Severe Dizziness Related to Postural Instability, Changes in Gait and Cognitive Skills in Patients with Chronic Peripheral Vestibulopathy

Abstract Introduction Peripheral vestibular disorders can lead to cognitive deficits and are more common in elderly patients. Objective To evaluate and correlate cognitive, balance and gait aspects in elderly women with chronic peripheral vestibular dizziness, and to compare them with elderly women without vestibular disorders. Methods Twenty-two women presenting peripheral vestibular dizziness episodes for at least six months participated in the study. The individuals were categorized by dizziness severity level: moderate (n = 11) or severe (n = 11). The control group (n = 11) included women showing no vestibulopathy, light-headedness or dizziness. Cognitive assessments and semi-static and dynamic balance assessments were performed with the Balance Master (Neurocom International, Inc., Clackamas, OR), while the Dizziness Handicap Inventory provided a score for the severity of the symptoms. The groups were submitted to statistics of inference and correlation between cognitive, balance and stability variables. Results The group with severe dizziness showed higher sway speed of the center of pressure in the anteroposterior direction, smaller step length, and slower gait than the control group. Regarding the cognitive variables, the group with severe dizziness symptoms presented significant correlations with stability and gait variables. Conclusion The relationship between cognitive aspects, balance and gait was stronger in women with severe dizziness than in those with no vestibulopathy.

Immediate effects of an anchor system on the stability limit of individuals with chronic dizziness of peripheral vestibular origin / Efeitos imediatos de um sistema de âncoras no limite de estabilidade de indivíduos com tontura crônica de origem vestibular periférica

Abstract Introduction The symptoms associated with chronic peripheral vestibulopathy exert a negative impact on the independence and quality of life of these individuals, and many individuals continue to suffer from these symptoms even after conventional vestibular rehabilitation. Objective To evaluate the acute effect of an anchor system for balance evaluation of patients with chronic dizziness who failed to respond to traditional vestibular rehabilitation. Methods Subjects over 50 years of age, presenting with chronic dizziness and postural instability of peripheral vestibular origin, participated in the study. The limit of stability was evaluated in three positions using the Balance Master® system: Position 1, standing with the arms along the body; Position 2, standing with the elbows bent at 90º (simulating holding the anchors); and Position 3, with the elbows bent at 90º holding the anchors. The variables of movement latency, endpoint excursion and directional control of movement were evaluated. Results Using the anchor system, significant reduction of time in the response at the beginning of the movement compared to Position 1 (p < 0.05); increased endpoint excursion in the left lateral direction compared to Position 1 (p < 0.05); and more directional control of movement in the anterior and posterior directions (p < 0.05) compared to the other positions, were found. Conclusion While using the system anchor, individuals with chronic peripheral vestibulopathy showed an immediate improvement in the stability limit in relation to the movement latency, endpoint excursion, and directional control of movement variables, suggesting that the haptic information aids postural control.

Resumo Introdução Os sintomas associados à vestibulopatia periférica crônica têm impacto negativo na independência e qualidade de vida dos indivíduos e muitos deles continuam a sofrer desses sintomas, mesmo depois de ter passado pela reabilitação vestibular convencional. Objetivo Avaliar o efeito agudo de um sistema de ancoragem para avaliação do equilíbrio de pacientes com tontura crônica que não responderam à reabilitação vestibular tradicional. Método Participaram do estudo indivíduos com mais de 50 anos que se apresentaram com tontura crônica e instabilidade postural de origem vestibular periférica. O limite de estabilidade foi avaliado em três posições, com o uso do sistema Balance Master®: Posição 1, de pé com os braços pendentes ao longo do corpo; Posição 2, de pé com os cotovelos flexionados em 90º (simulando a posição de segurar as âncoras); e Posição 3, com os cotovelos flexionados em 90º e segurando as âncoras. Foram avaliadas as variáveis de latência de movimento, o ponto final da excursão e o controle direcional do movimento. Resultados Com o uso do sistema de âncoras, ocorreu redução significante no tempo de resposta no início do movimento em comparação com a Posição 1 (p < 0,05); aumento no ponto final da excursão na direção lateral esquerda, em comparação com a Posição 1 (p < 0,05); e mais controle direcional do movimento nas direções anterior e posterior (p < 0,05), em comparação com as demais posições. Conclusão Enquanto usavam o sistema de âncoras, os indivíduos com vestibulopatia periférica demonstraram melhoria imediata no limite da estabilidade em relação às variáveis latência de movimento, ponto final da excursão e controle direcional do movimento. Isso sugere que a informação háptica auxilia no controle postural.