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Biomedical subjects

Joseph M Furman

Publications and source records attributed to Joseph M Furman.

At least 19 recordsLinked to original sources
PubMed2006

Visually induced postural sway in anxiety disorders.

Postural sensitivity to moving visual environments in patients with anxiety disorders was studied. We hypothesized that patients with anxiety disorders would have greater sway in response to a moving visual environment compared to healthy adults, especially if they have space and motion discomfort (SMD). Twenty-one patients with generalized anxiety without panic (NPA) and 38 patients with panic and agoraphobia (PAG) were compared to 22 healthy controls. SMD was evaluated in all subjects via questionnaire. Subjects stood on a force platform that was either fixed or rotating with the subject (i.e., sway referenced) during exposure to a sinusoidally moving visual surround. Center of pressure (COP) data were computed from force transducers in the platform as a measure of sway. Results showed that patients swayed significantly more in response to the moving visual scene compared to control subjects, with no differences between the NPA and PAG groups. SMD was a predictor of sway response in the patients: patients with high SMD swayed significantly more than both Controls and anxiety patients with low SMD. These results indicate that patients with anxiety disorders, particularly those with SMD, are more visually dependent for balance. This subgroup of patients may be amenable to treatment used for patients with balance disorders (i.e., vestibular rehabilitation) that focuses on sensory re-integration processes that address visual sensitivity.

Adolescent↗
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↗
PubMed2006

Responses to a virtual reality grocery store in persons with and without vestibular dysfunction.

People with vestibular dysfunction often complain of having difficulty walking in visually complex environments. Virtual reality (VR) may serve as a useful therapeutic tool for providing physical therapy to these people. The purpose of this pilot project was to explore the ability of people with and without vestibular dysfunction to use and tolerate virtual environments that can be used in physical therapy. We have chosen grocery store environments, which often elicit complaints from patients. Two patients and three control subjects were asked to stand and navigate in VR grocery stores while finding products. Perceived discomfort, simulator sickness symptoms, distance traveled, and speed of head movement were recorded. Symptoms and discomfort increased in one subject with vestibular dysfunction. The older subjects traveled a shorter distance and had greater speed of head movements compared with young subjects. Environments with a greater number of products resulted in more head movements and a shorter distance traveled.

Activities of Daily Living↗
PubMed2005

Prevention of motion sickness with rizatriptan: a double-blind, placebo-controlled pilot study.

BACKGROUND: Serotonergic triptan medications effectively reverse pain and associated symptoms of migraine. Vestibular symptoms, including dizziness and vertigo, occur in about one-third of migraineurs. The most frequent and consistent balance symptom in migraineurs is motion sickness, which is experienced by about half of migraineurs and may be related to serotonergic influences. This double-blind, placebo-controlled, crossover pilot study was designed to test the hypothesis that pre-treatment with the serotonin agonist rizatriptan would prevent motion sickness provocation in headache-free migraineurs. MATERIAL/METHODS: Ten healthy adult migraineurs (5 migrainous vertigo and 5 migraine without associated vestibular symptoms) with a history of motion sickness were tested in three sessions: a baseline vestibular battery and two motion sickness provocation sessions two hours following randomly ordered blinded pre-treatment with either oral rizatriptan 10 mg or placebo. Motion sickness was assessed using two standardized questionnaires. RESULTS: Motion sickness scores were lower following pre-treatment with rizatriptan compared with placebo in subjects with migrainous vertigo. Rizatriptan did not affect motion sickness in migraineurs without vertigo. Otolith-ocular reflex sensitivity was reduced following pretreatment with rizatriptan in both groups. CONCLUSIONS: This is the first study in humans testing a triptan serotonin agonist as a preventive tool for motion sickness. Rizatriptan prevented the development of motion sickness and severe motion sickness symptoms in patients with migrainous vertigo. These pilot data suggest a possible role for serotonin in the development of motion sickness symptoms in migraineurs with migrainous vertigo.

Adult↗
PubMed2005

The influence of dynamic visual cues for postural control in children aged 7-12 years.

Young children rely heavily on vision for postural control during the transition to walking. Although by 10 years of age, children have automatic postural responses similar to adults, it is not clear when the integration of sensory inputs becomes fully developed. The purpose of this study was to examine this transition in the sensory integration process in children aged 7-12 years. Healthy children and adults stood on a fixed or sway-referenced support surface while viewing full-field optic flow scenes that moved sinusoidally (0.1 and 0.25 Hz) in an anterior-posterior direction. Center of pressure was recorded, and measures of sway amplitude and phase were calculated at each stimulus frequency. Children and adults had significant postural responses during approximately two-thirds of the trials. In adults, there was a 90% decrease in sway on the fixed surface compared with the sway-referenced surface, but only a 50% decrease in children. The phase between the optic flow stimulus and postural response in children led that of adults by 52 degrees at 0.1 Hz and by 15 degrees at 0.25 Hz. Adults and children aged 7-12 years have similar ability to use dynamic visual cues for postural control. However, 7-12-year-old children do not utilize somatosensory cues to stabilize posture to the same extent as adults when visual and somatosensory cues are conflicting.

Adult↗
PubMed2005

Otoneurology.

Explore the source record for details and available documents.

Humans↗
PubMed2005

Motion sickness in migraine sufferers.

Motion sickness commonly occurs after exposure to actual motion, such as car or amusement park rides, or virtual motion, such as panoramic movies. Motion sickness symptoms may be disabling, significantly limiting business, travel and leisure activities. Motion sickness occurs in approximately 50% of migraine sufferers. Understanding motion sickness in migraine patients may improve understanding of the physiology of both conditions. Recent literature suggests important relationships between the trigeminal system and vestibular nuclei that may have implications for both motion sickness and migraine. Studies demonstrating an important relationship between serotonin receptors and motion sickness susceptibility in both rodents and humans suggest possible new motion sickness prevention therapies.

Humans↗
PubMed2005

Acrophobia and pathological height vertigo: indications for vestibular physical therapy?

BACKGROUND AND PURPOSE: Acrophobia (fear of heights) may be related to a high degree of height vertigo caused by visual dependence in the maintenance of standing balance. The purpose of this case report is to describe the use of vestibular physical therapy intervention following behavioral therapy to reduce a patient's visual dependence and height vertigo. CASE DESCRIPTION: Mr N was a 37-year-old man with agoraphobia (fear of open spaces) that included symptoms of height phobia. Exposure to heights triggered symptoms of dizziness. Intervention. Mr N underwent 8 sessions of behavioral therapy that involved exposure to heights using a head-mounted virtual reality device. Subsequently, he underwent 8 weeks of physical therapy for an individualized vestibular physical therapy exercise program. OUTCOMES: After behavioral therapy, the patient demonstrated improvements on the behavioral avoidance test and the Illness Intrusiveness Rating Scale, but dizziness and body sway responses to moving visual scenes did not decrease. After physical therapy, his dizziness and sway responses decreased and his balance confidence increased. DISCUSSION: Symptoms of acrophobia and sway responses to full-field visual motion appeared to respond to vestibular physical therapy administered after completion of a course of behavioral therapy. Vestibular physical therapy may have a role in the management of height phobia related to excessive height vertigo.

Adult↗
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↗
PubMed2005

Vestibular function in migraine-related dizziness: a pilot study.

Migraine-related dizziness (MRD) refers to a disorder in which vestibular symptoms are an integral part of migraine symptomatology. The purpose of this study was to better define the pathophysiology of MRD, which is incompletely understood and to generate hypotheses regarding MRD by assessing the semicircular canal-ocular reflex, the otolith-ocular reflex, visual-vestibular interaction, vestibulo-spinal function, and visually induced postural sway. Subjects included five subjects with MRD, five subjects with migraine without dizziness, and five headache-free controls. Subjects with migraine were tested interictally. Results indicated that the mean gain of the semicircular canal-ocular reflex during both sinusoidal and constant velocity rotation was reduced in subjects with MRD. No changes were noted in the dynamics of the semicircular canal-ocular reflex. The otolith-ocular reflex, assessed with constant velocity OVAR, indicated that subjects with MRD showed a larger modulation component. No group differences were found in the bias component during constant velocity OVAR, nor in semicircular canal-otolith interaction or visual-vestibular interaction. Computerized dynamic posturography indicated that subjects with MRD demonstrated a surface-dependent pattern. Postural sway during optic flow indicated that subjects with MRD swayed more than the other subjects. We hypothesize that competing processes of serotonergic excitation and inhibition alter central vestibular pathways differently for semicircular canal vs. otolithic responses and for vestibulo-ocular vs. vestibulo-spinal pathways.

Adult↗
PubMed2004

Simulator sickness when performing gaze shifts within a wide field of view optic flow environment: preliminary evidence for using virtual reality in vestibular rehabilitation.

BACKGROUND: Wide field of view virtual environments offer some unique features that may be beneficial for use in vestibular rehabilitation. For one, optic flow information extracted from the periphery may be critical for recalibrating the sensory processes used by people with vestibular disorders. However, wide FOV devices also have been found to result in greater simulator sickness. Before a wide FOV device can be used in a clinical setting, its safety must be demonstrated. METHODS: Symptoms of simulator sickness were recorded by 9 healthy adult subjects after they performed gaze shifting tasks to locate targets superimposed on an optic flow background. Subjects performed 8 trials of gaze shifting on each of the six separate visits. RESULTS: The incidence of symptoms of simulator sickness while subjects performed gaze shifts in an optic flow environment was lower than the average reported incidence for flight simulators. The incidence was greater during the first visit compared with subsequent visits. Furthermore, the incidence showed an increasing trend over the 8 trials. CONCLUSION: The performance of head unrestrained gaze shifts in a wide FOV optic flow environment is tolerated well by healthy subjects. This finding provides rationale for testing these environments in people with vestibular disorders, and supports the concept of using wide FOV virtual reality for vestibular rehabilitation.

Journal Article↗
PubMed2004

Underdevelopment of the postural control system in autism.

OBJECTIVE: To determine if abnormalities exist in postural control in autism and if they are related to age. METHODS: Dynamic posturography was performed in 79 autistic individuals without mental retardation and 61 healthy volunteers between ages 5 and 52 years. Both the sensory organization and the movement coordination portions of the test were performed. RESULTS: The autistic subjects had reduced postural stability (p = 0.002). Examination of age effects revealed that the development of postural stability was delayed in the autistic subjects (p < 0.001) and failed to achieve adult levels (p = 0.004). Postural stability was reduced under all conditions but was clinically significant only when somatosensory input was disrupted alone or in combination with other sensory challenges (mean reduction in stability of 2.6 +/- 1.0 for the first three conditions without somatosensory disruption vs 6.7 +/- 2.7 for the last three conditions with somatosensory disruption), indicating problems with multimodality sensory integration. CONCLUSIONS: The evidence from this and studies of the motor system suggests more general involvement of neural circuitry beyond the neural systems for social behavior, communication, and reasoning, all of which share a high demand on neural integration of information.

Adolescent↗
PubMed2004

Diagnosis of migrainous vertigo: validity of a structured interview.

BACKGROUND: Migraine and vestibular symptoms are co-morbid. Migraine is increasingly recognized as a cause of benign, recurrent vertigo. Although the International Headache Society does not currently include the diagnosis of migrainous vertigo, specific criteria have been proposed and utilized in clinical trials. MATERIAL/METHODS: Seventeen adult migraineurs were separately screened for the diagnosis of migrainous vertigo using a standardized structured interview for migrainous vertigo (SIM-V) and a clinical evaluation by an experienced neurotologist. The SIM-V was administered by a nurse who read and recorded subject responses, obtaining no additional information for the diagnosis of migrainous vertigo. Comparison of diagnoses between clinician and SIM-V was made using Cohen's kappa reliability testing. Subjects were asked to return for a second interview by the same nurse using the SIM-V, at least 2 weeks after the initial assessment. Testing stability was evaluated by comparing diagnoses obtained with each SIM-V administration. RESULTS: Cohen's kappa demonstrated excellent test validity (kappa=0.75). Fourteen subjects returned for repeat testing, with excellent retest stability (kappa=0.85). The additional three subjects could not be relocated or were not interested in attending a retest appointment. CONCLUSIONS: The SIM-V is an easy-to-administer screening tool for the diagnosis of migrainous vertigo. Diagnostic comparison to a standard clinical assessment shows good test validity. Retest stability was also demonstrated. The SIM-V may be a useful screening tool for migraineurs with an additional complaint of dizziness.

Adult↗
PubMed2004

Cognitive influences in postural control of patients with unilateral vestibular loss.

The aim of this study was to investigate the interference between postural control and cognitive processing in patients with surgically confirmed unilateral vestibular lesions. These patients were well-compensated for vestibular lesions with no symptoms of dizziness or definable postural deficit. We hypothesized that attentional processes would play a greater role in postural control of these patients compared to healthy age-matched controls suggesting that successful compensation for a vestibular impairment involves ongoing increased attentional resources, and is not an automatic process. To explore this hypothesis, we used a dual-task paradigm that combined postural challenges with concurrently performed cognitive tasks. The postural conditions were seated, standing on a fixed floor, standing on a sway-referenced floor, and standing on a translating floor. Cognitive tasks were simple, inhibitory, and forced choice reaction time (RT) tasks. Patients had slower RTs compared to the controls under all conditions, including the seated condition. This effect was particularly large for the choice and inhibitory tasks. Both groups had increased RTs as the postural task became more challenging. Postural sway increased similarly in the patients and controls when performing the RT tasks for all postural conditions. These results suggest that patients with vestibular lesions that are well-compensated require increased attention compared to healthy controls; however, this increased demand on attention extends beyond postural control. The site of action may be at the sensory integration level resolving multiple sensory signals for spatial orientation.

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↗