Understanding therapeutic approaches to anxiety in vestibular rehabilitation: a qualitative study of specialist physiotherapists in the UK

Purpose: People with vestibular disorders are typically treated by physiotherapists in vestibular rehabilitation. Anxiety is strongly associated with vestibular disorders; however, there is a lack of understanding about how physiotherapists respond to people presenting with anxiety within vestibular rehabilitation. This study aimed to explore physiotherapists’ current practice in assessing and treating patients with anxiety in vestibular rehabilitation.

Materials and methods: A qualitative study using semi-structured interviews with 10 specialist physiotherapists in vestibular rehabilitation in three university teaching hospitals in England. Data were analyzed using thematic analysis.

Results: Four themes were identified: (i) The therapeutic relationship, (ii) Adapting assessment and treatment, (iii) Psychological intervention and support, and (iv) Physiotherapists’ education and training. Physiotherapists reported using a range of behavioral and cognitive techniques and adapting their therapeutic approach by placing greater emphasis on education, building trust and pacing treatment. Physiotherapists highlighted the need for more specialist psychological support for patients during vestibular rehabilitation and tailored training and guidance on addressing anxiety within vestibular rehabilitation.

Conclusions: Physiotherapists working in vestibular rehabilitation consider managing aspects of anxiety within their scope of practice and describe taking a psychosocial therapeutic approach. There is limited access to expert psychological support for patients with anxiety within vestibular rehabilitation.

• Implications for rehabilitation

• Anxiety is strongly associated with vestibular disorders and it is common for these patients to be managed by physiotherapists in vestibular rehabilitation.

• Vestibular rehabilitation services could improve access to psychological expertise through dedicated psychological input, more effective signposting and referral pathways, and better access to inter-professional support from psychologists and/or CBT practitioners in managing more complex patients.

• Physiotherapists requested tailored training and guidance to enhance their ability to manage patients with anxiety more effectively in vestibular rehabilitation.

     

前庭性偏头痛患者前庭功能变化情况及临床特点分析

目的分析前庭性偏头痛患者前庭功能变化情况及临床特点。方法选取我院2018年1月至2019年6月收治的60例前庭性偏头痛患者,设为观察组;另选取2018年1月至2019年6月于我院接受常规体检的60例健康成年人,设为对照组。对比两组前庭功能,获取观察组患者前庭功能变化情况,同时结合其临床资料分析病情特点。结果观察组冷热试验、视频头脉冲试验、听阈、气骨导、声导抗异常率分别为51.67%、78.33%、10.00%、8.33%、15.00%,均高于对照组的11.67%、11.67%、1.67%、0.00%、0.00%,差异具有统计学意义(P<0.05)。观察组患者平均前庭症状持续时间为(6.2±1.1)h,普遍偏长;在观察组患者中,42例(70.00%)前庭症状持续时间偏长、36例(60.00%)眩晕、31例(51.67%)畏光、33例(55.00%)畏声、19例(31.67%)视觉先兆,均以中年多发、女性多发为主要特点。结论前庭性偏头痛患者前庭功能出现明显变化,且临床特点多样,前庭功能变化是导致临床症状和症状加重的主要因素。     

Migraine and vestibular symptoms--identifying clinical features that predict "vestibular migraine"

Background.— Migraine and symptoms that may suggest a vestibular disorder (referred to herein broadly as vestibular symptoms—VS) often co‐exist. In part due to a lack of standardized diagnostic criteria, this relationship remains unknown to many physicians. Objective.— To determine common clinical features that may be associated with “vestibular migraine” (VM). Methods.— We retrospectively reviewed charts of patients diagnosed with VM at a headache center. In this group we recorded certain demographic and clinical features related to their disorder, including the most common triggers of the VS and the specific characteristics of the symptoms that suggested VM. Results.— Our sample consisted of 147 patients (68% women, mean age = 45 years, 39% with aura). Migraine onset preceded the onset of VS by a mean of 8 years. A total of 62 patients (42%) had gradual onset of VS, while in 48 (33%) symptoms began suddenly. The most commonly reported symptoms that led to the diagnosis of VM were: unsteadiness (134; 91%), balance disturbance (120; 82%), “light‐headedness” (113; 77%), and vertigo (84; 57%). VS and headache occurred concomitantly in 48% of patients. A total of 67 (47%) patients had VS that were chronic from onset, 29 (21%) had episodic symptoms, and in 46 (32%) the VS had evolved from episodic to chronic (with an average duration of 7.04 years required for this evolution to occur). Conclusions.— Vestibular migraine is a heterogeneous condition with varying symptomatology. As with migraine itself, symptomatic expression varies along a spectrum that extends from episodic to chronic. As the histories of many of the patients we evaluated would not meet current International Classification of Headache Disorders criteria, we suggest that new criteria which account for the heterogeneity and natural history of the disorder may be required to adequately diagnose and treat those who suffer from VM.     

脑电图、经颅多普勒检测技术在前庭性偏头痛诊断中的应用价值

目的探讨脑电图(EEG)、经颅多普勒(TCD)检测技术在前庭性偏头痛(VM)诊断中的应用价值。方法选取我院2016年8月至2019年8月收治的116例VM患者作为研究组,另选取同期116名健康体检者作为对照组。两组均进行EEG、TCD检测,并对临床检查结果进行分析。结果研究组EEG异常率、TCD异常率均明显高于对照组(P<0.05)。EEG+TCD联合检测的异常率明显高于单项检测(P<0.05)。结论EEG+TCD联合检测可提高VM的诊断率,并为治疗方案的选择提供指导依据。     

前庭阵发症的MRI研究进展

前庭阵发症(vestibular paroxysmia,VP)是指反复短暂发作的旋转或非旋转性眩晕。该文综述了目前用于显示VP患者神经血管结构异常的多种成像方法,以期对VP影像学诊断及其发病机制的研究提供参考。     

个体化前庭训练对儿童感觉统合失调的治疗效果

目的:探讨个体化前庭训练对儿童感觉统合失调的临床效果。方法:选取经儿童感觉统合功能评量表确诊为前庭感觉统合失调的儿童60例,随机分为对照组和观察组各30例。对照组予常规感觉刺激,观察组根据个体化的前庭评估结果,在常规感觉刺激基础上制定个体化前庭治疗方案。分别于治疗前后采用儿童感觉统合能力发展评定量表、Conners父母症状问卷量表(Parent Symptom Questionnaire,PSQ)、动静态平衡能力测试评估其疗效。结果:治疗8周后,2组儿童感觉统合能力发展评定量表得分均较治疗前明显增加(均P<0.05)、且观察组的得分增加显著高于对照组(P<0.05);2组的动静态平衡能力均较治疗前明显增强(均P<0.05),观察组明显优于对照组(P<0.05);治疗后观察组PSQ(除冲动和焦虑外)的异常检出率明显低于治疗前(P<0.05),且显著低于对照组(P<0.05)。结论:个体化前庭训练应用于儿童感觉统合失调患者的临床疗效显著。     

Exploratory fall risk and preventive intervention in acute vestibular neuritis

ObjectiveTo analyze recovery from dizziness in patients with acute vestibular neuritis (AVN) after applying the “Dizziness & Fall Risk Assessment and Intervention (DFRAI)”.MethodsThis prospective study involved patients with AVN who underwent a survey of dizziness and fall risk. The patients received medical treatment and customized vestibular rehabilitation, and vestibular function was evaluated at the initial attack and 3 months later.ResultsForty-one patients underwent subjective questionnaire assessments, which showed significant improvement in visual analog scale-dizziness handicap inventory-fear of falling (VAS-DHI-FOF) results from the initial vertigo attack to 3 months later. In the sensory organization test (SOT), the initial composite score was 63 ± 13.1, which improved to 77.5 ± 4.9 3 months later. In caloric testing, the canal paresis (CP) score was 42.9 ± 35.2, which improved to 29.9 ± 23.5 3 months later.ConclusionsSubjective improvement in dizziness and objective recovery of vestibular function were confirmed. DFRAI is a comprehensive solution for dizziness, and appropriate application of the DFRAI is expected to have a positive effect on recovery from dizziness and fall prevention in patients with AVN.     

Vestibular Stimulation: Effects on Visual and Auditory Alertness in Children with Multiple Disabilities

Although vestibular stimulation has been related to increased alertness in both preterm infants and healthy full-term infants, empirical data indicating the effect of vestibular stimulation on alertness in children with multiple disabilities are lacking. In this study we investigated the effect of a brief period of rocking on visual and auditory alertness in children with severe multiple disabilities. The children's performance on one of the five tasks assessed (tracking a noise-making toy) was significantly better following a 3 min session of rocking in an adaptive swing. This finding is discussed relative to the need for additional research on the effects of vestibular stimulation.     

Flunarizine, the vestibular system and migraine

The vestibular function was extensively investigated in 75 patients suffering from migraine. Pathological findings were present in 62 patients (82.6%). With the exception of position nystagmus, vestibular abnormalities were not related to migraine characteristics. Fifty-six patients were treated with flunarizine 10 mg daily for three months. A favourable effect on headache was obtained in 44 patients (78.5%). Flunarizine therapy influenced significantly gaze nystagmus and position nystagmus. The latter tended to be related to anti-migraine efficacy. Other electronystagmographic parameters were not substantially influenced. The authors assume that the vestibular abnormalities in migraine are side phenomena, the clinical relevance of which, at least during the headache-free phase, is not yet well understood.     

帕金森病微电极导向治疗前后前庭功能变化

目的观察帕金森病微电极导向治疗前后前庭功能变化。方法采用眼震电图仪测试帕金森病患者手术前与手术后(3d～4周)的前庭功能。结果帕金森病患者手术后的前庭功能下降26例,占63.4%,手术后前庭功能改善11例,占26.8%,前庭功能无变化4例,占9.7%。结论帕金森病患者经过微电极导向治疗后,短期内其前庭功能大部分下降,可能与手术造成脑组织的水肿及热能量效应有关。     

人工耳蜗植入康复大前庭水管合并重及极重度听力损失

目的：了解人工耳蜗植人法康复大前庭水管综合征(LVAS)重度和极重度听力损失的效果。方法：3例LVAS畸形(LVAS组)与10例无畸形(无畸形组)重度以上感音神经性听力损失患者进行人工耳蜗植人。比较2组间手术植人情况、开机时映射调试时的伴随症状及听阈(T-level)、最大舒适阈(C-level)和补偿听阈。结果：①手术中LVAS组出现“井喷”现象1例。开机映射调试时出现耳鸣及头胀痛1例，眩晕及心慌气短1例；无畸形组中出现下眼睑跳动l例。②开机时LVAS组1例C—T level差值仅1～2个电流级，1例平均7个电流级。1例平均15个电流级；无畸形组除1例15个电流级外．其它均在20～25个电流级。开机1周、1个月时LVAS组的C—T level差值平均为30、50个电流级，补偿听阈平均为69和50dB SPL；无畸形组为43、58个电流级，62和47dB SPL。结论：LVAS畸形患者进行人工耳蜗手术时要迅速准确地插入电极；开机时C-T level范围较无畸形患者窄，出现伴随症状给予相应处理；经过一段时间的康复调试后其范围与无畸形患者相差不大，补偿听阈亦差异无显著性。     

异丙嗪联合甲氧氯普胺治疗前庭周围性眩晕急性发作

目的探讨异丙嗪联合甲氧氯普胺治疗前庭周围性眩晕急性发作的疗效、安全性及不良反应。方法回顾性分析36例应用异丙嗪联合甲氧氯普胺治疗前庭周围性眩晕急性发作的疗效。结果 33例有效,3例无效,有效率达92%,无一例出现明显不良反应。结论异丙嗪联合甲氧氯普胺治疗前庭周围性眩晕急性发作,简便实用,安全有效。