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Vestibular rehabilitation therapy in dizziness and disequilibrium
Linköping University, Department of Department of Health and Society, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Dizziness and disequilibrium can be caused by several dysfunctions within the balance system, and are common symptoms especially in higher ages. The general aim of this thesis was to evaluate the effects of vestibular rehabilitation therapy in patients with dizziness and disequilibrium, and to examine the influence of age, vestibular function and psychological aspects on recovery.

Four study samples were included in the thesis: physically active elderly, central vestibular dysfunction (CVD), acute unilateral vestibular loss (AUVL), and in the last study both AUVL and CVD. The measurements static and dynamic clinical balance tests, V AS, EuroQol, Hospital Anxiety and Depression Scale, UCLA Dizziness Questionnaire, Dizziness Handicap Inventory, Dizziness Beliefs Scale, electronystagmography, vestibular-evoked myogenic potentials, and computerized dynamic posturography were used.

The change in balance performance over a 7-year period was evaluated in 17 physically active elderly. Both static clinical balance tests and maximum walking speed showed impaired balance. The amount of sway measured by computerized dynamic posturography had not changed, but increased latencies of force response to sudden backward translations of the platform were seen.

The effects of balance training were evaluated in 23 elderly patients with dizziness and disequilibrium caused by CVD. Patients were randomized to exercise group or control group. The exercise group received group balance training twice a week for eight weeks. Improvements were seen only in the exercise group in clinical balance tests, dynamic posturography, maximum walking speed and subjective ratings.

The effects of home training with and without additional individualized physical therapy were evaluated in a randomized controlled study of 54 patients during six months after AUVL. Similar recovery was seen in the two training groups. Higher age correlated with worse performance on clinical balance tests on follow-ups but not with change over time. Higher age also correlated with higher subjective ratings of vertigo at the six-month follow-up. Greater caloric vestibular asymmetry correlated with worse performance on clinical balance tests and higher subjective ratings.

In a long-term follow-up after 3-6 years, about half of the patients reported residual symptoms after the AUVL. Patients with and without reported symptoms differed with respect to health-related quality of life, anxiety and depression, but not in clinical balance tests, electronystagmography or vestibular-evoked myogenic potentials.

The test-retest and inter-rater reliability of, and the relationships between, clinical balance tests and subjective ratings and questionnaires were assessed in 50 patients with residual symptoms of dizziness and disequilibrium after AUVL or CVD. Sharpened Romberg's test with eyes closed, standing on foam with eyes closed, standing on one leg with eyes open, and walking in a figure-of-eight were the most reliable and appropriate clinical balance tests. Clinical balance tests were seldom correlated with subjective ratings and questionnaires, which shows the importance of measuring both aspects of dizziness and disequilibrium.

In conclusion, balance performance deteriorates with aging, vestibular rehabilitation therapy may improve balance and decrease symptoms of dizziness and disequilibrium, and it is important to use clinical balance tests together with subjective ratings and questionnaires in these patients.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet , 2005. , 73 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 914
Keyword [en]
vestibular, dizziness, disequilibrium
National Category
Social Sciences
Identifiers
URN: urn:nbn:se:liu:diva-31947Local ID: 17782ISBN: 91-85299-27-8 (print)OAI: oai:DiVA.org:liu-31947DiVA: diva2:252770
Public defence
2005-10-28, Berzeliussalen, Hälsouniversitetet (Ingång 65), Campus US, Linköpings Universitet, Linköping, 09:00 (Swedish)
Opponent
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2012-09-27Bibliographically approved
List of papers
1. Changes in balance performance in physically active elderly people aged 73-80
Open this publication in new window or tab >>Changes in balance performance in physically active elderly people aged 73-80
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2000 (English)In: Scandinavian Journal of Rehabilitation Medicine, ISSN 0036-5505, E-ISSN 1940-2228, Vol. 32, no 4, 168-172 p.Article in journal (Refereed) Published
Abstract [en]

In our hospital in 1989 a series of 30 healthy elderly people participated in a study to evaluate the effect of physical training on improving balance. Thereafter, the majority of the people in this group continued with some kind of balance training. Seven years later we followed up 17 of the people who had participated in the original study. We wanted to evaluate the balance performance of these physically active elderly people (mean age 80.5 years) and compare it with their balance performance 7 years previously. Balance was found to be significantly impaired compared with 1989 in four out of six static balance tests. The time required to walk 30 m had increased significantly. The subjective ratings of vertigo and balance problems had not changed significantly, neither had the number of correct steps when walking forwards on one line and backwards between two lines. In dynamic posturography, the test with sway-referenced visual cues showed improved postural control, but no change in sway was seen in the other five sensory conditions. When sudden backward translations of the platform occurred, increased latencies of force response were seen.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-27788 (URN)10.1080/003655000750060913 (DOI)11201623 (PubMedID)12535 (Local ID)12535 (Archive number)12535 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
2. Effects of balance training in elderly people with nonperipheral vertigo and unsteadiness
Open this publication in new window or tab >>Effects of balance training in elderly people with nonperipheral vertigo and unsteadiness
2001 (English)In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 15, no 5, 463-470 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate the effect of balance training in group in elderly people with nonperipheral vertigo and unsteadiness.

Design: Randomized controlled study.

Setting: Ear, nose and throat department, University Hospital, Sweden.

Subjects: Twenty-three elderly subjects with nonperipheral vertigo and/or unsteadiness randomized into training group and control group.

Intervention: The training group attended balance training in group twice a week for eight weeks.

Main outcome measures: Timed static balance tests, walking tests and six sensory organization tests on EquiTest dynamic posturography were performed before and after the training period. Besides, the patients estimated their vertigo and unsteadiness on a visual analogue scale (VAS) before and after the training period.

Results: The training group improved significantly in standing on one leg with eyes open, walking forward on a line, walking speed, in three out of six tests on dynamic posturography and estimated less vertigo and unsteadiness measured with VAS. No changes were seen in the control group.

Conclusion: Balance training in elderly people with nonperipheral vertigo and unsteadiness seems to improve both objective and perceived balance.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-27824 (URN)10.1191/026921501680425180 (DOI)12576 (Local ID)12576 (Archive number)12576 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
3. Effects of home training and additional physical therapy on recovery after acute unilateral vestibular loss: a randomized study
Open this publication in new window or tab >>Effects of home training and additional physical therapy on recovery after acute unilateral vestibular loss: a randomized study
2005 (English)In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 19, no 1, 54-62 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate the effects of additional physical therapy on recovery after acute unilateral vestibular loss given to patients receiving home training.

Design: Randomized controlled trial.

Setting: Ear, nose and throat departments in three hospitals.

Subjects: Fifty-four patients (mean age 52 years) with acute unilateral vestibular loss within the last week confirmed with electronystagmography testing were included. Patients with central neurologic or auditory symptoms or other vertigo disease were excluded.

Interventions: Home training with or without additional physical therapy 12 times during 10 weeks.

Main measures: Electronystagmography testing was performed before and after the training period. Clinical static (Romberg?s test, sharpened Romberg?s test, standing on foam and standing on one leg) and dynamic (walking forward and backward on a line) balance tests and subjective ratings of vertigo and balance problems on a visual analogue scale were done one week, 10 weeks and six months after the start of training.

Results: Similar changes were seen in the two training groups.

Conclusions: No significant differences in outcome regarding balance function or perceived symptoms were found between home training with or without additional physical therapy.

National Category
Social Sciences
Identifiers
urn:nbn:se:liu:diva-29391 (URN)10.1191/0269215505cr830oa (DOI)14725 (Local ID)14725 (Archive number)14725 (OAI)
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2017-12-13Bibliographically approved
4. Influence of asymmetry of vestibular caloric response and age on balance and perceived symptoms after acute unilateral vestibular loss
Open this publication in new window or tab >>Influence of asymmetry of vestibular caloric response and age on balance and perceived symptoms after acute unilateral vestibular loss
2006 (English)In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 20, no 2, 142-148 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate the influence of asymmetry of vestibular caloric response and age on balance and perceived symptoms after acute unilateral vestibular loss.

Design: Prospective study.

Setting: Ear, nose and throat departments in three hospitals.

Subjects: Fifty-four patients (mean age 52 years) with acute unilateral vestibular loss participating in a randomized controlled training study were included.

Main measures: Electronystagmography testing was performed within one week after onset of symptoms and after 10 weeks. The outcome measures clinical static balance tests (sharpened Romberg's test with eyes closed, standing on foam with eyes closed, and standing on one leg with eyes open and closed) and subjective symptom ratings on a visual analogue scale were done after one week, 10 weeks and six months. The correlation between age and asymmetry of vestibular caloric response, respectively, and the outcome measures were analysed.

Results: Greater caloric asymmetry correlated with poorer performance at the sharpened Romberg's test and standing on one leg with eyes closed at all three follow-ups (rho=-0.31 to -0.54), and with higher symptom ratings at the 10-week and six-month follow-ups (rho=0.30-0.60). Higher age was associated with poorer performance on the sharpened Romberg's test and standing on one leg at all three follow-ups (rho=0.31-0.64), but did not change over time. Higher age was also associated with higher ratings of vertigo at the six-month follow-up, and less reduction of vertigo between the 10-week and six-month follow-ups (rho=0.29-0.48).

Conclusions: A higher degree of asymmetry of vestibular caloric response and high age seem to be associated with poor outcome in balance and perceived symptoms after acute unilateral vestibular loss.

National Category
Social Sciences
Identifiers
urn:nbn:se:liu:diva-33400 (URN)10.1191/0269215506cr886oa (DOI)19416 (Local ID)19416 (Archive number)19416 (OAI)
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2017-12-13Bibliographically approved
5. Long-term follow-up after acute unilateral vestibular loss and comparison between subjects with and without remaining symptoms
Open this publication in new window or tab >>Long-term follow-up after acute unilateral vestibular loss and comparison between subjects with and without remaining symptoms
2005 (English)In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 125, no 9, 946-953 p.Article in journal (Refereed) Published
Abstract [en]

Conclusions. About half of the subjects in this study reported remaining symptoms 3–6 years after acute unilateral vestibular loss. Differences could be seen between subjects with and without remaining symptoms regarding health-related quality of life, anxiety and depression.

Objective. To evaluate the presence of self-rated remaining symptoms 3–6 years after acute unilateral vestibular loss, and to compare subjects with and without such symptoms.

Material and methods. Firstly, 51 subjects answered a questionnaire which included the EuroQol EQ-5D, the Hospital Anxiety and Depression Scale, the University of California Los Angeles Dizziness Questionnaire, visual analogue scales and the Dizziness Handicap Inventory. Secondly, nine subjects with and nine without remaining symptoms participated in an extended testing procedure, including electronystagmography (ENG), determination of vestibular-evoked myogenic potentials (VEMPs) and clinical balance tests.

Results. In the first part of the study, 27 subjects reported remaining symptoms, 3 reported 1 additional period of symptoms and 21 had not experienced any symptoms at all in the 3–6 years since acute unilateral vestibular loss. In the second part, the group with remaining symptoms rated a lower health-related quality of life and a higher level of anxiety and depression. There were no differences between the two groups in terms of ENG tests, VEMPs or clinical balance tests.

National Category
Social Sciences
Identifiers
urn:nbn:se:liu:diva-29392 (URN)10.1080/00016480510043477 (DOI)14726 (Local ID)14726 (Archive number)14726 (OAI)
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2017-12-13Bibliographically approved
6. Reliability of clinical balance tests and subjective ratings in dizziness and disequilibrium
Open this publication in new window or tab >>Reliability of clinical balance tests and subjective ratings in dizziness and disequilibrium
2005 (English)In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 7, no 3, 96-107 p.Article in journal (Refereed) Published
Abstract [en]

The aim was to assess (i) the test–retest and inter-rater reliability of, and (ii) the relationships between, commonly used clinical balance tests and subjective ratings in subjects with dizziness and disequilibrium. Fifty subjects (26 men and 24 women, mean age 63 years) with dizziness and disequilibrium following acute unilateral vestibular loss or central neurological dysfunction were tested with static and dynamic clinical balance tests, visual analogue scales (VAS), University of California Los Angeles Dizziness Questionnaire (UCLA-DQ), Dizziness Beliefs Scale (DBS), European Quality of Life questionnaire (EQ-5D), Dizziness Handicap Inventory (DHI), and Hospital Anxiety and Depression Scale (HADS). Most tests showed good test–retest and inter-rater reliability. Few correlations were seen between objective and subjective tests, but several correlations were found between the different subjective instruments. Sharpened Romberg's test eyes closed, standing on foam eyes closed, standing on one leg eyes open and walking in a figure-of-eight are recommended as reliable and appropriate clinical balance tests in subjects with dizziness and disequilibrium. Subjects with central lesions may have difficulties when rating their symptoms on VAS. Total scores rather than scores for separate items are recommended for UCLA-DQ and DHI.

National Category
Social Sciences
Identifiers
urn:nbn:se:liu:diva-29393 (URN)10.1080/14038190510010403 (DOI)14727 (Local ID)14727 (Archive number)14727 (OAI)
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2017-12-13Bibliographically approved

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