What Is the Optimal Number of Treatment Sessions of Vestibular Rehabilitation?

What is the optimal number of treatment sessions of vestibular rehabilitation?

Eur Arch Otorhinolaryngol. 2013 Mar 7;
Rossi-Izquierdo M, Santos-Pérez S, Rubio-Rodríguez JP, Lirola-Delgado A, Zubizarreta-Gutiérrez A, San Román-Rodríguez E, Juíz-López P, Soto-Varela A

Vestibular rehabilitation is effective and safe in patients with instability. However, there is insufficient evidence for distinguishing between efficacies of different dosage of therapies. Therefore, the aim of the present study was to verify whether there were differences between two computerised dynamic posturography (CDP) therapies of different numbers of sessions, in order to establish the optimal strategy. We conducted a prospective, comparative study of two different dosage of CDP therapy (a 5-session group and another of 10-session group) in patients with instability due to chronic unilateral peripheral vestibular disorder. We used balanced block randomisation to include 13 patients in each group. Improvement was assessed using the Dizziness Handicap Inventory and the CDP with the sensorial organisation test (SOT) and limits of stability (LOS). We found a statistically significant improvement in both groups in composite score, visual and vestibular input (SOT); and in reaction time, distance and directional control (LOS). If we compare the groups regarding these improvements, we found that 10-session group showed a greater benefit in distance covered and directional control of LOS. Since significant improvement is obtained with only five sessions, we believe this to be the optimal number of treatment sessions for most patients with chronic unilateral peripheral vestibular disorder. Nevertheless, those patients with more reduced limits of stability, and consequently greater likelihood of falling as a result of their diminished base of support, are candidates for rehabilitation protocols with a greater number of sessions. HubMed – rehab


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

Clin Interv Aging. 2013; 8: 257-63
Duque G, Boersma D, Loza-Diaz G, Hassan S, Suarez H, Geisinger D, Suriyaarachchi P, Sharma A, Demontiero O

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 ( < 0.01). This effect was also associated with a significant reduction in falls and lower levels of fear of falling ( < 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. HubMed – rehab


Disruption of the Presynaptic Cytomatrix Protein Bassoon Degrades Ribbon Anchorage, Multiquantal Release, and Sound Encoding at the Hair Cell Afferent Synapse.

J Neurosci. 2013 Mar 6; 33(10): 4456-4467
Jing Z, Rutherford MA, Takago H, Frank T, Fejtova A, Khimich D, Moser T, Strenzke N

Inner hair cells (IHCs) of the cochlea use ribbon synapses to transmit auditory information faithfully to spiral ganglion neurons (SGNs). In the present study, we used genetic disruption of the presynaptic scaffold protein bassoon in mice to manipulate the morphology and function of the IHC synapse. Although partial-deletion mutants lacking functional bassoon (Bsn?Ex4/5) had a near-complete loss of ribbons from the synapses (up to 88% ribbonless synapses), gene-trap mutants (Bsngt) showed weak residual expression of bassoon and 56% ribbonless synapses, whereas the remaining 44% had a loosely anchored ribbon. Patch-clamp recordings and synaptic CaV1.3 immunolabeling indicated a larger number of Ca2+ channels for Bsngt IHCs compared with Bsn?Ex4/5 IHCs and for Bsngt ribbon-occupied versus Bsngt ribbonless synapses. An intermediate phenotype of Bsngt IHCs was also found by membrane capacitance measurements for sustained exocytosis, but not for the size of the readily releasable vesicle pool. The frequency and amplitude of EPSCs were reduced in Bsn?Ex4/5 mouse SGNs, whereas their postsynaptic AMPA receptor clusters were largely unaltered. Sound coding in SGN, assessed by recordings of single auditory nerve fibers and their population responses in vivo, was similarly affected in Bsngt and Bsn?Ex4/5 mice. Both genotypes showed impaired sound onset coding and reduced evoked and spontaneous spike rates. In summary, reduced bassoon expression or complete lack of full-length bassoon impaired sound encoding to a similar extent, which is consistent with the comparable reduction of the readily releasable vesicle pool. This suggests that the remaining loosely anchored ribbons in Bsngt IHCs were functionally inadequate or that ribbon independent mechanisms dominated the coding deficit. HubMed – rehab


Content Analysis of Four Fear of Falling Rating Scales by Linking to the International Classification of Functioning, Disability and Health.

PM R. 2013 Mar 1;
Bladh S, Nilsson MH, Carlsson G, Lexell J

OBJECTIVE: To gain a deeper understanding of the content of 4 fear of falling (FOF) rating scales by linking them to the International Classification of Functioning, Disability and Health (ICF). DESIGN: Linking study according to the ICF linking rules. SETTING: Not applicable. PATIENTS: Not applicable. METHODS: The rating scales were the Falls Efficacy Scale-International (FES-I), the Swedish version of the Falls Efficacy Scale (FES[S]), the Activities-specific Balance Confidence Scale (ABC), and the modified Survey of Activities and Fear of Falling in the Elderly (SAFFE). The process followed the established and updated linking rules. Three linkers independently identified all meaningful concepts in the rating scales and linked them to the most precise ICF categories. The linkers then discussed their results to reach consensus. If consensus was not attained, the linkers pursued the discussions with a fourth person to reach consensus. MAIN OUTCOME MEASUREMENTS: Not applicable. RESULTS: Most meaningful concepts from the overall questions were linked to the ICF component of body functions. Of the 62 items, all but one meaningful concept were linked to the component of activities and participation. All 4 rating scales covered the chapters of mobility and domestic life and had most linkages to the mobility chapter. CONCLUSIONS: The linking process revealed similarities and differences between the 4 FOF rating scales, as well as methodologic challenges in linking instruments to the ICF. By providing a content description that allows for a direct comparison of the rating scales, the results may be helpful when choosing an appropriate rating scale assessing FOF in clinical practice and research. A further head-to-head comparison through psychometric analyses is required to recommend appropriate FOF rating scales. Studies are also needed to investigate how the overall question and response categories of a rating scale affect respondents’ answers. HubMed – rehab