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Influence of asymmetry of vestibular caloric response and age on balance and perceived symptoms after acute unilateral vestibular loss
Linköpings universitet, Institutionen för hälsa och samhälle, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Oto-Rhino-Laryngologi. Linköpings universitet, Hälsouniversitetet.
Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Oto-Rhino-Laryngologi. Linköpings universitet, Hälsouniversitetet.
Linköpings universitet, Institutionen för hälsa och samhälle, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
2006 (Engelska)Ingår i: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 20, nr 2, s. 142-148Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

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

Design: Prospective study.

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

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

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

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

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

Ort, förlag, år, upplaga, sidor
2006. Vol. 20, nr 2, s. 142-148
Nationell ämneskategori
Samhällsvetenskap
Identifikatorer
URN: urn:nbn:se:liu:diva-33400DOI: 10.1191/0269215506cr886oaLokalt ID: 19416OAI: oai:DiVA.org:liu-33400DiVA, id: diva2:254223
Tillgänglig från: 2009-10-09 Skapad: 2009-10-09 Senast uppdaterad: 2017-12-13Bibliografiskt granskad
Ingår i avhandling
1. Vestibular rehabilitation therapy in dizziness and disequilibrium
Öppna denna publikation i ny flik eller fönster >>Vestibular rehabilitation therapy in dizziness and disequilibrium
2005 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

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

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

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

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

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

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

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

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

Ort, förlag, år, upplaga, sidor
Linköping: Linköpings universitet, 2005. s. 73
Serie
Linköping University Medical Dissertations, ISSN 0345-0082 ; 914
Nyckelord
vestibular, dizziness, disequilibrium
Nationell ämneskategori
Samhällsvetenskap
Identifikatorer
urn:nbn:se:liu:diva-31947 (URN)17782 (Lokalt ID)91-85299-27-8 (ISBN)17782 (Arkivnummer)17782 (OAI)
Disputation
2005-10-28, Berzeliussalen, Hälsouniversitetet (Ingång 65), Campus US, Linköpings Universitet, Linköping, 09:00 (Svenska)
Opponent
Tillgänglig från: 2009-10-09 Skapad: 2009-10-09 Senast uppdaterad: 2012-09-27Bibliografiskt granskad

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Av författaren/redaktören
Kammerlind, Ann-SofiLedin, TorbjörnÖdkvist, LarsSkargren, Elisabeth
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SjukgymnastikHälsouniversitetetOto-Rhino-Laryngologi
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