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Neuropsychiatric Aspects of Vestibular Disorders
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Julius Bourke, Georgia Jackson, Gerald Libby
Vestibular balance rehabilitation therapy (VBRT)88 aims to facilitate the process of compensation and involves a habituation programme that ultimately encourages the ‘avoidance of avoidance’. VBRT therefore also engages the behavioural component of the CBT model and is in this way similar in principle to graded exercise therapy in chronic pain syndromes such as fibromyalgia and chronic fatigue syndrome. VBRT is effective against hypersensitivity to motion, improves confidence with balance and reduces avoidance behaviour.89 Early forays into the combination of VBRT and CBT have yielded mixed results from small randomized trials, with positive results in terms of disability but without effect on the core symptoms of vertigo, anxiety or depression.90,91 This is perhaps not surprising with respect to symptoms of vertigo, as exposure to the activity that provokes symptoms is core to the process of compensation (part of the goal of VBRT); the patient needs to experience the symptoms in order for these subsequently to diminish.91
Fatigue in chronic medical conditions: A psychosomatic perspective
Published in S.R. Pandi-Perumal, Meera Narasimhan, Milton Kramer, Sleep and Psychosomatic Medicine, 2017
M. Zalai Dora, Gottschalk Raymond, Shapiro Colin Michael
At the other end of the fatigue spectrum (i.e., in individuals with chronic fatigue syndrome), graded exercise therapy was as efficacious as CBT in alleviating chronic fatigue.80 Exercise therapy has also shown promising results in those with cancer, although activity-based interventions appear to be less efficacious than psychological treatments.76 Notably, patients often do not maintain an increased activity schedule after treatment completion. Furthermore, in CBT trials, increased activity does not seem to directly contribute to the treatment effects; instead, changes in cognition appear to mediate the effects of CBT on fatigue.73,84 It is possible that temporary increases of activity help patients to realize that they are able to function despite feeling fatigued. This not only lessens the perceived functional impact of fatigue, but also decreases patients’ preoccupation with their fatigue.85 In the future, dismantling studies will need to explore the efficacy of individual treatment components (e.g., gradual increase of activity and cognitive interventions) on fatigue.
Systemic lupus erythematosus
Published in Rajan Madhok, Hilary Capell, The Year in Rheumatic Disorders Volume 4, 2004
AMÉRICA URIBE, SERGIO TOLOZA, GRACIELA ALARCÓN
patients. Although some patients may have overt neurocognitive impairment, others may have only very mild impairment (impairment that is only apparent to them). Like fatigue, the underlying pathological correlate of neurocognitive impairment is unclear at the moment; recently, however, it has been shown that global brain damage (ascertained by magnetization transfer imaging), but not disease duration, is highly correlated with neurocognitive impairment |8|. It is certain that, with increasing understanding of why these poorly defined symptoms occur so frequently in lupus patients, our treatment approaches will become more scientifically based and probably more successful. For the time being, however, graded exercise therapy may be all we have to offer to manage these patients' fatigue (but not their impaired cognition).
Graded exercise therapy for patients with chronic fatigue syndrome in secondary care – a benchmarking study
Published in Disability and Rehabilitation, 2022
Abigail Smakowski, James Adamson, Tracey Turner, Trudie Chalder
Graded exercise therapy aims to increase physical activity through guided exercise. Fatigue symptoms experienced by patients with CFS/ME lead to a general decrease in activity which over time causes the body to become weaker and deconditioned. The graded exercise programme aims to reverse this, so the body becomes stronger and reconditioned, thereby reducing symptoms. Core aims of GET are to increase muscle flexibility, muscle strength, and fitness levels so that activities that may be difficult at the start of treatment can be carried out more comfortably in the future. This rationale combined with support from RCTs suggests that patients with CFS can respond favourably to GET [7,8]. Indeed, in our clinic experience, anecdotally, patients who prefer not to have a psychological component to their treatment, appreciate having GET as an option.
Effects of activity pacing in patients with chronic conditions associated with fatigue complaints: a meta-analysis
Published in Disability and Rehabilitation, 2020
Ulric S. Abonie, Gavin R. H. Sandercock, Marelle Heesterbeek, Florentina J. Hettinga
In two studies [12,29], the intervention arm included activity pacing, cognitive behavioral therapy, and graded exercise therapy. The activity pacing intervention sought to encourage patients to avoid exacerbations of their symptoms by planning daily and weekly schedules of activities and rest breaks, and segmenting tasks into short time blocks. Cognitive behavioral therapy was aimed at diminishing the daily perceived cognitive, behavioral, emotional, and social consequences of illness and accompanying symptoms in order to optimize adherence to treatments. The graded exercise therapy component consisted of aerobic activities adapted to the individual’s physical capacity assessed at baseline taking into account a gradual increase in the duration and frequency of exercise sessions. The trials were delivered by clinical psychologists and exercise physiologists. The number of sessions ranged from 11 to 16 sessions, weekly or fortnightly, lasting for 8–12 weeks.
Conceptualizing the benefits of a group exercise program developed for those with chronic fatigue: a mixed methods clinical evaluation
Published in Disability and Rehabilitation, 2021
Victoria Strassheim, Vincent Deary, Deborah A. Webster, Jane Douglas, Julia L. Newton, Katie L. Hackett
Following a multi-centered randomized controlled trial of interventions for CFS/ME fatigue, graded exercise therapy was recommended as a treatment [12]. However, there has been much controversy over the reported findings of this study, both from researchers and from patient groups [13–15]. Although this approach has been suggested for CFS/ME fatigue, it is not known whether a graded exercise therapy approach is appropriate for a heterogeneous group of fatigued patients with a range of chronic diseases; particularly those who experience comorbid orthostatic dysregulation and related dizziness.