Vestibular Rehabilitation and Dizziness - Full Text View

Purpose

The purpose of this study is to determine whether vestibular exercises provide added benefit to balance rehabilitation in older adults with dizziness and normal vestibular function.

Condition	Intervention
Dizziness	Behavioral: standard balance rehabilitation Behavioral: gaze stability Behavioral: Control

Study Type:	Interventional
Study Design:	Allocation: Randomized Intervention Model: Parallel Assignment Masking: Double Blind (Subject, Outcomes Assessor) Primary Purpose: Treatment
Official Title:	Vestibular Rehabilitation and Dizziness in Geriatric Patients

Resource links provided by NLM:

MedlinePlus related topics: Dizziness and Vertigo Exercise and Physical Fitness Rehabilitation

U.S. FDA Resources

Further study details as provided by Department of Veterans Affairs:

Primary Outcome Measures:

symptoms of dizziness [ Time Frame: baseline, discharge from PT, 1 and 6 months post-PT ] [ Designated as safety issue: No ]
The subject's perception of dizziness and imbalance during ambulation and during sitting will be assessed using visual analogue scales.

Secondary Outcome Measures:

gaze stability [ Time Frame: baseline, discharge from PT, 1 and 6 months post-PT ] [ Designated as safety issue: No ]
visual acuity during head movements
fall risk [ Time Frame: baseline, discharge from PT, 1 and 6 months post-PT ] [ Designated as safety issue: No ]
fall risk is determined by dynamic gait index
Activities-specific balance confidence [ Time Frame: baseline, discharge from PT, 1 and 6 months post-PT ] [ Designated as safety issue: No ]
The ABC was developed to measure the subject's confidence with their balance across a continuum of activities.
Gait speed [ Time Frame: baseline, discharge from PT, 1 and 6 months post-PT ] [ Designated as safety issue: No ]
Subjects are asked to walk at their preferred gait speed. The time it takes to walk 20 feet is recorded using a calibrated stopwatch and gait speed is calculated.

Estimated Enrollment:	97
Study Start Date:	November 2012
Estimated Study Completion Date:	July 2015
Estimated Primary Completion Date:	July 2015 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Experimental: gaze stability standard balance rehabilitation plus vestibular-specific exercises	Behavioral: standard balance rehabilitation All subjects will perform balance and gait exercises in addition to the eye movement exercises and will be provided a written HEP consisting of balance and gait exercises designed to improve postural stability and mobility with progressively more challenging tasks. Balance exercises will include maintaining stability in standing with vision and somatosensory cues altered, dynamic weight shifting and performing ankle, hip and step strategies. Gait activities will include negotiating uneven terrains and obstacles, gait with slow head turns focusing on objects, varied speed (speeding up and slowing down), and unpredictable starts and stops. Walking for endurance will be included in the HEP. Each participant will receive a customized balance and gait HEP based on identified impairments and will be progressed according to ability and level of assistance at home as is standard in PT. Behavioral: gaze stability Vestibular adaptation and substitution exercises were designed originally based on the error signals (retinal slip) that induce changes in gain in the vestibular system and will be performed by the experimental group (GS). Adaptation exercises involve head movement while maintaining focus on a target, which may be stationary or moving. Typical progression of adaptation exercises involve increased velocity of head movement, movement of both target and head, target placed in a distracting visual pattern and maintenance of a challenging posture. Substitution exercises specifically attempt to facilitate use of alternative strategies, rather than teaching the specific strategies. During active eye-head exercise, a large eye movement to a target is made prior to the head moving to face the target, potentially facilitating use of preprogrammed eye movements.
Placebo Comparator: control standard balance rehabilitation plus placebo eye exercises	Behavioral: standard balance rehabilitation All subjects will perform balance and gait exercises in addition to the eye movement exercises and will be provided a written HEP consisting of balance and gait exercises designed to improve postural stability and mobility with progressively more challenging tasks. Balance exercises will include maintaining stability in standing with vision and somatosensory cues altered, dynamic weight shifting and performing ankle, hip and step strategies. Gait activities will include negotiating uneven terrains and obstacles, gait with slow head turns focusing on objects, varied speed (speeding up and slowing down), and unpredictable starts and stops. Walking for endurance will be included in the HEP. Each participant will receive a customized balance and gait HEP based on identified impairments and will be progressed according to ability and level of assistance at home as is standard in PT. Behavioral: Control The placebo exercises will consist of saccadic eye movements while the head is stationary and will be performed by the control group. These eye movements will be performed against a plain background in order to eliminate retinal slip and, therefore, eliminate the error signal for vestibular adaptation.

Arms

Assigned Interventions

Experimental: gaze stability

standard balance rehabilitation plus vestibular-specific exercises

Behavioral: standard balance rehabilitation

All subjects will perform balance and gait exercises in addition to the eye movement exercises and will be provided a written HEP consisting of balance and gait exercises designed to improve postural stability and mobility with progressively more challenging tasks. Balance exercises will include maintaining stability in standing with vision and somatosensory cues altered, dynamic weight shifting and performing ankle, hip and step strategies. Gait activities will include negotiating uneven terrains and obstacles, gait with slow head turns focusing on objects, varied speed (speeding up and slowing down), and unpredictable starts and stops. Walking for endurance will be included in the HEP. Each participant will receive a customized balance and gait HEP based on identified impairments and will be progressed according to ability and level of assistance at home as is standard in PT.

Behavioral: gaze stability

Vestibular adaptation and substitution exercises were designed originally based on the error signals (retinal slip) that induce changes in gain in the vestibular system and will be performed by the experimental group (GS). Adaptation exercises involve head movement while maintaining focus on a target, which may be stationary or moving. Typical progression of adaptation exercises involve increased velocity of head movement, movement of both target and head, target placed in a distracting visual pattern and maintenance of a challenging posture. Substitution exercises specifically attempt to facilitate use of alternative strategies, rather than teaching the specific strategies. During active eye-head exercise, a large eye movement to a target is made prior to the head moving to face the target, potentially facilitating use of preprogrammed eye movements.

Placebo Comparator: control

standard balance rehabilitation plus placebo eye exercises

Behavioral: standard balance rehabilitation

All subjects will perform balance and gait exercises in addition to the eye movement exercises and will be provided a written HEP consisting of balance and gait exercises designed to improve postural stability and mobility with progressively more challenging tasks. Balance exercises will include maintaining stability in standing with vision and somatosensory cues altered, dynamic weight shifting and performing ankle, hip and step strategies. Gait activities will include negotiating uneven terrains and obstacles, gait with slow head turns focusing on objects, varied speed (speeding up and slowing down), and unpredictable starts and stops. Walking for endurance will be included in the HEP. Each participant will receive a customized balance and gait HEP based on identified impairments and will be progressed according to ability and level of assistance at home as is standard in PT.

Behavioral: Control

The placebo exercises will consist of saccadic eye movements while the head is stationary and will be performed by the control group. These eye movements will be performed against a plain background in order to eliminate retinal slip and, therefore, eliminate the error signal for vestibular adaptation.

Detailed Description:

Dizziness is among the most prevalent complaints for which people seek medical help and the incidence increases with advancing age. Dizziness represents a diagnostic and treatment challenge because it is a subjective sensation, refers to a variety of symptoms (unsteadiness, spinning, sense of motion or lightheadedness), and has many potential contributory factors. Dizziness is often related to vestibular disease which is treated effectively with vestibular exercises. Successful management of dizziness is critical because dizziness is a major risk factor for falls in older adults.

There are parallels between the effects of age-related versus disease-related loss of vestibular function - in complaints of dizziness and increased risk for falls. Our question, then, is whether the same exercises that are beneficial for patients with vestibular pathology are beneficial for older patients with dizziness but normal vestibular function.

Older adults with dizziness who have been referred to Audiology for vestibular evaluation will be randomized to receive either standard balance rehabilitation plus placebo eye exercises (CON) or standard balance rehabilitation plus vestibular-specific exercises (GS). Primary outcomes include symptoms, balance-related confidence, dynamic visual acuity, postural stability as measured by sensory organization test, fall risk as measured by dynamic gait index, and gait speed. Assessment will occur at baseline, discharge from PT, 1 and 6 months post-PT.

Eligibility

Ages Eligible for Study:	60 Years and older
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

at least 60 years of age
documented balance or mobility problems
normal vestibular function, including otolith function

Exclusion Criteria:

cognitive impairment
progressive medical issues that would impact mobility (e.g., Parkinson's disease, cerebellar atrophy)
dizziness due to orthostatic hypotension or BPPV

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT01729039

Contacts

Contact: Stephanie Byrd

(423) 926-1171 ext 7872

stephanie.byrd@va.gov

Locations

United States, Tennessee
Mountain Home VA Medical Center James H. Quillen VA Medical Center, Mountain Home, TN	Recruiting
Mountain Home, Tennessee, United States, 37684
Contact: Stephanie Byrd 423-926-1171 ext 7872 stephanie.byrd@va.gov
Principal Investigator: Courtney D. Hall, PhD PT

Sponsors and Collaborators

Department of Veterans Affairs

Investigators

Principal Investigator:

Courtney D. Hall, PhD PT

Mountain Home VA Medical Center James H. Quillen VA Medical Center, Mountain Home, TN

More Information

No publications provided

Responsible Party:	Department of Veterans Affairs
ClinicalTrials.gov Identifier:	NCT01729039 History of Changes
Other Study ID Numbers:	E7613-R
Study First Received:	November 13, 2012
Last Updated:	April 10, 2013
Health Authority:	United States: Federal Government

Keywords provided by Department of Veterans Affairs:

rehabilitation
aged
aged, 80 and over
vestibular diseases

Additional relevant MeSH terms:

Dizziness
Vertigo
Sensation Disorders
Neurologic Manifestations
Nervous System Diseases

Signs and Symptoms
Vestibular Diseases
Labyrinth Diseases
Ear Diseases
Otorhinolaryngologic Diseases

ClinicalTrials.gov processed this record on May 23, 2013

Vestibular Rehabilitation and Dizziness (DZO)