Katrina Williams

Dynamic and functional balance tasks in subjects with persistent whiplash: a pilot trial.

Disturbances in static balance have been demonstrated in subjects with persistent whiplash. Some also report loss of balance and falls. These disturbances may contribute to difficulties in dynamic tasks. The aim of this study was to determine whether subjects with whiplash had deficits in dynamic and functional balance tasks when compared to a healthy control group. Twenty subjects with persistent pain following a whiplash injury and twenty healthy controls were assessed in single leg stance with eyes open and closed, the step test, Fukuda stepping test, tandem walk on a firm and soft surface, Singleton test with eyes open and closed, a stair walking test and the timed 10 m walk with and without head movement. Subjects with whiplash demonstrated significant deficits (p < 0.01) in single leg stance with eyes closed, the step test, tandem walk on a firm and soft surface, stair walking and the timed 10 m walk with and without head movement when compared to the control subjects. Specific assessment and rehabilitation directed towards improving these deficits may need to be considered in the management of patients with persistent whiplash if these results are confirmed in a larger cohort.

Effects of balance strategy training in myasthenia gravis: A case study series

Introduction: Studies of exercise in patients with myasthenia gravis (MG) are sparse. Balance strategy training (BST) multimodal exercise has proven efficacy in adults for enhancing balance and functional mobility. This prospective study aims to determine if BST improves functional ability and balance in people with MG. Methods: Seven individuals with MG participated in a 16‐session workstation intervention. Repeated measures (pre/post‐intervention and 4‐week follow‐up) consisting of quantitative myasthenia gravis score (QMG), 6‐minute walk test (6MWT), timed up and go (TUG) with dual task (TUGmanual and TUGcognitive), and standing stability on foam with eyes closed (foamEC) were assessed. Results: Most measurements showed sustained improvement at follow‐up. QMG, TUGcognitive, and foam EC achieved clinically significant improvements (>15%). No adverse effects were reported. Conclusions: BST was effective in improving balance and QMG scores in subjects with MG. A multimodal BST approach is thus suggested to target different aspects of balance and functional mobility. Muscle Nerve 49: 654–660, 2014

Simulator sickness in patients with neck pain and vestibular pathology during virtual reality tasks

Immersion in virtual environments can cause simulator sickness (SS). Further, head and neck movement in interactive virtual reality (VR) assessment and training stimulates the vestibular and cervical afferent systems that can cause dizziness in subjects with neck pain and vestibular pathology. This cross-sectional, observational, study investigated SS and factors that may influence this between 20 neck pain, 14 vestibular pathology and 20 asymptomatic control subjects. Pre-VR questionnaires included a visual symptom scale and dizziness intensity. SS measures included the simulator sickness visual analogue scale and the simulator sickness questionnaire. Significantly greater incidence of any SS and higher values were found in the vestibular and neck pain groups compared to the control group in selected SS measures. No significant differences were found when comparing SS measures between the vestibular and neck pain groups. Significant mild-to-moderate correlations for the entire population were found between both SS measures to pre-VR visual symptoms and dizziness intensity. SS levels in neck pain and vestibular populations are comparable and higher than asymptomatic individuals. Dizziness and visual disturbances may be associated with an increase in severity of SS in these clinical populations.

Healthcare students' experiences of an interprofessional, student-led neuro-rehabilitation community-based clinic.

ABSTRACT Student-led clinics are becoming more prominent as educators seek alternate models of clinical education for health professionals. The purpose of this study was to evaluate healthcare students’ experiences of an interprofessional student-led clinic for clients with neurological conditions. Thirteen students representing occupational therapy, physiotherapy, and speech pathology were recruited for the study. A sequential mixed-methods evaluation was employed and the results from the Interprofessional Education Scale and focus group revealed that the students experienced positive perceptions of working collaboratively with other professions, forming good relationships with others, as well as an increased respect for the roles of other professions. The findings suggest that providing a capstone opportunity, where students can work as part of an interprofessional team with a real client, in a format they may come across in future clinical practice, may be beneficial in providing them with essential interprofessional skills as new graduate health professionals.

Cervical kinematics in patients with vestibular pathology vs. patients with neck pain: A pilot study

OBJECTIVE Research has consistently shown cervical kinematic impairments in subjects with persistent neck pain (NP). It could be reasoned that those with vestibular pathology (VP) may also have altered kinematics since vestibular stimulation via head movement can cause dizziness and visual disturbances. However, this has not been examined to date. This pilot study investigated changes in cervical kinematics between asymptomatic control, NP and VP subjects using a Virtual Reality (VR) system. It was hypothesised that there would be altered kinematics in VP subjects, which might be associated with dizziness and visual symptoms. DESIGN Pilot cross sectional observational study. PARTICIPANTS Twenty control, 14 VP and 20 NP subjects. INTERVENTION Not applicable. MAIN OUTCOME MEASURES Measures included questionnaires (neck disability index, pain on movement, dizziness and pain intensity, visual disturbances) and cervical kinematics (range, peak and mean velocity, smoothness, symmetry, and accuracy of cervical motion) using a virtual reality system. RESULTS Results revealed significantly decreased mean velocity and symmetry of motion in both planes in those with NP but no differences in accuracy or range of motion. No significant differences were seen between VP subjects and asymptomatic controls. However, correlation analysis showed some moderate correlations between dizziness to selected kinematics in both the NP and the VP groups. CONCLUSIONS These results support that cervical kinematics are altered in NP patients, with velocity most affected. There is potential for VP subjects to also have altered kinematics, especially those who experience dizziness. More research is required.

The efficacy of vestibular rehabilitation in people reporting dizziness with multiple sclerosis: a systematic review and meta-analysis

Objectives Dizziness is estimated to affect 49%–75% of people with multiple sclerosis and has a significant impact on quality of life. Current management includes medications, lifestyle modifications and exercise therapies such as vestibular rehabilitation. The aim of this study was to evaluate the efficacy of vestibular rehabilitation in people reporting dizziness with multiple sclerosis. Methods Six electronic databases were searched from earliest date until October 2016. Search terms were based on three concepts; multiple sclerosis, dizziness and vestibular rehabilitation. All studies were screened independently by two authors according to pre-determined eligibility criteria. Standardised mean differences (effect sizes) and 95% CI were calculated to describe differences between groups (eg, intervention and control) and pooled in a meta-analysis where two or more studies were clinically homogeneous. The quality of evidence of the body of evidence was assessed using the GRADE approach. Results Two randomised controlled trials were identified with a total of 65 participants. In both studies, dizziness was measured using the patient reported Dizziness Handicap Inventory. Low quality evidence indicates there is no significant effect for vestibular rehabilitation on improving symptoms of dizziness compared with a control group of people with multiple sclerosis (SMD (95% CI) 0.76, (–0.19 to 1.70)). The quality of the meta-analysis was limited due to imprecision of results and risk of bias. The two studies identified only used a short period of vestibular rehabilitation (six to eight weeks). Conclusions There is low quality evidence that vestibular rehabilitation has no effect on dizziness in the multiple sclerosis population. Given the efficacy of vestibular rehabilitation in other causes of dizziness, further high quality studies with longer rehabilitation periods are required.

Are Changes in Gait and Balance Across the Disease Step Rating Scale in Multiple Sclerosis Statistically Significant and Clinically Meaningful

OBJECTIVES To explore differences in gait endurance, speed, and standing balance in people with multiple sclerosis (MS) across the Disease Step Rating Scale, and to determine if differences are statistically significant and clinically meaningful. DESIGN Observational study. SETTING Community rehabilitation - primary health care center. PARTICIPANTS Community-dwelling people with MS (N=222; mean age, 48±12y; 32% men). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Participants were categorized using the Disease Step Rating Scale. Demographics and clinical measures of gait endurance (6-minute walk test [6MWT]), gait speed (10-m walk test [10MWT] and 25-foot walk test [25FWT]), and balance (Berg Balance Scale [BBS]) were recorded in 1 session. Differences in these parameters across categories of the Disease Step Rating Scale were explored, and clinically meaningful differences were identified. RESULTS The 6MWT showed a greater number of significant differences across adjacent disease steps in those with less disability (P<.001), whereas the 10MWT and 25FWT demonstrated more significant changes in those with greater disability (P<.001). The BBS demonstrated significant differences across the span of the Disease Step Rating Scale categories (P<.001). Differences in gait and balance between adjacent Disease Step Rating Scale categories met most previously established levels of minimally detectable change and all minimally important change scores. CONCLUSIONS Our findings support the Disease Step Rating Scale is an observational tool that can be used by health professionals to categorize people with MS, with the categories reflective of statistically significant and clinically meaningful differences in gait and balance performance.