A feasibility study investigating different interventions for the treatment of benign paroxysmal positional vertigo in acute traumatic brain injury patients
Benign paroxysmal positional vertigo
PATIENT ASSESSMENTS Following consent patients will undergo ward-based assessments comprising a clinical history and examination, subjective questionnaires and balance tests, prior to randomisation to one of three treatment group. Following randomisation, patients will receive treatment as per their allocated group. At the end of treatment, the researchers will ask patients to participate in interviews to explore their thoughts of taking part in the trial. CLINICAL HISTORY AND EXAMINATION Participants will be assessed using routine clinical history and examination. This will comprise bedside eye movement and vestibular testing. At this point, the researchers will also note baseline data including: - Demographic data (age and gender) - Past medical history - Date and nature of injury - Severity and location of injury - Surgical interventions - Duration of hospital stay - Falls during hospital stay - Anti sickness or dizziness medications during hospital stay - Type of BPPV - Presence and length of post-traumatic amnesia - Functional status as measured by the Functional Ambulation Category SUBJECTIVE QUESTIONNAIRES AND BALANCE TESTS The researchers will ask participants to complete questionnaires regarding their symptoms, mood and function and complete objective tests of their balance (see below) Timepoint 0 - Questionnaires Dizziness Handicap inventory UCLA Dizziness questionnaire Activities Specific Balance Confidence Scale Hospital Anxiety and Depression Scale Euro QoL 5D Montreal Cognitive Assessment Awareness Questionnaire Timepoint 0 - Balance tests Modified Dynamic Gait Index Modified Clinical test of sensory integration in balance Balance tests will include tests of walking and balancing by the bedside, tests routinely used on the ward. These are commonly used measures of balance. For the walking test, a researcher will walk alongside the subject to ensure that there is no risk of falling. The researchers will ask patients and their carers to keep a falls
Patient Inclusion criteria: 1. Over the age of 18 years 2. Closed head injury as defined by CT imaging 3. Inpatient on major trauma or outlying ward 4. Able to give informed consent or consultee consent 5. Sufficient grasp of English to consent and complete outcome measures Staff inclusion criteria: 1. Members of ward staff involved in the trial 2. Able to consent to an audio-recorded interview
Patients exclusion criteria: 1. History of previous or current substance abuse 2. Orthopaedic or vascular cervical spine instability 3. Pregnant 4.Glasgow Coma Score at assessment less than 14 5. Medically unstable 6. Current prescription of Phenytoin 7. Active psychiatric disease, including those with a current or past history of active psychotic disease but not those with a past history of psychiatric disease Staff exclusion criteria: Does not meet inclusion criteria