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Cohen HS, Plankey MW, Ware D. A Retrospective Study of the Relationship Between Hypertension and Vestibular Disorders in Middle-Aged Women With and Without HIV. Cureus 2023; 15:e34988. [PMID: 36938264 PMCID: PMC10019901 DOI: 10.7759/cureus.34988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Patients often conflate the problem of lightheadedness from hypertension (HTN) and vertigo from a vestibular impairment, describing both problems as dizziness. The goal of the study was to learn if there is a relationship between measures of vestibular function and blood pressure. METHODS This retrospective study consisted of women who participated in a longitudinal study of the human immunodeficiency virus (HIV) and a control cohort of age-matched women without HIV. We used data from the point in time when participants were tested for vestibular functions with bi-thermal caloric tests and cervical vestibular evoked myogenic potentials; the data also included the blood pressure of the participants. RESULTS High odds ratios (1.48 to 2.05) suggest a relationship between HTN and vestibular impairment, although the sample size was too small to reach statistical significance. CONCLUSION The data suggest that high blood pressure may be related to vestibular impairments. Clinicians whose patients complain of vertigo and balance disorders consistent with vestibular impairments should consider blood pressure as a related problem during the initial visit.
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Affiliation(s)
- Helen S Cohen
- Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, USA
| | | | - Deanna Ware
- Medicine, Georgetown University Medical Center, Washington DC, USA
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2
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Millar A, Joubert K, Naude A. Prevalence of Peripheral Vestibular Impairment in Adults with Human Immunodeficiency Virus. J Audiol Otol 2020; 25:36-42. [PMID: 32829624 PMCID: PMC7835440 DOI: 10.7874/jao.2020.00164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/21/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Globally, the human immunodeficiency virus (HIV) is responsible for one of the most serious pandemics to date. The vulnerability of the vestibular system in individuals with HIV has been confirmed, and central vestibular impairments have been frequently reported. However, there are disagreements on the impact of HIV on peripheral vestibular function. Thus, the current study aimed to determine the prevalence of peripheral vestibular impairment, specifically related to the semi-circular canals (SCCs), in HIV-positive individuals receiving antiretroviral (ARV) treatment. SUBJECTS AND METHODS A total of 92 adults between the ages of 18 and 50 years (divided into two groups) participated in the study. The first group comprised HIV-positive individuals receiving ARV treatment (n1=60), and the second group comprised HIV-negative participants (n2=32). The video head impulse test was used to conduct the head impulse paradigm (HIMP). RESULTS Bilateral normal HIMP results were obtained in 95% of the HIV-positive participants and all HIV-negative participants. The gain of the left posterior SCCs was significantly lower in the HIV-positive group, while the gains of all other canals between the two groups were comparable. CONCLUSIONS The prevalence of peripheral vestibular impairment in the HIV-positive group was not significantly different from that of the HIV-negative group. The reduced prevalence in the current study may be attributed to participant characteristics, the test battery employed, and the central compensation of the vestibular dysfunctions at the later stages of infection.
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Affiliation(s)
| | - Karin Joubert
- Department of Audiology, Faculty of Humanities, University of the Witwatersrand, Johannesburg, South Africa.,Ndlovu Wits Audiology Clinic, Groblersdal, South Africa
| | - Alida Naude
- Centre for Augmentative and Alternative Communication, Faculty of Humanities, University of Pretoria, Hatfield, South Africa
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Screening for Vestibular Disorders Using the Modified Clinical Test of Sensory Interaction and Balance and Tandem Walking With Eyes Closed. Otol Neurotol 2020; 40:658-665. [PMID: 31083095 DOI: 10.1097/mao.0000000000002173] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Determine accurate cut-points and optimal combinations of screening tests of balance to detect patients with vestibular disorders. STUDY DESIGN Case-control study. SETTING Out-patient tertiary care. SUBJECTS AND METHODS Community-dwelling adults, without known neurological deficits or significant musculoskeletal disorders, including patients with vestibular disorders and healthy controls without vestibular disorders were tested while standing on medium density compliant foam with feet together and eyes closed under three head movement conditions, head stationary, and head moving in yaw and pitch at 0.33 Hz, for up to 30 seconds per trial. Dependent measures were trial duration, number of head movements during head movement trials, trunk kinematic measures, and number of correct tandem steps during tandem walking trials. RESULTS Receiver operator characteristics (ROC), sensitivity and specificity, and specific cut-points were calculated. Individual tests had moderate ROC values, from 0.67 to 0.84. ROC values were higher in the head moving trials than the head stationary trial and best for subjects aged 40 to 79. Using combined analyses of two or more tests, including published data on tandem walking, ROC values were higher, 0.80 to 0.90. Age- and sex-related performance differences were found. CONCLUSION Balance skills in standing and walking differ, so testing both skills is optimal and increases the likelihood of finding a deficit. Patients should be compared to age-appropriate norms. Kinematics and number of head movements were not very useful. This combined set of rapid, low-tech balance tests is useful in an initial approach to screening patients who may have vestibular disorders.
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Millar A, Joubert K, Naude A. Prevalence of hearing loss and tinnitus in a group of adults with Human Immunodeficiency Virus. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2020; 67:e1-e7. [PMID: 32129664 PMCID: PMC7059238 DOI: 10.4102/sajcd.v67i1.631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 07/25/2019] [Accepted: 08/06/2019] [Indexed: 11/16/2022] Open
Abstract
Background The Human Immunodeficiency Virus (HIV) has become a global pandemic. With the improvement of antiretroviral (ARV) treatment regimens, life-expectancy of HIV-positive individuals has increased. HIV literature suggests that head and neck manifestations may be the first indication of supressed immunity. Therefore, research regarding the effects of HIV and new treatment regimens on auditory function remains a priority. Objectives To describe the audiological characteristics and determine the prevalence of hearing loss and tinnitus in a group of HIV-positive individuals on ARV treatment residing in a rural province. Methods The study employed a cross-sectional descriptive research design. Participants were recruited from the clinic and pharmacy waiting areas of a medical centre in a rural area of Limpopo province, South Africa. Two participant groups, an HIV-positive group (N1 = 60) and an HIV-negative group (N2 = 32) were included in the study. The test battery comprised a comprehensive case history and a routine audiological test battery, which included otoscopy, tympanometry and pure tone audiometry (250 Hz to 8000 Hz). Results No statistically significant difference was found regarding the prevalence of hearing loss in the two participant groups (p = 0.709). However, the prevalence of tinnitus was significantly higher in the HIV-positive group (p = 0.05). Conclusion The insignificant difference in the audiological test battery results found between the two participant groups may be due to improved ARV treatment regimens and management strategies employed at the medical centre. However, the increased prevalence of tinnitus in the HIV-positive group may also be attributed to the ARV regimen and/or the result of subtle damage to the auditory system, which was not identified by the current audiological test battery. More insight may be obtained about the effects of HIV on hearing by employing a longitudinal research design and inclusion of a more ototoxicity sensitive test battery.
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Affiliation(s)
- Alison Millar
- Department of Speech Pathology and Audiology, University of the Witwatersrand, Johannesburg.
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Pichert MD, Plankey MW, Springer G, Cox C, Hoffman HJ, Cohen HS. Vestibular and oculomotor abnormalities among HIV-infected and HIV-uninfected men and women: A pilot study. J Vestib Res 2020; 30:329-334. [PMID: 32741798 PMCID: PMC11058317 DOI: 10.3233/ves-200707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine if middle-aged and aging men and women with HIV disease (HIV+) should be screened for vestibular and oculomotor dysfunction. METHODS Age- and sociodemographically matched HIV+ and HIV- men and women were tested on vestibular evoked myogenic potential (VEMP), bi-thermic caloric testing, Dix-Hallpike maneuvers and saccades. RESULTS HIV+ men had more caloric weakness than HIV- men. HIV+ subjects had more saccade abnormalities than HIV- subjects. A saccade abnormality was positively associated with being HIV+. Among the HIV+ sample, abnormalities were associated with increasing age, being male, ever taking monotherapy, and having an undetectable viral load. Only being male and having an undetectable viral load were statistically significant. Unilateral caloric weakness had a decreased prevalence with age per 10 years, and being HIV+ showed an increased prevalence. In HIV+ subjects only, these abnormalities decreased with age and being male but increased with undetectable viral load and ever taking antiretroviral monotherapy. No statistically significant differences were found. CONCLUSION Women are at greater risk of vestibular and oculomotor abnormalities than men. HIV+ adults are at greater risk than HIV- adults. Physicians who care for HIV+ men and women should monitor the symptoms of vestibular and oculomotor impairment.
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Affiliation(s)
| | | | - Gayle Springer
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Christopher Cox
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Howard J. Hoffman
- National Institute on Deafness and Other Communication Disorders, National Instiutes of Health, Bethesda, MD
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Quigley A, MacKay-Lyons M. Physical deficits among people living with HIV: a review of the literature and implications for rehabilitation. PHYSICAL THERAPY REVIEWS 2019. [DOI: 10.1080/10833196.2019.1701763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Adria Quigley
- Department of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Marilyn MacKay-Lyons
- Department of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
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7
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Mahomed W, Heinze BM, Vinck BH, Stoltz A. Auditory, video head impulse test and vestibular evoked myogenic potentials findings in adults with human immunodeficiency virus. Auris Nasus Larynx 2019; 47:367-376. [PMID: 31862282 DOI: 10.1016/j.anl.2019.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/12/2019] [Accepted: 11/29/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Even though there is an association between hearing loss and human immunodeficiency virus (HIV), particularly in low- and middle-income countries, further research is needed to investigate the nature of such hearing loss. Likewise, despite documented vestibular alterations in people with HIV, the true occurrence, presentation, and nature of these manifestations are yet to be established. Advances in technology for vestibular testing has allowed for objective site-of-lesion tests such as the video head impulse test (vHIT), cervical vestibular evoked myogenic potentials (cVEMPs) and ocular vestibular evoked myogenic potential (oVEMPs). The current study aimed to compare and describe auditory, vHIT, cVEMPs and oVEMPs findings in adults with and without HIV. METHODS The current study included an HIV positive group (n = 30) and an HIV negative group (n = 30) who underwent an auditory assessment (tympanometry and pure tone audiometry) and objective vestibular assessments. RESULTS The occurrence of hearing loss was 53.3% in the HIV positive group compared to 33.3% in the HIV negative group. A higher occurrence of vestibular involvement was documented in the HIV positive group (73.3%) compared to 13.3% in the HIV negative group. CONCLUSION Auditory assessment and objective measures of vestibular end-organ function (vHIT and VEMPs) can be useful to detect sub-clinical alterations. The equipment is mobile and can be performed in any health care setting such as infectious disease clinics for surveillance and monitoring purposes.
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Affiliation(s)
- Waseema Mahomed
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Private bag X20, Hatfield 0028, Pretoria, South Africa
| | - Barbara M Heinze
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Private bag X20, Hatfield 0028, Pretoria, South Africa.
| | - Bart Hme Vinck
- Department of Speech and Hearing Sciences, Ghent University, University Hospital Ghent, 10 Corneel Heymanslaan, 9000 Gent, Belgium
| | - Anton Stoltz
- Department of Internal Medicine, Steve Biko Academic Hospital, Private bag X20, Hatfield 0028, Pretoria, South Africa
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8
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Cohen HS. A review on screening tests for vestibular disorders. J Neurophysiol 2019; 122:81-92. [PMID: 30995137 PMCID: PMC6689777 DOI: 10.1152/jn.00819.2018] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 04/12/2019] [Accepted: 04/13/2019] [Indexed: 01/08/2023] Open
Abstract
Although many studies have reported on tests of the vestibular system a valid and reliable, evidence-based screening battery for easy clinical use remains elusive. Many screening tests attempt to assess the vestibulo-ocular reflex. Therefore, head shaking, the Dix-Hallpike maneuver, the supine roll test, and head impulse tests are discussed. Other tests address the spatial orientation functions of the vestibular system, such as the Bucket Test and the Fukuda Stepping test. Still, other tests are based on the known correlates with balance skills, both static and dynamic, such as tandem walking and the modern variation of the Romberg test, the modified Clinical Test of Sensory Interaction and Balance. This review provides a critical overview of the literature on some of these tests and their value for clinical use and in epidemiological studies.
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Affiliation(s)
- Helen S Cohen
- Bobby R. Alford Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine , Houston, Texas
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Berner K, Morris L, Baumeister J, Louw Q. Objective impairments of gait and balance in adults living with HIV-1 infection: a systematic review and meta-analysis of observational studies. BMC Musculoskelet Disord 2017; 18:325. [PMID: 28764704 PMCID: PMC5540197 DOI: 10.1186/s12891-017-1682-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 07/17/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Gait and balance deficits are reported in adults with HIV infection and are associated with reduced quality of life. Current research suggests an increased fall-incidence in this population, with fall rates among middle-aged adults with HIV approximating that in seronegative elderly populations. Gait and postural balance rely on a complex interaction of the motor system, sensory control, and cognitive function. However, due to disease progression and complications related to ongoing inflammation, these systems may be compromised in people with HIV. Consequently, locomotor impairments may result that can contribute to higher-than-expected fall rates. The aim of this review was to synthesize the evidence regarding objective gait and balance impairments in adults with HIV, and to emphasize those which could contribute to increased fall risk. METHODS This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An electronic search of published observational studies was conducted in March 2016. Methodological quality was assessed using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Narrative synthesis of gait and balance outcomes was performed, and meta-analyses where possible. RESULTS Seventeen studies were included, with fair to low methodological quality. All studies used clinical tests for gait-assessment. Gait outcomes assessed were speed, initiation-time and cadence. No studies assessed kinetics or kinematics. Balance was assessed using both instrumented and clinical tests. Outcomes were mainly related to center of pressure, postural reflex latencies, and timed clinical tests. There is some agreement that adults with HIV walk slower and have increased center of pressure excursions and -long loop postural reflex latencies, particularly under challenging conditions. CONCLUSIONS Gait and balance impairments exist in people with HIV, resembling fall-associated parameters in the elderly. Impairments are more pronounced during challenging conditions, might be associated with disease severity, are not influenced by antiretroviral therapy, and might not be associated with peripheral neuropathy. Results should be interpreted cautiously due to overall poor methodological quality and heterogeneity. Locomotor impairments in adults with HIV are currently insufficiently quantified. Future research involving more methodological uniformity is warranted to better understand such impairments and to inform clinical decision-making, including fall-prevention strategies, in this population.
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Affiliation(s)
- Karina Berner
- Division of Physiotherapy/Central Analytical Facilities (CAF) 3D Human Biomechanics Unit, Department of Rehabilitation & Health Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000 South Africa
| | - Linzette Morris
- Division of Physiotherapy/Central Analytical Facilities (CAF) 3D Human Biomechanics Unit, Department of Rehabilitation & Health Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000 South Africa
| | - Jochen Baumeister
- Exercise & Neuroscience Unit, Institute of Health, Nutrition and Sports Sciences, Europa-Universität Flensburg, Auf dem Campus 1, 24943 Flensburg, Germany
| | - Quinette Louw
- Division of Physiotherapy/Central Analytical Facilities (CAF) 3D Human Biomechanics Unit, Department of Rehabilitation & Health Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000 South Africa
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10
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Erlandson KM, Plankey MW, Springer G, Cohen HS, Cox C, Hoffman HJ, Yin MT, Brown TT. Fall frequency and associated factors among men and women with or at risk for HIV infection. HIV Med 2017; 17:740-748. [PMID: 27028463 DOI: 10.1111/hiv.12378] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Falls and fall-related injuries are a major public health concern. HIV-infected adults have been shown to have a high incidence of falls. Identification of major risk factors for falls that are unique to HIV infection or similar to those in the general population will inform development of future interventions for fall prevention. METHODS HIV-infected and uninfected men and women participating in the Hearing and Balance Substudy of the Multicenter AIDS Cohort Study and Women's Interagency HIV Study were asked about balance symptoms and falls during the prior 12 months. Falls were categorized as 0, 1, or ≥ 2; proportional odds logistic regression models were used to investigate relationships between falls and demographic and clinical variables and multivariable models were created. RESULTS Twenty-four per cent of 303 HIV-infected participants reported at least one fall compared with 18% of 233 HIV-uninfected participants (P = 0.27). HIV-infected participants were demographically different from HIV-uninfected participants, and were more likely to report clinical imbalance symptoms (P ≤ 0.035). In univariate analyses, more falls were associated with hepatitis C, female sex, obesity, smoking, and clinical imbalance symptoms, but not age, HIV serostatus or other comorbidities. In multivariable analyses, female sex and imbalance symptoms were independently associated with more falls. Among HIV-infected participants, smoking, a higher number of medications, and imbalance symptoms remained independent fall predictors, while current protease inhibitor use was protective. CONCLUSIONS Similar rates of falls among HIV-infected and uninfected participants were largely explained by a high prevalence of imbalance symptoms. Routine assessment of falls and dizziness/imbalance symptoms should be considered, with interventions targeted at reducing symptomatology.
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Affiliation(s)
- K M Erlandson
- Department of Medicine, Divisions of Infectious Diseases and Geriatric Medicine, University of Colorado, Aurora, CO, USA.
| | - M W Plankey
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, USA
| | - G Springer
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - H S Cohen
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - C Cox
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - H J Hoffman
- Epidemiology and Statistics Program, National Institute on Deafness and Other Communication Disorders (NIDCD), National Institutes of Health (NIH), Bethesda, MD, USA
| | - M T Yin
- Department of Medicine, Division of Infectious Diseases, Columbia University Medical Center, New York, NY, USA
| | - T T Brown
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins University, Baltimore, MD, USA
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Khoza-Shangase K, Jade Van Rie K. Pathological vestibular symptoms presenting in a group of adults with HIV/AIDS in Johannesburg, South Africa. S Afr J Infect Dis 2017. [DOI: 10.1080/23120053.2016.1216816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Katijah Khoza-Shangase
- Department of Speech Pathology and Audiology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Kayla Jade Van Rie
- Department of Speech Pathology and Audiology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
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12
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Sankarpandi SK, Baldwin AJ, Ray J, Mazzà C. Reliability of inertial sensors in the assessment of patients with vestibular disorders: a feasibility study. BMC EAR, NOSE, AND THROAT DISORDERS 2017; 17:1. [PMID: 28184173 PMCID: PMC5289044 DOI: 10.1186/s12901-017-0034-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 01/08/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Vestibular disorders affect an individual's stability, balance, and gait and predispose them to falls. Traditional laboratory-based semi-objective vestibular assessments are intrusive and cumbersome provide little information about their functional ability. Commercially available wearable inertial sensors allow us to make this real life assessments objective, with a detailed view of their functional abilities. Timed Up and Go (TUG) and Postural Sway tests are commonly used tests for gait and balance assessments. Our aim was to assess the feasibility, test-retest reliability and ability to classify fall status in individuals with vestibular disorders using parameters derived from the commercially available wearable system (inertial sensors and the Mobility Lab Software, APDM, Inc.). METHODS We recruited 27 individuals diagnosed either with unilateral or bilateral vestibular loss on vestibular function testing. Instrumented Timed Up and Go (iTUG) and Postural Sway (iSway) were administered three times during the first session and then repeated at a similar time the following week. To evaluate within and between sessions reliability of the parameters the Intra-Class Correlation coefficient (ICC) was used. Subsequently, the ability of reliable parameters (ICC ≥ 0.8) to classify fallers from non-fallers was estimated. RESULTS The iTUG test parameters showed good within and between sessions' reliability with mean ICC (between-sessions) values of 0.81 ± 0.17 and 0.69 ± 0.15, respectively. For the iSway test, the relative figures were; 0.76 ± 0.13 and 0.71 ± 0.14, respectively. A retrospective falls classification analysis with past 12 months falls history data yielded an accuracy of 66.70% with an area under the curve of 0.79. Mean Distance from centre of COP (mm) of accelerometer's trajectory (m/s2) from the iSway test was the only significant parameter to classify fallers from non-fallers. CONCLUSIONS Using a commercially available wearable system a subset of reliable iTUG and iSway parameters were identified and their ability to classify fallers were estimated. These parameters have potential to augment assessments of vestibular patients to enable clinicians and therapists to provide objective, tailored, personalised interventions for their gait and postural control and also to objectively evaluate and monitor the efficiency of their interventions.
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Affiliation(s)
- Sathish K Sankarpandi
- INSIGNEO Institute for in silico Medicine, University of Sheffield, Sheffield, UK.,School of Health Sciences, University of Salford, Manchester, UK.,University of Salford, 111, Crescent House, England M5 4WT UK
| | - Alice J Baldwin
- Ear, Nose and Throat Surgery Department, Sheffield Teaching Hospitals, Sheffield, UK
| | - Jaydip Ray
- Ear, Nose and Throat Surgery Department, Sheffield Teaching Hospitals, Sheffield, UK.,School of Health Sciences, University of Salford, Manchester, UK
| | - Claudia Mazzà
- INSIGNEO Institute for in silico Medicine, University of Sheffield, Sheffield, UK.,Department of Mechanical Engineering, University of Sheffield, Sheffield, UK
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Abstract
This article, based on the 52nd Eleanor Clarke Slagle lecture given at the 95th American Occupational Therapy Association Annual Conference & Expo, explores the concept of inquiry as the basis for a career and as an activity of daily living. Using the heliocentric theory and the space program at NASA as examples, the broad concept of inquiry is discussed, because it has led to important changes in society over the course of history. The article describes how a career as a clinician-scientist can be grounded in the concept of inquiry and explains how all occupational therapists and occupational therapy assistants can base their own careers in inquiry, using examples from the early history of the profession of occupational therapy and from work by current investigators. Practical suggestions applicable to every clinician are provided.
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Affiliation(s)
- Helen S Cohen
- Helen S. Cohen, EdD, OTR, FAOTA, is Professor, Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX;
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Cohen HS, Mulavara AP, Sangi-Haghpeykar H, Peters BT, Bloomberg JJ, Pavlik VN. Screening people in the waiting room for vestibular impairments. South Med J 2014; 107:549-53. [PMID: 25188617 DOI: 10.14423/smj.000000000000017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Primary care physicians need good screening tests of the vestibular system to help them determine whether patients who complain of dizziness should be evaluated for vestibular disorders. The goal of this study was to determine whether current, widely used screening tests of the vestibular system predict subsequent performance on objective diagnostic tests of the vestibular system (ENG). METHODS Of 300 subjects who were recruited from the waiting room of a primary care clinic and were screened there, 69 subjects subsequently volunteered for ENGs in the otolaryngology department. The screening study included age, history of vertigo, head impulse tests, Dix-Hallpike maneuvers, and the Clinical Test of Sensory Integration and Balance with the head still and the head pitching at 0.33 Hz. The ENG included Dix-Hallpike maneuvers, vestibular-evoked myogenic potentials, bithermal water caloric tests, and low-frequency sinusoids in the rotatory chair in darkness. RESULTS The scores on the screening were related to the total ENG, but odds ratios were not significant for some variables, probably because of the small sample size. CONCLUSIONS A larger sample may have yielded stronger results, but in general the high odds ratios suggest a relation between the ENG score and Dix-Hallpike responses and between the ENG scores and some Clinical Test of Sensory Integration and Balance responses.
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Affiliation(s)
- Helen S Cohen
- From the Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, the Department of Obstetrics and Gynecology, and the Department of Family and Community Medicine, Baylor College of Medicine, Universities Space Research Association, Wyle Science, Technology and Engineering Group, and the Neuroscience Laboratories, NASA/Johnson Space Center, Houston, Texas
| | - Ajitkumar P Mulavara
- From the Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, the Department of Obstetrics and Gynecology, and the Department of Family and Community Medicine, Baylor College of Medicine, Universities Space Research Association, Wyle Science, Technology and Engineering Group, and the Neuroscience Laboratories, NASA/Johnson Space Center, Houston, Texas
| | - Haleh Sangi-Haghpeykar
- From the Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, the Department of Obstetrics and Gynecology, and the Department of Family and Community Medicine, Baylor College of Medicine, Universities Space Research Association, Wyle Science, Technology and Engineering Group, and the Neuroscience Laboratories, NASA/Johnson Space Center, Houston, Texas
| | - Brian T Peters
- From the Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, the Department of Obstetrics and Gynecology, and the Department of Family and Community Medicine, Baylor College of Medicine, Universities Space Research Association, Wyle Science, Technology and Engineering Group, and the Neuroscience Laboratories, NASA/Johnson Space Center, Houston, Texas
| | - Jacob J Bloomberg
- From the Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, the Department of Obstetrics and Gynecology, and the Department of Family and Community Medicine, Baylor College of Medicine, Universities Space Research Association, Wyle Science, Technology and Engineering Group, and the Neuroscience Laboratories, NASA/Johnson Space Center, Houston, Texas
| | - Valory N Pavlik
- From the Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, the Department of Obstetrics and Gynecology, and the Department of Family and Community Medicine, Baylor College of Medicine, Universities Space Research Association, Wyle Science, Technology and Engineering Group, and the Neuroscience Laboratories, NASA/Johnson Space Center, Houston, Texas
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Does the human immunodeficiency virus influence the vestibulocollic reflex pathways? A comparative study. The Journal of Laryngology & Otology 2014; 128:772-9. [PMID: 25166876 DOI: 10.1017/s0022215114001996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND This study compared vestibulocollic reflex and vestibulo-ocular reflex functioning in subjects with and without human immunodeficiency virus. It also described test results throughout progression of the disease and compared the results of human immunodeficiency virus positive subjects who were receiving antiretroviral therapies with those not receiving this treatment. METHODS Subjects comprised 53 adults with human immunodeficiency virus (mean age 38.5 ± 4.4 years) and 38 without human immunodeficiency virus (mean age 36.9 ± 8.2 years). Clinical examinations included cervical vestibular-evoked myogenic potential and bithermal caloric testing. RESULTS Abnormal cervical vestibular-evoked myogenic potential and caloric results were significantly higher in the human immunodeficiency virus positive group (p = 0.001), with an odds ratio of 10.2. Vestibulocollic reflex and vestibulo-ocular reflex involvement increased with progression of the disease. There were more abnormal test results in subjects receiving antiretroviral therapies (66.7 per cent) than in those not receiving antiretroviral therapies (63.6 per cent), but this difference was insignificant. CONCLUSION Human immunodeficiency virus seems to influence vestibulocollic reflex pathways. Combining cervical vestibular-evoked myogenic potential and caloric testing may be useful to detect early neurological involvement in human immunodeficiency virus positive subjects.
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Heinze BM, Vinck BM, Hofmeyr LM, Swanepoel DW. Vestibular involvement in adults with HIV/AIDS. Auris Nasus Larynx 2014; 41:160-8. [DOI: 10.1016/j.anl.2013.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 08/16/2013] [Accepted: 09/20/2013] [Indexed: 11/29/2022]
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Cohen HS, Mulavara AP, Peters BT, Sangi-Haghpeykar H, Bloomberg JJ. Standing balance tests for screening people with vestibular impairments. Laryngoscope 2013; 124:545-50. [PMID: 23877965 DOI: 10.1002/lary.24314] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To improve the test standards for a version of the Romberg test and to determine whether measuring kinematic variables improved its utility for screening. STUDY DESIGN Healthy controls and patients with benign paroxysmal positional vertigo, postoperative acoustic neuroma resection, and chronic peripheral unilateral weakness were compared. METHODS Subjects wore Bluetooth-enabled inertial motion units while standing on the floor or medium-density, compliant foam, with eyes open or closed, with head still or moving in pitch or yaw. Dependent measures were time to perform each test condition, number of head movements made, and kinematic variables. RESULTS Patients and controls did not differ significantly with eyes open or with eyes closed while on the floor. With eyes closed, on foam, some significant differences were found between patients and controls, especially for subjects older than 59 years. Head movement conditions were more challenging than with the head still. Significantly fewer patients than controls could make enough head movements to obtain kinematic measures. Kinematics indicated that lateral balance control is significantly reduced in these patients compared to controls. Receiver operator characteristics and sensitivity/specificity analyses showed moderately good differences with older subjects. CONCLUSIONS Tests on foam with eyes closed, with head still or moving, may be useful as part of a screening battery for vestibular impairments, especially for older people. LEVEL OF EVIDENCE 3b.
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Affiliation(s)
- Helen S Cohen
- Bobby R. Alford Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, U.S.A
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Mulavara AP, Cohen HS, Peters BT, Sangi-Haghpeykar H, Bloomberg JJ. New analyses of the sensory organization test compared to the clinical test of sensory integration and balance in patients with benign paroxysmal positional vertigo. Laryngoscope 2013; 123:2276-80. [PMID: 23553110 DOI: 10.1002/lary.24075] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 12/26/2012] [Accepted: 02/05/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine whether the Sensory Organization Test (SOT) of the computerized dynamic posturography battery or the Clinical Test of Sensory Integration and Balance (CTSIB) is more likely to indicate balance disorders in people with benign paroxysmal positional vertigo (BPPV). STUDY DESIGN Normal controls were compared to patients with unilateral BPPV of the posterior semicircular canal. METHODS Subjects performed tests with eyes open or closed on stable and unstable surfaces, with head still or with head moving at 0.33 Hz in pitch or yaw. Dependent variables were the percent time of the standard duration each subject could perform the task, the number of head motions made, and kinematic variables measured with head- and torso-mounted inertial motion units. RESULTS Because equilibrium scores of control subjects improved significantly over repeated trials on SOT, patients were given only one trial per condition. For percent time between-group differences were found on CTSIB with eyes closed, on foam, head moving in yaw showing significantly reduced performance by BPPV subjects compared to controls. Compared to controls, patients made significantly fewer head movements on CTSIB, eyes closed, on foam, head still, in pitch and yaw. Kinematic data also differed between the groups on tests with eyes closed and unstable surfaces with different head movement combinations, indicating increased instability in BPPV patients. CONCLUSIONS For screening, CTSIB with head movements is more likely than SOT to indicate balance deficits, especially when dependent measures include percent time as well as head movement counts and kinematic measures.
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