Body Balance in Elderly Patients, 12 Months After Treatment for BPPV.

Body balance in elderly patients, 12 months after treatment for BPPV.

Braz J Otorhinolaryngol. 2013 Feb; 79(1): 39-46
Lança SM, Gazzola JM, Kasse CA, Branco-Barreiro FC, Vaz DP, Scharlach RC

Benign Paroxysmal Positional Vertigo is highly prevalent in the elderly population, triggering major changes in body balance. OBJECTIVE: To compare the results obtained from static posturography in the elderly before and after otoliths repositioning maneuvers and 12 months after treatment onset. Design: longitudinal, descriptive and analytical study. METHOD: Elderly patients with clinical diagnosis of BPPV submitted to Balance Rehabilitation Unit static posturography in 10 sensory conditions at three time intervals: before and after the repositioning maneuver and12 months after the treatment RESULTS: We studied 23 subjects with a mean age of 68.74 years. Posturography revealed that the stability limit was not significantly different when the three time intervals were compared (p = 0.405). The center of pressure (CoP) showed a significant change in condition 2 (stable surface and closed eyes), because after the repositioning maneuver, the CoP significantly differed vis-à-vis the results before and 12 months after the treatment (p = 0.003). The values of body velocity sway (BVS) were significantly different in six sensory conditions in these three time intervals. CONCLUSION: 12 months after the treatment for BPPV, the static posturography showed balance abnormalities similar to those found before treatment. HubMed – rehab


Prediction of postoperative pain after percutaneous nephrolithotomy: can preoperative experimental pain assessment identify patients at risk?

Urolithiasis. 2013 Apr; 41(2): 169-77
Pedersen KV, Olesen AE, Osther PJ, Arendt-Nielsen L, Drewes AM

Postoperative pain remains a significant problem and the individual variance in postoperative pain is not fully understood. In recent years, there has been focus on identifying risk factors predicting patients with high postoperative pain intensity or consumption of analgesics, which may facilitate an improvement in rehabilitation. This study evaluates the relationship between preoperative experimental pain assessment and postoperative pain and opioid consumption. Forty-four patients with uni- or bilateral kidney stone disease scheduled for percutaneous nephrolithotomy were included. The preoperative pain thresholds were measured using electrical (single and 5 repeated) and pressure pain stimulation over the flank bilaterally (stone-side = operation side and control-side = non-operation side). Postoperative pain scores were recorded on a numerical rating scale and analgesic consumption was registered. The responses to repeated electrical stimuli (temporal summation) were preoperatively increased on the stone-side compared to the control-side (P = 0.016). Preoperative electrical pain thresholds from the control-side correlated inversely with postoperative opioid consumption (single stimuli: ? = -0.43, P < 0.01; repeated stimuli: ? = -0.45, P < 0.005). This correlation was more pronounced for the 22 patients with unilateral renal calculi (single stimuli: ? = -0.54, P < 0.02; repeated stimuli: ? = -0.58, P < 0.01). There were no other correlations between the preoperative sensory tests and postoperative pain or opioid consumption. This study showed a correlation between the preoperative electrical pain thresholds on the control-side and postoperative opioid consumption after percutaneous nephrolithotomy. Preoperative measurement of the electrical pain thresholds may, therefore, be useful as a screening tool to identify patients at high risk of postoperative pain. HubMed – rehab


A randomized trial of two home-based exercise programmes to improve functional walking post-stroke.

Clin Rehabil. 2013 Mar 15;
Mayo NE, Mackay-Lyons MJ, Scott SC, Moriello C, Brophy J

Objective:To estimate the relative effectiveness in improving walking ability and other mobility and health outcomes post-stroke of two home-based exercise programmes – stationary cycling and an exercise and walking programme.Design:An observer-blinded, randomized, pragmatic, trial with repeated measures.Setting:Hospital centers in two Canadian cities.Subjects:People within 12 months of acute stroke who were able to walk >10 meters independently and healthy enough to engage in exercise.Interventions:Two dose-equivalent interventions, one involving stationary cycling and the other disability-targeted interventions were tested. Both protocols required daily moderate intensity exercise at home building up to 30 minutes per day. One group exercised on a stationary bicycle, the second group carried out mobility exercises and brisk walking.Main measures:The primary outcome was walking capacity as measured by the six-minute walk test (6MWT). Secondary outcomes were physical function, role participation, health-related quality of life exercise adherence, and adverse events.Results:The study failed to meet recruitment targets: 87 participants (cycle group, n = 43; exercise group, n = 44) participated. No significant effects of group or time were revealed for the 6MWT, which was approximately 320 m at randomization. A significant effect for role participation was found in favor of the exercise group (global odds ratio (OR) for cycling vs. exercise was 0.51; 95% confidence interval (CI), 0.27-0.95). Change in the 6MWT between highest and lowest adherence categories was statistically significant (p = 0.022).Conclusions:Both programmes were equally effective in maintaining walking capacity after discharge from stroke rehabilitation; or were equally ineffective in improving walking capacity.Clinical Trials Gov number:NCT00786045. HubMed – rehab