Impact of Level-up Element in Development of Exergame for Preventing Prolonged Orthostatic Dysregulation

Orthostatic dysregulation (OD) generally implies a systemic condition indicating poor circulatory function resulting from autonomic imbalance, which usually appears in a rather young population at or around puberty, predominantly in females. This condition can be recognized from the results of a questionnaire which has been proposed and prepared by the Pediatric OD Study Group of Japan as diagnostic criteria for OD. Schellong testing has also been developed as a screening method to determine OD or orthostatic hypotension. We carried out a survey and analyzed data collected with the questionnaire and Schellong test results among 152 young normal females ranging in age from 18 to 21 years in order to obtain the actual prevalence of OD in these subjects. Among 152 young normal females, 39 (25.7%) were confirmed to have OD based on the questionnaire. Although orthostatic dizziness was relatively common in this series of young females, regardless of the presence or absence of OD (90/152, 59.2%), this symptom, which is listed as one of the 5 major items on the questionnaire, was much more prevalent in subjects with OD (37/39, 94.9%). Similar prevalence patterns for fatigability or unexplained tiredness were also found in subjects with OD (28/39, 71.8%) when compared with total subjects (55/152, 36.2%). As for the positive rate of the Schellong test, subjects with and without OD showed 33.3% and 31.3%, respectively, and this difference was not statistically significant. There was, however, a highly significant difference in the fall in systolic pressure during the Schellong test procedure between subjects without OD and 10 subjects with OD in whom orthostatic dizziness frequently occurred.(ABSTRACT TRUNCATED AT 250 WORDS)

Orthostatic dysregulation (OD) has been identified as a kind of autonomic failure, however few studies have evaluated the autonomic dysfunction in patient with OD. Also the treatment of patients with OD has not been also necessarily standardized. We therefore investigated the cardiovascular autonomic function of 12 dizziness patients with OD using heart rate variability analysis (HRV) during the shellong test, and compared the findings with those of sex and aged-match healthy subjects. In addition, we discussed the clinical efficiency of cardiovascular α-adrenoreceptor stimulators or β-adrenoreceptor blockers for dizziness patients with OD.There was no significant difference in LF (low frequency power), HF (high frequency power) or LF/HF of HRV analysis between patients with OD and healthy subjects. However, the intersubject variation of the LF/HF value in patients with OD in supine and upright positions was apparently larger than that of the healthy adults, and some patients with OD showed extremely high values of LF/HF when upright.The cardiovascular α-adrenoreceptor stimulators improved dizziness symptoms in 4 of 8 patients that showed the lower values ( 4.2) of LF/HF value when upright. These results suggested that some dizziness patients with OD have an imbalance of sensitivity between α-adrenoreceptor and β-adrenoreceptor functions in the cardiovascular system. However, the cardiovascular autonomic function of OD patients requires further investigation.

In order to assess an association between orthostatic dysregulation (OD) and stress, we investigated the life-change-unite (LCU) score of dizzy patients with OD (n=258) and dizzy patients without OD (n=252) using the social readjustment rating scale (Holmes & Rahe, 1967), and also depression scores of the patients with a selfrated questionnaire for depression (SRQ-D). Nonparametric statistics used to analyze the data showed that at the .01 level of confidence, dizzy patients with OD had a significantly higher stress score than the dizzy patients without OD. Forty-eight percent of the patients with OD showed a significantly higher rate score on the SRQ-D, over 16 points, indicating that they were depressed, compared with that of the patients without OD. Particularly in the group of the dizzy male patients with OD between 40 and 64 years of age, rank order correlations between patients' LCU total and depression scores proved significant by Kendall's. We suggest that stress may be related to dizziness with OD and that a psychological approach may be useful for treatment of dizziness with OD.

Children with orthostatic dysregulation (OD) appear to have hypodynamia, as well as the symptoms described in the OD criteira. Hypodynamia, which is greatly influenced by motivation, volition and concentration, is unexceptionally recognized in their everyday life. It has been suggested that the symptoms and hypodynamia aggravate considerably the quality of life (QOL) of children with OD. The purpose of this study was to distinguish the characteristics of contingent negative variation (CNV) and post imperative negative variation, which may reflect the level of attention and motivation in children with OD. Twelve patients with OD aged 10-15 years and 23 age-matched healthy children were included. The CNV was recorded from Fz, Cz and Pz linked to earlobes during 30 trials consisting of a warning stimulus and an imperative stimulus with an interstimulus interval (ISI) of 2 s and an intertrial interval (ITI) of 10 s. The imperative stimulus of each trial required a button to be pressed. The untreated children with OD did not have a significantly smaller CNV amplitude than healthy children. Children with OD treated with midodrine and autonomic training had a significantly larger CNV amplitude than the untreated children, in the area of early, late and total CNV at the three sites. The present study confirms that children with OD have diminished motivation and deterioration of concentration, which cause hypodynamia in everyday life. Treatment for OD improves the symptoms, diminished motivation and deterioration of concentration, consequently restoring dynamia. Treatment for OD should be recommended to ameliorate QOL of children with OD.

Objectives:We aimed to examine the prevalence of orthostatic dysregulation among newly graduated female nurses after employment and its associations with autonomic nervous function, stress, and depressive symptoms.Methods:This follow-up study included 48 newly graduated female nurses (aged 22 ± 3 years) employed in acute care hospitals. The orthostatic dysregulation symptoms were evaluated using a screening checklist. A sit-to-stand test was conducted to assess the autonomic nervous function. Subjective stress and depressive symptoms were determined using a self-administered questionnaire. The data were collected at baseline on the first month and on the seventh month of employment. Statistical differences within groups were analyzed using paired t-test and McNemar’s test. The independent associations of orthostatic dysregulation status with stress and depressive symptoms were analyzed using a multivariate logistic regression model.Results:The percentage of individuals who were diagnosed with orthostatic dysregulation increased from 25.0% at baseline to 35.4% at follow-up. Logistic regression analyses revealed that stress and depressive symptoms were closely associated with orthostatic dysregulation status at follow-up, despite a weak association reported at baseline. The participants were categorized according to their orthostatic dysregulation status: among individuals without orthostatic dysregulation at baseline but with orthostatic dysregulation at follow-up, the increase in autonomic nervous activity, as assessed by the coefficient of variation of the R-R intervals, in response to the postural changes was significantly attenuated at follow-up. Furthermore, this group exhibited a significant increase in stress and depressive symptoms.Conclusions:At 7 months after employment, newly graduated nurses showed a higher prevalence of orthostatic dysregulation in combination with autonomic nervous system modulation, which was accompanied by an increase in stress and depressive symptoms. These observations suggest that the orthostatic dysregulation is associated with poor mental and physical health among newly graduated nurses in the early phase of employment.

We carried out a questionnaire survey regarding the symptoms of orthostatic dysregulation (OD) and administered the Schellong test to 301 healthy young females ranging in age from 18 to 21 years. OD was identified in 62 (20.6%) of the subjects based on the questionnaire. Although orthostatic dizziness was relatively common in the entire group of young females (171/301, 56.8%), this symptom was much more prevalent in the subjects with OD (58/62, 93.5%). There was also a highly significant difference between the systolic pressure decrease during the Schellong test procedure in 22 subjects with OD with frequent orthostatic dizziness and that in the 239 subjects without OD. Although the clinical value of the Schellong test in the assessment of OD and other related conditions has been brought into question because of its relatively poor specificity, we conclude that this test procedure may be useful in screening for OD or autonomic nerve dysfunction, since it presents the advantage of easy application in clinical practice.

Background: In recent years, the number of adolescents who do not attend school due to orthostatic dysregulation (OD) has increased rapidly in Japan, and countermeasures are urgently needed. In contrast, orthostatic intolerance (OI) is used as its counterpart in Western countries, and no internationally unified disease concept exists. Therefore, it is necessary to compare a population-based prospective study of OD and OI in adolescent urban communities. Objective: This study aims to show the clinical characteristics and prognosis of OD and OI in adolescent urban communities. Methods: We will launch the offspring cohort in 2022 in two school districts of Suita City, where we encourage medical examinations for all 11-, 14-, and 17-year-old adolescents. Approximately 200 adolescents of each age group will be undergoing medical examinations as research participants. We will perform a medical check-up to detect the constituents of metabolic syndrome, OD, and OI. We will implement questionnaires for the participants based on the Japanese OD Diagnostic and Treatment Guideline (OD symptoms) and diagnostic criteria in Western countries (OI symptoms). If any of the OD or OI symptoms (at least 3 points, 1 point or more) are positive, they will continue with a 10-minute standing test and their parents will fulfill the checklist for diagnosis of OD with psychosomatic disorder based on the aforementioned OD Guideline. Participants who are positive in the standing test will undergo echocardiography, Holter electrocardiography, and Parent-child home blood pressure measurements. We will refer to the Maternal and Child Health Handbook, Infant Health Examination, School Health Examination, and Lifestyle Related Disease Prevention Health Examination to explore OD and OI risk factors (for example, rapid change in growth curve and circadian rhythm formation). We will compare the prevalence of OD and OI by category using the respective diagnostic criteria in Japan and Western countries and reveal the relationship with classical risk, the diurnal variation in HBP of participants and their parents, cardiac function, and autonomic function. We will conduct follow-up studies every 3-year until 20 years old to examine morbidity and prognosis. In addition, we will perform a selected lifestyle questionnaire focusing on diet and physical activity for adolescents and then use metabolomic analysis to compare plasma metabolite profiles of with and without OD and OI participants to detect modifiable risk factors targeted in future interventions.

We examined dizzy patients with orthostatic dysregulation (OD) using the Schellong test, the Cornell Medical Index-Health Questionnaire (CMI) and the Yatabe-Guilford Personality test (Y-G test). Subjects were 134 patients (37 females and 97 females) who were confirmed to have OD based on a questionnaire survey conducted from December 1990 to November 1994.Systolic and diastolic pressures in the supine position in female patients with OD were lower than those in normal subjects. This tendency became more evident with advancing age.Of 17 males with OD, seven (41.2%) were types III or IV on the CMI, and seven (41.2%) were types B or E in the Y-G test which suggested mental and/or emotional Of 52 females with OD, 26 (50.0%) showed types III or IV on the CMI, and 19 (42.2%) were types B or E on the Y-G test. These results suggest that autonomic imbalance suspected on both the OD questionnaire results and the Schellong test is probably related to the occurrence of vertigo and/or dizziness, and that there is some correlation between OD and emotional and/or psychosomatic instability.

This is the first case report of orthostatic dysregulation (OD) manifested during postural change on the dental chair and intraoperatively monitored by heart rate variability (HRV) analysis. OD-associated autonomic dysfunction is induced by postural changes and easily leads to disturbance in circulatory dynamics; however, most dental practices have not yet realized the importance of managing OD. We measured autonomic activity in a patient with OD during dental therapy and assessed the clinical significance of HRV analysis for OD. The patient was a 17-year-old Japanese female. She was diagnosed with impacted wisdom teeth and had no previous history of a distinct systemic disease. A surgical procedure to extract the teeth was safely performed under both local anesthesia and sedation with nitrous oxide and midazolam. After the surgery, her postural change to sitting induced orthostatic hypotension. HRV variables showed parasympathetic dominance due to the upright position. Subsequently, her posture was returned to supine, and atropine sulfate administration for the immediate treatment of OD returned her blood pressure to normal levels. HRV variables showed relative sympathetic dominance due to an atropine-derived parasympathetic blockade. HRV analysis revealed OD-associated autonomic dysfunction and should become a standard tool for safe and secure dental management of OD.

The corrected QT interval (QTc) is affected by changes in autonomic sympathovagal modulation. The aim of this study was to determine whether children with orthostatic dysregulation (OD) have a longer QTc while standing than children without OD. We retrospectively assessed patients who underwent the Schellong test and electrocardiography between November 2016 and November 2019. Patients who met the criteria of OD subtypes according to the Japanese clinical guidelines for juvenile OD (version 1) were classified as OD positive (the OD-positive group), and patients who did not meet the criteria were classified as OD negative (the OD-negative group). There were 73 patients in the OD-positive group and 52 patients in the OD-negative group. Baseline heart rate, QT interval, and QTc were comparable between the OD-positive and OD-negative groups. Heart rate after standing was significantly higher in the OD-positive group than in the OD-negative group (median: 33 bpm vs. 21 bpm, p < 0.001). Further, shortening of QT interval after standing was greater in the OD-positive group than in the OD-negative group (median: 19 ms vs. 8 ms, p = 0.015). The QTc significantly increased from baseline to standing in both groups. Changes in the QT interval corrected by Bazett's formula were greater in the OD-positive group than in the OD-negative group (median: 73 ms vs. 42 ms, p < 0.001). The QTc increased significantly from baseline to standing in the OD-positive group. Thus, a high QTc while standing could be considered an auxiliary marker for OD diagnosis.

Orthostatic dysregulation (OD), a common psychosomatic disorder in children, is caused by circulation disturbance resulting from autonomic imbalance. OD is a significant public health threat due to its association with school refusal and depression in children. During the COVID-19 pandemic, many children suffered from school closures, lack of exercise, smartphone addiction, and school refusal. The COVID-19 pandemic made it much more difficult to deliver existing approaches to patients and families with OD and increased the risk of prolonged and severe OD. In response, web-based digital health solutions are expected to support patients and families. Digital therapeutics for OD can not only deliver established treatments online, such as pharmacotherapy and behavioral therapy but also provide new interventions, such as regular mental health programs led by clinical psychologists. It is necessary to keep in mind that digital therapeutics are not intended to replace established treatments, but rather to supplement them and provide additional support. However, most research on OD has been conducted in Japan. Therefore, to provide unique findings from Japan, it is important to conduct further epidemiological research using large-scale databases in the real world and reveal the clinical characteristics and detailed epidemiology of OD, leading to the development of novel treatments.

Orthostatic dysregulation (OD) is an autonomic nervous disorder of the circulatory system that occurs in students in the higher grades of elementary school and in high school. It has been reported to affect approximately 700,000 Japanese children and 30%-40% of children out of school. OD is often neglected because the primary symptoms reported by parents of children with OD include difficulty in waking up in the morning, headache, dizziness, and tiredness, which are also considered as personality traits. OD diagnosis is performed by a specialist in accordance with the guidelines established by the Japanese Society of Pediatric Psychosomatic Medicine in 2006. The test classifies OD into four subtypes, and each subtype is differently treated. However, because there are few OD specialists, a doctor's experience is often used for subtype classification. We attempted to determine the reproducibility of the doctor's rule of thumb using multivariate analysis, which is the simplest available method using the blood pressure and heart rate data obtained from the test. We obtained a discriminant accuracy of approximately 92% for the two most common OD subtypes. Despite the primary subtypes and limited subject data, we obtained positive results, potentially reproducing the doctor's rule of thumb.

The orthostatic test was administered to 134 dizzy patients (37 males and 97 females) who were identified as having orthostatic dysregulation from December 1990 through November 1994. The mean age of the male and female patients was 42.5 and 44.6 years, respectively, and the peak age decade was the 50s. Among the questionnaire items for orthostatic dysregulation, orthostatic dizziness was the most frequent major symptom and occurred in 116 of the patients (86.6%). Fatigue was the most frequent minor symptom and was found in 97 (72.4%). The incidence of positive orthostatic test results in the patients with orthostatic dysregulation (50.7%) was significantly higher (P < 0.01) than that in the control subjects (27.8%). There was also a significant difference (P < 0.01 or P < 0.05) between systolic pressure decrease during the orthostatic test procedure in the patients with orthostatic dysregulation and that in the control subjects. These results suggest that autonomic imbalance as reflected by the orthostatic dysregulation questionnaire and orthostatic test results is closely related to the occurrence of dizziness or vertigo.

We analyzed data collected from 134 patients (37 males and 97 females) with dizziness and/or vertigo who were confirmed to have orthostatic dysregulation (OD) based on a questionnaire survey between December 1990 and November 1994. The patients ranged in age from 10 to 80 years with a mean age of 42.5 years for males and 44.6 years for females. Patients with OD consulted our clinic more frequently in summer than in the other seasons.Orthostatic dizziness was the most common manifestation among the major symptoms of OD and was noted in 116 of 134 patients (86.6%). Fatigue was the most frequent complaint among the minor symptoms of OD and was noted in 97 of 134 patients (72.4%).OD was noted in 47 patients (35.1%) with dizziness or vertigo of unknown origin, in 22 (16.4%) of those with Meniere's disease, in 18 (13.4%) with dizziness or vertigo from central disorder, in 14 (10.4%) with hypotension, and 33 (24.6%) of those with other disorders.As for the positive rate on Schellong test, patients with OD and control subjects, showed 49.2% and 27.8%, respectively, and this difference was significant.These results suggest that autonomic imbalance suspected from the OD questionnaire and the Schellong test results probably affects the occurrence of vertigo and/or dizziness.

We previously reported that orthostatic dysregulation (OD) was relatively common in normal young females and that the Schellong test was a useful, practical procedure in the diagnosis of this condition.We carried out a survey and analyzed date from both the Yatabe-Guiford Personality test (Y-G test) and the Cornell Medical Index-Health Questionnaire (CMI) in 167 females aged 18 to 24 years (mean age =19.7 years). OD was confirmed in 38 and suspected in 32; the remaining 97 were considered to be normal from the results of the Questionnaire for OD.Of the 167 young females, 33 (19.8%) were type A in the Y-G test, 38 were type B (22.8%), 27 type C (16.1%), 52 type D (31.1%) and 17 type E (10.2%). Reports in the literature indicate that individuals with type B and type E Y-G results are apt to have mental and/or emotional “instability”. Of the 97 normal subjects, 28 were type B or type E (28.8%), of those with confirmed OD the number was 17 (44.7%) and of those with suspected OD it was 10 (31.2%). The difference between the normal subjects and those with confirmed OD was significant. Of 132 individuals with CMI types I and II 34 (25.8%) were Y-G types B and E and of 35 individuals with CMI type III and IV 21 (60%) were Y-G types B and E.These results suggest that there may be some correlation between OD and emotional and/or psychosomatic instability. Further studies on the practical implications of these testing procedures are necessary for the evaluation of individuals with OD.