Characterizing Patients with Unilateral Vestibular Hypofunction Using Kinematic Variability and Local Dynamic Stability during Treadmill Walking.
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ABSTRACT:
SUBMITTER: Liu P
PROVIDER: S-EPMC5530428 | biostudies-other | 2017
REPOSITORIES: biostudies-other
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Project description:The ability to move and maintain posture is critically dependent on motion and orientation information provided by the vestibular system. When this system delivers noisy or erred information it can, in some cases, be attenuated through habituation. Here we investigate whether multiple mechanisms of attenuation act to decrease vestibular gain due to noise added using supra-threshold random-waveform galvanic vestibular stimulation (GVS). Forty-five participants completed one of three conditions. Each condition consisted of two 4-min standing periods with stimulation surrounding a 1-h period of either walking with stimulation, walking without stimulation, or sitting quietly. An instrumented treadmill recorded horizontal forces at the feet during standing and walking. We quantified response attenuation to GVS by comparing vestibular stimulus-horizontal force gain between conditions. First stimulus exposure caused an 18% decrease in gain during the first 40 s of standing. Attenuation recommenced only when subjects walked with stimulation, resulting in a 38% decrease in gain over 60 min that did not transfer to standing following walking. The disparity in attenuation dynamics and absent carry over between standing and walking suggests that two mechanisms of attenuation, one associated with first exposure to the stimulus and another that is task specific, may act to decrease vestibulomotor gain.
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Project description:BackgroundWe aimed to analyze the effect of a physical therapy protocol on unilateral vestibular hypofunction and overall balance in elderly with vertigo.MethodsThe study included nine subjects, four male subjects (68.5 ± 11.09 years old) and five females (72.4 ± 7.09 years old). It was used the performance-oriented Mobility Assessment (POMA), to evaluate the balance and the Unterberger - Fukuda test for analysis of unilateral vestibular dysfunction through rotations and displacements of the body. We developed and applied a structured physical therapy protocol, consisting of group exercises.ResultsIt was observed that after the protocol, all participants improved balance (33.9 ± 5.1 vs. 47.3 ± 7.6, p < 0.0001) and displacement (111.1 ± 38.0 vs. 53.3 ± 34.6, p = 0.0001). However, it was not found significant differences for rotation.ConclusionThe proposed protocol has contributed to an improvement in balance and vestibular dysfunction of the aged.
| S-EPMC3938970 | biostudies-literature
Project description:This pilot study aimed to identify postural strategies in response to sensory perturbations (visual, auditory, somatosensory) in adults with and without sensory loss. We tested people with unilateral peripheral vestibular hypofunction (N = 12, mean age 62 range 23-78), or with Unilateral Sensorineural Hearing Loss (USNHL, N = 9, 48, 22-82), or healthy controls (N = 21, 52, 28-80). Postural sway and head kinematics parameters (Directional Path in the anterior-posterior and medio-lateral directions (sway & head); pitch, yaw and roll (head) were analyzed in response to 2 levels of auditory (none, rhythmic sounds via headphones), visual (static, dynamic) and somatosensory cues (floor, foam) within a simulated, virtual 3-wall display of stars. We found no differences with the rhythmic auditory cues. The effect of foam was magnified in the vestibular group compared with controls for anterior-posterior and medio-lateral postural sway, and all head direction except for medio-lateral. The vestibular group had significantly larger anterior-posterior and medio-lateral postural sway and head movement on the static scene compared with controls. Differences in pitch, yaw and roll emerged between vestibular and controls only with sensory perturbations. The USNHL group did not increase their postural sway and head movement with the increased visual load as much as controls did, particularly when standing on the foam. They did not increase their medio-lateral sway with the foam as much as controls did. These findings suggest that individuals with USNHL employ a compensatory strategy of conscious control of balance, the functional implications of which need to be tested in future research.
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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.
| S-EPMC5710259 | biostudies-literature
Project description:ObjectiveTo systematically evaluate the full spectrum of self-reported chronic symptoms in patients with unilateral vestibular hypofunction (UVH) and to investigate the effect of interventions on these symptoms.MethodsA systematic review was conducted following the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Statement (PRISMA). A literature search was performed in Pubmed, Web of Science, Embase, and Scopus to investigate self-reported symptoms and self-report questionnaires in patients with UVH. All original studies ranging from full-text clinical trials to case reports, written in English, German, and French, were included. The frequency of self-reported symptoms was presented. For self-report questionnaires, a meta-analysis was carried out to synthesize scale means by the pre- and post-intervention means and mean changes for studies that investigated interventions.ResultsA total of 2,110 studies were retrieved. Forty-seven studies were included after title-abstract selection and full-text selection by two independent reviewers. The symptoms of UVH patients included chronic dizziness (98%), imbalance (81%), symptoms worsened by head movements (75%), visually induced dizziness (61%), symptoms worsened in darkness (51%), and oscillopsia (22%). Additionally, UVH could be accompanied by recurrent vertigo (77%), tiredness (68%), cognitive symptoms (58%), and autonomic symptoms (46%). Regarding self-report questionnaires, UVH resulted on average in a moderate handicap, with an estimated mean total score on the Dizziness Handicap Inventory (DHI) and the Vertigo Symptom Scale (VSS) of 46.31 (95% CI: 41.17-51.44) and 15.50 (95% CI: 12.59-18.41), respectively. In studies that investigated the effect of vestibular intervention, a significant decrease in the estimated mean total DHI scores from 51.79 (95% CI: 46.61-56.97) (pre-intervention) to 27.39 (95% CI: 23.16-31.62) (post intervention) was found (p < 0.0001). In three studies, the estimated mean total Visual Analog Scale (VAS) scores were 7.05 (95% CI, 5.64-8.46) (pre-intervention) and 2.56 (95% CI, 1.15-3.97) (post-intervention). Finally, a subgroup of patients (≥32%) persists with at least a moderate handicap, despite vestibular rehabilitation.ConclusionA spectrum of symptoms is associated with UVH, of which chronic dizziness and imbalance are most frequently reported. However, semi-structured interviews should be conducted to define the whole spectrum of UVH symptoms more precisely, in order to establish a validated patient-reported outcome measure (PROM) for UVH patients. Furthermore, vestibular interventions can significantly decrease self-reported handicap, although this is insufficient for a subgroup of patients. It could therefore be considered for this subgroup of patients to explore new intervention strategies like vibrotactile feedback or the vestibular implant.Systematic review registration[https://www.crd.york.ac.uk/prospero/], identifier [CRD42023389185].
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Project description:A single-blind study to investigate the effects of noisy galvanic vestibular stimulation (nGVS) in straight walking and 2 Hz head yaw walking for healthy and bilateral vestibular hypofunction (BVH) participants in light and dark conditions. The optimal stimulation intensity for each participant was determined by calculating standing stability on a force plate while randomly applying six graded nGVS intensities (0-1000 µA). The chest-pelvic (C/P) ratio and lateral deviation of the center of mass (COM) were measured by motion capture during straight and 2 Hz head yaw walking in light and dark conditions. Participants were blinded to nGVS served randomly and imperceivably. Ten BVH patients and 16 healthy participants completed all trials. In the light condition, the COM lateral deviation significantly decreased only in straight walking (p = 0.037) with nGVS for the BVH. In the dark condition, both healthy (p = 0.026) and BVH (p = 0.017) exhibited decreased lateral deviation during nGVS. The C/P ratio decreased significantly in BVH for 2 Hz head yaw walking with nGVS (p = 0.005) in light conditions. This study demonstrated that nGVS effectively reduced walking deviations, especially in visual deprived condition for the BVH. Applying nGVS with different head rotation frequencies and light exposure levels may accelerate the rehabilitation process for patients with BVH.Clinical Trial Registration This clinical trial was prospectively registered at www.clinicaltrials.gov with the Unique identifier: NCT03554941. Date of registration: (13/06/2018).
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Project description:Background: This study aimed to determine whether vestibular rehabilitation using active video games (Exergames), including promoted head turns and unsupported locomotion, may facilitate vestibular compensation and gait in subjects with one-sided chronic peripheral vestibular hypofunction (cPVH). Methods: 12 patients with cPVH (mean age of 65 ± 12 years, 8 male) were recruited for this study. The study consisted of a four-week baseline control period T1-T2 followed by a four-week intervention period T2-T3. The intervention included exergames that required physical tasks such as steps, weight shifts or balance control to cognitive challenges, in a virtual environment to play the game. The subjects participated in a total of 176 min of exergaming in eight sessions. Because of the changing projection direction of the game to the wall, the subjects had to turn their heads constantly while playing the game. Dynamic visual acuity (DVA) was assessed. Vestibulo-Ocular reflex (VOR) gain deficit and cumulative overt saccade amplitude (COSA) were measured with the video head-impulse test. Additionally, the functional gait assessment (FGA), Extended Timed Get-Up-and-Go (ETGUG), and the Dizziness handicap inventory (DHI), were assessed. Results: DVA showed no significant group level change (p = 0.475, z = -0.714, d = 0.295) with a small effect size and improvements in five out of 12 subjects. Ipsilesional VOR gain did not improve (p = 0.157, z = -1.414, d = 0.481) on group level while there was an intermediate effect size and improvements in six out of 12 subjects. COSA got significant smaller (p = 0.006, z = -2.746, d = 1.354) with improvements in seven out of 12 subjects. The contralesional sides did not change. The FGA for the group significantly improved with an intermediate effect size (p < 0.001, z = -3.08, d = 1.617) and five individuals showed clinically relevant improvements. The ETGUG group value improved significantly with a strong effect size (p < 0.001, z = -2.67, d = 1.030), with seven individuals contributing to this change. The DHI showed no change (p = 0.172, z = -1.381, d = 0.592) neither on the group nor on the individuals' level. The game scores of the subjects improved during the intervention period of the intervention for every game. Conclusion: The results of this study demonstrate that exergaming with promoted head turns facilitates vestibular compensation in some subjects with cPVH. This is the first study that shows an improvement in cumulative overt saccade amplitude after exergaming in chronic vestibular subjects.
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Project description:Although human gait is often assumed to be periodic, significant variability exists. This variability appears to provide different information than the underlying periodic signal, particularly about fall risk. Most studies on variability have either used step-to-step metrics such as stride duration or point-wise standard deviations, neither of which explicitly capture the joint-level variability as a function of time. This work demonstrates that a second-order Fourier series for stance joints and a first-order Fourier series for swing joints can accurately capture the variability in joint angles as a function of time on a per-step basis for overground walking at the self-selected speed. It further demonstrates that a total of seven normal distributions, four linear relationships, and twelve continuity constraints can be used to describe how the Fourier series vary between steps. The ability of the proposed method to create curves that match human joint-level variability was evaluated both qualitatively and quantitatively using randomly generated curves.
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