Effects of vestibular stimulation on gait stability when walking at different step widths.

Vestibular information modulates muscle activity during gait, presumably to contribute to stability. If this is the case, stronger effects of perturbing vestibular information on local dynamic stability of gait, a measure of the locomotor system's response to small, naturally occurring perturbations, can be expected for narrow-base walking (which needs more control) than for normal walking and smaller effects for wide-base walking (which needs less control). An important mechanism to stabilize gait is to coordinate foot placement to center of mass (CoM) state. Vestibular information most likely contributes to sensing this CoM state. We, therefore, expected that stochastic electrical vestibular stimulation (EVS) would decrease the correlation between foot placement and CoM state during the preceding swing phase. In 14 healthy participants, we measured the kinematics of the trunk (as a proxy of the CoM), and feet, while they walked on a treadmill in six conditions: control (usual step width), narrow-base, and wide-base, each with and without stochastic EVS (peak amplitude of 5 mA; RMS of ~ 1.2 mA; frequency band from 0 to 25 Hz). Stochastic EVS decreased local dynamic stability irrespective of step width. Foot placement correlated stronger with trunk motion during walking with EVS than without in the control condition. However, residual variance in foot placement was increased when walking with EVS, indicating less precise foot placement. Thus, a vestibular error signal leads to a decrease in gait stability and precision of foot placement, but these effects are not consistently modulated by step width.

Síndrome vestibular secundária à otite média em gata / Secondary vestibular syndrome to otitis media in a cat

A Síndrome Vestibular é um distúrbio frequente na neurologia felina que é caracterizado como um conjunto de sinais neurológicos, causados por uma disfunção de qualquer parte do sistema vestibular. Este é dividido nos componentes periférico e central e o exame neurológico é essencial para localizar a origem da lesão. A Síndrome Vestibular Periférica pode ser causada por anomalias congênitas, neoplasias, traumas, pólipos e doenças inflamatórias; sendo a otite média/interna uma das principais etiopatogenias em cães e gatos. Dessa forma, o presente trabalho tem como objetivo apresentar um relato de caso de um felino, fêmea, sem raça definida, de sete meses de idade, apresentando Síndrome Vestibular secundária à otite média. O animal deu entrada na clínica com sinais neurológicos súbitos, apresentando nistagmo e incoordenação motora, bem como secreção nasal unilateral. Foram solicitados exames hematológicos e bioquímicos, ultrassonografia abdominal e radiografia de crânio, além de recomendada a internação. Nos exames bioquímicos, os valores de bilirrubina total e frações estavam acima do valor de referência e a relação albumina/globulina estava diminuída. O exame radiográfico confirmou a suspeita de otite média. O tratamento foi realizado com marbofloxacino e gabapentina. Após o tratamento, o animal apresentou melhora significativa do quadro clínico. Baseado no exposto, conclui-se que a Síndrome Vestibular secundária à alteração otológica é um quadro presente na rotina veterinária, sendo importante a associação de exame clínico e exames complementares para que seja possível chegar ao diagnóstico.

Vestibular syndrome is a frequent disorder in feline neurology that is characterized as a set of neurological signs caused by a dysfunction of any part of the vestibular system. The vestibular system is divided into peripheral and central components, and a neurological examination is essential to locate the origin of the lesion. The peripheral vestibular syndrome can be caused by congenital anomalies, neoplasms, trauma, polyps, and inflammatory diseases, with otitis media/internal being one of the main etiologies in dogs and cats. Thus, the present work aims to present a case report of a feline, female, mixed breed, seven months old, with secondary vestibular syndrome to otitis media. The animal was admitted to the clinic with sudden neurological signs, presenting nystagmus and motor incoordination, as well as unilateral nasal secretion. Hematological and biochemical tests, abdominal ultrasound, and skull radiography were requested, and hospitalization was recommended. In the biochemical tests, the values of total bilirubin and fractions were above the reference value and the albumin/globulin ratio was decreased. The radiographic examination confirmed the suspicion of otitis media. The treatment was performed with marbofloxacin and gabapentin. After treatment, the animal showed a significant improvement in clinical condition. Therefore, it is concluded that secondary vestibular syndrome to otologic alteration is a condition present in the veterinary routine, and the association of clinical examination and complementary exams is important so that it is possible to reach the diagnosis.

Aquatic physiotherapy: a vestibular rehabilitation option / Fisioterapia aquática: uma opção de reabilitação vestibular

Abstract Introduction: Vestibular rehabilitation is a fundamental resource for vestibular symptom control. Its performance in the aquatic environment is considered safe for the physical activities of the elderly, because they act simultaneously on musculoskeletal disorders and balance improvement. Objective: To evaluate the effects of an aquatic physiotherapy protocol in individuals with peripheral vestibular alterations. Methods: This was an interventional case study with a paired intentional sample of four subjects, who were selected for convenience. The subjects, all of them diagnosed with peripheral vestibulopathy, were submitted to twelve sessions of aquatic physiotherapy for vestibular rehabilitation, being evaluated for dizziness in three moments: initial, after six sessions and at the end of the sessions. The tests applied were: unipodal support to measure static balance, the Fukuda stepping test, which estimates the dynamic balance and the dizziness handicap inventory protocol, aimed at verifying how dizziness influences daily life. Results: When analyzing the static balance, initially the individuals were in the adaptive and abnormal dimensions, and all reached normality at the end of the protocol. Regarding the dynamic balance, the individuals initially showed marked impairment in the angular deviation, mainly to the side of pathology (75% to the left and 25% to the right), achieving improvement at the end of the study. However, it failed to reach statistical significance. The dizziness handicap inventory showed a statistically significant difference in its totality (p = 0.0414), which addresses the physical, functional and emotional factors. Conclusion: In conclusion, the aquatic physiotherapy protocol for vestibular rehabilitation of patients with peripheral impairment was positively assessed by the participants, considering the improvement in dizziness (static and dynamic) and its impact on daily activities.

Resumo Introdução: A reabilitação vestibular se consolida como um recurso fundamental para o controle de sintomas vestibulares e sua feitura no meio aquático é considerada segura para as atividades físicas dos idosos, atua simultaneamente nas desordens musculoesqueléticas e na melhoria do equilíbrio. Objetivo: Avaliar os efeitos de um protocolo de fisioterapia aquática em indivíduos com alterações vestibulares periféricas. Método: Estudo de caso intervencional com amostra intencional pareada de quatro sujeitos, selecionados por conveniência, diagnosticados com vestibulopatias periféricas. Os sujeitos foram submetidos a 12 sessões de fisioterapia aquática para reabilitação vestibular. Foram avaliados quanto à tontura em três momentos: inicial, após seis sessões e ao término dos atendimentos. Os testes aplicados foram: o apoio unipodal para mensurar o equilíbrio estático, a prova dos passos de Fukuda que estima o equilíbrio dinâmico e o protocolo dizziness handicap inventory com o objetivo de verificar o quanto a tontura influencia na vida cotidiana. Resultados: Ao analisar o equilíbrio estático, inicialmente os indivíduos se encontravam nas dimensões adaptativas e anormais e ao término do protocolo todos atingiram a normalidade. Em relação ao equilíbrio dinâmico, os indivíduos inicialmente apresentavam grande comprometimento no desvio angular principalmente para o lado da patologia (75% à esquerda e 25% à direita), conseguiram uma melhoria no fim do estudo. Todavia, não conseguiu atingir a significância estatística. O dizziness handicap inventory obteve diferença estatisticamente significante em sua totalidade (p = 0,0414), onde aborda os fatores físicos, funcionais e emocionais. Conclusão: O protocolo de fisioterapia aquática voltado para reabilitação vestibular de pacientes com comprometimento periférico foi avaliado de forma positiva pelos participantes, considerando-se a melhoria no quadro de tontura (estática e dinâmica) e do seu impacto nas atividades cotidianas.

Aquatic physiotherapy: a vestibular rehabilitation option.

INTRODUCTION: Vestibular rehabilitation is a fundamental resource for vestibular symptom control. Its performance in the aquatic environment is considered safe for the physical activities of the elderly, because they act simultaneously on musculoskeletal disorders and balance improvement. OBJECTIVE: To evaluate the effects of an aquatic physiotherapy protocol in individuals with peripheral vestibular alterations. METHODS: This was an interventional case study with a paired intentional sample of four subjects, who were selected for convenience. The subjects, all of them diagnosed with peripheral vestibulopathy, were submitted to twelve sessions of aquatic physiotherapy for vestibular rehabilitation, being evaluated for dizziness in three moments: initial, after six sessions and at the end of the sessions. The tests applied were: unipodal support to measure static balance, the Fukuda stepping test, which estimates the dynamic balance and the dizziness handicap inventory protocol, aimed at verifying how dizziness influences daily life. RESULTS: When analyzing the static balance, initially the individuals were in the adaptive and abnormal dimensions, and all reached normality at the end of the protocol. Regarding the dynamic balance, the individuals initially showed marked impairment in the angular deviation, mainly to the side of pathology (75% to the left and 25% to the right), achieving improvement at the end of the study. However, it failed to reach statistical significance. The dizziness handicap inventory showed a statistically significant difference in its totality (p = 0.0414), which addresses the physical, functional and emotional factors. CONCLUSION: In conclusion, the aquatic physiotherapy protocol for vestibular rehabilitation of patients with peripheral impairment was positively assessed by the participants, considering the improvement in dizziness (static and dynamic) and its impact on daily activities.

Asociaciones entre función vestibular y habilidades cognitivas: un enfoque básico-clínico / Associations between vestibular function and cognitive abilities: from basic to clinical approach

RESUMEN El sistema vestibular tiene un rol fundamental en funciones sensorio-motoras, control del equilibrio y estabilidad de la mirada. En las últimas décadas un amplio número de trabajos ha descrito la importancia de las aferencias vestibulares en el funcionamiento de diversas áreas del cerebro relacionadas con funciones cognitivas tales como la atención, memoria, navegación y otras habilidades visuo-espaciales. Estudios en pacientes con vestibulopatía han demostrado que estos individuos presentan disminución de su rendimiento en algunas pruebas neuropsicológicas; y, a su vez, que personas con patología cognitiva como deterioro cognitivo leve y demencia por enfermedad de Alzheimer tienen mayor probabilidad de presentar pruebas vestibulares alteradas. Esta revisión se enfoca en el papel que cumple el sistema vestibular y su asociación con habilidades cognitivas; basándose en estudios básicos y clínicos que describen una red vestibular cerebral y que han llevado a proponer modelos teóricos que relacionan la función vestibular con la cognición.

ABSTRACT The vestibular system is widely known for its role in sensory-motor functions, balance control and gaze stability. In recent decades, several research articles have described the importance of vestibular afferents in the functioning of brain areas related to cognitive skills such as attention, spatial memory, spatial navigation and other visuospatial abilities. Studies involving subjects with vestibulopathy reveal that these individuals show decreased performance on neuropsychological tests; and that patients with neurocognitive pathologies, such as mild cognitive impairment and dementia due to Alzheimer's disease, have a greater probability of producing diminished or absent responses in clinical vestibular electrophysiological tests. This literature review focuses on the role played by the vestibular system and its association with cognitive abilities. The review incorporates a description of basic and clinical research that describe the cortical vestibular network and emerging theoretical models linking vestibular function to cognition.

Comparison of ocular vestibular myogenic response by acoustic stimulation at 500 and 1000 Hz in healthy subjects.

OBJECTIVE: To compare the amplitude of potentials by acoustic stimulation at 500 Hz versus 1000 Hz in healthy subjects. METHODS: 25 subjects; potentials were performed with acoustic stimuli burst-type at 500 and 1000 Hz with a stimulation rate of 5.1 at 100 dB in both ears. Descriptive statistics tests were performed, confidence intervals were calculated for the mean with 95% reliability, standard error graphs and t-test for related samples. RESULTS: The values obtained in amplitude when performing an acoustic stimulus at 1000 Hz show a faster response compared to that obtained in the frequency of 500 Hz. The t-test showed a significant difference in the amplitude in the 1000 Hz frequency between ears with a significance value of p < 0.025. CONCLUSIONS: It is strengthened the hypothesis that in the amplitude of potentials by aerial acoustic stimulation in the frequency of 1000 Hz a greater amplitude is generated in relation to the one generated in the frequency of 500 Hz.

OBJETIVO: Comparar la amplitud de los potenciales miogénicos vestibulooculares por estimulación acústica a 500 y 1000 Hz en sujetos sanos. MÉTODO: Se estudiaron 25 sujetos y se realizaron potenciales con estímulos acústicos tipo burst a 500 y 1000 Hz con una tasa de estimulación de 5.1 a 100 dB en ambos oídos. Se realizaron pruebas de estadística descriptiva y se calcularon los intervalos de confianza para la media con un 95% de confiabilidad, las gráficas de error estándar y la prueba t para muestras relacionadas. RESULTADOS: Los valores obtenidos en amplitud al realizar estímulo acústico a 1000 Hz muestran una respuesta más rápida en comparación con la obtenida en la frecuencia de 500 Hz. La prueba t mostró una diferencia significativa en la amplitud en la frecuencia 1000 Hz entre oídos, con un valor de significancia p < 0.025. CONCLUSIONES: Se fortalece la hipótesis de que en los potenciales por estimulación acústica aérea en la frecuencia de 1000 Hz se genera una mayor amplitud en relación con la generada en la frecuencia de 500 Hz.

Alteraciones cognitivas espaciales y no espaciales relacionadas al sistema vestibular: una entidad subdiagnosticada / Space and non-space-related cognitive disturbances related to the vestibular system: an underdiagnosed entity

El sistema vestibular permite estabilizar las imágenes visuales en la retina durante el desplazamiento y mantener el balance postural. Hay proyecciones desde los núcleos vestibulares hasta la corteza cerebral, específicamente a nivel del hipocampo y la región témporo-parietal, relacionadas a la llamada cognición espacial y a algunos procesos cognitivos no espaciales como atención y cálculo numérico. La presente es una revisión bibliográfica de areas de estudio e investigación en relación a estos procesos. En los sistemas de búsqueda Pub Med y Google Académico, se encontraron 44 artículos, de los cuales dos fueron capítulos de libros de texto. Se elaboran conclusiones pertinentes

The vestibular system allows the stabilization of visual images in the retina during displacement, thus contributing to the maintenance of postural balance. There are projections from the vestibular nuclei to the cerebral cortex, specifically hippocampus and the temporo-parietal region, related to the so-called spatial cognition and to some non- spatial cognitive processes such as attention and numerical calculation. A literature review on study and research areas related to these processes is presented. Academic Google and PubMed search engines were utilized with a total of 44 articles found, two of which were textbook chapters. Pertinent conclusions are elaborated.

Exploración de los conductos semicirculares verticales con estimulación rotatoria inducida / Exploration of vertical semicircular ducts with induced rotatory stimulation

Las pruebas rotatorias han sido utilizadas durante más de un siglo para el estudio de la función vestibular por ser un estímulo fisiológico controlado muy efectivo sobre el laberinto posterior, habitualmente son los conductos semicirculares horizontales los que se exploran, pues se afectan con más frecuencia y son más fáciles de estudiar, sin embargo en ocasiones son los verticales los lesionados y por tanto deben emplearse otras alternativas para llegar a un diagnóstico certero. Se presenta un caso donde se evalúa la función fisiológica de los conductos semicirculares verticales a través de la electronistagmografía con estimulación rotatoria, empleando la técnica de estimulación tiempo-velocidad, con fases sucesivas de aceleración, velocidad constante, desaceleración y parada brusca, con una silla rotatoria computarizada, acoplada a un electronistagmógrafo. Se obtuvo arreflexia del canal vertical anterior derecho. A velocidades inferiores a 1 Hz es posible evaluar el reflejo vestíbulo ocular en los conductos semicirculares verticales, a pesar de que la frecuencia del estímulo está por debajo del nivel en que este reflejo funciona en las actividades diarias(AU)

Rotatory tests have been used for over a century for the study of vestibular function because it is a very effective physiological controlled stimulus on the posterior labyrinth, usually the horizontal semicircular ducts that are explored, since they are affected more frequently and are more easy to study, however sometimes the injured are vertical and therefore other alternatives must be used to arrive at a correct diagnosis. The aim of this study is to evaluate the range of physiological function of vertical semicircular ducts using electronystagmography and rotary stimulation. The method used was the technique of time - speed stimulation, with successive phases of acceleration, constant speed, deceleration and abrupt stop, with a computerized rotating chair. Vestibulo-ocular arreflexia of the right anterior vertical channel. It was shown that at speeds lower than 1 Hz it is possible to evaluate the Ocular Lobe Reflex in the vertical semicircular ducts, although the frequency of the stimulus is below the level at which this reflex works in daily activities(AU)

Postura e equilíbrio corporal de escolares de oito a doze anos com e sem respiração oral / Posture and body balance of schoolchildren aged 8 to 12 years with and without oral breathing

RESUMO Objetivo Avaliar a postura e o equilíbrio corporal de escolares com e sem respiração oral e, ainda, verificar se existe correlação entre os valores obtidos na avaliação da postura corporal e na análise dos sistemas sensoriais. Método A pesquisa foi realizada com escolares de 8 a 12 anos. A amostra foi subdividida em grupo estudo (escolares com respiração oral) e grupo controle (escolares sem respiração oral). A divisão dos grupos foi determinada com base em critérios pré-estabelecidos pesquisados na anamnese, avaliação auditiva e avaliação do sistema estomatognático. Os escolares selecionados, de ambos os grupos, foram submetidos à avaliação postural por meio do Software de Análise Postural (SAPO) na vista lateral direita e na vista lateral esquerda e Posturografia Dinâmica (Foam-laser Dynamic Posturography). Resultados Na avaliação da postura, foi encontrada diferença estatisticamente significante apenas no ângulo do joelho na vista lateral esquerda. No que se refere à Posturografia Dinâmica, foi encontrada diferença estatisticamente significante nos valores obtidos nos seis testes de organização sensorial (TOS). Foi observada correlação média entre a postura da cabeça em vista lateral esquerda e os sistemas sensoriais. Conclusão Os escolares com respiração oral apresentam alterações posturais quando comparados aos escolares sem respiração oral, principalmente, no posicionamento do joelho. O equilíbrio corporal no grupo de escolares com respiração oral mostrou estar mais prejudicado quando comparado ao grupo de escolares sem respiração oral. Existe correlação entre posicionamento cefálico e os diferentes sistemas sensoriais.

ABSTRACT Purpose This study aims to evaluate the posture and body balance of students with and without oral breathing, as well as to verify whether there is a correlation between the values obtained in this evaluation and those of the analysis of sensory systems. Methods The research was conducted with school children aged 8 to 12 years. The sample was subdivided into two study groups: schoolchildren with oral breathing and school children without oral breathing (control). The division of the groups was determined on the basis of pre-established criteria investigated in the anamnesis, hearing evaluation, and assessment of the stomatognathic system. The schoolchildren from both groups were submitted to postural evaluation using the Postural Assessment Software (SAPO) on the right and left lateral views and the Foam-laser Dynamic Posturography test. Results In the assessment of posture, a statistically significant difference was found only in the knee angle on the left lateral view. With regards to the Dynamic Posturography, there was a statistically significant difference in the values obtained in the six tests of sensory organization (TOS). There was a moderate correlation between the position of the head on the left lateral view and the sensory systems. Conclusions Schoolchildren with oral breathing present postural changes compared with those without oral breathing, mainly regarding the positioning of the knee. The body balance in the group of schoolchildren with oral breathing showed greater impairment compared with that in the group of schoolchildren without oral breathing. There is a correlation between the cephalic position and the different sensory systems.

The minimal caloric test asymmetric response in vertigo-free migraine patients / A resposta assimétrica ao teste calórico mínimo nos pacientes com enxaqueca sem vertigem

ABSTRACT Vertigo symptoms and subclinical vestibular dysfunctions may occur in migraine. The Minimal Caloric Test (MCT), an easy-to-perform, convenient and yet informative procedure was used to test the vestibular function in 30 vertigo-free migraine patients outside attacks and 30 paired controls. Although not statistically significant, a right-to-left nystagmus duration asymmetry greater than 25% was present in both groups. This difference was greater in the patients group, suggesting the presence of subclinical vestibular imbalance in migraine.

RESUMO Vertigem e alterações vestibulares subclínicas têm sido identificadas na enxaqueca. O teste calórico mínimo é simples de realizar, informativo e conveniente. Ele foi realizado em 30 pacientes com enxaqueca sem queixa de vertigem e 30 controles pareados. Embora não estatisticamente significativo, ocorreu assimetria direita-esquerda superior a 25% na duração do nistagmo em ambos os grupos, maior nos pacientes, o que sugere a presença de desequilíbrio vestibular subclínico na enxaqueca.

Effects of vestibular rehabilitation in the elderly: a systematic review.

BACKGROUND: Aging is characterized by gradual physiological changes in body systems. Changes in the vestibular system can occur and cause dizziness, vertigo and imbalance, symptoms that are common in the elderly. Vestibular rehabilitation is a therapeutic resource that has been widely used to improve this condition. AIMS: To complete a systematic review of the effects of vestibular rehabilitation on the elderly. METHODS: A search for relevant publications was conducted in SCIELO, PUBMED, MEDLINE, COCHRANE and LILACS databases. Clinical trials and cohort studies that were written in the English language and published over the course of the last 10 years were selected. The methodological quality of the studies was assessed using the PEDro scale. A critical analysis of the studies was composed. RESULTS: Eight studies that involved subjects who were over the age of 60 were selected for inclusion in the systematic review. The most common vestibular dysfunction identified was complaints about dizziness and imbalance. The Dizziness Handicap Inventory was the most frequently used assessment instrument, and the treatment protocol that prevailed was that suggested by Cawthorne and Cooksey. DISCUSSION: The PEDro scale showed that only one article was of an acceptable methodological quality and presented satisfactory outcome measures. This was due, in part, to a lack of a hidden randomization, masking of the subject, evaluators and therapists, and lack of outcome measures, which can reduce the quality of the evidence presented in this study. CONCLUSION: Clinical trials indicate that vestibular rehabilitation represents an effective means of treating elderly patients with vestibular disorders; however, evidence of its effectiveness remains lacking.

Efectos de la estimulación del neurodesarrollo en niños con antecedentes de encefalopatía hipóxico isquémica / The Effects of Neurodevelopmental Stimulation in Children with a History of Hypoxic Ischemic Encephalopathy / Efeitos da estimulaçÃo do neurodesenvolvimento em crianças com antecedentes de encefalopatia hipóxico isquêmica

Objetivo. Los efectos de la encefalopatía hipóxica isquémica en los recién nacidos pueden reflejarse en el deficiente desarrollo de patrones motores elementales que son el origen de la psicomotricidad. En este estudio se tuvo como objetivo establecer la efectividad de un procedimiento de evaluación e intervención, que precisara el tipo de desorganización motora asociada a este padecimiento. Método. Se evaluaron 15 niños con hipoxia, utilizando la Escala de evaluación del desarrollo cinesiológico de Vojta y la Escala de estimación del desarrollo psicomotor de Hellbrügge, con los que se pudieron identificar tres tipos de desorganización motora: patrón motor de tipo hipotónico/hipoquinético, patrón motor hiperexcitable y patrón motor rígido. Se elaboró un programa de corrección basado en los principios de estimulación vestibular y propioceptiva para activar posturas y posiciones humanas específicas y reducir la expresividad de los tipos identificados. Resultados. Después de ocho meses de tratamiento se identificaron cambios en la organización motriz como resultado de la aplicación del programa de corrección (t(15) = 8.37, p < 0.000). Discusión. Se discute la importancia del diseño de estrategias de intervención temprana para disminuir la manifestación de alguna discapacidad que en el futuro pudiera manifestarse.

Objective. Hypoxic encephalopathy effects in newborn children can be reflected in the inappropriate development of motor patterns that are the cornerstone of psychomotor activity. The main objective of this study was to systematize an assessment-intervention procedure in order to detect different types of motor. Method. 15 children were evaluated using Vojta and Hellbrügge scales. Three types of motor deviation were identified: hypotonic/hypokinetic motor pattern, hyperexcitable motor pattern and rigid motor pattern. A program for correction was subsequently drawn up, based on the principles of vestibular and proprioceptive stimulation to activate specific human postures and positions and reduce the identified motor deviations. Results. After 8 months of the treatment significant changes were detected in the organization of, after the application of the motor program (t(15) = 8.37, p <0.0001). Discussion. These results showed the necessity of the precise design of intervention procedures at an early age for the prevention of the occurrence of any disability.

Escopo. Os efeitos da encefalopatia hipóxico isquêmica nos recém nascidos podem se reflexar no deficiente desenvolvimento de patrões motores elementares que sÃo o origem da psicomotricidade. Em este estudo o escopo foi estabelecer a efetividade de um procedimento de avaliaçÃo e intervençÃo, que precisara o tipo de desorganizaçÃo motora associada a este padecimento. Metodologia. Foram avaliadas 15 crianças usando a Escada de avaliaçÃo do desenvolvimento cinesiolôgico de Vojta e Escada de estimaçÃo do desenvolvimento psicomotor de Hellbrugge, com os que se pode identificar três tipos de desorganizaçÃo motora: patrÃo motor de tipo hipotônico/hipoquinético, patrÃo motor hiperexcitável e patrÃo motor rígido. Depois foi feito um programa de correçÃo baseado nos princípios de estimulaçÃo vestibular e proprioceptiva para ativar as posturas e posiciones humanas específicas e reduzir os tipos de dificuldades motoras identificadas. Resultados. Depois de 8 meses de tratamento foram identificadas mudanças na organizaçÃo motora das como resultado da aplicaçÃo do programa de correçÃo (t(15) = 8.367, p < 0.0001). DiscussÃo. Foi discutida a importância do desenho de estratégias de intervençÃo precoce para diminuir a manifestaçÃo de qualquer possível incapacidade que no futuro possa se manifestar.

Assessment of gait deviation on the Babinski-Weill test in healthy Brazilians / Avaliacao do desvio no teste da marcha de Babinski-Weill em uma amostra representativa de individuos brasileiros saudaveis

Objective The aim of this study was to validate a simple and reproducible method for assessing gait deviation on the Babinski-Weill test in a representative sample of healthy Brazilians. Methods Gait deviations were measured in 75 individuals (median=30 years, 41 women) for forward, backwards, and Babinski-Weill steps. The test entailed blindfolded individuals walking 10 paces at a frequency of 1 Hz with deviations subsequently measured by a protractor. Results Mean gait deviation forward was 0.53° with standard deviation (SD)=4.22 and backwards was 2.14° with SD=4.29. No significant difference in deviation was detected between genders (t test p=0.40 forward and p=0.77 backwards) or for age (ANOVA, p=0.33 forward and p=0.63 backwards). On the Babinski-Weill test, mean gait deviation was 5.26°; SD=16.32 in women and -3.11°; SD=12.41 in men, with no significant difference between genders (t test, p=0.056). Discussion Defining normative gait patterns helps distinguish pathological states. .

Objetivo O objetivo deste trabalho foi validar para uso no Brasil um método simples e reprodutível para avaliação do desvio no teste da marcha de Babinski-Weill. Métodos As medidas de desvio da marcha foram realizadas em 75 indivíduos (mediana=30 anos, 41 mulheres) na marcha para frente, para trás e no teste da marcha Babinski-Weill. Durante os testes, indivíduos com olhos vendados andavam 10 passos na freqüência de 1 Hz, sendo os desvios mensurados com transferidor. Resultados O desvio para frente teve média de 0,53° com desvio padrão (DP)=4,22 e para trás 2,14° com DP=4,29. Não houve diferença nos desvios entre os gêneros (teste t p=0,40 frente e p=0,77 trás) e entre as idades (ANOVA, p=0,33 frente e p=0,63 trás). No teste da marcha de Babinski-Weill as mulheres desviaram em média 5,26°; DP=16,32 e os homens -3,11°; DP=12,41, sem diferença entre os gêneros (teste t, p=0,056). Discussão O estabelecimento de padrões de normalidade possibilita a identificação de estados patológicos. .

Estudio epidemiológico descriptivo de pacientes presentados al Comité de Oído del Servicio de ORL del Hospital Clínico de la Universidad de Chile entre los años 2004 y 2011 / Descriptive epidemiological study of patients presented at Ear committee of the ORL Department of the Hospital Clínico de la Universidad de Chile between the years 2004 and 2011

Introducción: En el Servicio de Otorrinolaringología del Hospital Clínico de la Universidad de Chile, existe una instancia de revisión semanal de los casos que generan más discusión diagnóstica en patología de oído y del sistema vestibular, que denominamos Comité de Oído. Objetivos: En este trabajo se pretende describir las características epidemiológicas de los pacientes evaluados en este comité. Material y método: Se realizó un estudio de tipo retrospectivo donde se revisaron los registros del libro del Comité de Oído entre los años 2004 y 2011. Resultados: Se obtuvo un total de 1.081 diagnósticos realizados en el Comité de Oído. El promedio de edad de los pacientes fue de 39,9 años, siendo el 57% de sexo femenino. La patología de oído medio fue la más frecuente representando el 71%% del total de las consultas. El diagnóstico individual más frecuente fue la otitis media crónica colesteatomatosa en el 19,3% de los casos. Conclusión: Estos resultados nos permiten conocer las características de los pacientes con patologías de oído y sistema vestibular que generan más controversia en nuestro servicio.

Introduction: At the Otolaryngology Department of the Hospital Clinico de la Universidad de Chile, there is a committee of weekly meeting that reviews cases that generate the most controversy in ear and vestibular system pathology. Aim: This paper aims to describe the epidemiological characteristics of patients evaluated at this committee. Material and method: We performed a retrospective study that reviewed the records of the ear committee between the years 2004 and 2011. Results: A total of 1081 diagnostics were made at the committee. The average age was 39.9 years, and 57% were female patients. Middle ear pathology was the most frequent, accounting for 71%% of all diagnostics. The most frequent individual diagnostic was cholesteatomatous chronic otitis media in 19.3(0)% of cases. Conclusion: These results allow us to know epidemiological characteristics of patients with ear and vestibular system diseases, and those cases that generate the most controversy in our service.

Balance Rehabilitation Unit (BRU TM) posturography in relapsing-remitting multiple sclerosis / Posturografia do Balance Rehabilitation Unit (BRU TM) na esclerose múltipla recorrente-remitente

OBJECTIVE: To evaluate balance control with Balance Rehabilitation Unit (BRU TM) posturography in patients with multiple sclerosis (MS). METHOD: A cross controlled study was performed including 39 relapsing-remitting multiple sclerosis patients with scores less than or equal to 4 in the Expanded Disability Status Scale (EDSS), and a homogeneous control group consisting of 65 healthy individuals, matched by the age and gender. The experimental group was distributed according to the EDSS scale scores in 0-2.5 and 3-4. To assess the vestibular system function, the patients underwent a neurotological evaluation, including posturography of the Balance Rehabilitation Unit (BRU TM). RESULTS: Statistically significant differences were observed when comparing the values of the sway velocity and the ellipse area of the MS 0-2.5 group with the control and the MS 3-4 group with the control. A statistically significant difference was verified between the MS 0-2.5 and the MS 3-4 groups in the condition 3 ellipse area values. CONCLUSION: The evaluation of the balance control with posturography of Balance Rehabilitation Unit (BRU TM) enables the identification of abnormalities of the sway velocity and confidential ellipse in patients with relapsing-remitting multiple sclerosis.

OBJETIVO: Avaliar o equilíbrio corporal à posturografia do Balance Rehabilitation Unit (BRU TM) em pacientes com esclerose múltipla (EM). MÉTODO: Estudo transversal controlado em 39 pacientes com esclerose múltipla do tipo recorrente-remitente, com pontuação menor ou igual a 4 na escala de incapacidade funcional expandida, e por um grupo controle homogêneo, constituído por 65 indivíduos hígidos, homogêneo em relação à idade e gênero. O grupo experimental foi distribuído, de acordo com a pontuação da EDSS, em 0-2,5 e 3-4. Para avaliar a função do sistema vestibular, os pacientes foram submetidos a uma avaliação otoneurológica, incluindo a posturografia do Balance Rehabilitation Unit (BRU TM). RESULTADOS: Foram observadas diferenças significantes na comparação dos valores da velocidade de oscilação e da área de elipse do grupo EM 0-2,5 com o controle e do grupo EM 3-4 com o controle; diferença significante foi verificada entre os grupos EM 0-2,5 e EM 3-4 nos valores da área de elipse na condição três. CONCLUSÃO: A avaliação do equilíbrio corporal por meio da posturografia do Balance Rehabilitation Unit (BRU TM) possibilita a identificação de anormalidades da velocidade de oscilação e da área de elipse em pacientes com esclerose múltipla.

Avaliação neurofisiológica das vias auditivas e do equilíbrio na afasia de broca: apresentação de um caso ilustrativo / Neurophysiologic evaluation of auditory pathways and the balance in Broca's aphasia: presentation of illustrative case

INTRODUÇÃO: Afasia é uma alteração neurológica decorrente de uma lesão em áreas cerebrais que são responsáveis pela linguagem. Frequentemente, a afasia ocorre como resultado de um acidente vascular cerebral, comprometendo a linguagem de expressão (afasia de Broca), a linguagem de entendimento (afasia de Wernicke) ou ambas (afasia mista). A avaliação otoneurológica corresponde a um grupo de procedimentos para avaliação sequencial do sistema auditivo e vestibular a de suas relações com o sistema nervoso central. O sistema auditivo e vestibular são de grande importância no controle dos mecanismos auditivos centrais, no processamento auditivo central, no controle do senso de movimento e no equilíbrio. OBJETIVO: Nosso objetivo foi apresentar a sequência da avaliação neurológica das vias auditivas (periféricas e centrais) e do sistema vestibular em um paciente com afasia de Broca. MÉTODOS: O paciente foi submetido a avaliação otorrinolaringológica, avaliação auditiva (audiometria tonal limiar convencional), testes de imitância acústica, pesquisa do reflexo acústico, avaliação do processamento auditivo central e do sistema vestibular. CONCLUSÃO: Nossos dados demonstram a importância da avaliação neurofisiológica das vias auditivas e do sistema vestibular em pacientes com afasia de Broca, para aprimorar o diagnóstico, tratamento e o acompanhamento evolutivo.

INTRODUCTION: Aphasia is a neurological disorder that results from damage to areas of the brain that are responsible for language. Often, the aphasia occurs as the result of a stroke, that leads to language expression impairment (Broca's aphasia), language comprehension impairment (Wernicke's aphasia) or the association of both (mixed aphasia). The otoneurologic evaluation is a group of semiologic standardized procedures that evaluates the relationship between the auditory and vestibular system and the central nervous system. The auditory pathways and the vestibular system are very important for the control of the central auditory mechanisms, the central auditory processing and the sense of movement and balance controls. OBJECTIVE: Our aim was to present the neurophysiologic evaluation of the auditory pathways (peripheral and central) and the vestibular system in patients with Broca's aphasia. METHODS: The patient was submitted to otorrinolaringologic evaluation, audiologic evaluation (tonal audiometria conventional), acoustics immittance measurements, research of the acoustic reflex and central auditory processing as well as vestibular system evaluation. CONCLUSIONS: Our data demonstrate the importance of the auditory pathways and the vestibular system neurophysiologic evaluation in patients with Broca's aphasia in order to improve the diagnosis, treatment and the follow-up.

Interpretação e utilidade da prova calórica: [revisão] / Interpretation and use of caloric testing: [review]

A prova calórica é o teste da avaliação otoneurológica que verifica a integridade do reflexo vestíbulo-ocular e possibilita avaliar cada labirinto separadamente. Os principais aspectos relacionados à realização, interpretação e utilidade da prova calórica foram revistos. MÉTODOS: Realizou-se revisão sistemática sobre as publicações ocorridas nos últimos cem anos sobre o assunto. Incluíram-se artigos originais transversais e longitudinais, de revisão e meta-análise. Excluíram-se revisões de papeleta, relatos de caso e editoriais. Os descritores utilizados foram: prova calórica, nistagmo, sistema vestibular, preponderância direcional, predomínio labiríntico, teste calórico monotermal, teste calórico com água gelada, fenômeno de Bell. Pesquisou-se as bases de dados COCHRAINE, MEDLINE, LILACS, CAPES. RESULTADOS: De 818 resumos de artigos, selecionou-se inicialmente 93 que preenchiam os critérios de inclusão. A leitura dos artigos resultou na seleção final de 55. Na análise dos artigos, enfatizou-se na discussão fundamentos da prova calórica, tipos de estimulação utilizados, prova calórica monotermal e com água gelada, questões relacionadas à interpretação dos resultados, variáveis e artefatos. COMENTÁRIOS FINAIS: os valores de referência utilizados na prova calórica podem variar de serviço para serviço, com ponto de corte definido a partir de estudos locais. Semiotécnica cuidadosa é fundamental para elevar a sensibilidade do exame.

Caloric testing is an otoneurologic evaluation of the status of the vestibular-ocular reflex; it allows an evaluation of each labyrinth separately. The main aspects on the use and interpretation of caloric testing are reviewed. METHOD: A systematic review of papers published in the past one hundred years on caloric testing was undertaken. The inclusion criteria were: cross-sectional, longitudinal, original articles, reviews and meta-analyses. Reviews of patient charts, case reports and editorials were excluded. The key-words were: caloric testing, nystagmus, vestibular system, directional preponderance, labyrinth predominance, monothermal caloric test, ice water caloric testing, Bell´s phenomenon. The databases were: COCHRAINE, MEDLINE, LILACS, CAPES. RESULTS: Ninety-three of 818 abstracts fulfilled the inclusion criteria. After reading these articles, 55 were selected for this study. These papers discussed the basics of caloric testing, the types of stimulation, the interpretation of results, variables, artifacts, and the monothermal and ice water caloric test. FINAL COMMENTS: Caloric testing reference values may vary according to each unit; the the cutoff point is defined based on local studies. Attention to the technique is essential to maximize test sensitivity.

Clínica, diagnóstico y terapéutica del vértigo posicional paroxístico benigno / Benign paroxysmal positional vertigo: clinical diagnosis and treatment

Benign paroxysmal positional vertigo is the most common vestibular disorder and it has a significant impact in health-related quality of life. The disease is probably caused by the accumulation of lithiasis material from the otolithic membrane of the utricle. Patients experience multiple short crises of vertigo lasting seconds when they lay or turn in bed. There are several clinical variants affecting posterior, horizontal or anterior canal and in some cases vestibular lithiasis can occur in two canals simultaneously. The diagnosis is performed by video-oculographic recording of positional nystagmus during positional testing to identify the canal affected. There are specific treatment maneuvers for each clinical variant, which are highly effective at short term

El vértigo posicional paroxístico benigno es el trastorno vestibular más frecuente y tiene un impacto significativo sobre la calidad de vida relacionada con la salud. La enfermedad se origina probablemente por la acumulación de un material litiásico procedente de la membrana otolítica del utrículo. Los pacientes sufren múltiples crisis de vértigo cortas que duran segundos cuando se acuestan o se dan la vuelta en la cama. Existen varias formas clínicas que pueden afectar los conductos posterior, horizontal o anterior y que en algunos casos afectan dos conductos simultáneamente. El diagnóstico se realiza mediante el registro videooculográfico del nistagmo posicional al realizar las pruebas posicionales para localizar el conducto afectado. Existen maniobras terapeúticas específicas para cada variante clínica, las cuales presentan una elevada efectividad a corto plazo