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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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Vermorken BL, Volpe B, van Boxel SCJ, Stultiens JJA, van Hoof M, Marcellis R, Loos E, van Soest A, McCrum C, Meijer K, Guinand N, Pérez Fornos A, van Rompaey V, Devocht E, van de Berg R. The VertiGO! Trial protocol: A prospective, single-center, patient-blinded study to evaluate efficacy and safety of prolonged daily stimulation with a multichannel vestibulocochlear implant prototype in bilateral vestibulopathy patients. PLoS One 2024; 19:e0301032. [PMID: 38547135 PMCID: PMC10977751 DOI: 10.1371/journal.pone.0301032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/02/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND A combined vestibular (VI) and cochlear implant (CI) device, also known as the vestibulocochlear implant (VCI), was previously developed to restore both vestibular and auditory function. A new refined prototype is currently being investigated. This prototype allows for concurrent multichannel vestibular and cochlear stimulation. Although recent studies showed that VCI stimulation enables compensatory eye, body and neck movements, the constraints in these acute study designs prevent them from creating more general statements over time. Moreover, the clinical relevance of potential VI and CI interactions is not yet studied. The VertiGO! Trial aims to investigate the safety and efficacy of prolonged daily motion modulated stimulation with a multichannel VCI prototype. METHODS A single-center clinical trial will be carried out to evaluate prolonged VCI stimulation, assess general safety and explore interactions between the CI and VI. A single-blind randomized controlled crossover design will be implemented to evaluate the efficacy of three types of stimulation. Furthermore, this study will provide a proof-of-concept for a VI rehabilitation program. A total of minimum eight, with a maximum of 13, participants suffering from bilateral vestibulopathy and severe sensorineural hearing loss in the ear to implant will be included and followed over a five-year period. Efficacy will be evaluated by collecting functional (i.e. image stabilization) and more fundamental (i.e. vestibulo-ocular reflexes, self-motion perception) outcomes. Hearing performance with a VCI and patient-reported outcomes will be included as well. DISCUSSION The proposed schedule of fitting, stimulation and outcome testing allows for a comprehensive evaluation of the feasibility and long-term safety of a multichannel VCI prototype. This design will give insights into vestibular and hearing performance during VCI stimulation. Results will also provide insights into the expected daily benefit of prolonged VCI stimulation, paving the way for cost-effectiveness analyses and a more comprehensive clinical implementation of vestibulocochlear stimulation in the future. TRIAL REGISTRATION ClinicalTrials.gov: NCT04918745. Registered 28 April 2021.
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Affiliation(s)
- Bernd L. Vermorken
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Benjamin Volpe
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Stan C. J. van Boxel
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Joost J. A. Stultiens
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marc van Hoof
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Rik Marcellis
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Elke Loos
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Neurosciences, Research Group Experimental Oto-Rhino-Laryngology (ExpORL), KU Leuven, University of Leuven, Leuven, Belgium
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Alexander van Soest
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Chris McCrum
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Kenneth Meijer
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Nils Guinand
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Centre, Maastricht, The Netherlands
- Division of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Angélica Pérez Fornos
- Division of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Vincent van Rompaey
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Centre, Maastricht, The Netherlands
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Elke Devocht
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Raymond van de Berg
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Centre, Maastricht, The Netherlands
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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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Molkov YI, Yu G, Ausborn J, Bouvier J, Danner SM, Rybak IA. Sensory Feedback and Central Neuronal Interactions in Mouse Locomotion. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.10.31.564886. [PMID: 37961258 PMCID: PMC10634960 DOI: 10.1101/2023.10.31.564886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Locomotion is a complex process involving specific interactions between the central neural controller and the mechanical components of the system. The basic rhythmic activity generated by locomotor circuits in the spinal cord defines rhythmic limb movements and their central coordination. The operation of these circuits is modulated by sensory feedback from the limbs providing information about the state of the limbs and the body. However, the specific role and contribution of central interactions and sensory feedback in the control of locomotor gait and posture remain poorly understood. We use biomechanical data on quadrupedal locomotion in mice and recent findings on the organization of neural interactions within the spinal locomotor circuitry to create and analyze a tractable mathematical model of mouse locomotion. The model includes a simplified mechanical model of the mouse body with four limbs and a central controller composed of four rhythm generators, each operating as a state machine controlling the state of one limb. Feedback signals characterize the load and extension of each limb as well as postural stability (balance). We systematically investigate and compare several model versions and compare their behavior to existing experimental data on mouse locomotion. Our results highlight the specific roles of sensory feedback and some central propriospinal interactions between circuits controlling fore and hind limbs for speed-dependent gait expression. Our models suggest that postural imbalance feedback may be critically involved in the control of swing-to-stance transitions in each limb and the stabilization of walking direction.
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Affiliation(s)
- Yaroslav I. Molkov
- Department of Mathematics and Statistics, Georgia State University, Atlanta, GA 30303, USA
- Neuroscience Institute, Georgia State University, Atlanta, GA 30303, USA
| | - Guoning Yu
- Department of Mathematics and Statistics, Georgia State University, Atlanta, GA 30303, USA
| | - Jessica Ausborn
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA 19129, USA
| | - Julien Bouvier
- Université Paris-Saclay, CNRS, Institut des Neurosciences Paris-Saclay, 91400, Saclay, France
| | - Simon M. Danner
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA 19129, USA
| | - Ilya A. Rybak
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA 19129, USA
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韩 鹏, 赵 欢, 张 令, 陈 耔, 张 玉, 张 甦, 任 鹏, 张 青. [Recent progress in vestibular prosthesis]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2023; 37:848-852. [PMID: 37828894 PMCID: PMC10803241 DOI: 10.13201/j.issn.2096-7993.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Indexed: 10/14/2023]
Abstract
Bilateral vestibulopathy(BVP) is one of the common diseases in the vestibular nervous system, with an incidence rate of about 4%-7% in the population, which can lead to a variety of body dysfunctions. At present, there are two main treatment methods for BVP. One is vestibular rehabilitation. However, only part of BVP patients can finally benefit from vestibular rehabilitation, and most patients will remain with permanent vestibular dysfunction. Benefiting from the maturity of cochlear implant technology, European and American countries took the lead in the development of vestibular prosthesis(VP) technology to restore the vestibular function in patients with BVP. This review will focus on the development history, principles, future applications and the related research progress of VP in China.
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Affiliation(s)
- 鹏 韩
- 西安交通大学第一附属医院耳鼻咽喉头颈外科(西安,710061)Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an, 710061, China
| | - 欢娣 赵
- 西安交通大学第二附属医院耳鼻咽喉头颈外科Department of Otorhinolaryngology Head and Neck Surgery, Second Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an
| | - 令 张
- 西安交通大学第一附属医院耳鼻咽喉头颈外科(西安,710061)Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an, 710061, China
| | - 耔辰 陈
- 西安交通大学第二附属医院耳鼻咽喉头颈外科Department of Otorhinolaryngology Head and Neck Surgery, Second Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an
| | - 玉忠 张
- 西安交通大学第二附属医院耳鼻咽喉头颈外科Department of Otorhinolaryngology Head and Neck Surgery, Second Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an
| | - 甦琳 张
- 华中科技大学同济医学院附属协和医院耳鼻咽喉科Department of Otorhinolaryngology Head and Neck Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - 鹏宇 任
- 西安交通大学第二附属医院神经外科Department of Neurosurgery, Second Affiliated Hospital of Xi'an Jiaotong University School of Medicine
| | - 青 张
- 上海交通大学附属新华医院耳鼻咽喉头颈外科Department of Otorhinolaryngology Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine
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Zhu M, van Stiphout L, Karabulut M, Pérez Fornos A, Guinand N, Meijer K, van de Berg R, McCrum C. Assessing balance in people with bilateral vestibulopathy using the Mini-Balance Evaluation Systems Test (Mini-BESTest): feasibility and comparison with healthy control data. J Neurol 2023; 270:4423-4433. [PMID: 37269353 PMCID: PMC10421784 DOI: 10.1007/s00415-023-11795-y] [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: 04/20/2023] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Bilateral vestibulopathy (BVP) leads to unsteadiness when walking, which worsens in darkness or on uneven ground, as well as falls. Since simple balance tests struggle to distinguish between BVP and healthy participants, we aimed (1) to test if the Mini-BESTest is feasible in BVP, (2) how people with BVP perform on the Mini-BESTest and (3) to compare these scores with healthy reference data. METHODS Fifty participants with BVP completed the Mini-BESTest. 12-month falls incidence was obtained by questionnaire. To compare the overall and sub-scores between our participants with BVP and those of healthy participants from the literature (n = 327; obtained via PubMed searches), Mann-Whitney U tests were used. Sub scores within the BVP group were also compared. Spearman correlations were used to investigate the relationships between Mini-BESTest score and age. RESULTS No floor or ceiling effects were observed. Participants with BVP had significantly lower Mini-BESTest total scores than the healthy group. Anticipatory, reactive postural control and sensory orientation sub scores of the Mini-BESTest were significantly lower in BVP, while dynamic gait sub scores were not significantly different. A stronger negative correlation between age and Mini-BESTest total score was found in BVP than in the healthy group. Scores did not differ between patients with different falls history. CONCLUSION The Mini-BESTest is feasible in BVP. Our results confirm the commonly reported balance deficits in BVP. The stronger negative association between age and balance in BVP might reflect the age-related decline in the remaining sensory systems with which people with BVP compensate.
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Affiliation(s)
- Meichan Zhu
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
- Department of Otorhinolaryngology, Guangzhou Twelfth People's Hospital (Guangzhou Otolarynology-Head and Neck Surgery Hospital), No. 1 Tianqiang Road, Tianhe District, Guangzhou, 510620, Guangdong, China.
| | - Lisa van Stiphout
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Mustafa Karabulut
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Angélica Pérez Fornos
- Service of Otorhinolaryngology and Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Nils Guinand
- Service of Otorhinolaryngology and Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Kenneth Meijer
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Raymond van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Christopher McCrum
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
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Sun Y, Zhu D, Song H, Chien JH. Vibrations on mastoid process alter the gait characteristics during walking on different inclines. PeerJ 2023; 11:e15111. [PMID: 36987452 PMCID: PMC10040183 DOI: 10.7717/peerj.15111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 03/02/2023] [Indexed: 03/30/2023] Open
Abstract
Background Eighty-eight percent of the persons with bilateral vestibular dysfunction have reported at least one fall within the past 5 years. The apparent alternations due to the bilateral vestibular dysfunctions (BVD) are the gait characteristics, such as slower walking speed, prolonged stance phase, and shorter step length. Unexpectedly, due to the prevalence of this BVD being relatively low, attention is not obtained as same as in other vestibular disorders. Moreover, how does walking on different inclines, part of daily activities, alter the gait characteristics under the unreliable bilateral vestibular systems? Previous studies used vibration-based stimulations (VS) as a perturbation to understand the postural control during walking while the bilateral vestibular systems were perturbed. Therefore, this study attempted to extend the knowledge to understand the alternations in spatial-temporal gait characteristics under perturbed bilateral vestibular systems while walking on different inclines. Methods Nineteen healthy young adults participated in this study. Eight walking conditions were randomly assigned to each participant: 0%, 3%, 6%, and 9% grade of inclines with/without VS. The preferred walking speed was used for gait analysis. The dependent variables were stance time, double support time, step length, step time, step width, foot clearance, and respective variabilities. All dependent variables were defined by two critical gait events: heel-strike and toe-off. Pre-Hoc paired comparisons with Bonferroni corrections were used to prioritize the dependent variables. A two-way repeated measure was used to investigate the effect of VS and the effect of inclines on the selected dependent variables from Pre-Hoc analysis. Post-Hoc comparisons were also corrected by the Bonferroni method. Results The step length, step time, foot clearance, and foot clearance variability were selected by the Pre-Hoc analysis because the corrected paired t-test demonstrated a significant VS effect (p < 0.05) on these gait parameters at least one of four inclines. The significant interaction between the effect of VS and the effect of inclines was found in step length (p = 0.005), step time (p = 0.028), and foot clearance variability (p = 0.003). The results revealed that implementing a VS increased step length and step time when walking on 0%, 3%, and 9% of grade inclines. In particular, the foot clearance variability was found when walking on 9% of grade inclines. Conclusion The observations in the current study suggested that VS increased the step length, step time, foot clearance, and foot clearance variability while walking on inclines. These results suggested that these gait parameters might be promising targets for future clinical investigations in patients with BVD while walking on different inclines. Importantly, the increases in spatial-temporal gait performance under bilateral VS might be an indicator of gait improvement while walking on different inclines.
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Affiliation(s)
- Yuxiao Sun
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Dongqi Zhu
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Huiyan Song
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jung H. Chien
- Independent Researcher, Omaha, Nebraska, United States
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Jabri S, Carender W, Wiens J, Sienko KH. Automatic ML-based vestibular gait classification: examining the effects of IMU placement and gait task selection. J Neuroeng Rehabil 2022; 19:132. [PMID: 36456966 PMCID: PMC9713134 DOI: 10.1186/s12984-022-01099-z] [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: 05/03/2022] [Accepted: 10/25/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Vestibular deficits can impair an individual's ability to maintain postural and/or gaze stability. Characterizing gait abnormalities among individuals affected by vestibular deficits could help identify patients at high risk of falling and inform rehabilitation programs. Commonly used gait assessment tools rely on simple measures such as timing and visual observations of path deviations by clinicians. These simple measures may not capture subtle changes in gait kinematics. Therefore, we investigated the use of wearable inertial measurement units (IMUs) and machine learning (ML) approaches to automatically discriminate between gait patterns of individuals with vestibular deficits and age-matched controls. The goal of this study was to examine the effects of IMU placement and gait task selection on the performance of automatic vestibular gait classifiers. METHODS Thirty study participants (15 with vestibular deficits and 15 age-matched controls) participated in a single-session gait study during which they performed seven gait tasks while donning a full-body set of IMUs. Classification performance was reported in terms of area under the receiver operating characteristic curve (AUROC) scores for Random Forest models trained on data from each IMU placement for each gait task. RESULTS Several models were able to classify vestibular gait better than random (AUROC > 0.5), but their performance varied according to IMU placement and gait task selection. Results indicated that a single IMU placed on the left arm when walking with eyes closed resulted in the highest AUROC score for a single IMU (AUROC = 0.88 [0.84, 0.89]). Feature permutation results indicated that participants with vestibular deficits reduced their arm swing compared to age-matched controls while they walked with eyes closed. CONCLUSIONS These findings highlighted differences in upper extremity kinematics during walking with eyes closed that were characteristic of vestibular deficits and showed evidence of the discriminative ability of IMU-based automated screening for vestibular deficits. Further research should explore the mechanisms driving arm swing differences in the vestibular population.
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Affiliation(s)
- Safa Jabri
- grid.214458.e0000000086837370Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109 USA
| | - Wendy Carender
- grid.412590.b0000 0000 9081 2336Department of Otolaryngology, Michigan Medicine, Ann Arbor, MI 48109 USA
| | - Jenna Wiens
- grid.214458.e0000000086837370Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, MI 48109 USA
| | - Kathleen H. Sienko
- grid.214458.e0000000086837370Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109 USA
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Walking Speed Classification from Marker-Free Video Images in Two-Dimension Using Optimum Data and a Deep Learning Method. Bioengineering (Basel) 2022; 9:bioengineering9110715. [DOI: 10.3390/bioengineering9110715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/09/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022] Open
Abstract
Walking speed is considered a reliable assessment tool for any movement-related functional activities of an individual (i.e., patients and healthy controls) by caregivers and clinicians. Traditional video surveillance gait monitoring in clinics and aged care homes may employ modern artificial intelligence techniques to utilize walking speed as a screening indicator of various physical outcomes or accidents in individuals. Specifically, ratio-based body measurements of walking individuals are extracted from marker-free and two-dimensional video images to create a walk pattern suitable for walking speed classification using deep learning based artificial intelligence techniques. However, the development of successful and highly predictive deep learning architecture depends on the optimal use of extracted data because redundant data may overburden the deep learning architecture and hinder the classification performance. The aim of this study was to investigate the optimal combination of ratio-based body measurements needed for presenting potential information to define and predict a walk pattern in terms of speed with high classification accuracy using a deep learning-based walking speed classification model. To this end, the performance of different combinations of five ratio-based body measurements was evaluated through a correlation analysis and a deep learning-based walking speed classification test. The results show that a combination of three ratio-based body measurements can potentially define and predict a walk pattern in terms of speed with classification accuracies greater than 92% using a bidirectional long short-term memory deep learning method.
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10
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Abstract
PURPOSE OF REVIEW The current review covers recent advances in bilateral vestibulopathy (BVP) in terms of its etiology, diagnosis, and treatments. RECENT FINDINGS The etiology of BVP depends on its clinical course and associated findings, and genetic abnormalities are increasingly recognized in isolated as well as complicated form of BVP. Recent developments in evaluation of the vestibular function have greatly enhanced the detection of BVP, and introduction of the consensus diagnostic criteria by Barany Society has facilitated research on BVP. Vestibular prosthesis may improve vestibular function, posture, gait and quality of life in patients with BVP and would expand the therapeutic options for BVP in near future. SUMMARY Genetics is expanding its role in identifying the causes of BVP of hitherto unknown etiology. The detection and investigation of BVP have been greatly enhanced by introduction of consensus diagnostic criteria and recent developments in methodology evaluating the vestibular function. Vestibular prothesis appears promising in managing BVP. VIDEO ABSTRACT http://links.lww.com/CONR/A59.
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Affiliation(s)
- Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul
- Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, Seongnam
| | - Hyo-Jung Kim
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, South Korea
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11
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Context-independent encoding of passive and active self-motion in vestibular afferent fibers during locomotion in primates. Nat Commun 2022; 13:120. [PMID: 35013266 PMCID: PMC8748921 DOI: 10.1038/s41467-021-27753-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/03/2021] [Indexed: 11/21/2022] Open
Abstract
The vestibular system detects head motion to coordinate vital reflexes and provide our sense of balance and spatial orientation. A long-standing hypothesis has been that projections from the central vestibular system back to the vestibular sensory organs (i.e., the efferent vestibular system) mediate adaptive sensory coding during voluntary locomotion. However, direct proof for this idea has been lacking. Here we recorded from individual semicircular canal and otolith afferents during walking and running in monkeys. Using a combination of mathematical modeling and nonlinear analysis, we show that afferent encoding is actually identical across passive and active conditions, irrespective of context. Thus, taken together our results are instead consistent with the view that the vestibular periphery relays robust information to the brain during primate locomotion, suggesting that context-dependent modulation instead occurs centrally to ensure that coding is consistent with behavioral goals during locomotion. Using experimental and computational approaches the authors show that the vestibular efferent system does not modulate peripheral coding during locomotion. Instead, vestibular afferents unambiguously convey information in a context independent manner.
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12
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Herssens N, How D, van de Berg R, McCrum C. Falls Among People With Bilateral Vestibulopathy: A Review of Causes, Incidence, Injuries, and Methods. JAMA Otolaryngol Head Neck Surg 2022; 148:187-192. [PMID: 34989780 DOI: 10.1001/jamaoto.2021.3673] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance People with bilateral vestibulopathy experience severe balance and mobility issues. Fear and anxiety are associated with reduced activity, which can further affect balance and fall risk. Understanding and intervening on falls in this population is essential. The aims of this narrative review are to provide an overview of the current knowledge and applied methods on fall incidence, causes, and injuries in bilateral vestibulopathy. Observations Eleven articles reporting falls incidence in people with bilateral vestibulopathy were deemed eligible, including 3 prospective and 8 retrospective studies, with a total of 359 participants, of whom 149 (42%) fell during the assessed period. When reported, the most common perceived causes of falls were loss of balance, darkness, and uneven ground. Information on sustained injuries was limited, with bruises and scrapes being the most common, and only 4 fractures were reported. As most studies included falls as a secondary, descriptive outcome measure, fall data obtained using best practice guidelines were lacking. Only 6 studies reported their definition of a fall, of which 2 studies explicitly reported the way participants were asked about their fall status. Only 3 studies performed a prospective daily fall assessment using monthly fall diaries (a recommended practice), whereas the remaining studies retrospectively collected fall-related data through questionnaires or interviews. While most studies reported the number of people who did and did not fall, the number of total falls in individual studies was lacking. Conclusions and Relevance The findings from this review suggest that falls in people with bilateral vestibulopathy are common but remain an understudied consequence of the disease. Larger prospective studies that follow best practice guidelines for fall data collection with the aim of obtaining and reporting fall data are required to improve current fall risk assessments and interventions in bilateral vestibulopathy.
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Affiliation(s)
- Nolan Herssens
- Space Medicine Team (HRE-OM), European Astronaut Centre, European Space Agency, Cologne, Germany.,Department of Rehabilitation Sciences and Physiotherapy/MOVANT, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Daniella How
- Institute of Sport and Exercise Sciences, Münster University, Münster, Germany
| | - Raymond van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Health Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University Medical Centre+, Maastricht, the Netherlands.,Faculty of Physics, Tomsk State University, Tomsk, Russia
| | - Christopher McCrum
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, the Netherlands
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13
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McCrum C, Vaes AW, Delbressine JM, Koopman M, Liu WY, Willems P, Meijer K, Spruit MA. A pilot study on the feasibility and effectiveness of treadmill-based perturbations for assessing and improving walking stability in chronic obstructive pulmonary disease. Clin Biomech (Bristol, Avon) 2022; 91:105538. [PMID: 34823220 DOI: 10.1016/j.clinbiomech.2021.105538] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 10/22/2021] [Accepted: 11/17/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Falls risk is elevated in chronic obstructive pulmonary disease (COPD). However, there is a lack of evidence regarding the contributing factors. Here, we examined the feasibility of, and initial responses to, large walking perturbations in COPD, as well as the adaptation potential of people with COPD to repeated walking perturbations that might indicate potential for perturbation-based balance training in COPD. METHODS 12 participants with COPD undergoing inpatient pulmonary rehabilitation and 12 age-gender-matched healthy control participants walked on an instrumented treadmill and experienced repeated treadmill-belt acceleration perturbations (leading to a forward balance loss). Three-dimensional motion capture was used to quantify the stability of participants body position during perturbed walking. Feasibility, stability following the initial perturbations and adaptation to repeated perturbations were assessed. FINDINGS Using perturbations in this manner was feasible in this population (no harness assists and participants completed the minimum number of perturbations). No clear, specific deficit in reactive walking stability in COPD was found (no significant effects of participant group on stability or recovery step outcomes). There were mixed results for the adaptability outcomes which overall indicated some adaptability to repeated perturbations, but not to the same extent as the healthy control participants. INTERPRETATION Treadmill-based perturbations during walking are feasible in COPD. COPD does not appear to result in significant deficits in stability following sudden perturbations and patients do demonstrate some adaptability to repeated perturbations. Perturbation-based balance training may be considered for fall prevention in research and practice in people with COPD.
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Affiliation(s)
- Christopher McCrum
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, the Netherlands.
| | - Anouk W Vaes
- Research and Development, CIRO, Horn, the Netherlands
| | | | - Maud Koopman
- Research and Development, CIRO, Horn, the Netherlands; Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Wai-Yan Liu
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, the Netherlands; Research and Development, CIRO, Horn, the Netherlands; Department of Orthopaedic Surgery, Máxima Medical Center, Eindhoven, the Netherlands; Department of Orthopaedic Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Paul Willems
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Kenneth Meijer
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Martijn A Spruit
- Research and Development, CIRO, Horn, the Netherlands; Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, the Netherlands
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14
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Grevendonk L, Connell NJ, McCrum C, Fealy CE, Bilet L, Bruls YMH, Mevenkamp J, Schrauwen-Hinderling VB, Jörgensen JA, Moonen-Kornips E, Schaart G, Havekes B, de Vogel-van den Bosch J, Bragt MCE, Meijer K, Schrauwen P, Hoeks J. Impact of aging and exercise on skeletal muscle mitochondrial capacity, energy metabolism, and physical function. Nat Commun 2021; 12:4773. [PMID: 34362885 PMCID: PMC8346468 DOI: 10.1038/s41467-021-24956-2] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 07/08/2021] [Indexed: 12/13/2022] Open
Abstract
The relationship between the age-associated decline in mitochondrial function and its effect on skeletal muscle physiology and function remain unclear. In the current study, we examined to what extent physical activity contributes to the decline in mitochondrial function and muscle health during aging and compared mitochondrial function in young and older adults, with similar habitual physical activity levels. We also studied exercise-trained older adults and physically impaired older adults. Aging was associated with a decline in mitochondrial capacity, exercise capacity and efficiency, gait stability, muscle function, and insulin sensitivity, even when maintaining an adequate daily physical activity level. Our data also suggest that a further increase in physical activity level, achieved through regular exercise training, can largely negate the effects of aging. Finally, mitochondrial capacity correlated with exercise efficiency and insulin sensitivity. Together, our data support a link between mitochondrial function and age-associated deterioration of skeletal muscle. Aging is associated with a progressive loss of muscle function. Here the authors characterize mitochondrial capacity and muscle function in young and older adults with similar habitual physical activity and also compared to older adults with exercise training or with physical impairment.
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Affiliation(s)
- L Grevendonk
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.,TI Food and Nutrition, Wageningen, The Netherlands
| | - N J Connell
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.,TI Food and Nutrition, Wageningen, The Netherlands
| | - C McCrum
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - C E Fealy
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.,TI Food and Nutrition, Wageningen, The Netherlands
| | - L Bilet
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.,TI Food and Nutrition, Wageningen, The Netherlands
| | - Y M H Bruls
- Department of Radiology and Nuclear Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - J Mevenkamp
- Department of Radiology and Nuclear Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - V B Schrauwen-Hinderling
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.,Department of Radiology and Nuclear Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - J A Jörgensen
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - E Moonen-Kornips
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - G Schaart
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - B Havekes
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.,Department of Internal Medicine, Division of Endocrinology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | | | - M C E Bragt
- Friesland-Campina, Amersfoort, The Netherlands
| | - K Meijer
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - P Schrauwen
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.,TI Food and Nutrition, Wageningen, The Netherlands
| | - J Hoeks
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands. .,TI Food and Nutrition, Wageningen, The Netherlands.
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15
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Namazi H. Complexity-based analysis of the correlation between stride interval variability and muscle reaction at different walking speeds. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102956] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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16
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Gerards MHG, Meijer K, Karamanidis K, Grevendonk L, Hoeks J, Lenssen AF, McCrum C. Adaptability to Balance Perturbations During Walking as a Potential Marker of Falls History in Older Adults. Front Sports Act Living 2021; 3:682861. [PMID: 34095828 PMCID: PMC8169998 DOI: 10.3389/fspor.2021.682861] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/19/2021] [Indexed: 11/13/2022] Open
Abstract
Given that falls most commonly occur during walking due to unexpected balance perturbations like trips and slips, walking-based balance assessment including walking stability and adaptability to such perturbations could be beneficial for fall risk assessment in older adults. This cross-sectional study reanalyzed data from two larger studies conducted with the same walking protocol. Participants completed unperturbed walking trials at speeds of 0.4 m/s up to 1.8 m/s in 0.2 m/s steps. Ten unannounced treadmill belt acceleration perturbations were then applied while participants walked at equivalent stability, assessed using the margins of stability. Retrospective (12 months) falls incidence was collected to divide participants into people with and without a history of falls. Twenty older adults (mean age 70.2 ± 2.9 years) were included in this analysis; eight people with one or more recent falls and 12 people without, closely matched by sex, age and height. No significant differences were found in unperturbed walking parameters or their variability. Overall perturbation-recovery step behavior differed slightly (not statistically significant) between the groups after the first perturbation and differences became more pronounced and significant after repetition of perturbations. The No-Falls group significantly reduced the number of recovery steps needed across the trials, whereas the Falls group did not show these improvements. People with a previous fall tended to have slightly delayed and more variable recovery responses after perturbation compared to non-fallers. Non-fallers demonstrate more signs of adaptability to repeated perturbations. Adaptability may give a broader indication of the ability of the locomotor system to respond and improve responses to sudden walking perturbations than unperturbed walking variability or recovery to a single novel perturbation. Adaptability may thus be a more useful marker of falls history in older adults and should be considered in further research.
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Affiliation(s)
- Marissa H G Gerards
- Department of Epidemiology, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands.,Department of Physical Therapy, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Kenneth Meijer
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Kiros Karamanidis
- Sports and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, United Kingdom
| | - Lotte Grevendonk
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands.,TI Food and Nutrition, Wageningen, Netherlands
| | - Joris Hoeks
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands.,TI Food and Nutrition, Wageningen, Netherlands
| | - Antoine F Lenssen
- Department of Epidemiology, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands.,Department of Physical Therapy, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Christopher McCrum
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
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17
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Sikandar T, Rabbi MF, Ghazali KH, Altwijri O, Alqahtani M, Almijalli M, Altayyar S, Ahamed NU. Using a Deep Learning Method and Data from Two-Dimensional (2D) Marker-Less Video-Based Images for Walking Speed Classification. SENSORS 2021; 21:s21082836. [PMID: 33920617 PMCID: PMC8072769 DOI: 10.3390/s21082836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/10/2021] [Accepted: 04/13/2021] [Indexed: 01/09/2023]
Abstract
Human body measurement data related to walking can characterize functional movement and thereby become an important tool for health assessment. Single-camera-captured two-dimensional (2D) image sequences of marker-less walking individuals might be a simple approach for estimating human body measurement data which could be used in walking speed-related health assessment. Conventional body measurement data of 2D images are dependent on body-worn garments (used as segmental markers) and are susceptible to changes in the distance between the participant and camera in indoor and outdoor settings. In this study, we propose five ratio-based body measurement data that can be extracted from 2D images and can be used to classify three walking speeds (i.e., slow, normal, and fast) using a deep learning-based bidirectional long short-term memory classification model. The results showed that average classification accuracies of 88.08% and 79.18% could be achieved in indoor and outdoor environments, respectively. Additionally, the proposed ratio-based body measurement data are independent of body-worn garments and not susceptible to changes in the distance between the walking individual and camera. As a simple but efficient technique, the proposed walking speed classification has great potential to be employed in clinics and aged care homes.
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Affiliation(s)
- Tasriva Sikandar
- Faculty of Electrical and Electronics Engineering, Universiti Malaysia Pahang, Pekan 26600, Malaysia; (T.S.); (K.H.G.)
| | - Mohammad F. Rabbi
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD 4222, Australia;
| | - Kamarul H. Ghazali
- Faculty of Electrical and Electronics Engineering, Universiti Malaysia Pahang, Pekan 26600, Malaysia; (T.S.); (K.H.G.)
| | - Omar Altwijri
- Biomedical Technology Department, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia; (O.A.); (M.A.); (M.A.); (S.A.)
| | - Mahdi Alqahtani
- Biomedical Technology Department, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia; (O.A.); (M.A.); (M.A.); (S.A.)
| | - Mohammed Almijalli
- Biomedical Technology Department, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia; (O.A.); (M.A.); (M.A.); (S.A.)
| | - Saleh Altayyar
- Biomedical Technology Department, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia; (O.A.); (M.A.); (M.A.); (S.A.)
| | - Nizam U. Ahamed
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA 15203, USA
- Correspondence:
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Herssens N, Saeys W, Vereeck L, Meijer K, van de Berg R, Van Rompaey V, McCrum C, Hallemans A. An exploratory investigation on spatiotemporal parameters, margins of stability, and their interaction in bilateral vestibulopathy. Sci Rep 2021; 11:6427. [PMID: 33742071 PMCID: PMC7979710 DOI: 10.1038/s41598-021-85870-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 03/05/2021] [Indexed: 12/12/2022] Open
Abstract
Integration of accurate vestibular, visual, and proprioceptive information is crucial in managing the centre of mass in relation to the base of support during gait. Therefore, bilateral loss of peripheral vestibular function can be highly debilitating when performing activities of daily life. To further investigate the influence of an impaired peripheral vestibular system on gait stability, spatiotemporal parameters, step-to-step variability, and mechanical stability parameters were examined in 20 patients with bilateral vestibulopathy and 20 matched healthy controls during preferred overground walking. Additionally, using a partial least squares analysis the relationship between spatiotemporal parameters of gait and the margins of stability was explored in both groups. Patients with bilateral vestibulopathy showed an increased cadence compared to healthy controls (121 ± 9 vs 115 ± 8 steps/min; p = 0.02; d = 0.77). In addition, although not significant (p = 0.07), a moderate effect size (d = 0.60) was found for step width variability (Coefficient of Variation (%); Bilateral vestibulopathy: 19 ± 11%; Healthy controls: 13 ± 5%). Results of the partial least squares analysis suggest that patients with peripheral vestibular failure implement a different balance control strategy. Instead of altering the step parameters, as is the case in healthy controls, they use the single and double support phases to control the state of the centre of mass to improve the mechanical stability.
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Affiliation(s)
- Nolan Herssens
- Department of Rehabilitation Sciences, Ghent University, Campus UZ Gent, Corneel Heymanslaan 10, Building B3, 9000, Ghent, Belgium. .,Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium. .,Multidisciplinary Motor Centre Antwerp (M2OCEAN), University of Antwerp, Antwerp, Belgium.
| | - Wim Saeys
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,RevArte Rehabilitation Hospital, Edegem, Belgium
| | - Luc Vereeck
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Multidisciplinary Motor Centre Antwerp (M2OCEAN), University of Antwerp, Antwerp, Belgium
| | - Kenneth Meijer
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Raymond van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Health Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Faculty of Physics, Tomsk State University, Tomsk, Russia
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Christopher McCrum
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Ann Hallemans
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Multidisciplinary Motor Centre Antwerp (M2OCEAN), University of Antwerp, Antwerp, Belgium
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19
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Herssens N, Dobbels B, Moyaert J, Van de Berg R, Saeys W, Hallemans A, Vereeck L, Van Rompaey V. Paving the Way Toward Distinguishing Fallers From Non-fallers in Bilateral Vestibulopathy: A Wide Pilot Observation. Front Neurol 2021; 12:611648. [PMID: 33732204 PMCID: PMC7957054 DOI: 10.3389/fneur.2021.611648] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/26/2021] [Indexed: 11/13/2022] Open
Abstract
Patients with bilateral vestibulopathy (BVP) present with unsteadiness during standing and walking, limiting their activities of daily life and, more importantly, resulting in an increased risk of falling. In BVP patients, falls are considered as one of the major complications, with patients having a 31-fold increased risk of falling compared to healthy subjects. Thus, highlighting objective measures that can easily and accurately assess the risk of falling in BVP patients is an important step in reducing the incidence of falls and the accompanying burdens. Therefore, this study investigated the interrelations between demographic characteristics, vestibular function, questionnaires on self-perceived handicap and balance confidence, clinical balance measures, gait variables, and fall status in 27 BVP patients. Based on the history of falls in the preceding 12 months, the patients were subdivided in a "faller" or "non-faller" group. Results on the different outcome measures were compared between the "faller" and "non-faller" subgroups using Pearson's chi-square test in the case of categorical data; for continuous data, Mann-Whitney U test was used. Performances on the clinical balance measures were comparable between fallers and non-fallers, indicating that, independent from fall status, the BVP patients present with an increased risk of falling. However, fallers tended to report a worse self-perceived handicap and confidence during performing activities of daily life. Spatiotemporal parameters of gait did not differ between fallers and non-fallers during walking at slow, preferred, or fast walking speed. These results may thus imply that, when aiming to distinguish fallers from non-fallers, the BVP patients' beliefs concerning their capabilities may be more important than the moderately or severely affected physical performance within a clinical setting. Outcome measures addressing the self-efficacy and fear of falling in BVP patients should therefore be incorporated in future research to investigate whether these are indeed able to distinguish fallers form non-fallers. Additionally, information regarding physical activity could provide valuable insights on the contextual information influencing behavior and falls in BVP.
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Affiliation(s)
- Nolan Herssens
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Bieke Dobbels
- Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Julie Moyaert
- Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Raymond Van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Health Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, Netherlands
- Faculty of Physics, Tomsk State University, Tomsk, Russia
| | - Wim Saeys
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- RevArte Rehabilitation Hospital, Edegem, Belgium
| | - Ann Hallemans
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Multidisciplinary Motor Centre Antwerp (MOCEAN), University of Antwerp, Antwerp, Belgium
| | - Luc Vereeck
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Multidisciplinary Motor Centre Antwerp (MOCEAN), University of Antwerp, Antwerp, Belgium
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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20
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Daily acute intermittent hypoxia combined with walking practice enhances walking performance but not intralimb motor coordination in persons with chronic incomplete spinal cord injury. Exp Neurol 2021; 340:113669. [PMID: 33647273 DOI: 10.1016/j.expneurol.2021.113669] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/14/2021] [Accepted: 02/25/2021] [Indexed: 12/15/2022]
Abstract
Persons living with incomplete spinal cord injuries (SCI) often struggle to regain independent walking due to deficits in walking mechanics. They often dedicate many weeks of gait training before benefits to emerge, with additional training needed for benefits to persist. Recent studies in humans with SCI found that daily bouts of breathing low oxygen (acute intermittent hypoxia, AIH) prior to locomotor training elicited persistent (weeks) improvement in overground walking speed and endurance. AIH-induced improvements in overground walking may result from changes in control strategies that also enhance intralimb coordination; however, this possibility remains untested. Here, we examined the extent to which daily AIH combined with walking practice (AIH + WALK) improved overground walking performance and intralimb motor coordination in persons with chronic, incomplete SCI. METHODS We recruited 11 persons with chronic (> 1 year), incomplete SCI to participate in a randomized, double-blind, balanced, crossover study. Participants first received either daily (5 consecutive days) AIH (15, 90-s episodes of 10.0% O2 with 60s intervals at 20.9% O2) or SHAM (15, 90s episodes at 20.9% O2 with 60s intervals at 20.9% O2) followed by 30-min of overground walking practice. They received the second treatment after a minimum 2-week washout period. We quantified overground walking performance, in terms of speed and endurance, using the 10-Meter Walk Test (10MWT) and 6-Minute Walk Test (6MWT), respectively. We quantified intralimb motor coordination using kinematic variability measures of foot trajectory (i.e., endpoint variability, EV) and of inter-joint coupling between the hip and knee, as well as between the knee and ankle joints (i.e., angular coefficient of correspondence, ACC). We compared the changes in walking performance relative to baseline (BL) between daily AIH + WALK and daily SHAM+WALK on treatment day 5 (T5), 1-week follow-up (F1), and 2-weeks follow-up (F2). We also compared these changes between participants who used bilateral walking aids (N = 5) and those who did not. To assess the effects of daily AIH + WALK on intralimb coordination, we compared potential treatment-induced changes in EV and ACC relative to BL at F1 and F2. RESULTS Participants improved overground walking performance (speed and endurance) after daily AIH + WALK, but not SHAM+WALK. Following daily AIH + WALK, participants decreased their 10MWT time at T5 by 28% (95% CI 0.2-10.1 s, p = 0.04), F1 by 28% (95% CI 1.1-13.5 s, p = 0.01), and F2 by 27% (95% CI 1.4-13.9 s, p = 0.01) relative to BL. The greatest decreases in the 10MWT occurred in participants who used bilateral walking aids (p < 0.05). We also found daily AIH + WALK resulted in an increase in 6MWT distance at T5 by 22% (95% CI 13.3-72.6 m, p = 0.001), F1 by 21% (95% CI 13.1-72.5 m, p = 0.001), and F2 by 16% (95% CI 2.9-62.2 m, p = 0.02). However, measures of EV and ACC during self-selected walking conditions did not change following daily AIH + WALK (all p-values >0.50). CONCLUSIONS Consistent with prior studies, daily AIH + WALK triggered improvements in walking speed and endurance that persisted for weeks after treatment. Greatest improvements in speed occurred in participants who used bilateral walking aids. No change in EV and ACC may suggest that intralimb motor coordination was not a significant gait training priority during daily AIH + WALK.
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21
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Akay T, Murray AJ. Relative Contribution of Proprioceptive and Vestibular Sensory Systems to Locomotion: Opportunities for Discovery in the Age of Molecular Science. Int J Mol Sci 2021; 22:1467. [PMID: 33540567 PMCID: PMC7867206 DOI: 10.3390/ijms22031467] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/20/2021] [Accepted: 01/26/2021] [Indexed: 12/29/2022] Open
Abstract
Locomotion is a fundamental animal behavior required for survival and has been the subject of neuroscience research for centuries. In terrestrial mammals, the rhythmic and coordinated leg movements during locomotion are controlled by a combination of interconnected neurons in the spinal cord, referred as to the central pattern generator, and sensory feedback from the segmental somatosensory system and supraspinal centers such as the vestibular system. How segmental somatosensory and the vestibular systems work in parallel to enable terrestrial mammals to locomote in a natural environment is still relatively obscure. In this review, we first briefly describe what is known about how the two sensory systems control locomotion and use this information to formulate a hypothesis that the weight of the role of segmental feedback is less important at slower speeds but increases at higher speeds, whereas the weight of the role of vestibular system has the opposite relation. The new avenues presented by the latest developments in molecular sciences using the mouse as the model system allow the direct testing of the hypothesis.
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Affiliation(s)
- Turgay Akay
- Atlantic Mobility Action Project, Brain Repair Centre, Department of Medical Neuroscience, Life Science Research Institute, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Andrew J. Murray
- Sainsbury Wellcome Centre for Neural Circuits and Behaviour, University College London, London W1T 4JG, UK
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22
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Starkov D, Snelders M, Lucieer F, Janssen AML, Pleshkov M, Kingma H, van Rompaey V, Herssens N, Hallemans A, Vereeck L, McCrum C, Meijer K, Guinand N, Perez-Fornos A, van de Berg R. Bilateral vestibulopathy and age: experimental considerations for testing dynamic visual acuity on a treadmill. J Neurol 2020; 267:265-272. [PMID: 33113022 PMCID: PMC7718189 DOI: 10.1007/s00415-020-10249-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/25/2020] [Accepted: 09/28/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Bilateral vestibulopathy (BVP) can affect visual acuity in dynamic conditions, like walking. This can be assessed by testing Dynamic Visual Acuity (DVA) on a treadmill at different walking speeds. Apart from BVP, age itself might influence DVA and the ability to complete the test. The objective of this study was to investigate whether DVA tested while walking, and the drop-out rate (the inability to complete all walking speeds of the test) are significantly influenced by age in BVP-patients and healthy subjects. METHODS Forty-four BVP-patients (20 male, mean age 59 years) and 63 healthy subjects (27 male, mean age 46 years) performed the DVA test on a treadmill at 0 (static condition), 2, 4 and 6 km/h (dynamic conditions). The dynamic visual acuity loss was calculated as the difference between visual acuity in the static condition and visual acuity in each walking condition. The dependency of the drop-out rate and dynamic visual acuity loss on BVP and age was investigated at all walking speeds, as well as the dependency of dynamic visual acuity loss on speed. RESULTS Age and BVP significantly increased the drop-out rate (p ≤ 0.038). A significantly higher dynamic visual acuity loss was found at all speeds in BVP-patients compared to healthy subjects (p < 0.001). Age showed no effect on dynamic visual acuity loss in both groups. In BVP-patients, increasing walking speeds resulted in higher dynamic visual acuity loss (p ≤ 0.036). CONCLUSION DVA tested while walking on a treadmill, is one of the few "close to reality" functional outcome measures of vestibular function in the vertical plane. It is able to demonstrate significant loss of DVA in bilateral vestibulopathy patients. However, since bilateral vestibulopathy and age significantly increase the drop-out rate at faster walking speeds, it is recommended to use age-matched controls. Furthermore, it could be considered to use an individual "preferred" walking speed and to limit maximum walking speed in older subjects when testing DVA on a treadmill.
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Affiliation(s)
- D Starkov
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands. .,Faculty of Physics, Tomsk State Research University, Tomsk, Russia. .,Maastricht University ENT Department, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - M Snelders
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - F Lucieer
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - A M L Janssen
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - M Pleshkov
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.,Faculty of Physics, Tomsk State Research University, Tomsk, Russia
| | - H Kingma
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.,Faculty of Physics, Tomsk State Research University, Tomsk, Russia
| | - V van Rompaey
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - N Herssens
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium.,Multidisciplinary Motor Centre Antwerp (M2OCEAN), University of Antwerp, Antwerp, Belgium
| | - A Hallemans
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium.,Multidisciplinary Motor Centre Antwerp (M2OCEAN), University of Antwerp, Antwerp, Belgium.,The Research Group MOVANT (MOVement ANTwerp), University of Antwerp, Antwerp, Belgium
| | - L Vereeck
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium.,Multidisciplinary Motor Centre Antwerp (M2OCEAN), University of Antwerp, Antwerp, Belgium
| | - C McCrum
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - K Meijer
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - N Guinand
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.,Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - A Perez-Fornos
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - R van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.,Faculty of Physics, Tomsk State Research University, Tomsk, Russia
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23
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Lucieer FMP, Van Hecke R, van Stiphout L, Duijn S, Perez-Fornos A, Guinand N, Van Rompaey V, Kingma H, Joore M, van de Berg R. Bilateral vestibulopathy: beyond imbalance and oscillopsia. J Neurol 2020; 267:241-255. [PMID: 33030608 PMCID: PMC7718190 DOI: 10.1007/s00415-020-10243-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 09/20/2020] [Accepted: 09/22/2020] [Indexed: 01/04/2023]
Abstract
Objective To optimize the current diagnostic and treatment procedures for patients with bilateral vestibulopathy (BV), this study aimed to determine the complete spectrum of symptoms associated with BV. Method A prospective mixed-method study design was used. Qualitative data were collected by performing semi-structured interviews about symptoms, context, and behavior. The interviews were recorded and transcribed until no new information was obtained. Transcriptions were analyzed in consensus by two independent researchers. In comparison to the qualitative results, quantitative data were collected using the Dizziness Handicap Inventory (DHI), Hospital Anxiety and Depression Scale (HADS) and a health-related quality of life questionnaire (EQ-5D-5L). Results Eighteen interviews were transcribed. Reported symptoms were divided into fourteen physical symptoms, four cognitive symptoms, and six emotions. Symptoms increased in many situations, such as darkness (100%), uneven ground (61%), cycling (94%) or driving a car (56%). These symptoms associated with BV often resulted in behavioral changes: activities were performed more slowly, with greater attention, or were avoided. The DHI showed a mean score of severe handicap (54.67). The HADS questionnaire showed on average normal results (anxiety = 7.67, depression = 6.22). The EQ-5D-5L demonstrated a mean index value of 0.680, which is lower compared to the Dutch age-adjusted reference 0.839 (60–70 years). Conclusion BV frequently leads to physical, cognitive, and emotional complaints, which often results in a diminished quality of life. Importantly, this wide range of symptoms is currently underrated in literature and should be taken into consideration during the development of candidacy criteria and/or outcome measures for therapeutic interventions such as the vestibular implant. Electronic supplementary material The online version of this article (10.1007/s00415-020-10243-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- F M P Lucieer
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - R Van Hecke
- Department of Rehabilitation Sciences, University of Ghent, Ghent, Belgium
| | - L 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, The Netherlands
| | - S Duijn
- Faculty of Health, Medicine and life Sciences, University of Maastricht, Maastricht, The Netherlands
| | - A Perez-Fornos
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences,, Geneva University Hospitals, Geneva, Switzerland
| | - N Guinand
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences,, Geneva University Hospitals, Geneva, Switzerland
| | - V Van Rompaey
- Faculty of Physics, Tomsk State Research University, Tomsk, Russian Federation
| | - H Kingma
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - M Joore
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Care and Public Health Research Institute (CAPHRI) of the Faculty of Health, Medicine and Life Sciences of Maastricht University (FHML), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - R 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, The Netherlands.,Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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24
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Yu Q, Guan B, Yu J, Lu Y, Chen C, Yu S. Reliability, internal consistency, and concurrent validity of a modified version of the dynamic gait index in people with vestibular disorders. Gait Posture 2020; 81:268-272. [PMID: 32846358 DOI: 10.1016/j.gaitpost.2020.07.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 07/14/2020] [Accepted: 07/21/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND People with vestibular disorders often have abnormalities in gait and balance. The Dynamic Gait Index (DGI) is a relatively effective clinical gait measure that has been validated for use in patients with vestibular disorders. The modified version of the DGI (M-DGI) is based on the original DGI. RESEARCH QUESTION The objective of this study was to refine and test the clinical application of the M-DGI, and to investigate whether it is an effective indicator of dynamic gait in patients with vestibular disorders. METHODS A reliability and validity study. All raters reviewed the instructions and scoring criteria for each M-DGI item prior to the initial test. The raters simultaneously scored two M-DGI tasks for the 75 subjects, and the two tasks were completed with an interval of two hours in-between. Reliability of total M-DGI scores was assessed using intraclass correlation coefficients (2,1). Internal consistency of the M-DGI was evaluated using Cronbach's alpha. Concurrent validity of the M-DGI with Dizziness Handicap Inventory (DHI) and Timed "Up & Go" Test (TUG) was assessed using Spearman's rank order correlation coefficient. RESULTS AND SIGNIFICANCE Interrater and intrarater reliability of the total M-DGI scores were reflected by ICCs of 0.99 and 0.97. Internal consistency of the M-DGI score was 0.9975. Spearman's rank order correlation coefficient of the M-DGI score with the Dizziness Handicap Inventory (DHI) and the Timed "Up & Go" Test (TUG) was 0.72 and 0.65, respectively.The M-DGI demonstrates acceptable reliability, internal consistency, and concurrent validity for use as a clinical gait measurement for patients with vestibular disorders.
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Affiliation(s)
- Qianru Yu
- Department of Otolaryngology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, 324 Jingwuweiqi Road, Jinan 250021, Shandong, China
| | - Benling Guan
- Department of Otolaryngology, Shandong University of Tradition Chinese Medicine, 16369 Jingshi Road, Jinan 250014, Shandong, China
| | - Jie Yu
- Department of Otolaryngology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, 324 Jingwuweiqi Road, Jinan 250021, Shandong, China
| | - Yu Lu
- Department of Otolaryngology, Shandong University of Tradition Chinese Medicine, 16369 Jingshi Road, Jinan 250014, Shandong, China
| | - Chengfang Chen
- Department of Otolaryngology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, 324 Jingwuweiqi Road, Jinan 250021, Shandong, China; Department of Otolaryngology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwuweiqi Road, Jinan 250021, Shandong, China
| | - Shudong Yu
- Department of Otolaryngology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, 324 Jingwuweiqi Road, Jinan 250021, Shandong, China; Department of Otolaryngology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwuweiqi Road, Jinan 250021, Shandong, China.
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