Dataset Information

Usability of the Video Head Impulse Test: Lessons From the Population-Based Prospective KORA Study.

ABSTRACT: Objective: The video head impulse test (vHIT) has become a common examination in the work-up for dizziness and vertigo. However, recent studies suggest a number of pitfalls, which seem to reduce vHIT usability. Within the framework of a population-based prospective study with naïve examiners, we investigated the relevance of previously described technical mistakes in vHIT testing, and the effect of experience and training. Methods: Data originates from the KORA (Cooperative Health Research in the Region of Augsburg) FF4 study, the second follow-up of the KORA S4 population-based health survey. 681 participants were selected in a case-control design. Three examiners without any prior experience were trained in video head impulse testing. VHIT quality was assessed weekly by an experienced neuro-otologist. Restrictive mistakes (insufficient technical quality restricting interpretation) were noted. Based on these results, examiners received further individual training. Results: Twenty-two of the 681 vHITs (3.2%) were not interpretable due to restrictive mistakes. Restrictive mistakes could be grouped into four categories: slippage, i.e., goggle movement relative to the head (63.6%), calibration problems (18.2%), noise (13.6%), and low velocity of the head impulse (4.6%). The overall rate of restrictive mistakes decreased significantly during the study (12% / examiner within the first 25 tested participants and 2.1% during the rest of the examinations, p < 0.0001). Conclusion: Few categories suffice to explain restrictive mistakes in vHIT testing. With slippage being most important, trainers should emphasize the importance of tight goggles. Experience and training seem to be effective in improving vHIT quality, leading to high usability.

SUBMITTER: Heuberger M

PROVIDER: S-EPMC6107793 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Usability of the Video Head Impulse Test: Lessons From the Population-Based Prospective KORA Study.

Heuberger Maria M Grill Eva E Saǧlam Murat M Ramaioli Cecilia C Müller Martin M Strobl Ralf R Holle Rolf R Peters Annette A Schneider Erich E Lehnen Nadine N

Frontiers in neurology 20180817

<b>Objective:</b> The video head impulse test (vHIT) has become a common examination in the work-up for dizziness and vertigo. However, recent studies suggest a number of pitfalls, which seem to reduce vHIT usability. Within the framework of a population-based prospective study with naïve examiners, we investigated the relevance of previously described technical mistakes in vHIT testing, and the effect of experience and training. <b>Methods:</b> Data originates from the KORA (Cooperative Health ...[more]

PMID: 30174641

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Project description:Importance:It is important to know whether recovery of the vestibuloocular reflex (VOR) as measured by the video head impulse test (vHIT) is associated with the recovery of dynamic balance. It is also critical to know how much change in VOR gain is clinically relevant for establishing the recovery of dynamic balance. Objectives:To investigate the association between improved VOR gain as measured by the vHIT and improved dynamic balance (reduced fall risk) as measured by the dynamic gait index (DGI) and to calculate the minimal clinically important difference of VOR gain. Design, Setting, and Participants:This retrospective case series study was performed at a tertiary referral center at the Johns Hopkins University School of Medicine. Thirty-eight consecutive patients with subacute or chronic dizziness from January 1, 2014, through May 31, 2017, who visited the vestibular physical therapy clinic were included in the study. Interventions:Each patient was evaluated with room light and video-infrared oculomotor examination, vHIT, and balance testing before and after vestibular physical therapy. Main Outcomes and Measures:Gain of the lesioned VOR and score on the DGI. Results:Among the 38 patients (25 women [66%]; mean [SD] age, 65 [14] years), the mean (SD) initial lesioned VOR gain was 0.66?(0.23) and initial DGI score was 16?(3). No correlation was found between initial VOR gain and initial DGI score (r?=?-0.04; 95% CI, -0.35 to 0.28). At follow-up, 15 patients (39%) had an improved VOR gain and 30 (79%) had an improved DGI score, which was correlated (r?=?0.49; 95% CI, 0.20-0.69). In those 15 patients with improved VOR gain, 14 (93%) had improvement of DGI score. In the 23 patients without improvement of VOR gain, 16 (70%) still showed improvement in their DGI score. When using VOR gain to estimate improvement of DGI, the minimal clinically important difference of VOR gain was -0.06. Conclusions and Relevance:The change of VOR gain in the vHIT was moderately associated with the change of DGI score. Improved VOR gain was associated with a high probability of improved dynamic balance. However, in most of the patients whose VOR gains did not improve, balance improvement occurred putatively through sensory reweighting strategies.

Project description:Background/hypothesisThe video Head Impulse Test (vHIT) is now widely used to test the function of each of the six semicircular canals individually by measuring the eye rotation response to an abrupt head rotation in the plane of the canal. The main measure of canal adequacy is the ratio of the eye movement response to the head movement stimulus, i.e., the gain of the vestibulo-ocular reflex (VOR). However, there is a need for normative data about how VOR gain is affected by age and also by head velocity, to allow the response of any particular patient to be compared to the responses of healthy subjects in their age range. In this study, we determined for all six semicircular canals, normative values of VOR gain, for each canal across a range of head velocities, for healthy subjects in each decade of life.Study designThe VOR gain was measured for all canals across a range of head velocities for at least 10 healthy subjects in decade age bands: 10-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80-89.MethodsThe compensatory eye movement response to a small, unpredictable, abrupt head rotation (head impulse) was measured by the ICS impulse prototype system. The same operator delivered every impulse to every subject.ResultsVestibulo-ocular reflex gain decreased at high head velocities, but was largely unaffected by age into the 80- to 89-year age group. There were some small but systematic differences between the two directions of head rotation, which appear to be largely due to the fact that in this study only the right eye was measured. The results are considered in relation to recent evidence about the effect of age on VOR performance.ConclusionThese normative values allow the results of any particular patient to be compared to the values of healthy people in their age range and so allow, for example, detection of whether a patient has a bilateral vestibular loss. VOR gain, as measured directly by the eye movement response to head rotation, seems largely unaffected by aging.

Dataset Information

Usability of the Video Head Impulse Test: Lessons From the Population-Based Prospective KORA Study.

Publications

Usability of the Video Head Impulse Test: Lessons From the Population-Based Prospective KORA Study.

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