Abstract of the Week

 Number 22; June 16, 2010

Yardley L, Donovan-Hall M, Smith HE, Walsh BM, Mullee M, Bronstein AM.  Effectiveness of primary care-based vestibular rehabilitation for chronic dizziness. Ann Intern Med. 2004 Oct 19;141(8):598-605.

Comment in: Ann Intern Med. 2005 Feb 15;142(4):309

Author reply 309-10. Ann Intern Med. 2004 Oct 19;141(8):641-3.

Summary for patients in: Ann Intern Med. 2004 Oct 19;141(8):I48.

BACKGROUND: Dizziness is a very common symptom and is usually managed in primary care. Vestibular rehabilitation for dizziness is a simple treatment that may be suitable for primary care delivery, but its effectiveness has not yet been determined. OBJECTIVE: To evaluate the effectiveness of nurse-delivered vestibular rehabilitation in primary care for patients with chronic dizziness. DESIGN: Single-blind randomized, controlled trial. SETTING: 20 general practices in southern England. PATIENTS: 170 adult patients with chronic dizziness who were randomly assigned to vestibular rehabilitation (n = 83) or usual medical care (n = 87). INTERVENTION: Each patient received one 30- to 40-minute appointment with a primary care nurse. The nurse taught the patient exercises to be carried out daily at home, with the support of a treatment booklet. MEASUREMENTS: Primary outcome measures were baseline, 3-month, and 6-month assessment of self-reported spontaneous and provoked symptoms of dizziness, dizziness-related quality of life, and objective measurement of postural stability with eyes open and eyes closed. RESULTS: At 3 months, improvement on all primary outcome measures in the vestibular rehabilitation group was significantly greater than in the usual medical care group; this improvement was maintained at 6 months. Of 83 treated patients, 56 (67%) reported clinically significant improvement compared with 33 of 87 (38%) usual care patients (relative risk, 1.78 [95% CI, 1.31 to 2.42]). LIMITATIONS: Psychological elements of the therapy may have contributed to outcomes, and the treatment may be effective only for well-motivated patients. CONCLUSIONS: Vestibular rehabilitation delivered by nurses in general practice improves symptoms, postural stability, and dizziness-related handicap in patients with chronic dizziness.

Number 21; June 9, 2010

Yardley L, Kirby S.  Evaluation of booklet-based self-management of symptoms in Ménière disease: a randomized controlled trial. Psychosom Med. 2006 Sep-Oct;68(5):762-9.

OBJECTIVE: This study examined the effectiveness of booklet-based education in vestibular rehabilitation (VR) and symptom control (SC) techniques to manage vertigo and dizziness in Ménière disease. METHODS: Participants (n = 360) were randomized to a waiting list control group or to receive either a VR or an SC self-management booklet. VR involved provoking dizziness in a controlled manner by making repeated head movements in order to promote neurological and psychological habituation. SC involved using applied relaxation, challenging negative beliefs, and lifestyle modification to reduce amplification of dizziness by anxiety. Subjective improvement in health, enablement (ability to understand and cope with symptoms), and adherence were measured at 3 and 6 months. Symptoms, handicap, anxiety and depression, and negative beliefs about symptoms were assessed pretreatment and at 3 and 6 months. RESULTS: At 6-month follow-up, 45 (37.5%) of the VR group and 47 (39.2%) of the SC group reported improvement compared with 19 (15.8%) controls; the relative probability of improvement compared with controls was 2.37 (95% confidence interval [CI], 1.48-3.80) for VR and 2.47 (95% CI, 1.55-3.95) for SC. Both intervention groups reported greater enablement than controls (p < .001, d > 0.70). At 3 months, the VR group had reduced symptoms, anxiety, handicap, and negative beliefs about dizziness; the SC group had reduced handicap; but the control group showed no improvement. Reported adherence levels were low and strongly related to outcome. CONCLUSIONS: Self-management booklets offer an inexpensive and easily disseminated means of helping people with Ménière disease to cope with dizziness symptoms.

Number 20; June 2, 2010

Webb TL, Joseph J, Yardley L, Michie S.  Using the internet to promote health behavior change: a systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy. J Med Internet Res. 2010 Feb 17;12(1):e4.

BACKGROUND: The Internet is increasingly used as a medium for the delivery of interventions designed to promote health behavior change. However, reviews of these interventions to date have not systematically identified intervention characteristics and linked these to effectiveness. OBJECTIVES: The present review sought to capitalize on recently published coding frames for assessing use of theory and behavior change techniques to investigate which characteristics of Internet-based interventions best promote health behavior change. In addition, we wanted to develop a novel coding scheme for assessing mode of delivery in Internet-based interventions and also to link different modes to effect sizes. METHODS: We conducted a computerized search of the databases indexed by ISI Web of Knowledge (including BIOSIS Previews and Medline) between 2000 and 2008. Studies were included if (1) the primary components of the intervention were delivered via the Internet, (2) participants were randomly assigned to conditions, and (3) a measure of behavior related to health was taken after the intervention. RESULTS: We found 85 studies that satisfied the inclusion criteria, providing a total sample size of 43,236 participants. On average, interventions had a statistically small but significant effect on health-related behavior (d(+) = 0.16, 95% CI 0.09 to 0.23). More extensive use of theory was associated with increases in effect size (P = .049), and, in particular, interventions based on the theory of planned behavior tended to have substantial effects on behavior (d(+) = 0.36, 95% CI 0.15 to 0.56). Interventions that incorporated more behavior change techniques also tended to have larger effects compared to interventions that incorporated fewer techniques (P < .001). Finally, the effectiveness of Internet-based interventions was enhanced by the use of additional methods of communicating with participants, especially the use of short message service (SMS), or text, messages. CONCLUSIONS: The review provides a framework for the development of a science of Internet-based interventions, and our findings provide a rationale for investing in more intensive theory-based interventions that incorporate multiple behavior change techniques and modes of delivery.

  Number 19; May 25, 2010

Schubert MC, Tusa RJ, Grine LE, Herdman SJ.  Optimizing the sensitivity of the head thrust test for identifying vestibular hypofunction. Phys Ther. 2004 Feb;84(2):151-8.

BACKGROUND AND PURPOSE: The head thrust test (HTT) is used to assess the vestibulo-ocular reflex. Sensitivity and specificity for diagnosing unilateral vestibular hypofunction (UVH) in patients following vestibular ablation is excellent (100%), although sensitivity is lower (35%-39%) for patients with nonsurgically induced UVH. The variability of the test results may be from moving the subject's head outside the plane of the lateral semicircular canals as well as using a head thrust of predictable timing and direction. The purpose of this study was to examine sensitivity and specificity of the horizontal HTT in identifying patients with UVH and bilateral vestibular hypofunction (BVH) when the head was flexed 30 degrees in attempt to induce acceleration primarily in the lateral semicircular canal and the head was moved unpredictably. SUBJECTS: The medical records of 176 people with and without vestibular dysfunction (n=79 with UVH, n=32 with BVH, and n=65 with nonvestibular dizziness) were studied. METHODS: Data were retrospectively tabulated from a de-identified database (ie, with health information stripped of all identifiers). RESULTS: Sensitivity of the HTT for identifying vestibular hypofunction was 71% for UVH and 84% for BVH. Specificity was 82%. DISCUSSION AND CONCLUSION: Ensuring the head is pitched 30 degrees down and thrust with an unpredictable timing and direction appears to improve sensitivity of the HTT.

  

Number 18; May 19, 2010

Giray M, Kirazli Y, Karapolat H, Celebisoy H, Bilgen C, Kirazli T.  Short-term effects of vestibular rehabilitation in patients with chronic unilateral vestibular dysfunction: a randomized controlled study. Arch Phys Med Rehabil. 2009 Aug;90(8):1325-31.

OBJECTIVE: To evaluate the short-term effects of vestibular rehabilitation on symptom, disability, balance, and postural stability in patients with chronic unilateral vestibular dysfunction. DESIGN: Randomized controlled trial. SETTING: Department of Physical Medicine and Rehabilitation, University Hospital. PARTICIPANTS: Patients (N=42) with chronic vestibular dysfunction were divided into either a rehabilitation group (group 1) or a control group (group 2). INTERVENTIONS: Patients in group 1 were treated with a customized exercise program for 4 weeks, while the patients in the control group did not receive any treatment. MAIN OUTCOME MEASURES: Subjects were assessed before and after the rehabilitation program with respect to symptoms (visual analog scale [VAS]), disability (Dizziness Handicap Inventory [DHI]), balance (Berg Balance Scale [BBS]), and postural stability (modified Clinical Test for Sensory Interaction on Balance [mCTSIB]). RESULTS: Significant improvements in all parameters (VAS, DHI, BBS, mCTSIB) were observed in group 1 (P<.05). When the 2 groups were compared, there were significant improvements in postexercise VAS, DHI (emotional, functional, physical, total), BBS, and mCTSIB (standing on a firm surface with eyes open, standing on a foam surface with eyes open, standing on a foam surface with eyes closed, mCTSIB mean) in favor of group 1 (P<.05). No significant improvements were seen in any parameters in the control group (P>.05). CONCLUSIONS: Significant improvements were seen in symptom, disability, balance, and postural stability in chronic unilateral vestibular dysfunction after an exercise program. Customized exercise programs are beneficial in treatment of chronic unilateral vestibular dysfunction.

Number 17; May 12, 2010

Dannenbaum E, Paquet N, Chilingaryan G, Fung J.  Clinical evaluation of dynamic visual acuity in subjects with unilateral vestibular hypofunction. Otol Neurotol. 2009 Apr;30(3):368-72.

OBJECTIVES: The objectives of this study are threefold: 1) to examine the effect of frequency of head motion on the clinical dynamic visual acuity (DVA) score in subjects with unilateral vestibular hypofunction (UVH); 2) to compare DVA scores between subjects with UVH and subjects with a complete unilateral vestibular deficit; and 3) to establish whether a relationship exists between the extent of the vestibular deficit and the DVA score. DESIGN: Experimental study. SETTING: Vestibular outpatient rehabilitation program. METHODS: A convenience sample of 10 subjects with UVH. MAIN OUTCOME MEASURES: Dynamic visual acuity scores were recorded using 2 standard acuity charts: Snellen and E-chart. The DVA scores were obtained at slow (0.5 Hz), moderate (1 and 1.5 Hz), and fast (2.0 Hz) frequencies of head motion in the horizontal and the vertical planes. Percentage of caloric weakness was compared with DVA scores in each subject to test whether a relationship exists between the two. RESULTS: As the frequency of head motion increased, the number of UVH subjects with an abnormal DVA score increased. Subjects with an abnormal DVA score at 1 Hz had the same or higher score as the frequency of the head motion was increased. Spearman correlation analyses revealed low-correlation coefficients between percentage of vestibular paresis at the caloric test and DVA scores (horizontal direction: r = 0.31, p = 0.38 for Snellen chart and r = -0.33, p = 0.35 for the E-chart; vertical: r = 0.05, p = 0.91 for the Snellen chart and r = -0.28, p = 0.50 for the E-chart). CONCLUSION: Subjects with UVH manifest impaired DVA. The frequency of head motion has an impact on clinical DVA scores in UVH subjects.

 Number 16; May 5, 2010

Hillier SL, Hollohan V.  Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD005397.

BACKGROUND: Unilateral peripheral vestibular dysfunction (UPVD) can occur as a result of disease, trauma or post-operatively. The dysfunction is characterized by complaints of dizziness, visual or gaze disturbances and balance impairment. Current management includes medication, physical manoeuvres and exercise regimes, the latter known collectively as vestibular rehabilitation (VR). OBJECTIVES: To assess the effectiveness of vestibular rehabilitation in the adult, community dwelling population of people with symptomatic unilateral peripheral vestibular dysfunction. SEARCH STRATEGY: The search included the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library Issue 1 2007, MEDLINE (1950 to 2007) and EMBASE (1974 to 2007). The date of the last search was March 2007. SELECTION CRITERIA: Randomised trials of adults living in the community, diagnosed with symptomatic unilateral peripheral vestibular dysfunction. Comparisons sought were: Vestibular rehabilitation versus control (placebo etc.). Vestibular rehabilitation versus other treatment (non-vestibular rehabilitation e.g. pharmacological). Vestibular rehabilitation versus another form of vestibular rehabilitation. Outcome measures that were considered included: frequency and severity of dizziness or visual disturbance; changes in balance impairment, function or quality of life; measure/s of physiological status with known functional correlation. DATA COLLECTION AND ANALYSIS: Both authors independently extracted data and assessed trials for quality. MAIN RESULTS: Thirty-two trials were identified and eleven were excluded because of mixed/unclear vestibular pathology, leaving twenty-one trials in the review. Included studies addressed the effectiveness of vestibular rehabilitation against control/sham interventions, non-vestibular rehabilitation interventions or other forms of vestibular rehabilitation, by comparing the subjects in each group who had significant resolution of symptoms and/or improved function. Individual and pooled data showed a statistically significant effect in favour of the vestibular rehabilitation over control or no intervention. The exception to this was when movement based vestibular rehabilitation was compared to physical manoeuvres for benign paroxysmal positional vertigo, where the latter was shown to be superior in cure rate in the short term. There were no reported adverse effects. AUTHORS' CONCLUSIONS: There is moderate to strong evidence that vestibular rehabilitation is a safe, effective management for unilateral peripheral vestibular dysfunction, based on a number of high quality randomised controlled trials. There is moderate evidence that vestibular rehabilitation provides a resolution of symptoms in the medium term. However there is evidence that for the specific diagnostic group of benign paroxysmal positional vertigo, physical (repositioning) manoeuvres are more effective in the short term than exercise based vestibular rehabilitation. There is insufficient evidence to discriminate between differing forms of vestibular rehabilitation.

  

Number 15; April 29, 2010

Lin KY, Hsu YS, Young YH.  Brainstem lesion in benign paroxysmal vertigo children: Evaluated by a combined ocular and cervical vestibular-evoked myogenic potential test. Int J Pediatr Otorhinolaryngol. 2010 May;74(5):523-7.

OBJECTIVE: This study utilized a combined ocular vestibular-evoked myogenic potential (oVEMP) and cervical VEMP (cVEMP) test in children with benign paroxysmal vertigo (BPV) to investigate whether the upper or lower brainstem is more frequently affected in BPV children. METHODS: Fifteen BPV children aged 4-14 years, and 15 age- and sex-matched healthy children were enrolled. All subjects underwent pure tone audiometry, stabilometry, and a combined oVEMP and cVEMP test using acoustic stimulation. RESULTS: All BPV patients displayed normal hearing and clear oVEMPs. However, 11 (73%) of 15 BPV patients had delayed cVEMPs, showing significant difference when compared with 100% normal cVEMPs in healthy children. The sway path and sway area in stabilometry were significantly different between BPV and healthy children, regardless of whether their eyes were open or closed. However, neither the sway path nor sway area correlated significantly with cVEMP results. CONCLUSION: Normal oVEMPs in BPV children indicate an intact vestibulo-ocular reflex pathway, which travels through the upper brainstem. In contrast, delayed cVEMPs in BPV children reflect a retrolabyrinthine lesion along the sacculo-collic reflex pathway, which descends via the lower brainstem. Hence, the lower brainstem is more frequently affected than the upper brainstem in children with BPV.

Number 14; April 14, 2010

Chou CH, Wang SJ, Young YH.  Feasibility of the simultaneous ocular and cervical vestibular-evoked myogenic potentials in unilateral vestibular hypofunction. Clin Neurophysiol. 2009 Sep;120(9):1699-705.

OBJECTIVE: This study compared the results of combined and individual ocular vestibular-evoked myogenic potential (oVEMP) and cervical VEMP (cVEMP) tests in healthy subjects and patients with unilateral vestibular hypofunction to confirm the effectiveness of the combined oVEMP and cVEMP test. METHODS: Twenty healthy volunteers and 12 patients with unilateral vestibular hypofunction underwent individual oVEMP and cVEMP tests in a random order, and combined oVEMP and cVEMP test on another day. RESULTS: Twenty healthy subjects had 100% response rates for oVEMPs and cVEMPs in both individual and combined stimulation modes. Significant positive correlations exist between individual and combined oVEMPs/cVEMPs in terms of latencies and amplitudes. In 12 patients with unilateral vestibular hypofunction, differences in abnormal percentages of oVEMPs or cVEMPs were non-significant. Additionally, the characteristic parameters of oVEMP/cVEMP among ears of healthy subjects, good and pathological ears of patients with unilateral vestibular hypofunction did not differ significantly, regardless of whether the individual or combined mode was used. CONCLUSIONS: The combined oVEMP and cVEMP test generates similar information to that obtained by individual mode, regardless of whether subjects are healthy or have unilateral vestibular hypofunction. SIGNIFICANCE: Simultaneous oVEMP and cVEMP tests may be a convenient screening tool for assessing crossed vestibulo-ocular reflex and ipsilateral sacculo-collic reflex, which definitely shortens the diagnostic test time. Thus, it may favor the large diffusion of these techniques.

 

 Number 13; April 7, 2010

Curthoys IS, Manzari L, Smulders YE, Bergess AM.  A review of the scientific basis and practical application of a new test of utricular function--ocular vestibular-evoked myogenic potentials to bone-conducted vibration. Acta Otorhinolaryngol Ital. 2009 Aug;29(4):179-86.

This is a review of recently published papers showing that bone-conducted vibration of the head causes linear acceleration stimulation of both inner ears and this linear acceleration is an effective way of selectively activating otolithic afferent neurons. This simple stimulus is used in a new test to evaluate clinically the function of the otoliths of the human inner ear. Single neuron studies in animals have shown that semicircular canal neurons are rarely activated by levels of bone-conducted vibration at 500 Hz which generate vigorous firing in otolithic irregular neurons and which result in a variety of vestibulo-spinal and vestibulo-ocular responses, and the latter is the focus of this review. In humans, 500 Hz bone-conducted vibration, delivered at the midline of the forehead, at the hairline (Fz), causes simultaneous and approximately equal amplitude linear acceleration stimulation at both mastoids and results in ocular-evoked myogenic potentials (oVEMPs) beneath both eyes. The first component of this myogenic potential, at a latency to peak of about 10 ms is a negative potential and is called n10 and, in healthy subjects, is equal in amplitude beneath both eyes, but after unilateral vestibular loss, the n10 potential beneath the eye opposite to the lesioned ear is greatly reduced or totally absent. n10 is a myogenic potential due to a crossed otolith-ocular pathway. In patients with total unilateral superior vestibular neuritis, in whom saccular function is largely intact (as shown by the presence of cervical vestibular evoked myogenic potentials (cVEMPs), but utricular function is probably compromised, there is a reduced n10 response beneath the contralesional eye, strongly indicating that n10 is due to utricular otolithic function.

Curthoys IS.  A critical review of the neurophysiological evidence underlying clinical vestibular testing using sound, vibration and galvanic stimuli. Clin Neurophysiol. 2010 Feb;121(2):132-44. Epub 2009 Nov 7.

In addition to activating cochlear receptors, air conducted sound (ACS) and bone conducted vibration (BCV) activate vestibular otolithic receptors, as shown by neurophysiological evidence from animal studies--evidence which is the foundation for using ACS and BCV for clinical vestibular testing by means of vestibular-evoked myogenic potentials (VEMPs). Recent research is elaborating the specificity of ACS and BCV on vestibular receptors. The evidence that saccular afferents can be activated by ACS has been mistakenly interpreted as showing that ACS only activates saccular afferents. That is not correct - ACS activates both saccular and utricular afferents, just as BCV activates both saccular and utricular afferents, although the patterns of activation for ACS and BCV do not appear to be identical. The otolithic input to sternocleidomastoid muscle appears to originate predominantly from the saccular macula. The otolithic input to the inferior oblique appears to originate predominantly from the utricular macula. Galvanic stimulation by surface electrodes on the mastoids very generally activates afferents from all vestibular sense organs. This review summarizes the physiological results, the potential artifacts and errors of logic in this area, reconciles apparent disagreements in this field. The neurophysiological results on BCV have led to a new clinical test of utricular function - the n10 of the oVEMP. The cVEMP tests saccular function while the oVEMP tests utricular function.

Number 12; March 31, 2010

Granier M, Renaud-Picard L, Chobaut JC, Tavernier L.  Mild head trauma: complications and acousticovestibular sequelae. Rev Stomatol Chir Maxillofac. 2006 Sep;107(4):253-63.

Head injury with fracture of the petrous bone is frequent and directly related to the development of human activity. Head trauma is associated with nearly 75% of traffic accidents; 5% of them with petrous bone fracture. Based on a clinical case, the acute injuries and secondary acoustic or vestibular sequelae after low-energy cranio-cerebral trauma are discussed here. The subject was a victim of a low-energy head trauma with brief loss of consciousness and translabyrinthine fracture of the petrous bone. This fracture caused invalidating equilibrium disorders related to a perilymphatic fistula. These disorders persisted for 3.5 years and required several hospitalizations and three surgical procedures. The acoustic problems progressed towards cophosis and persistent and invalidating tintinus. We discuss the pathogenesis and treatment of these different sequelae of the middle ear as well as the external lesions. Among labyrinthine involvement, especially unilateral destruction, fistulization, concussion, and post concussion syndrome are especially descripted. Bony dislocations dominate middle ear sequelae. We also discuss the medicolegal problems associated with this type of pathology.

  

Number 11; March 24, 2010

Rowlands RG, Campbell IK, Kenyon GS.  Otological and vestibular symptoms in patients with low grade (Quebec grades one and two) whiplash injury. J Laryngol Otol. 2009 Feb;123(2):182-5. Epub 2008 May 19.

OBJECTIVE: To establish the prevalence of new vestibular and otological symptoms in a group of patients who had sustained a low grade (Quebec grades one or two) whiplash injury. METHODS: A retrospective review of the case records of 109 patients undergoing assessment by a single practitioner for the purposes of compiling a medicolegal report on their whiplash injury. RESULTS: Four patients complained of short-lived, non-specific dizziness symptoms in the acute phase following their original injury. There were no reports of vertigo, tinnitus or hearing loss after a mean period of 149 days following the whiplash injury. CONCLUSIONS: No patients reported otological or persistent vestibular symptoms in the acute phase following their whiplash injury. This suggests that caution should be exercised when attributing these symptoms to such an injury. Before whiplash injuries are admitted as an aetiological factor in the development of such symptoms, other causes should be excluded.

 

Number 10; March 17, 2010

Broglio SP, Ferrara MS, Sopiarz K, Kelly MS. Reliable change of the sensory organization test. Clin J Sport Med. 2008 Mar;18(2):148-54.

OBJECTIVE: To establish the sensitivity and specificity of the NeuroCom Sensory Organization Test (SOT) and provide practitioners with cut-scores for clinical decision making using estimates of reliable change. DESIGN: Retrospective cohort study. SETTING: Research laboratory. PATIENTS: Healthy (n = 66) and concussed (n = 63) young adult participants. INTERVENTIONS: Postural control assessments on the NeuroCom SOT were completed twice (baseline and follow-up) for both groups. Postconcussion assessments were administered within 24 hours of injury diagnosis. MAIN OUTCOME MEASUREMENTS: The reliable change technique was used to calculate cut-scores for each SOT variable (composite balance; somatosensory, visual, and vestibular ratios) at the 95%, 90%, 85%, 80%, 75%, and 70% confidence interval levels. RESULTS: When cut-scores were applied to the post-concussion evaluations, sensitivity and specificity varied with SOT variable and confidence interval. An evaluation for change on one or more SOT variable resulted in the highest combined sensitivity (57%) and specificity (80%) at the 75% confidence interval. CONCLUSIONS: Use of reliable change scores to detect significant changes in performance on the SOT resulted in decreased sensitivity and improved specificity compared to a previous report. These findings indicate that some concussed athletes may not show large changes in postconcussion postural control and this postural control evaluation should not be used in exclusion of other assessment techniques. The postural control assessment should be combined with other evaluative measures to gain the highest sensitivity to concussive injuries.

  

Number 9; March 10, 2010

Register-Mihalik JK, Mihalik JP, Guskiewicz KM. Balance deficits after sports-related concussion in individuals reporting posttraumatic headache. Neurosurgery. 2008 Jul;63(1):76-80; discussion 80-2.

OBJECTIVE: Posttraumatic headache (PTH) may affect neurocognition after sports-related concussion. To our knowledge, no studies have examined how PTH affects balance after concussion using dynamic posturography. The purpose of this study is to compare balance after concussion between athletes reporting PTH and athletes not reporting PTH. METHODS: We conducted a retrospective, repeated-measures design with participants grouped by presence of postinjury report of headache. Balance testing was conducted on 108 concussed collegiate athletes (age, 18.83 +/- 1.27 yr; height, 180.92 +/- 10.01 cm; mass, 83.29 +/- 19.62 kg). Presence of PTH during the first postinjury test session (group) and test time (baseline, postinjury) served as the independent variables. The composite equilibrium score and the somatosensory, vestibular, and visual ratio scores served as dependent variables. A 2 x 2 mixed model analysis of variance was used to analyze each outcome measure. RESULTS: Significant decreases in all four measures assessed were noted after concussion compared with preseason baseline measures (P < 0.05). Significant group by test-time interactions were observed, suggesting that composite equilibrium (F1106 = 6.6089; P = 0.012) and vestibular ratio (F1106 = 7.156; P = 0.009) scores are affected by the presence of PTH. Athletes reporting PTH also demonstrated worse visual ratio scores compared with individuals not experiencing PTH (F1106 = 4.26; P = 0.041). No other significant findings were observed for the somatosensory ratio score. CONCLUSION: Current literature proposes that PTH is associated with cognitive deficits. Our study indicates that PTH may also contribute to increased balance deficits. We believe the deficits may be a result of increased sensory organization challenges after injury. Clinicians should be mindful of these findings when managing concussed athletes reporting headache.

  

Number 8; March 3, 2010

Broglio SP, Sosnoff JJ, Ferrara MS. The relationship of athlete-reported concussion symptoms and objective measures of neurocognitive function and postural control. Clin J Sport Med. 2009 Sep;19(5):377-82.

OBJECTIVE: Concussed athlete evaluations often include symptoms, balance, and neurocognitive assessments. We sought to identify the relationship between subjective symptom reports and objective clinical measures. DESIGN: A retrospective assessment. SETTING: A research laboratory. PATIENTS: Concussed collegiate-level athletes (N = 32, 19.7 years) evaluated pre- and postinjury (less than 48 hours). INTERVENTION: Each athlete completed an inventory of concussion-related symptoms, the NeuroCom Sensory Organization Test (SOT), and ImPACT neurocognitive assessment. Spearman correlations between balance symptoms and SOT scores and cognitive symptoms and ImPACT scores were completed. MAIN OUTCOME MEASURES: Symptoms related to balance and cognitive deficits, SOT composite balance and visual, vestibular, and somatosensory ratios, and ImPACT output scores. RESULTS: Significant Spearman correlations were noted between reports of "dizziness" and the SOT composite balance (rs = -0.55) and vestibular ratio (rs = -0.50). Similarly, "balance problems" were significantly correlated with composite balance (rs = -0.52) and the somatosensory (rs = -0.41), visual (rs = -0.39), and vestibular ratios (rs = -0.57). The cognitive symptom of "feeling mentally foggy" and ImPACT variables of reaction time (rs = 0.36) and "difficulty concentrating" and verbal memo