Fernando Freitas Ganança

Versão brasileira do Dizziness Handicap Inventory

Background: impact of dizziness on life quality (LQ). Aim: to adapt the Dizziness Handicap Inventory (DHI) for application in the Brazilian population; to assess its reproducibility; and to describe the results obtained in patients with chronic dizziness. Method: The DHI was initially applied in 45 patients with chronic dizziness and with a clinical diagnosis of vestibular syndrome. The application followed the stages of translation - from English to Portuguese - and linguistic adaptation, grammatical and idiomatic equivalence review and evaluation of its intra and inter-researchers reproducibility. Reproducibility was assessed by using the Wilcoxon Test for two dependent samples, P < 0.05. The questionnaire was applied on 250 patients with chronic vestibular syndrome in order to evaluate the impact of dizziness on LQ. Results: The Brazilian version of the DHI (Brazilian DHI) was well comprehended by the studied population and no statistically significant difference was found in the inter-researcher (P = 0.418) and intra-researcher (P = 0.244) reproducibility. All of the studied patients presented a loss in LQ due to dizziness. Aspects which were most affected were the physical ones, followed by, in a decreasing order, the functional and the emotional ones. Functional aspects were more compromised in older individuals. No association was verified between gender and the overall mean scores of the DHI and between gender and the mean scores of each aspect assessed by the DHI. Conclusion: the DHI was culturally adapted for application in the Brazilian population (Brazilian DHI). This instrument was considered to be a reliable tool to evaluate the impact of dizziness on LQ. Patients with chronic dizziness and with clinical diagnosis of vestibular syndrome presented a loss in LQ, due to this symptom. This loss was verified by the application of the Brazilian DHI. Physical aspects were the most compromised.

Tinnitus handicap inventory: adaptação cultural para o Português brasileiro

TEMA: o zumbido pode provocar muitos prejuizos na qualidade de vida dos pacientes. A avaliacao de quanto a qualidade de vida e prejudicada pelo zumbido pode ser util para o melhor conhecimento do paciente em relacao as limitacoes impostas por este sintoma, a programacao terapeutica e a verificacao da eficacia terapeutica, quando aplicado antes e apos o tratamento. OBJETIVO: adaptar culturalmente o Tinnitus Handicap Inventory (THI) para aplicacao na populacao brasileira e avaliar a sua reprodutibilidade. METODO: a adaptacao cultural do THI (Newman et al., 1996) seguiu as etapas indicadas por Guillemin et al. (1993), que incluem a traducao do idioma Ingles para o Portugues, adaptacao linguistica e revisao das equivalencias gramatical e idiomatica. Realizou-se, tambem, a avaliacao das reprodutibilidades inter e intra-pesquisadores deste questionario. Participaram 30 pacientes com zumbido, dos sexos feminino 19 (63,3%) ou masculino 11 (36,7%), com idade entre 39 e 79 anos (media 56,8 anos), encaminhados a partir de ambulatorio especifico em otoneurologia. RESULTADOS: o THI foi adaptado para ser aplicado na populacao brasileira, denominado THI Brasileiro. Nao houve diferenca estatisticamente significante quanto a reprodutibilidade inter-pesquisadores nos resultados obtidos a aplicacao da versao brasileira deste questionario, bem como da reprodutibilidade intra-pesquisadores. Verificou-se prejuizo da qualidade de vida em relacao aos aspectos emocionais, funcionais e/ou catastroficos em todos os pacientes avaliados. CONCLUSAO: o THI foi traduzido e adaptado culturalmente para ser aplicado na populacao brasileira, mostrando-se um instrumento confiavel para verificacao do prejuizo causado pelo zumbido na qualidade de vida.

Interferência da tontura na qualidade de vida de pacientes com síndrome vestibular periférica

Dizziness is one of the most common symptoms referred by adults. This symptom can decrease the dizzy patients quality of life. AIM: To describe the results obtained from the application of the Brazilian version of the DHI and compare them with the conclusion of the vestibular test of the same patients. STUDY DESIGN: Clinical randomized. MATERIAL METHOD: Twenty five consecutive patients with chronic dizziness complaint were submitted to this questionnaire at the Otoneurology Clinic of the Universidade Federal de Sao Paulo. These patients were female and male adults with ages ranging from 44 to 88 years. RESULTS: All patients presented handicap in their quality of life due to dizziness, mainly in the functional aspects. The functional aspects were worse (differences were statistically significant) in patients with peripheral vestibular hypofunction syndrome than the patients with peripheral vestibular hyperfunction syndrome. CONCLUSIONS: 1. Patients with chronic dizziness present abnormal quality of life because of dizziness, in relation to the physical, functional and emotional aspects, verified with the application of the Brazilian version of the DHI. Patients with peripheral vestibular hypofunction syndrome present worse quality of life because of dizziness related to the functional aspects than the patients with peripheral vestibular hyperfunction syndrome, verified at the application of the Brazilian version of the DHI.

Fatores associados ao equilíbrio funcional em idosos com disfunção vestibular crônica

Daily activities can be challenging for the elderly. AIM: To study the association between functional balance, evaluated by the Berg Balance Scale (BBS), sociodemographics, clinical and mobilility (Timed up and go test - TUGT, Dynamic Gait Index - DGI) variables in the elderly with chronic vestibular disorder. MATERIALS AND METHODS: A series study with one hundred and twenty elderly with chronic vestibular disorder. We performed the Mann-Whitney test, the Kruskal-Wallis test followed by Dunn test and the Spearman Coefficient (). RESULTS: Statistically significant associations and correlations were observed between total BBS score and age (=-0.354; p<0.001), age group (p<0.001), number off illnesses (p=0.030), number of illnesses (=-0.287; p=0.001), number of medications (p=0.014), number of medications (=-0.274; p=0.002), recurrent falls (p=0.010), tendency to fall (p=0.002), topographic diagnosis of central vestibular disorder (p<0.001) and periodicity of dizziness (p=0.039), TUGT (=-0.709; p<0.001) and DGI (=-0.748; p<0.001). CONCLUSIONS: Functional balance in the elderly with chronic vestibular disorders evaluated by the BBS is worse when associated with aging, with a more advanced age group (80 years or more), increasing number of illnesses, presence of five or more illnesses, use of multiple medications, recurrent falls, tendency to fall, central vestibular syndromes, daily dizziness, mobility and gait impairments.

Quedas em idosos com Vertigem Posicional Paroxística Benigna

UNLABELLED Benign Paroxysmal Positional Vertigo (BPPV) can cause falls, especially in the elderly. AIM to study whether or not elderly patients with BPPV have a reduction on their falls after the particle repositioning maneuver (PRM). MATERIALS AND METHODS retrospective study including elderly with BPPV who had fall(s) during the last year. All patients were submitted to the PRM according to the affected semicircular canal (SCC). After the abolition of positioning vertigo and nystagmus, the patients were submitted to a 12 month follow-up and were investigated about the number of fall(s). Wilcoxons test was performed to compare the number of fall(s) before and after 12 months of the PRM. RESULTS One hundred and twenty one patients were included in the study. One hundred and one patients presented involvement of the posterior SCC, 16 of the lateral and four of the anterior. We noticed a reduction on the number of falls, with statistically significant difference when all the patients were analyzed together (p<0.001), the posterior canal BPPV patients (p<0,001) and the lateral canal VPPB patients (p=0.002). We also found a tendency of statistically significant difference for the anterior canal BPPV patients (p=0.063). CONCLUSION BPPV elderly patients had indeed a reduction on the number of falls after the PRM.

Caracterização clínica de idosos com disfunção vestibular crônica

Dizziness is common among the elderly. AIM: To characterize social, demographic, clinical, functional and otoneurological data in elderly patients with chronic vestibular disorder. METHOD: A sequential study of 120 patients with chronic vestibular disorder. Simple descriptive analyses were undertaken. RESULTS: Most of the patients were female (68.3%) with a mean age of 73.40±5.77 years. The average number of illnesses associated with the vestibular disorder was 3.83±1.84; the patients were taking on average 3.86±2.27 different medications. The most prevalent diagnosis on the vestibular exam was unilateral vestibular loss (29.8%) and the most prevalent etiology was metabolic vestibulopathy (40.0%) followed by benign paroxysmal positional vertigo (36.7%). Fifty-two patients (43.3%) had experienced dizziness for 5 years or more. Sixty-four patients (53.3%) had at least one fall in the last year and thirty-five (29.2%) had recurrent falls. CONCLUSIONS: Most of the sample included females with associated diseases, and using many different drugs. The most prevalent vestibular diseases were metabolic and vascular labyrinth conditions. Dizziness is a chronic symptom in elderly patients. The association of two vestibular diseases is common. Falls are prevalent in chronic dizzy elderly patients.

Circunstâncias e conseqüências de quedas em idosos com vestibulopatia crônica

AIM: To investigate the circumstances and consequences of falls in the chronically dizzy elderly and to correlate them with the number of falls (one/two and more). METHOD: Transversal descriptive analytic study with 64 patients aged 65 or over, with history of falls and diagnostic of chronic vestibular dysfunction. We performed a descriptive analysis and Qui-Square test (<0.05). RESULTS: The sample was constituted by a female majority (76.6%) with a mean age of 73.62±5.69 years. The vestibular examination showed peripheral vestibulopathy in 81.5% of the cases and the most prevalent diagnostic hypothesis were benign paroxysmal positional vertigo (43.8%) and metabolic inner ear disease (42.2%). Recurrent falls were seen in 35 elderly (53.1%). In relation to the last fall, 39.1% of the patients had fallen in their homes, 51.6% of them occurred during the morning, 51.6% with some propulsion mechanism, 53.1% when walking, 25.0% caused by dizziness and 23.4% by stumbling. Activity restriction was significantly greater in patients that have already had two and more falls, when compared with those who had fallen only once (p=0.031). We found a significant association between the number of falls and their causes (p<0.001). Falls that have happened by slipping were more frequent in the elderly that reported one fall (p=0.0265) and falls that had happened because of dizziness were more frequent in the elderly that complained of two or more falls (p=0.0012). CONCLUSION: Fear and tendency to fall are referred by the majority of chronically dizzy elderly. Fall are more frequent in the morning, in the home and during walking. The propulsion direction is mentioned by half of the elderly and the most common cause for falls are dizziness and stumbling. The number of falls is significantly associated with activity restrictions after the last fall and with the causes for falling (slipping and dizziness).

Versão brasileira do Dynamic Gait Index

The Dynamic Gait Index (DGI) is a useful test to evaluate balance and gait. AIMS: The objectives of this study were to culturally adjust the DGI to the Portuguese language and to assess its reliability. METHODS: The method proposed by Guillemin et al. (1993) was used for a cultural adaptation of this tool. A prospective study was performed with 46 patients that were assessed in the cultural adaptation phase. The items that not understood by 20% or more patients were reworded and reapplied. The final Portuguese version of DGI was applied to 35 elderly in order to check intra and interobserver reliability. The Spearman rank coefficient was used to correlate intra and interobserver scores and the Wilcoxon test was applied to compare these scores. Internal consistency was analyzed by the Cronbach alpha coefficient. RESULTS: There were statistically significant correlations among the scores for intra and interobserver assessments for all items (p<0.001), which were classified as good and very strong correlations (ranging from r=0.655 to r=0.951). The DGI demonstrated high internal consistency in intra and interobserver assessments (varying from µ=0.820 to µ=0.894). CONCLUSION: The DGI was culturally adjusted to Brazilian Portuguese and proved to be a reliable tool.

Revisão sistemática sobre os efeitos da reabilitação vestibular em adultos de meia-idade e idosos

OBJECTIVE: To summarize the results of clinical trials on vestibular rehabilitation (VR) in middle-aged and elderly people with vestibular disorders. METHODS: A search for relevant trials was performed in the databases LILACS, EMBASE, MEDLINE, SciELO, Cochrane, ISI Web of Knowledge and virtual libraries of theses and dissertations. Randomized controlled trials published in the last 10 years and written in English, Portuguese or Spanish were included. The methodological quality of the studies was assessed by the PEDro scale. Results from the included studies were analyzed through a critical review of content. RESULTS: Nine studies were included in the review. Four studies reported on participants aged over 40 years (middle-aged and elderly) and five studies consisted exclusively of elderly subjects (over 60 years). Findings of vestibular dysfunction were diverse and the most common complaints were body imbalance or postural instability (3 studies), and vertigo or dizziness (3 studies). The Visual Analogue Scale (VAS) was the most commonly used instrument to assess subjective perception of symptoms of vestibular dysfunction (4 studies). According to the PEDro scale, four studies were considered to be of good quality. The most common experimental intervention was the Cawthorne & Cooksey protocol (4 studies). For most outcome measures, the studies comparing VR with another type of intervention showed no differences between the groups after the therapy. CONCLUSIONS: The studies included in this review provide evidence for the positive effects of VR in elderly and middle-aged adults with vestibular disturbances.

Circumstances and consequences of falls in elderly people with vestibular disorder

AIM To investigate the circumstances and consequences of falls in the chronically dizzy elderly and to correlate them with the number of falls (one/two and more). METHOD Transversal descriptive analytic study with 64 patients aged 65 or over, with history of falls and diagnostic of chronic vestibular dysfunction. We performed a descriptive analysis and Chi-Square test (x2<0.05). RESULTS The sample was constituted by a female majority (76.6%) with a mean age of 73.62+/-5.69 years. The vestibular examination showed peripheral vestibulopathy in 81.5% of the cases and the most prevalent diagnostic hypothesis were benign paroxysmal positional vertigo (43.8%) and metabolic inner ear disease (42.2%). Recurrent falls were seen in 35 elderly (53.1%). In relation to the last fall, 39.1% of the patients had fallen in their homes, 51.6% of them occurred during the morning, 51.6% with some propulsion mechanism, 53.1% when walking, 25.0% caused by dizziness and 23.4% by stumbling. Activity restriction was significantly greater in patients that have already had two and more falls, when compared with those who had fallen only once (p=0.031). We found a significant association between the number of falls and their causes (p<0.001). Falls that have happened by slipping were more frequent in the elderly that reported one fall (p=0.0265) and falls that had happened because of dizziness were more frequent in the elderly that complained of two or more falls (p=0.0012). CONCLUSION Fear and tendency to fall are referred by the majority of chronically dizzy elderly. Fall are more frequent in the morning, in the home and during walking. The propulsion direction is mentioned by half of the elderly and the most common cause for falls are dizziness and stumbling. The number of falls is significantly associated with activity restrictions after the last fall and with the causes for falling (slipping and dizziness).