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 OBJECTIVE : We sought to determine the effectiveness in decreasing some symptoms , such as vertigo , and increasing performance of daily life skills after vestibular rehabilitation . STUDY DESIGN AND SETTING : Patients who had chronic vertigo due to peripheral vestibular impairments were seen at a tertiary care center . They were referred for vestibular rehabilitation  and were assessed on  vertigo intensity and frequency with the use of the Vertigo Symptom Scale , the Vertigo H and icap Question naire , the Vestibular Disorders Activities of Daily Living Scale , and the Dizziness H and icap Inventory . They were then r and omly assigned to 1 of 3 home program treatment groups . RESULTS : Vertigo decreased and independence in activities of daily living improved significantly . Improvement was not affected by age , gender , or history of vertigo . CONCLUSION : For many patients a simple home program of vestibular habituation head movement exercises is related to reduction in symptoms and increasing independence in activities of daily living 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 Objective : To compare the effect of early customized vestibular rehabilitation with general instructions in patients after acoustic neuroma surgery . Setting : Tertiary referral centre . Subjects : Fifty-three patients after surgery . Design : A prospect i ve assessor-blinded , r and omized controlled trial . Interventions : After stratification for age ( < 50 years ; ≥50 years ) , patients were r and omly allocated into groups receiving general instructions or customized vestibular rehabilitation protocol s for 12 weeks . Outcome measures : St and ing Balance Sum , Timed Up and Go test , T and em Gait and Dynamic Gait Index . Balance performance was assessed preoperatively , at discharge ( one week after surgery ) , three , six , nine , 12 , 26 and 52 weeks after surgery . Results and discussion : All subjects clearly improved within the first six weeks after surgery . However , older subjects receiving vestibular rehabilitation performed significantly ( P<0.05 ) better on st and ing balance , Timed Up and Go test and T and em Gait , when compared with the older group that received only general instructions . This effect persisted up to 12 weeks and also became apparent on the Dynamic Gait Index . In addition , the older vestibular rehabilitation group had better balance scores at 12 weeks when compared with their original preoperative scores ( P<0.05 ) . This pattern remained even up to one year after surgery ( P<0.05 ) . Conclusion : In patients over 50 , early vestibular rehabilitation facilitates recovery of postural control after acoustic neuroma surgery . Customized vestibular rehabilitation should be given in addition to general instructions that stress the need of exposure to movement . Retention of the early beneficial effects even one year after surgery stresses the importance of customized vestibular rehabilitation 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 Abstract . Patients with chronic vestibular symptoms are common in neurological practice but the most effective treatment remains an open question . The purpose of our study was to conduct a controlled , between – group comparison of patients ’ responses to a customised exercise regime ( Group C , for customised ) versus treatment additionally incorporating simulator based desensitisation exposure ( Group S , for simulator ) integrating whole – body or visual environment rotators .  Forty chronic peripheral vestibular patients who had previously undergone conventional vestibular rehabilitation without notable improvement were r and omly assigned into Group C or S. Individuals attended therapy sessions twice weekly for eight weeks and were provided with a customised home programme . Response to treatment was assessed at four – week intervals with dynamic posturography , vestibular time constants , and question naires concerning symptoms , symptom – triggers and emotional status . At final assessment posturography and subjective scores had significantly improved for both groups , although Group S showed greater improvement . A statistically significant improvement for visual vertigo symptom scores was noted only for Group S ( p < 0.01 ; total improvement 53.5 % ) . Anxiety and depression levels significantly decreased for both groups ; improvements were significantly correlated particularly to improvements in visual vertigo ( SCQ ) ( p < 0.01 ; r = 0.53 and r = 0.57 , respectively ) . Significant differences were noted between groups ( p = 0.02 ) for posturography scores . Vestibular time constants showed no notable change in either group . Conclusions : Both groups improved but exposure to simulator motion gave overall better results . These effects were also observed in psychological symptoms and partly relate to simulator effects on visual vertigo symptoms . Visual motion and visuo – vestibular conflict situations should be incorporated in the rehabilitation of patients with refractory dizziness Tai Chi ( TC ) is a comparatively new intervention for peripheral vestibular hypofunction , which is often treated with vestibular rehabilitation ( VR ) . We compared gaze stability ( GZS ) , whole-body stability ( WBS ) and footfall stability ( FFS ) during locomotion among 26 people with vestibulopathy ( VSP ) , r and omized into two treatment arms ( 13 TC and 13 VR ) . Each intervention program was offered for 10 weeks . GZS improved more for VR than for TC , but WBS ( and FFS ) improved more for TC than for VR . There was a significant relationship between changes in GZS and WBS for the VR subjects ( r=0.60 , p=0.01 ) , but not for TC subjects . There was a significant relationship between changes in WBS and FFS for both VR ( r=0.65 , p < 0.01 ) and TC ( r=0.58 , p=0.02 ) groups ; the relationship disappeared in the VR but not the TC group when controlling for GZS . These findings suggest that VR and TC both benefit patients with VSP but via differing mechanisms . Moreover , these data are the first to test the assumption that improving gaze control among patients with VSP perforce improves postural stability : it does not . We conclude that GZS is most improved in those who receive VR , but that TC improves WBS and FFS without improving GZS , suggesting patients with VSP can rely on non-gaze related mechanisms to improve postural control PURPOSE To determine whether improved functional balance through a Tai Chi intervention is related to subsequent reductions in falls among elderly persons . METHODS Two hundred fifty-six healthy , physically inactive older adults aged 70 - 92 ( mean age + /- SD = 77.48 + /- 4.95 ) , recruited from a local health system in Portl and , OR , participated in a 6-month r and omized controlled trial , with allocation to Tai Chi or exercise stretching control , followed by a 6-month postintervention follow-up . Functional balance measures included Berg balance scale , dynamic gait index , and functional reach , assessed during the 6-month intervention period ( baseline , 3-month , and 6-month intervention endpoint ) and again at the 6-month postintervention follow-up . Fall counts were recorded during the 6-month postintervention follow-up period . Data were analyzed through intention-to-treat analysis of variance and logistic regression procedures . RESULTS Tai Chi participants who showed improvements in measures of functional balance at the intervention endpoint significantly reduced their risk of falls during the 6-month postintervention period , compared with those in the control condition ( odds ratio ( OR ) , 0.27 , 95 % confidence interval ( CI ) , 0.07 - 0.96 for Berg balance scale ; OR , 0.27 , 95 % CI , 0.09 - 0.87 for dynamic gait index ; OR , 0.20 , 95 % CI , 0.05 - 0.82 for functional reach ) . CONCLUSIONS Improved functional balance through Tai Chi training is associated with subsequent reductions in fall frequency in older persons OBJECTIVE To investigate whether specific rehabilitation for patients with dizziness has any effect on clinical balance measures and /or the apprehension of dizziness measured with a visual analogue scale ( VAS ) . DESIGN R and omized controlled trial . SUBJECTS Forty-two patients , 50 years or older with dizziness of central or age-related origin , identified in primary health care 
    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 OBJECTIVE : We sought to determine the effectiveness in decreasing some symptoms , such as vertigo , and increasing performance of daily life skills after vestibular rehabilitation . STUDY DESIGN AND SETTING : Patients who had chronic vertigo due to peripheral vestibular impairments were seen at a tertiary care center . They were referred for vestibular rehabilitation  and were assessed on  vertigo intensity and frequency with the use of the Vertigo Symptom Scale , the Vertigo H and icap Question naire , the Vestibular Disorders Activities of Daily Living Scale , and the Dizziness H and icap Inventory . They were then r and omly assigned to 1 of 3 home program treatment groups . RESULTS : Vertigo decreased and independence in activities of daily living improved significantly . Improvement was not affected by age , gender , or history of vertigo . CONCLUSION : For many patients a simple home program of vestibular habituation head movement exercises is related to reduction in symptoms and increasing independence in activities of daily living 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 Objective : To compare the effect of early customized vestibular rehabilitation with general instructions in patients after acoustic neuroma surgery . Setting : Tertiary referral centre . Subjects : Fifty-three patients after surgery . Design : A prospect i ve assessor-blinded , r and omized controlled trial . Interventions : After stratification for age ( < 50 years ; ≥50 years ) , patients were r and omly allocated into groups receiving general instructions or customized vestibular rehabilitation protocol s for 12 weeks . Outcome measures : St and ing Balance Sum , Timed Up and Go test , T and em Gait and Dynamic Gait Index . Balance performance was assessed preoperatively , at discharge ( one week after surgery ) , three , six , nine , 12 , 26 and 52 weeks after surgery . Results and discussion : All subjects clearly improved within the first six weeks after surgery . However , older subjects receiving vestibular rehabilitation performed significantly ( P<0.05 ) better on st and ing balance , Timed Up and Go test and T and em Gait , when compared with the older group that received only general instructions . This effect persisted up to 12 weeks and also became apparent on the Dynamic Gait Index . In addition , the older vestibular rehabilitation group had better balance scores at 12 weeks when compared with their original preoperative scores ( P<0.05 ) . This pattern remained even up to one year after surgery ( P<0.05 ) . Conclusion : In patients over 50 , early vestibular rehabilitation facilitates recovery of postural control after acoustic neuroma surgery . Customized vestibular rehabilitation should be given in addition to general instructions that stress the need of exposure to movement . Retention of the early beneficial effects even one year after surgery stresses the importance of customized vestibular rehabilitation 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 Abstract . Patients with chronic vestibular symptoms are common in neurological practice but the most effective treatment remains an open question . The purpose of our study was to conduct a controlled , between – group comparison of patients ’ responses to a customised exercise regime ( Group C , for customised ) versus treatment additionally incorporating simulator based desensitisation exposure ( Group S , for simulator ) integrating whole – body or visual environment rotators .  Forty chronic peripheral vestibular patients who had previously undergone conventional vestibular rehabilitation without notable improvement were r and omly assigned into Group C or S. Individuals attended therapy sessions twice weekly for eight weeks and were provided with a customised home programme . Response to treatment was assessed at four – week intervals with dynamic posturography , vestibular time constants , and question naires concerning symptoms , symptom – triggers and emotional status . At final assessment posturography and subjective scores had significantly improved for both groups , although Group S showed greater improvement . A statistically significant improvement for visual vertigo symptom scores was noted only for Group S ( p < 0.01 ; total improvement 53.5 % ) . Anxiety and depression levels significantly decreased for both groups ; improvements were significantly correlated particularly to improvements in visual vertigo ( SCQ ) ( p < 0.01 ; r = 0.53 and r = 0.57 , respectively ) . Significant differences were noted between groups ( p = 0.02 ) for posturography scores . Vestibular time constants showed no notable change in either group . Conclusions : Both groups improved but exposure to simulator motion gave overall better results . These effects were also observed in psychological symptoms and partly relate to simulator effects on visual vertigo symptoms . Visual motion and visuo – vestibular conflict situations should be incorporated in the rehabilitation of patients with refractory dizziness Tai Chi ( TC ) is a comparatively new intervention for peripheral vestibular hypofunction , which is often treated with vestibular rehabilitation ( VR ) . We compared gaze stability ( GZS ) , whole-body stability ( WBS ) and footfall stability ( FFS ) during locomotion among 26 people with vestibulopathy ( VSP ) , r and omized into two treatment arms ( 13 TC and 13 VR ) . Each intervention program was offered for 10 weeks . GZS improved more for VR than for TC , but WBS ( and FFS ) improved more for TC than for VR . There was a significant relationship between changes in GZS and WBS for the VR subjects ( r=0.60 , p=0.01 ) , but not for TC subjects . There was a significant relationship between changes in WBS and FFS for both VR ( r=0.65 , p < 0.01 ) and TC ( r=0.58 , p=0.02 ) groups ; the relationship disappeared in the VR but not the TC group when controlling for GZS . These findings suggest that VR and TC both benefit patients with VSP but via differing mechanisms . Moreover , these data are the first to test the assumption that improving gaze control among patients with VSP perforce improves postural stability : it does not . We conclude that GZS is most improved in those who receive VR , but that TC improves WBS and FFS without improving GZS , suggesting patients with VSP can rely on non-gaze related mechanisms to improve postural control PURPOSE To determine whether improved functional balance through a Tai Chi intervention is related to subsequent reductions in falls among elderly persons . METHODS Two hundred fifty-six healthy , physically inactive older adults aged 70 - 92 ( mean age + /- SD = 77.48 + /- 4.95 ) , recruited from a local health system in Portl and , OR , participated in a 6-month r and omized controlled trial , with allocation to Tai Chi or exercise stretching control , followed by a 6-month postintervention follow-up . Functional balance measures included Berg balance scale , dynamic gait index , and functional reach , assessed during the 6-month intervention period ( baseline , 3-month , and 6-month intervention endpoint ) and again at the 6-month postintervention follow-up . Fall counts were recorded during the 6-month postintervention follow-up period . Data were analyzed through intention-to-treat analysis of variance and logistic regression procedures . RESULTS Tai Chi participants who showed improvements in measures of functional balance at the intervention endpoint significantly reduced their risk of falls during the 6-month postintervention period , compared with those in the control condition ( odds ratio ( OR ) , 0.27 , 95 % confidence interval ( CI ) , 0.07 - 0.96 for Berg balance scale ; OR , 0.27 , 95 % CI , 0.09 - 0.87 for dynamic gait index ; OR , 0.20 , 95 % CI , 0.05 - 0.82 for functional reach ) . CONCLUSIONS Improved functional balance through Tai Chi training is associated with subsequent reductions in fall frequency in older persons OBJECTIVE To investigate whether specific rehabilitation for patients with dizziness has any effect on clinical balance measures and /or the apprehension of dizziness measured with a visual analogue scale ( VAS ) . DESIGN R and omized controlled trial . SUBJECTS Forty-two patients , 50 years or older with dizziness of central or age-related origin , identified in primary health care 
    Output:
    