Dataset Information

Accuracy of the bedside head impulse test in detecting vestibular hypofunction.

ABSTRACT:

Objective

To determine the accuracy of the bedside head impulse test (bHIT) by direct comparison with results from the quantitative head impulse test (qHIT) in the same subjects, and to investigate whether bHIT sensitivity and specificity changes with neuro-otological training.

Methods

Video clips of horizontal bHIT to both sides were produced in patients with unilateral and bilateral peripheral vestibular deficits (n = 15) and in healthy subjects (n = 9). For qHIT, eye and head movements were recorded with scleral search coils on the right eye and the forehead. Clinicians (neurologists or otolaryngologists) with at least 6 months of neuro-otological training ("experts": n = 12) or without this training ("non-experts": n = 45) assessed video clips for ocular motor signs of vestibular deficits on either side or of normal vestibular function.

Results

On average, bHIT sensitivity was significantly (t test: p<0.05) lower for experts than for non-experts (63% vs 72%), while bHIT specificity was significantly higher for experts than non-experts (78% vs 64%). This outcome was a consequence of the experts' tendency to accept bHIT with corresponding borderline qHIT values as still being normal. Fitted curves revealed that at the lower normal limit of qHIT, 20% of bHIT were rated as deficient by the experts and 37% by the non-experts.

Conclusions

When qHIT is used as a reference, bHIT sensitivity is adequate and therefore clinically useful in the hands of both neuro-otological experts and non-experts. We advise performing quantitative head impulse testing with search coils or high speed video methods when bHIT is not conclusive.

SUBMITTER: Jorns-Haderli M

PROVIDER: S-EPMC2117540 | biostudies-literature | 2007 Oct

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Accuracy of the bedside head impulse test in detecting vestibular hypofunction.

Jorns-Häderli M M Straumann D D Palla A A

Journal of neurology, neurosurgery, and psychiatry 20070112 10

<h4>Objective</h4>To determine the accuracy of the bedside head impulse test (bHIT) by direct comparison with results from the quantitative head impulse test (qHIT) in the same subjects, and to investigate whether bHIT sensitivity and specificity changes with neuro-otological training.<h4>Methods</h4>Video clips of horizontal bHIT to both sides were produced in patients with unilateral and bilateral peripheral vestibular deficits (n = 15) and in healthy subjects (n = 9). For qHIT, eye and head m ...[more]

PMID: 17220287

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Project description:ObjectivesVirtual reality (VR) offers an ecological setting and the possibility of altered visual feedback during head movements useful for vestibular research and treatment of vestibular disorders. There is however no data quantifying vestibulo-ocular reflex (VOR) during head impulse test (HIT) in VR. The main objective of this study is to assess the feasibility and performance of eye and head movement measurements of healthy subjects in a VR environment during high velocity horizontal head rotation (VR-HIT) under a normal visual feedback condition. The secondary objective is to establish the feasibility of VR-HIT recordings in the same group of normal subjects but under altered visual feedback conditions.DesignTwelve healthy subjects underwent video HIT using both a standard setup (vHIT) and VR-HIT. In VR, eye and head positions were recorded by using, respectively, an imbedded eye tracker and an infrared motion tracker. Subjects were tested under four conditions, one reproducing normal visual feedback and three simulating an altered gain or direction of visual feedback. During these three altered conditions the movement of the visual scene relative to the head movement was decreased in amplitude by 50% (half), was nullified (freeze) or was inverted in direction (inverse).ResultsEye and head motion recording during normal visual feedback as well as during all 3 altered conditions was successful. There was no significant difference in VOR gain in VR-HIT between normal, half, freeze and inverse conditions. In the normal condition, VOR gain was significantly but slightly (by 3%) different for VR-HIT and vHIT. Duration and amplitude of head impulses were significantly greater in VR-HIT than in vHIT. In all three altered VR-HIT conditions, covert saccades were present in approximatively one out of four trials.ConclusionOur VR setup allowed high quality recording of eye and head data during head impulse test under normal and altered visual feedback conditions. This setup could be used to investigate compensation mechanisms in vestibular hypofunction, to elicit adaptation of VOR in ecological settings or to allow objective evaluation of VR-based vestibular rehabilitation.

Project description:ObjectiveTo determine whether saccadic velocity in the suppression head impulse paradigm (SHIMP) test is a reliable indicator of vestibular loss at the acute and at the chronic stage in patients suffering from different vestibular pathologies.MethodsThirty-five normal subjects and 57 patients suffering from different vestibular pathologies associated with unilateral vestibular loss (UVL) or bilateral vestibular loss (BVL) were tested in the SHIMPs paradigm. SHIMPs were performed by turning the head 10 times at high velocities to the left or right side, respectively. The patients were instructed to fixate on a red spot generated by a head-fixed laser projected on the wall. In this SHIMPs paradigm, healthy subjects made a large anti-compensatory saccade at the end of the head turn (a SHIMP saccade). The peak saccadic velocity, the percentage of the trials completed with saccades in 10 trials, and the latency of the saccades were quantified in each group. A video-head impulse test (v-HIT) was systematically performed in all of our subjects as well as a caloric test. The dizziness handicap inventory questionnaire was also given to chronic UVL and BVL patients.ResultsAt the acute stage after a complete UVL, patients had zero or a few anti-compensatory saccades for low velocity head turns toward the lesioned side. These saccades had lower velocity than the anti-compensatory saccades recorded during head rotation toward the intact side and/or compared with the saccades measured in control subjects. At the chronic stage, some of the patients recovered the ability to perform SHIMP saccades at each head turn toward the lesioned side, but very often these saccades were of significantly lower velocity. In BVL patients, no anti-compensatory saccades, or only significantly smaller ones, could be detected for head turns to both sides.ConclusionSHIMP is a specific and sensitive test to detect a complete horizontal canal loss at the acute stage. In addition, it reflects the ability of patients with moderate horizontal vestibulo-ocular reflex gain decrease to generate anti-compensatory saccades in the chronic stage. In association with v-HIT, it allows determination of the residual vestibular function and to detect anti-compensatory saccades.

Project description:Importance:Individuals with vestibular hypofunction acutely restrict head motion to reduce symptoms of dizziness and nausea. This restriction results in abnormal decoupling of head motion from trunk motion, but the character, magnitude, and persistence of these deficits are unclear. Objective:To use wearable inertial sensors to quantify the extent of head and trunk kinematic abnormalities in the subacute stage after resection of vestibular schwannoma (VS) and the particular areas of deficit in head-trunk motion. Design, Setting, and Participants:This cross-sectional observational study included a convenience sample of 20 healthy adults without vestibular impairment and a referred sample of 14 adults 4 to 8 weeks after resection of a unilateral VS at a university and a university hospital outpatient clinic. Data were collected from November 12, 2015, through November 17, 2016. Exposures:Functional gait activities requiring angular head movements, including items from the Functional Gait Assessment (FGA; range, 1-30, with higher scores indicating better performance), the Timed Up & Go test (TUG; measured in seconds), and a 2-minute walk test (2MWT; measured in meters). Main Outcomes and Measures:Primary outcomes included peak head rotation amplitude (in degrees), peak head rotation velocity (in degrees per second), and percentage of head-trunk coupling. Secondary outcomes were activity and participation measures including gait speed, FGA score, TUG time, 2MWT distance, and the Dizziness Handicap Inventory score (range, 0-100, with higher scores indicating worse performance). Results:A total of 34 participants (14 men and 20 women; mean [SD] age, 39.3 [13.6] years) were included. Compared with the 20 healthy participants, the 14 individuals with vestibular hypofunction demonstrated mean (SD) reduced head turn amplitude (84.1° [15.5°] vs 113.2° [24.4°] for FGA-3), reduced head turn velocities (195.0°/s [75.9°/s] vs 358.9°/s [112.5°/s] for FGA-3), and increased head-trunk coupling (15.1% [6.5%] vs 5.9% [5.8%] for FGA-3) during gait tasks requiring angular head movements. Secondary outcomes were also worse in individuals after VS resection compared with healthy individuals, including gait speed (1.09 [0.27] m/s vs 1.47 [0.22] m/s), FGA score (20.5 [3.6] vs 30.0 [0.2]), TUG time (10.9 [1.7] s vs 7.1 [0.8] s), 2MWT (164.8 [37.6] m vs 222.6 [26.8] m), and Dizziness Handicap Inventory score (35.4 [20.7] vs 0.1 [0.4]). Conclusions and Relevance:With use of wearable sensors, deficits in head-trunk kinematics were characterized along with a spectrum of disability in individuals in the subacute stage after VS surgery compared with healthy individuals. Future research is needed to fully understand how patterns of exposure to head-on-trunk movements influence the trajectory of recovery of head-trunk coordination during community mobility.

Dataset Information

Accuracy of the bedside head impulse test in detecting vestibular hypofunction.

Objective

Methods

Results

Conclusions

Publications

Accuracy of the bedside head impulse test in detecting vestibular hypofunction.

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