Effectiveness of virtual reality-based vestibular rehabilitation in patients with peripheral vestibular hypofunction.

BACKGROUND: The rehabilitation of classical peripheral vestibular disorders is long and costly. Recently, interactive systems based on virtual reality (VR) technology have reduced the cost of vestibular rehabilitation therapy (VRT) and made the process more enjoyable. This study aims to investigate the effects of VR-based VRT in patients diagnosed with peripheral vestibular hypofunction (PVH). METHODS: In this study, a VR-based VRT program that utilized Sony Playstation®4 VR Head Mounted Display was applied to 25 patients (between 18-60) diagnosed with PVH. PVH was diagnosed by evaluating the patients' clinical histories, the findings in the "Micromedical Technologies VisualEyes Spectrum" videonystagmography (VNG) and the "Micromedical Aqua Stim" model bithermal water caloric tests. VR-based VRT program was applied to the patients for 4 weeks, 2 sessions per week, 8 sessions in total. Each session lasted around 30 to 40 min. All patients underwent the Dizziness Handicap Inventory (DHI), Sensory Organization Test (SOT), Adaptation Test (ADT), Limits of Stability (LOS), and Rhythmic Weight Shift (RWS) before, after, and 8-week follow-up of the VRT program. In addition, the Cybersickness Survey was applied to the patients at the end of the VR-based VRT session every week. RESULTS: The DHI mean scores of the patients were 54.60, 19.20, and 16.84, respectively, before, just after, and at the 8-week follow-up VRT (p < 0.001). The mean SOT composite score of the patients was obtained as 58.08 before VRT; 77.16 after VRT and 76.40 at 8-week after VRT (p < 0.000). On the other hand, the values in the 'movement velocity' and "direction control" parameters of the patients in LOS and RWS showed a significant improvement after VRT compared to before VRT (p < 0.000). From before VRT to 8 weeks after VRT, the patient's oscillation averages in the 'toes up' and 'toes down' positions in ADT reduced progressively (p < 0.000). DISCUSSION: This study demonstrates that implementing a VR-based VRT protocol may be an efficient option to improve posture stability and the quality of life in patients with PVH. In addition, VR-based vestibular rehabilitation therapy has shown to be effective for PVH patients in the mid-term.

Comparison of children with and without dyslexia using functional head impulse test and pediatric balance scale.

Purpose: The aim of this study is to compare functionality of vestibulo-ocular reflex (VOR) responses to evaluate the functional properties of the vestibular system and daily balance performance in children with dyslexia and children with normal development. Method: Fifteen participants diagnosed with dyslexia were included in the study group (SG), and 15 healthy participants were included in the control group (CG). All groups underwent Functional Head Impulse Test (f-HIT) and Pediatric Balance Scale (PBS). f-HIT was performed with at least 15 head impulses at 4000-5000-6000°/s2 randomly to the right and left in the plane of the horizontal semicircular canal (SCC). Statistical analysis was performed using descriptive statistics and the Mann-Whitney U test. Results: SG percentage values were obtained lower than CG percentage values. Comparisons between the two groups showed that there was a significant difference in all parameters (4000-5000-6000°/s2 and total) in the right-side stimulation, there was significant difference for 4,000 s2 and total correct answers in the left side. In addition, although there was no significant difference between the groups in terms of the PBS score, the SG scores were lower (p = 0.062). Conclusions: As a novel test, f-HIT, revealed the difference in functionality of vestibular performance in the dyslexia group. In the dyslexia group, f-HIT may be helpful in evaluating and monitoring the vestibular system.

Does Electrical Status Epilepticus in Sleep Adversely Affect Language in Self-Limiting Focal Epilepsies of Childhood?

Introduction: The electrical status epilepticus in sleep (ESES) accompanies a wide spectrum of focal and generalized epilepsies, which manifest with cognitive-linguistic regression. Both ESES and language impairment can be seen in self-limited focal epileptic syndromes of childhood (SFEC). The association between the presence of ESES pattern on the EEG and the severity of the language impairment has not been adequately clarified. Methods: Twenty-eight SFEC cases without intellectual and motor disabilities and 32 healthy children were recruited. Cases with active ESES (A-ESES, n=6) and without ESES pattern on EEG (non-ESES, n=22) were compared in terms of clinical features and linguistic parameters by both standard and descriptive assessment tools. Results: The only significantly different clinical feature in the A-ESES group was the increased prevalence of polytherapy. While most of the linguistic parameters were impaired in A-ESES and non-ESES groups compared to healthy controls, A-ESES patients differed from non-ESES patients only in terms of decreased complex sentence production, which was assessed by narrative analysis. A-ESES patients also showed trends toward producing lower numbers of words, nouns, verbs, and adverbs during narrative analysis. There were no differences among patients under polytherapy and monotherapy in terms of these language parameters. Conclusion: Our results show that ESES increases the negative effect of chronic epilepsy on complex sentence and word production. Linguistic distortions that are not reflected in objective tests can be detected by narrative tools. Complex syntactic production obtained by narrative analysis is an important parameter that extensively characterizes language skills in school-age children with epilepsy.

Role of Long-Term Vestibular Rehabilitation in a Patient with Posterior Fossa Tumor: A Case Report with 2 Years of Follow-Up.

BACKGROUND Lhermitte-Duclos disease (LDD) is caused by a rare slow-growing mass in the cerebellum. LDD generally is experienced by young adults, but also it has been encountered in the pediatric population. Lhermitte and Duclos first described cerebellar dysplastic gangliocytoma in 1920. The first case they described included occipital headache, paroxysmal vertigo, falls, hearing problems, and memory deficits. Our patient had typical symptoms of the disorder such as headache, nausea, vomiting, blurred vision, and imbalance. The purpose of this case report was to describe the outcome of a computerized dynamic posturography (CDP) vestibular training program combined with home-based exercises designed to improve balance function and reduce the risk of falling by an individual with a posterior fossa tumor. CASE REPORT A 36-year-old male patient was diagnosed with dysplastic gangliocytoma/ganglioglioma according to magnetic resonance imaging, computed tomography, and pathology reports on March 28, 2016. The patient was treated by partial cerebellar tumor resection on April 7, 2016. After the operation, he reported severe imbalance, nausea, and vomiting for 1 month and visited the Audiology Department on October 20, 2016. The patient was evaluated with the CDP-sensory organization test (SOT) and his composite equilibrium score of this examination was 48, 31% below normal. We administered a 6-week posturography-assisted vestibular rehabilitation (VR) protocol (extending an hour per week) combined with a home-based exercise program twice in 2 years. In the second evaluation we applied in 2018, SOT composite equilibrium score increased to 72 after VR, reaching normal limits. After 2 years, his complaints slightly alleviated and his SOT scores were better when we compared the VR results in 2016. CONCLUSIONS We demonstrated that long-term VR may affect a patient with dysplastic cerebellar gangliocytoma (LDD) presenting imbalance or dizziness.