Vestibular rehabilitation and dizziness in geriatric patients

老年患者的前庭康复和头晕

• 批准号: 9130600
• 负责人: COURTNEY HALL
• 金额: --
• 依托单位: JAMES H QUILLEN VA MEDICAL CENTER
• 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/9130600
• 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; Gait speed; 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; Symptoms; Testing; Time; Vestibular Diseases; Vestibular loss; Veterans; Visit; Visual; Visual Acuity; age related; analog; conditioning; cost; design; disability; equilibration disorder; exercise intervention; fall risk; falls; gait rehabilitation; gaze; high risk; human very old age (85+); improved; indexing; novel; older patient; otoconia; programs; reduce symptoms; symptomatic improvement

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常见的症状之一，头晕的发生率随着年龄的增长而增加。头晕对临床医生来说是一个诊断和治疗的挑战，因为它是一种主观感觉，可以指多种症状（不稳定、旋转、运动感或头晕），并且有多种潜在的促成因素。头晕通常与前庭病理有关，可以通过以下方法有效治疗： 前庭练习。不幸的是，很大一部分头晕患者 (2 - 40%) 从未得到头晕原因的诊断。成功治疗头晕至关重要，因为头晕是老年人跌倒的主要危险因素。这项研究的目标是为患有非前庭性头晕的老年人开发新颖的运动干预措施。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——无论是头晕还是跌倒风险增加。那么，我们的问题是，对患有前庭病变的患者有益的相同练习是否也对患有头晕但前庭功能正常的老年患者有益。已经证实，前庭锻炼可以减少前庭功能减退患者的头晕并改善姿势稳定性。 然而，目前尚不清楚前庭锻炼是否对患有头晕、容易跌倒但没有前庭病变的老年人有益。亚德利等人。研究发现，前庭康复可以减轻主要主诉头晕的个体的症状并增加姿势稳定性。 这些研究的局限性在于大多数患者没有特定的 诊断他们头晕的根本原因。因此，尚不清楚前庭运动是否有效，因为患者患有未确诊的前庭病理，或者前庭运动对于没有前庭病理的患者是否是一种有效的运动方法。鉴于跌倒发生率随着年龄的增长以及相关的发病率而增加，这项研究的结果将与大量退伍军人相关。具体目标 1：检查前庭锻炼在多大程度上可以增强无前庭病理的头晕老年人的康复效果。我们假设前庭锻炼将比安慰剂锻炼更大程度地减轻症状和跌倒风险，并在更大程度上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，通过视觉模拟量表、平衡相关置信量表、动态步态指数和步态速度测量，前庭锻炼的益处在出院后仍将保留，并且改善的保留将与家庭锻炼依从性相关。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，而视线稳定性的改善将预测跌倒风险的降低。因平衡和步态障碍而被转介接受物理治疗的非前庭头晕（即前庭功能正常，定义为正常水平半规管和耳石功能）的老年人 (n = 70) 将被随机分配接受 1) 前庭锻炼或 2) 安慰剂眼动锻炼。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) 视觉模拟量表测量主观主诉头晕、不平衡以及头晕干扰活动的时间百分比； 4）残疾； 5）与平衡相关的信心； 6) 头部运动时的视力作为注视稳定性的衡量标准； 7）动态步态指数作为跌倒风险的衡量标准； 8）优选的步态速度； 9）感觉组织测试作为姿势稳定性的衡量标准。将在基线、出院以及物理治疗出院后 1 个月和 6 个月时评估结果指标。