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Wuehr M, Möhwald K, Zwergal A. [Gait disorders - What the general practitioner should know]. MMW Fortschr Med 2024; 166:56-62. [PMID: 38806926 DOI: 10.1007/s15006-024-3853-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Affiliation(s)
- Max Wuehr
- Ludwig--Maximilians-Universität München, Deutsches Schwindel- und Gleichgewichtszentrum (DSGZ), Marchioninistraße 15, 81377, München, Deutschland.
| | - Ken Möhwald
- Campus Großhadern, LMU, DSGZ, Klinikum der Universität München, Marchioninistraße 15, 81377, München, Deutschland
| | - Andreas Zwergal
- Neurolog. Klinik u. Deutsches Schwindel- u. Gleichgewichtszentrum, Universitätsklinikum München, Marchioninistraße 15, 81377, München, Deutschland
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Grouvel G, Boutabla A, Corre J, Revol R, Franco Carvalho M, Cavuscens S, Ranieri M, Cugnot JF, McCrum C, van de Berg R, Guinand N, Pérez Fornos A, Armand S. Full-body kinematics and head stabilisation strategies during walking in patients with chronic unilateral and bilateral vestibulopathy. Sci Rep 2024; 14:11757. [PMID: 38783000 PMCID: PMC11116555 DOI: 10.1038/s41598-024-62335-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 05/15/2024] [Indexed: 05/25/2024] Open
Abstract
Chronic imbalance is a frequent and limiting symptom of patients with chronic unilateral and bilateral vestibulopathy. A full-body kinematic analysis of the movement of patients with vestibulopathy would provide a better understanding of the impact of the pathology on dynamic tasks such as walking. Therefore, this study aimed to investigate the global body movement during walking, its variability (assessed with the GaitSD), and the strategies to stabilise the head (assessed with the head Anchoring Index). The full-body motion capture data of 10 patients with bilateral vestibulopathy (BV), 10 patients with unilateral vestibulopathy (UV), and 10 healthy subjects (HS) walking at several speeds (slow, comfortable, and fast) were analysed in this prospective cohort study. We observed only a few significant differences between groups in parts of the gait cycle (shoulder abduction-adduction, pelvis rotation, and hip flexion-extension) during the analysis of kinematic curves. Only BV patients had significantly higher gait variability (GaitSD) for all three walking speeds. Head stabilisation strategies depended on the plan of motion and walking speed condition, but BV and UV patients tended to stabilise their head in relation to the trunk and HS tended to stabilise their head in space. These results suggest that GaitSD could be a relevant biomarker of chronic instability in BV and that the head Anchoring Index tends to confirm clinical observations of abnormal head-trunk dynamics in patients with vestibulopathy while walking.
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Affiliation(s)
- Gautier Grouvel
- Division of Otorhinolaryngology Head and Neck Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
| | - Anissa Boutabla
- Division of Otorhinolaryngology Head and Neck Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Julie Corre
- Division of Otorhinolaryngology Head and Neck Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Rebecca Revol
- Division of Otorhinolaryngology Head and Neck Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Marys Franco Carvalho
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Samuel Cavuscens
- Division of Otorhinolaryngology Head and Neck Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Maurizio Ranieri
- Division of Otorhinolaryngology Head and Neck Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Jean-François Cugnot
- Division of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Christopher McCrum
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Raymond van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Nils Guinand
- Division of Otorhinolaryngology Head and Neck Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Angélica Pérez Fornos
- Division of Otorhinolaryngology Head and Neck Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Stéphane Armand
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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Wuehr M, Eder J, Kellerer S, Amberger T, Jahn K. Mechanisms underlying treatment effects of vestibular noise stimulation on postural instability in patients with bilateral vestibulopathy. J Neurol 2024; 271:1408-1415. [PMID: 37973635 PMCID: PMC10896912 DOI: 10.1007/s00415-023-12085-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Previous studies indicate that imbalance in patients with bilateral vestibulopathy (BVP) may be reduced by treatment with low-intensity noisy galvanic vestibular stimulation (nGVS). OBJECTIVE To elucidate the potential mechanisms underlying this therapeutic effect. In particular, we determined whether nGVS-induced balance improvements in patients are compatible with stochastic resonance (SR)-a mechanism by which weak noise stimulation can paradoxically enhance sensory signal processing. METHODS Effects of nGVS of varying intensities (0-0.7 mA) on body sway were examined in 19 patients with BVP standing with eye closed on a posturographic force plate. We assumed a bell-shaped response curve with maximal sway reductions at intermediate nGVS intensities to be indicative of SR. An established SR curve model was fitted on individual patient outcomes, and three experienced human raters had to judge whether responses to nGVS were consistent with the exhibition of SR. RESULTS nGVS-induced reductions of body sway compatible with SR were found in 12 patients (63%) with optimal improvements of 31 ± 21%. In 10 patients (53%), nGVS-induced sway reductions exceeded the minimally important clinical difference (optimal improvement: 35 ± 21%), indicative of strong SR. This beneficial effect was more likely in patients with severe vestibular loss (i.e. lower video head impulse test gain; R = 0.663; p = 0.002) and considerable postural imbalance (baseline body sway; R = 0.616; p = 0.005). CONCLUSIONS More than half of the assessed patients showed robust improvements in postural balance compatible with SR when treated with nGVS. In particular, patients with a higher burden of disease may benefit from the non-invasive and well-tolerated treatment with nGVS.
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Affiliation(s)
- Max Wuehr
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Josefine Eder
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany
| | - Silvy Kellerer
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany
| | - Tamara Amberger
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany
| | - Klaus Jahn
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany
- Schön Klinik Bad Aibling, Bad Aibling, Germany
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van Stiphout L, Szmulewicz DJ, Guinand N, Fornos AP, Van Rompaey V, van de Berg R. Bilateral vestibulopathy: a clinical update and proposed diagnostic algorithm. Front Neurol 2023; 14:1308485. [PMID: 38178884 PMCID: PMC10766383 DOI: 10.3389/fneur.2023.1308485] [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: 10/06/2023] [Accepted: 11/29/2023] [Indexed: 01/06/2024] Open
Abstract
Bilateral vestibulopathy (BVP) is characterized by its heterogeneous and chronic nature with various clinical presentations and multiple etiologies. This current narrative review reflects on the main insights and developments regarding clinical presentation. In addition, it proposes a new diagnostic algorithm, and describes available and potential future therapeutic modalities.
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Affiliation(s)
- Lisa van Stiphout
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
| | - David J. Szmulewicz
- Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, VIC, Australia
- Bionics Institute, Melbourne, VIC, Australia
| | - Nils Guinand
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Angélica Pérez Fornos
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Raymond van de Berg
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
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Basta D, Rossi-Izquierdo M, Wonneberger K, Brugnera C, Bittar RSM, Greters ME, Ernst A, Soto-Varela A. Individualized Vibrotactile Neurofeedback Training in Patients with Chronic Bilateral Vestibulopathy. Brain Sci 2023; 13:1219. [PMID: 37626575 PMCID: PMC10452499 DOI: 10.3390/brainsci13081219] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
Patients with bilateral vestibulopathy (BVP) suffer from postural imbalance during daily life conditions, which in turn leads to a high frequency of falls. Unfortunately, vestibular rehabilitation has only modest and somewhat inconsistent effects in this patient group. Approximately 50% of BVP patients show an improved postural control after conventional vestibular rehabilitation training. New and more promising approaches are required. The individualized vibrotactile neurofeedback training (IVNT) in stance and gait conditions has already been described as highly effective in patients with various vestibular disorders. The purpose of the present multicenter study was to determine the efficacy of the IVNT in improving balance, reducing self-perceived disability, and improving gait in patients with confirmed BVP. In total, 22 patients performed the IVNT with the Vertiguard® system for 10 daily sessions. The dizziness handicap inventory (DHI), the stance stability score of the sensory organization test (SOT) and the score for everyday life mobility in stance and gait tasks (SBDT) were obtained immediately before and after the rehabilitation training period, as well as 3 and 12 months later. All measures improved significantly after the IVNT. Between 77.3% and 94.4% of patients showed an individual benefit (depending on outcome measure). The effect was not significantly reduced within the follow-up period of 12 months. The results demonstrate a high efficacy of the IVNT for vestibular rehabilitation in BVP patients.
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Affiliation(s)
- Dietmar Basta
- Department of Otolaryngology, Unfallkrankenhaus Berlin, University of Berlin, 12683 Berlin, Germany
| | | | | | - Cibele Brugnera
- Department of Otolaryngology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo 01246-903, Brazil
| | | | - Mário Edvin Greters
- Department of Otolaryngology, Pontifícia Universidade Católica de Campinas, Campinas 13034-685, Brazil
| | - Arne Ernst
- Department of Otolaryngology, Unfallkrankenhaus Berlin, University of Berlin, 12683 Berlin, Germany
| | - Andrés Soto-Varela
- Department of Otolaryngology, Complexo Hospitalario Universitario de Santiago de Compostela, 15706 Santiago de Compostela, Spain
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McLaren R, Smith PF, Taylor RL, Ravindran S, Rashid U, Taylor D. Efficacy of nGVS to improve postural stability in people with bilateral vestibulopathy: A systematic review and meta-analysis. Front Neurosci 2022; 16:1010239. [PMID: 36248647 PMCID: PMC9553993 DOI: 10.3389/fnins.2022.1010239] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/24/2022] [Indexed: 11/25/2022] Open
Abstract
Objective Noisy galvanic vestibular stimulation (nGVS) has been used to boost vestibular afferent information to the central nervous system. This has the potential to improve postural control for people for whom vestibular signals are weak, such as in bilateral vestibulopathy (BVP). The aim of this systematic review and meta-analysis is to investigate the evidence for nGVS as a modality to improve postural control in people with BVP. Methods A comprehensive systematic search was conducted of five databases up to July 2022 to find studies applying nGVS to people with BVP, with the aim of improving postural control. Two independent reviewers screened and identified eligible studies, completed a risk of bias evaluation (Cochrane) and extracted relevant data. The standardized mean difference (SMD) based on Hedges' g was calculated as a measure of effect size for the primary outcome measure that best identified postural control, and a forest plot generated. Results Seven studies met the eligibility criteria, with five being suitable for meta-analysis. Meta-analysis revealed a moderate effect in favor of nGVS improving postural control during standing and walking [pooled SMD = 0.47 95% CI (0.25, 0.7)]. nGVS-mediated improvements in postural control were most evident in observations of reduced sway velocity when standing on a firm surface with eyes closed, and in the reduced variability of gait parameters, particularly those measuring lateral stability. Conclusions Coincident nGVS in people with BVP improves postural control during standing and walking. This improvement appears to be context specific, in that vestibular augmentation is most effective in situations where visual inputs are limited, and where reliable context specific proprioceptive cues are available. Further research is warranted investigating additional circumstances in which nGVS improves postural control, including investigating the residual, and sustained effects of nGVS. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=342147, identifier: 342147.
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Affiliation(s)
- Ruth McLaren
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, School of Clinical Science, Auckland University of Technology, Auckland, New Zealand
- *Correspondence: Ruth McLaren
| | - Paul F. Smith
- Department of Pharmacology and Toxicology, School of Biomedical Sciences, The Brain Health Research Centre, University of Otago, Dunedin, New Zealand
- Eisdell Moore Centre for Hearing and Balance Research, University of Auckland, Auckland, New Zealand
| | - Rachael L. Taylor
- Eisdell Moore Centre for Hearing and Balance Research, University of Auckland, Auckland, New Zealand
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Shobika Ravindran
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, School of Clinical Science, Auckland University of Technology, Auckland, New Zealand
| | - Usman Rashid
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, School of Clinical Science, Auckland University of Technology, Auckland, New Zealand
| | - Denise Taylor
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, School of Clinical Science, Auckland University of Technology, Auckland, New Zealand
- Eisdell Moore Centre for Hearing and Balance Research, University of Auckland, Auckland, New Zealand
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