Outcomes After Rehabilitation for Adults With Balance Dysfunction

Department of Orthopedics and Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, United States
Archives of Physical Medicine and Rehabilitation (Impact Factor: 2.57). 03/2004; 85(2):227-33. DOI: 10.1016/j.apmr.2003.06.006
Source: PubMed


To assess balance, dynamic gait, and dynamic visual acuity outcomes after a vestibular and balance rehabilitation program and to determine which variables were significantly associated with improved balance and ambulation.
Retrospective case series.
Outpatient setting at a tertiary care facility.
Twenty patients who were seen for vestibular and balance therapy between July 1999 and June 2000.
A customized exercise program was developed for each patient according to the results of the assessment and included the following interventions, as indicated: gaze stabilization, balance and gait training, and habituation exercises.
The Dynamic Gait Index (DGI), Berg Balance Scale (BBS), Dynamic Visual Acuity Test (DVAT), and computerized post urography (Sensory Organization Test [SOT]).
The mean change scores for the DGI showed significant improvement for both patients with peripheral vestibular dysfunction and patients with central balance disorders. For the central balance disorders group, the BBS score also showed significant improvement. No difference was noted for pretherapy and posttherapy SOT scores between groups. The total group appeared to show an average improvement of more than 2 lines on the visual acuity chart on the clinical DVAT. Patients who were 66 years or older were 1.5 times more likely to score less than 20 on the DGI, and those whose pretherapy vertical dynamic visual acuity was 20/80 or worse were 1.3 times more likely to score less than 20 on the DGI.
Patients showed functional improvements in balance, visual acuity, and gait stability after balance and vestibular physical therapy. Age and pretherapy vertical dynamic visual acuity score influenced dynamic gait outcome after a balance rehabilitation program.

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Available from: Mary Beth Badke, Jun 18, 2014
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    • "disease and/or by the gravitational force [11]. Eye and body movements, subjective vertical orientation and motion sickness all depend on the way the human CNS deals with the gravitoinertial force [12]. However, the main cause of vertigo is the indistinguishable acceleration due to movement or gravity [13] [14]. "
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    ABSTRACT: This paper presents a methodology of human motion analysis and its clinical application used to study postural stability and balance control strategies in patients with various vestibular diseases. A marker-free analysis system was used to detect and evaluate motion of anatomical landmarks in single video camera records. The reconstructed motion trajectories of particular body segments were used to derive significant biomechanical parameters during balance control oriented tests with and without visual input. Pilot study was realized at the group of 22 patients to verify both the system functionality and the methodology suitability. All here included patients were evaluated separately as first, because of their different impairments affecting postural control. Then, the results were analysed within the group of here included patients as well. The first results showed that the method was efficient and proved quantitative changes in posture stability parameters as well as their dependence on visual perception. Also, the results obtained in patients with similar symptoms convinced us that the increasing number of analysed subjects and thus increasing database of patients' data could help clinicians to identify the background of closely related groups of posture disorders as well as to improve the patients' health status by supporting of decision making process aimed to select optimal treatment.
    10th International Conference on Digital Technologies, DT 2014, Zilina; 07/2014
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    • "Pojawiają się ponadto zaburzenia równowagi powodujące niestabilność przy chodzeniu, skłonność do upadków i lęk przed nimi [1]. W piśmiennictwie światowym u chorych z zawrotami nieukładowymi odsetek zaburzeń układu przedsionkowego o charakterze ośrodkowym rozpoznawany jest od 7% do 45% [2] [3] [4] [5]. "
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    ABSTRACT: The aim of the study was to evaluate the impact of physiotherapy on balance stability and quality of life improvement in patients with central vestibular system dysfunction.Material and methodsThe study was conducted on 31 patients (23 females, 8 males) with vertigo/dizziness and unsteadiness diagnosed for central vestibular system impairment based on videonystagraphy examinations, in ENT Department Medical University of Lodz between 2010-2011 years. Patients’ history of diseases were collected. The physiotherapeutic programme was individually introduced during four weeks (five time a week). The intervention included balance training and habituation exercises. At baseline and after patients were evaluated therapy with WHO Quality of Life-BREF (WHOQOL-BREF) and Dizzeness Handicap Inventory (DHI) self-assessment scales. Clinical examination with Romberg and stand one leg tests (eyes opened and closed) was performed.ResultsAfter therapy statistically significant differences in total DHI score (p < 0.005) and 3 subscales: physical, emotional, functional (p < 0.05) and WHOQOL-BREF only physical subscale (p < 0.05) compared baseline were found. There were no statistical differences between psychological, social relationships and environment subscales. In clinical evaluation significant reduction of unsteadiness in Romberg test (p < 0.05) and in stand one leg tests eyes opened and closed tests (p < 0.05) were found.Conclusion In patients with central vestibular system impairment after physical therapy betterment in clinical examination and some subjective self-assessment scales were observed. Lack of significant improvement in psychological, social relationships and environment domain in WHOQOL-BREF subscale indicated that these patients may need more psychological support or extensions in physiotherapy.
    Otolaryngologia polska. The Polish otolaryngology 02/2013; 67(1):11–17. DOI:10.1016/j.otpol.2012.09.001
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    • "It could be speculated that the vestibulo-spinal reflex was exercised as the training exercises were performed in standing positions. A previous study by Whitney [58,59] has suggested that DGI tends to improve after vestibular rehabilitation in patients with vestibular dysfunction. The results of our study are consistent with that claim. "
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    ABSTRACT: Background Peripheral vestibular hypofunction is a major cause of dizziness. When complicated with postural imbalance, this condition can lead to an increased incidence of falls. In traditional clinical practice, gaze stabilization exercise is commonly used to rehabilitate patients. In this study, we established a computer-aided vestibular rehabilitation system by coupling infrared LEDs to an infrared receiver. This system enabled the subjects’ head-turning actions to be quantified, and the training was performed using vestibular exercise combined with computer games and interactive video games that simulate daily life activities. Methods Three unilateral and one bilateral vestibular hypofunction patients volunteered to participate in this study. The participants received 30 minutes of computer-aided vestibular rehabilitation training 2 days per week for 6 weeks. Pre-training and post-training assessments were completed, and a follow-up assessment was completed 1 month after the end of the training period. Results After 6 weeks of training, significant improvements in balance and dynamic visual acuity (DVA) were observed in the four participants. Self-reports of dizziness, anxiety and depressed mood all decreased significantly. Significant improvements in self-confidence and physical performance were also observed. The effectiveness of this training was maintained for at least 1 month after the end of the training period. Conclusion Real-time monitoring of training performance can be achieved using this rehabilitation platform. Patients demonstrated a reduction in dizziness symptoms after 6 weeks of training with this short-term interactive game approach. This treatment paradigm also improved the patients’ balance function. This system could provide a convenient, safe and affordable treatment option for clinical practitioners.
    Journal of NeuroEngineering and Rehabilitation 10/2012; 9(1):77. DOI:10.1186/1743-0003-9-77 · 2.74 Impact Factor
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