Changes in postural control in patients with Parkinson's disease: a posturographic study

Objectives Postural instability is one of the most disabling features in Parkinson's disease (PD), and often leads to falls that reduce mobility and functional capacity. The objectives of this study were to analyse the limit of stability (LOS) and influence of the manipulation of visual, somatosensorial and visual vestibular information on postural control in patients with PD and healthy subjects. Design Cross-sectional. Setting Movement Disorders Unit, university setting. Participants Eighty-two subjects aged between 37 and 83 years: 41 with Parkinson's disease in the 'on' state and 41 healthy subjects with no neurological disorders. Both groups were matched in terms of sex and age. Main outcome measures Unified Parkinson's Disease Rating Scale (UPDRS)-motor score, modified Hoehn and Yahr staging, Dynamic Gait Index (DGI) and posturography with integrated virtual reality. The parameters analysed by posturography were LOS area, area of body centre of pressure excursion and balance functional reserve in the standing position in 10 conditions (open and closed eyes, unstable surface with eyes closed, saccadic and optokinetic stimuli, and visual vestibular interaction). Results The mean UPDRS motor score and DGI score were 27 [standard deviation (SD) 14] and 21 (SD 3), respectively. Thirteen participants scored between 0 and 19 points, indicating major risk of falls. Posturographic assessment showed that patients with PD had significantly lower LOS area and balance functional reserve values, and greater body sway area in all posturographic conditions compared with healthy subjects. Conclusions Patients with PD have reduced LOS area and greater postural sway compared with healthy subjects. The deterioration in postural control was significantly associated with major risk of falls. (C) 2015 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.Univ Fed Sao Paulo, Dept Neurol & Neurosurg, Movement Disorders Unit, Sao Paulo, SP, BrazilUniv Anhanguera Sao Paulo, Balance Rehabil & Social Inclus Postgrad Program, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Otorhinolaryngol Head & Neck Surg, Sao Paulo, SP, BrazilUniv Fed Rio Grande do Norte, Phys Therapy Dept, Natal, RN, BrazilUniv Fed Sao Paulo, Dept Neurol & Neurosurg, Movement Disorders Unit, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Otorhinolaryngol Head & Neck Surg, Sao Paulo, SP, BrazilWeb of Scienc

Avaliação otoneurológica em crianças com queixa de dificuldades escolares: pesquisa da função vestibular Otoneurologic evaluation in children with school difficulties: vestibular function investigation

Segundo a literatura, a disfunção vestibular infantil pode afetar consideravelmente a habilidade de comunicação e o desempenho escolar. OBJETIVO: Estudar a função vestibular em crianças com dificuldades escolares e suas queixas vestibulares. ESTUDO DE CASO: Estudo Clínico com coorte transversal. MATERIAL E MÉTODOS: Foram estudadas 50 crianças entre 7 e 12 anos, que freqüentavam escolas públicas de Piracicaba durante os anos de 2004 e 2005. Os procedimentos foram: anamnese; exame otorrinolaringológico; exame audiológico e avaliação vestibular. RESULTADOS: Das crianças avaliadas, 62,0% não relataram dificuldades escolares e 38,0% referiram ter dificuldades. A queixa geral mais comum foi de tontura (36,0%), e o sintoma mais comum no ambiente escolar foi de cefaléia (50,0%). Encontramos 74,2% de exame vestibular normal nas crianças sem dificuldades escolares e 31,6% de normalidade nas crianças com dificuldades. Encontramos alterações vestibulares de origem periférica irritativa tanto unilateral como bilateral, num total de 68,4% para as crianças com dificuldades escolares e um total de 25,8% para crianças sem dificuldades escolares. CONCLUSÃO: A queixa de atordoamento, o sintoma de náuseas e as dificuldades em ler e copiar apresentaram uma relação estatisticamente significante. Todas as alterações vestibulares encontradas foram de origem periférica irritativa. Os dados revelaram uma relação estatisticamente significante.<br>According to the literature, child vestibular dysfunctions can considerably affect their ability of communication and school performance. AIM: to study the vestibular function in children with school difficulties and associated symptoms. CASE STUDY: Clinical study with transversal cohort. METHOD: Research subjects were 50 school children between 7 and 12 years old, from a public school of Piracicaba city, during the years 2004 and 2005. The procedure was based on: anamnesis; otorrinolaryngologic evaluation; audiologic evaluation and vestibular evaluation. RESULTS: All children assessed, 62.0% did not have school difficulties and 38.0% had school difficulties. Dizziness was the most common general complaint (36.0%). Migraine was the most common symptom regarding the school environment (50.0%). We found a high rate of normal vestibular condition (74.2%) in children without school difficulties and low normality rate in those with school difficulties (31.6%). All found vestibular alterations, both unilateral and bilateral, had been of peripheral irritative origin, accounting for 68.4% of cases for children with school difficulties and 25.8% for children without school difficulties. CONCLUSION: Dizziness, nausea, reading and copying difficulties presented a statistically significant relationship between the studied variables. All found vestibular alterations had been of peripheral irritative origin. Data showed a statistically significant relationship among variables

A função vestibular em indivíduos usuários de implante coclear Vestibular function in cochlear implant users

A ocorrência de alteração no equilíbrio no período pós-cirúrgico ao implante coclear varia de 31 a 75%. OBJETIVO: Analisar a função vestibular no período pré e pós-operatório da cirurgia de implante coclear. MATERIAL E MÉTODO: Avaliou-se a função vestibular, por meio da vectoeletronistagmografia, de 38 pacientes, no pré e pós-cirúrgico de implante coclear. RESULTADOS: A principal queixa de desequilíbrio apresentada pelos pacientes foi a tontura, seguida pela vertigem postural e pela vertigem não-postural. Dos 38 pacientes avaliados, 13% deixaram de apresentar desequilíbrio após a cirurgia de implante coclear e apenas 5% referiram piora. Houve uma melhora na sintomatologia vestibular em 13% dos pacientes, sendo que esta possibilidade pode estar relacionada ao fenômeno de compensação vestibular e pela estimulação elétrica. Entretanto, foi observada na prova calórica uma piora na funcionalidade do sistema vestibular, tanto na orelha implantada como na orelha não-implantada. Assim, não há tendência de maior comprometimento na orelha implantada. CONCLUSÃO: O estudo demonstrou que o implante coclear pode comprometer o sistema vestibular em ambas as orelhas. Entretanto, a sintomatologia vestibular ocorre em menor proporção, podendo haver melhora no desequilíbrio após a cirurgia do implante coclear.<br>Balance alterations in the postoperative of cochlear implant surgeries varies from 31 to 75%. AIM: to analyze vestibular function in the pre and postoperative periods of cochlear implanted individuals. MATERIALS AND METHODS: the vestibular function was assessed, through electronystagmography, in 38 patients, in the pre and postoperative of cochlear implant procedures. RESULTS: The main complaint of unbalance reported by patients was dizziness, followed by postural vertigo and non-postural vertigo. Results: 13% of the patients did not show any balance disorder following cochlear implant surgery and just 5% showed symptoms worsening. 13 % of the patients showed an improvement, and this could be related to the vestibular compensation phenomenon and to electric stimulation. However, it was observed, in the caloric responses, a worsening in the vestibular system function, for both implanted and non-implanted ears. Thus, there is no evidence of more damage to the implanted ear. CONCLUSION: the study showed that cochlear implant surgeries could injure the vestibular system in both ears. However, the vestibular symptoms take place in a smaller proportion, and can improve after cochlear implant surgery