Vestibular rehabilitation and dizziness in geriatric patients

老年患者的前庭康复和头晕

• 批准号: 8959937
• 负责人: COURTNEY HALL
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-01 至 2016-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8959937
• 关键词: Address; Age; Balance training; Containment; Data; Diagnosis; Diagnostic; Disease; Dizziness; Economics; Elderly; Elements; Equilibrium; Esthesia; Evaluation; Exercise; Eye Movements; Functional disorder; Gait; Goals; Head Movements; Health Care Costs; Home environment; Impairment; Incidence; Individual; Injury; Intervention; Lightheadedness; Measures; Medical; Mission; Morbidity - disease rate; Motion; Movement; Outcome Measure; Outpatients; Participant; Pathology; Patient Care; Patients; Physical therapy; Pilot Projects; Placebos; Population; Quality of life; Randomized; Recovery; Regression Analysis; Rehabilitation Outcome; Rehabilitation therapy; Research; Risk Factors; Risk Reduction; Savings; Semicircular canal structure; Sensory; Sonal; Speed; Symptoms; Testing; Time; Vestibular Diseases; Vestibular loss; Veterans; Visit; Visual; Visual Acuity; age related; analog; conditioning; cost; design; disability; equilibration disorder; fall risk; falls; gaze; high risk; human very old age (85+); improved; indexing; novel; older patient; otoconia; programs; Address; Age; Balance training; Containment; Data; Diagnosis; Diagnostic; Disease; Dizziness; Economics; Elderly; Elements; Equilibrium; Esthesia; Evaluation; Exercise; Eye Movements; Functional disorder; Gait; Goals; Head Movements; Health Care Costs; Home environment; Impairment; Incidence; Individual; Injury; Intervention; Lightheadedness; Measures; Medical; Mission; Morbidity - disease rate; Motion; Movement; Outcome Measure; Outpatients; Participant; Pathology; Patient Care; Patients; Physical therapy; Pilot Projects; Placebos; Population; Quality of life; Randomized; Recovery; Regression Analysis; Rehabilitation Outcome; Rehabilitation therapy; Research; Risk Factors; Risk Reduction; Savings; Semicircular canal structure; Sensory; Sonal; Speed; Symptoms; Testing; Time; Vestibular Diseases; Vestibular loss; Veterans; Visit; Visual; Visual Acuity; age related; analog; conditioning; cost; design; disability; equilibration disorder; fall risk; falls; gaze; high risk; human very old age (85+); improved; indexing; novel; older patient; otoconia; programs

DESCRIPTION Dizziness is among the most prevalent complaints for which people seek medical help and the incidence of dizziness increases with age.Dizziness represents a diagnostic and treatment challenge for clinicians because it is a subjective sensation, can refer to a variety of symptoms (unsteadiness, spinning, a sense of movement or lightheadedness), and has a multitude of potential contributory factors.Dizziness is often related to vestibular pathology which is treated effectively with vestibular exercises. Unfortunately, a significant proportion of dizzy patients (2 - 40%) never receive a diagnosis for the cause of their dizziness. Successful management of dizziness is critical because dizziness is a major risk factor for falls in older adults. The goal f this study is to develop novel, exercise interventions for older adults with non-vestibular dizziness. There are parallels between the naturally occurring loss of vestibular function with age and the results of pathological loss of vestibular function - both in complaints of dizziness and in an increased risk for falls. Our question, then, is whether the same exercises that are beneficial for patients with vestibular pathology are beneficial for older patients with dizziness but normal vestibular function. It has been established that vestibular exercises decrease dizziness and improve postural stability in patients with vestibular hypofunction. It is unclear, however, if vestibular exercises are beneficial for older individuals with dizziness who are at ris for falls, but do not have vestibular pathology. Yardley et al. found that vestibular rehabilitatio reduced symptoms and increased postural stability in individuals with a primary complaint of dizziness. A limitation of these studies was that the majority of patients did not have a specific diagnosis for the underlying cause of their dizziness. Thus, it is unclear whether vestibular exercises were effective because the patients had undiagnosed vestibular pathology or whether vestibular exercises were an effective exercise approach for patients without vestibular pathology. Given the increased incidence of falls with age and the associated morbidity, the results of this study will be relevant to a substantial number of veterans. Specific Aim 1: Examine the extent to which vestibular exercises enhance rehabilitation outcomes in older adults with dizziness without vestibular pathology. We hypothesize that vestibular exercises will reduce symptoms and fall risk and improve gaze and postural stability to a greater extent than placebo exercises. Specific Aim 2: Determine the degree to which symptom improvement and fall risk reduction are retained after the intervention is completed. We hypothesize that the benefits of vestibular exercises will be retained after discharge as measured by visual analog scale, balance-related confidence scale, dynamic gait index, and gait speed, and that retention of improvements will be correlated with home exercise compliance. Specific Aim 3: Determine factors that influence rehabilitation outcomes. We hypothesize that exercise compliance will predict rehabilitation outcomes and that improved gaze stability will predict reduced fall risk. Older adults (n = 70) with non-vestibular dizziness (i.e., normal vestibular function, defined as normal horizontal semicircular canal and otolith function) who have been referred to physical therapy for balance and gait impairments will be randomized to receive 1) vestibular exercises or 2) placebo eye movement exercises. All subjects will receive standard gait and balance training. Outcome measures include: 1-3) visual analog scale measures of subjective complaints of dizziness, disequilibrium, and percent of time that dizziness interferes with activities; 4) disability; 5) balance-related confidence; 6) visual acuity during head movement as a measure of gaze stability; 7) dynamic gait index as a measure of fall risk; 8) preferred gait speed; 9) sensory organization test as a measure of postural stability. Outcome measures will be assessed at baseline, discharge, and 1-month and 6-months post-discharge from physical therapy.

描述 头晕是人们寻求医疗帮助的最普遍的抱怨之一，头晕的发生率随着年龄的增长而增加。昏昏欲睡是对临床医生的诊断和治疗挑战，因为它是一种主观的感觉，可以指出多种症状（不稳定，旋转，运动的象征或艰巨的效果），并且与效果相关。前庭练习。不幸的是，大部分头晕患者（2-40％）从未因头晕原因而得到诊断。成功管理头晕是至关重要的，因为头晕是老年人跌倒的主要危险因素。这项研究的目标是针对非vesibular头晕的老年人开发新颖的运动干预措施。与年龄的前庭功能的自然丧失和前庭功能丧失的结果之间存在相似之处 - 无论是头晕的抱怨还是跌倒的风险增加。因此，我们的问题是，对前庭病理学患者有益的相同锻炼是否对头晕但正常的前庭功能的老年患者有益。已经确定前庭锻炼可以减少头晕并改善前庭功能障碍患者的姿势稳定性。 但是，目前尚不清楚前庭练习是否有利于RIS跌倒但没有前庭病理学的老年人头晕。 Yardley等。发现前庭康复减轻了症状，并增加了头晕目眩的患者的姿势稳定性。 这些研究的局限性是，大多数患者没有特定的患者 诊断出其头晕的根本原因。因此，目前尚不清楚前庭运动是否有效，因为患者没有前庭病理学，还是前庭运动是对没有前庭病理学的患者的有效运动方法。鉴于随着年龄的增长和相关的发病率的跌落率增加，这项研究的结果将与大量的退伍军人有关。特定目的1：检查前庭锻炼的程度，可以在多大程度上增强没有前庭病理学的头晕的老年人的康复结果。我们假设前庭锻炼将减轻症状并降低风险，并在更大程度上改善凝视和姿势稳定性，而不是安慰剂运动。具体目标2：确定干预完成后保留症状改善和降低风险的程度。我们假设通过视觉模拟量表，与平衡相关的置信度量表，动态步态指数和步态速度来衡量，前庭练习的好处将保留，并且保留改进将与家庭运动的遵守相关。特定目的3：确定影响康复结果的因素。我们假设锻炼合规性将预测康复结果，并且改善的凝视稳定性将预测降低的风险。老年人（n = 70）具有非卵巢头晕的老年人（即正常的前庭功能，定义为正常水平的半圆形管和耳柱功能），他们已被转诊至物理治疗以进行物理治疗以进行平衡，并且步态刺激将随机化以接受1）前庭锻炼1）或2）安慰剂眼动运动。所有受试者都将接受标准步态和平衡培训。结果措施包括：1-3）视觉模拟量表的头晕，不平衡和头晕的时间百分比的主观申诉的视觉模拟量表衡量了活动。 4）残疾； 5）与平衡有关的信心； 6）在头部运动过程中的视力作为凝视稳定性的度量； 7）动态步态指数作为降落风险的衡量； 8）首选步态速度； 9）感官组织测试是姿势稳定性的量度。将在基线，排放以及1个月和6个月的分期疗法中评估结果指标。