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Souza WH, Zobeiri OA, Millar JL, Cullen KE, Schubert MC. Aging Delays Completion of Head Rotation Cycles in Continuous Gaze Stabilization Exercises despite Putative Healthy Vestibular Function. Gerontology 2024; 70:1113-1127. [PMID: 39111296 DOI: 10.1159/000540230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 07/01/2024] [Indexed: 09/13/2024] Open
Abstract
INTRODUCTION Aging is associated with loss of balance, with falls being one of the leading causes of death among the elderly in the USA. Gaze stabilization exercises (GSE) improve balance control in vestibular populations and could be useful to prevent falls in healthy individuals. However, the extent to which aging affects head kinematics in GSE is unknown. METHODS Forty-eight younger (n = 25, 24 ± 6 years, 60% female) and older (n = 23, 66 ± 5 years, 56% female) adults completed six 30-s GSE. Participants were asked to maintain gaze fixation on a stationary target while continuously performing head movements in pitch (e.g., vertical) and yaw (e.g., horizontal) directions. The visual target was placed on the wall 1 m or 2 m away or handheld at arm's length. Head kinematics were recorded with an inertial measurement unit placed on the back of the participants' head. RESULTS Older adults took significantly more time (e.g., delay) to complete cycles of head rotation in both pitch and yaw compared to younger participants across all GSE. Such delay was further increased during yaw head rotation while fixating gaze of the 1 m target. The average peak velocity (APV) and average angular displacement (AAD), however, were equivalent between groups in all GSE. CONCLUSION Aging leads to the maintenance of head rotation APV and AAD at the expense of delayed cycles of head rotation, suggesting an age-dependent prioritization strategy (e.g., adapt duration first, range second) during continuous head movements. The distance of the visual target and head movement direction influenced elderly performance and should be considered when prescribing GSE to older populations.
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Affiliation(s)
- Wagner H Souza
- Department of Biomedical Engineering, Cullen Lab, Johns Hopkins University, Baltimore, Maryland, USA,
- Department of Otolaryngology Head and Neck Surgery, Laboratory of Vestibular NeuroAdaptation, Johns Hopkins University, Baltimore, Maryland, USA,
- Toronto Rehabilitation Institute, KITE - University Health Network, Toronto, Ontario, Canada,
| | - Omid A Zobeiri
- Department of Biomedical Engineering, Cullen Lab, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer L Millar
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kathleen E Cullen
- Department of Biomedical Engineering, Cullen Lab, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Otolaryngology Head and Neck Surgery, Laboratory of Vestibular NeuroAdaptation, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Neuroscience, Johns Hopkins University, Baltimore, Maryland, USA
| | - Michael C Schubert
- Department of Otolaryngology Head and Neck Surgery, Laboratory of Vestibular NeuroAdaptation, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA
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Millar JL, Zobeiri OA, Souza WH, Schubert MC, Cullen KE. Head movement kinematics are differentially altered for extended versus short duration gait exercises in individuals with vestibular loss. Sci Rep 2023; 13:16213. [PMID: 37758749 PMCID: PMC10533850 DOI: 10.1038/s41598-023-42441-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/10/2023] [Indexed: 09/29/2023] Open
Abstract
Head kinematics are altered in individuals with vestibular schwannoma (VS) during short duration gait tasks [i.e., Functional Gait Assessment (FGA)], both before and after surgery, yet whether these differences extend to longer duration gait exercises is currently unknown. Here we examined the effects of vestibular loss and subsequent compensation on head kinematics in individuals with VS during gait exercises of relatively extended versus short duration (< 10 versus 30 s), compared to age-matched controls. Six-dimensional head movements were recorded during extended and short duration gait exercises before and then 6 weeks after sectioning of the involved vestibular nerve (vestibular neurectomy). Standard functional, physiological, and subjective clinical assessments were also performed at each time point. Kinematics were differentially altered in individuals with vestibular loss at both time points during extended versus short duration exercises. Range of motion was significantly reduced in extended tasks. In contrast, movement variability predominately differed for the short duration exercises. Overall, our results indicate that quantifying head kinematics during longer duration gait tasks can provide novel information about how VS individuals compensate for vestibular loss, and suggest that measurements of range of motion versus variability can provide information regarding the different strategies deployed to maintain functional locomotion.
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Affiliation(s)
- Jennifer L Millar
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Omid A Zobeiri
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
- Department of Biomedical Engineering, McGill University, Montreal, QC, Canada
| | - Wagner H Souza
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 720 Rutland Ave, Traylor 504, Baltimore, MD, 21205-2109, USA
| | - Michael C Schubert
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 720 Rutland Ave, Traylor 504, Baltimore, MD, 21205-2109, USA
| | - Kathleen E Cullen
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA.
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 720 Rutland Ave, Traylor 504, Baltimore, MD, 21205-2109, USA.
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, USA.
- Kavli Neuroscience Discovery Institute, Johns Hopkins University, Baltimore, MD, USA.
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Loyd BJ, Dibble LE, Weightman MM, Pelo R, Hoppes CW, Lester M, King LA, Fino PC. Volitional Head Movement Deficits and Alterations in Gait Speed Following Mild Traumatic Brain Injury. J Head Trauma Rehabil 2023; 38:E223-E232. [PMID: 36731009 DOI: 10.1097/htr.0000000000000831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Unconstrained head motion is necessary to scan for visual cues during navigation, for minimizing threats, and to allow regulation of balance. Following mild traumatic brain injury (mTBI) people may experience alterations in head movement kinematics, which may be pronounced during gait tasks. Gait speed may also be impacted by the need to turn the head while walking in these individuals. The aim of this study was to examine head kinematics during dynamic gait tasks and the interaction between kinematics and gait speed in people with persistent symptoms after mTBI. SETTING A clinical assessment laboratory. DESIGN A cross-sectional, matched-cohort study. PARTICIPANTS Forty-five individuals with a history of mTBI and 46 age-matched control individuals. MAIN MEASURES All participants were tested at a single time point and completed the Functional Gait Assessment (FGA) while wearing a suite of body-mounted inertial measurement units (IMUs). Data collected from the IMUs were gait speed, and peak head rotation speed and amplitude in the yaw and pitch planes during the FGA-1, -3, and -4 tasks. RESULTS Participants with mTBI demonstrated significantly slower head rotations in the yaw ( P = .0008) and pitch ( P = .002) planes. They also demonstrated significantly reduced amplitude of yaw plane head rotations ( P < .0001), but not pitch plane head rotations ( P = .84). Participants with mTBI had significantly slower gait speed during normal gait (FGA-1) ( P < .001) and experienced a significantly greater percent decrease in gait speed than healthy controls when walking with yaw plane head rotations (FGA-3) ( P = .02), but not pitch plane head rotations (FGA-4) ( P = .11). CONCLUSIONS Participants with mTBI demonstrated smaller amplitudes and slower speeds of yaw plane head rotations and slower speeds of pitch plane head rotations during gait. Additionally, people with mTBI walked slower during normal gait and demonstrated a greater reduction in gait speed while walking with yaw plane head rotations compared with healthy controls.
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Affiliation(s)
- Brian J Loyd
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula (Dr Loyd); Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City (Drs Dibble and Pelo); Courage Kenny Research Center-Allina Health, Minneapolis, Minnesota (Dr Weightman); Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, Texas (Dr Hoppes); Department of Physical Therapy, Texas State University, Round Rock (Dr Lester); School of Medicine, Oregon Health & Sciences University, Portland (Dr King); and Department of Health and Kinesiology, University of Utah, Salt Lake City (Dr Fino)
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Effects of Gaze Stabilization Exercises on Gait, Plantar Pressure, and Balance Function in Post-Stroke Patients: A Randomized Controlled Trial. Brain Sci 2022; 12:brainsci12121694. [PMID: 36552154 PMCID: PMC9775540 DOI: 10.3390/brainsci12121694] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/03/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
This study aims to explore the effects of gaze stabilization exercises (GSEs) on gait, plantar pressure, and balance function in post-stroke patients (≤6 months). Forty post-stroke patients were randomly divided into an experimental group (n = 20) and a control group (n = 20). The experimental group performed GSEs combined with physical therapy, while the control group only performed physical therapy, once a day, 5 days a week, for 4 weeks. The Berg Balance Scale (BBS) was used to test the balance function and the risk of falling, which was the primary outcome. The Timed Up and Go test (TUGT) evaluated the walking ability and the fall risk. The envelope ellipse area and the plantar pressure proportion of the affected side were used to measure the patient’s supporting capacity and stability in static standing. The anterior−posterior center of pressure displacement velocity was used to test the weight-shifting capacity. Compared to the control group, the swing phase of the affected side, swing phase’s absolute symmetric index, envelope ellipse area when eyes closed, and TUGT of the experimental group had significantly decreased after GSEs (p < 0.05); the BBS scores, TUGT, the anterior−posterior COP displacement velocity, and the plantar pressure proportion of the affected side had significantly increased after 4 weeks of training (p < 0.05). In conclusion, GSEs combined with physical therapy can improve the gait and balance function of people following stroke. Furthermore, it can enhance the weight-shifting and one-leg standing capacity of the affected side, thus reducing the risk of falling.
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Zobeiri OA, Wang L, Millar JL, Schubert MC, Cullen KE. Head movement kinematics are altered during balance stability exercises in individuals with vestibular schwannoma. J Neuroeng Rehabil 2022; 19:120. [PMID: 36352393 PMCID: PMC9648040 DOI: 10.1186/s12984-022-01109-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 11/01/2022] [Indexed: 11/11/2022] Open
Abstract
Abstract
Background
Balance stabilization exercises are often prescribed to facilitate compensation in individuals with vestibular schwannoma (VS). However, both the assessment and prescription of these exercises are reliant on clinical observations and expert opinion rather than on quantitative evidence. The aim of this study was to quantify head motion kinematics in individuals with vestibular loss while they performed commonly prescribed balance stability exercises.
Methods
Using inertial measurement units, head movements of individuals with vestibular schwannoma were measured before and after surgical deafferentation and compared with age-matched controls.
Results
We found that individuals with vestibular schwannoma experienced more variable head motion compared to healthy controls both pre- and postoperatively, particularly in absence of visual input, but that there was little difference between preoperative and postoperative kinematic measurements for our vestibular schwannoma group. We further found correlations between head motion kinematic measures during balance exercises, performed in the absence of visual input, and multiple clinical measurements for preoperative VS subjects. Subjects with higher head motion variability also had worse DVA scores, moved more slowly during the Timed up and Go and gait speed tests, and had lower scores on the functional gait assessment. In contrast, we did not find strong correlations between clinical measures and postoperative head kinematics for the same VS subjects.
Conclusions
Our data suggest that further development of such metrics based on the quantification of head motion has merit for the assessment and prescription of balance exercises, as demonstrated by the calculation of a “kinematic score” for identifying the most informative balance exercise (i.e., “Standing on foam eyes closed”).
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Weston AR, Loyd BJ, Taylor C, Hoppes C, Dibble LE. Head and Trunk Kinematics during Activities of Daily Living with and without Mechanical Restriction of Cervical Motion. SENSORS (BASEL, SWITZERLAND) 2022; 22:3071. [PMID: 35459056 PMCID: PMC9026113 DOI: 10.3390/s22083071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/06/2022] [Accepted: 04/12/2022] [Indexed: 11/16/2022]
Abstract
Alterations in head and trunk kinematics during activities of daily living can be difficult to recognize and quantify with visual observation. Incorporating wearable sensors allows for accurate and measurable assessment of movement. The aim of this study was to determine the ability of wearable sensors and data processing algorithms to discern motion restrictions during activities of daily living. Accelerometer data was collected with wearable sensors from 10 healthy adults (age 39.5 ± 12.47) as they performed daily living simulated tasks: coin pick up (pitch plane task), don/doff jacket (yaw plane task), self-paced community ambulation task [CAT] (pitch and yaw plane task) without and with a rigid cervical collar. Paired t-tests were used to discern differences between non-restricted (no collared) performance and restricted (collared) performance of tasks. Significant differences in head rotational velocity (jacket p = 0.03, CAT-pitch p < 0.001, CAT-yaw p < 0.001), head rotational amplitude (coin p = 0.03, CAT-pitch p < 0.001, CAT-yaw p < 0.001), trunk rotational amplitude (jacket p = 0.01, CAT-yaw p = 0.005), and head−trunk coupling (jacket p = 0.007, CAT-yaw p = 0.003) were captured by wearable sensors between the two conditions. Alterations in turning movement were detected at the head and trunk during daily living tasks. These results support the ecological validity of using wearable sensors to quantify movement alterations during real-world scenarios.
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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;
| | - Brian J. Loyd
- Department of Physical Therapy and Rehabilitation Sciences, University of Montana, 32 Campus Dr., Missoula, MT 59812, USA;
| | - Carolyn Taylor
- Department of Orthopedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA;
| | - Carrie Hoppes
- Army Baylor University Doctoral Program in Physical Therapy, U.S. Army Medical Center of Excellence, 3630 Stanley Road, San Antonio, 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;
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Wang L, Zobeiri OA, Millar JL, Souza Silva W, Schubert MC, Cullen KE. Continuous Head Motion is a Greater Motor Control Challenge than Transient Head Motion in Patients with Loss of Vestibular Function. Neurorehabil Neural Repair 2021; 35:890-902. [PMID: 34365845 DOI: 10.1177/15459683211034758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. The vestibular system is vital for gaze stability via the vestibulo-ocular reflex, which generates compensatory eye motion in the direction opposite to head motion. Consequently, individuals with peripheral vestibular loss demonstrate impaired gaze stability that reduces functional capacity and quality of life. To facilitate patients' compensatory strategies, two classes of gaze stabilization exercises are often prescribed: (i) transient (eg, ballistic) and (ii) continuous. However, the relative benefits of these two classes of exercises are not well understood. Objective. To quantify head motion kinematics in patients with vestibular loss while they performed both classes of exercises. Methods. Using inertial measurement units, head movements of 18 vestibular schwannoma patients were measured before and after surgical deafferentation and compared with age-matched controls. Results. We found that the head movement during both classes of exercises paralleled those of natural head movement recorded during daily activities. However, head movement patterns were more informative for continuous than transient exercises in distinguishing patients from healthy controls. Specifically, we observed coupling between kinematic measures in control subjects that was absent in patients for continuous but not transient head motion exercises. In addition, kinematic measures (eg, cycle duration) were predictive of standard clinical measures for continuous but not transient head motion exercises. Conclusions. Our data suggest that performing continuous head motion is a greater motor control challenge than transient head motion in patients with less reliable vestibular feedback during the sub-acute stage of recovery, which may also prove to be a reliable measure of progression in vestibular rehabilitation protocols.
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Affiliation(s)
- Lin Wang
- Department of Biomedical Engineering, 1466Johns Hopkins University, Baltimore, MD, USA
| | - Omid A Zobeiri
- Department of Biomedical Engineering, McGill University, Montreal, QC, Canada
| | - Jennifer L Millar
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University1466School of Medicine, Baltimore, MD, USA
| | - Wagner Souza Silva
- Department of Biomedical Engineering, 1466Johns Hopkins University, Baltimore, MD, USA.,Department of Physical Medicine and Rehabilitation, Johns Hopkins University1466School of Medicine, Baltimore, MD, USA
| | - Michael C Schubert
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University1466School of Medicine, Baltimore, MD, USA.,Department of Otolaryngology-Head and Neck Surgery, 1466Johns Hopkins University1466School of Medicine, Baltimore, USA
| | - Kathleen E Cullen
- Department of Biomedical Engineering, 1466Johns Hopkins University, Baltimore, MD, USA.,Department of Otolaryngology-Head and Neck Surgery, 1466Johns Hopkins University1466School of Medicine, Baltimore, USA.,Department of Neuroscience, Johns Hopkins University1466School of Medicine, Baltimore, USA.,Kavli Neuroscience Discovery Institute, 1466Johns Hopkins University, Baltimore, MD, USA
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