This document discusses chronic subjective dizziness (CSD), a condition characterized by non-vertiginous dizziness or imbalance that is exacerbated by motion and visual stimuli. CSD is thought to develop through classical and operant conditioning following acute vestibular disorders. Treatment involves diagnosis, education, pharmacology like SSRIs, psychotherapy, and vestibular rehabilitation therapy including habituation exercises and graded exposure. CSD is differentiated from other conditions through characteristic symptoms and normal exam findings despite a history of vestibular dysfunction.
Dr. Anton de Wijer is a specialist in special dental care, TMD and orofacial pain at the UMC St Radboud in the Netherlands. His practice focuses on treating temporomandibular disorders (TMD) using a multidisciplinary approach involving psychologists, manual therapists, dentists and other specialists. The document provides statistics on patients seen in his practice, describes the multidisciplinary treatment approach used at his clinic, and discusses the links between TMD and neck pain based on current research findings.
Cervicogenic Dizziness - identification and treatmentNVMT-symposium
Cervicogenic dizziness is a controversial diagnosis caused by dysfunction in the upper cervical spine that results in imbalance or disequilibrium. It is identified through a 5-step process including characteristics of imbalance-type dizziness, neck pain or stiffness exacerbating dizziness, and physical exam findings. Sustained natural apophyseal glides are an effective manual therapy treatment, shown to decrease dizziness and pain more than mobilizations or placebo. Multi-modal treatment including balance exercises is also recommended. Long-term follow up shows treatment effects are maintained for up to 12 months.
The document discusses a maladaptive perception model of chronic low back pain (CLBP). It summarizes evidence that CLBP is associated with changes in brain structure and function, sensory processing, motor control, and body perception. A plausible model is that maladaptive cognitive and sensory processes could influence tissue loading, sensitivity, fear and worry in a way that perpetuates pain. Experimental research supports the idea that correcting maladaptive body perception through sensory discrimination training and graded cortical retraining can reduce pain. Functional rehabilitation targeting both cognitive perception and self-perception may help normalize movement behaviors and integrate activities to mutually normalize perception and pain.
Assessment and management of complex pain conditionsSaurab Sharma
This was a presentation made at NITTE University during their first Physiotherapy Conference where I was invited as a Speaker. I am posting this thinking if this will be useful revision for those who attended and may be of some use to those who could not listen.
Presentatie Drs. Ronald Kan - Even wat rechtzetten NVMT-symposium
1) The document discusses evidence related to the effectiveness of manual therapy (MT) for various pain conditions like acute low back pain, chronic low back pain, and neck pain. It finds small but consistent effects for MT, though not more effective than other conservative treatments.
2) It explores how context, communication, and patient/therapist factors can influence pain through placebo and nocebo effects. Negative or threatening language can increase pain (nocebo), while positive expectations can decrease pain (placebo).
3) The language used by healthcare providers has enduring influence on patient beliefs and can potentially cause or increase disability if not carefully considered. Attention to communication is important to avoid iatrogenic outcomes.
A brief introduction to what Keele's Stratified care for low back pain: Subgrouping and targeting treatment for low back pain in primary care (STarT Back).
The STarT Back approach uses a simple tool to match patients suggesting with back pain to treatment packages appropriate for them. This has been shown to decrease disability from back pain, reduce time off work, and save money by making better use of health resources.
Efficacy of classification-based_cft_in_nsclbpMeziat
Artigo (6) importante para a preparação para o curso de dor lombar crônica. "Eficácia da Terapia Cognitiva Funcional em pacientes com dor lombar crônica inespecífica: ensaio clínico randomizado controlado."
There research on the effectiveness of Physical Therapy for back pain is not compelling. This presentation overviews the current evidence base and discusses the potential for classification of back pain to demonstrate stronger support for Physical Therapy.
The Specific Treatment of Problems of the Spine (STOPS) trial protocol is then presented. This study was recently completed showing moderate to strong effect sizes favouring Physical Therapy over evidence-based advice.
Note that the clinical protocol details in the presentation are examples only. For the full clinical protocol visit Physical Therapy Reviews
Dr. Anton de Wijer is a specialist in special dental care, TMD and orofacial pain at the UMC St Radboud in the Netherlands. His practice focuses on treating temporomandibular disorders (TMD) using a multidisciplinary approach involving psychologists, manual therapists, dentists and other specialists. The document provides statistics on patients seen in his practice, describes the multidisciplinary treatment approach used at his clinic, and discusses the links between TMD and neck pain based on current research findings.
Cervicogenic Dizziness - identification and treatmentNVMT-symposium
Cervicogenic dizziness is a controversial diagnosis caused by dysfunction in the upper cervical spine that results in imbalance or disequilibrium. It is identified through a 5-step process including characteristics of imbalance-type dizziness, neck pain or stiffness exacerbating dizziness, and physical exam findings. Sustained natural apophyseal glides are an effective manual therapy treatment, shown to decrease dizziness and pain more than mobilizations or placebo. Multi-modal treatment including balance exercises is also recommended. Long-term follow up shows treatment effects are maintained for up to 12 months.
The document discusses a maladaptive perception model of chronic low back pain (CLBP). It summarizes evidence that CLBP is associated with changes in brain structure and function, sensory processing, motor control, and body perception. A plausible model is that maladaptive cognitive and sensory processes could influence tissue loading, sensitivity, fear and worry in a way that perpetuates pain. Experimental research supports the idea that correcting maladaptive body perception through sensory discrimination training and graded cortical retraining can reduce pain. Functional rehabilitation targeting both cognitive perception and self-perception may help normalize movement behaviors and integrate activities to mutually normalize perception and pain.
Assessment and management of complex pain conditionsSaurab Sharma
This was a presentation made at NITTE University during their first Physiotherapy Conference where I was invited as a Speaker. I am posting this thinking if this will be useful revision for those who attended and may be of some use to those who could not listen.
Presentatie Drs. Ronald Kan - Even wat rechtzetten NVMT-symposium
1) The document discusses evidence related to the effectiveness of manual therapy (MT) for various pain conditions like acute low back pain, chronic low back pain, and neck pain. It finds small but consistent effects for MT, though not more effective than other conservative treatments.
2) It explores how context, communication, and patient/therapist factors can influence pain through placebo and nocebo effects. Negative or threatening language can increase pain (nocebo), while positive expectations can decrease pain (placebo).
3) The language used by healthcare providers has enduring influence on patient beliefs and can potentially cause or increase disability if not carefully considered. Attention to communication is important to avoid iatrogenic outcomes.
A brief introduction to what Keele's Stratified care for low back pain: Subgrouping and targeting treatment for low back pain in primary care (STarT Back).
The STarT Back approach uses a simple tool to match patients suggesting with back pain to treatment packages appropriate for them. This has been shown to decrease disability from back pain, reduce time off work, and save money by making better use of health resources.
Efficacy of classification-based_cft_in_nsclbpMeziat
Artigo (6) importante para a preparação para o curso de dor lombar crônica. "Eficácia da Terapia Cognitiva Funcional em pacientes com dor lombar crônica inespecífica: ensaio clínico randomizado controlado."
There research on the effectiveness of Physical Therapy for back pain is not compelling. This presentation overviews the current evidence base and discusses the potential for classification of back pain to demonstrate stronger support for Physical Therapy.
The Specific Treatment of Problems of the Spine (STOPS) trial protocol is then presented. This study was recently completed showing moderate to strong effect sizes favouring Physical Therapy over evidence-based advice.
Note that the clinical protocol details in the presentation are examples only. For the full clinical protocol visit Physical Therapy Reviews
AProf Jon Ford’s presentation from today at the World LBP Congress in Antwerp presenting new data on the STOPS approach, introducing STOPS Plus for more complex chronic pain and comparing clinical importance with STarT Back and Cognitive Functional Therapy
A review of the effectiveness of Yoga and meditation as a complementary to medications, in treatment of mental disorders from anxiety to schizophrenia- from children to seniors
This document summarizes the management of tremor and spasticity in multiple sclerosis. It discusses tremor, including types, assessment, and interventions like physiotherapy, oral medications, botulinum toxin injections, and deep brain stimulation. It also covers spasticity, defining it as part of the upper motor neuron syndrome and discussing its impact. Assessment of spasticity is highlighted as key to management. A multidisciplinary team approach is advocated to accurately assess issues, determine treatment goals, and provide non-pharmacological and pharmacological interventions.
The document discusses cancer-related fatigue (CRF), including its multidimensional nature, potential causes, and challenges in managing it. It provides an overview of approaches to addressing fatigue, including through physical exercise, psychological and behavioral interventions, managing other symptoms, and other targeted interventions. The key message is that awareness, screening, and comprehensive assessment of potential contributing factors is important to diagnose specific types of fatigue and identify the most appropriate targeted interventions.
Understanding fatigue and an introduction to the FACETS programmeMS Trust
This presentation by Alison Nook and Vicky Slingsby, Occupational Therapists at the Dorset MS Service, explores fatigue in multiple sclerosis, the most common MS symptom. It looks at how fatigue can be managed with energy effectiveness techniques and introduces FACETS (Fatigue: Applying Cognitive behavioural and Energy effectiveness Techniques to lifeStyle),
Persistent postural-perceptual dizziness (PPPD) is a chronic functional disorder characterized by non-spinning vertigo and unsteadiness lasting for at least 3 months. The diagnosis is made based on diagnostic criteria including symptoms exacerbated by upright posture, motion, and moving visual stimuli. PPPD can be triggered by acute or chronic vestibular disorders, neurological illnesses, or psychological distress. Treatment involves education, vestibular exercises, medication like SSRIs or SNRIs, and cognitive behavioral therapy.
2015: Post Stroke Fatigue - Why Live With It?-GiapSDGWEP
Post-stroke fatigue is a common problem, affecting 38-73% of stroke survivors. It can persist for months or years after a stroke and significantly impact quality of life. The document discusses factors that may contribute to post-stroke fatigue like depression, sleep disturbances, lack of exercise, and medications. It also reviews tools to assess fatigue severity and differentiates fatigue from excessive daytime sleepiness. While no pharmacological treatments have proven effective, non-drug interventions like exercise, energy conservation, and sleep management may help manage post-stroke fatigue. A randomized controlled trial found that cognitive therapy combined with graded activity training over 12 weeks can reduce persistent post-stroke fatigue.
2015: How do we encourage our patients to exercise?-LinkeSDGWEP
This document discusses strategies for encouraging patients to exercise. It begins by outlining current guidelines for physical activity in older adults, then discusses the physical and mental health benefits of exercise. While exercise is beneficial, adherence can be challenging due to various personal and environmental factors. The document provides tips for healthcare providers to help patients establish exercise routines, including assessing readiness to change, goal setting, addressing barriers, and utilizing social support. It emphasizes tailoring recommendations to individual needs and abilities.
This document discusses central sensitization, a condition where the central nervous system amplifies sensory processing, resulting in hypersensitivity and chronic pain. It begins by explaining how acute pain becomes chronic pain due to central sensitization. It then describes the mechanisms of central sensitization, including wind-up in the spinal cord, impaired descending pain inhibition, and changes in the brain. It discusses how central sensitization can be assessed through measures like conditioned pain modulation, exercise-induced analgesia, and hypersensitivity questionnaires. The document provides criteria for identifying central sensitization in musculoskeletal pain patients and signs and symptoms of central sensitization. It concludes by discussing treatment implications when central sensitization is present.
1. The document provides guidelines and information on treating back pain, including non-invasive and interventional options.
2. Non-pharmacological treatments like heat, massage, acupuncture, and spinal manipulation can provide small to moderate relief for acute/subacute back pain. Exercise and mindfulness therapies provide small to moderate relief for chronic back pain.
3. Pharmacological options for chronic back pain include NSAIDs as first line, and tramadol or duloxetine as second line. Opioids should only be considered as a last resort option for chronic back pain.
This study examined the effects of craniosacral therapy (CST) on heart rate variability (HRV) in 31 patients with subjective discomforts. HRV was measured before and after a 30-minute control rest period and a 30-minute CST session on consecutive days using a mobile device. Standard deviation of heart rate intervals (SDNN) and total power (TP), indicators of autonomic nervous system activity, increased significantly after CST but not the control rest. Heart rate also decreased significantly after CST compared to rest. However, interactions between treatment and HRV changes were not fully statistically significant. The study provides preliminary evidence that CST may positively influence autonomic nervous system regulation.
Efficacy of Treatments/ Assessments (ketamine infusion therapy, neurofeedback...SophiaRodriguez24
Explored in this presentation is the efficacy of treatments used in psychiatry such as ketamine infusion therapy, neurofeedback, and psychological testing. Those interested can learn more about the services and assessments that are used to diagnose and treat patients suffering from a wide range of illnesses and disorders such as depression, anxiety, PTSD, learning disabilities, insomnia, etc.
Common Brain Mechanisms Between Pain & AddictionPaul Coelho, MD
This document summarizes a perspective on common brain mechanisms of chronic pain and addiction. It proposes that chronic pain involves neuroadaptations similar to those seen in addiction, including reward deficiency, impaired inhibitory control, incentive sensitization, aberrant learning, and anti-reward allostatic neuroadaptations. The document provides epidemiological context on the prevalence and costs of chronic pain. It then reviews models of reward and addiction neurobiology and discusses how chronic pain may disrupt normal hedonic homeostasis in a manner analogous to addiction through an allostatic load. The perspective aims to inform improved chronic pain treatment by drawing parallels to addiction theories and interventions.
This research report summarizes a study examining the neural effects of cognitive-behavioral therapy (CBT) for generalized anxiety disorder (GAD). The study involved 21 adults with GAD and 11 healthy controls. Participants underwent functional MRI while viewing facial emotions before and after CBT (or a comparable waiting period for controls). Results showed that before treatment, those with GAD had blunted responses in brain regions involved in emotion processing when viewing happy faces, and greater connectivity between the amygdala and insula. After CBT, individuals with GAD showed attenuated activation in the amygdala and anterior cingulate in response to threat-related faces, as well as heightened insular responses to happy faces. The findings provide evidence
Chronic neck pain can last more than 6 months and is considered chronic. A physical therapist can effectively assess and treat chronic neck pain. The PT will perform assessments like questionnaires, range of motion and strength tests to determine the condition. Treatments may include exercises, manual therapy, education and ergonomic advice. Prognostic factors like age over 40 or prior history of neck issues can increase the risk of chronic neck pain.
Efficacy Of Meditation In The Management Of Anxietydburr
This document summarizes a research study on the efficacy of meditation for treating anxiety disorders. The study reviewed 11 research studies on meditation and anxiety. It found that mindfulness meditation was effective for preventing acute anxiety attacks and maintaining long-term management of anxiety. Meditation improved quality of life by reducing symptoms, improving relationships, and decreasing reliance on healthcare services. Regular meditation practice facilitated anxiety reduction and improved psychological outcomes.
Exercise for people with MS: A summary of the evidence and recommendations fo...MS Trust
1. The document summarizes evidence from research studies on the benefits of exercise for people with multiple sclerosis (MS). It finds that exercise can improve muscle strength, aerobic capacity, and quality of life while reducing fatigue, depression, and cardiovascular disease risk for people with MS.
2. The research shows that exercise programs involving both aerobic exercise and resistance training conducted 2-3 times per week are safe, effective, and recommended for people with mild to moderate MS. Supervised exercise is best to ensure proper progression.
3. While exercise has clear benefits, people with MS remain less physically active than healthy individuals due to factors like fatigue, impairment, and lack of time. Overcoming barriers to exercise requires behavior
Biofeedback and other Psychophysiological Techniques for Headache - Neuro Exp...Norton Healthcare
This document discusses biofeedback techniques for treating headaches, including migraine and tension headaches. It provides an overview of different types of biofeedback (GSR, thermal, EMG, EEG), describes how neurofeedback works to regulate brainwaves, and summarizes research showing biofeedback is efficacious for reducing headache frequency, duration and intensity. Comprehensive biofeedback programs can help patients control physiological processes contributing to headaches through techniques like relaxation, thermal biofeedback, mindfulness training and neurofeedback.
This document discusses biofeedback and psychophysiological techniques for treating headaches. It provides an overview of different types of biofeedback including GSR, thermal, EMG, and EEG biofeedback. Research evidence shows biofeedback is effective in reducing headache frequency, duration, and intensity for both migraines and tension headaches. Comprehensive biofeedback programs can help patients learn to control physiological processes contributing to headaches through techniques like relaxation, breathing exercises, thermal biofeedback, mindfulness training, and neurofeedback.
Presentation of first chapter [make your book]Alexis Aronis
The document discusses using a Venn diagram to visualize common structure elements between different preferred categories or genres that were previously chosen. It instructs the reader to use the simplified Venn diagram included to identify common elements of personal preferences between the chosen categories.
AProf Jon Ford’s presentation from today at the World LBP Congress in Antwerp presenting new data on the STOPS approach, introducing STOPS Plus for more complex chronic pain and comparing clinical importance with STarT Back and Cognitive Functional Therapy
A review of the effectiveness of Yoga and meditation as a complementary to medications, in treatment of mental disorders from anxiety to schizophrenia- from children to seniors
This document summarizes the management of tremor and spasticity in multiple sclerosis. It discusses tremor, including types, assessment, and interventions like physiotherapy, oral medications, botulinum toxin injections, and deep brain stimulation. It also covers spasticity, defining it as part of the upper motor neuron syndrome and discussing its impact. Assessment of spasticity is highlighted as key to management. A multidisciplinary team approach is advocated to accurately assess issues, determine treatment goals, and provide non-pharmacological and pharmacological interventions.
The document discusses cancer-related fatigue (CRF), including its multidimensional nature, potential causes, and challenges in managing it. It provides an overview of approaches to addressing fatigue, including through physical exercise, psychological and behavioral interventions, managing other symptoms, and other targeted interventions. The key message is that awareness, screening, and comprehensive assessment of potential contributing factors is important to diagnose specific types of fatigue and identify the most appropriate targeted interventions.
Understanding fatigue and an introduction to the FACETS programmeMS Trust
This presentation by Alison Nook and Vicky Slingsby, Occupational Therapists at the Dorset MS Service, explores fatigue in multiple sclerosis, the most common MS symptom. It looks at how fatigue can be managed with energy effectiveness techniques and introduces FACETS (Fatigue: Applying Cognitive behavioural and Energy effectiveness Techniques to lifeStyle),
Persistent postural-perceptual dizziness (PPPD) is a chronic functional disorder characterized by non-spinning vertigo and unsteadiness lasting for at least 3 months. The diagnosis is made based on diagnostic criteria including symptoms exacerbated by upright posture, motion, and moving visual stimuli. PPPD can be triggered by acute or chronic vestibular disorders, neurological illnesses, or psychological distress. Treatment involves education, vestibular exercises, medication like SSRIs or SNRIs, and cognitive behavioral therapy.
2015: Post Stroke Fatigue - Why Live With It?-GiapSDGWEP
Post-stroke fatigue is a common problem, affecting 38-73% of stroke survivors. It can persist for months or years after a stroke and significantly impact quality of life. The document discusses factors that may contribute to post-stroke fatigue like depression, sleep disturbances, lack of exercise, and medications. It also reviews tools to assess fatigue severity and differentiates fatigue from excessive daytime sleepiness. While no pharmacological treatments have proven effective, non-drug interventions like exercise, energy conservation, and sleep management may help manage post-stroke fatigue. A randomized controlled trial found that cognitive therapy combined with graded activity training over 12 weeks can reduce persistent post-stroke fatigue.
2015: How do we encourage our patients to exercise?-LinkeSDGWEP
This document discusses strategies for encouraging patients to exercise. It begins by outlining current guidelines for physical activity in older adults, then discusses the physical and mental health benefits of exercise. While exercise is beneficial, adherence can be challenging due to various personal and environmental factors. The document provides tips for healthcare providers to help patients establish exercise routines, including assessing readiness to change, goal setting, addressing barriers, and utilizing social support. It emphasizes tailoring recommendations to individual needs and abilities.
This document discusses central sensitization, a condition where the central nervous system amplifies sensory processing, resulting in hypersensitivity and chronic pain. It begins by explaining how acute pain becomes chronic pain due to central sensitization. It then describes the mechanisms of central sensitization, including wind-up in the spinal cord, impaired descending pain inhibition, and changes in the brain. It discusses how central sensitization can be assessed through measures like conditioned pain modulation, exercise-induced analgesia, and hypersensitivity questionnaires. The document provides criteria for identifying central sensitization in musculoskeletal pain patients and signs and symptoms of central sensitization. It concludes by discussing treatment implications when central sensitization is present.
1. The document provides guidelines and information on treating back pain, including non-invasive and interventional options.
2. Non-pharmacological treatments like heat, massage, acupuncture, and spinal manipulation can provide small to moderate relief for acute/subacute back pain. Exercise and mindfulness therapies provide small to moderate relief for chronic back pain.
3. Pharmacological options for chronic back pain include NSAIDs as first line, and tramadol or duloxetine as second line. Opioids should only be considered as a last resort option for chronic back pain.
This study examined the effects of craniosacral therapy (CST) on heart rate variability (HRV) in 31 patients with subjective discomforts. HRV was measured before and after a 30-minute control rest period and a 30-minute CST session on consecutive days using a mobile device. Standard deviation of heart rate intervals (SDNN) and total power (TP), indicators of autonomic nervous system activity, increased significantly after CST but not the control rest. Heart rate also decreased significantly after CST compared to rest. However, interactions between treatment and HRV changes were not fully statistically significant. The study provides preliminary evidence that CST may positively influence autonomic nervous system regulation.
Efficacy of Treatments/ Assessments (ketamine infusion therapy, neurofeedback...SophiaRodriguez24
Explored in this presentation is the efficacy of treatments used in psychiatry such as ketamine infusion therapy, neurofeedback, and psychological testing. Those interested can learn more about the services and assessments that are used to diagnose and treat patients suffering from a wide range of illnesses and disorders such as depression, anxiety, PTSD, learning disabilities, insomnia, etc.
Common Brain Mechanisms Between Pain & AddictionPaul Coelho, MD
This document summarizes a perspective on common brain mechanisms of chronic pain and addiction. It proposes that chronic pain involves neuroadaptations similar to those seen in addiction, including reward deficiency, impaired inhibitory control, incentive sensitization, aberrant learning, and anti-reward allostatic neuroadaptations. The document provides epidemiological context on the prevalence and costs of chronic pain. It then reviews models of reward and addiction neurobiology and discusses how chronic pain may disrupt normal hedonic homeostasis in a manner analogous to addiction through an allostatic load. The perspective aims to inform improved chronic pain treatment by drawing parallels to addiction theories and interventions.
This research report summarizes a study examining the neural effects of cognitive-behavioral therapy (CBT) for generalized anxiety disorder (GAD). The study involved 21 adults with GAD and 11 healthy controls. Participants underwent functional MRI while viewing facial emotions before and after CBT (or a comparable waiting period for controls). Results showed that before treatment, those with GAD had blunted responses in brain regions involved in emotion processing when viewing happy faces, and greater connectivity between the amygdala and insula. After CBT, individuals with GAD showed attenuated activation in the amygdala and anterior cingulate in response to threat-related faces, as well as heightened insular responses to happy faces. The findings provide evidence
Chronic neck pain can last more than 6 months and is considered chronic. A physical therapist can effectively assess and treat chronic neck pain. The PT will perform assessments like questionnaires, range of motion and strength tests to determine the condition. Treatments may include exercises, manual therapy, education and ergonomic advice. Prognostic factors like age over 40 or prior history of neck issues can increase the risk of chronic neck pain.
Efficacy Of Meditation In The Management Of Anxietydburr
This document summarizes a research study on the efficacy of meditation for treating anxiety disorders. The study reviewed 11 research studies on meditation and anxiety. It found that mindfulness meditation was effective for preventing acute anxiety attacks and maintaining long-term management of anxiety. Meditation improved quality of life by reducing symptoms, improving relationships, and decreasing reliance on healthcare services. Regular meditation practice facilitated anxiety reduction and improved psychological outcomes.
Exercise for people with MS: A summary of the evidence and recommendations fo...MS Trust
1. The document summarizes evidence from research studies on the benefits of exercise for people with multiple sclerosis (MS). It finds that exercise can improve muscle strength, aerobic capacity, and quality of life while reducing fatigue, depression, and cardiovascular disease risk for people with MS.
2. The research shows that exercise programs involving both aerobic exercise and resistance training conducted 2-3 times per week are safe, effective, and recommended for people with mild to moderate MS. Supervised exercise is best to ensure proper progression.
3. While exercise has clear benefits, people with MS remain less physically active than healthy individuals due to factors like fatigue, impairment, and lack of time. Overcoming barriers to exercise requires behavior
Biofeedback and other Psychophysiological Techniques for Headache - Neuro Exp...Norton Healthcare
This document discusses biofeedback techniques for treating headaches, including migraine and tension headaches. It provides an overview of different types of biofeedback (GSR, thermal, EMG, EEG), describes how neurofeedback works to regulate brainwaves, and summarizes research showing biofeedback is efficacious for reducing headache frequency, duration and intensity. Comprehensive biofeedback programs can help patients control physiological processes contributing to headaches through techniques like relaxation, thermal biofeedback, mindfulness training and neurofeedback.
This document discusses biofeedback and psychophysiological techniques for treating headaches. It provides an overview of different types of biofeedback including GSR, thermal, EMG, and EEG biofeedback. Research evidence shows biofeedback is effective in reducing headache frequency, duration, and intensity for both migraines and tension headaches. Comprehensive biofeedback programs can help patients learn to control physiological processes contributing to headaches through techniques like relaxation, breathing exercises, thermal biofeedback, mindfulness training, and neurofeedback.
Presentation of first chapter [make your book]Alexis Aronis
The document discusses using a Venn diagram to visualize common structure elements between different preferred categories or genres that were previously chosen. It instructs the reader to use the simplified Venn diagram included to identify common elements of personal preferences between the chosen categories.
Um acidente de autocarro matou um grupo de freiras. No céu, São Pedro pergunta às freiras sobre experiências sexuais passadas para determinar se podem entrar no céu. A última freira está com pressa para gargarejar com água-benta antes que outra freira coloque o seu corpo nela.
O documento discute quatro tópicos principais: 1) Construção e Arquitetura, focando em espaços funcionais em habitações e novos materiais, 2) Ruralidade e Urbanidade, distinguindo tipos de agricultura e sistemas de produção, 3) Administração e Segurança do Território, identificando instituições reguladoras e mecanismos de segurança, 4) Mobilidades Locais e Globais, analisando fluxos migratórios e meios de transporte. O documento fornece informações sobre esses tópicos relacionados a urban
Susan Torrance- Working Together #housingfinanceHousing Europe
This document discusses a proposed model called HARIS (Housing Association Resource for Investment Scheme) to provide long term financing for housing associations in Scotland. HARIS would establish a revolving fund to provide development financing for associations to build new homes. Completed developments would then be refinanced every six months through private finance providers to repay the revolving fund and allow further lending. The goal is to address issues of scale, access to private financing, and restrictive loan covenants by allowing all associations to collaborate and gain advantages of larger portfolios. Key challenges include governance structure and ensuring the model benefits smaller associations.
El documento presenta una introducción a la historia de Divergente, la cual se desarrolla en una distópica Chicago dividida en facciones. Cada facción se encarga de una función y representa un rasgo de la personalidad. Beatrice Prior, la protagonista, se encuentra confundida al tener que elegir una facción para siempre. Durante la prueba de simulación descubre que es "divergente", lo que significa que puede pertenecer a múltiples facciones. Esto la pone en peligro, por lo que decide fingir que sig
Este documento trata sobre los tipos de fármacos, la industria farmacéutica, el gasto farmacéutico y los problemas sociales relacionados con los medicamentos. Explica que los fármacos se clasifican según su función para tratar diferentes condiciones y enfermedades, y que la industria farmacéutica invierte grandes cantidades en investigación a pesar de los altos costos involucrados. También señala que el gasto farmacéutico es significativo a nivel global y plantea preocupaciones sobre el acceso a medicamentos y
This document discusses data curation roles and education. It outlines a study to identify key responsibilities of data curators through a content analysis of job descriptions and interviews. The study aims to develop a glossary to better define the profession and support curriculum development. It finds that data curation skills are evolving rapidly, outpacing higher education. While some library and information science programs provide data curation education, challenges include traditionally attracting humanities students rather than those with science backgrounds needed for the field.
Văn bản số 03/VBHN-BYT ngày 24/5/2016 của Bộ trưởng Bộ Y tế hợp nhất thông tư hướng dẫn hoạt động xuất khẩu, nhập khẩu thuốc và bao bì tiếp xúc trức tiếp với thuốc.
Este documento describe dos tipos de textos académicos: expositivos y argumentativos. Los textos expositivos buscan brindar información de manera objetiva analizando y detallando un tema, mientras que los textos argumentativos plantean ideas de manera subjetiva para legitimar información nueva. Cada tipo de texto tiene una estructura y propósito diferente y se utilizan en diversos géneros en la universidad como manuales, informes y ensayos.
7. el manejo adecuado de la intervención en el domicilioEmagister
El documento describe los desafíos y consideraciones clave para realizar intervenciones familiares efectivas en el hogar de las familias. Señala que aunque es posible realizar un trabajo educativo y psicológico eficaz en el domicilio de la familia, se deben establecer las condiciones adecuadas. Estas incluyen una buena planificación previa para garantizar la seguridad, prever riesgos y conocer de antemano la situación familiar, así como controlar aspectos como el tiempo, el espacio y las conductas durante la visita.
Este documento describe los principios fundamentales de la intervención con menores que tienen un consumo problemático de drogas. Propone dos niveles de intervención: prevención selectiva y prevención indicada. También destaca la importancia de enfocar la intervención desde una perspectiva educativa y de acompañamiento del adolescente, preservando la normalización del menor en su entorno familiar y social.
Enjuiciamiento y menores infractores EspañaEmagister
Este documento resume los principales cambios en el sistema de justicia juvenil en España desde la década de 1990. La ley de 1992 introdujo un sistema híbrido tutelar/penal centrado en el interés superior del menor. La ley de 2000 estableció un sistema integral de responsabilidad penal juvenil dentro del sistema penal ordinario, pero con un enfoque predominantemente educativo en lugar de punitivo. La ley se ha reformado en 2006 para aumentar la proporcionalidad de las sanciones con la gravedad del delito y ampliar las posibilidades de internamiento. El
This presentation discusses best practices for employers to comply with state and federal directives, develop appropriate and inclusive policies, and encourage diversity in the workplace.
Effects of Mindfulness Yoga vs Stretching and Resistance Training Exercises o...Divya Singh
Effects of Mindfulness Yoga vs Stretching and Resistance Training Exercises on Anxiety and Depression for People With Parkinson Disease : A Randomized Clinical Trial - Parkinson disease (PD) is the second most common chronic neurodegenerative disease with heterogeneous symptomatology.1
Although PD is characterized by 4 motor symptoms (resting tremor, rigidity, bradykinesia, and postural instability), patients with PD experience a variety of nonmotor symptoms, including neuropsychiatric problems, cognitive impairment, sleep disturbances, and autonomic dysfunction.
Psychological distress, including anxiety and depression (frequently co-occuring), is common in patients with PD, with a prevalence of 40% to 50%,2 and is associated with care dependency, poor work and social function, fast physical and cognitive decline, increased dementia risk, and high mortality.
Akathisia is a neurological side effect of antipsychotic and antidepressant medications characterized by inner restlessness and a constant need for movement. It is caused by a loss of dopamine function in the brain. The prevalence of akathisia ranges from 12.5-75% when taking first-generation antipsychotics. While difficult to diagnose, it can often be treated with benzodiazepines, beta-blockers like propranolol, or reducing the dose of the causative medication. Left untreated, akathisia can lead to poor treatment adherence.
Cognitive behavioral therapy (CBT) targets several key areas in treating bipolar disorder:
(1) Medication adherence through psychoeducation and treatment planning;
(2) Early detection of mood episodes using mood monitoring and developing intervention plans;
(3) Stress and lifestyle management including sleep, activities, and triggers through cognitive restructuring and skill building. CBT provides structure and strategies to help patients better manage their bipolar disorder.
The document provides an overview of the biology of mental illness by summarizing research on the neurobiology, genetics, and treatment of disorders such as schizophrenia, depression, and bipolar disorder. Key findings discussed include evidence that these conditions involve disruptions in brain structure and function, as well as influences from genetic and environmental factors. The document also traces historical conceptions of these illnesses and notes shifts towards more biologically-based diagnostic models and treatments targeting neural circuits and systems.
This document discusses a paradigm shift in spinal manual therapy from a biomechanical model to a neurophysiological model. It provides evidence that lower back pain is not caused by biomechanical factors like posture or spinal structure. While biomechanics was previously emphasized, evidence now shows biomechanics do not determine pain or pathology. The document advocates abandoning the postural-structural-biomechanical model and assessment of biomechanical factors in favor of a process-based approach focused on underlying neuromuscular processes rather than structure. Manual therapy should aim to facilitate changes in these processes rather than correct biomechanics, which are normal variations and cannot reliably be changed.
Fibromyalgia is a clinical syndrome characterized by widespread pain, fatigue, sleep disturbances, and other somatic and cognitive symptoms. It affects 2-5% of the general population and is more prevalent among women ages 20-50. The cause is unclear but may involve genetic and environmental factors as well as abnormalities in central pain processing and neuroendocrine function. Diagnosis is based on symptoms and involves assessing pain levels and tender points. Treatment focuses on managing symptoms and includes pharmacologic approaches like antidepressants as well as non-pharmacologic options such as exercise, therapy, and acupuncture. Acupuncture is thought to help fibromyalgia by inhibiting pain pathways, stimulating pain modulation pathways, and regulating neuroendocrine function like cortisol and growth hormone levels
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- Common neurological and psychiatric manifestations of Wilson's disease including movement disorders, dysarthria, and behavioral/mood changes.
- The importance of considering Wilson's disease in young patients presenting with recent neuropsychiatric symptoms that are treatment resistant.
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Physiotherapy in MND
Dr. Quazi Ibtesaam Huma (MPT)
Dr. Suvarna Ganvir (Phd, Prof & HOD)
Dept. of Neurophysiotherapy
DVVPF’s College of Physiotherapy
Content
Introduction
Types of MND
Clinical Features of MND
Diagnostic Procedure
Management: 1) Pharmaceutical
2) Physiotherapy
Motor Neuron Disease
Motor Neuron Disease are a group of neurodegenerative disorders that affects the nerves in the spine and brain to progressively lose its function.
Motor neuron diseases (MND) include a heterogeneous spectrum of inherited and sporadic (no family history) clinical disorders of the upper motor neurons (UMNs), lower motor neurons (LMNs), or a combination of both.
Types of MND
Amyotrophic Lateral Sclerosis
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease, characterized by progressive degeneration of motor neurons in the spinal cord, brain stem, and motor cortex, leading to progressive muscle atrophy and weakness.
Clinical Features
UPPER MOTOR NEURON
Loss of Dexterity
Muscle Weakness
Spasticity
Hyperreflexia
Pathological reflexes
LOWER MOTOR NEURON
Muscle Weakness
Muscle Atrophy
Hypotonicity
Hyporeflexia
Fasciculation
Muscle Cramp
Impairment related to LMN
Other clinical features
Diagnostic Criteria
Diagnostic Procedure
EMG-
It include signs of active denervation, such as fibrillation potentials and positive sharp waves;
Signs of chronic denervation, such as large motor unit potentials (increased duration, increased proportion of polyphasic potentials, increased amplitude)
Unstable motor unit potential
Nerve Conduction Velocity Studies,
Muscle And Nerve Biopsies,
Neuroimaging Studies - MRI
Management- Multidisciplinary Approach
Physical Therapy Examination
Cognition
Pain
Psychosocial Function
Joint integrity, ROM and Muscle strength.
Motor Function: Gross motor and Fine motor
Muscle tone and reflexes
Cranial nerve integrity
Sensations
Gait
Respiratory Function
Physiotherapy goals in MND treatment.
Pain reduction
Prevention for contractures
Maintenance of joint mobility
Regular review of posture
Positioning to relieve discomfort
House Modification and ergonomic advice.
Management of Sialorrhea and Pseudobulbar Affect
Management for Dysphagia
PEG procedure.
A PEG may be recommended as the disease progresses.
A PEG is a type of gastrostomy tube inserted via endoscopic surgery that creates a permanent opening into the stomach for the introduction of food.
Studies have found that PEG insertion may prolong survival. Patients with PEG were found to live 1 to 4 months longer than those individuals who refused it.
Management of Dysphagia
A palatal lift prosthesis may be prescribed for individuals with good articulation but who have a breathy voice quality or decreased loudness because of excessive air loss through the nose.
The device, a dental appliance designed to attach to the existing teeth and to elevate the soft palate, is custom-made by a prosthodontist.
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Migraine pathophysiology, diagnosis and treatmentsYung-Tsai Chu
Introduction of migraine, including symptoms, epidemiology, pathophysiology(neurotransmitter, neural network, channel, CGRP), diagnostic criteria and treatment (oral, intravenous therapy at ED and long-term prevention)
This document discusses autoimmune movement disorders, which can mimic neurodegenerative or metabolic conditions. Autoimmune syndromes are rarely isolated and accompanying clinical signs help with diagnosis. A detailed history and examination can reveal red flags to guide diagnosis, as timely identification is important given these conditions are treatable. The document then examines the clinical approach and various autoimmune movement disorders like cerebellar ataxia, chorea, dystonia, myoclonus, parkinsonism, paroxysmal movement disorders, stiff person spectrum disorders, tics, tremor, and sleep behavior disorders. It covers their characteristics, potential antibodies, investigations including imaging and antibody testing, management with drug therapy, and variable response and prognosis.
DR SANJAY PHADKE- Introducing Symposium on MIND- BODY MEDICINEDR VANI KULHALLI
The critical importance of mind body medicine as regards
- treatment gap of 80-96pc for mental illness
- proved benefit
- can be administered by non medical professionals
- safe and efficetive
Diagnosis and Treatment of Psychosomatic Disorder (Educational Slides)Andri Andri
This is a standard presentation for teaching medical students and colleagues about psychosomatic disorder, its diagnosis and therapy. We hope by reading this slides, you will understand the nature of psychosomatic disorder and its current approach in therapy
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The document discusses future trends and challenges in managing chronic illnesses like systemic lupus erythematosus (SLE). It outlines a shift from solely biomedical models of care to biopsychosocial models that address psychological and social factors in addition to disease. Improving health-related quality of life is emphasized over just controlling disease. Developing patient skills and resilience is important for long-term self-management of SLE. Interdisciplinary collaboration integrating behavioral science and medicine is needed to best help patients.
Multiple sclerosis: Medical and Nursing ManagementsReynel Dan
Multiple sclerosis (MS) is a chronic, progressive neurological disease involving demyelination of the central nervous system. It is characterized by exacerbations and remissions of symptoms that vary depending on the location of lesions in the brain and spinal cord. Common clinical manifestations include fatigue, weakness, sensory disturbances, and impaired coordination. While the exact cause is unknown, it is thought to involve an autoimmune response. Treatment focuses on managing relapses, reducing disease progression, and alleviating symptoms. Nursing care emphasizes education, rehabilitation, and supportive measures to help patients maintain optimal functioning.
2. OBJECTIVES
Review the history of Chronic Subjective Dizziness.
Define Chronic Subjective Dizziness.
Review the current literature on differential diagnosis, treatment,
and prognosis for patients with Chronic Subjective Dizziness.
3. HISTORY
Agoraphobia described by Karl Westphal in 1871 as dizziness,
spatial disorientation, and anxiety while in motion-rich environments
such as the marketplace (Staab, 2012)
Separation of disciplines (otologic, neurologic, psychiatric, etc.)
Phobic postural vertigo described by Brandt and Dieterich: (Brandt,
Huppert, & Dieterich, 1994)
Postural dizziness with fluctuating unsteadiness provoked by environmental stimuli
Patients often demonstrated psychological qualities (depression, obsessive-compulsive)
Anxiety and sleep disturbances
Absent findings on physical exam
Chronic Subjective Dizziness introduced by Staab and Ruckenstein
as they clarified physical symptoms that occur with PPV, defined the
relationship to behavioral factors, and clearly determined a precise
definition.
4. WHAT IS CHRONIC SUBJECTIVE
DIZZINESS (CSD)?
Non-vertiginous dizziness (i.e. subjective feeling of rocking or
swaying)
Often exacerbated by:
Standing and walking
Active or passive movement
Complex visual patterns
Moving visual stimuli
Visual activities requiring precision
5. CSD DEFINED
Primary symptoms
Unsteadiness, dizziness that may fluctuate throughout day but present daily
(>3 mo.)
Not vertigo
Postural Relationship
Symptoms related to body posture- worse when standing/walking, better
when sitting/recumbent
Differentiate postural from orthostatic
Provocative Factors
Symptoms made worse by motion, exposure to large-field visual stimulation or
visual patterns, or performance of precision visual activities
(Staab, 2012)
6. Precipitating Factors
Previous occurrence of neuro-otologic disease with resultant vestibular
dysfunction
Medical issue producing unsteadiness or dizziness
Psychiatric disorder contributing to dizziness symptoms
Physical Examination and Vestibular Laboratory Testing
Normal findings
OR…May reveal evidence of a condition that is active, has been treated, or is
resolved but cannot fully explain the patient’s symptoms
Behavioral Symptoms
Anxiety and depression
Significant psychological distress, psychiatric disorders, or adverse changes in
ADLs may be present
CSD is NOT a psychiatric illness, but patients with psychiatric disorders may be
predisposed to CSD
(Staab, 2012)
7. CSD DEFINITION SIMPLIFIED…
Persistent nonvertiginous dizziness or subjective imbalance
occurring daily for greater than 3 months
Hypersensitivity to motion and visual stimuli
Difficulty with precision visual tasks
Persistent symptoms despite a normal physical examination (or at
least no findings that can serve as an explanation for dizziness
symptoms)
8. CAUSATION OF CSD?
Classical and Operant Conditioning
Failure of Readaptation
9. CLASSICAL AND OPERANT
CONDITIONING
A new onset of a vestibular disorder produces a strong
physiologic response– which results in high anxiety– which
augments the conditioning process
Repeated exposures to the stimuli further sensitizes the system to
motion cues– creating a heightened awareness– reinforcing
hypersensitive responses
Operant conditioning concurrently reinforces avoidance of
provocative behaviors
10. FAILURE OF READAPTATION
CSD starts with an acute incident (e.g. presence of BPPV or
vestibular neuritis)
Maladjustment occurs during the acute vestibular incident,
followed by continued failure to readapt after the acute injury has
been compensated
13. PREDICTORS OF CSD
High levels of anxiety
Vigilance about vestibular symptoms
Catastrophic thinking
Inhibition of more flexible postural control strategies due to
anxiety
14. Retrospective study examined 1552 patients with vertigo
10.6% consistent with CSD
79.3% had a psychiatric disorder
Other often presented fear of heights and history of vestibular lesion
79% demonstrated balance deficits
(Odman & Maire, 2008)
16. DIFFERENTIAL DIAGNOSIS
CSD diagnosis determined by the characteristic history of postural
symptoms and provoking factors consistent with CSD
Physical examination utilized to determine if a vestibular deficit is
present that can explain patient’s symptoms
OR can be used to determine the extent a previous vestibular deficit has
recovered
Need to differentiate from:
Vestibular migraine, orthostatic tremor, bilateral vestibulopathy, peripheral
neuropathy, perilymph fistula, episodic ataxias, central causes, mild TBI, and
autonomic dysregulation
(Staab & Ruckenstein,
2007)
17. PHARMACOLOGICAL TREATMENT
Selective serotonin reuptake inhibitors (SSRIs) and Selective
norepinephrine reuptake inhibitors (SNRIs) have been found to be
effective in treatment of CSD
50% of patients had complete remission of symptoms
70% showed a significant positive effect
20% were not tolerant of the medications (due to sleep disturbances, nausea,
etc.)
Subjects with and without pre-existing anxiety/depression had similar results
Patients should be informed that within first few weeks on the
medication, anxiety symptoms may increase. Any concerns
should be discussed with his/her physician
(Staab & Ruckenstein,
2005)(Ruckenstein & Staab, 2009)
18. PSYCHOTHERAPY
With the prevalence of underlying psychological comorbidity,
psychotherapy logically plays an important role.
The literature is still sparse in terms of quality studies effectively
evaluating patient outcomes of those with CSD.
19. LITERATURE ON PSYCHOTHERAPY &
CSD
Cognitive Behavior Therapy (CBT) had a medium effect in reducing
dizziness (Schmid, Henningsen, Dieterich, Sattel, & Lahmann,
2011)
Shortage of long-term studies evaluating effectiveness
Randomized Control Trial by Edelman, Mahoney, & Cremer (2012)
found positive short-term effects
The improvements in dizziness immediately after treatment were
not sustained 1 year later (Holmberg, Karlberg, Harlacher, &
Magnusson, 2007)
20. VESTIBULAR AND BALANCE
REHABILITATIVE THERAPY
Mechanism
Behavioral promotion of habituation to vestibular symptoms and motion
sensitivity
Key is use of clinical expertise to assist the patient in a proper progression
Treatment components
Habituation, balance exercises, visual-vestibular exercises
Graded exposure to regular activities performed at baseline
Elimination of unnecessary safety aides (e.g. clenching onto shopping cart,
furniture surfing)
Reduce anxiety and avoidance of certain stimuli
May require 3-6 months of diligent treatment
(Staab, 2012)
(Staab,
2010)
22. BI-DIRECTIONAL RELATIONSHIP
The connection between vestibular disorders
and psychiatric disorders
Vestibular disorders may trigger psychiatric
disorders
Psychiatric disorders may causes symptoms of
dizziness
(Staab & Ruckenstein, 2007
23. REFERENCES
Brandt, T., Huppert, D., & Dieterich, M. (1994). Phobic postural vertigo: a first follow-up. Journal of neurology, 241(4),
191-195.
Edelman, S., Mahoney, A. E., & Cremer, P. D. (2012). Cognitive behavior therapy for chronic subjective dizziness: a
randomized, controlled trial. American journal of otolaryngology, 33(4), 395-401.
Holmberg, J., Karlberg, M., Harlacher, U., & Magnusson, M. (2007). One-year follow-up of cognitive behavioral therapy
for phobic postural vertigo. Journal of neurology, 254(9), 1189-1192.
Honaker, J. A., Gilbert, J. M., & Staab, J. P. (2010). Chronic subjective dizziness versus conversion disorder: discussion
of clinical findings and rehabilitation. American journal of audiology, 19(1), 3-8.
Ruckenstein, M. J. & Staab, J. P. (2009). Chronic subjective dizziness. Otolaryngologic Clinics of North America, 42(1),
71-77.
Schmid, G., Henningsen, P., Dieterich, M., Sattel, H., & Lahmann, C. (2011). Psychotherapy in dizziness: a systematic
review. Journal of Neurology, Neurosurgery & Psychiatry, 82(6), 601-606.
Staab, J. P. (2010). Behavioral aspects of vestibular rehabilitation. NeuroRehabilitation, 29(2), 179-183.
Staab, J. P. (2012). Chronic subjective dizziness. CONTINUUM: Lifelong Learning in Neurology, 18(5, Neuro-otology),
1118-1141.
Staab, J. P., & Ruckenstein, M. J. (2007). Expanding the differential diagnosis of chronic dizziness. Archives of
Otolaryngology–Head & Neck Surgery, 133(2), 170-176.
Staab, J. P., & Ruckenstein, M. J. (2005). Chronic dizziness and anxiety: effect of course of illness on treatment
outcome. Archives of Otolaryngology–Head & Neck Surgery, 131(8), 675-679.
Staab, J. P., Ruckenstein, M. J., Solomon, D., & Shepard, N. T. (2002). Serotonin reuptake inhibitors for dizziness with
psychiatric symptoms. Archives of Otolaryngology–Head & Neck Surgery, 128(5), 554-560.
Hinweis der Redaktion
Westphal described how postural control, locomotion, spatial orientation, and threat assessment
Traditionally there has been a separation between otologic, neurologic, cardiac, and psychiatric. However, with many vestibular patients this is not effective. Especially in the case of CSD.
There is value in knowing the different names associated with the same condition (e.g. CSD, PPV, Agoraphobia, PPPV-- Persistant postural perceptual vertigo)
Most common triggers for CSD:
Previous acute vestibular disorders (e.g. BBPV)
Episodic vestibular disorders (e.g. Meniere disease)
Concussion/ whiplash
Anxiety, panic attacks
Dysautonomias
Dysrhythmias
Adverse drug reactions or other medical events
Nonvertiginous dizziness/ subjective imbalance accompanied by hypersensitivity to motion stimuli and poor tolerance for complex visual stimuli or precision visual tasks, all occurring in the absence of active vestibular deficits. (Honaker, Dilbert, Staab, 2010)
With the acute vestibular disorder– anxiety is produced– leading to an alteration in postural control
Precipitating events trigger necessary acute adaption
Acute disorder resolves– natural vestibular, medical, and behavioral recovery takes place
IF successful, remission of the precipitating event and compensation for any deficits will be accompanied by return to baseline
Predisposing factors (anxious introverted temperament) increases chance that an acute postural and behavioral response will be magnified– limiting re-adaptation
Driving the system into a perpetual loop in which the high reactivity to motion stimuli and guarded postural control strategies turn previously benign circumstances into provocative situations
Staab described this model as being at the interface of neurology and psychiatry
Otogenic Chronic Subjective Dizziness
These patients had no history of anxiety disorder before developing an acute vestibular insult or other similar pathology (eg, vestibular neuronitis, benign positional vertigo, transient ischemic attack). Their neuro-otologic illness precipitated the onset of anxiety.
Psychogenic Chronic Subjective Dizziness
These patients had no physical disorders including no history of a vestibular disorder. They developed dizziness during the course of their primary anxiety disorder.
Interactive Chronic Subjective Dizziness
These patients had a history of an anxiety disorder or diathesis before the onset of any symptoms of dizziness. They developed CSD and a worsening of their anxiety disor- der subsequent to an acute and transient episode of true vertigo or medical condition causing dizziness.
CSD and Anxiety:
Results: Patients with the otogenic and psychogenic pat- terns of illness had a more complete response to SSRI treat- ment than did patients in the interactive group (P.01). Rates of SSRI intolerance were similar for all 3 groups.
Conclusions: Selective serotonin reuptake inhibitors are effective for patients with CSD and anxiety. How- ever, patients with clinically significant anxiety predat- ing neurotologic illness may require more intensive in- terventions.
Article by Staab and Ruckenstein (2007): nearly all patients were diagnosed with psychiatric or neurologic illness (e.g. migraines, mild TBIs, neurally mediated dysautonomias)
A retrospective study by Odman and Maire (2007) examined 1552 patients with vertigo, finding that 10.6% were consistent with the definition of CSD. Among these patients with CSD, 79.3% had a psychiatric disorder, others were often associated with fear of heights or a former vestibular lesion that was compensated for. 79% of them had poor balance on dynamic posturography testing
Patients with vestibular migraines often have difficulty moving in motion rich environments but often do ok watching it– not the case with CSD
Those with peripheral neuropathies, cerebellar degeneration, and movement disorders may have dizziness or postural unsteadiness, but have less trouble with complex visual stimuli
Autonomic dysregulation: may have more symptoms with orthostatic symptoms versus postural symptoms as in CSD
Vestibular suppressants are not effective in treatment of these patients
RCT by Edelman, Mahoney, & Cremer compared results of a group of patients with CSD who participated in 3 sessions of CBT administered by a licensed psychologist to a control group
The CBT group showed statistically significant improvements according to the dizziness handicap inventory, but not in underlying psychological outcomes measured on the Depression, Anxiety and Stress scales
The only long-term study conducted followed patients 1 year after CBT, finding the improvements in dizziness immediately after treatment were not sustained 1 year later (Holmberg, J., Karlberg, M., Harlacher, U., & Magnusson, 2007)
Shortage of long-term studies evaluating effectiveness
Beginning around WWII (Cooksey and Cawthorne) – mvt better than inactivity for vest injuries
***Must start out gentler and gradually progress than in patients with acute vestibular conditions OR WILL EXCERBATE SYMPTOMS!