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Biomedical subjects

Joseph M Furman

Publications and source records attributed to Joseph M Furman.

29 records · Page 2Linked to original sources
PubMed2004

Validation of a brief nurse-administered migraine assessment tool.

OBJECTIVE: To validate a brief tool for screening migraine. BACKGROUND: Migraine is a common, but underdiagnosed condition. Effective utilization of nonphysician personnel to reliably screen patients for migraine may improve identification of migraineurs for clinical treatment and research. METHODS: An 8-question Migraine Assessment Tool (based on International Headache Society criteria) was designed for administration by a nurse with no specialized headache training as a pre-assessment for the diagnosis of migraine for use in either a research or clinical environment. A community sample of 80 adults (71 women, 9 men; mean age, 33.7 years; 80% white, 14% African American, 2.5% Asian American) with self-reported headache was recruited through advertisements. A headache specialist independently diagnosed subjects using clinical assessment, and a nurse who works in a balance disorder clinic used the Migraine Assessment Tool. Agreement between physician and nurse-administered Migraine Assessment Tool diagnoses was determined. Each subject returned in 2 to 4 weeks for a second assessment, administered by the same nurse. Agreement between the 2 diagnoses from the Migraine Assessment Tool was calculated. RESULTS: Comparison between diagnosis by the physician versus the Migraine Assessment Tool revealed a positive predictive value of 0.85; negative predictive value, 0.84; sensitivity, 0.89; specificity, 0.79; and observed agreement, 0.85. Cohen's kappa reliability measure was 0.69, indicating good test reliability. Interestingly, in 8 of the 12 cases of disagreement, the examiner diagnosing nonmigraine diagnosed analgesic overuse headache. Comparing diagnoses assigned by the 2 separate administrations of the Migraine Assessment Tool revealed a Cohen's kappa of 0.69. Notably, 9 of the 12 cases of nonagreement on the 2 assessments were due to subjects endorsing analgesic overuse in only 1 of the 2 testing sessions. CONCLUSIONS: This study showed good reliability and stability of a new, brief, nurse-administered migraine questionnaire. In addition, the study also showed that consistency in self-reporting analgesic overuse within individuals with headache is poor. This suggests the need for repeat questioning about analgesic overuse on subsequent appointments to ensure absence of analgesic overuse headache.

Adult↗
PubMed2004

Effect of preparation on dual-task performance in postural control.

The authors applied an overlapping-task design to study the interaction between postural control and cognitive task processes in young (n = 10) and older (n = 10) adults. A rapid destabilizing floor translation was followed at specific time intervals by a simple auditory reaction time (RT) task. The translations were preceded by either an informational cue or no cue. Interference between postural task demands and the RT task was found only in the first 50 ms. Cueing also had an effect on both the onset of the postural recovery response and RT performance. The results suggest (a) only a brief interference between postural and cognitive processing demands in relatively easy tasks, (b) competition for a common central mechanism, possibly a response-selection mechanism, and (c) no differential impact of aging on that interaction.

Adult↗
PubMed2003

Visual-vestibular stimulation interferes with information processing in young and older humans.

Attention has been implicated in postural control and other tasks requiring sensory integration. The purpose of this study was to investigate the role of attention in sensory-motor processing of vestibular and combined visual-vestibular information during seated rotations using a dual-task interference approach. We hypothesized that auditory information processing would be influenced by concurrent visual-ocular, vestibulo-ocular, or combined visual-vestibulo-ocular processing. We further hypothesized that the effect would be greater in older subjects. Twenty older subjects (10 women, 10 men, 69.3+/-3.2 years) and 20 young subjects (10 women, 10 men, 23.5+/-2.9 years) were asked to perform information-processing tasks while they underwent several types of vestibular, visual-vestibular, and ocular motor paradigms. The information-processing tasks were: (1) an auditory simple reaction-time task (SRT), (2) an auditory go-no-go (disjunctive) reaction-time task (DRT), and (3) an auditory forced-choice task (CRT). The visual-vestibular-ocular motor conditions included: (1) no movement/darkness (NO), (2) no movement/fixation (FIX), (3) no movement/pursuit (P), (4) earth-vertical axis rotation (EVAR) in darkness, (5) EVAR with fixation (E-FIX), (6) off-vertical axis rotation (OVAR) in darkness, and (7) OVAR with fixation (O-FIX). Results showed that older subjects had longer reaction times for all combinations of stimulus condition and reaction-time task compared with young subjects. Compared with the NO baseline, reaction times during EVAR were longer for young and older subjects and during OVAR were longer for the young subjects. For FIX and P, the reaction times during P exceeded those during FIX and during NO for both groups. For E-FIX and O-FIX, reaction times did not differ from those during EVAR and OVAR. The interference with information processing by concurrent vestibular stimulation in the dark may be based upon cortical inhibition of auditory processes by vestibular stimulation. Eye movements induced by EVAR showed an increased phase lead during reaction-time tasks, suggesting altered vestibulo-ocular reflex (VOR) dynamics, possibly based on cerebellar-mediated changes in velocity storage. Since fixation of a head-fixed visual target did not add to the effect of rotation in the dark, a further implication of our results is that VOR-fixation while performing a concurrent information-processing task may be accomplished primarily by VOR suppression rather than by VOR cancellation.

Acoustic Stimulation↗
PubMed2003

Orientation of Listing's plane during static tilt in young and older human subjects.

Three-dimensional eye positions, when expressed as rotation vectors, are constrained to lie in a head-fixed Listing's plane. The offset and orientation of Listing's plane changes when the head is tilted. To assess the influence of age on this phenomenon, young (less than 30 years old) and older (>65 years old) human subjects were seated upright, pitched nose up and nose down, and rolled right ear down and left ear down. Listing's plane was computed from eye movements recorded using a dual scleral search coil while subjects scanned a complex visual scene. During pitch, Listing's plane counterpitched with respect to the head, while during roll, it translated in a manner consistent with "ocular counterrolling". There was no significant difference in this reorientation of Listing's plane between the young and older subjects. The only obvious difference between the two age groups was that the "thickness" of Listing's plane was greater in the older subjects. This suggests that aging has a small, but definite, influence on Listing's law.

Adaptation, Physiological↗
PubMed2003

Migrainous vertigo: development of a pathogenetic model and structured diagnostic interview.

PURPOSE OF REVIEW: Vestibular symptoms occur frequently in patients with migraine. This review refines recently proposed diagnostic criteria for migraine-related vestibular symptoms, and develops a pathophysiological model for the interface between migraine and the vestibular system. RECENT FINDINGS: The epidemiological link between migraine and vestibular symptoms and signs suggests shared pathogenetic mechanisms. Links between the vestibular nuclei, the trigeminal system, and thalamocortical processing centers provide the basis for the development of a pathophysiological model of migraine-related vertigo. During the last year, several studies have increased understanding of the relationship between migraine and vestibular symptoms. A study of motion sickness and allodynia in migraine patients supports the importance of central mechanisms of sensitization for migraine-related vestibular symptoms. A study has demonstrated effective treatment of vertigo with migraine therapy. The identification of migrainous vertigo, however, is hampered by a lack of standardized assessment criteria for both clinical and research practices. The application of published criteria for the diagnosis of migrainous vertigo allows the development of a standardized, structured assessment interview. SUMMARY: An understanding of the relationship between migraine and the vestibular system increases knowledge of the pathogenesis of both migraine and vertigo. In addition, studies have identified successful treatment, with standard migraine therapies, of vestibular symptoms in patients with both migraine and vertigo. The use of a standardized assessment tool to identify this unique population of patients will help future studies to test both the pathological model and effective treatment options.

Cerebral Cortex↗
PubMed2003

Otolith-ocular responses in patients with surgically confirmed unilateral peripheral vestibular loss.

The chronic effects of unilateral peripheral vestibular loss (UPVL) are influenced by vestibular compensation. This study documents the balance-related symptoms and quantitative vestibular laboratory testing of 20 patients with surgically confirmed UPVL. Included are measures of the semicircular canal-ocular reflex, the otolith-ocular reflex, and both static and dynamic semicircular canal-otolith-interaction. This study differs from previous studies of patients with UPVL in that a large number of patients with surgically confirmed lesions were tested with three types of off-vertical axis rotation, several of the patients had anatomically preserved superior vestibular nerves, and self-perceived level of disability related to dizziness and imbalance were available. Results confirmed previously reported changes in the vestibulo-ocular reflex of patients with UPVL. Also, there was no apparent effect of anatomically preserving the superior vestibular nerve during surgical resection of vestibular schwannomas based on either subjective or objective measures of vestibular dysfunction. Further, there were no apparent correlations between subjective measures of dizziness and imbalance and objective measures of vestibulo-ocular function. These results have clinical implications for the management of patients with unilateral vestibular loss and provide insights into the process of vestibular compensation especially with respect to the otolith-ocular reflex.

Adult↗
PubMed2002

Attentional dynamics in postural control during perturbations in young and older adults.

Temporal dynamics of attention during postural perturbations in young and older adults were investigated. Nineteen young and older subjects performed simple reaction time tasks during translational platform perturbations. Auditory or visual stimuli were presented randomly at delays from the onset of the platform perturbation. Reaction time was slowed before and during the platform movement, particularly in older subjects. Reaction times to stimuli presented at a 250-millisecond delay or later were not influenced by perturbation. The reaction times to the auditory stimuli were influenced more by perturbation than were those to visual targets. The postural response was unaltered by the presence of the reaction time task, but it differed between groups. Attention is engaged in response to a perturbation during the preperturbation time and during the initiation of the postural response in young and older adults. Sensory selection occurs in young and older adults, but to a greater degree in older subjects.

Accidental Falls↗
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↗
PubMed2002

Voluntary upper-extremity movements in patients with unilateral peripheral vestibular hypofunction.

BACKGROUND AND PURPOSE: People with peripheral vestibular pathology demonstrate motor impairments when responding and adapting to postural platform perturbations and during performance of sit-to-stand and locomotor tasks. This study investigated the influence of unilateral peripheral vestibular hypofunction on voluntary arm movement. SUBJECTS AND METHODS: Subjects without known neurological impairments and subjects with vestibular impairments performed 3 voluntary arm movements: an overhead reach to a target, a sideward reach to a target, and a forward flexion movement through 90 degrees. Subjects performed these tasks under precued and choice reaction time conditions. During all tasks, body segment motion was measured. Head velocity measurements were calculated for the side task only. RESULTS: Subjects with vestibular loss restricted upper body segment motion within the frontal and transverse planes for the 90-degree and overhead tasks. Average angular head velocity was lower for the group with vestibular hypofunction. Task uncertainty (the introduction of a choice reaction time paradigm) differentially influenced the groups regarding head velocity at target acquisition. DISCUSSION AND CONCLUSION: Individuals with vestibular loss altered their performance of voluntary arm movements. Such alterations may have served to minimize the functional consequences of gaze instability.

Analysis of Variance↗