CENC - Otolith Dysfunction and Postural Stability

CENC - 耳石功能障碍和姿势稳定性

• 批准号: 8784313
• 负责人: Faith Wurm Akin
• 金额: --
• 依托单位: JAMES H QUILLEN VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-10-01 至 2017-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8784313
• 关键词: Acceleration; Address; Age; Anterior semicircular canal (body structure); Bilateral; Blast Cell; Caloric Tests; Caring; Characteristics; Classification; Clinic; Clinical; Clinical Protocols; Clinical assessments; Communities; Complex; Control Groups; Data; Development; Diagnosis; Dizziness; Economics; Elderly; Enrollment; Equilibrium; Exercise; Force of Gravity; Functional disorder; Gait; Gender; Goals; Head; Head Movements; Health; Healthcare; Impairment; Incidence; Individual; Injury; International; Irrigation; Labyrinth; Lead; Lesion; Life; Measurement; Measures; Medical; Mission; Modeling; Nerve; Noise; Organ; Outpatients; Patient Care; Patient Self-Report; Patients; Peripheral; Population; Primary Health Care; Provider; Quality of life; Questionnaires; Rehabilitation therapy; Relative (related person); Research; Risk Factors; Saccule and Utricle; Savings; Semicircular canal structure; Sensory; Site; Structure; Symptoms; System; Testing; Traumatic Brain Injury; Vertigo; Vestibular Nerve; Vestibular loss; Veterans; Visit; Visual; Visual Acuity; Work; balance testing; base; clinically significant; cost; design; disability; equilibration disorder; fall risk; falls; gaze; improved; meetings; novel strategies; novel therapeutic intervention; organizational structure; otoconia; public health relevance; rehabilitation strategy; sensory integration; vestibulo-ocular reflex

DESCRIPTION (provided by applicant): Recent advances have led to the development of clinical tests that provide site-of-lesion information about vestibular (inner ear balance) function in patients suffering from dizziness or imbalance. Specifically, the vestibular evoked myogenic potential (VEMP) supplements the vestibular test battery by providing information about otolith organ function (a type of vestibular sensory organ). Although VEMPs are becoming more widely used in vestibular clinics throughout the world, the clinical significance of otolith organ dysfunction is unclear. The purpose of this study is to determine the consequences of otolith organ dysfunction on postural stability. These findings may lead to the development of novel approaches for patients with otolith organ dysfunction. The vestibular system is comprised of two types of sensory organs (semicircular canals and otolith organs) with unique contributions to balance. Loss of vestibular function can occur in one or both labyrinths, in one or both branches of the vestibular nerve, and in one or more vestibular sensory organs. Symptoms of vestibular loss include postural instability, visual blurring, and dizziness and/or imbalance. Moreover, the incidence of falls is greater in individuals with vestibular loss than in healthy individuals of the same age. The incidence of dizziness and imbalance increases in populations relevant to VA healthcare: older adults and individuals with traumatic brain injury (TBI). Preliminary data suggest that otolith dysfunction is prevalent in Veterans with TBI. Most research examining the effect of peripheral vestibular dysfunction on postural stability have used measurements of horizontal semicircular canals (hSCC) to determine vestibular loss (e.g., Herdman et al., 2000), because conventional vestibular clinical assessment has been limited to caloric or rotational testing (tests of hSCC/superior vestibular nerve function). Thus, it is unclear how dysfunction in other components of the vestibular system contributes to postural instability, and importantly, the incidence of falls. The use of tests of otolith function in addition to the tests of hSCC function provide the ability to differentiate vestibular end organ, and better explain the effect of peripheal vestibular loss on postural instability. Vestibular rehabilitation includes gaze stability exercise based on principles of adaptation of the vestibulo-ocular reflex (or semicircular canal); therefore this study has important implications for rehabilitation of patients with otolith dysfunction. The International Classification of Functioning, Disability, and Health (ICF) model will provide an organizational structure for the study to examine the complex relationships between "Health Condition" (in the proposed study, this refers to the specific vestibular groups: canal dysfunction otolith dysfunction, canal + otolith dysfunction), the components of health, and the context. The specific domains of the ICF include: body function and structure (body level); activity (individual level) and participation (societal level). Importantly, the ICF model considers both environmental and personal factors that impact function and disability. The specific aims are designed to determine the effect of otolith dysfunction on postural stability at the levels of impairment (Specific Aim 1), activity and participation (Specific Aim 2), and determine the interaction of age and otolith dysfunction on postural stability (Specific Aim 3). To address these aims, 5 groups of Veterans based on vestibular site-of-lesion tests (3 vestibular groups and 2 control groups) will be enrolled in the study (n = 124). Three vestibular groups will include Veterans complaining of dizziness and/or imbalance with: (1) horizontal semicircular canal (hSCC) dysfunction only (Canal Only), (2) otolith dysfunction only (Otolith Only), and (3) hSCC and otolith dysfunction (Canal+Otolith). The control groups will include (1) Veterans complaining of dizziness and/or imbalance with normal hSCC and otolith function (Dizzy Control) and (2) age- and gender- matched Veterans with no complaints of dizziness and/or imbalance and normal hSCC and otolith function (Healthy Control). To address the specific aims, balance measures, gait and mobility measures and self-report questionnaires will be compared between vestibular groups and across a wide age range.

描述(由申请人提供)： 最近的进展导致了临床测试的发展，这些测试提供了关于头晕或失衡患者的前庭(内耳平衡)功能的病变部位信息。特别是，前庭诱发肌源性电位(VEMP)通过提供有关耳石器官功能(前庭的一种类型)的信息来补充前庭测试电池 感觉器官)。虽然VEMP在世界各地的前庭诊所得到了越来越广泛的应用，但耳石器官功能障碍的临床意义尚不清楚。本研究的目的是确定耳石器官功能障碍对姿势稳定性的影响。这些发现可能会为耳石器官功能障碍患者开发新的治疗方法。前庭系统由两种类型的感觉器官(半规管和耳石器官)组成，对平衡有独特的贡献。前庭功能丧失可发生在一个或两个迷路，一个或两个前庭神经分支，以及一个或多个前庭感觉器官。前庭缺失的症状包括姿势不稳、视觉模糊、头晕和/或失衡。此外，前庭功能丧失的人跌倒的发生率比同龄的健康人更高。在与退伍军人管理局医疗保健相关的人群中，头晕和失衡的发生率增加：老年人和患有创伤性脑损伤(TBI)的个人。初步数据显示，退伍军人脑外伤患者普遍存在耳石功能障碍。大多数研究外周前庭功能障碍对姿势稳定性的影响的研究都使用水平半规管(HSCC)的测量来确定前庭丢失(例如，Herdman等人，2000)，因为传统的前庭临床评估仅限于冷热或旋转测试(HSCC/前庭上神经功能测试)。因此，目前还不清楚前庭系统其他部分的功能障碍如何导致姿势不稳定，更重要的是，摔倒的发生率。除HSCC功能检测外，耳石功能检测还能区分前庭终末器官，更好地解释外周前庭功能丧失对姿势不稳定的影响。前庭康复包括基于前庭-眼反射(或半规管)适应原理的凝视稳定训练，因此本研究对耳石功能障碍患者的康复具有重要意义。国际功能、残疾和健康分类(ICF)模式将为这项研究提供一个组织结构，以研究“健康状况”(在拟议的研究中，这指的是特定的前庭群体：耳石功能障碍、耳石功能障碍和前庭功能障碍)、健康的组成部分和背景之间的复杂关系。ICF的具体领域包括：身体功能和结构(身体水平)；活动(个人 (社会层面)和参与(社会层面)。重要的是，ICF模型同时考虑了影响功能和残疾的环境和个人因素。这些特定目标旨在确定耳石功能障碍在损害(特定目标1)、活动和参与(特定目标2)水平上对姿势稳定性的影响，并确定年龄的交互作用。 和耳石功能障碍对姿势稳定性的影响(特定目标3)。为了达到这些目标，基于前庭病变部位试验的5组退伍军人(3组前庭和2组对照)将被纳入研究(n=124)。三个前庭组将包括主诉头晕和/或耳石失衡的退伍军人：(1)仅水平半规管(HSCC)功能障碍(仅耳道)，(2)仅耳石功能障碍(仅耳石)，以及(3)HSCC和耳石功能障碍(耳道+耳石)。对照组将包括(1)退伍军人主诉头晕和/或耳石功能正常的HSCC和耳石功能(眩晕控制)和(2)年龄和性别匹配的退伍军人，没有头晕和/或不平衡的主诉，HSCC和耳石功能正常(健康对照)。为了解决具体目标，平衡测量、步态和活动度测量以及自我报告问卷将在前庭群体之间和广泛的年龄范围内进行比较。