EFFICACY OF VESTIBULAR REHABILITATION FOR PATIENTS WITH CHRONIC VERTIGO IN OLD AGE

Japan is one of the world's leading countries with a super-aging society among the countries in the world with the fastest rate of super-aging of society, with an aging rate of 28.1%, as estimated in 2018. In the elderly population, dizziness and balance disorders are well-known risk factors fo...

Full description

Saved in:
Bibliographic Details
Published inJIBI INKOKA TEMBO Vol. 63; no. 2; pp. 59 - 65
Main Authors Koiduka, Izumi, Miyamoto, Yasuhiro, Arai, Kotaro, Ohara, Akihiro, Shinohe, Tatsuya, Mikami, Koshi, Yaguchi, Yuichiro, Suzuki, Kaori, Nisimoto, Hiroshi, Inagaki, Taro, Sasano, Yasuyuki, Mochizuki, Fumihiro
Format Journal Article
LanguageJapanese
Published Society of Oto-rhino-laryngology Tokyo 15.04.2020
耳鼻咽喉科展望会
Subjects
Online AccessGet full text
ISSN0386-9687
1883-6429
DOI10.11453/orltokyo.63.2_59

Cover

Abstract Japan is one of the world's leading countries with a super-aging society among the countries in the world with the fastest rate of super-aging of society, with an aging rate of 28.1%, as estimated in 2018. In the elderly population, dizziness and balance disorders are well-known risk factors for falls. In the present study, we examined the effects of vestibular rehabilitation in patients aged 65 years old or older who had dizziness and an impaired sense of balance, which, as mentioned above, are major risk factors for falls. The subjects of this prospective interventional study comprised 21 patients with dizziness aged 65 years old or older (7 men and 14 women). We performed a comparative assessment of the patients using the Dizziness Handicap Inventory (DHI) before the start of vestibular rehabilitation intervention and 2 months after the start of the intervention. As vestibular rehabilitation, the subjects were asked to practice the X1 paradigm proposed by Tusa et al. and the Brandt-Daroff method at home for 2 months. The results revealed significant improvement of the average score and scores in the three categories of physical, emotional and functional well-being of the DHI at 2 months after the start of the intervention as compared to before the intervention. Among the vestibular rehabilitation methods, the X1 paradigm is mainly aimed at correcting the left-right difference in the semicircular canal vestibulo-ocular reflex, while the Brandt-Daroff method is aimed at promoting sensory substitution by vision and somatic sensation. In the patients with age-related balance disorder in this study, it appears that the subjective symptoms improved because of sensory substitution, mainly owing to the improvement of vision and somatic sensation by vestibular rehabilitation.
AbstractList Japan is one of the world's leading countries with a super-aging society among the countries in the world with the fastest rate of super-aging of society, with an aging rate of 28.1%, as estimated in 2018. In the elderly population, dizziness and balance disorders are well-known risk factors for falls. In the present study, we examined the effects of vestibular rehabilitation in patients aged 65 years old or older who had dizziness and an impaired sense of balance, which, as mentioned above, are major risk factors for falls. The subjects of this prospective interventional study comprised 21 patients with dizziness aged 65 years old or older (7 men and 14 women). We performed a comparative assessment of the patients using the Dizziness Handicap Inventory (DHI) before the start of vestibular rehabilitation intervention and 2 months after the start of the intervention. As vestibular rehabilitation, the subjects were asked to practice the X1 paradigm proposed by Tusa et al. and the Brandt-Daroff method at home for 2 months. The results revealed significant improvement of the average score and scores in the three categories of physical, emotional and functional well-being of the DHI at 2 months after the start of the intervention as compared to before the intervention. Among the vestibular rehabilitation methods, the X1 paradigm is mainly aimed at correcting the left-right difference in the semicircular canal vestibulo-ocular reflex, while the Brandt-Daroff method is aimed at promoting sensory substitution by vision and somatic sensation. In the patients with age-related balance disorder in this study, it appears that the subjective symptoms improved because of sensory substitution, mainly owing to the improvement of vision and somatic sensation by vestibular rehabilitation.
Japan is one of the world's leading countries with a super-aging society among the countries in the world with the fastest rate of super-aging of society, with an aging rate of 28.1%, as estimated in 2018. In the elderly population, dizziness and balance disorders are well-known risk factors for falls. In the present study, we examined the effects of vestibular rehabilitation in patients aged 65 years old or older who had dizziness and an impaired sense of balance, which, as mentioned above, are major risk factors for falls. The subjects of this prospective interventional study comprised 21 patients with dizziness aged 65 years old or older (7 men and 14 women). We performed a comparative assessment of the patients using the Dizziness Handicap Inventory (DHI) before the start of vestibular rehabilitation intervention and 2 months after the start of the intervention. As vestibular rehabilitation, the subjects were asked to practice the X1 paradigm proposed by Tusa et al. and the Brandt-Daroff method at home for 2 months. The results revealed significant improvement of the average score and scores in the three categories of physical, emotional and functional well-being of the DHI at 2 months after the start of the intervention as compared to before the intervention. Among the vestibular rehabilitation methods, the X1 paradigm is mainly aimed at correcting the left-right difference in the semicircular canal vestibulo-ocular reflex, while the Brandt-Daroff method is aimed at promoting sensory substitution by vision and somatic sensation. In the patients with age-related balance disorder in this study, it appears that the subjective symptoms improved because of sensory substitution, mainly owing to the improvement of vision and somatic sensation by vestibular rehabilitation.  我が国は世界でも有数の超高齢社会である。 本研究では, めまいや平衡障害を有する65歳以上の患者を対象として, 前庭リハビリテーションの効果について検討を加えた。 対象は65歳以上のめまい患者21名で, 男性7名, 女性14名で, 前向きの介入研究とした。 前庭リハビリテーションの効果については, Dizziness Handicap Inventory を用いて, 前庭リハビリテーション介入前と介入2ヵ月後を比較検討した。 なお前庭リハビリテーションには Tusa らが提唱した X1 パラダイムと Brandt-Daroff 法を被験者に行ってもらった。 結果, 前庭リハビリテーション介入前に比べて介入後は, Dizziness Handicap Inventory の平均値と三つのカテゴリー (動作・情緒・機能) とも有意に改善した。 前庭リハビリテーションの手法である, X1 パラダイムは半規管動眼反射の左右差を是正することを主な目的とし, Brandt-Daroff 法は半規管動眼反射の左右差を是正することを目的としている。 つまり一側性の前庭機能低下症例のみならず前庭機能の左右差が少ないとされる加齢性平衡障害の症例においては, 前庭リハビリテーションによって前庭代償が促進された結果, 自覚症状が改善したと考えられる。 めまい患者に対して前庭リハビリテーションを適用するにあたっては, 半規管動眼反射の左右差を是正することを目的とした前庭代償を促すことが重要である。
Author Ohara, Akihiro
Inagaki, Taro
Koiduka, Izumi
Shinohe, Tatsuya
Miyamoto, Yasuhiro
Sasano, Yasuyuki
Suzuki, Kaori
Arai, Kotaro
Nisimoto, Hiroshi
Mochizuki, Fumihiro
Yaguchi, Yuichiro
Mikami, Koshi
Author_FL 宮本 康裕
望月 文博
谷口 雄一郎
鈴木 香
四戸 達也
三上 公志
肥塚 泉
大原 章裕
稲垣 太朗
笹野 恭之
西本 寛志
荒井 光太郎
Author_FL_xml – sequence: 1
  fullname: 鈴木 香
– sequence: 2
  fullname: 宮本 康裕
– sequence: 3
  fullname: 笹野 恭之
– sequence: 4
  fullname: 荒井 光太郎
– sequence: 5
  fullname: 西本 寛志
– sequence: 6
  fullname: 四戸 達也
– sequence: 7
  fullname: 大原 章裕
– sequence: 8
  fullname: 稲垣 太朗
– sequence: 9
  fullname: 望月 文博
– sequence: 10
  fullname: 三上 公志
– sequence: 11
  fullname: 谷口 雄一郎
– sequence: 12
  fullname: 肥塚 泉
Author_xml – sequence: 1
  fullname: Koiduka, Izumi
  organization: Departmentt of Otolarhingology, St. Marianna University School of Medicine
– sequence: 1
  fullname: Miyamoto, Yasuhiro
  organization: Departmentt of Otolarhingology, St. Marianna University School of Medicine
– sequence: 1
  fullname: Arai, Kotaro
  organization: Departmentt of Otolarhingology, St. Marianna University School of Medicine
– sequence: 1
  fullname: Ohara, Akihiro
  organization: Departmentt of Otolarhingology, St. Marianna University School of Medicine
– sequence: 1
  fullname: Shinohe, Tatsuya
  organization: Departmentt of Otolarhingology, St. Marianna University School of Medicine
– sequence: 1
  fullname: Mikami, Koshi
  organization: Departmentt of Otolarhingology, St. Marianna University School of Medicine
– sequence: 1
  fullname: Yaguchi, Yuichiro
  organization: Departmentt of Otolarhingology, St. Marianna University School of Medicine
– sequence: 1
  fullname: Suzuki, Kaori
  organization: Departmentt of Otolarhingology, St. Marianna University School of Medicine
– sequence: 1
  fullname: Nisimoto, Hiroshi
  organization: Departmentt of Otolarhingology, St. Marianna University School of Medicine
– sequence: 1
  fullname: Inagaki, Taro
  organization: Departmentt of Otolarhingology, St. Marianna University School of Medicine
– sequence: 1
  fullname: Sasano, Yasuyuki
  organization: Departmentt of Otolarhingology, St. Marianna University School of Medicine
– sequence: 1
  fullname: Mochizuki, Fumihiro
  organization: Departmentt of Otolarhingology, St. Marianna University School of Medicine
BackLink https://cir.nii.ac.jp/crid/1390006221183883904$$DView record in CiNii
BookMark eNo9UE1Pg0AU3BhNrLU_wNsevFL3A_bjSBHKJgQMXTWeNrBslVrBQC_999JUvcy85M2bybwbcNn1nQPgDqMlxn5AH_phf-g_j_2S0SUxgbwAMywE9ZhP5CWYISqYJ5ng12Axjm2NUCC4ZIzPQBkniYrC6A0WCXyJN1qtnrOwhGWchiuVKR1qVeQwKUr4NI1xrjfwVekURmlZ5Cqabkqt1gVUOSyyRxiu41twta32o1v88hzoJNZR6mXFeorKvJ3gvlfXVnJBgkaQxiEfOc5RYC0WtKFVHaC64ZLIRiJpXV37GPOG-AxZjKoGia2gc3B_tu3a1tj2hJhKhBAjBE82U3-J_EkWnmW78VC9O_M9tF_VcDTVcGjt3pm_1xlGDTlBIP939qMajOvoD_NOZGk
ContentType Journal Article
Copyright 2020 Society of Oto-rhino-laryngology Tokyo
Copyright_xml – notice: 2020 Society of Oto-rhino-laryngology Tokyo
DBID RYH
DOI 10.11453/orltokyo.63.2_59
DatabaseName CiNii Complete
DatabaseTitleList

DeliveryMethod fulltext_linktorsrc
DocumentTitleAlternate 高齢者の慢性めまいに対する前庭リハビリテーションの効果
DocumentTitle_FL 高齢者の慢性めまいに対する前庭リハビリテーションの効果
EISSN 1883-6429
EndPage 65
ExternalDocumentID 130008025080
article_orltokyo_63_2_63_59_article_char_en
GroupedDBID ALMA_UNASSIGNED_HOLDINGS
JSF
OK1
RJT
RYH
ID FETCH-LOGICAL-j874-bbc97825d82de040e7705cc183d3ab50bd7929d909cebb4117d2460c10ad08f83
ISSN 0386-9687
IngestDate Thu Jun 26 23:40:17 EDT 2025
Wed Sep 03 06:31:11 EDT 2025
IsDoiOpenAccess true
IsOpenAccess true
IsPeerReviewed false
IsScholarly true
Issue 2
Language Japanese
LinkModel OpenURL
MergedId FETCHMERGED-LOGICAL-j874-bbc97825d82de040e7705cc183d3ab50bd7929d909cebb4117d2460c10ad08f83
OpenAccessLink https://www.jstage.jst.go.jp/article/orltokyo/63/2/63_59/_article/-char/en
PageCount 7
ParticipantIDs nii_cinii_1390006221183883904
jstage_primary_article_orltokyo_63_2_63_59_article_char_en
PublicationCentury 2000
PublicationDate 2020/04/15
2020-04-15
PublicationDateYYYYMMDD 2020-04-15
PublicationDate_xml – month: 04
  year: 2020
  text: 2020/04/15
  day: 15
PublicationDecade 2020
PublicationTitle JIBI INKOKA TEMBO
PublicationTitleAlternate O.R.L.Tokyo
PublicationTitle_FL OTO-RHINO-LARYNGOLOGY, TOKYO
耳鼻咽喉科展望
ORL, Tokyo
O.R.L.Tokyo
OTO-RHINO-LARYNGOLOGY,TOKYO
耳展
PublicationYear 2020
Publisher Society of Oto-rhino-laryngology Tokyo
耳鼻咽喉科展望会
Publisher_xml – name: Society of Oto-rhino-laryngology Tokyo
– name: 耳鼻咽喉科展望会
References 8) Cooksey FS: Rehabilitation in vestibular injuries. Proc R Soc Med 39: 273-278, 1946.
20) Lackner JR, Evanoff JN: Smooth pursuit eye movements elicited by somatosensory stimulation. Neurosci Lett 4: 43-48, 1977.
9) Dix MR: The rationale and technique of head exercises in the treatment of vertigo. Acta Otorhinolaryngolog Belgica 33: 370-384, 1979.
10) 澤井薫夫, 伊藤八次, 水田啓介: めまい・平衡障害例の平衡訓練成績. Equilibrium Res 56: 60-85, 1997.
18) American Geriatrics Society, British Geriatrics Society, American Academy of Orthopaedic Surgeons Panel on Falls Prevention: Guideline for the prevention of falls in older persons. J Am Geriatr Soc 2001 49: 664-672, 2001.
2) Neuhauser HK: Epidemiology of vertigo. Curr Opin Neurol 20: 40-46, 2007.
7) Cawthorne T: Vestibular injuries. Proc R Soc Med 39: 270-273, 1946.
1) 平成29年度高齢社会白書全版 http: //www8.cao.go.jp/kourei/whitepaper/w-2017/html/zenbun/index.html 参照 2018-09-16.
6) Prechet W, Dieringer N: Neuronal events paralleling functional recovery (compensation) following peripheral vestibular lesions. Berthoz A, Melvill Jones G (eds.): Elsevier, 1985, 251-268.
14) 増田圭名子: めまいの問診票 (和訳 Dizzness Handicap Inventry) の有用性の検討. Equilibrium Res 63: 555-563, 2004.
13) Herdman SJ: Role of vestibular adaptation in vestibular rehabilitation. Otolaryngol Head Neck Surg 119: 49-54, 1998.
12) Norre ME: Rational of rehabilitation treatment for vertigo. Am J Otolaryngol 8: 31-35, 1987.
4) 荒井秀典: フレイルの意義 (総説). 日本老年医学会雑誌 51: 497-501, 2014.
15) Tusa RJ, Herdman SJ: Vertigo and disequilibrium. Physical therapy for benign paroxysmal positional vertigo. Johnson R, Griffin J (eds.): Current Therapy in Neurological Disease, 4th ed. Mosby Year-Book, 1993, 246-248.
19) Bertera EM, Bertera RL: Fear of falling and activity avoidance in a national sample of older adults in the United States. Health Soc Work 33: 54-62, 2008.
16) Brandt T, Daroff RB: Physical therapy for benign paroxysmal positional vertigo. Arch Otolaryngol 106: 484-485, 1980.
5) Llinas R, Walton K: Vestibular compensation: A distributed property of the central nervous system. Asanuma H, Wilson VJ (eds.): Igaku Shoin, 1979, 145-166.
22) 五島史行, 新井基弘, 小川 郁: 慢性めまい患者に対する前庭リハビリテーションの治療効果. 日耳鼻 116: 1016-1023, 2013.
3) 牛尾宗貴: 特集 高齢者のふらつき感 深部知覚障害と高齢者のふらつき. MB ENT 125: 13-21, 2011.
11) 徳増厚二: めまい治療の現状と課題めまいのリハビリテーション. JOHNS 17: 825-829, 2001.
17) Rubenstein LZ: Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing 35 (Suppl 2): 37-41, 2006.
21) Zambarbieri D: Characteristics of eye movements evoked by the presentation of acoustic targets. Fuchs AF, Beaker W (eds): Progress in Oculomotor Research, Elsevier, 1981, 559-566.
References_xml – reference: 10) 澤井薫夫, 伊藤八次, 水田啓介: めまい・平衡障害例の平衡訓練成績. Equilibrium Res 56: 60-85, 1997.
– reference: 17) Rubenstein LZ: Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing 35 (Suppl 2): 37-41, 2006.
– reference: 6) Prechet W, Dieringer N: Neuronal events paralleling functional recovery (compensation) following peripheral vestibular lesions. Berthoz A, Melvill Jones G (eds.): Elsevier, 1985, 251-268.
– reference: 3) 牛尾宗貴: 特集 高齢者のふらつき感 深部知覚障害と高齢者のふらつき. MB ENT 125: 13-21, 2011.
– reference: 11) 徳増厚二: めまい治療の現状と課題めまいのリハビリテーション. JOHNS 17: 825-829, 2001.
– reference: 14) 増田圭名子: めまいの問診票 (和訳 Dizzness Handicap Inventry) の有用性の検討. Equilibrium Res 63: 555-563, 2004.
– reference: 18) American Geriatrics Society, British Geriatrics Society, American Academy of Orthopaedic Surgeons Panel on Falls Prevention: Guideline for the prevention of falls in older persons. J Am Geriatr Soc 2001 49: 664-672, 2001.
– reference: 19) Bertera EM, Bertera RL: Fear of falling and activity avoidance in a national sample of older adults in the United States. Health Soc Work 33: 54-62, 2008.
– reference: 5) Llinas R, Walton K: Vestibular compensation: A distributed property of the central nervous system. Asanuma H, Wilson VJ (eds.): Igaku Shoin, 1979, 145-166.
– reference: 7) Cawthorne T: Vestibular injuries. Proc R Soc Med 39: 270-273, 1946.
– reference: 21) Zambarbieri D: Characteristics of eye movements evoked by the presentation of acoustic targets. Fuchs AF, Beaker W (eds): Progress in Oculomotor Research, Elsevier, 1981, 559-566.
– reference: 9) Dix MR: The rationale and technique of head exercises in the treatment of vertigo. Acta Otorhinolaryngolog Belgica 33: 370-384, 1979.
– reference: 13) Herdman SJ: Role of vestibular adaptation in vestibular rehabilitation. Otolaryngol Head Neck Surg 119: 49-54, 1998.
– reference: 16) Brandt T, Daroff RB: Physical therapy for benign paroxysmal positional vertigo. Arch Otolaryngol 106: 484-485, 1980.
– reference: 1) 平成29年度高齢社会白書全版 http: //www8.cao.go.jp/kourei/whitepaper/w-2017/html/zenbun/index.html 参照 2018-09-16.
– reference: 8) Cooksey FS: Rehabilitation in vestibular injuries. Proc R Soc Med 39: 273-278, 1946.
– reference: 12) Norre ME: Rational of rehabilitation treatment for vertigo. Am J Otolaryngol 8: 31-35, 1987.
– reference: 2) Neuhauser HK: Epidemiology of vertigo. Curr Opin Neurol 20: 40-46, 2007.
– reference: 20) Lackner JR, Evanoff JN: Smooth pursuit eye movements elicited by somatosensory stimulation. Neurosci Lett 4: 43-48, 1977.
– reference: 4) 荒井秀典: フレイルの意義 (総説). 日本老年医学会雑誌 51: 497-501, 2014.
– reference: 15) Tusa RJ, Herdman SJ: Vertigo and disequilibrium. Physical therapy for benign paroxysmal positional vertigo. Johnson R, Griffin J (eds.): Current Therapy in Neurological Disease, 4th ed. Mosby Year-Book, 1993, 246-248.
– reference: 22) 五島史行, 新井基弘, 小川 郁: 慢性めまい患者に対する前庭リハビリテーションの治療効果. 日耳鼻 116: 1016-1023, 2013.
SSID ssib005879667
ssib005902162
ssib005879668
ssib058493089
ssib029852170
ssj0066717
ssib007484760
ssib002004161
Score 2.2020338
Snippet Japan is one of the world's leading countries with a super-aging society among the countries in the world with the fastest rate of super-aging of society, with...
SourceID nii
jstage
SourceType Publisher
StartPage 59
SubjectTerms Brandt-Daroff 法
Dizziness Handicap Inventory (DHI)
the Brandt-Daroff method
the X1 paradigm
vestibular compensation
X1 パラダイム
前庭代償
Title EFFICACY OF VESTIBULAR REHABILITATION FOR PATIENTS WITH CHRONIC VERTIGO IN OLD AGE
URI https://www.jstage.jst.go.jp/article/orltokyo/63/2/63_59/_article/-char/en
https://cir.nii.ac.jp/crid/1390006221183883904
Volume 63
hasFullText 1
inHoldings 1
isFullTextHit
isPrint
ispartofPNX JIBI INKOKA TEMBO, 2020/04/15, Vol.63(2), pp.59-65
link http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV3Pb9MwFLa2ceGCQIAYY8gHblGG6_zm1pZsDd0a6LJpO0WOk7J0qEFddugO_O18rtM2G0j8uFipnbiK3-f3vhf7PRPyLvMcweSEmRnjwrRlbpsZ7KApclbkEmpTLs9YOhm5gzP704VzsbX1ox1dUmcH8u63cSX_I1XUQa4qSvYfJLvuFBW4hnxRQsIo_0rGIJlRv9u_VFt3zsPTJOqdHXfHxjjElIyOo0QfqQM_z_iMy3CUnMJhTwZGfzCORxj-83CcREexEY2M-Pij0T0K73HVqBehaRgPu0YSnvTizQLS3e11aQxFNS_XAisXAlKvjEtxc3tVzqv1zeJGzHT1Ak9tACbQQ1WL5s7mwwNXu0BNHXqpPzw2u0rBaeO6MudX5awy4Y0vZl919qikul5ULXVm-a4ZuI15LbS69X3LhAcUtPVxo_DKlluslWuTOlybaX3CxK8GwF4e41HNv9Xq7w9c64Cnqwfv5dVW63gq0BgMlW2TR9zzlsv8wy8t90tlI2vF_Tq-B-_Qe_C7lQ4tAGNqpV9UeVq9jfvJAx9kaaMfwf0Ci6ls_5o5oOvlCdHrkWpW4dU7vX_4RmBMU_gPKjHE9qwsW6QoeUqeNN4M7WpoPiNbU_GcjFewpPEh3cCS3oclBSzpCpZUwZI2sKQNLGk0ooAlBSxfkOQwTPoDszm6w5z6HqZ7JgNQTyf3eV7ATBSexxwpYT5yS2QOy3IPtDwPWCCLLLM7HS_ntstkh0FH-BPfekl2ZtWseEVo5kq3KJwJpMNsaRUCNsPhkk9AdT2rw3fJBz0O6XedniVtpmO6GrHUtVKuCidYt6mQRmiQXbKPsUtlqUr4Qoq8cQ6f2wIwA2a__kP7Hnm8mRlvyE49vy32QVLr7O0SST8BxpJ4uQ
linkProvider Colorado Alliance of Research Libraries
openUrl ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=EFFICACY+OF+VESTIBULAR+REHABILITATION+FOR+PATIENTS+WITH+CHRONIC+VERTIGO+IN+OLD+AGE&rft.jtitle=JIBI+INKOKA+TEMBO&rft.au=Suzuki+Kaori&rft.au=Miyamoto+Yasuhiro&rft.au=Sasano+Yasuyuki&rft.au=Arai+Kotaro&rft.date=2020-04-15&rft.pub=Society+of+Oto-rhino-laryngology+Tokyo&rft.issn=0386-9687&rft.eissn=1883-6429&rft.volume=63&rft.issue=2&rft.spage=59&rft.epage=65&rft_id=info:doi/10.11453%2Forltokyo.63.2_59&rft.externalDocID=130008025080
thumbnail_l http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=0386-9687&client=summon
thumbnail_m http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=0386-9687&client=summon
thumbnail_s http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=0386-9687&client=summon