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Computer Methods in Biomechanics and Biomedical Engineering Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/gcmb20
Adapted physical activity intervention and vestibular disorders a
a
a
a
a
M. Donnard , A. Rahmani , P. Lorin , S. Boyas & B. Beaune a
Laboratoire Motricité, Interactions, Performance, MIP EA4334, Université du Maine, UFR des Sciences et Techniques, 72000, Le Mans, France Published online: 30 Jul 2014.
To cite this article: M. Donnard, A. Rahmani, P. Lorin, S. Boyas & B. Beaune (2014) Adapted physical activity intervention and vestibular disorders, Computer Methods in Biomechanics and Biomedical Engineering, 17:sup1, 186-187, DOI: 10.1080/10255842.2014.931676 To link to this article: http://dx.doi.org/10.1080/10255842.2014.931676
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
Computer Methods in Biomechanics and Biomedical Engineering, 2014 Vol. 17, No. S1, 186–187, http://dx.doi.org/10.1080/10255842.2014.931676
Adapted physical activity intervention and vestibular disorders M. Donnard*, A. Rahmani, P. Lorin, S. Boyas and B. Beaune Laboratoire Motricite´, Interactions, Performance, MIP EA4334, Universite´ du Maine, UFR des Sciences et Techniques, 72000, Le Mans, France Keywords: vertigo; ageing; autonomy; exercise; training
Downloaded by [Northeastern University] at 13:14 03 December 2014
1.
Introduction
In the inner ear, the vestibular system controls body balance and the sense of orientation during movement. Vestibular disorders (VD) have peripheral (labyrinth and vestibulocochlear nerve) or central (vestibular nucleus and cerebellum) origins. They result in a complex symptomatology: vertigo (rotation perception), unsteadiness, spontaneous nystagmus (unintentional eye movement), nausea, migraine or depression. VD dramatically affect people’s mobility. Associated with the ageing process, they are a major cause of falls. One in three people aged over 65 years suffers from balance disorders with at least one fall a year (Sturnieks et al. 2008). Fundamental techniques in vestibular rehabilitation (VR) are well known (Hassid et al. 2004). However, few studies have investigated the impacts of adapted physical activity (APA) intervention and ageing in patients with VDs. The purpose of the study was to investigate the effects of 6-week APA programme on mobility ability in a population aged over 50 years with VD. Empowering these patients in a daily home-based APA programme, we supposed that we could fight against VD symptoms and improve their health status promoting their casual mobility.
2.
Methods
Thirty patients older than 50 years with VD participated in this study. They had never experienced a fall but all suffered from vertigo. Sex and type of VD were not exclusion criteria. Three randomised groups of 10 persons were made: APA þ VR group (66 ^ 11.3 years), VR (64.5 ^ 8.2 years) and APA group (68.7 ^ 12.7 years). All rehabilitation programmes were six weeks long, and each patient’s adherence to protocol was individually controlled once a week. The APA programme was realised at home and designed as a personal notebook including recommendations and pictures (Figure 1). Patients had to attend it 3–5 times a week, each session lasting 30–45 min including walking, global strengthening, balance and stretching.
*Corresponding author. Email: [email protected] q 2014 Taylor & Francis
VR programme was set at the medical office once a week for 45 min using specific devices: the electronic rotating chair, the statokinetic postural platform and optokinetic stimulations. Assessments were performed in the same environment and the same sequence one week before and after the rehabilitation programmes. VD symptoms were evaluated by questionnaires: dizziness handicap inventory (DHI) estimates the severity of the symptoms (Bayat et al. 2012), and the Short Form 36 (SF36) traduces the self-perception of the health status (Jenkinson et al. 1993). Both were completed independently at home and showed a score over 100. The higher the scores, the more symptomatic the patient. Mobility is assessed using the timed up and go test (TUG). Patient had to do it twice with 1 min rest between each trial. Only the best time was recorded. Postural analyses were made in two static conditions: eyes open (EO) and eyes closed (EC) using a statokinetic platform (Multitest Framiralw) set at 50 Hz during 30 s. Three parameters were recorded: length (mm) of the statokinesigram (shifting of the plantar pressure centre: SPPC), area (mm2) of the SPPC, length function of the area (LFS). 3. Results and discussion The DHI scores significantly decreased after our homebased protocol (Table 1). The 17% improvement in our
Figure 1.
APA drill: one-foot balance.
Computer Methods in Biomechanics and Biomedical Engineering Table 1.
Results of the VD symptoms, mobility and posture before and after the protocol APA þ VR
DHI (/100) SF36 (/100) TUG (s) EO L (mm) A (mm2) LFS EC
Downloaded by [Northeastern University] at 13:14 03 December 2014
L (mm) A (mm2) LFS
187
VR
APA
Before
After
Before
After
Before
After
52.0 ^ 20.9 55.6 ^ 17.7 13.4 ^ 6.2
34.9 ^ 17.3§ 41.5 ^ 18.7§§ 9.9 ^ 3§§
58.2 ^ 25.0 52.9 ^ 22.2 12.3 ^ 3.2
43.6 ^ 23.9§ 46.2 ^ 18.5 10.5 ^ 3.0§
39.8 ^ 21.8 45.6 ^ 15.0 13.1 ^ 5.7
30.8 ^ 15.1 35.1 ^ 14.8§ 11.1 ^ 4.4§
441.9 ^ 249.4 287.8 ^ 390.6 0.88 ^ 0.5
495.1 ^ 294.3 238.4 ^ 269.6 1 ^ 0.6
376.7 ^ 181.6 266.1 ^ 325.0 0.7 ^ 0.3
310.3 ^ 148.1 185.4 ^ 151.2 0.7 ^ 0.3
606.5 ^ 555.9 422.4 ^ 327.3 1.2 ^ 1.1
448.4 ^ 157.4 250.4 ^ 115.8 0.9 ^ 0.2
759.4 ^ 502.0 635.7 ^ 545.7 1.04 ^ 0.4
604.7 ^ 369.0 267.9 ^ 199.7§ 1.16 ^ 0.5
460.1 ^ 305.4 240.0 ^ 341.8 0.9 ^ 0.5
445.5 ^ 286.2 226.3 ^ 239.5 0.9 ^ 0.4
938.9 ^ 757.9 479.1 ^ 365.0 1.6 ^ 1.3
568.5 ^ 352.5 394.9 ^ 351.0 1.0 ^ 0.3
TUG: time to perform timed up and go test; L: length ¼ total distance of displacement of plantar pressure centre; A: area ¼ total area of the plantar pressure centre; LFS: length function of the area ratio; §: p , 0.05 before–after; §§: p , 0.01 before–after; EO: eyes open; EC: eyes closed.
APA þ VR group was consistent with previous in elderly with VD after 8-week VR programme including APA interventions (19% – 29%) performed in specialised centre (Bayat et al. 2012) and confirmed that the addition of APA to VR is more beneficial to VR (þ 14%; p , 0.05) or APA (þ 9%; NS). Similar improvements were observed for the SF36 scores for APA þ VR (14%; p , 0.01), VR (13%; NS) and APA (11%; p , 0.05). Moreover, because a 25 point threshold is considered to distinguish good from bad health status, these results suggested that VD specificity could be a discriminating factor to well-being selfperception, according to age, sex and social class of the patients (Jenkinson et al. 1993; Lorin et al. 2010). The TUG test is commonly used to evaluate risks of fall, and a performing time of 12 s is often considered a down-limit for fall prediction in the elderly (Beauchet et al. 2011). Due to VD, patients were initially upper TUG threshold, and might be classified as fallers. Protocol clearly showed higher improvement in the APA þ VR group (þ 26.1%; p , 0.01) than in other groups (VR: 14.6%; APA: 15.3%; p , 0.05) after protocol. Subjects practising specific various APA regain ability to move, and feel confident controlling movements in their environment (Gillespie et al. 2012). Thus, we hypothesised that patients regain confidence practising APA independently at home, combining weekly recommendations and feedback as personal multidisciplinary VR management. However, no evidence of disappearance or extenuation of each specific VD could be made regarding a structural diagnosis. Postural control was based on three major sensorial systems: proprioceptive, visual and vestibular. Sensorial integration and postural control were built throughout ontogenesis, showing a sensorial maturation in adulthood (Mallau et al. 2006). APA þ VR only showed a significant reduction of the area after the protocol ( p , 0.01), mainly due to high initial values. However, this finding could also be an evident sign of postural control improvements
related rather to force and mobility benefits than visual dependence. 4.
Conclusions
Our programme focuses on empowering APA directly at home. APA is mainly beneficial in VR management regarding symptomatic and mobility criteria. The protocol brings confidence in the patient’s mobility skills and proves the benefits of combining conventional and multi-orientated techniques, as APA interventions in VR patient caring. These benefits appear to be crucial factors in fall prevention. Further perspectives will lead us to add a control group of patients with VD who do not follow any VR or APA intervention. Acknowledgements We thank all contributors to this study, especially patients and the medical staff.
References Bayat A, Pourbakht A, Saki N, Zainun Z, Nikakhlagh S, Mirmomeni G. 2012. Vestibular rehabilitation outcomes in the elderly with chronic vestibular dysfunction. Iran Red Crescent Med J. 14(11):705– 708. Beauchet O, Fantino B, Allali G, Muir SW, Montero-Odasso M, Annweiler C. 2011. Timed up and go test and risk of falls in older adults: a systematic review. J Nutr Health Aging. 15:10. Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, Lamb SE. 2012. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 9:CD007146. Hassid N, Hennaux C, Van Nechel C. 2004. La re´e´ducation vestibulaire. Editions Frision-Roche. Jenkinson C, Wright L, Coulter A. 1993. The SF 36 heath survey questionnaire, if used within its limits. BMJ. 307(6901):449. Lorin P, Manceau C, Foubert F. 2010. Effect of vestibular neuritis on postural control using wavelets and fractal analysis. Rev Laryngol Otol Rhinol. 131(4 – 5):235– 241. Mallau S, Viel S, Vaugoyeau M, Assaiante C. 2006. Integration senssorielle et controˆle postural au cours de l’ontoge´ne`se. In: Posture et e´quilibre. Solal edition. p. 153– 168. Sturnieks DL, St George R, Lord SR. 2008. Balance disorders in the elderly. Neurophysiol Clin. 38(6):467– 478.
Computer Methods in Biomechanics and Biomedical Engineering Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/gcmb20
Adapted physical activity intervention and vestibular disorders a
a
a
a
a
M. Donnard , A. Rahmani , P. Lorin , S. Boyas & B. Beaune a
Laboratoire Motricité, Interactions, Performance, MIP EA4334, Université du Maine, UFR des Sciences et Techniques, 72000, Le Mans, France Published online: 30 Jul 2014.
To cite this article: M. Donnard, A. Rahmani, P. Lorin, S. Boyas & B. Beaune (2014) Adapted physical activity intervention and vestibular disorders, Computer Methods in Biomechanics and Biomedical Engineering, 17:sup1, 186-187, DOI: 10.1080/10255842.2014.931676 To link to this article: http://dx.doi.org/10.1080/10255842.2014.931676
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
Computer Methods in Biomechanics and Biomedical Engineering, 2014 Vol. 17, No. S1, 186–187, http://dx.doi.org/10.1080/10255842.2014.931676
Adapted physical activity intervention and vestibular disorders M. Donnard*, A. Rahmani, P. Lorin, S. Boyas and B. Beaune Laboratoire Motricite´, Interactions, Performance, MIP EA4334, Universite´ du Maine, UFR des Sciences et Techniques, 72000, Le Mans, France Keywords: vertigo; ageing; autonomy; exercise; training
Downloaded by [Northeastern University] at 13:14 03 December 2014
1.
Introduction
In the inner ear, the vestibular system controls body balance and the sense of orientation during movement. Vestibular disorders (VD) have peripheral (labyrinth and vestibulocochlear nerve) or central (vestibular nucleus and cerebellum) origins. They result in a complex symptomatology: vertigo (rotation perception), unsteadiness, spontaneous nystagmus (unintentional eye movement), nausea, migraine or depression. VD dramatically affect people’s mobility. Associated with the ageing process, they are a major cause of falls. One in three people aged over 65 years suffers from balance disorders with at least one fall a year (Sturnieks et al. 2008). Fundamental techniques in vestibular rehabilitation (VR) are well known (Hassid et al. 2004). However, few studies have investigated the impacts of adapted physical activity (APA) intervention and ageing in patients with VDs. The purpose of the study was to investigate the effects of 6-week APA programme on mobility ability in a population aged over 50 years with VD. Empowering these patients in a daily home-based APA programme, we supposed that we could fight against VD symptoms and improve their health status promoting their casual mobility.
2.
Methods
Thirty patients older than 50 years with VD participated in this study. They had never experienced a fall but all suffered from vertigo. Sex and type of VD were not exclusion criteria. Three randomised groups of 10 persons were made: APA þ VR group (66 ^ 11.3 years), VR (64.5 ^ 8.2 years) and APA group (68.7 ^ 12.7 years). All rehabilitation programmes were six weeks long, and each patient’s adherence to protocol was individually controlled once a week. The APA programme was realised at home and designed as a personal notebook including recommendations and pictures (Figure 1). Patients had to attend it 3–5 times a week, each session lasting 30–45 min including walking, global strengthening, balance and stretching.
*Corresponding author. Email: [email protected] q 2014 Taylor & Francis
VR programme was set at the medical office once a week for 45 min using specific devices: the electronic rotating chair, the statokinetic postural platform and optokinetic stimulations. Assessments were performed in the same environment and the same sequence one week before and after the rehabilitation programmes. VD symptoms were evaluated by questionnaires: dizziness handicap inventory (DHI) estimates the severity of the symptoms (Bayat et al. 2012), and the Short Form 36 (SF36) traduces the self-perception of the health status (Jenkinson et al. 1993). Both were completed independently at home and showed a score over 100. The higher the scores, the more symptomatic the patient. Mobility is assessed using the timed up and go test (TUG). Patient had to do it twice with 1 min rest between each trial. Only the best time was recorded. Postural analyses were made in two static conditions: eyes open (EO) and eyes closed (EC) using a statokinetic platform (Multitest Framiralw) set at 50 Hz during 30 s. Three parameters were recorded: length (mm) of the statokinesigram (shifting of the plantar pressure centre: SPPC), area (mm2) of the SPPC, length function of the area (LFS). 3. Results and discussion The DHI scores significantly decreased after our homebased protocol (Table 1). The 17% improvement in our
Figure 1.
APA drill: one-foot balance.
Computer Methods in Biomechanics and Biomedical Engineering Table 1.
Results of the VD symptoms, mobility and posture before and after the protocol APA þ VR
DHI (/100) SF36 (/100) TUG (s) EO L (mm) A (mm2) LFS EC
Downloaded by [Northeastern University] at 13:14 03 December 2014
L (mm) A (mm2) LFS
187
VR
APA
Before
After
Before
After
Before
After
52.0 ^ 20.9 55.6 ^ 17.7 13.4 ^ 6.2
34.9 ^ 17.3§ 41.5 ^ 18.7§§ 9.9 ^ 3§§
58.2 ^ 25.0 52.9 ^ 22.2 12.3 ^ 3.2
43.6 ^ 23.9§ 46.2 ^ 18.5 10.5 ^ 3.0§
39.8 ^ 21.8 45.6 ^ 15.0 13.1 ^ 5.7
30.8 ^ 15.1 35.1 ^ 14.8§ 11.1 ^ 4.4§
441.9 ^ 249.4 287.8 ^ 390.6 0.88 ^ 0.5
495.1 ^ 294.3 238.4 ^ 269.6 1 ^ 0.6
376.7 ^ 181.6 266.1 ^ 325.0 0.7 ^ 0.3
310.3 ^ 148.1 185.4 ^ 151.2 0.7 ^ 0.3
606.5 ^ 555.9 422.4 ^ 327.3 1.2 ^ 1.1
448.4 ^ 157.4 250.4 ^ 115.8 0.9 ^ 0.2
759.4 ^ 502.0 635.7 ^ 545.7 1.04 ^ 0.4
604.7 ^ 369.0 267.9 ^ 199.7§ 1.16 ^ 0.5
460.1 ^ 305.4 240.0 ^ 341.8 0.9 ^ 0.5
445.5 ^ 286.2 226.3 ^ 239.5 0.9 ^ 0.4
938.9 ^ 757.9 479.1 ^ 365.0 1.6 ^ 1.3
568.5 ^ 352.5 394.9 ^ 351.0 1.0 ^ 0.3
TUG: time to perform timed up and go test; L: length ¼ total distance of displacement of plantar pressure centre; A: area ¼ total area of the plantar pressure centre; LFS: length function of the area ratio; §: p , 0.05 before–after; §§: p , 0.01 before–after; EO: eyes open; EC: eyes closed.
APA þ VR group was consistent with previous in elderly with VD after 8-week VR programme including APA interventions (19% – 29%) performed in specialised centre (Bayat et al. 2012) and confirmed that the addition of APA to VR is more beneficial to VR (þ 14%; p , 0.05) or APA (þ 9%; NS). Similar improvements were observed for the SF36 scores for APA þ VR (14%; p , 0.01), VR (13%; NS) and APA (11%; p , 0.05). Moreover, because a 25 point threshold is considered to distinguish good from bad health status, these results suggested that VD specificity could be a discriminating factor to well-being selfperception, according to age, sex and social class of the patients (Jenkinson et al. 1993; Lorin et al. 2010). The TUG test is commonly used to evaluate risks of fall, and a performing time of 12 s is often considered a down-limit for fall prediction in the elderly (Beauchet et al. 2011). Due to VD, patients were initially upper TUG threshold, and might be classified as fallers. Protocol clearly showed higher improvement in the APA þ VR group (þ 26.1%; p , 0.01) than in other groups (VR: 14.6%; APA: 15.3%; p , 0.05) after protocol. Subjects practising specific various APA regain ability to move, and feel confident controlling movements in their environment (Gillespie et al. 2012). Thus, we hypothesised that patients regain confidence practising APA independently at home, combining weekly recommendations and feedback as personal multidisciplinary VR management. However, no evidence of disappearance or extenuation of each specific VD could be made regarding a structural diagnosis. Postural control was based on three major sensorial systems: proprioceptive, visual and vestibular. Sensorial integration and postural control were built throughout ontogenesis, showing a sensorial maturation in adulthood (Mallau et al. 2006). APA þ VR only showed a significant reduction of the area after the protocol ( p , 0.01), mainly due to high initial values. However, this finding could also be an evident sign of postural control improvements
related rather to force and mobility benefits than visual dependence. 4.
Conclusions
Our programme focuses on empowering APA directly at home. APA is mainly beneficial in VR management regarding symptomatic and mobility criteria. The protocol brings confidence in the patient’s mobility skills and proves the benefits of combining conventional and multi-orientated techniques, as APA interventions in VR patient caring. These benefits appear to be crucial factors in fall prevention. Further perspectives will lead us to add a control group of patients with VD who do not follow any VR or APA intervention. Acknowledgements We thank all contributors to this study, especially patients and the medical staff.
References Bayat A, Pourbakht A, Saki N, Zainun Z, Nikakhlagh S, Mirmomeni G. 2012. Vestibular rehabilitation outcomes in the elderly with chronic vestibular dysfunction. Iran Red Crescent Med J. 14(11):705– 708. Beauchet O, Fantino B, Allali G, Muir SW, Montero-Odasso M, Annweiler C. 2011. Timed up and go test and risk of falls in older adults: a systematic review. J Nutr Health Aging. 15:10. Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, Lamb SE. 2012. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 9:CD007146. Hassid N, Hennaux C, Van Nechel C. 2004. La re´e´ducation vestibulaire. Editions Frision-Roche. Jenkinson C, Wright L, Coulter A. 1993. The SF 36 heath survey questionnaire, if used within its limits. BMJ. 307(6901):449. Lorin P, Manceau C, Foubert F. 2010. Effect of vestibular neuritis on postural control using wavelets and fractal analysis. Rev Laryngol Otol Rhinol. 131(4 – 5):235– 241. Mallau S, Viel S, Vaugoyeau M, Assaiante C. 2006. Integration senssorielle et controˆle postural au cours de l’ontoge´ne`se. In: Posture et e´quilibre. Solal edition. p. 153– 168. Sturnieks DL, St George R, Lord SR. 2008. Balance disorders in the elderly. Neurophysiol Clin. 38(6):467– 478.
