Spatial Cognitive Training for Chronic Vestibular Disorders

Study Overview
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Brief Summary
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In this study the investigators propose to apply cognitive training, which has been largely used in the realm of age-related cognitive decline, dementia, and Alzheimer's disease, in a novel clinical context to individuals with vestibular impairment. In prior work the investigators observed that individuals with vestibular loss have evidence of spatial cognitive impairment. The investigators plan to evaluate the preliminary efficacy and feasibility of a cognitive training program in a sample of participants with chronic vestibular impairment who display deficits in spatial ability. The cognitive training program will focus on visuospatial skills and will be used as an adjunct to traditional vestibular physical therapy (VPT).

Detailed Description
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Patients with chronic vestibular dysfunction with report symptoms of spatial cognitive impairment will be offered cognitive training. The intervention will consist of a well-validated cognitive training protocol that specifically targets spatial navigation skills. The protocol was developed by Willis et al. for the Adult Development and Enrichment Trial (ADEPT) trial, which trains map reading and route-learning skills through mental rotation training tasks over the course of 5 weeks. Patients will be assessed by study staff pre-intervention, immediately post-intervention and at 3 months post-intervention using spatial cognitive outcomes, quality of life measures, and gait and balance outcomes.

Official Title
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Spatial Cognitive Training for Chronic Vestibular Disorders

Conditions
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Vestibular Abnormality, Cognitive Training

Intervention / Treatment
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* Behavioral: Spatial Cognitive Training


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosis of chronic vestibular disorder (>6months & diagnosis from laboratory testing by neuro-otologist) Exclusion Criteria: Participants with dementia, or with blindness or deafness who cannot participate in cognitive training procedures.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Spatial Cognitive Training<br>map reading and route-learning skills | Behavioral: Spatial Cognitive Training<br>* map reading and route-learning skills<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from baseline in Dizziness Handicap Inventory | Subjective 25-item questionnaire measuring Quality of Life and disability on a scale from 0-100 | Baseline vs immediately post-training | 
| Change from immediate post-training to 3-months post-training in Dizziness Handicap Inventory | Subjective 25-item questionnaire measuring Quality of Life and disability on a scale from 0-100 | Immediately post-training to 3 months post-training | 
| Change from baseline in Dynamic Gait Index | Balance challenges during 8 different gait tasks (head turns, speed changes, over/around obstacles) with total score out of 24 points. | Baseline vs immediately post-training | 
| Change from immediate post-training to 3-months post-training in Dynamic Gait Index | Balance challenges during 8 different gait tasks (head turns, speed changes, over/around obstacles) with total score out of 24 points. | Immediately post-training to 3 months post-training | 
| Change from baseline in Four Square Step Test | Assesses dynamic balance, spatial, & sequencing skills while stepping forward/back/sideways over a low obstacle (measured in seconds) | Baseline vs immediately post-training | 
| Change from immediate post-training to 3-months post-training in Four Square Step Test | Assesses dynamic balance, spatial, & sequencing skills while stepping forward/back/sideways over a low obstacle (measured in seconds) | Immediately post-training to 3 months post-training | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from baseline in Money Road Map Test | Assessment of egocentric mental rotation in space by recording total number of errors in right-left discrimination mental rotation tasks. | Baseline vs immediately post-training | 
| Change from immediate post-training to 3-months post-training in Money Road Map Test | Assessment of egocentric mental rotation in space by recording total number of errors in right-left discrimination mental rotation tasks. | Immediately post-training to 3 months post-training | 
| Change from baseline in Benton Visual Retention Test | visual perception and visual memory assessment by asking participant to reproduce 10 designs following a 10-second exposure and scored 0-10 based on correct drawing reconstruction. | Baseline vs immediately post-training | 
| Change from immediate post-training to 3-months post-training in Benton Visual Retention Test | visual perception and visual memory assessment by asking participant to reproduce 10 designs following a 10-second exposure and scored 0-10 based on correct drawing reconstruction. | Immediately post-training to 3 months post-training | 
| Change from baseline in modified Clinical Test of Sensory Organization and Balance | Static standing balance during 4 conditions where sensory inputs are altered (eyes open/eyes closed on firm/foam surface) and each condition is timed for max of 30 seconds. | Baseline vs immediately post-training | 
| Change from immediate post-training to 3-months post-training in modified Clinical Test of Sensory Organization and Balance | Static standing balance during 4 conditions where sensory inputs are altered (eyes open/eyes closed on firm/foam surface) and each condition is timed for max of 30 seconds. | Immediately post-training to 3 months post-training | 
| Change from baseline in Activities-specific Balance Confidence Scale | Subjective questionnaire that determines confidence during daily tasks (scores range 0-100%) | Baseline vs immediately post-training | 
| Change from immediate post-training to 3-months post-training in Activities-specific Balance Confidence Scale | Subjective questionnaire that determines confidence during daily tasks (scores range 0-100%) | Immediately post-training to 3 months post-training | 
| Change from baseline in Santa Barbara Sense of Direction Scale | 15 question related to subjective sense of direction adeptness (ranging 1-7 for each item); cumulative score is divided by number of responses answered to yield a 1-7 total score. | Baseline vs immediately post-training | 
| Change from immediate post-training to 3-months post-training in Santa Barbara Sense of Direction Scale | 15 question related to subjective sense of direction adeptness (ranging 1-7 for each item); cumulative score is divided by number of responses answered to yield a 1-7 total score. | Immediately post-training to 3 months post-training |