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Alghwiri, Alia, Ahmad Alghadir, and Susan L. Whitney. "The vestibular activities and participation measure and vestibular disorders." Journal of Vestibular Research 23, no. 6 (2013): 305–12. http://dx.doi.org/10.3233/ves-130474.
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Cohen, Helen, Maureen Kane-Wineland, Laura V. Miller, and Catherine L. Hatfield. "Occupation and Visual/Vestibular Interaction in Vestibular Rehabilitation." Otolaryngology–Head and Neck Surgery 112, no. 4 (April 1995): 526–32. http://dx.doi.org/10.1177/019459989511200404.
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Otolaryngologists often prescribe head movement exercise programs for patients with vestibular disorders, although the effectiveness of these programs and the critical features of the exercises are poorly understood. Because many patients who dislike exercising do not follow through with their exercises, alternatives to the traditional repetitive exercises would be useful. Subjects diagnosed with vestibular disorders were treated for 6 weeks with either an outpatient exercise program that incorporated interesting, purposeful activities or a simple home program of head movements, comparable with the exercises otolaryngologists often give their patients when they do not refer to rehabilitation. Both treatments incorporated repetitive head movements in all planes in space, graduated in size and speed. Subjects were all tested before and after treatment with standard measures of vestibulo-ocular reflex and balance, level of vertigo, gross motor skills, and self-care independence. Subjects in both groups improved significantly on the functional measures, with slightly greater improvements in the occupational therapy group. The results were maintained 3 months after the cessation of intervention. These data suggest that graded purposeful activities are a useful alternative for treating this patient population and that the essential factor in any exercise program is the use of repetitive head movements.
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Harun, Aisha, Yevgeniy R. Semenov, and Yuri Agrawal. "Vestibular Function and Activities of Daily Living." Gerontology and Geriatric Medicine 1 (July 31, 2015): 233372141560712. http://dx.doi.org/10.1177/2333721415607124.
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Demer, Joseph L., and Benjamin T. Crane. "Vision and vestibular adaptation." Otolaryngology–Head and Neck Surgery 119, no. 1 (July 1998): 78–88. http://dx.doi.org/10.1016/s0194-5998(98)70176-7.
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This article summarizes six recent degree-of-freedom studies of visual-vestibular interaction during natural activities and relates the findings to canalotolith interactions evaluated during eccentric axis rotations. Magnetic search coils were used to measure angular eye and head movements of young and elderly subjects. A flux gate magnetometer was used to measure three-dimensional head translation. Three activities were studied: standing quietly, walking in place, and running in place. Each activity was evaluated with three viewing conditions: a visible target viewed normally, a remembered target in darkness, and a visible target viewed with x2 binocular telescopic spectacles. Canal-otolith interaction was assessed with passive, whole-body, transient, and steady-state rotations in pitch and yaw at multiple frequencies about axes that were either oculocentric or eccentric to the eyes. For each rotational axis, subjects regarded visible and remembered targets located at various distances. Horizontal and vertical angular vestibulo-ocular reflexes were demonstrable in all subjects during standing, walking, and running. When only angular gains were considered, gains in both darkness and during normal vision were less than 1.0 and were generally lower in elderly than in young subjects. Magnified vision with x2 telescopic spectacles produced only small gain increases as compared with normal vision. During walking and running all subjects exhibited significant mediolateral and dorsoventral head translations that were antiphase locked to yaw and pitch head movements, respectively. These head translations and rotations have mutually compensating effects on gaze in a target plane for typical viewing distances and allow angular vestibulo-ocular reflex gains of less than 1.0 to be optimal for gaze stabilization during natural activities. During passive, whole-body eccentric pitch and yaw head rotations, vestibulo-ocular reflex gain was modulated as appropriate to stabilize gaze on targets at the distances used. This modulation was evident within the first 80 msec of onset of head movement, too early to be caused by immediate visual tracking. Modeling suggests a linear interaction between canal signals and otolith signals scaled by the inverse of target distance. Vestibulo-ocular reflex performance appears to be adapted to stabilize gaze during translational and rotational perturbations that occur during natural activities, as is appropriate for relevant target distances. Although immediate visual tracking contributes little to gaze stabilization during natural activities, visual requirements determine the performance of vestibulo-ocular reflexes arising from both canals and otoliths. (Otolaryngol Head Neck Surg 1998;119:78-88.)
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Cohen, Helen S., and Kay T. Kimball. "Increased Independence and Decreased Vertigo after Vestibular Rehabilitation." Otolaryngology–Head and Neck Surgery 128, no. 1 (January 2003): 60–70. http://dx.doi.org/10.1067/mhn.2003.23.
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OBJECTIVE: We sought to determine the effectiveness in decreasing some symptoms, such as vertigo, and increasing performance of daily life skills after vestibular rehabilitation. STUDY DESIGN AND SETTING: Patients who had chronic vertigo due to peripheral vestibular impairments were seen at a tertiary care center. They were referred for vestibular rehabilitation and were assessed on vertigo intensity and frequency with the use of the Vertigo Symptom Scale, the Vertigo Handicap Questionnaire, the Vestibular Disorders Activities of Daily Living Scale, and the Dizziness Handicap Inventory. They were then randomly assigned to 1 of 3 home program treatment groups. RESULTS: Vertigo decreased and independence in activities of daily living improved significantly. Improvement was not affected by age, gender, or history of vertigo. CONCLUSION: For many patients a simple home program of vestibular habituation head movement exercises is related to reduction in symptoms and increasing independence in activities of daily living.
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Appiah-Kubi, Kwadwo Osei, Anne Galgon, Ryan Tierney, Richard Lauer, and W. Geoffrey Wright. "Effects of Vestibular Training on Postural Control of Healthy Adults." CommonHealth 1, no. 1 (April 2, 2020): 31–36. http://dx.doi.org/10.15367/ch.v1i1.299.
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Background: Postural stability depends on the integration of multisensory inputs to drive motor outputs. When visual and somatosensory input is available and reliable, this reduces the postural control system’s reliance on the vestibular system. Despite this, vestibular loss can still cause severe postural dysfunction (1,2). Training one or more of the three sensory systems can alter sensory weighting and change postural behavior. Vestibular activation exercises, including horizontal and vertical headshaking, influence vestibular-ocular and -motor responses and have been showed to be effective in vestibular rehabilitation (3–8).
Purpose/Hypothesis: To assess sensory reweighting of postural control processing and vestibular-ocular and -motor responses after concurrent vestibular activation with postural training. It was hypothesized that the effect of this training would significantly alter the pattern of sensory weighting by changing the ratio of visual, somatosensory and vestibular dependence needed to maintain postural stability, and significantly decrease vestibular responses.
Methods: Forty-two young healthy individuals (22 females; 23.0+3.9 years; 1.6+0.1 meters) were randomly assigned into four groups: 1) visual feedback weight shift training (WST) coupled with an active horizontal headshake (HHS), 2) same WST with vertical headshake (VHS), 3) WST with no headshake (NHS) and 4) no training/headshake control (CTL) groups. The headshake groups performed an intensive body WST together with horizontal or vertical rhythmic headshake at 80 to 120 beats/minute. The NHS group performed the WST with no headshake while the controls did not perform any training. Five 15-minute training sessions were performed on consecutive days for one week with the weight shift exercises involving upright limits of stability activities on a flat surface, foam or rocker board (Fig. 1). All groups performed baseline- and post-assessments including sensory organization test (SOT) and force platform ramp perturbations, coupled with electromyographic (EMG) recordings. A video head impulse test was also used to record horizontal vestibulo-ocular reflex (VOR) gain. A between- and within-group repeated measures ANOVA was used to analyze five COP sway variables, the equilibrium and composite scores and sensory ratios of the SOT as well as EMG signals and horizontal VOR gain. Similarly, COP variables, EMG, as well as vestibular reflex data (vertical VOR, vestibulo-collic reflex [VCR] and vestibulo-spinal [VSR] gains) during ramp perturbations were analyzed. Alpha level was set at p<.05.
Results: The training showed a significant somatosensory downweighting (p=.050) in the headshake groups compared to the other groups. Training also showed significant decreased horizontal VOR gain (p=.040), faster automatic postural response (p=.003) (Figs. 2-4) with improved flexibility (p=.010) in the headshake groups. Muscle activation pattern in medial gastrocnemius (p=.033) was significantly decreased in the headshake.
Conclusion: The concurrent vestibular activation and weight shift training modifies vestibular-dependent responses after the training intervention as evidenced in somatosensory downweighting, decreased VOR gain, better postural flexibility and faster automatic postural response. Findings suggest this is predominantly due to vestibular adaptation and habituation of VOR, VCR and VSR which induced sensory reweighting.
Clinical relevance: Findings may be used to guide the development of a vestibular-postural rehabilitation intervention in impaired neurological populations, such as with vestibular disorders or sensory integration problems.
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Pikatan, Orlando, I. Ketut Sumada, Ni Ketut Candra Wiratmi, and Desie Yuliani. "Vestibular Disorder Approach Base on International Classification of Vestibular Disorder." AKSONA 2, no. 1 (March 29, 2022): 34–39. http://dx.doi.org/10.20473/aksona.v2i1.206.
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Vestibular symptoms are symptoms that interfere with daily activities. Diagnosing these symptoms often relies on radiologic examinations that lead to a false negative. Proper clinical approach and study showed higher accuracy than radiologic examination on vestibular disease. These clinical approaches are based on time, triggers, and targeted analysis. The new vestibular symptoms will be classified into acute vestibular syndrome, episodic vestibular syndrome, and chronic vestibular syndrome. An acute vestibular syndrome is a vestibular symptom that lasts for days up to weeks. The episodic vestibular syndrome is vestibular symptoms that periodically appear. The chronic vestibular syndrome is a vestibular symptom that appears from months to years. Diagnosing vestibular symptoms must be precisely made. The proper termination is the best way to facilitate doctors in communicating with each other. Using this classification is a precise and easy way to detect vestibular etiology. This review is made for clinicians to determine and differentiate the etiology of the vestibular syndrome and gives information in uniforming nomenclature of vestibular symptoms.
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Hoffman, Donna L., Dennis P. O'Leary, and Dennis J. Munjack. "Autorotation Test Abnormalities of the Horizontal and Vertical Vestibulo-Ocular Reflexes in Panic Disorder." Otolaryngology–Head and Neck Surgery 110, no. 3 (March 1994): 259–69. http://dx.doi.org/10.1177/019459989411000302.
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Patients with panic disorder often describe dizziness as a disturbing symptom, with more severe episodes reported than in other psychiatric populations. Nineteen patients diagnosed as having a panic disorder were tested for vestibulo-ocular (VOR) abnormalities with the Vestibular Autorotation Test (VAT), a computerized test of the high-frequency (2 to 6 Hz) VOR. The patients were unselected for the presence or absence of balance disorders. Results showed VOR abnormalities, relative to a normal population, in the horizontal and/or vertical VORs of all 19 patients. Vestibulo-ocular reflex asymmetries were commonly present. Because the VAT tested the VOR over a frequency range encountered during common daily activities, the observed abnormalities could result in a perceptually moving visual field (oscillopsia). We hypothesize that the resulting experience of a visual-vestibular disturbance—perhaps in a biologically or psychologically predisposed individual—is catastrophically misinterpreted, leading to more bodily symptoms and anxiety. These could then contribute to more misinterpretation in a positive feedback sense, ultimately leading to a panic attack.
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Shepard, Neil T., and Steven A. Telian. "Programmatic Vestibular Rehabilitation." Otolaryngology–Head and Neck Surgery 112, no. 1 (January 1995): 173–82. http://dx.doi.org/10.1016/s0194-59989570317-9.
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Although the use of vestibular exercises for patients with persistent vertigo and dysequilibrium has received some attention for many years, organized vestibular rehabilitation therapy programs have only recently been introduced. The benefits of such programs are becoming widely accepted. They typically involve a three-pronged approach: habituation exercises designed to facilitate central nervous system compensation by extinguishing pathologic responses to head motion, postural control exercises, and general conditioning activities. This article will describe the programmatic approach to vestibular rehabilitation, emphasizing selection criteria and reviewing results that may be anticipated when this treatment modality is used in a variety of patient populations.
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Wang, Lin, Omid A. Zobeiri, Jennifer L. Millar, Wagner Souza Silva, Michael C. Schubert, and Kathleen E. Cullen. "Continuous Head Motion is a Greater Motor Control Challenge than Transient Head Motion in Patients with Loss of Vestibular Function." Neurorehabilitation and Neural Repair 35, no. 10 (August 8, 2021): 890–902. http://dx.doi.org/10.1177/15459683211034758.
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Background. The vestibular system is vital for gaze stability via the vestibulo-ocular reflex, which generates compensatory eye motion in the direction opposite to head motion. Consequently, individuals with peripheral vestibular loss demonstrate impaired gaze stability that reduces functional capacity and quality of life. To facilitate patients’ compensatory strategies, two classes of gaze stabilization exercises are often prescribed: (i) transient (eg, ballistic) and (ii) continuous. However, the relative benefits of these two classes of exercises are not well understood. Objective. To quantify head motion kinematics in patients with vestibular loss while they performed both classes of exercises. Methods. Using inertial measurement units, head movements of 18 vestibular schwannoma patients were measured before and after surgical deafferentation and compared with age-matched controls. Results. We found that the head movement during both classes of exercises paralleled those of natural head movement recorded during daily activities. However, head movement patterns were more informative for continuous than transient exercises in distinguishing patients from healthy controls. Specifically, we observed coupling between kinematic measures in control subjects that was absent in patients for continuous but not transient head motion exercises. In addition, kinematic measures (eg, cycle duration) were predictive of standard clinical measures for continuous but not transient head motion exercises. Conclusions. Our data suggest that performing continuous head motion is a greater motor control challenge than transient head motion in patients with less reliable vestibular feedback during the sub-acute stage of recovery, which may also prove to be a reliable measure of progression in vestibular rehabilitation protocols.
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Rinaudo, Carlo N., Michael C. Schubert, Phillip D. Cremer, William V. C. Figtree, Christopher J. Todd, and Americo A. Migliaccio. "Improved Oculomotor Physiology and Behavior After Unilateral Incremental Adaptation Training in a Person With Chronic Vestibular Hypofunction: A Case Report." Physical Therapy 99, no. 10 (June 13, 2019): 1326–33. http://dx.doi.org/10.1093/ptj/pzz083.
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Abstract Background and Purpose Traditional vestibular rehabilitation therapies are effective in reducing vestibular hypofunction symptoms, but changes to the vestibulo-ocular reflex (VOR) are minimal. This controlled case report describes an increase in VOR after 6 months of incremental VOR adaptation (IVA) training in a person with chronic unilateral vestibular hypofunction. Case Description The participant was a 58-year-old female with a confirmed (Neurologist P.D.C.) left vestibular lesion stable for 2 years prior to entering a clinical trial examining the effects of daily IVA training. She was evaluated monthly for self-reported symptoms (dizziness handicap inventory), VOR function (video head impulse test), and VOR behavior (Dynamic Visual Acuity test). Intervention consisted of 6 months of 15 minutes per day unassisted training using the IVA training regime with a device developed in our laboratory. The take-home device enables the VOR response to gradually normalize on the ipsilesional side via visual-vestibular mismatch training. The intervention was followed by a 6-month wash-out and 3-month control period. The control condition used the same training device set to function like standard VOR training indistinguishable to the participant. Outcomes After the intervention, ipsilesional VOR function improved substantially. The VOR adapted both via a 52% increase in slow-phase response and via 43% earlier onset compensatory saccades for passive head movements. In addition, the participant reported fewer symptoms and increased participation in sports and daily activities. Discussion Here, a participant with chronic vestibular hypofunction showing improved oculomotor performance atypical for traditional vestibular rehabilitation therapies, subsequent to using the newly developed IVA technique, is presented. It is the first time to our knowledge an improvement of this magnitude has been demonstrated as well as sustained over an extended period of time.
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Kozlovskaya, I. B., B. A. Lapin, N. V. Miller, and A. M. Badakva. "RUSSIAN VESTIBULAR INVESTIGATIONS WITH PRIMATES IN FLIGHTS OF THE BIOSATELLITES." Aerospace and Environmental Medicine 54, no. 6 (2020): 110–16. http://dx.doi.org/10.21687/0233-528x-2020-54-6-110-116.
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The BION program with primates included 2 vestibular studies one was focused on coordination of the eye and head movements and activities of the medial vestibular nuclei and cerebellum flocculus during angular head movements in the horizontal plane for gaze fixation and the other, on the central vestibular neurons and otolith-induced cardiac rhythm reaction during linear displacement about the body axis. Sensitivity of the central vestibular neurons to both angular and linear accelerations was found to increase at the beginning of microgravity and then normalized gradually, whereas the flocculus activity remained high throughout the mission.
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Erbele, Isaac D., Sara G. MacDowell, and Moisés A. Arriaga. "Can Dizziness Handicap Inventory and Activities-Specific Balance Confidence Scores Assess Vestibular Loss After Vestibular Schwannoma Excision?" Otology & Neurotology 41, no. 10 (December 2020): 1427–32. http://dx.doi.org/10.1097/mao.0000000000002842.
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Blouin, Jean-Sébastien, Christopher J. Dakin, Kees van den Doel, Romeo Chua, Bradford J. McFadyen, and John Timothy Inglis. "Extracting phase-dependent human vestibular reflexes during locomotion using both time and frequency correlation approaches." Journal of Applied Physiology 111, no. 5 (November 2011): 1484–90. http://dx.doi.org/10.1152/japplphysiol.00621.2011.
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Daily activities, such as walking, may require dynamic modulation of vestibular input onto motoneurons. This dynamic modulation is difficult to identify in humans due to limitations in the delivery and analysis of current vestibular probes, such as galvanic vestibular stimulation. Stochastic vestibular stimulation, however, provides an alternative method to extract human vestibular reflexes. Here, we used time-dependent coherence and time-dependent cross-correlation, coupled with stochastic vestibular stimulation, to investigate the phase dependency of human vestibular reflexes during locomotion. We found that phase-dependent activity from the medial gastrocnemius muscles is correlated with the vestibular signals over the 2- to 20-Hz bandwidth during the stance phase of locomotion. Vestibular-gastrocnemius coherence and time-dependent cross-correlations reached maximums at 21 ± 4 and 23 ± 8% of the step cycle following heel contact and before the period of maximal electromyographic activity (38 ± 5%). These results demonstrate 1) the effectiveness of these techniques in extracting the phase-dependent modulation of vestibulomuscular coupling during a cyclic task; 2) that vestibulomuscular coupling is phasically modulated during locomotion; and 3) that the period of strongest vestibulomuscular coupling does not correspond to the period of maximal electromyographic activity in the gastrocnemius. Therefore, we have shown that stochastic vestibular stimulation, coupled with time-frequency decomposition, provides an effective tool to assess the contribution of vestibular ex-afference to the muscular control during locomotion.
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Cohen, Helen S., Kay T. Kimball, and Angela S. Adams. "Application of the Vestibular Disorders Activities of Daily Living Scale." Laryngoscope 110, no. 7 (2000): 1204–9. http://dx.doi.org/10.1097/00005537-200007000-00026.
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Cohen, Helen S., and Kay T. Kimball. "Development of the Vestibular Disorders Activities of Daily Living Scale." Archives of Otolaryngology–Head & Neck Surgery 126, no. 7 (July 1, 2000): 881. http://dx.doi.org/10.1001/archotol.126.7.881.
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Bai, Jianying, Xin He, Yi Jiang, Tao Zhang, and Min Bao. "Rotating One’s Head Modulates the Perceived Velocity of Motion Aftereffect." Multisensory Research 33, no. 2 (January 8, 2020): 189–212. http://dx.doi.org/10.1163/22134808-20191477.
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Abstract As a prominent illusion, the motion aftereffect (MAE) has traditionally been considered a visual phenomenon. Recent neuroimaging work has revealed increased activities in MT+ and decreased activities in vestibular regions during the MAE, supporting the notion of visual–vestibular interaction on the MAE. Since the head had to remain stationary in fMRI experiments, vestibular self-motion signals were absent in those studies. Accordingly, more direct evidence is still lacking in terms of whether and how vestibular signals modulate the MAE. By developing a virtual reality approach, the present study for the first time demonstrates that horizontal head rotation affects the perceived velocity of the MAE. We found that the MAE was predominantly perceived as moving faster when its direction was opposite to the direction of head rotation than when its direction was the same as head rotation. The magnitude of this effect was positively correlated with the velocity of head rotation. Similar result patterns were not observed for the real motion stimuli. Our findings support a ‘cross-modal bias’ hypothesis that after living in a multisensory environment long-term the brain develops a strong association between signals from the visual and vestibular pathways. Consequently, weak biasing visual signals in the associated direction can spontaneously emerge with the input of vestibular signals in the multisensory brain areas, substantially modulating the illusory visual motion represented in those areas as well. The hypothesis can also be used to explain other multisensory integration phenomena.
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Appiah-Kubi, Kwadwo O., Evan Laing, and Masudul H. Imtiaz. "A Study Protocol to Evaluate the Effects of Vestibular Training on the Postural Control of Healthy Adults Using Virtual Reality." Applied Sciences 12, no. 23 (November 23, 2022): 11937. http://dx.doi.org/10.3390/app122311937.
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Postural instability is a common symptom of vestibular dysfunction due to an insult to the vestibular system. Vestibular rehabilitation is effective in decreasing dizziness and visual symptoms, and improving postural control through several mechanisms, including sensory reweighting. As part of the sensory reweighting mechanisms, vestibular activation training with headshake activities influences vestibular reflexes. However, combining challenging vestibular and postural tasks to facilitate more effective rehabilitation outcomes is underutilized. Our research goal is to develop a virtual reality vestibular rehabilitation method for vestibular-postural control in neurological populations with vestibular and/or sensorimotor control impairment. The NeuroCom® SMART Balance Master (Natus Medical Inc., Pleasanton, CA, USA), which was used in a prior study, is expensive and bulky. Hence, a novel study protocol is established in this paper with the detailed objectives and pre-/post-intervention data analysis pipeline (ANOVA, t-test, post hoc analysis, etc.) involving modern off-the-shelf sensors and custom instrumentation (electromyography, electrooculography, video head impulse testing, force plates, and virtual reality headsets). It is expected that the training will significantly decrease vestibuloocular reflex gains and eye movement variability, as well as reweight the somatosensory ratio, finetune postural muscle activation, and consequently improve postural flexibility and produce a faster automatic postural response. The findings may have implications for the future development of vestibular rehabilitation protocols.
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Rine, Rose. "Vestibular Rehabilitation for Children." Seminars in Hearing 39, no. 03 (July 20, 2018): 334–44. http://dx.doi.org/10.1055/s-0038-1666822.
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AbstractThis article focuses on vestibular rehabilitation (VR) for children. Reports of the presence of vestibular dysfunction in infants, young children, and adolescents have increased over the past decade. In addition to being a comorbidity of sensorineural hearing loss, vestibular dysfunction has been noted in children with cytomegalovirus, late prematurity, and concussion, to name a few. Despite ample evidence and reports of VR for adults, the selection and provision of exercises to be included in the VR protocol for children vary, depending on the nature of the lesion, impairments identified, age at the time of lesion, and developmental factors such as critical periods of development and intermodality interdependence. Unlike adults, children with loss of function or hypofunction of the vestibular apparatus since or shortly after birth present with a developmental delay that is progressive. Very young children may not be able to describe symptoms but rather only avoid activities or cry. This report provides a review of vestibular-related impairments in children, determinants of the symptoms and functional impairments of vestibular dysfunction, the mechanisms of recovery in children, the challenges of VR for children, and a summary of research on the efficacy for VR for children.
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Ko, Li-Wei, Rupesh Kumar Chikara, Po-Yin Chen, Ying-Chun Jheng, Chien-Chih Wang, Yi-Chiang Yang, Lieber Po-Hung Li, Kwong-Kum Liao, Li-Wei Chou, and Chung-Lan Kao. "Noisy Galvanic Vestibular Stimulation (Stochastic Resonance) Changes Electroencephalography Activities and Postural Control in Patients with Bilateral Vestibular Hypofunction." Brain Sciences 10, no. 10 (October 15, 2020): 740. http://dx.doi.org/10.3390/brainsci10100740.
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Patients with bilateral vestibular hypofunction (BVH) often suffer from imbalance, gait problems, and oscillopsia. Noisy galvanic vestibular stimulation (GVS), a technique that non-invasively stimulates the vestibular afferents, has been shown to enhance postural and walking stability. However, no study has investigated how it affects stability and neural activities while standing and walking with a 2 Hz head yaw turning. Herein, we investigated this issue by comparing differences in neural activities during standing and walking with a 2 Hz head turning, before and after noisy GVS. We applied zero-mean gaussian white noise signal stimulations in the mastoid processes of 10 healthy individuals and seven patients with BVH, and simultaneously recorded electroencephalography (EEG) signals with 32 channels. We analyzed the root mean square (RMS) of the center of pressure (COP) sway during 30 s of standing, utilizing AMTI force plates (Advanced Mechanical Technology Inc., Watertown, MA, USA). Head rotation quality when walking with a 2 Hz head yaw, with and without GVS, was analyzed using a VICON system (Vicon Motion Systems Ltd., Oxford, UK) to evaluate GVS effects on static and dynamic postural control. The RMS of COP sway was significantly reduced during GVS while standing, for both patients and healthy subjects. During walking, 2 Hz head yaw movements was significantly improved by noisy GVS in both groups. Accordingly, the EEG power of theta, alpha, beta, and gamma bands significantly increased in the left parietal lobe after noisy GVS during walking and standing in both groups. GVS post-stimulation effect changed EEG activities in the left and right precentral gyrus, and the right parietal lobe. After stimulation, EEG activity changes were greater in healthy subjects than in patients. Our findings reveal noisy GVS as a non-invasive therapeutic alternative to improve postural stability in patients with BVH. This novel approach provides insight to clinicians and researchers on brain activities during noisy GVS in standing and walking conditions in both healthy and BVH patients.
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Cullen, Kathleen E., and Jefferson E. Roy. "Signal Processing in the Vestibular System During Active Versus Passive Head Movements." Journal of Neurophysiology 91, no. 5 (May 2004): 1919–33. http://dx.doi.org/10.1152/jn.00988.2003.
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In everyday life, vestibular receptors are activated by both self-generated and externally applied head movements. Traditionally, it has been assumed that the vestibular system reliably encodes head-in-space motion throughout our daily activities and that subsequent processing by upstream cerebellar and cortical pathways is required to transform this information into the reference frames required for voluntary behaviors. However, recent studies have radically changed the way we view the vestibular system. In particular, the results of recent single-unit studies in head-unrestrained monkeys have shown that the vestibular system provides the CNS with more than an estimate of head motion. This review first considers how head-in-space velocity is processed at the level of the vestibular afferents and vestibular nuclei during active versus passive head movements. While vestibular information appears to be similarly processed by vestibular afferents during passive and active motion, it is differentially processed at the level of the vestibular nuclei. For example, one class of neurons in vestibular nuclei, which receives direct inputs from semicircular canal afferents, is substantially less responsive to active head movements than to passively applied head rotations. The projection patterns of these neurons strongly suggest that they are involved in generating head-stabilization responses as well as shaping vestibular information for the computation of spatial orientation. In contrast, a second class of neurons in the vestibular nuclei that mediate the vestibuloocular reflex process vestibular information in a manner that depends principally on the subject's current gaze strategy rather than whether the head movement was self-generated or externally applied. The implications of these results are then discussed in relation to the status of vestibular reflexes (i.e., the vestibuloocular, vestibulocollic, and cervicoocular reflexes) and implications for higher-level processing of vestibular information during active head movements.
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Shin, Joo-eun, Jie-yoon Kang, Ji-hae Yang, Seo-young Won, Ho-ryong Yoo, Yoon-sik Kim, and In-chan Seol. "Korean Medicine Treatment for Anterior Inferior Cerebellar Artery Infarction: A Case Report." Journal of Internal Korean Medicine 43, no. 2 (May 31, 2022): 166–74. http://dx.doi.org/10.22246/jikm.2022.43.2.166.
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Objective: The aim of this study is to report the effectiveness of Korean medicine for a patient with dizziness following anterior inferior cerebellar artery infarction.Methods: The patient was treated with traditional Korean methods including acupuncture, herbal therapy, moxibustion, and vestibular rehabilitation exercise during an admission period of seven days. The patient’s dizziness was assessed using a numeric rating scale (NRS) and the Korean Dizziness Handicap Inventory (K-DHI), Korean Activities-specific Balance Confidence (K-ABC), Korean Vestibular Disorders Activities of Daily Living (K-VADL), the modified Rankin scale (mRS), and the Korean version of the Modified Barthel Index (K-MBI).Results: After seven days of combined treatment with traditional methods and vestibular rehabilitation, the patient’s dizziness was reduced from NRS 6-7 to NRS 2. In addition, K-DHI decreased from 84 to 22; K-ABC improved from 52% to 78.125%; K-VADL reduced from 175 to 37; the mRS score changed from 4 to 1; and the K-MBI score increased from 86 to 98. No adverse events were observed during treatment.Conclusion: This study suggests that combined therapy of Korean medicine and vestibular rehabilitation can be effective treatment for anterior inferior cerebellar artery infarction patients.
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Stoian, Sorina, Romeo Calarasu, and Madalina Georgescu. "Vestibular rehabilitation contribution to improvement of health-related quality of life in vestibular neuronitis." Romanian Journal of Neurology 11, no. 2 (June 30, 2012): 75–82. http://dx.doi.org/10.37897/rjn.2012.2.4.
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Objective. Our study aims to evaluate health-related quality of life (HRQoL) and reveal the actual benefit of vestibular rehabilitation (VR) in patients with vestibular neuronitis. Material and methods. Twenty four patients diagnosed with vestibular neuronitis in the Institute of Phono-Audiology and Functional ENT Surgery and Otomed Medical Center Bucharest were assigned to 2 groups who underwent 1 month of VR in the aforementioned settings. Group 1 included patients who started VR within first month of disease and group 2 comprised patients who began VR after more than a month from the onset of symptoms. Group 2 served as control group because they began VR after group 1 had already finished one month of VR. HRQoL was assessed before and after VR, using Dizziness Handicap Inventory (DHI), Activities-specific Balance Confidence scale (ABC), disability scale and Visual Analog Scale (VAS). Results. Both groups achieved statistically significant improvements in almost all questionnaires after VR (p <0.05). When group 1 scores after one month of VR were compared to control group results before VR, we found statistically significant differences in DHI-Physical, disability scale and VAS (p < 0.05). After one month of VR, 13 patients became symptom free, while 11 patients still had bothering symptoms and continued VR. The latter category revealed significantly higher DHI scores and levels of intensity of symptoms on VAS during first examination (p < 0.05). Conclusions. VR improves HRQoL after vestibular neuronitis and reduces self-perceived disability and intensity of symptoms during usual activities. Higher DHI and VAS scores at first evaluation may predict a longer VR period needed. The clinical and emotional benefit of VR overweight it’s costs and recommend it as a valuable method in the management of vestibular neuronitis.
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Huang, Q., D. Zhou, and W. M. St John. "Vestibular and cerebellar modulation of expiratory motor activities in the cat." Journal of Physiology 436, no. 1 (May 1, 1991): 385–404. http://dx.doi.org/10.1113/jphysiol.1991.sp018556.
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Alghwiri, Alia A., Susan L. Whitney, Carol E. Baker, Patrick J. Sparto, Gregory F. Marchetti, Joan C. Rogers, and Joseph M. Furman. "The Development and Validation of the Vestibular Activities and Participation Measure." Archives of Physical Medicine and Rehabilitation 93, no. 10 (October 2012): 1822–31. http://dx.doi.org/10.1016/j.apmr.2012.03.017.
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Șlicaru, Adina-Camelia, and Andra-Mihaela Nemțanu. "Vestibular Reeducation and Its Effectiveness in Reducing the Vertigo Symptoms." GYMNASIUM XX, no. 1 (September 18, 2019): 47. http://dx.doi.org/10.29081/gsjesh.2019.20.1.04.
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Vertigo is a symptom that is common to multiple disorders, from orthopedic and cardiovascular to neurological, affecting in many cases the patient's daily life activities. That is why, to help fight this symptom, this paper aims to prove the effectiveness of vestibular reeducation therapy. French Alain Semont introduced and developed the vestibular reeducation in 1968, his work being continued by Michel Toupet. Vestibular physical therapy took off around 49 years ago, while in Romania it is still quite a new method, much less explored by the Romanian experts. Currently there are few studies in this field, being a specialization that is almost non-existent among the Romanian therapists.
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Abasi, Amirabas, Parvin Raji, Joseph H. Friedman, Mohammad-Reza Hadian, Reza Hoseinabadi, Somaye Abbasi, and Ahmadreza Baghestani. "Effects of Vestibular Rehabilitation on Fatigue and Activities of Daily Living in People with Parkinson’s Disease: A Pilot Randomized Controlled Trial Study." Parkinson's Disease 2020 (September 10, 2020): 1–7. http://dx.doi.org/10.1155/2020/8624986.
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One of the most disabling nonmotor symptoms in persons with Parkinson’s disease is fatigue, which can decrease the quality of life by restricting the function and activities of daily living (ADL). Nonetheless, sufficient evidence for treating fatigue, including drug or nondrug treatment, is not available. In this study, we evaluated the probable effects of vestibular rehabilitation on fatigue and ADL in patients with Parkinson’s disease. Methods. This was a single-blind clinical trial study in which patients with Parkinson’s disease voluntarily participated based on the inclusion and exclusion criteria. The patients were randomly assigned to the case and control groups. The case group received 24 sessions of vestibular rehabilitation protocol, and conventional rehabilitation was performed in the control group (i.e., 3 sessions each week, each lasted about 60 minutes). Both groups were also given fatigue management advice. Fatigue was measured by the Parkinson Fatigue Scale (PFS) and the Modified Fatigue Impact Scale (MFIS). ADL was measured by the Functional Independence Measure (FIM). All changes were measured from the baseline at the completion of the intervention. Results. Both fatigue (P≤0.001) and ADL (P≤0.001) improved significantly more in the vestibular intervention group than in the control one. Conclusion. Vestibular rehabilitation may improve fatigue and ADL and therefore can be used as an effective intervention for patients with Parkinson’s disease, which was also found to be well tolerated.
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Cohen, Helen S. "Use of the Vestibular Disorders Activities of Daily Living Scale to describe functional limitations in patients with vestibular disorders." Journal of Vestibular Research 24, no. 1 (2014): 33–38. http://dx.doi.org/10.3233/ves-130475.
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Kim, Gyutae, Sangmin Lee, and Kyu-Sung Kim. "Repeated Galvanic Vestibular Stimulation Modified the Neuronal Potential in the Vestibular Nucleus." Neural Plasticity 2020 (May 27, 2020): 1–14. http://dx.doi.org/10.1155/2020/5743972.
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Vestibular nucleus (VN) and cerebellar flocculus are known as the core candidates for the neuroplasticity of vestibular system. However, it has been still elusive how to induce the artificial neuroplasticity, especially caused by an electrical stimulation, and assess the neuronal information related with the plasticity. To understand the electrically induced neuroplasticity, the neuronal potentials in VN responding to the repeated electrical stimuli were examined. Galvanic vestibular stimulation (GVS) was applied to excite the neurons in VN, and their activities were measured by an extracellular neural recording technique. Thirty-eight neuronal responses (17 for the regular and 21 for irregular neurons) were recorded and examined the potentials before and after stimulation. Two-third of the population (63.2%, 24/38) modified the potentials under the GVS repetition before stimulation (p=0.037), and more than half of the population (21/38, 55.3%) changed the potentials after stimulation (p=0.209). On the other hand, the plasticity-related neuronal modulation was hardly observed in the temporal responses of the neurons. The modification of the active glutamate receptors was also investigated to see if the repeated stimulation changed the number of both types of glutamate receptors, and the results showed that AMPA and NMDA receptors decreased after the repeated stimuli by 28.32 and 16.09%, respectively, implying the modification in the neuronal amplitudes.
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Jacobson, Gary P., and Jaynee H. Calder. "Self-Perceived Balance Disability/Handicap in the Presence of Bilateral Peripheral Vestibular System Impairment." Journal of the American Academy of Audiology 11, no. 02 (February 2000): 76–83. http://dx.doi.org/10.1055/s-0042-1748013.
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AbstractThe purpose of this report was to characterize the self-perceived balance disability/handicap of patients with bilateral reductions and bilateral complete losses of peripheral vestibular system function. Data from 72 patients whose electronystagmography and rotational examinations suggested normal, unilateral, or bilateral reductions in peripheral vestibular system function were used in the first investigation. Patients also completed a Dizziness Handicap Inventory (DHI). Results demonstrated significant group differences for DHI total and physical subscale scores. There were significant differences between normal and bilateral weakness groups for the total DHI score and between normal and unilateral and normal and bilateral weakness groups for the physical subscale score. In a second investigation, an item analysis of the DHI is presented for five patients with bilateral complete losses of peripheral vestibular system function. Results show that, predictably, these patients have difficulty engaging in activities requiring an intact vestibulocular reflex (e.g., physical activities such as sports, household chores). Abbreviations: BFT = Balance Function Test, DHI = Dizziness Handicap Inventory, maximum SPV = maximum slow-phase eye velocity, VOR = vestibulocular reflex
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Umezaki, Toshiro, Ken Nakazawa, and Alan D. Miller. "Behaviors of hypoglossal hyoid motoneurons in laryngeal and vestibular reflexes and in deglutition and emesis." American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 274, no. 4 (April 1, 1998): R950—R955. http://dx.doi.org/10.1152/ajpregu.1998.274.4.r950.
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Reflex responses of hypoglossal motoneurons innervating the geniohyoid (GH) and thyrohyoid (TH) muscles from the superior laryngeal (SLN) and vestibular nerves and their behaviors during fictive swallowing and vomiting were examined by recording both the extracellular activities of 11 single cells in the hypoglossal nucleus and GH and TH muscle nerve activity in eight decerebrate, paralyzed, and artificially ventilated cats. The majority of TH motoneurons were either active and/or exhibited shortened antidromic latencies during early expiration. In contrast, GH motoneurons did not exhibit any respiratory-related activity. Electrical single-shock stimulation of the SLN never evoked an excitatory reflex response on GH or TH motoneurons but rather evoked inhibitory responses on the THs. Unlike other hypoglossal motoneurons, GH and TH motoneurons do not appear to receive vestibular inputs. However, they can exhibit robust activities during fictive swallowing and vomiting, particularly during expulsion. Thus these motoneurons may play an important role in airway protection during swallowing and vomiting but not in controlling upper airway patency regulated by vestibular afferents.
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Whitney, S. L., M. T. Hudak, and G. F. Marchetti. "The activities-specific balance confidence scale and the dizziness handicap inventory: a comparison." Journal of Vestibular Research 9, no. 4 (August 1, 1999): 253–59. http://dx.doi.org/10.3233/ves-1999-9402.
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Vestibular dysfunction can have a tremendous impact on an individual’s quality of life. The purpose of this paper is to determine if the level of handicap reported by individuals on the Dizziness Handicap Inventory (DHI), an inventory developed for use with individuals with complaints of dizziness symptoms, will be consistent with that reported on the Activities-specific Balance Confidence Scale (ABC), a tool developed for use with elderly individuals that attempts to assess a person’s confidence level in performing activities of daily living (ADL’s). A sample of convenience was used consisting of 71 subjects (15 males and 56 females) from a local Balance and Vestibular Clinic. The subjects ranged in age from 26 to 88 years of age. Both the DHI and the ABC were administered as part of an initial physical therapy evaluation to new patients at the clinic. A moderately strong negative correlation was found between the scores of the two inventories ( r s = − 0.6350). The results suggest that the ABC is a valid tool for use with individuals with complaints of dizziness.
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Oster, Linda M., and Guangwei Zhou. "Balance and Vestibular Deficits in Pediatric Patients with Autism Spectrum Disorder: An Underappreciated Clinical Aspect." Autism Research and Treatment 2022 (August 16, 2022): 1–5. http://dx.doi.org/10.1155/2022/7568572.
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Children with autism spectrum disorder (ASD) not only have communication and social difficulties, but also exhibit poor balance and motor control ability, which frequently affect daily activities. Effective balance and motor control rely on the integration of somatosensory, visual, and vestibular inputs. Although reports of balance dysfunction in ASD have been documented, comprehensive studies of balance and vestibular function in children with ASD are scarce. In this study, we retrospectively reviewed 36 pediatric patients diagnosed with ASD who underwent balance/vestibular laboratory testing in our speciality clinic. Results from sensory organization test (SOT) or modified clinical test for sensory integration of balance (mCTSIB) found that out of 15 patients, 80% had abnormal findings. Of the children who successfully completed each vestibular test, abnormal responses were observed in 12 (80%) sensory organization tests, 5 (24%) vestibular evoked myogenic potential (VEMP), 22 (66%) videonystagmography (VNG), and 11 (32%) sinusoidal rotary chair tests. These results indicate that balance and vestibular testing may be of diagnostic value for clinicians and providers as an aid in early detection, intervention, and the development of appropriate management and therapies for this patient population. Increased awareness of this topic is warranted to promote better clinical management of this special group of patients and improve their quality of life.
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Lee, Chang-Joong, and Si-Nae Ahn. "Effects of Sensory Integration Therapy on Sensory Integration and Motor Development in Preschool-Age Children With Developmental Delays." Korean Society of Cognitive Therapeutic Exercise 14, no. 1 (June 30, 2022): 57–67. http://dx.doi.org/10.29144/kscte.2022.14.1.57.
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The purpose of this study was to investigate the effect of combining vestibular-proprioceptive activities, bilateral coordination exercises, and visual perception training on sensory integration function and motor development in preschool-age children with developmental delay. This study is a case report of two male children with developmental delay, and was conducted over 16 sessions. In the initial evaluation and re-evaluation, the patients underwent a sensory profile, a motor fitness test (Bruininks-Oseretsky test of Motor Proficiency-2), and the Canadian Occupational Performance Measure. Both sensory integration function and motor development were evaluated. During the intervention period, vestibular-proprioceptive activities were alternately combined with bilateral coordination exercises or visual perception training and performed for 40 minutes each. The differences between the initial evaluation and re-evaluation results of each patient were analyzed.
When sensory integration function and motor development results before and after the intervention were compared, the first patient demonstrated improvement in seven areas and the second in four areas in the sensory profile. In the exercise fitness test, both patients demonstrated improved scores in all areas. Thus, it was confirmed that vestibular-proprioceptive activities, when combined with bilateral coordination exercise and visual perception training, had a positive effect on sensory integration function and motor development for preschool-age children with developmental delay.
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Asmundson, Gordon J. G., Murray B. Stein, and Desmond Ireland. "A factor analytic study of the dizziness handicap inventory: does it assess phobic avoidance in vestibular referrals?" Journal of Vestibular Research 9, no. 1 (February 1, 1999): 63–68. http://dx.doi.org/10.3233/ves-1999-9108.
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Panic disorder and agoraphobia have been associated with increased functional disability in individuals who have vestibular problems. The Dizziness Handicap Inventory (DHI), a 25-item self-report questionnaire with three rationally derived subscales, was designed to measure functional, emotional, and physical disability associated with vestibular disturbance. Despite the apparent usefulness of the DHI, there have been few studies of its psychometric properties. The primary purpose of the present study was to assess the factor structure of the DHI. A principal components analysis with oblique rotation was conducted on data collected from 95 patients referred to a tertiary-care vestibular disorders clinic for assessment of vestibular disturbance. Both 2-factor and 3-factor solutions are reported. The 2-factor solution was indicative of General Functional Limitations and Postural Difficulties. In the 3-factor solution, General Functional Limitations was split into factors indicative of Disability in Activities of Daily Living and Phobic Avoidance, while the Postural Difficulties factor remained stable. We also characterized the 3-factor solution by assessing the correlation of factor scores with measures of vestibular symptoms, mood, and anxiety. The general pattern of results does not support the validity of the original subscale structure of the DHI. Implications for revising the DHI to provide a more comprehensive and factorially valid assessment of disability associated with vestibular disturbance are discussed.
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Aratani, Mayra Cristina, Natalia Aquaroni Ricci, Heloisa Helena Caovilla, and Fernando Freitas Ganança. "Brazilian version of the Vestibular Disorders Activities of Daily Living Scale (VADL)." Brazilian Journal of Otorhinolaryngology 79, no. 2 (March 2013): 203–11. http://dx.doi.org/10.5935/1808-8694.20130036.
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Anastasopoulos, Dimitri, Nausika Ziavra, and Adolfo M. Bronstein. "Large gaze shift generation while standing: the role of the vestibular system." Journal of Neurophysiology 122, no. 5 (November 1, 2019): 1928–36. http://dx.doi.org/10.1152/jn.00343.2019.
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The functional significance of vestibular information for the generation of gaze shifts is controversial and less well established than the vestibular contribution to gaze stability. In this study, we asked seven bilaterally avestibular patients to execute voluntary, whole body pivot turns to visual targets up to 180° while standing. In these conditions, not only are the demands imposed on gaze transfer mechanisms more challenging, but also neck proprioceptive input represents an inadequate source of head-in-space motion information. Patients’ body segment was slower and jerky. In the absence of visual feedback, gaze advanced in small steps, closely resembling normal multiple-step gaze-shift patterns, but as a consequence of the slow head motion, target acquisition was delayed. In ~25% of trials, however, patients moved faster but the velocity of prematurely emerging slow-phase compensatory eye movements remained lower than head-in-space velocity due to vestibuloocular failure. During these trials, therefore, gaze advanced toward the target without interruption but, again, taking longer than when normal controls use single-step gaze transfers. That is, even when patients attempted faster gaze shifts, exposing themselves to gaze instability, they acquired distant targets significantly later than controls. Thus, while patients are upright, loss of vestibular information disrupts not only gaze stability but also gaze transfers. The slow and ataxic head and trunk movements introduce significant foveation delays. These deficits explain patients’ symptoms during upright activities and show, for the first time, the clinical significance of losing the so-called “anticompensatory” (gaze shifting) function of the vestibuloocular reflex. NEW & NOTEWORTHY Previous studies in sitting avestibular patients concluded that gaze transfers are not substantially compromised. Still, clinicians know that patients are impeded (e.g., looking side to side before crossing a road). We show that during large gaze transfers while standing, vestibularly derived head velocity signals are critical for the mechanisms governing reorientation to distant targets and multisegmental coordination. Our findings go beyond the traditional role of the vestibular system in gaze stability, extending it to gaze transfers, as well.
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K V, Jinu, Archana R, and Mukkadan J K. "Vestibular stimulation induced alteration in glutamate levels improves memory and anxiety scores in scopolamine induced dementia rats." International Journal of Research in Pharmaceutical Sciences 11, SPL2 (April 30, 2020): 206–13. http://dx.doi.org/10.26452/ijrps.v11ispl2.2217.
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Glutamate is an excitatory neurotransmitter which is essential for cognition but, at the same time, a neurotoxin if accumulated beyond a certain level. The derangement of glutamate level in brain is closely associated with Alzheimer’s disease. Vestibular stimulation is known to stabilize various neuro-chemical transmission in central nervous system, especially effective in enhancing acetyl choline level and reduction of acetyl cholinesterase level. So the current study has undertaken to evaluate glutamate level in dementia and vestibular stimulation groups and its role in improving memory and anxiety scores. In the present study, 32 Wistar rats were used. Scopolamine was used to induce dementia and caloric stimulation (bilateral, unilateral right and unilateral left) was used stimulate vestibular system. Behavioral parameters like water maze used to asses memory and elevated plus maze was used to assess anxiety in our study. Glutamate was quantified by spectroflurimetry and histopathology of hippocampus and cortex were assessed. Caloric vestibular stimulation effectively reduced glutamate level near to normal values and this result reflected in increased memory scores in water maze and increased exploratory activities in elevated plus maze. Especially unilateral left vestibular stimulation has found beneficial in reducing glutamate level. All these positive outcomes have proven that vestibular stimulation can increase memory and anxiety scores in dementia and thereby can be used as an alternative therapy in this field. Further animal studies and human studies are needed to dig deep into the molecular mechanisms behind its actions.
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Teggi, R., D. Caldirola, B. Fabiano, P. Recanati, and M. Bussi. "Rehabilitation after acute vestibular disorders." Journal of Laryngology & Otology 123, no. 4 (June 13, 2008): 397–402. http://dx.doi.org/10.1017/s0022215108002983.
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AbstractObjectives:To assess the efficacy of rehabilitation for dizzy patients after recent acute vestibular disturbance.Methods:Forty patients recently hospitalised for an acute episode of rotational vertigo which lasted days were randomly divided into two groups. The first group (20 patients; group R) underwent active rehabilitation, while the second group (20 patients; group C) were told only to ‘perform their daily activities’. Group R subjects underwent a total of 10 sessions of rehabilitation, including exercises on a stabilometric platform, point de mire and a series of five exercises repeated five times daily. All patients performed static stabilometry (posturography), undertook the dynamic gait index test, and completed a dizziness handicap questionnaire and a visual analogue scale for anxiety, at baseline and on completion.Results:At 25 days, the rehabilitated patients obtained better results for all recorded outcomes, compared with the control group. The greatest difference in the rehabilitated subjects, compared with the control group, was for the dynamic gait index test; however, this difference was not statistically significant. The visual analogue scale anxiety score was statistically significantly more reduced in rehabilitated patients compared with control patients. Control patients maintained a higher visual dependence for postural control.Conclusions:These results would appear to support the effectiveness of a supervised exercise programme for patients following acute onset of vestibular disturbance. A correlation was found in both groups between dynamic gait index results and anxiety. In our experience, a rehabilitation programme seems to reduce dependence on visual cues for postural control.
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Meretta, Bridget M., Susan L. Whitney, Gregory F. Marchetti, Patrick J. Sparto, and Robb J. Muirhead. "The five times sit to stand test: Responsiveness to change and concurrent validity in adults undergoing vestibular rehabilitation**." Journal of Vestibular Research 16, no. 4-5 (February 1, 2007): 233–43. http://dx.doi.org/10.3233/ves-2006-164-510.
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Objective: The purpose of this study was to determine if patients with balance and vestibular disorders would demonstrate clinically meaningful improvement in the Five Times Sit to Stand Test (FTSST) score as a result of vestibular rehabilitation and to determine the concurrent validity of the FTSST. Design: Retrospective chart review of 351 people who underwent individualized outpatient vestibular rehabilitation programs. Setting: Outpatient tertiary balance and vestibular clinic. Subjects: One hundred and seventeen patients (45 men, 72 women), mean age 62.7 years, with peripheral, central or mixed vestibular dysfunction. Main outcome measures: FTSST, gait speed, Timed Up and Go Test (TUG), Dynamic Gait Index (DGI), Dizziness Handicap Inventory (DHI), and Activities-Specific Balance Confidence Scale (ABC). Results: The mean change in FTSST score was 2.7 seconds. Subjects demonstrated statistically significant improvements in the FTSST, gait speed, ABC, DHI, DGI and TUG after vestibular rehabilitation (p < 0.01). The responsiveness-treatment coefficient (RT) was calculated as 0.58 for the FTSST indicating moderate responsiveness. Logistic regression showed that an improvement in the FTSST of greater than 2.3 seconds resulted in an odds ratio of 4.67 for demonstrating clinical improvement in DHI, compared with a change less than 2.3 seconds. The univariate linear regression model for baseline FTSST predicting FTSST change was significant (p < 0.01) and predicted 49% of the change variance. The FTSST scores demonstrated a moderate correlation with gait speed and the TUG (p< 0.01). FTSST improvement subsequent to vestibular rehabilitation was moderately correlated with improvements in the DGI and the TUG scores (p< 0.01). Conclusions: The FTSST was moderately responsive to change over time and was moderately related to measures of gait and dynamic balance.
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Ghaffari, Amin, Bahador Asadi, Armin Zareian, Malahat Akbarfahimi, Gholam Reza Raissi, and Fahimeh Fathali Lavasani. "The Effects of Vestibular Rehabilitation on Poststroke Fatigue: A Randomized Controlled Trial Study." Stroke Research and Treatment 2022 (August 31, 2022): 1–9. http://dx.doi.org/10.1155/2022/3155437.
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Background. A major complication caused by stroke is poststroke fatigue (PSF), and by causing limitations in doing activities of daily living (ADL), it can lower the quality of life. Objective. The present study is an attempt to examine the effects of vestibular rehabilitation on BADL (Basic Activities of Daily Living), fatigue, depression, and Lawton Instrumental Activities of Daily Living (IADL) in patients with stroke. Method. Patients with a history of stroke took part voluntarily in a single-blind clinical trial. The participants were allocated to control and experimental groups randomly. The experimental group attended 24 sessions of vestibular rehabilitation protocol, while the control group received the standard rehabilitation (including three sessions per week each for around 60 min). To measure fatigue, the Fatigue Impact Scale (FIS) and the Fatigue Assessment Scale (FAS) were used. Depression, BADL, and IADL were measured using the Beck Depression Inventory-II (BDI-II), Barthel Index (BI), and Lawton Instrumental Activities of Daily Living, respectively. All changes were measured from the baseline after the intervention. Results. Significant improvement was found in the experimental group compared to the control group ( p < 0.05 ) in FIS (physical, cognition, and social subscales), FAS, BDI-II, BADL, and IADL. Moreover, the results showed small to medium and large effect sizes for the physical subscale of FIS and FAS scores based on Cohen’s d , respectively; however, no significant difference was found in terms of cognition and social subscales of FIS, BDI-II, BADL, and IADL scores. Conclusion. It is possible to improve fatigue, depression, and independence in BADL and IADL using vestibular rehabilitation. Thus, it is an effective intervention in case of stroke, which is also well tolerated.
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Tran, Huynh-Truc, Yao-Chuen Li, Hung-Yu Lin, Shin-Da Lee, and Pei-Jung Wang. "Sensory Processing Impairments in Children with Developmental Coordination Disorder." Children 9, no. 10 (September 22, 2022): 1443. http://dx.doi.org/10.3390/children9101443.
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The two objectives of this systematic review were to examine the following: (1) the difference in sensory processing areas (auditory, visual, vestibular, touch, proprioceptive, and multi-sensory) between children with and without developmental coordination disorder (DCD), and (2) the relationship between sensory processing and motor coordination in DCD. The following databases were comprehensively searched for relevant articles: PubMed, Science Direct, Web of Science, and Cochrane library. There were 1107 articles (published year = 2010 to 2021) found in the initial search. Full-text articles of all possibly relevant citations were obtained and inspected for suitability by two authors. The outcome measures were sensory processing impairments and their relationship with motor coordination. A total of 10 articles met the inclusion criteria. Children with DCD showed significant impairments in visual integration, tactile integration, proprioceptive integration, auditory integration, vestibular integration, and oral integration processes when compared with typically developing children. Evidence also supported that sensory processing impairments were associated with poor motor coordination in DCD. Preliminary support indicated that DCD have sensory processing impairments in visual, tactile, proprioceptive, auditory, and vestibular areas, which might contribute to participation restriction in motor activities. It is important to apply sensory integration therapy in rehabilitation programs for DCD in order to facilitate participation in daily activities.
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Tamaki, Chizuko, Kristen Maul, Daniel S. Talian, and Sarah Sparks. "Deaf Individuals Who Report Having Good Balance Function Present with Significant Vestibular Deficits." Journal of the American Academy of Audiology 32, no. 08 (September 2021): 510–20. http://dx.doi.org/10.1055/s-0041-1731732.
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Abstract Background Vestibular and/or balance deficits are well documented in deaf individuals. In the adult population, poor vestibular and/or balance function can lead to activity limitations and increased risk of falling. An effective case history by health care providers to probe for potential balance concerns is necessary for appropriate referral; however, patients may not consistently report vestibular and balance symptoms. Currently, there is little information available as to how deaf individuals report these symptoms and how their reported balance ability relates to measures of balance and vestibular functions. Purpose The aim of the current study was to evaluate self-perceived balance ability in participants who self-identify as either deaf or hearing, and compare these results to measures of balance and vestibular functions. Research Design This is a prospective, between-group design. Study Sample Data from 57 adults between the ages of 18 to 29 years who self-reported as deaf (39) or hearing (18) were evaluated. Participants completed the activities-specific balance confidence (ABC) scale, a brief case history, self-report rating of balance (SRRB), the Modified Clinical Test of Sensory Integration of Balance (mCTSIB), along with both ocular vestibular-evoked myogenic potentials (oVEMPs) and cervical vestibular-evoked myogenic potentials (cVEMPs). Only participants with SRRBs of good or excellent were included in the inferential analyses. Results Proportions of participants rating their balance ability as either good or excellent were similar between both groups, as were the results on the ABC scale. Statistical analyses revealed significant associations between the groups on both oVEMPs and cVEMPs. No significant differences were observed on sway velocities in any of the mCTSIB conditions; however, more than one-third of deaf participants had mCTSIB Condition 4—on foam, eyes closed—scores above 2 standard deviations of the hearing group. Conclusion Deaf participants self-report similar ratings of balance ability as hearing participants despite significant differences in vestibular function. A relatively large subset of deaf participants had increased sway velocity on balance function testing that required increased reliance on vestibular cues. A thorough discussion of balance and vestibular symptoms should be completed when a patient who self-identifies as deaf is seen by a health care provider so that appropriate screenings or referrals can be completed as necessary.
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Danilov, Y. P., M. E. Tyler, K. L. Skinner, R. A. Hogle, and P. Bach-y-Rita. "Efficacy of electrotactile vestibular substitution in patients with peripheral and central vestibular loss." Journal of Vestibular Research 17, no. 2-3 (March 1, 2008): 119–30. http://dx.doi.org/10.3233/ves-2007-172-307.
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Vestibular dysfunction of either central or peripheral origin can significantly affect balance, posture, and gait. We conducted a pilot study to test the effectiveness of training with the BrainPort® balance device in subjects with a balance dysfunction due to peripheral or central vestibular loss. The BrainPort® balance device transmits information about the patient's head position via electrotactile stimulation of the tongue. Head position data is sensed by an accelerometer and displayed on the tongue as a pattern of stimulation. This pattern of stimulation moves forward, backward, and laterally on the tongue in direct response to head movements. Users of the device were trained to use this stimulation to adjust their position in order to maintain their balance. Twenty-eight subjects with peripheral or central vestibular loss were trained with the BrainPort balance device and tested using the following standardized quantitative measurements of the treatment effects: Computerized Dynamic Posturography (CDP) using the Sensory Organization Test (SOT), Dynamic Gait Index (DGI), Activities-specific Balance Confidence Scale (ABC), and Dizziness Handicap Inventory (DHI). All subjects had chronic balance problems and all but one had previously participated in vestibular rehabilitation therapy. The scores on the clinical tests upon entry into the study were compared to their scores following training with the BrainPort balance device. Our results exhibit consistent positive and statistically significant improvements in balance, posture and gait. These results exceed what could normally be achieved in three to five days of traditional balance training alone. Since this was not a controlled study, we are unable to distinguish the degree to which these improvements are attributable to training with the BrainPort balance device versus the balance exercises performed by all subjects as a part of the BrainPort training sessions. Nonetheless, after training with the BrainPort balance device, all subjects demonstrated significant improvements in performance beyond what might be expected from conventional vestibular rehabilitation therapy.
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Zanini, Sergio, Claudia Cordaro, Lucia Martucci, Ivana Del Piero, Simonetta Geotti, Marta Makuc, Annalisa Csillaghy, Marina Godio, and Monica Cazzagon. "Visual and vestibular functioning, and age and surgery effects on postural control in healthy children with vertical strabismus." Therapeutic Advances in Ophthalmology 10 (January 1, 2018): 251584141878800. http://dx.doi.org/10.1177/2515841418788005.
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Purpose: To describe visual and vestibular functioning and the effects of age and surgery effects on postural control in healthy children with vertical strabismus. Design: This is a comparative case series. Methods: We evaluated participants at the Scientific Institute Eugenio Medea during routine clinical activities. We enrolled 30 consecutive children/adolescents (age range 4–13 years) with isolated vertical strabismus, with and without corrective surgery. Participants were split into four subgroups according to age (4–8 years versus 9–13 years) and ocular surgery (surgery versus no surgery). The clinical protocol included ophthalmological, orthoptic, neurological, physiatrical, otolaryngological, and vestibular evaluations, and the instrumental protocol included ocular cyclotorsions assessment, posturography, and vestibular myogenic-evoked potentials. Main outcome measures of the study were the prevalence of study-relevant orthopedic, ocular, vestibular, and posturographic abnormalities. Results: Among the overall largely variable findings across patients’ groups, we found some interesting trends: larger binocular vision and convergence disorders in younger children, smaller prevalence of asymmetric vestibular-evoked potentials in operated children, less posturographic abnormalities in younger children. No clear-cut beneficial effect of surgery was found on all clinical and instrumental parameters considered, despite good re-alignment of the eyes. Conclusion: The pathophysiology of postural control in vertical strabismus is extremely complex and above the potential of this study design and should be specifically addressed in deeper experimental studies.
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Massot, Corentin, Maurice J. Chacron, and Kathleen E. Cullen. "Information transmission and detection thresholds in the vestibular nuclei: single neurons vs. population encoding." Journal of Neurophysiology 105, no. 4 (April 2011): 1798–814. http://dx.doi.org/10.1152/jn.00910.2010.
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Understanding how sensory neurons transmit information about relevant stimuli remains a major goal in neuroscience. Of particular relevance are the roles of neural variability and spike timing in neural coding. Peripheral vestibular afferents display differential variability that is correlated with the importance of spike timing; regular afferents display little variability and use a timing code to transmit information about sensory input. Irregular afferents, conversely, display greater variability and instead use a rate code. We studied how central neurons within the vestibular nuclei integrate information from both afferent classes by recording from a group of neurons termed vestibular only (VO) that are known to make contributions to vestibulospinal reflexes and project to higher-order centers. We found that, although individual central neurons had sensitivities that were greater than or equal to those of individual afferents, they transmitted less information. In addition, their velocity detection thresholds were significantly greater than those of individual afferents. This is because VO neurons display greater variability, which is detrimental to information transmission and signal detection. Combining activities from multiple VO neurons increased information transmission. However, the information rates were still much lower than those of equivalent afferent populations. Furthermore, combining responses from multiple VO neurons led to lower velocity detection threshold values approaching those measured from behavior (∼2.5 vs. 0.5–1°/s). Our results suggest that the detailed time course of vestibular stimuli encoded by afferents is not transmitted by VO neurons. Instead, they suggest that higher vestibular pathways must integrate information from central vestibular neuron populations to give rise to behaviorally observed detection thresholds.
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Mueller, Martin, Susan L. Whitney, Alia Alghwiri, Kefah Alshebber, Ralf Strobl, Ahmad Alghadir, Murad O. Al-momani, Joseph M. Furman, and Eva Grill. "Subscales of the Vestibular Activities and Participation questionnaire could be applied across cultures." Journal of Clinical Epidemiology 68, no. 2 (February 2015): 211–19. http://dx.doi.org/10.1016/j.jclinepi.2014.10.004.
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Parietti-Winkler, Cécile, Alexis Lion, Julien Frère, Philippe P. Perrin, Renaud Beurton, and Gérome C. Gauchard. "Prediction of Balance Compensation After Vestibular Schwannoma Surgery." Neurorehabilitation and Neural Repair 30, no. 5 (August 7, 2015): 395–401. http://dx.doi.org/10.1177/1545968315600270.
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Background. Balance compensation after vestibular schwannoma (VS) surgery is under the influence of specific preoperative patient and tumor characteristics. Objective. To prospectively identify potential prognostic factors for balance recovery, we compared the respective influence of these preoperative characteristics on balance compensation after VS surgery. Methods. In 50 patients scheduled for VS surgical ablation, we measured postural control before surgery (BS), 8 (AS8) days after, and 90 (AS90) days after surgery. Based on factors found previously in the literature, we evaluated age, body mass index and preoperative physical activity (PA), tumor grade, vestibular status, and preference for visual cues to control balance as potential prognostic factors using stepwise multiple regression models. Results. An asymmetric vestibular function was the sole significant explanatory factor for impaired balance performance BS, whereas the preoperative PA alone significantly contributed to higher performance at AS8. An evaluation of patients’ balance recovery over time showed that PA and vestibular status were the 2 significant predictive factors for short-term postural compensation (BS to AS8), whereas none of these preoperative factors was significantly predictive for medium-term postoperative postural recovery (AS8 to AS90). Conclusions. We identified specific preoperative patient and vestibular function characteristics that may predict postoperative balance recovery after VS surgery. Better preoperative characterization of these factors in each patient could inform more personalized presurgical and postsurgical management, leading to a better, more rapid balance recovery, earlier return to normal daily activities and work, improved quality of life, and reduced medical and societal costs.
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Ralli, Massimo, Giuseppe Nola, Luca Sparvoli, and Giovanni Ralli. "Unilateral Enlarged Vestibular Aqueduct Syndrome and Bilateral Endolymphatic Hydrops." Case Reports in Otolaryngology 2017 (2017): 1–6. http://dx.doi.org/10.1155/2017/6195317.
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Enlarged vestibular aqueduct (EVA) syndrome is a common congenital inner ear malformation characterized by a vestibular aqueduct with a diameter larger than 1.5 mm, mixed or sensorineural hearing loss that ranges from mild to profound, and vestibular disorders that may be present with a range from mild imbalance to episodic objective vertigo. In our study, we present the case of a patient with unilateral enlarged vestibular aqueduct and bilateral endolymphatic hydrops (EH). EH was confirmed through anamnestic history and audiological exams; EVA was diagnosed using high-resolution CT scans and MRI images. Therapy included intratympanic infusion of corticosteroids with a significant hearing improvement, more evident in the ear contralateral to EVA. Although most probably unrelated, EVA and EH may present with similar symptoms and therefore the diagnostic workup should always include the proper steps to perform a correct diagnosis. Association between progression of hearing loss and head trauma in patients with a diagnosis of EVA syndrome is still uncertain; however, these individuals should be advised to avoid activities that increase intracranial pressure to prevent further hearing deterioration. Intratympanic treatment with steroids is a safe and well-tolerated procedure that has demonstrated its efficacy in hearing, tinnitus, and vertigo control in EH.
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Meng, Hui, Andrea M. Green, J. David Dickman, and Dora E. Angelaki. "Pursuit—Vestibular Interactions in Brain Stem Neurons During Rotation and Translation." Journal of Neurophysiology 93, no. 6 (June 2005): 3418–33. http://dx.doi.org/10.1152/jn.01259.2004.
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Under natural conditions, the vestibular and pursuit systems work synergistically to stabilize the visual scene during movement. How translational vestibular signals [translational vestibuloocular reflex (TVOR)] are processed in the premotor pathways for slow eye movements continues to remain a challenging question. To further our understanding of how premotor neurons contribute to this processing, we recorded neural activities from the prepositus and rostral medial vestibular nuclei in macaque monkeys. Vestibular neurons were tested during 0.5-Hz rotation and lateral translation (both with gaze stable and during VOR cancellation tasks), as well as during smooth pursuit eye movements. Data were collected at two different viewing distances, 80 and 20 cm. Based on their responses to rotation and pursuit, eye-movement–sensitive neurons were classified into position–vestibular–pause (PVP) neurons, eye–head (EH) neurons, and burst–tonic (BT) cells. We found that approximately half of the type II PVP and EH neurons with ipsilateral eye movement preference were modulated during TVOR cancellation. In contrast, few of the EH and none of the type I PVP cells with contralateral eye movement preference modulated during translation in the absence of eye movements; nor did any of the BT neurons change their firing rates during TVOR cancellation. Of the type II PVP and EH neurons that modulated during TVOR cancellation, cell firing rates increased for either ipsilateral or contralateral displacement, a property that could not be predicted on the basis of their rotational or pursuit responses. In contrast, under stable gaze conditions, all neuron types, including EH cells, were modulated during translation according to their ipsilateral/contralateral preference for pursuit eye movements. Differences in translational response sensitivities for far versus near targets were seen only in type II PVP and EH cells. There was no effect of viewing distance on response phase for any cell type. When expressed relative to motor output, neural sensitivities during translation (although not during rotation) and pursuit were equivalent, particularly for the 20-cm viewing distance. These results suggest that neural activities during the TVOR were more motorlike compared with cell responses during the rotational vestibuloocular reflex (RVOR). We also found that neural responses under stable gaze conditions could not always be predicted by a linear vectorial addition of the cell activities during pursuit and VOR cancellation. The departure from linearity was more pronounced for the TVOR under near-viewing conditions. These results extend previous observations for the neural processing of otolith signals within the premotor circuitry that generates the RVOR and smooth pursuit eye movements.