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Grove CR, Loyd BJ, Dibble LE, Schubert MC. Evidence for the differential efficacy of yaw and pitch gaze stabilization mechanisms in people with multiple sclerosis. Exp Brain Res 2024; 242:1797-1806. [PMID: 38839617 DOI: 10.1007/s00221-024-06864-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/24/2024] [Indexed: 06/07/2024]
Abstract
People with multiple sclerosis (PwMS) who report dizziness often have gaze instability due to vestibulo-ocular reflex (VOR) deficiencies and compensatory saccade (CS) abnormalities. Herein, we aimed to describe and compare the gaze stabilization mechanisms for yaw and pitch head movements in PwMS. Thirty-seven PwMS (27 female, mean ± SD age = 53.4 ± 12.4 years old, median [IQR] Expanded Disability Status Scale Score = 3.5, [1.0]. We analyzed video head impulse test results for VOR gain, CS frequency, CS latency, gaze position error (GPE) at impulse end, and GPE at 400 ms after impulse start. Discrepancies were found for median [IQR] VOR gain in yaw (0.92 [0.14]) versus pitch-up (0.71 [0.44], p < 0.001) and pitch-down (0.81 [0.44], p = 0.014]), CS latency in yaw (258.13 [76.8]) ms versus pitch-up (208.78 [65.97]) ms, p = 0.001] and pitch-down (132.17 [97.56] ms, p = 0.006), GPE at impulse end in yaw (1.15 [1.85] degs versus pitch-up (2.71 [3.9] degs, p < 0.001), and GPE at 400 ms in yaw (-0.25 [0.98] degs) versus pitch-up (1.53 [1.07] degs, p < 0.001) and pitch-down (1.12 [1.82] degs, p = 0.001). Compared with yaw (0.91 [0.75]), CS frequency was similar for pitch-up (1.03 [0.93], p = 0.999) but lower for pitch-down (0.65 [0.64], p = 0.023). GPE at 400 ms was similar for yaw and pitch-down (1.88 [2.76] degs, p = 0.400). We postulate that MS may have preferentially damaged the vertical VOR and saccade pathways in this cohort.
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Affiliation(s)
- Colin R Grove
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
- Division of Physical Therapy, Department of Rehabilitation Medicine, School of Medicine, Emory University, Atlanta, GA, USA.
- Applied Vestibular Physiology Laboratory, Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, 1441 Clifton Road, NE, Atlanta, GA, 30322, USA.
| | - Brian J Loyd
- School of Physical Therapy and Rehabilitation Sciences, College of Health, University of Montana, Missoula, MT, USA
- School of Integrative Physiology and Athletic Training, College of Health, University of Montana, Missoula, MT, USA
| | - Leland E Dibble
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Michael C Schubert
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Tramontano M, Ferri N, Turolla A, Orejel Bustos AS, Casagrande Conti L, Sorge C, Pillastrini P, Manzari L. Video head impulse test in subacute and chronic stroke survivors: new perspectives for implementation of assessment in rehabilitation. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08721-x. [PMID: 38758244 DOI: 10.1007/s00405-024-08721-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/03/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION The Video Head Impulse Test (vHIT) is a safe and reliable assessment of peripheral vestibular function. Many studies tested its accuracy in clinical settings for differential diagnosis and quantification of the vestibulo-oculomotor reflex (VOR) in various disorders. However, the results of its application after lesions of the CNS are discordant and have never been studied in rehabilitation. This study aims to assess the VOR performance in a sample of stroke survivors. METHODS This is a cross-sectional study on 36 subacute and chronic stroke survivors; only persons with first-ever stroke and able to walk independently, even with supervision, were included. We performed VOR assessments for each semicircular canal by vHIT and balance assessments by the Berg Balance Scale and the MiniBESTest scale. RESULTS Two hundred and sixteen semicircular canals were assessed using the Head Impulse paradigm (in both the vertical and horizontal planes), while 72 semicircular canals were assessed using the Suppressed Head Impulse paradigm (horizontal plane). There was a high prevalence of participants with dysfunctional canals, particularly for the left anterior and right posterior canals, which were each prevalent in more than one-third of our sample. Furthermore, 16 persons showed an isolated canal dysfunction. The mean VOR gain for the vertical canals had confidence intervals out of the normal values (0.74-0.91 right anterior; 0.74-0.82 right posterior; 0.73-0.87 left anterior). CONCLUSION Our findings suggest that peripheral vestibular function may be impaired in people with stroke; a systematic assessment in a rehabilitation setting could allow a more personalized and patient-centred approach.
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Affiliation(s)
- Marco Tramontano
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
| | - Nicola Ferri
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Andrea Turolla
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
| | - Amaranta Soledad Orejel Bustos
- Santa Lucia Foundation, Scientific Institute for Research and Health Care, Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | | | - Chiara Sorge
- Santa Lucia Foundation, Scientific Institute for Research and Health Care, Rome, Italy
| | - Paolo Pillastrini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
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Weston AR, Dibble LE, Hoppes CW, Loyd BJ. People with multiple sclerosis and unilateral peripheral vestibular loss demonstrate similar alterations in head and trunk turning kinematics compared to healthy controls. Gait Posture 2023; 105:132-138. [PMID: 37562112 DOI: 10.1016/j.gaitpost.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 07/11/2023] [Accepted: 08/03/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Individuals with peripheral vestibulopathy are known to have difficulty with volitional head turns. This leads to differences in head and body turning kinematics, compared to those without vestibular dysfunction. Multiple sclerosis (MS), a neuro-inflammatory disease affecting the central nervous system, can cause vestibular dysfunction (dizziness, unsteadiness, gaze instability). However, head and trunk turning kinematics in people with MS (PwMS) have not been assessed. RESEARCH QUESTION Will PwMS, demonstrate head and body kinematics alterations similar to individuals with a peripheral dysfunction compared to vestibular healthy individuals? METHODS Eleven individuals with a recent vestibular schwannoma resection (VSR), fourteen PwMS, and 10 healthy control (HC) participants were fitted with head and trunk worn inertial measurement units (IMUs) and performed walking and turning tasks. Head and trunk peak turning speed and amplitude were extracted. Regression models controlling for gait speed were fit per outcome with post hoc corrections applied to significant models. RESULTS Yaw plane head turn speed and amplitude were significantly less in the VSR group compared to HC. Pitch plane head turn amplitude was significantly smaller in PwMS compared to HC (p = 0.04), however pitch plane speed did not differ between the groups. There was no difference between PwMS and the VSR group in yaw or pitch plane speed and amplitude. Both PwMS and the VSR group turned significantly slower than HC during the 180d body turn as measured at the head and trunk (head speed model p = 0.009 and <0.001; trunk speed model p < 0.001 for both groups) however the MS and VSR groups did not differ from each other. SIGNIFICANCE Turning kinematics while walking in PwMS are altered compared to HC and are similar to individuals with unilateral vestibular hypofunction. Centrally mediated vestibular dysfunction in PwMS may alter movement kinematics and should be considered during examination and treatment.
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Affiliation(s)
- Angela R Weston
- Department of Physical Therapy and Athletic Training, University of Utah, 520 Wakara Way, Salt Lake City, UT 84108, USA; Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, TX, 78234 USA.
| | - Leland E Dibble
- Department of Physical Therapy and Athletic Training, University of Utah, 520 Wakara Way, Salt Lake City, UT 84108, USA.
| | - Carrie W Hoppes
- Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, TX, 78234 USA.
| | - Brian J Loyd
- School of Physical Therapy and Rehabilitation Sciences, University of Montana, 32 Campus Dr., Missoula, MT 59812, USA.
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Grove CR, Wagner A, Loyd BJ, Dibble LE, Schubert MC. Unique compensatory oculomotor behavior in people living with multiple sclerosis. J Neurol Sci 2022; 442:120411. [PMID: 36088792 PMCID: PMC10518216 DOI: 10.1016/j.jns.2022.120411] [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: 06/06/2022] [Revised: 08/19/2022] [Accepted: 08/31/2022] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Globally, there are 3 million people living with multiple sclerosis (PLW-MS). A large proportion of PLW-MS have abnormal vestibular function tests that suggest central vestibular lesions. Yet, data regarding vestibular-ocular control in PLW-MS is limited. Thus, we aimed to further characterize compensatory saccade (CS) behavior in PLW-MS. METHODS We analyzed video head impulse data from four groups of six age- and sex-matched adults: people living with mild MS (PLW-mild-MS, people living with moderate MS (PLW-moderate-MS), people living with unilateral vestibular deafferentation (PLW-UVD), and healthy controls (HC). RESULTS PLW-moderate-MS had lower lateral canal vestibulo-ocular reflex (VOR) gain bilaterally compared to PLW-mild MS (p < 0.001), HC (p < 0.001), and PLW-UVD (p < 0.001). CS frequency was higher for impulses towards the less affected side in PLW-moderate-MS versus the more (p = 0.01) and less (p < 0.001) affected sides in PLW-mild-MS. CS latency was shorter (p < 0.001) and CS peak velocity was lower (p < 0.001) with impulses towards the more affected side versus the less affected side in PLW-moderate-MS. However, CS peak velocity with impulses towards each side was similar in PLW-mild-MS (p = 0.12). Gaze position error (GPE) was larger after impulses towards the more affected side versus the less affected side in PLW-moderate-MS (p < 0.001) and PLW-mild-MS (p < 0.001). MS-related disability was moderately associated with VOR gain (p < 0.001) and GPE (p < 0.001). Additionally, we identified micro-saccades and position correcting saccades that were uniquely employed by PLW-MS as compensatory gaze stabilizing strategies. CONCLUSIONS In PLW-MS, the characteristics of compensatory oculomotor behavior depend on the extent of residual VOR gain.
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Affiliation(s)
- Colin R Grove
- Department of Otolaryngology-Head and Neck Surgery, Laboratory of Vestibular NeuroAdaptation, Johns Hopkins University, Baltimore, MD, USA
| | - Andrew Wagner
- Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43212, USA; School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH 43212, USA
| | - Brian J Loyd
- School of Physical Therapy and Rehabilitation Sciences, University of Montana, Missoula, MT, USA
| | - Leland E Dibble
- Department of Physical Therapy and Athletic Training, University of Utah, 520 Wakara Way, Salt Lake City, UT, USA
| | - Michael C Schubert
- Department of Otolaryngology-Head and Neck Surgery, Laboratory of Vestibular NeuroAdaptation, Johns Hopkins University, Baltimore, MD, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA.
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Grove CR, Wagner A, Yang VB, Loyd BJ, Dibble LE, Schubert MC. Greater Disability Is Associated with Worse Vestibular and Compensatory Oculomotor Functions in People Living with Multiple Sclerosis. Brain Sci 2022; 12:1519. [PMID: 36358444 PMCID: PMC9688247 DOI: 10.3390/brainsci12111519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/01/2022] [Accepted: 11/06/2022] [Indexed: 08/15/2023] Open
Abstract
Globally, there are nearly three million people living with multiple sclerosis (PLW-MS). Many PLW-MS experience vertigo and have signs of vestibular dysfunction, e.g., low vestibulo-ocular reflex (VOR) gains or the presence of compensatory saccades (CSs), on video head impulse testing (vHIT). We examined whether the vestibular function and compensatory oculomotor behaviors in PLW-MS differed based on the level of MS-related disability. The VOR gain, CS frequency and latency, and gaze position error (GPE) were calculated from the individual traces obtained during six-canal vHIT for 37 PLW-MS (mean age 53.4 ± 12.4 years-old, 28 females) with vertigo and/or an imbalance. The subjects were grouped by their Expanded Disability Status Scale (EDSS) scores: PLW-min-MS (EDSS = 1.0-2.5, n = 8), PLW-mild-MS (EDSS = 3.0-4.5, n = 23), and PLW-moderate-MS (EDSS = 5.0-6.0, n = 6). The between-group differences were assessed with Kruskal-Wallis tests. The VOR gains for most of the canals were higher for PLW-min-MS compared to PLW-mild- and mod-MS, respectively. CS occurred less often in PLW-min-MS versus PLW-mild- and mod-MS, respectively. No clear trend in CS latency was found. The GPE was often lower for PLW-min-MS compared to PLW-mild- and mod-MS, respectively. Thus, our data demonstrate that worse VOR and compensatory oculomotor functions are associated with a greater MS-related disability. PLW-MS may benefit from personalized vestibular physical therapy.
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Affiliation(s)
- Colin R. Grove
- Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Andrew Wagner
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, OH 43212, USA
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH 43212, USA
| | - Victor B. Yang
- School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Brian J. Loyd
- School of Physical Therapy and Rehabilitation Sciences, University of Montana, Missoula, MT 59812, USA
| | - Leland E. Dibble
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT 84108, USA
| | - Michael C. Schubert
- Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD 21287, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD 21287, USA
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Wagner AR, Grove CR, Loyd BJ, Dibble LE, Schubert MC. Compensatory saccades differ between those with vestibular hypofunction and multiple sclerosis pointing to unique roles for peripheral and central vestibular inputs. J Neurophysiol 2022; 128:934-945. [PMID: 36069428 PMCID: PMC9550564 DOI: 10.1152/jn.00220.2022] [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: 05/16/2022] [Revised: 08/22/2022] [Accepted: 09/03/2022] [Indexed: 11/22/2022] Open
Abstract
Individuals with peripheral or central vestibular dysfunction recruit compensatory saccades (CSs) in response to high acceleration, yaw head impulses. Although CSs have been shown to be an effective strategy for reducing gaze position error (GPE) in individuals with peripheral hypofunction, for individuals with central vestibular dysfunction, the effectiveness of CS is unknown. The purpose of our study was to compare the effectiveness of CS, defined as the ability to compensate for head velocity and eye position errors, between persons with central and peripheral vestibular dysfunction. We compared oculomotor responses during video head impulse testing between individuals with unilateral peripheral vestibular deafferentation, a disorder of the peripheral vestibular afferents, and individuals with multiple sclerosis, a condition affecting the central vestibular pathways. We hypothesized that relative to individuals with peripheral lesions, individuals with central dysfunction would recruit CSs that were delayed and inappropriately scaled to head velocity and GPE. We show that CSs recruited by persons with central vestibular pathology were not uniformly deficient but instead were of a sufficient velocity to compensate for reductions in VOR gain. Compared to those with peripheral vestibular lesions, individuals with central pathology also recruited earlier covert CS with amplitudes that were better corrected for GPE. Conversely, those with central lesions showed greater variability in the amplitude of overt CS relative to GPE. These data point to a unique role for peripheral and central vestibular inputs in the recruitment of CS and suggest that covert CSs are an effective oculomotor strategy for individuals with multiple sclerosis.NEW & NOTEWORTHY Compensatory saccades (CSs) are recruited by individuals with unilateral vestibular deafferentation (UVD) to compensate for an impaired vestibulo-ocular reflex (VOR). The effectiveness of CS in multiple sclerosis (MS), a central vestibular impairment, is unknown. We show that in UVD and in MS, covert CSs compensate for reduced VOR gain and minimize gaze position error (GPE), yet in >50% of individuals with MS, overt CS worsened GPE, suggesting unique roles for peripheral and central vestibular inputs.
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Affiliation(s)
- Andrew R Wagner
- Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio
| | - Colin R Grove
- Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Brian J Loyd
- School of Physical Therapy and Rehabilitation Sciences, University of Montana, Missoula, Montana
| | - Leland E Dibble
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah
| | - Michael C Schubert
- Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
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Eğilmez OK, Tunç A, Yılmaz MS, Şahiner BG, Koçoğlu M, Eryılmaz HA, Güven M. Cervical vestibular evoked myogenic potentials and video head impulse test studies: alternative methods for detecting brainstem involvement in multiple sclerosis. Acta Otolaryngol 2022; 142:168-174. [PMID: 35200078 DOI: 10.1080/00016489.2022.2039759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Brainstem involvement (BSI) has been reported as a major predictive factor for future disability in Multiple Sclerosis (MS). AIMS/OBJECTIVES To evaluate whether Cervical Vestibular Evoked Myogenic Potentials (cVEMPs) and Video Head Impulse Test (vHIT) can be used to detect demyelinating lesions in vestibular pathways in MS. MATERIAL AND METHODS Fifty three people with MS and 40 controls were evaluated with Dizziness Handicap Inventory (DHI), vHIT and cVEMP. RESULTS The median value of DHI in MS group was significantly higher than controls (p<.001). According to vHIT results, while the results of horizontal canal vestibulo-ocular reflex gain in group with brain stem involvement (gBSI (+)) were significantly different from both controls and group without brain stem involvement (gBSI (-)) (p= .036 and .024, respectively), results of gBSI (-) were similar with controls (p= .858). When cVEMP results were examined, mean P1 wave latency in gBSI (+) was significantly longer than controls (p= .002), but difference between gBSI (-) and controls and gBSI (+) was not statistically significant (p= .104 and .279, respectively). CONCLUSIONS AND SIGNIFICANCE vHIT and cVEMP can be used in diagnosis and follow-up of people with MS without demyelinating brainstem lesions on MRI.
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Affiliation(s)
- Oğuz Kadir Eğilmez
- Department of Otorhinolaryngology, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Abdülkadir Tunç
- Department of Neurology, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Mahmut Sinan Yılmaz
- Department of Otorhinolaryngology, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Büşra Gebeş Şahiner
- Department of Otorhinolaryngology, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Mehmet Koçoğlu
- Department of Audiology, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Halil Alper Eryılmaz
- Department of Neurology, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Mehmet Güven
- Department of Otorhinolaryngology, Sakarya University Training and Research Hospital, Sakarya, Turkey
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