Otolith Dysfunction
| Status: | Recruiting |
|---|---|
| Conditions: | Neurology |
| Therapuetic Areas: | Neurology |
| Healthy: | No |
| Age Range: | 18 - 69 |
| Updated: | 2/10/2019 |
| Start Date: | January 4, 2016 |
| End Date: | December 31, 2019 |
| Contact: | Kara D McGregor, CCC/SLP |
| Email: | kara.mcgregor@va.gov |
| Phone: | (423) 926-1171 |
Vestibular Rehabilitation and Otolith Dysfunction
Recent studies suggest that otolith dysfunction is a common finding in individuals with a
history of head trauma/blast exposure and/or noise-induced hearing loss. Therefore, otolith
dysfunction may be a significant health concern for the Veteran population, and determining
optimal intervention strategies for otolith dysfunction is important for VA healthcare. The
purpose of this project is to compare the effectiveness of standard vestibular rehabilitation
compared to a novel treatment approach, centrifugation, in the treatment of individuals with
otolith dysfunction.
history of head trauma/blast exposure and/or noise-induced hearing loss. Therefore, otolith
dysfunction may be a significant health concern for the Veteran population, and determining
optimal intervention strategies for otolith dysfunction is important for VA healthcare. The
purpose of this project is to compare the effectiveness of standard vestibular rehabilitation
compared to a novel treatment approach, centrifugation, in the treatment of individuals with
otolith dysfunction.
The primary function of the vestibular (inner ear balance) system is to maintain gaze and
postural stability. The vestibular system is comprised of two types of sensory organs
(semicircular canals and otolith organs) each with unique contributions to balance.
Vestibular Rehabilitation (VR) is the treatment of choice for patients experiencing
dizziness, imbalance, and mobility impairments related to vestibular dysfunction. VR
typically includes gaze stability exercises, gait and balance training, and general
conditioning. Gaze stability exercises were developed based on the concepts of adaptation and
substitution with the goal of improving gaze stability by facilitating vestibular
compensation of the semicircular canal-mediated vestibulo-ocular reflex (VOR).
Many factors that might influence recovery, such as the involvement of different vestibular
sensory organs (semicircular canals versus otolith organs) have not been examined to
determine their impact on recovery. Most studies examining the effectiveness of VR have used
only tests of VOR function (caloric and rotational tests) that measure hSCC to determine
vestibular loss. Thus, little is known about interventions to facilitate vestibular
compensation of the otolith organs.
Recent studies have demonstrated adaptation following otolith organ stimulation using
centrifugation (or linear acceleration). The concept of using centrifugation for otolith
adaptation may be similar to using gaze stability exercises for VOR adaptation. Participants
with dizziness/imbalance related to otolith dysfunction will be randomized to receive a
staged intervention of either gaze stability exercises (n=14) or centrifugation (n=14)
followed by balance rehabilitation. Providing the intervention in stages allows isolation of
key components of vestibular rehabilitation.
postural stability. The vestibular system is comprised of two types of sensory organs
(semicircular canals and otolith organs) each with unique contributions to balance.
Vestibular Rehabilitation (VR) is the treatment of choice for patients experiencing
dizziness, imbalance, and mobility impairments related to vestibular dysfunction. VR
typically includes gaze stability exercises, gait and balance training, and general
conditioning. Gaze stability exercises were developed based on the concepts of adaptation and
substitution with the goal of improving gaze stability by facilitating vestibular
compensation of the semicircular canal-mediated vestibulo-ocular reflex (VOR).
Many factors that might influence recovery, such as the involvement of different vestibular
sensory organs (semicircular canals versus otolith organs) have not been examined to
determine their impact on recovery. Most studies examining the effectiveness of VR have used
only tests of VOR function (caloric and rotational tests) that measure hSCC to determine
vestibular loss. Thus, little is known about interventions to facilitate vestibular
compensation of the otolith organs.
Recent studies have demonstrated adaptation following otolith organ stimulation using
centrifugation (or linear acceleration). The concept of using centrifugation for otolith
adaptation may be similar to using gaze stability exercises for VOR adaptation. Participants
with dizziness/imbalance related to otolith dysfunction will be randomized to receive a
staged intervention of either gaze stability exercises (n=14) or centrifugation (n=14)
followed by balance rehabilitation. Providing the intervention in stages allows isolation of
key components of vestibular rehabilitation.
Inclusion Criteria:
- At least 18 years of age
- Documented balance or mobility problems, or healthy control without imbalance
- Otolith dysfunction or healthy control without vestibular dysfunction
Exclusion Criteria:
- Progressive neurological disorders and central vestibular abnormalities
- Benign paroxysmal positional vertigo
- Superior semicircular canal dehiscence
- Middle-ear pathology with conductive hearing loss
- Lower extremity joint replacement
- Cognitive impairment (Mini Mental Status Exam < 24/30)
- Severe depression (geriatric depression scale 10)
- Severe anxiety (geriatric anxiety inventory 11/30)
- Best-corrected visual acuity worse than 20/40 in the better eye
We found this trial at
1
site
Mountain Home, Tennessee 37684
Principal Investigator: Courtney D Hall, PhD PT
Phone: 423-926-1171
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