1
|
Grove CR, Klatt BN, Wagner AR, Anson ER. Vestibular perceptual testing from lab to clinic: a review. Front Neurol 2023; 14:1265889. [PMID: 37859653 PMCID: PMC10583719 DOI: 10.3389/fneur.2023.1265889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
Not all dizziness presents as vertigo, suggesting other perceptual symptoms for individuals with vestibular disease. These non-specific perceptual complaints of dizziness have led to a recent resurgence in literature examining vestibular perceptual testing with the aim to enhance clinical diagnostics and therapeutics. Recent evidence supports incorporating rehabilitation methods to retrain vestibular perception. This review describes the current field of vestibular perceptual testing from scientific laboratory techniques that may not be clinic friendly to some low-tech options that may be more clinic friendly. Limitations are highlighted suggesting directions for additional research.
Collapse
Affiliation(s)
- Colin R. Grove
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Division of Physical Therapy, Department of Physical Medicine and Rehabilitation School of Medicine, Emory University, Atlanta, GA, United States
| | - Brooke N. Klatt
- Physical Therapy Department, University of Pittsburgh, Pittsburgh, PA, United States
| | - Andrew R. Wagner
- Department of Otolaryngology—Head and Neck Surgery, Ohio State University Wexner Medical Center, Columbus, OH, United States
- School of Health and Rehabilitation Sciences, Ohio State University, Columbus, OH, United States
| | - Eric R. Anson
- Department of Otolaryngology, University of Rochester, Rochester, NY, United States
- Physical Therapy Department, University of Rochester, Rochester, NY, United States
- Department of Neuroscience, University of Rochester, Rochester, NY, United States
| |
Collapse
|
2
|
Harrell R, Cassidy A, Klatt B, Hovareshti P, Whitney S. Vestibular rehabilitation in cerebellar ataxia with neuropathy and vestibular areflexia syndrome (CANVAS)- A case report. J Otol 2023; 18:199-207. [PMID: 37877066 PMCID: PMC10593570 DOI: 10.1016/j.joto.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/12/2023] [Accepted: 06/29/2023] [Indexed: 10/26/2023] Open
Abstract
Background and purpose Cerebellar ataxia, neuropathy, and vestibular areflexia syndrome (CANVAS) is a neurodegenerative disease of the cerebellum. The disease progression is slow, with up to 25% of people diagnosed needing to use a wheelchair after 15 years from diagnosis. Vestibular symptoms arise from centrally-mediated ocular movement degradation and the reduced vestibular-ocular reflex functioning bilaterally. To date, no report has shown an improvement in VOR gain or gait outcome measures in someone with CANVAS after a course of vestibular physical therapy. Case description A 65-year-old male, Patient X, first noticed symptoms in his fourth decade of life and was diagnosed with (CANVAS) in his seventh decade. Patient X reported numbness and tingling in his hands and feet, decreased ability to perform daily activities, and several falls. Intervention Patient X completed a four-month course of vestibular physical therapy, including vestibular ocular reflex exercises, balance training, gait training, and the VestAid application for eye gaze compliance monitoring. The Vestaid application uses eyes and facial recognition software to record the percentage of time that the patient kept their eyes on the target. Outcomes After vestibular therapy, Patient X had a clinically meaningful improvement in gait speed: from 1.02 m/s to 1.13 m/s and in the Functional Gait Assessment from 20/30 to 27/30. Patient X's eye gaze compliance improved from a median of 43% (range 25-68%) to a median of 67% (58-83%). Discussion This case study demonstrates that vestibular rehabilitation improved eye gaze compliance and functional outcomes in a person living with CANVAS.
Collapse
Affiliation(s)
- R.G. Harrell
- School of Health and Rehabilitation Sciences, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, 15219, USA
| | - A.R. Cassidy
- School of Health and Rehabilitation Sciences, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, 15219, USA
- Rehabilitation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, 15219, USA
| | - B.N. Klatt
- School of Health and Rehabilitation Sciences, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, 15219, USA
| | - P. Hovareshti
- BlueHalo, Intelligent Automation, Rockville, MD, 20855, USA
| | - S.L. Whitney
- School of Health and Rehabilitation Sciences, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, 15219, USA
- Department of Otolaryngology, University of Pittsburgh Medical School, Pittsburgh, PA, 15219, USA
| |
Collapse
|
3
|
Lambert FM, Beraneck M, Straka H, Simmers J. Locomotor efference copy signaling and gaze control: An evolutionary perspective. Curr Opin Neurobiol 2023; 82:102761. [PMID: 37604066 DOI: 10.1016/j.conb.2023.102761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/08/2023] [Accepted: 07/22/2023] [Indexed: 08/23/2023]
Abstract
Neural replicas of the spinal motor commands that drive locomotion have become increasingly recognized as an intrinsic neural mechanism for producing gaze-stabilizing eye movements that counteract the perturbing effects of self-generated head/body motion. By pre-empting reactive signaling by motion-detecting vestibular sensors, such locomotor efference copies (ECs) provide estimates of the sensory consequences of behavioral action. Initially demonstrated in amphibian larvae during spontaneous fictive swimming in deafferented in vitro preparations, direct evidence for a contribution of locomotor ECs to gaze stabilization now extends to the ancestral lamprey and to tetrapod adult frogs and mice. Supporting behavioral evidence also exists for other mammals, including humans, therefore further indicating the mechanism's conservation during vertebrate evolution. The relationship between feedforward ECs and vestibular sensory feedback in ocular movement control is variable, ranging from additive to the former supplanting the latter, depending on vestibular sensing ability, and the intensity and regularity of rhythmic locomotor movements.
Collapse
Affiliation(s)
- François M Lambert
- Institut des Neurosciences Cognitives et Intégratives d'Aquitaine, CNRS Unité Mixte de Recherche 5287, Université de Bordeaux, 33706 Bordeaux, France
| | - Mathieu Beraneck
- Integrative Neuroscience and Cognition Center, CNRS UMR 8002, Université Paris Cité, 75006 Paris, France
| | - Hans Straka
- Department Biology II, Ludwig-Maximilians-University Munich, 82152 Planegg, Germany
| | - John Simmers
- Institut des Neurosciences Cognitives et Intégratives d'Aquitaine, CNRS Unité Mixte de Recherche 5287, Université de Bordeaux, 33706 Bordeaux, France.
| |
Collapse
|
4
|
Straka H, Lambert FM, Simmers J. Role of locomotor efference copy in vertebrate gaze stabilization. Front Neural Circuits 2022; 16:1040070. [PMID: 36569798 PMCID: PMC9780284 DOI: 10.3389/fncir.2022.1040070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/24/2022] [Indexed: 12/13/2022] Open
Abstract
Vertebrate locomotion presents a major challenge for maintaining visual acuity due to head movements resulting from the intimate biomechanical coupling with the propulsive musculoskeletal system. Retinal image stabilization has been traditionally ascribed to the transformation of motion-related sensory feedback into counteracting ocular motor commands. However, extensive exploration of spontaneously active semi-intact and isolated brain/spinal cord preparations of the amphibian Xenopus laevis, have revealed that efference copies (ECs) of the spinal motor program that generates axial- or limb-based propulsion directly drive compensatory eye movements. During fictive locomotion in larvae, ascending ECs from rostral spinal central pattern generating (CPG) circuitry are relayed through a defined ascending pathway to the mid- and hindbrain ocular motor nuclei to produce conjugate eye rotations during tail-based undulatory swimming in the intact animal. In post-metamorphic adult frogs, this spinal rhythmic command switches to a bilaterally-synchronous burst pattern that is appropriate for generating convergent eye movements required for maintaining image stability during limb kick-based rectilinear forward propulsion. The transition between these two fundamentally different coupling patterns is underpinned by the emergence of altered trajectories in spino-ocular motor coupling pathways that occur gradually during metamorphosis, providing a goal-specific, morpho-functional plasticity that ensures retinal image stability irrespective of locomotor mode. Although the functional impact of predictive ECs produced by the locomotory CPG matches the spatio-temporal specificity of reactive sensory-motor responses, rather than contributing additively to image stabilization, horizontal vestibulo-ocular reflexes (VORs) are selectively suppressed during intense locomotor CPG activity. This is achieved at least in part by an EC-mediated attenuation of mechano-electrical encoding at the vestibular sensory periphery. Thus, locomotor ECs and their potential suppressive impact on vestibular sensory-motor processing, both of which have now been reported in other vertebrates including humans, appear to play an important role in the maintenance of stable vision during active body displacements.
Collapse
Affiliation(s)
- Hans Straka
- Faculty of Biology, Ludwig-Maximilians-University Munich, Munich, Germany,*Correspondence: Hans Straka,
| | - François M. Lambert
- Institut de Neurosciences Cognitives et Intégratives d’Aquitaine (INCIA), CNRS UMR 5287, Université de Bordeaux, Bordeaux, France
| | - John Simmers
- Institut de Neurosciences Cognitives et Intégratives d’Aquitaine (INCIA), CNRS UMR 5287, Université de Bordeaux, Bordeaux, France
| |
Collapse
|
5
|
Dietrich H, Pradhan C, Heidger F, Schniepp R, Wuehr M. Downbeat nystagmus becomes attenuated during walking compared to standing. J Neurol 2022; 269:6222-6227. [PMID: 35412151 DOI: 10.1007/s00415-022-11106-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/24/2022] [Accepted: 03/24/2022] [Indexed: 11/28/2022]
Abstract
Downbeat nystagmus (DBN) is a common form of acquired fixation nystagmus related to vestibulo-cerebellar impairments and associated with impaired vision and postural imbalance. DBN intensity becomes modulated by various factors such as gaze direction, head position, daytime, and resting conditions. Further evidence suggests that locomotion attenuates postural symptoms in DBN. Here, we examined whether walking might analogously influence ocular-motor deficits in DBN. Gaze stabilization mechanisms and nystagmus frequency were examined in 10 patients with DBN and 10 age-matched healthy controls with visual fixation during standing vs. walking on a motorized treadmill. Despite their central ocular-motor deficits, linear and angular gaze stabilization in the vertical plane were functional during walking in DBN patients and comparable to controls. Notably, nystagmus frequency in patients was considerably reduced during walking compared to standing (p < 0.001). The frequency of remaining nystagmus during walking was further modulated in a manner that depended on the specific phase of the gait cycle (p = 0.015). These attenuating effects on nystagmus intensity during walking suggest that ocular-motor control disturbances are selectively suppressed during locomotion in DBN. This suppression is potentially mediated by locomotor efference copies that have been shown to selectively govern gaze stabilization during stereotyped locomotion in animal models.
Collapse
Affiliation(s)
- Haike Dietrich
- German Center for Vertigo and Balance Disorders, University Hospital, LMU, Munich, Germany
| | - Cauchy Pradhan
- German Center for Vertigo and Balance Disorders, University Hospital, LMU, Munich, Germany
| | - Felix Heidger
- German Center for Vertigo and Balance Disorders, University Hospital, LMU, Munich, Germany
| | - Roman Schniepp
- German Center for Vertigo and Balance Disorders, University Hospital, LMU, Munich, Germany
| | - Max Wuehr
- German Center for Vertigo and Balance Disorders, University Hospital, LMU, Munich, Germany.
| |
Collapse
|
6
|
Wuehr M, Decker J, Schenkel F, Jahn K, Schniepp R. Impact on daily mobility and risk of falling in bilateral vestibulopathy. J Neurol 2022; 269:5746-5754. [PMID: 35286481 PMCID: PMC9553788 DOI: 10.1007/s00415-022-11043-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 01/05/2023]
Abstract
Abstract
Objective
To study the behavioral relevance of postural and ocular-motor deficits on daily activity and risk of falling in patients with bilateral vestibular hypofunction (BVH).
Methods
Thirty patients with BVH and 30 age- and gender-matched healthy controls participated in a continuous 2-week assessment of daily activities and mobility using a body-worn inertial sensor and a 6-month prospective fall risk assessment. At inclusion, patients and controls further underwent a multi-modal clinical, score- and instrument-based assessment of general health and balance status. We analyzed the relationship between clinical, lab-, and sensor-based measures and their validity to identify those patients at a risk of general, frequent, and severe falling.
Results
Patients exhibited impairments in daily activity in particular in terms of reduced ambulatory activity (p = 0.009). 43% of patients experienced falls (13% in controls, p = 0.008) and 70% of these patients reported recurrent falling (0% in controls, p = 0.001) during prospective assessment. Severe fall-related injuries that would require medical attention neither occurred in patients nor in controls. Classificatory models based on multi-modal clinical, lab-, and sensor-based measures of balance and mobility identified patients who fell with an accuracy of 93% and patients who recurrently fell with an accuracy of 89%.
Conclusion
BVH is linked to particular impairments of patients’ daily activities which in turn are related to patients’ fall risk. Hence, off-laboratory measures of daily mobility may supplement standard clinical assessment in BVH to more adequately capture the burden of disease and to reliably identify those patients at a specific risk of falling.
Collapse
|
7
|
Context-independent encoding of passive and active self-motion in vestibular afferent fibers during locomotion in primates. Nat Commun 2022; 13:120. [PMID: 35013266 PMCID: PMC8748921 DOI: 10.1038/s41467-021-27753-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/03/2021] [Indexed: 11/21/2022] Open
Abstract
The vestibular system detects head motion to coordinate vital reflexes and provide our sense of balance and spatial orientation. A long-standing hypothesis has been that projections from the central vestibular system back to the vestibular sensory organs (i.e., the efferent vestibular system) mediate adaptive sensory coding during voluntary locomotion. However, direct proof for this idea has been lacking. Here we recorded from individual semicircular canal and otolith afferents during walking and running in monkeys. Using a combination of mathematical modeling and nonlinear analysis, we show that afferent encoding is actually identical across passive and active conditions, irrespective of context. Thus, taken together our results are instead consistent with the view that the vestibular periphery relays robust information to the brain during primate locomotion, suggesting that context-dependent modulation instead occurs centrally to ensure that coding is consistent with behavioral goals during locomotion. Using experimental and computational approaches the authors show that the vestibular efferent system does not modulate peripheral coding during locomotion. Instead, vestibular afferents unambiguously convey information in a context independent manner.
Collapse
|
8
|
Millar JL, Schubert MC. Report of oscillopsia in ataxia patients correlates with activity, not vestibular ocular reflex gain. J Vestib Res 2021; 32:381-388. [PMID: 34897108 DOI: 10.3233/ves-210106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patients with cerebellar ataxia report oscillopsia, "bouncy vision" during activity, yet little is known how this impacts daily function. The purpose of this study was to quantify the magnitude of oscillopsia and investigate its relation to vestibulo-ocular reflex (VOR) function and daily activity in cerebellar ataxia. METHODS 19 patients diagnosed with cerebellar ataxia and reports of oscillopsia with activity were examined using the video head impulse test (vHIT), Oscillopsia Functional Index (OFI), and clinical gait measures. Video head impulse data was compared against 40 healthy controls. RESULTS OFI scores in ataxia patients were severe and inversely correlated with gait velocity (r = -0.55, p < 0.05), but did not correlate with VOR gains. The mean VOR gain in the ataxic patients was significantly reduced and more varied compared with healthy controls. All patients had abnormal VOR gains and eye/head movement patterns in at least one semicircular canal during VHIT with passive head rotation. CONCLUSIONS Patients with cerebellar ataxia and oscillopsia have impaired VOR gains, yet severity of oscillopsia and VOR gains are not correlated. Patients with cerebellar ataxia have abnormal oculomotor behavior during passive head rotation that is correlated with gait velocity, but not magnitude of oscillopsia.
Collapse
Affiliation(s)
- Jennifer L Millar
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA
| | - Michael C Schubert
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA.,Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| |
Collapse
|
9
|
Wang L, Zobeiri OA, Millar JL, Souza Silva W, Schubert MC, Cullen KE. Continuous Head Motion is a Greater Motor Control Challenge than Transient Head Motion in Patients with Loss of Vestibular Function. Neurorehabil Neural Repair 2021; 35:890-902. [PMID: 34365845 DOI: 10.1177/15459683211034758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. The vestibular system is vital for gaze stability via the vestibulo-ocular reflex, which generates compensatory eye motion in the direction opposite to head motion. Consequently, individuals with peripheral vestibular loss demonstrate impaired gaze stability that reduces functional capacity and quality of life. To facilitate patients' compensatory strategies, two classes of gaze stabilization exercises are often prescribed: (i) transient (eg, ballistic) and (ii) continuous. However, the relative benefits of these two classes of exercises are not well understood. Objective. To quantify head motion kinematics in patients with vestibular loss while they performed both classes of exercises. Methods. Using inertial measurement units, head movements of 18 vestibular schwannoma patients were measured before and after surgical deafferentation and compared with age-matched controls. Results. We found that the head movement during both classes of exercises paralleled those of natural head movement recorded during daily activities. However, head movement patterns were more informative for continuous than transient exercises in distinguishing patients from healthy controls. Specifically, we observed coupling between kinematic measures in control subjects that was absent in patients for continuous but not transient head motion exercises. In addition, kinematic measures (eg, cycle duration) were predictive of standard clinical measures for continuous but not transient head motion exercises. Conclusions. Our data suggest that performing continuous head motion is a greater motor control challenge than transient head motion in patients with less reliable vestibular feedback during the sub-acute stage of recovery, which may also prove to be a reliable measure of progression in vestibular rehabilitation protocols.
Collapse
Affiliation(s)
- Lin Wang
- Department of Biomedical Engineering, 1466Johns Hopkins University, Baltimore, MD, USA
| | - Omid A Zobeiri
- Department of Biomedical Engineering, McGill University, Montreal, QC, Canada
| | - Jennifer L Millar
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University1466School of Medicine, Baltimore, MD, USA
| | - Wagner Souza Silva
- Department of Biomedical Engineering, 1466Johns Hopkins University, Baltimore, MD, USA.,Department of Physical Medicine and Rehabilitation, Johns Hopkins University1466School of Medicine, Baltimore, MD, USA
| | - Michael C Schubert
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University1466School of Medicine, Baltimore, MD, USA.,Department of Otolaryngology-Head and Neck Surgery, 1466Johns Hopkins University1466School of Medicine, Baltimore, USA
| | - Kathleen E Cullen
- Department of Biomedical Engineering, 1466Johns Hopkins University, Baltimore, MD, USA.,Department of Otolaryngology-Head and Neck Surgery, 1466Johns Hopkins University1466School of Medicine, Baltimore, USA.,Department of Neuroscience, Johns Hopkins University1466School of Medicine, Baltimore, USA.,Kavli Neuroscience Discovery Institute, 1466Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
10
|
Wang L, Zobeiri OA, Millar JL, Schubert MC, Cullen KE. Head movement kinematics are altered during gaze stability exercises in vestibular schwannoma patients. Sci Rep 2021; 11:7139. [PMID: 33785796 PMCID: PMC8010068 DOI: 10.1038/s41598-021-86533-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 03/17/2021] [Indexed: 12/17/2022] Open
Abstract
Gaze stability is the ability of the eyes to fixate a stable point when the head is moving in space. Because gaze stability is impaired in peripheral vestibular loss patients, gaze stabilization exercises are often prescribed to facilitate compensation. However, both the assessment and prescription of these exercises are subjective. Accordingly, here we quantified head motion kinematics in patients with vestibular loss while they performed the standard of care gaze stability exercises, both before and after surgical deafferentation. We also correlate the head kinematic data with standard clinical outcome measures. Using inertial measurement units, we quantified head movements in patients as they transitioned through these two vestibular states characterized by different levels of peripheral damage. Comparison with age-matched healthy control subjects revealed that the same kinematic measurements were significantly abnormal in patients both pre- and post-surgery. Regardless of direction, patients took a longer time to move their heads during the exercises. Interestingly, these changes in kinematics suggest a strategy that existed preoperatively and remained symmetric after surgery although the patients then had complete unilateral vestibular loss. Further, we found that this kinematic assessment was a good predictor of clinical outcomes, and that pre-surgery clinical measures could predict post-surgery head kinematics. Thus, together, our results provide the first experimental evidence that patients show significant changes in head kinematics during gaze stability exercises, even prior to surgery. This suggests that early changes in head kinematic strategy due to significant but incomplete vestibular loss are already maladaptive as compared to controls.
Collapse
Affiliation(s)
- Lin Wang
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, USA
| | - Omid A Zobeiri
- Department of Biomedical Engineering, McGill University, Montreal, QC, Canada
| | - Jennifer L Millar
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Michael C Schubert
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, USA.,Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Kathleen E Cullen
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, USA. .,Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, USA. .,Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, USA. .,Kavli Neuroscience Discovery Institute, Johns Hopkins University, Baltimore, USA.
| |
Collapse
|
11
|
Strategies for Gaze Stabilization Critically Depend on Locomotor Speed. Neuroscience 2019; 408:418-429. [DOI: 10.1016/j.neuroscience.2019.01.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 01/14/2019] [Accepted: 01/16/2019] [Indexed: 11/18/2022]
|
12
|
Dietrich H, Wuehr M. Selective suppression of the vestibulo-ocular reflex during human locomotion. J Neurol 2019; 266:101-107. [DOI: 10.1007/s00415-019-09352-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 04/26/2019] [Accepted: 04/29/2019] [Indexed: 11/28/2022]
|
13
|
Anson ER, Gimmon Y, Kiemel T, Jeka JJ, Carey JP. A Tool to Quantify the Functional Impact of Oscillopsia. Front Neurol 2018; 9:142. [PMID: 29599743 PMCID: PMC5862789 DOI: 10.3389/fneur.2018.00142] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 02/26/2018] [Indexed: 11/13/2022] Open
Abstract
Background Individuals with bilateral vestibular hypofunction (BVH) often report symptoms of oscillopsia during walking. Existing assessments of oscillopsia are limited to descriptions of severity and symptom frequency, neither of which provides a description of functional limitations attributed to oscillopsia. A novel questionnaire, the Oscillopsia Functional Impact scale (OFI) was developed to describe the impact of oscillopsia on daily life activities. Questions on the OFI ask how often individuals are able to execute specific activities considered to depend on gaze stability in an effort to link functional mobility impairments to oscillopsia for individuals with vestibular loss. Methods Subjective reports of oscillopsia and balance confidence were recorded for 21 individuals with BVH and 48 healthy controls. Spearman correlation coefficients were calculated to determine the relationship between the OFI and oscillopsia visual analog scale (OS VAS), oscillopsia severity questionnaire (OSQ), and Activities-Specific Balance Confidence scale to demonstrate face validity. Chronbach’s α was calculated to determine internal validity for the items of the OFI. A one-way MANOVA was conducted with planned post hoc paired t-tests for group differences on all oscillopsia questionnaires using a corrected α = 0.0125. Results The OFI was highly correlated with measures of oscillopsia severity (OS VAS; r = 0.69, p < 0.001) and frequency (OSQ; r = 0.84, p < 0.001) and also with the Activities-Specific Balance Confidence scale (r = −0.84, p < 0.001). Cronbach’s α for the OFI was 0.97. Individuals with BVH scored worse on all measures of oscillopsia and balance confidence compared to healthy individuals (p’s < 0.001). Conclusion The OFI appears to capture the construct of oscillopsia in the context of functional mobility. Combining with oscillopsia metrics that quantify severity and frequency allows for a more complete characterization of the impact of oscillopsia on an individual’s daily behavior. The OFI discriminated individuals with BVH from healthy individuals.
Collapse
Affiliation(s)
- Eric R Anson
- Department of Otolaryngology Head and Neck Surgery and the David M. Rubinstein Hearing Center, Johns Hopkins Medical Institutes, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Otolaryngology, University of Rochester, Rochester, NY, United States
| | - Yoav Gimmon
- Department of Otolaryngology Head and Neck Surgery and the David M. Rubinstein Hearing Center, Johns Hopkins Medical Institutes, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Tim Kiemel
- Kinesiology Department, University of Maryland, College Park, College Park, MD, United States
| | - John J Jeka
- Kinesiology Department, University of Delaware, Newark, DE, United States
| | - John P Carey
- Department of Otolaryngology Head and Neck Surgery and the David M. Rubinstein Hearing Center, Johns Hopkins Medical Institutes, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| |
Collapse
|