Guidelines of the French Society of Otorhinolaryngology and Head and Neck Surgery (SFORL) for vestibular rehabilitation in children with vestibular dysfunction. A systematic review.

INTRODUCTION: The consequence of complete or partial uncompensated vestibular dysfunction in children is usually balance disorders, with the risk of falls and increased fatigue, particularly during tasks requiring postural control. The aim of these recommendations is to establish guidelines for vestibular rehabilitation (VR) in children with vestibular impairment. MATERIAL AND METHODS: The guidelines were developed based on a systematic review of the international literature, validated by a multidisciplinary group of French-speaking otorhinolaryngologists, scientists, and physiotherapists. They are classified as grade A, B, C, or expert opinion according to a decreasing level of scientific evidence. RESULTS: A PubMed search of studies published between January 1990 and December 2021 was carried out using the keywords "vestibular," "rehabilitation," and "children". After filtering and reviewing the articles, a total of 10 publications were included to establish the recommendations. CONCLUSION: It is recommended that a vestibular assessment be carried out before VR, including a study of vestibulo-ocular reflex, otolithic function, and postural control. In cases of vestibular dysfunction, physiotherapy treatment is recommended from an early age to train different aspects of postural control, including anticipatory and reactive postural adjustments. VR adapted to the pediatric population is recommended for children whose vestibular dysfunction leads to functional disorders or symptoms of vertigo for those who have suffered head trauma. It is recommended that children with bilateral vestibular impairment be treated using gaze stabilization exercises for adaptation and substitution. Optokinetic stimulation and virtual reality are not recommended for children and young adolescents.

Effect of vestibular rehabilitation games in patients with persistent postural perceptual dizziness and its relation to anxiety and depression: prospective study.

PURPOSE: To evaluate the efficacy of vestibular rehabilitation therapy (VRT) for management of patients with persistent postural perceptual dizziness (PPPD) utilizing subjective and objectives outcome measures and to study the effect of degree of both anxiety and depression in patients on the response of vestibular rehabilitation therapy. METHODS: Thirty-three PPPD patients participated in this study. Selection of patients was based on the diagnostic criteria for PPPD stated by Barany society in the International Classification of Vestibular Disorders (2017). Every patient was subjected to history taking, anxiety and depression assessment, Arabic version of Dizziness Handicap Inventory (DHI), and sensory organization test (SOT). All patients received vestibular rehabilitations therapy. Assessment of VRT outcome was conducted after 6 weeks of VRT. RESULTS: The mean patients' age was 40.9 ± 16.3 years, and nearly equal gender distribution. Vestibular migraine was the most precipitating condition (24.2%) in patients with PPPD. (39.4%) of patients had abnormal scores of anxiety and depression tests, all patients had from moderate to severe degrees of handicap caused by dizziness as measured by DHI, most of patients had abnormal findings in all conditions of SOT. After vestibular rehabilitation therapy, DHI and SOT scores showed significant improvement after VRT. More improvement was found among the group with no anxiety and depression. CONCLUSION: VRT were effective in improving balance abnormalities in patients with PPPD evidenced by subjectively by DHI scores and objectively by SOT results. PPPD patients with concomitant psychiatric disorders; anxiety and depression experienced the least degree of improvement.

Terapia de rehabilitación vestibular en alteración mixta (central y periférica). Reporte de un caso / Vestibular rehabilitation therapy in mixed (central and peripheral) disorder. A case report

La terapia de rehabilitación vestibular es el tratamiento con mayor evidencia en la recuperación para la mayoría de los trastornos de equilibrio. En los casos que presentan una alteración estable del procesamiento central del equilibrio, o mixta, es decir, acompañada de una alteración a nivel del sistema nervioso periférico, la terapia de rehabilitación vestibular no se excluye como tratamiento. No obstante, los progresos suelen ser limitados y requieren de una mayor cantidad de sesiones. En este trabajo analizaremos un caso mixto, un paciente con síndrome de núcleo fastigial y el vértigo posicional paroxístico benigno (VPPB), desde la pesquisa y evaluación hasta el tratamiento y alta, en el Hospital Clínico Universidad de Chile.

Vestibular rehabilitation therapy is the treatment with the greatest evidence of recovery for most balance disorders. In the cases that have a loss of central balance processing, or mixed, that is, stable accompanied by a disorder of the peripheral nervous system the vestibular rehabilitation therapy is not excluded as a treatment; however, progress is usually limited and requires a greater number of sessions. In this work we will analyse a mixed case, a patient with nucleus fastigial syndrome and a benign paroxysmal positional vertigo, from the investigation and evaluation to the treatment and discharge, at the Hospital Clínico Universidad de Chile.

Efetividade da reabilitação vestibular no equilíbrio, tontura, funcionalidade e sintomas depressivos em idosos / Effectiveness of vestibular rehabilitation on balance, dizziness, functioning, and depressive symptoms in older adults

RESUMO Objetivo Avaliar a efetividade da reabilitação vestibular na funcionalidade, ganho dos canais semicirculares ao Video Head Impulse Test (v-HIT), nas respostas ao Potencial Evocado Miogênico Vestibular (VEMP), sintomas depressivos, equilíbrio e tontura em idosos. Métodos Estudo longitudinal, quase experimental e analítico, realizado entre dezembro de 2019 e julho de 2022, com 50 idosos com disfunção vestibular, submetidos à reabilitação vestibular e à aplicação dos exames VEMP, v-HIT, dos questionários e escalas Escala Visual Analógica, Dizziness Handicap Inventory e Escala de Equilíbrio de Berg, além do Questionário de Atividades Funcionais de Pfeffer e Escala de Depressão Geriátrica. Todos os exames e questionários foram aplicados antes e após oito sessões semanais de reabilitação vestibular. A análise estatística foi realizada pelo programa SPSS, por meio do teste Wilcoxon (p<0,05). Resultados Observou-se melhora do ganho do canal semicircular anterior direito (0,71/0,78), redução do incômodo da tontura (7/5), do impacto da tontura na qualidade de vida (35/15), melhora do equilíbrio (45/51), além de melhora da funcionalidade (2/1) e redução dos sintomas depressivos (5/3). Conclusão Idosos com disfunção vestibular submetidos à reabilitação vestibular apresentaram melhora do ganho do reflexo vestíbulo-ocular, do equilíbrio, da funcionalidade, redução do impacto da tontura na qualidade de vida e dos sintomas depressivos.

ABSTRACT Purpose To assess the effectiveness of vestibular rehabilitation on functioning, gains in semicircular canals in the Video Head Impulse Test (v-HIT), on responses to the vestibular evoked myogenic potentials (VEMP), depressive symptoms, balance, and dizziness in older adults. Methods Longitudinal, quasi-experimental, analytical study conducted between December 2019 and July 2022, in 50 older adults with vestibular disorders, submitted to vestibular rehabilitation and examinations: VEMP, v-HIT, the questionnaires, visual analog scale, Dizziness Handicap Inventory, Berg Balance Scale, Pfeffer's Functional Activities Questionnaire, and Geriatric Depression Scale. All examinations and questionnaires were applied before and after eight weekly vestibular rehabilitation sessions. Statistical analysis was performed in SPSS, with the Wilcoxon test (p<0.05). Results There was a gain in the anterior right semicircular canal (0.71/0.78), reduction in dizziness discomfort (7/5) and in the impact of dizziness on the quality of life (35/15), improvement in balance (45/51) and functioning (2/1), and reduction in depressive symptoms (5/3). Conclusion Older adults with vestibular disorder submitted to vestibular rehabilitation improved their gain in vestibulo-ocular reflex, balance, and functional activities and reduced their depressive symptoms and the impact of dizziness on their quality of life.

Habilidades cognitivas envolvidas na avaliação e reabilitação vestibular: revisão integrativa / Cognitive skills involved in vestibular assessment and rehabilitation: an integrative review / Habilidades cognitivas involucradas en la evaluación y rehabilitación vestibular: revisión integrativa

Introdução: a literatura relata a associação entre o desequilíbrio e o comprometimento cogntivo, porém não é clara sobre quais habilidades cognitivas estão envolvidas com o sistema vestibular. Objetivo: avaliar quais habilidades cognitivas então envolvidas na avaliação e reabilitação vestibular em indivíduos jovens adultos e idosos. Estratégia de pesquisa: trata-se de uma revisão integrativa de literatura realizada entre julho e outubro de 2020, os artigos foram selecionados por meio das principais bases de dados da saúde MEDLINE via PubMed, LILACS via Portal Regional da BVS; Cochrane, Scopus, Web of Science, e CINAHL acesso via Portal CAPES, utilizando os descritores "Cognition" OR "Cognitive Dysfunction" AND "Vestibular Function Tests" AND "Vertigo" AND "Vestibular Rehabilitation" e seus correlatos em português e espanhol. Critérios de seleção: Foram incluídos artigos publicados até 2020 que investigaram a cognição com avaliação e reabilitação vestibular (tradicional e/ou com tecnologias) em indivíduos acima de 18 anos. Foram excluídos artigos que não possuíam texto completo disponível ou que utilizaram outra forma de tratamento. Resultados: dos 6965 artigos resultantes da busca inicial, 16 foram incluídos na presente revisão por satisfazerem os critérios de inclusão. Destes, 12 são estudos transversais, e quatro, estudos longitudinais. Conclusão: observou-se relação entre disfunção vestibular uni e bilateral com a memória de trabalho, funções executivas, navegação espacial e atenção. Nos estudos que realizaram a reabilitação vestibular encontrou-se melhora das habilidades cognitivas em geral, capacidade visuoespacial, atenção, funções executivas, memória de trabalho espacial, aumento do ganho do reflexo vestíbulo-ocular, do controle postural e uma diminuição do sofrimento psicológico.

Introduction: The literature reports an association between imbalance and cognitive impairment. However, it is not yet clear which cognitive skills are involved with the vestibular system. Objective: To evaluate which cognitive skills are involved in vestibular assessment and rehabilitation in young and older adults. Research strategy: This is an integrative review of the literature, conducted between July and October 2020. The articles were selected through search in the main health databases - MEDLINE via PubMed, LILACS via Regional Portal of VHL, Cochrane, Scopus, Web of Science, and CINAHL, accessed via Portal CAPES, using the following descriptors "Cognition" OR "Cognitive Dysfunction" AND "Vestibular Function Tests" AND "Vertigo" AND "Vestibular Rehabilitation", and their equivalent terms in Portuguese and Spanish. Selection criteria: Articles published until 2020, investigating cognition with vestibular assessment or traditional and/or technology rehabilitation in subjects aged 18 years or older were included. Articles not available in full text or that used other types of treatment were excluded. Results: 16 out of the 6,965 articles initially retrieved met the inclusion criteria and were included in this review; 12 of them are cross-sectional, and four longitudinal studies. Conclusion: There was a relationship between uni- and bilateral vestibular dysfunction and working memory, executive functions, spatial navigation, and attention. The studies that conducted vestibular rehabilitation found improved overall cognitive skills, visuospatial capacity, attention, executive functions, spatial working memory, increased vestibulo-ocular reflex, postural control gains, and diminished psychological suffering.

Introducción: la literatura reporta la asociación entre desequilibrio y deterioro cognitivo, pero no está claro qué habilidades cognitivas están involucradas con el sistema vestibular. Objetivo: evaluar qué habilidades cognitivas están involucradas en la evaluación y rehabilitación vestibular en adultos jóvenes y ancianos. Estrategia de búsqueda: se trata de una revisión integradora de la literatura realizada entre julio y octubre de 2020, los artículos fueron seleccionados a través de las principales bases de datos en salud MEDLINE vía PubMed, LILACS vía Portal Regional BVS; Acceso a Cochrane, Scopus, Web of Science y CINAHL a través del Portal CAPES, utilizando los descriptores "Cognición" O "Disfunción cognitiva" Y "Pruebas de función vestibular" Y "Vértigo" Y "Rehabilitación vestibular" y sus correlatos en portugués y español. Criterios de selección: Se incluyeron artículos publicados hasta 2020 que investigaban la cognición con valoración vestibular y rehabilitación (tradicional y / o con tecnologías) en mayores de 18 años. Se excluyeron los artículos que no tenían el texto completo disponible o que usaban otra forma de tratamiento. Resultados: de los 6965 artículos resultantes de la búsqueda inicial, 16 se incluyeron en esta revisión por cumplir con los criterios de inclusión. De estos, 12 son estudios transversales y cuatro estudios longitudinales. Conclusión: hubo relación entre la disfunción vestibular uni y bilateral con la memoria de trabajo, funciones ejecutivas, navegación espacial y atención. En estudios que realizaron rehabilitación vestibular se encontró una mejora en las habilidades cognitivas en general, capacidad visuoespacial, atención, funciones ejecutivas, memoria de trabajo espacial, aumento de ganancia en el reflejo vestibular-ocular, control postural y una disminución del malestar psicológico.

Interface entre as medidas de benefício após a reabilitação vestibular - relato de casos / Interface between measures of benefit after vestibular rehabilitation - case report

RESUMO Esta pesquisa teve como objetivo caracterizar o efeito da reabilitação vestibular (RV) sobre o ganho do reflexo vestíbulo-ocular (RVO), a ocorrência das sacadas compensatórias, bem como sobre o equilíbrio corporal e a qualidade de vida, em três pacientes com hipofunção vestibular periférica. Trata-se de um estudo descritivo. Participaram da pesquisa três pacientes do gênero feminino, duas com 55 anos e uma com 67 anos, com diagnóstico médico de disfunção vestibular periférica. As participantes foram submetidas à anamnese, questionário Dizziness Handicap Inventory (DHI), avaliação clínica do equilíbrio corporal e ao Vídeo Teste do Impulso Cefálico (vHIT), pré e após RV. A RV foi aplicada de forma personalizada, baseada no protocolo de Cawthorne e Cooksey, associada a estímulos de realidade virtual. Após a RV, observou-se a redução da média do escore total do DHI, sugestivo da diminuição na restrição de participação. Na avaliação clínica do equilíbrio obtiveram-se resultados dentro da normalidade para as provas alteradas, pré RV. Quanto ao vHIT, constatou-se aumento do ganho do RVO para os canais semicirculares anteriormente afetados, condizente com padrões de normalidade, e extinção ou diminuição de ocorrência das sacadas compensatórias, nos três casos avaliados. O aumento do ganho do RVO e a extinção ou redução das sacadas compensatórias, após a RV, evidenciam sinais sugestivos de compensação vestibular. Esses resultados mostraram-se compatíveis com o aumento da estabilidade postural e menor restrição da qualidade de vida. Os achados, em conjunto, demonstram o benefício proporcionado pela RV nos três casos avaliados.

ABSTRACT The purpose of this research is to characterize the vestibular rehabilitation (VR), vestibulo-ocular reflex (VOR) gain, the occurrence of compensatory saccades, the static and dynamic balance, and the impact on quality of life in three patients with peripheral vestibular hypofunction. This is a descriptive study, approved by the ethics in research committee, under number 4,462.519. Three female patients participated in the study, two aged 55 and one aged 67, with a medical diagnosis of peripheral vestibular dysfunction. The participants underwent anamnesis, Dizziness Handicap Inventory (DHI) questionnaire, clinical assessment of postural balance and Video Head Impulse Test (vHIT), pre and post VR. The VR was applied in a personalized manner, based on the Cawthorne and Cooksey protocol, associated with virtual reality stimuli. After VR, a reduction in the total score average of DHI was observed, suggesting a decrease in participation restriction. The clinical balance assessment results were within the normal range for the altered tests, pre VR. In the three evaluated cases, vHIT showed increased RVO gain for the previously affected semicircular ducts (SCDs), compatible with normality standards, and reduction or extinction in the occurrence of compensatory saccades. The increase in VOR gain and the reduction or suppression of compensatory saccades after VR are suggestive signs of vestibular compensation. These results were compatible with increased postural stability and less restricted quality of life. These findings demonstrate the benefit provided by VR in the three evaluated cases.

Proposal for a body balance training program for children through an integrative literature review / Proposta de programa de treinamento do equilíbrio corporal para público infantil por meio de revisão integrativa da literatura

ABSTRACT Objective: to verify, in the literature, the proposals to rehabilitate the vestibular function, so as to propose a training program for body balance for children. Methods: this article sought studies that proposed to rehabilitate or train body balance in the Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed) and Scientific Electronic Library Online (SCIELO) databases, in addition to digital sources from Brazilian public universities. As descriptors, the terms "rehabilitation", "balance" and "child" were used, combined with the Boolean operator AND. The variables analyzed were: public submitted to the intervention, number of subjects and age group, number and frequency of sessions, number and/or time of execution of the exercise, duration of the session and the program. Results: 17 (60.74%) articles were Brazilian, 14 (50%) used the Cawthorne and Cooksey protocol, 9 (32.14%) studied children, and the majority (67.85%) organized the program in weeks. A body balance training program, stimulating the three body balance systems, consisting of 30-minute sessions twice a week for 7 weeks, totaling 14 sessions, was developed. Conclusion: the analysis of the variable related to the protocol/strategy to rehabilitate the vestibular function indicated that no study proposed the stimulation of the three body balance systems, with no standardization for children, adults and the elderly. A vestibular function rehabilitation program was developed for children, with stimulation of these three systems, expanding the therapeutic possibilities in this area.

RESUMO Objetivo: verificar, na literatura, as propostas para reabilitar a função vestibular e propor um programa de treinamento do equilíbrio corporal para o público infantil. Metodos: buscou-se estudos propondo reabilitar/treinar o equilíbrio corporal nas bases de dados MEDLINE/PubMed e SCIELO, além das fontes digitais de universidades públicas brasileiras. Descritores utilizados: rehabilitation, balance e child, combinando-os com o operador boleano AND. Analisou-se as variáveis: público submetido à intervenção, número de sujeitos e faixa etária, número e periodicidade das sessões, número e/ou tempo de execução do exercício, duração da sessão e do programa. Resultados: 17 eram brasileiros, 14 utilizaram o protocolo de Cawthorne e Cooksey, nove estudaram crianças, a maioria organizou o programa em semanas. Elaborou-se um programa de treinamento do equilíbrio corporal que estimula os três sistemas do equilíbrio corporal, constituido por sessões de 30 minutos duas vezes por semana, durante 7 semanas, totalizando 14 sessões. Conclusão: a análise da variável relativa ao protocolo/estratégia para reabilitar a função vestibular indicou que nenhum estudo propôs a estimulação dos três sistemas do equilíbrio corporal, não havendo padronização para os públicos infantil, adulto e idoso. Elaborou-se um programa de reabilitação da função vestibular para crianças, com estimulação destes três sistemas, ampliando as possibilidades terapêuticas.

Reflexiones sobre rehabilitación vestibular a propósito de un caso con uso de paradigma de tareas dobles / Insights on vestibular rehabilitation concerning one case with the use of dual task paradigm

Resumen Se presenta una reflexión producto de la introducción del paradigma de tareas dobles en el abordaje terapéutico en un caso de vestibulopatía unilateral periférica. Se aplicaron pautas de autovaloración de la discapacidad y riesgo de caídas, complementándose con una completa evaluación del equilibrio funcional y la marcha. Se planificó una terapia personalizada, jerarquizándose objetivos con un criterio funcional. Se incorporó el paradigma de tareas dobles, incluyéndose tareas cognitivas simples a la terapia tradicional de rehabilitación vestibular, con el fin de reducir la influencia cortical sobre la ejecución motora, potenciar la ganancia y funcionalidad de los reflejos remanentes, estimular funciones cognitivas superiores y potenciar procesos atencionales subyacentes, necesarios para lograr la compensación. Los resultados de la reevaluación mostraron una evolución favorable, con remisión de la sintomatología, disminución significativa de los puntajes obtenidos en las diferentes pautas empleadas y una mejoría subjetiva en el equilibrio y marcha funcional después de la terapia. Lo anterior se asoció a la recuperación de la autonomía e independencia para la ejecución de actividades diarias, incidiendo favorablemente en la calidad de vida de la paciente. Los hallazgos confirman los beneficios del programa de rehabilitación vestibular diseñado. Se requieren estudios adicionales, orientados a evidenciar y corroborar el impacto específico de la incorporación del paradigma de tareas dobles en la rehabilitación de los trastornos del equilibrio y especialmente, en procesos de estimulación o rehabilitación vestibular en adultos mayores.

Abstract This article presents the analysis and reflections evoked from an experience in vestibular rehabilitation with the introduction of the paradigm of dual task in a unilateral peripheral vestibulopathy case. First, disability self-assessment guidelines, risk of falls scales and assessment tools of functional balance and gait were applied in order to determine the main symptoms and the main difficulties observed. Afterwards, a personalized therapy was planned, in which work objectives were hierarchized based on a functional criterion, introducing "dual-task" strategies as tools for diminish cortical influence on motor performances, allowing the automation of the required task; enhance the gain and functionality of the remaining reflexes, especially vestibulo ocular and vestibulospinal reflex and stimulate superior cognitive functions and underlying attentional processes, necessary to achieve central compensation. The final assessment showed a favorable evolution, with a significant decrease in the after-therapy scores obtained in fear of falling and disability self-perception protocols, before and after therapy and, finally, an improvement in functional balance and gait, through the pre and post therapy performance in the timed up and go and assessment of unipedal stand tests. This allowed the patient to regain her autonomy and independence in daily life activities improving her quality of life, confirming the benefits of the designed vestibular rehabilitation program. However, more studies are needed to corroborate the specific contribution of the dual-task paradigm in vestibular rehabilitation and specially, in vestibular stimulation or rehabilitation processes in older adults.

Dosificación de tratamiento en terapia vestibular para lesiones vestibulares periféricas: una revisión / Treatment dosage in vestibular therapy for peripheral vestibular lesions: a review

La terapia vestibular ha mostrado una evolución constante hacia la práctica basada en evidencia principalmente en los últimos años, sin embargo, actualmente no existe consenso sobre la dosificación de tratamiento necesaria para generar resultados deseados en los usuarios. Por ello, el presente estudio pretende analizar la evidencia científica sobre la dosificación de tratamiento en la terapia vestibular para patologías vestibulares periféricas y su impacto en la práctica clínica. Se realizó una búsqueda bibliográfica en las bases de datos PubMed y Cochrane Library de acuerdo a términos claves. Los estudios incluidos fueron ensayos clínicos, revisiones sistemáticas y metaanálisis, publicados desde el año 2009 y realizado en seres humanos. Se encontraron 60 artículos relacionados con los términos claves utilizados, de los cuales 52 fueron eliminados por cumplir con los criterios de exclusión. Existe escasa literatura sobre la dosificación de tratamiento en terapia vestibular, demostrando formatos de aplicación muy disímiles. Resulta complejo establecer estándares para la dosis terapéutica producto de la heterogeneidad de las patologías vestibulares.

Recently, vestibular rehabilitation therapy has shown constant development towards evidence-based practice, however, at the present time, there is lack of consensus about treatment dosage needed to produce the desired results for the users. Therefore, the present study aimed to analyze scientific evidence relating to treatment dosage of vestibular rehabilitation therapy for peripheral vestibular pathologies, and its impact on clinical practice. We conducted a bibliographic search in PubMed, and Cochrane Library according to previously defined MeSH terms. Included studies were clinical trials, systematic revisions, and meta-analyses, that were published since 2009, and conducted with human participants. The initial search yielded 60 articles related to the MeSH terms chosen, from which 52 were eliminated according to exclusion criteria. There is a scarce number of scientific articles regarding treatment dosage, and also a heterogeneous application format. It is a complex task to establish standards regarding therapeutic doses, mainly due to the heterogeneity of vestibular pathologies.

Severe Dizziness Related to Postural Instability, Changes in Gait and Cognitive Skills in Patients with Chronic Peripheral Vestibulopathy

Abstract Introduction Peripheral vestibular disorders can lead to cognitive deficits and are more common in elderly patients. Objective To evaluate and correlate cognitive, balance and gait aspects in elderly women with chronic peripheral vestibular dizziness, and to compare them with elderly women without vestibular disorders. Methods Twenty-two women presenting peripheral vestibular dizziness episodes for at least six months participated in the study. The individuals were categorized by dizziness severity level: moderate (n = 11) or severe (n = 11). The control group (n = 11) included women showing no vestibulopathy, light-headedness or dizziness. Cognitive assessments and semi-static and dynamic balance assessments were performed with the Balance Master (Neurocom International, Inc., Clackamas, OR), while the Dizziness Handicap Inventory provided a score for the severity of the symptoms. The groups were submitted to statistics of inference and correlation between cognitive, balance and stability variables. Results The group with severe dizziness showed higher sway speed of the center of pressure in the anteroposterior direction, smaller step length, and slower gait than the control group. Regarding the cognitive variables, the group with severe dizziness symptoms presented significant correlations with stability and gait variables. Conclusion The relationship between cognitive aspects, balance and gait was stronger in women with severe dizziness than in those with no vestibulopathy.

Vestibular Rehabilitation for a Child With Posterior Fossa Syndrome: A Case Report.

PURPOSE: This case report assesses gaze stability, postural control, and balance pre- and post-physical therapy intervention, including vestibular rehabilitation, in a 4-year-old child with posterior fossa syndrome following gross total resection of a juvenile astrocytoma brain tumor. SUMMARY OF KEY POINTS: The child in this case study had improved balance and gaze stability, as determined by the Pediatric Balance Scale and the Dynamic Visual Acuity test upon completion of the 10-week intervention. STATEMENT OF CONCLUSION AND RECOMMENDATIONS FOR CLINICAL PRACTICE:: This case provides preliminary support of the need for vestibular screening in children with a diagnosis of posterior fossa syndrome. The success of the intervention suggests that vestibular rehabilitation exercises can be modified for use in preschool-aged children, and the specific intervention outlined in this case report can be easily replicated in a variety of treatment settings.

Impacto de la rehabilitación vestibular en el riesgo de caída y la confianza del paciente / Impact of vestibular rehabilitation on the risk of falling and patient confidence

RESUMEN Introducción: Las alteraciones del sistema vestibular como la hipofunción vestibular unilateral, predisponen al usuario a sufrir caídas alterando así su confianza. Objetivo: Determinar el impacto de la rehabilitación vestibular en el riesgo de caídas y el grado de confianza en mujeres con hipofunción vestibular unilateral. Material y método: Se realiza estudio prospectivo en 20 pacientes de género femenino mayores de 60 años con diagnóstico de patología vestibular periférica. Se evalúa el riesgo de caídas con escala Tinetti y el grado de confianza al realizar actividades de la vida diaria por medio de la escala ABC (Activities-specific Balance Confidence), antes y después de realizar terapia de rehabilitación vestibular (RV). Resultados: Las dos variables estudiadas Tinetti y escala ABC demostraron mejoras significativas en la mayoría de las pacientes, demostrando que a medida que aumenta el grado de confianza disminuye el riesgo de caídas. Conclusión: Los resultados obtenidos de este estudio sugieren que la terapia de RV es eficiente en mejorar el riesgo de caídas y favorecer el aumento de confianza en las actividades de la vida diaria en el grupo de pacientes estudiadas.

ABSTRACT Introduction: Changes in the vestibular system, such as unilateral vestibular hypo-function, predispose the user to suffer falls, thus altering his confidence. Aim: To determine the impact of vestibular rehabilitation on the risk of falls and the degree of confidence in women with unilateral vestibular hypofunction. Material and method: A prospective study was conducted in 20 female patients over 60 years of age with a diagnosis of peripheral vestibular pathology. The risk of falls with a Tinetti scale and the degree of confidence in carrying out activities of daily living are evaluated through the ABC scale (Activities-specific Balance Confidence), before and after performing vestibular rehabilitation therapy (VRT). Results: The two variables studied, Tinetti and ABC scale showed significant improvements in most of the patients, demonstrating that as the degree of confidence increases the risk of falls decreases. Conclusion: The results obtained from this study suggest that VRT is efficient in improving the risk of falls and favoring an increase in confidence in the activities of daily life in the group of patients studied.

Dependencia visual en otoneurología: consideraciones clínicas para la rehabilitación vestibular / Visual dependence in otoneurology: clinical considerations for vestibular rehabilitation

RESUMEN Los sistemas vestibular, visual y somatosensorial coordinan el control postural y se adaptan a las actividades cotidianas en diferentes contextos, sin embargo, cuando existe un cuadro clínico con sintomatología vestibular, las ponderaciones de estos sistemas cambian mayoritariamente al sistema visual, creando una dependencia visual. El cerebelo, que es el principal encargado de generar una compensación vestibular en casos de hipofunción vestibular, juega un rol destacado en el aprendizaje motor generando comportamientos adaptativos que se transforman en puntos claves en la rehabilitación vestibular. Este artículo pretende exponer lo que la literatura informa en relación a la dependencia visual en pacientes con hipofunción vestibular.

ABSTRACT The vestibular, visual and somatosensory systems coordinate postural control and adapt to daily activities in different contexts, however, when there is a clinical picture with vestibular symptoms, the weights of these systems change mainly to the visual system, creating a visual dependence. The cerebellum, which is the main responsible for generating vestibular compensation in cases of vestibular hypofunction, plays a prominent role in motor learning generating adaptive behaviors that become key points in vestibular rehabilitation. This article aims to expose what the literature reports in relation to visual dependence in patients with vestibular hypofunction.

Mecanismos neurofisiológicos de la rehabilitación vestibular / Neurophysiological mechanisms of vestibular rehabilitation

RESUMEN La rehabilitación vestibular es un concepto terapéutico utilizado en pacientes que presentan síntomas como vértigos y/o mareos, asociados a una afectación vestibular, además de otras manifestaciones clínicas. Este artículo busca entregar un análisis amplio de los elementos que interactúan para definir una patología, como a su vez intervenir en su compensación. Serán presentados elementos neuroanatómicos, fisiológicos y conceptuales de la rehabilitación para este tipo de pacientes con un enfoque clínico basados en la evidencia.

ABSTRACT Vestibular rehabilitation is a therapeutic concept used in patients suffering from dizziness and/or dizziness, in addition to other clinical manifestations. This article gives a broad analysis of the elements that interact to define a pathology, as well as to intervene in their compensation. Neuro anatomical, physiological and conceptual elements of rehabilitation for this type of patients will be presented with a clinical approach based on evidence.

First report of the efficacy of vestibular rehabilitation in improving function in patients with Neurofibromatosis type 2: an observational cohort study in a clinical setting.

PURPOSE: Patients with Neurofibromatosis type 2 often experience debilitating neuro-otological problems which affect their mobility and balance. This study examined the efficacy of a personalised program of vestibular rehabilitation for patients with Neurofibromatosis type 2. MATERIALS AND METHODS: An observational cohort study analysing routinely collected data for 21 patients in a highly specialised Neurofibromatosis type 2 service. Vestibular rehabilitation comprised an initial one-hour assessment followed by a patient-specific exercise program reviewed in person and by email consultations. Patients were subsequently followed-up at 9 months. The vestibular rehabilitation efficacy was assessed using the Dynamic Gait Index score. RESULTS: Nineteen of 21 patients were assessed as impaired and at risk of falls pre-rehabilitation (Dynamic Gait Index <19/24), of which 79% showed clinical improvement post-rehabilitation. There was a significant improvement in the Dynamic Gait Index scores pre-rehabilitation to post-rehabilitation (p < 0.001) and outcomes were subsequently maintained at the 9-month follow-up assessment. Whilst the pre-rehabilitation Dynamic Gait Index scores of patients with more severe genotype were lower compared to other patients, the beneficial effect of vestibular rehabilitation was similar amongst genetic severity groups. CONCLUSIONS: Personalised vestibular rehabilitation significantly improves function in Neurofibromatosis type 2, sustaining benefits for 9 months, irrespective of patients' age or genetic severity. Implications for rehabilitation Patients with Neurofibromatosis type 2 experience debilitating neuro-otological problems which affect their mobility and balance. A patient-tailored program of vestibular rehabilitation was offered in a highly specialised clinic for six months with a follow-up assessment at 9 months post-treatment. All patients improved from baseline, with 79% of them achieving clinically significant improvement in function and with statistically significant benefits sustained for 9 months. The beneficial effect of vestibular rehabilitation was similar for all patients, regardless of age or genetic severity, suggesting vestibular rehabilitation could be incorporated in routine clinical care in Neurofibromatosis type 2 clinics internationally.

Gradient impact of cognitive decline in unilateral vestibular hypofunction after rehabilitation: preliminary findings.

PURPOSE: Considering recent advances in central cognitive- and age-related processing interfering with balance and sensory reweighting in uncompensated vestibular disorders, purpose of this study is to highlight the vestibular rehabilitation (VR) outcomes in a population of older adults and age-matched mild cognitive impairment (MCI) patients, both affected by unilateral vestibular hypofunction (UVH) and undergoing VR. METHODS: Vestibulo-ocular reflex (VOR), postural sway examination (respectively, performed by video head impulse test and static posturography) and dizziness-related and quality-of-life scores were collected in 12 UVH MCI individuals ≥ 55 years and 12 matched UVH older adults with age-appropriate cognitive function-cognitively evaluated by means of Mini-Mental State Examination (MMSE) and Alzheimer's Disease Assessment Scale-before and after a VR protocol. RESULTS: A significant post-treatment reduction in surface, length and power spectra (PS) values within low-frequency domain and an improvement in performance measures were recorded in both groups. Moreover, the VR protocol highlighted-when comparing pre-/post-treatment differences (Δ)-a significant (i) increase in Δ VOR gain; (ii) decrease in Δ surface and length and (iii) increase in Δ PS within low-frequency domain in older adults when compared to MCI patients. Positive correlations were found between MMSE and Δ Dynamic Gait Index, Δ surface and Δ PS within low-frequency domain when treating patients as 'a continuum' along the cognitive decline. CONCLUSIONS: Present pilot findings suggest that the cognitive domain insight in older adults scheduled for VR protocols may positively impact on disability consequences.

An adaptive vestibular rehabilitation technique.

OBJECTIVES/HYPOTHESIS: There is a large variation in vestibular rehabilitation (VR) results depending on type of therapy, adherence, and the appropriateness for the patient's level of function. A novel adaptive vestibular rehabilitation (AVR) program was developed and evaluated. STUDY DESIGN: Technology and procedure development, and prospective multicenter trial. METHODS: Those with complete unilateral vestibular hypofunction and symptomatic at least 3 months with a Dizziness Handicap Inventory (DHI) >30 were eligible. Patients were given a device to use with their own computer. They were instructed to use the program daily, with each session lasting about 10 minutes. The task consisted of reporting orientation of the letter C, which appeared when their angular head velocity exceeded a threshold. The letter size and head velocity required were adjusted based on prior performance. Performance on the task was remotely collected by the investigator as well as a weekly DHI score. RESULTS: Four patients aged 31 to 74 years (mean = 51 years) were enrolled in this feasibility study to demonstrate efficacy. Two had treated vestibular schwannomas and two had vestibular neuritis. Starting DHI was 32 to 56 (mean = 42), which was reduced to 0 to 16 (mean = 11.5) after a month of therapy, a clinically and statistically significant (P < .05) improvement. The three who continued therapy an additional month improved to a DHI of 4. CONCLUSIONS: This AVR method has advantages over traditional VR in terms of cost and customization for patient ability and obtained a major improvement in symptoms. This study demonstrated a clinically and statistically significant decrease in symptoms after 4 weeks of therapy. LEVEL OF EVIDENCE: 2b. Laryngoscope, 128:713-718, 2018.

Evidências científicas da reabilitação vestibular na atenção primária à saúde: uma revisão sistemática / Scientific evidence of vestibular rehabilitation in primary health care: a systematic review

RESUMO Objetivos Investigar, na literatura, a efetividade de tratamentos usados para reabilitação vestibular (RV) na atenção primária à saúde. Estratégia de pesquisa A busca de publicações sobre RV na APS foi realizada nas bases de dados eletrônicas MEDLINE (acesso pela PubMed), PEDro e Web of Science. Critérios de seleção Foram selecionados ensaios clínicos controlados nas línguas inglesa, espanhola e portuguesa. A qualidade metodológica dos estudos foi avaliada pela escala PEDro. A análise dos resultados foi contemplada por meio de revisão crítica dos conteúdos. Resultados Cinco estudos foram revisados na íntegra, sendo a faixa etária dos participantes igual ou superior a 18 anos (n=5). A Vertigo Symptom Scale (60%) e a Escala Visual Analógica (40%) foram os instrumentos empregados para avaliar a percepção subjetiva da sintomatologia da disfunção vestibular. A escala PEDro revelou que dois artigos apresentaram delineamento de boa qualidade para condução do estudo experimental. A proposta de intervenção mais utilizada foi baseada nos exercícios de Yardley (60%). Conclusão Estudos controlados disponibilizam evidências de efeitos positivos da reabilitação vestibular na atenção primária à saúde, com melhoras no controle postural, capacidade funcional e qualidade de vida dos participantes.

ABSTRACT Purpose Investigate in the literature the effectiveness of treatments used for vestibular rehabilitation (VR) in PHC. Research strategy The search of publications on VR in PHC was carried out in electronic databases MEDLINE (access by PubMed), PEDro and Web of Science. Selection criteria Controlled clinical trials were selected in English, Spanish and Portuguese. The methodological quality of the studies was evaluated using the PEDro scale. The analysis of the results was examined through a critical review of the contents. Results Five studies were reviewed in their entirety, with the participants' age group being equal to or older than 18 years (n = 5). The Vertigo Symptom Scale and (60%) and Visual Analog Scale (40%) were the instruments used to evaluate the subjective perception of the symptomatology of vestibular dysfunction. The PEDro Scale revealed that two articles presented a good quality design for conducting the experimental study. The most used intervention proposal was the Yardley Exercises (60%). Conclusion Controlled studies provide evidence of positive effects of VR on PHC, with improvements in postural control, functional capacity and quality of life of participants.