Increased Symptom Severity and Persistence of Postural Control Deficits in Patients With Otolith Versus Canal Vestibular Dysfunction

Abstract

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...