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Nada N, El-Gohary MM, Essawy WM. The effect of increased listening effort on the balance performance of patients with compensated vestibular lesion. Auris Nasus Larynx 2024; 51:492-500. [PMID: 38522352 DOI: 10.1016/j.anl.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 11/24/2023] [Accepted: 12/06/2023] [Indexed: 03/26/2024]
Abstract
OBJECTIVES This study investigated the effects of listening effort (LE) on balance in patients with compensated vestibular deficits compared to healthy peers. METHODS The subjects included two main groups: a control group of 15 healthy subjects and a study group of 19 patients with compensated vestibular pathology. The computerized dynamic posturography test (CDP) was conducted without the speech-in-noise task as a baseline, then the participant was subjected to a dual task in which the auditory task (speech-in-noise sentences) was given as the primary task, and the balance function test was the secondary task. RESULTS WITHIN-GROUP ANALYSIS: The study group showed statistically significantly worse values of all body balance parameters under dual-task than the baseline in all conditions. These differences were much higher under the compliant platform conditions. However, these findings were not statistically significant in the control group. BETWEEN-GROUP ANALYSIS The study group showed a statistically significant decline in body balance reactions compared to the control group under dual-task with increased listening effort and the compliant platform. Study subgroup analysis revealed statistically significant differences between patients with unilateral vestibular loss (UVL) and those with bilateral vestibular loss (BVL) in the unstable platform condition. CONCLUSION Our study regarding implementing a dual-tasking paradigm as a measure of LE during the evaluation of chronic vestibular patients with CDP demonstrated how dual-tasking with increased LE affects postural stability. Because of this, patients will probably be more prone to tripping and falling in multitasking situations, as found in real-world settings. This fact should be taken into consideration while testing patients with chronic vertigo and compensated states at VNG. A dual-task paradigm helps uncover the unrevealed pathology.
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Affiliation(s)
- Nashwa Nada
- Department of Otolaryngology/Head and Neck Surgery, Audiovestibular Unit, Faculty of Medicine, Tanta University Hospital, El-Geish Street, Tanta, El-Gharbia 31511, Egypt.
| | | | - Wessam Mostafa Essawy
- Department of Otolaryngology/Head and Neck Surgery, Audiovestibular Unit, Faculty of Medicine, Tanta University Hospital, El-Geish Street, Tanta, El-Gharbia 31511, Egypt
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Anctil N, Malenfant Z, Cyr JP, Turcot K, Simoneau M. Less Vibrotactile Feedback Is Effective to Improve Human Balance Control during Sensory Cues Alteration. SENSORS (BASEL, SWITZERLAND) 2022; 22:6432. [PMID: 36080897 PMCID: PMC9460360 DOI: 10.3390/s22176432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/22/2022] [Accepted: 08/24/2022] [Indexed: 06/15/2023]
Abstract
For individuals with altered sensory cues, vibrotactile feedback improves their balance control. However, should vibrotactile feedback be provided every time balance control is compromised, or only one-third of the time their balance is compromised? We hypothesized that vibrotactile feedback would improve balance control more when provided every time their balance is compromised. Healthy young adults were randomly assigned to two groups: group 33% feedback (6 males and 6 females) and group 100% feedback (6 males and 6 females). Vibrotactile feedbacks related to the body's sway angle amplitude and direction were provided, while participants stood upright on a foam surface with their eyes closed. Then, we assessed if balance control improvement lasted when the vibrotactile feedback was removed (i.e., post-vibration condition). Finally, we verified whether or not vibrotactile feedback unrelated to the body's sway angle and direction (sham condition) altered balance control. The results revealed no significant group difference in balance control improvement during vibrotactile feedback. Immediately following vibrotactile feedback, both groups reduced their balance control commands; body sway velocity and the ground reaction forces variability decreased. For both groups, unrelated vibrotactile feedback worsened balance control. These results confirmed that participants processed and implemented vibrotactile feedback to control their body sways. Less vibrotactile feedback was effective in improving balance control.
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Affiliation(s)
- Noémie Anctil
- Faculté de Médecine, Département de Kinésiologie, Université Laval, Quebec, QC G1V 0A6, Canada
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (Cirris) du CIUSSS de la Capitale Nationale, Quebec, QC G1M 2S8, Canada
| | - Zachary Malenfant
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (Cirris) du CIUSSS de la Capitale Nationale, Quebec, QC G1M 2S8, Canada
- Faculté des Sciences et de Génie, Département de Génie Électrique et de Génie Informatique, Université Laval, Quebec, QC G1V 0A6, Canada
| | - Jean-Philippe Cyr
- Faculté de Médecine, Département de Kinésiologie, Université Laval, Quebec, QC G1V 0A6, Canada
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (Cirris) du CIUSSS de la Capitale Nationale, Quebec, QC G1M 2S8, Canada
| | - Katia Turcot
- Faculté de Médecine, Département de Kinésiologie, Université Laval, Quebec, QC G1V 0A6, Canada
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (Cirris) du CIUSSS de la Capitale Nationale, Quebec, QC G1M 2S8, Canada
| | - Martin Simoneau
- Faculté de Médecine, Département de Kinésiologie, Université Laval, Quebec, QC G1V 0A6, Canada
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (Cirris) du CIUSSS de la Capitale Nationale, Quebec, QC G1M 2S8, Canada
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Psychometric Properties of Cognitive-Motor Dual-Task Studies With the Aim of Developing a Test Protocol for Persons With Vestibular Disorders: A Systematic Review. Ear Hear 2021; 41:3-16. [PMID: 31283530 DOI: 10.1097/aud.0000000000000748] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Patients suffering from vestibular disorders (VD) often present with impairments in cognitive domains such as visuospatial ability, memory, executive function, attention, and processing speed. These symptoms can be attributed to extensive vestibular projections throughout the cerebral cortex and subcortex on the one hand, and to increased cognitive-motor interference (CMI) on the other hand. CMI can be assessed by performing cognitive-motor dual-tasks (DTs). The existing literature on this topic is scarce and varies greatly when it comes to test protocol, type and degree of vestibular impairment, and outcome. To develop a reliable and sensitive test protocol for VD patients, an overview of the existing reliability and validity studies on DT paradigms will be given in a variety of populations, such as dementia, multiple sclerosis, Parkinson's disease, stroke, and elderly. DESIGN The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An extensive literature search on psychometric properties of cognitive-motor DTs was run on MEDLINE, Embase, and Cochrane Databases. The studies were assessed for eligibility by two independent researchers, and their methodological quality was subsequently evaluated using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN). RESULTS AND CONCLUSIONS Thirty-three studies were included in the current review. Based on the reliability and validity calculations, including a static as well as dynamic motor task seems valuable in a DT protocol for VD patients. To evoke CMI maximally in this population, both motor tasks should be performed while challenging the vestibular cognitive domains. Out of the large amount of cognitive tasks employed in DT studies, a clear selection for each of these domains, except for visuospatial abilities, could be made based on this review. The use of the suggested DTs will give a more accurate and daily life representation of cognitive and motor deficiencies and their interaction in the VD population.
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Iandolo R, Carè M, Shah VA, Schiavi S, Bommarito G, Boffa G, Giannoni P, Inglese M, Mrotek LA, Scheidt RA, Casadio M. A two alternative forced choice method for assessing vibrotactile discrimination thresholds in the lower limb. Somatosens Mot Res 2019; 36:162-170. [PMID: 31267810 DOI: 10.1080/08990220.2019.1632184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The development of an easy to implement, quantitative measure to examine vibration perception would be useful for future application in clinical settings. Vibration sense in the lower limb of younger and older adults was examined using the method of constant stimuli (MCS) and the two-alternative forced choice paradigm. The focus of this experiment was to determine an appropriate stimulation site on the lower limb (tendon versus bone) to assess vibration threshold and to determine if the left and right legs have varying thresholds. Discrimination thresholds obtained at two stimulation sites in the left and right lower limbs showed differences in vibration threshold across the two ages groups, but not across sides of the body nor between stimulation sites within each limb. Overall, the MCS can be implemented simply, reliably, and with minimal time. It can also easily be implemented with low-cost technology. Therefore, it could be a good candidate method to assess the presence of specific deep sensitivity deficits in clinical practice, particularly in populations likely to show the onset of sensory deficits.
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Affiliation(s)
- Riccardo Iandolo
- a Robotics, Brain and Cognitive Sciences , Istituto Italiano di Tecnologia , Genova , Italy.,b Department of Informatics, Bioengineering, Robotics and System Engineering , University of Genova , Genova , Italy
| | - Marta Carè
- b Department of Informatics, Bioengineering, Robotics and System Engineering , University of Genova , Genova , Italy
| | - Valay A Shah
- c Department of Biomedical Engineering , Marquette University and Medical College of Wisconsin , Milwaukee , WI , USA
| | - Simona Schiavi
- d Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health , University of Genova , Genova , Italy
| | - Giulia Bommarito
- d Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health , University of Genova , Genova , Italy
| | - Giacomo Boffa
- d Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health , University of Genova , Genova , Italy
| | - Psiche Giannoni
- b Department of Informatics, Bioengineering, Robotics and System Engineering , University of Genova , Genova , Italy
| | - Matilde Inglese
- d Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health , University of Genova , Genova , Italy.,e Ospedale Policlinico San Martino-IRCSS , Genova , Italy
| | - Leigh Ann Mrotek
- c Department of Biomedical Engineering , Marquette University and Medical College of Wisconsin , Milwaukee , WI , USA
| | - Robert A Scheidt
- c Department of Biomedical Engineering , Marquette University and Medical College of Wisconsin , Milwaukee , WI , USA.,f Feinberg School of Medicine , Northwestern University , Chicago , IL , USA.,g Division of Civil, Mechanical and Manufacturing Innovation , National Science Foundation , Alexandria , VA , USA
| | - Maura Casadio
- a Robotics, Brain and Cognitive Sciences , Istituto Italiano di Tecnologia , Genova , Italy.,b Department of Informatics, Bioengineering, Robotics and System Engineering , University of Genova , Genova , Italy
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Sienko KH, Seidler RD, Carender WJ, Goodworth AD, Whitney SL, Peterka RJ. Potential Mechanisms of Sensory Augmentation Systems on Human Balance Control. Front Neurol 2018; 9:944. [PMID: 30483209 PMCID: PMC6240674 DOI: 10.3389/fneur.2018.00944] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/22/2018] [Indexed: 12/30/2022] Open
Abstract
Numerous studies have demonstrated the real-time use of visual, vibrotactile, auditory, and multimodal sensory augmentation technologies for reducing postural sway during static tasks and improving balance during dynamic tasks. The mechanism by which sensory augmentation information is processed and used by the CNS is not well understood. The dominant hypothesis, which has not been supported by rigorous experimental evidence, posits that observed reductions in postural sway are due to sensory reweighting: feedback of body motion provides the CNS with a correlate to the inputs from its intact sensory channels (e.g., vision, proprioception), so individuals receiving sensory augmentation learn to increasingly depend on these intact systems. Other possible mechanisms for observed postural sway reductions include: cognition (processing of sensory augmentation information is solely cognitive with no selective adjustment of sensory weights by the CNS), “sixth” sense (CNS interprets sensory augmentation information as a new and distinct sensory channel), context-specific adaptation (new sensorimotor program is developed through repeated interaction with the device and accessible only when the device is used), and combined volitional and non-volitional responses. This critical review summarizes the reported sensory augmentation findings spanning postural control models, clinical rehabilitation, laboratory-based real-time usage, and neuroimaging to critically evaluate each of the aforementioned mechanistic theories. Cognition and sensory re-weighting are identified as two mechanisms supported by the existing literature.
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Affiliation(s)
- Kathleen H Sienko
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Rachael D Seidler
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Wendy J Carender
- Michigan Balance Vestibular Testing and Rehabilitation, Department of Otolaryngology, Michigan Medicine, Ann Arbor, MI, United States
| | - Adam D Goodworth
- Department of Rehabilitation Sciences, University of Hartford, Hartford, CT, United States
| | - Susan L Whitney
- Departments of Physical Therapy and Otolaryngology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Robert J Peterka
- Department of Neurology, Oregon Health & Science University and National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, OR, United States
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