human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective : To investigate the effect of an additional vestibular stimulated exercise programme on balance for patients with benign paroxysmal positional vertigo . Design : R and omized controlled trial . Setting : Medical centre . Subjects : Twenty-six subjects with benign paroxysmal positional vertigo involving the unilateral posterior semicircular canal . Interventions : Subjects were r and omized into experimental or control groups . Thirteen subjects in the experimental group received the canalith repositioning manoeuvre and vestibular stimulated exercise training three times a week for four weeks . Thirteen subjects in the control group received only the canalith repositioning manoeuvre . Main measures : Static balance tests , t and em walk test , Dynamic Gait Index and subjective rating of the intensity of vertigo were measured at baseline , two-week and four-week assessment s. Results : Compared with the control group , subjects in the experimental group demonstrated a statistically significant improvement in single leg stance with eyes closed at the two-week assessment ( P<0.05 ) . Furthermore , stance on foam surface with eyes closed , single-leg stance with eyes closed , and Dynamic Gait Index at the four-week assessment were also significantly improved ( P<0.05 ) . Conclusion : The present study demonstrated that additional exercise training , which emphasizes vestibular stimulation , can improve balance ability and functional gait performance among patients with benign paroxysmal positional vertigo who had already undergone the canalith repositioning manoeuvre Symptoms of balance disorders including ' unsteadiness ' , ' dizziness and vertigo ' are common in the elderly and commonly found in general practice in medicine . There are many causes of balance disorders and vary from one person to another . Disorder of the internal ear or vestibular end-organ type is one cause . Unsteadiness of somato-sensory or proprioception is common in the elderly so is degenerative disorder of central control in brain . The elderly are prone to many chronic illnesses or disorders which are causes of balance disorder or give rise to more rapid degeneration of the central nervous system i.e. high blood pressure , diabetes mellitus , heart disease , proprioception and joint problems , arthritis and muscular weakness due to lack of good health and exercise . The objectives of this research study were to find the etiologies of balance disorders and how Balance Exercises and the ' National Health Service ' can be of benefit in helping to prevent them . 1565 elderly inhabitants ( age > or = 60 years ) of 20 communities adjacent to Siriraj Hospital were selected for study . Among these , 625 persons had a history of balance disorders . Among those , 256 had symptoms during the week selected for examination . The average age was 66 years old , women outnumbered men with a ratio of 2.4:1 . The common underlying causes were hypertension in 32.4 % , diabetes mellitus 13.8 % , arthritis 8.1 % , and heart disease 4.4 % respectively . All are still taking one or more types of drug . The subjects were r and omly divided into two groups for the study purpose of effectiveness of balance exercise . Group 1 did not perform the head balance exercise and Group 2 performed the head balance exercise . Audiometric testing showed impaired hearing in 90 % of the subjects . The majority slowed hearing loss in high frequencies . Testing of middle ear function found 75 % of Group 1 to have normal middle ear function 77 % of Group 2 . Brainstem Electrical Response Audiometry ( BERA ) showed normal response latencies of in 96 % of group 1 and 94 % of Group 2 . Poor morphology of waveform was found in 12 % of Group 1 and 16 % of Group 2 . Doppler sonography for intra-cranial blood flow measurement showed abnormal flow of the ICA in 17.6 % of group 1 and 20.16 % of group 2 . Basilar arterial abnormal flow was found in 77.6 % of Group 1 and 80.6 % of Group 2 respectively . The flow of ICA was improved after 8 weeks in both groups . The measurement of balance by Posturography showed 86.7 % abnormality in Group 1 and 83.5 % abnormality in Group 2 ( and the majority due to inner ear problems but many cases had a mixture of joints and CNS problems too ) . Results of the self-evaluation ( by question aires ) showed the elderly to have symptoms of light headedness in 51 % and loss of balance in 29 % , Vertigo with rotation occurred in 23.6 % . 49 % of the symptoms were intermittent , 56.4 % experienced a ' fall " . On question ing about the benefit and performance of Head and Neck Exercises , 82.8 % found the exercises were easy to perform , 56.4 % said the results were very beneficial Abstract Purpose : To evaluate short-term effects of balance Vestibular Rehabilitation Therapy ( VRT ) on balance , dizziness symptoms and quality of life of the elderly with chronic Benign Paroxysmal Positional Vertigo ( BPPV ) . Method : In this r and omized , single-blind and controlled trial , older adults with chronic BPPV were r and omized into two groups , the experimental group ( n = 7 , age : 69 ( 65–78 ) years ) and the control group ( n = 7 , age : 73 ( 65–76 ) years ) . Patients in the experimental group underwent balance VRT ( 50 min per session , two times a week ) and Canalith Repositioning Maneuver ( CRM ) as required , for 13 weeks . The control group was treated using only CRM as required . St and ing and dynamic balance , dizziness symptoms and quality of life were measured at the baseline , and at one , five , nine and thirteen weeks . Results : There were no between-group differences in dizziness , quality of life and st and ing balance over the 13 weeks . Significant differences were observed in dynamic balance measures between groups ( p < 0.05 for most tests ) through assessment s. In intragroup analysis , both groups showed improvements in all measurements except no improvement was found in majority of the dynamic balance tests in the control group . Conclusions : The patients who received additional balance VRT demonstrated better results in dynamic balance than those who received only CRM . Implication s for Rehabilitation The findings that balance VRT in addition to CRM improves dynamic balance in elderly people with BPPV should be useful in guiding rehabilitation professionals ’ clinical decision making to design interventions for seniors suffering from BPPV ; Improvements in tests of dynamic balance suggest that the risk of adverse consequences of BPPV in the elderly such as falls and fractures can be potentially reduced through implementation of CRM in conjunction with balance VRT ; Lack of additional improvement in Visual Analogue Scale of dizziness and Dizziness H and icap Index suggests that addition of balance VRT does not influence dizziness symptomatology , per se , and CRM alone is effective to ameliorate vertiginous symptoms and potentially improve quality of life UNLABELLED Benign paroxysmal positional vertigo ( BPPV ) may compromise the balance of elderly subjects . OBJECTIVE To observe the effects of the Epley maneuver in elderly subjects with BPPV and assess clinical and functional aspects of body balance . METHOD This is a prospect i ve clinical study . Patients diagnosed with BPPV ( Dix-Hallpike test ) were su bmi tted to the Timed Up & Go ( TUG ) test , the Clinical Test of Sensory Interaction and Balance ( CTSIB ) , and lower limb testing before and after they were repositioned using the modified Epley maneuver . RESULTS Most subjects were females , and the group 's mean age was 70.10 years ( SD = 7.00 ) . All patients had canalithiasis of the posterior canal . The following symptoms improved after the maneuver : postural instability ( p = 0.006 ) , nausea and vomiting ( p = 0.021 ) , and tinnitus ( p = 0.003 ) . Subjects improved their times significantly in the TUG and lower limb tests after the Epley maneuver ( p < 0.001 ) . Patients performed better on the CTSIB after the Epley maneuver  on condition 2 ( p < 0.003 ) , condition 3 ( p < 0.001 ) , condition 4 ( p < 0.001 ) , condition 5 ( p < 0.001 ) , and condition 6 ( p < 0.001 ) . CONCLUSION Clinical and functional aspects of body balance in elderly with BPPV improved after treatment with the modified Epley maneuver OBJECTIVE We evaluated the effectiveness of a management approach that combines the canalith repositioning maneuver ( CRM ) and vestibular rehabilitation ( VR ) in the treatment of benign positional paroxysmal vertigo ( BPPV ) in elderly persons . STUDY DESIGN AND SETTING Forty-seven patients ( > /=70 years old ) with the diagnosis of unilateral posterior semicircular canal BPPV formed the study population . This study has 2 parts . In the first part , patients were r and omly assigned to 1 of 2 groups : the CRM and avoidance ( no treatment ) . Patients were evaluated 1 month after the first visit . Those patients not responding to treatment were enrolled in the second part of the study , treated with an individualized combination of CRM and VR , and then reevaluated 3 months later . RESULTS Statistically significant improvement of vertigo and provoked nystagmus in 64 % of patients in the CRM group compared with the no-treatment group . After the addition of VR , 77 % of all patients improved . CONCLUSION A combination of CRM and VR improves  BPPV in the elderly . SIGNIFICANCE These findings suggest that although CRM is more effective than no treatment , VR can be added to improve the results in the treatment of BPPV Introduction Benign Paroxysmal Positional Vertigo is the most common cause of dizziness in elderly people . Recent studies have shown that the elderly present higher Benign Paroxysmal Positional Vertigo recurrence and that vertiginous symptomatology remission varies according to comorbidities and the therapeutic techniques applied . Objective To assess the short-term effectiveness of Vestibular Rehabilitation in addition to Canalith Repositioning Maneuver on positive to negative Dix-Hallpike test , on recurrence and number of maneuvers to achieve a negative test in elderly patients with chronic Benign Paroxysmal Positional Vertigo . Methods In this r and omized controlled trial , 7 older adults ( median age : 69 years , range 65–78 ) underwent Canalith Repositioning Maneuver and Vestibular Rehabilitation for thirteen weeks . Seven older adults ( median age : 73 years , range 65–76 ) in the control group received only Canalith Repositioning Maneuver . The participants were assessed at baseline ( T0 ) , one ( T1 ) , five ( T5 ) , nine ( T9 ) , and thirteen weeks ( T13 ) . We assessed the differences between the groups by Mann-Whitney and Fisher exact tests , and used the Friedman and Wilcoxon tests to determine the intragroup differences . Results No significant differences were found between groups for the positive to negative Dix-Hallpike test , recurrence , and number of maneuvers to achieve a negative test . The number of maneuvers to achieve negative Dix-Hallpike test was lower in intragroup comparisons in the experimental group . Conclusion The findings suggest that additional Vestibular Rehabilitation did not influence the positive to negative Dix-Hallpike test , recurrence , or number of maneuvers to achieve a negative test in elderly patients with chronic Benign Paroxysmal Positional Vertigo AIM To evaluate the number of weekly canalith repositioning procedures needed to eliminate positioning nystagmus in patients with benign paroxysmal positional vertigo and to verify influences of canalithiasis or cupulolithiasis and /or semicircular canal involvement . STUDY DESIGN clinical prospect i ve with transversal cohort . MATERIAL AND METHOD Sixty patients with benign paroxysmal positional vertigo were consecutively selected according to each combination of canalithiasis or cupulolithiasis with semicircular canal involvement . Patients were treated by means of canalith repositioning procedures repeated weekly until the elimination of the positioning nystagmus . Analysis of Variance was used to verify differences between the variables . RESULTS An average of 2.13 procedures ( from 1 to 8) was needed to eliminate the positioning nystagmus .  Canalithiasis required an average of 1.53 procedures , while cupulolithiasis needed 2.92 procedures ( p=0.0002 ) . An average of two procedures was needed to eliminate the positioning nystagmus in cases with posterior canal involvement , 2.39 procedures in cases with anterior canal involvement and 2.07 procedures in cases with lateral canal involvement ( p=0.5213 ) . CONCLUSIONS From one to eight weekly canalith repositioning procedures were needed , with an average of two , to eliminate positioning nystagmus in benign paroxysmal positional vertigo . Cupulolithiasis requires a greater number of procedures than canalithiasis to eliminate positioning nystagmus . Semicircular canal involvement did n't influence the number of therapeutic maneuvers Objectives The aim of this study was to determine the prevalence and related predictors of dizziness in a sample of community-dwelling people 65 years of age and older living in a metropolitan area in Germany . Design Prospect i ve cohort study . Setting Interdisciplinary Centre of Gerontology at the University of Erlangen-Nuremberg , Germany . Participants 6000 people aged 65 years and older recruited and r and omized from the registration office , 1801 were fully evaluated at baseline and were re-evaluated in a prospect i ve follow-up two years later . A full data set was obtained for 620 participants , of which 297 ( 47.9 % ) were females . Mean age was  
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective : To investigate the effect of an additional vestibular stimulated exercise programme on balance for patients with benign paroxysmal positional vertigo . Design : R and omized controlled trial . Setting : Medical centre . Subjects : Twenty-six subjects with benign paroxysmal positional vertigo involving the unilateral posterior semicircular canal . Interventions : Subjects were r and omized into experimental or control groups . Thirteen subjects in the experimental group received the canalith repositioning manoeuvre and vestibular stimulated exercise training three times a week for four weeks . Thirteen subjects in the control group received only the canalith repositioning manoeuvre . Main measures : Static balance tests , t and em walk test , Dynamic Gait Index and subjective rating of the intensity of vertigo were measured at baseline , two-week and four-week assessment s. Results : Compared with the control group , subjects in the experimental group demonstrated a statistically significant improvement in single leg stance with eyes closed at the two-week assessment ( P<0.05 ) . Furthermore , stance on foam surface with eyes closed , single-leg stance with eyes closed , and Dynamic Gait Index at the four-week assessment were also significantly improved ( P<0.05 ) . Conclusion : The present study demonstrated that additional exercise training , which emphasizes vestibular stimulation , can improve balance ability and functional gait performance among patients with benign paroxysmal positional vertigo who had already undergone the canalith repositioning manoeuvre Symptoms of balance disorders including ' unsteadiness ' , ' dizziness and vertigo ' are common in the elderly and commonly found in general practice in medicine . There are many causes of balance disorders and vary from one person to another . Disorder of the internal ear or vestibular end-organ type is one cause . Unsteadiness of somato-sensory or proprioception is common in the elderly so is degenerative disorder of central control in brain . The elderly are prone to many chronic illnesses or disorders which are causes of balance disorder or give rise to more rapid degeneration of the central nervous system i.e. high blood pressure , diabetes mellitus , heart disease , proprioception and joint problems , arthritis and muscular weakness due to lack of good health and exercise . The objectives of this research study were to find the etiologies of balance disorders and how Balance Exercises and the ' National Health Service ' can be of benefit in helping to prevent them . 1565 elderly inhabitants ( age > or = 60 years ) of 20 communities adjacent to Siriraj Hospital were selected for study . Among these , 625 persons had a history of balance disorders . Among those , 256 had symptoms during the week selected for examination . The average age was 66 years old , women outnumbered men with a ratio of 2.4:1 . The common underlying causes were hypertension in 32.4 % , diabetes mellitus 13.8 % , arthritis 8.1 % , and heart disease 4.4 % respectively . All are still taking one or more types of drug . The subjects were r and omly divided into two groups for the study purpose of effectiveness of balance exercise . Group 1 did not perform the head balance exercise and Group 2 performed the head balance exercise . Audiometric testing showed impaired hearing in 90 % of the subjects . The majority slowed hearing loss in high frequencies . Testing of middle ear function found 75 % of Group 1 to have normal middle ear function 77 % of Group 2 . Brainstem Electrical Response Audiometry ( BERA ) showed normal response latencies of in 96 % of group 1 and 94 % of Group 2 . Poor morphology of waveform was found in 12 % of Group 1 and 16 % of Group 2 . Doppler sonography for intra-cranial blood flow measurement showed abnormal flow of the ICA in 17.6 % of group 1 and 20.16 % of group 2 . Basilar arterial abnormal flow was found in 77.6 % of Group 1 and 80.6 % of Group 2 respectively . The flow of ICA was improved after 8 weeks in both groups . The measurement of balance by Posturography showed 86.7 % abnormality in Group 1 and 83.5 % abnormality in Group 2 ( and the majority due to inner ear problems but many cases had a mixture of joints and CNS problems too ) . Results of the self-evaluation ( by question aires ) showed the elderly to have symptoms of light headedness in 51 % and loss of balance in 29 % , Vertigo with rotation occurred in 23.6 % . 49 % of the symptoms were intermittent , 56.4 % experienced a ' fall " . On question ing about the benefit and performance of Head and Neck Exercises , 82.8 % found the exercises were easy to perform , 56.4 % said the results were very beneficial Abstract Purpose : To evaluate short-term effects of balance Vestibular Rehabilitation Therapy ( VRT ) on balance , dizziness symptoms and quality of life of the elderly with chronic Benign Paroxysmal Positional Vertigo ( BPPV ) . Method : In this r and omized , single-blind and controlled trial , older adults with chronic BPPV were r and omized into two groups , the experimental group ( n = 7 , age : 69 ( 65–78 ) years ) and the control group ( n = 7 , age : 73 ( 65–76 ) years ) . Patients in the experimental group underwent balance VRT ( 50 min per session , two times a week ) and Canalith Repositioning Maneuver ( CRM ) as required , for 13 weeks . The control group was treated using only CRM as required . St and ing and dynamic balance , dizziness symptoms and quality of life were measured at the baseline , and at one , five , nine and thirteen weeks . Results : There were no between-group differences in dizziness , quality of life and st and ing balance over the 13 weeks . Significant differences were observed in dynamic balance measures between groups ( p < 0.05 for most tests ) through assessment s. In intragroup analysis , both groups showed improvements in all measurements except no improvement was found in majority of the dynamic balance tests in the control group . Conclusions : The patients who received additional balance VRT demonstrated better results in dynamic balance than those who received only CRM . Implication s for Rehabilitation The findings that balance VRT in addition to CRM improves dynamic balance in elderly people with BPPV should be useful in guiding rehabilitation professionals ’ clinical decision making to design interventions for seniors suffering from BPPV ; Improvements in tests of dynamic balance suggest that the risk of adverse consequences of BPPV in the elderly such as falls and fractures can be potentially reduced through implementation of CRM in conjunction with balance VRT ; Lack of additional improvement in Visual Analogue Scale of dizziness and Dizziness H and icap Index suggests that addition of balance VRT does not influence dizziness symptomatology , per se , and CRM alone is effective to ameliorate vertiginous symptoms and potentially improve quality of life UNLABELLED Benign paroxysmal positional vertigo ( BPPV ) may compromise the balance of elderly subjects . OBJECTIVE To observe the effects of the Epley maneuver in elderly subjects with BPPV and assess clinical and functional aspects of body balance . METHOD This is a prospect i ve clinical study . Patients diagnosed with BPPV ( Dix-Hallpike test ) were su bmi tted to the Timed Up & Go ( TUG ) test , the Clinical Test of Sensory Interaction and Balance ( CTSIB ) , and lower limb testing before and after they were repositioned using the modified Epley maneuver . RESULTS Most subjects were females , and the group 's mean age was 70.10 years ( SD = 7.00 ) . All patients had canalithiasis of the posterior canal . The following symptoms improved after the maneuver : postural instability ( p = 0.006 ) , nausea and vomiting ( p = 0.021 ) , and tinnitus ( p = 0.003 ) . Subjects improved their times significantly in the TUG and lower limb tests after the Epley maneuver ( p < 0.001 ) . Patients performed better on the CTSIB after the Epley maneuver  on condition 2 ( p < 0.003 ) , condition 3 ( p < 0.001 ) , condition 4 ( p < 0.001 ) , condition 5 ( p < 0.001 ) , and condition 6 ( p < 0.001 ) . CONCLUSION Clinical and functional aspects of body balance in elderly with BPPV improved after treatment with the modified Epley maneuver OBJECTIVE We evaluated the effectiveness of a management approach that combines the canalith repositioning maneuver ( CRM ) and vestibular rehabilitation ( VR ) in the treatment of benign positional paroxysmal vertigo ( BPPV ) in elderly persons . STUDY DESIGN AND SETTING Forty-seven patients ( > /=70 years old ) with the diagnosis of unilateral posterior semicircular canal BPPV formed the study population . This study has 2 parts . In the first part , patients were r and omly assigned to 1 of 2 groups : the CRM and avoidance ( no treatment ) . Patients were evaluated 1 month after the first visit . Those patients not responding to treatment were enrolled in the second part of the study , treated with an individualized combination of CRM and VR , and then reevaluated 3 months later . RESULTS Statistically significant improvement of vertigo and provoked nystagmus in 64 % of patients in the CRM group compared with the no-treatment group . After the addition of VR , 77 % of all patients improved . CONCLUSION A combination of CRM and VR improves  BPPV in the elderly . SIGNIFICANCE These findings suggest that although CRM is more effective than no treatment , VR can be added to improve the results in the treatment of BPPV Introduction Benign Paroxysmal Positional Vertigo is the most common cause of dizziness in elderly people . Recent studies have shown that the elderly present higher Benign Paroxysmal Positional Vertigo recurrence and that vertiginous symptomatology remission varies according to comorbidities and the therapeutic techniques applied . Objective To assess the short-term effectiveness of Vestibular Rehabilitation in addition to Canalith Repositioning Maneuver on positive to negative Dix-Hallpike test , on recurrence and number of maneuvers to achieve a negative test in elderly patients with chronic Benign Paroxysmal Positional Vertigo . Methods In this r and omized controlled trial , 7 older adults ( median age : 69 years , range 65–78 ) underwent Canalith Repositioning Maneuver and Vestibular Rehabilitation for thirteen weeks . Seven older adults ( median age : 73 years , range 65–76 ) in the control group received only Canalith Repositioning Maneuver . The participants were assessed at baseline ( T0 ) , one ( T1 ) , five ( T5 ) , nine ( T9 ) , and thirteen weeks ( T13 ) . We assessed the differences between the groups by Mann-Whitney and Fisher exact tests , and used the Friedman and Wilcoxon tests to determine the intragroup differences . Results No significant differences were found between groups for the positive to negative Dix-Hallpike test , recurrence , and number of maneuvers to achieve a negative test . The number of maneuvers to achieve negative Dix-Hallpike test was lower in intragroup comparisons in the experimental group . Conclusion The findings suggest that additional Vestibular Rehabilitation did not influence the positive to negative Dix-Hallpike test , recurrence , or number of maneuvers to achieve a negative test in elderly patients with chronic Benign Paroxysmal Positional Vertigo AIM To evaluate the number of weekly canalith repositioning procedures needed to eliminate positioning nystagmus in patients with benign paroxysmal positional vertigo and to verify influences of canalithiasis or cupulolithiasis and /or semicircular canal involvement . STUDY DESIGN clinical prospect i ve with transversal cohort . MATERIAL AND METHOD Sixty patients with benign paroxysmal positional vertigo were consecutively selected according to each combination of canalithiasis or cupulolithiasis with semicircular canal involvement . Patients were treated by means of canalith repositioning procedures repeated weekly until the elimination of the positioning nystagmus . Analysis of Variance was used to verify differences between the variables . RESULTS An average of 2.13 procedures ( from 1 to 8) was needed to eliminate the positioning nystagmus .  Canalithiasis required an average of 1.53 procedures , while cupulolithiasis needed 2.92 procedures ( p=0.0002 ) . An average of two procedures was needed to eliminate the positioning nystagmus in cases with posterior canal involvement , 2.39 procedures in cases with anterior canal involvement and 2.07 procedures in cases with lateral canal involvement ( p=0.5213 ) . CONCLUSIONS From one to eight weekly canalith repositioning procedures were needed , with an average of two , to eliminate positioning nystagmus in benign paroxysmal positional vertigo . Cupulolithiasis requires a greater number of procedures than canalithiasis to eliminate positioning nystagmus . Semicircular canal involvement did n't influence the number of therapeutic maneuvers Objectives The aim of this study was to determine the prevalence and related predictors of dizziness in a sample of community-dwelling people 65 years of age and older living in a metropolitan area in Germany . Design Prospect i ve cohort study . Setting Interdisciplinary Centre of Gerontology at the University of Erlangen-Nuremberg , Germany . Participants 6000 people aged 65 years and older recruited and r and omized from the registration office , 1801 were fully evaluated at baseline and were re-evaluated in a prospect i ve follow-up two years later . A full data set was obtained for 620 participants , of which 297 ( 47.9 % ) were females . Mean age was  
    Output:
    