Clinical effectiveness of a physiotherapy-led, hospital-based vestibular service (original) (raw)
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Outcome evaluation of the dizziness handicap inventory in an outpatient vestibular clinic
Journal of Vestibular Research, 2017
BACKGROUND: The DHI is a widely used questionnaire for the evaluation of the self-reported disability in patients with dizziness and balance problems. OBJECTIVE: To investigate the relationship between the DHI scores and demographic, symptomatic and diagnostic parameters. METHODS: Retrospective study in 568 patients with balance problems. RESULTS: We observed a total of 61.3% of patients with moderate (DHI total score between 30 and 59) to severe (DHI total score between 60 and 100) disability. Patients with long-standing complaints (lasting longer than 3 months) experience their self-reported disability to a greater extent than patients with new onset pathology (illness duration of one month and less). Moreover, patients suffering from continuous complaints have a larger DHI score than patients with shorter symptom duration. The first effect (new onset vs. long-standing pathology) is primarily caused by emotional factors, the latter effect (symptom duration) is attributable to functional and physical factors, not to emotional aspects. Patients with daily and weekly complaints have larger DHI scores than patients who reported only one episode. Female patients reported larger DHI scores than males. We found no effect of age, diagnostic group (no diagnosis, episodic, acute or chronic vestibular syndrome) or reported symptoms on the DHI scores. CONCLUSIONS: The information retrieved from the DHI questionnaire is complementary to the information obtained from clinical investigation and diagnostic tests and therefore is an essential tool in a vestibular clinic.
Screening People in the Waiting Room for Vestibular Impairments
Southern Medical Journal
Objective: Primary care physicians need good screening tests of the vestibular system to help them determine whether patients who complain of dizziness should be evaluated for vestibular disorders. The goal of this study was to determine whether current, widely used screening tests of the vestibular system predict subsequent performance on objective diagnostic tests of the vestibular system (ENG).
A device for the functional evaluation of the VOR in clinical settings
We developed the head impulse testing device (HITD) based on an inertial sensing system allowing to investigate the functional performance of the rotational vestibulo-ocular reflex (VOR) by testing its gaze stabilization ability, independently from the subject's visual acuity, in response to head impulses at different head angular accelerations ranging from 2000 to 7000 deg/s 2 . HITD was initially tested on 22 normal subjects, and a method to compare the results from a single subject (patient) with those from controls was set up. As a pilot study, we tested the HITD in 39 dizzy patients suffering, non-acutely, from different kinds of vestibular disorders. The results obtained with the HITD were comparable with those from the clinical head impulse test (HIT), but an higher number of abnormalities was detectable by HITD in the central vestibular disorders group. The HITD appears to be a promising tool for detecting abnormal VOR performance while providing information on the functional performance of the rotational VOR, and can provide a valuable assistance to the clinical evaluation of patients with vestibular disorders.
Journal of Intellectual Disability - Diagnosis and Treatment, 2019
Background and Objective: Vestibular rehabilitation therapy (VRT) is an exercise-based program designed to improve balance function and alleviate problems related to dizziness, including vestibular hypofunction. This study aimed to evaluate the therapeutic effects of VRT exercises on balance function in adults with unilateral vestibular hypofunction (UVH). Methods: Thirty-one patients (mean age: 39.48 (±10.96) years old) with confirmed UVH participated in this study. The VRT program consisted of habituation and adaptation exercises in combination with gait and balance exercises. The handicapping influences of dizziness were measured with a dizziness handicap inventory (DHI) scale to measure the level of respondent's performance on physical, emotional, and functional dimensions. Visual analogue scale (VAS) was also used to rate the severity of dizziness symptoms. The DHI and VAS scales were assessed pre-intervention and postintervention at one, two, and four weeks follow-ups after the last rehabilitation session. Results: An analysis of variance showed a significant reduction and a consequent improvement in DHI scores after vestibular exercises in all domains: emotional, physical and functional (p < 0.001). The mean total DHI score significantly decreased by 15 points after one week, 24 points after two weeks and 15 points after four weeks of the last VRT session. The mean baseline VAS score was 7.71 (±0.91) that significantly decreased at one, two, and four weeks postintervention to 4.81 (±0.73), 3.77 (±0.61), and 3.16 (±0.97), respectively (p<0.001). Conclusion: The exercise-based VRT shows benefits for adult patients with chronic dizziness concerning improvement in the vertigo symptom scale, fall risk, balance and emotional status.
Consensus on Virtual Management of Vestibular Disorders: Urgent Versus Expedited Care
The Cerebellum
The virtual practice has made major advances in the way that we care for patients in the modern era. The culture of virtual practice, consulting, and telemedicine, which had started several years ago, took an accelerated leap as humankind was challenged by the novel coronavirus pandemic (COVID19). The social distancing measures and lockdowns imposed in many countries left medical care providers with limited options in evaluating ambulatory patients, pushing the rapid transition to assessments via virtual platforms. In this novel arena of medical practice, which may form new norms beyond the current pandemic crisis, we found it critical to define guidelines on the recommended practice in neurotology, including remote methods in examining the vestibular and eye movement function. The proposed remote examination methods aim to reliably diagnose acute and subacute diseases of the inner-ear, brainstem, and the cerebellum. A key aim was to triage patients into those requiring urgent emergency room assessment versus non-urgent but expedited outpatient management. Physicians who had expertise in managing patients with vestibular disorders were invited to participate in the taskforce. The focus was on two topics: (1) an adequate eye movement and vestibular examination strategy using virtual platforms and (2) a decision pathway providing guidance about which patient should seek urgent medical care and which patient should have non-urgent but expedited outpatient management.