Effectiveness of conventional versus virtual reality based vestibular rehabilitation in the treatment of dizziness, gait and balance impairment in adults with unilateral peripheral vestibular hypofunction

Vestibular rehabilitation is an evidence based treatment for peripheral unilateral vestibular hypofunction (UVH). It is effective in improving physical function (balance, gait and dynamic visual acuity) and in reducing symptoms of dizziness, but precise effects on gait are less well known. The increasing prevalence of technology worldwide has produced opportunities for professionals in the area of vestibular rehabilitation. One technology, virtual reality, has potential but evidence relating to its effectiveness is lacking. The thesis contains four studies related to two main objectives. The first objective was to investigate the effectiveness of an off-the-shelf virtual reality system, the Nintendo Wii Fit Plus™ (NWFP™) compared to conventional vestibular rehabilitation. In preparing to investigate effectiveness, study one quantified the usability and safety of the NWFP™ and found that patients with vestibular disease enjoyed balance exercises on the NWFP™ and perceived that it was beneficial. Subsequently, study two compared the effectiveness of the NWFP™ to conventional vestibular rehabilitation. A parallel group, randomised controlled trial allocated n=71 patients with UVH to six weeks of NWFP™ based vestibular rehabilitation or six weeks of conventional vestibular rehabilitation. Intention to treat analysis indicated that the NWFP™ was not superior in improving the primary outcome of gait speed or secondary outcomes of balance, dynamic visual acuity, other gait parameters, dizziness, anxiety or depression. However, significantly more enjoyment was reported by the NWFP™ group, in addition to less difficulty with, and less tiredness after exercising. Concurrently with the RCT, study three investigated the second objective, to compare the gait of healthy controls and UVH patients using computerised three dimensional gait analysis. Evidence was found that the primary impairment in UVH gait was reduced speed, and control In the medio-lateral direction. Study four investigated the reliability of computerised dynamic visual acuity testing and found that although DVA was more impaired in UVH patients when compared to healthy controls, reliability co-efficients were low. In conclusion this thesis presents novel findings on the effectiveness of virtual reality in vestibular rehabilitation and on the factors contributing to gait impairment in UVH

Normalisation method can affect gluteus medius electromyography results during weight bearing exercises in people with hip osteoarthritis (OA): a case control study.

Surface electromyography (sEMG) is used to assess muscle activation during therapeutic exercise, but data are significantly affected by inter-individual variability and requires normalisation of the sEMG signal to enable comparison between individuals. The purpose of this study was to compare two normalisation methods, a maximal method (maximum voluntary isometric contraction (MVIC)) and non-maximal peak dynamic method (PDM), on gluteus medius (GMed) activation using sEMG during three weight-bearing exercises in people with hip osteoarthritis (OA) and healthy controls. Thirteen people with hip OA and 20 controls performed three exercises (Squat, Step-Up, Step-Down). Average root-mean squared EMG amplitude based on MVIC and PDM normalisation was compared between groups for both involved and uninvolved hips using Mann-Whitney tests. Using MVIC normalisation, significantly higher normalised GMed EMG amplitudes were found in the OA group during all Step-up and down exercises on the involved side (p=0.02-0.001) and most of the Step exercises on the uninvolved side (p=0.03-0.04), but not the Squat (p\u3e0.05), compared to controls. Using PDM normalisation, significant between-group differences occurred only for Ascending Squat (p=0.03) on the involved side. MVIC normalisation demonstrated higher inter-trial relative reliability (ICCs=0.78-0.99) than PDM (ICCs=0.37-0.84), but poorer absolute reliability using Standard Error of Measurement. Normalisation method can significantly affect interpretation of EMG amplitudes. Although MVIC-normalised amplitudes were more sensitive to differences between groups, there was greater variability using this method, which raises concerns regarding validity. Interpretation of EMG data is strongly influenced by the normalisation method used, and this should be considered when applying EMG results to clinical populations

The effects of a home-based arm ergometry exercise programme on physical fitness, fatigue and activity in polio survivors: protocol for a randomised controlled trial.

ABSTRACT: BACKGROUND: Many Polio survivors have reduced mobility, pain and fatigue, which make access to conventional forms of aerobic exercise difficult. Inactivity leads to increased risk of health problems, many of which are prevalent among Polio survivors. Aerobic exercise programmes in Polio survivors should utilise stable muscle groups and should be designed to minimise exacerbation of pain and fatigue. A home-based arm ergometry aerobic exercise programme may represent an affordable and accessible exercise modality, incorporating exercise prescription principles in this group.Methods/design: This is a prospective, single blinded, randomised controlled trial. There are two arms; exercise intervention using arm ergometers and control. Polio survivors meeting eligibility criteria will be recruited and randomly allocated to intervention or control groups. Participants allocated to the intervention group will receive a small arm ergometer and a polar heart rate monitor. They will carry out a home-based moderate intensity (50-70% HRMax) aerobic exercise programme for eight weeks, following instruction by the treating physiotherapist. Assessments will occur at baseline and after eight weeks and will include tests of physical fitness, activity, energy cost of walking, fatigue and quality of life. Clinically feasible assessment tools including the Six Minute Arm Test, the Physical Activity Scale for People with Physical Disabilities questionnaire, the Physiological Cost Index, Fatigue Severity Scale and the SF-36v2 will be utilised. DISCUSSION: The efficacy of a home-based arm ergometry programme in Polio survivors will be examined. No previous trial has examined such a programme using a wide range of outcome measures pertinent to Polio survivors. This study will provide new information on the impact of arm ergometry on physical fitness, activity, body composition, fatigue, pain, muscle strength, and health related quality of life. Also, the study will provide information, which at present is lacking, on safety of aerobic exercise in Polio, as potential negative outcomes of activity including loss of muscle strength, increased pain and fatigue will be closely monitored.Trial registration: Clinicaltrials.gov identifier: NCT01271530

Intra-tester and inter-tester reliability of the MicroFET 3 hand-held dynamometer.

Background: The reliability of the MicroFET 3 has not previously been reported in the literature. The aim of this study was to evaluate intra-tester and inter-tester reliability of the MicroFET3 hand-held dynamometer (HHD) in three lower limb muscle groups. Methods: Maximum voluntary isometric contraction (MVIC) of hip extension, knee extension and ankle plantar-flexion were measured in 38 healthy participants (males=18, females= 20) by two testers on separate days using the MicroFET3 HHD. The reliability analysis was carried out using intra-class correlation coefficients (ICCs) to measure association and Band and Altman plots to demonstrate agreement. Results: The results showed that intra-tester reliability was moderate to excellent; with associations ranging from ICC 0.56 - 0.92 and higher agreement for knee and ankle than hip measurements was shown. Inter-tester reliability was lower, with hip and knee associations ranging from ICC 0.60 - 0.66. Ankle measurements intertester associations were particularly low (ICC 0.23 and 0.15). These values would not be considered acceptable for clinical use. Bland and Altman plots used to demonstrate agreement between testers displayed a considerable lack of agreement with discrepancies of up to 150N noted in measurements. Conclusion: The results suggest that the MicroFET3 HHD displayed moderate to excellent intra-tester reliability and poor to moderate inter-tester reliability and agreement with discrepancies noted between muscle groups. While use of this instrument can be recommended when consistently used by a single tester, further reliability analysis should be carried out before this instrument could be recommended for use by different testers in the clinical setting

Prevalence and distribution of musculoskeletal pain in patients with dizziness—A systematic review

Background and purpose Musculoskeletal disorders are among the leading causes of disability globally, but their role in patients with dizziness and imbalance is not well understood or explored. Such knowledge may be important as musculoskeletal pain and dizziness can mutually influence each other, leading to a complex condition requiring more comprehensive approaches to promote successful recovery. We conducted a systematic review to examine the extent and characteristic of reported musculoskeletal pain in patients with dizziness. Methods A comprehensive literature search in Medline, Embase, Cochrane, Scopus, Amed, Google Scholar, SveMed+, and Web of Science was conducted in March 2021. Inclusion criteria were studies examining patients with a vestibular diagnosis, patients with cervicogenic dizziness and patients included based on having dizziness as a symptom; and reported musculoskeletal pain. Data regarding age, sex, sample size, diagnosis and musculoskeletal pain was extracted. The Crowe Critical Appraisal Tool was used for assessing methodical quality of the included studies. Results Out of 1507 screened studies, 16 studies met the inclusion criteria. The total sample consisted of 1144 individuals with dizziness. The frequency of patients reporting pain ranged between 43% and 100% in the included studies. Pain intensity were scored between 5 and 7 on a 0–10 scale. Pain in the neck and shoulder girdle was most often reported, but musculoskeletal pain in other parts of the body was also evident. Discussion In the included studies, musculoskeletal pain was highly prevalent in patients with dizziness, with pain intensity that may have a moderate to severe interference with daily functioning. Pain in the neck and shoulder is well documented, but there are few studies addressing musculoskeletal pain in additional parts of the body. More research is needed to understand the relations between dizziness and musculoskeletal pain.publishedVersio

Effectiveness of conventional versus virtual reality based vestibular rehabilitation in the treatment of dizziness, gait and balance impairment in adults with unilateral peripheral vestibular loss: a randomised controlled trial.

BACKGROUND: Unilateral peripheral vestibular loss results in gait and balance impairment, dizziness and oscillopsia. Vestibular rehabilitation benefits patients but optimal treatment remains unkown. Virtual reality is an emerging tool in rehabilitation and provides opportunities to improve both outcomes and patient satisfaction with treatment. The Nintendo Wii Fit Plus (R) (NWFP) is a low cost virtual reality system that challenges balance and provides visual and auditory feedback. It may augment the motor learning that is required to improve balance and gait, but no trials to date have investigated efficacy. METHODS: In a single (assessor) blind, two centre randomised controlled superiority trial, 80 patients with unilateral peripheral vestibular loss will be randomised to either conventional or virtual reality based (NWFP) vestibular rehabilitation for 6 weeks. The primary outcome measure is gait speed (measured with three dimensional gait analysis). Secondary outcomes include computerised posturography, dynamic visual acuity, and validated questionnaires on dizziness, confidence and anxiety/depression. Outcome will be assessed post treatment (8 weeks) and at 6 months. DISCUSSION: Advances in the gaming industry have allowed mass production of highly sophisticated low cost virtual reality systems that incorporate technology previously not accessible to most therapists and patients. Importantly, they are not confined to rehabilitation departments, can be used at home and provide an accurate record of adherence to exercise. The benefits of providing augmented feedback, increasing intensity of exercise and accurately measuring adherence may improve conventional vestibular rehabilitation but efficacy must first be demonstrated. Trial registration Clinical trials.gov identifier: NCT01442623

The development and evaluation of a common assessment form for physiotherapy practice education in Ireland.

A sub-group of Chartered Physiotherapists in Education (CPE) was formed in 2004 to consider the adoption of a common assessment form (CAF) for assessing practice education placements for students studying physiotherapy in the Republic of Ireland. Following agreement from the four heads of departments, the needs of users (academic staff, practice tutors and practice educators) were established. As none of the existing forms met sufficient needs of the users, a new CAF was developed. The top features required by practice educators/tutors and HEIs, the positives of the existing forms and the behaviours indicated int he work of Cross \u26 Hicks1 were taken into account when developing the CAF. Following extensive revisions it was piloted on a small number of sites, revised by the committee and then validated by comparing scores to those of the existing assessment forms. Its inter-rater reliability was established bny comparing students\u27 grades between practic educators and practice tutors. Construct validity (PCC 0.906) and reliability estimates (ICC 0.84) were found to be satisfactory. As the validity and reliability fo the CAF was found to be satisfactory and greater than that of existing forms, the CAF was adopted by all for HEIs for use in summer 2007

PRECISION ALS-an integrated pan European patient data platform for ALS

Amyotrophic Lateral Sclerosis (ALS) is an incurable neurodegenerative condition. Despite significant advances in pre-clinical models that enhance understanding of disease pathobiology, translation of candidate drugs to effective human therapies has been disappointing. There is increasing recognition of the need for a precision medicine approach toward drug development, as many failures in translation can be attributed in part to disease heterogeneity in humans. PRECISION-ALS is an academic industry collaboration between clinicians, Computer Scientists, Information engineers, technologists, data scientists and industry partners that will address the key clinical, computational, data science and technology associated research questions to generate a sustainable precision medicine based approach toward new drug development. Using extant and prospectively collected population based clinical data across nine European sites, PRECISION-ALS provides a General Data Protection Regulation (GDPR) compliant framework that seamlessly collects, processes and analyses research-quality multimodal and multi-sourced clinical, patient and caregiver journey, digitally acquired data through remote monitoring, imaging, neuro-electric-signaling, genomic and biomarker datasets using machine learning and artificial intelligence. PRECISION-ALS represents a first-in-kind modular transferable pan-European ICT framework for ALS that can be easily adapted to other regions that face similar precision medicine related challenges in multimodal data collection and analysis

The Role of Emerging Technologies in Vestibular Rehabilitation

Book Summary: Recognized as two of the world\u27s leading authorities on the subject, Susan Herdman and Richard Clendaniel, joined by a team of expert contributors, deliver the 4th Edition of the field\u27s definitive text on the management of vestibular diseases and disorders. From assessment through therapy, they present the scientific and clinical knowledge you need to distinguish between vestibular and non-vestibular dizziness and to plan and implement the appropriate treatments