Participants
head shaking nystagmus, BPPV, nystagmus, vertigo, dizziness, Dix-Hallpike, Parkinson’s disease, vestibular disorders, Peripheral vestibular hypofunction
NYSTAGMUS, BENIGN PAROXYSMAL POSITIONAL VERTIGO, VESTIBULAR DISORDER
All patients signed consent prior to enrolling in the study. We recruited patients referred to an outpatient vestibular rehabilitation clinic with chief complaints of dizziness and/or imbalance. The participants first underwent an initial vestibular physical therapy evaluation of approximately 60 min. The evaluation included: detailed history, oculomotor screening which included saccades, smooth pursuit and convergence, assessment of spontaneous and gaze evoked nystagmus with and without infrared goggles, Dix-Hallpike and roll test to rule out benign paroxysmal positional vertigo (BPPV), and bedside head impulse test to screen for vestibulo-ocular (VOR) impairment. The assessment also included gait speed and gait stability with head turns in both horizontal planes and vertical planes, as well as the modified clinical test of sensory integration to assess static balance. Peripheral vestibular hypofunction was diagnosed by either positive findings on bithermal caloric testing during videonystagmography and/or positive bedside head impulse test, head shaking nystagmus and gaze evoked nystagmus and/or clinical history characterized by sudden onset of vertigo lasting hours, aural symptoms unilaterally and ruling out other central causes [
Description of Outcome Measures Collected at Baseline and PostIntraclass correlation coefficients of 0.86 and 0.74 were found for interrater and intra-rater reliability of the total FGA scores in vestibular disorders [Internal consistency was 0.79 (no confidence intervals provided for either).The minimal clinically important difference (MCID) on the FGA is considered 4 points [A score lesser or equal to 22 / 30 indicates increased fall risk in community dwelling older adults [Patients are asked to rise up from a chair, walk at their comfortable speed 10 feet, turn around a cone, walk back and sit down.The faster performance out of two trials was recorded.A score slower than 11.1 s in people with vestibular disorders [An MCID of 3.4 s was established for patients post back surgery [A multidirectional stepping test of dynamic balance and coordination. Participants are asked to step over 4 canes on the floor in a clockwise and then counterclockwise direction while being timed.Patients did one practice trial and then we recorded the faster performance out of two trials.A score > 15 s indicates increased fall risk in community dwelling adults over the age of 65 [Whitney et al. identified a cut off score of 12 s for patients with vestibular disorders [A score of less than 67% indicates increased fall risk in community dwelling adults [A minimal detectable change was identified as 13% in patients with Parkinson’s disease [The DHI is classified as mild (under 30), moderate (31–60) or severe (61–100) disability due to dizziness [The MCID for the DHI is considered to be 18 points [