Oculomotor and Vestibular Ocular Reflex Exercises in Patients With Benign Paroxysmal Positional Vertigo

NCT05333198 | Completed DMC

• 1 other identifier: RiphahIU Ezza Zikrea
• Study Type: interventional
• Target: 32
• Locations: 1 country
• Sites: 1

Brief Summary

The aim of this research is to assess effects of Oculomotor and VOR exercises on vertigo, dizziness and balance in patients with BPPV. Randomized controlled trial was conducted at Hameed Latif Hospital, Lahore. The sample size 32 participants which were divided into two groups, 16 participants in traditional physical therapy group and 16 in oculomotor and vestibular ocular reflex exercises group. Study duration was of 6 months. Sampling technique applied was non-probability consecutive sampling technique. Only 30-70 years individuals with Benign Paroxysmal Positional Vertigo (BPPV) were included. Tools used in the study are vertigo handicap questionnaire, visual vertigo analogue scale, dizziness handicap inventory, berg balance scale and dynamic gait index. The data was analyzed using SPSS.

Conditions

Benign Paroxysmal Positional Vertigo (Disorder)

Keywords

Benign Paroxysmal Positional Vertigo; Oculomotor exercises; Vestibular Ocular Reflex (VOR) exercises

Outcome Measures

Primary Outcomes (10)

• Vertigo Handicap Questionnaire

  It assess effect of vertigo on disability, handicap and benefits following therapeutic intervention both physically and psychologically.

  First reading at 0 day

• Vertigo Handicap Questionnaire

  It assess effect of vertigo on disability, handicap and benefits following therapeutic intervention both physically and psychologically.

  second reading after 3 weeks

• Visual Vertigo Analogue Scale

  Intensity of visual vertigo in nine challenging situations of visual motions that typically provoke dizziness

  First reading at 0 day

• Visual Vertigo Analogue Scale

  Intensity of visual vertigo in nine challenging situations of visual motions that typically provoke dizziness

  second reading after 3 weeks

• Dizziness Handicap Inventory

  Self-perceived handicapping effects imposed by dizziness.

  First reading at 0 day

• Dizziness Handicap Inventory

  Self-perceived handicapping effects imposed by dizziness.

  second reading after 3 weeks

• Berg Balance Scale

  Objectively determine a patient's ability (or inability) to safely balance during a series of predetermined tasks

  First reading at 0 day

• Berg Balance Scale

  Objectively determine a patient's ability (or inability) to safely balance during a series of predetermined tasks

  First reading at 3 week

• Dynamic Gait Index

  The clinical tool to assess gait, balance and fall risk. It evaluates not only usual steady-state walking, but also walking during more challenging tasks.

  first reading after 0 day

• Dynamic Gait Index

  The clinical tool to assess gait, balance and fall risk. It evaluates not only usual steady-state walking, but also walking during more challenging tasks.

  second reading after 3 weeks

Study Arms (2)

Traditional physical therapy using Epley's maneuver

OTHER

Epley's maneuver was performed once a week for three weeks. The maneuver was performed by patient in sitting position, head was rotated towards involved side and then extended to 30 degrees, it was then rotated to 180 degrees followed by patient rolling onto opposite side. Each position was maintained for 1-2 minutes.

Other: Traditional physical therapy using Epley's maneuver

Oculomotor and Vestibular Ocular Reflex (VOR) exercises

ACTIVE COMPARATOR

oculomotor and VOR exercises after Epley's maneuver. The exercises were performed for approximately 5 minutes daily or 1 to 2 minutes, 3 to 4 times a day, in sitting position. The exercises were continued for three weeks. The maneuver was performed by patient in sitting position, head was rotated towards involved side and then extended to 30 degrees, it was then rotated to 180 degrees followed by patient rolling onto opposite side. Each position was maintained for 1-2 minutes. Saccadic exercises were performed by moving eyes between two stationary targets. Smooth pursuit exercises were performed by tracking a moving target while keeping head still and VOR exercises were performed by moving head left to right while maintaining eyes on stationary target

Other: Oculomotor and Vestibular Ocular Reflex (VOR) exercises

Interventions

Traditional physical therapy using Epley's maneuver OTHER

Epley's maneuver was performed once a week for three weeks. The maneuver was performed by patient in sitting position, head was rotated towards involved side and then extended to 30 degrees, it was then rotated to 180 degrees followed by patient rolling onto opposite side. Each position was maintained for 1-2 minutes.

Traditional physical therapy using Epley's maneuver

Oculomotor and Vestibular Ocular Reflex (VOR) exercises OTHER

oculomotor and VOR exercises after Epley's maneuver. The exercises were performed for approximately 5 minutes daily or 1 to 2 minutes, 3 to 4 times a day, in sitting position. The exercises were continued for three weeks. The maneuver was performed by patient in sitting position, head was rotated towards involved side and then extended to 30 degrees, it was then rotated to 180 degrees followed by patient rolling onto opposite side. Each position was maintained for 1-2 minutes. Saccadic exercises were performed by moving eyes between two stationary targets. Smooth pursuit exercises were performed by tracking a moving target while keeping head still and VOR exercises were performed by moving head left to right while maintaining eyes on stationary target

Oculomotor and Vestibular Ocular Reflex (VOR) exercises

Eligibility Criteria

• Age: 30 Years - 60 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Patients who have vertigo with posterior canal involvement during Dix-Hallpike test with or without accompanying nystagmus (objective or subjective BPPV).
• Ability to walk at least 3 meters by itself with or without assistive device
• Normal vision with or without correction by spectacles or contact lenses

You may not qualify if:

• Patients with other neurologic conditions, orthopedic problems, and uncontrolled metabolic diseases to eliminate confounding factors affecting balance performance
• Unable to understand and answer a simple verbal command.
• Previously underwent oculomotor and vestibular ocular exercises.
• Other vestibular disorders like Meniere disease
• Long-term use of benzodiazepines (more than 20 years).
• Patients who are already performing structured physical activities such as muscle strengthening exercises, Pilates, yoga or high intensity aerobic exercises

Sponsors & Collaborators

• Riphah International University: lead

Study Sites (1)

Binash Afzal

Lahore, Punjab Province, 54000, Pakistan

Location

Related Publications (10)

• Kim HJ, Lee JO, Choi JY, Kim JS. Etiologic distribution of dizziness and vertigo in a referral-based dizziness clinic in South Korea. J Neurol. 2020 Aug;267(8):2252-2259. doi: 10.1007/s00415-020-09831-2. Epub 2020 Apr 16.

  PMID: 32300888 BACKGROUND

• Scocco DH, Garcia IE, Barreiro MA. Sitting Up Vertigo. Proposed Variant of Posterior Canal Benign Paroxysmal Positional Vertigo. Otol Neurotol. 2019 Apr;40(4):497-503. doi: 10.1097/MAO.0000000000002157.

  PMID: 30870365 BACKGROUND

• Dunlap PM, Holmberg JM, Whitney SL. Vestibular rehabilitation: advances in peripheral and central vestibular disorders. Curr Opin Neurol. 2019 Feb;32(1):137-144. doi: 10.1097/WCO.0000000000000632.

  PMID: 30461465 BACKGROUND

• Wu P, Cao W, Hu Y, Li H. Effects of vestibular rehabilitation, with or without betahistine, on managing residual dizziness after successful repositioning manoeuvres in patients with benign paroxysmal positional vertigo: a protocol for a randomised controlled trial. BMJ Open. 2019 Jun 18;9(6):e026711. doi: 10.1136/bmjopen-2018-026711.

  PMID: 31217316 BACKGROUND

• Kane AW, Diaz DS, Moore C. Physical Therapy Management of Adults with Mild Traumatic Brain Injury. Semin Speech Lang. 2019 Feb;40(1):36-47. doi: 10.1055/s-0038-1676652. Epub 2019 Jan 7.

  PMID: 30616293 BACKGROUND

• Hillier S, McDonnell M. Is vestibular rehabilitation effective in improving dizziness and function after unilateral peripheral vestibular hypofunction? An abridged version of a Cochrane Review. Eur J Phys Rehabil Med. 2016 Aug;52(4):541-56. Epub 2016 Jul 12.

  PMID: 27406654 BACKGROUND

• Arnold SA, Stewart AM, Moor HM, Karl RC, Reneker JC. The Effectiveness of Vestibular Rehabilitation Interventions in Treating Unilateral Peripheral Vestibular Disorders: A Systematic Review. Physiother Res Int. 2017 Jul;22(3). doi: 10.1002/pri.1635. Epub 2015 Jun 25.

  PMID: 26111348 BACKGROUND

• Meldrum D, Burrows L, Cakrt O, Kerkeni H, Lopez C, Tjernstrom F, Vereeck L, Zur O, Jahn K. Vestibular rehabilitation in Europe: a survey of clinical and research practice. J Neurol. 2020 Dec;267(Suppl 1):24-35. doi: 10.1007/s00415-020-10228-4. Epub 2020 Oct 13.

  PMID: 33048219 BACKGROUND

• Mempouo E, Lau K, Green F, Bowes C, Ray J. Customised vestibular rehabilitation with the addition of virtual reality based therapy in the management of persistent postural-perceptual dizziness. J Laryngol Otol. 2021 Oct;135(10):887-891. doi: 10.1017/S0022215121002127. Epub 2021 Aug 10.

  PMID: 34372958 BACKGROUND

• Lin SI, Tsai YJ, Lee PY. Balance performance when responding to visual stimuli in patients with Benign Paroxysmal Positional Vertigo (BPPV). J Vestib Res. 2020;30(4):267-274. doi: 10.3233/VES-200709.

  PMID: 32925126 BACKGROUND

MeSH Terms

Conditions

Benign Paroxysmal Positional Vertigo; Motor Activity

Interventions

Reflex, Vestibulo-Ocular; Exercise

Condition Hierarchy (Ancestors)

Vertigo; Vestibular Diseases; Labyrinth Diseases; Ear Diseases; Otorhinolaryngologic Diseases; Neurologic Manifestations; Nervous System Diseases; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Behavior

Intervention Hierarchy (Ancestors)

Vestibulocochlear Physiological Phenomena; Physiological Phenomena; Reflex; Nervous System Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena; Motor Activity; Movement; Musculoskeletal Physiological Phenomena

Study Officials

• Binash Afzal, PhD*

  Riphah International University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: January 21, 2022
• First Posted: April 18, 2022
• Study Start: February 15, 2021
• Primary Completion: October 15, 2021
• Study Completion: December 15, 2021
• Last Updated: April 18, 2022

Record last verified: 2022-04

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)