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Running head: EFFECTS OF DIZZINESS ON COORDINATION AND QUALITY OF LIFE 1

The Effects of Dizziness on Coordination and Quality of Life

For Adolescents and Teens

Kennedy Norman and Catherine Czabala

SMSEA 2017
EFFECTS OF DIZZINESS ON COORDINATION AND QUALITY OF LIFE 2

The Effects of Dizziness on Coordination and Quality of Life

For Adolescents and Teens

For some adults, and even children and adolescents, dizziness is a true concern and may

play a negative role in their lives. In other words, dizziness can be disabling and may result in

a loss of work and increased anxiety (Warren et al., 2016) Generally, dizziness is defined as a

sensation of movement most often described as rocking or spinning of the body, the

surroundings, or within the head (Mendel et al., 2010, pg. 391). This dizziness may impair the

quality of life and lead to other health issues. Numerous studies have discussed the effects of

dizziness on older adults; however, the literature surrounding dizziness and its effects on

coordination is limited for young adults or adolescents. Studies reveal that dizziness increases

with age and 39% of adults over 80 years of age are affected by dizziness (Roceanu et al., 2014;

Dros et al., 2011). Overall, dizziness is a common and most frequent symptom presented to

neurologist, ear nose and throat specialist, and other types of clinics (Chitsav et al., 2016). It is

important to include more literature to determine how dizziness affects the quality of life for

young people too.

This science project aims to focus on the effects of dizziness on coordination and the

quality of life for adolescents and teens. The literature will explore and discuss several themes

found in the research concerning dizziness, which includes the types, symptoms, factors, and

prevalence of dizziness, various assessment for dizziness, and the connection between dizziness

and the brain and coordination. This study will further advance the knowledge concerning how

dizziness affects teens and adolescents in their daily lives.

Review of Literature

Defining Dizziness
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Dizziness can have many different meanings. In some cases dizziness can be a range of

sensations of feelings that makes a person feel strange and uneasy. The Mayo clinic describes

dizziness as faint, woozy, or unsteady, while other researchers describe dizziness to include an

intense sensation of spinning (Balance Disorders, 2017). Despite the various descriptions, the

literature reveals that the description of dizziness is imprecise and can mean different things to

different people (Starr et al., 2015). The article Feeling Dizzy(2002) from Harvards Mens

Health Watch describes four distinct sensations: lightheadedness, near-fainting, loss of

equilibrium, and vertigo. Other researchers reveal doctors use a classification system for

dizziness using 4 categories- presyncope, vertigo, disequilibrium, and atypical (Starr et al.,

2015). Presyncope is a feeling of impending loss of consciousness with weak muscles and vision

loss, vertigo is defined as spinning, disequilibrium is loss of balance, and atypical is defined as

lightheadedness (Starr et al., 2015).

In some cases, dizziness is defined as the result or symptom of another disease or

ailment. According to the National Institute on Deafness and Other Communication Disorders,

dizziness may be the symptom of balance disorders. Other researchers agree and consider

dizziness as non specific symptom and regarded as both a syndrome and a symptom of one or

more diseases (Mendel et al., 2010, pg. 392). In several research articles, dizziness is more

likely seen as a symptom in older patients and the disease is treated and not the dizziness (Dros

et al., 2011; Ferreira et al., 2016).

Prevalence of Dizziness

Several studies have reviewed the prevalence of dizziness in adults. One study reveals

that after headache, vertigo, and dizziness are among the most frequent presenting symptoms,
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not only in neurology, but also in Ear, Nose, and Throat and internal medicine clinics (Roceanu

et al., 2014, pg. 108). Other studies conclude that 25% of adults experience dizziness and

dizziness is more common in women than men (Mendel et al., 2010; Feeling Dizzy, 2002;

Warren et al., 2016). Mendel etal. (2010) concluded that the overall prevalence of women was

27% and men were 14% of 4,200 participants (pg. 392). Other studies reveal with a survey of

30,000 people that dizziness and vertigo were at 17% and rises to 39% for adults over 80 years

old (Roceanu et al., 2014). Research concerning adolescents is very limited; however,

researchers have concluded that dizziness and vertigo appears to be as common as in adults

(Langhagen et al., 2015). Despite this conclusion, this study was completed in Germany and not

in North America. Clearly, the literature supports the prevalence of dizziness in older adults, but

there is a limited review of dizziness in teens and adolescents that should be further explored.

Different Types of Dizziness or Balance Disorders

There are many types of balance disorders that may be the cause of dizziness. The most

common are outlines in this literature review. The disorders are the most commonly found in the

literature concerning dizziness (Balance Disorder, 2017; Feeling Dizzy, 2002; Roceanu et

al., 2016; Star et al., 2015; Chitsaz, et al., 2014). Benign paroxysmal positional vertigo (BPPV)

is the brief, but intense episode of vertigo caused by a specific change in your head position. This

may occur when a person bends down to look under something or tilt the head to look up.

Labyrinthitis is an infection in the inner ear that may be caused by influenza. Menieres disease

is described as the episodes of vertigo, hearing loss, and ringing in the ear or tinnitus. Vestibular

neuronitis is the inflammation of the vestibular nerve which is the main cause of vertigo.

Perilymph fistula is the leakage of the inner ear fluid into the middle ear, which causes dizziness

and nausea. Mal de Debarquement syndrome is described as a feeling of continuous rocking or


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bobbing that may last a few hours to a few days. Migraine-associated dizziness is common even

though is not recognized often ( (Furman et al.,, 2000). According to research, most of these

balance disorders may affect anyone at any age, but are more likely to affect older adults or

people who are ill, such as stroke victims with risk factors such as high blood pressure (Feeling

Dizzy, 2002).

Complications

Despite the inability to precisely define dizziness, it has a negative effect on adults.

According to Warren et al. (2016), dizziness can cause problems at work and increase the levels

of anxiety. Prolonged or several bouts of dizziness can cause psychological problems as well. A

study on the relationship between psychological symptoms and chronic dizziness shows that

there is a relationship and a high prevalence between anxiety and chronic dizziness (Chitsza et

al., 2016). Besides anxiety, patients are more likely to suffer from falling and injuries from

falling. Also, people who ignore their dizziness may be ignoring an existing condition that may

become worse if left untreated ( Balance Disorder, 2017). Several studies discuss

complications in light of older patients and conclude imbalance, falling, tinnitus, anxiety, and

inability to function were common complications (Ferreira et al., 2016; Stam et al., 2016).

However, another study reviewed the literature concerning questionnaires that would assess the

quality of life and complications of dizziness. This study failed to find any relevant or validated

questionnaires assessing the complications of vertigo or dizziness (Duracinsky et al., 2007).

Therefore, more research is needed to create proper assessment of the complications of dizziness

and balance disorders for older adults as well as adolescents.

Dizziness Scales, Questionnaires, and Assessments


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Determining the impact, severity, and extent of dizziness, vertigo, and other balance

disorders is an important aspects in the literature. According to Grill et al. (2012), there are many

measures for the assessment of the impact of vertigo, but no consensus exists on which aspects

should be measured (pg. 261). The studys objective was to determine an international standard

for patients with vertigo and dizziness called International Core Set (ICF). The ICF for vertigo

was designed for health care providers working in inpatient and ambulatory settings. Researchers

state that the ICF provides health professionals with a framework to assess patients

comprehensively and will hopefully be used to evaluate existing measures and create new

measures of functioning Grill et al., 2012, pg. 270).

Another scale found in several studies was the Dizziness Handicap Inventory (DHI)

(Stam et al.,2016; Mi et al.,2012; Dros et al., 2011). According to Dros (2011), the DHI is a

self- report questionnaire used to assess the degree of disability associated with dizziness

regardless of its underlying causes (pg. 7). The questionnaire contains 25 items covering

functional, emotional, and physical aspects as subscales. The scores were described as mild,

moderate, and severe. This questionnaire has been translated into several languages and

therefore, accepted by researches as a reliable tool. Grill acknowledges that even though DHI

total score is well accepted, other studies have found inconsistencies in its subscales (2011).

Concerning the studies which used DHI, Dros et al. (2011) used 417 patients 65 years and

older and found that 60% of dizzy older patients experienced moderate to severe dizziness. The

inventory allowed the researcher to determine which patients suffered the most from dizziness

without knowing the exact cause or causes. Another Dutch study which used the DHI, followed

13 participants and found that the participants may have dizziness, but when reported to their

doctor may be wrongly assessed as a secondary problem ( Stam et al, 2016). The DHI should be
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used to provide a better assessment and to address the dizziness instead of trying to find the

cause of the dizziness (Stam et al., 2016). Researchers using the Korean version of the DHI

examined the reliability and credibility of the questionnaire by comparing the results of 150

patients who were previously diagnosed with Menieres disease and Benign Paroxysmal

Positional Vertigo (BPPV) (Mi et al., 2012). The researchers concluded that patients with

Menieres disease scored significantly higher than patients with BPPV and females with

Menieres suffered longer symptomatic periods with higher scores than males (Mi et al., 2012).

Researchers used self-rated questionnaires to study dizziness, unsteadiness, and vertigo

(Mendel et al., 2010; Tomanovic and Bergenius, 2010; Langhagen et al., 2015). Studies used the

questionnaires to determine classical symptoms as well as non-classical symptoms, such as

stepping in a hole, laterpulsion, walking on pillows, drop attacks, and tilt illusion (Tomanovic &

Bergenius, 2010). This study also used the questionnaire to determine the duration of vertigo

attacks among Menieres disease, benign paroxysmal positional vertigo, and unilateral peripheral

vestibular impairment (Tomonavic & Bergenius, 2010). Other studies used similar assessments

to determine dizziness and vertigo, vertigo types, duration, frequency and constraints in social

activities by dizziness or vertigo (Langhagen et al., 2015). This study used 1,661 8th-10th grade

students and concluded that adolescents suffered from vertigo at a similar rate as adults.

However, the researchers revealed a limitation of all studies on vertigo/dizziness is the lack of

an international classification for dizziness/ vertigo as it is available for other subjective

complaints such as headache for children and adolescents (Langhagen et al., 2015).

Two studies included in this literature review used scales (Chitsav et al., 2016; Faag et

al., 2007). Researchers used the Vertigo Severity Scale to evaluate the severity of dizziness of

184 patients. This scale used 15 questions linked to the subscales of vertigo/balance and
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autonomic/ anxiety. The study using the Vertigo Severity Scale concluded the prevalence of

dizziness with psychological disorders (Chitsav et al., 2016) Faag et al. (2007) noted that the

Vertigo Symptom Scale was used in a study to determine its effectiveness in order to describe

episodes of dizziness in a sample of patients suffering from peripheral vestibular disorders (pg.

440). Twenty patients were asked to use a diary to record feelings concerning dizziness and

vertigo and researchers compared diary entries to the scale. The researchers (Faag et al., 2007)

concluded that the scale is an adequate base, but needs to be developed for use with patients

diagnosed with peripheral vestibular symptoms to be able to evaluate care and treatment (pg.

445).

Other studies include analysis of the literature review of questionnaires assessing vertigo

and dizziness (Durancinsky et al., 2007). This study reviewed 29 articles reporting validation and

use of questionnaires using the Patient- Outcome Checklist. The questionnaires were classified as

quality of life, mixed symptoms and quality of life, and symptoms. The researchers used 4

quality of life, three mixed and one Menieres symptoms questionnaire. Researchers (Faag et al.,

2007) concluded that the literature review failed to find any relevant and validated

questionnaires assessing the impact of vertigo or dizziness on the quality of life; however,

mixed questionnaires were less valid (pg. 281).

Dizziness and the Brain

Dizziness can be a big problem or a little problem. Dizziness most commonly originates

from the vestibular system, and the brain. When the brain or vestibular system are damaged even

a little bit, a persons coordination and balance can become harder to maintain. Some situations

can have bad outcomes depending on the severity of the damage to the brain or vestibular

system. For example, when soldiers are in the military and they get hit or thrown onto their head
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by an explosion there are sometimes severe damage and other times there is not that much

damage to the brain of vestibular system.

The brain is a very important part of your body because it controls so much. When people

have had a TBI (traumatic brain injury) one of the problems that arises other than the injury is

dizziness. Dizziness can affect your coordination and balance but it can also cause other

problems like anxiety and severe depression. Anxiety and depression can become a part of any

major injury but to have those problems along with dizziness can be unbearable for some people.

In the whole study-population the association of the dichotomous variables anxiety and

disability was significant.... The same was the case between the association of depression and

disability (Gender differences in patients with dizziness and unsteadiness regarding self-

perceived disability, anxiety, depression, and its associations, 2012).

Injury to the brain and vestibular system cannot just cause injury but it can also cause

chronic dizziness. Patients that have chronic dizziness dont just lose their balance they also

endure very painful headaches and a feeling of fatigue. Headaches are found in patients with

peripheral, as well as central, vestibular disorder. (Gurley, J. M., Hujsak, B. D., & Kelly, J. L.,

2013). Many people who suffer from these headaches and disorders do not know when they are

going to happen. For many people with more severe cases they could wake every other day with

a horrible migraine and not have many options for how to make it go away. People with these

disorders often spend lots of time indoor and sleeping until the pain goes away.

The vestibular system is another thing dizziness can be caused by. The vestibular system

is affected by even the slightest change in your body. So when something in your body changes a

certain way then it can affect your balance and coordination and make you dizzy. Sometimes

when peoples bodys change in other ways they get dizzy spells which are caused by the
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vestibular system. Dizzy spells are when someone suddenly gets very dizzy and they start to feel

like they could fall over or pass out.

Sometimes dizziness that is caused from the vestibular system is not caused from an

injury. There are times that the dizziness caused by the vestibular system is because of an inner-

ear malfunction. These malfunctions can be genetic, so the person is born with it or they can be

from a disease that the person once had that left this malfunction as an effect. (Alsalaheen, B. A.,

Whitney, S. L., Mucha, A., Morris, L. O., Furman, J. M., & Sparto, P. J., 2013).

The aim of this literature review was to explore and discuss several themes found in the

research concerning dizziness and coordination. The research reveals that dizziness can have

various meaning and can be disease or disorder, such as Menieres disease, or a symptom of

other problems, such as high blood pressure or traumatic brain injury. Overall, the literature

reveals that women and the elderly are more likely to suffer from balance disorders. However,

there is limited research on the effects of dizziness on adolescents and adolescents quality of

life. The literature includes various research studies using different types of assessments and

scales to determine the severity of dizziness.The research also thoroughly examines the

connection of the vestibular system to the brain and the ability to balance.

Since there is limited information about the connection between dizziness and

coordination and its effects on adolescents daily lives, this study seeks to further advance the

knowledge concerning how dizziness affects teens and adolescents in their daily lives. The

literature supports the use of various scales and assessments and the use of adolescents instead of

adults or elderly adults.This science project aims to focus on the effects of dizziness on

coordination and the quality of life for adolescents and teens.


EFFECTS OF DIZZINESS ON COORDINATION AND QUALITY OF LIFE 11

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