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At least 1,171 records · Page 65Linked to original sources
PubMed2002

Effectiveness of the particle repositioning maneuver in benign paroxysmal positional vertigo with and without additional vestibular pathology.

OBJECTIVE: We compared the treatment outcome of patients with benign paroxysmal positional vertigo unassociated with additional objective evidence of vestibular pathology (BPPV) with that in patients who did demonstrate additional vestibular pathology on standard neurotologic testing (BPPV+). STUDY DESIGN: An open, retrospective, record-based study. SETTING: Specialized outpatient dizziness clinic. PATIENTS AND METHODS: We reviewed 58 unselected patients with a Dix-Hallpike test demonstrating positioning nystagmus characteristic of BPPV, who were treated during the past 4 years with the particle repositioning maneuver. Before treatment, all patients underwent detailed clinical and laboratory neurotological testing. MAIN OUTCOME MEASURES: The treatment outcome was assessed with regard to persistence of symptoms and the presence of positioning nystagmus on Dix-Hallpike testing. RESULTS: Seventy-eight percent of patients with BPPV no longer demonstrated characteristic positional nystagmus after 1 particle repositioning maneuver compared with 71% of patients with BPPV+ (p = 0.56) who did, whereas 13% of the BPPV and 14% of the BPPV+ group required more than 1 treatment to be rendered nystagmus negative on Dix-Hallpike testing (p = 0.89). However, 14% of patients with BPPV remained dizzy, compared with 63% patients from the BPPV+ group, despite a negative Dix-Hallpike test after treatment (p = 0.0018). Patients with horizontal canal paresis (n = 15) had a better outcome than patients with central vestibular dysfunction (n = 7, p = 0.006). Etiologic factors seemed to affect outcome-patients with idiopathic BPPV and those with a preceding acute vestibular neuronitis had a tendency for a better outcome than BPPV patients with any other etiology (p = 0.058). CONCLUSION: Our study demonstrates that patients with BPPV+ do not have a worse prognosis with respect to resolution of positional nystagmus, on performing the particle repositioning procedure, compared with patients with uncomplicated BPPV. However, they do suffer incomplete resolution of symptoms because of a coincidental anterior or horizontal canal dysfunction and otolithic or central vestibular dysfunction. It appears that the majority of patients with BPPV+ need further vestibular rehabilitation after the particle repositioning maneuver.

Acute Disease↗
PubMed1996

Neurodevelopmental treatment: application to nursing and effects on the hemiplegic stroke patient.

Nursing care of the hemiplegic stroke patient is based on a traditional approach, using compensatory rehabilitative principles. However, during recent years, the neurodevelopmental treatment (NDT) approach, based on the noncompensatory rehabilitative principles and focused on activating the affected side of the hemiplegic stroke patient, is increasingly begin applied to neuroscience nursing. Until recently, little evidence existed to support the superiority of the NDT approach. The NDT approach requires considerable investment in education and training. Therefore, benefit of the NDT approach in comparison to the traditional approach must be assessed and interventions applied accordingly.

Activities of Daily Living↗
PubMed2006

Quantitative analysis of the ankle strategy under translational platform disturbance.

The ankle strategy is one of the postural adjustment maneuvers humans utilize when the support platform is disturbed. This paper presents a quantitative analysis of the ankle strategy. A three-link sagittal biped model is considered. The first link represents the two legs locked together. The second link represents the two thighs locked together. The third link represents the hip, the torso, the upper limbs, the neck, and the head. The dynamics, control, and stability of the three-link biped, under platform translation, are considered. The disturbance of the platform is represented as an input and the effect of the muscular system is reduced to a set of torques applied to the joints and across the joints. Two digital computer simulations are presented to demonstrate the behavior of the biped under backward or forward platform disturbance. The simulations are compared with experimental measurements of humans subjected to postural disturbances. It is shown that the effect of a horizontal disturbance at the ankle appears to be about 40 times that of the effect of the disturbance at the knees and at least a few hundred times larger than the effect of a disturbance at the hip. This means that, under translational platform disturbance, the ankle angle is subjected to the largest excursion. The knee and the hip angle excursions are relatively minor. Consequently, the biped, as a whole, appears to move as a single inverted pendulum. Major postural corrections are initiated by the ankle excursion. Further, when the available ankle torque is limited or nonexistent, the stability requires resorting to the knee or hip strategies.

Ankle Joint↗
PubMed1996

Balance after stapedectomy: the measurement of spontaneous sway by posturography.

Sway was measured by static posturography in 25 patients undergoing stapedectomy, 16 first-side and nine second-side operations. Measurements were taken pre-operatively and at 1 week and 6 months after surgery, 25 age-matched controls were also tested. In both the first and second side groups, sway was greater at 1 week after surgery than pre-operatively when relying on vestibular function alone (P = 0.01 first-side, 0.05 second-side, 0.01 both sides taken together). By 6 months, sway measurements were no longer significantly different from pre-op or control values. Thus, it appears that there is a measurable increase in patients' sway following stapedectomy but this is well compensated by visual and proprioceptive information, and resolves fully with time. Patients undergoing a second side stapedectomy do not appear to fare worse than those undergoing first-side surgery.

Humans↗
PubMed1979

Uraemic sympathetic neuropathy after haemodialysis and transplantation.

Autonomic function in patients with uraemia treated conservatively, by haemodialysis, and by transplantation was evaluated by the pupillary reaction to tyramine, the Valsalva manoeuvre and a postural tolerance test. The pupillary reaction to tyramine is diminished in haemodialysis patients compared with control subjects. Renal transplantation improves, but does not correct the pupillary reaction to tyramine. The frequency of the diminished response roughly correlates with the degree of renal insufficiency, with results of a Valsalva manoeuvre, and with postural tolerance tests. Our data show that uraemic autonomic dysfunction is improved by successful renal transplantation, but not by adequate haemodialysis.

Adult↗
PubMed2006

Effect of reclining and chin-tuck position on the coordination between respiration and swallowing.

Chin-tuck position and reclining posture have been used in dysphagia patients to prevent aspiration during swallowing. However, both behavioural treatments may affect respiratory function. This study was carried out to test the hypothesis that if chin-tuck posture and body reclining affected respiratory function, this would be associated with altered coordination between respiration and swallowing. To investigate this hypothesis, respiratory parameters and manometry were used in each of four combinations of reclining posture and chin-tuck position. In the 60 degrees reclining with 60 degrees chin-tuck position, duration of swallowing apnea (0.89 s.d. 0.17 s) and submental electromyography burst (2.34 s.d. 0.84 s) were significantly longer when compared to both upright sitting and 30 degrees reclining positions. We conclude that 60 degrees reclining from vertical with 60 degrees chin-tuck may affect oral processing stages which delay and reduce a variety of oropharyngeal movements. These in turn significantly influence the coordination between respiration and swallowing.

Adult↗
PubMed1999

Contribution of the leg vasculature to hypotensive effects of an antiorthostatic posture change in humans.

1. Previous results from our laboratory have shown that vasodilatation in the legs prevents mean arterial pressure (MAP) from increasing during water immersion. Therefore, we tested the hypothesis that vasodilatation in the legs is necessary for the hypotensive effects to occur during a moderate antiorthostatic posture change. 2. Ten healthy males underwent a 5 min posture change from upright seated to horizontal supine (SUP) and back to seated again with (OCCL-SUP) and without simultaneous total arterial (154 +/- 1 mmHg) thigh occlusion, and a control seated period, also with and without arterial occlusion. Cardiac output (CO) was measured by a non-invasive foreign (N2O) gas rebreathing technique. 3. MAP (brachial auscultation) decreased during SUP from 94 +/- 3 to 84 +/- 2 mmHg (P < 0.0001) and total peripheral vascular resistance (TPR = MAP/CO, n = 8) decreased by 15 +/- 4 % (P < 0.001). During OCCL-SUP, MAP decreased from 98 +/- 2 to 90 +/- 2 mmHg (P < 0.005) and TPR decreased by 14 +/- 3 % (P < 0.01). 4. In conclusion, vasodilatation in the legs is not necessary for the decrease in MAP to occur during a moderate antiorthostatic manoeuvre. Therefore, vasodilatation in more central vascular beds (e.g. abdomen) can alone account for the hypotensive effects.

Adult↗
PubMed1976

The Landau reaction: a clinical and electromyographic analysis.

Thirty normal infants aged two months (N=10), five months (N=11) and eight months (N=9) participated in a three-month longitudinal study of the Landau reaction. Each infant's response to horizontal suspension was filmed and electromyographically recorded. Thoraco-lumbar extension and head elevation 90 degrees above the horizontal (face vertical to the horizontal) were present in 45 per cent of infants at four months and in 90 per cent of infants between five and 10 months. The postural response changed little between five and ten months of age. Less than 10 per cent of the infants regressed in postural response between monthly examinations. No infant hung limply over the examiner's hand, and electromyographic activity of the neck extensors never decreased to zero. All infants were able to reassume neck and spinal extension following active and passive flexion of the neck. Kicking activity was observed in 80 per cent of infants over four months of age. A pattern of motor responses for the normal infant was noted and variations from this pattern which have been observed in infants with motor dysfunction are discussed. The EMG recordings correlated well with the visual observations and provided an accurate written record of the responses. They proved to be a reliable research tool in the study of infants' gross motor responses.

Electromyography↗
PubMed1984

Early physiotherapy in the treatment of spastic diplegia.

This study reports the effect of early physiotherapy, using Vojta's method, on children with spastic diplegia. Eight children with spastic diplegia (in spite of early treatment which was started before nine months of age) were compared with 21 children with spastic diplegia in which treatment was started between nine months and three years of age. The average age of starting to walk was eight months earlier in the group treated early, although they had more severe complications. They tended to walk steadily with a gait pattern which was quite different from the classical pattern. All of the early treated patients had confirmed organic brain damage with abnormal CT scan or microcephaly. In conclusion, Vojta's method of treatment is one system which improves the prognosis for walking if performed early.

Age Factors↗
PubMed1985

The Landau reaction in fullterm and preterm infants at four months of age.

Twelve normal fullterm infants and 11 low-risk preterm infants were assessed at four months of age. Assessments included a Three-Component-Scale for the Landau reaction, the Touwen Scale for the Landau reaction, the Bayley Scales of Infant Development Motor Scale, and the Movement Assessment of Infants Muscle Tone Scale. A statistically significant relationship was found between gestational age (preterm vs. fullterm birth) and scores on the hip and kicking subcomponents on the Three-Component-Scale for the Landau reaction, and also between gestational age at birth and scores on the summary of tone-extremities and total risk score items on the Movement Assessment of Infants. Although preterm and fullterm infants may not show differences in scores on motor developmental level assessments, variations in postural reactions and muscle tone may be present at four months of age.

Female↗
PubMed1994

The use of waterbeds for very low-birthweight infants: effects on neuromotor development.

One hundred and seven infants aged < 32 weeks of gestation were stratified according to birthweight and randomly assigned to either a waterbed group (N = 53) or a mattress group (N = 54). All the infants were assessed on removal from the surface: 68 infants at 40 weeks gestation and 52 infants at four, eight, 12 and 18 months adjusted age. At the 18-month assessment, outcome was classified as normal, suspicious or abnormal. There were no significant differences between the groups at any age. The results suggest that the use of the waterbed as a positional surface in the neonatal intensive-care unit has no influence on the motor development of very low-birthweight infants.

Beds↗
PubMed1986

Stressing the postural response. A quantitative method for testing balance.

Using a series of graded destabilizing forces, we have developed a simple quantitative test of the postural response: the Postural Stress Test (PST). Suitable for widespread testing of elderly subjects, the test evaluates the subject's ability to avoid a fall as well as the appropriateness of the response. We have determined that by comparison with young subjects, the elderly controls have compromised although functionally effective balance. On the other hand, the balance response was severely compromised in half of the individuals with a history of falls. Experience with the Postural Stress Test suggests it will predict those elderly individuals with a tendency to fall as well as provide a simple mechanism for studying the balance response in the elderly.

Accidental Falls↗
PubMed1987

Posture-dependent chronotropic effect of carotid sinus massage.

The hypertensive carotid sinus can be divided into cardioinhibitory (chronotropic) and vasodepressor components; the former can be evaluated by carotid sinus massage performed in the supine position. We present the case of a patient in whom the abnormal cardioinhibitory response could only be demonstrated while in the sitting position.

Carotid Sinus↗