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Biomedical subjects

Diane M Wrisley

Publications and source records attributed to Diane M Wrisley.

11 recordsLinked to original sources
PubMed2006

Physical therapy for central vestibular dysfunction.

OBJECTIVE: To determine if vestibular physical therapy (PT) leads to improved functional outcomes in people with central vestibular dysfunction. DESIGN: Retrospective case series. SETTING: Outpatient PT clinic. PARTICIPANTS: Forty-eight patients with central vestibular dysfunction met the criteria for inclusion in this retrospective chart review. The 48 patients were divided into various subgroups including central vestibulopathy, cerebellar dysfunction, stroke, mixed central and peripheral vestibulopathy, and posttraumatic central disorders. INTERVENTION: Patients were treated with a custom-designed PT program for a mean of 5 visits over an average of 5 months. MAIN OUTCOME MEASURES: Patients completed the Activities-Specific Balance Confidence Scale, the Dizziness Handicap Inventory (DHI), the Dynamic Gait Index, the Timed Up & Go test, and the Five Times Sit-to-Stand (FTSTS) Test. RESULTS: Significant differences were demonstrated between initial evaluation and discharge in each of the assessment measures for the entire group. Post hoc tests were performed to determine if there was a significant difference in any of the assessment measures by diagnosis. Central vestibular diagnostic subgroup was shown to affect pre- to postintervention differences in the functional and disability measures (P< or =.05). With the exception of the FTSTS, effect sizes of change due to PT intervention were greater in those persons with severe disability at baseline as determined by a DHI score of more than 60. CONCLUSIONS: Patients with central vestibular dysfunctions improved in both subjective and objective measures of balance after PT intervention. Persons with cerebellar dysfunction improved the least.

Aged↗
PubMed2005

Clinical measurement of sit-to-stand performance in people with balance disorders: validity of data for the Five-Times-Sit-to-Stand Test.

BACKGROUND AND PURPOSE: People with balance disorders are characterized as having difficulty with transitional movements, such as the sit-to-stand movement. A valid and feasible tool is needed to help clinicians quantify the ability of people with balance disorders to perform transitional movements. The purpose of this study was to describe the concurrent and discriminative validity of data obtained with the Five-Times-Sit-to-Stand Test (FTSST). The FTSST was compared with the Activities-specific Balance Confidence Scale (ABC) and the Dynamic Gait Index (DGI). SUBJECTS AND METHODS: Eighty-one subjects without balance disorders and 93 subjects with balance disorders were recruited for the study. Each subject was asked to stand from a 43-cm-high chair 5 times as quickly as possible. The ABC and DGI scores were recorded. RESULTS: Subjects with balance disorders performed the FTSST more slowly than subjects without balance disorders. Discriminant analysis demonstrated that the FTSST correctly identified 65% of subjects with balance dysfunction, the ABC identified 80%, and the DGI identified 78%. The ability of the FTSST to identify subjects with balance dysfunction was better for subjects younger than 60 years of age (81%). DISCUSSION AND CONCLUSION: The FTSST displays discriminative and concurrent validity properties that make this test potentially useful in clinical decision making, although overall the ABC and the DGI are better than the FTSST at discriminating between subjects with and subjects without balance disorders.

Adolescent↗
PubMed2004

The effect of foot position on the modified clinical test of sensory interaction and balance.

OBJECTIVES: To determine whether there was a difference in the timed scores on a modified version of the Clinical Test of Sensory Interaction and Balance (CTSIB) with the feet apart versus feet together and to correlate modified CTSIB scores with Sensory Organization Test (SOT) scores. DESIGN: Prospective correlational study. SETTING: Outpatient clinic. PARTICIPANTS: Thirty patients (mean age, 58+/-17 y) with vestibular dysfunction who were undergoing vestibular therapy. INTERVENTIONS: Subjects completed the modified CTSIB with their feet together and feet apart at the end of a vestibular therapy session. Subjects also completed the SOT on the same day. MAIN OUTCOME MEASURES: Modified CTSIB scores (feet together, feet apart) and SOT scores. RESULTS: Modified CTSIB scores were slightly lower when performed with feet together as compared with feet apart. However, no statistically significant difference existed between scores on the modified CTSIB with feet together versus feet apart using the Wilcoxon signed-rank test (P<.05). The modified CTSIB correlated more strongly with SOT scores when performed with feet together than with feet apart using the Spearman rho. CONCLUSIONS: Scores on the modified CTSIB performed with the feet together did not differ from scores on the modified CTSIB performed with the feet apart. In persons with vestibular disorders, the CTSIB done with the feet together correlated more closely with the SOT.

Adult↗
PubMed2004

The influence of footwear on timed balance scores of the modified clinical test of sensory interaction and balance.

OBJECTIVES: To determine if timed balance scores on the modified Clinical Test of Sensory Interaction and Balance (CTSIB) were affected by shoe wear in patients with balance and vestibular disorders and to determine if there is a difference in correlation with the Sensory Organization Test (SOT) or in the sensitivity or specificity based on footwear. DESIGN: Prospective correlational trial. SETTING: Outpatient clinic. PARTICIPANTS: Thirty persons (mean age, 63+/-17 y) currently undergoing vestibular physical therapy (PT). INTERVENTION: All subjects completed the modified CTSIB with their shoes on and off at the end of a PT session; 16 of them (53%) also completed the SOT on the same day. MAIN OUTCOME MEASURES: Scores on the modified CTSIB and SOT. RESULTS: No difference existed between scores on the modified CTSIB with shoes on versus off. Similar correlation was found between the modified CTSIB performed with the shoes on and off and SOT scores. The sensitivity and specificity of the modified CTSIB was similar with shoes on and off. CONCLUSIONS: The modified CTSIB can be performed with or without shoes, with no difference expected in patient score or test sensitivity or specificity.

Adult↗
PubMed2004

Is perception of handicap related to functional performance in persons with vestibular dysfunction?

OBJECTIVE: The purpose of this study was to determine if scores between 0 and 30 (mild), 31 and 60 (moderate), and 61 and 100 (severe) on the Dizziness Handicap Inventory (DHI) differentiated a person's functional abilities. STUDY DESIGN: Retrospective case series. SETTING: Tertiary balance outpatient center. PATIENTS: Patients (n = 85; mean age, 61 years) with a variety of vestibular diagnoses participated. INTERVENTIONS: Patients completed the DHI, the Dynamic Gait Index (DGI), the 5 times sit to stand test (FTSST), the Activities-specific Balance Confidence (ABC) scale, gait speed, and the Timed "Up & Go" (TUG) during the same session. Reported numbers of falls within the last 4 weeks were recorded. MAIN OUTCOME MEASURES: The DGI, FTSST, ABC, gait speed, TUG, and gait speed were compared among DHI groups. RESULTS: Significant differences were identified using an analysis of variance between DHI groups on the DGI, the FTSST, ABC, and number of falls (p < 0.05). A significant difference was found between DHI groups (mild vs. severe and moderate vs. severe) on the DGI (p < 0.05) with greater DHI scores exhibiting more impaired walking. The FTSST was different between DHI groups mild and severe and DHI groups moderate and severe (p < 0.05), with slower FTSST scores with higher DHI scores. Reported falls were higher among the severe DHI group and the other 2 DHI groups (p < 0.05). All 3 DHI groupings were different from each other on the ABC (p < 0.001). CONCLUSION: Patients who perceive a greater handicap as a result of dizziness demonstrate greater functional impairment than patients who perceive less handicap from dizziness.

Adolescent↗
PubMed2004

Reliability, internal consistency, and validity of data obtained with the functional gait assessment.

BACKGROUND AND PURPOSE: The Functional Gait Assessment (FGA) is a 10-item gait assessment based on the Dynamic Gait Index. The purpose of this study was to evaluate the reliability, internal consistency, and validity of data obtained with the FGA when used with people with vestibular disorders. SUBJECTS: Seven physical therapists from various practice settings, 3 physical therapist students, and 6 patients with vestibular disorders volunteered to participate. METHODS: All raters were given 10 minutes to review the instructions, the test items, and the grading criteria for the FGA. The 10 raters concurrently rated the performance of the 6 patients on the FGA. Patients completed the FGA twice, with an hour's rest between sessions. Reliability of total FGA scores was assessed using intraclass correlation coefficients (2,1). Internal consistency of the FGA was assessed using the Cronbach alpha and confirmatory factor analysis. Concurrent validity was assessed using the correlation of the FGA scores with balance and gait measurements. RESULTS: Intraclass correlation coefficients of.86 and.74 were found for interrater and intrarater reliability of the total FGA scores. Internal consistency of the FGA scores was.79. Spearman rank order correlation coefficients of the FGA scores with balance measurements ranged from.11 to.67. DISCUSSION AND CONCLUSION: The FGA demonstrates what we believe is acceptable reliability, internal consistency, and concurrent validity with other balance measures used for patients with vestibular disorders.

Adult↗
PubMed2004

The sensitivity and specificity of the Timed "Up & Go" and the Dynamic Gait Index for self-reported falls in persons with vestibular disorders.

The purpose of this study was to determine the sensitivity and specificity of the Timed "Up & Go" (TUG) and Dynamic Gait Index in identifying self-reported fallers among persons with vestibular dysfunction. One hundred three patient charts were included from a tertiary vestibular physical therapy practice. The patients ranged in age from 14-90 years and had vestibular diagnoses, falls reported in the patient chart, and completed the TUG and/or the Dynamic Gait Index (DGI). Thirty-one persons reported falling one or more times in the previous 6 months during their initial assessment. Persons who took longer than 13.5 seconds to perform the TUG test were 3.7 times more likely to have reported a fall in the previous 6 months. Those persons with scores less than or equal to 18 on the DGI were 2.7 times (p = 0.03) more likely to have reported a fall in the previous 6 months. The sensitivity of the DGI at 18 or less was 70% and the specificity was 51%. People who scored greater than 11.1 seconds on the TUG were 5 times (p = 0.001) more likely to have reported a fall in the previous 6 months. Sensitivity (80%) and specificity (56%) were calculated for TUG scores of greater than 11.1 seconds. The TUG and the DGI appear to be helpful in identifying fall risk in persons with vestibular dysfunction. Slower scores on the TUG (> 11.1 seconds) and lower scores on the DGI (18) correlated with reports of falls in persons with vestibular dysfunction.

Accidental Falls↗
PubMed2003

Reliability of the dynamic gait index in people with vestibular disorders.

OBJECTIVE: To examine the interrater reliability of the Dynamic Gait Index (DGI) when used with patients with vestibular disorders and with previously published instructions. DESIGN: Correlational study. SETTING: Outpatient physical therapy clinic. PARTICIPANTS: Subjects included 30 patients (age range, 27-88y) with vestibular disorders, who were referred for vestibular rehabilitation. INTERVENTIONS: Subjects' performance on the DGI was concurrently rated by 2 physical therapists experienced in vestibular rehabilitation to determine interrater reliability. MAIN OUTCOME MEASURES: Percentage agreement, kappa statistics, and the ratio of subject variability to total variability were calculated for individual DGI items. Kappa statistics for individual items were averaged to yield a composite kappa score of the DGI. Total DGI scores were evaluated for interrater reliability by using the Spearman rank-order correlation coefficient. RESULTS: Interrater reliability of individual DGI items varied from poor to excellent based on kappa values (kappa range,.35-1.00). Composite kappa values showed good overall interrater reliability (kappa=.64) of total DGI scores. The Spearman rho demonstrated excellent correlation (r=.95) between total DGI scores given concurrently by the 2 raters. CONCLUSION: DGI total scores, administered by using the published instructions, showed moderate interrater reliability with subjects with vestibular disorders. The DGI should be used with caution in this population at this time, because of the lack of strong reliability.

Adult↗
PubMed2002

The effect of age on vestibular rehabilitation outcomes.

OBJECTIVE: The purpose of the retrospective chart review was to compare vestibular rehabilitation outcomes in young versus older adults. STUDY DESIGN: Retrospective matched design. METHODS: Twenty-three persons with vestibular disorders aged 20 to 40 years were matched by gender, vestibular diagnosis, and vestibular function test results to 23 older adults aged 60 to 80 years. The patients were treated with a custom-designed physical therapy exercise program. Patients completed the Dizziness Handicap Inventory, the Activities-Specific Balance Confidence (ABC) scale, and the Dynamic Gait Index; number of falls; and rated the severity of their dizziness. The two-sample test, the Mann-Whitney test, and McNemar's test for correlated proportions were used to determine whether there was a difference in scores between the two age groups at the beginning and end of physical therapy. RESULTS: During the initial evaluation, older adults reported having statistically greater space and motion discomfort and more severe symptoms on a scale of 0 to 100. Younger adults had more impaired DGI scores and a higher proportion of caloric testing abnormalities. After rehabilitation, overall improvement was seen in both the younger and older populations. There were no statistical differences between the two groups on the DHI, the DGI, reported symptoms at discharge, or number of falls. When only the complete matched-pair data were analyzed, there were no statistically significant differences between the age groups in the proportion of patients demonstrating clinical improvement. CONCLUSION: Age does not significantly influence the beneficial effects of vestibular rehabilitation for persons with vestibular disorders.

Adult↗
PubMed2002

Vestibular rehabilitation outcomes in patients with a history of migraine.

OBJECTIVES: The purpose of this study was to assess the efficacy of physical therapy for patients with vestibular disorders with and without a history of migraine headaches. STUDY DESIGN: Retrospective case series. SETTING: Outpatient physical therapy clinic. PATIENTS: Thirty patients with both a history of migraine and a diagnosis of vestibular/balance disorder considered unrelated to migraine were identified by retrospective chart review. Thirty patients without a history of migraine, matched retrospectively by diagnosis, vestibular function, and age (+/-5 years), were used as a comparison group. INTERVENTIONS: Both groups were treated with a custom-designed physical therapy program for a mean of 4.1 visits over a mean of 3.3 months. MAIN OUTCOME MEASURES: Patients completed the Dizziness Handicap Inventory, the Activities-Specific Balance Confidence Scale, the Dynamic Gait Index, and the Timed Up & Go Test and rated the severity of their dizziness on an analog scale of 0 to 100. RESULTS: Significant differences were demonstrated within both groups between initial evaluation and discharge in each of the assessment measures used. Patients with a history of migraine demonstrated worse scores on all outcome measures than did the patients without a history of migraine. There were no statistically significant differences between the two groups' scores before and after therapy except for the total Dizziness Handicap Inventory score at discharge (p < 0.05). CONCLUSIONS: Patients with vestibular disorders with or without a history of migraine demonstrated improvements in both subjective and objective measures of balance after physical therapy. Patients with a history of migraine perceived a greater handicap from dizziness than did patients without a history of migraine that was greater than the difference in physical function performance measures between groups.

Aged↗