Search Results (50)

Objectives: Assessing balance in highly trained individuals, such as military pilots, poses challenges, as deficits may be underestimated when compared to general population norms. To address this, several studies have proposed tailored databases providing reference values for specific populations. This study retrospectively analyzed balance characteristics in active-duty military pilots of the Italian Air Force. Methods: We enrolled 106 subjects split into two groups: 53 military pilots from the Italian Air Force and 53 civilians without flight experience or exposure to specific vestibular stimuli. All participants underwent ENT examinations with audiometric testing to exclude related pathologies, followed by a personal history collection. Subsequently, they completed the EquiTest protocol across six standard conditions. Results: Significant differences were observed between Army Aviators and Non-Aviators. The PREF variable showed the most consistent distinction, with military pilots demonstrating a superior performance (p < 0.01). Additionally, borderline differences were noted in Condition 6 of the equilibrium scores (p = 0.056), and in the Centre of Gravity (COG) analysis along the X-axis for Conditions 1 and 5 (p = 0.090), and for Condition 2 (p = 0.050). These findings suggest enhanced postural control strategies among Army Aviators under conditions of sensory conflict. Conclusions: These findings suggest that normative balance values specific to military pilots should be used when evaluating aviators recovering from balance deficits. Such tailored benchmarks can help determine the need for rehabilitation before returning to duty, ensuring optimal performance under demanding conditions. Further research is necessary to explore the underlying mechanisms responsible for these adaptations and to identify the specific stimuli that contribute to the enhanced balance capabilities observed in this highly trained population. Full article

Background/Objectives: This study evaluates the diagnostic efficacy of the apparent diffusion coefficient (ADC) and T1-weighted contrast-enhanced (T1W + C) and T2-weighted (T2W) imaging modalities in differentiating vestibular schwannomas (VSs) and cerebellopontine angle meningiomas (CPAMs), aiming to optimize clinical imaging protocols for these tumors. Methods: A retrospective analysis was conducted on 97 surgically and pathologically confirmed cases (65 VS, 32 CPAM) from Nanjing Drum Tower Hospital. Imaging features from ADC, T1W + C, and T2W sequences were extracted using medical imaging software. A support vector machine (SVM) model was trained to classify tumors based on these features, focusing on first-, second-, and third-order radiomic characteristics. Results: The ADC images demonstrated the highest classification efficiency, particularly with third-order features (AUC = 0.9817). The T2W images achieved the best accuracy (87.63%) using second-order features. Multimodal analysis revealed that ADC alone outperformed combinations with T1W + C or T2W sequences, suggesting limited added value from multi-sequence integration. Conclusions: Diffusion-weighted imaging (DWI) sequences, particularly ADC maps, exhibit superior diagnostic utility compared to T1W + C and T2W sequences in distinguishing VS and CPAM. The findings advocate prioritizing DWI in clinical imaging workflows to enhance diagnostic accuracy and streamline protocols. Full article

Background: The impact of dance training on brainstem-mediated vestibular reflexes remains unclear. This study examined the vestibulo-ocular reflex (VOR) and its suppression during high-speed head movements, which may closely resemble the head-turning speeds used in dancers’ spotting techniques, using the video head impulse test. Methods: Eighteen female college students (mean age: 21 years) were divided into two groups—nine trained dancers (≥six years of dance training) and nine age-matched non-dancers—all without a history of hearing, vestibular, or neurological disorders. VOR function was assessed using the head impulse paradigm (HIMP) and the suppression head impulse paradigm (SHIMP) for right and left lateral stimulation, with minimum head velocities of 150°/s. Results: All participants exhibited VOR measures within normal limits and the VOR gain of dancers did not significantly differ from that of non-dancers. However, most dancers reported a preference for right-sided pirouettes and the right-side SHIMP gain negatively correlated with years of training, suggesting a link between preferred turning direction and VOR suppression ability. Furthermore, dancers with over 15 years of training exhibited earlier anti-compensatory saccade latencies (~75 ms) during SHIMP. Conclusions: Trained dancers maintain a healthy VOR and may develop enhanced voluntary control, enabling more effective VOR suppression. The earlier onset of anti-compensatory saccades suggests neural adaptations in eye–head coordination for high-velocity movements. Given the study’s small sample size and the inclusion of non-fulltime dancers, future research with larger samples of professional dancers is needed for enhanced generalizability. These findings provide preliminary evidence of dance-related neuroplasticity in brainstem-mediated vestibular reflexes and open new research avenues. Full article

Background/Objectives: Vestibular Physical Therapy (VPT) plays a crucial role in the rehabilitation of patients with vestibular disorders by promoting vestibular compensation through adaptation, habituation, and substitution mechanisms. While traditional VPT approaches have demonstrated effectiveness in restoring balance and gaze stability, some patients with chronic vestibular dysfunction continue to experience persistent deficits. Methods: review of recent advancements in neuroplasticity research suggest the need for updated rehabilitation strategies that integrate sensorimotor substitution, saccadic training, optokinetic stimulation, and cognitive–motor dual-task training to optimize vestibular compensation. Results: This perspective article explores innovative VPT approaches aimed at improving dynamic gaze and postural stability in a more challenging way. We emphasize the importance of personalized rehabilitation strategies that leverage multisensory integration to enhance neuroplastic recovery. Conclusions: By refining VPT interventions, we can maximize functional outcomes and improve the quality of life for individuals with vestibular disorders. Full article

Acute vertigo or dizziness is a frequent presentation to the emergency department (ED), making up between 2.1% and 4.4% of all consultations. Given the nature of the ED where the priority is triage, diagnostic delays and misdiagnoses are common, with as many as a third of vertebrobasilar strokes presenting with acute vertigo or dizziness being missed. Here, we review diagnostic errors identified in the evaluation and treatment of the acutely dizzy patient and discuss strategies to overcome them. Lessons learned include focusing on structured history taking, asking about timing and triggers to inform a targeted examination, assessing subtle ocular motor findings (e.g., by use of HINTS(+)), and avoiding overreliance on brain imaging (including early magnetic resonance imaging including diffusion-weighted sequences [DWI-MRI]). Importantly, up to 20% of DWI-MRI may be false negatives if obtained within the first 24–48 h after symptom onset. Likewise, overreliance on focal neurologic findings to confirm a stroke diagnosis should be avoided because isolated dizziness, vertigo, or even unsteadiness may be the only symptoms in some patients with vertebrobasilar stroke. Furthermore, in patients with triggered episodic vestibular symptoms provocation maneuvers should be preferred over HINTS(+), and a potential diagnosis of stroke should not be immediately dismissed in younger patients presenting with a headache (where migraine may be more common), but the possibility of a vertebral artery dissection should be further evaluated. Importantly, moderate training of non-experts allows for significant improvement in diagnostic accuracy in the acutely dizzy patient and thus should be prioritized. Full article

Background/Objectives: Vestibular rehabilitation, an evidence-based physical therapy approach, plays a crucial role in managing and recovering from gaze and balance disorders, including those of central origin. This study, targeted at the community of Italian healthcare practitioners, is vital in understanding the application of vestibular rehabilitation in neurological disorders and in identifying knowledge gaps, barriers, and future directions. Methods: This is a cross-sectional study directed at healthcare professionals involved in neurorehabilitation in Italy. The survey consisted of 29 items grouped in 4 sections, which was estimated to take approximately 10 min to complete. The questions covered socio-demographic information, professional information, clinical practice, and future perspectives on vestibular rehabilitation. Results: Out of the 435 respondents, 290 completed the survey. Most of the respondents reported either no (32.87%) or little (42.91%) experience in vestibular rehabilitation. However, most participants (72.98%) recognized the importance of vestibular rehabilitation in treating neurological disorders. The most common condition treated was stroke (46.39%), while balance training (52.69%) and visual input exercises (26.35%) were the two most frequently used strategies. The main barriers to implementing vestibular rehabilitation in clinical practice were equipment cost and insufficient skills. Conclusions: Vestibular physical therapy is a promising complementary approach in neurorehabilitation. However, the study reveals a perceived lack of basic training in vestibular assessment and therapy. This suggests that more efforts are needed to bridge this knowledge gap and make necessary equipment more accessible. Full article

Background/Objectives: This study aimed to develop a machine learning (ML) algorithm that can predict unplanned reoperations and surgical/medical complications after vestibular schwannoma (VS) surgery. Methods: All pre- and peri-operative variables available in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (n = 110), except those directly related to our outcome variables, were used as input variables. A deep neural network model consisting of seven layers was developed using the Keras open-source library, with a 70:30 breakdown for training and testing. The feature importance of input variables was measured to elucidate their relative permutation effect in the ML model. Results: Of the 1783 patients with VS undergoing surgery, unplanned reoperation, surgical complications, and medical complications were seen in 8.5%, 5.2%, and 6.2% of patients, respectively. The deep neural network model had area under the curve of receiver operating characteristics (ROC-AUC) of 0.6315 (reoperation), 0.7939 (medical complications), and 0.719 (surgical complications). Accuracy, specificity, and negative predictive values of the model for all outcome variables ranged from 82.1 to 96.6%, while positive predictive values and sensitivity ranged from 16.7 to 51.5%. Variables such as the length of stay post-operation until discharge, days from operation to discharge, and the total hospital length of stay had the highest permutation importance. Conclusions: We developed an effective ML algorithm predicting unplanned reoperation and surgical/medical complications post-VS surgery. This may offer physicians guidance into potential post-surgical outcomes to allow for personalized medical care plans for VS patients. Full article

Background: Pusher behavior after stroke is an important sequela that interferes with rehabilitation and independence in activities of daily living. As represented by visual or vestibular feedback, conventional methods require substantial assistance and time commitments, but have limited effectiveness. A recent case series suggests that prone posture may alleviate pusher behavior in patients with acute stroke. This study was conducted to retrospectively investigate the effects of prone posture maneuvers. Methods: This retrospective cross-sectional observational study was conducted in a stroke care unit at a university hospital. In total, 37 acute stroke cases presenting with pusher behavior were included from 787 eligible patients. Individuals with pusher behavior were conditioned with prone posturing for 10 min for 2 consecutive days, in addition to regular daily rehabilitation training. The Scale for Contraversive Pushing (SCP) values, Stroke Impairment Assessment Set (SIAS), and functional activities were assessed before, immediately after, and three days after the intervention. Results: The SCP value and the ability to roll over and sit balanced significantly improved compared with the baseline (p < 0.05) and persisted for 3 days after the intervention. Multiple regression analysis identified the SIAS motor score as a determinant of SCP changes. Conclusions: The prone posture maneuver promptly and consistently suppressed pusher behavior, particularly in patients with mild paresis, as indicated by SCP values in acute stroke cases. The uncontrolled, single-site, and retrospective features of the current study require further investigation. Full article

Objectives: The objective of this narrative review was to examine the available literature regarding the increasingly popular method of exercise commonly referred to as “Functional Training” and its potential implications on vestibular and balance function. Methods: a narrative review of the experimental literature prior to September 2024 was conducted. To be included in this review, the selected investigations need to include some aspect of vestibular function, balance function, functional training, and/or functional movement and be conducted in humans. Results: Evidence emerged to support the claim that implementing a physical fitness training program may improve vestibular and balance function but that a functional training program or a physical fitness program designed to improve functional movements may improve vestibular and balance function to a greater extent. Additionally, these results may be altered by factors such as age and sex. Furthermore, while there is a multitude of literature regarding the impact of functional training on balance, few investigations combine these data with direct assessments of vestibular function. Conclusions: Functional training may aid in improving vestibular and balance function, along with scores on common tests such as the Y balance test. However, more research is necessary to elucidate the direct mechanisms by which functional training may impact vestibular and balance function. Full article

Background and Objectives: Unilateral vestibular hypofunction (UVH) in cases of insufficient central nervous system compensation leads to chronic dizziness. A customized vestibular rehabilitation (VR) program is more beneficial than a generic set of exercises for patients with chronic UVH. The purpose of the present study is to compare a customized remotely supervised VR program with a customized unsupervised VR program in chronic UVH patients. Methods: Participants were randomly allocated into two groups (Group A and Group B) and received an individualized 6-week home-based VR program that included adaptation and habituation exercises, balance and gait training. All individuals’ VR program implementation was evaluated weekly, allowing for exercise modifications. Moreover, Group A received additional remote supervision via phone communication (twice per week). The effectiveness of each VR program was evaluated using the scores of the Mini-BESTest, the Functional Gait Assessment (FGA), and the Dizziness Handicap Inventory (DHI). Results: At the 6-week assessment, participants in Group A had significantly better scores in objective and subjective evaluated parameters than those in Group B (p < 0.001). Group A also showed better compliance with the VR program. On the contrary, participants’ conformity in their individualized exercises was not affected by gender, duration of symptoms, or BMI (p > 0.05). Conclusions: Our clinical study highlights the advantages of using telephone communication, with a structured design and implementation, to assist individuals in successfully following a VR protocol. Full article

Reactive postural control (RPC), essential for maintaining balance during daily activities, relies on a complex sensory system integrating visual, vestibular, and proprioceptive inputs. Deficits in RPC can lead to falls, especially in unpredictable environments where sensory inputs are challenged. Traditional rehabilitation often fails to prepare patients adequately for real-world conditions. This study aims to explore the effects of varying instability levels (ILs) and sensory integration strategies (SIS) on RPC by evaluating balance disturbances without applying additional external force. Twenty-five healthy participants (12 men, 13 women, 24.5 ± 6.1 years) performed balance tasks on Abili^® platforms with adjustable ILs (0, 1, 2, 3) while altering sensory strategies (Basic, Visual, Proprioception, Vestibular) using the Modified Clinical Test of Sensory Integration and Balance (mCTSIB). RPC efficiency was measured using the 95th percentile confidence interval for chest movement’s ellipsoid volume and average velocity, analyzed with Wilcoxon signed-rank tests and Cliff’s delta effect size. Results showed significant increases in chest movement velocity and volume, particularly with the Vestibular strategy at higher ILs, with a 7176% increase in chest volume from Basic strategy at 0IL to Vestibular strategy at 3IL. Additionally, removing visual input (Visual and Vestibular strategies) had a greater impact on chest movement than increasing instability levels. These findings underscore the significant role of combined platform instability and reduced sensory input on postural control. This study presents a novel method for challenging balance and suggests that sensory integration with variable instability could be valuable in training and rehabilitation, even for healthy individuals. Full article

Many situations can induce dizziness in healthy participants, be it when riding a carrousel or when making head movements while wearing a head-mounted display. Everybody—maybe with the exception of vestibular loss patients—is prone to dizziness, albeit to widely varying degrees. Some people get dizzy after a single rotation around the body axis, while others can perform multiple pirouettes without the slightest symptoms. We have developed a form of vestibular habituation training with the purpose of reducing proneness to dizziness. The training consists of a short (8 min) exercise routine which is moderate enough that it can easily be integrated into a daily routine. Twenty volunteers performed the training over the course of two weeks. We measured subjective dizziness before and after each daily session. We also performed several vestibular tests before (pre-test) and after (post-test) the two-week training period. They included exposure to a rotating and pitching visual environment while standing upright, as well as a physical rotation that was abruptly stopped. The results show that the dizziness induced during a given daily session decreased over the course of the two weeks. The dizziness induced by the rotating visual stimulus was significantly less after completion of the training period compared with the initial pre-test. Also, postural stability and post-rotatory spinning sensations had improved when comparing the post-test with the pre-test. We conclude that a short regular vestibular training can significantly improve proneness to dizziness. Full article

Objectives: To evaluate the effectiveness of intensive customized vestibular rehabilitation after vestibular schwannoma (VS) excision. Methods: 52 patients who underwent VS removal via a translabyrinthine approach from 2020 to 2022 were involved in this study. Bedside examination, video head impulse test (vHIT), functional head impulse test (fHIT), and the dizziness handicap inventory (DHI) were performed before and after the rehabilitation, which consisted of 10 sessions of specifically designed vestibular, visual, and physical integrated training. Results: After rehabilitation, the vHIT showed overall unchanged values on the affected and healthy side. In contrast, the scores of fHIT, which explores the higher connection of the vestibular system with visual and cerebellar pathways, improved on both the pathological and healthy sides after training (p-value 0.004 and 0.000, respectively). The effectiveness of the rehabilitation was reinforced by the DHI scores, which were considerably lower after training. Conclusions: To our knowledge, this is the first study to explore fHIT outcomes after removal of VS, estimating the impact of rehabilitation on the overall compensation process. The outcomes support the role of extensive postsurgical rehabilitation in the compensatory process, even just a few days after surgery. Full article

This study investigated the efficacy of a 10-session nature-based therapeutic intervention for people with post-concussion symptoms. The intervention involved physical and vestibular exercises, sensory training, relaxation, and psychoeducation, all of which were integrated with the natural environment in a forest therapy garden. This study was designed with a passive control period followed by the intervention (n = 30). The Mental Fatigue Scale (MFS) was the primary outcome measure. The secondary outcome measures were the Warwick–Edinburg Mental Wellbeing Scale and the short version of the Quality of Life after Brain Injury. A Likert scale was used to examine the mental strain of the sessions themselves. The MFS (primary outcome) exhibited a significant decrease with a medium-sized effect from before to after the intervention. The secondary outcomes exhibited significant increases from the beginning to the end of the intervention. All outcomes were sustained at follow-up ten weeks later. No significant difference was found from the control period. This study indicates that the described nature-based intervention is a feasible treatment for reducing prolonged post-concussion symptoms. However, it should be studied more in-depth to understand the impact of the natural environment and to validate the results on a larger representative population. Full article

The reflexive responses to resist external forces and maintain posture result from the coordination between the vestibular system, muscle, tendon, and joint proprioceptors, and vision. Aging deteriorates these crucial functions, increasing the risk of falls. This study aimed to verify whether a training program with water bags, an Instability Neuromuscular training (INT) using the inertial load of water, could positively impact balance ability and dynamic stability. This study was conducted with twenty-two healthy older women aged ≥ 65 (mean age: 74.82 ± 7.00 years, height: 154.20 ± 5.49 cm, weight: 55.84 ± 7.46 kg, BMI: 23.55 ± 3.58 kg/m²). The participants were randomly allocated into two groups: a group that used water bags and a control group performing bodyweight exercises. The intervention training lasted 12 weeks, with 2 sessions per week totaling 24 sessions, each lasting 60 min. The pre- and post-tests were compared using t-tests to examine within- and-between-group differences. The effect size was examined based on the interaction between group and time using a two-way repeated measures ANOVA. The Modified Timed Up and Go manual (TUG manual), Sharpened Romberg Test (SRT), and Y-balance test (YBT) were conducted to assess dynamic stability, including gait function, static stability, and reactive ability. In comparison between groups, the waterbag training group showed a decrease in task completion time associated with an increase in walking speed in the TUG manual test (p < 0.05), and an increase in static stability and reaction time in the Sharpened Romberg test with eyes closed (p < 0.05), and an increase in single-leg stance ability in both legs in the Y-balance test (p < 0.05). All statistical confidence interval levels were set 95%. INT using the inertial load of water enhanced the somatosensory system and gait related to dynamic stability in older women. Therefore, the clinical application of this training program is expected to reduce the risk of falls in healthy older women, improving dynamic stability related to gait. Full article