Effects of using cane and vestibular rehabilitation on the walking function in elderly patients with dizziness.

OBJECTIVE: Adults over the age of 65 years with balance disorders are at about twice the risk of falls, compared with those without balance disorders. Falls contribute to about 74% of the proximal femoral fractures commonly seen in the elderly. Since balance disorders are more prevalent in older adults than in younger adults, it is important to deal with balance disorders in older adults to prevent falls and the resulting deterioration in their ADL (activity of daily living). In this study, we investigated the effects of vestibular rehabilitation (VR) and cane use on improving gait and balance in patients aged over 65 years with balance disorder. METHODS: Patients aged over 65 years presenting to the Department of Otolaryngology at St. Marianna University School of Medicine between July 1 and November 1, 2018, with symptoms of dizziness for ≥ 3 months and a Japanese translation of the Dizziness Handicap Inventory score of ≥ 26 were included in the study. We quantitatively analyzed their gait before and after VR, and with and without the use of a cane. RESULTS: A total of 21 patients participated in the study (14 women; mean age 73.9 ± 6.9 years). Before VR, using a cane made no difference to step length or walking speed. After VR, using a cane increased step length from 50.5 cm (95% confidence interval [CI], 47.4-53.7 cm) to 52.0 cm (95% CI, 48.9-55.1 cm) (p = 0.039). There was no change in walking speed. A comparison of walking assessment results while using a cane before and after VR showed that step length increased from 49.9 cm (95% CI, 46.6-53.2 cm) to 52.0 cm (95% CI, 48.9-55.1 cm) (p = 0.005), and walking speed increased from 90.5 cm/s (95% CI, 82.7-98.4 cm/s) to 96.1 cm/s (95% CI, 88.3-103.9 cm/s) (p = 0.005). CONCLUSIONS: Walking speed and step length with the use of a cane significantly improved following VR. VR and cane use may act synergistically to improve walking.

[Four Cases of Other Iatrogenic Immunodeficiency-associated Lymphoproliferative Disorders in the Head and Neck Region].

Other iatrogenic immunodeficiency-associated lymphoproliferative disorders (OIIA-LPD) comprise lymphoid proliferations or lymphomas that arise in patients treated with immunosuppressive drugs for autoimmune diseases, especially rheumatoid arthritis (RA) treated with methotrexate (MTX). MTX has been increasingly administered to patients with RA, resulting in methotrexate-associated lymphoproliferative disorder (MTX-LPD) in patients. We report herein on four cases of patients with RA, who diagnosed with head and neck region. In two cases (one case MTX and another case tacrolimus) drug therapy was discontinued, when the patients were diagnosed as having OIIA-LPD in only a few local findings. These patients have followed good clinical courses for 24 months. In the other two cases, consultations were performed for cervical lymphadenopathy by the Division of Rheumatology. In one case drug therapy was discontinued and a good clinical course was followed. In case of the other patient, however, who had undergone tacrolimus therapy after MTX therapy was discontinued, she relapsed and died. In the case of patients with an autoimmune disease such as RA who are taking MTX, tacrolimus, or anti TNF-α therapy, when cervical lymphadenopathy and extranodal disease are detected, OIIA-LPD should be suspected. We should cooperate with a hematologist-oncologist, a rheumatologist, and pathologist in such a case.

Plasticity of the human vestibulo-ocular reflex during off-vertical axis rotation.

OBJECTIVE: We investigated whether adaptive plasticity of the vestibulo-ocular reflex in humans occurs in response to visual-vestibular conflict stimulation during rotation about a 30° incline (off-vertical earth axis rotation, OVAR). METHODS: Subjects were 26 healthy adults (17 males and 9 females), ranging in age from 22 to 33 years (mean: 24.4) with no history of neurotological symptoms. Each testing session consisted of a pre-test, an adaptation period, and a post-test. The pre-test and the post-test were performed in complete darkness with the subjects' eyes opened. Subjects were rotated sinusoidally at 0.16Hz under OVAR, with a maximum angular velocity of 60°/s for 30s. Subjects were divided into two groups depending on the kind of visual stimulation. One group of subjects was rotated sinusoidally at 0.16Hz and 60°/s peak velocity under OVAR for 20min while viewing optokinetic stripes, which moved at the same frequency and peak velocity as the rotational chair but in the opposite direction (X2 adaptation paradigm). The other group of subjects was rotated sinusoidally at 0.16Hz and 60°/s peak velocity under OVAR for 20min while viewing optokinetic stripes, which moved at the same frequency and peak velocity as the rotatory chair but in the same direction (X0 adaptation paradigm). RESULTS: There was no significant difference in gain before or after adaptation using the X2 adaptation paradigm. VOR gain decreased significantly after adaptation using the X0 adaptation paradigm. CONCLUSION: We hypothesize that attenuation of VOR gain increase after the X2 adaptation paradigm is caused by tilt suppression. In the X0 adaptation paradigm, the decrease in VOR gain was facilitated by tilt suppression in addition to the plastic change of the VOR gain caused by visual-vestibular conflict stimulation. Consequently, the VOR gain change ratio in the X0 adaptation paradigm increased significantly compared to that in the X2 adaptation paradigm.

Does vertigo disappear only by rolling over? Rehabilitation for benign paroxysmal positional vertigo.

CONCLUSION: We propose that the rolling-over maneuver (ROM) is as effective as the canalith repositioning maneuver (CRP) for the treatment of benign paroxysmal positional vertigo (BPPV). ROM involves easy movements, with only a small load. This therapy is suitable for most BPPV patients, even for those without an indication for CRP. OBJECTIVES: BPPV is a common vestibular disorder. CRP is known to be an effective therapy for the treatment of BPPV. Because of its various movements of the head and body, it is impossible to perform CRP in BPPV patients with orthopedic impairments or in the elderly. For these patients, we perform a maneuver called ROM, which involves easy movements. In this study, we compared the efficacy of ROM with that of CRP in patients with posterior semicircular canal-type BPPV. PATIENTS AND METHODS: The study included 22 patients with BPPV who were randomized and divided into the following 2 groups: 1) those treated by the modified Epley maneuver as CRP; and 2) those treated by ROM. RESULTS: We found no significant difference between the two groups in the number of days from onset to remission of both nystagmus and vertigo.

Proteomic analysis of the rat cerebellar flocculus during vestibular compensation.

Unilateral labyrinthectomy (UL) in rats is used as a human vertigo model. In this model, spontaneous nystagmus and dysequilibrium caused by UL are ameliorated within 48-72 hours. The amelioration, termed vestibular compensation (VC), is long lasting. Although cerebellar flocculi have been reported to be involved in VC, the molecular mechanisms behind VC are unknown. In this study, we used 2D-DIGE to detect protein changes in flocculi during acute (48 hours) and chronic (1 week) stages of VC. We found 99 out of 967 protein spots that showed significant changes in their intensities. Of the 99 spots, 45 spots (ipsilateral side, 15; contralateral side, 30) changed unilaterally during the acute stage, whereas 46 spots (ipsilateral side, 21; contralateral side, 25) changed unilaterally during the chronic stage. Thus, the acute compensation mechanism is more complicated in the contralateral flocculus than in the ipsilateral flocculus. Using MALDI-TOF MS, we identified 10 proteins out of the 12 protein spots. Of these, 3 proteins involved in synaptic transmission, neuronal filament formation and vesicular transport, respectively, demonstrated altered expression only in the acute stage. Our results enhance the understanding of the role of the cerebellar flocculi in VC generation.