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Kontos AP, Zynda AJ, Minerbi A. Comparison of Vestibular/Ocular Motor Screening (VOMS) and Computerized Eye-tracking to Identify Exposure to Repetitive Head Impacts. Mil Med 2024:usae065. [PMID: 38531077 DOI: 10.1093/milmed/usae065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/06/2024] [Accepted: 02/15/2024] [Indexed: 03/28/2024] Open
Abstract
INTRODUCTION Military service members (SMs) are exposed to repetitive head impacts (RHIs) in combat and training that are purported to adversely affect brain health, including cognition, behavior, and function. Researchers have reported that RHI from blast-related exposure may affect both vestibular and ocular function, which in turn may be related to symptomology. As such, an examination of the effects of RHI on exposed military SMs should incorporate these domains. To date, researchers have not compared groups of exposed special operations forces (SOF) operators on combined clinical vestibular/ocular and eye-tracker-based outcomes. Therefore, the primary purpose of this study was to compare participant-reported symptoms and performance on the Vestibular/Ocular Motor Screening (VOMS) tool with performance on the computerized RightEye tracking system between SOF operators exposed to blast-related RHI and healthy controls without blast-related exposure. In addition, the study aimed to compare subgroups of snipers and breachers exposed to RHI to controls on the preceding metrics, as well as identify a subset of individual (demographic) factors, participant-reported symptoms, and performance metrics on VOMS and RightEye that best identify SOF operators exposed to RHI from unexposed controls. MATERIALS AND METHODS The study involved a cross-sectional design including 25 Canadian SOF SMs comprised of breachers (n = 9), snipers (n = 9), and healthy, unexposed controls (n = 7). The former 2 groups were combined into an RHI group (n = 18) and compared to controls (n = 7). Participants provided demographics and completed a self-reported concussion-related symptom report via the Military Acute Concussion Evaluation 2, the VOMS, and RightEye computerized eye-tracking assessments. Independent samples t-tests and ANOVAs were used to compare the groups on the outcomes, with receiver operating characteristic curve and area under the curve (AUC) analyses to identify predictors of blast exposure. This study was approved by the Defence Research Development Canada Human Research Ethics Committee and the Canadian Forces Surgeon General/Special Forces Command. RESULTS The results from t-tests supported group differences for age (P = .012), participant-reported symptoms (P = .006), and all VOMS items (P range = <.001-.02), with the RHI group being higher than healthy controls on all variables. ANOVA results supported group differences among snipers, breachers, and controls for age (P = .01), RightEye saccades (P = .04), participant-reported total symptom severity (P = .03), and VOMS total scores (P = .003). The results of the receiver operating characteristic curve analyses supported age (AUC = 0.81), Military Acute Concussion Evaluation 2 participant-reported total symptom severity (AUC = 0.87), and VOMS total scores (AUC = 0.92) as significant predictors of prior blast exposure. CONCLUSIONS Participant-reported concussion symptoms, VOMS scores, and age were useful in identifying SOF operators exposed to RHI from controls. RightEye metrics were not useful in differentiating RHI groups from controls. Differences between snipers and breachers warrant further research. Overall, the findings suggest that VOMS may be a useful tool for screening for the effects of exposure to RHI in SOF operators. Future investigations should be conducted on a larger sample of military SMs, consider additional factors (e.g., RHI exposure levels, medical history, and sex), and include additional assessment domains (e.g., balance, cognitive, and psychological).
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Affiliation(s)
- Anthony P Kontos
- University of Pittsburgh, Department of Orthopaedic Surgery, Concussion Research Laboratory, Pittsburgh, PA 15203, USA
| | - Aaron J Zynda
- University of Pittsburgh, Department of Orthopaedic Surgery, Concussion Research Laboratory, Pittsburgh, PA 15203, USA
| | - Amir Minerbi
- Institute for Pain Medicine, Rambam Health Campus, Haifa 3200003, Israel
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Corre J, Cugnot JF, Boutabla A, Cavuscens S, Ranieri M, van de Berg R, Peterka RJ, Guinand N, Fornos AP. Postural impairments in unilateral and bilateral vestibulopathy. Front Neurol 2024; 15:1324868. [PMID: 38450076 PMCID: PMC10915085 DOI: 10.3389/fneur.2024.1324868] [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: 10/20/2023] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
Chronic imbalance is a major complaint of patients suffering from bilateral vestibulopathy (BV) and is often reported by patients with chronic unilateral vestibulopathy (UV), leading to increased risk of falling. We used the Central SensoriMotor Integration (CSMI) test, which evaluates sensory integration, time delay, and motor activation contributions to standing balance control, to determine whether CSMI measures could distinguish between healthy control (HC), UV, and BV subjects and to characterize vestibular, proprioceptive, and visual contributions expressed as sensory weights. We also hypothesized that sensory weight values would be associated with the results of vestibular assessments (vestibulo ocular reflex tests and Dizziness Handicap Inventory scores). Twenty HCs, 15 UVs and 17 BVs performed three CSMI conditions evoking sway in response to pseudorandom (1) surface tilts with eyes open or, (2) surface tilts with eyes closed, and (3) visual surround tilts. Proprioceptive weights were identified in surface tilt conditions and visual weights were identified in the visual tilt condition. BVs relied significantly more on proprioception. There was no overlap in proprioceptive weights between BV and HC subjects and minimal overlap between UV and BV subjects in the eyes-closed surface-tilt condition. Additionally, visual sensory weights were greater in BVs and were similarly able to distinguish BV from HC and UV subjects. We found no significant correlations between sensory weights and the results of vestibular assessments. Sensory weights from CSMI testing could provide a useful measure for diagnosing and for objectively evaluating the effectiveness of rehabilitation efforts and future treatments designed to restore vestibular function such as hair cell regeneration and vestibular implants.
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Affiliation(s)
- Julie Corre
- Division of Otorhinolaryngology Head and Neck Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Jean-François Cugnot
- Division of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Anissa Boutabla
- Division of Otorhinolaryngology Head and Neck Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Samuel Cavuscens
- Division of Otorhinolaryngology Head and Neck Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Maurizio Ranieri
- Division of Otorhinolaryngology Head and Neck Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Raymond van de Berg
- Division of Vestibular Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Robert J. Peterka
- National Center for Rehabilitative Auditory Research, Veterans Administration Portland Health Care System and Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Nils Guinand
- Division of Otorhinolaryngology Head and Neck Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Angélica Pérez Fornos
- Division of Otorhinolaryngology Head and Neck Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
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So RJ, Cevallos A, Pile M, Biju K, Perez‐Heydrich C, Padova D, Walker C, Schubert M, Agrawal Y. Quantitative vestibular assessment: The development and validation of a novel, remote video head impulse test against in-clinic measurements. Laryngoscope Investig Otolaryngol 2023; 8:758-762. [PMID: 37342103 PMCID: PMC10278116 DOI: 10.1002/lio2.1069] [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: 01/13/2023] [Revised: 02/28/2023] [Accepted: 04/09/2023] [Indexed: 06/22/2023] Open
Abstract
Objectives To develop a novel remote head impulse test (rHIT), and to provide preliminary data validating the rHIT vestibular-ocular reflex (VOR) gains against the in-clinic vHIT. Methods A convenience sample of 10 patients referred for vestibular assessment at our institution was recruited. In-clinic vHIT was used to quantify lateral VOR gains. Patients subsequently underwent an rHIT protocol, whereby patients performed active, lateral head rotations while their eyes and heads were recorded using a laptop camera and video-conferencing software. The vHIT and rHIT VOR gains were compared using paired t-tests, and a Pearson correlation coefficient between the gains was calculated. Absolute accuracy, sensitivity, and specificity of the rHIT were additionally calculated. Results Of the 10 patients recruited, 4 were male, and the average ± standard deviation (SD) age was 61.4 ± 15.3 years. As determined by the vHIT, 2 patients had normal bilateral VOR gains, 6 with unilateral vestibular hypofunction, and 2 with bilateral vestibular hypofunction. The correlation between the rHIT and vHIT gains was 0.73 (p < .001). The rHIT exhibited an absolute accuracy of 75.0%, sensitivity of 70.0%, and specificity of 80.0%. When ears had a vHIT VOR gain less than 0.40, the rHIT exhibited 100.0% accuracy. Conversely, 60.0% of deficient ears with vHIT VOR gains greater than 0.40 were incorrectly categorized by the rHIT. Conclusion The rHIT may be better suited for detecting more severe vestibular deficiencies. Future iterations of the rHIT should aim to increase the video frame-rate capabilities to detect subtler VOR impairments. Level of Evidence 4.
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Affiliation(s)
- Raymond J. So
- Department of OtolaryngologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Medical Student Training in Aging Research Program, Department of Geriatric Medicine and GerontologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Ashley Cevallos
- Department of OtolaryngologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Macie Pile
- Department of OtolaryngologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Kevin Biju
- Department of OtolaryngologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Carlos Perez‐Heydrich
- Department of OtolaryngologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Dominic Padova
- Department of OtolaryngologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Courtney Walker
- Department of OtolaryngologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Michael Schubert
- Department of OtolaryngologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Yuri Agrawal
- Department of OtolaryngologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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Alterations in Corticocortical Vestibular Network Functional Connectivity Are Associated with Decreased Balance Ability in Elderly Individuals with Mild Cognitive Impairment. Brain Sci 2022; 13:brainsci13010063. [PMID: 36672045 PMCID: PMC9856347 DOI: 10.3390/brainsci13010063] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/19/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022] Open
Abstract
The corticocortical vestibular network (CVN) plays an important role in maintaining balance and stability. In order to clarify the specific relationship between the CVN and the balance ability of patients with mild cognitive impairment (MCI), we recruited 30 MCI patients in the community. According to age and sex, they were 1:1 matched to 30 older adults with normal cognitive function. We evaluated balance ability and performed MRI scanning in the two groups of participants. We analyzed functional connectivity within the CVN based on the region of interest. Then, we performed a Pearson correlation analysis between the functional connection and the Berg Balance Scale scores. The research results show that compared with the control group, there were three pairs of functional connections (hMST_R−Premotor_R, PFcm_R−SMA_L, and hMST_L−VIP_R) that were significantly decreased in the CVNs of the MCI group (p < 0.05). Further correlation analysis showed that there was a significant positive correlation between hMST_R−Premotor_R functional connectivity and BBS score (r = 0.364, p = 0.004). The decline in balance ability and increase in fall risk in patients with MCI may be closely related to the change in the internal connection mode of the corticocortical vestibular network.
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Yesantharao LV, Rosenberg P, Oh E, Leoutsakos J, Munro CA, Agrawal Y. Vestibular therapy to reduce falls in people with Alzheimer's disease: study protocol for a pilot randomized controlled trial. Pilot Feasibility Stud 2022; 8:167. [PMID: 35918757 PMCID: PMC9344717 DOI: 10.1186/s40814-022-01133-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 07/20/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Falls are highly common in patients with Alzheimer's disease (AD); around two-thirds of AD patients fall annually. Fall events are major drivers of injury, early institutionalization, and shorter survival. Balance and mobility impairment are among the most important fall risk factors in AD patients. Vestibular therapy (VT) is an effective rehabilitation intervention in improving balance and fall risk through vestibular function, but not often used in AD. We want to evaluate the feasibility of using VT to reduce falls and improve balance function in patients with AD and drive use of an existing, potentially beneficial therapy in a patient population whose high level of vestibular deficits is currently unaddressed. METHODS The proposed pilot clinical trial will be a parallel-group randomized controlled trial. Patients with a diagnosis of mild-moderate AD, age ≥ 60, and the presence of a caregiver will be recruited from the Johns Hopkins Memory and Alzheimer's Treatment Center. Eligible patients will be offered vestibular testing. Patients with vestibular loss will be offered participation in the VT trial. One-hundred AD patients with vestibular loss will be enrolled and randomized 1:1 into the control and intervention arms of the trial. All patients will undergo baseline balance and cognitive assessment, followed by 8 weeks of active control therapy or VT, consisting of ~25-min office sessions with a vestibular therapist. Patients will be tracked for falls and undergo follow-up balance and cognitive assessment at 8 and 52 weeks (1 year) to assess the potential short-term and longer-term effects, respectively, of VT on balance and cognition. The main outcomes of this trial are falls, balance (using the Berg Balance Scale and the Timed Up and Go test), and cognition (using the clock drawing test, the Card Rotations test, the Money Road Map test, and the triangle completion task). DISCUSSION As the population ages and the number of individuals with AD in the US grows to a projected 14 million in 2050, managing falls in AD will continue to grow as a critical public health concern; this trial assesses feasibility of a potential solution. TRIAL REGISTRATION ClinicalTrial.Gov identifier - NCT03799991 . Registered 01 August 2019.
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Affiliation(s)
- Lekha V Yesantharao
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Paul Rosenberg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Esther Oh
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Jeannie Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Cynthia A Munro
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Yuri Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.
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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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Park SY, Yeo SS, Jang SH, Cho IH, Oh S. Associations Between Injury of the Parieto-Insular Vestibular Cortex and Changes in Motor Function According to the Recovery Process: Use of Diffusion Tensor Imaging. Front Neurol 2021; 12:740711. [PMID: 34819909 PMCID: PMC8607691 DOI: 10.3389/fneur.2021.740711] [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: 07/13/2021] [Accepted: 10/01/2021] [Indexed: 11/30/2022] Open
Abstract
Background and Purpose: Parieto-insular vestibular cortex (PIVC) injury can cause symptoms such as abnormal gait and affects the integration and processing of sensory inputs contributing to self-motion perception. Therefore, this study investigated the association of the vestibular pathway in the gait and motor function recovery process in patients with PIVC injury using diffusion tensor imaging (DTI). Methods: We recruited 28 patients with stroke with only PIVC injury and reconstructed the PIVC using a 1.5-T scanner for DTI. Fractional anisotropy (FA), mean diffusivity (MD), and tract volume were measured. The functional ambulatory category (FAC) test was conducted, and motricity index (MI) score was determined. These were conducted and determined at the start (phase 1), end of rehabilitation (phase 2), and during the follow-up 6 months after onset. Results: Although the tract volume of PIVC showed a decrease in subgroup A, all of DTI parameters were not different between two subgroups in affected side (p > 0.05). The results of MI and FAC were significantly different according to the recovery process (p < 0.05). In addition, FA of the PIVC showed a positive correlation with FAC in phase 2 of the recovery process on the affected side. On the unaffected side, FA of the PIVC showed a significant negative correlation with MI in all processes (p < 0.05). Conclusion: The degree of projection pathways to PIVC injury at onset time seems to be related to early restoration of gait function. Moreover, we believe that early detection of the projection pathway for PIVC injury using DTI would be helpful in the clinical evaluation and prediction of the prognosis of patients with PIVC injury.
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Affiliation(s)
- Seo Yoon Park
- Department of Physical Therapy, College of Health Sciences, Dankook University, Cheonan, South Korea
| | - Sang Seok Yeo
- Department of Physical Therapy, College of Health Sciences, Dankook University, Cheonan, South Korea
| | - Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, South Korea
| | - In Hee Cho
- Department of Health, Graduate School, Dankook University, Cheonan, South Korea
| | - Seunghue Oh
- Department of Physical Therapy, Yeungnam University College, Daegu, South Korea
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Diaz-Artiles A, Karmali F. Vestibular Precision at the Level of Perception, Eye Movements, Posture, and Neurons. Neuroscience 2021; 468:282-320. [PMID: 34087393 DOI: 10.1016/j.neuroscience.2021.05.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 05/20/2021] [Accepted: 05/24/2021] [Indexed: 11/18/2022]
Abstract
Precision and accuracy are two fundamental properties of any system, including the nervous system. Reduced precision (i.e., imprecision) results from the presence of neural noise at each level of sensory, motor, and perceptual processing. This review has three objectives: (1) to show the importance of studying vestibular precision, and specifically that studying accuracy without studying precision ignores fundamental aspects of the vestibular system; (2) to synthesize key hypotheses about precision in vestibular perception, the vestibulo-ocular reflex, posture, and neurons; and (3) to show that groups of studies that are thoughts to be distinct (e.g., perceptual thresholds, subjective visual vertical variability, neuronal variability) are actually "two sides of the same coin" - because the methods used allow results to be related to the standard deviation of a Gaussian distribution describing the underlying neural noise. Vestibular precision varies with age, stimulus amplitude, stimulus frequency, body orientation, motion direction, pathology, medication, and electrical/mechanical vestibular stimulation, but does not vary with sex. The brain optimizes precision during integration of vestibular cues with visual, auditory, and/or somatosensory cues. Since a common concern with precision metrics is time required for testing, we describe approaches to optimize data collection and provide evidence that fatigue and session effects are minimal. Finally, we summarize how precision is an individual trait that is correlated with clinical outcomes in patients as well as with performance in functional tasks like balance. These findings highlight the importance of studying vestibular precision and accuracy, and that knowledge gaps remain.
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Affiliation(s)
- Ana Diaz-Artiles
- Bioastronautics and Human Performance Laboratory, Department of Aerospace Engineering, Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843-3141, USA. https://bhp.engr.tamu.edu
| | - Faisal Karmali
- Jenks Vestibular Physiology Laboratory, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston MA, USA.
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Correlations Between Multi-plane vHIT Responses and Balance Control After Onset of an Acute Unilateral Peripheral Vestibular Deficit. Otol Neurotol 2021; 41:e952-e960. [PMID: 32658113 DOI: 10.1097/mao.0000000000002482] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Previous studies reported that balance deficits in pitch (sagittal) and roll (lateral) planes during stance and gait after onset of an acute unilateral peripheral vestibular deficit (aUPVD) due to vestibular neuritis are weakly correlated with deficits in commonly explored lateral canal vestibular ocular reflex (VOR) responses. Theoretically, stronger correlations with roll and pitch balance deficits could be expected for vertical canal VOR responses. Therefore, we investigated these correlations. SETTING University Hospital. STUDY DESIGN Retrospective case review. PATIENTS Thirty three patients examined on average 5 days following onset of aUPVD. MAIN OUTCOME MEASURES Video head impulse test (vHIT) VOR gains in each vertical canal plane were converted to roll and pitch response asymmetries and correlated with patients' roll and pitch balance control measured during stance and gait with body-worn gyroscopes mounted at lumbar 1 to 3. RESULTS Mean caloric canal paresis was 92 ± 12%. Deficit side lateral vHIT mean gain was 0.4 ± 0.12, anterior gain 0.44 ± 0.18, and posterior gain, greater, 0.69 ± 0.15. Lateral VOR response gain asymmetries (37.2 ± 11.0%) were greater than roll VOR asymmetries calculated from all four vertical canal vHIT gains (16.2 ± 10.2%, p < 0.0001) and correlated (R = 0.56, p = 0.002). Pitch gain VOR asymmetries were less (4.9 ± 9.9%, p < 0.0001). All gait, but no stance, trunk roll angular velocity measures were correlated (p ≤ 0.03) with VOR roll asymmetries. CONCLUSIONS This report links roll balance control deficits during gait with roll VOR deficits and emphasises the need to perform anterior canal vHIT to judge effects of an aUPVD on balance control. Pitch VOR asymmetries were weakly affected by vestibular neuritis.
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Loyd BJ, Saviers-Steiger J, Fangman A, Paul SS, Fino PC, Lester ME, Dibble LE. Control of Linear Head and Trunk Acceleration During Gait After Unilateral Vestibular Deficits. Arch Phys Med Rehabil 2020; 102:456-462. [PMID: 32918908 DOI: 10.1016/j.apmr.2020.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 08/03/2020] [Accepted: 08/06/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To use clinically available inertial measurement units to quantify the control of linear accelerations at the head and trunk during gait in different sensory conditions in individuals with unilateral vestibular loss. DESIGN Observational study. SETTING Outpatient research laboratory. PARTICIPANTS Individuals (n=13; mean age, 47.6±13.7y; 69% women) 6 weeks after vestibular schwannoma resection surgery and vestibular healthy participants (n=16; mean age, 29.7±5.9y; 56% women). INTERVENTION Not applicable. MAIN OUTCOME MEASURES Walking speed normalized, root mean square values of cranial-caudal, medial-lateral, and anterior-posterior directed linear accelerations at the head and the trunk while walking in 2 visual sensory conditions (eyes open and eyes closed). RESULTS Linear mixed models for each root mean square value were fit on the effects of group, condition, and group by condition. The group by condition effect was used to examine the primary hypothesis that individuals with vestibular loss would experience greater change in triplanar root mean square values at the head and trunk from the eyes open to eyes closed condition compared with the vestibular healthy group. The group by condition effect was found to be significant at the head in the cranial-caudal (β=0.39; P=.002), medial-lateral (β=0.41; P<.001), and anterior-posterior (β=0.43; P<.001) directions. The group by condition effect was also significant in the cranial-caudal (β=0.39; P=.002), medial-lateral (β=0.39; P<.001), and anterior-posterior (β=0.23; P=.002) directions at the trunk. CONCLUSIONS Participants who underwent vestibular schwannoma resection were more impaired in their ability to control accelerations at the head and trunk without visual sensory information than vestibular healthy participants. These impairments were detectable using clinically available inertial measurement units.
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Affiliation(s)
- Brian J Loyd
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT.
| | - Jane Saviers-Steiger
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT
| | - Annie Fangman
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT
| | - Serene S Paul
- Discipline of Physiotherapy, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Peter C Fino
- Department of Health, Kinesiology, and Recreation, University of Utah, Salt Lake City, UT
| | - Mark E Lester
- Department of Physical Therapy, Texas State University, Round Rock, TX
| | - Leland E Dibble
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT
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Matos R, Navarro M, Pérez-Guillén V, Pérez-Garrigues H. The role of vertical semicircular canal function in the vertical component of skull vibration-induced nystagmus. Acta Otolaryngol 2020; 140:639-645. [PMID: 32329666 DOI: 10.1080/00016489.2020.1751877] [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] [Indexed: 10/24/2022]
Abstract
Background: Generally, vertical component of the skull vibratory nystagmus (VCN) is ignored in the clinical practise. Thus, the relative contribution of the vestibular organs in the presence of VCN remains unknown.Objectives: To determine the association between vertical semicircular canal (vSCC) function and the presence of VCN.Material and methods: Comparisons were made between Video Head Impulse Test and SVINT (100 Hz) results at the time of the acute peripheral vestibular lesion (PVL) and at the post-acute phase in patients diagnosed PVL. Later on, a paired analysis was performed restricting the assessments to patients with vestibular explorations in both the acute and post-acute phases.Results: In an univariable analysis, larger mean total gain differences (TGD) between vSCC VOR gains, significantly related with the appearance of VCN in nystagmography in the acute phase (p = .001), unlike the post-acute phase (p = .46). After a multivariate analysis, mean TGD was the only predictive factor of the VCN (p = .013). In the paired analysis, we found an increase in the post-acute phase mean TGD, approaching zero value.Conclusions and significance: Global relation between all vertical canals has at least a contributory role in the presence of the vertical component of nystagmus in SVINT.
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Affiliation(s)
- Ricardo Matos
- Department of Otorhinolaryngology, Centro Hospitalar Universitário São João EPE, Porto, Portugal University of Porto Medical School, Porto, Portugal.,University of Porto Medical School, Porto, Portugal
| | - Marta Navarro
- Otoneurology Unit, ENT Department, Hospital "La Fe", Valencia, Spain
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12
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Patel M, Roberts E, Arshad Q, Bunday K, Golding JF, Kaski D, Bronstein AM. The "broken escalator" phenomenon: Vestibular dizziness interferes with locomotor adaptation. J Vestib Res 2020; 30:81-94. [PMID: 32116265 DOI: 10.3233/ves-200693] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although vestibular lesions degrade postural control we do not know the relative contributions of the magnitude of the vestibular loss and subjective vestibular symptoms to locomotor adaptation. OBJECTIVE To study how dizzy symptoms interfere with adaptive locomotor learning. METHODS We examined patients with contrasting peripheral vestibular deficits, vestibular neuritis in the chronic stable phase (n = 20) and strongly symptomatic unilateral Meniere's disease (n = 15), compared to age-matched healthy controls (n = 15). We measured locomotor adaptive learning using the "broken escalator" aftereffect, simulated on a motorised moving sled. RESULTS Patients with Meniere's disease had an enhanced "broken escalator" postural aftereffect. More generally, the size of the locomotor aftereffect was related to how symptomatic patients were across both groups. Contrastingly, the degree of peripheral vestibular loss was not correlated with symptom load or locomotor aftereffect size. During the MOVING trials, both patient groups had larger levels of instability (trunk sway) and reduced adaptation than normal controls. CONCLUSION Dizziness symptoms influence locomotor adaptation and its subsequent expression through motor aftereffects. Given that the unsteadiness experienced during the "broken escalator" paradigm is internally driven, the enhanced aftereffect found represents a new type of self-generated postural challenge for vestibular/unsteady patients.
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Affiliation(s)
- Mitesh Patel
- Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, UK
| | - Ed Roberts
- Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, UK
| | - Qadeer Arshad
- Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, UK
| | - Karen Bunday
- Department of Social Sciences, University of Westminster, London, UK
| | - John F Golding
- Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, UK.,Department of Social Sciences, University of Westminster, London, UK
| | - Diego Kaski
- Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, UK
| | - Adolfo M Bronstein
- Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, UK
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13
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Murray D, Viani L, Garvan J, Murphy A, Vance R, Simoes-Franklin C, Smith J, Meldrum D. Balance, gait and dizziness in adult cochlear implant users: A cross sectional study. Cochlear Implants Int 2019; 21:46-52. [PMID: 31530102 DOI: 10.1080/14670100.2019.1662978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Cochlear implantation is associated with vestibular impairment due to the close proximity of the structures. The aim of the study was to quantify dizziness/vertigo, gaze instability, balance and gait problems in a sample of adult cochlear implant (CI) users.Methods: An observational, cross sectional study evaluated subjective dizziness (Vestibular Rehabilitation Benefit Questionnaire (VRBQ)), balance confidence (Activities Specific Balance Questionnaire (ABC)), gait (Functional Gait Assessment (FGA) and 10m walk test), balance (Equitest Sensory Organisation Test (SOT)), and computerised dynamic visual acuity (DVA). The Dix Hallpike test was performed to test for benign paroxysmal positional vertigo (BPPV).Results: Twenty participants (n=10F), 2.8(±2.7) years post implantation, with mean age 59.3(±15.8) years were assessed. Subjective dizziness (VRBQ) was low (15.0% (±15.5)) and balance confidence was high (ABC: 82.1%±14.9). FGA scores (25.1 ± 4.4) and gait speed (1.8 (±0.3) m/sec) were below normal. Dx Hallpike was positive in 3. Gaze instability was found in 50% (DVA loss, 0.29 (± 0.16) LogMAR), while 79% demonstrated balance impairment (mean SOT score, 57.8%±14.5), with 42% falling on SOT condition 5.Discussion: Evidence of vestibular dysfunction was identified in these adult CI users.Conclusion: Access to vestibular function assessment and rehabilitation is required in adult CI users.
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Affiliation(s)
- Deirdre Murray
- Beaumont Hospital, Dublin, Ireland.,School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Laura Viani
- Beaumont Hospital, Dublin, Ireland.,School of Medicine, Trinity College Dublin, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland.,National Cochlear Implant Programme, Beaumont Hospital, Dublin, Ireland
| | - James Garvan
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | - Cristina Simoes-Franklin
- Beaumont Hospital, Dublin, Ireland.,National Cochlear Implant Programme, Beaumont Hospital, Dublin, Ireland
| | | | - Dara Meldrum
- School of Medicine, Trinity College Dublin, Dublin, Ireland
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14
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Allum JHJ, Rust HM, Honegger F. Functional Testing of Vestibulo-Spinal Contributions to Balance Control: Insights From Tracking Improvement Following Acute Bilateral Peripheral Vestibular Loss. Front Neurol 2019; 10:550. [PMID: 31191439 PMCID: PMC6546919 DOI: 10.3389/fneur.2019.00550] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 05/07/2019] [Indexed: 11/13/2022] Open
Abstract
Background: A battery of stance and gait tasks can be used to quantify functional deficits and track improvement in balance control following peripheral vestibular loss. An improvement could be due to at least 3 processes: partial peripheral recovery of sensory responses eliciting canal or otolith driven vestibular reflexes; central compensation of vestibular reflex gains, including substitution of intact otolith responses for pathological canal responses; or sensory substitution of visual and proprioceptive inputs for vestibular contributions to balance control. Results: We describe the presumed action of all 3 processes observed for a case of sudden incapacitating acute bilateral peripheral loss probably due to vestibular neuritis. Otolith responses were largely unaffected. However, pathological decreases in all canal-driven vestibular ocular reflex (VOR) gains were observed. After 3 months of vestibular rehabilitation, balance control was normal but VOR gains remained low. Conclusions: This case illustrates the difficulty in predicting balance control improvements from tests of the 10 vestibular end organs and emphasizes the need to test balance control function directly in order to determine if balance control has improved and is normal again despite remaining vestibular sensory deficits. This case also illustrates that the presence of residual otolithic function may be crucial for balance control improvement in cases of bilateral vestibular hypofunction.
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Affiliation(s)
- John H. J. Allum
- Division of Audiology and Neurootology, Department of Otorhinolaryngology (ORL), University Hospital Basel, Basel, Switzerland
| | - Heiko Mario Rust
- Department of Neurology, University of Basel Hospital, Basel, Switzerland
- Division of Brain Sciences, Academic Department of Neuro-Otology, Charing Cross Hospital, Imperial College, London, United Kingdom
| | - Flurin Honegger
- Division of Audiology and Neurootology, Department of Otorhinolaryngology (ORL), University Hospital Basel, Basel, Switzerland
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15
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Vibert D, Allum JHJ, Kompis M, Wiedmer S, Stieger C, Häusler R, Caversaccio M. Measurements of Trunk Sway for Stance and Gait Tasks 2 Years after Vestibular Neurectomy. Audiol Neurootol 2018; 23:298-308. [PMID: 30541000 DOI: 10.1159/000494965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 10/29/2018] [Indexed: 11/19/2022] Open
Abstract
The aim of this study was to investigate changes in balance control for stance and gait tasks in patients 2 years before and after vestibular neurectomy (VN) performed to alleviate intractable Meniere's disease. Amplitudes of trunk sway in roll and pitch directions were measured for stance and gait tasks in 19 patients using gyroscopes mounted at the lower-back. Measurements before VN and 2 years later were compared to those of healthy age-matched controls (HC). We also examined if changes in trunk sway amplitudes were correlated with patients' subjective assessment of disability using the AAO-HNS scale. For patients with low AAO-HNS scores 0-2 (n = 14), trunk roll and pitch sway velocities, standing eyes closed on foam, increased 2 years post VN compared to HC values (p < 0.01). Trunk sway amplitudes remained at levels of HC for simple gait tasks, but task durations were longer and therefore gait slower. For complex gait tasks (stairs), balance control remained impaired at 2 years. In patients with AAO-HNS high scores level 6 (n = 5), balance control remained abnormal, compared to HC, 2 years postoperatively for all stance, several simple and all complex gait tasks. Trunk sway in the pitch and roll directions for stance tasks was correlated with clinical (AAO-HNS) scores (p ≤ 0.05). These results indicate that VN leads to chronic balance problems for stance and complex gait tasks. The problems are greater for patients with high compared to low AAO-HNS scores, thereby explaining the different symptoms reported by these patients. The lack of balance recovery in VN patients to levels of HCs after 2 years contrasts with the 3 months average recovery period for acute vestibular neuritis patients and is indicative of the effects of neurectomy on central compensation processes.
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Affiliation(s)
- Dominique Vibert
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland,
| | - John H J Allum
- Division of Audiology and Neurootology, Department of ORL, University of Basel Hospital, Basel, Switzerland
| | - Martin Kompis
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simona Wiedmer
- ARTORG Center for Artificial Hearing Research, University of Bern, Bern, Switzerland
| | - Christof Stieger
- ARTORG Center for Artificial Hearing Research, University of Bern, Bern, Switzerland
| | - Rudolf Häusler
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marco Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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16
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van Kordelaar J, Pasma JH, Cenciarini M, Schouten AC, van der Kooij H, Maurer C. The Reliance on Vestibular Information During Standing Balance Control Decreases With Severity of Vestibular Dysfunction. Front Neurol 2018; 9:371. [PMID: 29915556 PMCID: PMC5994722 DOI: 10.3389/fneur.2018.00371] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 05/07/2018] [Indexed: 11/29/2022] Open
Abstract
The vestibular system is involved in gaze stabilization and standing balance control. However, it is unclear whether vestibular dysfunction affects both processes to a similar extent. Therefore, the objective of this study was to determine how the reliance on vestibular information during standing balance control is related to gaze stabilization deficits in patients with vestibular dysfunction. Eleven patients with vestibular dysfunction and twelve healthy subjects were included. Gaze stabilization deficits were established by spontaneous nystagmus examination, caloric test, rotational chair test, and head impulse test. Standing balance control was assessed by measuring the body sway (BS) responses to continuous support surface rotations of 0.5° and 1.0° peak-to-peak while subjects had their eyes closed. A balance control model was fitted on the measured BS responses to estimate balance control parameters, including the vestibular weight, which represents the reliance on vestibular information. Using multivariate analysis of variance, balance parameters were compared between patients with vestibular dysfunction and healthy subjects. Robust regression was used to investigate correlations between gaze stabilization and the vestibular weight. Our results showed that the vestibular weight was smaller in patients with vestibular dysfunction than in healthy subjects (F = 7.67, p = 0.011). The vestibular weight during 0.5° peak-to-peak support surface rotations decreased with increasing spontaneous nystagmus eye velocity (ρ = −0.82, p < 0.001). In addition, the vestibular weight during 0.5° and 1.0° peak-to-peak support surface rotations decreased with increasing ocular response bias during rotational chair testing (ρ = −0.72, p = 0.02 and ρ = −0.67, p = 0.04, respectively). These findings suggest that the reliance on vestibular information during standing balance control decreases with the severity of vestibular dysfunction. We conclude that particular gaze stabilization tests may be used to predict the effect of vestibular dysfunction on standing balance control.
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Affiliation(s)
- Joost van Kordelaar
- Department of Biomechanical Engineering, Institute for Biomedical Technology and Technical Medicine (MIRA), University of Twente, Enschede, Netherlands.,Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
| | - Jantsje H Pasma
- Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
| | - Massimo Cenciarini
- Department of Neurology, University Medical Center Freiburg, Freiburg, Germany
| | - Alfred C Schouten
- Department of Biomechanical Engineering, Institute for Biomedical Technology and Technical Medicine (MIRA), University of Twente, Enschede, Netherlands.,Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
| | - Herman van der Kooij
- Department of Biomechanical Engineering, Institute for Biomedical Technology and Technical Medicine (MIRA), University of Twente, Enschede, Netherlands.,Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
| | - Christoph Maurer
- Department of Neurology, University Medical Center Freiburg, Freiburg, Germany
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17
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The Effect of Peripheral Vestibular Recovery on Improvements in Vestibulo-ocular Reflexes and Balance Control After Acute Unilateral Peripheral Vestibular Loss. Otol Neurotol 2018; 38:e531-e538. [PMID: 29135873 DOI: 10.1097/mao.0000000000001477] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients with an acute unilateral peripheral vestibular deficit (aUPVD), presumed to be caused by vestibular neuritis, show asymmetrical vestibular ocular reflexes (VORs) that improve over time. Questions arise regarding how much of the VOR improvement is due to peripheral recovery or central compensation, and whether differences in peripheral recovery influence balance control outcomes. METHODS Thirty patients were examined at aUPVD onset and 3, 6, and 13 weeks later with four different VOR tests: caloric tests; rotating (ROT) chair tests performed in yaw with angular accelerations of 5 and 20 degrees/s; and video head impulse tests (vHIT) in the yaw plane. ROT and vHIT responses and balance control of 11 patients who had a caloric canal paresis (CP) more than 90% at aUPVD onset and no CP recovery (no-CPR) at 13 weeks in caloric tests were compared with those of 19 patients with CP recovery (CPR) to less than 30%, on average. Balance control was measured with a gyroscope system (SwayStar) recording trunk sway during stance and gait tasks. RESULTS ROT and vHIT asymmetries of no-CPR and CPR patients reduced over time. The reduction was less at 13 weeks (36.2% vs. 83.5% on average) for the no-CPR patients. The no-CPR group asymmetries at 13 weeks were greater than those of CPR patients who had normal asymmetries. The greater asymmetries were caused by weaker deficit side responses which remained deficient in no-CPR patients at 13 weeks. Contra-deficit side vHIT and ROT responses remained normal. For all balance tests, sway was slightly greater for no-CPR compared with CPR patients at aUPVD onset and 3 weeks later. At 13 weeks, only sway during walking eyes closed was greater for the no-CPR group. A combination of 5 degrees/s ROT and balance tests could predict at onset (90% accuracy) which patients would have no-CPR at 13 weeks. CONCLUSIONS These results indicate that for ROT and vHIT tests, central compensation is observed in CPR and no-CPR patients. It acts primarily by increasing deficit side responses. Central compensation provides approximately 60% of the VOR improvement for CPR patients. The rest of the improvement is due to peripheral recovery which appears necessary to reduce VOR asymmetry to normal at 13 weeks on average. Balance control improvement is more rapid than that of the VOR and marginally affected by the lack of peripheral recovery. Both VOR and balance control measures at onset provide indicators of future peripheral recovery. For these reasons VOR and balance control needs to be tested at aUPVD onset and at 13 weeks.
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18
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Postural Stability Evaluation of Patients Undergoing Vestibular Schwannoma Microsurgery Employing the Inertial Measurement Unit. JOURNAL OF HEALTHCARE ENGINEERING 2018; 2018:2818063. [PMID: 29849995 PMCID: PMC5932418 DOI: 10.1155/2018/2818063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 02/19/2018] [Accepted: 03/06/2018] [Indexed: 11/18/2022]
Abstract
The article focuses on a noninvasive method and system of quantifying postural stability of patients undergoing vestibular schwannoma microsurgery. Recent alternatives quantifying human postural stability are rather limited. The major drawback is that the posturography system can evaluate only two physical quantities of body movement and can be measured only on a transverse plane. A complex movement pattern can be, however, described more precisely while using three physical quantities of 3-D movement. This is the reason why an inertial measurement unit (Xsens MTx unit), through which we obtained 3-D data (three Euler angles or three orthogonal accelerations), was placed on the patient's trunk. Having employed this novel method based on the volume of irregular polyhedron of 3-D body movement during quiet standing, it was possible to evaluate postural stability. To identify and evaluate pathological balance control of patients undergoing vestibular schwannoma microsurgery, it was necessary to calculate the volume polyhedron using the 3-D Leibniz method and to plot three variables against each other. For the needs of this study, measurements and statistical analysis were made on nine patients. The results obtained by the inertial measurement unit showed no evidence of improvement in postural stability shortly after surgery (4 days). The results were consistent with the results obtained by the posturography system. The evaluated translation variables (acceleration) and rotary variables (angles) measured by the inertial measurement unit correlate strongly with the results of the posturography system. The proposed method and application of the inertial measurement unit for the purpose of measuring patients with vestibular schwannoma appear to be suitable for medical practice. Moreover, the inertial measurement unit is portable and, when compared to other traditional posturography systems, economically affordable. Inertial measurement units can alternatively be implemented in mobile phones or watches.
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19
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Recovery of Vestibulo-Ocular Reflex Symmetry After an Acute Unilateral Peripheral Vestibular Deficit: Time Course and Correlation With Canal Paresis. Otol Neurotol 2017; 37:772-80. [PMID: 27159843 DOI: 10.1097/mao.0000000000001054] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We investigated how response asymmetries and deficit side response amplitudes for head accelerations used clinically to test the vestibular ocular reflex (VOR) are correlated with caloric canal paresis (CP) values. METHODS 30 patients were examined at onset of an acute unilateral peripheral vestibular deficit (aUPVD) and 3, 6, and 13 weeks later with three different VOR tests: caloric, rotating chair (ROT), and video head impulse tests (vHIT). Response changes over time were fitted with an exponential decay model and compared with using linear regression analysis. RESULTS Recovery times (to within 10% of steady state) were similar for vHIT-asymmetry and CP (>10 weeks) but shorter for ROT asymmetry (<4 weeks). Regressions with CP were similar (vHIT asymmetry, R = 0.68, ROT, R = 0.62). Responses to the deficit side were also equally well correlated with CP values (R = 0.71). Specificity for vHIT and 20 degrees/s ROT deficit side responses was 100% in comparison to CP values, sensitivity was 74% for vHIT, 75% for ROT. A decrease in normal side responses occurred for ROT but not for vHIT at 3 weeks. Normal side responses were weekly correlated with CP for ROT (R = 0.49) but not for vHIT (R = 0.17). CONCLUSIONS These results indicate that vHIT deficit side VOR gains are slightly better correlated with CP values than ROT, probably because of similar recovery time courses of vHIT and caloric responses and the lack of normal side vHIT changes. However, specificity and sensitivity is the same for vHIT and ROT tests.
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20
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Welgampola MS, Akdal G, Halmagyi GM. Neuro-otology- some recent clinical advances. J Neurol 2016; 264:188-203. [PMID: 27632181 PMCID: PMC5225204 DOI: 10.1007/s00415-016-8266-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 07/25/2016] [Accepted: 08/09/2016] [Indexed: 11/26/2022]
Abstract
Vestibular disorders manifesting as vertigo, chronic dizziness and imbalance are common problems in neurological practice. Here, we review some recent interesting and important advances in diagnosis of vestibular disorders using the video head impulse test and in the management of benign positional vertigo and migrainous vertigo.
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Affiliation(s)
| | - Gülden Akdal
- Neurology Department, Dokuz Eylül University Hospital, Izmir, Turkey
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21
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de Abajo J, Perez-Fernandez N. First trial response to sudden support surface displacement: the effect of vestibular compensation. Acta Otolaryngol 2016; 135:1036-44. [PMID: 26004282 DOI: 10.3109/00016489.2015.1049293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION The effect of visual condition is more intense in the first trial response in normal subjects and patients and in last trial response only in patients. The first trial effect is more evident in compensated patients in the eyes open condition with any type of perturbation, and in non-compensated patients with the angular displacements in either visual condition. OBJECTIVE The study of body reaction to FTR can help to understand the complex mechanisms involved in the postural response and to develop new therapies to improve stability and prevent falls in unilateral vestibular deficit (UVD). This work describes the adaptation effect and the visual influence on the postural response to repetitive balance perturbation stimulus in normal subjects, compensated, and uncompensated UVD patients. METHODS The magnitude of displacement has been measured when the support surface is linearly or angularly displaced. The differences between results in the first and late trial, and the differences between the eyes open and eyes closed situation have been compared. RESULTS Compensated patients recover the adaptation ability to unexpected changes on the support surface through visual preference mechanism. Not compensated patients present hypermetric postural response with greater instability in the eyes open and eyes closed situations.
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Affiliation(s)
- Jorge de Abajo
- Clínica Universidad de Navarra, Otorhinolaryngology , Pamplona , Spain
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22
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KUTILEK PATRIK, CAKRT ONDREJ, SOCHA VLADIMIR, HANA KAREL. VOLUME OF CONVEX HULL: A TECHNIQUE FOR QUANTIFYING HUMAN POSTURAL STABILITY. J MECH MED BIOL 2016. [DOI: 10.1142/s0219519416500135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Many disorders, such as nervous system disorders, can affect orientation of the body segments in 3D space negatively. Patients with these disorders often show body segments instability during stance tasks. Nowadays, 3-axis gyroscopes are about to be used to measure postural stability. The main objective of the paper is to describe a method which would be suitable for quantifying postural stability and 3D movement as a whole using a cheap 3-axis gyroscope. New method based on the volume of a 3D convex hull (CH) obtained by plotting pitch, roll and yaw angles versus each other was proposed for quantitative evaluation of 3D trunk sway. The sway was measured while patients with degenerative cerebellar disorder (Pts) and eleven healthy subjects (HSs) performed quiet stance on a firm surface (FiS) and foam surface (FoS) with open eyes (OE) and closed eyes (CE). The CH was used to identify differences in balance control, and there were significant differences found between the two groups. The median (Mdn) of the volume of Pts with OE on FiS is four times larger than the Mdn of the volume of HS with OE on FiS. The Mdn of the volume of Pts with CE on FoS is 80 times larger than the Mdn of the volume of HS with CE on FoS. It was therefore found that the volume of CH is suitable for quantifying postural sway and identifying differences in balance control.
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Affiliation(s)
- PATRIK KUTILEK
- Czech Technical University in Prague, Faculty of Biomedical Engineering, Sitna Sq. 3105, Kladno, Czech Republic
| | - ONDREJ CAKRT
- Czech Technical University in Prague, Faculty of Biomedical Engineering, Sitna Sq. 3105, Kladno, Czech Republic
- University Hospital Motol, Charles University in Prague, Department of Rehabilitation and Sport Medicine, 2nd Faculty of Medicine, V Uvalu 84, Prague, Czech Republic
| | - VLADIMIR SOCHA
- Czech Technical University in Prague, Faculty of Biomedical Engineering, Sitna Sq. 3105, Kladno, Czech Republic
| | - KAREL HANA
- Czech Technical University in Prague, Faculty of Biomedical Engineering, Sitna Sq. 3105, Kladno, Czech Republic
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23
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Scheltinga A, Honegger F, Timmermans DPH, Allum JHJ. The Effect of Age on Improvements in Vestibulo-Ocular Reflexes and Balance Control after Acute Unilateral Peripheral Vestibular Loss. Front Neurol 2016; 7:18. [PMID: 26925031 PMCID: PMC4757818 DOI: 10.3389/fneur.2016.00018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 02/05/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND An acute unilateral peripheral vestibular loss (aUVL) initially causes severe gaze and balance control problems. However, vestibulo-ocular reflexes (VOR) and balance control are nearly normal 3 months later as a result of peripheral recovery and/or central compensation. As pre-existing vestibular sensory loss is assumed to be greater in the healthy elderly, this study investigated whether improvements in VOR and balance function over time after aUVL are different for the elderly than for the young. METHODS Thirty aUVL patients divided into three age-groups were studied (8 age range 23-35, 10 with range 43-58, and 12 with range 60-74 years). To measure VOR function eye movements were recorded during caloric irrigation, rotating chair (ROT), and head impulse tests. Balance control during stance and gait was recorded as lower trunk angular velocity in the pitch and roll planes. Measurements were taken at deficit onset, and 3, 6, and 13 weeks later. RESULTS There was one difference in VOR improvements over time between the age-groups: Low acceleration ROT responses were less at onset in the elderly group. Deficit side VOR responses and asymmetries in each group improved to within ranges of healthy controls at 13 weeks. Trunk sway of the elderly was greater for stance and gait at onset when compared to healthy age-matched controls and the young and greater than that of the young and controls during gait tasks at 13 weeks. The sway of the young was not different from controls at either time point. Balance control for the elderly improved slower than for the young. CONCLUSION These results indicate that VOR improvement after an aUVL does not differ with age, except for low accelerations. Recovery rates are different between age-groups for balance control tests. Balance control in the elderly is more abnormal at aUVL onset for stance and gait tasks with the gait abnormalities remaining after 13 weeks. Thus, we conclude that balance control in the elderly is more affected by the UVL than for the young, and the young overcome balance deficits more rapidly. These differences with age should be taken into account when planning rehabilitation.
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Affiliation(s)
- Alja Scheltinga
- Division of Audiology and Neurootology, Department of ORL, University Hospital of Basel, Basel, Switzerland
- Radboud University, Nijmegen, Netherlands
| | - Flurin Honegger
- Division of Audiology and Neurootology, Department of ORL, University Hospital of Basel, Basel, Switzerland
| | - Dionne P. H. Timmermans
- Division of Audiology and Neurootology, Department of ORL, University Hospital of Basel, Basel, Switzerland
- Radboud University, Nijmegen, Netherlands
| | - John H. J. Allum
- Division of Audiology and Neurootology, Department of ORL, University Hospital of Basel, Basel, Switzerland
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Anson E, Jeka J. Perspectives on Aging Vestibular Function. Front Neurol 2016; 6:269. [PMID: 26779116 PMCID: PMC4701938 DOI: 10.3389/fneur.2015.00269] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 12/14/2015] [Indexed: 01/10/2023] Open
Abstract
Much is known about age-related anatomical changes in the vestibular system. Knowledge regarding how vestibular anatomical changes impact behavior for older adults continues to grow, in line with advancements in diagnostic testing. However, despite advancements in clinical diagnostics, much remains unknown about the functional impact that an aging vestibular system has on daily life activities such as standing and walking. Modern diagnostic tests are very good at characterizing neural activity of the isolated vestibular system, but the tests themselves are artificial and do not reflect the multisensory aspects of natural human behavior. Also, the majority of clinical diagnostic tests are passively applied because active behavior can enhance performance. In this perspective paper, we review anatomical and behavioral changes associated with an aging vestibular system and highlight several areas where a more functionally relevant perspective can be taken. For postural control, a multisensory perturbation approach could be used to bring balance rehabilitation into the arena of precision medicine. For walking and complex gaze stability, this may result in less physiologically specific impairments, but the trade-off would be a greater understanding of how the aging vestibular system truly impacts the daily life of older adults.
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Affiliation(s)
- Eric Anson
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins Medical Institutes , Baltimore, MD , USA
| | - John Jeka
- Department of Kinesiology, Temple University, Philadelphia, PA, USA; Department of Bioengineering, Temple University, Philadelphia, PA, USA
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Alsalaheen B, Haines J, Yorke A, Diebold J. King-Devick Test reference values and associations with balance measures in high school American football players. Scand J Med Sci Sports 2015; 26:235-9. [PMID: 26648587 DOI: 10.1111/sms.12628] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2015] [Indexed: 11/30/2022]
Abstract
The King-Devick test appears to be a promising tool in screening for concussions. However, limited evidence exists on the baseline associations between the K-D test and age and baseline screening tools used after concussion. Additionally, there are no published reference values for the K-D test in high school football players. The K-D test, the Balance Error Scoring System, and the Limits of Stability (LOS) test were administered to 157 high school football players. Additionally, a subsample of 62 participants completed the test twice to examine the reliability of K-D test. There was no relationship between the K-D test and the BESS, or the reaction time and directional control of LOS test. Students aged between 16 and 18 years demonstrated faster K-D test performance compared to students between 13 and 15 years of age. However, there was no association between K-D test and history of concussion. The reliability of the K-D test was (ICC2,1 = 0.89), and the minimal detectable change was 6.10 s. Normative reference values for high school football players are presented in this study.
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Affiliation(s)
- B. Alsalaheen
- Department of Physical Therapy; University of Michigan-Flint; Flint MI USA
| | - J. Haines
- Department of Physical Therapy; University of Michigan-Flint; Flint MI USA
| | - A. Yorke
- Department of Physical Therapy; University of Michigan-Flint; Flint MI USA
| | - J. Diebold
- Department of Physical Therapy; University of Michigan-Flint; Flint MI USA
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26
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Angeli SI, Snapp H, Velandia S, Morgenstein K. Utricular paresis and semicircular canal hyperactivity: a distinct otolith syndrome. Acta Otolaryngol 2015; 135:335-41. [PMID: 25740102 DOI: 10.3109/00016489.2014.985798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS Although combined utricular and canal paresis has been described previously, this is the first report of canal hyperactivity associated with utricular hypofunction. Unsteadiness and swaying were the most common symptoms, and patients with shorter duration of symptoms also had positional vertigo. We propose that this syndrome is a variant of utricular dysfunction and should be considered in the differential diagnosis of peripheral vestibular disorders. OBJECTIVE To describe a syndrome of instability associated with utricular dysfunction and hyperactive caloric responses. METHODS The study comprised 11 consecutive patients exhibiting abnormalities of the eccentric subjective visual vertical test (e-SVV) and high responses during the caloric test of the videonystagmography (VNG). We carried out a review of symptoms, physical examination, and vestibular tests. RESULTS There was no gender predilection or obvious etiology. The patients' main complaint included instability with linear symptoms (i.e., tilting, rocking, and swaying), with positional vertigo as a secondary symptom. Oculomotor testing, visual fixation index, and brain MRI were normal, excluding a central nervous system disorder. VNG was essentially normal except for hyperactive responses during the caloric testing in all patients. Abnormal e-SVV was found in 10 patients unilaterally and bilaterally in 1 patient. Abnormal oVEMP was found in seven of seven patients, further supporting a utricular site of lesion.
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Affiliation(s)
- Simon I Angeli
- Department of Otolaryngology, University of Miami Miller School of Medicine , Miami, FL , USA
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27
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Mucha A, Collins MW, Elbin R, Furman JM, Troutman-Enseki C, DeWolf RM, Marchetti G, Kontos AP. A Brief Vestibular/Ocular Motor Screening (VOMS) assessment to evaluate concussions: preliminary findings. Am J Sports Med 2014; 42:2479-86. [PMID: 25106780 PMCID: PMC4209316 DOI: 10.1177/0363546514543775] [Citation(s) in RCA: 459] [Impact Index Per Article: 45.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Vestibular and ocular motor impairments and symptoms have been documented in patients with sport-related concussions. However, there is no current brief clinical screen to assess and monitor these issues. PURPOSE To describe and provide initial data for the internal consistency and validity of a brief clinical screening tool for vestibular and ocular motor impairments and symptoms after sport-related concussions. STUDY DESIGN Cross-sectional study; Level of evidence, 2. METHODS Sixty-four patients, aged 13.9 ± 2.5 years and seen approximately 5.5 ± 4.0 days after a sport-related concussion, and 78 controls were administered the Vestibular/Ocular Motor Screening (VOMS) assessment, which included 5 domains: (1) smooth pursuit, (2) horizontal and vertical saccades, (3) near point of convergence (NPC) distance, (4) horizontal vestibular ocular reflex (VOR), and (5) visual motion sensitivity (VMS). Participants were also administered the Post-Concussion Symptom Scale (PCSS). RESULTS Sixty-one percent of patients reported symptom provocation after at least 1 VOMS item. All VOMS items were positively correlated to the PCSS total symptom score. The VOR (odds ratio [OR], 3.89; P < .001) and VMS (OR, 3.37; P < .01) components of the VOMS were most predictive of being in the concussed group. An NPC distance ≥5 cm and any VOMS item symptom score ≥2 resulted in an increase in the probability of correctly identifying concussed patients of 38% and 50%, respectively. Receiver operating characteristic curves supported a model including the VOR, VMS, NPC distance, and ln(age) that resulted in a high predicted probability (area under the curve = 0.89) for identifying concussed patients. CONCLUSION The VOMS demonstrated internal consistency as well as sensitivity in identifying patients with concussions. The current findings provide preliminary support for the utility of the VOMS as a brief vestibular/ocular motor screen after sport-related concussions. The VOMS may augment current assessment tools and may serve as a single component of a comprehensive approach to the assessment of concussions.
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Affiliation(s)
| | | | | | | | | | | | | | - Anthony P. Kontos
- Address correspondence to: Anthony P. Kontos, PhD, UPMC Sports Medicine Concussion Program, University of Pittsburgh Medical Center, 3200 South Water Street, Pittsburgh, PA 15203, USA,
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28
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Angeli SI, Telischi FF, Eshraghi AA. Middle fossa vestibular neurectomy for refractory vertigo: less is more. Ann Otol Rhinol Laryngol 2014; 123:359-64. [PMID: 24769882 DOI: 10.1177/0003489414526684] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study aimed to evaluate outcomes of the middle fossa (MF) superior vestibular neurectomy in unilateral Ménière's disease. PATIENTS AND METHODS Case series with preoperative and postoperative analysis of the 1995 American Academy of Otolaryngology hearing stage and vertigo class, gait instability, and results of vestibular-evoked myogenic potentials (VEMP). RESULTS Four out of the 5 patients had total vertigo control (class A) and 1 had near total control (class B) by the last visit (mean follow-up, 23.6 months). There were no changes in hearing thresholds and hearing stage. Four patients had resolution of their gait instability by 2 months after surgery. Postoperative VEMP responses were preserved in all 3 patients with positive VEMP preoperatively. CONCLUSION This is the first report of the anatomical and functional preservation of the inferior vestibular nerve in vestibular neurectomy for the treatment of refractory vertigo in unilateral Ménière's disease, with VEMP testing before and after vestibular neurectomy. The modified technique limits the surgical dissection and may help avoid complications such as postoperative hearing loss and persistent gait instability. This approach is indicated when other more conservative measures have failed, and patient selection is paramount to avoid long-term complications.
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Affiliation(s)
- Simon I Angeli
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
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29
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Influence of perturbation velocity on balance control in Parkinson's disease. PLoS One 2014; 9:e86650. [PMID: 24466187 PMCID: PMC3899304 DOI: 10.1371/journal.pone.0086650] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 12/17/2013] [Indexed: 11/19/2022] Open
Abstract
Underlying somatosensory processing deficits of joint rotation velocities may cause patients with Parkinson’s disease (PD) to be more unstable for fast rather than slow balance perturbations. Such deficits could lead to reduced proprioceptive amplitude feedback triggered by perturbations, and thereby to smaller or delayed stabilizing postural responses. For this reason, we investigated whether support surface perturbation velocity affects balance reactions in PD patients. We examined postural responses of seven PD patients (OFF medication) and eight age-matched controls following backward rotations of a support-surface platform. Rotations occurred at three different speeds: fast (60 deg/s), medium (30 deg/s) or slow (3.8 deg/s), presented in random order. Each subject completed the protocol under eyes open and closed conditions. Full body kinematics, ankle torques and the number of near-falls were recorded. Patients were significantly more unstable than controls following fast perturbations (26% larger displacements of the body’s centre of mass; P<0.01), but not following slow perturbations. Also, more near-falls occurred in patients for fast rotations. Balance correcting ankle torques were weaker for patients than controls on the most affected side, but were stronger than controls for the least affected side. These differences were present both with eyes open and eyes closed (P<0.01). Fast support surface rotations caused greater instability and discriminated Parkinson patients better from controls than slow rotations. Although ankle torques on the most affected side were weaker, patients partially compensated for this by generating larger than normal stabilizing torques about the ankle joint on the least affected side. Without this compensation, instability may have been greater.
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Relation Between Head Impulse Tests, Rotating Chair Tests, and Stance and Gait Posturography After an Acute Unilateral Peripheral Vestibular Deficit. Otol Neurotol 2013; 34:980-9. [DOI: 10.1097/mao.0b013e31829ce5ec] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Vestibular loss as a contributor to Alzheimer's disease. Med Hypotheses 2013; 80:360-7. [PMID: 23375669 DOI: 10.1016/j.mehy.2012.12.023] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 12/06/2012] [Accepted: 12/25/2012] [Indexed: 01/29/2023]
Abstract
Alzheimer's disease is a complex disorder whose etiology is still controversial. It is proposed that vestibular loss may contribute to the onset of Alzheimer's disease, which initially involves degeneration of cholinergic systems in the posterior parietal-temporal, medial-temporal, and posterior-cingulate regions. A major projection to this system emanates from the semicircular canals of the vestibular labyrinth, with vestibular damage leading to severe degeneration of the medial-temporal region. The vestibular loss hypothesis is further supported by the vestibular symptoms found in Alzheimer's patients as well as in various diseases that are major risk factors for Alzheimer's disease.
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Petrofsky JS, Alshammari F, Lee H, Yim JE, Bains G, Khowailed IA, Deshpande PP, Potnis P, Tse F, Cavalcanti P. Electroencephalography to assess motor control during balance tasks in people with diabetes. Diabetes Technol Ther 2012; 14:1068-76. [PMID: 22934800 DOI: 10.1089/dia.2012.0152] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Balance is sensed through peripheral and central receptors and mediated by central control through the brain and spinal cord. Although some evidence exists as to the areas of the brain involved and how processing of data occurs in young individuals, nothing has been published on people with diabetes. The purpose of this study was to examine the electroencephalogram (EEG) during common sensorimotor and balance training tasks and to relate these to task difficulty. SUBJECTS AND METHODS Postural sway and EEG change of alpha, beta, and sigma wave bands were measured in 17 young subjects, 10 older subjects, and 10 subjects with diabetes during eight progressively more difficult balance tasks with eyes open and closed, feet in tandem or apart, and on foam or a firm surface. RESULTS EEG power of beta and sigma wave bands showed significant increases on the cortical and parietal areas of the brain relative to the control tasks when eyes were open (P<0.05). The cortical involvement decreased as the task became more difficult with vision and somatosensory information reduced, whereas that of the parietal area increased with task difficulty. The greatest increase was in subjects with diabetes, and the least was in younger people. Individuals with diabetes had increased sigma and beta EEG power in all regions of the brain examined with increased complexity of the balance task. CONCLUSIONS This study demonstrated cortical and parietal involvement in static balance tasks commonly used in sensorimotor training. The results support the proposal that there was increased subcortical control with increase in task difficulty in the young subjects, but in subjects with diabetes, there was a major increase in activity across the brain.
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Affiliation(s)
- Jerrold S Petrofsky
- Department of Physical Therapy, School of Allied Health Professions, Loma Linda University, Loma Linda, California 92350, USA.
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