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Hoppes CW, Anson ER, Carender WJ, Marchetti GF, Hall CD, Whitney SL, Keinath C, Herdman SJ. Type, dose, and outcomes of physical therapy interventions for unilateral peripheral vestibular hypofunction: protocol for a systematic review. Syst Rev 2023; 12:164. [PMID: 37710291 PMCID: PMC10503155 DOI: 10.1186/s13643-023-02328-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 08/18/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Unilateral peripheral vestibular hypofunction can result in symptoms of dizziness, gaze and gait instability, and impaired navigation and spatial orientation. These impairments and activity limitations may negatively impact an individual's quality of life, ability to perform activities of daily living, drive, and work. There is strong evidence supporting vestibular physical therapy for reducing symptoms, improving gaze and postural stability, and improving function in individuals with vestibular hypofunction. However, there is great variability in clinical practice with regard to the type of interventions and only weak evidence to guide optimal exercise dosage. It is important to identify the most appropriate interventions and exercise dosage to optimize and accelerate recovery of function and to decrease distress. The objective of this systematic review is to determine which interventions and which doses are most effective in decreasing dizziness or vertigo, improving postural control, and improving quality of life in adults with unilateral peripheral vestibular hypofunction. METHODS The literature will be systematically searched using the following online databases: PubMed/MEDLINE, EMBASE, Web of Science (Science and Social Science Citation Index), Cumulative Index for Nursing and Allied Health Literature (CINAHL), and The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials [CENTRAL], Cochrane Methodology Register). The review will include randomized controlled trials (RCTs), including cluster RCTs, to assess the beneficial effects of the interventions. Assessment of methodological quality and risk of bias will be performed by two independent, blinded reviewers using the PEDro scale and Cochrane Risk of Bias version 2, respectively. The primary outcome measure will be change in self-perceived handicap related to dizziness from baseline to the end of the study, measured using the Dizziness Handicap Inventory. Other relevant outcome measures will include self-reported change in symptoms (to include severity, frequency, and duration) such as verbal or visual analog scales for dizziness. Tertiary outcome measures will include questionnaires related to disability and/or quality of life. DISCUSSION This systematic review will identify, evaluate, and integrate the evidence on the effectiveness of physical therapy interventions for unilateral peripheral vestibular hypofunction in an adult population. We anticipate our findings may inform individualized treatment and future research. Clinical recommendations generated from this systematic review may inform vestibular physical therapy treatment of individuals with unilateral peripheral vestibular hypofunction. TRIAL REGISTRATION In accordance with the guidelines, our systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 06 August 2021 (registration number CRD42021266163 ). In the event of protocol amendments, the date of each amendment will be accompanied by a description of the change and the rationale.
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Affiliation(s)
- Carrie W Hoppes
- Army-Baylor University Doctoral Program in Physical Therapy, Joint Base San Antonio-Fort Sam Houston, TX, USA.
| | - Eric R Anson
- Department of Otolaryngology, University of Rochester, Rochester, NY, USA
| | - Wendy J Carender
- Department of Otolaryngology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Courtney D Hall
- Hearing and Balance Research Program, Mountain Home VAMC, Mountain Home, TN, USA
- Department of Rehabilitative Sciences, Physical Therapy Program, East Tennessee State University, Johnson City, TN, USA
| | - Susan L Whitney
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Christiana Keinath
- Library, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Susan J Herdman
- Department of Physical Medicine and Rehabilitation, School of Medicine (Emerita), Emory University, Atlanta, GA, USA
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Agathos CP, Velisar A, Shanidze NM. A Comparison of Walking Behavior during the Instrumented TUG and Habitual Gait. SENSORS (BASEL, SWITZERLAND) 2023; 23:7261. [PMID: 37631797 PMCID: PMC10459909 DOI: 10.3390/s23167261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023]
Abstract
The timed up and go test (TUG) is a common clinical functional balance test often used to complement findings on sensorimotor changes due to aging or sensory/motor dysfunction. The instrumented TUG can be used to obtain objective postural and gait measures that are more sensitive to mobility changes. We investigated whether gait and body coordination during TUG is representative of walking. We examined the walking phase of the TUG and compared gait metrics (stride duration and length, walking speed, and step frequency) and head/trunk accelerations to normal walking. The latter is a key aspect of postural control and can also reveal changes in sensory and motor function. Forty participants were recruited into three groups: young adults, older adults, and older adults with visual impairment. All performed the TUG and a short walking task wearing ultra-lightweight wireless IMUs on the head, chest, and right ankle. Gait and head/trunk acceleration metrics were comparable across tasks. Further, stride length and walking speed were correlated with the participants' age. Those with visual impairment walked significantly slower than sighted older adults. We suggest that the TUG can be a valuable tool for examining gait and stability during walking without the added time or space constraints.
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Takahashi H, Inukai Y, Miyaguchi S, Otsuru N, Kawakami S, Onishi H. Effects of noisy galvanic vestibular stimulation on functional reach test. Neurosci Lett 2023; 810:137336. [PMID: 37315733 DOI: 10.1016/j.neulet.2023.137336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 06/16/2023]
Abstract
Balance disorders are a risk factor for falls in older individuals, and an increased center of pressure (COP) sway path length during standing and decreased reach distance in the functional reach test (FRT) predispose them to falls. Reportedly, noisy galvanic vestibular stimulation (nGVS) reduces COP sway path length during standing in young and community-dwelling older individuals and suggested to be a promising approach to improve balance function. However, the effect of nGVS on FRT remains unclear. Therefore, this study aimed to clarify the effect of nGVS on the FRT reach distance. This study has a cross-over design and included 20 healthy young adults. Interventions under nGVS (stimulation intensity: 0.2 mA) and sham (stimulation intensity: 0 mA) conditions were randomly administered to each participant. The participants underwent COP sway during standing measurements and FRT pre-intervention and post-intervention under each condition, and COP sway path length and the FRT reach distance were calculated. Statistical analysis revealed a significant decrease in post-intervention COP sway path length compared with pre-intervention COP sway path length under the nGVS condition. Conversely, the FRT reach distance remained the same under both nGVS and sham conditions. Thus, nGVS may improve the standing balance function but cannot change the FRT reach distance in healthy young individuals.
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Affiliation(s)
- Hirona Takahashi
- Graduate School, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata-shi, Niigata 950-3198, Japan; Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata-shi, Niigata 950-3198, Japan.
| | - Yasuto Inukai
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata-shi, Niigata 950-3198, Japan; Department of Physical Therapy, Niigata University of Health and Welfare, Niigata-shi, Niigata 950-3198, Japan.
| | - Shota Miyaguchi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata-shi, Niigata 950-3198, Japan; Department of Physical Therapy, Niigata University of Health and Welfare, Niigata-shi, Niigata 950-3198, Japan.
| | - Naofumi Otsuru
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata-shi, Niigata 950-3198, Japan; Department of Physical Therapy, Niigata University of Health and Welfare, Niigata-shi, Niigata 950-3198, Japan.
| | - Saki Kawakami
- Graduate School, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata-shi, Niigata 950-3198, Japan; Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata-shi, Niigata 950-3198, Japan.
| | - Hideaki Onishi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata-shi, Niigata 950-3198, Japan; Department of Physical Therapy, Niigata University of Health and Welfare, Niigata-shi, Niigata 950-3198, Japan.
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Reaves T, Bliss R, Chole D, Bridges J. Team Approach to Delayed Pediatric Vestibular Diagnosis: A Case Study. Pediatr Phys Ther 2023:00001577-990000000-00052. [PMID: 37071883 DOI: 10.1097/pep.0000000000001022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
BACKGROUND AND PURPOSE This report highlights the challenges of diagnosing pediatric vestibular neuritis following dental treatment and addressing fear avoidance behaviors. CASE DESCRIPTION An 11-year-old boy came to physical therapy with vestibular dysfunction following dental treatment that was unable to be diagnosed by emergency department staff. The participant received multispecialty treatment for 6 weeks. MEASUREMENTS Computerized Dynamic Posturography, Limits of Stability, Dizziness Handicap Inventory, Functional Gait Assessment, Dynamic Visual Acuity, and Modified Clinical Test of Sensory Interaction on Balance. OUTCOMES Most notable improvements were seen in Limits of Stability and Computerized Dynamic Posturography. The participant made a full return to school and sport. CONCLUSIONS The difficulty of pediatric vestibular neuritis diagnosis led to fear avoidance behaviors that were addressed by a collaborative specialty approach. WHAT THIS ADDS TO EVIDENCE This is the first documented case of pediatric vestibular neuritis as a complication of a dental procedure with intervention focused on fear avoidance behaviors.
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Affiliation(s)
- Tyler Reaves
- Department of Physical Therapy, University of Missouri School of Health Professions, Columbia, Missouri
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Kim B, Lohman E, Yim J. Effects of stabilizing reversal technique and vestibular rehabilitation exercise on dizziness and balance ability in patients with vestibular neuritis: An observational study. Medicine (Baltimore) 2022; 101:e28740. [PMID: 35089249 PMCID: PMC8797558 DOI: 10.1097/md.0000000000028740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 01/08/2022] [Indexed: 01/05/2023] Open
Abstract
Vestibular neuritis is a common disease of peripheral dizziness. Studies have shown that vestibular rehabilitation exercise (VRE) and proprioceptive neuromuscular facilitation (PNF) are effective to treat the symptoms of vestibular neuritis. However, the effect of VRE and PNF on the balance ability and dizziness in this patient cohort remains unclear.The aim of our observational study was to determine the changes in dizziness and balance ability of patients with vestibular neuritis who participated in the VRE program with stabilizing reversal technique (SRT).The reporting of this study conforms to the STROBE statement. Ten men and women aged ≥ 20 years who were diagnosed with vestibular neuritis were included. Patients performed VRE with SRT for 4 weeks with assistance from a therapist. VRE without SRT can also be performed at home. Dizziness was evaluated using the dizziness handicap inventory (DHI) and visual analog scale (VAS). Balance ability was assessed using the Berg's balance scale (BBS) and timed up and go test (TUG). At pre- and post-exercise, paired t test was performed to compare the within-group differences.After the program, DHI (45.40 ± 6.74 to 21.00 ± 7.07), VAS (5.90 ± 1.20 to 2.80 ± 0.92), BBS (45.10 ± 2.77 to 52.70 ± 1.83), and TUG (15.29 ± 1.13 to 12.06 ± 1.61) scores improved significantly in the VRE program group (P = .05).The VRE program combined with SRT was effective in reducing dizziness and increasing balance ability in patients with vestibular neuritis.
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Affiliation(s)
- Beomryong Kim
- Department of Physical Therapy, Design Hospital, Jeonju, Republic of Korea
- Department of Physical Therapy, The Graduate School of Sahmyook University, Seoul, Republic of Korea
| | - Everett Lohman
- Department of Physical Therapy, School of Allied Health Professions, Loma Linda University, Loma Linda, CA
| | - JongEun Yim
- Department of Physical Therapy, The Graduate School of Sahmyook University, Seoul, Republic of Korea
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Danneels M, Van Hecke R, Leyssens L, Degeest S, Cambier D, van de Berg R, Van Rompaey V, Maes L. 2BALANCE: a cognitive-motor dual-task protocol for individuals with vestibular dysfunction. BMJ Open 2020; 10:e037138. [PMID: 32665391 PMCID: PMC7365489 DOI: 10.1136/bmjopen-2020-037138] [Citation(s) in RCA: 4] [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] [Received: 01/23/2020] [Revised: 05/11/2020] [Accepted: 06/09/2020] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Aside from primary vestibular symptoms such as vertigo and dizziness, persons with vestibular dysfunction frequently express cognitive and motor problems. These symptoms have mainly been assessed in single-task setting, which might not represent activities of daily living accurately. Therefore, a dual-task protocol, consisting of the simultaneous performance of cognitive and motor tasks, was developed. This protocol assesses cognitive and motor performance in general, as well as cognitive-motor interference in specific. METHODS AND ANALYSIS The motor component of the 2BALANCE protocol consists of a static and dynamic postural task. These motor tasks are combined with different cognitive tasks assessing visuospatial cognition, processing speed, working memory and response inhibition. First, test-retest reliability will be assessed with an interval of 2 weeks in a group of young adults. Second, the 2BALANCE protocol will be validated in persons with bilateral vestibulopathy. Finally, the protocol will be implemented in persons with unilateral vestibular loss. DISCUSSION AND CONCLUSIONS The 2BALANCE project aims to elucidate the impact of vestibular dysfunction on cognitive and motor performance in dual-task setting. This protocol represents everyday situations better than single-task protocols, as dual-tasks such as reading street signs while walking are often encountered during daily activities. Ultimately, this project could enable individualised and holistic clinical care in these patients, taking into account single as well as dual-task performance. ETHICS AND DISSEMINATION The current study was approved by the ethics committee of Ghent University Hospital on 5 July 2019 with registration number B670201940465. All research findings will be disseminated in peer-reviewed journals and presented at vestibular as well as multidisciplinary international conferences and meetings. TRIALS REGISTRATION NUMBER NCT04126798, pre-results phase.
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Affiliation(s)
- Maya Danneels
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Ruth Van Hecke
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Laura Leyssens
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Sofie Degeest
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Dirk Cambier
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Raymond van de Berg
- Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands
- Faculty of Physics, Tomsk State University, Tomsk, Russian Federation
| | - Vincent Van Rompaey
- Faculty of Medicine and Health Sciences, Universiteit Antwerpen, Antwerpen, Belgium
- Department of Otorhinolaryngology and Head & Neck Surgery, University Hospital Antwerp, Edegem, Belgium
| | - Leen Maes
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
- Department of Otorhinolaryngology, University Hospital Ghent, Gent, Belgium
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