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Aryan R, Zobeiri OA, Millar JL, Schubert MC, Cullen KE. Effect of vestibular loss on head-on-trunk stability in individuals with vestibular schwannoma. Sci Rep 2024; 14:3512. [PMID: 38347021 PMCID: PMC10861475 DOI: 10.1038/s41598-024-53512-3] [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: 10/17/2023] [Accepted: 02/01/2024] [Indexed: 02/15/2024] Open
Abstract
The vestibulo-collic reflex generates neck motor commands to produce head-on-trunk movements that are essential for stabilizing the head relative to space. Here we examined the effects of vestibular loss on head-on-trunk kinematics during voluntary behavior. Head and trunk movements were measured in individuals with vestibular schwannoma before and then 6 weeks after unilateral vestibular deafferentation via surgical resection of the tumor. Movements were recorded in 6 dimensions (i.e., 3 axes of rotation and 3 axes of translation) using small light-weight inertial measurement units while participants performed balance and gait tasks. Kinematic measures differed between individuals with vestibular schwannoma (at both time points) and healthy controls for the more challenging exercises, namely those performed in tandem position or on an unstable surface without visual input. Quantitative assessment of the vestibulo-ocular reflex (VOR) revealed a reduction in VOR gain for individuals with vestibular schwannoma compared to control subjects, that was further reduced following surgery. These findings indicated that the impairment caused by either the tumor or subsequent surgical tumor resection altered head-on-trunk kinematics in a manner that is not normalized by central compensation. In contrast, we further found that head-on-trunk kinematics in individuals with vestibular schwannoma were actually comparable before and after surgery. Thus, taken together, our results indicate that vestibular loss impacts head-on-trunk kinematics during voluntary balance and gait behaviors, and suggest that the neural mechanisms mediating adaptation alter the motion strategies even before surgery in a manner that may be maladaptive for long-term compensation.
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Affiliation(s)
- Raabeae Aryan
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, 720 Rutland Ave, Traylor 504, Baltimore, MD, 21205-2109, USA
| | - Omid A Zobeiri
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, 720 Rutland Ave, Traylor 504, Baltimore, MD, 21205-2109, USA
- Department of Biomedical Engineering, McGill University, Montreal, QC, Canada
| | - Jennifer L Millar
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael C Schubert
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Kathleen E Cullen
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, 720 Rutland Ave, Traylor 504, Baltimore, MD, 21205-2109, USA.
- Department of Biomedical Engineering, McGill University, Montreal, QC, Canada.
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, USA.
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, USA.
- Kavli Neuroscience Discovery Institute, Johns Hopkins University, Baltimore, MD, USA.
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Souza WH, Grove CR, Gerend PL, Ryan C, Schubert MC. Regional differences in patient-reported outcomes as a proxy of healthcare practices for Americans living with vestibular symptoms. J Vestib Res 2022; 32:541-551. [PMID: 35811550 DOI: 10.3233/ves-220022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Geographical location is known to affect health outcomes; however, evidence regarding whether location affects healthcare for persons suspected to have vestibular dysfunction is lacking. OBJECTIVE To investigate whether location affects healthcare seeking and outcomes for adults with symptoms of vestibular pathology. METHODS We assessed for regional disparities associated with demographics, diagnosis, chronological factors, and financial expenditures from Americans who participated in the Vestibular Disorders Association registry (N = 905, 57.4±12.5 years, 82.7% female, 94.8% White, and 8.1% Hispanic or Latino). Respondents were grouped per geographical regions defined by the United States Census Bureau. RESULTS There were no significant between-region differences for age (p = 0.10), sex (p = 0.78), or ethnicity (p = 0.24). There were more Asian respondents in the West versus the Midwest (p = 0.05) and more Black respondents in the South versus the West (p = 0.05). The time to first seek care was shorter in the Northeast (17.3 [SD = 49.5] weeks) versus the South (42.4 [SD = 83.7] weeks), p = 0.015. The time from the first healthcare visit to receiving a final diagnosis was shorter in the Northeast (46.5 [SD = 75.4] weeks) versus the South (68.9 [SD = 89.7] weeks), p = 0.015. Compared to the Midwest, fewer respondents in the Northeast reported "no" out-of-pocket financial impact, p = 0.039. CONCLUSIONS Geographical location affects healthcare seeking and outcomes for persons suspected to have vestibular dysfunction.
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Affiliation(s)
- Wagner Henrique Souza
- Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Colin R Grove
- Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA
| | | | - Cynthia Ryan
- VEDA Vestibular Disorders Association (VeDA), Portland, OR, USA
| | - Michael C Schubert
- Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA.,Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA
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Zobeiri OA, Wang L, Millar JL, Schubert MC, Cullen KE. Head movement kinematics are altered during balance stability exercises in individuals with vestibular schwannoma. J Neuroeng Rehabil 2022; 19:120. [PMID: 36352393 PMCID: PMC9648040 DOI: 10.1186/s12984-022-01109-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 11/01/2022] [Indexed: 11/11/2022] Open
Abstract
Abstract
Background
Balance stabilization exercises are often prescribed to facilitate compensation in individuals with vestibular schwannoma (VS). However, both the assessment and prescription of these exercises are reliant on clinical observations and expert opinion rather than on quantitative evidence. The aim of this study was to quantify head motion kinematics in individuals with vestibular loss while they performed commonly prescribed balance stability exercises.
Methods
Using inertial measurement units, head movements of individuals with vestibular schwannoma were measured before and after surgical deafferentation and compared with age-matched controls.
Results
We found that individuals with vestibular schwannoma experienced more variable head motion compared to healthy controls both pre- and postoperatively, particularly in absence of visual input, but that there was little difference between preoperative and postoperative kinematic measurements for our vestibular schwannoma group. We further found correlations between head motion kinematic measures during balance exercises, performed in the absence of visual input, and multiple clinical measurements for preoperative VS subjects. Subjects with higher head motion variability also had worse DVA scores, moved more slowly during the Timed up and Go and gait speed tests, and had lower scores on the functional gait assessment. In contrast, we did not find strong correlations between clinical measures and postoperative head kinematics for the same VS subjects.
Conclusions
Our data suggest that further development of such metrics based on the quantification of head motion has merit for the assessment and prescription of balance exercises, as demonstrated by the calculation of a “kinematic score” for identifying the most informative balance exercise (i.e., “Standing on foam eyes closed”).
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Evaluation of Vestibular Function in Diagnosis of Vestibular Schwannomas. Curr Med Sci 2021; 41:661-666. [PMID: 34403089 DOI: 10.1007/s11596-021-2407-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
Vestibular schwannomas (VS) are benign tumors of the vestibular nerve. The common first symptoms are hearing loss and tinnitus, followed by imbalance, vertigo, and facial nerve involvement. The subjective symptoms of VS patients are not consistent with the severity of vestibular lesions and the results of vestibular tests, which often interfere with clinicians' diagnoses. Thus, the main screening and diagnostic methods for VS are audiometry and magnetic resonance imaging (MRI), ignoring the evaluation of vestibular function at the source of pathological lesions. With the development and improvement of vestibular evaluation technology and its wide application in the clinic, modern vestibular examination technology can reflect the severity and frequency of vestibular lesions and compensation from multiple perspectives, providing an objective basis for the diagnosis and treatment of vestibular diseases. In this report, we review the results and characteristics of vestibular tests in VS patients and further clarify the clinical value of vestibular function assessment in the diagnosis and treatment of VS.
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Bălaşa AF, Hurghiş CI, Tămaş F, Şerban GM, Kövecsi A, Florian IA, Chinezu R. Gross-total versus near-total resection of large vestibular schwannomas. An institutional experience. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY 2021; 61:485-492. [PMID: 33544800 PMCID: PMC7864290 DOI: 10.47162/rjme.61.2.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE We will report our experience of the surgical treatment of large vestibular schwannomas (VSs). PATIENTS, MATERIALS AND METHODS We conducted a retrospective study of patients operated on for Koos grade IV VS between 2007 and 2015 at the Department of Neurosurgery, Emergency County Hospital, Târgu Mureş, Romania. We studied the general preoperatory clinical data, the preoperative and postoperative facial nerve status, preoperative hearing on the affected side, and any postoperative complications, including death. RESULTS Sixty-six cases were included in our study. The mean age was 52.95 years and 66.7% (n=44) of the sample were female. All patients had suffered from tinnitus and this had been followed by loss of serviceable hearing on the affected side in 89.4% (n=59) of cases. Preoperative facial palsy was found in 53% (n=35) of patients. The mean tumor size was 40.35 mm. Gross-total resection (GTR) was achieved in 24 (36.36%) cases, while near-total resection (NTR) was obtained in 42 (63.64%) cases. New-onset facial palsy or degradation of the preoperative facial deficit occurred in 12 (18.18%) cases, most of whom were patients with a GTR (n=9, 37.5%). This was statistically significant. There were no significant postoperative differences between the GTR and NTR groups. There was one death in the GTR group. CONCLUSIONS We conclude that near-total tumor removal provides good surgical results and better postsurgical quality of life for patients when compared to gross-total tumor resection. Therefore, this should be the end goal of the resection of large VSs.
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Affiliation(s)
- Adrian Florian Bălaşa
- Department of Neurosurgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureş, Romania;
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Higuchi Y, Ikegami S, Horiguchi K, Aoyagi K, Nagano O, Serizawa T, Tajima Y, Hanazawa T, Yamakami I, Iwadate Y. Predicting Potential of Rapid Tumor Growth in Small to Medium Vestibular Schwannomas on the Basis of Sway Assessed Using Posturography. World Neurosurg 2021; 148:e406-e414. [PMID: 33444828 DOI: 10.1016/j.wneu.2020.12.175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/30/2020] [Accepted: 12/31/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The relationship between quantitative posturography results and growth of vestibular schwannomas (VSs) during conservative management has not been studied. We aimed to clarify the relationship between the presence of disequilibrium based on posturographic measurement and VS growth. METHODS This retrospective, single-center study included 53 patients with VSs (Koos stage I or II) managed conservatively after initial diagnosis. Radiographic progression was considered present if 20% volumetric growth was observed over the imaging interval. Posturography was performed at initial diagnosis, and sway velocity (SV) and sway area were calculated. Tumor growth-free survival was estimated using the Kaplan-Meier method. RESULTS Mean follow-up period was 2.87 ± 2.58 years, up to tumor growth detection or last follow-up magnetic resonance imaging. Tumor growth incidence was 40.8% and 61.2% at 2 and 5 years, respectively. Cerebellopontine angle extension and SV with eyes open were related to tumor growth. Tumor growth-free survival of patients with cerebellopontine angle extension and patients with intracanalicular tumor at 2 years was 37.3% and 76.4%, respectively. Tumor growth-free survival of patients with SV >2.06 cm/second and patients with SV ≤2.06 cm/second at 2 years was 30.8% and 68.9%, respectively. The Cox hazard model demonstrated a significant risk for future tumor growth with SV >2.06 cm/second (relative risk, 2.475; 95% confidence interval, 1.11-5.37, P = 0.027). CONCLUSIONS We demonstrated a positive correlation between SV with eyes open and future tumor growth. Posturographic data are objective and quantitative; thus, SV may be a potential predictor of future growth of VSs.
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Affiliation(s)
- Yoshinori Higuchi
- Departments of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
| | - Shiro Ikegami
- Departments of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Kentaro Horiguchi
- Departments of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Kyoko Aoyagi
- Departments of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba, Japan; Department of Neurosurgery, Chiba Cerebral and Cardiovascular Center, Chiba, Japan
| | - Osamu Nagano
- Department of Neurosurgery, Chiba Cerebral and Cardiovascular Center, Chiba, Japan
| | - Toru Serizawa
- Tokyo Gamma Unit Center, Tsukiji Neurological Clinic, Tokyo, Japan
| | - Yosuke Tajima
- Department of Neurosurgery, Matsudo City General Hospital, Chiba, Japan
| | - Toyoyuki Hanazawa
- Departments of Otorhinolaryngology/Head and Neck Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Iwao Yamakami
- Department of Neurosurgery, Seikei-kai Chiba Medical Center, Chiba, Japan
| | - Yasuo Iwadate
- Departments of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
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Zhou Y, Zhao W, Tian L, Yu J, Yuan Y, Wang J. The prediction of the tumor size of a vestibular schwannoma by clinical performance and vestibular function tests. J Neurooncol 2018; 140:679-686. [PMID: 30238349 DOI: 10.1007/s11060-018-2998-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 09/10/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the relationship between vestibular schwannoma (VS) size and the dysfunction and compensation of the vestibular system. METHODS One hundred fifty-two patients with unilateral VS were investigated using multiple auditory-vestibular function tests such as audiometry, sensory organization test (SOT), caloric test, cervical vestibular-evoked myogenic potential (cVEMP) test, and ocular VEMP (oVEMP) test. RESULTS In this study, 89% of patients with unilateral VS had mild to severe hearing loss on the involved side. All patients showed higher threshold values or no response in the cVEMP and oVEMP tests, which both exhibited a lower response rate on the affected side than on the unaffected side. Patients with a tumor size ≥ 30 mm had significantly lower equilibrium scores for condition 5 and condition 6 of the SOT, which were associated with vestibular dysfunction, higher rates of canal paresis in the caloric test, and lower response rates in the cVEMP and oVEMP tests on the affected sides, compared with the results of patients with a tumor size ≤ 14 mm and patients with a tumor size of 15-29 mm. CONCLUSIONS A diameter > 30 mm may be the critical threshold at which vestibular function is affected and vestibular compensation is interfered with by a VS tumor. Functional performance of the vestibular system can help clinicians predict the size of a tumor and provide a basis for the development of treatment protocols.
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Affiliation(s)
- Yujuan Zhou
- Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, People's Republic of China
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, 200031, People's Republic of China
| | - Weidong Zhao
- Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, People's Republic of China
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, 200031, People's Republic of China
| | - Liang Tian
- Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, People's Republic of China
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, 200031, People's Republic of China
| | - Jing Yu
- Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, People's Republic of China
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, 200031, People's Republic of China
| | - Yasheng Yuan
- Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, People's Republic of China.
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, 200031, People's Republic of China.
| | - Jing Wang
- Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, People's Republic of China.
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, 200031, People's Republic of China.
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Goebel S, Mehdorn HM. A missing piece? Neuropsychiatric functioning in untreated patients with tumors within the cerebellopontine angle. J Neurooncol 2018; 140:145-153. [PMID: 29982872 DOI: 10.1007/s11060-018-2944-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 06/27/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To date, little is known about neuropsychiatric symptoms in patients with tumors within the cerebellopontine angle (CPA). These, however, might be of clinical relevance. Aim of this study was thus to assess possible impairment in cognition, elevation in mood symptoms, and fatigue in this specific patient group. METHODS Forty-five patients with an untreated CPA tumor (27 vestibularis schwannoma, 18 meningioma) were tested within a cross-sectional observational study in a single institution prior to neurosurgical treatment. Patients were administered a multifaceted battery comprising of widely-used tests for assessment of neuropsychiatric functioning. RESULTS The majority of the included patients (69%) showed neurocognitive impairment, most frequently in the areas of attention and visuo-motor speed (e.g., alertness) (62%) as well as visuo-construction (44%). Impaired structural integrity of the brain stem was accompanied by more serious neurocognitive deficits. About one-third of the sample reported clinically relevant depression and/or anxiety and an even higher proportion (48%) described high levels of fatigue. Cognitive and affective symptoms as well as fatigue contributed significantly to patients' Quality of Life, indicating the clinical relevance of neuropsychiatric symptoms in patients with CPA tumors. CONCLUSIONS Although patients with untreated CPA tumors often suffer from devastating and prominent physical symptoms, neuropsychiatric problems are also frequent. Including these aspects in the routine clinical assessment and initiating treatment accordingly might thus improve clinical management of the patients and improve Quality of Life.
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Affiliation(s)
- Simone Goebel
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Christian-Albrechts University, Olshausenstraße 62, 24118, Kiel, Germany.
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Nam GS, Jung CM, Kim JH, Son EJ. Relationship of Vertigo and Postural Instability in Patients With Vestibular Schwannoma. Clin Exp Otorhinolaryngol 2018; 11:102-108. [PMID: 29307173 PMCID: PMC5951069 DOI: 10.21053/ceo.2017.01277] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 11/01/2017] [Accepted: 11/08/2017] [Indexed: 12/26/2022] Open
Abstract
Objectives Growth of vestibular schwannomas (VS) causes progressive vestibular symptoms and postural instability. Since the tumor grows slowly, compensation of decaying vestibular input may decrease subjective symptoms of dizziness. This study aims to estimate the relationship of subjective vestibular symptoms and objective postural instability in patients with VS. Methods A retrospective review of 18 patients newly diagnosed with VS and with subjective vertigo symptoms was performed. The results of vestibular function tests including the sensory organization test (SOT) using computerized dynamic posturography, caloric test, and self-report measures of subjective dizziness handicap (Dizziness Handicap Inventory) and visual analogue scale were compared according to the onset of vertigo symptoms. Results In VS patients, SOT showed decreased equilibrium score for all vestibular function related conditions, condition (C) 5 and 6, and composite (COMP) score. COMP scores were not correlated with visual analogue scale or Dizziness Handicap Inventory scores. Acute onset group included six patients and insidious onset group, 12 patients. Equilibrium scores for C5 and C6, and COMP scores were lower for insidious onset group, but the difference was not statistically significant. Conclusion Our findings confirmed postural instability is prevalent in VS patients. SOT parameters did not differ significantly between acute onset and insidious onset groups, but increased tumor size and canal weakness were noted in the insidious onset group. Clinicians should consider that postural instability is likely present even in patients who do not complain of acute vertigo, and appropriate counseling should be discussed with the patients.
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Affiliation(s)
- Gi-Sung Nam
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chan Min Jung
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hyung Kim
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Jin Son
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Frère J, Hoffmann CP, Gauchard GC, Parietti-Winkler C. Does the postural variable affect the determination of balance compensation level in vestibular schwannoma patients? Med Eng Phys 2017; 47:214-217. [DOI: 10.1016/j.medengphy.2017.06.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 05/20/2017] [Accepted: 06/14/2017] [Indexed: 10/19/2022]
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Hoffmann CP, Seigle B, Frère J, Parietti-Winkler C. Dynamical analysis of balance in vestibular schwannoma patients. Gait Posture 2017; 54:236-241. [PMID: 28351744 DOI: 10.1016/j.gaitpost.2017.03.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 03/03/2017] [Accepted: 03/08/2017] [Indexed: 02/02/2023]
Abstract
The analysis of the complexity of postural fluctuations is a recent method for assessing postural control. Complexity relates to the irregularity of the center of pressure time series and characterizes the ability of postural control to meet a changing environment. In our study, we used the sample entropy (SampEn) parameter to evaluate the complexity of postural sway velocity time series in patients with vestibular schwannoma (n=19) compared to healthy controls (n=20), using the sensory organization test. Patients performed postural assessments three days before surgical ablation of the tumor, then three times after surgery, at eight, thirty, and ninety days. The control group underwent posturographic tests only once. Our results demonstrated that SampEn values distinguished both groups before surgery only in postural tasks where vestibular afferences significantly contribute to maintaining balance. We also found an immediate decrease of complexity after the surgical resection of the tumor. Our results are in line with the theory of complexity loss of physiological systems stating that reducing the number of their structural components or altering their coupling leads to a decrease in complexity. Finally, our findings showed that progressive restoration of complexity over time was such that no difference was found between the two groups ninety days after surgery, due to the implementation of central adaptive mechanisms and the substitution by other sensory afferences. Thus, the SampEn parameter can highlight the postural effects of vestibular pathology, and complexity analysis appears to be a valuable tool for investigating the temporal structure of CoP time series.
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Affiliation(s)
- Charles P Hoffmann
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, F-54000 Nancy, France; Laboratory "Développement, Adaptation et Handicap" (DevAH - EA 3450), Faculty of Sports Science and Faculty of Medicine, University of Lorraine, 9 avenue de la Forêt de Haye, CS 50184, F-54505 Vandœuvre-lès-Nancy, France.
| | - Benoît Seigle
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, F-54000 Nancy, France
| | - Julien Frère
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, F-54000 Nancy, France; Laboratory "Développement, Adaptation et Handicap" (DevAH - EA 3450), Faculty of Sports Science and Faculty of Medicine, University of Lorraine, 9 avenue de la Forêt de Haye, CS 50184, F-54505 Vandœuvre-lès-Nancy, France
| | - Cécile Parietti-Winkler
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, F-54000 Nancy, France; Laboratory "Développement, Adaptation et Handicap" (DevAH - EA 3450), Faculty of Sports Science and Faculty of Medicine, University of Lorraine, 9 avenue de la Forêt de Haye, CS 50184, F-54505 Vandœuvre-lès-Nancy, France
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Ribeyre L, Spitz E, Frère J, Gauchard G, Parietti-Winkler C. Correlations between postural control and psychological factors in vestibular schwannoma patients. J Vestib Res 2016; 26:387-394. [DOI: 10.3233/ves-160588] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Laurence Ribeyre
- University of Lorraine, University of Paris Descartes, Apemac EA 4360, Metz, France
- Department of ENT, University Hospital of Nancy, Nancy, France
| | - Elisabeth Spitz
- University of Lorraine, University of Paris Descartes, Apemac EA 4360, Metz, France
| | - Julien Frère
- University of Lorraine, DevAH EA3450, Vandoeuvre Les Nancy, France
| | - Gerome Gauchard
- University of Lorraine, DevAH EA3450, Vandoeuvre Les Nancy, France
| | - Cécile Parietti-Winkler
- University of Lorraine, DevAH EA3450, Vandoeuvre Les Nancy, France
- Department of ENT, University Hospital of Nancy, Nancy, France
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Parietti-Winkler C, Lion A, Frère J, Perrin PP, Beurton R, Gauchard GC. Prediction of Balance Compensation After Vestibular Schwannoma Surgery. Neurorehabil Neural Repair 2015; 30:395-401. [PMID: 26253176 DOI: 10.1177/1545968315600270] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Balance compensation after vestibular schwannoma (VS) surgery is under the influence of specific preoperative patient and tumor characteristics. Objective To prospectively identify potential prognostic factors for balance recovery, we compared the respective influence of these preoperative characteristics on balance compensation after VS surgery. Methods In 50 patients scheduled for VS surgical ablation, we measured postural control before surgery (BS), 8 (AS8) days after, and 90 (AS90) days after surgery. Based on factors found previously in the literature, we evaluated age, body mass index and preoperative physical activity (PA), tumor grade, vestibular status, and preference for visual cues to control balance as potential prognostic factors using stepwise multiple regression models. Results An asymmetric vestibular function was the sole significant explanatory factor for impaired balance performance BS, whereas the preoperative PA alone significantly contributed to higher performance at AS8. An evaluation of patients' balance recovery over time showed that PA and vestibular status were the 2 significant predictive factors for short-term postural compensation (BS to AS8), whereas none of these preoperative factors was significantly predictive for medium-term postoperative postural recovery (AS8 to AS90). Conclusions We identified specific preoperative patient and vestibular function characteristics that may predict postoperative balance recovery after VS surgery. Better preoperative characterization of these factors in each patient could inform more personalized presurgical and postsurgical management, leading to a better, more rapid balance recovery, earlier return to normal daily activities and work, improved quality of life, and reduced medical and societal costs.
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Affiliation(s)
- Cécile Parietti-Winkler
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital of Nancy, Nancy, France Laboratory "Développement, Adaptation et Handicap" (DevAH - EA 3450), University of Lorraine, Vandœuvre-lès-Nancy, France
| | - Alexis Lion
- Laboratory "Développement, Adaptation et Handicap" (DevAH - EA 3450), University of Lorraine, Vandœuvre-lès-Nancy, France Sport Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg
| | - Julien Frère
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital of Nancy, Nancy, France Laboratory "Développement, Adaptation et Handicap" (DevAH - EA 3450), University of Lorraine, Vandœuvre-lès-Nancy, France
| | - Philippe P Perrin
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital of Nancy, Nancy, France Laboratory "Développement, Adaptation et Handicap" (DevAH - EA 3450), University of Lorraine, Vandœuvre-lès-Nancy, France
| | - Renaud Beurton
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital of Nancy, Nancy, France
| | - Gérome C Gauchard
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital of Nancy, Nancy, France Laboratory "Développement, Adaptation et Handicap" (DevAH - EA 3450), University of Lorraine, Vandœuvre-lès-Nancy, France
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