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OBJECTIVE The investigation of supervised vestibular rehabilitation treatment role for individuals with dizziness and imbalance due to peripheral, unilateral vestibular disorders. DATABASES REVIEWED Cochrane, PubMed, and Physiotherapy Evidence Database (PEDro) were utilized to identify relevant studies. METHODS The key search terms used were "Vestibular Rehabilitation and Unilateral Vestibular Hypofunction," "Vestibular Rehabilitation and Unilateral Vestibular Loss," and "Vestibular Rehabilitation and Supervision." A manual search was performed by exploring the references of included articles to identify studies not captured through the computer-based searches. The quality of the studies was assessed according to the PEDro scale. Inclusion criteria were: 1) studies with patients, aged from 18 to 80 years, with acute or chronic dizziness and disequilibrium due to unilateral vestibular dysfunction, 2) randomized control trials (RCTs), 3) studies comparing supervised vestibular rehabilitation program with an unsupervised vestibular rehabilitation program or home-based training or standard care or placebo, and 4) articles written in the English language. Studies reporting cases of vertigo and imbalance due to possible recurrent pathologies, acute benign paroxysmal positional vertigo, or central neurological/orthopedic deficits, were excluded. RESULTS A total of 448 articles were retrieved from the systematic database search strategy. Five of them were included in the systematic review after full-text analysis, plus one more after manual searching of their references. All studies involved supervised vestibular rehabilitation treatment programs compared with unsupervised home training, the performance of daily activities and, standard care. Based on PEDro's scoring system, one study rated as high-quality RCT, three studies were considered of fair quality and one scored as low-quality RCT. CONCLUSIONS Although most RCTs report better outcomes with a supervised vestibular rehabilitation treatment program regarding the emotional status, dizziness, and balance improvement, this systematic review failed to provide a strong evidence that supervision is superior to unsupervised protocols in patients with UNH. The self-reported subjective measures used by the included RCTs represent a serious limitation of their results.

BACKGROUND Balance rehabilitation programs constitute the most common treatment for balance disorders. Nonetheless, lack of resources and of highly expert physiotherapists barriers for patients to have individualized rehabilitation sessions and the required in person monitoring of the rehabilitation program. Therefore, balance rehabilitation programs are often transferred to the home environment, with a high risk of the patient mis-performing the exercises or failing to follow the programme at all. OBJECTIVE Holobalance is a persuasive coaching system with the capacity to offer full-scale rehabilitation services at home. Holobalance comprises of several modules, from rehabilitation program management to Augmented Reality (AR) coach presentation. One of the modules is the scoring module, which assesses the performance of the patient using wearable devices. METHODS The data-driven scoring module described in the present work is based on an extensive dataset (~1300 rehabilitation exercise sessions) collected during the Holobalance pilot study. Its scope is to be used as a training and testing dataset for training machine learning (ML) models, which can infer the scoring components of all physical rehabilitation exercises. RESULTS The results of the trained model improved the performance of the scoring module, in terms of more accurate assessment of a performed exercise, when compared to a rule-based scoring model deployed at an early phase of the system (k-statistic value of 15.9% for the sitting exercises, 20.8% for the standing exercises and 26.8% for the walking exercises). CONCLUSIONS Finally, the resulting performance of the model resembles the threshold of the interobserver variability, enabling the trustworthy usage of the scoring module to the closed-loop chain of the Holobalance coaching system.

Physical inactivity and sedentary time are associated with all-cause mortality, chronic non-communicable diseases and falls in the elderly. Objective of this review is to assess and summarize recommendations from clinical guidelines for physical activity (PA) of older adults in general and related to falls. A scoping review of the existing clinical guidelines was conducted. The included studies should have been developed under the auspices of a health organization and their methodology should be described in detail. Nine clinical guidelines providing specific recommendations for the elderly were identified. There was a strong agreement across the guidelines regarding goals, activities parameters, adverse effects of PA, in addition to reference for preventing falls. Keeping even the minimum of physical activity, introducing balance exercises and strengthening exercises for preventing falls, avoiding unexpected accelerations in the intensity of the activities, applying the necessary precautions and consulting a health professional are the main pillars of recommendations. Despite any deficiencies in definitions, monitoring and optimal dosage consistency of recommendations, is an ideal incentive for countries and organizations to adopt and enhance physical activity as an antidote to the degeneration of human's health and quality of life.

In this study, we propose a dynamic Bayesian network (DBN)-based approach to behavioral modelling of community dwelling older adults at risk for falls during the daily sessions of a hologram-enabled vestibular rehabilitation therapy programme. The component of human behavior being modelled is the level of frustration experienced by the user at each exercise, as it is assessed by the NASA Task Load Index. Herein, we present the topology of the DBN and test its inference performance on real-patient data.Clinical Relevance— Precise behavioral modelling will provide an indicator for tailoring the rehabilitation programme to each individual’s personal psychological needs.

The basic principles of elemental metabolomics were applied to investigate whether alteration of egg metallome could be achieved after two flavonoids addition, namely hesperidin and naringin in diets of laying hens. A total of 72 hens were divided into six groups: Control (C) (basal diet), E1 (750 mg hesperidin/kg diet), E2 (1500 mg hesperidin/kg diet), N1 (750 mg naringin/kg diet), N2 (1500 mg naringin/kg diet), and VE (200 mg vitamin E/kg diet). The same diet was provided to birds of all treatments, with the exception of added supplements. The diets had the same vitamin and mineral premix, thus, all birds received the same number of elements because no differences on feed intake existed. The egg elemental profile consisted of As, Ca, Cd, Co, Cr, Cu, Fe, Mg, Mn, Mo, Ni, Pb, Sb, Se, Sr, V, Zn, and was determined using ICP-MS. Flavonoid supplementation altered the elemental profile. Most notably, in both albumen and yolk, hesperidin increased Ni, Pb, and Sr concentration while it decreased that of Co and Sb. Naringin increased Cd, Cr, Cu, Ni, and V and lowered the concentration of Co and Sb in both yolk and albumen. Vitamin E supplementation, in comparison to the control, decreased Co in both albumen and yolk and also raised Sb in albumen. Flavonoid presence led to the differences in deposition of certain trace minerals in egg compared to that of hens fed a basal diet or a diet with vitamin E supplementation.

Falls, caused by dizziness and balance deficits, and their consequences in terms of the resultant functional limitations and of the associated costs for the involved actors as well as for the healthcare system are a serious problem in modern societies. Vestibular rehabilitation therapy (VRT) is proposed as a personalized intervention both for ameliorating symptoms and for improving balance. The outcomes of the therapy are not the same in all patients and the reasons are explored in this study with data mining methods applied in two retrospective datasets. According to our findings, patients with unstable lesions, concurrent psychological problems and with headaches are poorer candidates for VRT. Patients with stable vestibular deficits, of recent onset and relatively intact psychological, acoustic, visual and proprioceptive systems are better candidates for VRT.

In this work we present a framework for the analysis and mining of multiparametric data related to balance disorders. The overall concept is to define the schema of the analysis that provides optimal results for diagnostic decision support in balance disorders. The work is part of the integrated EMBalance platform which targets the management of patients with balance disorders, from the diagnosis to treatment and evolution of the disease. The obtained results in four different balance disorders range from 76.4% to 92.1%.

In this work we present the decision support of the EMBalance platform. EMBalance is a platform for the management of balance disorders in terms of diagnosis, treatment and evolution. The EMBalance platform aims to extend existing but generic and currently uncoupled balance modelling activities leading to a multi-scale and patient-specific balance model, which will be incorporated in a Decision Support System (DSS), towards the early diagnosis, prediction and the efficient treatment planning of balance disorders. The diagnosis part of the decision support system uses various data ranging from demographic characteristics to clinical examinations, auditory and vestibular tests. Currently we present some initial technical choices and indicative results of the decision support system for diagnosing balance disorders, based on data mining techniques and clinical guidelines.

Balance disorders are expressed with main symptoms of vertigo, dizziness instability and disorientation. Most of them are caused by inner ear pathologies, but neurological, medical and psychological factors are also responsible. Balance disorders overwhelmingly affect daily activities and cause psychological and emotional hardship. They are also the main cause of falls which are a global epidemic. Home based balance rehabilitation is an effective approach for alleviating symptoms and for improving balance and self-confidence. However, the adherence in such programs is usually low with lack of motivation and disease related issues being the most influential factors. Holobalance adopts the Capability, Opportunity and Motivation (COM) and Behaviour (B) model to identify the sources of the behaviour that should be targeted for intervention and proposes specific Information Technology components that provide the identified interventions to the users in order to achieve the target behavioural change, which in this case is adherence to home base rehabilitation

Physical inactivity and sedentary time are associated with all-cause mortality, chronic non-communicable diseases and falls in the elderly. Objective of this review is to assess and summarize recommendations from clinical guidelines for physical activity (PA) of older adults in general and related to falls. A scoping review of the existing clinical guidelines was conducted. The included studies should have been developed under the auspices of a health organization and their methodology should be described in detail. Nine clinical guidelines providing specific recommendations for the elderly were identified. There was a strong agreement across the guidelines regarding goals, activities parameters, adverse effects of PA, in addition to reference for preventing falls. Keeping even the minimum of physical activity, introducing balance exercises and strengthening exercises for preventing falls, avoiding unexpected accelerations in the intensity of the activities, applying the necessary precautions and consulting a health professional are the main pillars of recommendations. Despite any deficiencies in definitions, monitoring and optimal dosage consistency of recommendations, is an ideal incentive for countries and organizations to adopt and enhance physical activity as an antidote to the degeneration of human’s health and quality of life.