Evaluation of the Effect of Vestibular Exercises on Dizziness and Postural Control in Parkinson Patients
Introduction: Non-motor symptoms of Parkinson disease have significant effects on the quality of life in this group of patients. Among these symptoms, dizziness is associated with the changes in Orthostatic Hypotension (OH). About 30% of people over 65 years have dizziness; However, the exact mechanism of dizziness in these patients was not clear. Dizziness has symptoms such as fainting, light headache, vertigo and imbalance. The present study is based on the given fact that one of the reasons for dizziness in Parkinson patients is the disturbance of balance systems. In addition, the vestibular system is one of the main elements involved in normal balance. As, the role of vestibular system in Parkinson disease has been suggested in previous studies. The main aim of current study is to investigate the effects of vestibular exercises on the dizziness of Parkinson patients.
Materials and Methods: Twenty-four patients participated in this study based on the inclusion criteria and were randomly assigned into intervention and control groups. Dizziness Handicap Inventory-Persian (DHI-P) was used for dizziness measurement. In addition, Berg Balance Scale (BBS), Functional Reach (FR) and 2 Minutes Walking Test (2MWT) were used for measuring the postural control before and after interventions. The intervention group performed the vestibular exercises and the control group performed the conventional exercises (3 days a week for 60 minutes and a total of 24 sessions).
Results: The total score of DHI-P showed a significant improvement in the intervention group compared to the control group (P<0.001). Also, the BBS tests (P<0.001), FR (P<0.001), 2MWT (P=0.001) showed a significant improvement in the intervention group.
Conclusion: Based on the results of this study, it could be suggested that vestibular exercises, as none sophisticated, feasible, and low cost rehabilitation–protocol has beneficial effects for patients with Parkinson disease. This protocol does not need any particular equipment and can be used in all environments while it can reduce dizziness and improve motor skills and postural control in this group of patients.
Fereshtehnejad SM, Shafieesabet M, Rahmani A, Delbari A, Lökk J. Medium-to-high prevalence of screening-detected parkinsonism in the urban area of Tehran, Iran: Data from a community-based door-to-door study. Neuropsychiatric Disease and Treatment. 2015; 11:321-32. [DOI:10.2147/NDT.S77391] [PMID] [PMCID]
Rossi-Izquierdo M, Soto-Varela A, Santos-Perez S, Sesar-Ignacio A, Labella-Caballero T, Rossi-Izquierdo M, et al. Vestibular rehabilitation with computerised dynamic posturography in patients with Parkinson’s disease: Improving balance impairment. Disability and Rehabilitation. 2009; 31(23):1907-16. [DOI:10.1080/09638280902846384] [PMID]
Luxon L. Evaluation and management of the dizzy patient. Journal of Neurology, Neurosurgery & Psychiatry. 2004; 75(suppl 4):iv45-52. [DOI:10.1136/jnnp.2004.055285] [PMID] [PMCID]
Angeli S, Marchese R, Abbruzzese G, Gandolfo C, Conti M, Gasparetto B, et al. Tilt-table test during transcranial Doppler monitoring in Parkinson’s disease. Parkinsonism & Related Disorders. 2003; 10(1):41-6. [DOI:10.1016/S1353-8020 (03)00069-5]
Goldstein D, Holmes C, Dendi R, Bruce S, Li S-T. Orthostatic hypotension from sympathetic denervation in Parkinson’s disease. Neurology. 2002; 58(8):1247-55. [DOI:10.1212/WNL.58.8.1247] [PMID]
Yilmaz LÇ, Tunç T, İnan LE. The causes of dizziness in Parkinson’s disease. International Journal of Clinical Medicine. 2014; 5(12):667-73. [DOI:10.4236/ijcm.2014.512092]
Colledge N, Lewis S, Mead G, Sellar R, Wardlaw J, Wilson J. Magnetic resonance brain imaging in people with dizziness: A comparison with non-dizzy people. Journal of Neurology, Neurosurgery & Psychiatry. 2002; 72(5):587-9. [DOI:10.1136/jnnp.72.5.587] [PMCID]
Zeigelboim BS, Klagenberg KF, Teive HA, Munhoz RP, Martins-Bassetto J. Vestibular rehabilitation: clinical benefits to patients with Parkinson's disease. Arquivos de Neuro-Psiquiatria. 2009; 67(2A):219-23. [DOI:10.1590/s0004-282x2009000200009] [PMID]
Santos JB, Garcia AP. [Study of the impact of the quality of life of individuals with dizziness (PortuguesE)]. Otolaryngology Act. 2007; 25(2):152-6.
Jafarzadeh S, Bahrami E, Pourbakht A, Jalaie S, Daneshi A. Validity and reliability of the Persian version of the dizziness handicap inventory. Journal of Research in Medical Sciences. 2014; 19(8):769-75.
Jacobson GP, Newman CW. The development of the dizziness handicap inventory. Archives of Otolaryngology–Head & Neck Surgery. 1990; 116(4):424-7. [DOI:10.1001/archotol.1990.01870040046011]
Hebert JR, Corboy JR, Manago MM, Schenkman M. Effects of vestibular rehabilitation on multiple sclerosis–related fatigue and upright postural control: A randomized controlled trial. Physical Therapy. 2011; 91(8):1166-83. [DOI:10.2522/ptj.20100399] [PMID]
Hosseinabadi R, Sheibanizadeh A, Shahidi G, Gholamipur A, Kamali M. Survey of saccadic parameters using videonystagmography in patients with idiopathic Parkinson's disease and normal subjects. Audiology. 2008; 17(1).
Ansari NN, Naghdi S, Hasson S, Valizadeh L, Jalaie S. Validation of a Mini-Mental State Examination (MMSE) for the Persian population: A pilot study. Applied Neuropsychology. 2010; 17(3):190-5. [DOI:10.1080/09084282.2010.499773] [PMID]
Beck AT, Steer RA, Brown GK. Beck depression inventory-II. San Antonio: Psychological Corporation; 1996.
Ghassemzadeh H, Mojtabai R, Karamghadiri N, Ebrahimkhani N. Psychometric properties of a Persian‐language version of the Beck Depression Inventory‐Second edition: BDI‐II‐PERSIAN. Depression and Anxiety. 2005; 21(4):185-92. [DOI:10.1002/da.20070] [PMID]
Moghaddam JF, Nakhaee N, Sheibani V, Garrusi B, Amirkafi A. Reliability and validity of the Persian version of the Pittsburgh Sleep Quality Index (PSQI-P). Sleep and Breathing. 2012; 16(1):79-82. [DOI:10.1007/s11325-010-0478-5] [PMID]
Asghari A, Saed F, Dibajnia P. Psychometric properties of the Depression Anxiety Stress Scales-21 (DASS-21) in a non-clinical Iranian sample. International Journal of Psychology. 2008; 2(2):82-102.
Lovibond S, Lovibond P. Manual for the Depression Anxiety Stress Scales. Sidney: Psychology Foundation of Australia; 1995.
Morris S, Morris ME, Iansek R. Reliability of measurements obtained with the Timed ”Up & Go” test in people with Parkinson disease. Physical Therapy. 2001; 81(2):810-8. [DOI:10.1093/ptj/81.2.810] [PMID]
Frazzitta G, Maestri R, Ferrazzoli D, Riboldazzi G, Bera R, Fontanesi C, et al. Multidisciplinary intensive rehabilitation treatment improves sleep quality in Parkinson’s disease. Journal of Clinical Movement Disorders. 2015; 2(1):11. [DOI:10.1186/s40734-015-0020-9] [PMID] [PMCID]
Salavati M, Negahban H, Mazaheri M, Soleimanifar M, Hadadi M, Sefiddashti L, et al. The Persian version of the Berg Balance Scale: Inter and intra-rater reliability and construct validity in elderly adults. Disability and Rehabilitation. 2012; 34(20):1695-8. [DOI:10.3109/09638288.2012.660604]
Asgari T, Hadian MR, Nakhostin-Ansari N, Abdolvahhab M, Jalili M, Faghih-Zadeh S. [Berg Balance Scale reliability for evaluation in children with spastic diplegia (Persian)]. Archive of Rehabilitation. 2007; 8(2):13-6.
Duncan PW, Weiner DK, Chandler J, Studenski S. Functional reach: A new clinical measure of balance. Journal of Gerontology. 1990; 45(6):M192-7. [DOI:10.1093/geronj/45.6.M192]
Butland RJ, Pang JA, Gross ER, Woodcock AA, Geddes DM. Two-, six-, and 12-minute walking tests in respiratory disease. British Medical Journal (Clinical Research ed.). 1982; 284(6329):1607-8. [DOI:10.1136/bmj.284.6329.1607]
Connelly DM, Thomas BK, Cliffe SJ, Perry WM, Smith RE. Clinical utility of the 2-minute walk test for older adults living in long-term care. Physiotherapy Canada. 2009; 61(2):78-87. [DOI:10.3138/physio.61.2.78]
Severiano MIR, Zeigelboim BS, Teive HAG, Santos GJB, Fonseca VR. Effect of virtual reality in Parkinson’s disease: A prospective observational study. Archives of neuro-psychiatry. 2018; 76(2):78-84. [DOI:10.1590/0004-282x20170195] [PMID]
Petzinger GM, Holschneider D, Fisher B, McEwen S, Kintz N, Halliday M, et al. The effects of exercise on dopamine neurotransmission in Parkinson’s disease: Targeting neuroplasticity to modulate basal ganglia circuitry. Brain Plasticity. 2015; 1(1):29-39. [DOI:10.3233/BPL-150021] [PMID] [PMCID]
Lauterbach EC. The neuropsychiatry of Parkinson’s disease and related disorders. Psychiatric Clinics. 2004; 27(4):801-25. [DOI:10.1016/j.psc.2004.07.001]
Schor CM. Neuromuscular plasticity and rehabilitation of the ocular near response. Optometry and Vision Science. 2009; 86(7):E788-E802. [DOI:10.1097/OPX.0b013e3181ae00a5] [PMID]
Badaracco C, Labini FS, Meli A, Tufarelli D. Oscillopsia in labyrinthine defective patients: Comparison of objective and subjective measures. American Journal of Otolaryngology. 2010; 31(6):399-403. [DOI:10.1016/j.amjoto.2009.06.002] [PMID]
Cromwell RL, Newton RA, Carlton LG. Horizontal plane head stabilization during locomotor tasks. Journal of Motor Behavior. 2001; 33(1):49-58. [DOI:10.1080/00222890109601902] [PMID]