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- Malmström, Eva Maj, et al.
(författare)
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Co-morbidities to Vestibular Impairments—Some Concomitant Disorders in Young and Older Adults
- 2021
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Ingår i: Frontiers in Neurology. - : Frontiers Media SA. - 1664-2295. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- Background: Dizziness and pain are common complaints that often appear concomitantly, with or without a causal relationship. However, these symptoms might maintain and exacerbate each other and other co-morbidities. Therefore, adequate rehabilitation may have to include an expanded focus on other deficits and preconditions, especially in older adults and in patients. Objective: To understand how frequently vestibular dysfunction coincided with medical conditions and aging, we studied two categories: Study 1: patients referred to a vestibular unit and Study 2: senior members in a fitness association. Method: Study 1: 49 patients [34 females/15 males; mean age 52 years (SEM 2.0)] seeking health care for balance disorders and vestibular deficits were asked in questionnaires about their perception of dizziness and pain, and emotional and functional strains. Study 2: 101 senior members in a fitness association [91 females/10 males; mean age 75 years (SEM 0.6)], were assessed for vestibular and balance deficits and for any co-morbidities. The participants were monitored for falls for 12 months after the initial assessments. Result: Study 1: Co-morbidity often existed between dizziness and pain (65%). The patients reported high emotional and functional strain related to their dizziness and pain. Patients older than 60 years reported longer durations of pain (p ≤ 0.028) but less emotional strain (p = 0.036), compared to younger patients. Study 2: 84% of the participants had a vestibular impairment, often without noticing any symptoms. Furthermore, 40% reported cardiovascular illnesses, 12% musculoskeletal disorders, and 63% reported other medical conditions. Forty-two percent experienced falls within 1 year after the initial assessments (thereof 42% in the group with vestibular deficits and 38% in the group without vestibular deficits). Conclusion: To enhance and preserve postural control, both in patients with vestibular deficits and in older adults, we suggest an expanded clinical perspective. Hence, we recommend detailed examinations of the vestibular system but simultaneously probing for possible co-morbidities. Since aging often entails deterioration of multimodal processes related to maintained mobility and postural stability, our results add focus on the importance of addressing balance disorders together with additional medical conditions.
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- Malmström, Eva-Maj, et al.
(författare)
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Dizziness and localized pain are often concurrent in patients with balance or psychological disorders
- 2020
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Ingår i: Scandinavian Journal of Pain. - : Walter de Gruyter GmbH. - 1877-8860 .- 1877-8879. ; 20:2, s. 353-362
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Tidskriftsartikel (refereegranskat)abstract
- Background and aims Symptoms of dizziness and pain are both common complaints and the two symptoms often seem to coincide. When symptoms appear concomitant for sustained periods of time the symptoms might maintain and even exacerbate each other, sometimes leading to psychological distress. In order to evaluate such comorbidity we studied patients referred to a vestibular unit and to a psychiatric outpatient clinic with respectively balance disorders and psychological issues. Methods Consecutive patients referred to a vestibular unit (n = 49) and a psychiatric outpatient clinic (n = 62) answered the Dizziness Handicap Inventory (DHI) questionnaire and a questionnaire detailing occurrence of dizziness and pain. Results The experience of dizziness and pain often coincided within individuals across both clinical populations, especially if the pain was located to the neck/shoulder or the back (p = 0.006). Patients who reported dizziness had significantly more often pain (p = 0.024); in the head (p = 0.002), neck/shoulders (p = 0.003) and feet (p = 0.043). Moreover, patients who reported dizziness stated significantly higher scoring on emotional (p < 0.001) and functional (p < 0.001) DHI sub-scales. Furthermore, patients who reported an accident in their history suffered significantly more often from dizziness (p = 0.039) and pain (p < 0.001); in the head (p < 0.001), neck/shoulders (p < 0.001) and arms (p = 0.045) and they scored higher on the emotional (p = 0.004) and functional (p = 0.002) DHI sub-scales. Conclusions The findings suggest comorbidity to exist between dizziness and neck/shoulder or back pain in patients seeking health care for balance disorders or psychological issues. Patients suffering from dizziness and pain, or with both symptoms, also reported higher emotional and functional strain. Thus, healthcare professionals should consider comorbidity when determining diagnosis and consequent measures. Implications Clinicians need to have a broader "receptive scope" in both history and clinical examinations, and ask for all symptoms. Although the patients in this study visited a vestibular unit respectively a psychological clinic, they commonly reported pain conditions when explicitly asked for this symptom. A multimodal approach is thus to favor, especially when the symptoms persist, for the best clinical management.
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- Cohen, Helen S., et al.
(författare)
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International guidelines for education in vestibular rehabilitation therapy
- 2011
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Ingår i: Journal of Vestibular Research. - 1878-6464. ; 21:5, s. 243-250
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Tidskriftsartikel (refereegranskat)abstract
- The Barany Society Ad Hoc Committee on Vestibular Rehabilitation Therapy has developed guidelines for developing educational programs for continuing education. These guidelines may be useful to individual therapists who seek to learn about vestibular rehabilitation or who seek to improve their knowledge bases. These guidelines may also be useful to professional organizations or therapists who provide continuing education in vestibular rehabilitation. We recommend a thorough background in basic vestibular science as well as an understating of current objective diagnostic testing and diagnoses, understanding of common tests used by therapists to assess postural control, vertigo and ability to perform activities of daily living. We recommend that therapists be familiar with the evidence supporting efficacy of available treatments as well as with limitations in the current research.
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- Cohen, Helen S., et al.
(författare)
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International survey of vestibular rehabilitation therapists by the Barany Society Ad Hoc Committee on Vestibular Rehabilitation Therapy
- 2009
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Ingår i: Journal of Vestibular Research. - 1878-6464. ; 19:1-2, s. 15-20
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Tidskriftsartikel (refereegranskat)abstract
- The goal of this study was to determine how occupational and physical therapists learn about vestibular rehabilitation therapy, their educational backgrounds, referral patterns, and their ideas about entry-level and advanced continuing education in vestibular rehabilitation therapy. The Barany Society Ad Hoc Committee for Vestibular Rehabilitation Therapy invited therapists around the world to complete an E-mail survey. Participants were either known to committee members or other Barany Society members, known to other participants, identified from their self-listings on the Internet, or volunteered after reading notices published in publications read by therapists. Responses were received from 133 therapists in 19 countries. They had a range of educational backgrounds, practice settings, and referral patterns. Few respondents had had any training about vestibular rehabilitation during their professional entry-level education. Most respondents learned about vestibular rehabilitation from continuing education courses, interactions with their colleagues, and reading. All of them endorsed the concept of developing standards and educating therapists about vestibular anatomy and physiology, vestibular diagnostic testing, vestibular disorders and current intervention strategies. Therefore, the Committee recommends the development of international standards for education and practice in vestibular rehabilitation therapy.
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- Malmström, Eva-Maj
(författare)
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Cervical influence on dizziness and orientation
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of the work was to examine the influence of cervical biomechanical conditions on movement performance, to study musculoskeletal findings accompanying possible cervicogenic dizziness and to evaluate the influence of cervical proprioception on head orientation. Two devices, measuring cervical range of motion, were compared: Myrin, an inclinometer/compass method and Zebris®, a 3-dimensional ultrasound movement analyser. Both devices showed good reliability and agreement with less variability for the computerized method. The Myrin can be used in clinical routine work and the Zebris® adds information about 3-dimensional movements. (Study I). Cervical range of motion was examined in three dimensions in 120 neck-healthy subjects. Movement patterns of combined primary and coupled movements and the influence of age, gender and body mass index on these movements were investigated. Coupled movements are a natural part of cervical motion together with primary movements. Age affects the majority of primary and coupled cervical movements; the coupled movements of primary rotation and lateral flexion are especially changed with age (Study II). Twenty-two patients with dizziness of suspected cervical origin were examined with a structured physical examination and carefully examined to exclude other causes of dizziness. The effects of physiotherapy, based on these musculoskeletal findings, were evaluated directly after treatment and again long-term with questionnaires. Patients with suspected cervicogenic dizziness had some musculoskeletal findings in common, e.g., tenderness and tightness in the dorsal neck muscles, preserved cervical mobility and reduced cervico-thoracic mobility. Treatment based on these findings reduced both neck pain and dizziness. Some patients seem to need a maintenance strategy to avoid relapses in the long-term (Study III). Twenty neck-healthy subjects were examined before and after a unilateral neck muscle fatiguing task with head repositioning tests. An average overshoot before the fatiguing task decreased after acute muscle fatigue and the increased accuracy was significant and most pronounced for movements directed towards the fatigued side (Study IV). Eleven subjects with bilateral vestibulopathy were compared to fifteen healthy subjects in their ability to reproduce different head on trunk target positions. The subjects with bilateral vestibulopathy maintained their ability to recognize and fine-tune head on trunk movements (Study V). Cervical movement performance changed with increasing age. Treatment of cervical musculoskeletal findings reduced both neck pain symptoms and dizziness; diagnosis ex juvantibus supports the diagnosis of cervicogenic dizziness. Cervical proprioception is an important factor in sensing head on trunk movements. Lund University, Faculty of Medicine Doctoral Dissertation Series 2008:52
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| 9. |
- Malmström, Eva-Maj, et al.
(författare)
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Influence of prolonged unilateral cervical muscle contraction on head repositioning - Decreased overshoot after a 5-min static muscle contraction task.
- 2010
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Ingår i: Manual Therapy. - : Elsevier BV. - 1356-689X. ; 15, s. 229-234
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Tidskriftsartikel (refereegranskat)abstract
- The ability to reproduce a specified head-on-trunk position can be an indirect test of cervical proprioception. This ability is affected in subjects with neck pain, but it is unclear whether and how much pain or continuous muscle contraction factors contribute to this effect. We studied the influence of a static unilateral neck muscle contraction task (5 min of lateral flexion at 30% of maximal voluntary contraction) on head repositioning ability in 20 subjects (10 women, 10 men; mean age 37 years) with healthy necks. Head repositioning ability was tested in the horizontal plane with 30 degrees target and neutral head position tests; head position was recorded by Zebris((R)), an ultrasound-based motion analyser. Head repositioning ability was analysed for accuracy (mean of signed differences between introduced and reproduced positions) and precision (standard deviation of the differences). Accuracy of head repositioning ability increased significantly after the muscle contraction task, as the normal overshoot was reduced. An average overshoot of 7.1 degrees decreased to 4.6 degrees after the muscle contraction task for the 30 degrees target and from 2.2 degrees to 1.4 degrees for neutral head position. The increased accuracy was most pronounced for movements directed towards the activated side. Hence, prolonged unilateral neck muscle contraction may increase the sensitivity of cervical proprioceptors.
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