Revisão sistemática sobre os efeitos da reabilitação vestibular em adultos de meia-idade e idosos

Abstract

Objective: To summarize the results of clinical trials on vestibular rehabilitation (VR) in middle-aged and elderly people with vestibular disorders. Methods: A search for relevant trials was performed in the databases LILACS, EMBASE, MEDLINE, SciELO, Cochrane, ISI Web of Knowledge and virtual libraries of theses and dissertations. Randomized controlled trials published in the last 10 years and written in English, Portuguese or Spanish were included. The methodological quality of the studies was assessed by the PEDro scale.Results from the included studies were analyzed through a critical review of content. Results: Nine studies were included in the review.Four studies reported on participants aged over 40 years (middle-aged and elderly) and five studies consisted exclusively of elderly subjects (over 60 years). Findings of vestibular dysfunction were diverse and the most common complaints were body imbalance or postural instability (3 studies), and vertigo or dizziness (3 studies). The Visual Analogue Scale (VAS) was the most commonly used instrument to assess subjective perception of symptoms of vestibular dysfunction (4 studies). According to the PEDro scale, four studies were considered to be of good quality. The most common experimental intervention was the Cawthorne & Cooksey protocol (4 studies). For most outcome measures, the studies comparing VR with another type of intervention showed no differences between the groups after the therapy. Conclusions: The studies included in this review provide evidence for the positive effects of VR in elderly and middle-aged adults with vestibular disturbances.Key words: vestibular diseases; rehabilitation; older adults. ResumoObjetivo: Sistematizar os resultados de ensaios clínicos sobre reabilitação vestibular (RV) em indivíduos de meia-idade e idosos com distúrbios vestibulares. Métodos: A busca de publicações sobre a RV em indivíduos com distúrbios vestibulares foi realizada nas bases de dados LILACS, EMBASE, MEDLINE, SciELO, Cochrane, ISI Web of Knowledge e bibliotecas virtuais de teses e dissertações.Foram selecionados ensaios clínicos aleatórios e controlados dos últimos 10 anos em língua inglesa, portuguesa e espanhola. A qualidade metodológica dos estudos foi avaliada pela escala PEDro. A análise dos resultados dos estudos foi feita por meio de revisão crítica dos conteúdos. Resultados: Nove estudos foram revisados na íntegra, sendo a faixa etária dos participantes acima de 40 anos (n= 4) e composta exclusivamente por idosos (n=5). Os achados de disfunção vestibular foram diversificados, sendo os mais comuns queixa de desequilíbrio corporal ou instabilidade postural (n=3) e queixa de vertigem ou tontura (n=3). A Escala Visual Analógica (EVA) foi o instrumento mais utilizado para avaliar a percepção subjetiva da sintomatologia da disfunção vestibular (n=4). A escala PEDro revelou que quatro dos artigos apresentaram delineamento de boa qualidade para a condução do estudo experimental. A proposta de intervenção mais utilizada foi o protocolo de Cawthorne ...

Effects of conventional versus multimodal vestibular rehabilitation on functional capacity and balance control in older people with chronic dizziness from vestibular disorders: design of a randomized clinical trial

“…The VR protocols are considered effective at reducing dizziness and its consequences [14,18]. However, there are few randomized clinical trials that investigate VR effects on exclusively older subjects, who, in addition to the vestibular disorder, present other impairments related to ageing that may negatively influence body balance control.…”

“…In a previous systematic review of the effects of VR on adults and older people with dizziness, it was observed that the Cawthorne&Cooksey protocol was the most common therapeutic approach reported by the selected studies [14]. …”

“…There is also reason to believe that a multimodal protocol might increase older people’s independence in daily activities and body balance control, and as a consequence may reduce falls. Moreover, only a few clinical trials have so far investigated the effects of VR on samples composed exclusively of older individuals; and original and better designed trials are still required in order to provide reliable conclusions [14]. …”

Internet-based interventions for adults with hearing loss, tinnitus and vestibular disorders: a protocol for a systematic review

“…No recent review has focused solely on Internet interventions for tinnitus. Moreover, systematic reviews for vestibular rehabilitation were found [50], but these were not specific to Internet-based interventions. Reviews that have investigated Internet interventions have either explored a specific health conditions (e.g.…”

A influência do protocolo de reabilitação de Cawthorne e Cooksey no equilíbrio de idosas

“…Entre os protocolos de reabilitação vestibular encontrados na literatura, um dos mais utilizados é o de Cawthorne e Cooksey, criado na Inglaterra em 1946 e implantado no Brasil há duas décadas 6 . Este protocolo é constituído por exercícios que envolvem movimentos de cabeça, pescoço e olhos, exercícios de controle postural em várias posições, uso de superfície de suporte macia para diminuição do input proprioceptivo e exercícios de olhos fechados, dentre outros, com o intuito de aprimorar a interação vestibulovisual durante a movimentação cefálica e melhorar a estabilidade postural estática e dinâmica 9 .…”