Propriedades psicométricas do dizziness handicap inventory-child/adolescent - versão reduzida / Psychometric properties of the dizziness handicap inventory-child/adolescent (DHI-CA) - short form

RESUMO Introdução A tontura na infância e adolescência interfere no comportamento psicológico e pode levar a consequências, como mau rendimento escolar e distúrbios de linguagem. Objetivo Desenvolver e verificar a aplicabilidade da versão reduzida do Dizziness Handicap Inventory-Child/Adolescent (DHI-CA) em crianças e adolescentes em fase escolar. Métodos Estudo metodológico de validação, desenvolvido nas unidades de ensino da rede pública municipal do Distrito Sanitário Cabula/Beiru de Salvador, Bahia. Os dados foram coletados por meio do Dizziness Handicap Inventory Child/Adolescent (DHI-CA) e da proposta reduzida, denominada Dizziness Handicap Inventory Child/Adolescent-short form (DHI-CA/SF). O DHI-CA/SF é composto de 15 questões objetivas, divididas em subescalas correspondentes aos aspectos emocionais, físicos e funcionais. Resultados A amostra foi composta por 97 crianças e adolescentes. Destas, 69 eram do sexo feminino (71,1%) e 28 (28,9%) eram do sexo masculino. A faixa etária esteve entre 7 e 15 anos, com média de 11 anos. A consistência interna referente à escala total foi de α=0,84 e α=0,66, para a subescala funcional, α=0,61 para a emocional e α=0,65 para a física. Quanto à concordância das duas aplicações do DHI-CA/SF, foi verificado que os coeficientes de correlação intraclasse, intraexaminadores, demonstraram concordância satisfatória e de satisfatória a excelente para os itens, na segunda aplicação. Os valores de concordância na segunda aplicação foram os seguintes: emocional: 0,70; funcional: 0,93 e física: 0,80. Conclusão A partir do Dizziness Handicap Inventory Child/Adolescent DHI-CA, foi possível obter uma versão reduzida, denominada Dizziness Handicap Inventory Child/Adolescent-short form (DHI/CA-SF), aplicável em crianças ou adolescentes com queixas de tontura.

ABSTRACT Introduction Dizziness during childhood and adolescence interferes with psychological behavior, and can lead to consequences such as poor academic performance and language disorders. Purpose To develop and verify the applicability of the short version of the Dizziness Handicap Inventory-Child/Adolescent (DHI-CA) in school-going children and adolescents. Methods A methodological validation study developed in municipal public network teaching units of Cabula Sanitary District/ Beiru de Salvador, Bahia. Data were collected by means of the Dizziness Handicap Inventory Child/Adolescent (DHI-CA) and proposed short version denominated Dizziness Handicap Inventory Child/Adolescent-short form (DHI-CA/SF). The DHI-CA/SF is composed of 15 objective questions divided into subscales corresponding to emotional, physical and functional aspects. Results The sample of 97 children and adolescents was composed of 69 girls (71.1%) and 28 (28.9%), boys. The age-range was from 7 to 15 years with mean age of 11 years. Internal consistency relative to the total scale was α=0.84; and α=0.66 for the functional; α=0.61, emotional, and α=0.65 for the physical subscale. Relative to agreement between the two applications of DHI-CA/SF, the authors verified that the intra-examiner intraclass correlation coefficients demonstrated satisfactory agreement, and satisfactory to excellent agreement for the items in the second application. Agreement values in the second application were: - emotional: 0.70; - Functional: 0.93, and Physical: 0.80. Conclusion By means of the Dizziness Handicap Inventory Child/Adolescent DHI-CA it was possible to obtain a short version denominated Dizziness Handicap Inventory Child/Adolescent-short form (DHI/CA-SF) applicable in children or adolescents with complaints of dizziness.

Subjective visual vertical with the bucket method in Brazilian healthy individuals / Vertical visual subjetiva com o método do balde em indivíduos brasileiros hígidos

ABSTRACT INTRODUCTION: The capacity of a healthy individual to estimate the true vertical in relation to the Earth when a fluorescent line is aligned in a completely dark room is called the subjective visual vertical. OBJECTIVE: To evaluate subjective visual vertical using the bucket method in healthy Brazilian individuals. METHODS: Binocular subjective visual vertical was measured in 100 healthy volunteers, 50 females and 50 males. The volunteers indicated the estimated position in which a fluorescent line inside a bucket reached the vertical position. A total of ten repetitions were performed, five clockwise and five counterclockwise. Data were tabulated and analyzed statistically. RESULTS: It was observed that the highest concentration of absolute values of vertical deviation was present up to 3°, regardless of gender, and the vertical deviation did not increase with age. The analysis of the mean of the absolute values of deviations from the vertical of 90% of the sample showed a maximum value of 2.6°, and at the analysis of 95%, the maximum value was 3.4° deviation from the vertical. CONCLUSION: The bucket method is easy to perform and interpret when assessing the deviation of the subjective visual vertical in relation to the true vertical in healthy Brazilian individuals.

Resumo Introdução: A capacidade que um indivíduo hígido tem em estimar a vertical verdadeira em relação à Terra, quando alinha uma linha fluorescente em uma sala completamente escura é denominada de Vertical Visual Subjetiva (VVS). Objetivo: Avaliar a VVS com o método do balde em indivíduos brasileiros hígidos. Método: A VVS binocular foi medida em 100 voluntários hígidos, 50 do gênero feminino e 50 do masculino. Os voluntários indicaram a posição estimada em que uma linha fluorescente no interior de um balde alcançou a posição vertical. Foram realizadas 10 repetições, cinco no sentido horário e cinco no anti-horário. Os dados foram tabulados e submetidos à análise estatística. Resultados: Observou-se que a maior concentração dos valores absolutos dos desvios da vertical esteve presente até 3º, independente do gênero e o desvio da vertical não aumentou conforme a idade. À análise da média dos valores absolutos dos desvios da vertical de 90% da amostra, foi encontrado o valor máximo de 2,6º e à análise de 95% o valor máximo foi de 3,4 de desvio da vertical. Conclusão: O método do balde é fácil de realizar e de interpretar na avaliação do desvio da vertical visual subjetiva em relação à vertical verdadeira de indivíduos brasileiros hígidos.

Subjective visual vertical with the bucket method in Brazilian healthy individuals.

INTRODUCTION: The capacity of a healthy individual to estimate the true vertical in relation to the Earth when a fluorescent line is aligned in a completely dark room is called the subjective visual vertical. OBJECTIVE: To evaluate subjective visual vertical using the bucket method in healthy Brazilian individuals. METHODS: Binocular subjective visual vertical was measured in 100 healthy volunteers, 50 females and 50 males. The volunteers indicated the estimated position in which a fluorescent line inside a bucket reached the vertical position. A total of ten repetitions were performed, five clockwise and five counterclockwise. Data were tabulated and analyzed statistically. RESULTS: It was observed that the highest concentration of absolute values of vertical deviation was present up to 3°, regardless of gender, and the vertical deviation did not increase with age. The analysis of the mean of the absolute values of deviations from the vertical of 90% of the sample showed a maximum value of 2.6°, and at the analysis of 95%, the maximum value was 3.4° deviation from the vertical. CONCLUSION: The bucket method is easy to perform and interpret when assessing the deviation of the subjective visual vertical in relation to the true vertical in healthy Brazilian individuals.

Adaptação brasileira do dizziness handicap inventory para a população infantil: confiabilidade dos resultados / Brazilian adaptation of the dizziness handicap inventory for the pediatric population: reliability of the results

RESUMO Objetivo: Avaliar a confiabilidade dos resultados numa versão adaptada do Dizziness Handicap Inventory (DHI) brasileiro para crianças. Métodos: (1) adaptação semântica do DHI, primeira versão, para população infantil; (2) apreciação do DHI por juízes fonoaudiólogos, para adequação semântica da versão adaptada; (3) aplicação do piloto em 15 indivíduos para ajustes semânticos; (4) aplicação da versão adaptada do DHI, em 119 crianças com relato de tontura; (5) teste-reteste de 34 crianças. Resultados: Com relação ao gênero, verificou-se médias mais elevadas do escore total nas crianças do gênero feminino. Não houve associação entre os escores do Dizziness Handicap Inventory-Child/Adolescent (DHI-CA) e a idade das crianças. Foram constatados índices adequados de consistência interna e estabilidade dos resultados na escala total e nas três subescalas. Conclusão: O Dizziness Handicap Inventory-Child/Adolescent mostrou-se confiável para quantificação do impacto da tontura na qualidade de vida das crianças e adolescentes em fase escolar, sendo a confiabilidade dos resultados uma primeira contribuição para a validação desse instrumento.

ABSTRACT Purpose: To evaluate the reliability of the results in an adapted version of the Brazilian Dizziness Handicap Inventory (DHI) adapted for children. Methods: 1) semantic adaptation of DHI, first version, for child population; 2) appreciation of DHI by speech therapy judges for semantic appropriateness of the adapted version; application of the adapted version of DHI in 119 children with dizziness report; 4) application of DHI, adapted version, in 119 children suffering from dizziness symptoms; 5) test/re-test of 34 children. Results: In the group, there were higher average total scores in girls. There was no association between the scores of the Dizziness Handicap Inventory-Child/Adolescent (DHI-CA) and the age of the children. Adequate levels of internal consistency and stability of the results were verified in the full scale and the three subscales. Conclusion: DHI-CA appeared to be capable of reliably quantifying the impact of dizziness on quality of life of school-age children and adolescents, and the reliability of results is a first contribution to the validation of this instrument.

Posturografia dinâmica computadorizada na avaliação do equilíbrio corporal de indivíduos com disfunção vestibular / Computerized dynamic posturography in the assessment of body balance in individuals with vestibular dysfunction

Objetivo Avaliar o equilíbrio corporal de pacientes portadores de disfunção vestibular, por meio da posturografia dinâmica computadorizada. Métodos Estudo com 116 indivíduos com disfunção vestibular periférica, com idades entre 22 anos e 6 meses e 94 anos e 1 mês. Foram submetidos à avaliação otoneurológica completa, avaliação otorrinolaringológica, além da posturografia dinâmica computadorizada com os testes de organização sensorial, controle motor e de adaptação. Resultados O teste de organização sensorial foi o mais sensível para detectar alterações do equilíbrio e a condição 4, em que os pacientes permanecem na posição ortostática, com os pés afastados e sobre os sensores da superfície de referência, com os olhos abertos; condição 5, na qual os pacientes continuam na posição com os olhos fechados e a condição 6, em que os pacientes mantém os olhos abertos e o campo visual sofre deslocamentos anteroposteriores. Nas três condições, a superfície de referência oscila com movimentos similares à gangorra e foram as que os participantes apresentaram maiores dificuldades. Houve maior ocorrência de quedas se compararmos ao risco de quedas, avaliado quando o paciente tem pontuação entre 60 e 69 no índice de equilíbrio, principalmente a partir da condição 4 do teste de organização sensorial e entre os idosos. As mulheres tiveram maior número de quedas durante os testes. Conclusão A posturografia dinâmica computadorizada detectou as alterações relacionadas ao equilíbrio corporal, auxiliando no diagnóstico das disfunções e complementando a avaliação vestibular. .

Purpose To evaluate the body balance of patients with vestibular dysfunction with computerized dynamic posturography. Methods Study of 116 individuals with peripheral vestibular dysfunction, aged 22 years and 6 months old to 94 years and 1 month old were subjected to a complete otoneurological assessment; computerized dynamic posturography with a sensory organization test, motor control test, and adaptation test; and an otolaryngological evaluation. Results The sensory organization test detected balance changes with the most sensitivity. Condition 4, during which the patients stood with their feet apart with them placed on the sensors of the reference surface and with their eyes open; condition 5, during which the patients remained in position with their eyes closed; condition 6, during which the patients kept their eyes open and their visual field underwent anterior-posterior displacement; and all three conditions when the reference surface moved in a see-saw manner were the conditions during which the participants had the greatest difficulties. The results showed patients with composite scores between 60 and 69, which indicated a higher occurrence of falls compared to the risk of falls, during condition 4 of the sensory organization test and among the elderly. Women had a higher number of falls during testing. Conclusion Computerized dynamic posturography, which concisely detected body balance changes, can be used in the diagnosis of vestibular disorders to complement vestibular assessments. .

Vestibular evoked myogenic potentials and digital vectoelectronystagmography's study in patients with benign paroxysmal positional vertigo

INTRODUCTION: Benign Paroxysmal Positional Vertigo (BPPV) is a very common vestibular disorder characterized by brief but intense attacks of rotatory vertigo triggered by simple rapid movement of the head. The integrity of the vestibular pathways can be assessed using tests such as digital vectoelectronystagmography (VENG) and vestibular evoked myogenic potentials (VEMP). AIM: This study aimed to determine the VEMP findings with respect to latency, amplitude, and waveform peak to peak and the results of the oculomotor and vestibular components of VENG in patients with BPPV. METHODS: Although this otoneurological condition is quite common, little is known of the associated VEMP and VENG changes, making it important to research and describe these results. RESULTS: We examined the records of 4438 patients and selected 35 charts after applying the inclusion and exclusion criteria. Of these, 26 patients were women and 9 men. The average age at diagnosis was 52.7 years, and the most prevalent physiological cause, accounting for 97.3% of cases, was ductolithiasis. There was a statistically significant association between normal hearing and mild contralateral sensorineural hearing loss. The results of the oculomotor tests were within the normal reference ranges for all subjects. Patients with BPPV exhibited symmetrical function of the semicircular canals in their synergistic pairs (p < 0.001). The caloric test showed statistically normal responses from the lateral canals. The waveforms of all patients were adequate, but the VEMP results for the data-crossing maneuver with positive positioning showed a trend toward a relationship for the left ear Lp13. There was also a trend towards an association between normal reflexes in the caloric test and the inter-peak VEMP of the left ear. It can be concluded that although there are some differences between the average levels of the VENG and VEMP results, these differences were not statistically significant. CONCLUSION: In...

Vestibular evoked myogenic potentials and digital vectoelectro-nystagmography's study in patients with benign paroxysmal positional vertigo.

INTRODUCTION: Benign Paroxysmal Positional Vertigo (BPPV) is a very common vestibular disorder characterized by brief but intense attacks of rotatory vertigo triggered by simple rapid movement of the head. The integrity of the vestibular pathways can be assessed using tests such as digital vectoelectronystagmography (VENG) and vestibular evoked myogenic potentials (VEMP). AIM: This study aimed to determine the VEMP findings with respect to latency, amplitude, and waveform peak to peak and the results of the oculomotor and vestibular components of VENG in patients with BPPV. METHOD: Although this otoneurological condition is quite common, little is known of the associated VEMP and VENG changes, making it important to research and describe these results. RESULTS: We examined the records of 4438 patients and selected 35 charts after applying the inclusion and exclusion criteria. Of these, 26 patients were women and 9 men. The average age at diagnosis was 52.7 years, and the most prevalent physiological cause, accounting for 97.3% of cases, was ductolithiasis. There was a statistically significant association between normal hearing and mild contralateral sensorineural hearing loss. The results of the oculomotor tests were within the normal reference ranges for all subjects. Patients with BPPV exhibited symmetrical function of the semicircular canals in their synergistic pairs (p < 0.001). The caloric test showed statistically normal responses from the lateral canals. The waveforms of all patients were adequate, but the VEMP results for the data-crossing maneuver with positive positioning showed a trend toward a relationship for the left ear Lp13. There was also a trend towards an association between normal reflexes in the caloric test and the inter-peak VEMP of the left ear. It can be concluded that although there are some differences between the average levels of the VENG and VEMP results, these differences were not statistically significant. CONCLUSION: In conclusion, the results of audiologic assessment, hearing thresholds, positioning maneuvers, and caloric tests have no effect on the quantitative results of VEMP. Additional research is warranted to establish the relationships among VENG, VEMP, and BPPV, especially as concerns the oculomotor tests.

Balance Rehabilitation Unit (BRU™) posturography in benign paroxysmal positional vertigo.

UNLABELLED: Posturography has been used in the evaluation of patients with vestibular disorders. AIM: To evaluate balance control with the Balance Rehabilitation Unit (BRU™) posturography in patients with Benign Paroxysmal Positional Vertigo. STUDY DESIGN: Prospective case-control. MATERIALS AND METHODS: A cross-sectional controlled study was carried out in 45 patients with BPPV, and a homogeneous control group consisting of 45 healthy individuals. Patients were submitted to a balance function evaluation by means of the Balance Rehabilitation Unit (BRU™) posturography. RESULTS: The mean values of the ellipse area and the sway velocity in a firm surface and saccadic stimulation (p = 0.060). CONCLUSION: The Balance Rehabilitation Unit (BRU™) posturography enables to identify postural control abnormalities in patients with BPPV.

Posturografia do Balance Rehabilitation Unit (BRU TM) na vertigem posicional paroxística benigna / Balance Rehabilitation Unit (BRU TM) posturography in benign paroxysmal positional vertigo

A posturografia tem sido utilizada na avaliação de pacientes com vestibulopatias. OBJETIVO: Avaliar o equilíbrio corporal à posturografia do Balance Rehabilitation Unit (BRU TM) em pacientes com vertigem posicional paroxística benigna (VPPB). Desenho de Estudo: Caso controle prospectivo. MATERIAL E MÉTODO: Estudo transversal controlado em 45 pacientes com VPPB e por um grupo controle homogêneo constituído de 45 indivíduos hígidos. Os pacientes foram submetidos à avaliação otoneurológica, incluindo a posturografia do Balance Rehabilitation Unit (BRU TM). RESULTADOS: A média dos valores da área de elipse e da velocidade de oscilação no grupo experimental foi significantemente maior (p < 0,05) do que a do grupo controle em todas as condições avaliadas, com exceção da velocidade de oscilação em superfície firme e estimulação sacádica (p = 0,060). CONCLUSÃO: A posturografia do Balance Rehabilitation Unit (BRU TM) possibilita a identificação de anormalidades do controle postural em pacientes com vertigem posicional paroxística benigna.

Posturography has been used in the evaluation of patients with vestibular disorders. AIM: To evaluate balance control with the Balance Rehabilitation Unit (BRU TM) posturography in patients with Benign Paroxysmal Positional Vertigo. Study design: Prospective case-control. MATERIALS AND METHODS: A cross-sectional controlled study was carried out in 45 patients with BPPV, and a homogeneous control group consisting of 45 healthy individuals. Patients were submitted to a balance function evaluation by means of the Balance Rehabilitation Unit (BRU TM) posturography. RESULTS: The mean values of the ellipse area and the sway velocity in a firm surface and saccadic stimulation (p = 0.060). CONCLUSION: The Balance Rehabilitation Unit (BRU TM) posturography enables to identify postural control abnormalities in patients with BPPV.

Posturografia com estímulos de realidade virtual nas diferentes disfunções vestibulares / Posturography with virtual reality stimuli in different vestibular dysfunctions

OBJETIVO: Avaliar o equilíbrio corporal e quantificar possíveis alterações na posturografia estática do Balance Rehabilitation Unit (BRU TM) em pacientes com disfunção vestibular. MÉTODOS: Estudo retrospectivo, com prontuários de 100 pacientes com topodiagnóstico de disfunção vestibular periférica ou central e 100 indivíduos hígidos compondo o Grupo Controle, de ambos os gêneros, entre 7 a 86 anos. Para a posturografia foi utilizado o equipamento Balance Rehabilitation Unit (BRU TM), da Medicaa®. Foram analisados os parâmetros limite de estabilidade, área de elipse e velocidade de oscilação em dez condições sensoriais. RESULTADOS: A média dos valores do limite de estabilidade, da área de elipse e da velocidade de oscilação do Grupo Experimental foi significativa em relação ao Grupo Controle em todas as condições. A média dos parâmetros do gênero feminino do Grupo Experimental foi significativa em relação ao do Grupo Controle em todas as condições avaliadas. Os pacientes com disfunção vestibular central obtiveram maiores valores que os pacientes com disfunção vestibular periférica nas variáveis área de elipse e velocidade de oscilação, porém menor valor da área do limite de estabilidade. CONCLUSÃO: A posturografia com estímulos de realidade virtual foi um método de avaliação eficaz para detectar alterações relacionadas às variáveis limite de estabilidade, área de elipse e velocidade de oscilação, uma vez que o Grupo Controle obteve melhor desempenho, tanto entre os grupos quanto entre os gêneros. Entre as disfunções vestibulares, os indivíduos com acometimento periférico obtiveram melhor desempenho do que os indivíduos com disfunção vestibular central em todas as variáveis analisadas na posturografia.

PURPOSE: To assess body balance and to quantify possible alterations over the static posturography of the Balance Rehabilitation Unit (BRU TM) in patients with vestibular dysfunction. METHODS: Retrospective study, with files of 100 patients with topographic diagnosis of peripheral or central vestibular dysfunction and 100 healthy individuals that composed the control group, of both genders, with ages varying between 7 and 86 years. For the posturography, the Balance Rehabilitation Unit (BRU TM), of Medicaa® was used. The following parameters were analyzed: stability limits, elliptical area, and speed of oscillation in ten sensory conditions. RESULTS: Mean values ​​of the stability limit, the elliptical area and the speed of oscillation in the experimental group was significant when compared to the control group in all conditions. The mean parameters of the female experimental group were significant when compared to the control group in all conditions. Patients with central vestibular dysfunction obtained higher values than patients with peripheral vestibular dysfunction in the variables elliptical area and speed of oscillation, however with lower value of the area of the stability limit. CONCLUSION: Posturography with virtual reality stimuli was an effective assessment method for detecting alterations related to the variables stability limits, elliptical area, and speed of oscillation, since the control group performed better, both between groups and between genders. Among the vestibular dysfunctions, individuals with peripheral condition performed better than those with central vestibular dysfunction in all the variables analyzed on posturography.

Posturography with virtual reality stimulations in normal young adults with no balance complaints.

PURPOSE: To analyze the findings of posturography with virtual reality stimuli carried out in young healthy adults with no otoneurological complaints, based on the parameters center of pressure, limit of stability and sway speed for different visual stimuli, and regarding differences between female and male genders. METHODS: Participants were 50 healthy individuals of both genders (50% female and 50% male) with ages ranging from 18 to 25 years (mean age 21.30 years), with no complaints regarding body balance, and with vestibular outcomes assessed through digital vectonistagmography within normal limits. Posturography was composed of 11 visual stimuli and determined the limit of stability area (LOS), the ellipse area, and the sway speed in ten sensorial conditions. Results were calculated for the studied age range and analyzed according to the values for each stimulus, with the aim to obtain normality parameters. RESULTS: The average values obtained in posturography regarding limit of stability, ellipse area and sway speed for stimuli with viso-vestibular interaction presented significant differences between genders, and, in all cases, women obtained lower values than men. CONCLUSION: The findings of posturography with virtual reality stimuli in healthy young adults evidence that the parameters center of pressure, limit of stability and sway speed present differences between genders and, therefore, must be considered separately.

Posturografia com estímulos de realidade virtual em adultos jovens sem alterações do equilíbrio corporal / Posturography with virtual reality stimulations in normal young adults with no balance complaints

OBJETIVO: Analisar os achados à posturografia com estímulos de realidade virtual realizada em adultos jovens, hígidos e sem queixas otoneurológicas, de acordo com parâmetros de centro de pressão, limite de estabilidade e velocidade da oscilação para diferentes estímulos visuais e em relação aos gêneros masculino e feminino. MÉTODOS: Participaram 50 indivíduos hígidos de ambos os gêneros (50 por cento gênero feminino e 50 por cento masculino), com idades entre 18 e 25 anos (média de idade 21,30 anos), sem queixas relacionadas ao equilíbrio corporal e avaliação vestibular com vectonistagmografia digital dentro dos padrões de normalidade. A posturografia foi composta por 11 estímulos visuais e determinou a área do limite de estabilidade (LOS), área de elipse, e velocidade de oscilação em dez condições sensoriais. Os resultados foram calculados para a faixa etária estudada e analisados quanto aos valores para cada estímulo, visando à obtenção de limites de normalidade dos parâmetros. RESULTADOS: Os valores médios obtidos na posturografia, quanto ao limite de estabilidade, à área da elipse e à velocidade de oscilação para os estímulos com interação visuo-vestibular apresentaram diferenças entre os gêneros, sendo que em todos os casos as mulheres obtiveram valores inferiores aos dos homens. CONCLUSÃO: Os achados à posturografia com estímulos de realidade virtual em adultos jovens hígidos evidenciam que os parâmetros centro de pressão, limite de estabilidade e velocidade da oscilação apresentam diferenças entre os gêneros, e portanto, devem ser considerados separadamente.

PURPOSE: To analyze the findings of posturography with virtual reality stimuli carried out in young healthy adults with no otoneurological complaints, based on the parameters center of pressure, limit of stability and sway speed for different visual stimuli, and regarding differences between female and male genders. METHODS: Participants were 50 healthy individuals of both genders (50 percent female and 50 percent male) with ages ranging from 18 to 25 years (mean age 21.30 years), with no complaints regarding body balance, and with vestibular outcomes assessed through digital vectonistagmography within normal limits. Posturography was composed of 11 visual stimuli and determined the limit of stability area (LOS), the ellipse area, and the sway speed in ten sensorial conditions. Results were calculated for the studied age range and analyzed according to the values for each stimulus, with the aim to obtain normality parameters. RESULTS: The average values obtained in posturography regarding limit of stability, ellipse area and sway speed for stimuli with viso-vestibular interaction presented significant differences between genders, and, in all cases, women obtained lower values than men. CONCLUSION: The findings of posturography with virtual reality stimuli in healthy young adults evidence that the parameters center of pressure, limit of stability and sway speed present differences between genders and, therefore, must be considered separately.

Betahistine in the treatment of tinnitus in patients with vestibular disorders.

UNLABELLED: Betahistine is a medicine used to treat vestibular disorders that has also been used to treat tinnitus. AIM: To assess the effects of betahistine on tinnitus in patients with vestibular disorders. MATERIAL AND METHOD: Retrospective data were collected from patient records for individuals presenting with vestibular dysfunction and tinnitus. Patients included had received betahistine 48 mg/day and clinical outcomes were compared with a control group comprising individuals who were unable to receive betahistine due to gastritis, ulcers, pregnancy, asthma or hypersensitivity to the drug. Patients underwent control of any aggravating factors and also standard vestibular exercises as a basis for treatment. The intensity, frequency and duration of tinnitus were assessed on the first day of dosing and after 120 days of treatment. Clinical improvement was defined as a total or partial reduction of tinnitus after treatment. RESULTS: Clinical improvement was observed in 80/262 (30. 5%) of patients treated with betahistine and 43/252 (17. 1%) of control patients. Betahistine significantly (p<0. 0001) improved tinnitus in treated individuals. CONCLUSIONS: The daily dosage of 48 mg of betahistine during 120 consecutive days is useful to reduce or eliminate tinnitus in patients with vestibular disorders.

Betahistine in the treatment of tinnitus in patients with vestibular disorders / Betaistina no tratamento do zumbido em pacientes com distúrbios vestibulares

Betahistine is a medicine used to treat vestibular disorders that has also been used to treat tinnitus. AIM: To assess the effects of betahistine on tinnitus in patients with vestibular disorders. MATERIAL AND METHOD: Retrospective data were collected from patient records for individuals presenting with vestibular dysfunction and tinnitus. Patients included had received betahistine 48 mg/day and clinical outcomes were compared with a control group comprising individuals who were unable to receive betahistine due to gastritis, ulcers, pregnancy, asthma or hypersensitivity to the drug. Patients underwent control of any aggravating factors and also standard vestibular exercises as a basis for treatment. The intensity, frequency and duration of tinnitus were assessed on the first day of dosing and after 120 days of treatment. Clinical improvement was defined as a total or partial reduction of tinnitus after treatment. RESULTS: Clinical improvement was observed in 80/262 (30. 5 percent) of patients treated with betahistine and 43/252 (17. 1 percent) of control patients. Betahistine significantly (p<0. 0001) improved tinnitus in treated individuals. CONCLUSIONS: The daily dosage of 48 mg of betahistine during 120 consecutive days is useful to reduce or eliminate tinnitus in patients with vestibular disorders.

A betaistina é um medicamento utilizado no tratamento de distúrbios da função vestibular, que também tem sido utilizado para tratar o zumbido. OBJETIVO: Avaliar o efeito da betaistina sobre o zumbido de pacientes com distúrbios vestibulares. MATERIAL E MÉTODO: Foram coletados dados retrospectivos de pacientes com vestibulopatia e zumbido. Os pacientes incluídos receberam 48 mg/dia de betaistina ao dia e os resultados clínicos foram comparados com os de um grupo controle, que incluiu indivíduos impossibilitados de receber betaistina devido à gastrite, úlceras, gravidez, asma ou hipersensibilidade ao medicamento. Os pacientes realizaram controle de fatores agravantes e exercícios de reabilitação vestibular, como tratamento de base para a vestibulopatia. A intensidade, frequência e duração do zumbido foram avaliadas no primeiro dia e após 120 dias de tratamento. A melhora clínica foi definida pela redução total ou parcial do zumbido após o tratamento. RESULTADOS: Observou-se melhora clínica do zumbido em 80/262 (30,5 por cento) dos pacientes tratados com a betaistina e em 43/252 (17,1 por cento) pacientes do grupo controle. A betaistina melhorou significativamente (p<0.0001) o zumbido nos indivíduos tratados. CONCLUSÃO: A dose de 48 mg/dia de betaistina durante 120 dias consecutivos é útil na redução ou eliminação do zumbido de pacientes com distúrbios vestibulares.

Balance Rehabilitation Unit (BRU™) posturography in relapsing-remitting multiple sclerosis.

OBJECTIVE: To evaluate balance control with Balance Rehabilitation Unit (BRU™) posturography in patients with multiple sclerosis (MS). METHOD: A cross controlled study was performed including 39 relapsing-remitting multiple sclerosis patients with scores less than or equal to 4 in the Expanded Disability Status Scale (EDSS), and a homogeneous control group consisting of 65 healthy individuals, matched by the age and gender. The experimental group was distributed according to the EDSS scale scores in 0-2.5 and 3-4. To assess the vestibular system function, the patients underwent a neurotological evaluation, including posturography of the Balance Rehabilitation Unit (BRU™). RESULTS: Statistically significant differences were observed when comparing the values of the sway velocity and the ellipse area of the MS 0-2.5 group with the control and the MS 3-4 group with the control. A statistically significant difference was verified between the MS 0-2.5 and the MS 3-4 groups in the condition 3 ellipse area values. CONCLUSION: The evaluation of the balance control with posturography of Balance Rehabilitation Unit (BRU™) enables the identification of abnormalities of the sway velocity and confidential ellipse in patients with relapsing-remitting multiple sclerosis.

Balance Rehabilitation Unit (BRU TM) posturography in relapsing-remitting multiple sclerosis / Posturografia do Balance Rehabilitation Unit (BRU TM) na esclerose múltipla recorrente-remitente

OBJECTIVE: To evaluate balance control with Balance Rehabilitation Unit (BRU TM) posturography in patients with multiple sclerosis (MS). METHOD: A cross controlled study was performed including 39 relapsing-remitting multiple sclerosis patients with scores less than or equal to 4 in the Expanded Disability Status Scale (EDSS), and a homogeneous control group consisting of 65 healthy individuals, matched by the age and gender. The experimental group was distributed according to the EDSS scale scores in 0-2.5 and 3-4. To assess the vestibular system function, the patients underwent a neurotological evaluation, including posturography of the Balance Rehabilitation Unit (BRU TM). RESULTS: Statistically significant differences were observed when comparing the values of the sway velocity and the ellipse area of the MS 0-2.5 group with the control and the MS 3-4 group with the control. A statistically significant difference was verified between the MS 0-2.5 and the MS 3-4 groups in the condition 3 ellipse area values. CONCLUSION: The evaluation of the balance control with posturography of Balance Rehabilitation Unit (BRU TM) enables the identification of abnormalities of the sway velocity and confidential ellipse in patients with relapsing-remitting multiple sclerosis.

OBJETIVO: Avaliar o equilíbrio corporal à posturografia do Balance Rehabilitation Unit (BRU TM) em pacientes com esclerose múltipla (EM). MÉTODO: Estudo transversal controlado em 39 pacientes com esclerose múltipla do tipo recorrente-remitente, com pontuação menor ou igual a 4 na escala de incapacidade funcional expandida, e por um grupo controle homogêneo, constituído por 65 indivíduos hígidos, homogêneo em relação à idade e gênero. O grupo experimental foi distribuído, de acordo com a pontuação da EDSS, em 0-2,5 e 3-4. Para avaliar a função do sistema vestibular, os pacientes foram submetidos a uma avaliação otoneurológica, incluindo a posturografia do Balance Rehabilitation Unit (BRU TM). RESULTADOS: Foram observadas diferenças significantes na comparação dos valores da velocidade de oscilação e da área de elipse do grupo EM 0-2,5 com o controle e do grupo EM 3-4 com o controle; diferença significante foi verificada entre os grupos EM 0-2,5 e EM 3-4 nos valores da área de elipse na condição três. CONCLUSÃO: A avaliação do equilíbrio corporal por meio da posturografia do Balance Rehabilitation Unit (BRU TM) possibilita a identificação de anormalidades da velocidade de oscilação e da área de elipse em pacientes com esclerose múltipla.

Comparison of different protocols for vestibular rehabilitation in patients with peripheral vestibular disorders.

PURPOSE: To compare the therapeutic efficacy of two protocols for vestibular rehabilitation in several vestibular disordes. METHODS: Twenty patients with chronic peripheral disorders of both genders (prevalence of females, with 60% of the sample) and mean age of 55 years and 9 months participated in this study. Group 1 carried out exercices based on stimulation of vertical and horizontal vestibulocular reflex, and Group 2 carried out exercices based on a protocol of personalized vestibular rehabilitation. Data analysis considered the complaint manifested during anamnesis and the clinical evolution of the patient during the execution of the exercises. The results obtained from the application of the Dizziness Handicap Inventory questionnaire (DHI) and the dizziness visual analog scale (VAS), both before and after vestibular rehabilitation, were also considered in the analysis. RESULTS: Differences were found in the values obtained in VAS and DHI (physical and functional scales and total score), in both groups. However, the comparison of the groups after rehabilitation showed that Group 2 obtained better scores than Group 1, both in VAS and DHI (functional scale and total value). CONCLUSION: Vestibular rehabilitation allowed significant improvement in otoneurological clinical profile and in self-perception of dizziness, regardless the therapeutic method used. Personalized vestibular rehabilitation was more efficient than the vestibulocular reflex stimulation protocol in improving quality of life of individuals with chronic periferal disorders.

Comparação de diferentes protocolos de reabilitação vestibular em pacientes com disfunções vestibulares periféricas / Comparison of different protocols for vestibular rehabilitation in patients with peripheral vestibular disorders

OBJETIVO: Comparar a eficácia terapêutica de dois protocolos de reabilitação vestibular em diferentes disfunções vestibulares. MÉTODOS: Participaram 20 pacientes com disfunções periféricas crônicas, de ambos os gêneros (prevalência do gênero feminino, com 60 por cento da amostra), com média de idade de 55 anos e 9 meses. O Grupo 1 realizou exercícios baseados na estimulação do reflexo vestíbulocular vertical e horizontal, e o Grupo 2 realizou exercícios baseados em um protocolo de reabilitação vestibular personalizado. A análise de dados levou em consideração a queixa durante a anamnese e a evolução clínica do paciente a partir da execução dos exercícios. Além disso, foram obtidos os resultados do questionário Dizziness Handicap Inventory (DHI) e da escala analógica e visual de tontura (EVA), pré e pós reabilitação vestibular. RESULTADOS: Houve diferença nos valores da EVA e do DHI (escala física, funcional e no valor total), pré e pós-reabilitação vestibular, em ambos os grupos. Porém, na comparação dos dois grupos no momento pós-reabilitação, o Grupo 2 obteve melhores resultados que o Grupo 1, tanto na EVA quanto no DHI (escala funcional e no valor total). CONCLUSÃO: A reabilitação vestibular possibilitou melhora significativa do quadro otoneurológico clínico e na auto-percepção da tontura independentemente da terapêutica empregada. A reabilitação vestibular personalizada mostrou-se mais eficaz do que o protocolo de estimulação do reflexo vestibulocular na melhora da qualidade de vida de indivíduos com disfunções periféricas crônicas.

PURPOSE: To compare the therapeutic efficacy of two protocols for vestibular rehabilitation in several vestibular disordes. METHODS: Twenty patients with chronic peripheral disorders of both genders (prevalence of females, with 60 percent of the sample) and mean age of 55 years and 9 months participated in this study. Group 1 carried out exercices based on stimulation of vertical and horizontal vestibulocular reflex, and Group 2 carried out exercices based on a protocol of personalized vestibular rehabilitation. Data analysis considered the complaint manifested during anamnesis and the clinical evolution of the patient during the execution of the exercises. The results obtained from the application of the Dizziness Handicap Inventory questionnaire (DHI) and the dizziness visual analog scale (VAS), both before and after vestibular rehabilitation, were also considered in the analysis. RESULTS: Differences were found in the values obtained in VAS and DHI (physical and functional scales and total score), in both groups. However, the comparison of the groups after rehabilitation showed that Group 2 obtained better scores than Group 1, both in VAS and DHI (functional scale and total value). CONCLUSION: Vestibular rehabilitation allowed significant improvement in otoneurological clinical profile and in self-perception of dizziness, regardless the therapeutic method used. Personalized vestibular rehabilitation was more efficient than the vestibulocular reflex stimulation protocol in improving quality of life of individuals with chronic periferal disorders.

Impacto da tontura na qualidade de vida de idosos com vestibulopatia crônica / Impact of dizziness on the life quality of elderly with chronic vestibulopathy

TEMA: impacto da tontura na qualidade de vida (QV) em idosos vestibulopatas crônicos. OBJETIVO: avaliar a associação entre o impacto da tontura na QV de idosos com disfunção vestibular crônica e variáveis demográficas e clínicas. MÉTODO: estudo prospectivo em que 120 idosos com disfunção vestibular crônica submeteram-se à versão brasileira do Dizziness Handicap Inventory (DHI). Foram utilizados os testes de Mann-Whitney, Kruskal-Wallis e Coeficiente de Correlação de Spearman para verificar a associação de QV e as variáveis demográficas e clínicas. RESULTADOS: ocorreram associações significantes entre a presença de tontura rotatória e não rotatória com o escore total do DHI (p = 0,010) e subescala física (p = 0,049) e funcional (p = 0,009); entre quedas recorrentes com o DHI total (p = 0,004) e subescalas física (p = 0,045), funcional (p = 0,010) e emocional (p = 0,011). Correlações significantes foram encontradas entre incapacidade funcional e o DHI total (ρ = + 0,557; p < 0,001) e subescalas física (ρ = + 0,326; p < 0,001), funcional (ρ = + 0,570; p < 0,001) e emocional (ρ = + 0,521; p(0,001). CONCLUSÕES: o impacto da tontura na QV é maior nos idosos com tontura rotatória e não rotatória, quedas recorrentes e incapacidade funcional.

BACKGROUND: dizziness impact on the quality of life (QoL) of elderly patients with chronic vestibular dysfunction. AIM: to evaluate the association between the impact of dizziness on the QoL of elderly patients with chronic vestibular dysfunction and demographic and clinical variables. METHOD: a prospective study. A hundred and twenty elderly patients with chronic vestibular dysfunction underwent the Brazilian version of the Dizziness Handicap Inventory (DHI). In order to verify the association between the QoL and the demographic and clinical variables, the following testes were used: Mann-Whitney, Kruskal-Wallis and Spearman's correlation coefficient. RESULTS: there were significant associations between the presence of rotating and non-rotating dizziness with the total score of the DHI (p = 0.010) and physical (p = 0.049) and functional (p = 0.009) subscales; between recurrent falls with total DHI (p = 0.004) and physical (p = 0.045), functional (p = 0.010) and emotional (p = 0.011) subscales. Significant correlations were found between functional incapacity and total DHI (r = + 0,557; p < 0.001) and physical (r = + 0,326; p < 0.001), functional (r = + 0,570; p < 0.001) and emotional (r = + 0,521; p < 0.001) subscales. CONCLUSIONS: the impact of dizziness on the QoL is higher in elderly patients with rotating and non-rotating dizziness, recurrent falls and functional incapacity.

Balance Rehabilitation Unit (BRU) posturography in Menière's disease.

UNLABELLED: Posturography has been used in the evaluation of patients with vestibular disorders. AIM: To evaluate balance control with the Balance Rehabilitation Unit (BRU) posturography in patients with Menière's disease. STUDY DESIGN: Prospective case-control. MATERIAL AND METHOD: 30 patients diagnosed with Menière's disease and a control group consisting of 40 healthy matching individuals in relation to age and gender, were submitted to a balance function evaluation by means of a Balance Rehabilitation Unit (BRU) posturography. RESULTS: Comparing patients with Menière's disease and the control group, we found significant differences between the values of the sway speed in the static force plate, down optokinetic stimulation (p=0.038) and horizontal visual vestibular interaction (p=0.049); and of the ellipse area in the static force plate, eyes closed (p=0.001); left optokinetic stimulation (p=0.007); down optokinetic stimulation (p=0.003); horizontal visual vestibular interaction (p=0.003); and vertical visual vestibular interaction (p=0.028). CONCLUSION: The postural control assessment with the Balance Rehabilitation Unit (BRU) posturography enables the identification of sway speed and ellipse area abnormalities in patients with Menière's disease.