Background: Uncompensated vestibular hypofunction results in postural instability, visual blurring with head movement, and subjective complaints of dizziness and/or imbalance. We sought to answer the question, “Is vestibular exercise effective at enhancing recovery of function in people with peripheral (unilateral or bilateral) vestibular hypofunction?” Methods: A systematic review of the literature was performed in 5 databases published after 1985 and 5 additional sources for relevant publications were searched. Article types included meta-analyses, systematic reviews, randomized controlled trials, cohort studies, case control series, and case series for human subjects, published in English. One hundred thirty-five articles were identified as relevant to this clinical practice guideline. Results/Discussion: Based on strong evidence and a preponderance of benefit over harm, clinicians should offer vestibular rehabilitation to persons with unilateral and bilateral vestibular hypofunction with impairments and functional limitations related to the vestibular deficit. Based on strong evidence and a preponderance of harm over benefit, clinicians should not include voluntary saccadic or smooth-pursuit eye movements in isolation (ie, without head movement) as specific exercises for gaze stability. Based on moderate evidence, clinicians may offer specific exercise techniques to target identified impairments or functional limitations. Based on moderate evidence and in consideration of patient preference, clinicians may provide supervised vestibular rehabilitation. Based on expert opinion extrapolated from the evidence, clinicians may prescribe a minimum of 3 times per day for the performance of gaze stability exercises as 1 component of a home exercise program. Based on expert opinion extrapolated from the evidence (range of supervised visits: 2-38 weeks, mean = 10 weeks), clinicians may consider providing adequate supervised vestibular rehabilitation sessions for the patient to understand the goals of the program and how to manage and progress themselves independently. As a general guide, persons without significant comorbidities that affect mobility and with acute or subacute unilateral vestibular hypofunction may need once a week supervised sessions for 2 to 3 weeks; persons with chronic unilateral vestibular hypofunction may need once a week sessions for 4 to 6 weeks; and persons with bilateral vestibular hypofunction may need once a week sessions for 8 to 12 weeks. In addition to supervised sessions, patients are provided a daily home exercise program. Disclaimer: These recommendations are intended as a guide for physical therapists and clinicians to optimize rehabilitation outcomes for persons with peripheral vestibular hypofunction undergoing vestibular rehabilitation.

Background: Vestibular dysfunction, characterized by nausea, dizziness, imbalance, and/or gait disturbance, represents an important sport-related concussion (SRC) subtype associated with prolonged recovery. Vestibular physical therapy promotes recovery; however, the benefit of earlier therapy is unclear. Hypothesis: Earlier vestibular therapy for young athletes with SRC is associated with earlier return to play (RTP), return to learn (RTL), and symptom resolution. Study Design: Retrospective cohort study. Level of Evidence: Level 3. Methods: Patients aged 5 to 23 years with SRC who initiated vestibular rehabilitation therapy (VRT) from January 2019 to December 2019 were included and patient records were reviewed. Therapy initiation was defined as either early, ≤30 days postinjury, or late (>30 days). Univariate comparisons between groups, Kaplan-Meier plots, and multivariate Cox proportional hazard modeling were performed. Results: Overall, 23 patients (10 early, 13 late) aged 16.14 ± 2.98 years and 43.5% were male patients. There was no difference between group demographics or medical history. Median initial total and vestibular symptom scores were comparable between groups. The late therapy group required additional time to RTP (110 days [61.3, 150.8] vs 31 days [22.5, 74.5], P = 0.03) and to achieve symptom resolution (121.5 days [71, 222.8] vs 54 days [27, 91], P = 0.02), but not to RTL (12 days [3.5, 26.5] vs 17.5 days [8, 20.75], P = 0.09). Adjusting for age and initial total symptom score, earlier therapy was protective against delayed symptom resolution (P = 0.01). Conclusion: This pilot study suggests that initiating VRT within the first 30 days after SRC is associated with earlier RTP and symptom resolution. Further prospective trials to evaluate if even earlier VRT should be pursued to further improve recovery time. Clinical Relevance: Clinicians should screen for vestibular dysfunction and consider modifying follow-up schedules after SRC to initiate VRT within a month of injury for improved outcomes.

No description available.

[pt] O foco do presente estudo são as narrativas de (des)esperança de estudantes de um curso pré-vestibular comunitário. Os objetivos consistem em investigar como eles constroem suas narrativas de (des)esperança, as identidades de si e dos outros e os significados que atribuem ao curso e à educação, em um contexto nacional adverso às pautas educacionais. Do ponto de vista teórico, a pesquisa está ancorada na Linguística Aplicada Contemporânea, em sua vertente indisciplinar e crítica, junto aos Estudos da Narrativa e Identidades, incluindo as coletivas. Os conceitos de narrativas, esperança e identidades são mobilizados em consonância com a concepção de linguagem enquanto discurso e em articulação às práticas sociais. A partir da abordagem metodológica qualitativa e interpretativista, são analisadas entrevistas realizadas com cinco jovens e adultos que estudaram em um pré-vestibular comunitário. Há três grandes temas na análise dos dados: desigualdades, desmotivação e desesperança; cultivando o esperançar; pré-vestibular comunitário e significados atribuídos. Percebe-se, nas entrevistas, que a esperança é muito presente nas narrativas. Os participantes da pesquisa apontam como a desigualdade, a falta de oportunidades e o ensino público deficitário contribuem para a desesperança e a desmotivação. As identidades (co)construídas são de resistência e de projeto e incluem a coletividade. O curso pré-vestibular comunitário, para eles, é um elemento propulsor para um futuro promissor e esperançoso, a ponto de alguns desejarem atuar, agora, como voluntários no projeto. A esperança, então, continua. / [en] The focus of the present study is the narratives of hope(lessness) of students from a community pre-university course. The objectives consist of investigating how they construct their narratives of hope(lessness), the identities of themselves and others, and the meanings they attribute to the course and education, in a national context adverse to educational agendas. From a theoretical point of view, the research is anchored in Contemporary Applied Linguistics, in its non-disciplinary and critical aspect, together with Narrative and Identity Studies, including collective ones. The concepts of narratives, hope and identities are mobilized in line with the conception of language as discourse and in conjunction with social practices. Using a qualitative and interpretive methodological approach, interviews carried out with five young people and adults who studied in a community pre-university course are analyzed. There are three major themes in data analysis: inequalities, demotivation, and hopelessness; cultivating hope; community pre-university course and attributed meanings. It is clear in the interviews that hope is very present in the narratives. The research participants point out how inequality, lack of opportunities and deficient public education contribute to hopelessness and demotivation. The (co)constructed identities are of resistance and project and include the collective. The community pre-university course, for them, is a driverfor a promising and hopeful future, to the point that some now wish to act as volunteers in the project. Hope, then, continues.

The aim of this thesis was to evaluate the effect of rehabilitation with visual biofeedback at acute stage after vestibular schwannoma surgery and to evaluate if preoperative intratympanic aplication of gentamicin has influence on vestibular compensation of standing stability. The study was attended by 20 patients (12 women and 8 men) in the age from 28 to 63 years. Eight patients had vestibular schwannoma diagnosed in their left side, twelve in the right side. Rehabilitation program using interactive rehabilitation system Homebalance took place from the 5th postoperative day until hospital discharge, daily 15 to 20 min. To evaluate of therapeutic intervention objectively the device Synapsys Posturography System was used. Stabilometric examination was done before operation of vestibular schwannoma, after operation and after termination of rehabilitation with visual biofeedback. Statistic analysis showed significant increase of mean values of measured parameters CoP (sway velocity CoP, length of trajectory of CoP, area of the confidence ellipse CoP) postoperatively compared to preoperative values. After termination of therapeutic intervention there was any significant decrease of values of parameters CoP compared to postoperative status. Between group of patients with preoperative aplication of...

Excerpt: Recently, clinical vestibular tests have been developed for assessing otolith function. Little is known about treatment for otolith dysfunction, and this case report offers a perspective on using otolith stimulation to treat vestibular loss.

Despite our understanding of the impact of noise-induced damage to the auditory system, much less is known about the impact of noise exposure on the vestibular system. In this article, we review the anatomical, physiological, and functional evidence for noise-induced damage to peripheral and central vestibular structures. Morphological studies in several animal models have demonstrated cellular damage throughout the peripheral vestibular system and particularly in the otolith organs; however, there is a paucity of data on the effect of noise exposure on human vestibular end organs. Physiological studies have corroborated morphological studies by demonstrating disruption across vestibular pathways with otolith-mediated pathways impacted more than semicircular canal-mediated pathways. Similar to the temporary threshold shifts observed in the auditory system, physiological studies in animals have suggested a capacity for recovery following noise-induced vestibular damage. Human studies have demonstrated that diminished sacculo-collic responses are related to the severity of noise-induced hearing loss, and dose-dependent vestibular deficits following noise exposure have been corroborated in animal models. Further work is needed to better understand the physiological and functional consequences of noise-induced vestibular impairment in animals and humans.

Today, it is possible to restore hearing in congenitally deaf children and severely hearing-impaired adults through cochlear implants (CIs). A CI consists of an external sound processor that provides acoustically induced signals to an internal receiver. The receiver feeds information to an electrode array inserted into the fluid-filled cochlea, where it provides direct electrical stimulation to the auditory nerve. Despite its great success, there is still room for improvement, so as to provide the patient with better frequency resolution, pitch information for music and speech perception and overall improved quality of sound.  A better stimulation mode for the auditory nerves by increasing the number of stimulation points is believed to be a part of the solution. Current technology depends on strong electrical pulses to overcome the anatomical gap between neurons and the CI. The spreading of currents limits the number of stimulation points due to signal overlap and crosstalk. Closing the anatomical gap between spiral ganglion neurons and the CI could lower the stimulation thresholds, reduce current spread, and generate a more discrete stimulation of individual neurons. This strategy may depend on the regenerative capacity of auditory neurons, and the ability to attract and guide them to the electrode and bridge the gap. Here, we investigated the potential of cultured human and murine neurons from primary inner ear tissue and human neural progenitor cells to traverse this gap through an extracellular matrix gel. Furthermore, nanoparticles were used as reservoirs for neural attractants and applied to CI electrode surfaces. The nanoparticles retained growth factors, and inner ear neurons showed affinity for the reservoirs in vitro. The potential to obtain a more ordered neural growth on a patterned, electrically conducting nanocrystalline diamond surface was also examined. Successful growth of auditory neurons that attached and grew on the patterned substrate was observed. By combining the patterned diamond surfaces with nanoparticle-based reservoirs and nerve-stimulating gels, a novel, high resolution CI may be created. This strategy could potentially enable the use of hundreds of stimulation points compared to the 12 – 22 used today. This could greatly improve the hearing sensation for many CI recipients.

published_or_final_version / Physiology / Doctoral / Doctor of Philosophy

published_or_final_version / abstract / Physiology / Doctoral / Doctor of Philosophy