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The evaluation of gait and balance tests in patients after vestibular schwannoma surgery
Chejnovská, Lucie ; Čakrt, Ondřej (advisor) ; Hrubá, Silvie (referee)
The thesis deals with the evaluation of gait and balance tests in patients after vestibular schwannoma surgery. The experimental part focuses on the evaluation of dynamics of walking tests during hospitalization of patients diagnosed with vestibular schwannoma. The aim of the experimental part is also to analyze statistically significant correlations between measurable parameters of vestibulo-ocular reflex and walking tests and to evaluate the correlation between the subjective scale of fall fear and the objective assessment of walking and dynamic postural stability. A total of 28 patients aged 33 to 68 (14 men and 14 women) were incuded in the research with diagnosed vestibular schwannoma. Measurements were performed three times in patients (before surgery, after surgery and before the end of hospitalization). After the surgery, in addition to standard rehabilitation, training with visual biofeedback was included using the interactive Homebalance system. Gait and balance assessments were performed throug the tests Timed Up and Go, Four Step Square Test and Functional Gait Assessment. Examinations were complemented by a questionnaire of subjective assessment of fear of falling Falls Efficacy Scale. Statistical analysis showed a significant correlation coefficient in the correlation of Four Step...
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The effect of locomotion speed on linear path integration performance in patients with peripheral vestibulopathy
Petříčková, Kristina ; Čakrt, Ondřej (advisor) ; Jeřábek, Jaroslav (referee)
DIPLOMOVÁ PRÁCE 2017 Kristina Petříčková Abstract This diploma thesis is focused on the effect of peripheral vestibular dysfunction and locomotion speed on the ability to walk a straight path. Nineteen patients with chronic peripheral vestibular dysfunction and twenty healthy volunteers participated in this study. The angle deviation from 10 meters long straight path while walking with eyes closed was measured, using three locomotion speeds: slow, preferred and fast walking. Tandem gait with eyes opened and closed was also tested for maximum of 15 steps. There was no statistical difference between group of patients and the control group in any of the tested gait speeds. Within both groups, there was a significant difference between deviations in different gait speeds, specifically between slow and preferred speed and between slow and fast speed. There was a statistical difference in tandem gait between patients and controls when walking with eyes closed. It has been shown that locomotion speed effects magnitude of deviation in path integration task. However, slow walking with eyes closed did not quantitatively differ in chronic compensated patients and healthy subjects. Tandem gait has been proven to be more sensitive with overall obvious difference, although in individual tandem gait testing it is...
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The dynamic of vestibular compensation in patients after vestibular schwannoma surgery
Kletenská, Markéta ; Čakrt, Ondřej (advisor) ; Čada, Zdeněk (referee)
The thesis deals with the issue of vestibular compensation in patiens after vestibular schwannoma surgery. The aim of this thesis was to objectively evaluate the dynamics of vestibular compensation in the early postoperative period and to determine whether the application of gentamicin impacts the dynamics of equilibrium functions. 32 patients participated in the study (20 women and 12 men) ranging from 28 to 73 years of age. Patients underwent a rehabilitation program with visual feedback using the interactive rehabilitation system, Homebalance. This rehabilitation program was carried out daily from the 5th postoperative day until hospital discharge. Patients were examined preoperatively, postoperatively and after rehabilitation. To assess the vestibular compensation, static posturography, the Synapsys Posturography System, and the Activities-Specific Balance Confidence Scale were used. The statistical analysis showed a significant increase in mean values of measured COP parameters (the length of the COP trajectory and COP confidence elipse area) postoperatively. After completing the rehabilitation program no significant reduction of measured COP parameters was found. The total score from the Activities- Specific Balance Confidence Scale showed a statistically significant decrease in postoperative...
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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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Evaluation of the effect of rehabilitation using visual biofeedback for patients after vestibular schwannoma resection
Jandová, Nikola ; Čakrt, Ondřej (advisor) ; Chovanec, Martin (referee)
The aim of this thesis was to evaluate the effect of rehabilitation with visual biofeedback at acute stage after vestibular schwannoma surgery and to evaluate if preoperative intratympanic aplication of gentamicin has influence on vestibular compensation of standing stability. The study was attended by 20 patients (12 women and 8 men) in the age from 28 to 63 years. Eight patients had vestibular schwannoma diagnosed in their left side, twelve in the right side. Rehabilitation program using interactive rehabilitation system Homebalance took place from the 5th postoperative day until hospital discharge, daily 15 to 20 min. To evaluate of therapeutic intervention objectively the device Synapsys Posturography System was used. Stabilometric examination was done before operation of vestibular schwannoma, after operation and after termination of rehabilitation with visual biofeedback. Statistic analysis showed significant increase of mean values of measured parameters CoP (sway velocity CoP, length of trajectory of CoP, area of the confidence ellipse CoP) postoperatively compared to preoperative values. After termination of therapeutic intervention there was any significant decrease of values of parameters CoP compared to postoperative status. Between group of patients with preoperative aplication of...
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Clinical findings and diagnosis of vestibular lesions in patiens with vestibular schwannomem
Kalitová, Petra ; Langmeier, Miloš (advisor) ; Šlapák, Ivo (referee) ; Kozler, Petr (referee)
Summary: The aim of our study was diagnosis and rehabilitation of vestibular loss in patients with vestibular schwannoma. In the first part we focused on analysis of a group of patients before resection of vestibular schwannoma, mainly on evaluation of gain of posturography and on optimalisation of diagnostic algorithm of vestibular pathology. Throughout the second experiment, we studied if rehabilitation of postural gait with visual biofeedback will speed up vestibular compensation in patients after resection of vestibular schwannoma. The group consisted of 44 patients, who underwent surgical removal of vestibular schwannoma. Before surgery each patient underwent clinical vestibular examination, electronystagmographic recordings and posturography. In the second part of the study 17 patients from previous group were chosen. These patients underwent rehabilitation and rehabilitation with biofeedback. For evaluation was used independent samples T-test and cross-tabulation. A great number of variables were reduced by factor analysis. For statistical analysis of the group with rehabilitation was used nonparametric Wilcoxon signed rank test. Statistical analysis revealed that the most typical parameter for vestibular pathology is the time of the step quick turn test, which is a part of posturography. We proved...
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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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