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The assessment of the compensation of stabilometric parameters in patients after vestibular schwannoma surgery
Kozlová, Eva ; Čakrt, Ondřej (advisor) ; Hrubá, Silvie (referee)
In this thesis, we have been dealing with the evaluation of progressing of the postural stability in the patients after the operation of the vestibular schwannoma (VS). The stability was evaluated by means of stabilometric parameters (COP trajectory length, COP confidence ellipse area). We measured the development of the parameters before operation, immediately after resection and before the discharge. The set contained 17 patients (n = 17). The level of static importance we determined p ≤ 0,05. We found a statistically significant difference between the measurement before the operation and the measurement immediately after the operation (COP confidence ellipse area: p = 0,0183, COP trajectory length: p = 0,0355). On the other hand, the change in both parameters in the measurement before the discharge and the testing after the resection wasn't statistically significant (COP confidence ellipse area: p = 0,4081, COP trajectory length: p = 0,9991). Our next goal was to find out if the stability fault correlates with the disorder of function VOR. We testing the function of t-VOR by the subjective visual vertical (SVV) (n = 24), the function of the r-VOR by the dynamic visual acuity (DVA) (n = 28) and the caloric test (n = 21). We found a statistically significant correlation of both stabilometric...
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The evaluation of adaptation of the vestibulo-ocular reflex in patients after vestibular schwannoma surgery
Hladíková, Veronika ; Čakrt, Ondřej (advisor) ; Jeřábek, Jaroslav (referee)
This thesis deals with the evaluation of the vestibulo-ocular reflex in patients indicated for neurosurgical resection of vestibular schwannoma, executed at the Motol University Hospital. To evaluate the function of the vestibulo-ocular reflex, three types of clinical examinations were used. In periods before the surgery, early after the surgery and before leaving the hospital we monitored the patients' ability to perceive subjective visual vertical, which reflects tonic function of otolith organs. Before the surgery we also tested relative dynamic visual acuity during passive isolated head movements in the transversal plane, whose impairment is related to dysfunction of lateral semicircular canals. Furthermore, we obtained patients' preoperative values achieved in caloric reflex test. In the early postoperative period, bordered by the first day after the vestibular schwannoma surgery and the last day of the hospitalization, patients underwent specialized vestibular rehabilitation. Based on statistical analysis of acquired data, we found out that in some patients there was a lesion of the vestibulo-ocular reflex already before the surgery and moreover, there was a correlation between dysfunction of translational and rotational parts of the vestibulo-ocular reflex. Although variance of subjective...
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Perception of subjective visual vertical
Radvanská, Edita ; Čakrt, Ondřej (advisor) ; Kučerová, Klára (referee)
Postural balance system is a multisensory-organized complex using afference of exteroceptors, enteroceptors, proprioceptors and the visual and the vestibular system. The utriculus and the sacculus are otolith organs placed in the vestibular labyrinth and they are capable of recognizing the direction of gravity. Their function is crucial for keeping postural stability during stand and walk. The ability to recognize the geophysical vertical is failing if the vestibular system is impaired. There are the subjective visual vertical (SVV), the subjective postural vertical (SPV) and the subjective haptic vertical (SHV) which can be tested in humans. This study is interested in SVV, its pathophysiology and measuring. We are comparing the accuracy of measurement of SVV by the Bucket method and a mobile application Visual Vertical in healthy subjects in our experiment.
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Perception of verticality in patients with developmental coordination disorder
Žídek, Radim ; Čakrt, Ondřej (advisor) ; Demeková, Júlia (referee)
Bibliographic identification Author's first name and surname: Bc. Radim Žídek Title of the master thesis: Perception of verticality in patiens with developmental coordination disorder Department: Department of Rehabilitation and Sports Medicine, 2nd faculty of medicine, Charles University and FN Motol Supervisor: PhDr. Ondřej Čakrt, Ph.D. The year of presentation: 2017 Annotation: Developmental coordination disorder is typical for poor motor learning and motor coordination that cannot be related to any neurological or mental disease. The exact reason of it stays still unknown. There are theories that say that dysfunctional collaboration of afferent systems causes developmental coordination disorder. Thanks to afferent systems a human organism is able to perceive different modalities. One of the modalities is a perception of verticality. In theoretical part of this thesis we summarized information about developmental coordination disorder and postural and balance control. In experimental part we tested 35 pupils of primary school (age 13-15). Using MABC-2 we classified the pupils into children with and without predispositions for developmental coordination disorder. Then we tested their ability of perceiving subjective visual and subjective haptic verticality. According to statistical evaluation there is no...
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The effect of targeted rehabilitation on vestibular compensation in patients after vestibular schwannoma resection.
Holá, Irena ; Čakrt, Ondřej (advisor) ; Čada, Zdeněk (referee)
The thesis deals with the evaluation of the impact of preoperative application of gentamicin on vestibular compensations of patient after vestibular schwannoma surgery. The trial involved 32 patients with diagnosed vestibular schwannoma and hospitalized with the indicated for neurosurgical resection at the University Hospital Motol. Ototoxic gentamicin was transtympanically applied to ten of these patients two months before their surgery. After the surgery the patients underwent a rehabilitation program based on the visual biofeedback using the Homebalance system. To evaluate the vestibular compensation the subjective visual vertical measurement and the Dynamic Gait Index standardized walking test were used. In total, each patient performed three examinations: before the surgery, after the surgery and before the end of hospitalization. Statistical analysis of the measured data showed the statistically significant increase tilt of subjective visual vertical and the decrease in the overall score of Dynamic Gait Index after surgery. Reduction in the subjective visual vertical tilt and the overall score of Dynamic Gait Index after rehabilitation has not been proven to be statistically significant. Any statistically significant difference was found between the group of patients treated by gentamicin and...
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The evaluation of vestibulospinal and vestibuloocular reflex in patients during early postoperative period after vestibular schwannoma resection
Markvartová, Anna ; Čakrt, Ondřej (advisor) ; Chovanec, Martin (referee)
The thesis deals with the issues of balance disorders in patients after vestibular schwannoma surgery. The aim of this thesis is to evaluate the effect of targeted rehabilitation with biofeedback on balance disorders and subjective visual vertical compensation. During the period of one year, a group of 20 vestibular schwannoma patients were examined and treated in University Hospital Motol. The compensation of vestbuloocular refex was assessed by a tilt of subjective visual vertical. The level of vestibulospinal compensation was determined according to score of the Activities-Specific Balance Confidence Scale. Patients were examined before the surgery, after the surgery and after the rehabilitation. The Homebalance system, developed by Support center for application outputs and spin-off companies at the 1st Faculty of Medicine, Charles University in Prague, branch office in Kladno, was used for the therapy with visual biofeedback. Another aim of this thesis was to monitor the effect of vestibular prehabituation with ototoxic gentamicin application two months before surgery. The statistical analysis of data proved in the case of subjective visual vertical tilt a significant increase of deviation after surgery and a decrease after rehabilitation. According to the ABC questionnaire the confidence of...
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Compensation of balance disoder in time in patients after vestibular schwannana resection
Hajná, Barbora ; Čakrt, Ondřej (advisor) ; Chovanec, Martin (referee)
Introduction: Disorders of balance and dizziness are characteristic symptoms in patients after vestibular schwannoma surgery and often have a negative impact on their quality of life. This thesis deals with impairment of postural stability particularly in patients at the long time period after surgery. The aim of this study is to observe the longitudinal development of vestibular compensation from acute postoperative period to time of several years after surgery. Another aim is to evaluate the short-term effect of vestibular rehabilitation in a long time period after surgical treatment, and to compare the results of measuring the subjective visual vertical, posturography, score of the Dizziness Handicap Inventory questionnaire, age and tumor size in these patients. Methods: Examined group consisted of 10 patients after resection of vestibular schwannoma (mean age 41.4 ± 12.1 years; 2 women and 8 men). All patients underwent intensive rehabilitation program in the acute phase after surgery. 7 patients did exercise with visual feedback, and 3 patients had conventional rehabilitation without visual feedback. In long time period after surgery all patients underwent one exercise unit with visual feedback. Patients underwent computerized posturography examination using force platform Balance Master® in...
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The inpluence of age on the perception of verticality in healthy individuals
Kmeť, Jan ; Čakrt, Ondřej (advisor) ; Slabý, Kryštof (referee)
INTRODUCTION - The ability to maintain stability while standing given by function of multisenzory system consists of vision, somatosensory and vestibular system and integration of the CNS. Due to aging there is a decrease of functional capacity of the organism, including these systems, resulting in a deterioration of the balance. Examination of subjective visual and haptic vertical is sensitive diagnostic criterion for functionality of these systems. OBJECTIVE - To compare the ability of verticality perception in young and elderly. METHODS - We examined 64 probands in visual and haptic subjective vertical. The first group consisted of 30 subjects aged 20 to 30 years. In the second group there were 34 people aged over 60. RESULTS - The values of the subjective visual vertical not differ between groups (0.1 ± 0.75 ř for the young and 0.1 ± 1.91 ř for seniors). Results of subjective haptic vertical differed on the significance level of p = 0.004 (0.8 ± 3.67 in the young and 3.7 ± 4.15 for seniors). CONCLUSION - Because subjective haptic vertical is diagnostic criterion mainly for the somatosensory system, we can assume that this particular system is responsible for a decrease in functional capacity and deterioration of stability in the elderly.
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Changes in perception of subjective vertical in cerebrovascular accident patients
Kříž, Petr ; Čakrt, Ondřej (advisor) ; Bitnar, Petr (referee)
Cerebro-vascular accident often affects parts of brain responsible for spatial orientation. Optimal integration of afference from visual, somatosensory and vestibular system is necessary for maintaining balance and often in the end for the functional indepencence of the patient. Examination of subjective vertical is a sensitive signifier for spatial orientation and the ability to discern graviception. By using clinical examination of subjective visual vertical it is possible to objectify and quantify graviception disorder excluding visual context. Current level of understanding in this field is briefly summarized in theoretical part of this study. In practical part subjective visual vertical examination by bucket-method was for statistically comparison of 29 patients after a cerebro- vascular accident with 34 healthy seniors. Hypotheses about the influence of a side of a lesion and a time elapsed since the lesions were also tested. The study concludes that the perception of verticality in patients after cerebro- vascular accident can be severely affected. Additionally, the study highlights the reliability of examination of patients after cerebro-vascular accident using clinically practical bucket-method.
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Compensation of the subjective visual vertical in patients after surgery of the vestibular schwannoma
Kmeť, Jan ; Čakrt, Ondřej (advisor) ; Pospíšilová, Mariana (referee)
In patients with the vestibular schwannoma balance disorders are common symptom. Problems can appear before a surgery, because of an oppression of the nerve the afferents from vestibular system of affected side is aborted. But it is often that patients have no problems with balance until the operation. After the operation they have a balance disorder, a vertigo and a change in the perception of the vertical. Thanks to the rest of the afferent systems and the otherside vestibular system it comes to a slowly compensation and to a new setting of the verticality in the central nervous system. This bachelor thesis studies our sense of the verticality and a function of each receptor, which participate in modelation of this sense. In practical part we handle the subjective visual vertical, which is a result of the vestibular function. We also observe progress and velocity of SVV compensation in patients after a removal of the vestibular schwannoma and we compare it with the state before the operation.
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