Validated argentine version of the visual vertigo analogue scale.

BACKGROUND: Visual vertigo (VV), triggered by environmental or dynamic visual stimuli and repetitive visual patterns, can affect daily life activities. The Visual Vertigo Analogue Scale (VVAS) is a valid and reliable self-administered questionnaire to assess VV, which has been culturally adapted to the Argentine population but has not been validated. OBJECTIVE: To validate the Argentine version of VVAS (VVAS-A) by confirming its psychometric properties in patients with vestibular disorders. METHODS: Vestibular patients (n = 82) completed the VVAS-A and the Dizziness Handicap Inventory Argentine version (DHI-A) during their initial visit and one week later. The VVAS-A's internal consistency, test retest reliability, ceiling and floor effects, and construct validity were determined. Test-retest data (n = 71) was used to calculate reliability using the intraclass correlation coefficient (ICC 2.1). RESULTS: A ceiling effect was observed in 12 patients (14.6%). Internal consistency was acceptable (Cronbach's alpha: 0.91). The reliability was r = 0.764 [CI 95%: 0.7 -0.86]). Correlations were observed between the VVAS-A and the total DHI-A score (rho = 0.571), the DHI-A physical subscale (rho: 0.578), and DHI-A functional and emotional subscales of the DHI-A (rho: 0.537 and 0.387, respectively). CONCLUSION: The VVA-A is a valid, reliable tool to evaluate VV in patients with vestibular disorders.

Eficacia de la férula nocturna y el ultrasonido para tratar el síndrome del túnel carpiano. Estudio clínico controlado y aleatorizado / Night splinting effectiveness in carpal tunnel syndrome. A randomized controlled clinical trial

Objetivo: Comparar la eficacia de la inmovilización nocturna de la muñeca con una férula cubital en ángulo neutro junto con la aplicación de ultrasonido en pacientes con síndrome del túnel carpiano leve y moderado. Materiales y Métodos: Entre octubre de 2007 y marzo de 2010, se incluyó a pacientes >18 años con síndrome del túnel carpiano confirmado por electromiografía en un hospital de Buenos Aires. Se realizó una aleatorización estratificada, con bloques permutados aleatorios, y apareamiento por sexo y edad. Los pacientes fueron asignados al grupo experimental (GE) o al grupo de control (GC). Ambos grupos recibieron ultrasonido de 1 MHz pulsante por 15 min, 3 veces por semana, durante 6 semanas. Los pacientes del GE, además, utilizaron una férula nocturna. Se evaluaron el dolor y la parestesia con la escala analógica visual de 100 mm, la PSFS y el test de Moberg, al comenzar, a las 3 semanas y, al finalizar, a las 6 semanas, y durante el seguimiento, al mes, y a los 3 y 6 meses, con evaluador a ciego. Resultados: Se analizó a 32 pacientes del GC y a 33 del GE. Al finalizar el tratamiento, todas las variables habían mejorado en ambos grupos, con diferencia de medias estadísticamente significativa para el dolor a favor del GE a las 3 semanas de tratamiento 1,64 (IC95% 0,38-2,91; p = 0,012), pero sin diferencia clínica significativa. No se informaron efectos adversos. Conclusión: El tratamiento con una férula nocturna y ultrasonido no es superior al ultrasonido solo en pacientes con STC. Nivel de Evidencia; II

Objective: To compare the effectiveness of night wrist immobilization using an ulnar splint in neutral angle versus the use of ultrasound (US) in patients with Carpal Tunnel Syndrome (CTS). Materials and Methods: Study population included over 18 years of age that were treated for electromyography-confirmed CTS between October 2007 and March 2010 at a Buenos Aires hospital. A sex- and age-stratified randomization was performed by using randomly permuted blocks, allocating patients into the experimental group (EG) and control group (CG). Pulsed US therapy was administered for 15 minutes to all patients three times a week for six weeks at a frequency of 1 MHz. In addition, EG patients were also prescribed night splint. Pain and paresthesia were evaluated using a 100mm Visual Analogue Scale (VAS), the Patient Specific Functional Scale (PSFS), and the Moberg pickup test (MPUT) at baseline, at 3 and 6 weeks, and at 3 and 6 months after treatment institution by a blinded investigator. Results: Study population consisted of 85 cases (65 patients) that were randomly allocated to CG (n=42) or EG (n=43). Improvement of all the variables was observed at the end of treatment in both groups, with a 1.64 (95% CI: 0.38-2.91, P=0.012) statistically significant difference in means for pain in favor of the EG at 3 weeks of treatment, but without a significant clinical difference. No adverse effects were observed. Conclusion: The effectiveness of combined night splint and US therapy is not superior to the US alone treatment in CTS patients. Level of Evidence; II

Acute Bilateral Superior Branch Vestibular Neuropathy.

The rapid onset of a bilateral vestibular hypofunction (BVH) is often attributed to vestibular ototoxicity. However, without any prior exposure to ototoxins, the idiopathic form of BVH is most common. Although sequential bilateral vestibular neuritis (VN) is described as a cause of BVH, clinical evidence for simultaneous and acute onset bilateral VN is unknown. We describe a patient with an acute onset of severe gait ataxia and oscillopsia with features compatible with acute BVH putatively due to a bilateral VN, which we serially evaluated with clinical and laboratory vestibular function testing over the course of 1 year. Initially, bilateral superior and horizontal semicircular canals and bilateral utricles were impaired, consistent with damage to both superior branches of each vestibular nerve. Hearing was spared. Only modest results were obtained following 6 months of vestibular rehabilitation. At a 1-year follow-up, only the utricular function of one side recovered. This case is the first evidence supporting an acute presentation of bilateral VN as a cause for BVH, which would not have been observed without critical assessment of each of the 10 vestibular end organs.

Resultados tras la rehabilitación vestibular y terapia Wii ® en pacientes con hipofunción vestibular unilateral crónica / Outcomes after vestibular rehabilitation and Wii ® therapy in patients with chronic unilateral vestibular hypofunction

Introducción y objetivos: La rehabilitación vestibular está destinada a maximizar la compensación central de la enfermedad vestibular periférica. El objetivo del presente estudio fue analizar las diferencias de la percepción de discapacidad, el riesgo de caídas y la estabilidad de la mirada antes y después de un tratamiento de rehabilitación vestibular con el uso complementario de terapia Wii® en pacientes con diagnóstico de hipofunción vestibular unilateral crónica. Materiales y métodos: Se revisaron registros de pacientes entre abril de 2009 y mayo de 2011 del área de rehabilitación vestibular de un hospital universitario. Las variables estudiadas fueron el Dizziness Handicap Inventory, el índice dinámico de la marcha y la agudeza visual dinámica. Todos los sujetos usaron Wii® como complemento. Resultados: Sesenta y nueve casos (41 mujeres y 28 hombres). La mediana de edad fue 64 años. La mediana de Dizziness Handicap Inventory inicial fue de 40 puntos (rango 0-84, percentil 25-75 = 20-59) y final de 24 (rango 0-76, percentil 25-75 = 10-40) p < 0,0001. La mediana del índice dinámico de la marcha inicial fue 21 puntos (rango 8-24, percentil 25-75 = 17,5-23) y final de 23 (rango 12-24, percentil 25-75 = 21-23) p < 0,0001. La mediana de la agudeza visual dinámica inicial fue 2 (rango 0-6, percentil 25-75 = 1-4) y final de 1 (rango 0-3, percentil 25-75 = 0-2) p < 0,0001. Conclusión: Se observó una disminución de los valores del Dizziness Handicap Inventory, un aumento de los valores del índice dinámico de la marcha y una mejoría en la agudeza visual dinámica; todas estas variaciones fueron estadísticamente significativas (AU)

Introduction and objectives: Vestibular rehabilitation therapy is an exercise-based programme designed to promote central nervous system compensation for inner ear deficit. The objective of the present study was to analyse the differences in the perception of handicap, the risk of falls, and gaze stability in patients diagnosed with chronic unilateral vestibular hypofunction before and after vestibular rehabilitation treatment with complementary Wii® therapy. Materials and methods: A review was performed on the clinical histories of patients in the vestibular rehabilitation area of a university hospital between April 2009 and May 2011. The variables studied were the Dizziness Handicap Inventory, the Dynamic Gait Index and dynamic visual acuity. All subjects received complementary Wii® therapy. Results: There were 69 cases (41 woman and 28 men), with a median age of 64 years. The initial median Dizziness Handicap Inventory score was 40 points (range 0-84, percentile 25-75 = 20-59) and the final, 24 points (range 0-76, percentile 25-75 = 10.40), P < .0001. The initial median for the Dynamic Gait Index score was 21 points (range 8-24, percentile 25-75 = 17.5-2.3) and the final, 23 (range 12-24, percentile 25-75 = 21-23), P < .0001. The initial median for dynamic visual acuity was 2 (range 0-6, percentile 25-75 = 1-4) and the final, 1 (range 0-3, percentile 25-75 = 0-2), P < .0001. Conclusion: A reduction was observed in the Dizziness Handicap Inventory Values. Values for the Dynamic Gait Index increased and dynamic visual acuity improved. All these variations were statistically significant (AU)

Outcomes after vestibular rehabilitation and Wii® therapy in patients with chronic unilateral vestibular hypofunction.

INTRODUCTION AND OBJECTIVES: Vestibular rehabilitation therapy is an exercise-based programme designed to promote central nervous system compensation for inner ear deficit. The objective of the present study was to analyse the differences in the perception of handicap, the risk of falls, and gaze stability in patients diagnosed with chronic unilateral vestibular hypofunction before and after vestibular rehabilitation treatment with complementary Wii® therapy. MATERIALS AND METHODS: A review was performed on the clinical histories of patients in the vestibular rehabilitation area of a university hospital between April 2009 and May 2011. The variables studied were the Dizziness Handicap Inventory, the Dynamic Gait Index and dynamic visual acuity. All subjects received complementary Wii® therapy. RESULTS: There were 69 cases (41 woman and 28 men), with a median age of 64 years. The initial median Dizziness Handicap Inventory score was 40 points (range 0-84, percentile 25-75=20-59) and the final, 24 points (range 0-76, percentile 25-75=10.40), P<.0001. The initial median for the Dynamic Gait Index score was 21 points (range 8-24, percentile 25-75=17.5-2.3) and the final, 23 (range 12-24, percentile 25-75=21-23), P<.0001. The initial median for dynamic visual acuity was 2 (range 0-6, percentile 25-75=1-4) and the final, 1 (range 0-3, percentile 25-75=0-2), P<.0001. CONCLUSION: A reduction was observed in the Dizziness Handicap Inventory Values. Values for the Dynamic Gait Index increased and dynamic visual acuity improved. All these variations were statistically significant.