{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T11:36:43Z","timestamp":1776685003326,"version":"3.51.2"},"reference-count":49,"publisher":"Walter de Gruyter GmbH","issue":"1","license":[{"start":{"date-parts":[[2020,10,29]],"date-time":"2020-10-29T00:00:00Z","timestamp":1603929600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"j_jaoa.2020.147_abs_001_w2aab3b7c10b1b6b1aab1c16b1Aa\"><jats:title>Context<\/jats:title><jats:p>There is a paucity of research assessing the efficacy of osteopathic manipulative treatment (OMT) in patients with vertigo.<\/jats:p><\/jats:sec><jats:sec id=\"j_jaoa.2020.147_abs_002_w2aab3b7c10b1b6b1aab1c16b2Aa\"><jats:title>Objective<\/jats:title><jats:p>To assess the feasibility of conducting a randomized, controlled trial comparing OMT and vestibular rehabilitation therapy (VRT), alone or in combination, in patients with vertigo and somatic dysfunction.<\/jats:p><\/jats:sec><jats:sec id=\"j_jaoa.2020.147_abs_003_w2aab3b7c10b1b6b1aab1c16b3Aa\"><jats:title>Methods<\/jats:title><jats:p>Volunteers with vertigo who were also diagnosed with somatic dysfunction (SD) were prospectively enrolled in a blinded, randomized, controlled cohort comparative effectiveness study and assigned to 1 of 4 groups: OMT alone, VRT alone, a combination of OMT and VRT (OMT\/VRT), or a nonintervention control group. Participants between 18 and 79 years of age were included if they had experienced symptoms of vertigo for at least 3 months\u2019 duration, demonstrated somatic dysfunction, and could participate in computerized dynamic posturography (CDP) testing, tolerate manual therapy and exercises, and communicate effectively in English or Spanish. A total of 3 treatments lasting 45 minutes each were administered 1 week apart to each participant. OMT in this study consisted of counterstrain, myofascial release, balanced ligamentous tension, soft tissue, HVLA, and articulatory techniques. Comparisons were made between composite scores (CS) assessed with computerized dynamic posturography (CDP), dizziness handicap inventory (DHI), optometric evaluation, and osteopathic structural examinations collected before the first treatment, after the third\/final treatment, and 3 months after the final treatment. (<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/ClinicalTrials.gov\">ClinicalTrials.gov<\/jats:ext-link>number<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"ctgov:NCT01529151\">NCT01529151<\/jats:ext-link>)<\/jats:p><\/jats:sec><jats:sec id=\"j_jaoa.2020.147_abs_004_w2aab3b7c10b1b6b1aab1c16b4Aa\"><jats:title>Results<\/jats:title><jats:p>A total of 23 patients were included in the study: 7 in the OMT group, 5 in the VRT group, 6 in the OMT\/VRT group, and 5 in the control group. The OMT\/VRT group demonstrated significant improvement in DHI score (P=0.0284) and CS (P=0.0475) between pre- and 3-month posttreatment measures. For total severity, improvements were significant in the OMT group both from pretreatment to immediate posttreatment measures (P=0.0114) and from pretreatment to 3-month posttreatment measures (P=0.0233). There was a statistical difference between the OMT and control groups from pretreatment to 3-month posttreatment DHI scores (P=0.0332). Also, there was a statistical difference in DHI score between VRT and control from pre- to 3-month posttreatment scores (P=0.0338). OMT\/VRT statistically and clinically improved visual acuity in patients\u2019 right eyes from pre- to posttreatment (P=0.0325). In all participants, vergence dysfunction was prevalent (5; 21.7%) in addition to vertical heterophoria (15; 65.2%).<\/jats:p><\/jats:sec><jats:sec id=\"j_jaoa.2020.147_abs_005_w2aab3b7c10b1b6b1aab1c16b5Aa\"><jats:title>Conclusion<\/jats:title><jats:p>A combination of OMT and VRT significantly reduced vertigo and improved balance 3 months after treatment (P&lt;0.05). There was a high prevalence in vergence and vertical heterophoria, which are not typical screening measurements used by physical therapists and physicians to assess vertigo patients. With a small sample size, this study demonstrated the feasibility of an interdisciplinary team evaluating and treating patients with vertigo in a community setting. A larger study is needed to assess the efficacy of OMT\/VRT in vertigo patients.<\/jats:p><\/jats:sec>","DOI":"10.7556\/jaoa.2020.147","type":"journal-article","created":{"date-parts":[[2020,10,30]],"date-time":"2020-10-30T15:00:49Z","timestamp":1604070049000},"page":"71-83","source":"Crossref","is-referenced-by-count":12,"title":["Osteopathic manipulative treatment in individuals with vertigo and somatic dysfunction: a randomized, controlled, comparative feasibility study"],"prefix":"10.1515","volume":"121","author":[{"given":"Marcel","family":"Fraix","sequence":"first","affiliation":[{"name":"Western University of Health Sciences College of Osteopathic Medicine of the Pacific , Pomona , CA , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sondos","family":"Badran","sequence":"additional","affiliation":[{"name":"Western University of Health Sciences College of Osteopathic Medicine of the Pacific , Pomona , CA , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victoria","family":"Graham","sequence":"additional","affiliation":[{"name":"California State University Northridge , Northridge , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Donna","family":"Redman-Bentley","sequence":"additional","affiliation":[{"name":"Western University of Health Sciences College of Osteopathic Medicine of the Pacific , Pomona , CA , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric L.","family":"Hurwitz","sequence":"additional","affiliation":[{"name":"The University of Hawaii , Manoa , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valerie L.","family":"Quan","sequence":"additional","affiliation":[{"name":"Western University of Health Sciences College of Osteopathic Medicine of the Pacific , Pomona , CA , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle","family":"Yim","sequence":"additional","affiliation":[{"name":"The Dignity Health California Hospital Medical Center , Los Angeles , CA , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary","family":"Hudson-McKinney","sequence":"additional","affiliation":[{"name":"Western University of Health Sciences College of Osteopathic Medicine of the Pacific , Pomona , CA , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael A.","family":"Seffinger","sequence":"additional","affiliation":[{"name":"Western University of Health Sciences College of Osteopathic Medicine of the Pacific , Pomona , CA , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"374","published-online":{"date-parts":[[2020,10,29]]},"reference":[{"key":"2021022021042883172_j_jaoa.2020.147_ref_001_w2aab3b7c10b1b6b1ab2b2b1Aa","doi-asserted-by":"crossref","unstructured":"Bhattacharyya, N, Gubbels, SP, Schwartz, SR, et al.. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngol Head Neck Surg. 2017;156(3_suppl):S1-S47. https:\/\/doi.org\/10.1177\/0194599816689667","DOI":"10.1177\/0194599816689667"},{"key":"2021022021042883172_j_jaoa.2020.147_ref_002_w2aab3b7c10b1b6b1ab2b2b2Aa","doi-asserted-by":"crossref","unstructured":"Lai, YT, Wang, TC, Chuang, LJ, Chen, MH, Wang, PC. Epidemiology of vertigo: a national survey. Otolaryngol Head Neck Surg. 2011 Jul;145 (1):110-6. https:\/\/doi.org\/10.177\/0194599811400007","DOI":"10.1177\/0194599811400007"},{"key":"2021022021042883172_j_jaoa.2020.147_ref_003_w2aab3b7c10b1b6b1ab2b2b3Aa","doi-asserted-by":"crossref","unstructured":"Neuhauser, HK. The epidemiology of dizziness and vertigo. Handb Clin Neurol. 2016;137:67-82. https:\/\/doi.org\/10.1016\/B978-0-444-63437-5.00005-4","DOI":"10.1016\/B978-0-444-63437-5.00005-4"},{"key":"2021022021042883172_j_jaoa.2020.147_ref_004_w2aab3b7c10b1b6b1ab2b2b4Aa","doi-asserted-by":"crossref","unstructured":"Lopez-Escamez, JA, Gamiz, MJ, Fernandez-Perez, A, Gomez-Fi\u00f1ana, M, Sanchez-Canet, I. Impact of treatment on health-related quality of life in patients with posterior canal benign paroxysmal positional vertigo. Otol Neurotol. 2003;24(4):637-641. https:\/\/doi.org\/10.1097\/00129492-200307000-00018","DOI":"10.1097\/00129492-200307000-00018"},{"key":"2021022021042883172_j_jaoa.2020.147_ref_005_w2aab3b7c10b1b6b1ab2b2b5Aa","unstructured":"Glossary Review Committee, for the Educational Council on Osteopathic Principles and the American Association of Colleges of Osteopathic Medicine. Glossary of Osteopathic Terminology. April 2002."},{"key":"2021022021042883172_j_jaoa.2020.147_ref_006_w2aab3b7c10b1b6b1ab2b2b6Aa","doi-asserted-by":"crossref","unstructured":"Li, Y, Peng, B. Pathogenesis, diagnosis, and treatment of cervical vertigo. Pain Physician. 2015;18(4):E583-E595.","DOI":"10.36076\/ppj.2015\/18\/E583"},{"key":"2021022021042883172_j_jaoa.2020.147_ref_007_w2aab3b7c10b1b6b1ab2b2b7Aa","doi-asserted-by":"crossref","unstructured":"Magnusson, M, Malmstr\u00f6m, EM. The conundrum of cervicogenic dizziness. Handb Clin Neurol. 2016;137:365-369. https:\/\/doi.org\/10.1016\/B978-0-444-63437-5.00026-1","DOI":"10.1016\/B978-0-444-63437-5.00026-1"},{"key":"2021022021042883172_j_jaoa.2020.147_ref_008_w2aab3b7c10b1b6b1ab2b2b8Aa","doi-asserted-by":"crossref","unstructured":"Yacovino, DA, Hain, TC. Clinical characteristics of cervicogenic-related dizziness and vertigo. Semin Neurol. 2013;33(3):244-255. https:\/\/doi.org\/10.1055\/s-0033-1354592","DOI":"10.1055\/s-0033-1354592"},{"key":"2021022021042883172_j_jaoa.2020.147_ref_009_w2aab3b7c10b1b6b1ab2b2b9Aa","unstructured":"Rubin, AM, Woolley, SM, Dailey, VM, Goebel, JA. Postural stability following mild head or whiplash injuries. Am J Otol. 1995;16(2):216-221."},{"key":"2021022021042883172_j_jaoa.2020.147_ref_010_w2aab3b7c10b1b6b1ab2b2c10Aa","doi-asserted-by":"crossref","unstructured":"Endo, K, Suzuki, H, Yamamoto, K. Consciously postural sway and cervical vertigo after whiplash injury. Spine (Phila Pa 1976). 2008;33 (16):E539-E542. https:\/\/doi.org\/10.1097\/BRS.0b013e31817c55fe","DOI":"10.1097\/BRS.0b013e31817c55fe"},{"key":"2021022021042883172_j_jaoa.2020.147_ref_011_w2aab3b7c10b1b6b1ab2b2c11Aa","doi-asserted-by":"crossref","unstructured":"Treleaven, J, Jull, G, Sterling, M. Dizziness and unsteadiness following whiplash injury: characteristic features and relationship with cervical joint position error. J Rehabil Med. 2003;35(1):36-43. https:\/\/doi.org\/10.1080\/16501970306109","DOI":"10.1080\/16501970306109"},{"key":"2021022021042883172_j_jaoa.2020.147_ref_012_w2aab3b7c10b1b6b1ab2b2c12Aa","doi-asserted-by":"crossref","unstructured":"Freppel, S, Bisdorff, A, Colnat-Coulbois, S, et al.. Visuo-proprioceptive interactions in degenerative cervical spine diseases requiring surgery. Neuroscience. 2013;255:226-232. https:\/\/doi.org\/10.1016\/j.neuroscience.2013.09.060","DOI":"10.1016\/j.neuroscience.2013.09.060"},{"key":"2021022021042883172_j_jaoa.2020.147_ref_013_w2aab3b7c10b1b6b1ab2b2c13Aa","doi-asserted-by":"crossref","unstructured":"Colledge, NR, Barr-Hamilton, RM, Lewis, SJ, Sellar, RJ, Wilson, JA. Evaluation of investigations to diagnose the cause of dizziness in elderly people: a community based controlled study. BMJ. 1996;313 (7060):788-792. https:\/\/doi.org\/10.1136\/bmj.313.7060.788","DOI":"10.1136\/bmj.313.7060.788"},{"key":"2021022021042883172_j_jaoa.2020.147_ref_014_w2aab3b7c10b1b6b1ab2b2c14Aa","doi-asserted-by":"crossref","unstructured":"Humphreys, BK, Peterson, C. Comparison of outcomes in neck pain patients with and without dizziness undergoing chiropractic treatment: a prospective cohort study with 6 month follow-up. Chiropr Man Therap. 2013;21(1):3. https:\/\/doi.org\/10.1186\/2045-709X-21-3","DOI":"10.1186\/2045-709X-21-3"},{"key":"2021022021042883172_j_jaoa.2020.147_ref_015_w2aab3b7c10b1b6b1ab2b2c15Aa","doi-asserted-by":"crossref","unstructured":"Strunk, RG, Hawk, C. Effects of chiropractic care on dizziness, neck pain, and balance: a single-group, preexperimental, feasibility study. J Chiropr Med. 2009;8(4):156-164. https:\/\/doi.org\/10.1016\/j.jcm.2009.08.002","DOI":"10.1016\/j.jcm.2009.08.002"},{"key":"2021022021042883172_j_jaoa.2020.147_ref_016_w2aab3b7c10b1b6b1ab2b2c16Aa","doi-asserted-by":"crossref","unstructured":"Fraix, M. Osteopathic manipulative treatment and vertigo: a pilot study. PM R. 2010;2(7):612-618. https:\/\/doi.org\/10.1016\/j.pmrj.2010.04.001","DOI":"10.1016\/j.pmrj.2010.04.001"},{"key":"2021022021042883172_j_jaoa.2020.147_ref_017_w2aab3b7c10b1b6b1ab2b2c17Aa","doi-asserted-by":"crossref","unstructured":"Papa, L, Amodio, A, Biffi, F, Mandara, A. Impact of osteopathic therapy on proprioceptive balance and quality of life in patients with dizziness. J Bodyw Mov Ther. 2017;21(4):866-872. https:\/\/doi.org\/10.1016\/j.jbmt.2017.03.001","DOI":"10.1016\/j.jbmt.2017.03.001"},{"key":"2021022021042883172_j_jaoa.2020.147_ref_018_w2aab3b7c10b1b6b1ab2b2c18Aa","doi-asserted-by":"crossref","unstructured":"Cabrera Kang, CM, Tusa, RJ. Vestibular rehabilitation: rationale and indications. Semin Neurol. 2013;33(3):276-285. https:\/\/doi.org\/10.1055\/s-0033-1354593","DOI":"10.1055\/s-0033-1354593"},{"key":"2021022021042883172_j_jaoa.2020.147_ref_019_w2aab3b7c10b1b6b1ab2b2c19Aa","doi-asserted-by":"crossref","unstructured":"Grod, JP, Diakow, PR. Effect of neck pain on verticality perception: a cohort study. Arch Phys Med Rehabil. 2002;83(3):412-415. https:\/\/doi.org\/10.1053\/apmr.2002.29660","DOI":"10.1053\/apmr.2002.29660"},{"key":"2021022021042883172_j_jaoa.2020.147_ref_020_w2aab3b7c10b1b6b1ab2b2c20Aa","doi-asserted-by":"crossref","unstructured":"Yahia, A, Ghroubi, S, Jribi, S, et al.. Chronic neck pain and vertigo: is a true balance disorder present?. Ann Phys Rehabil Med. 2009;52 (7-8):556-567. https:\/\/doi.org\/10.1016\/j.rehab.2009.07.033","DOI":"10.1016\/j.rehab.2009.07.033"},{"key":"2021022021042883172_j_jaoa.2020.147_ref_021_w2aab3b7c10b1b6b1ab2b2c21Aa","doi-asserted-by":"crossref","unstructured":"Stanton, TR, Leake, HB, Chalmers, KJ, Moseley, GL. Evidence of impaired proprioception in chronic, idiopathic neck pain: systematic review and meta-analysis. Phys Ther. 2016;96(6):876-887. https:\/\/doi.org\/10.2522\/ptj.20150241","DOI":"10.2522\/ptj.20150241"},{"key":"2021022021042883172_j_jaoa.2020.147_ref_022_w2aab3b7c10b1b6b1ab2b2c22Aa","doi-asserted-by":"crossref","unstructured":"de Vries, J, Ischebeck, BK, Voogt, LP, et al.. Joint position sense error in people with neck pain: a systematic review. Man Ther. 2015;20 (6):736-744. https:\/\/doi.org\/10.1016\/j.math.2015.04.015","DOI":"10.1016\/j.math.2015.04.015"},{"key":"2021022021042883172_j_jaoa.2020.147_ref_023_w2aab3b7c10b1b6b1ab2b2c23Aa","doi-asserted-by":"crossref","unstructured":"Telian, SA, Shepard, NT. Update on vestibular rehabilitation therapy. Otolaryngol Clin North Am. 1996;29(2):359-371.","DOI":"10.1016\/S0030-6665(20)30399-6"},{"key":"2021022021042883172_j_jaoa.2020.147_ref_024_w2aab3b7c10b1b6b1ab2b2c24Aa","doi-asserted-by":"crossref","unstructured":"Whitney, SL, Sparto, PJ. Principles ofvestibular physical therapy rehabilitation. Neurorehabilitation. 2011;29(2):157-166. https:\/\/doi.org\/10.3233\/nre-2011-0690","DOI":"10.3233\/NRE-2011-0690"},{"key":"2021022021042883172_j_jaoa.2020.147_ref_025_w2aab3b7c10b1b6b1ab2b2c25Aa","doi-asserted-by":"crossref","unstructured":"Nashner, LM. Organization and programming of motor activity during posture control. Prog Brain Res. 1979;50:177-184. https:\/\/doi.org\/10.1016\/S0079-6123(08)60818-3","DOI":"10.1016\/S0079-6123(08)60818-3"},{"key":"2021022021042883172_j_jaoa.2020.147_ref_026_w2aab3b7c10b1b6b1ab2b2c26Aa","doi-asserted-by":"crossref","unstructured":"Nashner, L, Shupert, CL, Horak, F, Black, FO. Organization of postural control: an analysis of sensory and mechanical constraints. Progress in Brain Research. 1989;80:411-8; discussion 395-7.","DOI":"10.1016\/S0079-6123(08)62237-2"},{"key":"2021022021042883172_j_jaoa.2020.147_ref_027_w2aab3b7c10b1b6b1ab2b2c27Aa","unstructured":"Brandt, T. Vertigo: Its Multisensory Syndromes, 2nd ed. Berlin: Springer; 1999."},{"key":"2021022021042883172_j_jaoa.2020.147_ref_028_w2aab3b7c10b1b6b1ab2b2c28Aa","unstructured":"Leigh, RJ, Zee, D. The Neurology of Eye Movements, 4th ed. New York: Oxford University Press; New York; 2006."},{"key":"2021022021042883172_j_jaoa.2020.147_ref_029_w2aab3b7c10b1b6b1ab2b2c29Aa","unstructured":"Ciuffreda, KJ, Tannen, B. Eye Movement Basics for the Clinician. St. Louis: Mosby Year Book, 1995."},{"key":"2021022021042883172_j_jaoa.2020.147_ref_030_w2aab3b7c10b1b6b1ab2b2c30Aa","doi-asserted-by":"crossref","unstructured":"Anoh-Tanon, MJ, Bremond-Gignac, D, Wiener-Vacher, SR. Vertigo is an underestimated symptom of ocular disorders: dizzy children do not always need MRI. Pediatr Neurol. 2000;23(1):49-53. https:\/\/doi.org\/10.1016\/s0887-8994(00)00140-5","DOI":"10.1016\/S0887-8994(00)00140-5"},{"key":"2021022021042883172_j_jaoa.2020.147_ref_031_w2aab3b7c10b1b6b1ab2b2c31Aa","doi-asserted-by":"crossref","unstructured":"Bucci, MP, L\u00ea, TT, Wiener-Vacher, S, Br\u00e9mond-Gignac, D, Bouet, A, Kapoula, Z. Poor postural stability in children with vertigo and vergence abnormalities. Invest Ophthalmol Vis Sci. 2009;50(10):4678-4684. https:\/\/doi.org\/10.1167\/iovs.09-3537","DOI":"10.1167\/iovs.09-3537"},{"key":"2021022021042883172_j_jaoa.2020.147_ref_032_w2aab3b7c10b1b6b1ab2b2c32Aa","doi-asserted-by":"crossref","unstructured":"Winkler, PA, Ciuffreda, KJ. Ocular fixation, vestibular dysfunction, and visual motion hypersensitivity. Optometry. 2009;80(9):502-512. https:\/\/doi.org\/10.1016\/j.optm.2009.01.014","DOI":"10.1016\/j.optm.2009.01.014"},{"key":"2021022021042883172_j_jaoa.2020.147_ref_033_w2aab3b7c10b1b6b1ab2b2c33Aa","doi-asserted-by":"crossref","unstructured":"Anand, V, Buckley, JG, Scally, A, Elliott, DB. Postural stability in the elderly during sensory perturbations and dual tasking: the influence of refractive blur. Invest Ophthalmol Vis Sci. 2003;44(7):2885-2891. https:\/\/doi.org\/10.1167\/iovs.02-1031","DOI":"10.1167\/iovs.02-1031"},{"key":"2021022021042883172_j_jaoa.2020.147_ref_034_w2aab3b7c10b1b6b1ab2b2c34Aa","unstructured":"Ehrenfeucter, WC. Chapter 34. Screening Osteopathic Structural Examination and Ch. 35 Segmental Motion Testing. In: Chila, AG, executive ed. Foundations of Osteopathic Medicine. 3rd ed. Baltimore, MD: Lippincott Williams & Wilkins; 2011:410-436."},{"key":"2021022021042883172_j_jaoa.2020.147_ref_035_w2aab3b7c10b1b6b1ab2b2c35Aa","unstructured":"American Osteopathic Association. Foundations of Osteopathic Medicine. 3rd ed. Chila, A, ed. Philadelphia, PA: Lippincott Williams & Wilkins."},{"key":"2021022021042883172_j_jaoa.2020.147_ref_036_w2aab3b7c10b1b6b1ab2b2c36Aa","unstructured":"Fraix, M, Gordon, A, Graham, V, Hurwitz, E, Seffinger, MA. Use of the SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness. J Am Osteopath Assoc. 2013;113(5):394-403."},{"key":"2021022021042883172_j_jaoa.2020.147_ref_037_w2aab3b7c10b1b6b1ab2b2c37Aa","doi-asserted-by":"crossref","unstructured":"Allum, JH, Shepard, NT. An overview of the clinical use of dynamic posturography in the differential diagnosis of balance disorders. J Vestib Res. 1999;9(4):223-252.","DOI":"10.3233\/VES-1999-9401"},{"key":"2021022021042883172_j_jaoa.2020.147_ref_038_w2aab3b7c10b1b6b1ab2b2c38Aa","doi-asserted-by":"crossref","unstructured":"Mutlu, B, Serbetcioglu, B. Discussion of the dizziness handicap inventory. J Vestib Res. 2013;23(6):271-277. https:\/\/doi.org\/10.3233\/VES-130488","DOI":"10.3233\/VES-130488"},{"key":"2021022021042883172_j_jaoa.2020.147_ref_039_w2aab3b7c10b1b6b1ab2b2c39Aa","doi-asserted-by":"crossref","unstructured":"Jacobson, GP, Newman, CW. The development of the Dizziness Handicap Inventory. Arch Otolaryngol Head Neck Surg. 1990;116 (4):424-427. https:\/\/doi.org\/10.1001\/archotol.1990.01870040046011","DOI":"10.1001\/archotol.1990.01870040046011"},{"key":"2021022021042883172_j_jaoa.2020.147_ref_040_w2aab3b7c10b1b6b1ab2b2c40Aa","doi-asserted-by":"crossref","unstructured":"Clendaniel, RA. Outcome measures for assessment of treatment of the dizzy and balance disorder patient. Otolaryngol Clin North Am. 2000;33(3):519-533. https:\/\/doi.org\/10.1016\/s0030-6665(05)70225-5","DOI":"10.1016\/S0030-6665(05)70225-5"},{"key":"2021022021042883172_j_jaoa.2020.147_ref_041_w2aab3b7c10b1b6b1ab2b2c41Aa","doi-asserted-by":"crossref","unstructured":"Wrisley, DM, Stephens, MJ, Mosley, S, Wojnowski, A, Duffy, J, Burkard, R. Learning effects of repetitive administrations of the sensory organization test in healthy young adults. Arch Phys Med Rehabil. 2007;88(8):1049-1054. https:\/\/doi.org\/10.1016\/j.apmr.2007.05.003","DOI":"10.1016\/j.apmr.2007.05.003"},{"key":"2021022021042883172_j_jaoa.2020.147_ref_042_w2aab3b7c10b1b6b1ab2b2c42Aa","doi-asserted-by":"crossref","unstructured":"Kniestedt, C, Stamper, RL. Visual acuity and its measurement. Ophthalmol Clin North Am. 2003;16(2):155-v. https:\/\/doi.org\/10.1016\/s0896-1549(03)00013-0","DOI":"10.1016\/S0896-1549(03)00013-0"},{"key":"2021022021042883172_j_jaoa.2020.147_ref_043_w2aab3b7c10b1b6b1ab2b2c43Aa","doi-asserted-by":"crossref","unstructured":"Ricci, F, Cedrone, C, Cerulli, L. Standardized measurement of visual acuity. Ophthalmic Epidemiol. 1998;5(1):41-53. https:\/\/doi.org\/10.1076\/opep.5.1.41.1499","DOI":"10.1076\/opep.5.1.41.1499"},{"key":"2021022021042883172_j_jaoa.2020.147_ref_044_w2aab3b7c10b1b6b1ab2b2c44Aa","doi-asserted-by":"crossref","unstructured":"Varma, R, McKean-Cowdin, R, Vitale, S, Slotkin, J, Hays, RD. Vision assessment using the NIH Toolbox [published correction appears in Neurology. 2013;80(24):2277]. Neurology. 2013;80(11 Suppl 3): S37-S40. https:\/\/doi.org\/10.1212\/WNL.0b013e3182876e0a","DOI":"10.1212\/WNL.0b013e3182876e0a"},{"key":"2021022021042883172_j_jaoa.2020.147_ref_045_w2aab3b7c10b1b6b1ab2b2c45Aa","unstructured":"Cooper, J, Duckman, R. Convergence insufficiency: incidence, diagnosis, and treatment. J Am Optom Assoc. 1978;49:673-80."},{"key":"2021022021042883172_j_jaoa.2020.147_ref_046_w2aab3b7c10b1b6b1ab2b2c46Aa","unstructured":"Griffin, JR, Borsting, EJ. Binocular Anomalies, 5th ed. Optometric Extension Program Foundation; California; 2010."},{"key":"2021022021042883172_j_jaoa.2020.147_ref_047_w2aab3b7c10b1b6b1ab2b2c47Aa","doi-asserted-by":"crossref","unstructured":"Kapoula, Z, Gaertner, C, Yang, Q, Denise, P, Toupet, M. Vergence and standing balance in subjects with idiopathic bilateral loss of vestibular function. PLoS One. 2013;8(6):e66652. https:\/\/doi.org\/10.1371\/journal.pone.0066652","DOI":"10.1371\/journal.pone.0066652"},{"key":"2021022021042883172_j_jaoa.2020.147_ref_048_w2aab3b7c10b1b6b1ab2b2c48Aa","doi-asserted-by":"crossref","unstructured":"Jackson, DN, Bedell, HE. Vertical heterophoria and susceptibility to visually induced motion sickness. Strabismus. 2012;20(1):17-23. https:\/\/doi.org\/10.3109\/09273972.2011.650813","DOI":"10.3109\/09273972.2011.650813"},{"key":"2021022021042883172_j_jaoa.2020.147_ref_049_w2aab3b7c10b1b6b1ab2b2c49Aa","doi-asserted-by":"crossref","unstructured":"Rosser, DA, Cousens, SN, Murdoch, IE, Fitzke, FW, Laidlaw, DA. How sensitive to clinical change are ETDRS logMAR visual acuity measurements? Invest Ophthalmol Vis Sci. 2003;44(8):3278-3281. https:\/\/doi.org\/10.1167\/iovs.02-1100","DOI":"10.1167\/iovs.02-1100"}],"container-title":["Journal of Osteopathic Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.degruyter.com\/document\/doi\/10.7556\/jaoa.2020.147\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyter.com\/document\/doi\/10.7556\/jaoa.2020.147\/html","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,11,25]],"date-time":"2022-11-25T21:24:19Z","timestamp":1669411459000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.degruyter.com\/document\/doi\/10.7556\/jaoa.2020.147\/html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,29]]},"references-count":49,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020,10,29]]},"published-print":{"date-parts":[[2021,2,1]]}},"alternative-id":["10.7556\/jaoa.2020.147"],"URL":"https:\/\/doi.org\/10.7556\/jaoa.2020.147","relation":{},"ISSN":["2702-3648"],"issn-type":[{"value":"2702-3648","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10,29]]}}}