Vestibular rehabilitation and dizziness in geriatric patients

老年患者的前庭康复和头晕

• 批准号: 8272055
• 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 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8272055
• 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

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. PUBLIC HEALTH RELEVANCE: Relevance of Proposed Research to VA Patient Care Mission: This research directly addresses the mission of the VA by attending to quality-of-life mandates. The number of Veterans age 85 years and older has tripled this decade (VetData, 2010). Older Veterans, particularly those over 85, are among the most vulnerable of the veteran population and are at highest risk for suffering fall-related injuries. An estimate of outpatient costs to the VA in 2001 for fall-related injuries as nearly $3.3 million for the initial visit alone (Luther, 2005). The potential for large economic savings by reducing falls incidence, thus fall-related injuries, is evident. Given the increased incidence of falls with age and the morbidity associated with falls, the results of this study willbe relevant to a substantial number of veterans. The proposed study has the potential to develop novel rehabilitation approaches to reduce the risk of falls in older veterans with dizziness. This project will contribute to improved quality of life and containment of health care costs in the elderly.

描述 头晕是人们寻求医疗帮助的最常见的主诉之一，头晕的发生率随着年龄的增长而增加。头晕是临床医生诊断和治疗的一个挑战，因为它是一种主观感觉，可以指各种症状(不稳定、旋转、运动感或头晕)，并有许多潜在的致病因素。头晕通常与前庭病理有关，前庭锻炼可以有效地治疗这种疾病。不幸的是，相当大比例的眩晕患者(2-40%)从未得到头晕病因的诊断。头晕的成功管理是至关重要的，因为头晕是老年人跌倒的主要风险因素。这项研究的目标是为患有非前庭眩晕的老年人开发新的运动干预措施。随着年龄的增长，自然发生的前庭功能丧失与前庭功能病理性丧失的结果有相似之处--既有头晕的主诉，也有摔倒风险的增加。那么，我们的问题是，同样对前庭病变患者有益的运动是否也对头晕但前庭功能正常的老年患者有益。前庭运动可以减少前庭功能减退患者的眩晕和改善姿势的稳定性。然而，尚不清楚前庭锻炼是否对在RIS摔倒但没有前庭病变的头晕目眩的老年人有益。Yardley等人。研究发现，前庭康复减轻了以头晕为主要主诉的个人的症状，并增加了姿势的稳定性。这些研究的局限性是，大多数患者没有特定的 对他们头晕的根本原因进行诊断。因此，尚不清楚前庭锻炼是否有效，因为患者有未确诊的前庭病变，或者对于没有前庭病变的患者来说，前庭锻炼是否是一种有效的锻炼方法。鉴于跌倒的发生率随着年龄的增长而增加，以及相关的发病率，这项研究的结果将与相当数量的退伍军人相关。具体目标1：检查前庭运动在多大程度上促进无前庭病变的头晕老年患者的康复效果。我们假设，与安慰剂练习相比，前庭练习将在更大程度上减少症状和跌倒风险，并改善凝视和姿势稳定性。具体目标2：确定干预完成后症状改善和跌倒风险降低的保留程度。我们假设，通过视觉模拟评分、平衡相关信心评分、动态步态指数和步态速度来衡量，出院后前庭锻炼的益处将被保留，并且改善的保留将与家庭锻炼的顺应性相关。具体目标3：确定影响康复效果的因素。我们假设，运动依从性将预测康复结果，而凝视稳定性的改善将预测跌倒风险的降低。70名老年人(n=70)无前庭眩晕(即前庭功能正常，定义为正常的水平半规管和耳石功能)，已被推荐接受平衡和步态障碍的物理治疗，他们将被随机分为1)前庭练习或2)安慰剂眼球运动练习。所有受试者都将接受标准步态和平衡训练。结果测量包括：1-3)主观抱怨头晕、不平衡和头晕干扰活动的时间百分比的视觉模拟量表测量；4)残疾；5)与平衡相关的信心；6)头部移动时的视力作为凝视稳定性的测量；7)动态步态指数作为跌倒风险的测量；8)首选步态速度；9)感觉组织测试作为姿势稳定性的测量。结果测量将在基线、出院以及物理治疗出院后1个月和6个月进行评估。 公共卫生相关性： 建议研究与退伍军人管理局患者护理使命的相关性：这项研究通过关注生活质量任务直接解决退伍军人管理局的使命。这十年，85岁及以上的退伍军人人数增加了两倍(vetdata，2010)。老年退伍军人，特别是85岁以上的退伍军人，是退伍军人中最脆弱的群体，他们遭受与跌倒有关的伤害的风险最高。2001年退伍军人管理局因跌倒而受伤的门诊费用估计，仅第一次就诊就接近330万美元(路德，2005年)。通过减少跌倒事件，从而减少与跌倒相关的伤害，可以节省大量经济开支的潜力是显而易见的。考虑到跌倒的发生率随着年龄的增长而增加，以及与跌倒相关的发病率，这项研究的结果将与相当数量的退伍军人相关。这项拟议的研究有可能开发新的康复方法，以降低患有头晕的老年退伍军人跌倒的风险。该项目将有助于提高老年人的生活质量和控制医疗费用。