scholarly journals Incremental Velocity Error as a New Treatment in Vestibular Rehabilitation (INVENT VPT) Trial: study protocol for a randomized controlled crossover trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ann-Margret Ervin ◽  
Michael C. Schubert ◽  
Americo A. Migliaccio ◽  
Jamie Perin ◽  
Hamadou Coulibaly ◽  
...  
Keyword(s):  
Military Service ◽  
Crossover Trial ◽  
Vestibular Rehabilitation ◽  
Sensory Impairment ◽  
Randomized Controlled ◽  
Ocular Reflex ◽  
Military Service Members ◽  
The Us ◽  
Vestibulo Ocular Reflex ◽  
New Treatment

Abstract Background A clinical pattern of damage to the auditory, visual, and vestibular sensorimotor systems, known as multi-sensory impairment, affects roughly 2% of the US population each year. Within the population of US military service members exposed to mild traumatic brain injury (mTBI), 15–44% will develop multi-sensory impairment following a mild traumatic brain injury. In the US civilian population, multi-sensory impairment-related symptoms are also a common sequela of damage to the vestibular system and affect ~ 300–500/100,000 population. Vestibular rehabilitation is recognized as a critical component of the management of multi-sensory impairment. Unfortunately, the current clinical practice guidelines for the delivery of vestibular rehabilitation are not evidence-based and primarily rely on expert opinion. The focus of this trial is gaze stability training, which represents the unique component of vestibular rehabilitation. The aim of the Incremental Velocity Error as a New Treatment in Vestibular Rehabilitation (INVENT VPT) trial is to assess the efficacy of a non-invasive, incremental vestibular adaptation training device for normalizing the response of the vestibulo-ocular reflex. Methods The INVENT VPT Trial is a multi-center randomized controlled crossover trial in which military service members with mTBI and civilian patients with vestibular hypofunction are randomized to begin traditional vestibular rehabilitation or incremental vestibular adaptation and then cross over to the alternate intervention after a prescribed washout period. Vestibulo-ocular reflex function and other functional outcomes are measured to identify the best means to improve the delivery of vestibular rehabilitation. We incorporate ecologically valid outcome measures that address the common symptoms experienced in those with vestibular pathology and multi-sensory impairment. Discussion The INVENT VPT Trial will directly impact the health care delivery of vestibular rehabilitation in patients suffering from multi-sensory impairment in three critical ways: (1) compare optimized traditional methods of vestibular rehabilitation to a novel device that is hypothesized to improve vestibulo-ocular reflex performance, (2) isolate the ideal dosing of vestibular rehabilitation considering patient burden and compliance rates, and (3) examine whether recovery of the vestibulo-ocular reflex can be predicted in participants with vestibular symptoms. Trial registration ClinicalTrials.gov NCT03846830. Registered on 20 February 2019.

scholarly journals Incremental Velocity Error As A New Treatment In Vestibular Rehabilitation (INVENT VPT Trial): Study Protocol For A Randomized Controlled Crossover Trial

2021 ◽  
Author(s):  
Ann Margret Ervin ◽  
Michael Schubert ◽  
Americo Migliaccio ◽  
Jamie Perin ◽  
Hamadou Coulibaly ◽  
...  
Keyword(s):  
Military Service ◽  
Crossover Trial ◽  
Vestibular Rehabilitation ◽  
Sensory Impairment ◽  
Randomized Controlled ◽  
Ocular Reflex ◽  
Military Service Members ◽  
The Us ◽  
Vestibular Adaptation ◽  
Vestibulo Ocular Reflex

Abstract Background: A clinical pattern of damage to the auditory, visual, and vestibular sensorimotor systems, known as multi-sensory impairment, affects a significant percent of the US population. Within the population of US military service members exposed to mild traumatic brain injury (mTBI), 15 – 44% will develop multi-sensory impairment following a mild traumatic brain injury. In the US civilian population, multi-sensory impairment related symptoms are also a common sequela of damage to the vestibular system and affect ~ 300-500/100,000 population. Vestibular rehabilitation is recognized as a critical component of the management of multi-sensory impairment. Unfortunately, the current clinical practice guidelines for the delivery of vestibular rehabilitation are not evidence-based and primarily rely on expert opinion. The focus of the INVENT VPT trial is gaze stability training, which represents the unique component of vestibular rehabilitation. The aim of the INVENT VPT trial is to assess the efficacy of a non-invasive, incremental vestibular adaptation training device for normalizing the response of the vestibulo-ocular reflex. Methods: The INVENT VPT trial is a multicenter randomized controlled crossover trial in which military service members with mTBI and civilian patients with vestibular hypofunction are randomized to begin traditional vestibular rehabilitation or incremental vestibular adaptation and then cross over to the alternate intervention after a prescribed washout period. Vestibulo-ocular reflex function and other functional outcomes are measured to identify the best means to improve delivery of vestibular rehabilitation. We incorporate ecologically valid outcome measures that address the common symptoms experienced in those with vestibular pathology and multi-sensory impairment. Discussion: The INVENT VPT Trial will directly impact the health care delivery of vestibular rehabilitation in patients suffering from multi-sensory impairment in three critical ways: 1) Compare optimized traditional methods of vestibular rehabilitation to a novel device that is hypothesized to improve vestibulo-ocular reflex performance; 2) Isolate the ideal dosing of vestibular rehabilitation considering patient burden and compliance rates; 3) Examine whether recovery of the vestibulo-ocular reflex can be predicted in participants with vestibular symptoms. Trial registration: ClinicalTrials.gov, NCT03846830. Registered 20 February 2019,https://clinicaltrials.gov/ct2/show/NCT03846830

Long-term effects of vestibular rehabilitation and head-mounted gaming task procedure in unilateral vestibular hypofunction: a 12-month follow-up of a randomized controlled trial

2018 ◽  
Vol 33 (1) ◽  
pp. 24-33 ◽  
Author(s):  
Andrea Viziano ◽  
Alessandro Micarelli ◽  
Ivan Augimeri ◽  
Domenico Micarelli ◽  
Marco Alessandrini
Keyword(s):  
Power Spectra ◽  
Vestibular Rehabilitation ◽  
Performance Measure ◽  
Self Report ◽  
Long Term Effects ◽  
Ocular Reflex ◽  
Vestibular Hypofunction ◽  
Vestibulo Ocular Reflex ◽  
Reflex Gain

Objective: To investigate the long-term effects of adding virtual reality–based home exercises to vestibular rehabilitation in people with unilateral vestibular hypofunction. Design: Follow-up otoneurological examination in two randomized groups following a previous one-month trial. Setting: Tertiary rehabilitation center. Subjects: A total of 47 patients with unilateral vestibular hypofunction, one group ( n = 24) undergoing conventional vestibular rehabilitation and the other one ( n = 23) implementing, in addition, head-mounted gaming home exercises, 20 minutes per day for one month. Interventions: One year after completing rehabilitation, patients underwent testing with static posturography, video head impulse test, self-report questionnaires, and a performance measure. Main measures: Vestibulo-ocular reflex gain, posturographic parameters such as length, surface, and fast Fourier transform power spectra, self-report, and gait performance measure scores. Results: Vestibulo-ocular reflex gain was significantly better with respect to pretreatment in both groups. The mixed-method group showed significantly higher gain scores: mean (standard deviation (SD)) at 12 months was 0.71 (0.04), versus 0.64 (0.03) for the vestibular rehabilitation–only group ( P < 0.001). Accordingly, some classical posturography scores such as surface with eyes open and length with eyes closed and low-frequency power spectra were significantly different between groups, with the virtual reality group showing improvement ( P < 0.001). Self-report measures were significantly better in both groups compared to pretreatment, with significant improvement in the mixed-method group as compared to conventional rehabilitation alone: Dizziness Handicap Inventory mean total score was 24.34 (2.8) versus 35.73 (5.88) with a P-value <0.001. Conclusion: Results suggest that head-mounted gaming home exercises are a viable, effective, additional measure to improve long-term vestibular rehabilitation outcomes.

Assessment of Vestibulo-ocular Reflex Gain and Catch-up Saccades During Vestibular Rehabilitation

2018 ◽  
Vol 39 (10) ◽  
pp. e1111-e1117 ◽  
Author(s):  
Elena Navari ◽  
Niccolò Cerchiai ◽  
Augusto Pietro Casani
Keyword(s):  
Vestibular Rehabilitation ◽  
Ocular Reflex ◽  
Vestibulo Ocular Reflex ◽  
Reflex Gain ◽  
Catch Up

Imagining Military Suicide

2019 ◽  
pp. 191-209
Author(s):  
Ken MacLeish
Keyword(s):  
United States ◽  
Military Personnel ◽  
Military Service ◽  
Causes Of Death ◽  
Entire System ◽  
American Military ◽  
Military Service Members ◽  
The Us ◽  
Contemporary United States ◽  
Military Suicide

Military suicide is widely regarded as a crisis in the contemporary United States. Indeed, the rate of military suicide has risen consistently over the course of the US wars in Iraq and Afghanistan and is one of the leading causes of death among American military personnel. Military suicide is widely regarded as scandalous sign of the trauma of war and the indifference or failure of military institutions. This chapter places these assumptions in the broader context of the entire system of war-making that shapes military service members’ experience. It describes that system in terms of military biopolitics under which the mechanisms that seek to police and prevent military suicide are fundamentally linked to the mechanisms that have already exposed soldiers to harm and empowered them to commit violence.

Research and methodologic opportunities and challenges conducting research among US military personnel

2020 ◽  
pp. 445-452
Author(s):  
Ann I Scher ◽  
David W Niebuhr ◽  
Darrell Singer
Keyword(s):  
Military Personnel ◽  
Military Service ◽  
Young Men ◽  
Service Members ◽  
Epidemiologic Research ◽  
Us Military ◽  
Military Service Members ◽  
The Us ◽  
Conducting Research ◽  
The Military

This chapter explores the opportunities and challenges in conducting epidemiologic research among US military personnel. The US military represents a unique opportunity for neurological and neuropsychiatric epidemiology. Comprised of a subset of the US population, military service members represent an open cohort who are exposed to a variety of occupational, physical, and psychological environments. While pre-accession socioeconomic status of individual military service members may vary, once in service, employment benefits and social support, including healthcare, are highly standardized. These attributes offer both strengths and constraints when conducting epidemiologic research among the military. Challenges (or possibly opportunities) associated with studying military populations include demographics, the ‘healthy warrior’ effect, and access. Meanwhile, opportunities include capture of medical encounter data in a standardized way as well as the size of the population, which makes it feasible to study relatively rare conditions. Indeed, the economic and ethnic diversity of the US military enhances the ability to study population subgroups. While the military population is predominantly young men, this is also a strength as young men are often under-represented in civilian population studies.

scholarly journals Relationship between vestibulo-ocular reflex gain and dizziness handicap inventory score to predict effectiveness of vestibular rehabilitation

2021 ◽  
Author(s):  
Morteza Hamidi Nahrani ◽  
Mehdi Akbari ◽  
Mohammad Maarefvand
Keyword(s):  
Vestibular Rehabilitation ◽  
Head Impulse Test ◽  
Dizziness Handicap Inventory ◽  
Strong Negative Correlation ◽  
Ocular Reflex ◽  
Vestibular Hypofunction ◽  
Before And After ◽  
Vestibulo Ocular Reflex ◽  
Reflex Gain

Background and Aim: Evaluating the effective­ness of vestibular rehabilitation (VR) in patients with vestibular lesions has always been a challe­nge. The questionnaires that are used for this pur­pose mostly show the degree of vestibular dis­ability rather than providing information about improvement of vestibular dysfunction. This study aimed to evaluate whether video head imp­ulse test (vHIT) that is used for the examination of vestibulo-ocular reflex (VOR), is a useful method for predicting the effectiveness of VR and has a correlation with dizziness handicap inventory (DHI) score. Methods: Participants were 42 patients with unilateral peripheral vestibular hypofunction (UPVH) undergoing VR. Patients were assessed before and after rehabilitation by the vHIT in all ipsilesional and contralesional semicircular can­als (SCCs) and the DHI. The changes in DHI score and VOR gain before and after rehabili­tation, were shown as ΔDHI and ΔVOR and their correlation was evaluated. Results: VOR gain from ipsilesional and contra­lesional SCCs was improved significantly after VR. There was a significant strong negative correlation between ΔVOR gain from ipsile­sional SCCs and ΔDHI score but no significant correlation was found between the ΔDHI score and ΔVOR gain from contralesional SCCs. Conclusion: vHIT test is a useful tool to evaluate the effectiveness of VR. VOR gain is correlated with the DHI score. Therefore, the improvement in vHIT results in all three SCCs after VR may be a good predictor of the degree of improvement in dizziness-related disability. Keywords: Vestibular rehabilitation; follow-up; unilateral vestibular hypofunction; video head impulse test; dizziness handicap inventory

scholarly journals VestAid: A Tablet-Based Technology for Objective Exercise Monitoring in Vestibular Rehabilitation

Sensors ◽  
2021 ◽  
Vol 21 (24) ◽  
pp. 8388
Author(s):  
Pedram Hovareshti ◽  
Shamus Roeder ◽  
Lisa S. Holt ◽  
Pan Gao ◽  
Lemin Xiao ◽  
...  
Keyword(s):  
Vestibular Rehabilitation ◽  
Laboratory Evaluation ◽  
Measurement Unit ◽  
Movement Velocity ◽  
Post Exercise ◽  
Ocular Reflex ◽  
Perceived Difficulty ◽  
Vestibulo Ocular Reflex ◽  
All Speeds ◽  
Patient Performance

(1) Background: Current vestibular rehabilitation therapy is an exercise-based approach aimed at promoting gaze stability, habituating symptoms, and improving balance and walking in patients with mild traumatic brain injury (mTBI). A major component of these exercises is the adaptation of the vestibulo-ocular reflex (VOR) and habituation training. Due to acute injury, the gain of the VOR is usually reduced, resulting in eye movement velocity that is less than head movement velocity. There is a higher chance for the success of the therapy program if the patient (a) understands the exercise procedure, (b) performs the exercises according to the prescribed regimen, (c) reports pre- and post-exercise symptoms and perceived difficulty, and (d) gets feedback on performance. (2) Methods: The development and laboratory evaluation of VestAid, an innovative, low-cost, tablet-based system that helps patients perform vestibulo-ocular reflex (VORx1) exercises correctly at home without therapist guidance, is presented. VestAid uses the tablet camera to automatically assess patient performance and compliance with exercise parameters. The system provides physical therapists (PTs) with near real-time, objective (head speed and gaze fixation compliance), and subjective (perceived difficulty and pre- and post- exercise symptoms) metrics through a web-based provider portal. The accuracy of the head-angle and eye-gaze compliance metrics was evaluated. The accuracy of estimated head angles calculated via VestAid’s low-complexity algorithms was compared to the state-of-the-art deep-learning method on a public dataset. The accuracy of VestAid’s metric evaluation during the VORx1 exercises was assessed in comparison to the output of an inertial measurement unit (IMU)-based system. (3) Results: There are low mean interpeak time errors (consistently below 0.1 s) across all speeds of the VORx1 exercise, as well as consistently matching numbers of identified peaks. The spatial comparison (after adjusting for the lag measured with the cross-correlation) between the VestAid and IMU-based systems also shows good matching, as shown by the low mean absolute head angle error, in which for all speeds, the mean is less than 10 degrees. (4) Conclusions: The accuracy of the system is sufficient to provide therapists with a good assessment of patient performance. While the VestAid system’s head pose evaluation model may not be perfectly accurate as a result of the occluded facial features when the head moves further towards an extreme in pitch and yaw, the head speed measurements and associated compliance measures are sufficiently accurate for monitoring patients’ VORx1 exercise compliance and general performance.

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