Search keywords: balance elderly vertigo Search Date 1/9/07

Some abstracts of interest:

• Ig Sanita Pubbl. 2005 Mar-Apr;61(2):117-32. [Epidemiology of falls among the elderly.]

Mancini C, Williamson D, Binkin N, Michieletto F, De Giacomi GV.

ASUR Regione Marche, Zona Territoriale n. 8 Civitanova Marche.

Falls among the elderly have important physical and psychological consequences. Interventions of proven effectiveness exist at individual and population level for their prevention. Studies conducted in other countries have estimated the prevalence and identified the health and environmental risk factors associated with falls, while in Italy, the information available is limited to elderly living in protected residences. To estimate therefore the prevalence of falls and to estimate the association between these events and different risk factors, a series of questions on falls and their possible determinants were included in Studio Argento, a cross-sectional survey of the state of health of the non-institutionalized population >65 years of age that was conducted in 2002 in 11 Italian Regions. Methods. In each region, two-stage cluster sampling was used to sample 210 individuals. In the first phase, 30 communes were selected, with the probability of selection proportionate to their population; in the second phase, simple random sampling using the communal population register to select the persons to be interviewed. Interviews were conducted in the homes of the study subjects using a standardized questionnaire. Data from the 11 regions were merged for purposes of the analysis, and the C-sample routine of Epi-Info version 2002 was used to conduct the analysis, taking into account of the survey design and the size of the total population >65 years in the various Regions. SUDAAN, an application of SAS was used for the calculation of the rate ratios (R.R.) and 95% confidence intervals (95% CI) and the population-attributable fractions, taking into account potentially confounding variables. Results. A total of 2,273 persons were included in the study. During the previous 12 months, 651 (28.6%; 95% CI = 26.4%-30.7%) had fallen; of these 43.1% (95% IC = 38.6%-47.7%) had fallen 2 or more times. Sixty percent (95% CI = 55,6%-64,2%) of those who had fallen reported having fallen at home. Risk factors for falls included stroke (adjusted RR = 1.4 (95% CI = 1.03-1.8)). diabetes (adjusted RR = 1.7 (95% CI = 1.2-2.1)). visual difficulties (adjusted RR = 1.3 (95% CI = 1.02-1.6)). urinary incontinence (adjusted RR = 1.3 (95%CI= 1.1-1.5) and physical inactivity (adjusted RR = 1.3 (95% CI = 1.03-1.5)). In addition, the consumption of anti-anxiety drugs was also associated with a greater risk of falls. The highest population-attributable fractions were seen for urinary incontinence (9.4%) and lack of physical activity (10.0%). Conclusions. Falls are common in Italian elderly and are linked with the fragility of aging. To prevent falls, it is necessary to intervene on factors associated with fragility. Methods include encouraging regular physical activity to improve equilibrium and muscle strength and the continuous monitoring of health status to prevent further deterioration. Moreover studies carried out in other countries have demonstrated that the multidisciplinary interventions targeted at persons who have already experienced a fall reduces their risk of further falls. These interventions consist of evaluations of visual acuity, balance, and gait and a review of clinical history with eventual modifications of drug therapy and the environmental risks in the home.

PMID: 17206182 [PubMed - in process]

• Neurosurgery. 2006 Jul;59(1):67-76; discussion 67-76. Untreated vestibular schwannomas: vertigo is a powerful predictor for health-related quality of life.

Myrseth E, Moller P, Wentzel-Larsen T, Goplen F, Lund-Johansen M.

Department of Neurosurgery, Haukeland University Hospital, Jonas Lies vei, Bergen, Norway. erling.myrseth@helse-bergen.no

OBJECTIVE: The aim of the present study was to characterize the relation between quality of life (QOL) and the four major complaints (hearing loss, tinnitus, vertigo, and unsteadiness) caused by unilateral vestibular schwannomas (VS) in a cohort of well-characterized untreated patients. METHODS: One hundred ninety-nine consecutive patients (91 men, 108 women) with a mean age of 56.9 years were studied prospectively during the 4-year period from 2001 to 2004. The average length of time from symptom onset to the radiological diagnosis was 4.2 years. The patients were subject to a standardized examination including magnetic resonance imaging, evaluation of hearing acuity, balance function by stabilimetry, and a visual analogue scale self-evaluation of tinnitus and vertigo. Furthermore, the patients responded to two questionnaires: Short-Form 36 and the Glasgow Benefit Inventory. A reference population was recruited from 80 adults who visited Haukeland University Hospital as nonpatients or nonstaff members. All data were recorded prospectively in a customized case report form. Statistical analysis was performed with SPSS software. RESULTS: The response rates of the Short-Form 36 and Glasgow Benefit Inventory questionnaires were 91.5 and 89.9%, respectively. According to the Short-Form 36 questionnaire, the patients scored significantly below that of expected norms with the exception of physical function and mental health. Patients report negative benefit on the general and physical sections of the Glasgow Benefit Inventory questionnaire. Regression analysis showed that vertigo had a strong negative impact on QOL, whereas unilateral hearing loss and tinnitus had less impact on QOL. CONCLUSION: Vertigo is the symptom causing the most pronounced negative effect on QOL in patients with VS. The more frequent VS symptoms, unilateral hearing loss and tinnitus, seem to be less important in the patients' perception of QOL as evaluated by the questionnaires used in this study. If vertigo could be relieved by treatment, this symptom should be a primary focus when discussing treatment options in small- to medium-sized VS.

PMID: 16823302 [PubMed - indexed for MEDLINE]

• Neurol Sci. 2006 Dec;27(6):412-6 Primary postural instability: a cause of recurrent sudden falls in the elderly.

Djaldetti R, Lorberboym M, Melamed E.

Department of Neurology, Rabin Medical Center, Beilinson Campus, Petah Tiqva 49100, Israel.

Elderly patients with recurrent falls are frequently diagnosed with an extrapyramidal syndrome. This study aims to characterise a distinct group of patients with recurrent falls and postural instability as a hallmark of the clinical examination. The study took place in the Movement Disorders Unit, Rabin Medical Center, Petah Tiqva, Israel among 26 patients with recurrent falls who had no clinical evidence of a neurodegenerative disease. Medical records, neurological examination and brain imaging studies were assessed. Falls in these patients were sudden, unprovoked, with no vertigo or loss of consciousness. All had postural instability with minimal or no abnormality on the neurological examination. Brain imaging showed diffuse ischaemic changes in 65%. [(123)I]-FPCIT SPECT with the dopamine transporter ligand, performed in five patients, was normal in all. Recurrent falls might be caused by a neurological syndrome that primarily affects balance control. The importance of identifying this disorder is its distinction from other parkinsonian syndromes causing falls.

PMID: 17205226 [PubMed - in process]

• Zhonghua Liu Xing Bing Xue Za Zhi. 2005 Sep;26(9):720-2. [Study on the causes and risk factors on vertigo and balance disorders in 118 elderly patients] [Article in Chinese]

Huang WN, Xu J, Gao B, Zhou JM, Liu GF.

Department of Otorhinolaryngology, Beijing Hospital, Beijing 100730, China.

OBJECTIVE: To understand the various factors causing vertigo and balance disorders in the elderly. METHODS: 118 elderly patients (aged equal or older than 60 years of age) with vertigo or balance disorders were retrospectively analyzed through clinical symptoms, audio-vestibular function tests, X-ray, CT scan or MRI in cervical vertebras, brain and inner ears, ultrasonography, transcranial doppler (TCD) or magnetic resonance angiography (MRA) in blood vessels on head and neck. RESULTS: Of 118 patients, 70 (23%) of them suffered perip heral vestibular disorders while 29 (58%) having cerebral vertigo or dizzness, leaving 19 cases (16%) as unclassified. CONCLUSION: For elderly patients, vertigo and balance disorders were commonly caused by many kinds of peripheral and cerebral vestibular pathological disfunctions while the functional weakness of vestibular organs and systems affected by the physiological process of ageing and different concommitant diseases as well as environmental, psychogenic factors should also be considered.

PMID: 16471227 [PubMed - in process]

• Scand J Prim Health Care. 2005 Dec;23(4):215-20.Click here to read Links Balance performance and self-perceived handicap among dizzy patients in primary health care.

Hansson EE, Mansson NO, Hakansson A.

Department of Clinical Sciences, Family Medicine, Lund University, SE-205 02 Malmo, Sweden. eva.ekvall-hansson@med.lu.se

OBJECTIVE: To study the diagnostic panorama at a primary health care centre where the physiotherapist is specialized in dizziness. To study balance measures of dizzy patients as well as measures of self-perceived handicap and to analyse whether these measures correlate. DESIGN: Retrospective study of computerized medical records. SETTING: A primary health care centre in Malmo, Sweden. SUBJECTS: A total of 119 patients with dizziness, 73 women and 46 men, aged from 22 to 90 years. MAIN OUTCOME MEASURES: Diagnoses according to specified criteria. Four balance measures: tandem standing, standing on one leg, walking in a figure of eight, and walking heel to toe on a line. The Dizziness Handicap Inventory (DHI). RESULTS: Six different groups of diagnoses were found: multisensory dizziness, peripheral vestibular disorder, dizziness as a symptom caused by whiplash-associated disorder, unspecific dizziness, phobic postural vertigo, and dizziness of cervical origin. The group with multisensory dizziness performed poorer on the balance measures than the other groups. The group with phobic postural vertigo had the highest total scores on DHI, while the vestibular group had the lowest total score. Subjects over 65 years old had more disturbances in balance, but a lower level of self-perceived handicap, than subjects aged 65 or younger. DHI did not correlate with any of the balance measures. CONCLUSIONS: Self-perceived handicap, measured with DHI, and disturbed balance measured with clinical methods, do not necessarily correlate. Elderly patients with dizziness seem to have more disturbances in balance than younger patients but a lower level of self-perceived handicap.

PMID: 16272069 [PubMed - indexed for MEDLINE]

• Int J Pediatr Otorhinolaryngol. 2006 Feb;70(2):259-65. Epub 2005 Aug 15.Click here to read Links Vertigo and balance problems in children--an epidemiologic study in Finland.

Niemensivu R, Pyykko I, Wiener-Vacher SR, Kentala E.

Department of Otorhinolaryngology, Helsinki University Hospital, Finland.

OBJECTIVES: There is only scant data about the frequency and characteristics of vertigo in children. The aim of the study was to determine the prevalence and characteristics of vertigo and balance problems in children aged between 1 and 15 years. METHOD: One thousand and fifty children aged from 1 to 15 years from one child welfare unit and three schools in Helsinki University Hospital District received a questionnaire acquiring about their dizzy symptoms. RESULTS: Of 1050 eligible children, 938 (89%) or a caregiver completed a simple screening questionnaire, 8% had experienced vertigo and 23% of these it was so severe vertigo that it prevented their present activity. Reason for vertigo was unknown in one third of the children and 69% could name a provocative factor for their vertigo. CONCLUSION: Balance problems are not rare in children and can limit their daily activities.

PMID: 16102845 [PubMed - in process]

• Int J Audiol. 2005 Apr;44(4):191-6. Links Prevalence of vestibulopathy in benign paroxysmal positional vertigo patients with and without prior otologic history.

Roberts RA, Gans RE, Kastner AH, Listert JJ.

The American Institute of Balance, Seminole, FL, USA. rroberts@dizzy.com

The purpose of this study was to determine the prevalence of reduced or absent labyrinthine reactivity (vestibulopathy) in two groups of participants with posterior canal BPPV. One group had prior diagnosis of otologic disease (positive history group). No one in the second group had ever been diagnosed with otologic disease (negative history group). Caloric responses were retrospectively analyzed for the two groups. Patients with a positive history exhibited a greater prevalence of vestibulopathy than patients with a negative history. The positive history group, on average, also exhibited a larger unilateral weakness than those patients in the negative history group. We conclude that patients with BPPV and a history of otologic disease are more likely to present with vestibulopathy, than patients with BPPV and no history of otologic disease. This finding supports the benefit of complete vestibular evaluation in patients with BPPV to ensure comprehensive and successful treatment outcome.

PMID: 16011047 [PubMed - indexed for MEDLINE]

• Physiother Res Int. 2005;10(1):10-22. Links The relationship between the Activities-specific Balance Confidence Scale and the Dynamic Gait Index in peripheral vestibular dysfunction.

Legters K, Whitney SL, Porter R, Buczek F.

Physical Therapy Program, Gannon University, Erie, PA 16541, USA. legters001@gannon.edu

BACKGROUND AND PURPOSE: People with vestibular dysfunction experience dizziness, vertigo and postural instability. The persistence of these symptoms may result in decreased balance confidence. The purpose of the present study was to examine the relationship between decreased balance confidence and gait dysfunction in patients with unilateral peripheral vestibular dysfunction. METHOD: A retrospective review of 137 charts with the Activities-specific Balance Confidence (ABC) Scale and the Dynamic Gait Index (DGI) scores was completed. Spearman rank-order correlation analysis was performed of the total sample, by age group and by degree of vestibular weakness. RESULTS: A moderate correlation of r = 0.58 (p < 0.001) was found between the ABC Scale score and the DGI score in the total sample. Those with mild or moderate vestibular weakness had a correlation of r = 0.72 (p < 0.001) between the ABC Scale score and the DGI score, compared with a correlation of r = 0.48 in those with severe or total vestibular weakness. CONCLUSIONS: Decreased balance confidence and increased fall risk are critical issues for people with vestibular dysfunction. The effects of aging did not have a significant impact on the relationship. The correlation between balance confidence and gait dysfunction was stronger in those with mild or moderate vestibular weakness, although those with severe or total weakness were more disabled by their vestibular symptoms.

PMID: 15991483 [PubMed - indexed for MEDLINE]

• J Biomech. 2005 Jun;38(6):1263-72.Click here to read Links Ability of static and statistical mechanics posturographic measures to distinguish between age and fall risk.

Norris JA, Marsh AP, Smith IJ, Kohut RI, Miller ME.

Biomedical Engineering Department, School of Biomedical Engineering and Sciences, Wake Forest University Baptist Medical Center, Winston-Salem, NC 27157-1022, USA.

Traditional posturographic analysis and four statistical mechanics techniques were applied to center-of-pressure (COP) trajectories of young, older "low-fall-risk" and older "high-fall-risk" individuals. Low-fall-risk older adults were active 3 days per week in a cardiac rehabilitation program, while high-fall-risk older adults were diagnosed with perilymph fistula. Subjects diagnosed with perilymph fistula must have experienced two of the following vestibular findings: constant disequilibrium, positional vertigo and/or a positive fistula test. Non-parametric statistical tests were used to determine whether the posturographic measures could detect differences between the young and older "low-fall-risk" groups (age comparison) and between the older "low-" and "high-risk" groups (risk of falling comparison). The statistical mechanics techniques were more sensitive than the traditional measures: detecting significant differences between the young and older "low-risk" groups, while none of the traditional measures were significantly different. In addition, interpretation of the statistical mechanics techniques may offer more insight into the nature of the process controlling the COP trajectories. However, the methods offered slightly different explanations. For instance, the Hurst rescaled range analysis suggests that the movement of the COP is governed solely by anti-persistent behavior, whereas the stabilogram diffusion analysis suggests a short-term persistence balanced by a long-term anti-persistence. These discrepancies highlight the need for a model that incorporates the biological systems responsible for maintaining balance and experimental methods to directly quantify their status and roles. Until such a model exists, however, the statistical mechanics techniques appear to have some advantages over traditional posturographic measures for studying balance control.

PMID: 15863111 [PubMed - indexed for MEDLINE]

• Acta Otorrinolaringol Esp. 2005 Jan;56(1):12-6. Links [Electrooculography. Its value in the diagnosis of the patient with a balance disorder] [Article in Spanish]

Domenech Campos E, Armengot Carceller M, Barona de Guzman R.

Servicio de Otorrinolaringologia, Hospital Arnau de Vilanova, Valencia. xaferrer@inicia.es

INTRODUCTION: Controversy persists on the value of electrooculography (EOG) in the diagnosis of the unbalanced patient. The aim of this study has been to know the utility of EOG in the diagnosis of patients with equilibrium disorders. MATERIAL AND METHODS: We have examined 1000 patients in whom EOG test has been performed for unbalance symptoms. Results have been classified in peripheric or central pattern. Those patients included in the central pattern group have been compared with the results of imaging techniques. RESULTS: 45.7% of EOG performed showed pathological signs, 29.2% were of peripheral characteristics and 16.5% of central ones, of whom 6% showed different pathologies in the imaging test. DISCUSSIONS AND CONCLUSIONS: EOG in now a days of high value in the diagnosis of unbalanced patient, specially in those cases in which other clinical explorations were normal.

PMID: 15747718 [PubMed - indexed for MEDLINE]

• Clin Rehabil. 2005 Jan;19(1):54-62.Click here to read Links Effects of home training and additional physical therapy on recovery after acute unilateral vestibular loss--a randomized study.

Kammerlind AS, Ledin TE, Odkvist LM, Skargren EI.

Linkoping University, Department of Health and Society, Sweden. ankam@ihs.liu.se

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.

PMID: 15704509 [PubMed - indexed for MEDLINE]

• Hear Res. 2004 Oct;196(1-2):26-32.Click here to read Links The usefulness of computerized dynamic posturography for the study of equilibrium in patients with Meniere's disease: correlation with clinical and audiologic data.

Soto A, Labella T, Santos S, Rio MD, Lirola A, Cabanas E, Elhendi W.

Department of Otolaryngology, Clinical Hospital and School of Medicine, Santiago de Compostela, Spain. ciandsot@usc.es

The use of computerized dynamic posturogaphy (CDP) in the evaluation of patients with balance alterations not only allows quantification of the subject's capacity to maintain a stable centre of gravity, but also analysis of the degree to which the subject is able to use different types of sensory information. The present study investigated the possible use of CDP for clinical staging of vestibular diseases, specifically Meniere's disease (MD). We applied CDP sensory organization tests to 75 patients with definitive MD (AAO-HNS 1995 criteria). A total of 98 CDP sessions were included in the analysis, which focused on four CDP parameters specifically related to vestibular function (condition-5 score, condition-6 score, overall balance score, and VEST, a measure of the relative importance of vestibular information for maintenance of balance). We found a statistically significant relationship between audiometric hearing threshold and CDP scores, especially in patients with audiometrically advanced disease. In addition, CDP scores showed statistically significant variation with time elapsed since the last typical vertigo attack, suggesting that patients can be usefully grouped into three MD activity-level categories: recent post-attack (less than 1 week since last vertigo attack), late post-attack (1 week - 60 days since last attack), and inactive MD (more than 60 days since last attack). On the basis of these results, we propose expected ranges for each of the four CDP parameters in each of the three MD activity-level categories, allowing staging in terms of balance and posture. This staging system complements existing staging systems (based on audiometric criteria, and on subjective assessment of the severity of vertigo attacks and their implications for quality of life).

PMID: 15464298 [PubMed - indexed for MEDLINE]

• J Vestib Res. 2004;14(1):47-52.Click here to read Links Prevalence of dizziness and vertigo in an urban elderly population.

Jonsson R, Sixt E, Landahl S, Rosenhall U.

Department of Audiology, Sahlgren University Hospital, Goteborg, Sweden.

The prevalence of balance symptoms (vertigo, dizziness, and dysequilibrium) was investigated in an epidemiological study of elderly people, the longitudinal and cross-sectional gerontological and geriatric population study from Goteborg, Sweden (H70). Three different age cohorts were studied, one at age 70, one at age 75 and one at ages 79, 82, 85, 88 and 90 years. Altogether 2011 participants answered the questionnaire at 3197 occasions. The overall prevalence of balance problems at age 70 was 36% (women) and 29% (men). Balance symptoms were more common among women than men, and increased with increasing age. At ages 88-90 years the corresponding values were 51-45%. The most common symptom was poor balance/general unsteadiness (11-41%). Rotatory symptoms occurred in 2-17%. Other types of symptoms were less common. Precipitating factors were rising from supine to sitting position in 17-40%. Balance symptoms in a side position were uncommon, but occurred more often when tilting the head backwards (up to 14%). Signs that possibly could indicate neurological involvement were uncommon. Falls in conjuncture to dizziness, vertigo and similar symptoms occurred in 7-15%, in about equal proportions indoors as outdoors.

PMID: 15156096 [PubMed - indexed for MEDLINE]

• Acta Otorhinolaryngol Ital. 2002 Oct;22(5):263-7. Links [Balance disorders in the elderly] [Article in Italian]

Bracchi E, Rizzo S, Longari F, Bernardini M, Bizzotti C, Frenguelli A.

Clinica Otorinolaringologica e Chirurgia Cervico-facciale R, Universita di Perugia.

In the elderly patient, instability is a syndrome in which a loss of balance, during ambulation or while standing, can give rise to falls, with consequent disability and morbidity. Maintaining the correct static and dynamic balance is known to be the result of the synergetic functioning of different systems. In old age, however, the efficiency of these mechanisms is impaired because of the physiological process of aging, which affects all of the organs and systems of the human body. Besides that, different concomitant causes such as cardiovascular and dysmetabolic pathologies, chronic pharmacological therapies etc. contribute to the aging of our organism. The object of this study was to evaluate 40 subjects, 21 males and 19 females, aged between 70 and 86, who were referred to us with craniofacial trauma consequent to a fall. Upon hospitalization, all of the patients were asked to fill in a questionnaire evaluating the incidence of the vertigo symptom as a possible cause of the falls. All of the subjects underwent the following clinicoinstrumental examinations: standard audiometric evaluation, vestibular tests, neurological and ophthalmic examination. Careful appraisal of the results obtained enabled us to conclude that balance disorders in the elderly patient are due to the synergetic action of three factors: aging, concomitant diseases and environmental factors. In conclusion, we can affirm that balance disorders giving rise to a fall in the elderly are attributable to the concomitance of different factors that determine a clinical state of imbalance, defined by some Authors with the term "presbivertigo". It follows that a suitable diagnostic protocol must be employed, comprising a detailed medical, pharmacological and functional history, a study both of the environmental conditions in which the patient lives and the modalities according to which the traumatic event occurred. It is, last of all, indispensable that steps be taken to improve these environmental conditions, such as choosing flooring materials, light fixtures, stairs, bathroom furnishings and suitable footwear promoting proper foot placement and support on the ground.

PMID: 12510336 [PubMed - indexed for MEDLINE]

• Otolaryngol Head Neck Surg. 2001 May;124(5):526-30.Click here to read Links Short-lasting drop attacks in Meniere's disease.

Kentala E, Havia M, Pyykko I.

Department of Otolaryngology, Helsinki University Central Hospital, Finland. erna.kentala@huch.fi

OBJECTIVES: To study the vertigo attacks known as Tumarkin attacks or drop attacks (DA). DA are characterized by sudden loss of balance with or without falls but with preserved consciousness, and they are supposedly triggered by changes in the otolith function of Meniere's disease (MD). STUDY DESIGN AND SETTING: Data from 243 consecutive MD patients were collected into a database of an otoneurologic expert system. RESULTS: DA was experienced by 72% (n = 173) of the patients with MD. It correlated with visually provoked vertigo. Gait difficulties, tinnitus, and anxiety were more common in the DA group. Long lasting vertigo attacks were more frequently provoked in the DA subjects by physical strain (58% vs 14%), head movements or changes in head position (71% vs 48%), pressure changes (54% vs 12%), or rapid movements in visual surroundings (65% vs 35%) than in the non-DA subjects. CONCLUSION: DA are common in MD patients. The abrupt occurrence of DA make them poorly tolerated. SIGNIFICANCE: DA are more common in advanced MD.

PMID: 11337657 [PubMed - indexed for MEDLINE]

• Scand J Rehabil Med. 2000 Dec;32(4):168-72. Links Changes in balance performance in physically active elderly people aged 73-80.

Gustafson AS, Noaksson L, Kronhed AC, Moller M, Moller C.

Department of Otorhinolaryngology, University Hospital, Linkoping, Sweden. anngu@inr.liu.se

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.

PMID: 11201623 [PubMed - indexed for MEDLINE]

• Acta Otorrinolaringol Esp. 2000 Jun-Jul;51(5):377-82. Links [Prevalence of headaches and medication use in patients with recurrent vertigo] [Article in Spanish]

Lopez-Escamez JA, Lopez-Nevot A.

Unidad de ORL, Hospital de Poniente, Almeria.

Headache and episodic vertigo are common symptoms in adults. Migraine-related dizziness and vertigo is a clinical process that is difficult to assess because specific diagnostic criteria are lacking. Although studies have demonstrated a relationship between migraine and dizziness, the prevalence of headache among patients with episodic vertigo is underestimated. A clinical inventory was used to determine the prevalence of headache among 150 patients with episodic vertigo and the impact that dizziness had on the quality of life using an ordinal scale for disability. Patients were questioned about drug use and self-perceived effectiveness. Twenty-three percent of the patients experienced a severe problem that disabled them for work. The prevalence of headache was 68.6% (71% of women and 64% of men). Forty-five percent of patients with episodic vertigo and 44% with headache did not obtain any benefit from symptomatic treatment. A subset of patients suffered from migraine-related dizziness and vertigo and were able to control their balance disorder with migraine therapy.

PMID: 11000677 [PubMed - indexed for MEDLINE]

• Acta Otolaryngol. 2000 Jun;120(4):508-16. Links Balance control near the limit of stability in various sensory conditions in healthy subjects and patients suffering from vertigo or balance disorders: impact of sensory input on balance control.

El-Kahky AM, Kingma H, Dolmans M, de Jong I.

Department of Otolaryngology, Head and Neck Surgery, University Hospital Maastricht, The Netherlands.

The large inter-individual variability within the normal population, the limited reproducibility due to habituation or fatigue, and the impact of instruction and the subject's motivation, all constitute a major problem in posturography. These aspects hinder reliable evaluation of the changes in balance control in the case of disease and complicate objectivation of the impact of therapy and sensory input on balance control. In this study, we examine whether measurement of balance control near individualized limits of stability and under very challenging sensory conditions might reduce inter- and intra-individual variability compared to the well-known Sensory Organization Test (SOT). To do so, subjects balance on a platform on which instability increases automatically until body orientation or body sway velocity surpasses a safety limit. The maximum tolerated platform instability is then used as a measure for balance control under 10 different sensory conditions. Ninety-seven healthy subjects and 107 patients suffering from chronic dizziness (whiplash syndrome (n = 25), Meniere's disease (n = 28), acute (n = 28) or gradual (n = 26) peripheral function loss) were tested. In both healthy subjects and patients this approach resulted in a low intra-individual variability (< 14.5(%). In healthy subjects and patients, balance control was maximally affected by closure of the eyes and by vibration of the Achilles' tendons. The other perturbation techniques applied (sway referenced vision or platform, cooling of the foot soles) were less effective. Combining perturbation techniques reduced balance control even more, but the effect was less than the linear summation of the effect induced by the techniques applied separately. The group averages of healthy subjects show that vision contributed maximum 37%, propriocepsis minimum 26%, and labyrinths maximum 44% to balance control in healthy subjects. However, a large inter-individual variability was observed. Balance control of each patient group was less than in healthy subjects in all sensory conditions. Similar to healthy subjects, patients also show a large inter-individual variability, which results in a low sensitivity of the test. With the exception of some minor differences between Whiplash and Meniere patients, balance control did not differ between the four patient groups. This points to a low specificity of the test. Balance control was not correlated with the outcome of the standard vestibular examination. This study strengthens our notion that the contribution of the sensory inputs to balance control differs considerably per individual and may simply be due to differences in the vestibular function related to the specific pathology, but also to differences in motor learning strategies in relation to daily life requirements. It is difficult to provide clinically relevant normative data. We conclude that, like the SOT, the current test is merely a functional test of balance with limited diagnostic value.

PMID: 10958403 [PubMed - indexed for MEDLINE]

• Am J Otol. 2000 May;21(3):356-63. Links The effect of the canalith repositioning maneuver on resolving postural instability in patients with benign paroxysmal positional vertigo.

Blatt PJ, Georgakakis GA, Herdman SJ, Clendaniel RA, Tusa RJ.

Department of Orthopaedics and Rehabilitation, University of Miami, Coral Gables, Florida, USA.

OBJECTIVE: Patients with benign paroxysmal positional vertigo (BPPV) often experience postural instability as well as brief episodes of vertigo. The purpose of this study was to determine whether successful resolution of the episodic vertigo, through use of the canalith repositioning treatment, would be accompanied by improvement in postural stability. STUDY DESIGN: Prospective clinical study. SETTING: Outpatient tertiary care facility in a university. PATIENTS: Thirty-three patients with a diagnosis of the canalithiasis form of BPPV affecting the posterior canal unilaterally. All patients had complete remission of the positional vertigo after treatment. Patients with abnormal caloric or rotary chair test results were excluded from the study. INTERVENTION: The posterior canal BPPV was treated by the canalith repositioning treatment. MAIN OUTCOME MEASURES: Postural stability was assessed by computerized dynamic posturography before and 1 to 2 weeks after treatment. Six different subtests were used. RESULTS: A significant number of patients had abnormal stability, as measured with computerized dynamic posturography, before treatment. After treatment there was a significant increase in the number of subjects with normal results on the different subtests; however, not all patients had normal postural stability. Younger subjects were more likely to show improved stability. CONCLUSIONS: Treatment of BPPV using the canalith repositioning treatment results in improved postural stability in patients with BPPV. Not all patients have normal stability after treatment, however, and assessment and treatment of the balance problems may be necessary.

PMID: 10821549 [PubMed - indexed for MEDLINE]

* Otolaryngol Clin North Am. 2000 Jun;33(3):637-57. Links Assessment of unexplained falls and gait unsteadiness: the impact of age.

Dominguez RO, Bronstein AM.

Departamento de Neurologia, Hospital Sirio-Libanes, Buenos Aires, Argentina.

When a patient with a balance disorder reports rotational vertigo, the clinician rightly focuses his or her attention on the vestibular system. This article reviews the possible diagnoses in the many patients who primarily report falls or gait disorder. Falls can be caused by predisposing neurologic conditions impairing gait, cardiovascular conditions, or epileptic episodes. The proportion of idiopathic falls, however, remains high. In the elderly, environmental circumstances, visual defects, psychotropic medication, and poor general health are additional risk factors. Clinical assessment of gait is more revealing and less expensive than computerized posture/ gait systems. The diagnosis of orthostatic tremor, however, requires either Fourier analysis of sway platform signals or electromyography.

PMID: 10815041 [PubMed - indexed for MEDLINE]

• Otolaryngol Head Neck Surg. 2000 May;122(5):630-4.Click here to read Links Unrecognized benign paroxysmal positional vertigo in elderly patients.

Oghalai JS, Manolidis S, Barth JL, Stewart MG, Jenkins HA.

Bobby R. Alford Department of Otorhinolaryngology and Communicative Sciences, Baylor College of Medicine, Houston, TX 77030, USA.

Balance disorders in elderly patients are associated with an increased risk of falls but are often difficult to diagnose because of comorbid chronic medical problems. We performed a cross-sectional study to determine the prevalence of unrecognized benign paroxysmal positional vertigo (BPPV) and associated lifestyle sequelae in a public, inner-city geriatric population. Dizziness was found in 61% of patients, whereas balance disorders were found in 77% of patients. Nine percent were found to have unrecognized BPPV. Multivariate analysis demonstrated that the presence of a spinning sensation and the absence of a lightheadedness sensation predicted the presence of unrecognized BPPV. Patients with unrecognized BPPV were more likely to have reduced activities of daily living scores, to have sustained a fall in the previous 3 months, and to have depression. These data indicate that unrecognized BPPV is common within the elderly population and has associated morbidity. Further prospective studies are warranted.

PMID: 10793337 [PubMed - indexed for MEDLINE]

• Acta Otolaryngol. 1997 Jul;117(4):468-71. Links Horizontal otolith-ocular responses to lateral translation in benign paroxysmal positional vertigo.

Anastasopoulos D, Lempert T, Gianna C, Gresty MA, Bronstein AM.

MRC Human Movement and Balance Unit, National Hospital for Neurology, London, U.K.

Benign paroxysmal positional vertigo (BPPV) is assumed to result from utricular damage, but it is controversial if patients have manifest utricular dysfunction. Therefore, we investigated linear vestibulo-ocular reflexes (LVORs) during lateral whole-body translation in 14 patients with unilateral BPPV. Patients were subjected to linear acceleration steps of 0.24 g along the interaural axis, which were applied randomly to the left and right, both in the dark and in the light with a visual target at a distance of 60 cm. The LVOR was measured by EOG from the slow phase velocity of the averaged and desaccaded compensatory eye movement. In normal cases, maximum asymmetry of LVOR velocity was 13% in the dark and 10% in the light. In patients, LVOR velocities were normal in the dark but mildly reduced in the light (p < 0.05). Five patients had mild LVOR asymmetries in the dark (range 18-38%) and two in the light (11 and 13%), but there was no consistent relationship to the affected side. The absence of gross changes of the LVOR may be explained either by minor utricular damage that is functionally irrelevant or by central compensation of a chronic unilateral deficit.

PMID: 9288198 [PubMed - indexed for MEDLINE]

• Otolaryngol Head Neck Surg. 1995 Apr;112(4):526-32.Click here to read Links Occupation and visual/vestibular interaction in vestibular rehabilitation.

Cohen H, Kane-Wineland M, Miller LV, Hatfield CL.

Department of Otorhinolaryngology and Communicative Sciences, Baylor College of Medicine, Houston, TX 77030, USA.

Otolaryngologists often prescribe head movement exercise programs for patients with vestibular disorders, although the effectiveness of these programs and the critical features of the exercises are poorly understood. Because many patients who dislike exercising do not follow through with their exercises, alternatives to the traditional repetitive exercises would be useful. Subjects diagnosed with vestibular disorders were treated for 6 weeks with either an outpatient exercise program that incorporated interesting, purposeful activities or a simple home program of head movements, comparable with the exercises otolaryngologists often give their patients when they do not refer to rehabilitation. Both treatments incorporated repetitive head movements in all planes in space, graduated in size and speed. Subjects were all tested before and after treatment with standard measures of vestibulo-ocular reflex and balance, level of vertigo, gross motor skills, and self-care independence. Subjects in both groups improved significantly on the functional measures, with slightly greater improvements in the occupational therapy group. The results were maintained 3 months after the cessation of intervention. These data suggest that graded purposeful activities are a useful alternative for treating this patient population and that the essential factor in any exercise program is the use of repetitive head movements.

PMID: 7700657 [PubMed - indexed for MEDLINE]

• Ugeskr Laeger. 1992 Oct 19;154(43):2950-5. Links [Accidental falls in nursing homes. A study of the extent and circumstances of accidental falls in nursing homes] [Article in Danish]

Viskum B.

Embedslaegeinstitutionen for Vejle Amt.

Accidental falls in 54 nursing homes with 2228 elderly residents aged 65 years and over were registered during a period of seven months. During the seven months, 512 of the elderly residents fell on a total of 934 occasions. Forty-two fractures of the neck of the femur occurred. The risk of falls for elderly residents of nursing homes is very high, but the majority of falls do not result in permanent damage. In this investigation, no differences could be demonstrated between staff groups or circumstances concerning falls with and without resultant damage. All falls should be regarded as warnings and result in detailed investigation of the circumstances of the fall in view of prophylactic measures. Accidental falls are caused by a complex interaction between a series of health, therapy, furnishing and attitudes. Various circumstances are emphasized in this investigation which are connected with an increased risk of falling, e.g. vertigo, problems of balance, certain aids and activities in connection with toileting.

PMID: 1462381 [PubMed - indexed for MEDLINE]

• Acta Otorhinolaryngol Ital. 1990 Sep-Oct;10(5):499-503. Links [Modified Semont's maneuver in the treatment of benign paroxysmal positional vertigo] [Article in Italian]

Magnano M, Canale G, Lacilla M, Roberto C, Albera R.

Istituto di Clinica Otorinolaringoiatrica, Univesita di Torino.

Benign paroxysmal positional vertigo (BPPV) is one of the most frequent causes of vertigo. It is characterized by a peripheral balance impairment which occurs during specific movements or positions of the head. The etiology of BPPV is not clear although recent studies by Harada have given more weight to the otolithic theory. The present author has found frequent otoconia attached to the dark cell area around the crista of the semicircular canals. The treatment of BPPV is based on functional re-education of the patient (Semont maneuvers, the Brandt Daroff technique, Norre's V.H.T). The present study involves 62 patients affected by BPPV. The Hallpike maneuver was employed to define the affected side and then the modified Semont maneuver was performed. Recovery was obtained in all patients. The cure rate proved to be 82% after the first examination. The modified Semont maneuver is easier to perform than the traditional maneuver and has given excellent therapeutic results.

PMID: 2095109 [PubMed - indexed for MEDLINE]

• J Otolaryngol. 1986 Aug;15(4):248-52. Vertigo and imbalance in the elderly.

McClure? JA.

The diagnosis of vestibular disorders causing dizziness and imbalance in the elderly can present a difficult problem. Knowledgeable diagnosis depends on an understanding of the role of the vestibular end-organs as motion sensors and sensors of gravity as well as an understanding of how the vestibular system influences body balance and how visual mechanisms interact with the vestibular system. Based on a knowledge of these physiological principles, a number of interesting aspects of age-related vestibular disorders are discussed in more detail.

PMID: 3489106 [PubMed - indexed for MEDLINE]

• Age Ageing. 1978;Suppl:134-6. Falls and disorders of postural balance.

Stout RW.

PMID: 727053 [PubMed - indexed for MEDLINE]

-- DaniPershouse - 22 Jan 2007