Postural Responses Characterization in elderly Patients with Bilateral Vestibular Hypofunction

Acta Otolaryngol. 2013 Apr;133(4):361-7. doi: 10.3109/00016489.2012.739731. Epub 2013 Jan 14.

Abstract

CONCLUSIONS:

The measurement of the energy consumption (EC) of the body’s center of pressure (COP) to maintain the upright stance position was higher in elderly patients with bilateral vestibular hypofunction (BVH) compared with a control group and may be a valid parameter in the assessment of balance disorders.

OBJECTIVE:

The aim of the study was to evaluate the energy consumption of the COP in elderly patients with BVH.

METHODS:

The COP was recorded on a force platform (FP) for eight elderly patients with BVH related to aging and eight normal control group subjects. The EC of the COP was calculated using the discrete wavelet transform. The two groups were tested in standing position on the FP in three sensory conditions:1, eyes open; 2, eyes closed; and 3, standing on a foam pad placed on the force platform. Wilcoxon’s rank test and multi-factor analysis of variance were used, with the level of significance set at 0.05.

RESULTS:

BVH patients showed higher values of EC of the COP signal measured in arbitrary units compared with the control group (conditions 1 and 2). None of the BVH patients could perform the test in condition 3. BVH patients had increased EC in the frequency band between 0.1 and 0.78 Hz when the visual information was canceled (condition 2).

Effects of balance training using a virtual-reality system in older fallers. Clinical interventions in aging

Clin Interv Aging. 2013;8:257-63. doi: 10.2147/CIA.S41453. Epub 2013 Feb 28.

Duque G1, Boersma D, Loza-Diaz G, Hassan S, Suarez H, Geisinger D, Suriyaarachchi P, Sharma A, Demontiero O.

 

Abstract

Poor balance is considered a challenging risk factor for falls in older adults. Therefore, innovative interventions for balance improvement in this population are greatly needed. The aim of this study was to evaluate the effect of a new virtual-reality system (the Balance Rehabilitation Unit [BRU]) on balance, falls, and fear of falling in a population of community-dwelling older subjects with a known history of falls. In this study, 60 community-dwelling older subjects were recruited after being diagnosed with poor balance at the Falls and Fractures Clinic, Nepean Hospital (Penrith, NSW, Australia). Subjects were randomly assigned to either the BRU-training or control groups. Both groups received the usual falls prevention care. The BRU-training group attended balance training (two sessions/week for 6 weeks) using an established protocol. Change in balance parameters was assessed in the BRU-training group at the end of their 6-week training program. Both groups were assessed 9 months after their initial assessment (month 0). Adherence to the BRU-training program was 97%. Balance parameters were significantly improved in the BRU-training group (P < 0.01). This effect was also associated with a significant reduction in falls and lower levels of fear of falling (P < 0.01). Some components of balance that were improved by BRU training showed a decline after 9 months post-training. In conclusion, BRU training is an effective and well-accepted intervention to improve balance, increase confidence, and prevent falls in the elderly.

KEYWORDS:

balance; elderly; falls; postural instability; virtual reality

Postural response characterization in elderly patients with bilateral vestibular hypofunction

Hamlet Suarez, Gonzalo Sotta, Cecilia San Roman, Sofia Arocena, Enrique Ferreira, Dario Geisinger, Alejo Suarez & Juan Picerno

Abstract

Conclusions: The measurement of the energy consumption (EC) of the body’s center of pressure (COP) to maintain the upright stance position was higher in elderly patients with bilateral vestibular hypofunction (BVH) compared with a control group and may be a valid parameter in the assessment of balance disorders. Objective: The aim of the study was to evaluate the energy consumption of the COP in elderly patients with BVH. Methods: The COP was recorded on a force platform (FP) for eight elderly patients with BVH related to aging and eight normal control group subjects. The EC of the COP was calculated using the discrete wavelet transform. The two groups were tested in standing position on the FP in three sensory conditions:1, eyes open; 2, eyes closed; and 3, standing on a foam pad placed on the force platform. Wilcoxon’s rank test and multi-factor analysis of variance were used, with the level of significance set at 0.05. Results: BVH patients showed higher values of EC of the COP signal measured in arbitrary units compared with the control group (conditions 1 and 2). None of the BVH patients could perform the test in condition 3. BVH patients had increased EC in the frequency band between 0.1 and 0.78 Hz when the visual information was canceled (condition 2).

Keywords

Wavelets, posturography, postural control

Energy Consumption of the Body’s Center of Pressure Signal in Older Adults with Balance Disorders

Hamlet Suarez, Gonzalo Sotta, Enrique Ferreira, Cecilia San Roman
, Sofia Arocena, and Fernando Bagalciague

 

The aim of this study was to measure the total energy consumption of the body’s center of pressure and
its proportion in 3 frequency bands in elderly patients with balance disorders. Sixteen patients with central
vestibular disorders related with the aging process were assessed and divided in two groups: 1—Eight patients
with bilateral vestibular hypofunction. 2—Eight patients with normal vestibular responses. A control group of nine
healthy subjects was also assessed. Center of pressure recording was performed using a force platform with
the patient in the standing position with the eyes open. Pathological groups showed a significantly higher total
energy consumption than the control group (
P
= 0.001). Patients with central vestibular disorders and normal
vestibular response had a higher proportion of energy consumption at low frequencies (
<0.1 Hz) (
P
= 0.001),
whereas patients with bilateral vestibular hypofunction had greater energy consumption at high frequencies (>0.78 Hz) (P = 0.001). These results suggest that the measurement of the energy consumption of the center
of pressure may be a suitable balance disorder parameter for elderly patients. Also, the analysis by bands of
frequencies allows the discrimination of the presence or absence of peripheral vestibular information in patients
with central vestibular disorders.

Effects of balance training using a virtual-reality system in older fallers

Gustavo Duque, Derek Boersma, Griselda Loza-Diaz, Sanobar Hassan, Hamlet Suarez, Dario Geisinger, Pushpa Suriyaarachchi, Anita Sharma, and Oddom Demontiero

 

Abstract

Poor balance is considered a challenging risk factor for falls in older adults. Therefore, innovative interventions for balance improvement in this population are greatly needed. The aim of this study was to evaluate the effect of a new virtual-reality system (the Balance Rehabilitation Unit [BRU]) on balance, falls, and fear of falling in a population of community-dwelling older subjects with a known history of falls. In this study, 60 community-dwelling older subjects were recruited after being diagnosed with poor balance at the Falls and Fractures Clinic, Nepean Hospital (Penrith, NSW, Australia). Subjects were randomly assigned to either the BRU-training or control groups. Both groups received the usual falls prevention care. The BRU-training group attended balance training (two sessions/week for 6 weeks) using an established protocol. Change in balance parameters was assessed in the BRU-training group at the end of their 6-week training program. Both groups were assessed 9 months after their initial assessment (month 0). Adherence to the BRU-training program was 97%. Balance parameters were significantly improved in the BRU-training group (P < 0.01). This effect was also associated with a significant reduction in falls and lower levels of fear of falling (P < 0.01). Some components of balance that were improved by BRU training showed a decline after 9 months post-training. In conclusion, BRU training is an effective and well-accepted intervention to improve balance, increase confidence, and prevent falls in the elderly.

Keywords: falls, balance, postural instability, virtual reality, elderly

A multicenter observational study on the role of comorbidities in the recurrent episodes of benign paroxysmal positional vertigo

Alessandro De Stefanoa, Francesco Dispenzab, Hamlet Suarezc, Nicolas Perez-Fernandezd, Raquel Manrique-Huarted, Jae Ho Bane, Min Beom Kime, Michael Struppf, Katharina Feilf, Carlos A. Oliveirag, Andres L. Sampaiog, Mercedes F.S. Araujog, Fayez Bahmad Jrg, Mauricio M. Ganançah, Fernando F. Ganançah, Ricardo Doriguetoh, Hyung Leei, Gautham Kulamarvaj, Navneet Mathurk, Pamela Di Giovannil, Anna Grazia Petruccim, Tommaso Staniscian, Leonardo Citraroa, Adelchi Crocea

Abstract

Objective

Primary objective of this study was to find a statistical link between the most worldwide comorbidities affecting the elderly population (hypertension, diabetes, osteoarthrosis, osteoporosis and depression) and recurrent episodes of BPPV. Secondary objective was defining possible “groups of risk” for people suffering recurrent positional vertigo related to the presence of a well documented comorbidity.

Methods

This was an observational, cross-sectional, multicenter, spontaneous, non-pharmacological study. The data of 1092 patients suffering BPPV evaluated in 11 different Departments of Otolaryngology, Otoneurology and Neurology, referring Centers for positional vertigo evaluation, were retrospectively collected.

Results

Regarding evaluated comorbidities (hypertension, diabetes, osteoarthrosis, osteoporosis and depression), data analysis showed the presence of at least one comorbid disorder in 216 subjects (19.8%) and 2 or more in 408 subjects (37.4%). Moreover there was a statistical significant difference between the number of comorbidities and the number of recurrences, otherwise said as comorbidity disorders increased the number of relapses increased too.

Conclusion

The presence of a systemic disease may worsen the status of the posterior labyrinth causing a more frequent otolith detachment. This condition increases the risk for patients suffering BPPV to have recurrent episodes, even if correctly managed by repositioning maneuvers. The combination of two or more of aforementioned comorbidities further increases the risk of relapsing BPPV, worsened by the presence of osteoporosis. On the basis of this results it was possible to define “groups of risk” useful for predicting BPPV recurrence in patients with one or more comorbidity.

Abbreviations
BPPV, benign paroxysmal positional vertigo; PSC, posterior semicircular canals; HSC, horizontal semicircular canal; ASC, anterior semicircular canal; OA, osteoarthrosis; CRM, canalith repositioning maneuver; OR, odds ratio
Keywords
BPPV; Vertigo; Hypertension; Diabetes; Osteoarthrosis; Osteoporosis; Otolaryngology; Comorbidity; Neurology; Elderly