Biological feedback techniques in rehabilitation of patients with impaired equilibrium function

Vestibular rehabilitation with application of biological feedback methods has been performed in 25 patients with vestibular disorders. In them, an objective method of functional computer stabilometry verified equilibrium disturbance. Compared to the control group of 30 patients treated conventionally with drugs, biological feedback methods proved high effectiveness.     

Difference by instructional set in stabilometry

There is no standard for the awareness of standing posture in stabilometry, yet little research addressing the matter has been carried out. In the present study, we evaluated the influence of different instructional sets during a test on stabilometry. Stabilometry was performed on 349 male subjects. Two different instructions were prepared for the subjects regarding the awareness of their standing posture. These instructions were a) "Please relax when you stand" (R-standing), and b) "Please make an effort to minimize your body sway" (E-standing). Subjects were classified into four groups according to the combination of these instructions they received. For the five body sway parameters, a comparison between R-standing and E-standing was performed, controlling for possible confounders such as age, height, body weight, educational history, alcohol consumption, and smoking status. The sway length in E-standing was larger than that in R-standing, even after the adjustment for possible confounders. Our results indicate that the difference in the instructional set caused a significant measurement bias. Thorough-going unification of instructions for the stabilometry should be recommended when stabilometry is performed in an epidemiological investigation.     

Normal values in rhinomanometry

Despite various methods of investigation, there are few reports as to the normal values of nasal airway resistance. A total of 56 adult subjects free of any nasal disease underwent nasal airway resistance measurement using active anterior rhinomanometry according to the guidelines of the international committee on standardization of rhinomanometry. Inspiratory and expiratory resistance was measured before and after application of a topical decongestant spray. This test was reproducible in that 46 of the subjects underwent a second study with resistance values quite close to that of the initial measurement. The upper range of the total inspiratory nasal airway resistance was 0.45 Pa s/cm3 before and 0.3 Pa s/cm3 after decongestant administration. There was no statistically significant difference between the inspiratory and expiratory resistance measurements. No correlation could be made between nasal airway resistance, age, sex, height or weight.     

Physiologie des Gleichgewichtes und dessen Diagnostik

Summary Disorders of the extrapyramidal and vestibular system lead to a reduction of the equilibrium at rest and/or at movement, which easily can be demonstrated by tests like Romberg and Soleo/C or Unterberger and others. Investigative methods, that yield more exact results, are the stabilometry and the Pendular-Platform-Test (PPT): The subject stands upright on a platform, which turns with regular sinusoidal movements around a central vertical axis; the angular acceleration can be adjusted in steps.The platform was recently reconstructed and provided with four pressure-to-voltage transducers, which allow measurement of equilibrium also at rest. Moreover, since a function generator is feeding into the power amplifier, that drives the platform, the parameters of acceleration and deceleration can be varied independently. Therefore this new modification of PPT is a clinically relevant loading test of equilibrium and allows the combined examination of static and dynamic equilibrium.     

Investigation into dizziness before and after Epley's maneuver for benign paroxysmal positional vertigo using stabilometry

OBJECTIVE: To investigate the cause of dizziness after Epley's maneuver using stabilometry. METHODS: Subjects were 35 patients with posterior canal type BPPV. First we performed stabilometry, next Epley's maneuver, then stabilometry was performed again. The enveloped area and the locus length per second of stabilometry were compared. RESULTS: Seventeen patients reported a feeling of dizziness after the treatment, whereas the other 18 patients did not. The patients were divided into two groups: 17 patients with dizziness (WD) and 18 patients without dizziness (WOD) after the treatment. In the WD group, the enveloped area (P=0.0495) and the locus length per second (P=0.0099) before Epley's maneuver were significantly lower than those after Epley's maneuver. In the WOD group, there was no significant difference in the stabilometry parameter between values obtained before and after Epley's maneuver. There were no significant differences found in either parameter between these two groups either before or after applying Epley's maneuver. CONCLUSIONS: Epley's maneuver is a treatment for the posterior semicircular canal. Malfunction of the otolith organ remains. It is considered that the cause of dizziness after Epley's maneuver comes from otolith dysfunction.     

Head-tilting stabilometry in patients with benign paroxysmal positional vertigo

OBJECTIVE: One of the pathologic conditions underlying benign paroxysmal positional vertigo (BPPV) is degeneration of the otolith organs. In this study, we examined changes in the parameters of stabilometry under an upright condition and head-tilt conditions in patients with BPPV. METHODS: We performed stabilometry on 21 patients with right BPPV, on 21 patients with left BPPV and on 21 controls. First, the subject stood barefoot in an upright position with both feet together on the platform with eyes closed. Next, tilting of the head about 30 degrees to the left was added. Then, tilting about 30 degrees to the right was performed. RESULTS: In right BPPV patients, the total length of velocity vectors in the right or left direction on right or left head-tilt were significantly smaller than those in an upright position. The enveloped area and total length of velocity vectors in the right or left direction were significantly larger than those in controls. In left BPPV patients, there were no parameters that showed any significant difference. CONCLUSIONS: In this study, lesions of right BPPV patients were coincidentally more severe than those in left BPPV patients, and velocity vectors with head-tilts were significantly smaller than in an upright position. Using the total length of the velocity vectors, head-tilting stabilometry has the potential to become a reliable otolith function examination method.     

Orthostatic postural control in vestibular neuritis: a stabilometric analysis.

Posturographic data for 182 vestibular neuritis patients were recorded on a static posturographic platform (stabilometry) with the patients' eyes both open and closed. Three of the parameters studied are presented here: mean position of the center of pressure, area of the statokinesigram, and Romberg's quotient. Vestibular neuritis modifies the performance of the fine-postural system in unpredictable ways, varying with the subject. It may disturb either the mean position of the center of pressure or the integration of visual input. Sixty of the patients in this study did not use visual input to stabilize their position in relation to their surroundings. The value of stabilometry as a method for observing the integration of visual input in the control of orthostatic posture is discussed.     

The estimation of the efficacy of manual therapy included in the combined treatment of cochlear-vestibular disorders based on the results of computed stabilography

The objective of the present study was to estimate the efficacy of the combined treatment of spondylogenic cochlear-vestibular disorders with the use of both medicamental and non-medicamental modalities. Computed static stabilometry was applied for diagnostics of postural disbalance and evaluation of the treatment outcomes. It was shown that the application of manual therapy for the management of 56 patients presenting with spondylogenic cochlear-vestibular disorders resulted in the decrease of tinnitus and the improvement of vestibular and cochlear functions.     

Nasal dyspnea: the place of rhinomanometry in its objective assessment

BACKGROUND: "Nasal dyspnea" describes the common symptom of nasal airway obstruction, which usually is assessed subjectively. Objective, quantitative methods are needed to assess the nasal airway adequately. METHODS: Rhinomanometry, in use for >30 years, was reviewed. RESULTS: No other symptom of rhinitis can be measured as objectively and accurately as that of nasal obstruction. Determinations by rhinomanometry are precise, usually better than 5%. Most rhinomanometers meet the published requirements of standardization by the International Rhinologic Society. An improved system for scoring symptoms of nasal dyspnea is suggested. Rhinomanometry, potentially a gold standard for the objective measurement of obstructed nasal airflow, has a proven place in the selection of patients for septal and nasal valve reconstruction. CONCLUSION: Recommendations are given for extension of the standards to account for the near universal computerization of equipment. Miniaturization of equipment will increase its application to trials of drugs for rhinitis.     

Somatosensorial disorders. Alterations in the quality of life in patients presenting with peripheral vestibular dysfunction

The authors undertook the assessment of the available methods for the analysis of the sensations of patients suffering pathology of the vestibular analyzer. The fact that such conditions as dizziness and disequilibrium have great influence on the social status of a patient and his (her) position in society accounts for the use of functional stabilometry in the clinical practice along with the evaluation of quality of life. It is emphasized that the timely diagnosis of these disorders and elucidation of their primary causes are as important for the successful treatment of this pathology as the choice of an adequate course of medicamental and rehabilitative therapy.     

Mechanisms of physical rehabilitation of patients with vestibular disorders

The following methods of rehabilitation of patients with equilibrium disturbance have been analysed: 1) nonspecific exercise; 2) specific physical training to enhance the flow of impulses providing formation of the mechanism of the vestibular function compensation at the subconscious level; 3) specific training on the stabilographic platform based on the biological feedback principle. It was found that the most effective recovery of the statokinetic function was achieved under combination of the above methods. The effect manifested both in subjective improvement of the patients' general condition and objective response as shown by functional computed stabilometry.     

Factors influencing long-term progress in patients with vestibular neuritis

We previously reported that platform stabilometry was effective in evaluating the condition of patients with vestibular neuritis. In the present study, we increased the patient population (n = 31) and followed them up for long-term (253.5 +/- 36.5 days after admission) to determine factors influencing prognosis. We examined the stability of patients with vestibular neuritis using platform stabilometry at 5 time points: P1, (5.3 +/- 0.7 days after admission); P2, (22.2 +/- 1.2 days); P3, (73.2 +/- 2.5 days); P4, (159.2 +/- 9.2 days); and P5, (258.3 +/- 23.5 days). For some elements--the total length of locus and the area of surroundings with open or closed eyes--the total length of locus with open eyes decreased significantly (P<0.05) following disease amelioration. Important factors for improving elements of platform stabilometry in patients with vestibular neuritis were age, presence of upper respiratory infection, and the duration of nystagmus.     

The effect of cochlear implants on vestibular-evoked myogenic potential responses and postural stability

Objective

Current spread by electrical stimulation via inserted cochlear implant (CI) electrodes and the consequential increase in sound input can affect the equilibrium of patients. The aim of the present study was to clarify the effect of CIs on the equilibrium of patients through cervical vestibular-evoked myogenic potential (cVEMP) testing and static stabilometry performed with the CIs turned on (CI-on) and off (CI-off).

Symposium on sensorineural hearing loss in children: early detection and intervention. Impedance measurement.

Although impedance measurement is a relatively new procedure, at least in this country, it is rapidly being recognized as one of the most significant contributions since the development of the pure tone audiometer. With the basic applications of the procedure it is possible to determine not only the presence but also to a great extent the specific nature of middle ear impairment, even in patients for whom audiometric results are limited and uncertain. Further applications of impedance measurement include the determination of nonorganic hearing loss and site-of-lesion testing to distinguish between cochlear and retrocochlear lesions. Finally it appears that the procedure may even permit the prediction of severity and configuration of sensorineural loss. Although impedance measurement has great value in all patients with hearing disorders, it is particularly appropriate in pediatric evaluation. Its objectivity, its ease of application, and the information that can be obtained with it make impedance measurement a significant and valuable addition to the battery for evaluation of hearing disorders in children.     

Comparison between stabilometry with and without head tilts in a roll plane

OBJECTIVE: We examined the influence of head-tilting on stabilometry, which is similar to positional nystagmus in a sitting position. METHODS: The subjects were 35 healthy individuals and 11 patients with unilateral vestibular disorder. We compared parameters measured in an upright position and those with left head-tilt or right head-tilt. We used Wilcoxon's signed ranks test for statistical analysis. RESULTS: In the group of healthy adults, the Enveloped area with left head-tilt and right head-tilt increased significantly compared to that in the upright position (P=0.0111). The parameters that decreased significantly were Locus length per unit area (P=0.0007). The center of gravity on the Y-axis shifted backward significantly (P<0.0001). In the group of unilateral vestibular disorder, there were no parameters that showed significant difference CONCLUSION: One could argue that a combination of displacement of the body itself, influence of proprioceptive sensation, and influence of otolith affects the output of stabilometry. It would be possible to develop this test if the first and the second are excluded.     

Forcing the voice and variance of speed: correlation between the speed of displacement of the center of gravity and the work of the postural muscles

Using stabilometry, our experimental protocol was designed to demonstrate a quantitative parameter of posture to study forcing of the voice. Analysis of the graphs has shown a perfect correlation between increases in variance of the speed of displacement of the centre of gravity and the increase in the electrical signal from the postural muscles, which is evidence their activation during forcing of the voice. As well as the clinical applications of this protocol, it seems necessary to undertake other studies such cinematography recording of respiration.     

基于WOS数据库的高度近视黄斑裂孔性视网膜脱离研究特征及趋势分析

目的 对近20年高度近视黄斑裂孔性视网膜脱离相关文献进行计量学分析,探讨其研究特征、热点及趋势。 方法 基于Web of Science核心合集,采用VOSviewer软件对2001年至2020年高度近视黄斑裂孔性视网膜脱离相关文献的总体特征进行关系网络构建及可视化分析。 结果 本分析共有237篇文献,总共被引5 272次,篇均被引22次。在20年的时间里SCI发文量呈上升趋势,2016年达到峰值。发表论文数量最多的国家是中国,其次是日本、意大利、美国。发表论文数量最多和h指数最高的机构是日本大阪大学。发表论文数量排名前2位的期刊是Retina和American Journal of Ophthalmology。关键词共现分析发现,高度近视黄斑裂孔性视网膜脱离相关研究,主要集中在玻璃体切除相关手术的探索上。该领域被引用次数排名前十的文献提示不同的年限研究的侧重点有区别,2001—2011年主要为玻璃体切割术的使用推广和内容物的填充,2011年之后为内界膜填塞、内界膜翻瓣、内外路联合手术的探索。 结论 近些年高度近视黄斑裂孔性视网膜脱离的研究主要集中在玻璃体切割手术为基础的手术方式的改进上,如何更为恰当的处理玻璃体切割手术中的内界膜是国际学者研究的热点,具有较广阔的前景。     

Study on 242 inpatients reporting vertigo and dizziness

We studied 242 inpatients--men (34%) and women (66%) reporting vertigo and dizziness while hospitalized at Hakodate Municipal Hospital from July 1999 to June 2002. Adults over 65 years old accounted for 47.3% of all subjects. Reports of symptoms tended to increase in March, August, and December. Cases were classified into 4 groups: 1) peripheral disorders (35.7%), 2) central disorders (7.9%), 3) disorders of other origins (8.3%), and 4) disorders of unknown origin (47.1%). Group 1) involved vestibular neuritis (10.1% of all cases), Meniere diseases (12.4%), benign paroxysmal positional vertigo (BPPV) (5.8%), and sudden deafness with vertigo (5.8%). Patients with vestibular neuritis--25 subjects including men (68%) and women (32%)--tended to be admitted mainly in July. Vestibular compensation in 15 patients with vestibular neuritis was studied using the platform stabilometry. The total length of a locus and the area of surroundings with open eyes decreased significantly (p < 0.05) as the condition of patients improved. In conclusion, many subjects reporting vertigo and dizziness had vestibular neuritis and few had BPPV. We found platform stabilometry to be useful in estimation of improvement in patients with vestibular neuritis.     

Comparison of tinnitus masking and tinnitus retraining therapy

Two methods for treating tinnitus are compared. Tinnitus masking has been used for over 25 years, and although this method is used in clinics around the world, there are many misconceptions regarding the proper protocol for its clinical application. Tinnitus retraining therapy has been used clinically for over 12 years and has received considerable international attention. Although these methods are distinctive in their basic approach to tinnitus management, certain aspects of treatment appear similar. These aspects of treatment have created considerableconfusion and controversy, especially regarding the use of "sound therapy" as a basic component of treatment. It is the objective of this article to clarify the major differences that exist between these two forms of treatment.     

Patients with an acoustic neurinoma examined with a tilting room

Patients with acoustic neurinomas do not usually show vertigo or spontaneous nystagmus, suggesting a gradual decrease of vestibular function with adequate compensation. Seventeen patients with acoustic neurinoma were examined to test their postural control. Examination in the tilting room showed a visual dominance in postural control with these patients irrespective of involvement of the central vestibular system. The subjective horizon was determined in addition to routine audiovestibular examination, to be informed about the compensation process. When routine audiovestibular examination points to an acoustic neurinoma, a pathological subjective horizon favours the diagnosis, although this is not mandatory. The combination of tilting room and stabilometry is superior in detecting visual dominance to the standard Romberg test.