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1.
BMJ ; 367: l5922, 2019 11 05.
Artigo em Inglês | MEDLINE | ID: mdl-31690561

RESUMO

OBJECTIVE: To investigate the clinical effectiveness and safety of stand alone and blended internet based vestibular rehabilitation (VR) in the management of chronic vestibular syndromes in general practice. DESIGN: Pragmatic, three armed, parallel group, individually randomised controlled trial. SETTING: 59 general practices in the Netherlands. PARTICIPANTS: 322 adults aged 50 and older with a chronic vestibular syndrome. INTERVENTIONS: Stand alone VR comprising a six week, internet based intervention with weekly online sessions and daily exercises (10-20 minutes a day). In the blended VR group, the same internet based intervention was supplemented by face-to-face physiotherapy support (home visits in weeks 1 and 3). Participants in the usual care group received standard care from a general practitioner, without any restrictions. MAIN OUTCOME MEASURES: The primary outcome was vestibular symptoms after six months as measured by the vertigo symptom scale-short form (VSS-SF range 0-60, clinically relevant difference ≥3 points). Secondary outcomes were dizziness related impairment, anxiety, depressive symptoms, subjective improvement of vestibular symptoms after three and six months, and adverse events. RESULTS: In the intention-to-treat analysis, participants in the stand alone and blended VR groups had lower VSS-SF scores at six months than participants in the usual care group (adjusted mean difference -4.1 points, 95% confidence interval -5.8 to -2.5; and -3.5 points, -5.1 to -1.9, respectively). Similar differences in VSS-SF scores were seen at three months follow-up. Participants in the stand alone and blended VR groups also experienced less dizziness related impairment, less anxiety, and more subjective improvement of vestibular symptoms at three and six months. No serious adverse events related to online VR occurred during the trial. CONCLUSION: Stand alone and blended internet based VR are clinically effective and safe interventions to treat adults aged 50 and older with a chronic vestibular syndrome. Online VR is an easily accessible form of treatment, with the potential to improve care for an undertreated group of patients in general practice. TRIAL REGISTRATION: Netherlands Trial Register NTR5712.


Assuntos
Medicina Geral/métodos , Modalidades de Fisioterapia , Qualidade de Vida , Telemedicina/métodos , Doenças Vestibulares/reabilitação , Idoso , Doença Crônica/psicologia , Doença Crônica/reabilitação , Feminino , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Países Baixos , Síndrome , Resultado do Tratamento , Doenças Vestibulares/diagnóstico , Doenças Vestibulares/psicologia
2.
Auris Nasus Larynx ; 46(1): 70-77, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30691599

RESUMO

OBJECTIVE: Dizziness is one of the most common symptoms in the general population. Patients with dizziness experience balance problems and anxiety, which can lead to decreased physical activity levels and participation in their daily activities. Moreover, recovery of vestibular function from vestibular injury requires physical activity. Although there are reports that decreased physical activity is associated with handicap, anxiety, postural instability and reduced recovery of vestibular function in patients with chronic dizziness, these data were collected by self-report questionnaires. Therefore, the objective data of physical activity and the relationships between physical activity, handicap, anxiety and postural stability in patients with chronic dizziness are not clear. The purpose of this research was to objectively measure the physical activity of patients with chronic dizziness in daily living as well as handicap, anxiety and postural stability compared to healthy adults. Additionally, we aimed to investigate the relationships between physical activity, handicap, anxiety and postural stability in patients with chronic dizziness. METHODS: Twenty-eight patients with chronic dizziness of more than 3 months caused by unilateral vestibular hypofunction (patient group) and twenty-eight age-matched community dwelling healthy adults (healthy group) participated in this study. The amount of physical activity including time of sedentary behavior, light physical activity, moderate to vigorous physical activity and total physical activity using tri-axial accelerometer, self-perceived handicap and anxiety using questionnaires, and postural stability were measured using computerized dynamic posturography. RESULTS: The results showed worse handicap, anxiety and postural stability in the patient group compared to the healthy group. Objective measures of physical activity revealed that the patient group had significantly longer time of sedentary behavior, shorter time of light physical activity, and shorter time of total physical activity compared to the healthy group; however, time of moderate to vigorous physical activity was not significantly different between groups. Moreover, there were correlations between physical activity and postural stability in the patient group, while there were no correlations between physical activity, handicap or anxiety in the patient group. CONCLUSION: These results suggest that objectively measured physical activity of the patients with chronic unilateral vestibular hypofunction is lower compared to the healthy adults, and less active patients showed decreased postural stability. However, the details of physical activity and causal effect between physical activity and postural stability were not clear and further investigation is needed.


Assuntos
Ansiedade/complicações , Exercício , Equilíbrio Postural , Doenças Vestibulares/fisiopatologia , Acelerometria , Idoso , Tamanho Corporal , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , Doença Crônica , Pessoas com Deficiência , Exercício/fisiologia , Exercício/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Autorrelato , Autoavaliação , Inquéritos e Questionários , Doenças Vestibulares/psicologia , Testes de Função Vestibular
3.
PM R ; 10(11): 1223-1236.e2, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30503230

RESUMO

BACKGROUND: Deficits in sensory integration and fear of falling in complex environments contribute to decreased participation of adults with vestibular disorders. With recent advances in virtual reality technology, head-mounted displays are affordable and allow manipulation of the environment to test postural responses to visual changes. OBJECTIVES: To develop an assessment of static and dynamic balance with the Oculus Rift and (1) to assess test-retest reliability of each scene in adults with and without vestibular hypofunction; (2) to describe changes in directional path and sample entropy in response to changes in visuals and surface and compare between groups; and (3) to evaluate the relation between balance performance and self-reported disability and balance confidence. DESIGN: Test-retest, blocked-randomized experimental design. SETTING: Research laboratory. PARTICIPANTS: Twenty-five adults with vestibular hypofunction and 16 age- and sex-matched adults. METHODS: Participants stood on the floor or stability trainers while wearing the Oculus Rift. For 3 moving "stars" scenes, they stood naturally. For a "park" scene, they were asked to avoid a virtual ball. The protocol was repeated 1-4 weeks later. OUTCOME: Anteroposterior and mediolateral center-of-pressure directional path and sample entropy were derived from a force plate. RESULTS: We observed good to excellent reliability in the 2 groups, with most intraclass correlations above 0.8 and only 2 at approximately 0.4. The vestibular group had higher directional path for the stars scenes and lower directional path for the park scene compared with controls, with large variability in the 2 groups. Sample entropy decreased with more challenging environments. In the vestibular group, less balance confidence strongly correlated with more sway for the stars scenes and less sway for the park scene. CONCLUSION: Virtual reality paradigms can shed light on the control mechanism of static and dynamic postural control. Clinical utility and implementation of our portable Oculus Rift assessment should be further studied. LEVEL OF EVIDENCE: II.


Assuntos
Equilíbrio Postural/fisiologia , Doenças Vestibulares/fisiopatologia , Doenças Vestibulares/reabilitação , Realidade Virtual , Acidentes por Quedas , Adulto , Idoso , Medo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Reprodutibilidade dos Testes , Autocontrole , Interface Usuário-Computador , Doenças Vestibulares/psicologia
5.
J Neurol ; 265(Suppl 1): 63-69, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29785522

RESUMO

Persistent postural-perceptual dizziness (PPPD) is one of the most common causes of chronic vestibular disorders, with a substantial portion of the affected patients showing no significant improvement to standard therapies (i.e., pharmacotherapy, behavioral psychotherapy). Patients with PPPD have been shown to have a significant comorbidity with anxiety disorders and depression. Further, these patients show an activation of the autonomic nervous system resulting in symptoms such as nausea, increase of heart rate, and sweating. Based on the comorbidities and the activation of the autonomic nervous system, we addressed the question whether non-invasive vagus nerve stimulation (nVNS) might be a treatment option for these patients. In this prospective study we, therefore, applied nVNS to patients with treatment-refractory (to the standard therapy) PPPD. The stimulation protocol was similar to previous studies in patients with cluster headache and consisted of stimulations during exacerbations or acute attacks of vertigo, but also with regular stimulations in the morning and evening as prophylactic treatment. Results showed that non-invasive vagus nerve stimulation significantly improved quality of life, as measured by the EQ-5D-3L (p = 0.04), and depression, as measured by the HADS-D (p = 0.002), in the nVNS group, but not in the age- and sex-matched group with standard of care (SOC) treatment. Moreover, in the pooled analysis (additional 4 weeks of stimulation also in the SOC-group), less severe vertigo attacks/exacerbations (p = 0.04), a decrease in total postural sway path as measured by posturography (p = 0.02), as well as tendentious less anxiety (p = 0.08), occurred after stimulation. These data imply that short term nVNS is a safe and promising treatment option in patients with otherwise refractory PPPD.


Assuntos
Tontura/terapia , Qualidade de Vida , Estimulação do Nervo Vago , Doenças Vestibulares/terapia , Adulto , Ansiedade/terapia , Depressão/terapia , Tontura/psicologia , Feminino , Humanos , Masculino , Equilíbrio Postural , Doenças Vestibulares/psicologia
6.
J Neurophysiol ; 119(3): 1209-1221, 2018 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-29357473

RESUMO

DFNA9 is a rare progressive autosomal dominantly inherited vestibulo-cochlear disorder, resulting in a homogeneous group of patients with hearing impairment and bilateral vestibular function loss. These patients suffer from a deteriorated sense of spatial orientation, leading to balance problems in darkness, especially on irregular surfaces. Both behavioral and functional imaging studies suggest that the remaining sensory cues could compensate for the loss of vestibular information. A thorough model-based quantification of this reweighting in individual patients is, however, missing. Here we psychometrically examined the individual patient's sensory reweighting of these cues after complete vestibular loss. We asked a group of DFNA9 patients and healthy control subjects to judge the orientation (clockwise or counterclockwise relative to gravity) of a rod presented within an oriented square frame (rod-in-frame task) in three different head-on-body tilt conditions. Our results show a cyclical frame-induced bias in perceived gravity direction across a 90° range of frame orientations. The magnitude of this bias was significantly increased in the patients compared with the healthy control subjects. Response variability, which increased with head-on-body tilt, was also larger for the patients. Reverse engineering of the underlying signal properties, using Bayesian inference principles, suggests a reweighting of sensory signals, with an increase in visual weight of 20-40% in the patients. Our approach of combining psychophysics and Bayesian reverse engineering is the first to quantify the weights associated with the different sensory modalities at an individual patient level, which could make it possible to develop personal rehabilitation programs based on the patient's sensory weight distribution. NEW & NOTEWORTHY It has been suggested that patients with vestibular deficits can compensate for this loss by increasing reliance on other sensory cues, although an actual quantification of this reweighting is lacking. We combine experimental psychophysics with a reverse engineering approach based on Bayesian inference principles to quantify sensory reweighting in individual vestibular patients. We discuss the suitability of this approach for developing personal rehabilitation programs based on the patient's sensory weight distribution.


Assuntos
Sinais (Psicologia) , Reconhecimento Visual de Modelos , Doenças Vestibulares/psicologia , Adaptação Fisiológica , Idoso , Teorema de Bayes , Proteínas da Matriz Extracelular/genética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Orientação Espacial , Psicofísica , Doenças Vestibulares/genética
7.
Neuropsychologia ; 111: 112-116, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29374553

RESUMO

Unilateral vestibular loss (UVL) is accompanied by deficits in processing of visual and vestibular self-motion cues. The present study examined whether multisensory integration of these two types of information is, nevertheless, intact in such patients. Patients were seated on a rotating platform with a screen simulating 3D rotation in front of them and asked to judge the relative magnitude of two successive rotations in the yaw plane in three conditions: vestibular stimulation, visual stimulation and bimodal stimulation (congruent stimuli from both modalities together). Similar to findings in healthy controls, UVL patients exhibited optimal multisensory integration during both ipsi- and contralesional rotations. The benefit of multisensory integration was more pronounced on the ipsilesional side. These results show that visuo-vestibular integration for passive self-motion is automatic and suggests that it functions without additional cognitive mechanisms, unlike more complex multisensory tasks such as postural control and spatial navigation, previously shown to be impaired in UVL patients.


Assuntos
Percepção de Movimento , Autoimagem , Doenças Vestibulares , Percepção Visual , Adulto , Teorema de Bayes , Feminino , Lateralidade Funcional , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Biológicos , Percepção de Movimento/fisiologia , Propriocepção/fisiologia , Psicofísica , Rotação , Interface Usuário-Computador , Doenças Vestibulares/fisiopatologia , Doenças Vestibulares/psicologia , Percepção Visual/fisiologia , Adulto Jovem
8.
Disabil Rehabil ; 40(7): 829-835, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-28129508

RESUMO

PURPOSE: People with vestibular disorders are typically treated by physiotherapists in vestibular rehabilitation. Anxiety is strongly associated with vestibular disorders; however, there is a lack of understanding about how physiotherapists respond to people presenting with anxiety within vestibular rehabilitation. This study aimed to explore physiotherapists' current practice in assessing and treating patients with anxiety in vestibular rehabilitation. MATERIALS AND METHODS: A qualitative study using semi-structured interviews with 10 specialist physiotherapists in vestibular rehabilitation in three university teaching hospitals in England. Data were analyzed using thematic analysis. RESULTS: Four themes were identified: (i) The therapeutic relationship, (ii) Adapting assessment and treatment, (iii) Psychological intervention and support, and (iv) Physiotherapists' education and training. Physiotherapists reported using a range of behavioral and cognitive techniques and adapting their therapeutic approach by placing greater emphasis on education, building trust and pacing treatment. Physiotherapists highlighted the need for more specialist psychological support for patients during vestibular rehabilitation and tailored training and guidance on addressing anxiety within vestibular rehabilitation. CONCLUSIONS: Physiotherapists working in vestibular rehabilitation consider managing aspects of anxiety within their scope of practice and describe taking a psychosocial therapeutic approach. There is limited access to expert psychological support for patients with anxiety within vestibular rehabilitation. Implications for rehabilitation Anxiety is strongly associated with vestibular disorders and it is common for these patients to be managed by physiotherapists in vestibular rehabilitation. Vestibular rehabilitation services could improve access to psychological expertise through dedicated psychological input, more effective signposting and referral pathways, and better access to inter-professional support from psychologists and/or CBT practitioners in managing more complex patients. Physiotherapists requested tailored training and guidance to enhance their ability to manage patients with anxiety more effectively in vestibular rehabilitation.


Assuntos
Ansiedade/terapia , Competência Clínica , Fisioterapeutas , Relações Profissional-Paciente , Doenças Vestibulares/psicologia , Doenças Vestibulares/reabilitação , Feminino , Humanos , Entrevistas como Assunto , Masculino , Educação de Pacientes como Assunto
9.
Cortex ; 104: 193-206, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-28669509

RESUMO

Out-of-body experiences (OBEs) are states during which people experience their centre of awareness as located outside of their physical body, along with the sensation of seeing the environment from an elevated viewpoint. OBE is encountered in epilepsy, migraine and depersonalization, and it is not an uncommon experience in the general population. Current neuroscientific models of bodily self-consciousness consider that OBE are related to a failure to integrate visual, somatosensory and vestibular signals. These models have highlighted the importance of visual-vestibular mismatch in OBE. Case reports from older clinical literature suggest that vestibular disorders may precipitate OBE, but we were lacking population-based evidence that OBE is related to vestibular disorders. The present observational, prospective study describes otoneurological, neuropsychological and phenomenological correlates of OBE in the largest sample of patients with dizziness to date (n = 210) compared to a group of age- and gender-matched controls with no history of dizziness (n = 210). We show a significantly higher occurrence of OBE in patients with dizziness (14%) than in healthy participants (5%). Most of the patients experienced OBE only after they started having dizziness for the first time. OBE in patients with dizziness were mainly related to peripheral vestibular disorders. We also identify depersonalization-derealization, depression and anxiety as the main predictors of OBE in patients with dizziness, as well as a contribution of migraine. Depersonalization-derealization was the only significant predictor of OBE in healthy controls. Altogether, our data indicate that OBE in patients with dizziness may arise from a combination of perceptual incoherence evoked by the vestibular dysfunction with psychological factors (depersonalization-derealization, depression and anxiety) and neurological factors (migraine).


Assuntos
Imagem Corporal/psicologia , Despersonalização/psicologia , Tontura/psicologia , Doenças Vestibulares/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/psicologia , Conscientização/fisiologia , Depressão/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Inquéritos e Questionários , Vestíbulo do Labirinto/fisiopatologia
10.
J Vestib Res ; 27(2-3): 89-101, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29064826

RESUMO

Bilateral vestibular loss (BVL) causes a unique behavioural syndrome in rodents, with symptoms such as locomotor hyperactivity and changes in exploratory behaviour. Many of these symptoms appear to be indirect consequences of the loss of vestibular reflex function and are difficult to explain. Although such symptoms have been reported before, there have been few systematic studies of the effects of BVL using automated digital tracking systems in which many behavioural symptoms can be measured simultaneously with high precision. In this study, data were obtained from rats with BVL induced by intratympanic sodium arsanilate injections (n = 7) or sham injections (n = 8) and their behaviour in the open field was measured at 3 days and 23 days post-injection using Ethovision™ tracking software. BVL rats demonstrated reduced thigmotaxis, with more time spent in the central zones. Twenty-three days post-injection, BVL animals showed increased locomotor activity in the open field. The increase in activity was also reflected in the number of transitions between each zone of the field. In addition to increased activity, BVL animals showed increased whole body rotations following lesions. Using linear discriminant analysis (LDA) and random forest classification (RFC), we were able to show that the indirect behavioural effects of BVL, excluding direct measurement of vestibular reflex function, could correctly predict whether animals had received a BVL with a high degree of accuracy at both day 3 and day 23 post-BVL (83% and 100% for LDA, and 100% and 100% for RFC, respectively). RFC has been similarly successful in classifying other hyperactivity syndromes such as attention deficit hyperactivity disorder. These results suggest that BVL results in a unique behavioural signature that can identify vestibular loss in rats even without direct vestibular reflex measurements.


Assuntos
Comportamento Exploratório , Doenças Vestibulares/psicologia , Animais , Ácido Arsanílico , Lateralidade Funcional , Hipercinese/etiologia , Hipercinese/psicologia , Injeções , Masculino , Atividade Motora , Ratos , Ratos Wistar , Reflexo Vestíbulo-Ocular , Rotação , Membrana Timpânica , Doenças Vestibulares/induzido quimicamente , Doenças Vestibulares/complicações , Testes de Função Vestibular
11.
J Vestib Res ; 27(2-3): 113-125, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29064827

RESUMO

BACKGROUND: Movements may be generated consistent with imagining one's own body transformed or "disembodied" to a new position. Based on this concept we hypothesized that patients with objective balance deficits (obj-BD) would have altered neural transformation processes executing own body transformation (OBT) with functional consequences on balance control. Also we examined whether feeling unstable due to dizziness only (DO), without an obj-BD, also lead to an impaired OBT. METHODS: 32 patients with chronic dizziness were tested: 16 patients with obj-BD as determined by balance control during a sequence of stance and gait tasks, 16 patients with dizziness only (DO). Patients and 9 healthy controls (HCs) were asked to replicate roll trunk movements of an instructor in a life size video: first, with spontaneously copied (SPO) or "embodied" egocentric movements (lean when the instructor leans); second, with "disembodied" or "transformed" movements (OBT) with exact replication - lean left when the instructor leans left. Onset latency of trunk roll, rise time to peak roll angle (interval), roll velocity, and amplitude were measured. RESULTS: SPO movements were always mirror-imaged. OBT task latencies were significantly longer and intervals shorter than for SPO tasks (p < 0.03) for all groups. Obj-BD but not DO patients had more errors for the OBT task and, compared to HCs, had longer onset latencies (p < 0.05) and smaller velocities (p < 0.003) and amplitudes (p < 0.001) in both the SPO and OBT tasks. Measures of DO patients were not significantly different from those of HCs. CONCLUSIONS: Mental transformation (OBT) and SPO copying abilities are impaired in subjects with obj-BD and dizziness, but not with dizziness only. We conclude that processing the neuropsychological representation of the human body (body schema) slows when balance control is deficient.


Assuntos
Imaginação , Doenças Vestibulares/psicologia , Adulto , Idoso , Imagem Corporal , Doença Crônica , Cognição , Tontura/psicologia , Feminino , Marcha , Humanos , Masculino , Pessoa de Meia-Idade , Movimento , Equilíbrio Postural , Reflexo Vestíbulo-Ocular
12.
Int J Audiol ; 56(12): 936-941, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28854827

RESUMO

OBJECTIVE: The aim of the study was to test the reliability and validity of the Dizziness Handicap Inventory in the Greek language (DHI). DESIGN: This study was performed in a university tertiary centre. Internal consistency was estimated using Cronbach's alpha for the DHI, physical (DHI-P), functional (DHI-F) and emotional (DHI-E) subscale scores. Correlation between DHI (total and subscales) and the SOT (sensory organisation test) as well as correlation between the DHI and FGA (functional gait assessment) was tested using Spearman's correlation coefficient. Test-retest reliability was tested using ICC (Intraclass Correlation Coefficient). SAMPLE SIZE: Ninety (90) patients were included in the study. RESULTS: Internal consistency was excellent for the total score and very good for the physical functional and emotional subscale scores. No statistically significant correlation was found between SOT and DHI. There was a moderate correlation between FGA and total DHI scores (r = -0.472; p < 0.0001) and poor to moderate between FGA and DHI subscale scores (DHI-E r1 = -0.342; p1 = 0.001, DHI-F r2 = -0.448 p2 < 0.0001, DHI-P r3 = -0.472 p3 < 0.0001). Test-retest reliability was excellent. CONCLUSION: Greek version of DHI is recommended as a valid measure for patients with vestibular disorders.


Assuntos
Avaliação da Deficiência , Tontura/diagnóstico , Linguagem , Tradução , Doenças Vestibulares/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Tontura/fisiopatologia , Tontura/psicologia , Emoções , Feminino , Marcha , Grécia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Centros de Atenção Terciária , Doenças Vestibulares/fisiopatologia , Doenças Vestibulares/psicologia , Adulto Jovem
13.
Ear Hear ; 38(6): e352-e358, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28562425

RESUMO

OBJECTIVES: Vestibular dysfunction in childhood can have a major effect on a child's developmental process. Balance function has been reported to be poorer in children with attention deficit and hyperactivity disorder (ADHD) than in their typically developing peers. Due to contradictory available evidence and the paucity of research on vestibular function specifically in children with combined ADHD (cADHD), we designed this aged-matched study to assess vestibular function in children with cADHD. DESIGN: We enrolled 30 typically developing children (15 boys and 15 girls; mean age, 9 years 6 months; range, 7 to 12 years) and 33 children (19 boys and 14 girls; mean age, 9 years 0 months; range, 7 to 12 years) with cADHD diagnosed by our research psychiatrist. Typically developing controls were used to obtain normative data on vestibular testing and to examine the impact of age on the vestibular response parameters, and these results were compared with those of the cADHD group. All children underwent the sinusoidal harmonic acceleration subtype of the rotary chair test (0.01, 0.02, 0.08, 0.16, and 0.32 Hz) and the cervical vestibular-evoked myogenic potential (cVEMP) test. RESULTS: At all five frequencies in the sinusoidal harmonic acceleration test, there was no significant correlation between age and any of the following rotary chair response parameters in typically developing children: vestibulo-ocular reflex (VOR) gain, phase, asymmetry, and fixation index. Furthermore, there was no significant correlation between age and any of the following cVEMP parameters for the right and left ears of control group: p1 and n1 latency, amplitude, threshold, and amplitude ratio. Significantly higher VOR gains were observed for children with cADHD at frequencies of 0.01 (p = 0.001), 0.08 (p < 0.001), 0.16 (p = 0.001), and 0.32 (p = 0.003) Hz, when compared with the control group. Furthermore, fixation abilities were significantly lower in the cADHD group than in the control group at 0.16 (p < 0.001) and 0.32 (p < 0.001) Hz. cVEMP parameters showed no significant differences between the two groups. CONCLUSIONS: Our results showed higher VOR gains and poorer fixation abilities in children with cADHD compared with typically developing children. Cerebellar dysfunction in patients with ADHD has been well documented in the literature, and our findings of cVEMP and rotary chair tests for these children showed impaired vestibular function in these children, based on increased VOR gain values and decreased fixation capabilities. Because VOR gain is mediated through the inferior olive and controlled by the cerebellum, our results suggest that central inhibition of vestibular function may be deficient in children with cADHD, resulting in higher VOR gains. Also, there is general agreement that failure of fixation suppression indicates a central lesion. The lesion can originate from the parietal-occipital cortex, the pons, or the cerebellum. However, failure of fixation suppression is most prominent in lesions involving the midline cerebellum that could be counted for children with cADHD. We believe that this contribution is theoretically and practically relevant as high VOR gains and decreased suppression capabilities may result in symptoms of reading and writing difficulties, learning disabilities, vertigo, and motion sickness in these children. Therefore, assessment of vestibular function in children with cADHD at a young age must be considered when developing rehabilitation protocols for these children.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Reflexo Vestíbulo-Ocular/fisiologia , Doenças Vestibulares/fisiopatologia , Potenciais Evocados Miogênicos Vestibulares/fisiologia , Transtorno do Deficit de Atenção com Hiperatividade/complicações , Estudos de Casos e Controles , Criança , Feminino , Humanos , Masculino , Rotação , Doenças Vestibulares/complicações , Doenças Vestibulares/psicologia , Testes de Função Vestibular
14.
J Vestib Res ; 27(1): 27-37, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28387693

RESUMO

BACKGROUND: The search for reliable and valid signs and symptoms of mild traumatic brain injury (mTBI), commonly synonymous with concussion, has lead to a growing body of evidence that individuals with long-lasting, unremitting impairments often experience visual and vestibular symptoms, such as dizziness, postural and gait disturbances. OBJECTIVE: Investigate the role of visual-vestibular processing deficits following concussion. METHODS: A number of clinically accepted vestibular, oculomotor, and balance assessments as well as a novel virtual reality (VR)-based balance assessment device were used to assess adults with post-acute concussion (n = 14) in comparison to a healthy age-matched cohort (n = 58). RESULTS: Significant between-group differences were found with the VR-based balance device (p = 0.001), with dynamic visual motion emerging as the most discriminating balance condition. The symptom reports collected after performing the oculomotor and vestibular tests: rapid alternating horizontal eye saccades, optokinetic stimulation, and gaze stabilization, were all sensitive to health status (p < 0.05), despite the absence of oculomotor abnormalities being observed, except for near-point convergence. The BESS, King-Devick, and Dynamic Visual Acuity tests did not detect between-group differences. CONCLUSION: Postural and visual-vestibular tasks most closely linked to spatial and self-motion perception had the greatest discriminatory outcomes. The current findings suggest that mesencephalic and parieto-occipital centers and pathways may be involved in concussion.


Assuntos
Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/psicologia , Doenças Vestibulares/etiologia , Doenças Vestibulares/psicologia , Transtornos da Visão/etiologia , Transtornos da Visão/psicologia , Concussão Encefálica/complicações , Concussão Encefálica/psicologia , Convergência Ocular , Tontura/complicações , Tontura/psicologia , Feminino , Transtornos Neurológicos da Marcha/complicações , Transtornos Neurológicos da Marcha/psicologia , Humanos , Masculino , Doenças do Nervo Oculomotor/etiologia , Doenças do Nervo Oculomotor/fisiopatologia , Equilíbrio Postural , Acompanhamento Ocular Uniforme , Reflexo Vestíbulo-Ocular , Movimentos Sacádicos , Testes de Função Vestibular , Realidade Virtual , Acuidade Visual , Adulto Jovem
15.
Vestn Otorinolaringol ; 82(1): 34-37, 2017.
Artigo em Russo | MEDLINE | ID: mdl-28252587

RESUMO

The objective of the present study was to elucidate the peculiar features of the psychosomatic status in the patients with chronic vertebrogenic and cochleovestibular disorders The psychosomatic status was evaluated in 117 patients at the age from 21 to 65 years presenting with these conditions using the psychometric tests based on the STAI questionnaire (the state-trait anxiety inventory) adapted for the determination of the level of reactive and personal anxiety. It was shown that the vestibular disorders, tympanophonia, and hearing impairment have a negative influence on the psychogenic status of the patients suffering from cochleovestibulopathy. As many as 92.3% of the patients were characterized by the high or moderately high level of reactive and personal anxiety. The depressive conditions of various severity were diagnosed in 29.1% of the patients. The correction of postural muscular disbalance made it possible to achieve the well apparent reduction of the manifestations of reactive anxiety without prescription of the pharmacotherapeutic treatment and thereby to increase the effectiveness of the management of the patients presenting with the vertebrogenic and cochleovestibular disorders.


Assuntos
Ansiedade/diagnóstico , Doenças Cocleares/psicologia , Depressão/diagnóstico , Transtornos da Audição/psicologia , Doenças Vestibulares/psicologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
17.
Auris Nasus Larynx ; 44(6): 700-707, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28238393

RESUMO

OBJECTIVE: Balance function has been reported to be worse in ADHD children than in their normal peers. The present study hypothesized that an improvement in balance could result in better cognitive performance in children with ADHD and concurrent vestibular impairment. This study was designed to evaluate the effects of comprehensive vestibular rehabilitation therapy on the cognitive performance of children with combined ADHD and concurrent vestibular impairment. METHODS: Subject were 54 children with combined ADHD. Those with severe vestibular impairment (n=33) were randomly assigned to two groups that were matched for age. A rehabilitation program comprising overall balance and gate, postural stability, and eye movement exercises was assigned to the intervention group. Subjects in the control group received no intervention for the same time period. Intervention was administered twice weekly for 12 weeks. Choice reaction time (CRT) and spatial working memory (SWM) subtypes of the Cambridge Neuropsychological Test Automated Battery (CANTAB) were completed pre- and post-intervention to determine the effects of vestibular rehabilitation on the cognitive performance of the subjects with ADHD and concurrent vestibular impairment. ANCOVA was used to compare the test results of the intervention and control group post-test. RESULTS: The percentage of correct trial scores for the CRT achieved by the intervention group post-test increased significantly compared to those of the control group (p=0.029). The CRT mean latency scores were significantly prolonged in the intervention group following intervention (p=0.007) compared to the control group. No significant change was found in spatial functioning of the subjects with ADHD following 12 weeks of intervention (p>0.05). CONCLUSION: The study highlights the effect of vestibular rehabilitation on the cognitive performance of children with combined ADHD and concurrent vestibular disorder. The findings indicate that attention can be affected by early vestibular rehabilitation, which is a basic program for improving memory function in such children. Appropriate vestibular rehabilitation programs based on the type of vestibular impairment of children can improve their cognitive ability to some extent in children with ADHD and concurrent vestibular impairment (p>0.05).


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Cognição , Memória de Curto Prazo , Memória Espacial , Doenças Vestibulares/reabilitação , Transtorno do Deficit de Atenção com Hiperatividade/complicações , Criança , Movimentos Oculares , Feminino , Marcha , Humanos , Masculino , Testes Neuropsicológicos , Equilíbrio Postural , Postura , Tempo de Reação , Doenças Vestibulares/complicações , Doenças Vestibulares/psicologia
18.
J Laryngol Otol ; 131(3): 232-238, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28088930

RESUMO

OBJECTIVE: To determine whether demographic characteristics or balance examination findings can predict the adherence of older people with instability to a vestibular rehabilitation programme. METHODS: A prospective case-control study was conducted of 120 patients aged 65 years or more (mean age, 77.3 ± 6.33 years). Two groups were classified according to patients' adherence with the follow-up post-rehabilitation protocol. Analysed variables included: age, sex, body mass index, Timed Up and Go test findings, computerised dynamic posturography, Dizziness Handicap Inventory scores and Short Falls Efficacy Scale - International questionnaire results, number of falls, and type of vestibular rehabilitation. RESULTS: Two groups were established: adherents (99 individuals) and non-adherents (21 individuals). There were differences between the groups regarding: sex (female-to-male ratio of 4.8:1 in adherents and 1.63:1 in non-adherents), age (higher in non-adherents) and voluntary movement posturographic test results (non-adherents had poorer scores). CONCLUSION: The patients most likely to abandon a vestibular rehabilitation programme are very elderly males with low scores for centre of gravity balancing and limits of stability.


Assuntos
Tontura/reabilitação , Cooperação do Paciente , Modalidades de Fisioterapia/psicologia , Doenças Vestibulares/reabilitação , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Tontura/psicologia , Feminino , Humanos , Masculino , Equilíbrio Postural , Estudos Prospectivos , Fatores Sexuais , Inquéritos e Questionários , Doenças Vestibulares/psicologia , Testes de Função Vestibular
19.
J Neurol ; 264(3): 554-563, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28074268

RESUMO

Behavioral studies in rodents and humans have demonstrated deficits of spatial memory and orientation in bilateral vestibular failure (BVF). Our aim was to explore the functional consequences of chronic vestibular failure on different cognitive domains including spatial as well as non-spatial cognitive abilities. Sixteen patients with a unilateral vestibular failure (UVF), 18 patients with a BVF, and 17 healthy controls (HC) participated in the study. To assess the cognitive domains of short-term memory, executive function, processing speed and visuospatial abilities the following tests were used: Theory of Visual Attention (TVA), TAP Alertness and Visual Scanning, the Stroop Color-Word, and the Corsi Block Tapping Test. The cognitive scores were correlated with the degree of vestibular dysfunction and the duration of the disease, respectively. Groups did not differ significantly in age, sex, or handedness. BVF patients were significantly impaired in all of the examined cognitive domains but not in all tests of the particular domain, whereas UVF patients exhibited significant impairments in their visuospatial abilities and in one of the two processing speed tasks when compared independently with HC. The degree of vestibular dysfunction significantly correlated with some of the cognitive scores. Neither the side of the lesion nor the duration of disease influenced cognitive performance. The results demonstrate that vestibular failure can lead to cognitive impairments beyond the spatial navigation deficits described earlier. These cognitive impairments are more significant in BVF patients, suggesting that the input from one labyrinth which is distributed into bilateral vestibular circuits is sufficient to maintain most of the cognitive functions. These results raise the question whether BVF patients may profit from specific cognitive training in addition to physiotherapy.


Assuntos
Disfunção Cognitiva/etiologia , Doenças Vestibulares/complicações , Doenças Vestibulares/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Função Executiva , Feminino , Humanos , Masculino , Memória de Curto Prazo , Entrevista Psiquiátrica Padronizada , Pessoa de Meia-Idade , Testes Neuropsicológicos , Percepção Espacial , Pensamento , Doenças Vestibulares/reabilitação
20.
Curr Opin Neurol ; 30(1): 84-89, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27845944

RESUMO

PURPOSE OF REVIEW: The last year has seen a great deal of new information published relating vestibular dysfunction to cognitive impairment in humans, especially in the elderly. The objective of this review is to summarize and critically evaluate this new evidence in the context of the previous literature. RECENT FINDINGS: This review will address the recent epidemiological/survey studies that link vestibular dysfunction with cognitive impairment in the elderly; recent clinical investigations into cognitive impairment in the context of vestibular dysfunction, both in the elderly and in the cases of otic capsule dehiscence and partial bilateral vestibulopathy; recent evidence that vestibular impairment is associated with hippocampal atrophy; and finally recent evidence relating to the hypothesis that vestibular dysfunction could be a risk factor for dementia. SUMMARY: The main implication of these recent studies is that vestibular dysfunction, possibly of any type, may result in cognitive impairment, and this could be especially so for the elderly. Such symptoms will need to be considered in the treatment of patients with vestibular disorders.


Assuntos
Transtornos Cognitivos/etiologia , Cognição/fisiologia , Doenças Vestibulares/complicações , Transtornos Cognitivos/fisiopatologia , Transtornos Cognitivos/psicologia , Humanos , Fatores de Risco , Doenças Vestibulares/fisiopatologia , Doenças Vestibulares/psicologia
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