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Meldrum D, Kearney H, Hutchinson S, McCarthy S, Quinn G. Wearable sensor and smartphone assisted vestibular physical therapy for multiple sclerosis: usability and outcomes. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1406926. [PMID: 39050817 PMCID: PMC11267627 DOI: 10.3389/fresc.2024.1406926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/05/2024] [Indexed: 07/27/2024]
Abstract
Introduction Vertigo, dizziness, gaze instability and disequilibrium are highly prevalent in people with MS (PwMS) and head movement induced dizziness is commonly reported. Vestibular physical therapy (VPT) is a specialised, non-invasive and effective therapy for these problems but usually involves travel for the person to a specialist center with both personal and carbon costs. The use of wearable sensors to track head movement and smartphone applications to deliver and track programs has potential to improve VPT in MS. Methods This study investigated the usability and effects of a commercially available digital VPT system (wearable head sensor, smartphone app and clinician software) to deliver VPT to PwMS. A pre/post treatment design was employed and the primary outcome was the System Usability Scale (SUS). Other patient reported outcomes were the Service User Acceptability Questionnaire (SUTAQ), the Patient Enablement Instrument (PEI) and the Dizziness Handicap Inventory (DHI). Physical outcomes measurements included Mini-BESTest (MB), Modified Dynamic Gait Index (mDGI), Gait Speed (GS), Dynamic Visual Acuity (DVA) and head kinematics and symptoms during exercise. Results Sixteen PwMS (14 female), mean age 44(±14) years were recruited to the study and twelve completed VPT. Mean adherence to exercise, measured digitally was 60% (±18.4). SUS scores were high at 81 (±14) and SUTAQ scores also demonstrated high levels of satisfaction and acceptability of the system. Statistically significant improvements in MB (mean change 2.25; p = 0.004), mDGI (median change 1.00; p = 0.008), DVA (median change -1.00; p = 0.004) were found. Head frequencies significantly improved with concurrent decreased intensity of dizziness during head movements (mean change across 4 gaze stabilization exercises was 23 beats per minute; p < 0.05). Non-significant improvements were seen in DHI (p = 0.07) and GS (p = 0.15). 64.5% of follow up visits were conducted remotely (video or phone), facilitated by the system. Discussion This study had two main outcomes and benefits for PwMS. Firstly, we showed that the system used was both acceptable and could be used by PwMS. Secondly, we demonstrated an improvement in a range of dizziness, balance and gait metrics with remotely delivered care. This system has the potential to positively impact on MS physiotherapy service provision with the potential to deliver effective remote care.
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Affiliation(s)
- D. Meldrum
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - H. Kearney
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- MS Unit, Department of Neurology, St. James’s Hospital, Dublin, Ireland
| | - S. Hutchinson
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- MS Unit, Department of Neurology, St. James’s Hospital, Dublin, Ireland
| | - S. McCarthy
- Physiotherapy Department, St. James’s Hospital, Dublin, Ireland
| | - G. Quinn
- Physiotherapy Department, St. James’s Hospital, Dublin, Ireland
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McCulloch KL, Oh AS, Cecchini AS, Zhang W, Harrison C, Favorov O. Validity and Responsiveness of the Portable Warrior Test of Tactical Agility After Rehabilitation in Service Members With Mild Traumatic Brain Injury. Phys Ther 2023; 103:pzad100. [PMID: 37847662 PMCID: PMC10641927 DOI: 10.1093/ptj/pzad100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 01/23/2023] [Accepted: 03/26/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVE The Portable Warrior Test of Tactical Agility (POWAR-TOTAL) is a performance-based test designed to assess active-duty service members diagnosed with mild traumatic brain injuries (mTBIs) and could potentially inform return to duty decisions. To examine the validity and responsiveness of the POWAR-TOTAL measure, this study collected self-reported and performance measures by active-duty service members before and after an episode of physical therapist care. METHODS Seventy-four individuals, enrolled in care for mTBI symptoms at 1 of 2 concussion specialty Intrepid Spirit Centers, were examined the week that they initiated physical therapy with the intention to return to active duty. Self-reported measures of concussion symptoms, pain, posttraumatic stress, headache, dizziness, and sleep quality were used, as were concurrent measures of mobility and balance. The POWAR-TOTAL task (motor and cognitive skills in single and dual-task conditions) was administered. Forty-nine active-duty service members returned for posttherapy testing using the same test battery. Effect sizes for change in measures were calculated. Construct validity was assessed by correlating change scores on POWAR with concurrent self-report and mobility measures. Responsiveness was evaluated using an anchor-based approach. RESULTS Significant improvements in self-reported and performance-based measures, including POWAR, were observed after therapy with moderate to large effect sizes. Improvement in POWAR performance correlated with improvement in both performance and self-reported measures. After therapy, individuals who registered improvement on the Patient Global Impression of Change scale demonstrated significantly faster POWAR motor performance than those who rated little or no improvement in their condition. CONCLUSION The POWAR-TOTAL captured improvement on a military-specific task after completing physical therapy for mTBI and could serve as an indicator of physical recovery and readiness for return to duty. IMPACT Challenging cognitive and motor measures for service members may aid in the assessment of recovery and the ability to successfully return to duty after concussion as part of a comprehensive examination approach.
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Affiliation(s)
- Karen L McCulloch
- Curriculum in Human Movement Science and Division of Physical Therapy, Department of Allied Health Sciences, School of Medicine, UNC–Chapel Hill, Chapel Hill, North Carolina, USA
| | - Annabell S Oh
- The Geneva Foundation, Joint Base Lewis-McChord, Madigan Army Medical Center, Intrepid Spirit Center, Tacoma, Washington, USA
| | - Amy S Cecchini
- The Geneva Foundation, Fort Liberty (Fort Bragg), Womack Army Medical Center, Intrepid Spirit Center, Fayetteville, North Carolina, USA
| | - Wanqing Zhang
- Office of Research and Scholarship, Department of Allied Health Sciences, School of Medicine, UNC–Chapel Hill, Chapel Hill, North Carolina, USA
| | - Courtney Harrison
- Curriculum in Human Movement Science and Division of Physical Therapy, Department of Allied Health Sciences, School of Medicine, UNC–Chapel Hill, Chapel Hill, North Carolina, USA
| | - Oleg Favorov
- Department of Biomedical Engineering, School of Medicine, UNC–Chapel Hill, Chapel Hill, North Carolina, USA
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Rodríguez-Montesdeoca I, de Miguel ÁR, Falcón-González JC, Borkoski-Barreiro S, Benítez-Robaina S, Guerra-Jimenez G, Pavone J, Ramos-Macías A. Dynamic Visual Acuity Results in Otolith Electrical Stimulation in Bilateral Vestibular Dysfunction. J Clin Med 2022; 11:5706. [PMID: 36233574 PMCID: PMC9573650 DOI: 10.3390/jcm11195706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/16/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background. Patients with bilateral vestibular disease (BVD) experience oscillopsia with a detriment to visual acuity (VA). This VA is driven mainly by the VOR that has two components: rotational and translational. VA can be tested by using dynamic visual acuity (DVA) on a treadmill because both systems are activated. The aim of this study is to compare VA before and after chronic electrical stimulation of the otolith organ. (2) Materials and Method. Five patients suffering from bilateral vestibular dysfunction (BVD), previously implanted with a new vestibular implant prototype, were included in this study with the aim to check VA with and without vestibular implant use (W and W/O) in static, 2 km/h and 4 km/h walking situations. DVAtreadmill was measured on a treadmill with a dynamic illegible E (DIE) test in static and dynamic conditions (while walking on the treadmill at 2 and 4 km/h). The DVA score was registered in a logarithm of the minimum angle of resolution (LogMAR) for each speed. In addition, every patient completed the oscillopsia severity questionnaire (OSQ) and video head impulse test (vHIT) before and after activation of the vestibular implant. (3) Results. The analysis shows a significant difference in OSQ scores and DVA with an improvement in dynamic conditions. Organized corrective saccades during the use of a vestibular implant with no changes in gain were also detected in the video head impulse tests (vHIT). (4) Conclusion. The vestibular implant with otolithic stimulation offers changes in the response of DVA, which makes this paper one of the first to address the possible restoration of it. It is not possible to rule out other contributing factors (presence of covert saccades, somatosensory system, …). More work seems necessary to understand the neurophysiological basis of these findings, but this implant is added as a therapeutic alternative for the improvement of oscillopsia.
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Affiliation(s)
- Isaura Rodríguez-Montesdeoca
- Department of Otolaryngology, and Head and Neck Surgery, Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, 35016 Las Palmas, Spain
| | - Ángel Ramos de Miguel
- Hearing and Balance Laboratory, University of Las Palmas de Gran Canaria, 35001 Las Palmas, Spain
| | - Juan Carlos Falcón-González
- Department of Otolaryngology, and Head and Neck Surgery, Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, 35016 Las Palmas, Spain
| | - Silvia Borkoski-Barreiro
- Department of Otolaryngology, and Head and Neck Surgery, Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, 35016 Las Palmas, Spain
| | - Susana Benítez-Robaina
- Department of Otolaryngology, and Head and Neck Surgery, Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, 35016 Las Palmas, Spain
| | - Gloria Guerra-Jimenez
- Department of Otolaryngology, and Head and Neck Surgery, Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, 35016 Las Palmas, Spain
| | - Joana Pavone
- Department of Otolaryngology, and Head and Neck Surgery, Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, 35016 Las Palmas, Spain
| | - Angel Ramos-Macías
- Department of Otolaryngology, and Head and Neck Surgery, Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, 35016 Las Palmas, Spain
- Department of Otolaryngology, Faculty of Medicine, University of Las Palmas de Gran Canaria, 35001 Las Palmas, Spain
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Kaae C, Cadigan K, Lai K, Theis J. Vestibulo-ocular dysfunction in mTBI: Utility of the VOMS for evaluation and management – A review. NeuroRehabilitation 2022; 50:279-296. [DOI: 10.3233/nre-228012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Individuals who have suffered a concussion/mild traumatic brain injury (mTBI) frequently report symptoms associated with vestibular and/or oculomotor dysfunction (VOD) like dizziness, nausea, fatigue, brain fog, headache, gait and neurocognitive impairments which are associated with the development of chronic symptoms. The Vestibular/Ocular Motor Screening (VOMS) tool has been established as a reliable and clinically relevant complement to use alongside a battery of post-concussion tests to improve screening and referral for further evaluation and treatment of VOD. OBJECTIVES: This paper will review the pathoanatomy and symptomatology of common vestibular and oculomotor disorders after concussion, as well as the utility of the VOMS to assist in diagnosis, referral, and management. METHODS: Primary articles were identified using a search via PubMed, Google Scholar, OneSearch, and CINAHL. Search key terms were combinations of “mild traumatic brain injury” or “concussion” or “pursuit” or “accommodation” or “vergence” or “convergence insufficiency” or “saccades” or “vestibulo-ocular reflex” or “vestibular ocular motor screen” or “vestibular rehabilitation”, or “vision rehabilitation” including adult and pediatric populations that were published in print or electronically from 1989 to 2021 in English. Classic papers on anatomy of eye movements, vestibular system and pathological changes in mTBI were also included, regardless of publication date. RESULTS: Objective impairments are commonly found during testing of smooth pursuit, saccades, vergence, accommodation, vestibular ocular reflex, and visual motion sensitivity after mTBI. These deficits can be actively treated with vestibular physical therapy and oculomotor/neuro-optometric vision therapy. VOMS is an efficient and reliable tool that can be used by all healthcare and rehabilitation providers to aid in diagnosis of post-concussion VOD, to help facilitate the decision to refer for further evaluation and treatment to expedite symptomatic post-concussion recovery. CONCLUSIONS: VOD is common after concussion in acute, post-acute, and chronic phases. Once areas of impairments are identified through proper assessment, clinicians can maximize recovery by referring to vestibular physical therapy and/or neuro-optometry to design a targeted treatment program to address individual deficits.
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Affiliation(s)
- Cristen Kaae
- Kaiser Permanente Medical Center, Vallejo, CA, USA
| | | | - Katherine Lai
- Kaiser Permanente Medical Center, Oakland, CA, USA
- Herbert Wertheim School of Optometry & Vision Science at the University of California, Berkeley, CA, USA
| | - Jacqueline Theis
- Herbert Wertheim School of Optometry & Vision Science at the University of California, Berkeley, CA, USA
- Virginia Neuro-Optometry at Concussion Care Centre of Virginia, Richmond VA, USA
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Grove CR, Whitney SL, Pyle GM, Heiderscheit BC. Instrumented Gait Analysis to Identify Persistent Deficits in Gait Stability in Adults With Chronic Vestibular Loss. JAMA Otolaryngol Head Neck Surg 2021; 147:729-738. [PMID: 34196673 DOI: 10.1001/jamaoto.2021.1276] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance Regaining the ability to walk safely is a high priority for adults with vestibular loss. Thus, practitioners need comprehensive knowledge of vestibulopathic gait to design, provide, and/or interpret outcomes of interventions. To date, few studies have characterized the effects of vestibular loss on gait. Objectives To investigate the use of an instrumented 2-minute walk test in adults with vestibular loss, to further characterize vestibulopathic gait, and to assess whether those with chronic vestibular loss have enduring gait deficits. Design, Setting, and Participants This cross-sectional study, conducted between April 3, 2018, and June 27, 2019, recruited adults 20 to 79 years of age from an academic, tertiary, hospital-based, ambulatory care setting who were healthy or had confirmed unilateral or bilateral vestibular hypofunction. Of the 43 adults who were screened from convenience and referred samples, 2 declined, and 7 were excluded because of health conditions. Exposures The main exposure was the instrumented 2-minute walk test, which was conducted with participants using wearable inertial measurement units while they walked a 10-m path at their self-selected speed and turned 180° in their self-selected direction at either end. Main Outcomes and Measures The primary measures were spatiotemporal gait metrics (eg, stride length [SL] and peak whole-body turning velocity). Multivariate analysis of variance was used to assess between-group differences. Validity was assessed using the area under the curve from receiver operator characteristic analyses. Results Data from 17 healthy adults (mean [SD] age, 39.27 [11.20] years; 13 [76%] female) and 13 adults with vestibular loss (mean [SD] age, 60.50 [10.81] years; 6 [46%] female) were analyzed. Very large between-group differences were found for SL (left) (estimated marginal mean [SE] for healthy vs vestibular groups, 1.47 [0.04] m vs 1.31 [0.04] m; Cohen d, 1.35; 95% CI, 0.18-2.52), SL (right) (estimated marginal mean [SE] for healthy vs vestibular groups, 1.46 [0.04] m vs 1.29 [0.04] m; Cohen d, 1.44; 95% CI, 0.25-2.62), and peak turn velocity (estimated marginal mean [SE] for healthy vs vestibular groups, 240.17 [12.78]°/s vs 189.74 [14.70]°/s; Cohen d, 1.23; 95% CI, 0.07-2.40). The area under the curve was 0.79 (95% CI, 0.62-0.95) for SL (left), 0.81 (95% CI, 0.64-0.97) for SL (right), and 0.86 (95% CI, 0.72-0.99) for peak turn velocity. Conclusions and Relevance In this cross-sectional study, instrumented gait analysis had good discriminative validity and revealed persistent deficits in gait stability in those with chronic vestibular loss. The findings of this study suggest that these clinically and functionally meaningful deficits could be targets for vestibular rehabilitation.
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Affiliation(s)
- Colin R Grove
- Department of Surgery, University of Wisconsin-Madison
| | - Susan L Whitney
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - G Mark Pyle
- Department of Surgery, University of Wisconsin-Madison
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Dankova M, Jerabek J, Jester DJ, Zumrova A, Paulasova Schwabova J, Cerny R, Kmetonyova S, Vyhnalek M. Clinical dynamic visual acuity in patients with cerebellar ataxia and vestibulopathy. PLoS One 2021; 16:e0255299. [PMID: 34324564 PMCID: PMC8320895 DOI: 10.1371/journal.pone.0255299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 07/13/2021] [Indexed: 11/18/2022] Open
Abstract
Deterioration of dynamic visual acuity (DVA) as a result of impaired vestibulo-ocular reflex (VOR) has been well described in peripheral vestibulopathies, however, changes in DVA in patients with degenerative cerebellar ataxias (CA) and its relation to VOR impairment in these patients has not yet been evaluated. Our aim was to assess the alterations of DVA in CA and to evaluate its relation to vestibular function. 32 patients with CA and 3 control groups: 13 patients with unilateral and 13 with bilateral vestibulopathy and 21 age matched healthy volunteers were examined by clinical DVA test, VOR was assessed by video Head Impulse Test and caloric irrigation. The severity of ataxia in CA was assessed by Scale for the assessment and rating of ataxia (SARA). Relationship between DVA and vestibular function in CA patients was examined by linear regressions. DVA impairment was highly prevalent in CA patients (84%) and its severity did not differ between CA and bilateral vestibulopathy patients. The severity of DVA impairment in CA was linked mainly to VOR impairment and only marginally to the degree of ataxia. However, DVA impairment was present also in CA patients without significant vestibular lesion showing that central mechanisms such as impairment of central adaptation of VOR are involved. We suggest that the evaluation of DVA should be a standard part of clinical evaluation in patients with progressive CA, as this information can help to target vestibular and oculomotor rehabilitation.
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Affiliation(s)
- Michaela Dankova
- Department of Neurology, Centre of Hereditary Ataxias, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Jaroslav Jerabek
- Department of Neurology, Centre of Hereditary Ataxias, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Dylan J. Jester
- School of Aging Studies, University of South Florida, Tampa, FL, United States of America
| | - Alena Zumrova
- Department of Paediatric Neurology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Jaroslava Paulasova Schwabova
- Department of Neurology, Centre of Hereditary Ataxias, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Rudolf Cerny
- Department of Neurology, Centre of Hereditary Ataxias, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Silvia Kmetonyova
- Department of Neurology, Centre of Hereditary Ataxias, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Martin Vyhnalek
- Department of Neurology, Centre of Hereditary Ataxias, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
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Thompson-Harvey A, Dutcher CE, Monroe HA, Sinks BC, Goebel JA. Detection of VOR dysfunction during the gaze stabilization test: Does target size matter? J Vestib Res 2021; 31:495-504. [PMID: 33896858 DOI: 10.3233/ves-201602] [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 The Gaze Stabilization Test (GST) identifies vestibulo-ocular reflex (VOR) dysfunction using a decline in target recognition with increasing head velocity, but there is no consensus on target (optotype) size above static visual acuity. OBJECTIVE To determine the optimal initial optotype size above static visual acuity to be used during the GST in subjects with unilateral vestibular dysfunction and healthy individuals. METHODS Eight subjects with unilateral vestibular dysfunction (UVD) and 19 age-matched, healthy control subjects were studied with the standard GST protocol using two optotype sizes, 0.2 and 0.3 logMAR above static visual acuity (ΔlogMAR). Maximal head velocity achieved while maintaining fixation on both optotypes was measured. Sensitivity, specificity and receiver-operator characteristic area under the curve (ROC AUC) analyses were performed to determine the optimal head velocity cut off point for each optotype, based on ability to identify the lesioned side of the UVD group from the control group. RESULTS There was a significant difference in maximal head velocity between the UVD group and control group using 0.2 ΔlogMAR (p = 0.032) but not 0.3 ΔlogMAR (p = 0.061). While both targets produced similar specificities (90%) for distinguishing normal from subjects with UVD, 0.2 ΔlogMAR targets yielded higher sensitivity (75%) than 0.3 logMAR (63%) and accuracy (86% vs 80%, respectively) in detecting the lesioned side in subjects with UVD versus controls with maximal head velocities≤105 deg/s (p = 0.017). Furthermore, positive likelihood ratios were nearly twice as high when using 0.2 ΔlogMAR targets (+ LR 10) compared to 0.3 ΔlogMAR (+ LR 6.3). CONCLUSION The 0.2 ΔlogMAR optotype demonstrated significantly superior identification of subjects with UVD, better sensitivity and positive likelihood ratios than 0.3 ΔlogMAR for detection of VOR dysfunction. Using a target size 0.2logMAR above static visual acuity (ΔlogMAR) during GST may yield better detection of VOR dysfunction to serve as a baseline for gaze stabilization rehabilitation therapy.
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Affiliation(s)
- Adam Thompson-Harvey
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | | | - Belinda C Sinks
- Dizziness and Balance Center, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Joel A Goebel
- Dizziness and Balance Center, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, USA
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Grove CR, Heiderscheit BC, Pyle GM, Loyd BJ, Whitney SL. The Gait Disorientation Test: A New Method for Screening Adults With Dizziness and Imbalance. Arch Phys Med Rehabil 2020; 102:582-590. [PMID: 33338462 DOI: 10.1016/j.apmr.2020.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To develop and evaluate a new method for identifying gait disorientation due to vestibular dysfunction. DESIGN The gait disorientation test (GDT) involves a timed comparison of the ability to walk 6.096 m with eyes open versus eyes closed. In this prospective study, participants were grouped based on vestibular function. All participants completed a clinical examination, self-report- and performance-based measures relevant to vestibular rehabilitation, and the tasks for the GDT. Vestibular-impaired participants underwent the criterion standard, videonystagmography and/or rotational chair testing. SETTING Ambulatory clinic, tertiary referral center. PARTICIPANTS Participants (N=40) (20 vestibular-impaired, 30 women, 49.9±16.1years old) were enrolled from a convenience/referral sample of 52 adults. MAIN OUTCOME AND MEASURE(S) We determined test-retest reliability using the intraclass correlation coefficient model 3,1; calculated the minimal detectable change (MDC); examined concurrent validity through Spearman correlation coefficients; assessed criterion validity with the area under the curve (AUC) from receiver operator characteristic analysis; and computed the sensitivity, specificity, diagnostic odds ratio (DOR), likelihood ratios for positive (LR+) and negative (LR-) tests, and posttest probabilities of a diagnosis of vestibulopathy. The 95% confidence interval demonstrates measurement uncertainty. RESULTS Test-retest reliability was 0.887 (0.815, 0.932). The MDC was 3.7 seconds. Correlations with other measures ranged from 0.59 (0.34, 0.76) to -0.85 (-0.92, -0.74). The AUC was 0.910 (0.822, 0.998), using a threshold of 4.5 seconds. The sensitivity and specificity were 0.75 (0.51, 0.91) and 0.95 (0.75, 1), respectively. The DOR=57 (6, 541.47), LR+ =15 (2.18, 103.0), and LR- =0.26 (0.12, 0.9). Positive posttest probabilities were 89%-94%. CONCLUSIONS AND RELEVANCE The GDT has good reliability, excellent discriminative ability, strong convergent validity, and promising clinical utility.
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Affiliation(s)
- Colin R Grove
- School of Medicine and Public Health, Department of Surgery, University of Wisconsin-Madison, Madison, WI; Institute for Clinical and Translational Research, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI.
| | - Bryan C Heiderscheit
- Institute for Clinical and Translational Research, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI; Department of Orthopedics and Rehabilitation, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - G Mark Pyle
- School of Medicine and Public Health, Department of Surgery, University of Wisconsin-Madison, Madison, WI
| | - Brian J Loyd
- Department of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, MT; Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT
| | - Susan L Whitney
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA
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Chen PY, Chou LW, Jheng YC, Huang SE, Li LPH, Yu CH, Kao CL. Development of a Computerized Device for Evaluating Vestibular Function in Locomotion: A New Evaluation Tool of Vestibular Hypofunction. Front Neurol 2020; 11:485. [PMID: 32595589 PMCID: PMC7303327 DOI: 10.3389/fneur.2020.00485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 05/04/2020] [Indexed: 11/17/2022] Open
Abstract
To evaluate vestibular function in the clinic, current assessments are applied under static conditions, such as with the subject in a sitting or supine position. Considering the complexities of daily activities, the combination of dynamic activities, dynamic visual acuity (DVA) and postural control could produce an evaluation that better reflects vestibular function in daily activities. Objective: To develop a novel sensor-based system to investigate DVA, walking trajectory, head and trunk movements and the chest-pelvis rotation ratio during forward and backward overground walking in both healthy individuals and patients with vestibular hypofunction. Methods: Fifteen healthy subjects and 7 patients with bilateral vestibular hypofunction (BVH) were recruited for this study. Inertial measurement units were placed on each subject's head and torso. Each subject walked forward and backward for 5 m twice with 2 Hz head yaw. Our experiment comprised 2 stages. In stage 1, we measured forward (FW), backward (BW), and medial-lateral (MLW) walking trajectories; head and trunk movements; and the chest-pelvis rotation ratio. In stage 2, we measured standing and locomotion DVA (loDVA). Using Mann–Whitney U-test, we compared the abovementioned parameters between the 2 groups. Results: Patients exhibited an in-phase chest/pelvis reciprocal rotation ratio only in FW. The walking trajectory deviation, calculated by normalizing the summation of medial-lateral swaying with 1/2 body height (%), was significantly larger (FW mean ± standard deviation: 20.4 ± 7.1% (median (M)/interquartile range (IQR): 19.3/14.4–25.2)in healthy vs. 43.9 ± 27. 3% (M/IQR: 36.9/21.3–56.9) in patients, p = 0.020)/(BW mean ± standard deviation: 19.2 ± 11.5% (M/IQR: 13.6/10.4–25.3) in healthy vs. 29.3 ± 6.4% (M/IQR: 27.7/26.5–34.4) in patients, p = 0.026), and the walking DVA was also significantly higher (LogMAR score in the patient group [FW LogMAR: rightDVA: mean ± standard deviation:0.127 ± 0.081 (M/IQR: 0.127/0.036–0.159) in healthy vs. 0.243 ± 0.101 (M/IQR: 0.247/0.143–0.337) in patients (p = 0.013) and leftDVA: 0.136 ± 0.096 (M/IQR: 0.127/0.036–0.176) in healthy vs. 0.258 ± 0.092 (M/IQR: 0.247/0.176–0.301) in patients (p = 0.016); BW LogMAR: rightDVA: mean ± standard deviation: 0.162 ± 0.097 (M/IQR: 0.159/0.097–0.273) in healthy vs. 0.281 ± 0.130 (M/IQR: 0.273/0.176–0.418) in patients(p = 0.047) and leftDVA: 0.156 ± 0.101 (M/IQR: 0.159/0.097–0.198) in healthy vs. 0.298 ± 0.153 (M/IQR: 0.2730/0.159–0.484) in patients (p = 0.038)]. Conclusions: Our sensor-based vestibular evaluation system provided a more functionally relevant assessment for the identification of BVH patients.
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Affiliation(s)
- Po-Yin Chen
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Li-Wei Chou
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - Ying-Chun Jheng
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-En Huang
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Lieber Po-Hung Li
- Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan.,Faculty of Medicine and Institute of Brain Science, School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Chung-Huang Yu
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - Chung-Lan Kao
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Abstract
Concussion is an ongoing concern for health care providers. The incidence rates continue to be high and the rate of recovery is variable due to potential risk factors. With no valid biomarkers, diagnosis and assessment of concussion remain a clinical challenge. The heterogeneity in presentation following injury provides an additional level of complexity, requiring the screening and evaluation of diverse body systems, including oculomotor, vestibular, autonomic, psychiatric, cervical, and cognitive symptoms. While a few tools, such as the Vestibular/Ocular Motor Screening and Balance Error Scoring System, have been developed specifically for concussion, the vast majority of tests are adapted from other conditions. Further complicating the process is the overlapping and interactive nature of the multiple domains of postconcussion presentation. This commentary illustrates how clinicians can conceptualize the multiple profiles that present following concussion and describes tools that are available to assist with screening and evaluation of each area. The multifaceted nature of concussion warrants broad clinical screening skills and an interdisciplinary approach to management. J Orthop Sports Phys Ther 2019;49(11):787-798. doi:10.2519/jospt.2019.8855.
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11
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Ramaioli C, Cuturi LF, Ramat S, Lehnen N, MacNeilage PR. Vestibulo-Ocular Responses and Dynamic Visual Acuity During Horizontal Rotation and Translation. Front Neurol 2019; 10:321. [PMID: 31024422 PMCID: PMC6467074 DOI: 10.3389/fneur.2019.00321] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 03/14/2019] [Indexed: 11/13/2022] Open
Abstract
Dynamic visual acuity (DVA) provides an overall functional measure of visual stabilization performance that depends on the vestibulo-ocular reflex (VOR), but also on other processes, including catch-up saccades and likely visual motion processing. Capturing the efficiency of gaze stabilization against head movement as a whole, it is potentially valuable in the clinical context where assessment of overall patient performance provides an important indication of factors impacting patient participation and quality of life. DVA during head rotation (rDVA) has been assessed previously, but to our knowledge, DVA during horizontal translation (tDVA) has not been measured. tDVA can provide a valuable measure of how otolith, rather than canal, function impacts visual acuity. In addition, comparison of DVA during rotation and translation can shed light on whether common factors are limiting DVA performance in both cases. We therefore measured and compared DVA during both passive head rotations (head impulse test) and translations in the same set of healthy subjects (n = 7). In addition to DVA, we computed average VOR gain and retinal slip within and across subjects. We observed that during translation, VOR gain was reduced (VOR during rotation, mean ± SD: position gain = 1.05 ± 0.04, velocity gain = 0.97 ± 0.07; VOR during translation, mean ± SD: position gain = 0.21 ± 0.08, velocity gain = 0.51 ± 0.16), retinal slip was increased, and tDVA was worse than during rotation (average rDVA = 0.32 ± 0.15 logMAR; average tDVA = 0.56 ± 0.09 logMAR, p = 0.02). This suggests that reduced VOR gain leads to worse tDVA, as expected. We conclude with speculation about non-oculomotor factors that could vary across individuals and affect performance similarly during both rotation and translation.
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Affiliation(s)
- Cecilia Ramaioli
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Munich, Germany.,Institute of Medical Technology, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Luigi F Cuturi
- Unit for Visually Impaired People, Italian Institute of Technology, Genoa, Italy
| | - Stefano Ramat
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Nadine Lehnen
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Munich, Germany.,Institute of Medical Technology, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Paul R MacNeilage
- Department of Psychology, Cognitive and Brain Sciences, University of Nevada, Reno, NV, United States
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Rehabilitation of an Adolescent Equestrian Athlete With a History of Multiple Concussions: A Case Report Describing an Adapted Return-to-Sport Protocol. J Orthop Sports Phys Ther 2018; 48:934-942. [PMID: 30053793 PMCID: PMC6671687 DOI: 10.2519/jospt.2018.8214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Equestrian riding is a sport with a high risk of concussion. Currently, the literature guiding rehabilitation for concussions in equestrian athletes is limited, especially for directing return to sport. CASE DESCRIPTION In this case report, a 14-year-old female equestrian athlete presented to physical therapy following her third concussion in 3 years. Her primary complaints were headaches, dizziness, difficulty concentrating, light sensitivity, and neck pain. On examination, the patient demonstrated reproduction of symptoms during testing of the vestibular-ocular reflex, showed a 3-line symptomatic loss on the dynamic visual acuity test, and had impairments in the joint position error test (1/5 correct on the left, 4/5 correct on the right) and a Balance Error Scoring System (BESS) score of 38/60 errors. A return-to-riding protocol was adapted from general return-to-sport guidelines and tailored to meet the unique demands of the patient's equestrian sport. The protocol included phased progression through no activity, light aerobic activity, moderate aerobic activity, sport-specific nonjumping skills, sport-specific jumping skills, full practice, and return to competition. During the protocol, the patient participated in 8 physical therapy sessions over 4 weeks for vestibular training, aerobic conditioning, and cervical and core exercises, as well as equestrian exercises at her stables. OUTCOMES At the final evaluation, the patient reported no symptoms at rest, with exercise, or when testing vestibular-ocular reflex. Improvements were noted in the dynamic visual acuity test, joint position error, and BESS, with changes in the BESS exceeding minimal detectable change. The patient completed the full return-to-riding protocol in 8 weeks and was able to return to equestrian competition without complaints. DISCUSSION This case report describes the physical therapy management of an adapted return-to-sport protocol for an equestrian athlete with a history of multiple sport-related concussions. LEVEL OF EVIDENCE Therapy, level 5. J Orthop Sports Phys Ther 2018;48(12):934-942. Epub 27 Jul 2018. doi:10.2519/jospt.2018.8214.
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Roller RA, Hall CD. A speed-based approach to vestibular rehabilitation for peripheral vestibular hypofunction: A retrospective chart review. J Vestib Res 2018; 28:349-357. [PMID: 29689764 PMCID: PMC9249287 DOI: 10.3233/ves-180633] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: OBJECTIVE: METHODS: RESULTS: CONCLUSIONS:
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Affiliation(s)
| | - Courtney D. Hall
- James H. Quillen VA Medical Center, Mountain Home, TN, USA
- Department of Physical Therapy, East Tennessee State University, Johnson City, TN, USA
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14
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SANTOS-GORJÓN P. Revisión sobre la agudeza visual dinámica. REVISTA ORL 2017. [DOI: 10.14201/orl.17139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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15
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Beaton KH, Schubert M, Shelhamer M. Assessment of vestibulo-ocular function without measuring eye movements. J Neurosci Methods 2017; 283:1-6. [PMID: 28336357 DOI: 10.1016/j.jneumeth.2017.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/10/2017] [Accepted: 03/18/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The vestibulo-ocular reflex (VOR) maintains stable gaze during head motion. Deficiencies lead to apparent world motion due to incomplete stabilization of eyes in space. VOR measurement requires specialized apparatus, trained operators, and significant setup time. NEW METHOD We present a system (VON: vestibulo-ocular nulling) for rapid vestibulo-ocular assessment without measuring eye movements per se. VON uses a head-mounted motion sensor, laptop computer with user input control, and laser target whose position is controlled by the computer. As the head moves, the target is made to move in the same manner with a gain set by the subject. When the subject sets the gain so the target appears stationary in space, it is stationary on the retinas. One can determine from this gain the extent to which the eyes move in space when the head moves, which is the amount by which the VOR is deficient. From this the gain of the compensatory eye movements is derived. RESULTS VON was compared with conventional video-based VOR measures. Both methods track expected changes in gain over 20min of adaptation to minifying spectacles. VON measures are more consistent across subjects, and pre-adaptation values are closer to compensatory. COMPARISON WITH EXISTING METHOD VON is a rapid means to assess vestibulo-ocular performance. As a functional perceptual measure, it accounts for gaze-stabilizing contributions that are not apparent in the standard VOR, such as pursuit and perceptual tolerance. CONCLUSIONS VON assesses functional VOR performance. Future implementations will make VOR assessment widely available to investigators and clinicians.
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Affiliation(s)
- Kara H Beaton
- Department of Otolaryngology - Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Michael Schubert
- Department of Otolaryngology - Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Mark Shelhamer
- Department of Otolaryngology - Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Biomedical Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD, United States.
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Comparison of the gaze stabilization test and the dynamic visual acuity test in unilateral vestibular loss patients and controls. Otol Neurotol 2015; 36:746-53. [PMID: 25502453 DOI: 10.1097/mao.0000000000000689] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Compare the dynamic visual acuity test (DVAT) and gaze stabilization test (GST) in patients with unilateral vestibular loss (UVL) and healthy control subjects using a novel computerized testing system prototype. STUDY DESIGN Cross-sectional study. SETTING Tertiary academic referral laboratory. PATIENTS Seventeen UVL patients (median age 62 yr) with bithermal caloric asymmetry (≥49%) or ablative surgery and 17 control subjects (median age 57 yr). INTERVENTION(S) Diagnostic. MAIN OUTCOME MEASURE(S) Comparison of DVAT and GST results during self-generated sinusoidal head movements using transient unpredictable target presentations less than 95 milliseconds in duration. RESULTS UVL patients had significantly higher DVAT scores toward the lesioned side compared with controls (p = 0.001) and the non-lesioned side (p = 0.003), but the non-lesioned side was not significantly different from controls (p = 0.157). When comparing GST scores, UVL patients required a slower head velocity to maintain visual acuity with movement toward the lesioned side compared with controls (p < 0.001) and the non-lesioned side (p = 0.004). In addition, UVL patients had significantly lower scores toward the non-lesioned side (p = 0.002) compared to controls. ROC curve analysis identified optimal thresholds for abnormal test results to discriminate the lesioned side from controls. A DVAT score greater than or equal to 0.3 ΔlogMAR provided 65% sensitivity and 88% specificity while a GST score less than or equal to 95 degrees/s provided 71% sensitivity and 100% specificity. When GST results were normal, adding DVAT increased overall sensitivity to 88% with 88% specificity. CONCLUSIONS Both GST and DVAT demonstrated reduced gaze stabilization toward the lesioned side in the patient group compared with normal controls. Performing GST first and utilizing DVAT when GST was normal provides optimal identification of patients with vestibular dysfunction.
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Ramaioli C, Colagiorgio P, Sağlam M, Heuser F, Schneider E, Ramat S, Lehnen N. The effect of vestibulo-ocular reflex deficits and covert saccades on dynamic vision in opioid-induced vestibular dysfunction. PLoS One 2014; 9:e110322. [PMID: 25329150 PMCID: PMC4203781 DOI: 10.1371/journal.pone.0110322] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 09/21/2014] [Indexed: 11/18/2022] Open
Abstract
Patients with bilateral vestibular dysfunction cannot fully compensate passive head rotations with eye movements, and experience disturbing oscillopsia. To compensate for the deficient vestibulo-ocular reflex (VOR), they have to rely on re-fixation saccades. Some can trigger “covert” saccades while the head still moves; others only initiate saccades afterwards. Due to their shorter latency, it has been hypothesized that covert saccades are particularly beneficial to improve dynamic visual acuity, reducing oscillopsia. Here, we investigate the combined effect of covert saccades and the VOR on clear vision, using the Head Impulse Testing Device – Functional Test (HITD-FT), which quantifies reading ability during passive high-acceleration head movements. To reversibly decrease VOR function, fourteen healthy men (median age 26 years, range 21–31) were continuously administrated the opioid remifentanil intravenously (0.15 µg/kg/min). VOR gain was assessed with the video head-impulse test, functional performance (i.e. reading) with the HITD-FT. Before opioid application, VOR and dynamic reading were intact (head-impulse gain: 0.87±0.08, mean±SD; HITD-FT rate of correct answers: 90±9%). Remifentanil induced impairment in dynamic reading (HITD-FT 26±15%) in 12/14 subjects, with transient bilateral vestibular dysfunction (head-impulse gain 0.63±0.19). HITD-FT score correlated with head-impulse gain (R = 0.63, p = 0.03) and with gain difference (before/with remifentanil, R = −0.64, p = 0.02). One subject had a non-pathological head-impulse gain (0.82±0.03) and a high HITD-FT score (92%). One subject triggered covert saccades in 60% of the head movements and could read during passive head movements (HITD-FT 93%) despite a pathological head-impulse gain (0.59±0.03) whereas none of the 12 subjects without covert saccades reached such high performance. In summary, early catch-up saccades may improve dynamic visual function. HITD-FT is an appropriate method to assess the combined gaze stabilization effect of both VOR and covert saccades (overall dynamic vision), e.g., to document performance and progress during vestibular rehabilitation.
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Affiliation(s)
- Cecilia Ramaioli
- German Center for Vertigo and Balance Disorders, Munich University Hospital, Munich, Germany
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
- * E-mail:
| | - Paolo Colagiorgio
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Murat Sağlam
- German Center for Vertigo and Balance Disorders, Munich University Hospital, Munich, Germany
| | - Fabian Heuser
- Department of Anesthesiology, Klinikum rechts der Isar, TU Munich, Munich, Germany
| | - Erich Schneider
- German Center for Vertigo and Balance Disorders, Munich University Hospital, Munich, Germany
- Clinical Neurosciences, Munich University Hospital, Munich, Germany
- Brandenburg University of Technology, Cottbus-Senftenberg, Germany
| | - Stefano Ramat
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Nadine Lehnen
- German Center for Vertigo and Balance Disorders, Munich University Hospital, Munich, Germany
- Department of Neurology, Munich University Hospital, Munich, Germany
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The Effect of Optotype Size and Velocity Parameters on the Performance of Healthy Young Adult Subjects on the Gaze Stabilization Test. Otol Neurotol 2013; 34:1090-5. [DOI: 10.1097/mao.0b013e31827f192e] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kaeser PF, Borruat FX. Altered vision during motion: an unusual symptom of cerebellar dysfunction, quantifiable by a simple clinical test. Acta Ophthalmol 2010; 88:791-6. [PMID: 19725817 DOI: 10.1111/j.1755-3768.2009.01544.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To report a series of patients with cerebellar dysfunction and altered vision during motion, and to quantify their visual impairment in motion with a simple clinical test. METHODS Twenty consecutive patients suffering from cerebellar dysfunction and altered vision during motion were examined between 1994 and 2007. A control group consisted of 20 age- and sex-matched healthy people. All patients had a full neuro-ophthalmic examination. Near visual acuity (NVA) was measured at rest (static NVA) and during chair rotation (dynamic NVA). Distance visual acuity (DVA) was measured at rest (static DVA) and during rotation of the patient's head (dynamic DVA). RESULTS Only four of the 20 patients reported altered vision during motion spontaneously. The remaining 16 patients admitted this unusual visual disturbance only when asked specifically. All patients exhibited abnormal eye movements, including saccadic smooth pursuit (20/20), dysmetric saccades (15/20), nystagmus (19/20) and impaired suppression of vestibulo-ocular reflex (VOR) (20/20). During rotation of the examination chair (dynamic NVA), the drop in NVA averaged 5.6 lines (range 1-10 lines). During rotation of the patient's head (dynamic DVA), the drop in DVA averaged only 2.5 lines (range 0-10 lines). For the control group, there was no significant drop in NVA under dynamic conditions. CONCLUSION Patients with cerebellar dysfunction rarely complain spontaneously of altered vision during motion. However, specific questioning may bring up this unusual symptom. The use of a simple clinical test, consisting of NVA measurement during rotation of the examination chair (dynamic NVA), allows practitioners to quantify the level of visual impairment in patients presenting altered VOR modulation.
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The effects of habituation and gaze stability exercises in the treatment of unilateral vestibular hypofunction: a preliminary results. J Neurol Phys Ther 2010; 34:111-6. [PMID: 20588098 DOI: 10.1097/npt.0b013e3181deca01] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE The efficacy of both habituation and adaptation exercise interventions in the treatment of unilateral vestibular hypofunction has been demonstrated by previous studies. The purpose of this article is to describe the preliminary results of an ongoing study that compares the effects of these 2 different exercise approaches on outcomes related to vestibular function. METHODS Seven participants with unilateral vestibular hypofunction completed a 6-week exercise intervention after random assignment to either habituation exercises or gaze stability (GS) adaptation exercises. The following measures were performed pre- and posttreatment: Dizziness Handicap Inventory to measure the symptom impact, motion sensitivity quotient (MSQ) to assess sensitivity to head movements, and the dynamic visual acuity (DVA) test as a measure of GS during head movements. RESULTS After the 6-week intervention, there was an overall improvement in the Dizziness Handicap Inventory, the MSQ score, and both the active and passive DVA. The habituation and GS intervention group participants each demonstrated similar improvements in both the MSQ score and the active and passive DVA measures. DISCUSSION AND CONCLUSIONS The improvement in the MSQ score for the GS group and the improvement in the DVA measures for the habituation group were unexpected findings. Head movement, which is required by both exercise interventions, rather than the specific type of exercise may be the critical factor underlying the observed improvements in motion sensitivity and DVA.
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Computerized dynamic visual acuity test in the assessment of vestibular deficits. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/s1567-4231(10)09014-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Herishanu YO. Abnormal cancellation of the vestibulo-ocular reflex (VOR) after mild head and/or neck trauma. Neuroophthalmology 2009. [DOI: 10.3109/01658109209058144] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Clinical evaluation of dynamic visual acuity in subjects with unilateral vestibular hypofunction. Otol Neurotol 2009; 30:368-72. [PMID: 19318888 DOI: 10.1097/mao.0b013e31819bda35] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objectives of this study are threefold: 1) to examine the effect of frequency of head motion on the clinical dynamic visual acuity (DVA) score in subjects with unilateral vestibular hypofunction (UVH); 2) to compare DVA scores between subjects with UVH and subjects with a complete unilateral vestibular deficit; and 3) to establish whether a relationship exists between the extent of the vestibular deficit and the DVA score. DESIGN Experimental study. SETTING Vestibular outpatient rehabilitation program. METHODS A convenience sample of 10 subjects with UVH. MAIN OUTCOME MEASURES Dynamic visual acuity scores were recorded using 2 standard acuity charts: Snellen and E-chart. The DVA scores were obtained at slow (0.5 Hz), moderate (1 and 1.5 Hz), and fast (2.0 Hz) frequencies of head motion in the horizontal and the vertical planes. Percentage of caloric weakness was compared with DVA scores in each subject to test whether a relationship exists between the two. RESULTS As the frequency of head motion increased, the number of UVH subjects with an abnormal DVA score increased. Subjects with an abnormal DVA score at 1 Hz had the same or higher score as the frequency of the head motion was increased. Spearman correlation analyses revealed low-correlation coefficients between percentage of vestibular paresis at the caloric test and DVA scores (horizontal direction: r = 0.31, p = 0.38 for Snellen chart and r = -0.33, p = 0.35 for the E-chart; vertical: r = 0.05, p = 0.91 for the Snellen chart and r = -0.28, p = 0.50 for the E-chart). CONCLUSION Subjects with UVH manifest impaired DVA. The frequency of head motion has an impact on clinical DVA scores in UVH subjects.
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Ariano RE, Zelenitsky SA, Kassum DA. Aminoglycoside-Induced Vestibular Injury: Maintaining a Sense of Balance. Ann Pharmacother 2008; 42:1282-9. [DOI: 10.1345/aph.1l001] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective To describe the mechanism and risk factors for the development of aminoglycoside-induced vestibular injury and discuss their implications for therapeutic monitoring of aminoglycoside antibiotics. Data Sources: A MEDLINE search (1975–January 2008) was performed to identify literature on aminoglycoside-induced vestibular injury and risk factors associated with this outcome and their impact on therapeutic drug monitoring. Additional references were identified through review of bibliographies of identified articles. Study Selection And Data Extraction: Data on the mechanisms of vestibular toxicity and its development in association with aminoglycoside exposure were extracted from identified references. Data Synthesis: The mechanism leading to the development of irreversible vestibular injury from exposure to aminoglycosides appears to be through the excessive production of oxidative free radicals. This production and subsequent toxicity appears to be a time-dependent process and is unrelated to dose or serum concentration. For similarly designed studies, the pooled incidence of vestibular toxicity is 10.9% for gentamicin, 7.4% for amikacin, 3.5% for tobramycin, and 1.1% for netilmicin. Current evidence suggests that this form of drug toxicity is not restricted to traditionally dosed systemic therapy, since intraperitoneal administration, high-dose once-daily administration, topical inhalation, and eardrop administration have all been associated with the development of this adverse outcome. Conclusions: Given the lack of association between serum concentrations and vestibulotoxicity, it is imperative for the pharmacist to interview the patient and not focus solely on maintaining target range drug concentrations. Minimizing the duration of exposure to aminoglycosides is recommended to reduce the risk from this form of drug toxicity.
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Affiliation(s)
- Robert E Ariano
- Department of Pharmacy, St. Boniface General Hospital and Associate Professor, Faculty of Pharmacy; and Department of Pharmacology & Therapeutics, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Keshner EA, Streepey J, Dhaher Y, Hain T. Pairing virtual reality with dynamic posturography serves to differentiate between patients experiencing visual vertigo. J Neuroeng Rehabil 2007; 4:24. [PMID: 17620142 PMCID: PMC1948002 DOI: 10.1186/1743-0003-4-24] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Accepted: 07/09/2007] [Indexed: 11/15/2022] Open
Abstract
Background To determine if increased visual dependence can be quantified through its impact on automatic postural responses, we have measured the combined effect on the latencies and magnitudes of postural response kinematics of transient optic flow in the pitch plane with platform rotations and translations. Methods Six healthy (29–31 yrs) and 4 visually sensitive (27–57 yrs) subjects stood on a platform rotated (6 deg of dorsiflexion at 30 deg/sec) or translated (5 cm at 5 deg/sec) for 200 msec. Subjects either had eyes closed or viewed an immersive, stereo, wide field of view virtual environment (scene) moved in upward pitch for a 200 msec period for three 30 sec trials at 5 velocities. RMS values and peak velocities of head, trunk, and head with respect to trunk were calculated. EMG responses of 6 trunk and lower limb muscles were collected and latencies and magnitudes of responses determined. Results No effect of visual velocity was observed in EMG response latencies and magnitudes. Healthy subjects exhibited significant effects (p < 0.05) of visual field velocity on peak angular velocities of the head. Head and trunk velocities and RMS values of visually sensitive subjects were significantly larger than healthy subjects (p < 0.05), but their responses were not modulated by visual field velocity. When examined individually, patients with no history of vestibular disorder demonstrated exceedingly large head velocities; patients with a history of vestibular disorder exhibited head velocities that fell within the bandwidth of healthy subjects. Conclusion Differentiation of postural kinematics in visually sensitive subjects when exposed to the combined perturbations suggests that virtual reality technology could be useful for differential diagnosis and specifically designed interventions for individuals whose chief complaint is sensitivity to visual motion.
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Affiliation(s)
- Emily A Keshner
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Room 1406, 345 East Superior St., Chicago, IL 60611 USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, 345 East Superior St., Chicago, IL 60611 USA
- Dept. of Physical Therapy, College of Health Professions, Temple University, Jones Hall 600, 3307 Broad St., Philadelphia PA 19140 USA
| | - Jefferson Streepey
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Room 1406, 345 East Superior St., Chicago, IL 60611 USA
| | - Yasin Dhaher
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Room 1406, 345 East Superior St., Chicago, IL 60611 USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, 345 East Superior St., Chicago, IL 60611 USA
- Biomedical Engineering Department, Northwestern University, 2145 Sheridan Road, Evanston, IL 60208-3107 USA
| | - Timothy Hain
- Department of Physical Therapy and Human Movement Science, Feinberg School of Medicine, Northwestern University, 645 N. Michigan Ave., Chicago, IL 60611 USA
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Goebel JA, Tungsiripat N, Sinks B, Carmody J. Gaze stabilization test: a new clinical test of unilateral vestibular dysfunction. Otol Neurotol 2007; 28:68-73. [PMID: 17106431 DOI: 10.1097/01.mao.0000244351.42201.a7] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Evaluate the sensitivity, specificity, and reliability of the Gaze Stabilization Test (GST) for detection of unilateral vestibular dysfunction. STUDY DESIGN Prospective controlled clinical trial. SETTING Tertiary academic referral laboratory. PATIENTS Fourteen patients (mean age, 63.8 yr; range, 43-77 yr) with history of vertigo and greater than 50% bithermal caloric asymmetry; 14 control subjects (mean age, 45.8 yr; range, 23-78 yr). INTERVENTION(S) Diagnostic test protocol with computerized system of target presentation and head velocity monitoring. MAIN OUTCOME MEASURE(S) Comparison of peak head velocity with ipsilesional and contralesional head movement-allowing gaze stability by randomly presenting transient (75 ms) targets of three optotypes above static acuity in patients and healthy subjects during self-generated headshake movements. RESULTS GST demonstrated 93% specificity, 64% sensitivity, and a reliability index of 0.91 for the detection of unilateral dysfunction with ipsilesional movement. Peak head velocity in healthy subjects averaged 147 degrees per second, whereas ipsilesional velocities dropped significantly to an average of 84 degrees per second. Surprisingly, peak velocities were also significantly reduced to an average of 112 degrees per second with contralesional movements. CONCLUSION GST is a reliable specific test of gaze stability which has diagnostic and rehabilitative applications in patients with vestibular dysfunction. Reduced contralesional velocities may help explain oscillopsia in patients with unilateral dysfunction.
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Affiliation(s)
- Joel A Goebel
- Dizziness and Balance Center, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
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Roberts RA, Gans RE, Johnson EL, Chisolm TH. Computerized dynamic visual acuity with volitional head movement in patients with vestibular dysfunction. Ann Otol Rhinol Laryngol 2006; 115:658-66. [PMID: 17044536 DOI: 10.1177/000348940611500902] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Patients with uncompensated vestibular dysfunction frequently report blurred vision during head movement, a symptom termed oscillopsia. One way to measure the functional deficit associated with an impaired vestibulo-ocular reflex is by comparing visual acuity from a baseline condition in which there is no head movement to visual acuity obtained during a dynamic condition with head movement. A previously described test incorporated a treadmill upon which patients walked during assessment of visual acuity. The objective of the current investigation was to evaluate an alternative method of assessing dynamic visual acuity that uses volitional head movement instead of walking on a treadmill. METHODS Fifteen participants with normal vestibular function and 16 participants with impaired vestibular function were enrolled. All participants performed the visual acuity task under baseline conditions with no movement and also under dynamic conditions that included 1) walking on a treadmill and 2) volitionally moving their head in the vertical plane. RESULTS No difference in performance was observed between the treadmill task and the volitional head movement task. Participants with impaired vestibular function performed more poorly under the dynamic conditions than did participants with normal vestibular function. CONCLUSIONS The results suggest that the volitional head movement paradigm may be useful in identification of patients with functional deficits of the vestibulo-ocular reflex.
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Chen PR, Hsu LP, Tu CE, Young YH. Radiation-induced oscillopsia in nasopharyngeal carcinoma patients. Int J Radiat Oncol Biol Phys 2005; 61:466-70. [PMID: 15667968 DOI: 10.1016/j.ijrobp.2004.05.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2004] [Revised: 05/03/2004] [Accepted: 05/10/2004] [Indexed: 11/28/2022]
Abstract
PURPOSE To apply a battery of audiovestibular function tests and magnetic resonance imaging (MRI) to investigate the causes of oscillopsia in nasopharyngeal carcinoma (NPC) patients after irradiation (RT). METHODS AND MATERIALS Of 300 NPC patients, 12 (4%) developed oscillopsia after RT. The mean accumulated radiation dose to the nasopharynx was 112 +/- 30 Gy. Each patient underwent a battery of audiovestibular function tests, including audiometry and the dynamic illegible E, caloric, and rotational tests. RESULTS Excluding 3 patients with neck fibrosis who could not perform the head turning movement, the remaining 9 patients displayed 100% abnormal dynamic illegible E test results and 100% abnormal refixation saccades. All 12 patients presented with bilateral hearing loss, caloric reductions, and reduced gains of the vestibular ocular reflex (VOR) on the rotational test, indicating bilateral VOR loss. After excluding tumor relapse and radiation necrosis of the brain by MRI, the oscillopsia in these 12 irradiated NPC patients was attributed to bilateral VOR loss. CONCLUSION Radiation-induced oscillopsia in our NPC patients was attributed to bilateral VOR loss, possibly as a result of higher radiation doses. Hence, the therapeutic benefits of a second course of RT are associated with the potential risk of oscillopsia after RT.
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Affiliation(s)
- Peir-Rong Chen
- Department of Otolaryngology, Buddhist Tzu-Chi General Hospital, Hualien, Taiwan
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Abstract
Posture has traditionally been examined by isolating individual control pathways to determine their specific contributions. However, if these pathways are responsive to functional contexts, then their responses may differ when the system is receiving simultaneous inputs from multiple pathways. Thus, we may never fully understand how the central nervous system (CNS) organizes behaviors in the real world from studies conducted in the minimized environment of the laboratory. The consequence of this is that when findings from the laboratory are applied to therapeutic intervention, the intervention may not be appropriate for all circumstances and will not fully meet the needs of the patient. We have united an immersive dynamic virtual environment with motion of a posture platform to record the biomechanical and physiological responses to combined visual, vestibular, and proprioceptive inputs. The virtual environment possesses content, contrast, and texture so that we can examine postural responses as they might occur in a complex, real-world environment. In this paper we specifically describe the factors guiding our choices of virtual technology and present data from young adults, elderly adults, and an individual with bilateral labyrinthine loss to demonstrate how multimodal inputs influence their postural response organization. Significant implications for future experimental and rehabilitation protocols are also discussed.
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Affiliation(s)
- Emily A Keshner
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, Illinois 60611, USA
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Tice AD, Rehm SJ, Dalovisio JR, Bradley JS, Martinelli LP, Graham DR, Gainer RB, Kunkel MJ, Yancey RW, Williams DN. Practice Guidelines for Outpatient Parenteral Antimicrobial Therapy. Clin Infect Dis 2004; 38:1651-72. [PMID: 15227610 DOI: 10.1086/420939] [Citation(s) in RCA: 410] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2004] [Accepted: 02/10/2004] [Indexed: 11/04/2022] Open
Affiliation(s)
- Alan D Tice
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, USA.
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Badke MB, Shea TA, Miedaner JA, Grove CR. Outcomes after rehabilitation for adults with balance dysfunction. Arch Phys Med Rehabil 2004; 85:227-33. [PMID: 14966706 DOI: 10.1016/j.apmr.2003.06.006] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To assess balance, dynamic gait, and dynamic visual acuity outcomes after a vestibular and balance rehabilitation program and to determine which variables were significantly associated with improved balance and ambulation. DESIGN Retrospective case series. SETTING Outpatient setting at a tertiary care facility. PARTICIPANTS Twenty patients who were seen for vestibular and balance therapy between July 1999 and June 2000. INTERVENTIONS A customized exercise program was developed for each patient according to the results of the assessment and included the following interventions, as indicated: gaze stabilization, balance and gait training, and habituation exercises. MAIN OUTCOME MEASURES The Dynamic Gait Index (DGI), Berg Balance Scale (BBS), Dynamic Visual Acuity Test (DVAT), and computerized post urography (Sensory Organization Test [SOT]). RESULTS The mean change scores for the DGI showed significant improvement for both patients with peripheral vestibular dysfunction and patients with central balance disorders. For the central balance disorders group, the BBS score also showed significant improvement. No difference was noted for pretherapy and posttherapy SOT scores between groups. The total group appeared to show an average improvement of more than 2 lines on the visual acuity chart on the clinical DVAT. Patients who were 66 years or older were 1.5 times more likely to score less than 20 on the DGI, and those whose pretherapy vertical dynamic visual acuity was 20/80 or worse were 1.3 times more likely to score less than 20 on the DGI. CONCLUSIONS Patients showed functional improvements in balance, visual acuity, and gait stability after balance and vestibular physical therapy. Age and pretherapy vertical dynamic visual acuity score influenced dynamic gait outcome after a balance rehabilitation program.
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Affiliation(s)
- Mary Beth Badke
- Department of Orthopedics and Rehabilitation, University of Wisconsin Hospital and Clinics, Madison, WI 53562, USA.
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Abstract
OBJECTIVE Children with sensorineural hearing impairment (SNHI) and concomitant vestibular hypofunction demonstrate deficits in gaze stability that may affect reading. The objective of this study was to develop a reliable, valid clinical test of dynamic visual acuity (DVA) for children. METHODS Seventy-six typically developing children, 26 adults and 11 children with sensorineural hearing impairment participated. Visual acuity was tested under three conditions: (1) head stable (static acuity), (2) head tipped forward 30 degrees and passively rotated 30 degrees in the yaw plane at 2 Hz (horizontal dynamic acuity) and (3) head passively moved in the pitch plane 30 degrees at 2 Hz (vertical dynamic acuity, vDVA). The difference, in number of chart lines, between static dynamic acuity was calculated (dynamic acuity score). Based on normative data collected, results were scored as: (1) pass < or =2S.D. from the normative mean and (2) fail > or =2S.D. from normative mean. Children were grouped by age to enable examination of the effect of age on scores. RESULTS We found excellent test-retest and inter-tester reliability (ICC(2,2)=0.94 and ICC(3,2)=0.84) for the horizontal dynamic acuity (hDVA) test. Sensitivity, specificity, positive and negative predictive values were 100% to identify children with bilateral vestibular hypofunction (BVH). Although a statistical difference was found, the difference was not clinically significant (all achieved DVA scores <2 lines). The vertical dynamic acuity test was not tolerated by most children, precluding its usefulness. CONCLUSIONS The clinical test of horizontal dynamic acuity is a reliable test for children as young as 3 years. It is simple and inexpensive, and will enable identification of those for whom more extensive testing is warranted.
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Affiliation(s)
- Rose Marie Rine
- Department of Orthopaedics and Rehabilitation, Division of Physical Therapy, University of Miami School of Medicine, Coral Gables, FL 33146, USA.
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Abstract
The purpose of this study was to evaluate the relative contributions of inputs from the vestibular system and the trunk to head-trunk coordination. Twelve healthy adults and 6 adults with diminished bilateral labyrinthine input (LD) were seated with their trunk either fixed to the seat or free to move. Subjects received 10-cm, 445-cm/s(2) anterior-posterior ramps and 0.35- to 4.05-Hz sum-of-sines translations while performing a mental distraction task in the dark. Kinematics of the head and trunk were derived from an Optotrak motion analysis system and a linear accelerometer placed on the head. EMG signals were collected from neck and paraspinal muscles. Data were tested for significance with multivariate ANOVA (MANOVA) and Bonferroni post hoc analyses. Initial linear and angular head acceleration directions differed in healthy subjects when the trunk was fixed or free, but did not differ in LD subjects. Peak head angular accelerations were significantly greater with the trunk fixed than when free, and were greater in LD than in control subjects. EMG response latencies did not differ when the trunk was fixed or free. Low-frequency phase responses in the healthy subjects were close to 90 degrees and had a delayed descent as frequency increased, suggesting some neural compensation that was absent in the LD subjects. Results of this study revealed a strong initial reliance on system mechanics and on signals from segmental receptors. The vestibular system may act to damp later response components and to monitor the position of the head in space secondary to feedback from segmental proprioceptors rather than to generate the postural reactions.
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Affiliation(s)
- Emily A Keshner
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago and Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA.
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Sargent EW, Goebel JA, Hanson JM, Beck DL. Idiopathic Bilateral Vestibular Loss. Otolaryngol Head Neck Surg 1997; 116:157-62. [PMID: 9051057 DOI: 10.1016/s0194-59989770318-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
We describe the clinical and laboratory features of 13 patients with bilateral loss of peripheral vestibular sensitivity of no known cause. In the office, screening for this condition was possible using illegible e-testing and examination of the patient for refixation saccades after brisk head movements while attempting visual fixation. Diagnosis was confirmed by bilaterally reduced caloric responses (<20 degrees/second on all 4 caloric irrigations) and abnormally low gain of the vestibulo-ocular reflex on rotational chair testing. The mean age of the patients was 68 years. We noted two patterns of symptom onset: onset associated with vertigo (10 patients) and insidious progressive disequilibrium not associated with vertigo (3 patients). Only 38 % of the patients complained of subjective oscillopsia. The subjects performed poorly on platform posturography, particularly when deprived of visual and somatosensory feedback. When associated with vertigo, bilateral vestibular loss may be the result of bilateral sequential vestibular neuritis; when not associated with vertigo, disequilibrium may be caused by slow, symmetrical loss of peripheral function as a result of aging. Although the subjects in this report were elderly, idiopathic bilateral vestibular loss has been reported in patients of all ages.
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Affiliation(s)
- E W Sargent
- Department of Otolaryngology-Head and Neck Surgery, St. Louis University School of Medicine, MO 63110-0250, USA
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Longridge NS. Progressive vestibular failure in childhood. ACTA OTO-LARYNGOLOGICA. SUPPLEMENTUM 1989; 468:375-7. [PMID: 2635538 DOI: 10.3109/00016488909139080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- N S Longridge
- Department of Otolaryngology, Vancover General Hospital, B.C., Canada
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