Despite the importance of symptomatology in the diagnosis of vestibular dysfunction, the qualitative nature of the symptoms related to semicircular canal (canal) versus otolith dysfunction is not fully understood. The purpose of this study was to compare symptoms, and their severity, in individuals with canal versus otolith peripheral vestibular dysfunction. A subjective tool, the Descriptive Symptom Index (DSI), was developed to enable categorization of symptoms as rotary, linear, imbalance or falls, and nondistinct. Fourteen adults were recruited and grouped based on vestibular function testing: canal only dysfunction, otolith only dysfunction, or canal and otolith dysfunction. Also, the Dizziness Handicap Inventory (DHI) was used to grade the severity of perceived limitations due to symptoms. The DSI was reliable and differentiated those with canal (rotary symptoms) versus otolith (linear symptoms) dysfunction. Most individuals with otolith only dysfunction did not report rotary symptoms. DHI scores were significantly higher in those with otolith dysfunction, regardless of canal functional status. All who experienced falls had otolith dysfunction and none had canal only dysfunction. Results support the importance of using linear and rotary descriptors of perceived disorientation as part of diagnosing vestibular dysfunction.
Dedicated emergency department CT scanners can have significant daily periods of consistent lack of use. The idle time can be reduced by identifying patterns of referral time and correcting specific operational delays.
Purpose/Hypothesis: The purposes of this study were to compare gait and balance performance of a patient with chronic lower extremity spasticity and other motor deficits secondary to stroke prior to botulinum toxin, following botulinum toxin, and with combined botulinum toxin and body weight supported treadmill training (BWSTT), and to determine if those outcomes were maintained across time. Number of Subjects: A single-subject design (A/B1/B2/Delayed Post-Test) was used. Materials/Methods: Four weeks following lower extremity botulinum toxin injections (B1), intense BWSTT three sessions per week for eight weeks was added to the intervention (B2). The dependent variables, measured weekly, included: Berg balance scale, timed-up-and-go, 10-meter walk test and 6-minute walk test. The stroke impact scale (SIS) was measured one time during A and the Delayed Post-Test. Results: Each dependent variable showed significant improvement from A to B1, and performance remained improved through B2 phase and at the time of the Delayed Post-Test. Clinically significant differences were found in the mobility and handicap dimensions of the SIS. Conclusions: For this participant, BWSTT did not enhance outcomes beyond those observed with botulinum toxin injections alone. Improvements that were made during intervention were maintained at the Delayed Post-Test. Clinical Relevance: Previous literature has indicated limited functional carryover following botulinum toxin injections to reduce spasticity. The participant in this study enhanced functional outcomes following botulinum toxin injections only and was able to maintain those improvements during and after intense task-specific gait training.Purpose/Hypothesis: The two studies reported here evaluate the effectiveness of electrical stimulation in the management of long standing stroke impairments in a home-based exercise program. The two targeted impairments are chronic shoulder subluxation and wrist/finger contractures. Both studies compared exercise through implanted microstimulators (BIONs) with a standard surface stimulation program. Number of Subjects: Fourteen individuals with chronic shoulder subluxation due to stroke and 16 persons with wrist or finger contractures following stroke have participated in a 6 week stimulation program, either using surface electrodes or implanted microstimulators (BIONs). The average time from the stroke was 35 months. Materials/Methods: Following consent, subjects were randomized into either surface or implant stimulation groups. Following instruction regarding the appropriate equipment, subjects exercised daily at home for two or three 30 minute stimulation sessions. The exercise program continued for 6 weeks. Assessments of passive wrist and finger range of motion, or shoulder subluxation through xray, were done before and after the exercise programs. After 6 weeks of follow-up, individuals with implants were provided support for continued use. Individuals who had been compliant with surface stimulation were offered the continued use of the s...
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