Vestibular Rehabilitation and Dizziness
- Conditions
- Dizziness
- Interventions
- Behavioral: standard balance rehabilitationBehavioral: gaze stabilityBehavioral: Control
- Registration Number
- NCT01729039
- Lead Sponsor
- VA Office of Research and Development
- Brief Summary
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.
- 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. The investigators' 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 physical therapy (PT), 1 and 6 months post-PT.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 49
- at least 50 years of age
- documented balance or mobility problems
- normal vestibular function, including otolith function
- cognitive impairment
- progressive medical issues that would impact mobility (e.g., Parkinson's disease, cerebellar atrophy)
- dizziness due to orthostatic hypotension or Benign Paroxysmal Positional Vertigo (BPPV)
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description gaze stability gaze stability standard balance rehabilitation plus vestibular-specific exercises gaze stability standard balance rehabilitation standard balance rehabilitation plus vestibular-specific exercises control Control standard balance rehabilitation plus placebo eye exercises control standard balance rehabilitation standard balance rehabilitation plus placebo eye exercises
- Primary Outcome Measures
Name Time Method Visual Analog Scale - Head Movement 6 weeks This scale was used to measure perceived level of dizziness after one minute of horizontal head movement at 1 hertz (Hz). This technique uses a 10-cm line with one end being no symptoms (score = 0) and the other representing the worse possible symptoms (score = 10) and is commonly used to assess perception of pain. The subject is asked to place a mark on the 10-cm line at a point which indicates the intensity of his/her perception of symptoms of dizziness and the distance along that line is measured. Scores range from 0 to 10 with higher scores indicating worse perceived dizziness.
Visual Analog Scale - Disequilibrium 6 weeks This scale was used to measure perceived level of unsteadiness while walking. This technique uses a 10-cm line with one end being no symptoms (score = 0) and the other representing the worse possible symptoms (score = 10) and is commonly used to assess perception of pain. The subject is asked to place a mark on the 10-cm line at a point which indicates the intensity of his/her perception of symptoms of unsteadiness and the distance along that line is measured. Scores range from 0 to 10 with higher scores indicating worse perceived unsteadiness.
- Secondary Outcome Measures
Name Time Method Dynamic Gait Index 6 weeks The dynamic gait index (DGI) assesses an individual's ability to modify balance while walking in the presence of external demands. The 8 items of the DGI include walking while changing speed and turning the head, walking over and around obstacles, and stair climbing. Scoring of the DGI is based on a 4-point scale from 0 to 3 with 0 indicating severe impairment and 3 indicating normal ability. A maximum total score of 24 is possible and scores of \< 20 indicate high risk for falling.
Activities-specific Balance Confidence Scale 6 weeks As a result of their disequilibrium, subjects report decreased confidence that they can maintain their balance in a variety of situations. The Activities-specific balance confidence scale (ABC) was developed to measure the subject's confidence with their balance across a range of 16 activities of increasing challenge. Items are rated on a rating scale that ranges from 0 - 100% with a score of zero representing no confidence and a score of 100 representing complete confidence. An overall score is calculated by averaging the items with higher scores indicating higher (better) balance confidence.
10 Meter Walk Test 6 weeks This measure assesses walking speed over a short distance. Subjects were asked to walk at their preferred gait speed for a distance of 30 feet which allowed 5 feet for acceleration and deceleration at the beginning and end of the walk. The time it took to walk 20 feet was recorded using a calibrated stopwatch and gait speed (ft/s) was calculated.
Trial Locations
- Locations (2)
Mountain Home VA Medical Center James H. Quillen VA Medical Center, Mountain Home, TN
🇺🇸Mountain Home, Tennessee, United States
Atlanta VA Medical and Rehab Center, Decatur, GA
🇺🇸Decatur, Georgia, United States