Effectiveness of vestibular rehabilitation on balance, dizziness, functioning, and depressive symptoms in older adults

Ribeiro, Marlon Bruno Nunes; Mancini, Patrícia Cotta; Bicalho, Maria Aparecida Camargos

doi:10.1590/2317-6431-2022-2750en

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Audiology - Communication Research

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Sumário

Original Article • Audiol., Commun. Res. 28 • 2023 • https://doi.org/10.1590/2317-6431-2022-2750en copy

Effectiveness of vestibular rehabilitation on balance, dizziness, functioning, and depressive symptoms in older adults

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose

To assess the effectiveness of vestibular rehabilitation on functioning, gains in semicircular canals in the Video Head Impulse Test (v-HIT), on responses to the vestibular evoked myogenic potentials (VEMP), depressive symptoms, balance, and dizziness in older adults.

Methods

Longitudinal, quasi-experimental, analytical study conducted between December 2019 and July 2022, in 50 older adults with vestibular disorders, submitted to vestibular rehabilitation and examinations: VEMP, v-HIT, the questionnaires, visual analog scale, Dizziness Handicap Inventory, Berg Balance Scale, Pfeffer’s Functional Activities Questionnaire, and Geriatric Depression Scale. All examinations and questionnaires were applied before and after eight weekly vestibular rehabilitation sessions. Statistical analysis was performed in SPSS, with the Wilcoxon test (p<0.05).

Results

There was a gain in the anterior right semicircular canal (0.71/0.78), reduction in dizziness discomfort (7/5) and in the impact of dizziness on the quality of life (35/15), improvement in balance (45/51) and functioning (2/1), and reduction in depressive symptoms (5/3).

Conclusion

Older adults with vestibular disorder submitted to vestibular rehabilitation improved their gain in vestibulo-ocular reflex, balance, and functional activities and reduced their depressive symptoms and the impact of dizziness on their quality of life.

Keywords:
Postural balance; Dizziness; Aged; Rehabilitation; Quality of life

Cervical VEMP	Mean (standard deviation)	Minimum	Maximum
Right ear
P13	16.24 (2.41)	13.86	26.33
N23	24.58 (2.67)	20.50	33.00
Amplitude	67.83 (86.39)	11.52	389.39
asymmetry index	25.90 (19.85)	1.31	69.32
Corrected asymmetry index	26.54 (20.14)	2.63	66.34
Left ear
P13	16.19 (2.02)	12.50	22.17
N23	25.00 (2.94)	20.83	31.00
Amplitude	52.15 (50.33)	8.82	252.79
Ocular VEMP
Right ear
P15	14.93 (1.69)	10.83	16.50
N10	11.12 (2.37)	7.82	17.33
Amplitude	4.29 (7.42)	0.97	26.48
Asymmetry index	26.94 (29.67)	7.69	92.93
Left ear
P15	16.29 (1.06)	14.83	18.53
N10	10.91 (0.70)	10.00	12.33
Amplitude	2.91 (1.91)	0.97	8.14

v-HIT	Mean (standard deviation)	Minimum	Maximum
Lateral left	0.85 (0.19)	0.10	1.16
Lateral right	0.92 (0.23)	0.01	1.29
Anterior left	0.81 (0.22)	0.07	1.19
Anterior right	0.71 (0.26)	0.02	1.15
Posterior left	0.67 (0.19)	0.60	0.98
Posterior right	0.62 (0.19)	-0.01	0.92
Lateral asymmetry	11.71 (13.71)	0	90
Anterior asymmetry	19.62 (20.37)	0	97
Posterior asymmetry	15.93 (15.00)	0	69
VAS	7.30 (2.18)	2	10
DHI Total	39.56 (22.91)	6	90
Physical	13.40 (7.26)	0	28
Functional	14.04 (8.74)	0	34
Emotional	12.12 (9.82)	0	36
BBS	44.02 (9.17)	11	56
Pfeffer	3.44 (4.13)	0	14
GDS-15	5.32 (3.00)	0	11

	Before VR			After VR
Cervical VEMP	Median	Q₁	Q₃	Median	Q₁	Q₃	p-value ^* * Wilcoxon test
Left P13	15.33	15.17	15.33	15.83	14.74	15.83	0.310
Left N23	23.67	22.83	23.67	24.33	22.16	24.33	0.752
Left amplitude	42.13	17.21	42.13	30.65	16.99	30.65	0.063
Asymmetry index	20.87	10.64	20.87	30.73	19.89	30.73	0.686
Corrected asymmetry index	20.29	9.69	20.29	27.77	15.75	27.77	0.893
Right P13	16.00	14.95	16.00	16.67	16.17	16.67	0.799
Right N23	24.50	22.70	24.50	25.17	22.67	25.17	0.878
Right amplitude	44.10	15.74	40.10	26.26	9.00	11.42	0.959
Ocular VEMP
Left P15	15.50	14.67	15.50	15.29	13.50	15.29	0.273
Left N10	10.92	10.00	10.92	11.42	9.29	11.42	1.000
Left amplitude	2.11	1.10	2.11	2.93	1.46	2.93	0.144
Asymmetry index	17.91	9.27	17.21	20.78	2.11	20.78	0.655
Right P15	16.25	15.33	16.25	15.75	13.92	15.75	0.581
Right N10	10.67	10.50	10.67	10.50	9.50	10.50	1.000
Right amplitude	2.31	1.60	2.31	3.12	1.55	3.12	0.068

	Before VR			After VR
v-HIT	Median	Q₁	Q₃	Median	Q₁	Q₃	p-value ^* * Wilcoxon test
Lateral left	0.85	0.81	0.89	0.87	0.82	0.87	0.969
Lateral right	0.92	0.87	0.97	0.97	0.88	0.97	0.479
Anterior left	0.81	0.73	0.84	0.84	0.75	0.84	0.343
Anterior right	0.71	0.57	0.74	0.78	0.67	0.78	0.041
Posterior left	0.72	0.58	0.72	0.73	0.58	0.73	0.252
Posterior right	0.66	0.51	0.66	0.71	0.55	0.71	0.116
Lateral asymmetry	11.71	4.00	9.50	13.00	6.00	13.00	0.318
Anterior asymmetry	13.00	7.00	13.00	12.00	7.00	12.00	0.371
Posterior asymmetry	12.00	6.00	12.00	8.00	4.00	8.00	0.213
VAS	7.00	6.00	7.00	5.00	3.00	5.00	0.000
DHI Total	36.00	20.00	37.00	15.00	6.00	15.00	0.000
DHI Physical	14.00	8.00	14.00	2.00	0.00	2.00	0.000
DHI Functional	12.00	8.00	12.00	8.00	4.00	8.00	0.000
DHI Emotional	8.00	4.00	8.00	3.00	0.00	3.00	0.000
BBS	45.00	40.00	45.00	54.00	51.00	54.00	0.000
Pfeffer	5.00	3.00	5.00	3.00	1.25	3.00	0.000
GDS-15	2.00	0.00	2.00	1.00	0.00	1.00	0.007

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[1] Conflict of interests: No.