients [95% confidence interval (CI)]: composite = 0.95 (0.92, 0.97), somatosensory = 0.20 (-0.06, 0.44), vision = 0.93 (0.88, 0.96), vestibular = 0.91 (0.85, 0.94), and visual preference = 0.19 (-0.07, 0.43). The mean differences (95% CI; p value) for the composite score between administrations were: 2.7 (1.0, 4.4; 0.002) for visits 1 and 2; 1.4 (-0.3, 3.1; 0.099) for visits 2 and 3; 0.7 (-1.0, 2.4; 0.403) for visits 3 and 4; and 0.4 (-1.3, 2.1; 0.653) for visits 4 and 5. CONCLUSIONS Test-retest reliability was excellent for the composite, vision, and vestibular scores, but it was poor for the somatosensory and visual preference scores. A learning effect for the composite score was identified, but performance was stable after two administrations. Changes in the composite score that are greater than 6.5 points exceed the measurement error for the test.
Collapse
Affiliation(s)
| | | | | | | | - G Mark Pyle
- University of Wisconsin-Madison, Madison, Wisconsin
| |
Collapse
|
19
|
Zobeiri OA, Mischler GM, King SA, Lewis RF, Cullen KE. Effects of vestibular neurectomy and neural compensation on head movements in patients undergoing vestibular schwannoma resection. Sci Rep 2021; 11:517. [PMID: 33436776 PMCID: PMC7804855 DOI: 10.1038/s41598-020-79756-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 12/07/2020] [Indexed: 01/29/2023] Open
Abstract
The vestibular system is vital for maintaining balance and stabilizing gaze and vestibular damage causes impaired postural and gaze control. Here we examined the effects of vestibular loss and subsequent compensation on head motion kinematics during voluntary behavior. Head movements were measured in vestibular schwannoma patients before, and then 6 weeks and 6 months after surgical tumor removal, requiring sectioning of the involved vestibular nerve (vestibular neurectomy). Head movements were recorded in six dimensions using a small head-mounted sensor while patients performed the Functional Gait Assessment (FGA). Kinematic measures differed between patients (at all three time points) and normal subjects on several challenging FGA tasks, indicating that vestibular damage (caused by the tumor or neurectomy) alters head movements in a manner that is not normalized by central compensation. Kinematics measured at different time points relative to vestibular neurectomy differed substantially between pre-operative and 6-week post-operative states but changed little between 6-week and > 6-month post-operative states, demonstrating that compensation affecting head kinematics is relatively rapid. Our results indicate that quantifying head kinematics during self-generated gait tasks provides valuable information about vestibular damage and compensation, suggesting that early changes in patient head motion strategy may be maladaptive for long-term vestibular compensation.
Collapse
Affiliation(s)
- Omid A Zobeiri
- Department of Biomedical Engineering, McGill University, Montreal, QC, Canada
| | - Gavin M Mischler
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, USA
| | - Susan A King
- Jenks Vestibular Physiology Laboratory, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
- Departments of Otolaryngology and Neurology, Harvard Medical School, Boston, MA, USA
| | - Richard F Lewis
- Jenks Vestibular Physiology Laboratory, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
- Departments of Otolaryngology and Neurology, Harvard Medical School, Boston, MA, USA
| | - Kathleen E Cullen
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, USA.
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, USA.
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, USA.
- Kavli Neuroscience Discovery Institute, Johns Hopkins University, Baltimore, USA.
| |
Collapse
|
20
|
Can Dizziness Handicap Inventory and Activities-Specific Balance Confidence Scores Assess Vestibular Loss After Vestibular Schwannoma Excision? Otol Neurotol 2020; 41:1427-1432. [PMID: 33170812 DOI: 10.1097/mao.0000000000002842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Evaluate and compare the Dizziness Handicap Inventory with Activities-specific Balance Confidence scores shortly after vestibular schwannoma excision. STUDY DESIGN Retrospective database review. SETTING Tertiary care center. PATIENTS Adults undergoing vestibular schwannoma excision between January 2015 and December 2019. INTERVENTION Diagnostic, therapeutic, and rehabilitative. MAIN OUTCOME MEASURES Postoperative change in Dizziness Handicap Inventory scores and Activities-specific Balance Confidence scores 2 to 3 weeks after surgical intervention in relation to preoperative vestibular testing. RESULTS A total of 49 patients met inclusion criteria. The average change in the Dizziness Handicap Inventory was 6 (p = 0.07, 95% CI 0-13). This was weakly correlated to preoperative caloric testing values (r = -0.31, p = 0.03), but not cervical vestibular evoked myogenic potentials (cVEMP) values (r = -0.17, p = 0.23). The average change in Activities-specific Balance Confidence was -10% (p = 0.007, 95% CI -3 to -17%). This change was moderately correlated with preoperative caloric values (r = 0.42, p = 0.006), but it was not correlated with cVEMP (r = 0.07, p = 0.66). CONCLUSIONS In vestibular schwannoma patients, factors other than preoperative vestibular function likely affect postoperative Dizziness Handicap Inventory and Activities-specific Balance Confidence scores. The change in Activities-specific Balance Confidence was slightly more consistent with expected physiological vestibular loss, and it represents another tool in a multidisciplinary vestibular evaluation of the postoperative patient.
Collapse
|
21
|
Herdman SJ, Hall CD, Heusel-Gillig L. Factors Associated With Rehabilitation Outcomes in Patients With Unilateral Vestibular Hypofunction: A Prospective Cohort Study. Phys Ther 2020; 100:2009-2022. [PMID: 32737972 DOI: 10.1093/ptj/pzaa138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The purpose of this study was to determine factors associated with rehabilitation outcomes following vestibular rehabilitation (VR). METHODS In this prospective cohort study, 116 patients who completed at least 2 supervised sessions participated. Patient characteristics and comorbidities were recorded. Initial and discharge measures included symptom intensity, balance confidence, quality of life, percent of time symptoms interfere with life, perceived benefits of VR, gait speed, fall risk, visual acuity during head movement, and anxiety/depression. Intention-to-treat analyses were performed to determine outcomes at discharge. Bivariate correlations between independent (group characteristics and baseline measures) and dependent (discharge measures) variables were determined. Logistic regressions were performed to identify factors associated with whether a patient would have a normal score or meaningful change at discharge. RESULTS There was a large effect of VR with significant improvement for the group as a whole on each outcome measure. For each outcome measure, most patients improved. Based on preliminary logistic regression, 2 patient characteristics were associated with outcome: number of therapy visits predicted meaningful improvement in gait speed, and falls after the onset of the unilateral vestibular hypofunction (UVH) predicted meaningful change in the percent of time symptoms interfered with life. Initial Activities-Specific Balance Confidence Scale (ABC) and Dynamic Gait Index scores predicted normal ABC scores at discharge, and initial ABC scores predicted recovery of Dynamic Gait Index scores. Preliminary prediction models were generated for balance confidence, impact of dizziness on life, dynamic visual acuity, gait speed, and fall risk. CONCLUSIONS Therapists may use these findings for patient education or to determine the need for adjunct therapy, such as counseling. IMPACT Not all people with UVH improve following VR, but there is little research examining why. This study looked at multiple factors and identified number of visits and falls after onset of UVH as patient characteristics associated with outcomes following VR; these findings will help therapists create better predictive models.
Collapse
Affiliation(s)
- Susan J Herdman
- Department of Rehabilitation Medicine, Emory University, Atlanta, Georgia; 2056 Hessian Ct, Stone Mountain, GA 30087 (USA)
| | - Courtney D Hall
- Hearing and Balance Research Program, James H Quillen VAMC, Mountain Home, Tennessee; and Department of Physical Therapy, East Tennessee State University, Johnson City, Tennessee
| | | |
Collapse
|
22
|
Ceylan DŞ, Ataş A, Kaya M. The Effect of Galvanic Vestibular Stimulation in the Rehabilitation of Patients with Vestibular Disorders. ORL J Otorhinolaryngol Relat Spec 2020; 83:25-34. [PMID: 32992316 DOI: 10.1159/000509971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/03/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of the study was to increase the participants' satisfaction with the unilateral peripheral vestibular pathology, in addition to the exercise program, with galvanic vestibular stimulation (GVS). METHODS Participants were divided into 2 groups: study group (41 subjects) and control group (32 subjects). Participants who underwent videonystagmography and sensory organization testing, which were objective test methods at the beginning, were invited to check in every week for 6 weeks to perform GVS and/or exercise in the exercise program. Objective tests were repeated at the end of the sixth week. A visual analog scale (VAS) was administered every week. RESULTS Unilateral weakness, balance scores 4, 5, 6; visual, vestibular, preference and strategy scores 5, 6; center of gravity 1, 2, 3, 4, 5, 6; composite scores were different between the groups after rehabilitation (p < 0.05). In terms of VAS, the study group began to feel better at the end of the first week than the control group (p < 0.01). DISCUSSION/CONCLUSION It was found that the study group benefited both from an objective and a subjective point of view more than participants in the control group.
Collapse
Affiliation(s)
- Didem Şahin Ceylan
- Department of Audiology, Faculty of Health Sciences, Uskudar University, İstanbul, Turkey,
| | - Ahmet Ataş
- Department of Ear, Nose and Throat, Medicine Faculty, Istanbul University Cerrahpaşa, İstanbul, Turkey
| | - Melda Kaya
- Department of Audiology, Health Sciences Institute, Istanbul University Cerrahpaşa, İstanbul, Turkey
| |
Collapse
|
23
|
Sestak A, Maslovara S, Zubcic Z, Vceva A. Influence of vestibular rehabilitation on the recovery of all vestibular receptor organs in patients with unilateral vestibular hypofunction. NeuroRehabilitation 2020; 47:227-235. [PMID: 32741787 DOI: 10.3233/nre-203113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Only a few studies in the literature demonstrate the effect of vestibular rehabilitation (VR) on all vestibular receptor organs. Furthermore, very little evidence of the effect of VR on isolated otolith dysfunction (IOD) is available. OBJECTIVE The study aimed to investigate the effect of VR on all vestibular receptor organs in patients with different types of unilateral vestibular hypofunction (UVH). METHODS We enrolled 80 patients with three different types of UVH; combined and isolated loss of semicircular canal and otolith organ function. All patients performed a 12-week customized program of VR and received a full battery of vestibular function tests, before and after the VR. The DHI and SF-36 were performed before, after 6 weeks, and 12 weeks of the VR. RESULTS Parameters of the caloric test, video head impulse test, ocular and cervical vestibular evoked myogenic potentials were significantly improved after VR. A total of 59 (74%) patients fully recovered, with no significant difference in recovery regarding the type (p = 0.13) and stage of UVH (p = 0.13). All patients reported significantly lower disability and a better quality of life after the VR based on the DHI and SF-36 score. CONCLUSIONS Vestibular rehabilitation has a positive effect on the recovery of all vestibular receptor organs and it should be used in patients with IOD.
Collapse
Affiliation(s)
- Anamarija Sestak
- Department of Otolaryngology, County General and Veterans Hospital Vukovar, Zupanijska, Vukovar, Croatia
| | - Sinisa Maslovara
- Department of Otolaryngology, County General and Veterans Hospital Vukovar, Zupanijska, Vukovar, Croatia.,Department of Ophthalmology, Optometry and Otorhinolaryngology, Faculty of Dental Medicine and Health, Crkvena, Osijek, Croatia
| | - Zeljko Zubcic
- Department of Otorhinolaryngology and Maxillofacial Surgery, Medical Faculty, University of Osijek, J. Huttlera, Osijek, Croatia.,Department of Otorhinolaryngology and Head and Neck Surgery, Clinical Hospital Centre Osijek, J. Huttlera, Osijek, Croatia
| | - Andrijana Vceva
- Department of Otorhinolaryngology and Maxillofacial Surgery, Medical Faculty, University of Osijek, J. Huttlera, Osijek, Croatia.,Department of Otorhinolaryngology and Head and Neck Surgery, Clinical Hospital Centre Osijek, J. Huttlera, Osijek, Croatia
| |
Collapse
|
24
|
Basura GJ, Adams ME, Monfared A, Schwartz SR, Antonelli PJ, Burkard R, Bush ML, Bykowski J, Colandrea M, Derebery J, Kelly EA, Kerber KA, Koopman CF, Kuch AA, Marcolini E, McKinnon BJ, Ruckenstein MJ, Valenzuela CV, Vosooney A, Walsh SA, Nnacheta LC, Dhepyasuwan N, Buchanan EM. Clinical Practice Guideline: Ménière's Disease. Otolaryngol Head Neck Surg 2020; 162:S1-S55. [PMID: 32267799 DOI: 10.1177/0194599820909438] [Citation(s) in RCA: 141] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Ménière's disease (MD) is a clinical condition defined by spontaneous vertigo attacks (each lasting 20 minutes to 12 hours) with documented low- to midfrequency sensorineural hearing loss in the affected ear before, during, or after one of the episodes of vertigo. It also presents with fluctuating aural symptoms (hearing loss, tinnitus, or ear fullness) in the affected ear. The underlying etiology of MD is not completely clear, yet it has been associated with inner ear fluid (endolymph) volume increases, culminating in episodic ear symptoms (vertigo, fluctuating hearing loss, tinnitus, and aural fullness). Physical examination findings are often unremarkable, and audiometric testing may or may not show low- to midfrequency sensorineural hearing loss. Conventional imaging, if performed, is also typically normal. The goals of MD treatment are to prevent or reduce vertigo severity and frequency; relieve or prevent hearing loss, tinnitus, and aural fullness; and improve quality of life. Treatment approaches to MD are many and typically include modifications of lifestyle factors (eg, diet) and medical, surgical, or a combination of therapies. PURPOSE The primary purpose of this clinical practice guideline is to improve the quality of the diagnostic workup and treatment outcomes of MD. To achieve this purpose, the goals of this guideline are to use the best available published scientific and/or clinical evidence to enhance diagnostic accuracy and appropriate therapeutic interventions (medical and surgical) while reducing unindicated diagnostic testing and/or imaging.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Matthew L Bush
- University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Julie Bykowski
- University of California San Diego, San Diego, California, USA
| | - Maria Colandrea
- Duke University School of Nursing and Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | | | | | - Kevin A Kerber
- University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | | | | | - Evie Marcolini
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Brian J McKinnon
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | | | | | | | - Sandra A Walsh
- Consumers United for Evidence-Based Healthcare, Baltimore, Maryland, USA
| | - Lorraine C Nnacheta
- American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Virginia, USA
| | - Nui Dhepyasuwan
- American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Virginia, USA
| | - Erin M Buchanan
- American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Virginia, USA
| |
Collapse
|
25
|
Vestibular Schwannoma Tumor Size Is Associated With Acute Vestibular Symptoms After Gamma Knife Therapy. Otol Neurotol 2020; 40:1088-1093. [PMID: 31335798 DOI: 10.1097/mao.0000000000002312] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess how pretreatment vestibular schwannoma (VS) tumor characteristics are associated with vestibular symptoms after gamma knife (GK) surgery. STUDY DESIGN Retrospective chart review of patients undergoing GK treatment for VS at our institution from 2005 to 2018. SETTING Academic tertiary referral center. PATIENTS Patients receiving primary GK surgery for vestibular schwannomas with at least 6 months of follow up. Patients with neurofibromatosis 2 or previous surgery were excluded. MAIN OUTCOME MEASURES The presence of posttreatment vestibular symptoms within 6 months after GK. Clinical records were assessed for pretreatment tumor, patient, and treatment characteristics that impacted posttreatment symptoms. RESULTS All patients received radiation doses between 12 and 13 Gy. Of 115 patients, the average age was 60. Thirty-seven (32%) patients developed vestibular symptoms within 6 months post-GK, and 18 patients were referred for vestibular rehabilitation. Ten of 13 patients undergoing vestibular rehabilitation reported improvement. Overall, 112 patients had tumor measurements. Pretreatment tumors were significantly smaller for patients with acute vestibular symptoms (mean 1.43 cm versus 1.71 cm, p = 0.007). On multivariate analysis, smaller tumor size (p = 0.009, odds ratio [OR] = 0.29, 95% confidence interval [CI] [0.12-0.73]) was significantly associated with vestibular symptoms within 6 months of GK. Patients with tumors less than 1.6 cm were more likely to receive referrals for vestibular rehabilitation within 6 months posttreatment (25% versus 9.4%, p = 0.026, OR = 3.22, 95% CI [1.00, 11.32]). CONCLUSIONS Smaller vestibular schwannomas were significantly associated with higher rates of post-GK vestibular symptoms. Pretreatment tumor size may be used to counsel patients on the likelihood of post-GK vestibular symptoms and vestibular rehabilitation.
Collapse
|
26
|
Millar JL, Gimmon Y, Roberts D, Schubert MC. Improvement After Vestibular Rehabilitation Not Explained by Improved Passive VOR Gain. Front Neurol 2020; 11:79. [PMID: 32153490 PMCID: PMC7044341 DOI: 10.3389/fneur.2020.00079] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 01/22/2020] [Indexed: 01/13/2023] Open
Abstract
Gaze stability exercises are a critical component of vestibular rehabilitation for individuals with vestibular hypofunction and many studies reveal the rehabilitation improves functional performance. However, few studies have examined the vestibular physiologic mechanisms (semicircular canal; otolith) responsible for such recovery after patients with vestibular hypofunction complete gaze and gait stability exercises. The purpose of this study was to compare behavioral outcome measures (i.e., visual acuity during head rotation) with physiological measures (i.e., gain of the vestibulo-ocular reflex) of gaze stability following a progressive vestibular rehabilitation program in patients following unilateral vestibular deafferentation surgery (UVD). We recruited n = 43 patients (n = 18 female, mean 52 ± 13 years, range 23-80 years) after unilateral deafferentation from vestibular schwannoma; n = 38 (25 female, mean 46.9 ± 15.9 years, range 22-77 years) age-matched healthy controls for dynamic visual acuity testing, and another n = 28 (14 female, age 45 ± 17, range 20-77 years) healthy controls for video head impulse testing. Data presented is from n = 19 patients (14 female, mean 48.9 ± 14.7 years) with UVD who completed a baseline assessment ~6 weeks after surgery, 5 weeks of vestibular physical therapy and a final measurement. As a group, subjective and fall risk measures improved with a meaningful clinical relevance. Dynamic visual acuity (DVA) during active head rotation improved [mean ipsilesional 38.57% ± 26.32 (n = 15/19)]; mean contralesional 39.96% ± 22.62 (n = 12/19), though not uniformly. However, as a group passive yaw VOR gain (mean ipsilesional pre 0.44 ± 0.18 vs. post 0.44 ± 0.15; mean contralesional pre 0.81 ± 0.19 vs. post 0.85 ± 0.09) did not show any change (p ≥ 0.4) after rehabilitation. The velocity of the overt compensatory saccades during ipsilesional head impulses were reduced after rehabilitation; no other metric of oculomotor function changed (p ≥ 0.4). Preserved utricular function was correlated with improved yaw DVA and preserved saccular function was correlated with improved pitch DVA. Our results suggest that 5 weeks of vestibular rehabilitation using gaze and gait stability exercises improves both subjective and behavioral performance despite absent change in VOR gain in a majority of patients, and that residual otolith function appears correlated with such change.
Collapse
Affiliation(s)
- Jennifer L Millar
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology - Head and Neck Surgery, Baltimore, MD, United States
| | - Yoav Gimmon
- Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology - Head and Neck Surgery, Baltimore, MD, United States.,Department of Physical Therapy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Dale Roberts
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Michael C Schubert
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology - Head and Neck Surgery, Baltimore, MD, United States
| |
Collapse
|
27
|
Chang TP, Schubert MC. Association of the Video Head Impulse Test With Improvement of Dynamic Balance and Fall Risk in Patients With Dizziness. JAMA Otolaryngol Head Neck Surg 2019; 144:696-703. [PMID: 29955786 DOI: 10.1001/jamaoto.2018.0650] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance It is important to know whether recovery of the vestibuloocular reflex (VOR) as measured by the video head impulse test (vHIT) is associated with the recovery of dynamic balance. It is also critical to know how much change in VOR gain is clinically relevant for establishing the recovery of dynamic balance. Objectives To investigate the association between improved VOR gain as measured by the vHIT and improved dynamic balance (reduced fall risk) as measured by the dynamic gait index (DGI) and to calculate the minimal clinically important difference of VOR gain. Design, Setting, and Participants This retrospective case series study was performed at a tertiary referral center at the Johns Hopkins University School of Medicine. Thirty-eight consecutive patients with subacute or chronic dizziness from January 1, 2014, through May 31, 2017, who visited the vestibular physical therapy clinic were included in the study. Interventions Each patient was evaluated with room light and video-infrared oculomotor examination, vHIT, and balance testing before and after vestibular physical therapy. Main Outcomes and Measures Gain of the lesioned VOR and score on the DGI. Results Among the 38 patients (25 women [66%]; mean [SD] age, 65 [14] years), the mean (SD) initial lesioned VOR gain was 0.66 (0.23) and initial DGI score was 16 (3). No correlation was found between initial VOR gain and initial DGI score (r = -0.04; 95% CI, -0.35 to 0.28). At follow-up, 15 patients (39%) had an improved VOR gain and 30 (79%) had an improved DGI score, which was correlated (r = 0.49; 95% CI, 0.20-0.69). In those 15 patients with improved VOR gain, 14 (93%) had improvement of DGI score. In the 23 patients without improvement of VOR gain, 16 (70%) still showed improvement in their DGI score. When using VOR gain to estimate improvement of DGI, the minimal clinically important difference of VOR gain was -0.06. Conclusions and Relevance The change of VOR gain in the vHIT was moderately associated with the change of DGI score. Improved VOR gain was associated with a high probability of improved dynamic balance. However, in most of the patients whose VOR gains did not improve, balance improvement occurred putatively through sensory reweighting strategies.
Collapse
Affiliation(s)
- Tzu-Pu Chang
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Neuro-Medical Scientific Center, Department of Neurology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan.,Department of Medicine, Tzu Chi University, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Michael C Schubert
- Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
28
|
Gaze stabilisation exercises in vestibular rehabilitation: review of the evidence and recent clinical advances. J Neurol 2019; 266:11-18. [DOI: 10.1007/s00415-019-09459-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/04/2019] [Accepted: 07/06/2019] [Indexed: 10/26/2022]
|
29
|
Hrubá S, Chovanec M, Čada Z, Balatková Z, Fík Z, Slabý K, Zvěřina E, Betka J, Plzak J, Čakrt O. The evaluation of vestibular compensation by vestibular rehabilitation and prehabilitation in short-term postsurgical period in patients following surgical treatment of vestibular schwannoma. Eur Arch Otorhinolaryngol 2019; 276:2681-2689. [PMID: 31187238 DOI: 10.1007/s00405-019-05503-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 06/03/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Vestibular schwannoma removal causes unilateral vestibular deafferentation, which results in dizziness and postural unsteadiness. Vertigo and balance problems together are among the most important aspects affecting quality of life. Intensive vestibular rehabilitation, which starts before surgery, with following postsurgical supervised rehabilitation, using visual biofeedback propose an instrument to accelerate a recovery process. Another option how to accelerate the vestibular compensation, is employment of presurgical gentamicin ablation together with vestibular rehabilitation (prehabilitation) of vestibular function. Purpose of present study was to examine the dynamics of vestibular compensation process using supervised intensive vestibular rehabilitation with visual biofeedback in the short-term postsurgical period. The second aim was to compare both studied groups mainly to evaluate if prehabilitation has potential to accelerate the compensation process in the early postoperative course. METHODS The study included 52 patients who underwent the retrosigmoid vestibular schwannoma removal. They were divided into two groups. The first group was prehabilitated with intratympanic application of gentamicin before surgery to cause unilateral vestibular loss (14 patients), the second group (38 patients) was treated in standard protocol without prehabilitation. All patients underwent at home vestibular training before surgery to learn new movement patterns. Following the surgery supervised intensive vestibular rehabilitation including visual biofeedback was employed daily in both groups between the 5th and 14th postoperative day. Outcome measurements included an evaluation of subjective visual vertical (SVV), posturography and the Activities-Specific Balance Confidence Scale (ABC). ANOVA for repeated measurements was used for statistical analysis. RESULTS We observed significant improvement in SVV (p < 0.05), posturography parameters (p < 0.05) and ABC scores (p < 0.05) with postoperative rehabilitation program following surgery in both groups. There was no statistically significant difference between group treated by prehabilitation and group without prehabilitation. CONCLUSIONS Results of this study showed that intensive postsurgical rehabilitation represents key factor in compensation process following retrosigmoid vestibular schwannoma surgery. Prehabilitation did not speed up recovery process.
Collapse
Affiliation(s)
- Silvie Hrubá
- Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University and University Hospital Motol, Postgraduate Medical School, Prague, Czech Republic.
| | - Martin Chovanec
- Department of Otorhinolaryngology, 3rd Faculty of Medicine, University Hospital Kralovské Vinohrady, Charles University, Prague, Czech Republic
| | - Zdeněk Čada
- Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University and University Hospital Motol, Postgraduate Medical School, Prague, Czech Republic
| | - Zuzana Balatková
- Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University and University Hospital Motol, Postgraduate Medical School, Prague, Czech Republic
| | - Zdeněk Fík
- Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University and University Hospital Motol, Postgraduate Medical School, Prague, Czech Republic
| | - Kryštof Slabý
- Department of Rehabilitation and Sports Medicine, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Eduard Zvěřina
- Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University and University Hospital Motol, Postgraduate Medical School, Prague, Czech Republic
| | - Jan Betka
- Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University and University Hospital Motol, Postgraduate Medical School, Prague, Czech Republic
| | - Jan Plzak
- Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University and University Hospital Motol, Postgraduate Medical School, Prague, Czech Republic
| | - Ondřej Čakrt
- Department of Rehabilitation and Sports Medicine, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| |
Collapse
|
30
|
Maslovara S, Butkovic-Soldo S, Peric M, Pajic Matic I, Sestak A. Effect of vestibular rehabilitation on recovery rate and functioning improvement in patients with chronic unilateral vestibular hypofunction and bilateral vestibular hypofunction. NeuroRehabilitation 2019; 44:95-102. [PMID: 30776020 DOI: 10.3233/nre-182524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The minimal number of studies have documented the impact of Vestibular rehabilitation (VR) on the recovery rate of patients with Chronic Unilateral Vestibular Hypofunction (CUVH) and Bilateral Vestibular Hypofunction (BVH). OBJECTIVES The goal of the study was to show and compare the impact of vestibular rehabilitation (VR) in patients with CUVH and BVH. METHODS We analysed the data of 30 patients with CUVH and 20 with BVH treated with VR. The patients with CUVH during their eight-week treatment were controlled every two weeks, while the patients with BVH were controlled every three months during their one-year treatment; they filled in the DHI and ABC questionnaires every time. RESULTS In both groups of patients, there was significantly less disablement between the initial and final DHI scores (from 59-20 in CUVH and 74-41 in BVH group). There was a significant increase in the balance confidence between the initial and final ABC Scale in both groups of patients (from 49.5-90% in CUVH and 42-73% in BVH group). CONCLUSIONS Well-planned and individually adjusted system of vestibular exercises leads to a significant decrease in clinical symptoms and improvement of functioning and confidence in activities in both the CUVH and the BVH patients.
Collapse
Affiliation(s)
- Sinisa Maslovara
- Department of Otolaryngology, County General and Veterans Hospital Vukovar, Vukovar, Croatia.,Department of Otorhinolaryngology and Maxillofacial Surgery, Medical Faculty, University of Osijek, Osijek, Croatia
| | - Silva Butkovic-Soldo
- Department of Neurology, Medical Faculty, University of Osijek, Osijek, Croatia.,Department of Neurology, Clinical Hospital Center Osijek, Osijek, Croatia
| | - Mihaela Peric
- Center for Translational and Clinical Research, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Ivana Pajic Matic
- Department of Otorhinolaryngology and Maxillofacial Surgery, Medical Faculty, University of Osijek, Osijek, Croatia.,ENT Department, General Hospital "Josip Bencevic", Slavonski Brod, Croatia
| | - Anamarija Sestak
- Department of Otolaryngology, County General and Veterans Hospital Vukovar, Vukovar, Croatia
| |
Collapse
|
31
|
Roller RA, Hall CD. A speed-based approach to vestibular rehabilitation for peripheral vestibular hypofunction: A retrospective chart review. J Vestib Res 2018; 28:349-357. [PMID: 29689764 PMCID: PMC9249287 DOI: 10.3233/ves-180633] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: OBJECTIVE: METHODS: RESULTS: CONCLUSIONS:
Collapse
Affiliation(s)
| | - Courtney D. Hall
- James H. Quillen VA Medical Center, Mountain Home, TN, USA
- Department of Physical Therapy, East Tennessee State University, Johnson City, TN, USA
| |
Collapse
|
32
|
Crane BT, Schubert MC. An adaptive vestibular rehabilitation technique. Laryngoscope 2018; 128:713-718. [PMID: 28543062 PMCID: PMC5700867 DOI: 10.1002/lary.26661] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 04/05/2017] [Accepted: 04/11/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVES/HYPOTHESIS There is a large variation in vestibular rehabilitation (VR) results depending on type of therapy, adherence, and the appropriateness for the patient's level of function. A novel adaptive vestibular rehabilitation (AVR) program was developed and evaluated. STUDY DESIGN Technology and procedure development, and prospective multicenter trial. METHODS Those with complete unilateral vestibular hypofunction and symptomatic at least 3 months with a Dizziness Handicap Inventory (DHI) >30 were eligible. Patients were given a device to use with their own computer. They were instructed to use the program daily, with each session lasting about 10 minutes. The task consisted of reporting orientation of the letter C, which appeared when their angular head velocity exceeded a threshold. The letter size and head velocity required were adjusted based on prior performance. Performance on the task was remotely collected by the investigator as well as a weekly DHI score. RESULTS Four patients aged 31 to 74 years (mean = 51 years) were enrolled in this feasibility study to demonstrate efficacy. Two had treated vestibular schwannomas and two had vestibular neuritis. Starting DHI was 32 to 56 (mean = 42), which was reduced to 0 to 16 (mean = 11.5) after a month of therapy, a clinically and statistically significant (P < .05) improvement. The three who continued therapy an additional month improved to a DHI of 4. CONCLUSIONS This AVR method has advantages over traditional VR in terms of cost and customization for patient ability and obtained a major improvement in symptoms. This study demonstrated a clinically and statistically significant decrease in symptoms after 4 weeks of therapy. LEVEL OF EVIDENCE 2b. Laryngoscope, 128:713-718, 2018.
Collapse
Affiliation(s)
- Benjamin T. Crane
- Department of Otolaryngology, University of Rochester
- Department of Neuroscience, University of Rochester
- Department of Bioengineering, University of Rochester
| | - Michael C. Schubert
- Department of Otolaryngology, Johns Hopkins University
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University
| |
Collapse
|
33
|
Tjernström F, Fransson PA, Kahlon B, Karlberg M, Lindberg S, Siesjö P, Magnusson M. PREHAB vs. REHAB – presurgical treatment in vestibular schwannoma surgery enhances recovery of postural control better than postoperative rehabilitation: Retrospective case series. J Vestib Res 2018; 27:313-325. [DOI: 10.3233/ves-170626] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Fredrik Tjernström
- Department of Otorhinolaryngology, Head and Neck Surgery, Skåne University Hospital, Lund, Sweden
| | - Per-Anders Fransson
- Department of Otorhinolaryngology, Head and Neck Surgery, Skåne University Hospital, Lund, Sweden
| | - Babar Kahlon
- Department of Neurosurgery, Clinical Sciences, Skåne University Hospital, Lund, Sweden
| | - Mikael Karlberg
- Department of Otorhinolaryngology, Head and Neck Surgery, Skåne University Hospital, Lund, Sweden
| | - Sven Lindberg
- Department of Otorhinolaryngology, Head and Neck Surgery, Skåne University Hospital, Lund, Sweden
| | - Peter Siesjö
- Department of Neurosurgery, Clinical Sciences, Skåne University Hospital, Lund, Sweden
| | - Måns Magnusson
- Department of Otorhinolaryngology, Head and Neck Surgery, Skåne University Hospital, Lund, Sweden
| |
Collapse
|
34
|
Paul SS, Dibble LE, Walther RG, Shelton C, Gurgel RK, Lester ME. Characterization of Head-Trunk Coordination Deficits After Unilateral Vestibular Hypofunction Using Wearable Sensors. JAMA Otolaryngol Head Neck Surg 2017; 143:1008-1014. [PMID: 28859201 DOI: 10.1001/jamaoto.2017.1443] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance Individuals with vestibular hypofunction acutely restrict head motion to reduce symptoms of dizziness and nausea. This restriction results in abnormal decoupling of head motion from trunk motion, but the character, magnitude, and persistence of these deficits are unclear. Objective To use wearable inertial sensors to quantify the extent of head and trunk kinematic abnormalities in the subacute stage after resection of vestibular schwannoma (VS) and the particular areas of deficit in head-trunk motion. Design, Setting, and Participants This cross-sectional observational study included a convenience sample of 20 healthy adults without vestibular impairment and a referred sample of 14 adults 4 to 8 weeks after resection of a unilateral VS at a university and a university hospital outpatient clinic. Data were collected from November 12, 2015, through November 17, 2016. Exposures Functional gait activities requiring angular head movements, including items from the Functional Gait Assessment (FGA; range, 1-30, with higher scores indicating better performance), the Timed Up & Go test (TUG; measured in seconds), and a 2-minute walk test (2MWT; measured in meters). Main Outcomes and Measures Primary outcomes included peak head rotation amplitude (in degrees), peak head rotation velocity (in degrees per second), and percentage of head-trunk coupling. Secondary outcomes were activity and participation measures including gait speed, FGA score, TUG time, 2MWT distance, and the Dizziness Handicap Inventory score (range, 0-100, with higher scores indicating worse performance). Results A total of 34 participants (14 men and 20 women; mean [SD] age, 39.3 [13.6] years) were included. Compared with the 20 healthy participants, the 14 individuals with vestibular hypofunction demonstrated mean (SD) reduced head turn amplitude (84.1° [15.5°] vs 113.2° [24.4°] for FGA-3), reduced head turn velocities (195.0°/s [75.9°/s] vs 358.9°/s [112.5°/s] for FGA-3), and increased head-trunk coupling (15.1% [6.5%] vs 5.9% [5.8%] for FGA-3) during gait tasks requiring angular head movements. Secondary outcomes were also worse in individuals after VS resection compared with healthy individuals, including gait speed (1.09 [0.27] m/s vs 1.47 [0.22] m/s), FGA score (20.5 [3.6] vs 30.0 [0.2]), TUG time (10.9 [1.7] s vs 7.1 [0.8] s), 2MWT (164.8 [37.6] m vs 222.6 [26.8] m), and Dizziness Handicap Inventory score (35.4 [20.7] vs 0.1 [0.4]). Conclusions and Relevance With use of wearable sensors, deficits in head-trunk kinematics were characterized along with a spectrum of disability in individuals in the subacute stage after VS surgery compared with healthy individuals. Future research is needed to fully understand how patterns of exposure to head-on-trunk movements influence the trajectory of recovery of head-trunk coordination during community mobility.
Collapse
Affiliation(s)
- Serene S Paul
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City.,Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Leland E Dibble
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City
| | - Raymond G Walther
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City
| | - Clough Shelton
- Otolaryngology Division, School of Medicine, University of Utah, Salt Lake City
| | | | - Mark E Lester
- Doctoral Program in Physical Therapy, US Army-Baylor University, Ft Sam Houston, Texas
| |
Collapse
|
35
|
Carender WJ, Grzesiak M. Vestibular rehabilitation following surgical repair for Superior Canal Dehiscence Syndrome: A complicated case report. Physiother Theory Pract 2017; 34:146-156. [PMID: 28891720 DOI: 10.1080/09593985.2017.1374491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Superior Canal Dehiscence Syndrome (SCDS) causes auditory and vestibular symptoms. Following surgical repair of the dehiscence, patients often experience dizziness and imbalance. This case report describes a postoperative vestibular exercise program, focusing on the principles of central compensation and habituation, and how it was modified for a patient with delayed progress secondary to strabismus and visual vertigo. A 63-year-old male with history of strabismus eye surgery, right hearing loss, aural fullness, and sensitivity to loud sounds was referred for vestibular rehabilitation (VR). He was seen for one preoperative and six postoperative PT visits over eight months. Outcome measures two weeks postoperative were as follows: Dizziness Handicap Inventory (DHI) 38/100; Timed Up & Go (TUG) 9.92 seconds; Dynamic Gait Index (DGI) 16/24; and a 3-line difference in Dynamic Visual Acuity (DVA). Improved outcomes at discharge included: DHI 18/100; TUG 6.87 seconds; DGI 23/24; and 1-line difference in DVA. He was able to return to work and previously enjoyed recreational activities. Postoperative vestibular rehabilitation programs are functionally and symptomatically beneficial following surgical repair for SCDS. Deviations from expected recovery should be addressed to achieve optimal outcomes as demonstrated in this complicated case report.
Collapse
Affiliation(s)
- Wendy J Carender
- a Department of Otolaryngology-Head and Neck Surgery , University of Michigan , Ann Arbor , MI , USA
| | - Melissa Grzesiak
- a Department of Otolaryngology-Head and Neck Surgery , University of Michigan , Ann Arbor , MI , USA
| |
Collapse
|
36
|
Alattar AA, Hirshman BR, McCutcheon BA, Chen CC, Alexander T, Harris J, Carter BS. Risk Factors for Readmission with Cerebrospinal Fluid Leakage Within 30 Days of Vestibular Schwannoma Surgery. Neurosurgery 2017. [DOI: 10.1093/neuros/nyx197] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Cerebrospinal fluid (CSF) leak is a well-recognized complication after surgical resection of vestibular schwannomas and is associated with a number of secondary complications, including readmission and meningitis.
OBJECTIVE
To identify risk factors for and timing of 30-d readmission with CSF leak.
METHODS
Patients who had undergone surgical resection of a vestibular schwannoma from 1995 to 2010 were identified in the California Office of Statewide Health Planning and Development database. The most common admission diagnoses were identified by International Classification of Disease, ninth Revision, diagnosis codes, and predictors of readmission with CSF leak were determined using logistic regression.
RESULTS
A total of 6820 patients were identified. CSF leak, though a relatively uncommon cause of admission after discharge (3.52% of all patients), was implicated in nearly half of 490 readmissions (48.98%). Significant independent predictors of readmission with CSF leak were male sex (odds ratio [OR] 1.72, 95% confidence interval [CI] 1.32-2.25), first admission at a teaching hospital (OR 3.32, 95% CI 1.06-10.39), CSF leak during first admission (OR 1.84, 95% CI 1.33-2.55), obesity during first admission (OR 2.10, 95% CI 1.20-3.66), and case volume of first admission hospital (OR of log case volume 0.82, 95% CI 0.70-0.95). Median time to readmission was 6 d from hospital discharge.
CONCLUSION
This study has quantified CSF leak as an important contributor to nearly half of all readmissions following vestibular schwannoma surgery. We propose that surgeons should focus on technical factors that may reduce CSF leakage and take advantage of potential screening strategies for the detection of CSF leakage prior to first admission discharge.
Collapse
Affiliation(s)
- Ali A Alattar
- School of Medicine, University of California San Diego, La Jolla, California
| | - Brian R Hirshman
- Division of Neurological Surgery, University of California San Diego, San Diego, California
- Computation, Organization, and Society Program, School of Computer Science, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | | | - Clark C Chen
- Division of Neurological Surgery, University of California San Diego, San Diego, California
| | - Thomas Alexander
- Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California
| | - Jeffrey Harris
- Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California
| | - Bob S Carter
- Division of Neurological Surgery, University of California San Diego, San Diego, California
| |
Collapse
|
37
|
Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Evidence-Based Clinical Practice Guideline: FROM THE AMERICAN PHYSICAL THERAPY ASSOCIATION NEUROLOGY SECTION. J Neurol Phys Ther 2017; 40:124-55. [PMID: 26913496 PMCID: PMC4795094 DOI: 10.1097/npt.0000000000000120] [Citation(s) in RCA: 254] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Uncompensated vestibular hypofunction results in postural instability, visual blurring with head movement, and subjective complaints of dizziness and/or imbalance. We sought to answer the question, "Is vestibular exercise effective at enhancing recovery of function in people with peripheral (unilateral or bilateral) vestibular hypofunction?" METHODS A systematic review of the literature was performed in 5 databases published after 1985 and 5 additional sources for relevant publications were searched. Article types included meta-analyses, systematic reviews, randomized controlled trials, cohort studies, case control series, and case series for human subjects, published in English. One hundred thirty-five articles were identified as relevant to this clinical practice guideline. RESULTS/DISCUSSION Based on strong evidence and a preponderance of benefit over harm, clinicians should offer vestibular rehabilitation to persons with unilateral and bilateral vestibular hypofunction with impairments and functional limitations related to the vestibular deficit. Based on strong evidence and a preponderance of harm over benefit, clinicians should not include voluntary saccadic or smooth-pursuit eye movements in isolation (ie, without head movement) as specific exercises for gaze stability. Based on moderate evidence, clinicians may offer specific exercise techniques to target identified impairments or functional limitations. Based on moderate evidence and in consideration of patient preference, clinicians may provide supervised vestibular rehabilitation. Based on expert opinion extrapolated from the evidence, clinicians may prescribe a minimum of 3 times per day for the performance of gaze stability exercises as 1 component of a home exercise program. Based on expert opinion extrapolated from the evidence (range of supervised visits: 2-38 weeks, mean = 10 weeks), clinicians may consider providing adequate supervised vestibular rehabilitation sessions for the patient to understand the goals of the program and how to manage and progress themselves independently. As a general guide, persons without significant comorbidities that affect mobility and with acute or subacute unilateral vestibular hypofunction may need once a week supervised sessions for 2 to 3 weeks; persons with chronic unilateral vestibular hypofunction may need once a week sessions for 4 to 6 weeks; and persons with bilateral vestibular hypofunction may need once a week sessions for 8 to 12 weeks. In addition to supervised sessions, patients are provided a daily home exercise program. DISCLAIMER These recommendations are intended as a guide for physical therapists and clinicians to optimize rehabilitation outcomes for persons with peripheral vestibular hypofunction undergoing vestibular rehabilitation.Video Abstract available for more insights from the author (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A124).
Collapse
|
38
|
Rajendran V, Jeevanantham D. Assessment of physical function in geriatric oncology based on International Classification of Functioning, Disability and Health (ICF) framework. CURRENT GERIATRICS REPORTS 2016. [DOI: 10.1007/s13670-016-0162-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
39
|
Whitney SL, Alghadir AH, Anwer S. Recent Evidence About the Effectiveness of Vestibular Rehabilitation. Curr Treat Options Neurol 2016; 18:13. [DOI: 10.1007/s11940-016-0395-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
40
|
Abstract
Data related to the efficacy of vestibular rehabilitation and its evolution as an intervention are provided. Concepts and various treatment strategies are described, with explanations of why people with uncompensated peripheral and central vestibular disorders might improve with rehabilitation. Various tests and measures are described that are commonly used to examine patients and determine their level of ability to participate in their environment. Factors that affect recovery, both positively and negatively, are described in order to better prognosticate recovery. A case utilizing many of the principles discussed is included to provide insight into how to utilize vestibular rehabilitation with a person with an uncompensated peripheral vestibular loss.
Collapse
|
41
|
Prognostic Factors of Balance Quality After Transpetrosal Vestibular Schwannoma Microsurgery. Otol Neurotol 2015; 36:886-91. [DOI: 10.1097/mao.0000000000000740] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
42
|
Huang K, Sparto PJ, Kiesler S, Siewiorek DP, Smailagic A. iPod-based in-home system for monitoring gaze-stabilization exercise compliance of individuals with vestibular hypofunction. J Neuroeng Rehabil 2014; 11:69. [PMID: 24746068 PMCID: PMC3999729 DOI: 10.1186/1743-0003-11-69] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 04/07/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In the physical therapy setting, physical therapists (PTs) often prescribe exercises for their clients to perform at home. However, it is difficult for PTs to obtain information about their clients' compliance with the prescribed exercises, the quality of performance and symptom magnitude. We present an iPod-based system for capturing this information from individuals with vestibular hypofunction while they perform gaze stabilization exercises at home. METHOD The system's accuracy for measurement of rotational velocity against an independent motion tracker was validated. Then a seven day in-home trial was conducted with 10 individuals to assess the feasibility of implementing the system. Compliance was measured by comparing the recorded frequency and duration of the exercises with the exercise prescription. The velocity and range of motion of head movements was recorded in the pitch and yaw planes. The system also recorded dizziness severity before and after each exercise was performed. Each patient was interviewed briefly after the trial to ascertain ease of use. In addition, an interview was performed with PTs in order to assess how the information would be utilized. RESULTS The correlation of the velocity measurements between the iPod-based system and the motion tracker was 0.99. Half of the subjects were under-compliant with the prescribed exercises. The average head velocity during performance was 140 deg/s in the yaw plane and 101 deg/s in the pitch plane. CONCLUSIONS The iPod-based system was able to be used in-home. Interviews with PTs suggest that the quantitative data from the system will be valuable for assisting PTs in understanding exercise performance of patients, documenting progress, making treatment decisions, and communicating patient status to other PTs.
Collapse
Affiliation(s)
- Kevin Huang
- Carnegie Mellon University, 5000 Forbes Ave, Pittsburgh, PA 15213, USA
| | - Patrick J Sparto
- University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213, USA
| | - Sara Kiesler
- Carnegie Mellon University, 5000 Forbes Ave, Pittsburgh, PA 15213, USA
| | | | - Asim Smailagic
- Carnegie Mellon University, 5000 Forbes Ave, Pittsburgh, PA 15213, USA
| |
Collapse
|
43
|
Abstract
PURPOSE To describe the performance of high school adolescents during common functional gait and balance measures used in vestibular physical therapy. METHODS A cross-sectional study of 91 participants determined their performance on the Activities-specific Balance Confidence (ABC) scale, Dynamic Gait Index, Functional Gait Assessment, Timed "Up and Go" (TUG), Five Times Sit to Stand (FTSTS) test, tests of gait speed (GS), and the Balance Error Scoring System. In a subset of this sample, GS, TUG, and the FTSTS were repeated twice to examine test-retest reliability. RESULTS The measures of GS, TUG, and FTSTS were normally distributed. The Activities-specific Balance Confidence, Dynamic Gait Index, and Functional Gait Assessment exhibited a ceiling effect. The timed measures exhibited moderate to good reliability. CONCLUSIONS These performance scores may provide end points for discharge from vestibular physical therapy. However, clinicians should be aware of the ceiling effect exhibited by some measures.
Collapse
|
44
|
Gauchard GC, Parietti-Winkler C, Lion A, Simon C, Perrin PP. Impact of pre-operative regular physical activity on balance control compensation after vestibular schwannoma surgery. Gait Posture 2013; 37:82-7. [PMID: 22824677 DOI: 10.1016/j.gaitpost.2012.06.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 05/31/2012] [Accepted: 06/16/2012] [Indexed: 02/02/2023]
Abstract
Vestibular compensation after unilateral vestibular deafferentation is modulated by certain individual characteristics, such as pre-operative visual neurosensory preference or vestibular pattern. Physical activity (PA) allows the implementation of new sensorimotor and behavioral strategies leading to an improvement of balance control. This study aimed to evaluate the effect of the level of PA before surgery on balance compensatory mechanisms in patients after vestibular schwannoma (VS) surgery. Thirty patients with VS, 15 considered as regularly physically active and 15 as sedentary participated in this study, including an evaluation of gaze control by videonystagmography and postural control by a sensory organization test. Patients considered as physically active before surgery presented the best pattern of postural compensation, with the classical decrease in postural performances at short term (i.e. eight days) and the increase in postural performances at middle and long terms (i.e. 90 and 180 days, respectively) after surgery. For the sedentary patients, the consequences of surgery were more difficult to manage at short term, even though this did not prevent the ability to compensate well later on. Pre-operative practice of PA promotes the neuroplasticity of neural networks involved in motor learning, which allows to benefit of physical therapy more rapidly and efficiently.
Collapse
Affiliation(s)
- Gérome C Gauchard
- National Institute for Health and Medical Research (Inserm), U 954, Thematic group Neurodegenerative diseases, Neuroplasticity, Cognition, Faculty of Medicine, Vandoeuvre-lès-Nancy, France.
| | | | | | | | | |
Collapse
|
45
|
Top-down approach to vestibular compensation: translational lessons from vestibular rehabilitation. Brain Res 2012; 1482:101-11. [PMID: 22981400 DOI: 10.1016/j.brainres.2012.08.040] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Revised: 07/23/2012] [Accepted: 08/23/2012] [Indexed: 12/19/2022]
Abstract
This review examines vestibular compensation and vestibular rehabilitation from a unified translational research perspective. Laboratory studies illustrate neurobiological principles of vestibular compensation at the molecular, cellular and systems levels in animal models that inform vestibular rehabilitation practice. However, basic research has been hampered by an emphasis on 'naturalistic' recovery, with time after insult and drug interventions as primary dependent variables. The vestibular rehabilitation literature, on the other hand, provides information on how the degree of compensation can be shaped by specific activity regimens. The milestones of the early spontaneous static compensation mark the re-establishment of static gaze stability, which provides a common coordinate frame for the brain to interpret residual vestibular information in the context of visual, somatosensory and visceral signals that convey gravitoinertial information. Stabilization of the head orientation and the eye orientation (suppression of spontaneous nystagmus) appear to be necessary by not sufficient conditions for successful rehabilitation, and define a baseline for initiating retraining. The lessons from vestibular rehabilitation in animal models offer the possibility of shaping the recovery trajectory to identify molecular and genetic factors that can improve vestibular compensation.
Collapse
|
46
|
Singh S, Gupta RK, Kumar P. Vestibular evoked myogenic potentials in children with sensorineural hearing loss. Int J Pediatr Otorhinolaryngol 2012; 76:1308-11. [PMID: 22721524 DOI: 10.1016/j.ijporl.2012.05.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Revised: 05/21/2012] [Accepted: 05/25/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE OF THE STUDY To assess the saccular function using the vestibular evoked myogenic potential (VEMP) test in children with severe to profound sensorineural hearing loss. METHODS 15 children (12 males and 3 females) with severe to profound sensorineural hearing loss in the age range of 4-12 years constituted the study group. 10 children (6 males and 4 females) with normal hearing constituted the control group. All the children were evaluated for saccular function by using the vestibular evoked myogenic potentials (VEMP). RESULTS For study group the mean P1 and N1 latencies values were 15.12ms and 23.86ms, respectively. For control group the mean P1 and N1 latencies were 15.39ms and 23.68ms. The comparison of mean P1 and N1 latencies values between study and control groups revealed no significant difference (p>0.05). Furthermore, the mean amplitude values of VEMP responses for study and control groups were 75.78μV and 160.51μV, respectively. The comparison mean amplitude values between study and control groups revealed statistically significant difference (p<0.05). Out of 15 children in the study group 2 children had the absent VEMP response in both the ears. CONCLUSION Because the vestibular function plays an important role in gross motor development in children, audiologists and otologist should recognize and understand the vestibular dysfunction in hearing impaired children and be prepared to undertake appropriate evaluations. However, additional research is needed on a larger sample size to determine the value of routine vestibular evaluation in children with sensorineural hearing loss and its potential benefit on the clinical outcome of these patients along with VEMP testing.
Collapse
Affiliation(s)
- Satbir Singh
- All India Institute of Speech & Hearing, Mysore 570006, India.
| | | | | |
Collapse
|
47
|
Alsalaheen BA, Whitney SL, Mucha A, Morris LO, Furman JM, Sparto PJ. Exercise prescription patterns in patients treated with vestibular rehabilitation after concussion. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2012; 18:100-8. [PMID: 22786783 DOI: 10.1002/pri.1532] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 03/01/2012] [Accepted: 05/10/2012] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Individuals with concussion often complain of persistent dizziness and imbalance, and these problems have been treated with vestibular rehabilitation exercises. The purpose of this study is to describe the vestibular rehabilitation exercise prescriptions provided to individuals after concussion. METHODS A retrospective chart review of vestibular rehabilitation home exercise programmes prescribed by physical therapists for 104 participants who were diagnosed with concussion was conducted. Each of the exercises was classified by exercise type, duration and frequency. Frequency counts of the most common exercise types were recorded. Exercise progression patterns were examined by determining how exercise types were modified from visit to visit. RESULTS Eye-head coordination exercises were the most commonly prescribed exercise type (in 95% of participants), followed by standing static balance exercises (in 88% of participants), and ambulation exercises (in 76% of participants). CONCLUSIONS Understanding the prescription patterns of expert clinicians may elucidate the vestibular-related impairments of individuals after concussion and may provide a resource for therapists who may be starting vestibular rehabilitation programmes for management of individuals with concussion. To improve quality of care, future research should be directed to relate outcomes to the exercise prescription patterns.
Collapse
Affiliation(s)
- Bara A Alsalaheen
- University Of Pittsburgh, Department of Physical Therapy, Pittsburgh, PA, USA
| | | | | | | | | | | |
Collapse
|
48
|
|
49
|
Herdman SJ, Hall CD, Delaune W. Variables Associated With Outcome in Patients With Unilateral Vestibular Hypofunction. Neurorehabil Neural Repair 2011; 26:151-62. [PMID: 21959673 DOI: 10.1177/1545968311407514] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Not all individuals with unilateral vestibular hypofunction (UVH) have fewer subjective complaints and improved function after vestibular rehabilitation. Objective. To identify factors and/or combinations of factors that are strongly associated with rehabilitation outcome in patients with UVH and that ultimately can be used to develop models to predict outcome. Methods. Data from 209 patients with UVH were analyzed. All patients participated in similar vestibular rehabilitation (5 weeks of home exercises and once-weekly clinic visits). Outcome measures included intensity of oscillopsia and dysequilibrium, balance confidence, perceived disability, percentage of time symptoms interfered with activities, gait speed, fall risk, and dynamic visual acuity (DVA). Bivariate correlation and regression analysis were used to determine relationships between baseline (pretherapy) measures and outcome at discharge. Results. No baseline measure of subjective complaints (eg, symptom intensity) predicted improvement of physical function (eg, gait speed). Similarly, no baseline measure of physical function predicted improvement of subjective complaints. Certain patient characteristics, such as gender and time from onset, were not related to any outcomes. Most comorbidities did not affect outcome; however, anxiety and/or depression were associated with lower balance confidence and higher percentage of time for which symptoms interfered with activities at discharge. Baseline DVA and gait speed were associated with DVA and gait speed at discharge, respectively. Dynamic gait index (DGI) at discharge was affected by age, baseline DGI, and history of falls. Conclusion. These results provide insight into recovery of patients with UVH. Therapists can use this information in the development of expectations for patient outcome and treatment priorities.
Collapse
Affiliation(s)
- Susan J. Herdman
- Emory University School of Medicine, Atlanta, GA, USA
- Rehabilitation Research & Development Center, Atlanta VAMC, Decatur, GA, USA
| | - Courtney D. Hall
- Emory University School of Medicine, Atlanta, GA, USA
- Rehabilitation Research & Development Center, Atlanta VAMC, Decatur, GA, USA
| | - William Delaune
- Rehabilitation Research & Development Center, Atlanta VAMC, Decatur, GA, USA
| |
Collapse
|
50
|
Alrwaily M, Whitney SL. Vestibular rehabilitation of older adults with dizziness. Otolaryngol Clin North Am 2011; 44:473-96, x. [PMID: 21474018 DOI: 10.1016/j.otc.2011.01.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The role of rehabilitation for treatment of older adults with dizziness and balance disorders is reviewed. Theories related to functional recovery from peripheral and central vestibular disorders are presented. Suggestions on which older adults might benefit from vestibular rehabilitation therapy are presented. Promising innovative rehabilitation strategies and technologies that might enhance recovery of the older adult with balance dysfunction are discussed.
Collapse
Affiliation(s)
- Muhammad Alrwaily
- Department of Physical Therapy, University of Pittsburgh, 6035 Forbes Tower, Pittsburgh, PA 15260, USA
| | | |
Collapse
|