Vestibular rehabilitation and dizziness in geriatric patients

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。头晕是一种主观感觉，可以指多种症状，因此对临床医生来说，头晕的诊断和治疗是一个挑战。（不稳定、旋转、运动感或头晕），并且有许多潜在的促成因素。头晕通常与前庭病理有关，前庭练习可以有效地治疗这种病理。不幸的是，很大一部分头晕患者（2 - 40%）从未接受过头晕原因的诊断。成功地管理头晕是至关重要的，因为头晕是老年人福尔斯跌倒的主要危险因素。本研究的目的是为老年人非前庭性头晕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病理性前庭功能丧失的结果之间存在相似之处--无论是头晕的主诉还是福尔斯的风险增加。因此，我们的问题是，对前庭病变患者有益的相同锻炼是否对前庭功能正常但头晕的老年患者有益。已经确定前庭练习可以减少前庭功能减退患者的头晕并改善其姿势稳定性。 然而，对于有福尔斯危险但没有前庭病变的老年人来说，前庭锻炼是否有益还不清楚。亚德利等人发现，前庭康复可以减轻症状，增加以头晕为主诉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异性的 诊断他们头晕的根本原因。因此，目前尚不清楚前庭练习是否有效，因为患者有未诊断的前庭病理或前庭练习是否是一种有效的运动方法，为患者没有前庭病理。考虑到福尔斯的发病率随年龄增长而增加以及相关的发病率，本研究的结果将与大量退伍军人相关。具体目标1：检查前庭练习在多大程度上增强了无前庭病变的老年头晕患者的康复效果。我们假设，前庭练习将减少症状和跌倒的风险，并在更大程度上改善凝视和姿势稳定性比安慰剂练习。具体目标2：确定干预完成后症状改善和跌倒风险降低的程度。我们假设，前庭锻炼的好处将保留出院后的视觉模拟量表，平衡相关的信心量表，动态步态指数，和步态速度，并保留改善将与家庭锻炼的依从性。具体目标3：确定影响康复结果的因素。我们假设，运动依从性将预测康复结果，提高凝视稳定性将预测降低跌倒风险。老年人（n = 70）非前庭性头晕（即，正常的前庭功能，定义为正常的水平半规管和耳石功能）的患者将随机接受1）前庭锻炼或2）安慰剂眼球运动锻炼。所有受试者将接受标准步态和平衡训练。成果指标包括：1-3）头晕、不平衡和头晕干扰活动的时间百分比的主观主诉的视觉模拟量表测量; 4）残疾; 5）平衡相关的信心; 6）头部运动期间的视敏度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）优选步态速度; 9）感觉组织测试作为姿势稳定性的测量。将在基线、出院、物理治疗出院后1个月和6个月评估结局指标。

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.