Effects of long-term vestibular rehabilitation therapy with vibrotactile sensory augmentation for people with unilateral vestibular disorders – A randomized preliminary study

BACKGROUND AND OBJECTIVE This pilot study aimed to investigate the effects of incorporating vibrotactile sensory augmentation (SA) on balance performance among people with unilateral vestibular disorders (UVD). METHODS Eight participants with UVD were recruited. Participants completed 18 balance training sessions across six weeks in a clinical setting. Four participants (68.1±7.5 yrs) were randomized to the experimental group (EG) and received trunk-based vibrotactile SA while performing the balance exercises, and four participants (63.1±11.3 yrs) were assigned to the control group (CG); CG participants completed the balance training without SA. Clinical and kinematic balance performance measures were collected before training; midway through training; and one week, one month, and six months after training. RESULTS All participants, regardless of group, demonstrated improvements in a subset of the clinical or balance metrics immediately following completion of the balance training protocol. The EG showed significantly greater improvements than the CG for the Activities-specific Balance Confidence Scale and postural stability during the two standing balance exercises with head movements. The EG also had larger improvements than the CG for the Sensory Organization Test (SOT), Mini Balance Evaluations Systems Test, Gait Speed Test, Dynamic Gait Index, Functional Gait Assessment, and vestibular reliance metric calculated based on the SOT. CONCLUSIONS Incorporating vibrotactile SA into vestibular rehabilitation programs may lead to additional benefits that may be retained up to six months after training, compared to training without vibrotactile SA. A larger study is warranted to demonstrate statistical significance between the groups.

[1]  S B Sepic,et al.  Relationships among walking performance, postural stability, and functional assessments of the hemiplegic patient. , 1987, American journal of physical medicine.

[2]  C. Wall,et al.  The effect of vibrotactile feedback on postural sway during locomotor activities , 2013, Journal of NeuroEngineering and Rehabilitation.

[3]  Babak Taati,et al.  Vision-based assessment of parkinsonism and levodopa-induced dyskinesia with pose estimation , 2017, Journal of NeuroEngineering and Rehabilitation.

[4]  H. Neuhauser Epidemiology of vertigo , 2007, Current opinion in neurology.

[5]  K H Sienko,et al.  Effects of multi-directional vibrotactile feedback on vestibular-deficient postural performance during continuous multi-directional support surface perturbations. , 2009, Journal of vestibular research : equilibrium & orientation.

[6]  D. Wrisley,et al.  Reliability, internal consistency, and validity of data obtained with the functional gait assessment. , 2004, Physical therapy.

[7]  Herman Kingma,et al.  Salient and placebo vibrotactile feedback are equally effective in reducing sway in bilateral vestibular loss patients. , 2010, Gait & posture.

[8]  K. Sienko,et al.  Determining the preferred modality for real-time biofeedback during balance training. , 2013, Gait & posture.

[9]  F. Hlavačka,et al.  Effectiveness of different visual biofeedback signals for human balance improvement. , 2014, Gait & posture.

[10]  Roseli Saraiva Moreira Bittar,et al.  Effects of electrotactile vestibular substitution on rehabilitation of patients with bilateral vestibular loss , 2010, Neuroscience Letters.

[11]  S. Studenski,et al.  Functional reach: a new clinical measure of balance. , 1990, Journal of gerontology.

[12]  Mingzhong Tian The Effect of Displacement , 2012 .

[13]  M. Badke,et al.  Effects of Vestibular and Balance Rehabilitation on Sensory Organization and Dizziness Handicap , 2005, The Annals of otology, rhinology, and laryngology.

[14]  E Kentala,et al.  Effect of displacement, velocity, and combined vibrotactile tilt feedback on postural control of vestibulopathic subjects. , 2010, Journal of vestibular research : equilibrium & orientation.

[15]  Susan L. Whitney,et al.  Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Evidence-Based Clinical Practice Guideline , 2016, Journal of neurologic physical therapy : JNPT.

[16]  F. Horak,et al.  Auditory biofeedback substitutes for loss of sensory information in maintaining stance , 2007, Experimental Brain Research.

[17]  F. Horak Postural compensation for vestibular loss and implications for rehabilitation. , 2010, Restorative neurology and neuroscience.

[18]  Kathleen H Sienko,et al.  Biofeedback improves postural control recovery from multi-axis discrete perturbations , 2012, Journal of NeuroEngineering and Rehabilitation.

[19]  Y. Lajoie,et al.  Predicting falls within the elderly community: comparison of postural sway, reaction time, the Berg balance scale and the Activities-specific Balance Confidence (ABC) scale for comparing fallers and non-fallers. , 2004, Archives of gerontology and geriatrics.

[20]  J. Allum,et al.  The balance control of bilateral peripheral vestibular loss subjects and its improvement with auditory prosthetic feedback. , 2005, Journal of vestibular research : equilibrium & orientation.

[21]  Michael C Schubert,et al.  Disorders of balance and vestibular function in US adults: data from the National Health and Nutrition Examination Survey, 2001-2004. , 2009, Archives of internal medicine.

[22]  K H Sienko,et al.  A Conceptual Framework for the Progression of Balance Exercises in Persons with Balance and Vestibular Disorders. , 2015, Physical medicine and rehabilitation international.

[23]  Michael C Schubert,et al.  Vestibulo-ocular physiology underlying vestibular hypofunction. , 2004, Physical therapy.

[24]  J. McQuaid,et al.  The Montreal Cognitive Assessment , 2015, Journal of the International Association of Providers of AIDS Care.

[25]  P. Alam,et al.  R , 1823, The Herodotus Encyclopedia.

[26]  J. Allum,et al.  Improvements in Trunk Sway Observed for Stance and Gait Tasks during Recovery from an Acute Unilateral Peripheral Vestibular Deficit , 2003, Audiology and Neurotology.

[27]  Lucy Yardley,et al.  Rehabilitation of balance disorders in the patient with vestibular pathology , 2004 .

[28]  Antonio Nardone,et al.  Using psychometric techniques to improve the Balance Evaluation Systems Test: the mini-BESTest. , 2010, Journal of rehabilitation medicine.

[29]  K H Sienko,et al.  The role of sensory augmentation for people with vestibular deficits: Real-time balance aid and/or rehabilitation device? , 2017, Journal of vestibular research : equilibrium & orientation.

[30]  A. Meli,et al.  Vestibular rehabilitation and 6-month follow-up using objective and subjective measures , 2006, Acta oto-laryngologica.

[31]  Kaoru Ogawa,et al.  Efficacy of a Vibrotactile Neurofeedback Training in Stance and Gait Conditions for the Treatment of Balance Deficits: A Double-Blind, Placebo-Controlled Multicenter Study , 2011, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[32]  L. E. Powell,et al.  The Activities-specific Balance Confidence (ABC) Scale. , 1995, The journals of gerontology. Series A, Biological sciences and medical sciences.

[33]  Michelle McDonnell,et al.  Vestibular rehabilitation for unilateral peripheral vestibular dysfunction , 2011, Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery.

[34]  C. Wall,et al.  Vibrotactile tilt feedback improves dynamic gait index: a fall risk indicator in older adults. , 2009, Gait & posture.

[35]  Diane Podsiadlo,et al.  The Timed “Up & Go”: A Test of Basic Functional Mobility for Frail Elderly Persons , 1991, Journal of the American Geriatrics Society.

[36]  Jae Yun Jung,et al.  Effect of vestibular rehabilitation on dizziness in the elderly. , 2009, American journal of otolaryngology.

[37]  P. Bach-y-Rita Tactile Sensory Substitution Studies , 2004, Annals of the New York Academy of Sciences.

[38]  P. Alam ‘S’ , 2021, Composites Engineering: An A–Z Guide.

[39]  F. O. Black,et al.  Adaptation to altered support and visual conditions during stance: patients with vestibular deficits , 1982, The Journal of neuroscience : the official journal of the Society for Neuroscience.

[40]  P. Bach-y-Rita,et al.  Efficacy of electrotactile vestibular substitution in patients with bilateral vestibular and central balance loss , 2006, 2006 International Conference of the IEEE Engineering in Medicine and Biology Society.

[41]  D. Basta,et al.  Vibrotactile neurofeedback balance training in patients with Parkinson's disease: reducing the number of falls. , 2013, Gait & posture.

[42]  Maw-Sheng Chern,et al.  Deterministic lot-size inventory models with shortages and deterioration for fluctuating demand , 1999, Oper. Res. Lett..

[43]  J. Allum,et al.  Directional effects of biofeedback on trunk sway during stance tasks in healthy young adults. , 2010, Gait & posture.

[44]  Kathleen H. Sienko,et al.  Effects of long-term balance training with vibrotactile sensory augmentation among community-dwelling healthy older adults: a randomized preliminary study , 2017, Journal of NeuroEngineering and Rehabilitation.

[45]  D. Basta,et al.  Vestibular rehabilitation by auditory feedback in otolith disorders. , 2008, Gait & posture.

[46]  D. Wrisley,et al.  Physical Therapy Outcomes for Persons With Bilateral Vestibular Loss , 2001, The Laryngoscope.

[47]  J. Allum,et al.  Effects of biofeedback on trunk sway during dual tasking in the healthy young and elderly. , 2009, Gait & posture.

[48]  Shahnawaz Anwer,et al.  Recent Evidence About the Effectiveness of Vestibular Rehabilitation , 2016, Current Treatment Options in Neurology.

[49]  Kok-Sing Tang,et al.  Improving impaired balance function: Real-time versus carry-over effects of prosthetic feedback , 2011, 2011 Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[50]  Barbara Susan Robinson,et al.  Use of an Electrotactile Vestibular Substitution System to Facilitate Balance and Gait of an Individual with Gentamicin-Induced Bilateral Vestibular Hypofunction and Bilateral Transtibial Amputation , 2009, Journal of neurologic physical therapy : JNPT.

[51]  C. Foster,et al.  Vestibular rehabilitation. , 1994, Bailliere's clinical neurology.

[52]  C. Granger,et al.  The functional independence measure: a new tool for rehabilitation. , 1987, Advances in clinical rehabilitation.

[53]  Jeonghee Kim,et al.  Cell phone based balance trainer , 2012, Journal of NeuroEngineering and Rehabilitation.

[54]  S. Whitney,et al.  Efficacy of vestibular rehabilitation. , 2000, Otolaryngologic clinics of North America.

[55]  Anna Maria Turcato,et al.  Comparison of Reliability, Validity, and Responsiveness of the Mini-BESTest and Berg Balance Scale in Patients With Balance Disorders , 2012, Physical Therapy.

[56]  J. Allum,et al.  Directional effects of biofeedback on trunk sway during gait tasks in healthy young subjects. , 2009, Gait & posture.

[57]  R. Tusa,et al.  Falls in patients with vestibular deficits. , 2000, The American journal of otology.

[58]  Sandeep K Subramanian,et al.  Does Provision of Extrinsic Feedback Result in Improved Motor Learning in the Upper Limb Poststroke? A Systematic Review of the Evidence , 2010, Neurorehabilitation and neural repair.

[59]  Roseli Saraiva Moreira Bittar,et al.  Effects of vibrotactile vestibular substitution on vestibular rehabilitation – preliminary study , 2015, Brazilian journal of otorhinolaryngology.

[60]  S. Studenski,et al.  Meaningful Change and Responsiveness in Common Physical Performance Measures in Older Adults , 2006, Journal of the American Geriatrics Society.

[61]  Marjorie H. Woollacott,et al.  Motor Control: Theory and Practical Applications , 1995 .

[62]  J. Cummings,et al.  The Montreal Cognitive Assessment, MoCA: A Brief Screening Tool For Mild Cognitive Impairment , 2005, Journal of the American Geriatrics Society.

[63]  C. Newman,et al.  The development of the Dizziness Handicap Inventory. , 1990, Archives of otolaryngology--head & neck surgery.

[64]  E. Hansson,et al.  Falls among dizzy patients in primary healthcare: an intervention study with control group , 2008, International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation.

[65]  Elizabeth J. Anderson,et al.  Balance Interventions for Diabetic Peripheral Neuropathy: A Systematic Review , 2011, Journal of geriatric physical therapy.

[66]  Justin R. Davis,et al.  Trunk sway reductions in young and older adults using multi-modal biofeedback. , 2010, Gait & posture.

[67]  R. Peterka Sensorimotor integration in human postural control. , 2002, Journal of neurophysiology.

[68]  Robert Burkard,et al.  Learning effects of repetitive administrations of the sensory organization test in healthy young adults. , 2007, Archives of physical medicine and rehabilitation.

[69]  A. Goodworth,et al.  Potential Mechanisms of Sensory Augmentation Systems on Human Balance Control , 2018, Front. Neurol..

[70]  R. Clendaniel Outcome measures for assessment of treatment of the dizzy and balance disorder patient. , 2000, Otolaryngologic clinics of North America.