Publications by authors named "Alessandro Micarelli"

63 Publications

Smell Impairment in Stage I-II Obesity: Correlation with Biochemical Regulators and Clinical Aspects.

Laryngoscope 2022 Jul 30. Epub 2022 Jul 30.

University of Rome Tor Vergata, Department of Clinical Sciences and Translational Medicine - ENT Unit, Rome, Italy.

Objective: To evaluate the differences in olfactory sensitivity, nutritional habits, levels of modulators of feeding and smell, bioelectrical impedance analysis (BIA) measures and metabolic assays between two groups of participants with stage I and II obesity and reciprocal relationships between these parameters.

Methods: Eighteen participants with stage I (11 female; mean age = 54.3 ± 13.1 years) and 20 participants with stage II (10 female; mean age = 54.5 ± 11.9) obesity underwent a food frequency questionnaire and Sniffin' Sticks® test battery, anthropometric parameters, and BIA measurements as well as metabolic assays (including plasma levels of leptin, insulin, ghrelin, glucose, insulin-like growth factor-1 [IGF-1] and usual laboratory parameters).

Results: The stage II obesity participants demonstrated significant higher levels of insulin and leptin and lower levels of ghrelin and IGF-1, a reduction in odor identification (OI) and in total olfactory score, and an increase in visceral and total fat percentage. Among a mosaic of multiple correlations, ghrelin was found to positively correlate with OI and leptin negatively with odor discrimination.

Conclusion: The present study expands the notions positing the olfactory perception - and its connections with metabolic cues, foods habits and BIA measures - changes across the two most important obesity stages. This could ameliorate clinical and research deepening of obesity-related olfactory behavior with possible consequences on diagnosis, treatment and prevention of onset and development of obesity, thus opening possible future strategies involving multidisciplinary contributions.

Level Of Evidence: Level 3 Laryngoscope, 2022.
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http://dx.doi.org/10.1002/lary.30325DOI Listing
July 2022

Video Head Impulse Test Changes Related to Obstructive Sleep Apnea: In Reply to the Work of Xin-Da Xu et al.

Front Neurol 2022 28;13:889187. Epub 2022 Apr 28.

Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy.

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http://dx.doi.org/10.3389/fneur.2022.889187DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9100950PMC
April 2022

The impact of experience on recurrence rates after biopsy punch excision for pilonidal disease.

Colorectal Dis 2022 Mar 28. Epub 2022 Mar 28.

Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy.

Aim: We present the outcomes and the recurrences of 848 patients with pilonidal disease (PD) treated by biopsy punch excision (BPE) and we weigh our results against progressively obtained operative experience. BPE is a modified 'merged' version of both the Bascom 'pit picking' procedure and the Gips procedure. It employs biopsy punches of different calibre, depending on whether treatment is in the natal cleft (calibre as small as possible) or lateral (larger calibre punches or even small incision). Sometimes this procedure is referred to as the Bascom-Gips procedure.

Methods: In all, 848 consecutive patients with PD were treated from January 2011 until December 2016 (sex 622 [73.4%] men and 226 [26.6%] women; median age 26.2 years, mean age 24.6 ± 28.99 [range 14-55] years, men 25.1 years, women 24.8 years). Of these 848 patients, 287 were operated in 2011-2012, 301 in 2013-2014 and 260 in 2015-2016. The recurrence rates were recorded 12, 24 and 60 months after surgery both cumulatively and by examining the outcomes of the three biennia individually (years of treatment 2011-2012 or group A, 2013-2014 or group B, 2015-2016 or group C).

Results: The mean operating time was 34 ± 24.45 min. Postoperative complications included early (<24 h; n = 22 or 2.6%) and delayed (>24 h; n = 26 or 3.1%) postoperative bleeding. Postoperative fluid collections (<2 weeks) occurred in 83/848 patients (9.8%) and included haematoma (n = 25) and seroma (n = 58). Full recovery was obtained after a mean of 21 ± 12.72 days and work/school/university activities were resumed after a mean of 4 ± 12.02 days. Twelve-, 24- and 60-month follow-ups were possible in 725 (85.5%), 682 (80.4%) and 595 (70.2%) patients out of 848. An overall significant (ꭓ  = 16.87, P = 0.0002) difference was found in the recurrence rates: 59 recurrences/725 patients (or 8.1%) after 1 year, 89 recurrences/682 patients (or 13.0%) after 2 years and 98 recurrences/595 (or 16.4%) after 5 years. However, when subgrouping patients in three 24-month subsets, the recurrence rates showed a steady and progressive decrease in the three biennia 2011-2012 (group A), 2013-2014 (group B) and 2015-2016 (group C) at 12-, 48- and 60-month follow-ups. Recurrences after 12 months were 29/225 (12.9%), 19/285 (6.7%) and 11/215 (5.1%) (ꭓ  = 8.53, P = 0.014) in groups A, B and C respectively; after 24 months, 36/226 (15.9%), 31/242 (12.8%) and 22/214 (10.2%) (ꭓ  = 2.38, P = 0.30 N.S.) in groups A, B and C respectively; after 60 months, 38/194 (19.5%), 36/215 (16.7%) and 24/186 (12.9%) (ꭓ  = 2.23, P = 0.32) in groups A, B and C respectively.

Conclusions: BPE is an effective, disease-targeted, minimally invasive and inexpensive way to treat PD. Its results are influenced by the experience of the team involved, especially regarding early recurrences/failure of surgery. At least 5-year follow-ups are needed to ascertain the outcome of surgery for PD.
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http://dx.doi.org/10.1111/codi.16126DOI Listing
March 2022

Role of New Anatomy, Biliopancreatic Reflux, and Helicobacter Pylori Status in Postgastrectomy Stump Cancer.

J Clin Med 2022 Mar 9;11(6). Epub 2022 Mar 9.

"Pietro Valdoni" Department of Surgery, Policlinico "Umberto I", "Sapienza" University of Rome, 00161 Rome, Italy.

Distal gastrectomy for benign gastroduodenal peptic disease has become rare, but it still represents a widely adopted procedure for advanced and, in some countries, even for early distal gastric cancer. Survival rates following surgery for gastric malignancy are constantly improving, hence the residual mucosa of the gastric stump is exposed for a prolonged period to biliopancreatic reflux and, possibly, to Helicobacter pylori (HP) infection. Biliopancreatic reflux and HP infection are considered responsible for gastritis and metachronous carcinoma in the gastric stump after oncologic surgery. For gastrectomy patients, in addition to eradication treatment for cases that are already HP positive, endoscopic surveillance should also be recommended, for prompt surveillance and detection in the residual mucosa of any metaplastic-atrophic-dysplastic features following surgery.
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http://dx.doi.org/10.3390/jcm11061498DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8952228PMC
March 2022

Low Ambient Temperature Exposition Impairs the Accuracy of a Non-invasive Heat-Flux Thermometer.

Front Physiol 2022 4;13:830059. Epub 2022 Mar 4.

Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy.

Background: Indirect core body temperature (CBT) monitoring from skin sensors is gaining attention for in-field applications thanks to non-invasivity, portability, and easy probe positioning. Among skin sensors, heat-flux devices, such as the so-called Double Sensor (DS), have demonstrated reliability under various experimental and clinical conditions. Still, their accuracy at low ambient temperatures is unknown. In this randomized cross-over trial, we tested the effects of cold temperature exposition on DS performance in tracking CBT.

Methods: Twenty-one participants were exposed to a warm (23.2 ± 0.4°C) and cold (-18.7 ± 1.0°C) room condition for 10 min, following a randomized cross-over design. The accuracy of the DS to estimate CBT in both settings was assessed by quantitative comparison with esophageal (reference) and tympanic (comparator) thermometers, using Bland-Altman and correlation analyses (Pearson's correlation coefficient, , and Lin's concordance correlation coefficient, ).

Results: In the warm room setting, the DS showed a moderate agreement with the esophageal sensor [bias = 0.09 (-1.51; 1.69) °C,  = 0.40 ( = 0.069), CCC = 0.22 (-0.006; 0.43)] and tympanic sensor [bias = 2.74 (1.13; 4.35) °C,  = 0.54 ( < 0.05), CCC = 0.09 (0.008; 0.16)]. DS accuracy significantly deteriorated in the cold room setting, where DS temperature overestimated esophageal temperature [bias = 2.16 (-0.89; 5.22) °C,  = 0.02 (0.94), CCC = 0.002 (-0.05; 0.06)]. Previous exposition to the cold influenced temperature values measured by the DS in the warm room setting, where significant differences ( < 0.00001) in DS temperature were observed between randomization groups.

Conclusion: DS accuracy is influenced by environmental conditions and previous exposure to cold settings. These results suggest the present inadequacy of the DS device for in-field applications in low-temperature environments and advocate further technological advancements and proper sensor insulation to improve performance in these conditions.
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http://dx.doi.org/10.3389/fphys.2022.830059DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8931521PMC
March 2022

Onset and resolution failure of recurrent benign paroxysmal positional vertigo: the role of cervical range of motion.

Eur Arch Otorhinolaryngol 2022 Apr 29;279(4):2183-2192. Epub 2022 Jan 29.

Department of Clinical Sciences and Translational Medicine, ENT Unit, University of Rome Tor Vergata, Rome, Italy.

Purpose: To explore possible associations between cervical spine mobility, measured by cervical range of motion (CROM) and a possible earlier onset of recurrent benign paroxysmal positional vertigo (BPPV), as well as an increased failure rate of canalith repositioning procedures.

Methods: Medical records of 749 patients (247, 253 and 249 patients with a CROM ≤ 45°, between 45.1° and 55° and > 55.1°, respectively) with a first-time diagnosis of non-traumatic BPPV were included in this retrospective study. Age, gender, canal involvement and CROM values were treated as prospective prognostic factors for time of BPPV recurrence onset (RO) and number of manoeuvres needed to achieve resolution (resolution rate, RR). A multiple regression analysis was performed.

Results: A significant increase in the incidence of recurrent BPPV was found in patients with reduced CROM (139 [56.27%;], 102 [40.31%] and 87 [34.93%], respectively, belonging to ≤ 45°, 45.1°-55° and > 55.1° subgroups; X = 9.42, p = 0.008). A strong association between age, CROM and recurrent BPPV RO and RR was demonstrated, respectively (multiple correlation coefficients = 0.492678 and 0.593493, respectively, p value < 10). Canal involvement was in line with the previous experiences.

Conclusion: The results from this retrospective analysis unveiled the previously unexplored relation between reduction in cervical spine mobility and BPPV recurrence and treatment failure. The data from this study do not indicate the mechanisms by which this comorbidity might directly cause recurrent BPPV. However, they may suggest CROM to be evaluated, in association with other known risk factors for increased susceptibility to BPPV recurrence.
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http://dx.doi.org/10.1007/s00405-021-07226-1DOI Listing
April 2022

Impact of Nutritional Intervention on Taste Perception-A Scoping Review.

Foods 2021 Nov 9;10(11). Epub 2021 Nov 9.

ENT Unit, Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy.

The aim of the present scoping review was to evaluate the impact of experimental meal loads or observational diet changes/habits on taste tests in both healthy subjects and patients. A systematic search performed in PubMed, Scopus, and Institute for Scientific Information (ISI) Web of Science electronic databases retrieved, respectively 2981, 6258, and 7555 articles from January 2000 to December 2020. A total of 17 articles were included for full-text review. Literature results were stratified according to the observational/interventional approach, the involvement of healthy subjects or patients, the taste test, and the meal/dietary changes. The present scoping review reinforced the notions postulating that certain taste tests (for example focusing on fatty acid, salt, or sugar) might be specifically influenced by the nutritional intervention and that other ones might be susceptible to a wide span of changes beyond the extent of tastant included in the specific food changes. This could also depend on the inhomogeneity of literature trend: The short duration of the intervention or the random type of meal load, unsuitability of the taste test chosen, and the presence of underlying disorders. Future studies for a better comprehension of taste tests reliability in relation to specific food changes are thus to be fostered.
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http://dx.doi.org/10.3390/foods10112747DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8625746PMC
November 2021

Italian Expert Consensus on Clinical and Therapeutic Management of Multiple Chemical Sensitivity (MCS).

Int J Environ Res Public Health 2021 10 27;18(21). Epub 2021 Oct 27.

Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy.

Multiple chemical sensitivity (MCS) is a multisystem, recurrent, environmental disorder that flares in response to different exposures (i.e., pesticides, solvents, toxic metals and molds) under the threshold limit value (TLV) calculated for age and gender in the general population. MCS is a syndrome characterized by cutaneous, allergic, gastrointestinal, rheumatological, endocrinological, cardiological and neurological signs and symptoms. We performed a systematic review of the literature to summarize the current clinical and therapeutic evidence and then oriented an eDelphi consensus. Four main research domains were identified (diagnosis, treatment, hospitalization and emergency) and discussed by 10 experts and an MCS patient. Thus, the first Italian MCS consensus had the double aim: (a) to improve MCS knowledge among healthcare workers and patients by standardizing the clinical and therapeutic management to MCS patients; and (b) to improve and shed light on MCS misconceptions not supported by evidence-based medicine (EBM).
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http://dx.doi.org/10.3390/ijerph182111294DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8582949PMC
October 2021

The Effect of Cold Exposure on Cognitive Performance in Healthy Adults: A Systematic Review.

Int J Environ Res Public Health 2021 09 15;18(18). Epub 2021 Sep 15.

Institute of Mountain Emergency Medicine, Eurac Research, 39100 Bolzano, Italy.

Several aspects of cognition can be affected after cold exposure, but contradictory results have been reported regarding affected cognitive domains. The aim of the current systematic review was to evaluate the effects of specific cold exposure on cognitive performance in healthy subjects. A systematic search was performed using MEDLINE (through PubMed), EMBASE (Scopus) and PsycINFO databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria were healthy subjects exposed to a cold environment (either simulated or not) and cognitive performance related to cold exposure with an experimental design. The literature search identified 18 studies, eight studies investigated the effect of cold air exposure and ten the effect of cold water immersion on cognitive performance of healthy subjects. There were several differences among the studies (environmental temperature reached, time of exposure, timing, and type of cognitive test administration). Cold exposure induced in most of the experimental settings (15 of 18) an impairment of CP even before accidental hypothermia was established. The most investigated and affected cognitive domains were attention and processing speed, executive function, and memory. Gender differences and effects of repeated exposure and possible acclimation on cognitive performance need further studies to be confirmed.
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http://dx.doi.org/10.3390/ijerph18189725DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8470111PMC
September 2021

Changes in daily energy expenditure and movement behavior in unilateral vestibular hypofunction: Relationships with neuro-otological parameters.

J Clin Neurosci 2021 Sep 17;91:200-208. Epub 2021 Jul 17.

ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy; Eurac Research, Institute of Mountain Emergency Medicine, Bolzano, Italy. Electronic address:

The vestibular system has been found to affect energy homeostasis and body composition, due to its extensive connections to the brainstem and melanocortin nuclei involved in regulating the metabolism and feeding behavior. The aim of this study was to evaluate - by means of a wrist-worn physical activity tracker and bioelectrical impedance analysis (BIA) - the energy expenditure (EE) in resting (REE) and free-living conditions and movement behavior in a group of chronic unilateral vestibular hypofunction (UVH) patients when compared with a control group (CG) of healthy participants. Forty-six chronic UVH and 60 CG participants underwent otoneurological (including video-Head Impulse Test [vHIT] for studying vestibulo-ocular reflex [VOR] and static posturography testing [SPT]), and EE and movement measurements and self-report (SRM) andperformance measures (PM). As well as significant (p < 0.001) changes in SPT variables (area and path length) and SRM/PM, UVH participants also demonstrated significantly (p < 0.001) lower values in REE, movement EE, hours/day spent upright, number of strides and distance covered and total daily EE (p = 0.007) compared to the CG. UVH patients consumed significantly lower Kcal/min in sweeping (p = 0.001) and walking upstairs and downstairs (p < 0.001) compared to the CG. Multiple correlations were found between free-living and resting EE and neuro-otological parameters in UVH participants. Since the melanocortin system could be affected along the central vestibular pathways as a consequence of chronic vestibular deafferentation, data collected by reliable wearables could reflect the phenomena that constitute an increased risk of falls and sedentary lifestyle for patients affected by UVH, and could improve rehabilitation stages.
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http://dx.doi.org/10.1016/j.jocn.2021.07.012DOI Listing
September 2021

Sleep Performance and Chronotype Behavior in Unilateral Vestibular Hypofunction.

Laryngoscope 2021 10 30;131(10):2341-2347. Epub 2021 Jun 30.

Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy.

Objective: To evaluate sleep behavior and its relation to otoneurological parameters in a group of patients with chronic unilateral vestibular hypofunction (UVH) without self-reported sleep disturbances when compared with healthy subjects serving as a control group (CG).

Methods: Fifty-one patients affected by UVH underwent a retrospective clinical and instrumental otoneurological examination, a 1-week actigraphy sleep analysis, and a series of self-report and performance measures (SRM/PM). A CG of 60 gender- and age-matched healthy subjects was also enrolled. A between-group analysis of variance was performed for each variable, while correlation analysis was performed in UVH patients between otoneurological, SRM/PM, and actigraphy measure scores.

Results: When compared with CG subjects, UVH patients were found to be spending less time sleeping and taking more time to go from being fully awake to asleep, based on actigraphy-based sleep analysis. Also, SRM/PM depicted UVH patients to have poor sleep quality and to be more prone to an evening-type behavior. Correlations were found between vestibular-related functionality indexes and subjective sleep quality, as well as between longer disease duration and reduced sleep time.

Conclusion: For the first time, a multiparametric sleep analysis was performed on a large population-based sample of chronic UVH patients. While a different pattern in sleep behavior was found, the cause is still unclear. Further research is needed to expand the extent of knowledge about sleep disruption in vestibular disorders.

Level Of Evidence: 3 Laryngoscope, 131:2341-2347, 2021.
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http://dx.doi.org/10.1002/lary.29719DOI Listing
October 2021

Insight into the use of tympanic temperature during target temperature management in emergency and critical care: a scoping review.

J Intensive Care 2021 Jun 12;9(1):43. Epub 2021 Jun 12.

Institute of Mountain Emergency Medicine, Eurac Research, Drususallee/Viale Druso 1, I-39100, Bolzano, Italy.

Background: Target temperature management (TTM) is suggested to reduce brain damage in the presence of global or local ischemia. Prompt TTM application may help to improve outcomes, but it is often hindered by technical problems, mainly related to the portability of cooling devices and temperature monitoring systems. Tympanic temperature (T) measurement may represent a practical, non-invasive approach for core temperature monitoring in emergency settings, but its accuracy under different TTM protocols is poorly characterized. The present scoping review aimed to collect the available evidence about T monitoring in TTM to describe the technique diffusion in various TTM contexts and its accuracy in comparison with other body sites under different cooling protocols and clinical conditions.

Methods: The scoping review was conducted following the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for scoping reviews (PRISMA-ScR). PubMed, Scopus, and Web of Science electronic databases were systematically searched to identify studies conducted in the last 20 years, where T was measured in TTM context with specific focus on pre-hospital or in-hospital emergency settings.

Results: The systematic search identified 35 studies, 12 performing T measurements during TTM in healthy subjects, 17 in patients with acute cardiovascular events, and 6 in patients with acute neurological diseases. The studies showed that T was able to track temperature changes induced by either local or whole-body cooling approaches in both pre-hospital and in-hospital settings. Direct comparisons to other core temperature measurements from other body sites were available in 22 studies, which showed a faster and larger change of T upon TTM compared to other core temperature measurements. Direct brain temperature measurements were available only in 3 studies and showed a good correlation between T and brain temperature, although T displayed a tendency to overestimate cooling effects compared to brain temperature.

Conclusions: T was capable to track temperature changes under a variety of TTM protocols and clinical conditions in both pre-hospital and in-hospital settings. Due to the heterogeneity and paucity of comparative temperature data, future studies are needed to fully elucidate the advantages of T in emergency settings and its capability to track brain temperature.
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http://dx.doi.org/10.1186/s40560-021-00558-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8199814PMC
June 2021

Postural and clinical outcomes of sustained natural apophyseal glides treatment in cervicogenic dizziness patients: A randomised controlled trial.

Clin Rehabil 2021 Nov 26;35(11):1566-1576. Epub 2021 Apr 26.

Department of Clinical Sciences and Translational Medicine, University of Rome 'Tor Vergata', Rome, Italy.

Objective: To evaluate how self-report and posturographic measures could be affected in patients with cervicogenic dizziness undergoing sustained natural apophyseal glides.

Design: Randomised controlled single-blind study.

Setting: Tertiary rehabilitation centre.

Subjects: Patients affected by cervicogenic dizziness, diagnosed by applying accepted criteria. Forty-one patients (19 male, 22 female: mean age 44.3 ± 14.8 years) receiving treatment, and 39 patients (18 male, 21 female: mean age 43.8 ± 13.9 years) receiving placebo were included in the study.

Interventions: The treatment group underwent sustained natural apophyseal glides, while the placebo was constituted by a detuned laser. Both groups received their interventions six times over 4 weeks.

Main Measures: Outcomes were tested by means of self-report measures such as perceived dizziness, neck disability, anxiety and depression. Also, cervical range of motion and posturography testing with power spectra frequency were analysed.

Results: When compared to placebo, treated patients demonstrated a significant decrease in perceived dizziness (post-treatment total Dizziness Handicap Inventory score 20.5 ± 5.3 as compared to 26.2 ± 6 baseline), neck disability and pain (Neck Disability Index and Neck Pain Index post-treatment scores 12.5 ± 4.3 and 45.6 ± 15.1, respectively, as compared to baseline scores of 15.1 ± 4.8 and 62.5 ± 14.3), as well as significant improvement in cervical range of motion and some posturographic parameters.

Conclusion: Sustained natural apophyseal glides may represent a useful intervention in reaching short-term beneficial effects in patients with cervicogenic dizziness, with respect to self-perceived symptoms, proprioceptive integration and cervical range of motion improvement.
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http://dx.doi.org/10.1177/02692155211012413DOI Listing
November 2021

Usefulness of postural sway spectral analysis in the diagnostic route and clinical integration of cervicogenic and vestibular sources of dizziness: A cross-sectional preliminary study.

J Vestib Res 2021 ;31(5):353-364

Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy.

Background: Posturography power spectra (PS) implementation has been proven to discriminate between sensory inputs detriment of vestibular and proprioceptive origin.

Objective: To deepen the role of posturography testing in the diagnostic route of dizzy conditions, by comparing two groups of patients -93 affected by cervicogenic dizziness (CGD) and 72 by unilateral vestibular hypofunction (UVH) -with a group of 98 age- and gender-matched healthy subjects, serving as control group (CON).

Methods: All participants underwent otoneurological testing including video head impulse test (vHIT) and posturography testing with PS analysis. They also filled in Dizziness Handicap Inventory (DHI), Tampa Scale for Kinesiophobia and Hospital Anxiety and Depression Scale questionnaires.

Results: UVH and CGD patients were found to have significant increase in vestibular- and proprioceptive-related PS values when compared with CON. Receiver operating characteristic curves found PS values to reliably discriminate both groups from CON. Positive and negative correlations were respectively found between vestibular-/proprioceptive-related PS domain and DHI in both groups and between PS and vHIT scores in UVH patients.

Conclusions: PS analysis demonstrated to be useful in differentiating CGD and UVH patients each other and when compared to CON, to objectively represent perceived symptoms filled along the DHI scale and to corroborate the rate of vestibular deficit in UVH patients.
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http://dx.doi.org/10.3233/VES-190729DOI Listing
November 2021

Changes in body composition in unilateral vestibular hypofunction: relationships between bioelectrical impedance analysis and neuro-otological parameters.

Eur Arch Otorhinolaryngol 2021 Jul 3;278(7):2603-2611. Epub 2021 Jan 3.

Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy.

Purpose: Experimental works have indicated the potential of the vestibular system to affect body composition to be mediated by its extensive connections to brainstem nuclei involved in regulating metabolism and feeding behavior. The aim of this study was to evaluate-by means of bioelectrical impedance analysis (BIA)-the body composition in a group of chronic UVH normal-weighted patients when compared with an equally balanced group of healthy participants, serving as a control group (CG).

Methods: Forty-six chronic UVH and 60 CG participants underwent otoneurological (including video Head Impulse Test [vHIT] and static posturography testing [SPT]), BIA measurements and self-report (SRM) and performance measures (PM).

Results: Beyond significant (p < 0.001) changes in SPT variables (surface and length) and SRM/PM (including Dizziness Handicap Inventory, Dynamic Gait Index and Activity Balance Confidence scales), UVH participants demonstrated significant (p < 0.001) higher values of fat mass and visceral fat and lower values of muscle mass (p = 0.004), when compared to CG. Significant correlations were found in UVH participants between otoneurological and BIA measurements.

Conclusion: These study findings represent the first clinical in-field attempt at depicting, with the use of BIA parameters, changes in body composition related to chronic UVH. Since such alterations in metabolic parameters could be considered both the consequences and/or the cause of vestibular-related quality of life deficit, BIA parameters could be considered as cheap, easy to use, noninvasive assessments in case of chronic UVH.
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http://dx.doi.org/10.1007/s00405-020-06561-zDOI Listing
July 2021

Reciprocal influences between cognitive decline and vestibular processing: commentary to "Dizziness in patients with cognitive impairment".

J Vestib Res 2020 Nov 27. Epub 2020 Nov 27.

Department of Clinical Sciences and Translational Medicine, University of Rome 'Tor Vergata', Italy.

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http://dx.doi.org/10.3233/VES-200724DOI Listing
November 2020

Hearables: New Perspectives and Pitfalls of In-Ear Devices for Physiological Monitoring. A Scoping Review.

Front Physiol 2020 16;11:568886. Epub 2020 Oct 16.

Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy.

Technological advancements are opening the possibility of prolonged monitoring of physiological parameters under daily-life conditions, with potential applications in sport science and medicine, and in extreme environments. Among emerging wearable technologies, in-ear devices or hearables possess technical advantages for long-term monitoring, such as non-invasivity, unobtrusivity, good fixing, and reduced motion artifacts, as well as physiological advantages related to the proximity of the ear to the body trunk and the shared vasculature between the ear and the brain. The present scoping review was aimed at identifying and synthesizing the available evidence on the use and performance of in-ear monitoring of physiological parameters, with focus on applications in sport science, sport medicine, occupational medicine, and extreme environment settings. Pubmed, Scopus, and Web of Science electronic databases were systematically searched to identify studies conducted in the last 10 years and addressing the measurement of three main physiological parameters (temperature, heart rate, and oxygen saturation) in healthy subjects. Thirty-nine studies were identified, 24 performing temperature measurement, 12 studies on heart/pulse rate, and three studies on oxygen saturation. The collected evidence supports the premise of in-ear sensors as an innovative and unobtrusive way for physiological monitoring during daily-life and physical activity, but further research and technological advancement are necessary to ameliorate measurement accuracy especially in more challenging scenarios.
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http://dx.doi.org/10.3389/fphys.2020.568886DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7596679PMC
October 2020

Self-perceived general and ear-nose-throat symptoms related to the COVID-19 outbreak: a survey study during quarantine in Italy.

J Int Med Res 2020 Oct;48(10):300060520961276

Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy.

Objective: To survey perceived general and ear-nose-throat (ENT) symptoms of COVID-19 in relation to psychological impact, mental health, perception of information and demographic characteristics in quarantined subjects during a lockdown period in Italy.

Methods: Participants were 1380 respondents who completed an online survey. A logistic regression model was used to evaluate the association between the independent variables and perceived symptoms.

Results: Participants reported different prevalences of perceived ENT and general symptoms. Coryza, cough, sore throat and tinnitus were the most common symptoms, and there was a low prevalence of anxiety, depression and stress compared with the psychological impact of the symptom. Comparison of the two symptom groups demonstrated a common need for updates, their relationship with the media and correct information about the route of transmission.

Conclusions: The health information provided during a disease outbreak must be grounded in evidence. This would help to prevent adverse psychological reactions and somatization symptoms that can engulf healthcare systems, especially in clinical areas like ENT, which frequently treat airway problems.
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http://dx.doi.org/10.1177/0300060520961276DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8164561PMC
October 2020

Bridging the gap between temporomandibular disorders, static balance impairment and cervicogenic dizziness: Posturographic and clinical outcomes.

J Electromyogr Kinesiol 2020 Oct 6;54:102455. Epub 2020 Aug 6.

University of Rome Tor Vergata, Department of Clinical Sciences and Translational Medicine, Italy.

Several studies have investigated the possible influence of temporomandibular disorders (TMD) on body posture and whether cervical spine disorders, such as cervicogenic dizziness (CGD) could play an additional role in affecting static balance. The purpose of this study was to analyze static postural behavior by means of static posturography, in patients affected by either TMD or CGD alone or by both conditions, and to compare findings with a group of healthy subjects. Significant changes in posturographic parameters were found among the three groups of patients and when compared with controls. When the three study groups were compared to each other, subjects affected by a combination of TMD and CGD showed worse postural performances with respect to subjects affected by CGD or TMD alone. Correlations with self-perceived dizziness, anxiety, depression and jaw functionality, investigated by means of validated questionnaires, were found among all patient groups. These results provide new evidences for the presence of static balance alterations in patients suffering from TMD with and without associated cervical spine impairment, by using a reliable diagnostic technique. Further studies are needed in order to identify any causal relation between these two disorders.
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http://dx.doi.org/10.1016/j.jelekin.2020.102455DOI Listing
October 2020

Reciprocal roles of joint position error, visual dependency and subjective perception in cervicogenic dizziness.

Somatosens Mot Res 2020 12 10;37(4):262-270. Epub 2020 Aug 10.

Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy.

Aim: Since cervical joint position error (JPE) and visual dependency (VD) may reflect altered ascending inputs from the neck receptors, the aim of the present study was to test how these parameters may be impacted by those clinical parameters in cervicogenic dizziness (CGD) patients when compared with healthy subjects participants.

Materials And Methods: 93 subjects participants fulfilling inclusion criteria for CGD and 98 age- and gender-matched healthy subjects volunteers - undergoing cervical relocation and rod and disc test to evaluate JPE and VD, respectively - were compared to each other. Cervical range of motion (CROM), Dizziness Handicap Inventory (DHI), Neck Disability Index (NDI), Neck pain intensity (NPI), Tampa Scale for Kinesiophobia (TSK-17) and Hospital Anxiety and Depression Scale (HADS) were also collected in both groups.

Results: When compared to healthy participants, CGD patients were found to have a higher degree of JPE in right ( = 0.008, mean difference, MD: 2.88) and left ( = 0.006, MD: 2.55) rotation as well as in extension ( = 0.011, MD: 2.31), flexion ( = 0.009, MD: 2.35) and mean value ( = 0.001, MD: 2.53) and higher degrees of error in CCW at +40° and -40° ( = 0.012, MD: 0.85 and  = 0.016, MD: 0.82, respectively) and CW at +40° and -40° ( = 0.018, MD: 0.83 and  = 0.015 MD: 0.81, respectively). CGD patients also demonstrated a significant reduction in degrees of CROM in active flexion ( = 0.011, MD: -34.63), extension ( = 0.018, MD: -21.67), left ( = 0.012, MD: -28.29) and right ( = 0.009, MD: -28.52) rotation, and left ( = 0.02, MD: -7.29) and right ( = 0.021, MD: -5.05) lateral flexion. Furthermore, these patients demonstrated higher scores in total DHI ( = 0.007, MD: 25.17) (and relative DHI-P, DHI-F, DHI-E;  = 0.009, MD: 11.4;  = 0.014, MD: 8.73 and  = 0.018, MD: 5.03, respectively), in TSK-17 ( = 0.017, MD: 17.56), and HADS, both in anxiety ( = 0.022, MD: 4.62) and depression ( = 0.02, MD: 7.31) subscale.

Conclusions: A possible common physiopathological background may impact on processes involved in both the JPE and VD behaviour, entangled in a vicious circle with the impaired subjective clinical and quality of life perception.
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http://dx.doi.org/10.1080/08990220.2020.1803257DOI Listing
December 2020

Combination of in-situ collagen injection and rehabilitative treatment in long-lasting facial nerve palsy: a pilot randomized controlled trial.

Eur J Phys Rehabil Med 2021 Jun 15;57(3):366-375. Epub 2020 Jul 15.

Department of Clinical Sciences and Translational Medicine, Tor Vergata University, Rome, Italy.

Background: Many rehabilitative attempts have been made to prevent or reduce residual deficits in patients with established and long-term facial palsy (FP). In many clinical settings in-situ injection of collagen-based medical devices have been demonstrated to provide nutritional support for tissues.

Aim: To test the effectiveness of a collagen-based treatment for patients complaining of long standing FP, who are following a proprioceptive neuromuscular facilitation protocol (Kabat method) (group A), compared to a FP group only undergoing the Kabat method (group B).

Design: Randomised controlled trial.

Setting: Tertiary referral outpatient center and University Hospital.

Population: Forty-one patients with a medical diagnosis of long-term unilateral peripheral FP.

Methods: Twenty-one Group A patients were compared, after randomization, to nineteen matched group B patients after 8 weeks of treatment. The outcomes were electromyographic findings, validated questionnaires (Facial Disability Index, FDI and General health-related quality of life assessment, QOL) and clinical grading (House-Brackmann, HB, and synkinesis grading scale). A correlation analysis was performed between pre-/post-treatment differences (Δ) in outcome and clinical-demographic measures.

Results: A significant within-subjects improvement, both in electrophysiological and questionnaire scores, was found in both groups. When compared with group B, group A patients exhibited a significant reduction of post-treatment polyphasic potentials of voluntary activity of orbicularis oculi (P=0.017) and oris (P=0.015) and a significant increase in post-treatment duration of voluntary activity of orbicularis oris (P=0.018). Group A subjects demonstrated a significant improvement in questionnaire subscales regarding overall disease perception. Although positive correlations between the ∆FDI and ∆percentage of polyphasic potentials of voluntary activity were found in both groups, negative correlations in group A were found between disease duration and ∆duration of voluntary activity of orbicularis oculi and oris.

Conclusions: The combination of physical rehabilitative procedures with in-situ collagen injections, possibly acting in redirecting the phenomena of reinnervation/reorganization, demonstrated encouraging results in patients affected by long term FP.

Clnical Rehabilitation Impact: In-situ collagen injection could be a safe option enlarging the 'window of opportunity' to improve the voluntary muscle contraction pattern and general and specific disability referred by patients affected by long standing FP.
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http://dx.doi.org/10.23736/S1973-9087.20.06393-5DOI Listing
June 2021

Temporomandibular disorders and cervicogenic dizziness: Relations between cervical range of motion and clinical parameters.

Cranio 2022 Jul 16;40(4):348-357. Epub 2020 Jun 16.

Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy.

Objective: To analyze the cervical range of motion (CROM) and clinical parameters in patients affected by myogenous temporomandibular disorders (TMD), cervicogenic dizziness (CGD), both TMD and CGD (TMD/CGD), and a group of healthy subjects (HS).

Methods: CROM degrees, Dizziness Handicap Inventory (DHI), Tampa Scale for Kinesiophobia (TSK-17), Hospital Anxiety and Depression Scale (HADS), and Jaw Functional Limitation Scale 20 (JFLS-20) scores were compared between 46 TMD patients, 49 CGD subjects, 43 TMD/CGD patients, and 98 HS.

Results: TMD/CGD and CGD patients demonstrated significantly lower CROM degrees and higher DHI, TSK-17, and HADS values when compared to TMD patients. TMD/CGD and TMD patients demonstrated higher JFLS-20 values when compared to CGD and HS. Significant negative correlations were found in TMD/CGD and TMD patients between JFLS-20 and CROM in flexion and extension.

Discussion: Present findings demonstrated a relation between spine movement impairment and TMD.
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http://dx.doi.org/10.1080/08869634.2020.1780772DOI Listing
July 2022

Olfactory-Related Quality of Life in Multiple Chemical Sensitivity: A Genetic-Acquired Factors Model.

Int J Mol Sci 2019 Dec 25;21(1). Epub 2019 Dec 25.

Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", 00133 Rome, Italy.

Genetic polymorphisms as well as environmental exposures to chemical compounds, iatrogenic, psychological, and physical trauma may play a pathophysiological role in multiple chemical sensitivity (MCS) olfactory complaints, given that xenobiotic metabolism is influenced by sequence variations in genes of metabolizing enzymes. Thus, the aim of the present study was to depict-by means of multiple regression analysis-how different genetic conditions, grouped according to their function as well as clinical background and environmental exposure may interfere with those olfactory complaints referred by MCS patients. Therefore, MCS patients after gene polymorphism sequencing, the olfactory-related quality of life score-calculated by means of the Questionnaire of Olfactory Disorder in forty-six MCS patients-have been found to significantly rely on the phase I and II enzymes score and exposure to previous compounds and surgical treatments. The present work-implementing for the first time a genetic-acquired factors model on a regression analysis-further reinforces those theories, positing MCS as a complex, multifactorial, disease in which the genetic risk related to phase I and II enzymes involved in xenobiotic detoxification, olfactory, and neurodegenerative diseases play a necessary, but probably not sufficient role, along the pathophysiological route of the disease.
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http://dx.doi.org/10.3390/ijms21010156DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6981591PMC
December 2019

Surgical treatment of otosclerosis leading to changes in postural control and quality of life.

Laryngoscope 2020 10 5;130(10):2448-2454. Epub 2019 Dec 5.

Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Italy.

Objective: Evaluating postural function in patients with otosclerosis by assessing otoneurological function and balance-related quality of life before and 6 weeks after surgical treatment. Correlations between and clinical features were investigated.

Methods: Thirty-three patients affected by otosclerosis underwent otoneurological examination, video Head Impulse Test (vHIT), and static posturography before and after stapedotomy. Quality of life and dizziness-related handicap were screened by means of validated questionnaires. Correlation analysis was performed in order to discover possible relations with audiological pre- and postoperative parameters.

Results: A significant improvement in posturographic parameters was found. Correlation analysis yielded a negative correlation between preoperative bone conduction auditory threshold and both vHIT scores and postural performance improvement, evaluated by spectral analysis. Moreover, a positive correlation was also found between improvements in posturographic scores and quality-of-life questionnaires.

Conclusion: The study results demonstrated an improvement in postural function and self-reported measures in a cohort of patients with otosclerosis 6 weeks after stapedotomy. The inverse correlation with preoperative auditory levels may reflect lesser chance for balance restoration in cases with worse sensorineural function. Possible implications for daily activities and overall quality of life were suggested by improved self-report questionnaire results.

Level Of Evidence: 4 Laryngoscope, 130:2448-2454, 2020.
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http://dx.doi.org/10.1002/lary.28438DOI Listing
October 2020

Postural control abnormalities related to sleep deprivation in patients with Marfan Syndrome.

J Vestib Res 2019;29(5):261-269

Department of Clinical Sciences and Translational Medicine, Otolaryngology Unit, 'Tor Vergata' University, Rome, Italy.

Background: Marfan syndrome (MFS) is a rare autosomal dominant connective tissue disorder affecting virtually every organ. Sleep disturbances, associated to high collapsibility in upper airways, are common in MFS; daytime sleepiness could lead to reduction in attention and motor coordination, with detrimental effects on balance.

Objective: To evaluate otoneurological function in MFS patients, compared to healthy subjects, and to investigate possible correlations with sleep deprivation extent.

Methods: Forty-one MFS patients underwent a thorough otoneurological examination, video Head Impulse Test (vHIT), and static posturography. Sleep parameters were recorded by home monitoring. Daytime sleepiness and dizziness-related handicap were screened by means of Dizziness Handicap Inventory (DHI) and Epworth Sleepiness Scale (ESS). Results were compared with 49 healthy controls (HC).

Results: DHI and ESS scores were increased in MFS patients (p < 0,01). vHIT scores showed no between-group effect. Classical (surface and length) and frequency-domain posturographic parameters were significantly increased in MFS with respect to HC (p < 0,01). A positive correlation was found between ESS scores and posturographic parameters in MFS patients.

Conclusions: An impaired postural control, related to the extent of sleep deprivation, was found in MFS patients. Such results could advocate for screening and treating sleep deprivation and balance dysfunctions in MFS patients.
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http://dx.doi.org/10.3233/VES-190684DOI Listing
June 2020

Diagnostic route of cervicogenic dizziness: usefulness of posturography, objective and subjective testing implementation and their correlation.

Disabil Rehabil 2021 06 26;43(12):1730-1737. Epub 2019 Oct 26.

Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy.

Purpose: To evaluate posturography measurements, and their association with other clinical tests used for cervicogenic dizziness diagnosis, in a cohort of subjects suffering from cervicogenic dizziness, compared with healthy subjects.

Materials And Methods: Ninety-three cervicogenic dizziness patients and 98 age- and gender-matched healthy subjects underwent video-Head impulse test, posturography testing, evaluation of cervical spine movements by means of cervical range of motion goniometer and self-report and performance measures, including Dizziness Handicap Inventory, Neck Disability Index, Neck Pain Intensity, Tampa Scale for Kinesiophobia and Hospital Anxiety and Depression Scale.

Results: Cervicogenic dizziness patients demonstrated significant increases in classical posturography parameters (i.e., surface and length) and in power spectra values within middle and high-frequency interval depicting balance control alterations especially due to proprioceptive integration changes. Furthermore, decreases in degrees of cervical range of motion and increases of self-report and performance measures - highlighting significant complaints of subjective feeling of dizziness - were found in these patients when compared with healthy subjects. Multiple correlations were found between posturography testing and cervical range of motion and Dizziness Handicap Inventory as well as between different self-report and performance measures in cervicogenic dizziness patients.

Conclusions: The implementation of posturography - including power spectra analysis - coupled with appropriate exclusion of other disorders, may represent a useful tool in improving cervicogenic dizziness assessment in terms of cost, time consumption and correlation with other measurements.Implications for rehabilitationUncertainties in diagnostic assessment of cervicogenic dizziness reflect doubts regarding the causes underpinning the symptoms of imbalance, unsteadiness, and disorientation.Posturography measurement is a low-cost, time-sparing technique and its implementations have proven to be useful in detecting significant alterations in body sway during perturbating situations.Implementation of power spectra analysis on posturography testing may represent a useful tool in improving cervicogenic dizziness assessment also in terms of rehabilitative treatment follow-up.
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http://dx.doi.org/10.1080/09638288.2019.1680747DOI Listing
June 2021

Evaluation of Task-Related Brain Activity: Is There a Role for F FDG-PET Imaging?

Biomed Res Int 2019 2;2019:4762404. Epub 2019 Jul 2.

Department of Biomedicine and Prevention, Faculty of Medicine and Surgery, Tor Vergata University, Rome, Italy.

Positron emission tomography (PET) with 2-[18F]-fluorodeoxyglucose (FDG) has been widely used for the evaluation of cortical glucose metabolism in several neurodegenerative disorders while its potential role in the evaluation of cortical and subcortical activity during a task in the healthy and pathological brain still remains to be a matter of debate. Few studies have been carried out in order to investigate the potential role of this radiotracer for the evaluation of brain glucose consumption during dynamic brain activation. The aim of this review is to provide a general overview of the applications of FDG-PET in the evaluation of cortical activation at rest and during tasks, describing first the physiological basis of FDG distribution in brain and its kinetic in vivo. An overview of the imaging protocols and image interpretation will be provided as well. As a last aspect, the results of the main studies in this field will be summarized and the results of PET findings performed in healthy subjects and patients suffering from various diseases will be reported.
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http://dx.doi.org/10.1155/2019/4762404DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6634077PMC
January 2020

Age-related Assessment of Postural Control Development: A Cross-sectional Study in Children and Adolescents.

J Mot Behav 2020 22;52(4):418-426. Epub 2019 Jul 22.

Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy.

The aim of this study was to outline an age-dependent range of posturography measures obtained from healthy children. One hundred and fifty healthy 4-18-year-old children underwent video Head Impulse Test and static posturography testing. Surface, length and power spectra values were compared between each group of pupils and 32 healthy adults. As well as a significant ( < 0.025) increase in surface and length, when compared to healthy adults, increased values within the low/middle frequency domain and within the high frequency domain were also observed in 4-13 and 4-7-year-old children, respectively. In conclusion, although the nature of postural control development remains largely undetermined, this study represents a first attempt to outline an age-dependent normal range of the relative contribution of inputs in typically developing children.
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http://dx.doi.org/10.1080/00222895.2019.1643284DOI Listing
May 2021

Vestibular rehabilitation in older adults with and without mild cognitive impairment: Effects of virtual reality using a head-mounted display.

Arch Gerontol Geriatr 2019 Jul - Aug;83:246-256. Epub 2019 May 10.

University of Rome Tor Vergata, Department of Clinical Sciences and Translational Medicine, Italy.

Purpose: Due to the gap in the knowledge in the field of vestibular rehabilitation the purpose of this randomized study is to highlight the outcomes of head-mounted display (HMD) implementation in older adults and patients with mild cognitive impairment (MCI), suffering from unilateral vestibular hypofunction (UVH).

Materials And Methods: Vestibulo-ocular reflex (VOR) gain, postural sway examination and dizziness-related and quality of life scores were collected in 12 UVH elderly and 12 UVH subjects suffering from MCI only undergoing vestibular rehabilitation and in 11 UVH elderly and 12 UVH subjects suffering from MCI undergoing a home-based HMD + vestibular rehabilitation protocol.

Results: Although the within-subjects analysis found in all groups a significant (p < 0.05) improvement in posturography parameters and dizziness-related and quality of life scores and no changes in VOR gain, implementation of HMD demonstrated a significant (p < 0.05) increase in post-treatment between-group comparisons in the same tests and VOR gain with respect to those older adults and participants with MCI only undergoing vestibular rehabilitation. Positive correlations were discovered between Mini-Mental Score Exam values and pre-/post-treatment differences in (i) power spectra values in the low-frequency interval (r = 0.72) and in (ii) Dynamic Gait Index scores (r = 0.76).

Conclusions: This study demonstrates that the implementation of a home-based virtual reality protocol may be a safe option in order to ameliorate VOR, postural control and the quality of life also in the vestibular impaired patients in whom the presence of cognitive decline could hinder the achievement of the goal of rehabilitation.
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http://dx.doi.org/10.1016/j.archger.2019.05.008DOI Listing
March 2020
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