Evaluation of vestibular exercises in the management of benign paroxysmal positional vertigo

Aim

(1) To evaluate the role of vestibular exercises in the management of benign paroxysmal positional vertigo (BPPV). (2) To compare the three vestibular exercises (Semont’s manoeuvre, Epley’s manoeuvre or Brandt-Daroff exercises) in the treatment of BPPV.

Settings and Design

Prospective randomised study

Methods and Material

Fourty-eight patients diagnosed as BPPV in the study period November 2005–2006 were included in the study. They were randomly assigned to one of three groups, and the corresponding manoeuvre was done on them. Follow-up were at 2 weeks and 3 months.

Results

Thirty-five of the 48 patients (72.91%) reported relief of symptoms at 2 weeks and no recurrence of symptoms at 3 months. Result was best for the group which was subjected to the Epley manoeuvre (87.5%).

Conclusions

Performance of any of the three manoeuvres can be expected to give good results in the management of BPPV. The Epley manoeuvre appears to be better than the other two in terms of relief of symptoms and prevention of recurrence.     

Effect of the abdominal draw-in manoeuvre in combination with ankle dorsiflexion in strengthening the transverse abdominal muscle in healthy young adults: A preliminary, randomised, controlled study

Objectives

To compare the effect of the abdominal draw-in manoeuvre with the abdominal draw-in manoeuvre in combination with ankle dorsiflexion on changes in muscle thickness and associated muscle activity in abdominal muscles.

Design

A preliminary, randomised, controlled study.

Setting

University laboratory.

Participants

Forty healthy adults (18 males, 22 females) were allocated at random to the experimental group [mean age (SD) 24 (1.6) years, n = 20] or the control group [mean age (SD) 24 (1.9) years, n = 20]. The experimental group performed the abdominal draw-in manoeuvre in combination with ankle dorsiflexion, and the control group performed the abdominal draw-in manoeuvre alone, five times a day.

Main outcome measures

Ultrasonography and electromyography were used to determine the intervention-related changes in muscle activity and the thickness of abdominal muscles during the abdominal draw-in manoeuvre or the abdominal draw-in manoeuvre in combination with ankle dorsiflexion.

Results

A significant difference was found in the thickness of the transverse abdominal muscle between the groups [mean difference 0.24 cm, 95% confidence interval (CI) 0.08 to 0.40, P =0.005. On electromyography, a significant difference was demonstrated in the amplitude of the transverse abdominal muscle contraction between the two techniques in the experimental group (mean difference 68.76 mV, 95% CI 53.16 to 84.36, P =0.000. The intra-class correlation coefficient (ICC_2,1) showed excellent test-retest reliability of ultrasound measurement of the abdominal muscles: 0.96 (95% CI 0.85 to 0.99) for the transverse abdominal muscle, 0.87 (95% CI 0.62 to 0.98) for the internal oblique muscle and 0.77 (95% CI 0.44 to 0.96) for the external oblique muscle.

Conclusions

This is the first study to demonstrate the additive effect of ankle dorsiflexion on deep core muscle thickness and activity, thus contributing to existing knowledge about therapeutic exercise for the effective management of low back pain.     

瓦尔萨瓦动作引起眼眶、纵隔气肿一例并文献复习

目的 提高对瓦尔萨瓦动作可能引起气压伤的认识. 方法 通过报道1例瓦尔萨瓦动作引起的眼眶气肿、纵隔气肿典型病例并文献复习,分析和讨论本病的病因、发病机制、临床表现、诊断、治疗及预后情况. 结果 瓦尔萨瓦动作可引起眼眶气肿、颈部皮下气肿及纵隔气肿,可保守治疗,预后较好. 结论 瓦尔萨瓦动作或其他引起鼻内压力增加的动作要适当用力,以防气压伤.     

Imaging of the ureters on intravenous urography: Does a valsalva help?

A prospective trial, comparing filling of the ureters on routine urography with ureteric filling following a valsalva manoeuvre, was performed. A significantly greater length of ureter was filled by the study patients than controls, allowing this frequently poorly imaged structure to be visualized more consistently.     

Testing of autonomic cardiovascular regulation—methodological considerations

Summary. The different analyses of the results on autonomic nervous function tests were evaluated in 43 male and 32 female diabetic patients and in 24 male and 24 female control subjects, aged 47–67 years, all without any known heart disease. The Valsalva ratio of the first effort did not differ from the mean Valsalva ratio of three efforts. During deep breathing, heart rate variation and max/min R-R interval ratio determined from the first three breathing cycles did not differ from the respective variables calculated from six consecutive breathing cycles. Diastolic blood pressure response to isometric handgrip was greater during the third minute than during the first and the first two minutes. In conclusion, the tests for the evaluation of autonomic nervous function can be simplified without losing their diagnostic value.     

Diagnostic value of the Valsalva ratio reduction in diabetic autonomic neuropathy: use of an age-related normal range

A curvilinear age-related normal range for the Valsalva ratio is presented. Application of this range was used to identify abnormalities in ratios obtained from 59 patients with diabetes mellitus aged 16-60 years. It was found that 35 had normal, 6 had borderline and 18 had abnormal results. Comparison with other autonomic function tests of the cardiovascular and pupillary systems showed that abnormalities of the Valsalva ratio correlated most highly with the sinus arrhythmia test results. Repeat measurements of ratios in healthy and diabetic subjects yielded coefficients of variation of 15.4% and 10.5% respectively.     

Autonomic function in amyotrophic lateral sclerosis: a study of cardiovascular responses

Autonomically mediated cardiovascular responses were evaluated in 15 ALS patients and compared with 15 healthy subjects. The respiratory sinus arrhythmia, the heart rate response to a Valsalva manoeuvre, to isometric handgrip and to a dive reflex test was normal, indicating a normal function of vagal nerves. The heart rate and blood pressure responses during an orthostatic test were normal, indicating a normal function of sympathetic nerves. The increase in blood pressure and blood flow in the contralateral forearm which occurs on handgrip in healthy subjects was reduced in the ALS patients. The cause of this is unclear, but could be related to decreased function of "ergoreceptors" or altered vascular reactivity in atrophic muscle.     

Different Valsalva Manoeuvre Procedures for the Diagnosis of Right-to-Left Shunt by Contrast-Transcranial Doppler

The main purpose of this study was to compare two contrast agent injection times during the Valsalva manoeuvre (VM) for the diagnosis of right-to-left shunt using contrast-transcranial Doppler (c-TCD). In total, 992 consecutive patients underwent testing. All patients underwent step 1, and then a coin toss was used to determine the order of steps 2 and 3. The following testing steps were repeated twice: (1) a contrast agent (CA) was infused at rest (CA at rest testing); (2) the VM was initiated immediately after CA injection and released 10 s after CA injection (CA pre-VM testing); and (3) a CA was injected 5 s after initiating the VM, which was released 5 s after CA injection (CA mid-VM testing). For the CA at rest, pre-VM and mid-VM groups, significant differences were observed in the positive right-to-left shunt diagnosis rates (11.49% vs. 23.08% vs. 26.11%, respectively, with an inter-group significance of p < 0.05) and grade classifications (p < 0.05). Although the times to first microbubble appearance were similar between the CA at rest and the CA pre-VM groups (8.96 ± 3.40 s vs. 8.42 ± 3.72 s, p > 0.05), it was shorter (6.4 ± 2.75 s, p < 0.05) for the CA mid-VM group than for the other two groups. For the c-TCD testing, the CA mid-VM group yielded different results for diagnosing right-to-left shunts relative to the CA pre-VM group.     

Brain oxygenation responses to an autonomic challenge: a quantitative fMRI investigation of the Valsalva manoeuvre

In late age, the autonomic nervous system (ANS) has diminished ability to maintain physiological homeostasis in the brain in response to challenges such as to systemic blood pressure changes caused by standing. We devised an fMRI experiment aiming to map the cerebral effects of an ANS challenge (Valsalva manoeuvre (VM)). We used dual-echo fMRI to measure the effective transverse relaxation rate (R₂*, which is inversely proportional to brain tissue oxygenation levels) in 45 elderly subjects (median age 80 years old, total range 75–89) during performance of the VM. In addition, we collected fluid-attenuated inversion recovery (FLAIR) data from which we quantified white matter hyperintensity (WMH) volumes. We conducted voxelwise analysis of the dynamic changes in R₂* during the VM to determine the distribution of oxygenation changes due to the autonomic stressor. In white matter, we observed significant decreases in oxygenation levels. These effects were predominantly located in posterior white matter and to a lesser degree in the right anterior brain, both concentrated around the border zones (watersheds) between cerebral perfusion territories. These areas are known to be particularly vulnerable to hypoxia and are prone to formation of white matter hyperintensities. Although we observed overlap between localisation of WMH and triggered deoxygenation on the group level, we did not find significant association between these independent variables using subjectwise statistics. This could suggest other than recurrent transient hypoxia mechanisms causing/contributing to the formation of WMH.