The Development and Validation of the Vestibular Activities and Participation (VAP) Measure for People with Vestibular Disorders Based on the International Classification of Functioning, Disability and Health (ICF)

Background: Activities and participation domains are affected in people with vestibular disorders; however, specialized outcome measures for evaluating activities and participation according to the International Classification of Functioning, Disability and Health (ICF) do not exist. Purpose: To develop and validate the Vestibular Activities and Participation (VAP) measure for people with vestibular disorders according to the ICF. Methods: A list of activities and participation candidate items were generated and included in a survey. The survey was then sent to a panel of vestibular experts and agreement was obtained on the items to include in the VAP using the Delphi technique. The psychometric properties of the VAP were established including test-retest reliability; minimum detectable change at 95% confidence level (MDC95), concurrent validity with the World Health Organization Disability Assessment Schedule II (WHODAS II); convergent validity with the Dizziness Handicap Inventory (DHI), and discriminant validity. The test-retest reliability of the VAP total score was estimated using the Intra Class Correlation Coefficient (ICC), model (3,1) and the 95% confidence interval (CI). Agreement per-item was estimated using Cohen's kappa statistics. Concurrent and convergent validity were examined using the Spearman correlation coefficient (rho). Discriminant validity was established using a generalized linear model (GLM). Results: Fifty five activities and participation items were generated in which 32 of them had 70% or greater agreement for inclusion in the VAP. The test-retest reliability of the VAP total score was excellent (ICC=.95), (CI=.91-.97). Un-weighted kappa (.41-.80) and weighted kappa (.58-.94) were good to excellent. The VAP had strong correlation (rho=.7, p<.05) with the WHODAS II and moderate to strong correlations (rho=.54-.74) with the DHI subscale and total scores. The MDC95 was .58. After adjustment for age, gender and self-reported imbalance were independent predictors of the transformed VAP total score.Conclusion: The VAP measure was developed to examine the disabling effect of vestibular disorders on people's activities and participation based on the ICF. The VAP demonstrated excellent reliability and was validated with external instruments

Efficacy of proprioceptive neuromuscular facilitation on spasticity in patients with stroke: a systematic review

purpose: this review was conducted to investigate the effects of proprioceptive neuromuscular facilitation (PNF) on spasticity post-stroke.materials and methods: PubMed, SCOPUS, PEDro, CINAHL, MEDLINE, REHABDATA, and Web of Science databases were searched until may 2020. the methodological quality was evaluated using the physiotherapy evidence database (PEDro) scale. many inclusion and exclusion criteria of the studies were determined.Results: Six studies were included in this systematic review. three were pilot studies, clinical controlled trials (n = 2), and randomized controlled trials (n = 1). the scores on the PEDro scale ranged from two to five, with a median score of three. the findings of this study showed heterogeneous evidence on the benefits of the PNF intervention on spasticity post-stroke.Conclusion: The evidence for the effect of the PNF on spasticity in patients with stroke was limited. further strong clinical trials with long-term follow-up are needed

Relationship between Sleep Quality and Shoulder Disorders in People with Stroke

Background and objective: The primary aim of the study was to investigate the relationship between sleep quality (SQ) and shoulder disorders in people after a stroke. The secondary aim was to explore the relationship between SQ and stroke outcomes, including the impact of stroke, fatigue, and quality of life (QOL). Material and Methods: A sample of 94 stroke patients was included. The Pittsburgh Sleep Quality Index (PSQI) was used to assess SQ, whereas the Shoulder Pain and Disability Index (SPADI) was utilized to assess shoulder pain and disability. The Stroke Impact Scale 16, the Modified Fatigue Impact Scale, and the Medical Outcomes Study Short Form 12 were also used as secondary measures. Results: The prevalence of poor SQ, shoulder pain, and shoulder disability in our sample was 60%, 78%, and 85%, respectively. The global PSQI score had a significant association with the SPADI pain subscale. There were some significant correlations between the PSQI subscales and shoulder pain and disability. The PSQI significantly correlated with stroke recovery, fatigue, and QOL. The daytime dysfunction PSQI subscale was significantly correlated with all shoulder and stroke outcomes and their subscale. Conclusion: SQ was associated more with the non-motor outcomes of stroke, including pain, cognitive fatigue, and mental status, than the motor outcomes. Considering SQ during upper extremity rehabilitation and care processes is essential

Vestibular evoked myogenic potential (VEMP) test-retest reliability in adults

Background: the technique of measuring ocular vestibular evoked myogenic potentials (oVEMP) in response to Mini-shaker vibration is relatively new, there is a limited normative data to define the presence or absence of a response in the literature.Objective: to determine the test-retest reliability of cervical and ocular VEMPs (cVEMP and oVEMP, respectively) to air-conducted sound (ACS) and bone-conducted vibration (BCV) stimulation and to determine normative ranges for the responses.Methods: twenty normal-hearing individuals (40 ears) and 20 hearing impaired volunteers with normal balance function (40 ears) were examined in this study. ACS cVEMP and BCV oVEMP (using a Mini-shaker) were recorded from both groups to assess the test-retest reliability and to collect normative VEMP data for P1/N1 latencies and amplitudes from 20 normal hearing individuals. To test reliability, VEMP recordings were repeated within the same session. RESULTS: The test-retest reliability for all the cVEMP parameters showed excellent reliability whereas oVEMP parameters showed between fair and excellent reliability depending on the parameter tested. Normative data for VEMP P1/N1 latencies and amplitudes were established.Conclusions: normative data and test-retest reliability for BCV oVEMP using the Mini-shaker at 100 Hz were established in our study for the first time in the literature. Responses appear reliable. <br/

Predictors of Dizziness and Hearing Disorders in People with Long COVID

Background and Objectives: Individuals report persistent symptoms after becoming infected by SARS-CoV-2 (COVID-19) that last for >4 weeks (long-COVID syndrome). Dizziness and hearing loss have been reported among long-COVID symptoms. However, little is known about the potential predictors of dizziness and hearing loss in individuals with long COVID. This study aimed to explore the presence and correlates of dizziness and hearing loss in a sample of people with long-COVID syndrome. Materials and Methods: Individuals aged 18 years and older who were infected with COVID-19 at least 8 weeks prior to the start of the study were included if they were not diagnosed with dizziness or hearing loss before getting COVID-19. Demographics and COVID-19-related information were collected. Participants completed the Dizziness Handicap Inventory (DHI), Activities-Specific Balance Confidence (ABC) scale, Falls Efficacy Scale International (FES-I), Modified Fatigue Impact Scale (MFIS), and Medical Outcomes Study Short Form 12 (SF-12). Finally, hearing was assessed using pure-tone audiometry (PTA) in a subsample. Results: Two hundred and nine individuals (66% female) with a mean (SD) age of 27 (9) participated in the study. Perceived dizziness and hearing loss were reported in 26 and 15.3% of the sample, respectively. Logistic regression was conducted to identify potential predictors of dizziness and hearing loss separately. After controlling for age and severity of dizziness, female sex and high fatigue severity were associated with an increased likelihood of reporting dizziness (R2 = 31%). The severity of dizziness and neurological symptoms during the acute stage of COVID-19 were associated with an increased likelihood of reporting hearing loss (R2 = 10.4%) after controlling for age. Conclusions: Dizziness and hearing loss present in long COVID and can be disabling. Females with high levels of fatigue should be questioned about persistent dizziness. Hearing loss should be considered in individuals with neurological symptoms and severe dizziness as a consequence of long COVID

Lower Limb Muscle Fatigue Alters Spatiotemporal Gait Parameters and Turning Difficulty Characteristics in Parkinson’s Disease

Objective To determine the effects of lower limb muscle fatigue on spatiotemporal gait parameters and turning difficulty characteristics during the extended Timed Up and Go (extended TUG) test in individuals with different severity stages of Parkinson’s disease (PD). Methods Forty individuals with PD, classified as Hoehn and Yahr (H&Y) stages 2 and 3 participated in this pre- and post-experimental study design. The participants performed a continuous sit-to-stand task from a chair based on 30 cycles/min set-up to induce lower limb muscle fatigue. They performed extended TUG test immediately before and after completing the fatigue protocol. Spatiotemporal gait parameters and turning difficulty characteristics were recorded using two GoPro® Hero 4 Silver cameras. Data were subjected to a repeated-measure ANOVA. Results Individuals with PD experience significant changes in spatiotemporal gait parameters, specifically stride velocity and length, under conditions of lower limb muscle fatigue (p=0.001). These changes were more pronounced in individuals with PD in the H&Y stage 3 group. Additionally, both PD groups exhibited difficulty with turning, requiring more than five steps to complete a 180° turn and taking more than 3 seconds to accomplish it. Conclusion These findings highlight the impact of muscle fatigue on gait performance in PD and suggest that individuals in later stages of the disease may be particularly affected. Further research is needed to explore interventions that can mitigate these gait impairments and improve mobility in individuals with PD

Collegiate Athletes\u27 Concussion Awareness, Understanding, and -Reporting Behaviors in Different Countries With Varying Concussion Publicity

CONTEXT: Concussions are a global public health concern, and education on the importance of self-reporting may not reach all athletes to the same degree around the world. OBJECTIVE: To determine if differences were present in the concussion awareness, understanding, and -reporting behaviors of collegiate athletes\u27 in 3 countries with varied degrees of concussion publicity. DESIGN: Cross-sectional survey. SETTING: Collegiate sports medicine clinics. PATIENTS OR OTHER PARTICIPANTS: Collegiate athletes in the United States (n = 964; high publicity), Ireland (n = 302; moderate publicity), and Jordan (n = 129; low publicity). The degree of concussion publicity was categorized based on the extent of national public health awareness initiatives, care guidelines, research publications, and mass media coverage. MAIN OUTCOME MEASURE(S): Participants completed a 10- to 15-minute survey on concussion awareness, understanding, and -reporting behaviors. The main outcome measures were concussion education (awareness; 21 options; select all sources of concussion information), concussion knowledge (understanding; maximum score of 49), and diagnosed/nondisclosed concussion history (reporting behaviors; self-report yes/no items). RESULTS: A higher proportion of Jordanian athletes reported never having received concussion information previously (73.6%) than Irish (24.2%) or US athletes (9.4%). Knowledge differed among countries (P \u3c .0001, η2 = .28), with US athletes displaying higher total knowledge scores (40.9 ± 4.5) than Jordanian (35.1 ± 5.6) and Irish (32.1 ± 3.5) athletes. Greater percentages of Irish and US athletes reported a history of a diagnosed concussion (31.8% and 29.6%, respectively) and history of concussion nondisclosure (25.2% and 15.5%, respectively) than Jordanian athletes (2.3% and 0.0% for history of a diagnosed concussion and history of concussion nondisclosure, respectively). CONCLUSIONS: In the United States, where concussion publicity is high, formal legislation exists, and sports medicine resources and concussion awareness and understanding were increased. More culturally appropriate concussion initiatives are needed globally to ensure that athletes around the world can identify concussive injuries and understand the dangers of continued sport participation while concussed

Evidence for a left ear bias in incidence of Meniere’s disease

Objective: to explore a side of lesion differences in Meniere’s disease (MD).Design: a retrospective review (2019–2021) was conducted of patients with definite MD, as defined by 2015 Bárány Society diagnostic criteria. Testing information included pure tone audiometry, tympanometry, and extra-tympanic electrocochleography (ECochG). Normative ECochG data from healthy subjects determined the 95% cut-off value for clinical abnormality.Study sample: 107 patients with definite MD were included in the study and 40 healthy controls.Results: the review identified 75 patients with unilateral MD and 32 patients with bilateral MD according to their clinical histories. 79% of unilateral cases were found to have MD on the L ear. 94% of bilateral MD cases had L ears more affected than R ears. Objective ECochG testing indicated a greater incidence of elevated SP/AP area curve and amplitude ratios in L ears. On binomial testing, all results indicate a highly significant bias of MD to the L side.Conclusions: unilateral MD appears more common on the L side than the R, suggesting that the disease process underlying MD is not symmetrical. MD also appears more common in females than males. It appears that there is a physiological asymmetry in the progression/cause of MD.Financial disclosures: this study was funded by Deanship of Scientific Research, the University of Jordan.Disclosure statement: no potential conflict of interest was reported by the authors. <br/