University Hospital Lucus Augusti

Lugo, Spain

University Hospital Lucus Augusti

Lugo, Spain

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Basta D.,Charité - Medical University of Berlin | Rossi-Izquierdo M.,University Hospital Lucus Augusti | Soto-Varela A.,University of Santiago de Compostela | Greters M.E.,University of Sao Paulo | And 7 more authors.
Otology and Neurotology | Year: 2011

Objective: Vestibular rehabilitation strategies mostly require a long-lasting training in stance conditions, which is finally not always successful. The individualized training in everyday-life conditions with an intuitive tactile neurofeedback stimulus seems to be a more promising approach. Hence, the present study was aimed at investigating the efficacy of a new vibrotactile neurofeedback system for vestibular rehabilitation. Study Design: Double-blinded trial. Patients: One hundred five patients who experience one of the following balance disorders for more than 12 months were included in the study: canal paresis, otolith disorder, removal of an acoustic neuroma, microvascular compression syndrome, Parkinson's disease, and presbyvertigo. Interventions: Vibrotactile neurofeedback training was performed daily (15 min) over 2 weeks with the Vertiguard system in those 6 tasks of the Standard Balance Deficit Test with the most prominent deviations from the normative values. Main Outcome Measures Trunk and ankle sway, dizziness handicap inventory, and vestibular symptom score were measured in the verum and placebo group before the training, on the last training day and 3 months later. Results: A significant reduction in trunk and ankle sway as well as in the subjective symptom scores were observed in the verum group. Such an effect could not be found in any of the outcome parameters of the placebo group. Conclusion: The vibrotactile neurofeedback training applied in the present study is a highly efficient method for the reduction of body sway in different balance disorders. Because the rehabilitation program is easy to perform, not exhausting, and time saving, elderly patients and those with serious, long-lasting balance problems also can participate successfully. © 2011, Otology & Neurotology, Inc.


Basta D.,Charité - Medical University of Berlin | Rossi-Izquierdo M.,University Hospital Lucus Augusti | Soto-Varela A.,University of Santiago de Compostela | Ernst A.,Charité - Medical University of Berlin
Otology and Neurotology | Year: 2013

OBJECTIVE: Mobility is crucial to maintain a sufficient quality of life. Posturography should be therefore focused on the investigation of daily-life activities (mobile posturography). Nowadays, postural control is often estimated by stance tasks on a force plate under different sensorimotor conditions. This technique applies an indirect approximation of the center of body mass and is not related to tasks required for mobility. An alternative approach would be the direct measurement of body sway during daily-life conditions close to the center of body mass. The present study was aimed at investigating normal age-dependent postural control strategies by analyzing the body sway of male and female subjects in daily-life tasks. Furthermore, the results were compared with data of age- and sex-matched vestibular disorders to determine the sensitivity of the mobile posturography. STUDY DESIGN: Prospective study. PATIENTS: The patient group included 76 subjects, and the control group comprised a total of 246 healthy volunteers. Trunk sway measures were performed using the Vertiguard-D device. With the device fixed by a belt at the hip (center of body mass), the subjects had to undergo 14 daily-life tasks under different sensorimotor conditions. Ankle sway was determined during the sensory organization test (SOT) on the BalanceMaster force plate in all patients by estimating the center of body mass from center of pressure changes within the plantar area. RESULTS: A nonlinear relationship between age and body sway was observed in majority of all the conditions. Furthermore, large sex-related differences in body sway were observed.The sensitivity of the mobile posturography was higher than determined during the SOT-force plate measurements or reported in literature before for state-of-the-art platform posturography. CONCLUSION: The present results indicate that the method introduced here can quantify postural deficits in a broad range and in an inhomogenous sample of patients. Copyright © 2013 Otology & Neurotology, Inc.


Rossi-Izquierdo M.,University Hospital Lucus Augusti | Ernst A.,Charité - Medical University of Berlin | Soto-Varela A.,University of Santiago de Compostela | Santos-Perez S.,University of Santiago de Compostela | And 3 more authors.
Gait and Posture | Year: 2013

The aim of this study was to assess effectiveness of balance training with a vibrotactile neurofeedback system in improving overall stability in patients with Parkinson's disease (PD).Ten patients diagnosed with idiopathic PD were included. Individualization of the rehabilitation program started with a body sway analysis of stance and gait tasks (Standard Balance Deficit Test, SBDT) by using the diagnostic tool of the applied device (Vertiguard®-RT). Those tasks with the poorest outcome as related to age- and gender-related controls were included in the training program (not more than six tasks). Improvement of postural stability was assessed by performing SBDT, Sensory Organization Test (SOT) of Computerized Dynamic Posturography (CDP), Dizziness Handicap Inventory (DHI), activity-specific balance confidence scale and recording the number of falls over the past three months. Furthermore, scores of SOT and DHI of 10 PD patients previously trained in an earlier study (by using CDP) were compared with results of those in the present study.After neurofeedback training (NFT), there was a statistically significant improvement in body sway (calculated over all training tasks), number of falls, and scores of SOT, DHI and ABC. In comparison with CDP-training, a statistically significant higher increase of SOT score was observed for patients after NFT with the Vertiguard-RT device compared to CDP training.Our results showed that a free-field vibrotactile NFT with Vertiguard®-RT device can improve balance in PD patients in everyday life conditions very effectively, which might led in turn to a reduction of falls. © 2012 Elsevier B.V.


Rossi-Izquierdo M.,University Hospital Lucus Augusti | Santos-Perez S.,University of Santiago de Compostela | Soto-Varela A.,University of Santiago de Compostela
European Archives of Oto-Rhino-Laryngology | Year: 2011

Vestibular rehabilitation has been found to be effective and safe in patients with instability. There is insufficient evidence, however, for distinguishing between the efficacies of different rehabilitation techniques. The objective of this study is to verify whether there are differences between two instrumental vestibular rehabilitation techniques, computerised dynamic posturography (CDP) and optokinetic stimulation (OKN), in order to establish the optimal strategy for each patient. We conducted a prospective, comparative study of the two techniques (CDP and OKN) in patients with instability due to chronic unilateral peripheral vestibular disorder. We randomly included 12 patients in each group, performing the evaluation with the Dizziness Handicap Inventory and the CDP with the sensorial organisation test (SOT), rhythmic weight shift and limits of stability (LOS). We found a statistically significant improvement in both groups in average balance score according to the SOT. In the OKN group, however, improvement was greater in visual preference. The CDP group showed greater benefits in the visual and vestibular input and LOS. Patients with poor vestibular and visual input or with reduced LOS will benefit more from an exercise protocol with CDP. Patients with poor visual preference, however, are ideal candidates for rehabilitation with OKN. © 2011 Springer-Verlag.


Amor-Dorado J.C.,University Hospital Lucus Augusti | Barreira-Fernandez M.P.,University Hospital Lucus Augusti | Aran-Gonzalez I.,Complexo Hospitalario Of Pontevedra | Casariego-Vales E.,University Hospital Lucus Augusti | And 2 more authors.
Otology and Neurotology | Year: 2012

Objective: To compare the outcome and probability of recurrence in a series of patients with unilateral idiopathic benign paroxysmal positional vertigo of the posterior canal (PC-BPPV) that were randomly treated by Brandt-Daroff exercise (B-D exercise) or by particle repositioning maneuver (PRM). Study Design: Randomized prospective clinical trial. Setting: Tertiary referral center. Patients: Patients were included in this study if they complained of vertigo and had been diagnosed as having unilateral idiopathic PC-BPPV for at least 1 week before Dix-Hallpike maneuver (DHM), remained for 30 days in the randomly assigned treatment, and had at least 48 months' follow-up. INTERVENTION: Forty-one patients were treated with a single PRM and 40 patients by B-D exercise. MAIN OUTCOME MEASURE: Resolution of benign paroxysmal positional nystagmus on the DHM. The probability of recurrence was also studied. Results: At Day 7, DHM was negative in 80.5% of the PRM-treated patients and in 25% of those treated by B-D exercise (p < 0.001). At Month 1, the differences between both treatment groups remained statistically significant (92.7% in PRM versus 42.5% in the B-D exercise had a negative DHM; p < 0.001). The variable that influenced that DHM became negative was the PRM (RR = 4.8; 95% confidence interval, 2.5-9.2; p < 0.001). The number of recurrences in PRM and B-D exercise were 0.56 ± 0.8 and 0.48 ± 0.8, respectively (p = 0.48). The recurrence rate at 48 months was 35.5% (15/41) in B-D exercise and 36.6% (9/31) in the PRM group (p = 0.62). Although the time interval until the first recurrence was similar (p = 0.44), patients included in the PRM group showed a significantly longer time interval between the first and second recurrence (p = 0.04). Conclusion: PRM is more effective treatment and as safe as B-D exercise in the short term for unilateral and idiopathic PC-BPPV, and although it does not reduce the probability of recurrence in the 4-year follow-up period compared with B-D exercise, it may delay the second recurrence's onset in those patients who had already experienced a single recurrence. Our study supports the use of PRM as the treatment of choice in unilateral and idiopathic PC-BPPV, although exercise may be also considered as an alternative treatment in selected cases. © 2012, Otology & Neurotology, Inc.


PubMed | Hospital Clinico Universitario, University of Santiago de Compostela and University Hospital Lucus Augusti
Type: Journal Article | Journal: Aging clinical and experimental research | Year: 2016

The aim of the study is to assess whether obesity affects balance in elderly patients with postural instability.It is a case-control study, with cases defined by BMI 30kg/m(2), and developed in a third level university hospital.We included 135 patients aged 65years old or more who presented postural instability. Balance assessment was through the sensory organisation test (SOT), limits of stability (LOS) and rhythmic weight shift (RWS) of computerised dynamic posturography (CDP) and the modified timed up-and-go (TUG) test. The patients also completed the Dizziness Handicap Inventory and short Falls Efficacy Scale-International questionnaire.Patients with obesity took longer to perform the modified TUG and required more steps. Also these patients had poorer scores in the subjective tests. In the CDP there were no significant differences in the SOT nor the LOS, and only there was a statistical significant difference in the anterior-posterior directional control of the RWS. Obese patients have a higher risk of fallings compared to non-obese patients.In essence, our results indicate that obesity interferes in the balance of elderly patients with postural instability, putting them at a greater risk of fallings, performing worse dynamic tasks and feeling more disabled. Although continued education on training balance may be useful in older population, since the obese group shows more rate of fallers, rehabilitation programmes focus on dynamic tasks in these patients could be useful to reduce their fall risk and improve their quality of life.


PubMed | University Hospital Lucus Augusti
Type: Journal Article | Journal: European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery | Year: 2015

To assess whether a subjective questionnaire that measures the disability caused by balance disorders in daily life activities is correlated to objective assessment of balance in elderly patients with age-related instability. We included 37 subjects aged 65 years or more who presented balance disorders induced solely by age. Balance assessment was through the sensory organisation test and limits of stability of computerised dynamic posturography, the SwayStar system and the modified timed up and go test. The patients also completed the dizziness handicap inventory (DHI) questionnaire. The SwayStar balance control index (BCI) was most significantly correlated to the DHI score and the score of its different scales. When we divided the patients into subgroups according to DHI score, we only found statistically significant differences in the BCI and number of falls. In our population of elderly patients with instability, there is practically no correlation between the DHI and the static balance assessment. However, there is greater correlation with the BCI, which could show that dynamic balance is perceived as more disabling for these patients. In this case, when designing a rehabilitation protocol we should focus more on dynamic activities such as gait.


PubMed | University Hospital Lucus Augusti, University of Santiago de Compostela, Hospital Clinico Universitario and Complexo Hospitalario Universitario
Type: Comparative Study | Journal: Auris, nasus, larynx | Year: 2015

The aim of this study is to determine whether clinical and instrumental examination of balance can predict the risk of falls in elderly patients with instability.It is a case control study, with cases defined by falls in the last year, developed in a third level university hospital.Seventy patients aged 65 years or more who met at least one of the following inclusion criteria: (a) at least one fall in the last year; (b) spend more than 15s during the timed up and go test (TUG); (c) a score of less than 68% average balance in the sensory organisation test (SOT) of the computerised dynamic posturography (CDP); or (d) at least one fall in the CDP-SOT.TUG test, CDP-SOT, CDP centre of gravity balancing (CG) and limits of stability (LOS), Dizziness Handicap Inventory (DHI) test and short FES-I test.Number of steps and time (TUG), average balance and use of sensorial information (CDP-SOT), speed and directional control (CDP-CG and LOS), DHI score and short FES-I score.Comparing subjects without falls (non-fallers) vs subjects with at least one fall (fallers) in the last year, fallers obtain worse scores than non-fallers in condition 2 (p=0.043) and use of somatosensory information (p=0.039). Comparing subjects with five falls or less (non-multiple-fallers) vs subjects with more than five falls (multiple-fallers), multiple-fallers obtain worse scores than non-multiple-fallers in overall balance (p=0.023), condition 6 (p=0.036), directional control (swaying (p=0.006) and LOS (p=0.023)) and short FES-I score (p=0.007).The three most useful parameters for identifying unstable elderly patients at particularly high risk of repeated falls are mean balance in the CDP SOT, directional control of CDP LOS and short FES-I score.


PubMed | University of Santiago de Compostela, Complexo Hospitalario Universitario and University Hospital Lucus Augusti
Type: Journal Article | Journal: The Annals of otology, rhinology, and laryngology | Year: 2016

To analyze the equilibriometric differences between 2 populations of elderly patients (young elderly and very elderly) with instability induced solely by age.Cross-sectional study, with 2 study groups classified according to patient age (cut-points in twenty-fifth and seventy-fifth percentiles of the age of the sample).64 patients aged 65 years or more. Two groups of 32 subjects were established: group A (people 65 years of age or older but less than 72.6, twenty-fifth percentile) and group B (patients 82.5 years, seventh-fifth percentile, or older). Main analyzed variables: timed up-and-go test, sensory organization test of the computerized dynamic posturography, Dizziness Handicap Inventory (DHI), and Short Falls Efficacy Scale-International (FES-I) questionnaires. Students t test or the Mann-Whitney test were used.The older patients obtain poorer scores in the equilibriometric tests but not in all of them. In the sensory organization test, the older patients make poorer use of visual and vestibular information; they also require more time and steps for the timed up-and-go. With regards to the questionnaires, fear of falling is greater (higher Short FES-I scores) but not subjective perception of disability (DHI scores without differences).There is a need to establish aged subgroups of elderly patients with instability, adapting therapeutic strategies.


PubMed | Complexo Hospitalario Universitario Of Santiago, Hospital Clinico Universitario, University Hospital Lucus Augusti and Complexo Hospitalario Universitario
Type: Journal Article | Journal: Aging clinical and experimental research | Year: 2015

Evaluate the effectiveness of vestibular rehabilitation (VR) to improve the balance in older people, assessed immediately afterwards.(a) To verify the maintenance of improvement of the balance achieved in the medium term (6-12 months). (b) To consider whether this improvement results in a reduction in the number of falls. (c) To compare among themselves the effectiveness of three different methods of VR in improving balance and to explore whether there are differences to achieve a reduction in the number of falls.Experimental study, single-centre, open, randomised (balanced blocks of patients) in four branches in parallel, in 220 elderly patients (over 64 years) with high risk of falls and a follow-up period of 12 months.Department of Otolaryngology of the University Hospital of Santiago.People over 64 years, fulfilling one of the following requirements: (a) At least one fall in the last year. (b) Take at least 16 s or require some support in perform the test timed up and go. (c) A percentage of average balance in the sensory organisation test (SOT) in the dynamic posturography (CDP) <68%. (d) At least one fall in any of the conditions in the SOT of CDP.Three different protocols of VR.The percentage of average balance in the SOT in CDP. Secondary measures: time and supports in the test of timed up and go, scores of the dynamic posturography and SwayStar system, and rate of falls.

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