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Chang TP, Hong YC, Schubert MC. Visual vertigo and motion sickness is different between persistent postural-perceptual dizziness and vestibular migraine. Am J Otolaryngol 2024; 45:104321. [PMID: 38696894 DOI: 10.1016/j.amjoto.2024.104321] [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] [Received: 01/15/2024] [Accepted: 04/18/2024] [Indexed: 05/04/2024]
Abstract
INTRODUCTION Persistent postural-perceptual dizziness (PPPD) and vestibular migraine (VM) share symptoms of visual vertigo and motion sickness that can be confusing for clinicians to distinguish. We compare the severity of these symptoms and dynamic subjective visual vertical (dSVV) in these two common vestibular conditions. METHOD Twenty-nine patients with PPPD, 37 with VM, and 29 controls were surveyed for subjective symptoms using the visual vertigo analogue scale (VVAS) and motion sickness susceptibility questionnaire during childhood (MSA) and the past 10 years (MSB). dSVV is a measure of visual dependence measures perception of verticality against a rotating background (5 deg./s). RESULTS VVAS revealed contextual differences for dizziness between those with PPPD and VM. Ratings of visual vertigo were most severe in PPPD, less in VM, and mild in controls (VVAS PPPD 27.1, VM 11.2, control 4.6, p < 0.001). MSA was more severe in VM than in PPPD or control (12.8 vs 7.6 vs 8.5, p = 0.01). MSB was more severe in VM than controls (MSB score 12.9 VS 8.1 p = 0.009) but was not different than PPPD (MSB score 10.0, p = 0.10). dSVV alignment was similar among the three groups (p = 0.83). Both VM and PPPD groups had greater simulator sickness than controls after completing the dSVV. CONCLUSIONS Patients with PPPD report more visual vertigo than those with VM, but a history of motion sickness as a child is more common in VM. Additionally, the environmental context that induces visual vertigo is different between PPPD and VM.
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Affiliation(s)
- Tzu-Pu Chang
- Department of Neurology/Neuro-medical Scientific Center, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan; Department of Neurology, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Ying-Chi Hong
- Department of Research, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Michael C Schubert
- Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Li XX, Yu HY, Li JJ, Liu XL, Zheng HY, Li YF, Li Q, Liu SY. Cross-cultural adaptation and construct validity of the Chinese Version of Visual Vertigo Analogue Scale by using structural equation modeling. J Vestib Res 2024; 34:125-132. [PMID: 38042999 DOI: 10.3233/ves-220102] [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: 12/04/2023]
Abstract
BACKGROUND Visual vertigo (VV) is a disease characterized by various visual signal-induced discomforts, including dizziness, unsteady balance, activity avoiding, and so forth. Distinguishing it from other kinds of dizziness is important because it needs the combination of visual training and vestibular rehabilitation together. However, there is no appropriate tool to diagnose VV in China, thus we would like to introduce an effective tool to China. OBJECTIVE The aim of this study was to establish the reliability and validity of the Chinese version of visual vertigo analogue scale (VVAS-CH) and to achieve its cross-cultural adaptation in order to promote its further usage in China. METHODS A total of 1681 patients complaining of vertigo or dizziness were enrolled and they were asked to complete the VVAS-CH. The cross-cultural adaptation, reliability and construct validity of the VVAS-CH were determined. RESULTS Split-half reliability was 0.939, showing a good reliability. Factor analysis identified only one common factor for the nine items that explained 64.83% of the total variance. Most fit indices reached acceptable levels, proving the good fit of the VVAS-CH model. CONCLUSIONS The VVAS-CH validated in this study can be used as an effective tool for diagnosing and evaluating VV in patients whose native language is Chinese.
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Affiliation(s)
- Xiao-Xiao Li
- Department of Otolaryngology, Head and Neck Surgery, Nan-fang Hospital, Southern Medical University, Guang-Zhou, Guangdong, China
- Institute of Sound and Vibration Research, University of Southampton, Southampton, UK
| | - Hai-Yun Yu
- Teaching and Researching Section of Physiology, School of Basic Medical Sciences, Southern Medical University, Guang-Zhou, Guangdong, China
| | - Jing-Jing Li
- Department of Otolaryngology, Head and Neck Surgery, Nan-fang Hospital, Southern Medical University, Guang-Zhou, Guangdong, China
- Distinct Health Care, Cheng-Du, Si-Chuan, China
| | - Xiao-Long Liu
- Department of Otolaryngology, Head and Neck Surgery, Nan-fang Hospital, Southern Medical University, Guang-Zhou, Guangdong, China
| | - Hang-Yu Zheng
- Department of Otolaryngology, Head and Neck Surgery, Nan-fang Hospital, Southern Medical University, Guang-Zhou, Guangdong, China
| | - Yan-Fei Li
- Department of Otolaryngology, Head and Neck Surgery, Nan-fang Hospital, Southern Medical University, Guang-Zhou, Guangdong, China
| | - Qi Li
- Department of Otolaryngology, Head and Neck Surgery, Nan-fang Hospital, Southern Medical University, Guang-Zhou, Guangdong, China
| | - Si-Yuan Liu
- Department of Otolaryngology, Head and Neck Surgery, Nan-fang Hospital, Southern Medical University, Guang-Zhou, Guangdong, China
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Wibble T, Pansell T. Translation and validation of a Swedish version of the Visual Vertigo Analogue Scale. Ann Med 2023; 55:572-577. [PMID: 36896483 PMCID: PMC10795583 DOI: 10.1080/07853890.2023.2177724] [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: 10/23/2022] [Accepted: 02/01/2023] [Indexed: 03/11/2023] Open
Abstract
PURPOSE The present study aimed to construct and validate a Swedish translation (VVAS-S) of the Visual Vertigo Analogue Scale (VVAS). MATERIALS AND METHODS The original English VVAS was translated into Swedish by the two authors and back-translated by an independent professional translator. Pilot-tests were performed on two healthy participants and five patients suffering from Visually Induced Dizziness (VID). The translation was deemed understandable by all subjects. Twenty-one patients with VID were recruited to complete the VVAS-S, once in-lab and once at home after 2-3 weeks. Cronbach's alpha, inter-item consistency and internal consistency were calculated. RESULTS Test-retest values were reliably strong across all items. Cronbach's alpha was 0.843, which is considered to represent very-high reliability. The corrected-item total-correlation was above 0.3 for all items, meaning they were appropriately associated with one-another. Fourteen out of 36 inter-item correlation interactions were within the 0.2-0.4 range. CONCLUSIONS The VVAS-S was found to be comparable to the original VVAS in terms of internal reliability. The translation was perceived as easy to implement by all participants and can be considered ready for clinical use in a Swedish-speaking setting. Item-specific correlations may be valuable for developing future vertigo questionnaires.Key messagesThe Swedish version of the Visual Vertigo Analogue Scale is a questionnaire suitable for evaluating visually induced dizziness in a Swedish population. This study found that the Swedish questionnaire was comparable to the original in terms of internal consistency. The Swedish Visual vertigo Analogue Scale can be found as an appendix to this article.
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Affiliation(s)
- Tobias Wibble
- Department of Clinical Neuroscience, Division of Ophthalmology and Vision, Marianne Bernadotte Centre, Karolinska Institutet, Stockholm, Sweden
| | - Tony Pansell
- Department of Clinical Neuroscience, Division of Ophthalmology and Vision, Marianne Bernadotte Centre, Karolinska Institutet, Stockholm, Sweden
- St. Erik Eye Hospital, Stockholm, Sweden
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4
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Wibble T, Pansell T. Clinical characteristics of visual motion hypersensitivity: a systematic review. Exp Brain Res 2023:10.1007/s00221-023-06652-3. [PMID: 37341755 DOI: 10.1007/s00221-023-06652-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 06/11/2023] [Indexed: 06/22/2023]
Abstract
This qualitative systematic review presents an overview of the state of the research relating to visual motion hypersensitivity (VMH) and offers a reference tool for future studies in the field. The study set out to identify and collate articles investigating risk groups with aberrant responses to visual motion as compared to healthy control groups, presenting evidence for risk factors associated with visual motion hypersensitivity. Data were synthesized into the state of the research and analyzed in the context of the clinical characteristics of each risk factor. Literature searches were performed on Medline Ovid, EMBASE, Web of Science, and Cinahl, identifying a total of 586 studies of which 54 were finally included. Original articles published between the dates of commencement for each database and 19th January 2021 were included. JBI critical appraisal tools were implemented for each corresponding article type. In total, the following number of studies was identified for each respective risk factor: age (n = 6), migraines (n = 8), concussions (n = 8), vestibular disorders (n = 13), psychiatric conditions (n = 5), and Parkinson's disease (n = 5). Several studies described VMH as the primary concern (n = 6), though these primarily included patients with vestibulopathies. There were considerable differences in the nomenclature employed to describe VMH, depending largely on the investigating group. An overview of investigated risk factors and their evaluation methods was presented in a Sankey diagram. Posturography was the most implemented methodology but due to diverse measurements meta-analyses were not possible. One may however note that while the easily implemented Vestibular Ocular Motor Screening (VOMS) was designed for concussed patients, it may prove useful for other risk groups.
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Affiliation(s)
- Tobias Wibble
- Department of Clinical Neuroscience, Division of Ophthalmology and Vision, Marianne Bernadotte Centre, Karolinska Institutet, Stockholm, Sweden.
- St. Erik Eye Hospital, Stockholm, Sweden.
| | - Tony Pansell
- Department of Clinical Neuroscience, Division of Ophthalmology and Vision, Marianne Bernadotte Centre, Karolinska Institutet, Stockholm, Sweden
- St. Erik Eye Hospital, Stockholm, Sweden
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Chen TAJ, Dion Parenteau ML, Marchand K, Zhang HZ, Dannenbaum E, Lamontagne A, Fung J. A Pilot Study to Assess Visual Vertigo in People with Persistent Postural-Perceptual Dizziness with a New Computer-Based Tool. J Clin Med 2023; 12:jcm12051766. [PMID: 36902553 PMCID: PMC10003047 DOI: 10.3390/jcm12051766] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/16/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Visual vertigo (VV) is a common symptom in people with persistent postural-perceptual dizziness (PPPD). Few subjective scales are validated for assessing the intensity of VV, yet these scales are limited by recall bias, as they require individuals to rate their symptoms from memory. The computer-Visual Vertigo Analogue Scale (c-VVAS) was developed by adapting five scenarios from the original paper-VVAS (p-VVAS) into 30 s video clips. The aim of this pilot study was to develop and test a computerized video-based tool for the assessment of visual vertigo in people with PPPD. METHODS PPPD participants (n = 8) and age- and sex-matched controls (n = 8) completed the traditional p-VVAS and the c-VVAS. A questionnaire about their experiences using the c-VVAS was completed by all participants. RESULTS There was a significant difference between the c-VVAS scores from the PPPD and the control group (Mann-Whitney, p < 0.05). The correlation between the total c-VVAS scores and the total c-VVAS scores was not significant (r = 0.668, p = 0.07). The study showed a high acceptance rate of the c-VVAS by participants (mean = 91.74%). CONCLUSION This pilot study found that the c-VVAS can distinguish PPPD subjects from healthy controls and that it was well-received by all participants.
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Affiliation(s)
- Tsun-Ai Jasper Chen
- School of Physical and Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montréal, QC H3G 1Y5, Canada
| | - Marie-Li Dion Parenteau
- School of Physical and Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montréal, QC H3G 1Y5, Canada
| | - Kirby Marchand
- School of Physical and Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montréal, QC H3G 1Y5, Canada
| | - Hong Zhi Zhang
- School of Physical and Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montréal, QC H3G 1Y5, Canada
| | - Elizabeth Dannenbaum
- Jewish Rehabilitation Hospital, Site of the Centre Intégré de Santé et de Services Sociaux de Laval (CISSS-Laval), Research Site of Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain (CRIR), Laval, QC H7V 1R2, Canada
- Correspondence:
| | - Anouk Lamontagne
- Jewish Rehabilitation Hospital, Site of the Centre Intégré de Santé et de Services Sociaux de Laval (CISSS-Laval), Research Site of Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain (CRIR), Laval, QC H7V 1R2, Canada
| | - Joyce Fung
- Jewish Rehabilitation Hospital, Site of the Centre Intégré de Santé et de Services Sociaux de Laval (CISSS-Laval), Research Site of Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain (CRIR), Laval, QC H7V 1R2, Canada
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6
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Gamble R, Sumner P, Wilson-Smith K, Derry-Sumner H, Rajenderkumar D, Powell G. Using interpretative phenomenological analysis to probe the lived experiences of persistent postural-perceptual dizziness (PPPD). J Vestib Res 2023; 33:89-103. [PMID: 36710692 PMCID: PMC10041438 DOI: 10.3233/ves-220059] [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] [Received: 05/20/2022] [Accepted: 01/05/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND Persistent Postural-Perceptual Dizziness (PPPD) is a chronic neuro-vestibular condition characterised by subjective dizziness, non-spinning vertigo, and postural imbalance. Symptoms are typically induced by situations of visuo-vestibular conflict and intense visual-motion. OBJECTIVE Little research has focused on the lived experiences of people with PPPD. Therefore, our objective was to present an in-depth exploration of patient experiences and sense-making, and the effect of PPPD on psycho-social functioning. METHODS We conducted semi-structured interviews with 6 people with PPPD, who were recruited from an Audiovestibular department in Wales. We present a case-by-case Interpretive Phenomenological Analysis (IPA) for each participant and present common themes. RESULTS Our analysis revealed a range of superordinate and subordinate themes, individualised to each participant, but broadly described under the following headings: dismissal and non-belief, identity loss, dissociative experiences, poor psychological well-being and processes of sense-making. CONCLUSION The qualitative experiences documented in this study will help clinicians and researchers to better understand the lived experiences of PPPD, how PPPD patients make sense of their symptoms, and the psycho-social impacts of the condition.
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Affiliation(s)
- Ryan Gamble
- School of Psychology, Cardiff University, Cardiff, UK
| | - Petroc Sumner
- School of Psychology, Cardiff University, Cardiff, UK
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7
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Frank AJ, Hoppes CW, Dunlap PM, Costa CM, Whitney SL. Categorizing individuals based on the severity of Visual Vertigo Analogue Scale symptoms. J Vestib Res 2022; 32:433-441. [PMID: 35466914 DOI: 10.3233/ves-210131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The Visual Vertigo Analogue Scale (VVAS) assesses visual vertigo. Instead of the original scoring methods (positive VVAS > 1), we propose categorizing patients as having No (0), Mild (0.1-40), Moderate (40.01-70), or Severe (70.01-100) symptoms. OBJECTIVE Our primary aim was to validate an alternative interpretation of the VVAS by exploring the relationship between categories of visual vertigo symptoms and measures of activity and participation, dizziness handicap, anxiety, and depression. We aimed to describe the severity of visual vertigo reported by patients in different vestibular diagnostic categories. METHODS Participants with vestibular disorders (n = 250) completed the VVAS, Vestibular Activities and Participation (VAP) Measure, Dizziness Handicap Inventory (DHI), and the Hospital Anxiety and Depression Scale (HADS). RESULTS Patients with central disorders were more symptomatic than those with peripheral vestibular disorders. As evaluated by one-way ANOVA, the scores on the VAP, HADS, and DHI significantly differed among mild, moderate, severe, and no visual vertigo categories (p < 0.001). As VVAS severity increased, activity and participation decreased (r = 0.582, p < 0.001); dizziness handicap increased (r = 0.597, p < 0.001, n = 199); anxiety increased (r = 0.405, p < 0.001); and depression increased (r = 0.521, p < 0.001). CONCLUSIONS The findings of this study support the use of an alternative VVAS interpretation method of categorizing symptoms as none, mild, moderate, and severe visual vertigo.
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Affiliation(s)
- Amanda J Frank
- Hearing Center of Excellence, San Antonio, TX, USA.,zCore Business Solutions, Inc., Round Rock, TX, USA
| | - Carrie W Hoppes
- Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, TX, USA
| | - Pamela M Dunlap
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Cláudia M Costa
- Ph.D. Program in Neuroscience, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Susan L Whitney
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
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Ak AK, Çelebisoy N, Özdemir HN, Gökçay F. Vestibular Migraine And Persistent Postural Perceptual Dizziness: Handicap, Emotional Comorbidities, Quality Of Life And Personality Traits. Clin Neurol Neurosurg 2022; 221:107409. [DOI: 10.1016/j.clineuro.2022.107409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/24/2022] [Accepted: 08/03/2022] [Indexed: 11/16/2022]
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Mandour AES, El-Gharib AM, Emara AA, Elmahallawy TH. Virtual reality versus optokinetic stimulation in visual vertigo rehabilitation. Eur Arch Otorhinolaryngol 2021; 279:1609-1614. [PMID: 34611745 DOI: 10.1007/s00405-021-07091-y] [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: 07/08/2021] [Accepted: 09/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Visual vertigo (VV) is a condition at which there is worsening or triggering of vestibular symptoms in certain visual environments with large size (full field) repetitive or moving visual patterns as shopping malls. PURPOSE This work was designed to study effect of virtual reality and optokinetic stimulation on rehabilitation of VV. METHOD A total of 60 subjects divided into 2 groups that were simply randomized by the concealed envelope method: Group I consisted of 30 VV patients underwent vestibular rehabilitation using virtual reality. Group II consisted of 30 VV patients underwent vestibular rehabilitation using optokinetic stimulation. RESULTS Significant improvement in performance in the two groups after rehabilitation with no statistically significant difference when comparing both groups. CONCLUSIONS A combined intense rehabilitation program including OPK stimulation or VR rehabilitation combined with home-based exercises appeared to be equally effective for management of patients with VV and improving their quality of life.
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Alharbi AA, Johnson EG, Albalwi AA, Ambode OI, Cordett TK, Alshehri FH, Daher NS. Correlation between anxiety and chronic motion sensitivity. J Vestib Res 2021; 32:163-170. [PMID: 34486999 DOI: 10.3233/ves-201625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Chronic motion sensitivity (CMS) is a combination of autonomic symptoms provoked by exposure to motion. The correlation between anxiety and CMS is not yet well understood. OBJECTIVES 1) To compare median anxiety levels between young adults with and without CMS. 2) To examine the effect of anxiety on postural stability with immersion virtual reality. 3) To compare anxiety levels between sexes. METHODS Participants included 60 adults (20-40 years), with and without CMS. After determining their current and general anxiety levels, postural stability was measured. RESULTS There were significant differences in median (minimum, maximum) state- and trait-anxiety scores between participants with and without CMS, but no significant differences in median state- and trait-anxiety scores between males and females with CMS. There was a significant inverse relationship between state- and trait-anxiety scores and postural stability (ρ= -0.28, p = 0.03, and ρ= -0.32, p = 0.01, respectively). The stepwise regression analysis showed the Motion Sickness Susceptibility Questionnaire-Short Form score to be the only variable contributing significantly to postural stability (R2 = 26.2%; t = -4.5, p < 0.001). CONCLUSIONS Young adults with CMS are more anxious, although anxiety does not contribute to postural stability in this group. Anxiety levels do not appear to differ between young adult males and females with CMS.
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Affiliation(s)
- Ahmad A Alharbi
- Department of Physical Therapy, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk, Saudi Arabia
| | - Eric G Johnson
- Department of Physical Therapy, School of Allied Health Professions, Loma Linda University, Loma Linda, CA, USA
| | - Abdulaziz A Albalwi
- Department of Physical Therapy, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk, Saudi Arabia
| | - Oluwaseun I Ambode
- Department of Physical Therapy, School of Allied Health Professions, Loma Linda University, Loma Linda, CA, USA
| | - Tim K Cordett
- Department of Physical Therapy, School of Allied Health Professions, Loma Linda University, Loma Linda, CA, USA
| | - Fahad H Alshehri
- Department of Physical Therapy, College of Applied Medical Science, Taif University, Taif, Saudi Arabia
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11
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The Role of the Functional Head Impulse Test with and without Optokinetic Stimuli in Vestibular Migraine and Acute Unilateral Vestibulopathy: Discovering a Dynamic Visual Dependence. J Clin Med 2021; 10:jcm10173787. [PMID: 34501235 PMCID: PMC8432176 DOI: 10.3390/jcm10173787] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/16/2021] [Accepted: 08/18/2021] [Indexed: 11/29/2022] Open
Abstract
(1) Background: Visually induced vertigo (i.e., vertigo provoked by moving visual scenes) can be considered a noticeable feature of vestibular migraines (VM) and can be present in patients suffering from acute unilateral vestibulopathy (AUV). Hypersensitivity to moving or conflicting visual stimulation is named visual dependence. (2) Methods: Visuo-vestibular interactions were analyzed via the functional Head Impulse Test (fHIT) with and without optokinetic stimulation (o-fHIT) in 25 patients with VM, in 20 subjects affected by AUV, and in 20 healthy subjects. We calculated the percentage of correct answers (%CA) without and with the addition of the optokinetic background (OB). (3) In VM groups, the %CA on the fHIT was 92.07% without OB and 73.66% with OB. A significant difference was found between %CA on the deficit side and that on the normal side in AUV, both without OB and with OB. (4) Conclusions: The fHIT results in terms of %CA with and without OB could be useful to identify the presence of a dynamic visual dependence, especially in patients suffering from VM. The difference in %CA with and without OB could provide instrumental support to help correctly identify subjects suffering from VM. We propose the use of the fHIT in clinical practice whenever there is a need to highlight a condition of dynamic visual dependence.
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12
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Verdecchia DH, Hernandez D, Andreu MF, Salzberg SE, Whitney SL. Validated argentine version of the visual vertigo analogue scale. J Vestib Res 2021; 32:235-243. [PMID: 34308920 DOI: 10.3233/ves-210062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Visual vertigo (VV), triggered by environmental or dynamic visual stimuli and repetitive visual patterns, can affect daily life activities. The Visual Vertigo Analogue Scale (VVAS) is a valid and reliable self-administered questionnaire to assess VV, which has been culturally adapted to the Argentine population but has not been validated. OBJECTIVE To validate the Argentine version of VVAS (VVAS-A) by confirming its psychometric properties in patients with vestibular disorders. METHODS Vestibular patients (n = 82) completed the VVAS-A and the Dizziness Handicap Inventory Argentine version (DHI-A) during their initial visit and one week later. The VVAS-A's internal consistency, test retest reliability, ceiling and floor effects, and construct validity were determined. Test-retest data (n = 71) was used to calculate reliability using the intraclass correlation coefficient (ICC 2.1). RESULTS A ceiling effect was observed in 12 patients (14.6%). Internal consistency was acceptable (Cronbach's alpha: 0.91). The reliability was r = 0.764 [CI 95%: 0.7 -0.86]). Correlations were observed between the VVAS-A and the total DHI-A score (rho = 0.571), the DHI-A physical subscale (rho: 0.578), and DHI-A functional and emotional subscales of the DHI-A (rho: 0.537 and 0.387, respectively). CONCLUSION VVAS-A is a valid, reliable tool to evaluate VV in patients with vestibular disorders.
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Affiliation(s)
- Daniel H Verdecchia
- Physical Therapy Program, Health SciencesDepartment, Universidad Nacional de la Matanza, Buenos Aires, Argentina.,Physical Therapy Program, UniversidadMaimónides, City of Buenos Aires, Argentina.,Physical Therapy Program, Medical School, Universidad de Buenos Aires
| | - Daniel Hernandez
- Physical Therapy Program, Medical School, Universidad de Buenos Aires.,Physical TherapyUnit, Acute Care Hospital "Carlos G. Durand". City of BuenosAires, Argentina
| | - Mauro F Andreu
- Physical Therapy Program, Health SciencesDepartment, Universidad Nacional de la Matanza, Buenos Aires, Argentina
| | - Sandra E Salzberg
- Physical TherapyUnit, Acute Care Hospital "Carlos G. Durand". City of BuenosAires, Argentina
| | - Susan L Whitney
- Departments of Physical Therapyand Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA
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13
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Azzi JL, Khoury M, Séguin J, Rourke R, Hogan D, Tse D, Lelli DA. Characteristics of persistent postural perceptual dizziness patients in a multidisciplinary dizziness clinic. J Vestib Res 2021; 32:285-293. [PMID: 34151875 DOI: 10.3233/ves-190749] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Persistent Postural Perceptual Dizziness (PPPD) is a newly defined condition which was added to the International Classification of Vestibular Disorders in 2017. Little is known about its impact on patients. OBJECTIVE The goal of this study was to analyze the symptomology, epidemiology and impact of PPPD on patients. METHODS A retrospective chart review was done to identify patients who attended the Multidisciplinary Dizziness Clinic (MDC) and were diagnosed with PPPD. Responses to demographic questions, health-related quality of life surveys and several well-validated questionnaires commonly used to assess dizziness severity were analyzed. RESULTS One hundred patients were diagnosed with PPPD between March 2017 and January 2019, of which 80%(80/100) were females. The average Dizziness Handicap Index score was 60.3±19.0. Responses to the Patient Health Questionnaire classified 53 patients (53/99;53.5%) as moderately to severely depressed. Sixty-four patients (64/100;64.0%) were minimally or mildly anxious according to the Generalized Anxiety Disorder scale. The average Vertigo Symptom Scale score was 24.1/60. The average Situational Vertigo Questionnaire score was 2.00. Forty-nine (49/100;49.0%) patients had migraine symptoms according to the Migraine Screen Questionnaire. CONCLUSIONS In conclusion, patients with PPPD display important handicap and an elevated risk of depression, anxiety and migraines.
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Affiliation(s)
- Jayson Lee Azzi
- Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michel Khoury
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jeanne Séguin
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ryan Rourke
- Department of Otolaryngology -Head and Neck Surgery, University of Ottawa, Ontario, Canada
| | - Debora Hogan
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Darren Tse
- Department of Otolaryngology -Head and Neck Surgery, University of Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Daniel A Lelli
- Division of Neurology, Department of Internal Medicine, University of Ottawa, Ontario, Canada
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14
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Trinidade A, Harman P, Stone J, Staab JP, Goebel JA. Assessment of Potential Risk Factors for the Development of Persistent Postural-Perceptual Dizziness: A Case-Control Pilot Study. Front Neurol 2021; 11:601883. [PMID: 33551961 PMCID: PMC7859446 DOI: 10.3389/fneur.2020.601883] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/29/2020] [Indexed: 12/21/2022] Open
Abstract
Objectives: (1) To assess whether neuroticism, state anxiety, and body vigilance are higher in patients with persistent postural-perceptual dizziness (PPPD) compared to a recovered vestibular patient group and a non-dizzy patient group; (2) To gather pilot data on illness perceptions of patients with PPPD. Materials and Methods: 15 cases with PPPD and two control groups: (1) recovered vestibular patients (n = 12) and (2) non-dizzy patients (no previous vestibular insult, n = 12). Main outcome measures: Scores from the Big Five Inventory (BFI) of personality traits, Generalized Anxiety Disorder - 7 (GAD-7) scale, Body Vigilance Scale (BVS), Dizziness Handicap Inventory (DHI), modified Vertigo Symptom Scale (VSS) and Brief Illness Perception Questionnaire (BIPQ). Results: Compared to non-dizzy patients, PPPD cases had higher neuroticism (p = 0.02), higher introversion (p = 0.008), lower conscientiousness (p = 0.03) and higher anxiety (p = 0.02). There were no differences between PPPD cases and recovered vestibular patients in BFI and GAD-7. PPPD cases had higher body vigilance to dizziness than both control groups and their illness perceptions indicated higher levels of threat than recovered vestibular patients. Conclusion: PPPD patients showed statistically significant differences to non-dizzy patients, but not recovered vestibular controls in areas such as neuroticism and anxiety. Body vigilance was increased in PPPD patients when compared with both recovered vestibular and non-dizzy patient groups. PPPD patients also exhibited elements of negative illness perception suggesting that this may be the key element driving the development of PPPD. Large scale studies focusing on this area in the early stages following vestibular insult are needed.
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Affiliation(s)
- Aaron Trinidade
- Southend University Hospital NHS Foundation Trust, Southend-on-Sea, United Kingdom
| | - Paula Harman
- Southend University Hospital NHS Foundation Trust, Southend-on-Sea, United Kingdom
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Joel A Goebel
- Washington University in St. Louis School of Medicine, St. Louis, MO, United States
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15
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Powell G, Derry-Sumner H, Shelton K, Rushton S, Hedge C, Rajenderkumar D, Sumner P. Visually-induced dizziness is associated with sensitivity and avoidance across all senses. J Neurol 2020; 267:2260-2271. [PMID: 32306170 PMCID: PMC7359147 DOI: 10.1007/s00415-020-09817-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/30/2020] [Accepted: 04/01/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Persistent postural perceptual dizziness (PPPD) is a common chronic condition presenting in neurology and neuro-otology clinics. Symptoms lie on a spectrum in the general population. The cause is unknown and thought to involve interactions between visual and vestibular systems, but symptoms also correlate with anxiety and migraine. OBJECTIVE To test whether PDDD symptoms are associated with reported differences in other senses (touch, hearing, smell and taste); to investigate possible mediation via anxiety or migraine; to discover the proportion of variance accountable to these non-vestibular factors. METHODS We measured self-report multisensory sensitivity, anxiety, visual difficulties, visual discomfort and migraine in patients with PPPD (N = 29) and a large general population cohort (N > 1100). We used structural equation modelling to examine relationships between the factors using a step-wise approach. RESULTS We found increased self-reported over-sensitivity in sensory domains beyond vision and balance in both patients with PPPD and non-clinical participants with more PPPD symptoms. SEM analysis revealed that anxiety partly, but not wholly, mediated this relationship. Adding visual difficulties and visual discomfort to the model allowed it to explain 50% of PPPD symptom variance. Most of the path coefficients and mediation effects in our model were unchanged between participants with and without migraine. CONCLUSIONS Our findings support the idea that PPPD is a complex neurological condition that includes broad perceptual factors, and may suggest that some brains are predisposed to generalised cross-modal sensory-overload. This may give rise to vulnerability to severe PPPD should a vestibular insult occur.
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Affiliation(s)
- Georgina Powell
- School of Psychology, Cardiff University, Tower building, Park Place, Cardiff, UK.
| | - Hannah Derry-Sumner
- Department of Audiovestibular Medicine, University Hospital of Wales, Cardiff, UK
| | - Katherine Shelton
- School of Psychology, Cardiff University, Tower building, Park Place, Cardiff, UK
| | - Simon Rushton
- School of Psychology, Cardiff University, Tower building, Park Place, Cardiff, UK
| | - Craig Hedge
- School of Psychology, Cardiff University, Tower building, Park Place, Cardiff, UK
| | - Deepak Rajenderkumar
- Department of Audiovestibular Medicine, University Hospital of Wales, Cardiff, UK
| | - Petroc Sumner
- School of Psychology, Cardiff University, Tower building, Park Place, Cardiff, UK
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16
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Chaudhary S, Saywell N, Kumar A, Taylor D. Visual Fixations and Motion Sensitivity: Protocol for an Exploratory Study. JMIR Res Protoc 2020; 9:e16805. [PMID: 32716003 PMCID: PMC7418000 DOI: 10.2196/16805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 05/04/2020] [Accepted: 05/19/2020] [Indexed: 12/02/2022] Open
Abstract
Background Motion sensitivity after vestibular disorders is associated with symptoms of nausea, dizziness, and imbalance in busy environments. Dizziness and imbalance are reported in places such as supermarkets and shopping malls which have unstable visual backgrounds; however, the mechanism of motion sensitivity is poorly understood. Objective The main aim of this exploratory observational study is to investigate visual fixations and postural sway in response to increasingly complex visual environments in healthy adults and adults with motion sensitivity. Methods A total of 20 healthy adults and 20 adults with motion sensitivity will be recruited for this study. Visual fixations, postural sway, and body kinematics will be measured with a mobile eye tracker device, force plate, and 3D motion capture system, respectively. Participants will be exposed to experimental tasks requiring visual fixation on letters, projected on a range of backgrounds on a large screen during quiet stance. Descriptive statistics (mean and standard deviation) will be calculated for each of the variables. One-way independent-measures analyses of variance will be performed to investigate the differences between groups for all variables. Results Data collection was started in May 2019 and was completed by February 2020. It was approved by Health and Disability Ethics Committees, Ministry of Health, New Zealand on November 2, 2018 (Ethics ref: 18/CEN/193). We are currently processing the data and will begin data analysis in July 2020. We expect the results to be available for publication by the end of 2020. The trial was funded by the Neurology Special Interest Group, Physiotherapy New Zealand, and the Eisdell Moore Centre in November 2018. Conclusions This study will provide a detailed investigation of visual fixations in response to increasingly complex visual environments. Investigating characteristics of visual fixations in healthy adults and those with motion sensitivity will provide insight into this disabling condition and may inform the development of new intervention strategies which explicitly cater to the needs of this population. Trial Registration Australian New Zealand Clinical Trials Registry, ACTRN12619000254190; https://tinyurl.com/yxbn7nks International Registered Report Identifier (IRRID) PRR1-10.2196/16805
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Affiliation(s)
| | - Nicola Saywell
- Auckland University of Technology, Auckland, New Zealand
| | - Arun Kumar
- Manipal Institute of Technology, Manipal, Karnataka, India
| | - Denise Taylor
- Auckland University of Technology, Auckland, New Zealand
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17
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Functional Head Impulse Test With and Without Optokinetic Stimulation in Subjects With Persistent Postural Perceptual Dizziness (PPPD): Preliminary Report. Otol Neurotol 2019; 41:e70-e75. [PMID: 31789799 DOI: 10.1097/mao.0000000000002446] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Persistent postural perceptual dizziness (PPPD) is a clinical condition characterized by unsteadiness present on most days for a period of at least 3 months. The aim of our work was to assess vestibular function, the role of anxiety, and possible interactions between visual and vestibular systems in patients with PPPD. STUDY DESIGN Cross-sectional prospective study. SETTING Tertiary referral center. PATIENTS Twenty-five PPPD patients. INTERVENTIONS Clinical history was collected before examination; vestibular function was assessed through bedside examination, video and functional head impulse test (video-HIT, f-HIT). The latter test was based on having the patient identify an optotype displayed on a computer screen during passive head rotations. The test was repeated while optokinetic stimulation (OKS) was given on the screen. Results were compared with those of 25 controls. State and trait anxiety levels were measured with the State-Trait Anxiety Inventory (STAI) questionnaire. Anxiety before and after vestibular examination was assessed using a VAS scale. MAIN OUTCOME MEASURE Results of video and functional HIT with and without OKS. RESULTS Video-HIT and f-HIT showed normal values in all subjects. f-HIT with OKS provoked more reading errors in patients than in controls. The interaction of group per time detected different decreasing trends between the two groups (p = 0.0002).Patients presented a reduction in anxiety levels after examination. Nine patients fulfilled diagnostic criteria for vestibular migraine, eight of whom presented nystagmus either to positional tests or vibration test. Only anxiety levels before testing were predictive of worsening of f-HIT with optokinetic stimulation (p = 0.0007). CONCLUSIONS Our data support the hypothesis that increased anxiety may play a role in visuo-vestibular interactions; moreover, they are not inconsistent with the hypothesis that OKS might provoke a "threatening effect," leading to gaze bias during examination.
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18
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Persistent Postural-Perceptual Dizziness-A Systematic Review of the Literature for the Balance Specialist. Otol Neurotol 2019; 39:1291-1303. [PMID: 30289841 DOI: 10.1097/mao.0000000000002010] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To present a systematic review of the current data on persistent postural-perceptual dizziness (PPPD), a useful and relatively new diagnosis for a disorder that has previously been known by many different names. In addition, to discuss diagnostic criteria and management strategies for this condition with the otologist in mind. DATA SOURCES CINAHL, Embase, PubMed, Medline, PsycINFO, PubMed, Google Scholar. REVIEW METHOD The phrase "persistent postural-perceptual dizziness" and its acronym "PPPD" were used. RESULTS From 318 articles, 15 were selected for full analysis with respect to PPPD. Most were case-control studies, with one consensus paper from the Bárány Society available. Overall, the pathophysiology of PPPD remains relatively poorly understood, but is likely to be a maladaptive state to a variety of insults, including vestibular dysfunction and not a structural or psychiatric one. Cognitive behavioral therapy, vestibular rehabilitation, selective serotonin uptake inhibitors (SSRIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs) all seem to have a role in its management. CONCLUSIONS PPPD is useful as a diagnosis for those treating dizziness as it helps to define a conglomeration of symptoms that can seem otherwise vague and allows for more structured management plans in those suffering from it.
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Abstract
PURPOSE A case study of a 12-year-old boy with Irlen syndrome illustrates the overlapping symptoms of Irlen syndrome and vestibular-related dizziness. SUMMARY OF KEY POINTS Individuals with Irlen syndrome have eyestrain and headache, and often report visual perceptual distortions of blurring, doubling, and movement of print on the page. These symptoms can be relieved with the use of individually prescribed tinted lenses or overlays. Visually induced dizziness, also known as visual vertigo, is characterized by dizziness and/or unsteadiness that is triggered by complex, distorted, large field/moving visual stimuli. Visually induced dizziness can be effectively treated with progressive, controlled exposure to optokinetic visual stimuli. The child with Irlen syndrome had impaired balance, impaired gaze stability, and symptoms of visual vertigo. His complaint of visually induced dizziness resolved following vestibular rehabilitation. CONCLUSIONS AND RECOMMENDATIONS FOR CLINICAL PRACTICE When an individual with Irlen syndrome complains of dizziness, ruling out a concomitant diagnosis of a central and/or peripheral vestibular disorder is warranted. WHAT THIS ADDS TO THE EVIDENCE The visual symptoms associated with Irlen syndrome can overlap with those of visually induced dizziness. This case report is the first to describe overlapping visual and vestibular complaints of dizziness in an individual with Irlen syndrome.
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20
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Anderson MN, Womble MN, Mohler SA, Said A, Stephenson-Brown K, Kontos AP, Elbin RJ. Preliminary Study of Fear of Re-Injury following Sport-Related Concussion in High School Athletes. Dev Neuropsychol 2019; 44:443-451. [PMID: 31537099 DOI: 10.1080/87565641.2019.1667995] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The influence of fear of re-injury that this variable has on recovery outcomes following sports-related concussion remains unknown. We examined changes in fear of re-injury throughout concussion recovery, and compared changes in neurocognitive, symptom, vestibular/ocular motor, and recovery time outcomes between concussed adolescent athletes who endorsed high and low fear of re-injury. Individuals with high fear of re-injury were more symptomatic and more likely to exhibit vestibular/ocular motor symptoms over clinical cutoffs than those with low fear of re-injury. Recovery time was not significantly different between the groups. These findings may help explain performance on more subjective concussion assessments.
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Affiliation(s)
- Melissa N Anderson
- Concussion Research Lab, Department of Kinesiology, The University of Georgia , Athens , Georgia , USA
| | - Melissa N Womble
- Inova Sports Medicine Concussion Program, Department of Orthopaedics & Sports Medicine, Inova Medical Group , Fairfax , Virginia , USA
| | - Samantha A Mohler
- Office for Sport Related Concussion Research/Department of Health, Human Performance and Recreation, The University of Arkansas , Fayetteville , Arkansas , USA
| | - Azkya Said
- Office for Sport Related Concussion Research/Department of Health, Human Performance and Recreation, The University of Arkansas , Fayetteville , Arkansas , USA
| | - Katie Stephenson-Brown
- Office for Sport Related Concussion Research/Department of Health, Human Performance and Recreation, The University of Arkansas , Fayetteville , Arkansas , USA
| | - Anthony P Kontos
- Department of Orthopaedic Surgery, The University of Pittsburgh Medical Center , Pittsburgh , Pennsylvania , USA
| | - R J Elbin
- Office for Sport Related Concussion Research/Department of Health, Human Performance and Recreation, The University of Arkansas , Fayetteville , Arkansas , USA
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21
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Baraldi C, Gherpelli C, Alicandri Ciufelli M, Monzani D, Pini LA, Pani L, Guerzoni S. A case-control study of visually evoked postural responses in childhood with primary headaches. Neurol Sci 2019; 41:305-311. [PMID: 31502001 DOI: 10.1007/s10072-019-04072-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 09/04/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND Disorientation, nausea, confusion, dizziness, and displacement are frequently complained by headache-suffering children. Anyhow, the cause of these symptoms is still unclear, and a dysfunction of vestibular pathways or their alteration due to central pain pathways hyper-activation, has been proposed. The aim of this study is to use posturography to explore the balance function of headache-suffering children during pain-free periods. METHODS Posturography was performed on 19 migraineurs, 11 tension-type headache sufferers, and 20 healthy controls. Posturographic measures were performed during headache-free periods under different conditions: with eyes opened, eyes closed, and during right and left optokinetic stimulation. The last 2 conditions were used to mimic unreliable visual signals that can confound vestibular system. RESULTS During eyes-closed conditions, headache-suffering children displayed higher displacements than healthy controls, since statokinesiogram surface was higher in tension-type headache sufferers and migraineurs compared with controls (P value = 0.0095). Romberg's index, indicating the overall stability of the subject, was lower in healthy controls than in headache sufferers (P = 0.0139), thus suggesting a vestibular impairment in the seconds. Moreover, both during right and left optokinetic stimulation, the statokinesiogram length was higher in headache-suffering children (P < 0.0001). Thereafter, statokinesiogram surface was higher in migraineurs during right optokinetic stimulation (P = 0.0388) than in tension-type headache sufferers when stimulation was directed on the opposite side (P = 0.0249). CONCLUSIONS These results suggest a central alteration of vestibular pathways in headache-suffering children, that makes balance function more dependent from visual inputs than healthy subjects, even in inter-ictal phases.
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Affiliation(s)
- Carlo Baraldi
- School of Pharmacology and Clinical Toxicology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy.
| | - Chiara Gherpelli
- Otolaryngology Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | | | - Daniele Monzani
- Otolaryngology Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Luigi Alberto Pini
- Medical Toxicology Unit- Headache and Drug Abuse Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Luca Pani
- Section of Pharmacology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Campi 287, 41124, Modena, Italy
| | - Simona Guerzoni
- Medical Toxicology Unit- Headache and Drug Abuse Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
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22
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Abstract
PURPOSE OF REVIEW Disorders of posture and balance cause significant patient morbidity, with reduction of quality of life as patients refrain from critical activities of daily living such as walking outside the home and driving. This review describes recent efforts to characterize visual disorders that interact with the neural integrators of positional maintenance and emerging therapies for these disorders. RECENT FINDINGS Abnormalities of gait and body position sense may be unrecognized by patients but are correlated with focal neurological injury (stroke). Patients with traumatic brain injury can exhibit visual vertigo despite otherwise normal visual functioning. The effect of visual neglect on posture and balance, even in the absence of a demonstrable visual field defect, has been characterized quantitatively through gait analysis and validates the potential therapeutic value of prism treatment in some patients. In addition, the underlying neural dysfunction in visual vertigo has been explored further using functional imaging, and these observations may allow discrimination of patients with structural causes from those whose co-morbid psychosocial disorders may be primarily contributory.
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Affiliation(s)
- Jeffrey R Hebert
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO, 80045, USA.,Department of Neurology, University of Colorado School of Medicine, Aurora, CO, 80045, USA.,Marcus Institute for Brain Health, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Prem S Subramanian
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, 80045, USA. .,Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, 80045, USA. .,Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, 80045, USA. .,Sue Anschutz-Rodgers UCHealth Eye Center, 1675 Aurora Ct Mail Stop F731, Aurora, CO, 80045, USA.
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23
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Zur O, Ben-Rubi Shimron H, Leisman G, Carmeli E. Balance versus hearing after cochlear implant in an adult. BMJ Case Rep 2017; 2017:bcr-2017-220391. [PMID: 29018011 DOI: 10.1136/bcr-2017-220391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The effect of vestibular rehabilitation (VR) on anxiety, dizziness and poor balance that developed after cochlear implant (CI) surgery is described. A 54-year-old woman, with profound hearing loss since the age of 2 years, underwent right CI surgery 2 years previously. On implant activation, the patient immediately felt dizziness and imbalance, which affected the ability to perform activities of daily living and increased anxiety to where the patient considered the CI removal. Prior to VR the patient was evaluated with the Dizziness Handicap Inventory and the Visual Vertigo Dizziness Questionnaire and clinically with the Zur Balance Scale and Video Head Impulse Test. The patient underwent 14 VR sessions over 4 months that included compensation, adaptation and habituation exercises. After VR the patient was able to maintain good balance while using the CI. Dizziness and anxiety improved dramatically. This report increases awareness that a CI could compromise balance, which can be overcome with personalised VR.
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Affiliation(s)
- Oz Zur
- Department of Physiotherapy, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,The Israeli Center for Treating Dizziness and Balance Disorders, Ra'anana, Israel
| | | | - Gerry Leisman
- Department of Physical Therapy, University of Haifa, Haifa, Israel.,Department of Neuroscience, The National Institute for Brain and Rehabilitation Sciences, Nazareth, Israel
| | - Eli Carmeli
- Department of Physical Therapy, University of Haifa, Haifa, Israel
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24
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Moaty AS, EL Mahallawi TH, Emara AA, Talaat HS, Zeinelabedeen AM, Dimitriadis PA, Allam A, Bowes C, Ray J. The role of customized vestibular rehabilitation with visual desensitization in the management of visual vertigo syndrome. HEARING BALANCE AND COMMUNICATION 2017. [DOI: 10.1080/21695717.2017.1347367] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Asmaa Salah Moaty
- Audiovestibular Unit, Otolaryngology Department, Faculty of Medicine, Menoufiya University, Menoufia, Egypt
- Otolaryngology Department, Sheffield Teaching Hospitals, Sheffield, UK
| | | | - Afaf Ahmed Emara
- Audiovestibular Unit, Otolaryngology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Hossam Sanyelbhaa Talaat
- Audiovestibular Unit, Otolaryngology Department, Faculty of Medicine, Menoufiya University, Menoufia, Egypt
| | | | | | - Ahmed Allam
- Otolaryngology Department, Sheffield Teaching Hospitals, Sheffield, UK
- Otolaryngology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Christopher Bowes
- Otolaryngology Department, Sheffield Teaching Hospitals, Sheffield, UK
| | - Jaydip Ray
- Otolaryngology Department, Sheffield Teaching Hospitals, Sheffield, UK
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25
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Armstrong D, Charlesworth E, Alderson AJ, Elliott DB. Is there a link between dizziness and vision? A systematic review. Ophthalmic Physiol Opt 2016; 36:477-86. [PMID: 27255594 DOI: 10.1111/opo.12299] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 03/03/2016] [Indexed: 12/11/2022]
Abstract
PURPOSE The aim of this study was to systematically review the literature to investigate the link (if any) between vision and dizziness. METHODS Medline, CINAHL, AMED, Web of Science and The Cochrane Library were searched with keywords chosen to find articles which investigated the causes of dizziness and considered vision as a possible trigger. Citation chaining of all included papers was performed in addition to the hand searching of all reference lists. Unpublished literature was identified using www.opengrey.eu. The review considered studies involving adults which link, measure or attempt to improve any aspect of vision in relation to dizziness. RESULTS Nine thousand six hundred and eighty one possible references were found, and the abstracts were screened independently by two reviewers to determine if they should be included in the study. Thirteen papers were found which investigated whether dizziness was linked to an assessment of vision. Visual impairment measures were crude and typically self-report, or Snellen visual acuity with little or no measurement details. Five studies found an independent link between dizziness and vision, five found a weak association (typically finding a link when univariate analyses were used, but not when multivariate analyses were used), and three found no association. Studies finding a strong link were usually cross-sectional with a large study population whereas those finding a weak association had relatively small numbers of participants. Studies which did not find an association used a broad definition of dizziness that included the term light-headedness, an unreliable Rosenbaum near visual acuity chart or an unusual categorisation of visual acuity. CONCLUSIONS This review suggests that dizziness (although likely not 'light-headedness') is linked with poor vision although further studies using more appropriate measures of vision are recommended.
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Affiliation(s)
- Deborah Armstrong
- Bradford School of Optometry and Vision Science, University of Bradford, Bradford, UK
| | - Emily Charlesworth
- Bradford School of Optometry and Vision Science, University of Bradford, Bradford, UK
| | - Alison J Alderson
- Bradford School of Optometry and Vision Science, University of Bradford, Bradford, UK
| | - David B Elliott
- Bradford School of Optometry and Vision Science, University of Bradford, Bradford, UK
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26
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Kontos AP, Sufrinko A, Elbin RJ, Puskar A, Collins MW. Reliability and Associated Risk Factors for Performance on the Vestibular/Ocular Motor Screening (VOMS) Tool in Healthy Collegiate Athletes. Am J Sports Med 2016; 44:1400-6. [PMID: 26980845 DOI: 10.1177/0363546516632754] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Vestibular/Ocular Motor Screening (VOMS) is a newly developed screening tool that evaluates vestibular and ocular motor symptom (eg, headache, dizziness, nausea, fogginess) provocation after a sport-related concussion. Baseline data on the VOMS are needed to extend the application of this measure to broad age groups and to document normal variations in performance. PURPOSE The primary purpose of this study was to examine the internal consistency of the VOMS in a large sample of healthy, nonconcussed collegiate athletes. The secondary purpose was to investigate the effects of patient sex and history of motion sickness, migraines, and concussions on baseline VOMS scores. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A total of 263 National Collegiate Athletic Association Division I athletes (mean ± SD age, 19.85 ± 1.35 years) completed self-reported demographic and medical history at preseason physical examinations and baseline screening. Internal consistency of the VOMS was assessed with Cronbach α. A series of univariate nonparametric tests (χ(2) with odds ratios [ORs] and 95% CIs) were used to examine the associations among medical history risk factors and VOMS clinical cutoff scores (score of ≥2 for any individual VOMS symptom, near point of convergence [NPC] distance of ≥5 cm), with higher scores representing greater symptom provocation. RESULTS Internal consistency of the VOMS was high (Cronbach α = .97), and 89% of athletes scored below cutoff levels (ie, 11% false-positive rate). Female athletes (OR, 2.99 [95% CI, 1.34-6.70]; P = .006) and those with a personal history of motion sickness (OR, 7.73 [95% CI, 1.94-30.75]; P = .009) were more likely to have ≥1 VOMS scores above cutoff levels. No risk factors were associated with increased odds of an abnormal NPC distance. CONCLUSION The VOMS possesses internal consistency and an acceptable false-positive rate among healthy Division I collegiate student-athletes. Female sex and a history of motion sickness were risk factors for VOMS scores above clinical cutoff levels among healthy collegiate student-athletes. Results support a comprehensive baseline evaluation approach that includes an assessment of premorbid vestibular and oculomotor symptoms.
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Affiliation(s)
- Anthony P Kontos
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Alicia Sufrinko
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - R J Elbin
- Office for Sport Concussion Research, University of Arkansas, Fayetteville, Arkansas, USA
| | - Alicia Puskar
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Michael W Collins
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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27
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Van Ombergen A, Lubeck AJ, Van Rompaey V, Maes LK, Stins JF, Van de Heyning PH, Wuyts FL, Bos JE. The Effect of Optokinetic Stimulation on Perceptual and Postural Symptoms in Visual Vestibular Mismatch Patients. PLoS One 2016; 11:e0154528. [PMID: 27128970 PMCID: PMC4851359 DOI: 10.1371/journal.pone.0154528] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 04/14/2016] [Indexed: 11/23/2022] Open
Abstract
Background Vestibular patients occasionally report aggravation or triggering of their symptoms by visual stimuli, which is called visual vestibular mismatch (VVM). These patients therefore experience discomfort, disorientation, dizziness and postural unsteadiness. Objective Firstly, we aimed to get a better insight in the underlying mechanism of VVM by examining perceptual and postural symptoms. Secondly, we wanted to investigate whether roll-motion is a necessary trait to evoke these symptoms or whether a complex but stationary visual pattern equally provokes them. Methods Nine VVM patients and healthy matched control group were examined by exposing both groups to a stationary stimulus as well as an optokinetic stimulus rotating around the naso-occipital axis for a prolonged period of time. Subjective visual vertical (SVV) measurements, posturography and relevant questionnaires were assessed. Results No significant differences between both groups were found for SVV measurements. Patients always swayed more and reported more symptoms than healthy controls. Prolonged exposure to roll-motion caused in patients and controls an increase in postural sway and symptoms. However, only VVM patients reported significantly more symptoms after prolonged exposure to the optokinetic stimulus compared to scores after exposure to a stationary stimulus. Conclusions VVM patients differ from healthy controls in postural and subjective symptoms and motion is a crucial factor in provoking these symptoms. A possible explanation could be a central visual-vestibular integration deficit, which has implications for diagnostics and clinical rehabilitation purposes. Future research should focus on the underlying central mechanism of VVM and the effectiveness of optokinetic stimulation in resolving it.
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Affiliation(s)
- Angelique Van Ombergen
- Antwerp University Research centre for Equilibrium and Aerospace (AUREA), University of Antwerp, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- * E-mail:
| | - Astrid J. Lubeck
- Research Institute MOVE, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, Netherlands
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology, Antwerp University Hospital, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Leen K. Maes
- Antwerp University Research centre for Equilibrium and Aerospace (AUREA), University of Antwerp, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium
| | - John F. Stins
- Research Institute MOVE, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, Netherlands
| | - Paul H. Van de Heyning
- Antwerp University Research centre for Equilibrium and Aerospace (AUREA), University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology, Antwerp University Hospital, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Floris L. Wuyts
- Antwerp University Research centre for Equilibrium and Aerospace (AUREA), University of Antwerp, Antwerp, Belgium
| | - Jelte E. Bos
- Research Institute MOVE, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, Netherlands
- TNO Perceptual and Cognitive Systems, Soesterberg, The Netherlands
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28
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Payette MC, Bélanger C, Léveillé V, Grenier S. Fall-Related Psychological Concerns and Anxiety among Community-Dwelling Older Adults: Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0152848. [PMID: 27043139 PMCID: PMC4820267 DOI: 10.1371/journal.pone.0152848] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 03/20/2016] [Indexed: 12/30/2022] Open
Abstract
Fear of falling and other fall-related psychological concerns (FRPCs), such as falls-efficacy and balance confidence, are highly prevalent among community-dwelling older adults. Anxiety and FRPCs have frequently, but inconsistently, been found to be associated in the literature. The purpose of this study is to clarify those inconsistencies with a systematic review and meta-analysis and to evaluate if the strength of this relationship varies based on the different FRPC constructs used (e.g., fear of falling, falls-efficacy or balance confidence). A systematic review was conducted through multiple databases (e.g., MEDLINE, PsycINFO) to include all articles published before June 10th 2015 that measured anxiety and FRPCs in community-dwelling older adults. Active researchers in the field were also contacted in an effort to include unpublished studies. The systematic review led to the inclusion of twenty relevant articles (n = 4738). A random-effect meta-analysis revealed that the mean effect size for fear of falling and anxiety is r = 0.32 (95% CI: 0.22-0.40), Z = 6.49, p < 0.001 and the mean effect size for falls-efficacy or balance confidence and anxiety is r = 0.31 (95% CI: 0.23-0.40), Z = 6.72, p < 0.001. A Q-test for heterogeneity revealed that the two effect sizes are not significantly different (Q(19) = 0.13, p = n.s.). This study is the first meta-analysis on the relationship between anxiety and FRPCs among community-dwelling older adults. It demonstrates the importance of considering anxiety when treating older adults with FRPCs.
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Affiliation(s)
- Marie-Christine Payette
- Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada
- Centre de recherche de l’Institut Universitaire de Gériatrie de Montréal, Montreal, Quebec, Canada
- Laboratoire d'Étude sur l'Anxiété et la Dépression gÉRiatrique (LEADER), Montreal, Quebec, Canada
| | - Claude Bélanger
- Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Vanessa Léveillé
- Centre de recherche de l’Institut Universitaire de Gériatrie de Montréal, Montreal, Quebec, Canada
- Laboratoire d'Étude sur l'Anxiété et la Dépression gÉRiatrique (LEADER), Montreal, Quebec, Canada
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Sébastien Grenier
- Centre de recherche de l’Institut Universitaire de Gériatrie de Montréal, Montreal, Quebec, Canada
- Laboratoire d'Étude sur l'Anxiété et la Dépression gÉRiatrique (LEADER), Montreal, Quebec, Canada
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
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29
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Anson E, Jeka J. Perspectives on Aging Vestibular Function. Front Neurol 2016; 6:269. [PMID: 26779116 PMCID: PMC4701938 DOI: 10.3389/fneur.2015.00269] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 12/14/2015] [Indexed: 01/10/2023] Open
Abstract
Much is known about age-related anatomical changes in the vestibular system. Knowledge regarding how vestibular anatomical changes impact behavior for older adults continues to grow, in line with advancements in diagnostic testing. However, despite advancements in clinical diagnostics, much remains unknown about the functional impact that an aging vestibular system has on daily life activities such as standing and walking. Modern diagnostic tests are very good at characterizing neural activity of the isolated vestibular system, but the tests themselves are artificial and do not reflect the multisensory aspects of natural human behavior. Also, the majority of clinical diagnostic tests are passively applied because active behavior can enhance performance. In this perspective paper, we review anatomical and behavioral changes associated with an aging vestibular system and highlight several areas where a more functionally relevant perspective can be taken. For postural control, a multisensory perturbation approach could be used to bring balance rehabilitation into the arena of precision medicine. For walking and complex gaze stability, this may result in less physiologically specific impairments, but the trade-off would be a greater understanding of how the aging vestibular system truly impacts the daily life of older adults.
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Affiliation(s)
- Eric Anson
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins Medical Institutes , Baltimore, MD , USA
| | - John Jeka
- Department of Kinesiology, Temple University, Philadelphia, PA, USA; Department of Bioengineering, Temple University, Philadelphia, PA, USA
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30
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Abstract
This chapter provides an introduction to the topic of multisensory integration in balance control in, both, health and disease. One of the best-studied examples is that of visuo-vestibular interaction, which is the ability of the visual system to enhance or suppress the vestibulo-ocular reflex (VOR suppression). Of clinical relevance, examination of VOR suppression is clinically useful because only central, not peripheral, lesions impair VOR suppression. Visual, somatosensory (proprioceptive), and vestibular inputs interact strongly and continuously in the control of upright balance. Experiments with visual motion stimuli show that the visual system generates visually-evoked postural responses that, at least initially, can override vestibular and proprioceptive signals. This paradigm has been useful for the study of the syndrome of visual vertigo or vision-induced dizziness, which can appear after vestibular disease. These patients typically report dizziness when exposed to optokinetic stimuli or visually charged environments, such as supermarkets. The principles of the rehabilitation treatment of these patients, which use repeated exposure to visual motion, are presented. Finally, we offer a diagnostic algorithm in approaching the patient reporting oscillopsia - the illusion of oscillation of the visual environment, which should not be confused with the syndrome mentioned earlier of visual vertigo.
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Affiliation(s)
- A M Bronstein
- Neuro-otology Unit, Imperial College London, Charing Cross Hospital and National Hospital for Neurology and Neurosurgery, London, United Kingdom.
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