Dario Alpini

Short form of the Dizziness Handicap Inventory: construction and validation through Rasch analysis.

A new item response scale is presented, which measures the severity of self-reported balance deficits. The scale, DHIsf, is a short form of the Dizziness Handicap Inventory. The scale was constructed and validated by Rasch analysis. Rasch analysis was applied to rescore or remove any items misfitting, redundant, or off-target, until an optimal instrument was obtained. The 25-item, 3-level Dizziness Handicap Inventory was, thus, reduced to the 13-item, 2-level DHIsf. The retained items explore the domains of eye/head movements, full body activities, and mood alterations. Data were collected from 55 outpatients (63 +/- 13 yr; 43 females) attending otoneurological rehabilitation referral at a general hospital because of complaints of dizziness or imbalance. They were fully independent in ambulation and showed no evidence of major neurological or orthopedic diseases. Objective tests included brain computed tomography, sovraaorctic Doppler sonography, craniocorpography, static posturography, and nystagmography. The findings were categorized as pathologic, borderline, or normal. At least one examination was borderline or abnormal in 42 patients. The DHIsf was well targeted on this sample, with a mean score of 5.7/13 (standard deviation, 2.8; median, 5; range, 1-13). The Rasch statistics showed that the 13 items evenly fitted a hierarchy of difficulty within a homogeneous construct. A moderate but significant variance explanation of DHIsf measures was provided by a two-way analysis of variance model, with craniocorpography and nystagmography as independent categorical variables (r2 = 0.15; P = 0.018). When the clinical tests were individually taken into account, their outcome (dichotomized as abnormal v borderline or normal) could not be predicted by either of the DHIsf measures or raw scores (logistic regression). The DHIsf compares favorably with the original Dizziness Handicap Inventory, shows some consistency with the instrumental findings, and provides original information on the severity of imbalance syndromes, as it is seen from the patients perspective.

The application of virtual reality to document coping deficits after a stroke: Report of a case

An immersive virtual reality (IVR) paradigm to assess cognitive flexibility and problem solving was used to document everyday life-coping failures in a patient with cognitive sequelae of an anterior left thalamic stroke. Three years after the ischemie event, the patient was showing clear signs of frontal lobe dysfunction when left unsupervised in real-life settings, yet his performance on traditional neuropsychological tests tapping frontal functions was unremarkable. We speculated, and provided evidence, that his conduct was influenced by the setting and the presence of an examiner who would strengthen his impaired ability to self-generate control over a number of higher order cognitive activities. Thanks to the immersive effect and nonverbal aspects of the interaction provided by IVR, we could document our patients cognitive difficulties on two separate occasions. The reasons why IVR was superior to traditional tests are analyzed with reference to well-known cognitive models of the way frontal networks...

Virtual Environments in the Diagnosis, Prevention, and Intervention of Age-Related Diseases: A Review of VR Scenarios Proposed in the EC VETERAN Project

A group of worldwide virtual reality and health-care researchers have decided to combine their efforts in a multidisciplinary project titled VETERAN-virtual environments in the diagnosis, prevention and intervention of age-related diseases. The main goal of the VETERAN project is the tuning and testing of different virtual environments, designed to address the cognitive/functional impairments that may occur due to the aging process and age-related disorders. In particular the developed modules will address the problems commonly found in the following pathologies that have a strong impact on the elderly health care policy: Alzheimers disease and other senile dementias; stroke and unilateral spatial neglect; mobility-related accidents within specific environments (e.g., falls, shocks). The project will focus on research into clinical aspects of age-related diseases and disorders of high morbidity and specifically target goals of prevention, treatment, or delay in onset. Another goal of the VETERAN project is to define and develop new protocols and tools to be used for general rehabilitation purposes. These tools will aim to provide systematic restorative training within the context of functionally relevant, ecologically valid simulated environments. This approach is hoped to optimise the degree of transfer of training and/or generalisation of learning to the persons real world environment.

Chronic cerebrospinal venous insufficiency in Meniere disease

Objectives The aim of this study was to focus on patients suffering from cochleo-vestibular disorder with and without Ménière disease (MD) in order to verify whether chronic cerebrospinal drainage abnormalities could play a role in the etiopathogenesis of endolymphatic hydrops. Methods Fifty-two volunteers were enrolled and subdivided into two groups: 24 definite MD and 28 not-MD. Both magnetic resonance venography imaging with contrast-enhanced imaging of the venous cerebrospinal system (MRV) and venous echo-color Doppler (ECD) were performed. Results MRV showed abnormalities in 83% of MD and 57% of not-MD subjects (p < 0.001). Asymmetrical cervical venous flow, assessed by MRV, was confirmed by ECD in 62.5% of MD but in only 21.5% of not-MD subjects (p<0.001). Conclusion Chronic cerebrospinal venous insufficiency might be the anatomical background, which provides a predisposing factor for the development of endolymphatic hydrops in MD patients.

Figure ice skating induces vestibulo-ocular adaptation specific to required athletic skills

The aim of the paper is to investigate whether rotational vestibulo-ocular and visuo-vestibulo-ocular reflexes may undergo different adaptive gain changes depending on specific athletic motor skills required by the different specialities of figure skating. Twenty-five right-handed athletes from the Italian National Figure Skating Team were investigated, divided into three groups according to their discipline: 8 dancers, 13 singles and 4 pairs. Rotational vestibulo-ocular and visuo-vestibuloocular reflexes were recorded by electrooculography as slow phases of per-rotatory nystagmus during 0.10-Hz sinusoidal stimulation, respectively, in the darkness and in the light. Gain was reduced only in dancers whereas it was normal in singles and pairs. A clearcut clockwise directional preponderance was revealed only in dancers. The results confirm that, also from a vestibular point of view, singles and dancers look different, with pairs as an intermediate pattern. Furthermore, it has been shown that the human rotational vestibulo-ocular system is capable of asymmetric adaptation. Alterations in rotational vestibulo-ocular parameters observed in figure skaters result from vestibular habituation, but these kind of adaptations depend on the athletic tasks specific for each discipline, and they provide evidence for interdependent mechanisms for control of clockwise and counterclockwise oculomotor control at least in the low-frequency stimulation domain.

Nickel earlobe dermatitis and clinical non-relevance of the oral exposure

Objective  Nickel is the most common cause of allergic contact dermatitis (ACD). Because nickel restriction is commonly imposed on many patients with the only earlobe ACD to nickel hypersensitivity, the aim of this study was to identify the role of occasional and extended oral nickel exposure in these patients.

Postural control modifications induced by synchronized ice skating

Some papers investigated the effects of specialized trainings on postural control adaptation. Particularly, several studies have been performed in ballet dancers. To our knowledge postural control in ice skaters, in general, has not yet been studied. Synchronized skating is an internationally recognized form of figure skating in which a team of 16 athletes, usually female, skate together. Similarities exist between the training regimens of synchronized skaters and ballet dancers with the major difference being that the skaters must maintain postural control during high velocity movement across the ice, that can be viewed as a destabilizing surface. In the present paper we compare static postural control in Synchronized skaters and a control group of physically fit individuals who had not received any on ice training or specialized balance training in order to investigate if the specialized type of activity that synchronized skaters regularly participate on ice may modify postural control. Posturography (Tetrax by Sunlight, Israel) was recorded from 18 female synchronized skaters (mean 21.5 years of age), members of the Italian National Synchronized Skating Team. The control group consisted of 15 females (mean age 22.5 years). The parameters considered in this study were dimensionless values. They were: stability indicator (ST) which represents the status of the general postural stability: stability was lower in skaters than in controls in all conditions even not significant (p=0.10); weight distribution, expressed as an index named “Weight Distribution Index” (WDI). Synchronized skaters unexpectedly showed higher WDI values (less balance) than the Controls under the less challenging rigid pressure plate conditions. Yet, when place on the more challenging 10 cm foam padded pressure plate, the Skaters had lower WDI values than the Controls (better balance).

Ménière disease and gluten sensitivity: Recovery after a gluten-free diet

We report the case of a 63-year-old female with definite unilateral Ménière disease, osteoarthritis of the distal finger joints with mucous cysts and Heberdens nodes, and constipation with recurrent abdominal pain whose symptoms remitted after 6months of a restrictive gluten-free diet.

Bilateral sudden sensorineural hearing loss and chronic venous cerebrospinal insufficiency: a case report.

Objectives: We report a case of bilateral sudden sensorineural hearing loss (SSHL) in a patient suffering from chronic venous cerebrospinal insufficiency (CCSVI). Methods: Audiometric testing confirmed bilateral sensorineural hearing loss with hypoexcitability to caloric stimulation on the left side and echo-colour Doppler examination showed abnormal cerebral venous deficiency. Results: The patients condition improved after 15 days following medical treatment. Conclusions: CCSVI may explain the anatomical background which provides a predisposing factor for SSHL although further studies are needed to verify whether this observation is casual or coincidental.

Influence of compact disk recording protocols on reliability and comparability of speech audiometry outcomes: acoustic analysis

OBJECTIVE To assess whether different compact disk recording protocols, used to prepare speech test material, affect the reliability and comparability of speech audiometry testing. MATERIAL AND METHODS We conducted acoustic analysis of compact disks used in clinical practice, to determine whether speech material had been recorded using similar procedures. To assess the impact of different recording procedures on speech test outcomes, normal hearing subjects were tested using differently prepared compact disks, and their psychometric curves compared. RESULTS Acoustic analysis revealed that speech material had been recorded using different protocols. The major difference was the gain between the levels at which the speech material and the calibration signal had been recorded. Although correct calibration of the audiometer was performed for each compact disk before testing, speech recognition thresholds and maximum intelligibility thresholds differed significantly between compact disks (p < 0.05), and were influenced by the gain between the recording level of the speech material and the calibration signal. CONCLUSION To ensure the reliability and comparability of speech test outcomes obtained using different compact disks, it is recommended to check for possible differences in the recording gains used to prepare the compact disks, and then to compensate for any differences before testing.