Dizziness Handicap Inventory and Visual Vertigo Analog Scale in Vestibular Dysfunction

Can head sway patterns differentiate between patients with Meniere's disease vs. peripheral vestibular hypofunction?

Background

Meniere's disease (MD) is defined by episodic vertigo, unilateral sensorineural hearing loss and fluctuating aural symptoms. Due to the variable clinical presentation, objective tests of MD may have significant diagnostic utility. Head kinematics derived from a head-mounted display (HMD) have demonstrated to be sensitive to vestibular dysfunction. The purpose of this pilot study was to investigate whether head sway can differentiate between patients with MD, vestibular hypofunction (VH) and healthy controls.

Materials/methods

80 adults (30 healthy controls, 32 with VH, and 18 with MD) were recruited from a tertiary vestibular clinic. All underwent a postural control assessment using the HTC Vive Pro Eye HMD that recorded head sway in the anterior-posterior (AP), medio-lateral (ML), pitch, yaw and roll direction. Participants were tested with 2 levels of visual load: a static versus oscillating star display. Each scene lasted 60 s and was repeated twice. Sway in each direction was quantified using root mean square velocity (VRMS) for the first 20 s and full 60 s of each scene.

Results

Static visual: participants with VH showed significantly larger head VRMS than controls in the AP (60 s and 20 s) and pitch (20 s) directions. Dynamic visual: participants with VH showed significantly larger head VRMS than controls all directions for both the 60 and 20 s analysis. Participants with MD did not differ significantly from the control or the VH group.

Conclusion

While limited in numbers, Patients with MD had a high variability in head sway in all directions, and their average head sway was between controls and those with VH. A larger sample as well as patients with worse symptoms at time of testing could elucidate whether head sway via HMD could become a viable test in this population. A similar finding between 20- and 60-s scene and the full portability of the system with an in-clinic testing setup could help these future endeavors. Head sway derived from HMD is sensitive to VH and can be clinically useful as an outcome measure to evaluate sensory integration for postural control.

Effects of Transcranial Direct Current Stimulation on Clinical Features of Dizziness and Cortical Activation in a Patient with Vestibular Migraine

BACKGROUND

Vestibular migraine (VM) is common migraine that occurs in patients with dizziness. Vestibular rehabilitation for managing VM generally remains unclear. Recently, it has been reported that transcranial direct current stimulation (tDCS) has positive effects in alleviating dizziness. This study investigated the effects of tDCS on dizziness and cortical activation in a patient with VM.

METHODS

We recruited a male patient aged 31 years with no dizziness. The patient watched a video to induce dizziness using a virtual reality device. The study applied the intervention using tDCS for 4 weeks and measured 4 assessments: functional near-infrared spectroscopy (fNIRS), quantitative electroencephalography (qEEG), dizziness handicap inventory, and visual vertigo analog scale.

RESULTS

We showed the activation in the middle temporal gyrus and inferior temporal gyrus (ITG) of the left hemisphere and in the superior temporal gyrus and ITG of the right hemisphere in the pre-intervention. After the intervention, the activation of these areas decreased. In the results of qEEG, excessive activation of C3, P3, and T5 in the left hemisphere and C4 in the right hemisphere before intervention disappeared after the intervention.

CONCLUSIONS

This study indicated that tDCS-based intervention could be considered a viable approach to treating patients with vestibular dysfunction and dizziness caused by VM.

Application of clinical indicators in evaluating vestibular compensation efficacy in benign recurrent vestibular vertigo patients with short-term personalized vestibular rehabilitation

BACKGROUND

Short-term personalized vestibular rehabilitation (ST-PVR) can establish stable vestibular compensation. However, there is a lack of a clear definition for clinical indicators that can dynamically reflect the progress of vestibular rehabilitation (VR).

OBJECTIVE

To explore the clinical indicators suitable for evaluating the effectiveness of ST-PVR in treating benign recurrent vertigo (BRV).

METHODS

In total, 50 patients diagnosed with BRV were enrolled. All patients received the ST-PVR treatment program. At 2 and 4 weeks after rehabilitation, subjective scales, including the visual analogue scale (VAS), dizziness handicap inventory scale (DHI), activities-specific balance confidence scale (ABC) and generalized anxiety disorder (GAD-7) were assessed. Objective vestibular function tests were performed. VR grading was determined.

RESULTS

At 2 weeks after rehabilitation, significant enhancements were observed in VAS, DHI, ABC, GAD-7, UW, vHIT results, and VR grading scores (p < 0.05). The sensory organization test (SOT) results demonstrated statistically significant improvements at 2 weeks and 4 weeks after rehabilitation (p < 0.05).

CONCLUSION AND SIGNIFICANCE

Both subjective scales and partial examination results in objective assessment can serve as indicators to dynamically monitor the compensatory process of vestibular function in patients with BRV. The VR efficacy grading score, which incorporates the above indicators, allows for quantification of the changes that occur during the vestibular rehabilitation process.

Contextual sensory integration training vs. traditional vestibular rehabilitation: a pilot randomized controlled trial

BACKGROUND

We created a clinical virtual reality application for vestibular rehabilitation. Our app targets contextual sensory integration (C.S.I.) where patients are immersed in safe, increasingly challenging environments while practicing various tasks (e.g., turning, walking). The purpose of this pilot study was to establish the feasibility of a randomized controlled trial comparing C.S.I. training to traditional vestibular rehabilitation.

METHODS

Thirty patients with vestibular dysfunction completed the Dizziness Handicap Inventory (DHI), Activities-Specific Balance Confidence Scale (ABC), Visual Vertigo Analog Scale (VVAS), Functional Gait Assessment (FGA), Timed-Up-and-Go (TUG), and Four-Square Step Test (FSST). Following initial assessment, the patients were randomized into 8 weeks (once per week in clinic + home exercise program) of traditional vestibular rehabilitation or C.S.I. training. Six patients had to stop participation due to the covid-19 pandemic, 6 dropped out for other reasons (3 from each group). Ten patients in the traditional group and 8 in the C.S.I group completed the study. We applied an intention to treat analysis.

RESULTS

Following intervention, we observed a significant main effect of time with no main effect of group or group by time interaction for the DHI (mean difference - 18.703, 95% CI [-28.235, -9.172], p = 0.0002), ABC (8.556, [0.938, 16.174], p = 0.028), VVAS, (-13.603, [-25.634, -1.573], p = 0.027) and the FGA (6.405, [4.474, 8.335], p < 0.0001). No changes were observed for TUG and FSST.

CONCLUSION

Patients' symptoms and function improved following either vestibular rehabilitation method. C.S.I training appeared comparable but not superior to traditional rehabilitation.

TRIAL REGISTRATION

This study (NCT04268745) was registered on clincaltrials.gov and can be found at https://clinicaltrials.gov/ct2/show/NCT04268745 .

The Effects of Vestibular Rehabilitation and Manual Therapy on Patients with Unilateral Vestibular Dysfunction: A Randomized and Controlled Clinical Study

(1) Objective: To determine the effect of a directed vestibular rehabilitation therapy (VRT) program with manual therapy (MT) on dizziness-related disability and imbalance symptoms among patients with peripheral unilateral vestibular dysfunction. (2) Methods: Eighty patients (54.75 ± 1.34 years) were allocated either to a control group (n = 40), who underwent a directed VRT program, or to an experimental group (n = 40), who received the same program plus MT once a week/4 weeks. We assessed their level of disability (Dizziness Handicap Inventory, DHI), balance confidence (the Activities-specific Balance Confidence scale-16 items), postural balance (resistive multisensor platform), and the frequency and intensity of dizziness symptoms (visual analog scale). (3) Results: Post-intervention between-group improvements were observed regarding DHI total score and intensity in the experimental group (p < 0.001), as well as four weeks later. Six months after, the experimental group exhibited improvements in the center of pressure velocity with eyes open (p = 0.019), DHI total score (p = 0.001) and subscales (all p < 0.05), and intensity (p = 0.003) and frequency (p = 0.010) of dizziness. Balance confidence improvements were observed 1 month (p = 0.035) and 6 months (p = 0.038) post-intervention. (4) Conclusions: Directed VRT plus MT is a safe and beneficial intervention that speeds up recovery for patients suffering from dizziness and instability derived from unilateral vestibular dysfunction.

Cervicogenic Dizziness Associated With Craniocervical Instability: A Case Report

Cervicogenic dizziness (CGD) is a clinical syndrome characterized by an illusory sensation of motion and disequilibrium secondary to neck pathologies. Reported here is the case of a 40-year-old male presented with neck pain, dizziness, and aural symptoms in the past 12 months. The patient was previously diagnosed with Meniere’s disease and treated with a low-sodium diet, betahistine and vestibular rehabilitation for 4 months, but the symptoms had not been relieved. Subsequently he sought out chiropractic evaluation. Radiographic clues illustrated a subtle anterolisthesis of the occiput on the cervical spine, manifested by a dissociation of the clivo-axial angle (CXA). After exclusion of other neurological, vascular and vestibular causes, craniocervical instability was considered as the cause of the CGD. He was treated with multi-component intervention consisting of spinal manipulation, intermittent motorized traction and ultrasound therapy to release cervical complaints. The patient reported salutary consequences to the 3-month treatment course with no neurologic sequelae. The current study serves as a vivid example of identifying CGD based on a subtle radiographic clue and by utilizing CXA as an assessment tool for craniocervical instability.

Visual Fixations and Motion Sensitivity: Protocol for an Exploratory Study

Background

Motion sensitivity after vestibular disorders is associated with symptoms of nausea, dizziness, and imbalance in busy environments. Dizziness and imbalance are reported in places such as supermarkets and shopping malls which have unstable visual backgrounds; however, the mechanism of motion sensitivity is poorly understood.

Objective

The main aim of this exploratory observational study is to investigate visual fixations and postural sway in response to increasingly complex visual environments in healthy adults and adults with motion sensitivity.

Methods

A total of 20 healthy adults and 20 adults with motion sensitivity will be recruited for this study. Visual fixations, postural sway, and body kinematics will be measured with a mobile eye tracker device, force plate, and 3D motion capture system, respectively. Participants will be exposed to experimental tasks requiring visual fixation on letters, projected on a range of backgrounds on a large screen during quiet stance. Descriptive statistics (mean and standard deviation) will be calculated for each of the variables. One-way independent-measures analyses of variance will be performed to investigate the differences between groups for all variables.

Results

Data collection was started in May 2019 and was completed by February 2020. It was approved by Health and Disability Ethics Committees, Ministry of Health, New Zealand on November 2, 2018 (Ethics ref: 18/CEN/193). We are currently processing the data and will begin data analysis in July 2020. We expect the results to be available for publication by the end of 2020. The trial was funded by the Neurology Special Interest Group, Physiotherapy New Zealand, and the Eisdell Moore Centre in November 2018.

Conclusions

This study will provide a detailed investigation of visual fixations in response to increasingly complex visual environments. Investigating characteristics of visual fixations in healthy adults and those with motion sensitivity will provide insight into this disabling condition and may inform the development of new intervention strategies which explicitly cater to the needs of this population.

Trial Registration

Australian New Zealand Clinical Trials Registry, ACTRN12619000254190; https://tinyurl.com/yxbn7nks

International Registered Report Identifier (IRRID)

PRR1-10.2196/16805

The Effectiveness of Medical Prophylactic Treatment on Vestibular Migraine and Its Effect on the Quality Of Life

OBJECTIVES

The aim of the present study was to determine the efficacy of propranolol treatment in patients with vestibular migraine by the Visual Analog Scale, Dizziness Handicap Inventory (DHI), Vertigo Symptom Scale, and Vestibular Disorders Activities of Daily Living Scale (VADL) and its effect on the quality of life.

MATERIALS AND METHODS

The study population consisted of 38 patients with vertigo/dizziness who underwent routine evaluation and vestibular examinations, were diagnosed with definitive vestibular migraine, and received the same medical treatment protocol (propranolol). The questionnaires and scales that were applied to the patients before and after treatment were evaluated. The results were evaluated with 95% confidence interval, and p<0.05 was accepted as statistically significant.

RESULTS

The mean age of the patients was 47.55 (18-75) years, and 27 (71%) patients were female, and 11 (29%) were male. The mean total scores of the DHI before and after treatment were 50.21±22.39 (range: 8-92) and 9.31±9.86 (range: 0-58), respectively (p<0.001). The degree of disability after treatment was low in all patients (p<0.001). The total scores of the VADL before and after treatment were 186.63±79.65 (range: 32-280) and 55.52±51.89 (range: 28-273), respectively (p<0.001). There was no correlation between these two scales (p=0.235).

CONCLUSION

To our knowledge, this is the first study to evaluate both the efficacy of propranolol treatment and its effects on the quality of life in vestibular migraine. The severity, frequency, and number of attacks and disability scores were reduced, and the quality of life was improved in patients with vestibular migraine with propranolol treatment.