The effects of vestibular stimulaton on hemineglect: implications for rehabilitation
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Hemineglect poses a significant impediment to functional rehabilitation post brain injury. Caloric stimulation, a form of vestibular stimulation, has been shown to improve neglect. The purpose of this paper is to review the neglect phenomenon, to examine the literature on the effects of vestibular stimulation on hemineglect, and to outline possible treatment strategies for the management of neglect. Of the various models, the majority of the literature supports the theory that neglect is a representational deficit. Manifestations of neglect are affected by vestibular stimulation. All examined studies demonstrated a transient reduction in left neglect following caloric stimulation. This indicates that vestibular stimulation may become a powerful tool in the treatment of patients with hemineglect. The potential of other forms of stimulation are also explored. Based on the results of this review, it is recommended that further studies be conducted to determine the most practical and effective application of vestibular stimulation.Keywords:
Caloric theory
Acquired brain injury
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The objective of this review is to describe the major impairments resulting from acquired brain injury (ABI) and their rehabilitation interventions resulting in better functional outcomes. Because of the nature of deficits and treatment cost, these patients may be lost to follow up. Comprehensive rehabilitation services integrated with neurosciences units are scarce in Pakistan. Keeping in view the diversity and chronicity of impairments, the follow up needs to be well planned in terms of duration and patient convenience. The rehabilitation needs of these patients go beyond physiotherapy alone, which is considered as the only form of rehabilitation in Pakistan. We focus only on the major impairments most seen after ABI. The rehabilitation team members providing their services and the possibilities are comprehensively explained in the review. These types of services need to be run by government and funded by government, with parallel efforts to make national guidelines and registry to keep a track of patients suffering from ABI. The proposed ABI rehabilitation pathway will not only improve the clinical care and continued support delivered by health services to adults with ABI but will also facilitate community reintegration and support their families and care givers.
Acquired brain injury
Community-based rehabilitation
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Bárány's thermal convection theory was questioned after the observation of caloric nystagmus in space under microgravity conditions. Our study was undertaken to gain more insight into the mechanisms that play a role during caloric stimulation of the vestibular system.
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A degree of motor recovery is typically seen after acquired brain injury in children. The extent to which rehabilitation efforts can claim credit for this is disputed. Strong correlations between late impairment outcomes and early severity and impairment indices are seen both in adults and children. These correlations have been interpreted by some as evidence that recovery is largely intrinsic and that any additional rehabilitation effects are small. Such views are belied by published animal studies demonstrating the possibility of large rehabilitation effects. Animal models suggest that to achieve similar rehabilitation treatment effect sizes in clinical practice, rehabilitation 'doses' should be greater, rehabilitation efforts should start sooner, and premature accommodation of impairment should be avoided.
Acquired brain injury
Motor impairment
Promotion (chess)
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Complaints of imbalance in the elderly are commonly heard by clinicians, and pathology of the vestibular system may play an important role in these complaints. While there is solid anatomical evidence for age related decline of some vestibular structures, a corresponding deterioration in physiologic function has not been convincingly demonstrated. Vestibular function is traditionally measured with caloric irrigations. Although there has been some age dependent change in caloric response shown, there is no good parallel between caloric response and imbalance in the elderly patient. Our experiment confirms that slow phase velocity of caloric responses does not decline with age. Calorics measure only one part of the vestibular system, and so should not be regarded as representative of balance system function. As a result, measured caloric response does not parallel documented anatomic age-related decline of the vestibular system.
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Vestibular disorders
Caloric theory
Caloric test
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Caloric stimulation of the vestibular system is associated with autonomic response. The lateralization in the nervous system activities also involves the autonomic nervous system.To compare the effect of the right and left ear caloric test on the cardiac sympathovagal tone in healthy persons.This self-control study was conducted on 12 healthy male volunteers. The minimal ice water caloric test was applied for vestibular stimulation. This was done by irrigating 1 milliliter of 4 ± 2 °C ice water into the external ear canal in 1 s. In each experiment, only one ear was stimulated. For each ear, the pessimum position was considered as sham control and the optimum position was set as caloric vestibular stimulation of horizontal semicircular channel. The order of right or left caloric vestibular stimulation and the sequence of optimum or pessimum head position in each set were random. The recovery time between each calorie test was 5 min. The short-term heart rate variability (HRV) was used for cardiac sympathovagal tone metrics. All variables were compared using the analysis of variance.After caloric vestibular stimulation, the short-term time-domain and frequency-domain HRV indices as well as, the systolic and the diastolic arterial blood pressure, the respiratory rate and the respiratory amplitude, had no significant changes. These negative results were similar in the right and the left sides. Nystagmus duration of left caloric vestibular stimulations in the optimum and the pessimum positions had significant differences (e.g., 72.14 ± 39.06 vs 45.35 ± 35.65, P < 0.01). Nystagmus duration of right caloric vestibular stimulations in the optimum and the pessimum positions had also significant differences (e.g., 86.42 ± 67.20 vs 50.71 ± 29.73, P < 0.01). The time of the start of the nystagmus following caloric vestibular stimulation had no differences in both sides and both positions.Minimal ice water caloric stimulation of the right and left vestibular system did not affect the cardiac sympathovagal balance according to HRV indices.
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Abstract BACKGROUND. Vestibular disorders are a group of widely spread diseases that have as a common denominator the disturbance of the equilibrium system. The assessment of vestibular disorders consists in a complex examination of the patient including a thorough anamnesis, a rigorous clinical examination and multiple functional explorations. OBJECTIVE. To asses weather there is a correlation between the data obtained in posturography and those obtained in the videonystagmography in patients with peripheral vestibular disorders. MATERIAL AND METHODS. Collecting data from the observation sheets of patients diagnosed with peripheral vestibular syndrome and examined in the Department of Otorhinolaryngology of the “Sfanta Maria” Hospital in Bucharest over a period of 18 months. RESULTS. We analyzed a number of 97 cases of patients diagnosed with peripheral vestibular disorder. A large number of patients (49) had correlated changes in the caloric tests and also in the posturography. A second group of patients (43) had changes in caloric tests but with no changes in posturography. The third group of 5, paradoxically, had a vestibular deficiency in posturography associated with normal caloric reactivity. CONCLUSION. The results obtained with the videonystagmography are correlated with those of the caloric and rotational videonystagmographic tests in the case of acute vestibular diseases. In chronic vestibular diseases, it is possible to find caloric vestibular paresis in the presence of a normal posturography. The “vestibular omission” is a phenomenon in which the patient does not use the vestibular input of a normal labyrinth with caloric and rotary tests within normal limits. As no vestibular examination can be considered as selfstaging diagnosis, we always have to establish the final diagnosis correlating the results of all the tests available.
Posturography
Caloric theory
Electronystagmography
Paresis
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Objective To examine the nature of agitation in patients with brain injury and quantify the relation between agitation and patient progress in rehabilitation. Design Cross-sectional, correlational. Setting Urban, inpatient rehabilitation facility in the midwestern United States. Participants Sixty-nine patients with acquired brain injury admitted to an acute rehabilitation hospital. Main Outcome Measures Therapy Engagement using the Rehabilitation Therapy Engagement Scale; Functional Status using the Functional Independence Measure. Results Agitated behavior was inversely associated with engagement in rehabilitation therapy even after controlling for injury severity. Engagement in therapy mediated the relation between agitated behavior and progress in rehabilitation as assessed using a Functional Independence Measure efficiency ratio. Conclusions Progress in acute brain injury rehabilitation appears to be meaningfully influenced by the complex interplay among injury severity, agitation, and engagement. The findings are consistent with a theoretical model, suggesting that agitated patients make less progress in rehabilitation not only because of greater injury severity but also because agitation disrupts engagement in rehabilitation therapies. Multiple clinical purposes may be better served by measuring behavioral excess on a continuum than in a dichotomous fashion.
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Recent rehabilitation counselling literature has pointed to major developments in the contribution of rehabilitation counsellors to acquired brain injury (ABI) rehabilitation. Rehabilitation counsellors have widened their skill base in case management, vocational evaluation, and in the therapeutic relationship between counsellor and client. It is evident, however, that better methods of ABI rehabilitation service delivery, including those services provided by rehabilitation counsellors, continue to be sought. Strategies needed to ensure the advancement of rehabilitation counselling practice and research in ABI rehabilitation are discussed, and involve the adoption of a systems approach, a shift away from dominant clinical psychological analyses in favour of psychosocial frameworks, and the co-participation of persons with ABI in the rehabilitation process.
Acquired brain injury
Rehabilitation counseling
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