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Papers by Antonio Lirola-Delgado

Research paper thumbnail of Alteraciones del Equilibrio en ancianos, ¿Se incrementa la inestabilidad con el paso de los años?

Objetivo: Analizar las diferencias equilibriométricas en dos poblaciones de ancianos con inestabi... more Objetivo: Analizar las diferencias equilibriométricas en dos poblaciones de ancianos con inestabilidad debida a la edad, con rangos de edad diferentes. Diseño del estudio: Estudio transversal con personas de 65 años o más, con alteraciones del equilibrio. Material y método: Muestra: 129 personas. 2 grupos con los percentiles 25 y 75 (grupo A [65,72.6) y grupo B ≥82.5). Variables: edad, sexo, tests " timed up and go" y de "organización sensorial de la posturografía dinámica (PD)", balanceos del centro de gravedad de la PD, límites de estabilidad de la PD, cuestionarios, caídas y número de ingresos hospitalarios por caídas. Estudio estadístico: programa SPSS 15.0 para Windows. Resultados: Ancianos de mayor edad peores puntuaciones en los tests equilibriométricos. Utilizan peor las informaciones visual y vestibular, pero no la somatosensorial. Conclusiones: Es preciso establecer subgrupos de ancianos con inestabilidad, ajustando las estrategias terapéuticas en base ...

Research paper thumbnail of Adherence of older people with instability in vestibular rehabilitation programmes: prediction criteria

The Journal of Laryngology & Otology, 2017

Objective:To determine whether demographic characteristics or balance examination findings can pr... more Objective:To determine whether demographic characteristics or balance examination findings can predict the adherence of older people with instability to a vestibular rehabilitation programme.Methods:A prospective case–control study was conducted of 120 patients aged 65 years or more (mean age, 77.3 ± 6.33 years). Two groups were classified according to patients’ adherence with the follow-up post-rehabilitation protocol. Analysed variables included: age, sex, body mass index, Timed Up and Go test findings, computerised dynamic posturography, Dizziness Handicap Inventory scores and Short Falls Efficacy Scale – International questionnaire results, number of falls, and type of vestibular rehabilitation.Results:Two groups were established: adherents (99 individuals) and non-adherents (21 individuals). There were differences between the groups regarding: sex (female-to-male ratio of 4.8:1 in adherents and 1.63:1 in non-adherents), age (higher in non-adherents) and voluntary movement postu...

Research paper thumbnail of Can we predict the risk of falls in elderly patients with instability?

Research paper thumbnail of What is the optimal number of treatment sessions of vestibular rehabilitation?

European Archives of Oto-Rhino-Laryngology, 2013

Research paper thumbnail of Reduction of falls in older people by improving balance with vestibular rehabilitation (ReFOVeRe study): design and methods

Aging clinical and experimental research, Jan 25, 2015

Evaluate the effectiveness of vestibular rehabilitation (VR) to improve the balance in older peop... more Evaluate the effectiveness of vestibular rehabilitation (VR) to improve the balance in older people, assessed immediately afterwards. SECONDARY OBJECTIVES: (a) To verify the maintenance of improvement of the balance achieved in the medium term (6-12 months). (b) To consider whether this improvement results in a reduction in the number of falls. (c) To compare among themselves the effectiveness of three different methods of VR in improving balance and to explore whether there are differences to achieve a reduction in the number of falls. Design: Experimental study, single-centre, open, randomised (balanced blocks of patients) in four branches in parallel, in 220 elderly patients (over 64 years) with high risk of falls and a follow-up period of 12 months. Department of Otolaryngology of the University Hospital of Santiago. People over 64 years, fulfilling one of the following requirements: (a) At least one fall in the last year. (b) Take at least 16 s or require some support in perfor...

Research paper thumbnail of Vestibular rehabilitation with mobile posturography as a “low-cost” alternative to vestibular rehabilitation with computerized dynamic posturography, in old people with imbalance: a randomized clinical trial

Aging Clinical and Experimental Research

Research paper thumbnail of Presbyvestibulopathy, Comorbidities, and Perception of Disability: A Cross-Sectional Study

Research paper thumbnail of Modified Timed Up and Go Test for Tendency to Fall and Balance Assessment in Elderly Patients With Gait Instability

Research paper thumbnail of Vestibular Rehabilitation Using Posturographic System in Elderly Patients with Postural Instability: Can the Number of Sessions Be Reduced?

Clinical Interventions in Aging

Purpose: Vestibular rehabilitation (VR) using posturography systems has proved useful in improvin... more Purpose: Vestibular rehabilitation (VR) using posturography systems has proved useful in improving balance among elderly patients with postural instability. However, its high cost hinders its use. The objective of this study is to assess whether two different protocols of VR with posturography, one of them longer (ten sessions) and the other shorter (five sessions), show significant differences in the improvement of balance among old patients with instability. Patients and Methods: This is a prospective, experimental, single-center (Department of Otorhinolaryngology of a tertiary referral hospital), randomized (into balanced patient blocks) study with two parallel arms, in 40 people over 65 years of age, with instability and at a high risk of falling. The percentage of the average balance (composite) in the sensory organization test (SOT) of the CDP (main outcome measure), other CDP scores, time and steps in the "timed up and go" test, scores of Dizziness Handicap Inventory (DHI), short Falls Efficacy Scale-International (short FES-I), and Vertiguard were compared before and 3 weeks after VR between both intervention groups. Results: The two treatment groups (20 patients per group) were comparable in age, sex, and pre-VR balance evaluation. In both groups, we observed a significant improvement in global balance (composite) after VR (49±11.34 vs 57±13.48, p=0.007, in the group undergoing 10 sessions; 51±12.55 vs 60±12.99, p=0.002, 5 sessions). In both groups, we also observed improvements in other posturographic parameters (in the SOT and limits of stability) but not in the timed up and go scores or in the questionnaires. Comparison of the improvement level achieved in both groups revealed no significant differences between them. Conclusion: The protocols of vestibular rehabilitation by posturography of 5 sessions in elderly patients with postural instability are as effective as those of 10 sessions for improving balance among elderly patients with postural instability. Trial Registration: ClinicalTrials.gov identifier: NCT03034655. Registered on

Research paper thumbnail of Optimising costs in reducing rate of falls in older people with the improvement of balance by means of vestibular rehabilitation (ReFOVeRe study): a randomized controlled trial comparing computerised dynamic posturography vs mobile vibrotactile posturography system

BMC Geriatrics, Jan 3, 2019

Background: Accidental falls, especially for the elderly, are a major health issue. Balance disor... more Background: Accidental falls, especially for the elderly, are a major health issue. Balance disorders are one of their main causes. Vestibular rehabilitation (VR) has proven to be useful in improving balance of elderly patients with instability. Its major handicap is probably its cost, which has prevented its generalisation. So, we have designed a clinical trial with posturographic VR, to assess the optimum number of sessions necessary for a substantial improvement and to compare computerised dynamic posturography (CDP) (visual feedback) and mobile posturography (vibrotactile feedback). Methods: Design: randomized controlled trial. It is an experimental study, single-center, open, randomized (balanced blocks of patients) in four branches in parallel, in 220 elderly patients with high risk of falls; follow-up period: twelve months. Setting: Department of Otorhinolaryngology of a tertiary referral hospital. Participants: people over 65 years, fulfilling two or more of the following requirements: a) at least one fall in the last twelve months. b) take at least 16 s or require some support in perform the "timed up and go" test. c) a percentage of average balance in the sensory organization test (SOT) of the CDP < 68%. d) at least one fall in any of the conditions in SOT-CDP. e) a score in Vertiguard's gSBDT > 60%. Intervention: Four differents protocols of vestibular rehabilitation (randomization of the patients). Main outcome measure: The percentage of average balance in the SOT-CDP. Secondary measures: time and supports in the "timed up and go" test, scores of the CDP and Vertiguard, and rate of falls.

Research paper thumbnail of Balance Disorders in the Elderly: Does Instability Increase Over Time?

To analyze the equilibriometric differences between 2 populations of elderly patients (young elde... more To analyze the equilibriometric differences between 2 populations of elderly patients (young elderly and very elderly) with instability induced solely by age. Cross-sectional study, with 2 study groups classified according to patient age (cut-points in twenty-fifth and seventy-fifth percentiles of the age of the sample). 64 patients aged 65 years or more. Two groups of 32 subjects were established: group A (people 65 years of age or older but less than 72.6, twenty-fifth percentile) and group B (patients 82.5 years, seventh-fifth percentile, or older). Main analyzed variables: timed up-and-go test, sensory organization test of the computerized dynamic posturography, Dizziness Handicap Inventory (DHI), and Short Falls Efficacy Scale-International (FES-I) questionnaires. Student&amp;amp;amp;amp;amp;amp;amp;amp;#39;s t test or the Mann-Whitney test were used. The older patients obtain poorer scores in the equilibriometric tests but not in all of them. In the sensory organization test, the older patients make poorer use of visual and vestibular information; they also require more time and steps for the timed up-and-go. With regards to the questionnaires, fear of falling is greater (higher Short FES-I scores) but not subjective perception of disability (DHI scores without differences). There is a need to establish aged subgroups of elderly patients with instability, adapting therapeutic strategies.

Research paper thumbnail of Does patient environment have any influence on balance?

Aging Clinical and Experimental Research

Background Although patient environment is a factor to consider when planning a vestibular rehabi... more Background Although patient environment is a factor to consider when planning a vestibular rehabilitation program, there are no studies correlating this factor to outcomes of balance assessment. Aim To evaluate whether there are differences in objective evaluation of balance in elderly patients at risk of falls according to the environment in which they live (urban or rural) and their lifestyle (considering cardiovascular risk factors). Methods Cross-sectional study of a sample of 139 elderly patients with high risk of falls assessed with objective outcome measures: Computer Dynamic Posturography (CDP), and the modified Timed Up-and-Go (TUG) test; and subjective outcome measures: Dizziness Handicap Inventory (DHI) and short Falls Efficacy Scale-International (short FES-I). Rural or urban environment was defined according to administrative and legal criteria. Results Elderly patients at risk of fall living in rural environment show better composite results in SOT with better scores in Condition 6 and fewer falls during the CDP. They also require fewer steps to perform the TUG test. Discussion The present study provides evidence that patient environment has an influence in balance. Conclusion Patient environment should be considered when analyze tests evaluating static and dynamic balance.

Research paper thumbnail of Prognostic factors that modify outcomes of vestibular rehabilitation in elderly patients with falls

Aging Clinical and Experimental Research

Background Our previous study has shown that vestibular rehabilitation (VR) is an effective techn... more Background Our previous study has shown that vestibular rehabilitation (VR) is an effective technique to reduce falls in elderly patients. It would be interesting to establish patients’ clinical characteristics in which vestibular rehabilitation is expected to be more effective. Aims Evaluate factors that could modify rehabilitation outcomes in elderly patients with previous falls. Methods Fifty-seven patients randomized to one of the intervention group (computerized dynamic posturography—CDP—training, optokinetic stimulus or exercise at home) and with previous falls were analyzed. Patients were assessed with objective outcome measures (sensorial organization test and limits of stability—LOS—of CDP, modified timed up and go test—TUG—and number of falls) and with subjective outcome measures (dizziness handicap inventory and Short falls efficacy scale-international—Short FES-I) during a 12-month follow-up period. Results In the logistic regression model, a worse score in the maximum excursion (MXM), and a shorter time in the TUG significantly associated with a reduction > 50% of falls. Also, association with a higher score in the Short FES-I was close to a statistical significance. There was no statistical significance association with other covariables. Discussion In patients with reduced limits of stability, VR seems to be more effective and they should be encouraged to perform it. But on the other hand, patients with longer time in the TUG show worse outcomes and may benefit more with gait training. Conclusions VR in elderly people with previous falls is effective regardless of their age and gender.

Research paper thumbnail of Vestibular rehabilitation in elderly patients with postural instability: reducing the number of falls—a randomized clinical trial

Aging Clinical and Experimental Research

Research paper thumbnail of Short-term effectiveness of vestibular rehabilitation in elderly patients with postural instability: a randomized clinical trial

European Archives of Oto-Rhino-Laryngology

Balance becomes more precarious with age, and even without pathological disorders, the physiologi... more Balance becomes more precarious with age, and even without pathological disorders, the physiological decline in balance that occurs with age is a factor that also favors falls. So the aim of the present study is to assess the short-term effectiveness of three different methods of vestibular rehabilitation, compared to a control group, in improving balance in elderly patients with postural instability. 139 elderly patients with high risk of falls were included and randomized to one of the following study arms: computer dynamic posturography (CDP) training, optokinetic stimulus, exercises at home, or control group. Patients were assessed with objective and subjective outcome measures. The individuals that trained using CDP improved significantly more than the control group on the average balance score (p &amp;amp;lt; 0.001) and reducing the number of falls in the sensorial organization test (p &amp;amp;lt; 0.001). In addition, the analysis showed a statistically significant effect in the limits of stability only with the CDP training in comparison with the control group (p &amp;amp;lt; 0.001). In our present study, supervised and customized exercises with CDP were more effective than the control group in the posturographic short-term assessment. An increased age did not affect the potential for improvement after training. So we conclude that elderly patients with high risk of falling should begin vestibular rehabilitation as soon as possible in order to avoid the potential harm of falls, mainly injuries and psychological consequences due to fear of falling again.

Research paper thumbnail of Posturographic limits of stability can predict the increased risk of falls in elderly patients with instability?

Acta oto-laryngologica, Jan 4, 2016

There was a difference in average score of the sensory organization test (SOT) of the case group ... more There was a difference in average score of the sensory organization test (SOT) of the case group (elderly instability) compared to the control group (healthy subjects). Cases had worse scores on the limits of stability (LOS) than controls, but were only able to confirm statistically significant differences in the movement velocity. To study the LOS of elderly patients with instability vs healthy subjects of the same age to try to explain the increased risk of falls in elderly patients with instability. Fifty individuals ≥65 years, 30 cases (at least one of the next inclusion criteria: ≥1 fall in the last 12 months, >15 s or some support in the timed up and go test, composite <68 in SOT, ≥1 fall during production of the SOT) compared to 20 controls. Postural study: SOT and LOS, Smart Equitest Neurocom(®) platform. t-Student test (p < 0.05). Mean value of overall balance: patients with instability =56% vs controls =77.1% (p < 0.001). Movement velocity: cases =2243°/s vs co...

Research paper thumbnail of Registro posturográfico y craneocorporográfico de las alteraciones del equilibrio producidas por el alcohol

Research paper thumbnail of Is there a relationship between short FES-I test scores and objective assessment of balance in the older people with age-induced instability?

Archives of gerontology and geriatrics, Jan 18, 2015

Fear of falling (FOF) is a common problem among the elderly. The purpose of this study is to eval... more Fear of falling (FOF) is a common problem among the elderly. The purpose of this study is to evaluate whether there is a correlation between FOF, estimated via the short FES-I test, and objective evaluation of balance in a group of elderly patients with age-related instability. The balance of 139 subjects of more than 65 years of age is evaluated by the timed up and go test and the computerised dynamic posturography (CDP). Different groups of elderly patients were established according to the number of falls in the previous 12 months, and the correlation with short FES-I test scores was evaluated. Based on the results, ROC curves were calculated. The short FES-I test presents a good capacity to distinguish between subjects with ≤3 falls/year and subjects with ≥4 falls/year (AUC 0.719, 95%CI 0.627-0.810). A test score of 14.5 is the best cut-off point (74% sensitivity, 51% specificity). Using this cut-off point, the study sample comprises two groups: subjects with test scores of 7-14...

Research paper thumbnail of Is there a relationship between short FES-I test scores and objective assessment of balance in the older people with age-induced instability?

Archives of Gerontology and Geriatrics, 2015

Fear of falling (FOF) is a common problem among the elderly. The purpose of this study is to eval... more Fear of falling (FOF) is a common problem among the elderly. The purpose of this study is to evaluate whether there is a correlation between FOF, estimated via the short FES-I test, and objective evaluation of balance in a group of elderly patients with age-related instability. The balance of 139 subjects of more than 65 years of age is evaluated by the timed up and go test and the computerised dynamic posturography (CDP). Different groups of elderly patients were established according to the number of falls in the previous 12 months, and the correlation with short FES-I test scores was evaluated. Based on the results, ROC curves were calculated. The short FES-I test presents a good capacity to distinguish between subjects with ≤3 falls/year and subjects with ≥4 falls/year (AUC 0.719, 95%CI 0.627-0.810). A test score of 14.5 is the best cut-off point (74% sensitivity, 51% specificity). Using this cut-off point, the study sample comprises two groups: subjects with test scores of 7-14 vs 15-28, with the first group obtaining best results with statistical significance (Student&amp;amp;amp;amp;amp;amp;amp;amp;#39;s t-test and the Mann-Whitney test) in most of the balance tests. The short FES-I is an excellent instrument that measures FOF in the elderly, and it is correlated with their number of falls both in real life and on the CDP. It is simple and fast, and so can be considered an extraordinary screening test relative to real risk of falls in the elderly.

Research paper thumbnail of Impact of obesity in elderly patients with postural instability

Aging Clinical and Experimental Research, 2015

The aim of the study is to assess whether obesity affects balance in elderly patients with postur... more The aim of the study is to assess whether obesity affects balance in elderly patients with postural instability. It is a case-control study, with cases defined by BMI ≥30 kg/m(2), and developed in a third level university hospital. We included 135 patients aged 65 years old or more who presented postural instability. Balance assessment was through the sensory organisation test (SOT), limits of stability (LOS) and rhythmic weight shift (RWS) of computerised dynamic posturography (CDP) and the modified timed up-and-go (TUG) test. The patients also completed the Dizziness Handicap Inventory and short Falls Efficacy Scale-International questionnaire. Patients with obesity took longer to perform the modified TUG and required more steps. Also these patients had poorer scores in the subjective tests. In the CDP there were no significant differences in the SOT nor the LOS, and only there was a statistical significant difference in the anterior-posterior directional control of the RWS. Obese patients have a higher risk of fallings compared to non-obese patients. In essence, our results indicate that obesity interferes in the balance of elderly patients with postural instability, putting them at a greater risk of fallings, performing worse dynamic tasks and feeling more disabled. Although continued education on training balance may be useful in older population, since the obese group shows more rate of fallers, rehabilitation programmes focus on dynamic tasks in these patients could be useful to reduce their fall risk and improve their quality of life.

Research paper thumbnail of Alteraciones del Equilibrio en ancianos, ¿Se incrementa la inestabilidad con el paso de los años?

Objetivo: Analizar las diferencias equilibriométricas en dos poblaciones de ancianos con inestabi... more Objetivo: Analizar las diferencias equilibriométricas en dos poblaciones de ancianos con inestabilidad debida a la edad, con rangos de edad diferentes. Diseño del estudio: Estudio transversal con personas de 65 años o más, con alteraciones del equilibrio. Material y método: Muestra: 129 personas. 2 grupos con los percentiles 25 y 75 (grupo A [65,72.6) y grupo B ≥82.5). Variables: edad, sexo, tests " timed up and go" y de "organización sensorial de la posturografía dinámica (PD)", balanceos del centro de gravedad de la PD, límites de estabilidad de la PD, cuestionarios, caídas y número de ingresos hospitalarios por caídas. Estudio estadístico: programa SPSS 15.0 para Windows. Resultados: Ancianos de mayor edad peores puntuaciones en los tests equilibriométricos. Utilizan peor las informaciones visual y vestibular, pero no la somatosensorial. Conclusiones: Es preciso establecer subgrupos de ancianos con inestabilidad, ajustando las estrategias terapéuticas en base ...

Research paper thumbnail of Adherence of older people with instability in vestibular rehabilitation programmes: prediction criteria

The Journal of Laryngology & Otology, 2017

Objective:To determine whether demographic characteristics or balance examination findings can pr... more Objective:To determine whether demographic characteristics or balance examination findings can predict the adherence of older people with instability to a vestibular rehabilitation programme.Methods:A prospective case–control study was conducted of 120 patients aged 65 years or more (mean age, 77.3 ± 6.33 years). Two groups were classified according to patients’ adherence with the follow-up post-rehabilitation protocol. Analysed variables included: age, sex, body mass index, Timed Up and Go test findings, computerised dynamic posturography, Dizziness Handicap Inventory scores and Short Falls Efficacy Scale – International questionnaire results, number of falls, and type of vestibular rehabilitation.Results:Two groups were established: adherents (99 individuals) and non-adherents (21 individuals). There were differences between the groups regarding: sex (female-to-male ratio of 4.8:1 in adherents and 1.63:1 in non-adherents), age (higher in non-adherents) and voluntary movement postu...

Research paper thumbnail of Can we predict the risk of falls in elderly patients with instability?

Research paper thumbnail of What is the optimal number of treatment sessions of vestibular rehabilitation?

European Archives of Oto-Rhino-Laryngology, 2013

Research paper thumbnail of Reduction of falls in older people by improving balance with vestibular rehabilitation (ReFOVeRe study): design and methods

Aging clinical and experimental research, Jan 25, 2015

Evaluate the effectiveness of vestibular rehabilitation (VR) to improve the balance in older peop... more Evaluate the effectiveness of vestibular rehabilitation (VR) to improve the balance in older people, assessed immediately afterwards. SECONDARY OBJECTIVES: (a) To verify the maintenance of improvement of the balance achieved in the medium term (6-12 months). (b) To consider whether this improvement results in a reduction in the number of falls. (c) To compare among themselves the effectiveness of three different methods of VR in improving balance and to explore whether there are differences to achieve a reduction in the number of falls. Design: Experimental study, single-centre, open, randomised (balanced blocks of patients) in four branches in parallel, in 220 elderly patients (over 64 years) with high risk of falls and a follow-up period of 12 months. Department of Otolaryngology of the University Hospital of Santiago. People over 64 years, fulfilling one of the following requirements: (a) At least one fall in the last year. (b) Take at least 16 s or require some support in perfor...

Research paper thumbnail of Vestibular rehabilitation with mobile posturography as a “low-cost” alternative to vestibular rehabilitation with computerized dynamic posturography, in old people with imbalance: a randomized clinical trial

Aging Clinical and Experimental Research

Research paper thumbnail of Presbyvestibulopathy, Comorbidities, and Perception of Disability: A Cross-Sectional Study

Research paper thumbnail of Modified Timed Up and Go Test for Tendency to Fall and Balance Assessment in Elderly Patients With Gait Instability

Research paper thumbnail of Vestibular Rehabilitation Using Posturographic System in Elderly Patients with Postural Instability: Can the Number of Sessions Be Reduced?

Clinical Interventions in Aging

Purpose: Vestibular rehabilitation (VR) using posturography systems has proved useful in improvin... more Purpose: Vestibular rehabilitation (VR) using posturography systems has proved useful in improving balance among elderly patients with postural instability. However, its high cost hinders its use. The objective of this study is to assess whether two different protocols of VR with posturography, one of them longer (ten sessions) and the other shorter (five sessions), show significant differences in the improvement of balance among old patients with instability. Patients and Methods: This is a prospective, experimental, single-center (Department of Otorhinolaryngology of a tertiary referral hospital), randomized (into balanced patient blocks) study with two parallel arms, in 40 people over 65 years of age, with instability and at a high risk of falling. The percentage of the average balance (composite) in the sensory organization test (SOT) of the CDP (main outcome measure), other CDP scores, time and steps in the "timed up and go" test, scores of Dizziness Handicap Inventory (DHI), short Falls Efficacy Scale-International (short FES-I), and Vertiguard were compared before and 3 weeks after VR between both intervention groups. Results: The two treatment groups (20 patients per group) were comparable in age, sex, and pre-VR balance evaluation. In both groups, we observed a significant improvement in global balance (composite) after VR (49±11.34 vs 57±13.48, p=0.007, in the group undergoing 10 sessions; 51±12.55 vs 60±12.99, p=0.002, 5 sessions). In both groups, we also observed improvements in other posturographic parameters (in the SOT and limits of stability) but not in the timed up and go scores or in the questionnaires. Comparison of the improvement level achieved in both groups revealed no significant differences between them. Conclusion: The protocols of vestibular rehabilitation by posturography of 5 sessions in elderly patients with postural instability are as effective as those of 10 sessions for improving balance among elderly patients with postural instability. Trial Registration: ClinicalTrials.gov identifier: NCT03034655. Registered on

Research paper thumbnail of Optimising costs in reducing rate of falls in older people with the improvement of balance by means of vestibular rehabilitation (ReFOVeRe study): a randomized controlled trial comparing computerised dynamic posturography vs mobile vibrotactile posturography system

BMC Geriatrics, Jan 3, 2019

Background: Accidental falls, especially for the elderly, are a major health issue. Balance disor... more Background: Accidental falls, especially for the elderly, are a major health issue. Balance disorders are one of their main causes. Vestibular rehabilitation (VR) has proven to be useful in improving balance of elderly patients with instability. Its major handicap is probably its cost, which has prevented its generalisation. So, we have designed a clinical trial with posturographic VR, to assess the optimum number of sessions necessary for a substantial improvement and to compare computerised dynamic posturography (CDP) (visual feedback) and mobile posturography (vibrotactile feedback). Methods: Design: randomized controlled trial. It is an experimental study, single-center, open, randomized (balanced blocks of patients) in four branches in parallel, in 220 elderly patients with high risk of falls; follow-up period: twelve months. Setting: Department of Otorhinolaryngology of a tertiary referral hospital. Participants: people over 65 years, fulfilling two or more of the following requirements: a) at least one fall in the last twelve months. b) take at least 16 s or require some support in perform the "timed up and go" test. c) a percentage of average balance in the sensory organization test (SOT) of the CDP < 68%. d) at least one fall in any of the conditions in SOT-CDP. e) a score in Vertiguard's gSBDT > 60%. Intervention: Four differents protocols of vestibular rehabilitation (randomization of the patients). Main outcome measure: The percentage of average balance in the SOT-CDP. Secondary measures: time and supports in the "timed up and go" test, scores of the CDP and Vertiguard, and rate of falls.

Research paper thumbnail of Balance Disorders in the Elderly: Does Instability Increase Over Time?

To analyze the equilibriometric differences between 2 populations of elderly patients (young elde... more To analyze the equilibriometric differences between 2 populations of elderly patients (young elderly and very elderly) with instability induced solely by age. Cross-sectional study, with 2 study groups classified according to patient age (cut-points in twenty-fifth and seventy-fifth percentiles of the age of the sample). 64 patients aged 65 years or more. Two groups of 32 subjects were established: group A (people 65 years of age or older but less than 72.6, twenty-fifth percentile) and group B (patients 82.5 years, seventh-fifth percentile, or older). Main analyzed variables: timed up-and-go test, sensory organization test of the computerized dynamic posturography, Dizziness Handicap Inventory (DHI), and Short Falls Efficacy Scale-International (FES-I) questionnaires. Student&amp;amp;amp;amp;amp;amp;amp;amp;#39;s t test or the Mann-Whitney test were used. The older patients obtain poorer scores in the equilibriometric tests but not in all of them. In the sensory organization test, the older patients make poorer use of visual and vestibular information; they also require more time and steps for the timed up-and-go. With regards to the questionnaires, fear of falling is greater (higher Short FES-I scores) but not subjective perception of disability (DHI scores without differences). There is a need to establish aged subgroups of elderly patients with instability, adapting therapeutic strategies.

Research paper thumbnail of Does patient environment have any influence on balance?

Aging Clinical and Experimental Research

Background Although patient environment is a factor to consider when planning a vestibular rehabi... more Background Although patient environment is a factor to consider when planning a vestibular rehabilitation program, there are no studies correlating this factor to outcomes of balance assessment. Aim To evaluate whether there are differences in objective evaluation of balance in elderly patients at risk of falls according to the environment in which they live (urban or rural) and their lifestyle (considering cardiovascular risk factors). Methods Cross-sectional study of a sample of 139 elderly patients with high risk of falls assessed with objective outcome measures: Computer Dynamic Posturography (CDP), and the modified Timed Up-and-Go (TUG) test; and subjective outcome measures: Dizziness Handicap Inventory (DHI) and short Falls Efficacy Scale-International (short FES-I). Rural or urban environment was defined according to administrative and legal criteria. Results Elderly patients at risk of fall living in rural environment show better composite results in SOT with better scores in Condition 6 and fewer falls during the CDP. They also require fewer steps to perform the TUG test. Discussion The present study provides evidence that patient environment has an influence in balance. Conclusion Patient environment should be considered when analyze tests evaluating static and dynamic balance.

Research paper thumbnail of Prognostic factors that modify outcomes of vestibular rehabilitation in elderly patients with falls

Aging Clinical and Experimental Research

Background Our previous study has shown that vestibular rehabilitation (VR) is an effective techn... more Background Our previous study has shown that vestibular rehabilitation (VR) is an effective technique to reduce falls in elderly patients. It would be interesting to establish patients’ clinical characteristics in which vestibular rehabilitation is expected to be more effective. Aims Evaluate factors that could modify rehabilitation outcomes in elderly patients with previous falls. Methods Fifty-seven patients randomized to one of the intervention group (computerized dynamic posturography—CDP—training, optokinetic stimulus or exercise at home) and with previous falls were analyzed. Patients were assessed with objective outcome measures (sensorial organization test and limits of stability—LOS—of CDP, modified timed up and go test—TUG—and number of falls) and with subjective outcome measures (dizziness handicap inventory and Short falls efficacy scale-international—Short FES-I) during a 12-month follow-up period. Results In the logistic regression model, a worse score in the maximum excursion (MXM), and a shorter time in the TUG significantly associated with a reduction > 50% of falls. Also, association with a higher score in the Short FES-I was close to a statistical significance. There was no statistical significance association with other covariables. Discussion In patients with reduced limits of stability, VR seems to be more effective and they should be encouraged to perform it. But on the other hand, patients with longer time in the TUG show worse outcomes and may benefit more with gait training. Conclusions VR in elderly people with previous falls is effective regardless of their age and gender.

Research paper thumbnail of Vestibular rehabilitation in elderly patients with postural instability: reducing the number of falls—a randomized clinical trial

Aging Clinical and Experimental Research

Research paper thumbnail of Short-term effectiveness of vestibular rehabilitation in elderly patients with postural instability: a randomized clinical trial

European Archives of Oto-Rhino-Laryngology

Balance becomes more precarious with age, and even without pathological disorders, the physiologi... more Balance becomes more precarious with age, and even without pathological disorders, the physiological decline in balance that occurs with age is a factor that also favors falls. So the aim of the present study is to assess the short-term effectiveness of three different methods of vestibular rehabilitation, compared to a control group, in improving balance in elderly patients with postural instability. 139 elderly patients with high risk of falls were included and randomized to one of the following study arms: computer dynamic posturography (CDP) training, optokinetic stimulus, exercises at home, or control group. Patients were assessed with objective and subjective outcome measures. The individuals that trained using CDP improved significantly more than the control group on the average balance score (p &amp;amp;lt; 0.001) and reducing the number of falls in the sensorial organization test (p &amp;amp;lt; 0.001). In addition, the analysis showed a statistically significant effect in the limits of stability only with the CDP training in comparison with the control group (p &amp;amp;lt; 0.001). In our present study, supervised and customized exercises with CDP were more effective than the control group in the posturographic short-term assessment. An increased age did not affect the potential for improvement after training. So we conclude that elderly patients with high risk of falling should begin vestibular rehabilitation as soon as possible in order to avoid the potential harm of falls, mainly injuries and psychological consequences due to fear of falling again.

Research paper thumbnail of Posturographic limits of stability can predict the increased risk of falls in elderly patients with instability?

Acta oto-laryngologica, Jan 4, 2016

There was a difference in average score of the sensory organization test (SOT) of the case group ... more There was a difference in average score of the sensory organization test (SOT) of the case group (elderly instability) compared to the control group (healthy subjects). Cases had worse scores on the limits of stability (LOS) than controls, but were only able to confirm statistically significant differences in the movement velocity. To study the LOS of elderly patients with instability vs healthy subjects of the same age to try to explain the increased risk of falls in elderly patients with instability. Fifty individuals ≥65 years, 30 cases (at least one of the next inclusion criteria: ≥1 fall in the last 12 months, >15 s or some support in the timed up and go test, composite <68 in SOT, ≥1 fall during production of the SOT) compared to 20 controls. Postural study: SOT and LOS, Smart Equitest Neurocom(®) platform. t-Student test (p < 0.05). Mean value of overall balance: patients with instability =56% vs controls =77.1% (p < 0.001). Movement velocity: cases =2243°/s vs co...

Research paper thumbnail of Registro posturográfico y craneocorporográfico de las alteraciones del equilibrio producidas por el alcohol

Research paper thumbnail of Is there a relationship between short FES-I test scores and objective assessment of balance in the older people with age-induced instability?

Archives of gerontology and geriatrics, Jan 18, 2015

Fear of falling (FOF) is a common problem among the elderly. The purpose of this study is to eval... more Fear of falling (FOF) is a common problem among the elderly. The purpose of this study is to evaluate whether there is a correlation between FOF, estimated via the short FES-I test, and objective evaluation of balance in a group of elderly patients with age-related instability. The balance of 139 subjects of more than 65 years of age is evaluated by the timed up and go test and the computerised dynamic posturography (CDP). Different groups of elderly patients were established according to the number of falls in the previous 12 months, and the correlation with short FES-I test scores was evaluated. Based on the results, ROC curves were calculated. The short FES-I test presents a good capacity to distinguish between subjects with ≤3 falls/year and subjects with ≥4 falls/year (AUC 0.719, 95%CI 0.627-0.810). A test score of 14.5 is the best cut-off point (74% sensitivity, 51% specificity). Using this cut-off point, the study sample comprises two groups: subjects with test scores of 7-14...

Research paper thumbnail of Is there a relationship between short FES-I test scores and objective assessment of balance in the older people with age-induced instability?

Archives of Gerontology and Geriatrics, 2015

Fear of falling (FOF) is a common problem among the elderly. The purpose of this study is to eval... more Fear of falling (FOF) is a common problem among the elderly. The purpose of this study is to evaluate whether there is a correlation between FOF, estimated via the short FES-I test, and objective evaluation of balance in a group of elderly patients with age-related instability. The balance of 139 subjects of more than 65 years of age is evaluated by the timed up and go test and the computerised dynamic posturography (CDP). Different groups of elderly patients were established according to the number of falls in the previous 12 months, and the correlation with short FES-I test scores was evaluated. Based on the results, ROC curves were calculated. The short FES-I test presents a good capacity to distinguish between subjects with ≤3 falls/year and subjects with ≥4 falls/year (AUC 0.719, 95%CI 0.627-0.810). A test score of 14.5 is the best cut-off point (74% sensitivity, 51% specificity). Using this cut-off point, the study sample comprises two groups: subjects with test scores of 7-14 vs 15-28, with the first group obtaining best results with statistical significance (Student&amp;amp;amp;amp;amp;amp;amp;amp;#39;s t-test and the Mann-Whitney test) in most of the balance tests. The short FES-I is an excellent instrument that measures FOF in the elderly, and it is correlated with their number of falls both in real life and on the CDP. It is simple and fast, and so can be considered an extraordinary screening test relative to real risk of falls in the elderly.

Research paper thumbnail of Impact of obesity in elderly patients with postural instability

Aging Clinical and Experimental Research, 2015

The aim of the study is to assess whether obesity affects balance in elderly patients with postur... more The aim of the study is to assess whether obesity affects balance in elderly patients with postural instability. It is a case-control study, with cases defined by BMI ≥30 kg/m(2), and developed in a third level university hospital. We included 135 patients aged 65 years old or more who presented postural instability. Balance assessment was through the sensory organisation test (SOT), limits of stability (LOS) and rhythmic weight shift (RWS) of computerised dynamic posturography (CDP) and the modified timed up-and-go (TUG) test. The patients also completed the Dizziness Handicap Inventory and short Falls Efficacy Scale-International questionnaire. Patients with obesity took longer to perform the modified TUG and required more steps. Also these patients had poorer scores in the subjective tests. In the CDP there were no significant differences in the SOT nor the LOS, and only there was a statistical significant difference in the anterior-posterior directional control of the RWS. Obese patients have a higher risk of fallings compared to non-obese patients. In essence, our results indicate that obesity interferes in the balance of elderly patients with postural instability, putting them at a greater risk of fallings, performing worse dynamic tasks and feeling more disabled. Although continued education on training balance may be useful in older population, since the obese group shows more rate of fallers, rehabilitation programmes focus on dynamic tasks in these patients could be useful to reduce their fall risk and improve their quality of life.