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Chen Z, Liu Y, Sun Y, Wei X, Liu H, Lv Y, Shan J, Dong S, Xiao L, Rong L. Increased parietal operculum functional connectivity following vestibular rehabilitation in benign paroxysmal positional vertigo patients with residual dizziness: a randomized controlled resting-state fMRI study. Neuroradiology 2025; 67:931-942. [PMID: 39754615 DOI: 10.1007/s00234-024-03535-4] [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: 09/10/2024] [Accepted: 12/22/2024] [Indexed: 01/06/2025]
Abstract
INTRODUCTION Residual dizziness (RD) is common in patients with benign paroxysmal positional vertigo (BPPV) after successful canalith repositioning procedures. This study aimed to investigate the therapeutic effects of vestibular rehabilitation (VR) on BPPV patients experiencing RD, and to explore the impact of VR on functional connectivity (FC), specifically focusing on the bilateral parietal operculum (OP) cortex. METHODS Seventy patients with RD were randomly assigned to either a four-week VR group or a control group that received no treatment. Assessments included the dizziness Visual Analog Scale (VAS), Dizziness Handicap Inventory (DHI), Hamilton Anxiety/Depression Scale (HAMA/HAMD), and resting-state functional magnetic resonance imaging. RESULTS The VR group exhibited a significant decline in scores on VAS, DHI, HAMA and HAMD following training (all p < 0.05). Furthermore, the VR group demonstrated increased FC between the left OP and both the left precuneus and left middle frontal gyrus (MFG), and between the right OP and the right MFG (voxel-level p < 0.001; cluster-level p < 0.05, FDR corrected). Additionally, these changes in FC were found to correlate with clinical features, including scores on HAMA (p = 0.012, r = - 0.513) and DHI (p = 0.022, r = - 0.475) after the intervention. CONCLUSION This study demonstrated the therapeutic effects of VR in alleviating RD and emotional disorders, as well as in improving overall quality of life. Notably, these positive outcomes might be associated with increased FC between brain regions involved in mood regulation and vestibular processing. Our findings offer novel neuroimaging evidence that supports the hypothesis that VR facilitates dynamic vestibular compensation.
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Affiliation(s)
- Zhengwei Chen
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Quanshan District, Xuzhou, 221006, Jiangsu, China
| | - Yueji Liu
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Quanshan District, Xuzhou, 221006, Jiangsu, China
| | - Yang Sun
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Quanshan District, Xuzhou, 221006, Jiangsu, China
| | - Xiue Wei
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Quanshan District, Xuzhou, 221006, Jiangsu, China
| | - Haiyan Liu
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Quanshan District, Xuzhou, 221006, Jiangsu, China
| | - You Lv
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Quanshan District, Xuzhou, 221006, Jiangsu, China
| | - Junjun Shan
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Quanshan District, Xuzhou, 221006, Jiangsu, China
| | - Shanshan Dong
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Quanshan District, Xuzhou, 221006, Jiangsu, China
| | - Lijie Xiao
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Quanshan District, Xuzhou, 221006, Jiangsu, China.
| | - Liangqun Rong
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Quanshan District, Xuzhou, 221006, Jiangsu, China.
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Im YH, Lee HJ, Jeon EJ. Adherence to customized vestibular rehabilitation therapy: influencing factors and clinical implications in vestibulopathy. Front Neurol 2025; 16:1538989. [PMID: 40040913 PMCID: PMC11878102 DOI: 10.3389/fneur.2025.1538989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Accepted: 01/14/2025] [Indexed: 03/06/2025] Open
Abstract
Objective Customized vestibular rehabilitation therapy (CVRT) is an effective treatment approach for various vestibular disorders. However, low adherence significantly limits its efficacy, and factors influencing adherence remain underexplored. This study aimed to identify factors affecting adherence to CVRT across major vestibulopathy categories, including acute unilateral vestibular hypofunction (AUVH), chronic unilateral vestibular hypofunction (CUVH), and bilateral vestibular hypofunction (BVH). Methods A retrospective analysis of 90 patients who were prescribed four sessions of CVRT and underwent the therapy was conducted. Patients were classified as adherent (≥3 sessions) or non-adherent (≤2 sessions). Demographic characteristics, baseline questionnaire scores, and vestibular function test (VFT) results were compared. Change in questionnaire scores and VFT results before and after CVRT, as well as mid-treatment follow-up questionnaire scores were analyzed. Results Adherence rates were highest in CUVH (86.7%) and lowest in BVH (46.2%). Among patients with AUVH, poor functional reach test scores were significantly associated with lower adherence (p = 0.045). In the CUVH category, patients with mild dizziness in the initial questionnaire were non-adherent (p = 0.019). CVRT improved subjective dizziness symptoms and VFT parameters, with the greatest gains observed in AUVH. However, no significant differences in symptom improvement were found between adherent and non-adherent patients. Patients whose symptoms improved rapidly to a mild degree after starting the CVRT were more likely to be non-adherent, with this tendency being especially pronounced in those with AUVH. Conclusion Adherence to CVRT varies by vestibulopathy category and is influenced by baseline symptom severity. Tailoring CVRT strategies based on individual clinical profiles may enhance adherence and optimize therapeutic outcomes.
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Fontaine M, Dhooge I, Dhondt C, Van Hecke R, Acke F, Van den Bossche L, Van Hoecke H, De Leenheer E, Maes L. Vestibular Infant Screening-Rehabilitation (VIS-REHAB): protocol for a randomised controlled trial on Vestibular Rehabilitation Therapy (VRT) in vestibular-impaired children. BMJ Open 2024; 14:e085575. [PMID: 39806605 PMCID: PMC11667345 DOI: 10.1136/bmjopen-2024-085575] [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: 02/20/2024] [Accepted: 09/16/2024] [Indexed: 01/16/2025] Open
Abstract
INTRODUCTION A vestibular deficit can have a substantial impact on the overall development of children. Therefore, it is of utmost importance that vestibular-impaired problems are treated early and effectively through Vestibular Rehabilitation Therapy (VRT). Although VRT is sufficiently proven and standardised in adults, there remains a lack of research examining its efficacy in children. To assess the effectiveness of VRT in vestibular-impaired children, the Vestibular Infant Screening-Rehabilitation (VIS-REHAB) protocol was developed with the following objectives: (1) to investigate the short-term effect of a combined postural control and gaze stabilisation protocol, compared with receiving no therapy and (2) to investigate the most important factors that may influence the effect of and outcome after application of the VIS-REHAB protocol in a group of vestibular-impaired children. This study aims to address lingering questions in the existing literature in a standardised manner, with the ultimate objective to establish evidence-based rehabilitation guidelines. METHODS AND ANALYSIS The VIS-REHAB study is a two-parallel group, superiority, randomised controlled crossover trial with 1:1 allocation ratio. The study includes patients aged 3-17 years old with identified peripheral vestibular dysfunction. Primary and secondary outcome measures assess gaze stability, postural stability, motor performance and quality of life. The effectiveness of the VIS-REHAB protocol will be evaluated through parallel group and crossover analyses using analysis of covariance (ANCOVA). Additionally, prespecified subgroup analyses will be conducted to assess influencing factors that may impact the outcome and effect of VIS-REHAB. ETHICS AND DISSEMINATION At the start of the VIS-REHAB study, an amendment will be submitted to the ethics committee of Ghent University Hospital for the following applications: (EC2018/0435), (EC2018/0959), (EC2015/1441) and (EC2015/1442). The trial is registered at Clinical Trials (clinicaltrials.gov) with registry name VIS-REHAB and identifier NCT06177132. All research findings will be disseminated in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT06177132.
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Affiliation(s)
- Marieke Fontaine
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
- Faculty of Medicine and Health Sciences, Department of Head and Skin, Ghent University, Gent, Belgium
| | - Ingeborg Dhooge
- Faculty of Medicine and Health Sciences, Department of Head and Skin, Ghent University, Gent, Belgium
- Department of Otorhinolaryngeology, Head and Neck Surgery, University Hospital Ghent, Gent, Belgium
| | - Cleo Dhondt
- Faculty of Medicine and Health Sciences, Department of Head and Skin, Ghent University, Gent, Belgium
| | - Ruth Van Hecke
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Frederic Acke
- Faculty of Medicine and Health Sciences, Department of Head and Skin, Ghent University, Gent, Belgium
- Department of Otorhinolaryngeology, Head and Neck Surgery, University Hospital Ghent, Gent, Belgium
| | - Lena Van den Bossche
- Faculty of Medicine and Health Sciences, Department of Head and Skin, Ghent University, Gent, Belgium
| | - Helen Van Hoecke
- Faculty of Medicine and Health Sciences, Department of Head and Skin, Ghent University, Gent, Belgium
- Department of Otorhinolaryngeology, Head and Neck Surgery, University Hospital Ghent, Gent, Belgium
| | - Els De Leenheer
- Faculty of Medicine and Health Sciences, Department of Head and Skin, Ghent University, Gent, Belgium
- Department of Otorhinolaryngeology, Head and Neck Surgery, University Hospital Ghent, Gent, Belgium
| | - Leen Maes
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
- Department of Otorhinolaryngeology, Head and Neck Surgery, University Hospital Ghent, Gent, Belgium
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Lilios A, Nikitas C, Skoulakis C, Alagianni A, Chatziioannou I, Asimakopoulou P, Chimona T. The Unveiled Potential of Telehealth Practice in Vestibular Rehabilitation: A Comparative Randomized Study. J Clin Med 2024; 13:7015. [PMID: 39685471 DOI: 10.3390/jcm13237015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2024] [Accepted: 11/18/2024] [Indexed: 12/18/2024] Open
Abstract
Background and Objectives: Unilateral vestibular hypofunction (UVH) in cases of insufficient central nervous system compensation leads to chronic dizziness. A customized vestibular rehabilitation (VR) program is more beneficial than a generic set of exercises for patients with chronic UVH. The purpose of the present study is to compare a customized remotely supervised VR program with a customized unsupervised VR program in chronic UVH patients. Methods: Participants were randomly allocated into two groups (Group A and Group B) and received an individualized 6-week home-based VR program that included adaptation and habituation exercises, balance and gait training. All individuals' VR program implementation was evaluated weekly, allowing for exercise modifications. Moreover, Group A received additional remote supervision via phone communication (twice per week). The effectiveness of each VR program was evaluated using the scores of the Mini-BESTest, the Functional Gait Assessment (FGA), and the Dizziness Handicap Inventory (DHI). Results: At the 6-week assessment, participants in Group A had significantly better scores in objective and subjective evaluated parameters than those in Group B (p < 0.001). Group A also showed better compliance with the VR program. On the contrary, participants' conformity in their individualized exercises was not affected by gender, duration of symptoms, or BMI (p > 0.05). Conclusions: Our clinical study highlights the advantages of using telephone communication, with a structured design and implementation, to assist individuals in successfully following a VR protocol.
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Affiliation(s)
- Andreas Lilios
- Department of Otolaryngology, Head and Neck Surgery, University Hospital of Larisa, 413 34 Larisa, Greece
| | - Christos Nikitas
- 1st Department of Otolaryngology, Head and Neck Surgery, National and Kapodistrian University of Athens, Hippocrateion General Hospital, 115 27 Athens, Greece
| | - Charalampos Skoulakis
- Department of Otolaryngology, Head and Neck Surgery, University Hospital of Larisa, 413 34 Larisa, Greece
| | - Aggeliki Alagianni
- Department of Otolaryngology, Head and Neck Surgery, University Hospital of Larisa, 413 34 Larisa, Greece
| | - Ioannis Chatziioannou
- Department of Otolaryngology, Head and Neck Surgery, University Hospital of Larisa, 413 34 Larisa, Greece
| | - Panagiota Asimakopoulou
- Department of Otolaryngology, Head and Neck Surgery, Chania General Hospital, 733 00 Chania, Greece
| | - Theognosia Chimona
- Department of Otolaryngology, Head and Neck Surgery, Chania General Hospital, 733 00 Chania, Greece
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Babcock R, Viana S, Roach V, Shiley C, Lazaro R, Wilson AT, Beato M. Examining the effects of amplitude-based training as a component of the plan of care in an individual with olivopontocerebellar atrophy. Physiother Theory Pract 2024; 40:1888-1897. [PMID: 37165996 DOI: 10.1080/09593985.2023.2210218] [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: 11/03/2022] [Revised: 04/26/2023] [Accepted: 04/26/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Amplitude-based exercise training has been shown to be effective in the motor performance of individuals with idiopathic Parkinson's disease, with limited research investigating its effects on Parkinson plus syndromes such as olivopontocerebellar atrophy (OPCA). The purpose of this clinical case report is to examine the effects of amplitude-based training exercises on an individual with OPCA. CASE DESCRIPTION A 68-year-old man with a 14-month history of OPCA presented to physical therapy with bradykinesia, rigidity, and postural instability. The individual participated in 34 intervention sessions. Pre- and post-test measurements were collected for the following outcome measures: Five Times Sit to Stand (FTSTS); Functional Gait Assessment (FGA); Activities-Specific Balance Confidence Scale (ABC-6); 9 Hole Peg Test (9HPT); preferred and maximal gait speed. OUTCOMES Improvements reaching Minimum Detectable Change (MDC) or Minimal Clinically Important Difference (MCID) were recorded with a pre (Week 1) and post (Week 20) intervention: FGA score (4-point improvement (MDC95 = 4 points), preferred gait speed (0.09 meters/second improvement (MCID = 0.05 meters/second)), FTSTS (6-second improvement (MDC95 = 2.3 seconds)), and 9HPT on the dominant hand (3-second improvement (MDC95 = 2.6 seconds)). Fluctuations during the plan of care were observed for these measures, and additional outcomes did not demonstrate a worsening of function. CONCLUSION In an individual with OPCA, amplitude-based exercise training as a component of the plan of care increased dynamic balance in walking, gait speed, and hand dexterity. However, these results need to be validated on a larger sample of individuals with OPCA through randomized controlled trials.
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Affiliation(s)
| | - Samantha Viana
- Veterans Affairs Orlando Healthcare System, Orlando, FL, USA
| | - Victoria Roach
- Veterans Affairs Boston Healthcare System, Boston, MA, USA
| | | | - Rolando Lazaro
- Department of Physical Therapy, Sacramento State University, Sacramento, CA, USA
| | - Abigail T Wilson
- School of Kinesiology and Rehabilitation Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
| | - Morris Beato
- School of Kinesiology and Rehabilitation Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
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Son CH, Sim GW, Kim K. A Study on the Effects of a Self-Administered Eye Exercise Program on the Balance and Gait Ability of Chronic Stroke Patients: A Randomized Controlled Trial. J Pers Med 2024; 14:595. [PMID: 38929816 PMCID: PMC11204622 DOI: 10.3390/jpm14060595] [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: 04/27/2024] [Revised: 05/14/2024] [Accepted: 05/31/2024] [Indexed: 06/28/2024] Open
Abstract
This study investigates the effects of a self-administered eye exercise (SEE) program on the balance and gait ability of chronic stroke patients hospitalized due to hemiplegia. This study includes 42 patients diagnosed with stroke-related hemiplegia and hospitalized at D Rehabilitation Hospital. The researcher randomly allocated 42 patients into two groups: the experimental group (EG, n = 21, mean age = 58.14 ± 7.69 years, mean BMI = 22.83 ± 2.19 kg/m2) and the control group (CG, n = 21, mean age = 58.57 ± 6.53 years, mean BMI = 22.81 ± 2.36 kg/m2). The SEE program was applied to the EG and the general self-administered exercise (SE) program was applied to the CG. After 4 weeks of intervention, weight distribution of the affected side, the Timed Up and Go test (TUG), step length of the affected side, step length of the unaffected side, gait speed, and cadence were analyzed and compared. In the within-group comparison, both groups showed significant differences in weight distribution (p < 0.05), TUG (p < 0.05), step length of the affected side (p < 0.05), step length of the unaffected side (p < 0.05), gait speed (p < 0.05), and cadence (p < 0.05). In the between-group comparison, a significant difference in the TUG (p < 0.05) was observed. The SEE program had an overall similar effect to the SE program in improving the balance and gait ability of chronic stroke patients, and had a greater effect on dynamic balance ability. Therefore, the SEE program can be proposed as a self-administered exercise program to improve balance and gait ability in stroke patients who are too weak to perform the SE program in a clinical environment or have a high risk of falling.
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Affiliation(s)
| | | | - Kyoung Kim
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Gyeongsan 38453, Republic of Korea; (C.-H.S.); (G.-W.S.)
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Hall CD, Flynn S, Clendaniel RA, Roberts DC, Stressman KD, Pu W, Mershon D, Schubert MC. Remote assessment and management of patients with dizziness: development, validation, and feasibility of a gamified vestibular rehabilitation therapy platform. Front Neurol 2024; 15:1367582. [PMID: 38872821 PMCID: PMC11169667 DOI: 10.3389/fneur.2024.1367582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 05/08/2024] [Indexed: 06/15/2024] Open
Abstract
Introduction Dizziness is a growing public health concern with as many as 95 million adults in Europe and the United States experiencing vestibular hypofunction, which is associated with reduced quality of life, poorer health, and falls. Vestibular rehabilitation therapy (VRT) is effective in reducing symptoms and improving balance; however, limited access to qualified clinicians and poor patient adherence impedes optimal delivery. The goal of this study was to develop and evaluate the feasibility of a remote therapeutic monitoring VRT Platform application (APP) for the assessment and treatment of vestibular dysfunction. Methods User-centered iterative design process was used to gather and integrate the needs of users (clinicians and patients) into the design at each stage of development. Commonly used vestibular patient-reported outcome measures (PROs) were integrated into the APP and adults with chronic dizziness were enrolled to evaluate validity and reliability of the APP compared to standard clinical measures (CLIN). Gaze stabilization exercises were gamified to provide an engaging experience and an off-the-shelf sensor captured eye and head movement to provide feedback on accuracy of performance. A prospective, pilot study design with pre-and post-treatment assessment assessed feasibility of the APP compared to standard VRT (CLIN). Results Participants with dizziness wanted a summary rehabilitation report shared with their clinicians, felt that an app could help with accountability, and believed that a gaming format might help with exercise adherence. Clinicians felt that the app should include features to record and track eye and head movement, monitor symptoms, score accuracy of task performance, and measure adherence. Validity and reliability of the digital PROs (APP) were compared to scores from CLIN across two sessions and found to have good validity, good to excellent test-retest reliability, and excellent usability (≥88%ile). The pilot study demonstrated feasibility for use of the APP compared to CLIN for treatment of vestibular hypofunction. The mean standard system usability score of the APP was 82.5 indicating excellent usability. Discussion Both adult patients with chronic dizziness and VRT clinicians were receptive to the use of technology for VRT. The HiM-V APP is a feasible alternative to clinical management of adults with chronic peripheral vestibular hypofunction.
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Affiliation(s)
- Courtney D. Hall
- Mountain Home Hearing and Balance Research Program, James H. Quillen Veterans Affairs Medical Center, Mountain Home, TN, United States
- Physical Therapy Program, College of Clinical and Rehabilitative Health Sciences, East Tennessee State University, Johnson City, TN, United States
| | | | - Richard A. Clendaniel
- Department of Orthopedic Surgery, Physical Therapy Division, Duke University Medical Center, Durham, NC, United States
- Department of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, NC, United States
| | - Dale C. Roberts
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | - Kara D. Stressman
- Mountain Home Hearing and Balance Research Program, James H. Quillen Veterans Affairs Medical Center, Mountain Home, TN, United States
| | - William Pu
- Blue Marble Health, Altadena, CA, United States
| | | | - Michael C. Schubert
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, United States
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Özgirgin ON, Kingma H, Manzari L, Lacour M. Residual dizziness after BPPV management: exploring pathophysiology and treatment beyond canalith repositioning maneuvers. Front Neurol 2024; 15:1382196. [PMID: 38854956 PMCID: PMC11157684 DOI: 10.3389/fneur.2024.1382196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/22/2024] [Indexed: 06/11/2024] Open
Abstract
Despite the high success rate of canalith repositioning maneuvers (CRMs) in the treatment of benign paroxysmal positional vertigo (BPPV), a growing number of patients report residual dizziness symptoms that may last for a significant time. Although the majority of BPPV cases can be explained by canalolithiasis, the etiology is complex. Consideration of the individual patient's history and underlying pathophysiology of BPPV may offer the potential for treatment approaches supplementary to CRMs, as well as a promising alternative for patients in whom CRMs are contraindicated. This article provides a summary of the possible underlying causes of BPPV and residual dizziness, along with suggestions for potential management options that may be considered to relieve the burden of residual symptoms.
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Affiliation(s)
| | - Herman Kingma
- Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Maastricht University Medical Center, Maastricht, Limburg, Netherlands
| | - Leonardo Manzari
- Vestibology Science, MSA ENT Academy Center, Cassino, Lazio, Italy
| | - Michel Lacour
- Aix-Marseille Université, Neurosciences Department, Marseille, France
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Gui M, Lv L, Qin L, Wang C. Vestibular dysfunction in Parkinson's disease: a neglected topic. Front Neurol 2024; 15:1398764. [PMID: 38846039 PMCID: PMC11153727 DOI: 10.3389/fneur.2024.1398764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/14/2024] [Indexed: 06/09/2024] Open
Abstract
Dizziness and postural instability are frequently observed symptoms in patient with Parkinson's disease (PD), potentially linked to vestibular dysfunction. Despite their significant impact on quality of life, these symptoms are often overlooked and undertreated in clinical practice. This review aims to summarize symptoms associated with vestibular dysfunction in patients with PD and discusses vestibular-targeted therapies for managing non-specific dizziness and related symptoms. We conducted searches in PubMed and Web of Science using keywords related to vestibular dysfunction, Parkinson's disease, dizziness, and postural instability, alongside the reference lists of relevant articles. The available evidence suggests the prevalence of vestibular dysfunction-related symptoms in patients with PD and supports the idea that vestibular-targeted therapies may be effective in improving PD symptoms.
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Affiliation(s)
- Meilin Gui
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Lingling Lv
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Lixia Qin
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
- China National Clinical Research Center on Mental Disorders, Changsha, China
| | - Chunyu Wang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
- Department of Medical Genetics, The Second Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
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Cui Q, Wen C, Yan J, Wang R, Han R, Huang L. Effects of Different Durations and Frequencies of Vestibular Rehabilitation in Patients With Residual Symptoms After Benign Paroxysmal Positional Vertigo Repositioning. Ann Otol Rhinol Laryngol 2024; 133:307-316. [PMID: 38031431 DOI: 10.1177/00034894231216277] [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: 12/01/2023]
Abstract
OBJECTIVES This study aimed to explore the effects of different duration and daily frequency of vestibular rehabilitation (VR) in patients with residual symptoms after benign paroxysmal positional vertigo (BPPV) successful repositioning. METHOD Patients with successful BPPV repositioning (n = 118) were divided into 3 groups according to VR duration and frequency: group A (n = 30; 15 minutes, 3 times/day), group B (n = 30; 30 minutes, 3 times/day), group C (n = 28; 15 minutes, 6 times/day), and control group D (n = 30; no VR). All patients completed the dizziness handicap inventory (DHI) and vestibular rehabilitation benefit questionnaire (VRBQ) at baseline and after 2 and 4 weeks. RESULTS The emotional scores and the proportion of severe dizziness disability in the DHI scores were significant differences between VR groups A to C and control group D after 2 and 4 weeks (all P < .05). There were significant differences in total DHI and VRBQ scores among the VR groups A to C after 2 and 4 weeks (all P < .05). Interestingly, emotion scores were not significantly different in group A (P = .385), group B (P = .569), and group C (P = .340) between 2 and 4 weeks. Meanwhile at 2 weeks, the difference in motion-provoked dizziness score between group A and B was statistically significant (P = .02). CONCLUSIONS A total VR duration over 4 weeks can reduce dizziness and improve VR benefits in routine therapy in patients with residual dizziness after successful BPPV repositioning. Emotional improvement can be observed after 2 weeks. VR may help to relieve motion-provoked dizziness earlier if patients are willing to consider increasing the duration to more than 15 minutes.
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Affiliation(s)
- Qingjia Cui
- Rehabilitation Centre of Otolaryngology-Head and Neck, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, P.R. China
| | - Cheng Wen
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, P.R. China
- Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology-Head and Neck Surgery, Ministry of Education, Beijing, P.R. China
| | - Jin Yan
- Rehabilitation Centre of Otolaryngology-Head and Neck, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, P.R. China
| | - Rui Wang
- Rehabilitation Centre of Otolaryngology-Head and Neck, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, P.R. China
| | - Renjie Han
- Rehabilitation Centre of Otolaryngology-Head and Neck, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, P.R. China
| | - Lihui Huang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, P.R. China
- Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology-Head and Neck Surgery, Ministry of Education, Beijing, P.R. China
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Shi Q, Wu RJ, Liu J. Effect of health education based on information-motivation-behavioral skills model on patients with unilateral vestibular dysfunction. World J Clin Cases 2024; 12:903-912. [PMID: 38414598 PMCID: PMC10895628 DOI: 10.12998/wjcc.v12.i5.903] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/05/2023] [Accepted: 01/19/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Vestibular dysfunction (VH) is a common concomitant symptom of late peripheral vestibular lesions, which can be trauma, poisoning, infection, heredity, and neurodegeneration, but about 50% of the causes are unknown. The study uses the information-motivation-behavioral skills (IMB) model for health education, effectively improve the quality of life, increase their self-confidence, reduce anxiety and depression, and effectively improve the psychological state of patients. AIM To explore the effect of health education based on the IMB model on the degree of vertigo, disability, anxiety and depression in patients with unilateral vestibular hypofunction. METHODS The clinical data of 80 patients with unilateral vestibular hypofunction from January 2019 to December 2021 were selected as the retrospective research objects, and they were divided into the control group and the observation group with 40 cases in each group according to different nursing methods. Among them, the control group was given routine nursing health education and guidance, and the observation group was given health education and guidance based on the IMB model. The changes in self-efficacy, anxiety and depression, and quality of life of patients with unilateral VH were compared between the two groups. RESULTS There was no significant difference in General Self-Efficacy Scale (GSES) scale scores between the two groups of patients before nursing (P > 0.05), which was comparable; after nursing, the GSES scale scores of the two groups were higher than those before nursing. The nursing group was higher than the control group, and the difference was statistically significant (P < 0.05). There was no significant difference in the scores of Hospital Anxiety and Depression Scale (HADS) and anxiety and depression subscales between the two groups before nursing (P > 0.05). After nursing, the HADS score, anxiety, and depression subscale scores of the two groups of patients were lower than those before nursing, and the nursing group was lower than the control group, and the difference was statistically significant (P < 0.05). After nursing, the Dizziness Handicap Inventory (DHI) scale and DHI-P, DHI-E and DHI-F scores in the two groups were decreased, and the scores in the nursing group were lower than those in the control group, and the difference was statistically significant (P < 0.05). CONCLUSION Health education based on the IMB model can effectively improve patients' quality of life, increase self-efficacy of patients with unilateral vestibular hypofunction, enhance patients' confidence, enable patients to resume normal work and life as soon as possible, reduce patients' anxiety and depression, and effectively improve patients' psychological status.
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Affiliation(s)
- Qiong Shi
- Department of Neurology, Wuahan Fourth Hospital, Wuhan 430000, Hubei Province, China
| | - Ruo-Jun Wu
- Department of Critical Care Medicine, Wuhan No. 1 Hospital, Wuhan 430033, Hubei Province, China
| | - Jiang Liu
- Department of Neurology, Wuahan Fourth Hospital, Wuhan 430000, Hubei Province, China
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12
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Van Laer L, Hallemans A, Janssens de Varebeke S, De Somer C, Van Rompaey V, Vereeck L. Compensatory strategies after an acute unilateral vestibulopathy: a prospective observational study. Eur Arch Otorhinolaryngol 2024; 281:743-755. [PMID: 37642710 DOI: 10.1007/s00405-023-08192-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/14/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE In case of an acute unilateral vestibulopathy (UVP), compensatory strategies such as restoration and adaptation will lead to a decrease in intensity of the symptoms. Although measurements of compensatory strategies are available, currently, an overview taking the different strategies into account is lacking. The objectives of this study are to explore compensatory strategies and to investigate the association between compensatory strategies and patient characteristics. METHODS Restoration was objectified by the vestibulo-ocular reflex (VOR) gain on the video head impulse test, and adaptation-consisting of visual, multisensory, and behavioral substitution-was objectified by the Visual Vertigo Analog Scale (VVAS), Antwerp Vestibular Compensation Index (AVeCI), and Perez and Rey score (PR score), respectively. Adequate restoration and adaptation levels were interpreted as follows: VOR gain > 0.80, VVAS ≤ 40%, AVeCI > 0 and PR score ≤ 55. RESULTS Sixty-two UVP patients, 34 men and 28 women, were included with an average age of 52.1 ± 17.3 years. At 10.5 ± 1.4 weeks after onset, 41.9% of the UVP patients reached adequate restoration levels and 58.1-86.9% reached adequate adaptation levels. Furthermore, significant associations were found between (1) restoration status and UVP etiology [Odds Ratio (OR) with 95% CI: 4.167 {1.353;12.828}] and balance performance (OR: 4.400 {1.258;15.386}), (2) visual sensory substitution status and perceived handicap (OR: 8.144 {1.644;40.395}), anxiety (OR: 10.000 {1.579;63.316}) and depression (OR: 16.667 {2.726;101.896}), and (3) behavioral substitution status and balance performance (OR: 4.143 {1.341;12.798}). CONCLUSION UVP patients with adequate compensatory strategies presented with better balance performance, lower perceived handicap, and lower anxiety and depression scores.
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Affiliation(s)
- Lien Van Laer
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium.
- Multidisciplinary Motor Centre Antwerp (M2OCEAN), University of Antwerp, Antwerp, Belgium.
| | - Ann Hallemans
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
- Multidisciplinary Motor Centre Antwerp (M2OCEAN), University of Antwerp, Antwerp, Belgium
| | | | - Clara De Somer
- Rehabilitation Center Sint-Lievenspoort Ghent, Ghent, Belgium
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital Edegem, Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Luc Vereeck
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
- Multidisciplinary Motor Centre Antwerp (M2OCEAN), University of Antwerp, Antwerp, Belgium
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Hanna C, Yao R, Sajjad M, Gold M, Blum K, Thanos PK. Exercise Modifies the Brain Metabolic Response to Chronic Cocaine Exposure Inhibiting the Stria Terminalis. Brain Sci 2023; 13:1705. [PMID: 38137153 PMCID: PMC10742065 DOI: 10.3390/brainsci13121705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 11/28/2023] [Accepted: 12/02/2023] [Indexed: 12/24/2023] Open
Abstract
It is well known that exercise promotes health and wellness, both mentally and physiologically. It has been shown to play a protective role in many diseases, including cardiovascular, neurological, and psychiatric diseases. The present study examined the effects of aerobic exercise on brain glucose metabolic activity in response to chronic cocaine exposure in female Lewis rats. Rats were divided into exercise and sedentary groups. Exercised rats underwent treadmill running for six weeks and were compared to the sedentary rats. Using positron emission tomography (PET) and [18F]-Fluorodeoxyglucose (FDG), metabolic changes in distinct brain regions were observed when comparing cocaine-exposed exercised rats to cocaine-exposed sedentary rats. This included activation of the secondary visual cortex and inhibition in the cerebellum, stria terminalis, thalamus, caudate putamen, and primary somatosensory cortex. The functional network of this brain circuit is involved in sensory processing, fear and stress responses, reward/addiction, and movement. These results show that chronic exercise can alter the brain metabolic response to cocaine treatment in regions associated with emotion, behavior, and the brain reward cascade. This supports previous findings of the potential for aerobic exercise to alter the brain's response to drugs of abuse, providing targets for future investigation. These results can provide insights into the fields of exercise neuroscience, psychiatry, and addiction research.
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Affiliation(s)
- Colin Hanna
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Clinical Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacob School of Medicine and Biosciences, State University of New York at Buffalo, Buffalo, NY 14203, USA
| | - Rutao Yao
- Department of Nuclear Medicine, State University of New York at Buffalo, Buffalo, NY 14203, USA
| | - Munawwar Sajjad
- Department of Nuclear Medicine, State University of New York at Buffalo, Buffalo, NY 14203, USA
| | - Mark Gold
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Kenneth Blum
- Division of Addiction Research and Education, Center for Sports, Exercise and Global Mental Health, Western University Health Sciences, Pomona, CA 91766, USA
| | - Panayotis K. Thanos
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Clinical Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacob School of Medicine and Biosciences, State University of New York at Buffalo, Buffalo, NY 14203, USA
- Department of Psychology, State University of New York at Buffalo, Buffalo, NY 14203, USA
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Ortega Solís J, Reynard P, Spruyt K, Bécaud C, Ionescu E, Thai-Van H. Developing a serious game for gaze stability rehabilitation in children with vestibular hypofunction. J Neuroeng Rehabil 2023; 20:128. [PMID: 37752531 PMCID: PMC10521575 DOI: 10.1186/s12984-023-01249-x] [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: 05/31/2023] [Accepted: 09/13/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Children with vestibular hypofunction (VH) may have gaze instability, balance disorders, and delayed postural-motor development. Gaze stabilization exercises (GSE) are designed to improve dynamic visual acuity (DVA). We aimed to assess the acceptability of a serious game prototype called Kid Gaze Rehab (KGR) designed to implement GSE training in children with VH, combined with traditional vestibular rehabilitation. Effects on DVA and motor performance were also analyzed. METHODS Twelve children (6 to 9 years old) were included. Sessions were held at the hospital twice a week, for 5 weeks. An adapted French version of The Child Simulator Sickness Questionnaire (SSQ) and the Face Scale Pain-Revised (FPS-R) were used to assess pain in the cervical region and undesirable side effects after each session. Vestibular and motor function parameters (active and passive DVA and Movement Assessment Battery for Children-Second Edition, MABC-2) were assessed before and after the training. RESULTS All children included completed the 10 sessions. The FPS-R visual analog scale and SSQ showed good cervical tolerance and no oculomotor or vegetative adverse effects nor spatial disorientation. After training, active DVA scores were significantly improved for the right, left, and up directions (p < 0.05). Passive DVA scores were significantly improved for the left and down directions (p < 0.01 and p < 0.05, respectively). MABC-2 scores were improved in the balance and ball skill sections (p < 0.05). CONCLUSION An innovative pediatric training method, the use of a dedicated serious game for gaze stabilization was well-tolerated as a complement to conventional vestibular rehabilitation in children with VH. Moreover, both DVA and motor performance were found to improve in the study sample. Although replication studies are still needed, serious game-based training in children with VH could represent a promising rehabilitation approach for years to come. TRIAL REGISTRATION The study was conducted in accordance with the Declaration of Helsinki and approved by an Institutional Review Board (local ethics committee, CPP Sud-Est IV, ID 2013-799). The study protocol was registered on ClinicalTrials.gov (NCT04353115).
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Affiliation(s)
- José Ortega Solís
- Service d'Audiologie & Explorations Oto-Neurologiques, Hospices Civils de Lyon, 5 Place d'Arsonval, Lyon, 69003, France
- Société française de kinésithérapie vestibulaire, Toulouse, France
| | - Pierre Reynard
- Service d'Audiologie & Explorations Oto-Neurologiques, Hospices Civils de Lyon, 5 Place d'Arsonval, Lyon, 69003, France
- Société française de kinésithérapie vestibulaire, Toulouse, France
- Université Claude Bernard Lyon 1, Lyon, France
- Centre de Recherche et d'Innovation en Audiologie Humaine, Institut Pasteur, Institut de l'Audition, rue du Docteur Roux, Paris, 75015, France
| | - Karen Spruyt
- Université Paris Cité, NeuroDiderot - INSERM, Hôpital Robert Debré AP-HP, 48 Bd Sérurier, Bingen, Paris, 75019, France
| | - Cécile Bécaud
- Service d'Audiologie & Explorations Oto-Neurologiques, Hospices Civils de Lyon, 5 Place d'Arsonval, Lyon, 69003, France
- Société française de kinésithérapie vestibulaire, Toulouse, France
| | - Eugen Ionescu
- Service d'Audiologie & Explorations Oto-Neurologiques, Hospices Civils de Lyon, 5 Place d'Arsonval, Lyon, 69003, France
- Centre de Recherche et d'Innovation en Audiologie Humaine, Institut Pasteur, Institut de l'Audition, rue du Docteur Roux, Paris, 75015, France
| | - Hung Thai-Van
- Service d'Audiologie & Explorations Oto-Neurologiques, Hospices Civils de Lyon, 5 Place d'Arsonval, Lyon, 69003, France.
- Université Claude Bernard Lyon 1, Lyon, France.
- Centre de Recherche et d'Innovation en Audiologie Humaine, Institut Pasteur, Institut de l'Audition, rue du Docteur Roux, Paris, 75015, France.
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Huang Q, Liu L, Ma P, Sun Y, Wang Z, Bai J, Liu T. Grading for suction loss in small incision lenticule extraction. Int Ophthalmol 2023; 43:665-675. [PMID: 36044110 DOI: 10.1007/s10792-022-02456-6] [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] [Received: 01/26/2022] [Accepted: 07/31/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION To observe the characteristics of suction loss in small-incision lenticule extraction (SMILE) and analyze the factors affecting the stability of the suction ring, classify and grade suction loss, and determine the principles for its prevention and control. METHODS This study enrolled patients who underwent SMILE between June 2014 and June 2017. The relationship between the stability of the suction ring and suction loss was ascertained using surgical records and video recordings. The suction loss was classified and graded according to its characteristics and relationship with eye or head movement. The effect of target intervention on suction loss was observed. RESULTS Suction loss can be divided into sudden and progressive types. According to the severity, the latter was divided into three grades (grade 1A or 1B, 2 and 3). Of the 1200 eyes (608 patients), two (0.17%) had sudden suction loss, and 132 (11%) had progressive suction loss. The superior part, inferior part, and other parts accounted for 63.4%, 19.3%, and 17.3% of progressive suction loss, respectively. The proportion of grades 1A, 1B, 2, and 3 suction loss was 53%, 34%, 12%, and 1%, respectively. The location of the threatened suction loss was opposite to the direction of the patient's head movement. After the intraoperative intervention, grades 1 and 2 did not develop into "actual" suction loss. CONCLUSIONS Progressive suction loss was the most frequently observed suction loss during SMILE procedure. Grading suction loss can elucidate its underlying mechanism, which can guide targeted intervention measures to effectively control and reduce suction loss-induced damage, and further improve the safety and efficacy of SMILE.
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Affiliation(s)
- Qing Huang
- Department of Ophthalmology, Army Medical University of People's Liberation Army, Chongqing, China
| | - Lina Liu
- Chongqing Baiji Eye Hospital Management Co. LTD, Chongqing, China
| | - Pingqi Ma
- Department of Ophthalmology, Army Medical University of People's Liberation Army, Chongqing, China
| | - Yulin Sun
- Department of Ophthalmology, Army Medical University of People's Liberation Army, Chongqing, China
| | - Zhiqiang Wang
- Department of Ophthalmology, Army Medical University of People's Liberation Army, Chongqing, China
| | - Ji Bai
- Chongqing Baiji Eye Hospital Management Co. LTD, Chongqing, China
| | - Ting Liu
- Department of Ophthalmology, Army Medical University of People's Liberation Army, Chongqing, China.
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Burnett WD, Tweten M, Okpalauwaekwe U, Trask C, Milosavljevic S. The effect of selected rest break activities on reaction time, balance, and perceived discomfort after one hour of simulated occupational whole-body vibration exposure in healthy adults. Ann Med 2023; 55:2244965. [PMID: 37572647 PMCID: PMC10424600 DOI: 10.1080/07853890.2023.2244965] [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: 06/15/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 08/14/2023] Open
Abstract
MATERIALS & METHODS Eleven healthy adults participated in four 1-hour sessions of ecologically valid WBV exposure followed by one of four 5-minute activities: sitting, walking, 2 min of gaze stabilization exercise (GSE) coupled with 3 min of trunk mobility exercise (GSE + MOBIL), or 2 min of GSE coupled with a 3-minute walk (GSE + WALK). Baseline and post-activity measurements (rating of perceived discomfort, balance and postural sway measurements, 5-minute psychomotor vigilance task test) were submitted to a paired t-test to determine the effect of WBV exposure and activities on physical, cognitive, and sensorimotor systems and to a repeated measures ANOVA to determine any differences across activities. RESULTS We observed degradation of the slowest 10% reaction speed outcomes between baseline and post-activity after walking (7.3%, p < 0.05) and sitting (8.6%, p < 0.05) but not after GSE + MOBIL or GSE + WALK activities. Slowest 10% reaction speed after GSE + MOBIL activity was faster than all other activities. The rating of perceived discomfort was higher after SIT and WALK activities. There were no notable differences in balance outcomes. CONCLUSION When compared to sitting for 5 min, an activity including GSE and an active component, such as walking or trunk mobility exercises, resulted in maintenance of reaction time after WBV exposure. If confirmed in occupational environments, GSE may provide a simple, rapid, effective, and inexpensive means to protect against decrements in reaction time after WBV exposure.
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Affiliation(s)
- Wadena D. Burnett
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Michael Tweten
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Catherine Trask
- Division of Ergonomics, KTH Royal Institute of Technology, Stockholm, Sweden
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Aldawsary N, Almarwani M. The combined effect of gaze stability and balance exercises using telerehabilitation in individuals with vestibular disorders during the COVID-19 pandemic: A pilot study. PLoS One 2023; 18:e0282189. [PMID: 37146078 PMCID: PMC10162509 DOI: 10.1371/journal.pone.0282189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 02/04/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Vestibular rehabilitation is recognized as the most effective intervention to relieve symptoms of dizziness and imbalance related to vestibular disorders. OBJECTIVE This study aimed to examine the combined effect of gaze stability and balance exercises using telerehabilitation in individuals with vestibular disorders during the COVID-19 pandemic. METHODS This pilot study was a quasi-experimental, single-group design pre- to post-telerehabilitation intervention. Individuals with vestibular disorders between the ages of 25-60 participated in this study (n = 10). Participants underwent four weeks of combined gaze stability and balance exercises using telerehabilitation at their homes. The Arabic version of the Activities-Specific Balance Confidence scale (A-ABC), Berg Balance Scale (BBS), and the Arabic version of the Dizziness Handicap Inventory (A-DHI) were assessed pre- and post-vestibular telerehabilitation. Wilcoxon signed rank test was used to examine the magnitude of difference pre- and post-intervention scores of outcome measures. The effect size (r) for the Wilcoxon signed rank was calculated. RESULTS After four weeks of vestibular telerehabilitation, there was an improvement in BBS and A-DHI outcome measures (p < .001), with moderate effect size for both scales (r = 0.6). However, A-ABC showed no significant improvement among participants. CONCLUSION This pilot study found that the combined effect of gaze stability and balance exercises using telerehabilitation appear to be effective in improving balance and activities of daily living in individuals with vestibular disorders.
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Affiliation(s)
- Nada Aldawsary
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
- Department of Medical Rehabilitation, Physical Therapy Department, Ministry of Health, Riyadh, Saudi Arabia
| | - Maha Almarwani
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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18
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Ma N, Liu H, Liu B, Zhang L, Li B, Yang Y, Liu W, Chen M, Shao J, Zhang X, Ni X, Zhang J. Effectiveness and acceptance of Vestibulo-Ocular Reflex adaptation training in children with recurrent vertigo with unilateral vestibular dysfunction and normal balance function. Front Neurol 2022; 13:996715. [PMID: 36588896 PMCID: PMC9800911 DOI: 10.3389/fneur.2022.996715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
Objective This was a block randomized controlled study to evaluate the effectiveness and acceptance of Vestibulo-Ocular Reflex (VOR) adaptation training in children with recurrent vertigo with unilateral vestibular dysfunction (UVD) and normal balance function. Methods Thirty children, aged 4-13 years, diagnosed with recurrent vertigo of childhood (RVC) with UVD (according to a caloric test) and normal balance function were analyzed. These 30 children were divided into 10 blocks based on similar age and severity of vertigo. Three children in each block were randomly assigned to one of three groups to receive 1 month of treatment. Group A received vestibular-ocular reflex (VOR) adaptation training, Group B received Cawthorne-Cooksey training, and a control group received no training. All children were administered pharmacotherapy [Ginkgo biloba leaf extract (drops)]. The Dizziness Handicap Inventory (DHI), Visual Analog Scale of Quality of Life with Vertigo (VAS-QLV), and canal paralysis (CP) on the caloric test were recorded before and after treatment, and the effectiveness of treatment was evaluated. The Visual Analog Scale of Acceptance (VAS-A) was used to evaluate the acceptance of the training in the two groups that received training. Results There were 10 children each in Group A, Group B, and the control group; the male to female ratio was 1, and the average age in each group was 9.0 ± 3.2, 8.4 ± 3.0, and 8.3 ± 2.6 years, respectively. The effective rate was 100% in Group A, 65% in Group B, and 60% in Group C. The recovery rate on caloric testing after treatment was 100, 70, and 50%, respectively. DHI scores before and after training were 56.8 ± 12.4 and 8.8 ± 6.1 in Group A, 57.8 ± 12.6 and 18.8 ± 9.7 in Group B, and 56.8 ± 12.4 and 24.0 ± 15.3 in Group C (all P = 0.000). VAS-QLV scores before and after training were 7.5 ± 1.0 and 0.9 ± 0.9 in Group A, 6.4 ± 2.2 and 2.7 ± 1.1 in Group B, and 6.6 ± 1.6 and 2.6 ± 1.4 in Group C (all P < 0.05). The CP values before and after training were 35.7 ± 15.1 and 12.9 ± 8.7 in Group A, 33.6 ± 20.1 and 23.6 ± 19.3 in Group B, and 38.6 ± 21.1 and 24.8 ± 17.9 in Group C (P = 0.001, P = 0.015, and P = 0.050, respectively). Between-group comparisons showed that the decreases in DHI and VAS-QLV scores after training were significantly different (P = 0.015, P = 0.02), while CP values were not (P = 0.139). After training, the DHI value had decreased significantly more in Group A compared with Group C (P < 0.05), but there were no other differences. After training, VAS-QLV scores in Group A had decreased significantly more compared with Group B and C (P < 0.05). In terms of acceptance, the VAS-A score was 7.6 ± 2.2 in Group A and 3.1 ± 2.8 in Group B (P =0.004), The acceptance rate was 70% in group A and 10% in group B. there was no significant correlation between age and VAS-A in either group A or group B (P > 0.05). Conclusion This study strongly suggests that vestibular rehabilitation training should be performed in children with vertigo to improve symptoms. For children with RVC with UVD but normal balance function, a single VOR adaptation program can effectively improve vertigo symptoms, and given its simplicity, time-effectiveness, and excellent outcomes, it is associated with better acceptance in children compared to classic Cawthorne-Cooksey training.
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Affiliation(s)
- Ning Ma
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China,Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, China
| | - Handi Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China,Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, China
| | - Bing Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China,Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, China
| | - Li Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China,Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, China
| | - Bei Li
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China,Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, China
| | - Yang Yang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China,Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, China
| | - Wei Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China,Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, China
| | - Min Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China,Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, China
| | - Jianbo Shao
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China,Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, China
| | - Xiao Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China,Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, China
| | - Xin Ni
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China,Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, China,*Correspondence: Xin Ni ✉
| | - Jie Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China,Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, China,Jie Zhang ✉
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Sever E, Kiliç G, Algun ZC. The Effects of Vestibular Rehabilitation on Kinesiophobia and Balance with Individuals Who has Vestibular Hypofunction. Indian J Otolaryngol Head Neck Surg 2022; 74:4319-4324. [PMID: 34804903 PMCID: PMC8589630 DOI: 10.1007/s12070-021-02979-x] [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: 08/23/2021] [Accepted: 11/06/2021] [Indexed: 02/07/2023] Open
Abstract
The study aimed to examine the effects of vestibular rehabilitation on kinesiophobia, quality of life, dynamic visual acuity, and balance. Thirty vestibular hypofunction patients aged 18-65 years who were diagnosed by videonystagmography (VNG) voluntarily participated in the study. Before and after treatment Tampa Kinesiophobia Scale, World Health Organization Quality of Life Scale-Turkish Short Form, Tandem Stance Test, Dynamic Visual Acuity, Visual Analog Scale to measure dizziness, Subjective Visual Vertical and Subjective for verticality and horizontality perception Visual Horizontal tests were applied. The exercise program was applied for 8 weeks. Patients were observed in the hospital every two weeks. The exercises given in the session were given as home exercises, 3 times a day, for 10 repetitions. As a result of the study, statistical correlations were found tandem stance test, subjective visual vertical and subjective visual horizontal tests for the perception of verticality and horizontality, visual analog scale to measure the severity of dizziness, dynamic visual acuity, quality of life and tampa kinesiophobia scales (p < 0.05). It can be said that vestibular rehabilitation improves the quality of life, balance, dynamic visual acuity, and overcomes kinesiophobia in patients. Trial registration number: NCT05070936, Date of registration:10/06/2021 (Retrospectively registered).
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Affiliation(s)
- Ebru Sever
- Department of Physiotherapy and Rehabilitation, İstanbul Medipol University, Kavacık South Campus, 34815 Beykoz, İstanbul, Turkey
| | - Gamze Kiliç
- Department of Physiotherapy and Rehabilitation, İstanbul Medipol University, Kavacık South Campus, 34815 Beykoz, İstanbul, Turkey
| | - Zeliha Candan Algun
- Department of Physiotherapy and Rehabilitation, İstanbul Medipol University, Kavacık South Campus, 34815 Beykoz, İstanbul, Turkey
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20
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Loyd BJ, Fangman A, Peterson DS, Gappmaier E, Thackeray A, Schubert MC, Dibble LE. Rehabilitation to Improve Gaze and Postural Stability in People With Multiple Sclerosis: A Randomized Clinical Trial. Neurorehabil Neural Repair 2022; 36:678-688. [PMID: 36113117 PMCID: PMC10518217 DOI: 10.1177/15459683221124126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND People with multiple sclerosis (PwMS) frequently experience dizziness and imbalance that may be caused by central vestibular system dysfunction. Vestibular rehabilitation may offer an approach for improving dysfunction in these people. OBJECTIVE To test the efficacy of a gaze and postural stability (GPS) retraining intervention compared to a strength and endurance (SAE) intervention in PwMS. METHODS About 41 PwMS, with complaints of dizziness or history of falls, were randomized to either the GPS or SAE groups. Following randomization participants completed 6-weeks of 3×/week progressive training, delivered one-on-one by a provider. Following intervention, testing was performed at the primary (6-weeks) and secondary time point (10-weeks). A restricted maximum likelihood estimation mixed effects model was used to examine changes in the primary outcome of the Dizziness Handicap Inventory (DHI) between the 2 groups at the primary and secondary time point. Similar models were used to explore secondary outcomes between groups at both timepoints. RESULTS Thirty-five people completed the study (17 GPS; 18 SAE). The change in the DHI at the primary time point was not statistically different between the GPS and SAE groups (mean difference = 2.33 [95% CI -9.18, 12.85]). However, both groups demonstrated significant improvement from baseline to 6-weeks (GPS -8.73; SAE -7.31). Similar results were observed for secondary outcomes and at the secondary timepoint. CONCLUSIONS In this sample of PwMS with complaints of dizziness or imbalance, 6-weeks of GPS training did not result in significantly greater improvements in dizziness handicap or balance compared to 6-weeks of SAE training.
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Affiliation(s)
- Brian J. Loyd
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, MT, USA
| | - Annie Fangman
- Department of Physical Therapy and Athletic Training, University of Utah College of Health, Salt Lake City, UT, USA
| | | | - Eduard Gappmaier
- Department of Physical Therapy and Athletic Training, University of Utah College of Health, Salt Lake City, UT, USA
| | - Anne Thackeray
- Department of Physical Therapy and Athletic Training, University of Utah College of Health, Salt Lake City, UT, USA
| | - Michael C. Schubert
- Department of Otolaryngology-Head and Neck Surgery, John Hopkins University School of Medicine, Baltimore, MD, USA
| | - Leland E. Dibble
- Department of Physical Therapy and Athletic Training, University of Utah College of Health, Salt Lake City, UT, USA
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21
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Group Vestibular Rehabilitation Program: A Cost-Effective Outpatient Management Option for Dizzy Patients. Otol Neurotol 2022; 43:1065-1071. [PMID: 36075105 DOI: 10.1097/mao.0000000000003675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES This study was performed to evaluate the effectiveness of our novel group vestibular rehabilitation therapy (G-VRT) and to analyze the factors affecting outcomes. STUDY DESIGN Retrospective case series. SETTING Tertiary referral center. PATIENTS Patients with chronic dizziness who received G-VRT between December 2019 and July 2020. INTERVENTION The G-VRT program consisted of a 1-hour physical therapy session by an otologist in a small group setting. MAIN OUTCOME MEASURES Dizziness Handicap Inventory, visual analog scale, functional level scales, and video head impulse test, as well as the compliance to the program, were evaluated. RESULTS All scores of dizziness questionnaires were significantly improved after G-VRT ( p < 0.001). The overall vestibule-ocular reflex gain calculated by video head impulse test increased compared to the initial scores, whereas the average PR scores of all three semicircular canals significantly decreased from the initial scores, indicating enhanced vestibular compensation ( p < 0.05). Enrolled patients showed high compliance to the program. CONCLUSION G-VRT program is a cost-effective and efficient way to provide relief for chronic dizzy patients. Further case-control studies in a larger group, as well as comparative studies with generic or customized vestibular exercise, will be needed to validate the clinical value of G-VRT.
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22
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Longitudinal [18]UCB-H/[18F]FDG imaging depicts complex patterns of structural and functional neuroplasticity following bilateral vestibular loss in the rat. Sci Rep 2022; 12:6049. [PMID: 35411002 PMCID: PMC9001652 DOI: 10.1038/s41598-022-09936-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/23/2022] [Indexed: 11/10/2022] Open
Abstract
Neuronal lesions trigger mechanisms of structural and functional neuroplasticity, which can support recovery. However, the temporal and spatial appearance of structure–function changes and their interrelation remain unclear. The current study aimed to directly compare serial whole-brain in vivo measurements of functional plasticity (by [18F]FDG-PET) and structural synaptic plasticity (by [18F]UCB-H-PET) before and after bilateral labyrinthectomy in rats and investigate the effect of locomotor training. Complex structure–function changes were found after bilateral labyrinthectomy: in brainstem-cerebellar circuits, regional cerebral glucose metabolism (rCGM) decreased early, followed by reduced synaptic density. In the thalamus, increased [18F]UCB-H binding preceded a higher rCGM uptake. In frontal-basal ganglia loops, an increase in synaptic density was paralleled by a decrease in rCGM. In the group with locomotor training, thalamic rCGM and [18F]UCB-H binding increased following bilateral labyrinthectomy compared to the no training group. Rats with training had considerably fewer body rotations. In conclusion, combined [18F]FDG/[18F]UCB-H dual tracer imaging reveals that adaptive neuroplasticity after bilateral vestibular loss is not a uniform process but is composed of complex spatial and temporal patterns of structure–function coupling in networks for vestibular, multisensory, and motor control, which can be modulated by early physical training.
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23
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Bauwens A, Larock F. Vestibular asthenopia. J Fr Ophtalmol 2021; 44:1560-1565. [PMID: 34556339 DOI: 10.1016/j.jfo.2021.05.008] [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: 04/05/2021] [Accepted: 05/17/2021] [Indexed: 11/28/2022]
Abstract
Vestibular asthenopia, analogous to visual asthenopia, is a sensory (or sensory-motor) discomfort consisting of a set of subjective symptoms, the expression of which is essentially visual and whose origin is a transient vestibular incident. It can be considered the result of a sudden global central disorder, such as a "computer glitch," following a chain of events in response to an initial vestibular disease, even minor and devoid of clinical signs. This disorder results in inadequate processing and imperfect integration of afferent visual and vestibular input, leading to ocular fatigue, pain associated with eye movement, and sensitivity to retinal slip.
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Affiliation(s)
- A Bauwens
- Unité de Réhabilitation Vestibulaire, CHU UCL Namur, 5500 Dinant, Belgium.
| | - F Larock
- Service d'ophtalmologie, CHU UCL Bruxelles, 1200 Bruxelles, Belgium
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24
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Xavier F, Chouin E, Montava M, Tighilet B, Lavieille JP, Chabbert C. Status of rehabilitation of the dizzy patient in France: focus on vestibular physiotherapy. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2021. [DOI: 10.1080/21679169.2021.1969427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Frédéric Xavier
- Laboratoire de Neurosciences Cognitives, LNC UMR 7291; Unit GDR2074 CNRS, Team Pathophysiology and Therapy of Vestibular Disorders, Aix Marseille Université-CNRS, Marseille, France
| | - Emmanuelle Chouin
- Laboratoire de Neurosciences Cognitives, LNC UMR 7291; Unit GDR2074 CNRS, Team Pathophysiology and Therapy of Vestibular Disorders, Aix Marseille Université-CNRS, Marseille, France
| | - Marion Montava
- Assistance Publique des Hôpitaux de Marseille, Otorhinolaryngology and Head Neck Surgery Department, Conception University Hospital, Marseille, France
- Aix Marseille Univ, CNRS UMR 7051, INP, Institut NeuroPhysiopathologie, Marseille, France
| | - Brahim Tighilet
- Laboratoire de Neurosciences Cognitives, LNC UMR 7291; Unit GDR2074 CNRS, Team Pathophysiology and Therapy of Vestibular Disorders, Aix Marseille Université-CNRS, Marseille, France
| | - Jean-Pierre Lavieille
- Laboratoire de Neurosciences Cognitives, LNC UMR 7291; Unit GDR2074 CNRS, Team Pathophysiology and Therapy of Vestibular Disorders, Aix Marseille Université-CNRS, Marseille, France
- Assistance Publique des Hôpitaux de Marseille, Otorhinolaryngology and Head Neck Surgery Department, Conception University Hospital, Marseille, France
| | - Christian Chabbert
- Laboratoire de Neurosciences Cognitives, LNC UMR 7291; Unit GDR2074 CNRS, Team Pathophysiology and Therapy of Vestibular Disorders, Aix Marseille Université-CNRS, Marseille, France
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25
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Van Hecke R, Deconinck FJA, Wiersema JR, Clauws C, Danneels M, Dhooge I, Leyssens L, Van Waelvelde H, Maes L. Balanced Growth project: a protocol of a single-centre observational study on the involvement of the vestibular system in a child's motor and cognitive development. BMJ Open 2021; 11:e049165. [PMID: 34117049 PMCID: PMC8202106 DOI: 10.1136/bmjopen-2021-049165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 05/07/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The involvement of the vestibular system in the motor and higher (cognitive) performances of typically developing or vestibular-impaired children is currently unknown or has only scarcely been explored. Interestingly, arguments for an interaction between vestibular, motor and cognitive functions in children can also be supported by research on children known for their difficulties in motor and/or cognitive processing (eg, children with neurodevelopmental disorders (NDD)), as they often present with vestibular-like characteristics. Therefore, in order to elucidate this interaction, and to increase the understanding of the pathophysiology and symptomatology of vestibular disorders and NDD in children, the Balanced Growth project was developed. It includes the following objectives: (1) to understand the association between motor skills, cognitive performances and the vestibular function in typically developing school-aged children, with special focus on the added value of the vestibular system in higher cognitive skills and motor competence; (2) to investigate whether a vestibular dysfunction (with/without an additional auditory disease) has an impact on motor skills, cognitive performances and motor-cognitive interactions in children and (3) to assess if an underlying vestibular dysfunction can be identified in school-aged children with NDD, with documentation of the occurrence and characteristics of vestibular dysfunctions in this group of children using an extensive vestibular test battery. METHODS AND ANALYSIS In order to achieve the objectives of the observational cross-sectional Balanced Growth study, a single-task and dual-task test protocol was created, which will be performed in three groups of school-aged children (6-12 years old): (1) a typically developing group (n=140), (2) (audio) vestibular-impaired children (n=30) and (3) children with an NDD diagnosis (n=55) (ie, autism spectrum disorder, attention deficit/hyperactivity disorder and/or developmental coordination disorder). The test protocol consists of several custom-made tests and already existing validated test batteries and includes a vestibular assessment, an extensive motor assessment, eight neurocognitive tests, a cognitive-motor interaction assessment and includes also additional screenings to control for potential confounding factors (eg, hearing status, intelligence, physical activity, etc). ETHICS AND DISSEMINATION The current study was approved by the ethics committee of Ghent University Hospital on 4 June 2019 with registration number B670201940165 and is registered at Clinical Trials (clinicaltrials.gov) with identifier NCT04685746. All research findings will be disseminated in peer-reviewed journals and presented at vestibular as well as multidisciplinary international conferences and meetings. TRIAL REGISTRATION NUMBER NCT04685746.
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Affiliation(s)
- Ruth Van Hecke
- Department of Rehabilitation Sciences, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
| | - Frederik J A Deconinck
- Department of Movement and Sports Sciences, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
| | - Jan R Wiersema
- Department of Experimental Clinical and Health Psychology, Ghent University Faculty of Psychology and Educational Sciences, Ghent, Belgium
| | - Chloe Clauws
- Department of Rehabilitation Sciences, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
| | - Maya Danneels
- Department of Rehabilitation Sciences, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
| | - Ingeborg Dhooge
- Department of Otorhinolaryngology, University Hospital Ghent, Ghent, Belgium
- Department of Head and Skin, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
| | - Laura Leyssens
- Department of Rehabilitation Sciences, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
| | - Hilde Van Waelvelde
- Department of Rehabilitation Sciences, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
| | - Leen Maes
- Department of Rehabilitation Sciences, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
- Department of Otorhinolaryngology, University Hospital Ghent, Ghent, Belgium
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26
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Thompson-Harvey A, Dutcher CE, Monroe HA, Sinks BC, Goebel JA. Detection of VOR dysfunction during the gaze stabilization test: Does target size matter? J Vestib Res 2021; 31:495-504. [PMID: 33896858 DOI: 10.3233/ves-201602] [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 The Gaze Stabilization Test (GST) identifies vestibulo-ocular reflex (VOR) dysfunction using a decline in target recognition with increasing head velocity, but there is no consensus on target (optotype) size above static visual acuity. OBJECTIVE To determine the optimal initial optotype size above static visual acuity to be used during the GST in subjects with unilateral vestibular dysfunction and healthy individuals. METHODS Eight subjects with unilateral vestibular dysfunction (UVD) and 19 age-matched, healthy control subjects were studied with the standard GST protocol using two optotype sizes, 0.2 and 0.3 logMAR above static visual acuity (ΔlogMAR). Maximal head velocity achieved while maintaining fixation on both optotypes was measured. Sensitivity, specificity and receiver-operator characteristic area under the curve (ROC AUC) analyses were performed to determine the optimal head velocity cut off point for each optotype, based on ability to identify the lesioned side of the UVD group from the control group. RESULTS There was a significant difference in maximal head velocity between the UVD group and control group using 0.2 ΔlogMAR (p = 0.032) but not 0.3 ΔlogMAR (p = 0.061). While both targets produced similar specificities (90%) for distinguishing normal from subjects with UVD, 0.2 ΔlogMAR targets yielded higher sensitivity (75%) than 0.3 logMAR (63%) and accuracy (86% vs 80%, respectively) in detecting the lesioned side in subjects with UVD versus controls with maximal head velocities≤105 deg/s (p = 0.017). Furthermore, positive likelihood ratios were nearly twice as high when using 0.2 ΔlogMAR targets (+ LR 10) compared to 0.3 ΔlogMAR (+ LR 6.3). CONCLUSION The 0.2 ΔlogMAR optotype demonstrated significantly superior identification of subjects with UVD, better sensitivity and positive likelihood ratios than 0.3 ΔlogMAR for detection of VOR dysfunction. Using a target size 0.2logMAR above static visual acuity (ΔlogMAR) during GST may yield better detection of VOR dysfunction to serve as a baseline for gaze stabilization rehabilitation therapy.
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Affiliation(s)
- Adam Thompson-Harvey
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | | | - Belinda C Sinks
- Dizziness and Balance Center, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Joel A Goebel
- Dizziness and Balance Center, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, USA
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27
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Zwergal A, Dieterich M. [Update on diagnosis and therapy in frequent vestibular and balance disorders]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2021; 89:211-220. [PMID: 33873210 DOI: 10.1055/a-1432-1849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The 8 most frequent vestibular disorders account for more than 70% of all presentations of vertigo, dizziness, and imbalance. In acute (and mostly non-repetitive) vestibular disorders acute unilateral vestibulopathy and vestibular stroke are most important, in episodic vestibulopathies benign paroxysmal positional vertigo (BPPV), Menière's disease and vestibular migraine, and in chronic vestibular disorders bilateral vestibulopathy/presbyvestibulopathy, functional dizziness and cerebellar dizziness. In the last decade, internationally consented diagnostic criteria and nomenclature were established for the most frequent vestibular disorders, which can be easily applied in clinical practice. The diagnostic guidelines are based on history taking (including onset, duration, course, triggers, accomanying symptoms), clinical examination, and only a few apparative tests (by videooculography and audiometry) for securing the diagnosis. Treatment of vestibular disorders includes physical training (repositioning maneuvers, multimodal balance training) and pharmacological approaches (e.g., corticosteroids, antiepileptics, antidepressants, potassium-canal-blockers, drugs enhancing neuroplasticity). For most drugs, high-level evidence from prospective controlled trials is lacking. In clinical practice, the most frequent vestibular disorders can be treated effectively, thus avoiding chronicity and secondary comorbidity (by immobility, falls or psychiatric disorders such as anxiety or depression).
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Affiliation(s)
- Andreas Zwergal
- LMU Klinikum, Neurologische Klinik und Deutsches Schwindel- und Gleichgewichtszentrum (DSGZ)
| | - Marianne Dieterich
- LMU Klinikum, Neurologische Klinik und Deutsches Schwindel- und Gleichgewichtszentrum (DSGZ)
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28
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Galgon AK, Holmberg JM. Commentary on: Convergence Vestibulo-ocular Reflex in Unilateral Vestibular Hypofunction: Behavioral Evidence in Support for a Novel Gaze Stability Exercise. J Neurol Phys Ther 2021; 45:12-13. [PMID: 33315833 DOI: 10.1097/npt.0000000000000346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Anne K Galgon
- Physical Therapy Department (A.K.G.), University of the Sciences, Philadelphia, Pennsylvania; and Intermountain Hearing & Balance Center (J.M.H.), Salt Lake City, Utah
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29
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Liu L, Hu X, Zhang Y, Pan Q, Zhan Q, Tan G, Wang K, Zhou J. Effect of Vestibular Rehabilitation on Spontaneous Brain Activity in Patients With Vestibular Migraine: A Resting-State Functional Magnetic Resonance Imaging Study. Front Hum Neurosci 2020; 14:227. [PMID: 32595463 PMCID: PMC7303278 DOI: 10.3389/fnhum.2020.00227] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 05/20/2020] [Indexed: 12/20/2022] Open
Abstract
Previous studies have shown that vestibular migraine (VM) is a cerebral disease with recurrent vertigo. Vestibular rehabilitation (VR) is an effective type of physical therapy for minimizing vestibular symptoms, as it improves vestibular compensation in patients with VM. Currently, the cerebral regions that are associated with the pathogenesis of VM are largely unknown. To further understand the underlying mechanisms of VM, we performed resting-state functional magnetic resonance imaging (fMRI) before and after 1 month of VR in 14 patients with VM. The Dizziness Handicap Inventory (DHI), the 36-Item Short-Form Health Survey (SF-36), the Hamilton Depression Scale (HAMD) and the Hamilton Anxiety Scale (HAMA) scores were included as clinical outcomes. The amplitude of low-frequency fluctuation (ALFF) was assessed to characterize spontaneous brain activity. The correlations between the clinical characteristics and ALFF values were assessed. After 1 month of VR training, the DHI scores in patients with VM were significantly lower than those at baseline (p = 0.03), as were the HAMA scores (p = 0.02). We also found that the ALFF values in the left posterior cerebellum of VM patients increased significantly after 1 month of VR training. Moreover, the ALFF values in the left cerebellum were inversely correlated with the patients’ DHI scores. Overall, this study showed that VR exercise for 1 month has a positive effect on vestibular symptoms in patients with VM. Asymmetric cerebellar hyperactivity might be a functional compensation for vestibular dysfunction in patients with VM.
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Affiliation(s)
- Li Liu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Department of Neurology, Chongqing Renji Hospital, University of Chinese Academy of Sciences, Chongqing, China
| | - Xiaofei Hu
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yixin Zhang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qi Pan
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qunling Zhan
- Department of Neurology, Chongqing Renji Hospital, University of Chinese Academy of Sciences, Chongqing, China
| | - Ge Tan
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kuiyun Wang
- Department of Neurology, The Jintang First People's Hospital, Sichuan University, Sichuan, China
| | - Jiying Zhou
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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