Evidence of Vestibular and Balance Dysfunction in Patients With Mild Cognitive Impairment and Alzheimer's Disease.

OBJECTIVES: Given the expected rise in dementia prevalence, early diagnosis is vital. As a growing body of literature has identified a potential association between vestibular function and cognition, vestibular assessment may aid in early screening. The aim of the study was to better comprehend the proposed association between vestibular function and Alzheimer's disease (AD) by comparing vestibular parameters (vestibular function testing and clinical balance measures) between a group with mild cognitive impairment (MCI), AD, and healthy controls with age-normal cognition. DESIGN: Cross-sectional analysis of the GECkO study, an ongoing prospective single-center longitudinal cohort study. This study included 100 older adults (55 to 84 years). A total of 33 participants with MCI, 17 participants with AD, and 50 participants of age, sex, and hearing-matched healthy controls were included. RESULTS: Participants with AD demonstrated a delayed latency of the p13 component measured by cervical vestibular-evoked myogenic potentials (cVEMP) compared with healthy controls and participants with MCI. Other measures including n23 latency, presence of intact responses, rectified amplitude, mean rectified voltage (measured by cVEMP) and lateral vestibulo-ocular reflex gain (measured by video Head Impulse Test [vHIT]) did not differ between groups. The Timed Up and Go (TUG), Performance-Oriented Mobility Assessment-Balance subscale (POMA-B), and Functional Gait Assessment (FGA) differed significantly between the three groups. Here, more cognitively impaired groups were associated with worse clinical balance scores. CONCLUSIONS: Vestibular and balance deficits were more prevalent in groups with increasing cognitive decline. Regarding vestibular function testing, p13 latency as measured by cVEMP was delayed in participants with AD. Other cVEMP or vHIT measures did not differ between groups. All three clinical balance assessments (TUG, POMA-B, and FGA) resulted in worse scores along the AD continuum. Future research integrating vestibular parameters that add value (including otolith function testing, balance, and spatial navigation) is recommended to validate the association between vestibular function and cognition while avoiding redundant testing.

Compensatory strategies after an acute unilateral vestibulopathy: a prospective observational study.

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.

The Antwerp Vestibular Compensation Index (AVeCI): an index for vestibular compensation estimation, based on functional balance performance.

PURPOSE: To create an index that is a measure of the amount of vestibular compensation and for which only functional balance performance is needed. METHODS: The medical charts of 62 eligible peripheral vestibular dysfunction (PVD) patients were analyzed retrospectively. To be included, the following vestibulo-ocular reflex (VOR) and balance performance data had to be available: (1) caloric and sinusoidal harmonic acceleration test (SHA) and (2) standing balance sum-eyes closed (SBS-EC), Timed Up and Go Test and Dynamic Gait Index. Patients were divided into three groups: normal caloric- and SHA test (group 1), abnormal caloric- and normal SHA test (group 2, PVD compensated) and abnormal caloric- and SHA test (group 3, PVD uncompensated). Next to the use of non-parametric tests to study the VOR and balance variables, logistic regression was used to identify the balance measures that predict whether PVD patients were compensated or uncompensated. This resulted also in the construction of a continuous measure representing the degree of compensation. RESULTS: Logistic regression identified SBS-EC and age to classify uncompensated from compensated patients with sensitivity of 83.9% and specificity of 72.4%. Then an index was created, called the Antwerp Vestibular Compensation Index, AVeCI = - 50 + age × 0.486 + SBS-EC × 0.421. A patient belongs to the uncompensated group when AVeCI < 0 and to the compensated group when AVeCI > 0, with respective group means of - 5 and 5. CONCLUSION: AVeCI stages the degree of compensation of PVD patients and can serve to evaluate rehabilitation effects.

Reliability and concurrent validity of a modified timed up and go test for healthy preschoolers.

The purpose of this study was to assess the interrater and test-retest reliability and the concurrent validity of the modified timed up and go test for preschoolers. As such, we aim to determine the most suited outcome of the modified timed up and go test: the best or the average performance. Thirty-two children (age 3-5) performed three timed up and go test trials as fast as possible on two separate occasions. During the first session, two researchers recorded the time to perform the task simultaneously. For reliability analyses, intra-class correlation coefficients (ICCs) and the minimal detectable change were determined. A Pearson correlation coefficient was calculated to determine concurrent validity between the timed up and go test and the balance subscale of the Movement Assessment Battery for Children, 2nd edition. Interrater (ICC > 0.97) and test-retest (ICC > 0.75) reliability were good both for the average and the best timed up and go test performance. A minimal detectable change of 1.86 s was found for the best performance, and 2.30 s for the average performance. Only the best timed up and go test performance correlated significantly with the balance subscale of the Movement Assessment Battery for Children, 2nd edition, though fair (r = -0.347, p = 0.007).Conclusion: The modified timed up and go test for preschoolers using the best performance is reliable and recommended to reduce standard and measurement error. What is Known: • A large variety of timed up and go test protocols is available for children • The protocols differ in the instructions on walking speed (self-selected/fastest), the use of an extra motivation (e.g., touch a star on the wall) and the applied outcome (average/best performance) What is New: • The best timed up and go test performance induces more consistent test results between raters and sessions and also less standard and measurement error in 3- to 5-year-old children • The best timed up and go test performance should be preferred over the average performance to achieve both reliable and valid test results in 3- to 5-year-old children.

Feasibility of the clinical dynamic visual acuity test in typically developing preschoolers.

OBJECTIVES: To determine the feasibility of the dynamic visual acuity test (DVA) in children who are preschoolers. METHODS: Thirty-three preschoolers [3 years old (n = 11), 4 years old (n = 6), 5 years old (n = 8), and 6 years old (n = 8)], performed a static visual acuity test (SVA), a passive horizontal DVA (hDVA) at 1 and 2 Hz, and a DVA on treadmill at three age-specific walking speeds (slow/medium/high). The DVA scores, the difference between SVA and hDVA, were used to determine false positive results. RESULTS: The SVA was performed by 31/33 children, the hDVA and DVA on treadmill at slow and medium speed by 27/33 and the DVA on treadmill at high speed by 25/33. Except for one 5 years old, all drop-outs were 3 years old. The hDVA at 2 Hz was administered in only six children because of difficulties with focusing on reading the symbols at this frequency. False positive results for the hDVA at 1 Hz were found in 3/27 children, all 3 years old, and 2/6 for the hDVA at 2 Hz. CONCLUSIONS: The DVA on treadmill seems useful for preschoolers from age 5, but this should be further investigated in children with underlying pathologies.

Vestibular (dys)function in children with sensorineural hearing loss: a systematic review.

OBJECTIVE: The objective of this study is to provide an overview of the prevalence of vestibular dysfunction in children with SNHL classified according to the applied test and its corresponding sensitivity and specificity. DESIGN: Data were gathered using a systematic search query including reference screening. STUDY SAMPLE: Pubmed, Web of Science and Embase were searched. Strategy and reporting of this review was based on the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Methodological quality was assessed with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. RESULTS: All studies, regardless the applied vestibular test, showed that vestibular function differs significantly between children with hearing loss and normal hearing (p < 0.05). Compared with caloric testing, the sensitivity of the Rotational Chair Test (RCT) varies between 61 and 80% and specificity between 21 and 80%, whereas this was, respectively, 71-100% and 30-100% for collic Vestibular Evoked Myogenic Potentials (cVEMP). Compared with RCT, the sensitivity was 88-100% and the specificity was 69-100% for the Dynamic Visual Acuity test, respectively, 67-100% and 71-100% for the (video) Head Impulse Test and 83% and 86% for the ocular VEMP. CONCLUSIONS: Currently, due to methodological shortcoming, evidence on sensitivity and specificity of vestibular tests is unknown to moderate. Future research should focus on adequate sample sizes (subgroups >30).

A Modified Version of the Timed Up and Go Test for Children Who Are Preschoolers.

PURPOSE: This study investigated factors predicting the Timed Up and Go (TUG) test in children who are preschoolers, using a modified protocol of the TUG. METHOD: This was a cross-sectional study of children 3 to 5 years old (n = 192). Regression analysis identified predictive factors for TUG performances. Differences in mean values (standard deviation) were calculated for each age group. RESULTS: The results of 172 children were analyzed. Age and ethnicity were predictive of TUG performance (R = 0.280). Children who are preschoolers with Flemish ethnicity need less time to perform the TUG than their peers with another ethnicity (P < .05), but this difference is not significant for the age groups. The TUG performance differs significantly among all age groups (P < .05). CONCLUSIONS: A modified protocol for the TUG, which is sensitive to age-related changes in dynamic balance control, is proposed for children who are preschoolers.

Psychometric properties of functional balance tests in children: a literature review.

AIM: Identifying balance problems are the first step towards monitoring and rehabilitation. Therefore, this paper aims to make an overview of the psychometric properties of the functional balance tests available for children. METHOD: A literature search was performed in PubMED and Web of Science on 8 February 2014 and updated on 6 July 2014. A conceptual framework for functional balance tests was defined, taking balance control components and task constraints into account. The tests were selected for inclusion by consensus of 2-3 reviewers using the conceptual framework. RESULTS: Fourteen tests were investigated in 25 articles and analysed within the conceptual framework. The Timed Up and Go test, Pediatric Balance Scale, and Pediatric Reach Test are well investigated and all show good reliability. Validity remains unclear because of lack of a criterion standard to measure balance control. INTERPRETATION: Because of the lack of good methodological studies, strong evidence for the use of one or more functional balance tests in children cannot be provided. Moreover, it is necessary that a criterion standard to measure balance is established.

How do patients with chronic dizziness experience a web-based home rehabilitation programme for customised vestibular therapy ('WeBaVeR')? A qualitative study.

BACKGROUND: Vestibular rehabilitation therapy (VRT) is the first choice approach for chronic dizziness. However, current home treatment programmes often lack attention to the individual needs of the patient and the integration of visual desensitisation therapy. We therefore developed a customised web-based VRT programme containing visual desensitisation exercises. OBJECTIVE: To assess the user experience (usability, satisfaction, acceptability, and quality) of patients with chronic dizziness with the customised WEb-BAsed VEstibular Rehabilitation, further called 'WeBaVeR'. METHODS: Patients with chronic dizziness, attending the Department of Otorhinolaryngology of the Antwerp University Hospital (period September 2021 to May 2022), received a customised programme, i.e. exercises supported by our web application and booklet. The programme lasted 6 weeks, with weekly supervision by phone. Patients' user experience was examined with the System Usability Scale (SUS), Client Satisfaction Questionnaire (CSQ), Service User Technology Acceptability Questionnaire (SUTAQ), and the User version of the Mobile Application Rating Scale (uMARS). RESULTS: Twelve patients with chronic dizziness (mean age: 45.33 ± 13.26 years) participated. The overall rated level of perceived usability (mean SUS score: 78.75 ± 8.95 points), satisfaction (mean CSQ score: 33.08 ± 3.37 points), acceptability (mean SUTAQ score: 105.67 ± 13.40 points) and quality (mean uMARS score: 94.58 ± 10.69 points) was good. The main remarks concerned the user interface and the interactive capabilities of the web application, and that WeBaVeR does not increase health awareness, or accessibility to health care providers. CONCLUSION: Patients with chronic dizziness consider WeBaVeR as useful, acceptable, satisfactory and of good quality. To facilitate implementation in practice, further optimisation of WeBaVeR based on the feedback received, is useful.

A full-body motion capture gait dataset of 138 able-bodied adults across the life span and 50 stroke survivors.

This reference dataset contains biomechanical data of 138 able-bodied adults (21-86 years) and 50 stroke survivors walking bare-footed at their preferred speed. It is unique due to its size, and population, including adults across the life-span and over 70 years, as well as stroke survivors. Full-body kinematics (PiG-model), kinetics and muscle activity of 14 back and lower limbs muscles was collected with a Vicon motion capture system, ground-embedded force plates, and a synchronized surface EMG system. The data is reliable to compare within and between groups as the same methodology and infrastructure were used to gather all data. Both source files (C3D) and post-processed ready-to-use stride-normalized kinematics, kinetics and EMG data (MAT-file, Excel file) are available, allowing high flexibility and accessibility of analysis for both researchers and clinicians. These records are valuable to examine ageing, typical and hemiplegic gait, while also offering a wide range of reference data which can be utilized for age-matched controls during normal walking.

Fear avoidance beliefs, anxiety, and depression in healthy individuals and persons with vestibular disorders across cultures.

Background/introduction: In persons with vestibular disorders, disturbed vestibular input and accompanying dizziness can be associated with anxiety or depression. To avoid dizziness, persons with vestibular disorders can develop mal-adaptive fear avoidance behaviors which can negatively influence daily life functioning. The aims of this study were to (1) document different psychological factors in patients with vestibular disorders and healthy adults across cultures and (2) to assess the convergent validity of the 9-item Vestibular Activities Avoidance Instrument (VAAI), which quantifies fear avoidance beliefs. Methods: Psychological factors and disability were measured in Dutch-speaking healthy adults and English- and Dutch-speaking persons with vestibular disorders using the VAAI, the Dizziness Handicap Inventory (DHI), the Hospital Anxiety and Depression Scale (HADS) and the Activities-Specific Balance Confidence Scale (ABC). The convergent validity of the VAAI was investigated by performing correlation analyses between the VAAI, the DHI, the HADS, and the ABC. Results: A total of 151 Dutch-speaking healthy adults, 404 English-speaking participants with vestibular disorders, and 126 Dutch-speaking participants with vestibular disorders were included. Participants with vestibular disorders presented with higher levels of fear avoidance beliefs (VAAI), perceived disability (DHI), anxiety and depression (HADS), and lower confidence during balance activities (ABC) compared to healthy adults. Regarding the convergent validity of the VAAI, there were moderate to strong correlation coefficients (r = 0.39-0.74) between fear avoidance and the DHI, HADS, and ABC in participants with vestibular disorders. Conclusions: Participants with vestibular disorders report a higher psychological burden compared to healthy adults. These results emphasize the importance of assessing psychological factors in persons with vestibular disorders. In addition, evidence was provided for convergent validity, supporting the VAAI as a valid outcome measure across cultures.

Chronic symptoms in patients with unilateral vestibular hypofunction: systematic review and meta-analysis.

Objective: To systematically evaluate the full spectrum of self-reported chronic symptoms in patients with unilateral vestibular hypofunction (UVH) and to investigate the effect of interventions on these symptoms. Methods: A systematic review was conducted following the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Statement (PRISMA). A literature search was performed in Pubmed, Web of Science, Embase, and Scopus to investigate self-reported symptoms and self-report questionnaires in patients with UVH. All original studies ranging from full-text clinical trials to case reports, written in English, German, and French, were included. The frequency of self-reported symptoms was presented. For self-report questionnaires, a meta-analysis was carried out to synthesize scale means by the pre- and post-intervention means and mean changes for studies that investigated interventions. Results: A total of 2,110 studies were retrieved. Forty-seven studies were included after title-abstract selection and full-text selection by two independent reviewers. The symptoms of UVH patients included chronic dizziness (98%), imbalance (81%), symptoms worsened by head movements (75%), visually induced dizziness (61%), symptoms worsened in darkness (51%), and oscillopsia (22%). Additionally, UVH could be accompanied by recurrent vertigo (77%), tiredness (68%), cognitive symptoms (58%), and autonomic symptoms (46%). Regarding self-report questionnaires, UVH resulted on average in a moderate handicap, with an estimated mean total score on the Dizziness Handicap Inventory (DHI) and the Vertigo Symptom Scale (VSS) of 46.31 (95% CI: 41.17-51.44) and 15.50 (95% CI: 12.59-18.41), respectively. In studies that investigated the effect of vestibular intervention, a significant decrease in the estimated mean total DHI scores from 51.79 (95% CI: 46.61-56.97) (pre-intervention) to 27.39 (95% CI: 23.16-31.62) (post intervention) was found (p < 0.0001). In three studies, the estimated mean total Visual Analog Scale (VAS) scores were 7.05 (95% CI, 5.64-8.46) (pre-intervention) and 2.56 (95% CI, 1.15-3.97) (post-intervention). Finally, a subgroup of patients (≥32%) persists with at least a moderate handicap, despite vestibular rehabilitation. Conclusion: A spectrum of symptoms is associated with UVH, of which chronic dizziness and imbalance are most frequently reported. However, semi-structured interviews should be conducted to define the whole spectrum of UVH symptoms more precisely, in order to establish a validated patient-reported outcome measure (PROM) for UVH patients. Furthermore, vestibular interventions can significantly decrease self-reported handicap, although this is insufficient for a subgroup of patients. It could therefore be considered for this subgroup of patients to explore new intervention strategies like vibrotactile feedback or the vestibular implant. Systematic review registration: [https://www.crd.york.ac.uk/prospero/], identifier [CRD42023389185].

Comparison of Clinical Balance and Visual Dependence Tests in Patients With Chronic Dizziness With and Without Persistent Postural-Perceptual Dizziness: A Cross-Sectional Study.

Background: The diagnosis of persistent postural-perceptual dizziness (PPPD) is primarily based on medical history taking. Research on the value of clinical balance and visual dependence tests in identifying PPPD is scarce. Objectives: (1) to contrast clinical balance and visual dependence tests between PPPD patients, dizzy non-PPPD patients, and healthy persons; and (2) to evaluate whether these clinical tests can help to identify PPPD in patients with chronic dizziness. Methods: Consecutive patients with chronic dizziness (38 PPPD and 21 non-PPPD) and 69 healthy persons underwent Static Balance tests, the Timed Up and Go test, the Tandem Gait test, and the Functional Gait Assessment (FGA). Visual dependence tests included the Visual Vertigo Analog Scale (VVAS), the Rod-and-Disc test (RDT), and postural sway while facing rotating dots. Groups were compared using ANOVA with post-hoc Tukey, or independent samples t-tests. The value of the clinical tests for PPPD identification was evaluated through logistic regression and Partial Least Squares Discriminant (PLS-DA) analyses. Results: PPPD patients had significantly higher VVAS scores than dizzy non-PPPD patients (p = 0.006). Facing rotating dots, PPPD and dizzy non-PPPD patients had increased postural sway compared to healthy persons (PPPD vs. healthy: center of pressure (COP) velocity p < 0.001, and COP area p < 0.001; but non-PPPD vs. healthy: COP velocity p = 0.116 and COP area p = 0.207). PPPD patients had no significantly increased postural sway compared to dizzy non-PPPD patients. PPPD and dizzy non-PPPD patients also scored significantly worse on balance tests compared to healthy persons (PPPD vs. healthy: for all balance tests p < 0.001; non-PPPD vs. healthy: FGA p < 0.001, for all other tests p < 0.05). Differences were insignificant in balance scores between PPPD and dizzy non-PPPD patients, or in RDT scores between the three study groups. In patients with chronic dizziness, a higher VVAS score was most associated with PPPD [odds ratio 1.04; 95% CI (1.01; 1.07); p = 0.010]. The cross-validated (CV) PLS-DA model with all clinical tests included, had fair discriminative ability (CVerror = 47%). Conclusion: PPPD patients were more visually dependent, but did not have worse postural balance compared to dizzy non-PPPD patients. Elevated VVAS scores characterized PPPD most in patients with chronic dizziness.

Systematic review and meta-analysis of the therapeutic management of patients with cervicogenic dizziness.

BACKGROUND: Patients with cervicogenic dizziness (CGD) present with dizziness, cervical spine dysfunctions, and postural imbalance, symptoms that can significantly impact their daily functioning. OBJECTIVES: To provide evidence-based recommendations for the management of patients with CGD. METHODS: Three databases were searched for randomized controlled trials (RCTs) (last search 15 May 2021). Outcome measures included dizziness, cervical spine, and balance parameters. Cochrane standard methodological procedures were used and included the RoB 2.0 and GRADE. Where possible, RCTs were pooled for meta-analysis. RESULTS: Thirteen RCTs (n = 898 patients) of high (two RCTs), moderate (five RCTs), and low (six RCTs) methodological quality were analyzed. Six RCTs were included in the meta-analysis. Only three RCTs specified the cause of CGD. They showed inconsistent findings for the effectiveness of exercise therapy in patients with traumatic CGD. Manual therapy and manual therapy combined with exercise therapy may reduce CGD, cervical spine, and balance dysfunctions. CONCLUSION: There is moderate quality of evidence that manual therapy reduces CGD, cervical spine, and balance symptoms. When manual therapy is combined with exercise therapy, the positive effect on CGD, cervical spine, and balance symptoms is even stronger. However, the quality of the evidence here is very low.

Effect of age on treatment outcomes in benign paroxysmal positional vertigo: A systematic review.

BACKGROUND: Benign paroxysmal positional vertigo (BPPV) can lead to an increased fall risk in older adults. Therefore, we examined the influence of age on the effectiveness of canalith-repositioning procedures (CRPs) for the treatment of BPPV. METHODS: Pubmed, Web of Science, and the bibliographies of selected articles were searched for studies conducted before September 2020 that examined the effectiveness of treatments for BPPV in various age groups. Meta-analyses were performed to compare treatment effectiveness and recurrence rates for younger and older adults. Odds ratios were calculated in a random-effects model. Mean differences were calculated using a fixed-effects model. A significance level of p < 0.05 (95% confidence interval) was set. The risk of bias and the methodological quality of all included articles were examined. RESULTS: Forty-five studies were retrieved after full-text screening, of which 29 studies were included for a qualitative review. The remaining 16 studies were eligible for inclusion in the meta-analysis (3267 participants with BPPV). The success rate of a single CRP was higher in the younger group (72.5% vs. 67%, p < 0.001). An average of 1.4 and 1.5 CRPs was needed for complete recovery in the younger and older groups, respectively (p = 0.02). However, global treatment success did not differ between these groups (97.5% vs. 94.6%, p = 0.41). The recurrence rate was higher in the older population (23.2% vs. 18.6%, p = 0.007). CONCLUSIONS: Although more CRPs are needed, the rate of complete recovery in older adults is similar to that observed in younger adults.

Clinical characteristics and diagnostic aspects of cervicogenic dizziness in patients with chronic dizziness: A cross-sectional study.

BACKGROUND AND OBJECTIVES: Chronic dizziness can significantly affect quality of life, but identifying the underlying cause remains challenging. This study focuses on proprioceptive cervicogenic dizziness (CGD) and aims: (1) to compare clinical test results between patients with CGD, dizzy patients without CGD, and healthy controls; and (2) to evaluate the diagnostic value of the clinical tests for CGD in patients with chronic dizziness. METHODS: Sixty patients with chronic dizziness (18 with CGD and 42 without CGD), and 43 healthy controls underwent clinical tests evaluating neck function (mobility, proprioception, muscle function and disability), balance control, and the presence of visually induced dizziness. Data were analysed through one-way ANOVA, chi-square, independent samples t-test, and logistic regression analyses. RESULTS: Patients with CGD had significantly more neck pain-related disability (Neck Bournemouth questionnaire (NBQ), p = 0.006), but better static (Static Balance, p = 0.001) and dynamic balance (Tandem Gait, p = 0.049), compared to dizzy patients without CGD. Univariable analyses revealed that increased NBQ (OR 1.05 [1.01; 1.09], p = 0.017), Joint Position Error (JPE) after extension (OR 1.52 [1.00; 2.32], p = 0.050), and Tandem Gait scores (OR 1.09 [1.01; 1.18], p = 0.046) were individually associated with higher odds of having CGD. Their optimal cut-off level (based on the maximum Youden index) had high sensitivity but low specificity for CGD. The multivariable model, including NBQ and Tandem Gait, had fair discriminative ability (AUC = 0.74, 95% CI [0.61; 0.87]). CONCLUSION: The combined use of the NBQ and Tandem Gait tests had the highest discriminative ability to detect CGD in patients with chronic dizziness.

Outcome for dizzy patients in a physiotherapy practice: an observational study.

BACKGROUND: Dizziness is a common reason for referral to physiotherapy. Additional information on clinical characteristics, treatment effect and prognostic indicators in physiotherapy practice are needed. METHODS: A retrospective observational study. Based on a standardised clinical evaluation patients were labelled as having Benign Paroxysmal Positioning Vertigo (BPPV) or not (no-BPPV). BPPV was treated with repositioning manoeuvres and exercises. In no-BPPV, treatment was based on additional clinical tests. Treatment was provided once per week and considered successful when the patient was free of symptoms confirmed by negative positional tests. RESULTS: From 148 referred patients, 88 were labelled as having BPPV, 60 as no-BPPV. The symptom of a short-lasting spinning sensation provoked by head movements was highly suggestive of BPPV. On average, in BPPV treatment was completed after 2.27 ± 1.68 treatments, in no-BPPV this was after 4.91 ± 3.46 treatments. The delayed outcome was related to higher 'age' and 'concomitant neck pain' in BPPV and with higher 'age' only in no-BPPV. Favourable outcome was related to the feature 'dizziness provoked by movements in the horizontal plane' in BPPV. CONCLUSIONS: Clinical evaluation and treatment in physiotherapy practice can be an effective and safe option for patients with dizziness. Several clinical variables with prognostic values were identified.Key messagesClinical evaluation and treatment in physiotherapy practice can be part of low threshold care for dizzy patients.Despite prior medical screening, one-third of patients without signs of BPPV were sent back for further evaluation, illustrating the need for interdisciplinary collaboration.Based on the description of the dizziness symptom (vertigo rather than light-headedness), provocation of the dizziness by movements, and a short duration of the dizziness attack, and positive clinical vestibular tests, BPPV treatment could be initiated.

The reliability of the Dutch version of the vestibular activities avoidance instrument in persons with and without dizziness.

BACKGROUND: Avoidance of activities that trigger dizziness in persons with vestibular disorders may inhibit dynamic vestibular compensation mechanisms. OBJECTIVE: To determine the reliability of the Vestibular Activities Avoidance Instrument (VAAI) 81 and 9 item tool and to compare the VAAI scores in Dutch-speaking healthy adults and in patients with vestibular disorders. METHODS: A prospective cohort study was conducted including 151 healthy participants and 106 participants with dizziness. All participants completed the 81-item VAAI. Within 7 days, the VAAI was completed a second time by 102 healthy adults and 43 persons with dizziness. RESULTS: The average 81-item VAAI scores [54.8(47.1) vs. 228.1(78.3)] and 9-item VAAI scores [2.4(5.9) vs. 28.1(12)] were significantly different between healthy adults and participants with dizziness (p < 0.001). In participants with dizziness the ICC for the 81-item VAAI was 0.95 (95% CI: 0.91, 0.97) and for the 9-item VAAI was 0.92 (95% CI: 0.85, 0.95). Cronbach's alpha for the 81-item VAAI was 0.97 and 0.85 for the 9-item VAAI. The minimal detectable change was 47.8 for the 81-item VAAI and 8.9 for the 9-item VAAI. CONCLUSIONS: Persons with dizziness have a greater tendency to avoid movements. Both test-retest reliability and internal consistency of the Dutch version of the VAAI were excellent.

Subjective perception of activity level: A prognostic factor for developing chronic dizziness after vestibular schwannoma resection?

Introduction: A vestibular schwannoma (VS) resection causes an acute unilateral vestibular deafferentation resulting in acute postoperative symptoms. Despite the expected resolution of most of the symptoms, due to central vestibular compensation, more than one out of four patients develop chronic dizziness. Several predictive factors, such as age and tumor size, have been suggested. Despite its potential effect on the process of central vestibular compensation, the level of physical activity after VS resection was not yet considered. Therefore, the association between the level of physical activity and chronic dizziness after VS resection will be investigated. Methods: This retrospective cohort study included 66 patients who underwent a retro-sigmoid VS resection between October 2001 and February 2007. Patients were assessed before surgery and at 9 weeks and 6 months postoperatively. At 9 weeks, patients were asked to report their level of physical activity (PA) during the past week by using a visual analogue scale and their balance performance was assessed by four standing balance conditions with eyes closed and the Timed Up and Go test (TUG). Based on the Dizziness Handicap Inventory (DHI) score at 6 months, patients were divided in a chronic dizziness group (DHI > 30) and non-chronic dizziness group (DHI-score ≤ 30). Age, sex, Koos classification, preoperative vestibular function, treatment group, balance performance, and level of PA were compared between both groups and used as independent variables in linear regression analyses with the DHI score at 6 months as dependent variable. Results: The chronic dizzy patients revealed to have significantly lower levels of PA (p < 0.001) and worse static and dynamic balance performance (p = 0.023 and p = 0.041, respectively) 9 weeks after surgery. After elimination, the multiple regression analysis resulted in a model with two variables (PA level, TUG) which significantly predicted the DHI score (F 2,42 = 6.581; R 2 = 0.239; p = 0.003). Conclusion: This study revealed associations between (1) the level of PA and balance performance in the subacute phase and (2) chronic dizziness after VS resection. Assessment of the level of PA and balance performance during the subacute phase, which can be performed in a non-invasive and non-time-consuming way, might therefore provide prognostic information after VS resection.