Oculomotor and Vestibular Ocular Reflex Exercises in Patients With Benign Paroxysmal Positional Vertigo

Study Overview
=================
Brief Summary
-----------------
The aim of this research is to assess effects of Oculomotor and VOR exercises on vertigo, dizziness and balance in patients with BPPV. Randomized controlled trial was conducted at Hameed Latif Hospital, Lahore. The sample size 32 participants which were divided into two groups, 16 participants in traditional physical therapy group and 16 in oculomotor and vestibular ocular reflex exercises group. Study duration was of 6 months. Sampling technique applied was non-probability consecutive sampling technique. Only 30-70 years individuals with Benign Paroxysmal Positional Vertigo (BPPV) were included. Tools used in the study are vertigo handicap questionnaire, visual vertigo analogue scale, dizziness handicap inventory, berg balance scale and dynamic gait index. The data was analyzed using SPSS.

Detailed Description
-----------------
Randomized controlled trial was conducted at Hameed Latif Hospital, Lahore. The sample size 32 participants which were divided into two groups, 16 participants in traditional physical therapy group and 16 in oculomotor and vestibular ocular reflex exercises group. Study duration was of 6 months. Sampling technique applied was non-probability consecutive sampling technique. Only 30-70 years individuals with Benign Paroxysmal Positional Vertigo (BPPV) were included. Tools used in the study are vertigo handicap questionnaire, visual vertigo analogue scale, dizziness handicap inventory, berg balance scale and dynamic gait index. The data was analyzed using SPSS.

Official Title
-----------------
Effects of Oculomotor and Vestibular Ocular Reflex Exercises on Vertigo, Dizziness and Balance in Patients With Benign Paroxysmal Positional Vertigo

Conditions
-----------------
Benign Paroxysmal Positional Vertigo (Disorder)

Intervention / Treatment
-----------------
* Other: Traditional physical therapy using Epley's maneuver
* Other: Oculomotor and Vestibular Ocular Reflex (VOR) exercises


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Patients who have vertigo with posterior canal involvement during Dix-Hallpike test with or without accompanying nystagmus (objective or subjective BPPV). Ability to walk at least 3 meters by itself with or without assistive device Normal vision with or without correction by spectacles or contact lenses Exclusion Criteria: Patients with other neurologic conditions, orthopedic problems, and uncontrolled metabolic diseases to eliminate confounding factors affecting balance performance Unable to understand and answer a simple verbal command. Previously underwent oculomotor and vestibular ocular exercises. Other vestibular disorders like Meniere disease Long-term use of benzodiazepines (more than 20 years). Patients who are already performing structured physical activities such as muscle strengthening exercises, Pilates, yoga or high intensity aerobic exercises

Ages Eligible for Study
-----------------
Minimum Age: 30 Years
Maximum Age: 60 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Traditional physical therapy using Epley's maneuver<br>Epley's maneuver was performed once a week for three weeks. The maneuver was performed by patient in sitting position, head was rotated towards involved side and then extended to 30 degrees, it was then rotated to 180 degrees followed by patient rolling onto opposite side. Each position was maintained for 1-2 minutes. | Other: Traditional physical therapy using Epley's maneuver<br>* Epley's maneuver was performed once a week for three weeks. The maneuver was performed by patient in sitting position, head was rotated towards involved side and then extended to 30 degrees, it was then rotated to 180 degrees followed by patient rolling onto opposite side. Each position was maintained for 1-2 minutes.<br>|
| Active Comparator: Oculomotor and Vestibular Ocular Reflex (VOR) exercises<br>oculomotor and VOR exercises after Epley's maneuver. The exercises were performed for approximately 5 minutes daily or 1 to 2 minutes, 3 to 4 times a day, in sitting position. The exercises were continued for three weeks. The maneuver was performed by patient in sitting position, head was rotated towards involved side and then extended to 30 degrees, it was then rotated to 180 degrees followed by patient rolling onto opposite side. Each position was maintained for 1-2 minutes. Saccadic exercises were performed by moving eyes between two stationary targets. Smooth pursuit exercises were performed by tracking a moving target while keeping head still and VOR exercises were performed by moving head left to right while maintaining eyes on stationary target | Other: Oculomotor and Vestibular Ocular Reflex (VOR) exercises<br>* oculomotor and VOR exercises after Epley's maneuver. The exercises were performed for approximately 5 minutes daily or 1 to 2 minutes, 3 to 4 times a day, in sitting position. The exercises were continued for three weeks. The maneuver was performed by patient in sitting position, head was rotated towards involved side and then extended to 30 degrees, it was then rotated to 180 degrees followed by patient rolling onto opposite side. Each position was maintained for 1-2 minutes. Saccadic exercises were performed by moving eyes between two stationary targets. Smooth pursuit exercises were performed by tracking a moving target while keeping head still and VOR exercises were performed by moving head left to right while maintaining eyes on stationary target<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Vertigo Handicap Questionnaire | It assess effect of vertigo on disability, handicap and benefits following therapeutic intervention both physically and psychologically. | First reading at 0 day | 
| Vertigo Handicap Questionnaire | It assess effect of vertigo on disability, handicap and benefits following therapeutic intervention both physically and psychologically. | second reading after 3 weeks | 
| Visual Vertigo Analogue Scale | Intensity of visual vertigo in nine challenging situations of visual motions that typically provoke dizziness | First reading at 0 day | 
| Visual Vertigo Analogue Scale | Intensity of visual vertigo in nine challenging situations of visual motions that typically provoke dizziness | second reading after 3 weeks | 
| Dizziness Handicap Inventory | Self-perceived handicapping effects imposed by dizziness. | First reading at 0 day | 
| Dizziness Handicap Inventory | Self-perceived handicapping effects imposed by dizziness. | second reading after 3 weeks | 
| Berg Balance Scale | Objectively determine a patient's ability (or inability) to safely balance during a series of predetermined tasks | First reading at 0 day | 
| Berg Balance Scale | Objectively determine a patient's ability (or inability) to safely balance during a series of predetermined tasks | First reading at 3 week | 
| Dynamic Gait Index | The clinical tool to assess gait, balance and fall risk. It evaluates not only usual steady-state walking, but also walking during more challenging tasks. | first reading after 0 day | 
| Dynamic Gait Index | The clinical tool to assess gait, balance and fall risk. It evaluates not only usual steady-state walking, but also walking during more challenging tasks. | second reading after 3 weeks | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Benign Paroxysmal Positional Vertigo, Oculomotor exercises, Vestibular Ocular Reflex (VOR) exercises