Type, dose, and outcomes of physical therapy interventions for unilateral peripheral vestibular hypofunction: protocol for a systematic review.

Background: Unilateral peripheral vestibular hypofunction can result in symptoms of dizziness, gaze and gait instability, and impaired navigation and spatial orientation. These impairments and activity limitations may negatively impact an individual's quality of life, ability to perform activities of daily living, drive, and work. There is strong evidence supporting vestibular physical therapy for reducing symptoms, improving gaze and postural stability, and improving function in individuals with vestibular hypofunction.

The Psychometric Properties of the 9-Item Vestibular Activities Avoidance Instrument.

Objective: The purpose of this study was to establish the psychometric properties of the 9-Item Vestibular Activities Avoidance Instrument (VAAI-9), a patient-reported outcome measure developed to identify fear avoidance beliefs in persons with vestibular disorders.

Methods: This prospective cohort study included 100 participants 18 years and older seeking care at a balance disorders clinic for dizziness. Participants completed the VAAI-9, the Dizziness Handicap Inventory (DHI), and other patient-reported outcomes at the initial visit and the 3-month follow-up.

Rating of perceived difficulty scale for measuring intensity of standing balance exercises in individuals with vestibular disorders.

Background: A method for prescribing the difficulty or intensity of standing balance exercises has been validated in a healthy population, but requires additional validation in individuals with vestibular disorders.

Objective: This study validated the use of ratings of perceived difficulty for estimation of balance exercise intensity in individuals with vestibular disorders.

Methods: Eight participants with a confirmed diagnosis of a vestibular disorder and 16 healthy participants performed two sets of 16 randomized static standing exercises across varying levels of difficulty.

Fixational eye movements following concussion.

The purpose of this study was to evaluate fixational eye movements (FEMs) with high spatial and temporal resolution following concussion, where oculomotor symptoms and impairments are common. Concussion diagnosis was determined using current consensus guidelines. A retinal eye-tracking device, the tracking scanning laser ophthalmoscope (TSLO), was used to measure FEMs in adolescents and young adults following a concussion and in an unaffected control population.

Fear Avoidance Beliefs Are Associated With Perceived Disability in Persons With Vestibular Disorders.

Objective: The purpose of this study was to determine the association between fear-avoidance beliefs and disability in 3 months in people with vestibular disorders while accounting for demographic and clinical characteristics.

Methods: This prospective cohort study included people aged 18 to 100 years who reported dizziness. Participants were recruited from a balance disorders clinic and outpatient physical therapy clinics.

Using change scores on the vestibular ocular motor screening (VOMS) tool to identify concussion in adolescents.

Objective: To develop clinical cutoffs using change scores for the VOMS individual items and an overall VOMS change score that identified concussion in adolescent athletes.

Methods: Change score clinical cutoffs were calculated from a sample of adolescents (13-18 years) with SRC (147) and a sample of uninjured adolescents CONTROL (147). Receiver operating characteristic (ROC) curves, with area under the curve (AUC), based on Youden's statistic were used to identify optimal cutoffs for identifying SRC from CONTROLS using VOMS individual item change scores, an overall VOMS change scores, and NPC distance (cm).

Exploratory Factor Analysis of the Vestibular Activities Avoidance Instrument.

Importance: Fear avoidance is a behavioral response to dizziness that can lead to chronic symptoms and maladaptation of the vestibular system, but there is no valid and reliable clinical measure of fear avoidance for persons with dizziness. Although the Vestibular Activities Avoidance Instrument (VAAI) was developed to identify fear avoidance beliefs in persons with dizziness, it was considered too long for clinical use.

Objective: To continue development of the VAAI for clinical use by reducing its length and by assessing the internal consistency and construct validity through associations with measures of disability, quality of life, and psychological well-being.

Measurement Properties of the Dizziness Handicap Inventory-Children and Adolescents for Children and Adolescents Postconcussion.

Purpose: The purpose of this study was to examine and report the construct validity, internal consistency, and item structure of the Dizziness Handicap Inventory-Children and Adolescents (DHI-CA) in postconcussion children and adolescents.

Methods: A retrospective chart review was conducted for 132 participants. Data were extracted on the DHI-CA, Sports Concussion Assessment Tool-III symptom inventory, and Vestibulo-ocular Motor Screening.

Changes in Vestibular/Ocular-Motor Screen Scores in Adolescents Treated With Vestibular Therapy After Concussion.

Purpose: To examine interrelationships among Vestibular/Ocular-Motor Screen (VOMS) items and to characterize the recovery of VOMS performance in a sample of adolescents treated with vestibular physical therapy (VPT) after concussion.

Methods: Seventy-seven patients with concussion and 77 participants without concussion completed the study. Adolescents with concussion received an individualized VPT intervention consisting of targeted exercises for gaze stability, postural stability, ocular-motor control, habituation, and aerobic activities.

Reliability and Validity of Ratings of Perceived Difficulty During Performance of Static Standing Balance Exercises.

Background: Standardized instruments for measuring the intensity of balance exercises in clinical environments are lacking.

Objective: The objective of this study was to develop a method for quantifying the perceived intensity of standing balance exercises.

Design: A test-retest study design was used, with repeated evaluations within the same visit and between visits 1 week later.

Risk Factors for Vestibular and Oculomotor Outcomes After Sport-Related Concussion.

Objective: To investigate the association between risk factors and vestibular-oculomotor outcomes after sport-related concussion (SRC).

Study Design: Cross-sectional study of patients seen 5.7 ± 5.

CHARACTERIZATION OF CERVICAL SPINE IMPAIRMENTS IN CHILDREN AND ADOLESCENTS POST-CONCUSSION.

Background: Patients with concussion may present with cervical spine impairments, therefore accurate characterization of cervical post-concussion impairments is needed to develop targeted physical therapy interventions.

Purpose: To characterize the type, frequency and severity of cervical impairments in children and adolescents referred for physical therapy after concussion.Study design: Retrospective, descriptive study.

Reliability of Postural Sway Measures of Standing Balance Tasks.

The reliability of balance exercises performance in experimental and clinical studies has typically been confined to a small set of exercises. In order to advance the field of assessing balance exercise intensity, establishing the reliability of performance during a more diverse array of exercises should be undertaken. The purpose of this study was to investigate the test-retest reliability of postural sway produced during performance of 24 different balance tasks, and to evaluate the reliability of different measures of postural sway.

Effect of home-based rehabilitation on activities of daily living and gait in older adults with heart failure at risk for falling: A retrospective cohort study.

Purpose: The purpose of this study is to describe improvement in activities of daily living (ADL) and gait speed, and associated factors in subjects receiving home-based rehabilitation after hospital admission for heart failure.

Methods: A total of 1,055 patients (mean age 82 ± 8 years SD) receiving post-admission home care services for heart failure. Subjects were included if they were referred for home-care rehabilitation after inpatient admission with ICD-9 code indicating heart failure at inpatient discharge, primary home care, or co-morbid diagnosis on admission Outcome and Assessment Information Set version-C (OASIS-C).

A Comparative Meta-Analysis of the Effects of Concussion on a Computerized Neurocognitive Test and Self-Reported Symptoms.

Context:   Meta-analyses examining construct-specific cognitive impairment concurrently with self-reported symptoms postconcussion are sparse.

Objective:   To review the literature on the effects of concussion on construct-specific neurocognitive declines and to compare them with self-reported symptoms before 1 week and between 1 and 3 weeks postconcussion.

Data Sources:   Relevant studies in PubMed, CINAHL, and PsycINFO published from January 1, 1999 through November 30, 2015.

Using Acute Performance on a Comprehensive Neurocognitive, Vestibular, and Ocular Motor Assessment Battery to Predict Recovery Duration After Sport-Related Concussions.

Background: A sport-related concussion (SRC) is a heterogeneous injury that requires a multifaceted and comprehensive approach for diagnosis and management, including symptom reports, vestibular/ocular motor assessments, and neurocognitive testing.

Purpose: To determine which acute (eg, within 7 days) vestibular, ocular motor, neurocognitive, and symptom impairments predict the duration of recovery after an SRC.

Study Design: Cohort study (prognosis); Level of evidence, 2.

A Quality Improvement Project in Balance and Vestibular Rehabilitation and Its Effect on Clinical Outcomes.

Background And Purpose: Unwarranted variation in practice is among the principal contributors of suboptimal outcomes in health care. This variation can be minimized via quality improvement initiatives. However, quality improvement projects focus mostly on assessing processes, and less attention is given to the effect of the variation on clinical outcomes.

Cross-cultural adaptation and measurement properties of the Arabic version of the Fall Efficacy Scale International.

Objective: To translate the Falls Efficacy Scale International (FES-I) into Arabic according to the World Health Organization`s (WHO) criteria and to evaluate the concurrent validity of the FES-I in persons living with balance and vestibular disorders.

Methods: This cross-sectional descriptive study included 43 persons with balance and vestibular disorders presenting to an outpatient dizziness center at King Abdulaziz University Hospital, Riyadh, Kingdom of Saudi Arabia between June 2012 and May 2013. All participants completed the Arabic version of the FES-I and the Dizziness Handicap Inventory (DHI) during their assessment with the clinical audiologist.

Outcomes of usual versus a specialized falls and balance program in the home.

A retrospective cohort study with adjustment for baseline group differences was conducted to determine if there was a difference in Outcome and Information Data Set (OASIS-C) activities of daily living (ADL) outcomes as well as the duration and number of home care visits between usual home care rehabilitation services and a home care rehabilitation team that was specially trained in falls identification and prevention. Data from adult Medicare beneficiaries who were treated in a large multistate home care practice with at least one visit by a physical therapist were retrieved retrospectively for analysis (n = 3,907 records). Patients identified as having multiple fall risk factors based on OASIS-C assessment undergoing a specialized care program demonstrated greater improvements in mean total ADL scores after home healthcare rehabilitation services compared with subjects at fall risk receiving usual care.

Relationship Between Cognitive Assessment and Balance Measures in Adolescents Referred for Vestibular Physical Therapy After Concussion.

Objective: To examine the relationship between cognitive and balance performance in adolescents with concussion.

Design: Retrospective case series.

Setting: Tertiary.

The use of a knowledge translation program to increase use of standardized outcome measures in an outpatient pediatric physical therapy clinic: administrative case report.

Background And Purpose: Pediatric physical therapists face many challenges related to the application of research evidence to clinical practice. A multicomponent knowledge translation (KT) program may be an effective strategy to support practice change. The purpose of this case report is to describe the use of a KT program to improve the knowledge and frequency of use of standardized outcome measures by pediatric physical therapists practicing in an outpatient clinic.

Predictors of functional and gait outcomes for persons poststroke undergoing home-based rehabilitation.

Background: The literature on the impact of home-based rehabilitation on functional outcomes for patients after stroke is limited. The purpose of this study was to describe the outcomes of home-based rehabilitation (HBR) on functional and gait performance for patients after stroke and associated factors that contribute to better outcomes after an episode of care.

Methods: The nature of the study design was retrospective and the settings used were home care services.

Performance of high school adolescents on functional gait and balance measures.

Purpose: To describe the performance of high school adolescents during common functional gait and balance measures used in vestibular physical therapy.

Methods: A cross-sectional study of 91 participants determined their performance on the Activities-specific Balance Confidence (ABC) scale, Dynamic Gait Index, Functional Gait Assessment, Timed "Up and Go" (TUG), Five Times Sit to Stand (FTSTS) test, tests of gait speed (GS), and the Balance Error Scoring System. In a subset of this sample, GS, TUG, and the FTSTS were repeated twice to examine test-retest reliability.

Responsiveness and minimal detectable change of the dynamic gait index and functional gait index in persons with balance and vestibular disorders.

Background And Purpose: We performed a retrospective chart review to determine the responsiveness and minimal detectable change (MDC95) in persons with balance and vestibular disorders with the dynamic gait index (DGI) and the functional gait assessment (FGA).

Methods: The study cohort consisted of 326 patients with a mean age of 60 ± 18.3 years (range, 18-95 years; 69% female).

Comparison of virtual reality based therapy with customized vestibular physical therapy for the treatment of vestibular disorders.

We examined outcomes in persons with vestibular disorders after receiving virtual reality based therapy (VRBT) or customized vestibular physical therapy (PT) as an intervention for habituation of dizziness symptoms. Twenty subjects with vestibular disorders received VRBT and 18 received PT. During the VRBT intervention, subjects walked on a treadmill within an immersive virtual grocery store environment, for six sessions approximately one week apart.