1
|
Kim MK, Yun SY, Lee S, Lee JO, Sung SY, Lee JY, Kim HJ, Park HY, Choi JY, Song JJ, Choi BY, Koo JW, Kim JS. Efficacy of vestibular rehabilitation and its facilitating and hindering factors from real-world clinical data. Front Neurol 2024; 15:1329418. [PMID: 38487329 PMCID: PMC10938910 DOI: 10.3389/fneur.2024.1329418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 02/22/2024] [Indexed: 03/17/2024] Open
Abstract
Background and purpose Customized vestibular rehabilitation improved dizziness and imbalance in several randomized controlled trials. In the present study, we determined the efficacy of customized vestibular rehabilitation using real-world observational data. Methods In this retrospective observational study, we recruited 64 patients (median age = 60, interquartile range = 48-66.3) who completed the customized vestibular rehabilitation from January to December 2022. The outcomes of rehabilitation were evaluated using the dizziness handicap inventory (DHI) or vestibular disorders activities of daily living scale (VADL). The factors associated with outcomes were assessed with a generalized linear model, of which covariates included patients' age, sex, duration of illness, type of vestibular disorders, initial DHI and VADL scores, exercise compliance, and initial hospital anxiety and depression scale (HADS) scores. Results After the median of 6 (4-6) weeks of rehabilitation, DHI and VADL scores significantly improved in patients with either peripheral or central vestibular disorders (Wilcoxon signed-rank test, p < 0.05). The initial DHI and VADL scores showed a positive while the sum of HADS scores showed a negative correlation with the outcome. In contrast, the age, sex, duration of illness, types of vestibular disorders, and exercise compliance did not affect the outcome. Discussion and conclusion Customized vestibular rehabilitation is effective for central as well as peripheral disorders, especially when the symptoms are severe and the psychological distress is mild.
Collapse
Affiliation(s)
- Min-Ku Kim
- Department of Neurology, Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - So-Yeon Yun
- Department of Neurology, Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Seonkyung Lee
- Department of Neurology, Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Ja-Ok Lee
- Department of Neurology, Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Soo-Yun Sung
- Department of Neurology, Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Ju-Young Lee
- Department of Neurology, Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Hyo-Jung Kim
- Biomedical Research Institute, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Hye Youn Park
- Department of Psychiatry, Dizziness Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Jeong-Yoon Choi
- Department of Neurology, Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Jae-Jin Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Dizziness Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Byung Yoon Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Dizziness Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Ja-Won Koo
- Department of Otorhinolaryngology-Head and Neck Surgery, Dizziness Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Ji-Soo Kim
- Department of Neurology, Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| |
Collapse
|
2
|
Chen X, Wei D, Fang F, Song H, Yin L, Kaijser M, Gurholt TP, Andreassen OA, Valdimarsdóttir U, Hu K, Duan M. Peripheral vertigo and subsequent risk of depression and anxiety disorders: a prospective cohort study using the UK Biobank. BMC Med 2024; 22:63. [PMID: 38336700 PMCID: PMC10858592 DOI: 10.1186/s12916-023-03179-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/15/2023] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Peripheral vertigo is often comorbid with psychiatric disorders. However, no longitudinal study has quantified the association between peripheral vertigo and risk of psychiatric disorders. Furthermore, it remains unknown how the white matter integrity of frontal-limbic network relates to the putative peripheral vertigo-psychiatric disorder link. METHODS We conducted a cohort study including 452,053 participants of the UK Biobank with a follow-up from 2006 through 2021. We assessed the risks of depression and anxiety disorders in relation to a hospitalization episode involving peripheral vertigo using Cox proportional hazards models. We also examined the associations of peripheral vertigo, depression, and anxiety with MRI fractional anisotropy (FA) in a subsample with brain MRI data (N = 36,087), using multivariable linear regression. RESULTS Individuals with an inpatient diagnosis of peripheral vertigo had elevated risks of incident depression (hazard ratio (HR) 2.18; 95% confidence interval (CI) 1.79-2.67) and anxiety (HR 2.11; 95% CI 1.71-2.61), compared to others, particularly within 2 years after hospitalization (HR for depression 2.91; 95% CI 2.04-4.15; HR for anxiety 4.92; 95% CI 3.62-6.69). Depression was associated with lower FA in most studied white matter regions, whereas anxiety and peripheral vertigo did not show statistically significant associations with FA. CONCLUSIONS Individuals with an inpatient diagnosis of peripheral vertigo have increased subsequent risks of depression and anxiety disorders, especially within 2 years after hospitalization. Our findings further indicate a link between depression and lower microstructural connectivity as well as integrity beyond the frontal-limbic network.
Collapse
Affiliation(s)
- Xiaowan Chen
- Department of Otolaryngology Head and Neck Surgery, the First Hospital of Lanzhou University, Lanzhou, Gansu Province, China
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden
- Department of Otolaryngology Head and Neck Surgery & Audiology and Neurotology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Dang Wei
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Fang Fang
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Huan Song
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Li Yin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Kaijser
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Tiril Pedersen Gurholt
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Institute of Clinical Medicine, Oslo University Hospital &, University of Oslo, Oslo, Norway
| | - Ole Andreas Andreassen
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Institute of Clinical Medicine, Oslo University Hospital &, University of Oslo, Oslo, Norway
| | - Unnur Valdimarsdóttir
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Epidemiology, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Kejia Hu
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden.
| | - Maoli Duan
- Department of Otolaryngology Head and Neck Surgery & Audiology and Neurotology, Karolinska University Hospital, Stockholm, Sweden.
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 171 77, Stockholm, Sweden.
| |
Collapse
|
3
|
Dunlap PM, Alradady FA, Costa CM, Delitto A, Terhorst L, Sparto PJ, Furman JM, Marchetti GF, Staab JP, Chueh J, Whitney SL. The Psychometric Properties of the 9-Item Vestibular Activities Avoidance Instrument. Phys Ther 2023; 103:pzad094. [PMID: 37459243 DOI: 10.1093/ptj/pzad094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/24/2023] [Accepted: 07/02/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVE The purpose of this study was to establish the psychometric properties of the 9-Item Vestibular Activities Avoidance Instrument (VAAI-9), a patient-reported outcome measure developed to identify fear avoidance beliefs in persons with vestibular disorders. METHODS This prospective cohort study included 100 participants 18 years and older seeking care at a balance disorders clinic for dizziness. Participants completed the VAAI-9, the Dizziness Handicap Inventory (DHI), and other patient-reported outcomes at the initial visit and the 3-month follow-up. To measure test-retest reliability, the VAAI-9 was completed again 5 days after the initial visit and was analyzed using a 2-way mixed ICC for absolute agreement. Internal consistency was determined using the Cronbach alpha. The Spearman correlation coefficient was used to assess convergent validity of the VAAI-9 with other outcomes. Receiver operating characteristic curves were used to identify baseline VAAI-9 cutoff scores for those who reported mild (DHI ≤ 30) or moderate or severe (DHI > 30) perceived disability at the 3-month follow-up. RESULTS The mean age of the study cohort was 49 (SD = 16) years; 73 (73%) were women. Seventy-one participants completed the 5-day follow-up, and 68 completed the 3-month follow-up. The VAAI-9 demonstrated excellent internal consistency (α = 0.91) and test-retest reliability (ICC = 0.90). Baseline VAAI-9 scores had moderate to strong associations with other outcome measures at baseline and 3 months. A baseline VAAI-9 score of 26 or higher had a sensitivity of 80.6% and a specificity of 78.4% for identifying a DHI score of >30 at 3 months (area under the curve = 0.86). CONCLUSIONS The results provide evidence of excellent reliability and validity for the 9-item VAAI in persons with vestibular disorders. A baseline VAAI-9 score of ≥26 identified individuals at risk of persistent moderate to severe disability due to dizziness. IMPACT Initial levels of fear avoidance beliefs measured using the VAAI-9 provided important prognostic information about outcomes for persons with vestibular symptoms.
Collapse
Affiliation(s)
- Pamela M Dunlap
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Fai A Alradady
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Anthony Delitto
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lauren Terhorst
- School of Health and Rehabilitation Sciences Data Center and Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Patrick J Sparto
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Joseph M Furman
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Gregory F Marchetti
- Department of Physical Therapy, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Jeffrey P Staab
- Departments of Psychiatry and Psychology and Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jasmine Chueh
- School of Health Professions, Stony Brook University, Stony Brook, New York, USA
| | - Susan L Whitney
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
4
|
Herdman D, Picariello F, Moss-Morris R. Validity of the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS) in Patients With Dizziness. Otol Neurotol 2022; 43:e361-e367. [PMID: 34999617 DOI: 10.1097/mao.0000000000003460] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
HYPOTHESIS The Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS) will be a valid and reliable combined measure of depression and anxiety in people with vertigo and dizziness. BACKGROUND Co-occurrence of depressive, anxiety, and somatic symptoms are common. The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder Scale-7 (GAD-7) measure symptoms of depression and anxiety respectively, although measuring them separately may be suboptimal in people who have illness-related distress. There is some evidence that these scales can be combined in long-term conditions resulting in the PHQ-ADS, but validity is yet to be determined in people with vertigo and dizziness. METHODS Two separate datasets from a tertiary vestibular clinic were analyzed where the PHQ-ADS was completed at initial clinical assessment (n = 624) and while on a waiting list (n = 185). A cross-sectional design was used to examine the factor structure (confirmatory factor analysis), internal consistency (omega index), and construct validity (Pearson correlation coefficient) of the PHQ-ADS. Construct validity was determined against the dizziness handicap inventory (DHI). RESULTS A bi-factor PHQ-ADS model had good fit to the data (χ2 = 397.163, 249.763; comparative fit index [CFI] = 0.954, 0.919; Tucker-Lewis index [TLI] = 0.938, 0.892; root mean squared error of approximation [RMSEA] = 0.076, 0.098). The general distress factor explained 81 to 85% of the common variance between items. There were moderate to large significant positive correlations between the PHQ-ADS and DHI. CONCLUSION The PHQ-ADS appears to have good structural validity in patients with vertigo and dizziness. Clinicians and researchers can use this scale where a composite psychological measure is desired.
Collapse
Affiliation(s)
- David Herdman
- Health Psychology Section, Institute of Psychiatry Psychology and Neuroscience, King's College London
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Federica Picariello
- Health Psychology Section, Institute of Psychiatry Psychology and Neuroscience, King's College London
| | - Rona Moss-Morris
- Health Psychology Section, Institute of Psychiatry Psychology and Neuroscience, King's College London
| |
Collapse
|
5
|
Li L, Gao X, Liu J, Qi X. Cognitive behavior therapy for dizziness: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e22945. [PMID: 33350720 PMCID: PMC7769344 DOI: 10.1097/md.0000000000022945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 09/28/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To investigate the association between cognitive behavior therapy (CBT) and dizziness. METHODS The databases including PubMed, Embase, Cochrane Library and Web of science will be searched for randomized controlled trials. Weighted mean difference and 95% confidence interval will be utilized to calculate the effect of CBT on dizziness between the 2 groups. CONCLUSIONS This meta-analysis will provide a high-quality synthesis from existing evidence for the relationship between CBT and dizziness. OSF REGISTRATION NUMBER 10.17605/OSF.IO/YNH5W.
Collapse
Affiliation(s)
- Lin Li
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou
- Department of Neurology, Hunan Provincial People's Hospital, Changsha
| | - Xiaoping Gao
- Department of Neurology, Hunan Provincial People's Hospital, Changsha
| | - Jianguo Liu
- Department of Neurology, The Sixth Medical Center of PLA General Hospital, Beijing, P.R. China
| | - Xiaokun Qi
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou
- Department of Neurology, The Sixth Medical Center of PLA General Hospital, Beijing, P.R. China
| |
Collapse
|
6
|
Zhu C, Li Y, Ju Y, Zhao X. Dizziness handicap and anxiety depression among patients with benign paroxysmal positional vertigo and vestibular migraine. Medicine (Baltimore) 2020; 99:e23752. [PMID: 33350759 PMCID: PMC7769355 DOI: 10.1097/md.0000000000023752] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 11/18/2020] [Indexed: 11/27/2022] Open
Abstract
To investigate the dizziness handicap and anxiety depression among patients with benign paroxysmal positional vertigo (BPPV) and vestibular migraine (VM).A prospective cohort study in which patients came from the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University was conducted. Patients were diagnosed with BPPV and VM from September 2016 to December 2017. Dizziness handicap inventory (DHI) scale and hospital anxiety and depression scale (HADS) were assessed among subjects before treatment and 3 months follow-up.We used the Mann-Whitney U test to compare the DHI and HADS scores of BPPV and VM patients before and after 3 months and found significantly statistical difference. Before treatment, the median DHI scores of BPPV and VM were 34 and 60, with a Z = -5.643 (P = .001); The median HADS scores were 6 and 14, with Z = -4.807 (P = .001). After 3 months follow-up, the median DHI scores of BPPV and VM were 0 and 22, with a Z = -8.425 (P = .001); The median HADS scores were 6 and 14, with Z = -7.126 (P = .001) 51.11% VM patients and 12.21% BPPV patients have anxiety and depression. A Spearman correlation revealed a significantly moderate positive correlation (r = .455, P < .001) between DHI and HADS scores.The emotional, functional and physical effects of vertigo on VM patients were more significant than BPPV patients. The change of DHI scores in BPPV and VM patients was positively correlated with changes in the anxiety and depression in the HADS.
Collapse
Affiliation(s)
- Cuiting Zhu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
- China National Clinical Research Center for Neurological Diseases
- Center of Stroke, Beijing Institute for Brain Disorders
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yiqing Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
- China National Clinical Research Center for Neurological Diseases
- Center of Stroke, Beijing Institute for Brain Disorders
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yi Ju
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
- China National Clinical Research Center for Neurological Diseases
- Center of Stroke, Beijing Institute for Brain Disorders
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
- China National Clinical Research Center for Neurological Diseases
- Center of Stroke, Beijing Institute for Brain Disorders
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| |
Collapse
|
7
|
van Vugt VA, Bosmans JE, Finch AP, van der Wouden JC, van der Horst HE, Maarsingh OR. Cost-effectiveness of internet-based vestibular rehabilitation with and without physiotherapy support for adults aged 50 and older with a chronic vestibular syndrome in general practice. BMJ Open 2020; 10:e035583. [PMID: 33060078 PMCID: PMC7566722 DOI: 10.1136/bmjopen-2019-035583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 06/25/2020] [Accepted: 08/21/2020] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES To evaluate the cost-effectiveness of stand-alone and blended internet-based vestibular rehabilitation (VR) in comparison with usual care (UC) for chronic vestibular syndromes in general practice. DESIGN Economic evaluation alongside a three-armed, individually randomised controlled trial. SETTING 59 Dutch general practices. PARTICIPANTS 322 adults, aged 50 years and older with a chronic vestibular syndrome. INTERVENTIONS Stand-alone VR consisted of a 6-week, internet-based intervention with weekly online sessions and daily exercises. In blended VR, this intervention was supplemented with face-to-face physiotherapy support. UC group participants received usual general practice care without restrictions. MAIN OUTCOME MEASURES Societal costs, quality-adjusted life years (QALYs), Vertigo Symptom Scale-Short Form (VSS-SF), clinically relevant response (≥3 points VSS-SF improvement). RESULTS Mean societal costs in both the stand-alone and blended VR groups were statistically non-significantly higher than in the UC group (mean difference (MD) €504, 95% CI -1082 to 2268; and €916, 95% CI -663 to 2596). Both stand-alone and blended VR groups reported non-significantly more QALYs than the UC group (MD 0.02, 95% CI -0.00 to 0.04; and 0.01, 95% CI -0.01 to 0.03), and significantly better VSS-SF Scores (MD 3.8 points, 95% CI 1.7 to 6.0; and 3.3 points, 95% CI 1.3 to 5.2). For stand-alone VR compared with UC, the probability of cost-effectiveness was 0.95 at a willingness-to-pay ratio of €24 161/QALY, €600/point improvement in VSS-SF and €8000/clinically relevant responder in VSS-SF. For blended VR versus UC, the probability of cost-effectiveness was 0.95 at a willingness-to-pay ratio of €123 335/QALY, €900/point improvement in VSS-SF and €24 000/clinically relevant responder in VSS-SF. CONCLUSION Stand-alone and blended internet-based VR non-significantly increased QALYs and significantly reduced vestibular symptoms compared with UC, while costs in both groups were non-significantly higher. Stand-alone VR has the highest probability to be cost-effective compared with UC. TRIAL REGISTRATION NUMBER The Netherlands Trial Register NTR5712.
Collapse
Affiliation(s)
- Vincent A van Vugt
- Department of General Practice, Amsterdam UMC - Location VUMC, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Judith E Bosmans
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Aureliano P Finch
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Johannes C van der Wouden
- Department of General Practice, Amsterdam UMC - Location VUMC, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Henriëtte E van der Horst
- Department of General Practice, Amsterdam UMC - Location VUMC, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Otto R Maarsingh
- Department of General Practice, Amsterdam UMC - Location VUMC, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| |
Collapse
|
8
|
Correia A, Pimenta C, Alves M, Virella D. Better balance: a randomised controlled trial of oculomotor and gaze stability exercises to reduce risk of falling after stroke. Clin Rehabil 2020; 35:213-221. [PMID: 32907392 DOI: 10.1177/0269215520956338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the effect of a domiciliary program of oculomotor and gaze stability exercises on the incidence of falls and risk of fall in stroke survivors. DESIGN Two-arm, non-blinded parallel randomized controlled trial. SUBJECTS Stroke survivors older than 60 years, with positive Romberg test and autonomous gait after the stroke. SETTING Physiotherapy outpatient clinic of a tertiary care hospital. INTERVENTIONS Every participant accomplished the current rehabilitation program; the intervention group was randomly allocated into an additional three weeks intervention with a domiciliary program of oculomotor and gaze stability exercises. MAIN MEASURES Primary outcome was the incidence of falls through the three weeks after the intervention started; in addition, the variation of the estimated risk for falling assessed by both Berg Balance Scale (four points) and Timed Up and Go Test (four seconds) was the secondary outcome. RESULTS 79 patients were recruited and 68 completed the protocol (control group 35; intervention group 33). During the follow up, falls were registered in 4/35 participants in the control group and no event occurred in the intervention group (P = 0.064). The estimated risk for falling decreased in 11/35 control group participants and in 28/33 intervention group participants (RR 0.37; 95%CI 0.22-0.62; P < 0.001). CONCLUSION After three weeks of a domiciliary program of oculomotor and gaze stability exercises, the estimated risk of falling significantly diminished and no falls occurred among the intervention group. These findings encourage further exploration of this promising intervention. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02280980.
Collapse
Affiliation(s)
- Anabela Correia
- Physiotherapy, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal. Teaching and Research Unit of Physiotherapy and Rehabilitation, Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Portugal
| | - Carla Pimenta
- Physiotherapy, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal. Teaching and Research Unit of Physiotherapy and Rehabilitation, Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Portugal
| | - Marta Alves
- Epidemiology and Statistics Office of the Research Unit, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| | - Daniel Virella
- Epidemiology and Statistics Office of the Research Unit, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| |
Collapse
|
9
|
Liu L, Hu X, Zhang Y, Pan Q, Zhan Q, Tan G, Wang K, Zhou J. Effect of Vestibular Rehabilitation on Spontaneous Brain Activity in Patients With Vestibular Migraine: A Resting-State Functional Magnetic Resonance Imaging Study. Front Hum Neurosci 2020; 14:227. [PMID: 32595463 PMCID: PMC7303278 DOI: 10.3389/fnhum.2020.00227] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 05/20/2020] [Indexed: 12/20/2022] Open
Abstract
Previous studies have shown that vestibular migraine (VM) is a cerebral disease with recurrent vertigo. Vestibular rehabilitation (VR) is an effective type of physical therapy for minimizing vestibular symptoms, as it improves vestibular compensation in patients with VM. Currently, the cerebral regions that are associated with the pathogenesis of VM are largely unknown. To further understand the underlying mechanisms of VM, we performed resting-state functional magnetic resonance imaging (fMRI) before and after 1 month of VR in 14 patients with VM. The Dizziness Handicap Inventory (DHI), the 36-Item Short-Form Health Survey (SF-36), the Hamilton Depression Scale (HAMD) and the Hamilton Anxiety Scale (HAMA) scores were included as clinical outcomes. The amplitude of low-frequency fluctuation (ALFF) was assessed to characterize spontaneous brain activity. The correlations between the clinical characteristics and ALFF values were assessed. After 1 month of VR training, the DHI scores in patients with VM were significantly lower than those at baseline (p = 0.03), as were the HAMA scores (p = 0.02). We also found that the ALFF values in the left posterior cerebellum of VM patients increased significantly after 1 month of VR training. Moreover, the ALFF values in the left cerebellum were inversely correlated with the patients’ DHI scores. Overall, this study showed that VR exercise for 1 month has a positive effect on vestibular symptoms in patients with VM. Asymmetric cerebellar hyperactivity might be a functional compensation for vestibular dysfunction in patients with VM.
Collapse
Affiliation(s)
- Li Liu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Department of Neurology, Chongqing Renji Hospital, University of Chinese Academy of Sciences, Chongqing, China
| | - Xiaofei Hu
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yixin Zhang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qi Pan
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qunling Zhan
- Department of Neurology, Chongqing Renji Hospital, University of Chinese Academy of Sciences, Chongqing, China
| | - Ge Tan
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kuiyun Wang
- Department of Neurology, The Jintang First People's Hospital, Sichuan University, Sichuan, China
| | - Jiying Zhou
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
10
|
van Vugt VA, van der Wouden JC, Essery R, Yardley L, Twisk JWR, van der Horst HE, Maarsingh OR. Internet based vestibular rehabilitation with and without physiotherapy support for adults aged 50 and older with a chronic vestibular syndrome in general practice: three armed randomised controlled trial. BMJ 2019; 367:l5922. [PMID: 31690561 PMCID: PMC6829201 DOI: 10.1136/bmj.l5922] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
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.
Collapse
Affiliation(s)
- Vincent A van Vugt
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
| | - Johannes C van der Wouden
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
| | - Rosie Essery
- Department of Psychology, University of Southampton, Southampton, UK
| | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, UK
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Henriëtte E van der Horst
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
| | - Otto R Maarsingh
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
| |
Collapse
|
11
|
Morisod B, Mermod M, Maire R. Posturographic pattern of patients with chronic subjective dizziness before and after vestibular rehabilitation. J Vestib Res 2018; 27:305-311. [PMID: 29125531 DOI: 10.3233/ves-170628] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Chronic subjective dizziness (CSD) is frequently encountered in neurotology clinics. This diagnosis is mainly clinical, but computerized dynamic posturography (CDP) could be a helpful instrumental tool in the identification of these patients and validation of the treatment. This study was aimed to look for a specific posturographic pattern among patients diagnosed with CSD, and to eventually visualize improvement after vestibular rehabilitation. METHODS Single center, retrospective review from 2009 to 2014. We included patients diagnosed with CSD who underwent CDP in their neurotologic assessment. For those patients who benefited from vestibular rehabilitation, we compared their pre- and post-rehabilitation posturographies. RESULTS We included 114 patients, of whom 74% had known anxiety disorders and 33% a history of past vestibular disorder. 62% of the assessment posturographies were abnormal. The most affected sub-items were limit of stability, composite score of sensory organization tests and condition 5 in respectively 34%, 23% and 20% of the cases. In univariate analysis, only pathologic videonystagmography and history of unilateral vestibular dysfunction were significantly related to abnormal posturography. In the 42 patients who had vestibular rehabilitation and a post rehabilitation posturography, the proportion of abnormal posturography significantly dropped from 79% to 33% (p < 0.001). When it was assessed, 79% of the patients reported a subjective improvement. CONCLUSION Patients with CSD have a high rate of abnormal posturography, but without a specific pattern. Vestibular rehabilitation is an effective tool in the therapeutic armamentarium.
Collapse
Affiliation(s)
- Benoît Morisod
- Department of Otorhinolaryngology, Head and Neck Surgery, Neurotology Unit, Lausanne University Hospital, Switzerland
| | - Maxime Mermod
- Department of Otorhinolaryngology, Head and Neck Surgery, Neurotology Unit, Lausanne University Hospital, Switzerland
| | - Raphaël Maire
- Department of Otorhinolaryngology, Head and Neck Surgery, Neurotology Unit, Lausanne University Hospital, Switzerland
| |
Collapse
|
12
|
Cognitive Behavior Therapy as Augmentation for Sertraline in Treating Patients with Persistent Postural-Perceptual Dizziness. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8518631. [PMID: 29707579 PMCID: PMC5863356 DOI: 10.1155/2018/8518631] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 01/29/2018] [Accepted: 02/08/2018] [Indexed: 12/28/2022]
Abstract
Background Persistent postural-perceptual dizziness (PPPD) is a common vestibular disorder. This study was conducted to assess whether the addition of cognitive behavior therapy (CBT) could significantly improve the efficacy and acceptability of sertraline in treating PPPD. Methods PPPD patients were recruited and randomly assigned to control and experiment groups. Patients in both groups received sertraline 50–200 mg/day, and only patients in the experiment group received CBT (twice a week, one hour per time). The treatment was continued for eight weeks. At baseline, week 2, week 4, and week 8, the 25-item Dizziness Handicap Inventory (DHI), Hamilton Anxiety Rating Scale (HARS), and Hamilton Depression Rating Scale (HDRS) were used to assess the self-perceived handicapping effects caused by PPPD, anxiety, and depressive symptoms, respectively. The dose of sertraline used and the adverse events in both groups were recorded and analyzed. Results In total, 91 PPPD patients were randomly assigned to the control group (n = 45) and experiment group (n = 46). After eight weeks of treatment, the average DHI scores, HDRS scores, and HARS scores were significantly decreased in both groups. But compared to the control group, the experiment group had significantly lower average DHI score, HDRS score, and HARS score at weeks 4 and 8. Moreover, the dose of sertraline used in the experiment group was significantly lower than that in the control group, and adverse events occurred more frequently in the control group than in the experiment group (48.9% versus 26.1%, p = 0.025). Conclusion These results demonstrated that the addition of CBT could significantly improve the efficacy and acceptability of sertraline in treating PPPD and reduce the dose of sertraline used.
Collapse
|
13
|
Miyazaki H, Nomura Y, Mardassi A, Deveze A, Miura M, Jike M, Magnan J. How minimally invasive vestibular neurotomy for incapacitating Meniere's disease improves dizziness and anxiety. Acta Otolaryngol 2017; 137:707-711. [PMID: 28125309 DOI: 10.1080/00016489.2017.1278790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
CONCLUSION Patients with incapacitating Meniere Disease (MD) suffer in their daily lives and activities because of the dizziness and anxiety induced by MD. Minimally Invasive Vestibular Neurotomy (MIVN) is a safe and effective surgical treatment for these individuals, and improved their dizziness and anxiety. OBJECTIVES This study aimed to assess the state of dizziness and anxiety of patients with incapacitating MD and its improvement through MIVN. METHOD A total of 118 patients with incapacitating MD who underwent MIVN in France and Japan were evaluated. The DHI (Dizziness Handicap Inventory), SAST (Short Anxiety Screening Test), and STAI (State Trait Anxiety Index) questionnaires were used to evaluate disequilibrium and anxiety. RESULTS The MIVN method appears safe and effective for patients with incapacitating MD. Pre-operative assessment results by DHI and SAST were significantly related to each other, and were influenced by lifestyle and profession. This prospective study showed that MIVN improved dizziness and anxiety in these patients.
Collapse
Affiliation(s)
- Hidemi Miyazaki
- Department of Otolaryngology, Tokyo Kyosai Hospital, Tokyo, Japan
- Department of Otolaryngology, Tokyo Women’s Medical University Medical Center East, Tokyo, Japan
| | - Yasuyuki Nomura
- Department of Otolaryngology-Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Ali Mardassi
- Department of Otolaryngology, University Aix Marseille II L’Hôpital Nord, Marseille, France
| | - Arnaud Deveze
- Department of Otolaryngology, University Aix Marseille II L’Hôpital Nord, Marseille, France
| | - Masahiro Miura
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Maki Jike
- Department of Public Health, Nihon University School of Medicine, Tokyo, Japan
| | - Jacques Magnan
- Department of Otolaryngology, University Aix Marseille II L’Hôpital Nord, Marseille, France
| |
Collapse
|
14
|
Abstract
PURPOSE OF REVIEW This article summarizes an approach to evaluating dizziness for the general neurologist and reviews common and important causes of dizziness and vertigo. RECENT FINDINGS Improved methods of diagnosing patients with vertigo and dizziness have been evolving, including additional diagnostic criteria and characterization of some common conditions that cause dizziness (eg, vestibular migraine, benign paroxysmal positional vertigo, chronic subjective dizziness). Other uncommon causes of dizziness (eg, superior canal dehiscence syndrome, episodic ataxia type 2) have also been better clarified. Distinguishing between central and peripheral causes of vertigo can be accomplished reliably through history and examination, but imaging techniques have further added to accuracy. What has not changed is the necessity of obtaining a basic history of the patient's symptoms to narrow the list of possible causes. SUMMARY Dizziness and vertigo are extremely common symptoms that also affect function at home and at work. Improvements in the diagnosis and management of the syndromes that cause dizziness and vertigo will enhance patient care and cost efficiencies in a health care system with limited resources. Clinicians who evaluate patients with dizziness will serve their patient population well by continuing to manage patients with well-focused workup and attentive care.
Collapse
|
15
|
Walker A, Kantaris X, Chambers M. Understanding therapeutic approaches to anxiety in vestibular rehabilitation: a qualitative study of specialist physiotherapists in the UK. Disabil Rehabil 2017; 40:829-835. [PMID: 28129508 DOI: 10.1080/09638288.2016.1277393] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
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.
Collapse
Affiliation(s)
- Andrew Walker
- a Faculty of Health, Social Care and Education , Kingston University and St George's University of London , London , UK.,b Health Innovation Network , London , UK
| | - Xenya Kantaris
- a Faculty of Health, Social Care and Education , Kingston University and St George's University of London , London , UK
| | - Mary Chambers
- a Faculty of Health, Social Care and Education , Kingston University and St George's University of London , London , UK
| |
Collapse
|
16
|
van Vugt VA, van der Wouden JC, Bosmans JE, Smalbrugge M, van Diest W, Essery R, Yardley L, van der Horst HE, Maarsingh OR. Guided and unguided internet-based vestibular rehabilitation versus usual care for dizzy adults of 50 years and older: a protocol for a three-armed randomised trial. BMJ Open 2017; 7:e015479. [PMID: 28110290 PMCID: PMC5253547 DOI: 10.1136/bmjopen-2016-015479] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Dizziness is a common symptom in general practice with a high prevalence among older adults. The most common cause of dizziness in general practice is peripheral vestibular disease. Vestibular rehabilitation (VR) is a safe and effective treatment for peripheral vestibular disease that entails specific exercises to maximise the central nervous system compensation for the effects of vestibular pathology. An internet-based VR intervention has recently been shown to be safe and effective. Online interventions are low cost and easily accessible, but prone to attrition and non-adherence. A combination of online and face-to-face therapy, known as blended care, may balance these advantages and disadvantages. METHODS AND ANALYSIS A single-blind, three-arm, randomised controlled trial among patients aged 50 years and over presenting with dizziness of vestibular origin in general practice will be performed. In this study, we will compare the clinical and cost-effectiveness of stand-alone internet-based VR and internet-based VR with physiotherapeutic support ('blended care') with usual care during 6 months of follow-up. We will use a translated Dutch version of a British online VR intervention. Randomisation will be stratified by dizziness severity. The primary outcome measure is the Vertigo Symptoms Scale-Short Form. Intention-to-treat analysis will be performed, adjusting for confounders. The economic evaluation will be conducted from a societal perspective. We will perform an additional analysis on the data to identify predictors of successful treatment in the same population to develop a clinical decision rule for general practitioners. ETHICS AND DISSEMINATION The ethical committee of the VU University Medical Center approved ethics and dissemination of the study protocol. The insights and results of this study will be widely disseminated through international peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER Pre-results, NTR5712.
Collapse
Affiliation(s)
- Vincent A van Vugt
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Johannes C van der Wouden
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Judith E Bosmans
- Department of Health Sciences, Faculty of Earth and Life Sciences, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Martin Smalbrugge
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Willianne van Diest
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Rosie Essery
- Department of Psychology, University of Southampton, Southampton, UK
| | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, UK
| | - Henriëtte E van der Horst
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Otto R Maarsingh
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
17
|
DSM-5 somatic symptom disorder in patients with vertigo and dizziness symptoms. J Psychosom Res 2016; 91:26-32. [PMID: 27894459 DOI: 10.1016/j.jpsychores.2016.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 10/11/2016] [Accepted: 10/16/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVE DSM-5 somatic symptom disorder (SSD) could potentially be a highly relevant diagnosis for patients with vertigo and dizziness. The criteria of SSD, particularly the B-criterion with its three components (cognitive, affective, behavioral), have however not yet been investigated in this patient group. METHODS We evaluated a large sample (n=399) of outpatients presenting in a neurological setting. Physical examinations and a psychometric assessment (SCID-I) were conducted; patients completed self-report questionnaires. The diagnosis of SSD was assigned retrospectively. The prevalence of SSD, its diagnostic criteria, and its overlap with former DSM-IV somatoform disorders were evaluated; comparisons were drawn between (1) patients fulfilling different components of the B-criterion and (2) patients with diagnoses after DSM-IV vs. DSM-5. RESULTS SSD was almost twice as common as DSM-IV somatoform disorders. Patients with all three components of the B-criterion reported the highest impairment levels. Patients with both DSM-IV somatoform disorders and DSM-5 SSD were more impaired compared to groups with one of the diagnoses; patients with DSM-IV somatoform disorders only were more impaired than those with SSD only. CONCLUSIONS Our findings demonstrate that SSD is highly prevalent in patients with vertigo and dizziness. The classification of severity based on the number of psychological symptoms appears valid and may assist in finding suitable treatment options according to clinical practice guidelines. Future studies should investigate the overlap of SSD and other psychiatric disorders, this may assist in better defining the diagnostic criteria of SSD.
Collapse
|
18
|
Peluso ÉTP, Quintana MI, Ganança FF. Anxiety and depressive disorders in elderly with chronic dizziness of vestibular origin. Braz J Otorhinolaryngol 2016; 82:209-14. [PMID: 26515771 PMCID: PMC9449034 DOI: 10.1016/j.bjorl.2015.04.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 04/06/2015] [Accepted: 04/08/2015] [Indexed: 11/30/2022] Open
Abstract
Introduction Dizziness is one of the most prevalent symptoms in the elderly. Anxiety and depression are common in dizzy adult patients, but there is scarce information about comorbidity between vestibular disturbances and psychiatric disorders in the aged. Objective To assess the prevalence of anxiety and depression disorders in elderly with chronic dizziness of vestibular origin. Methods Transversal study that used the Brazilian version of the Composite International Diagnostic Interview 2.1 to assess anxiety and depressive disorders in elderly patients (≥60 years old) with chronic dizziness. Results Most of the 44 patients included in the study were female (88.6%) with a mean age of 71 years (±7.5), 68.1% had experienced dizziness for 1 year or more. The most prevalent diagnosis was benign paroxysmal positional vertigo (52.3%). The prevalence of generalized anxiety disorder and specific phobias during life were 29.5% and 22.7%, respectively, and, in the last 12 months, 18.2% and 15.9%. There was no patient with panic disorder, agoraphobia or social phobia. The prevalence of depressive disorder during life was 45.4%, and, in the last 12 months, were 11.3%. Conclusion Aged patients with chronic dizziness had high prevalence of some mental disorders.
Collapse
Affiliation(s)
- Érica Toledo Piza Peluso
- Professional Master's Program in Body Balance Rehabilitation and Social Inclusion, Universidade Anhanguera de São Paulo, São Paulo, SP, Brazil.
| | - Maria Inês Quintana
- Department of Psychiatry and Medical Psychology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Fernando Freitas Ganança
- Department of Otolaryngology and Head and Neck Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| |
Collapse
|
19
|
Abstract
Functional and psychiatric disorders that cause vestibular symptoms (i.e., vertigo, unsteadiness, and dizziness) are common. In fact, they are more common than many well-known structural vestibular disorders. Neurologists and otologists are more likely to encounter patients with vestibular symptoms due to persistent postural-perceptual dizziness or panic disorder than Ménière's disease or bilateral vestibular loss. Successful approaches to identifying functional and psychiatric causes of vestibular symptoms can be incorporated into existing practices without much difficulty. The greatest challenge is to set aside dichotomous thinking that strongly emphasizes investigations of structural diseases in favor of a three-pronged approach that assesses structural, functional, and psychiatric disorders simultaneously. The pathophysiologic mechanisms underlying functional and psychiatric causes of vestibular symptoms are better understood than many clinicians realize. Research methods such as advanced posturographic analysis and functional brain imaging will push this knowledge further in the next few years. Treatment plans that include patient education, vestibular rehabilitation, cognitive and behavioral therapies, and medications substantially reduce morbidity and offer the potential for sustained remission when applied systematically. Diagnostic and therapeutic approaches are necessarily multidisciplinary in nature, but they are well within the purview of collaborative care teams or networks of clinicians coordinated with the neurologists and otologists whom patients consult first.
Collapse
Affiliation(s)
- M Dieterich
- Department of Neurology, Ludwig-Maximilians-University Munich, Klinikum Grosshadern, Munich, Germany; German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University Munich, Klinikum Grosshadern, Munich, Germany.
| | - J P Staab
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - T Brandt
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University Munich, Klinikum Grosshadern, Munich, Germany
| |
Collapse
|
20
|
Abstract
Behavioral factors have long been recognized as affecting spatial orientation and balance function. Neuroanatomic and neurophysiologic studies conducted worldwide over the last 30 years have substantially advanced our knowledge about the inherently strong connectivity among threat/anxiety, vestibular, visual, and somatosensory systems in the brain. Clinical investigations have shed greater light on the nature of functional and psychiatric disorders that manifest or magnify vestibular morbidity. Concepts of these syndromes have changed over 150 years. Even their nomenclature has had different meanings in different eras. This chapter will review functional and psychiatric vestibular disorders. Terminology will follow the International Classification of Diseases, 11th edition, beta draft and the International Classification of Vestibular Disorders. Anxiety plays a central role in behavioral vestibular morbidity. Anxiety, traumatic stress, obsessive, and depressive disorders may be primary causes of episodic and chronic vestibular symptoms or secondary complications of other vestibular disorders. These psychiatric illnesses affect 30-50% of patients who consult neurologists or otologists for vestibular symptoms. Coexisting psychiatric disorders adversely affect treatment for patients with structural vestibular diseases, especially when unrecognized. Persistent postural-perceptual dizziness is the leading cause of long-term vestibular disability. Fortunately, pharmacologic, psychotherapeutic, and rehabilitative treatments of these illnesses have improved in recent years.
Collapse
Affiliation(s)
- J P Staab
- Department of Psychiatry and Psychology, and Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
21
|
Killington MJ, Speck K, Kahlbaum J, Fabian J, Edwards D, Stobie J. Quality-of-life for individuals with a vestibular impairment following an acquired brain injury (ABI); the clients' perspective. Brain Inj 2015; 29:490-500. [PMID: 25615883 DOI: 10.3109/02699052.2014.995226] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE To investigate how a vestibular deficit following an acquired brain injury (ABI) affects an individuals' quality-of-life. RESEARCH DESIGN A qualitative exploratory design. PARTICIPANTS Nine community dwelling individuals who experienced significant symptoms and limitations as a result of their vestibular deficits. METHODS The individuals participated in face-to-face interviews with open ended questions. Data was analysed initially using a case study research approach, exploring the experience for each individual and then cross-case analysis to determine common themes for the group with the assistance of nVivo 10 qualitative analysis software. RESULTS Thematic analysis determined four main themes arising from the interviews; (1) validation, (2) definitive diagnosis is more difficult amongst an array of ABI symptoms, (3) vestibular adaptation is more difficult in the presence of an ABI and (4) emotional and social. CONCLUSION Individuals who suffer a brain injury and experience vestibular symptoms as part of their overall presentation are not diagnosed in a timely manner, with individuals, their families, associates and even health professionals feeling uncertain of the legitimacy of their reported symptoms. It is important that all patients who experience an acquired brain injury are screened for vestibular impairment and, if necessary, receive vestibular rehabilitation including explanation and education.
Collapse
Affiliation(s)
- M J Killington
- South Australian Brain Injury Rehabilitation Services, Hampstead Rehabilitation Centre, Royal Adelaide Hospital , Northfield , Australia
| | | | | | | | | | | |
Collapse
|
22
|
Lacour M, Bernard-Demanze L. Interaction between Vestibular Compensation Mechanisms and Vestibular Rehabilitation Therapy: 10 Recommendations for Optimal Functional Recovery. Front Neurol 2015; 5:285. [PMID: 25610424 PMCID: PMC4285093 DOI: 10.3389/fneur.2014.00285] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 12/15/2014] [Indexed: 12/30/2022] Open
Abstract
This review questions the relationships between the plastic events responsible for the recovery of vestibular function after a unilateral vestibular loss (vestibular compensation), which has been well described in animal models in the last decades, and the vestibular rehabilitation (VR) therapy elaborated on a more empirical basis for vestibular loss patients. The main objective is not to propose a catalog of results but to provide clinicians with an understandable view on when and how to perform VR therapy, and why VR may benefit from basic knowledge and may influence the recovery process. With this perspective, 10 major recommendations are proposed as ways to identify an optimal functional recovery. Among them are the crucial role of active and early VR therapy, coincidental with a post-lesion sensitive period for neuronal network remodeling, the instructive role that VR therapy may play in this functional reorganization, the need for progression in the VR therapy protocol, which is based mainly on adaptation processes, the necessity to take into account the sensorimotor, cognitive, and emotional profile of the patient to propose individual or "à la carte" VR therapies, and the importance of motivational and ecologic contexts. More than 10 general principles are very likely, but these principles seem crucial for the fast recovery of vestibular loss patients to ensure good quality of life.
Collapse
Affiliation(s)
- Michel Lacour
- Laboratoire de Neurobiologie Intégrative et Adaptative, UMR 7260 CNRS/Université Aix-Marseille, Fédération de Recherche 3C, Centre de St Charles, Marseille, France
| | - Laurence Bernard-Demanze
- Laboratoire de Neurobiologie Intégrative et Adaptative, UMR 7260 CNRS/Université Aix-Marseille, Fédération de Recherche 3C, Centre de St Charles, Marseille, France
- Service d’otorhinolaryngologie et d’otoneurologie, CHU Nord, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| |
Collapse
|
23
|
Abstract
The aim of this study was to perform a 3-year follow-up of primary somatoform vertigo and dizziness (SVD) regarding health care use and treatment. Ninety-two patients with dizziness underwent detailed vestibular neurophysiological testing and a Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Psychometric assessments comprised the Vertigo Symptom Scale, the Vertigo Handicap Questionnaire, the SCL-90-R, and the Short-Form-36 Health Survey. At the 3-year follow-up, 65 patients with primary SVD (anxiety, n = 29; depression, n = 14; somatoform disorders, n = 22) were reassessed (70.7% response). The patients improved in symptom severity (p < 0.05), handicap (p < 0.01), and physical quality of life (QoL; p < 0.05) but showed no change in emotional distress. A total of 63.1% (of n = 65) had ongoing SVD. A total of 69.2% (of n = 65) received different forms of treatments. A total of 46.1% (of n = 65) searched redundant medical diagnostic procedures. The patients with decreased coping capacity over time obtained the best prognosis. Primary SVD is an ineffectively treated disorder. Recommendations for specific complaint-oriented psychotherapy programs were given.
Collapse
|
24
|
E.J. Mahoney A, Edelman S, D. Cremer P. Cognitive behavior therapy for chronic subjective dizziness: longer-term gains and predictors of disability. Am J Otolaryngol 2013. [PMID: 23177378 DOI: 10.1016/j.amjoto.2012.09.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE The study sought to evaluate the longer-term effects of a brief cognitive behavior therapy (CBT) intervention for patients with chronic subjective dizziness (CSD). In addition, it sought to identify predictors of longer-term disability in this group. MATERIALS AND METHODS Forty-four patients with CSD referred by a neuro-otological clinic were followed-up six months after completing a brief treatment program based on the CBT model of panic disorder. Patients completed the following measures: Dizziness Handicap Inventory, Depression, Anxiety and Stress Scales, Dizziness Symptoms Inventory, and the Safety Behaviours Inventory. Measures were completed at pre and post-treatment, as well as at one and six months post-treatment. RESULTS Treatment gains observed immediately after treatment were maintained at one and six months post-treatment. High levels of pre-treatment anxiety predicted higher levels of disability at six months post-treatment. Duration and severity of dizziness, and medical or psychiatric comorbidity did not predict disability at six month follow-up. CONCLUSIONS A brief CBT intervention for patients with CSD produced improvements in physical symptoms, disability, and functional impairment which were sustained at one month and six months post intervention. Patients with high levels of anxiety prior to treatment had higher levels of disability at six months post-treatment. It is possible that more focused interventions that specifically target anxiety might produce further benefits for this cohort.
Collapse
|
25
|
Winter L, Wollmer MA, Laurens J, Straumann D, Kruger THC. Cox's Chair Revisited: Can Spinning Alter Mood States? Front Psychiatry 2013; 4:132. [PMID: 24133463 PMCID: PMC3796758 DOI: 10.3389/fpsyt.2013.00132] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 09/30/2013] [Indexed: 11/17/2022] Open
Abstract
Although there is clinical and historical evidence for a vivid relation between the vestibular and emotional systems, the neuroscientific underpinnings are poorly understood. The "spin doctors" of the nineteenth century used spinning chairs (e.g., Cox's chair) to treat conditions of mania or elevated arousal. On the basis of a recent study on a hexapod motion-simulator, in this prototypic investigation we explore the impact of yaw stimulation on a spinning chair on mood states. Using a controlled experimental stimulation paradigm on a unique 3-D-turntable at the University of Zurich we included 11 healthy subjects and assessed parameters of mood states and autonomic nervous system activity. The Multidimensional Mood State Questionnaire and Visual Analog Scales (VAS) were used to assess changes of mood in response to a 100 s yaw stimulation. In addition heart rate was continuously monitored during the experiment. Subjects indicated feeling less "good," "relaxed," "comfortable," and "calm" and reported an increased alertness after vestibular stimulation. However, there were no objective adverse effects of the stimulation. Accordingly, heart rate did not significantly differ in response to the stimulation. This is the first study in a highly controlled setting using the historical approach of stimulating the vestibular system to impact mood states. It demonstrates a specific interaction between the vestibular system and mood states and thereby supports recent experimental findings with a different stimulation technique. These results may inspire future research on the clinical potential of this method.
Collapse
Affiliation(s)
- Lotta Winter
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Division of Clinical Psychology, Medical School Hannover , Hannover , Germany
| | | | | | | | | |
Collapse
|
26
|
Winter L, Kruger THC, Laurens J, Engler H, Schedlowski M, Straumann D, Wollmer MA. Vestibular stimulation on a motion-simulator impacts on mood States. Front Psychol 2012. [PMID: 23181042 PMCID: PMC3502037 DOI: 10.3389/fpsyg.2012.00499] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We are familiar with both pleasant and unpleasant psychotropic effects of movements associated with vestibular stimulation. However, there has been no attempt to scientifically explore the impact of different kinds of vestibular stimulation on mood states and biomarkers. A sample of 23 healthy volunteers were subjected to a random sequence of three different passive rotational (yaw, pitch, roll) and translational (heave, sway, surge) vestibular stimulation paradigms using a motion-simulator (hexapod). Mood states were measured by means of questionnaires and visual analog scales. In addition, saliva cortisol and α-amylase samples were taken. Compared to a subliminal control paradigm all rotational and two translational stimulations produced significant changes in mood states: Yaw rotation was associated with feeling more comfortable, pitch rotation with feeling more alert and energetic, and roll rotation with feeling less comfortable. Heave translation was associated with feeling more alert, less relaxed, and less comfortable and surge translation with feeling more alert. Biomarkers were not affected. In conclusion, we provide first experimental evidence that passive rotational and translational movements may influence mood states on a short-term basis and that the quality of these psychotropic effects may depend on the plane and axis of the respective movements.
Collapse
Affiliation(s)
- Lotta Winter
- Division of Clinical Psychology and Sexual Medicine, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School Hannover, Germany
| | | | | | | | | | | | | |
Collapse
|
27
|
Zheng Y, Cheung I, Smith PF. Performance in anxiety and spatial memory tests following bilateral vestibular loss in the rat and effects of anxiolytic and anxiogenic drugs. Behav Brain Res 2012; 235:21-9. [PMID: 22824589 DOI: 10.1016/j.bbr.2012.07.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Revised: 07/11/2012] [Accepted: 07/14/2012] [Indexed: 02/05/2023]
Abstract
Vestibular dysfunction in humans is associated with anxiety and cognitive disorders. However, various animal studies of the effects of vestibular loss have yielded conflicting results, from reduced anxiety to increased anxiety, depending on the particular model of vestibular dysfunction and the anxiety test used. In this study we revisited the question of whether rats with surgical bilateral vestibular deafferentation (BVD) exhibit changes in anxiety-related behaviour by testing them in the open field maze (OFM), elevated plus maze (EPM) and elevated T maze (ETM) in the presence of a non-sedating anxiolytic drug, buspirone, or an anxiogenic drug, FG-7142. We also tested the animals in a spatial T maze (STM) in order to evaluate their cognitive function under the same set of conditions. We found that BVD animals exhibited increased locomotor activity (P≤0.003), reduced supported and unsupported rearing (P≤0.02 and P≤0.000, respectively) and reduced thigmotaxis (P≤0.000) in the OFM, which for the most part the drugs did not modify. By contrast, there were no significant differences between BVD and sham control animals in the EPM and the BVD animals exhibited a marginally longer escape latency in the ETM (P≤0.03), with no change in avoidance latency. In the STM, the BVD animals demonstrated a large and significant decrease in accuracy compared to the sham control animals (P≤0.000), which was not affected by drug treatment. These results have replicated previous findings regarding increased locomotor activity, reduced rearing and thigmotaxis in the OFM, and impaired performance in the STM. However, they failed to replicate some previous results obtained using the EPM and ETM. Overall, they do not support the hypothesis that BVD animals exhibit increased anxiety-like behaviour and suggest that the cognitive deficits may be independent of the emotional effects of vestibular loss.
Collapse
Affiliation(s)
- Yiwen Zheng
- Department of Pharmacology and Toxicology, School of Medical Sciences, University of Otago Medical School, P.O. Box 913, Dunedin, New Zealand
| | | | | |
Collapse
|
28
|
Edelman S, Mahoney AE, Cremer PD. Cognitive behavior therapy for chronic subjective dizziness: a randomized, controlled trial. Am J Otolaryngol 2012; 33:395-401. [PMID: 22104568 DOI: 10.1016/j.amjoto.2011.10.009] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 10/08/2011] [Indexed: 02/07/2023]
Abstract
PURPOSE The aim of this study was to evaluate the effects of a brief cognitive behavior therapy (CBT) intervention on the physical symptoms, illness-related disability, and psychologic distress of patients with chronic subjective dizziness. MATERIALS AND METHODS Forty-one patients with chronic subjective dizziness referred by a neurootologic clinic were randomly assigned to immediate treatment or a wait-list control. Three weekly treatment sessions based on the CBT model of panic disorder, adapted for patients with dizziness, were administered by a clinical psychologist. Treatment included psychoeducation, behavioral experiments, exposure to feared stimuli, and attentional refocusing. Outcomes were measured on the Dizziness Handicap Inventory and the Depression, Anxiety and Stress Scales. Two further measures developed for this study; the Dizziness Symptoms Inventory and the Safety Behaviours Inventory were used to measure physical symptoms and safety behaviors. RESULTS The intervention was associated with significant reductions in disability on the Dizziness Handicap Inventory, reduced dizziness and related physical symptoms on the Dizziness Symptoms Inventory, and reduced avoidance and safety behaviors as measured by the Safety Behaviours Inventory. Pre- to posteffect sizes ranged from 0.98 to 1.15. There was no change in psychologic outcomes measured on the Depression, Anxiety and Stress Scales. CONCLUSIONS A 3-session psychologic intervention based on the CBT model can produce significant improvements in dizziness-related symptoms, disability, and functional impairment among patients with chronic subjective dizziness. This suggests that treatment of this condition may be reasonably simple and cost-effective for most of the patients.
Collapse
|
29
|
Alrwaily M, Whitney SL. Vestibular rehabilitation of older adults with dizziness. Otolaryngol Clin North Am 2011; 44:473-96, x. [PMID: 21474018 DOI: 10.1016/j.otc.2011.01.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The role of rehabilitation for treatment of older adults with dizziness and balance disorders is reviewed. Theories related to functional recovery from peripheral and central vestibular disorders are presented. Suggestions on which older adults might benefit from vestibular rehabilitation therapy are presented. Promising innovative rehabilitation strategies and technologies that might enhance recovery of the older adult with balance dysfunction are discussed.
Collapse
Affiliation(s)
- Muhammad Alrwaily
- Department of Physical Therapy, University of Pittsburgh, 6035 Forbes Tower, Pittsburgh, PA 15260, USA
| | | |
Collapse
|
30
|
Wiltink J, Tschan R, Michal M, Subic-Wrana C, Eckhardt-Henn A, Dieterich M, Beutel ME. Dizziness: anxiety, health care utilization and health behavior--results from a representative German community survey. J Psychosom Res 2009; 66:417-24. [PMID: 19379958 DOI: 10.1016/j.jpsychores.2008.09.012] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2008] [Revised: 09/01/2008] [Accepted: 09/16/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND Due to the lack of epidemiological data on the relation of dizziness and anxiety, we investigated the prevalence of dizziness and anxiety in a representative sample of the German population. We explored the consequences of comorbid anxiety for emotional distress, functional impairment, health care utilization, and health behavior in dizziness. METHODS By the end of 2006, we surveyed a total of 1287 persons between 14 and 90 years of age in their homes by trained interviewers with standardized self-rating questionnaires on anxiety (Patient Health Questionnaire, Generalized Anxiety Disorder Scale, Mini-Social Phobia Inventory) and dizziness (Vertigo Symptom Scale). The sample was representative for the German population in terms of age, sex, and education. RESULTS Symptoms of dizziness were reported by 15.8% of the participants. Of the participants with dizziness, 28.3% reported symptoms of at least one anxiety disorder (generalized anxiety, social phobia, panic). Persons with dizziness reported more somatic problems such as hypertension, migraine, diabetes, etc. Comorbid anxiety was associated with increased health care use and impairment. CONCLUSION Dizziness is a highly prevalent symptom in the general population. A subgroup with comorbid anxiety is characterized by an increased subjective impairment and health care utilization due to their dizziness. Because treatment options for distinct neurotologic disorders are also known to reduce psychological symptoms, and in order to avoid unnecessary medical treatment, early neurologic and psychiatric/psychotherapeutic referral may be indicated.
Collapse
Affiliation(s)
- Jörg Wiltink
- Clinic of Psychosomatic Medicine and Psychotherapy, Johannes Gutenberg-University Mainz, Germany
| | | | | | | | | | | | | |
Collapse
|
31
|
Effects of bilateral vestibular deafferentation on anxiety-related behaviours in Wistar rats. Behav Brain Res 2008; 193:55-62. [PMID: 18547657 DOI: 10.1016/j.bbr.2008.04.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Revised: 03/13/2008] [Accepted: 04/23/2008] [Indexed: 02/05/2023]
Abstract
Despite frequent reports that patients with vestibular dysfunction exhibit an unusually high incidence of anxiety disorders, few studies have investigated the emotional effects of vestibular damage in animals. In this study we investigated the effects of a permanent surgical bilateral vestibular deafferentation (BVD) on the performance of rats in a series of anxiety tests at 3 weeks (3-W), 3 months (3-M) and 5 months (5-M) following the lesion. We used the elevated plus maze (EPM), elevated T maze (ETM), hyponeophagia and social interaction tests. Contrary to expectation, we found that, at 3 and 5M post-op, BVD rats spent more rather than less time on the open arms of the EPM compared to sham controls, and they displayed a lack of learned inhibitory avoidance in the ETM. Compared to sham controls, BVD rats showed no significant difference over the 3 time points in their latencies to eat in a novel situation; however, they did engage in social interaction to a significantly lesser extent. Finally, blood corticosterone levels were not significantly different between BVD and sham rats at 6 months post-op. These results suggest that BVD causes changes in the performance of rats in the EPM and ETM that might reflect emotional changes, or could be due to the cognitive impairment and hyperactivity caused by BVD.
Collapse
|