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Fu M, Zhang L, Zhao X, Lv Z, Tang P. Association between screen time and self-reported balance disorders in middle-aged and older adults: national health and nutrition examination survey. Aging Clin Exp Res 2024; 36:128. [PMID: 38856860 PMCID: PMC11164770 DOI: 10.1007/s40520-024-02778-8] [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: 12/29/2023] [Accepted: 05/16/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Balance disorders can give rise to sensations of instability, lightheadedness, vertigo, disequilibrium, or syncope, ultimately leading to grave medical, physical, emotional, and societal ramifications. These conditions are highly prevalent among individuals aged 40 and above. Screen time encompasses activities associated with television viewing, video game playing, and non-work-related computer usage. Prolonged screen exposure may engender a spectrum of health issues and even elevate overall mortality rates. However, the available evidence on the potential link between excessive screen time and balance dysfunction remains limited. AIMS The primary aim of this study was to explore the possible association between prolonged screen exposure and impaired balance function. METHODS This cross-sectional study utilized data from participants who completed a comprehensive questionnaire in the NHANES database between 1999 and 2002, all of whom were aged over 40 and under 85 years. Participants' screen time was categorized into two groups (< 4 h/d and ≥4 h/d) for subsequent data analysis. Logistic regression, combined with propensity score matching (PSM), was employed to investigate the correlation between screen time and balance disorders. RESULTS A total of 5176 participants were enrolled in this study, comprising 2,586 men and 2,590 women, with a prevalence rate of balance disorders at 25.7% (1331/5176). The incidence of balance disorders was found to be significantly higher among individuals who spent 4 hours or more per day on screen time compared to those with less screen time (P<0.001). Multivariate logistic analysis conducted on the unmatched cohort revealed a significant association between screen time and balance disorders, with an odds ratio (OR) 1.8 (95%CI 1.57 ∼ 2.05). These findings remained consistent even after adjusting for confounding factors, yielding an OR 1.43 (95%CI 1.24 ∼ 1.66). Moreover, the association persisted when employing various multivariate analyses such as propensity score matching adjusted model, standardized mortality ratio weighting model and pairwise algorithmic model; all resulting in ORs ranging from 1.38 to 1.43 and p-values < 0.001. CONCLUSIONS After controlling for all covariates, screen time (watching TV, playing video games, and using computers outside of work) was associated with balance dysfunction among middle-aged and older adults. This finding may offer a possible idea for the prevention of dizziness and balance disorders. Nevertheless, additional research is imperative to further validate these results.
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Affiliation(s)
- Minjun Fu
- Center for Rehabilitation Medicine, Department of Neuro-electrophysiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, 310014, China.
| | - Lingju Zhang
- Center for Rehabilitation Medicine, Department of Neuro-electrophysiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, 310014, China
| | - Xiaoyu Zhao
- Center for Rehabilitation Medicine, Department of Neuro-electrophysiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, 310014, China
| | - Zhijun Lv
- Center for Rehabilitation Medicine, Department of Neuro-electrophysiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, 310014, China
| | - Pei Tang
- Center for Rehabilitation Medicine, Department of Neuro-electrophysiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, 310014, China
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Rabellino D, Thome J, Densmore M, Théberge J, McKinnon MC, Lanius RA. The Vestibulocerebellum and the Shattered Self: a Resting-State Functional Connectivity Study in Posttraumatic Stress Disorder and Its Dissociative Subtype. CEREBELLUM (LONDON, ENGLAND) 2023; 22:1083-1097. [PMID: 36121553 PMCID: PMC10657293 DOI: 10.1007/s12311-022-01467-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Abstract
The flocculus is a region of the vestibulocerebellum dedicated to the coordination of neck, head, and eye movements for optimal posture, balance, and orienting responses. Despite growing evidence of vestibular and oculomotor impairments in the aftermath of traumatic stress, little is known about the effects of chronic psychological trauma on vestibulocerebellar functioning. Here, we investigated alterations in functional connectivity of the flocculus at rest among individuals with post-traumatic stress disorder (PTSD) and its dissociative subtype (PTSD + DS) as compared to healthy controls. Forty-four healthy controls, 57 PTSD, and 32 PTSD + DS underwent 6-min resting-state MRI scans. Seed-based functional connectivity analyses using the right and left flocculi as seeds were performed. These analyses revealed that, as compared to controls, PTSD and PTSD + DS showed decreased resting-state functional connectivity of the left flocculus with cortical regions involved in bodily self-consciousness, including the temporo-parietal junction, the supramarginal and angular gyri, and the superior parietal lobule. Moreover, as compared to controls, the PTSD + DS group showed decreased functional connectivity of the left flocculus with the medial prefrontal cortex, the precuneus, and the mid/posterior cingulum, key regions of the default mode network. Critically, when comparing PTSD + DS to PTSD, we observed increased functional connectivity of the right flocculus with the right anterior hippocampus, a region affected frequently by early life trauma. Taken together, our findings point toward the crucial role of the flocculus in the neurocircuitry underlying a coherent and embodied self, which can be compromised in PTSD and PTSD + DS.
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Affiliation(s)
- Daniela Rabellino
- Department of Psychiatry, Western University, University Hospital, (Room C3-103), 339 Windermere Road, London, ON, N6A 5A5, Canada.
- Imaging, Lawson Health Research Institute, London, ON, Canada.
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
| | - Janine Thome
- Department of Theoretical Neuroscience, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- Clinic for Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Maria Densmore
- Department of Psychiatry, Western University, University Hospital, (Room C3-103), 339 Windermere Road, London, ON, N6A 5A5, Canada
- Imaging, Lawson Health Research Institute, London, ON, Canada
| | - Jean Théberge
- Department of Psychiatry, Western University, University Hospital, (Room C3-103), 339 Windermere Road, London, ON, N6A 5A5, Canada
- Imaging, Lawson Health Research Institute, London, ON, Canada
- Department of Medical Biophysics, Western University, London, ON, Canada
| | - Margaret C McKinnon
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Homewood Research Institute, Guelph, ON, Canada
- Mood Disorders Program and Anxiety Treatment and Research Centre, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Ruth A Lanius
- Department of Psychiatry, Western University, University Hospital, (Room C3-103), 339 Windermere Road, London, ON, N6A 5A5, Canada
- Imaging, Lawson Health Research Institute, London, ON, Canada
- Department of Neuroscience, Western University, London, ON, Canada
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Smith JL, Diekfuss JA, Dudley JA, Ahluwalia V, Zuleger TM, Slutsky-Ganesh AB, Yuan W, Foss KDB, Gore RK, Myer GD, Allen JW. Visuo-vestibular and cognitive connections of the vestibular neuromatrix are conserved across age and injury populations. J Neuroimaging 2023; 33:1003-1014. [PMID: 37303280 DOI: 10.1111/jon.13136] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/25/2023] [Accepted: 06/02/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND AND PURPOSE Given the prevalence of vestibular dysfunction in pediatric concussion, there is a need to better understand pathophysiological disruptions within vestibular and associated cognitive, affective, and sensory-integrative networks. Although current research leverages established intrinsic connectivity networks, these are nonspecific for vestibular function, suggesting that a pathologically guided approach is warranted. The purpose of this study was to evaluate the generalizability of the previously identified "vestibular neuromatrix" in adults with and without postconcussive vestibular dysfunction to young athletes aged 14-17. METHODS This retrospective study leveraged resting-state functional MRI data from two sites. Site A included adults with diagnosed postconcussive vestibular impairment and healthy adult controls and Site B consisted of young athletes with preseason, postconcussion, and postseason time points (prospective longitudinal data). Adjacency matrices were generated from preprocessed resting-state data from each sample and assessed for overlap and network structure in MATLAB. RESULTS Analyses indicated the presence of a conserved "core" network of vestibular regions as well as areas subserving visual, spatial, and attentional processing. Other vestibular connections were also conserved across samples but were not linked to the "core" subnetwork by regions of interest included in this study. CONCLUSIONS Our results suggest that connections between central vestibular, visuospatial, and known intrinsic connectivity networks are conserved across adult and pediatric participants with and without concussion, evincing the significance of this expanded, vestibular-associated network. Our findings thus support this network as a workable model for investigation in future studies of dysfunction in young athlete populations.
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Affiliation(s)
- Jeremy L Smith
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jed A Diekfuss
- Emory Sports Performance and Research Center (SPARC), Flowery Branch, Georgia, USA
- Emory Sports Medicine Center, Atlanta, Georgia, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jonathan A Dudley
- Pediatric Neuroimaging Research Consortium, Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Vishwadeep Ahluwalia
- Georgia State University/Georgia Tech Center for Advanced Brain Imaging (CABI), Atlanta, Georgia, USA
| | - Taylor M Zuleger
- Emory Sports Performance and Research Center (SPARC), Flowery Branch, Georgia, USA
- Emory Sports Medicine Center, Atlanta, Georgia, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
- Neuroscience Graduate Program, University of Cincinnati, Cincinnati, Ohio, USA
| | - Alexis B Slutsky-Ganesh
- Emory Sports Performance and Research Center (SPARC), Flowery Branch, Georgia, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Weihong Yuan
- Pediatric Neuroimaging Research Consortium, Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Kim D Barber Foss
- Emory Sports Performance and Research Center (SPARC), Flowery Branch, Georgia, USA
| | - Russell K Gore
- Mild TBI Brain Health and Recovery Lab, Shepherd Center, Atlanta, Georgia, USA
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
| | - Gregory D Myer
- Emory Sports Performance and Research Center (SPARC), Flowery Branch, Georgia, USA
- Emory Sports Medicine Center, Atlanta, Georgia, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
- Youth Physical Development Centre, Cardiff Metropolitan University, Wales, UK
| | - Jason W Allen
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
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Li H, Zhang X, Yang Y, Xie A. Abnormal eye movements in Parkinson's disease: From experimental study to clinical application. Parkinsonism Relat Disord 2023; 115:105791. [PMID: 37537120 DOI: 10.1016/j.parkreldis.2023.105791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 07/24/2023] [Accepted: 07/28/2023] [Indexed: 08/05/2023]
Abstract
Parkinson's disease (PD) is a neurodegenerative disease that integrates a series of motor symptoms and non-motor symptoms, making early recognition challenging. The exploration of biomarkers is urgently required. Abnormal eye movements in PD have been reported to appear in a variety of ways since eye tracking technology was developed, such as decreased saccade amplitude, extended saccade latency, and unique saccade patterns. Non-invasive, objective and simple eye tracking has the potential to provide effective biomarkers for the PD diagnosis, progression and cognitive impairment, as well as ideas for research into the occurrence and treatment strategy of motor symptoms. In this review, we introduced the fundamental eye movement patterns and typical eye movement paradigms (such as fixation, pro-saccade, anti-saccade, smooth tracking, and visual search), summarized the symptoms of various ocular motor abnormalities in PD, and discussed the research implications of oculomotor investigation to the pathogenesis of PD and related motor symptoms, as well as the clinical implications as biomarkers and its inspiration on treatment.
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Affiliation(s)
- Han Li
- Department of Neurology, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China.
| | - Xue Zhang
- Department of Neurology, Affiliated Qingdao Central Hospital of Qingdao University, Qingdao Cancer Hospital, Qingdao, China
| | - Yong Yang
- Department of Neurology, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Anmu Xie
- Department of Neurology, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China; The Cerebral Vascular Disease Institute, Qingdao University, Qingdao, China.
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Kobel MJ, Wagner AR, Merfeld DM. Recurrence quantification analysis of postural sway in patients with persistent postural perceptual dizziness. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1142018. [PMID: 37576917 PMCID: PMC10415033 DOI: 10.3389/fresc.2023.1142018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 06/30/2023] [Indexed: 08/15/2023]
Abstract
Background Persistent postural perceptual dizziness (PPPD) is a common cause of chronic dizziness and imbalance. Emerging evidence suggests that changes in quantitative measures of postural control may help identify individuals with PPPD, however, traditional linear metrics of sway have yielded inconsistent results. Methodologies to examine the temporal structure of sway, including recurrent quantification analysis (RQA), have identified unique changes in dynamic structure of postural control in other patient populations. This study aimed to determine if adults with PPPD exhibit changes in the dynamic structure of sway and whether this change is modulated on the basis of available sensory cues. Methods Twelve adults diagnosed with PPPD and twelve age-matched controls, completed a standard battery of quiet stance balance tasks that involved the manipulation of visual and/or proprioceptive feedback. For each group, the regularity and complexity of the CoP signal was assessed using RQA and the magnitude and variability of the CoP signal was quantified using traditional linear measures. Results An overall effect of participant group (i.e., healthy controls vs. PPPD) was seen for non-linear measures of temporal complexity quantified using RQA. Changes in determinism (i.e., regularity) were also modulated on the basis of availability of sensory cues in patients with PPPD. No between-group difference was identified for linear measures assessing amount and variability of sway. Conclusions Participants with PPPD on average exhibited sway that was similar in magnitude to, but significantly more repeatable and less complex than, healthy controls. These data show that non-linear measures provide unique information regarding the effect of PPPD on postural control, and as a result, may serve as potential rehabilitation outcome measures.
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Affiliation(s)
- Megan J. Kobel
- Department of Otolaryngology—Head & Neck Surgery, Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Andrew R. Wagner
- Department of Otolaryngology—Head & Neck Surgery, Ohio State University Wexner Medical Center, Columbus, OH, United States
- Department of Health & Rehabilitation Sciences, Ohio State University, Columbus, OH, United States
| | - Daniel M. Merfeld
- Department of Otolaryngology—Head & Neck Surgery, Ohio State University Wexner Medical Center, Columbus, OH, United States
- Department of Health & Rehabilitation Sciences, Ohio State University, Columbus, OH, United States
- Department of Speech and Hearing Science, Ohio State University, Columbus, OH, United States
- Department of Biomedical Engineering, Ohio State University, Columbus, OH, United States
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Tian L, Ma S, Li Y, Zhao MF, Xu C, Wang C, Zhang X, Gao L. Repetitive transcranial magnetic stimulation can improve the fixation of eyes rather than the fixation preference in children with autism spectrum disorder. Front Neurosci 2023; 17:1188648. [PMID: 37547145 PMCID: PMC10400712 DOI: 10.3389/fnins.2023.1188648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/03/2023] [Indexed: 08/08/2023] Open
Abstract
Background Transcranial magnetic stimulation (TMS) has been introduced into the intervention of autism spectrum disorders (ASD) as a possible new therapeutic option for modifying pathological neuroplasticity. However, the stimulating protocols of rTMS for ASD have not been approved unanimously, which affects the clinical popularization and application of rTMS. In addition, there is little research on the improvement of social processing of autistic children by rTMS. Methods We explored the clinical efficacy of rTMS and improvement of face processing with the protocol of left high-frequency and right low-frequency on bilateral dorsolateral prefrontal cortex (DLPFC), with a sample of 45 ASD participants aged 2-18. Results Our results showed that both the score on the Childhood Autism Rating Scale (CARS) and the fixations on the eyes of the human faces improved by two-session rTMS intervention, except for the percentage of eyes fixation. The mediation analysis indicated the item of "Adaptation to Change" of CARS mediated dominantly the improvement of eye-gaze behavior of ASD participants by rTMS. Conclusion Our study revealed the mechanism of rTMS in improving the eye-gaze behavior of the autism population, deepened the understanding of the function of rTMS in treating autistic social disorders, and provided a reference for combined treatment for ASD.
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Affiliation(s)
- Li Tian
- Tianjin Anding Hospital, Tianjin, China
| | - Shuai Ma
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yin Li
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Meng-fei Zhao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Chang Xu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Chen Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Xin Zhang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Lei Gao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tianjin Medical University, Tianjin, China
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Smith JL, Ahluwalia V, Gore RK, Allen JW. Eagle-449: A volumetric, whole-brain compilation of brain atlases for vestibular functional MRI research. Sci Data 2023; 10:29. [PMID: 36641517 PMCID: PMC9840609 DOI: 10.1038/s41597-023-01938-1] [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: 08/17/2022] [Accepted: 01/04/2023] [Indexed: 01/15/2023] Open
Abstract
Human vestibular processing involves distributed networks of cortical and subcortical regions which perform sensory and multimodal integrative functions. These functional hubs are also interconnected with areas subserving cognitive, affective, and body-representative domains. Analysis of these diverse components of the vestibular and vestibular-associated networks, and synthesis of their holistic functioning, is therefore vital to our understanding of the genesis of vestibular dysfunctions and aid treatment development. Novel neuroimaging methodologies, including functional and structural connectivity analyses, have provided important contributions in this area, but often require the use of atlases which are comprised of well-defined a priori regions of interest. Investigating vestibular dysfunction requires a more detailed atlas that encompasses cortical, subcortical, cerebellar, and brainstem regions. The present paper represents an effort to establish a compilation of existing, peer-reviewed brain atlases which collectively afford comprehensive coverage of these regions while explicitly focusing on vestibular substrates. It is expected that this compilation will be iteratively improved with additional contributions from researchers in the field.
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Affiliation(s)
- Jeremy L. Smith
- grid.189967.80000 0001 0941 6502Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia USA
| | - Vishwadeep Ahluwalia
- grid.213917.f0000 0001 2097 4943Georgia Institute of Technology, Atlanta, Georgia USA ,grid.256304.60000 0004 1936 7400GSU/GT Center for Advanced Brain Imaging, Atlanta, Georgia USA
| | - Russell K. Gore
- grid.213917.f0000 0001 2097 4943Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia USA ,grid.419148.10000 0004 0384 2537Shepherd Center, Atlanta, Georgia USA
| | - Jason W. Allen
- grid.189967.80000 0001 0941 6502Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia USA ,grid.213917.f0000 0001 2097 4943Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia USA ,grid.189967.80000 0001 0941 6502Department of Neurology, Emory University School of Medicine, Atlanta, Georgia USA
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Frank AJ, Hoppes CW, Dunlap PM, Costa CM, Whitney SL. Categorizing individuals based on the severity of Visual Vertigo Analogue Scale symptoms. J Vestib Res 2022; 32:433-441. [PMID: 35466914 DOI: 10.3233/ves-210131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The Visual Vertigo Analogue Scale (VVAS) assesses visual vertigo. Instead of the original scoring methods (positive VVAS > 1), we propose categorizing patients as having No (0), Mild (0.1-40), Moderate (40.01-70), or Severe (70.01-100) symptoms. OBJECTIVE Our primary aim was to validate an alternative interpretation of the VVAS by exploring the relationship between categories of visual vertigo symptoms and measures of activity and participation, dizziness handicap, anxiety, and depression. We aimed to describe the severity of visual vertigo reported by patients in different vestibular diagnostic categories. METHODS Participants with vestibular disorders (n = 250) completed the VVAS, Vestibular Activities and Participation (VAP) Measure, Dizziness Handicap Inventory (DHI), and the Hospital Anxiety and Depression Scale (HADS). RESULTS Patients with central disorders were more symptomatic than those with peripheral vestibular disorders. As evaluated by one-way ANOVA, the scores on the VAP, HADS, and DHI significantly differed among mild, moderate, severe, and no visual vertigo categories (p < 0.001). As VVAS severity increased, activity and participation decreased (r = 0.582, p < 0.001); dizziness handicap increased (r = 0.597, p < 0.001, n = 199); anxiety increased (r = 0.405, p < 0.001); and depression increased (r = 0.521, p < 0.001). CONCLUSIONS The findings of this study support the use of an alternative VVAS interpretation method of categorizing symptoms as none, mild, moderate, and severe visual vertigo.
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Affiliation(s)
- Amanda J Frank
- Hearing Center of Excellence, San Antonio, TX, USA.,zCore Business Solutions, Inc., Round Rock, TX, USA
| | - Carrie W Hoppes
- Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, TX, USA
| | - Pamela M Dunlap
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Cláudia M Costa
- Ph.D. Program in Neuroscience, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Susan L Whitney
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
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Stark M, Huang H, Yu LF, Martin R, McCarthy R, Locke E, Yager C, Torad AA, Kadry AM, Elwan MA, Smith ML, Bradley D, Boolani A. Identifying Individuals Who Currently Report Feelings of Anxiety Using Walking Gait and Quiet Balance: An Exploratory Study Using Machine Learning. SENSORS 2022; 22:s22093163. [PMID: 35590853 PMCID: PMC9105708 DOI: 10.3390/s22093163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/06/2022] [Accepted: 04/18/2022] [Indexed: 12/10/2022]
Abstract
Literature suggests that anxiety affects gait and balance among young adults. However, previous studies using machine learning (ML) have only used gait to identify individuals who report feeling anxious. Therefore, the purpose of this study was to identify individuals who report feeling anxious at that time using a combination of gait and quiet balance ML. Using a cross-sectional design, participants (n = 88) completed the Profile of Mood Survey-Short Form (POMS-SF) to measure current feelings of anxiety and were then asked to complete a modified Clinical Test for Sensory Interaction in Balance (mCTSIB) and a two-minute walk around a 6 m track while wearing nine APDM mobility sensors. Results from our study finds that Random Forest classifiers had the highest median accuracy rate (75%) and the five top features for identifying anxious individuals were all gait parameters (turn angles, variance in neck, lumbar rotation, lumbar movement in the sagittal plane, and arm movement). Post-hoc analyses suggest that individuals who reported feeling anxious also walked using gait patterns most similar to older individuals who are fearful of falling. Additionally, we find that individuals who are anxious also had less postural stability when they had visual input; however, these individuals had less movement during postural sway when visual input was removed.
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Affiliation(s)
- Maggie Stark
- Department of Medicine, Lake Erie Osteopathic College of Medicine, Elmira, NY 14901, USA;
| | - Haikun Huang
- Department of Computer Science, George Mason University, Fairfax, VA 22030, USA; (H.H.); (L.-F.Y.)
| | - Lap-Fai Yu
- Department of Computer Science, George Mason University, Fairfax, VA 22030, USA; (H.H.); (L.-F.Y.)
| | - Rebecca Martin
- Department of Physical Therapy, Hanover College, Hanover, IN 47243, USA;
| | - Ryan McCarthy
- Department of Biology, Clarkson University, Potsdam, NY 13699, USA;
- Department of Psychology, Clarkson University, Potsdam, NY 13699, USA
| | - Emily Locke
- Department of Chemistry and Biomolecular Science, Clarkson University, Potsdam, NY 13699, USA;
| | - Chelsea Yager
- Department of Neurology, St. Joseph’s Hospital Health Center, Syracuse, NY 13203, USA;
| | - Ahmed Ali Torad
- Department of Physical Therapy, Clarkson University, Potsdam, NY 13699, USA; (A.A.T.); (A.M.K.); (M.A.E.)
- Faculty of Physical Therapy, Kafrelsheik University, Kafr El Sheik 33516, Egypt
| | - Ahmed Mahmoud Kadry
- Department of Physical Therapy, Clarkson University, Potsdam, NY 13699, USA; (A.A.T.); (A.M.K.); (M.A.E.)
- Faculty of Physical Therapy, Kafrelsheik University, Kafr El Sheik 33516, Egypt
| | - Mostafa Ali Elwan
- Department of Physical Therapy, Clarkson University, Potsdam, NY 13699, USA; (A.A.T.); (A.M.K.); (M.A.E.)
- Faculty of Physical Therapy, Beni-Suef University, Beni-Suef 62521, Egypt
| | - Matthew Lee Smith
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX 77843, USA;
| | - Dylan Bradley
- Canino School of Engineering Technology, State University of New York, Canton, NY 13617, USA;
| | - Ali Boolani
- Department of Biology, Clarkson University, Potsdam, NY 13699, USA;
- Department of Physical Therapy, Clarkson University, Potsdam, NY 13699, USA; (A.A.T.); (A.M.K.); (M.A.E.)
- Correspondence:
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Smith JL, Trofimova A, Ahluwalia V, Casado Garrido JJ, Hurtado J, Frank R, Hodge A, Gore RK, Allen JW. The "vestibular neuromatrix": A proposed, expanded vestibular network from graph theory in post-concussive vestibular dysfunction. Hum Brain Mapp 2021; 43:1501-1518. [PMID: 34862683 PMCID: PMC8886666 DOI: 10.1002/hbm.25737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 11/07/2022] Open
Abstract
Convergent clinical and neuroimaging evidence suggests that higher vestibular function is subserved by a distributed network including visuospatial, cognitive-affective, proprioceptive, and integrative brain regions. Clinical vestibular syndromes may perturb this network, resulting in deficits across a variety of functional domains. Here, we leverage structural and functional neuroimaging to characterize this extended network in healthy control participants and patients with post-concussive vestibular dysfunction (PCVD). Then, 27 healthy control subjects (15 females) and 18 patients with subacute PCVD (12 female) were selected for participation. Eighty-two regions of interest (network nodes) were identified based on previous publications, group-wise differences in BOLD signal amplitude and connectivity, and multivariate pattern analysis on affective tests. Group-specific "core" networks, as well as a "consensus" network comprised of connections common to all participants, were then generated based on probabilistic tractography and functional connectivity between the 82 nodes and subjected to analyses of node centrality and community structure. Whereas the consensus network was comprised of affective, integrative, and vestibular nodes, PCVD participants exhibited diminished integration and centrality among vestibular and affective nodes and increased centrality of visual, supplementary motor, and frontal and cingulate eye field nodes. Clinical outcomes, derived from dynamic posturography, were associated with approximately 62% of all connections but best predicted by amygdalar, prefrontal, and cingulate connectivity. No group-wise differences in diffusion metrics or tractography were noted. These findings indicate that cognitive, affective, and proprioceptive substrates contribute to vestibular processing and performance and highlight the need to consider these domains during clinical diagnosis and treatment planning.
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Affiliation(s)
- Jeremy L Smith
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Anna Trofimova
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Vishwadeep Ahluwalia
- Georgia State University, Atlanta, Georgia, USA.,Center for Advanced Brain Imaging, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Jose J Casado Garrido
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
| | | | | | | | - Russell K Gore
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA.,Shepherd Center, Atlanta, Georgia, USA
| | - Jason W Allen
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA.,Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA.,Department of Neurology, Emory University School of Medicine Emory University Hospital, Atlanta, Georgia, USA
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11
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Smaakjær P, Wachner LG, Rasmussen RS. Vision therapy improves binocular visual dysfunction in patients with mild traumatic brain injury. Neurol Res 2021; 44:439-445. [PMID: 34781837 DOI: 10.1080/01616412.2021.2000825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate benefits of binocular vision and ocular motility training in patients with long-term sequelae after mild traumatic brain injury (mTBI). METHODS Twenty-eight mTBI (concussion) patients from 25 to 61 years of age with oculomotor dysfunction were selected by optometric examination. The vision therapy was designed to improve convergence, pursuit and saccades as well as to increase fusional reserves. The vision therapy was conducted by a neurooptometrist and a speech therapist, and took place weekly for 1 hour during 10 continuous weeks. Between vision training sessions, patients trained at home for 15-20 minutes daily. Before and after vision therapy, patients completed a test battery including the Groffman Visual Tracing Test, King-Devick test (K-D), a reading speed test, Multidimensional Fatigue Inventory (MFI-20) and patient interviews based on a modified version of the Canadian Occupational Performance Measure (COPM). RESULTS Twenty-seven patients completed the vision therapy. After the therapy, improvements were measured on all test parameters, e.g. Groffman Visual Tracing Test (p < 0.05), K-D-Test (p = 0.01), Reading Speed Test (p < 0.01) and MFI-20 total (p < 0.05). The results for the modified COPM were significantly improved for both performance and satisfaction (0.0001 < p < 0.01). CONCLUSION Vision therapy improved fixation stability and endurance. Reading speed measured by the numbers of saccades and regressions time consumption per read word increased. There was also an improvement in visual attention, possibly making patients safer in traffic and outdoor activities.
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Affiliation(s)
- Peter Smaakjær
- Department of Vision, CSU-Slagelse, Center of Communication, Slagelse, Denmark
| | - Lone Grønnegaard Wachner
- Department of Speech & Brain Pathology, CSU-Slagelse, Center of Communication, Slagelse, Denmark
| | - Rune Skovgaard Rasmussen
- Department of Speech & Brain Pathology, CSU-Slagelse, Center of Communication, Slagelse, Denmark
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12
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D'Amelio A, Boccignone G. Gazing at Social Interactions Between Foraging and Decision Theory. Front Neurorobot 2021; 15:639999. [PMID: 33859558 PMCID: PMC8042312 DOI: 10.3389/fnbot.2021.639999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/09/2021] [Indexed: 11/30/2022] Open
Abstract
Finding the underlying principles of social attention in humans seems to be essential for the design of the interaction between natural and artificial agents. Here, we focus on the computational modeling of gaze dynamics as exhibited by humans when perceiving socially relevant multimodal information. The audio-visual landscape of social interactions is distilled into a number of multimodal patches that convey different social value, and we work under the general frame of foraging as a tradeoff between local patch exploitation and landscape exploration. We show that the spatio-temporal dynamics of gaze shifts can be parsimoniously described by Langevin-type stochastic differential equations triggering a decision equation over time. In particular, value-based patch choice and handling is reduced to a simple multi-alternative perceptual decision making that relies on a race-to-threshold between independent continuous-time perceptual evidence integrators, each integrator being associated with a patch.
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Affiliation(s)
- Alessandro D'Amelio
- PHuSe Lab, Department of Computer Science, Universitá degli Studi di Milano, Milan, Italy
| | - Giuseppe Boccignone
- PHuSe Lab, Department of Computer Science, Universitá degli Studi di Milano, Milan, Italy
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13
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Ellmers TJ, Cocks AJ, Kal EC, Young WR. Conscious Movement Processing, Fall-Related Anxiety, and the Visuomotor Control of Locomotion in Older Adults. J Gerontol B Psychol Sci Soc Sci 2021; 75:1911-1920. [PMID: 32761087 PMCID: PMC7566972 DOI: 10.1093/geronb/gbaa081] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Indexed: 12/25/2022] Open
Abstract
Objectives Older adults anxious about falling will often consciously process walking movements in an attempt to avoid falling. They also fixate their gaze on the present step rather than looking ahead to plan future actions. The present work examined whether conscious movement strategies result in such restricted visual planning. Methods A total of 18 community-dwelling older adults (agemean = 71.22; SD = 5.75) walked along a path and stepped into two raised targets. Repeated-measures analyses of variance were used to compare gaze behavior and movement kinematics when participants walked: (a) at baseline (ground level); (b) under conditions designed to induce fall-related anxiety (walkway elevated 0.6 m); and (c) in the absence of anxiety (ground level), but with explicit instructions to consciously process movements. Results Participants reported increased conscious movement processing when walking both on the elevated walkway (fall-related anxiety condition) and at ground level when instructed to consciously process gait. During both conditions, participants altered their gaze behavior, visually prioritizing the immediate walkway 1–2 steps ahead (areas needed for the on-line visual control of individual steps) at the expense of previewing distal areas of the walking path required to plan future steps. These alterations were accompanied by significantly slower gait and increased stance durations prior to target steps. Conclusions Consciously processing movement (in the relative absence of anxiety) resulted in gaze behavior comparable to that observed during conditions of fall-related anxiety. As anxious participants also self-reported directing greater attention toward movement, this suggests that fall-related anxiety may disrupt the visual control of gait through increased conscious movement processing.
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Affiliation(s)
- Toby J Ellmers
- College of Health and Life Sciences, Brunel University London, UK.,Centre for Cognitive Neuroscience, Brunel University London, UK
| | - Adam J Cocks
- College of Health and Life Sciences, Brunel University London, UK.,Centre for Cognitive Neuroscience, Brunel University London, UK
| | - Elmar C Kal
- College of Health and Life Sciences, Brunel University London, UK.,Centre for Cognitive Neuroscience, Brunel University London, UK
| | - William R Young
- College of Health and Life Sciences, Brunel University London, UK.,School of Sport and Health Sciences, University of Exeter, UK
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14
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Bednarczuk NF, Bradshaw JM, Mian SY, Papoutselou E, Mahmoud S, Ahn K, Chudenkov I, Fuentealba C, Hussain S, Castro P, Bronstein AM, Kaski D, Arshad Q. Pathophysiological dissociation of the interaction between time pressure and trait anxiety during spatial orientation judgments. Eur J Neurosci 2020; 52:3215-3222. [PMID: 31950532 DOI: 10.1111/ejn.14680] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 11/27/2019] [Accepted: 12/11/2019] [Indexed: 01/02/2023]
Abstract
Spatial orientation is achieved by integrating visual, vestibular and proprioceptive cues. Individuals that rely strongly upon visual cues to facilitate spatial orientation are termed visually dependent. Heightened visual reliance commonly occurs in patients following vestibular dysfunction and can influence clinical outcome. Additionally, psychological factors, including anxiety, are associated with poorer clinical outcome following vestibular dysfunction. Given that visual dependency measures are affected by psychological and contextual influences, such as time pressure, we investigated the interaction between time pressure and anxiety upon visual dependency in healthy controls and vestibular migraine patients. Visual dependency was assessed using a "Rod and Disk" task at baseline and under time pressure (3 s to complete the task). Non-situational (trait) and situational (state) anxiety levels were quantified using the Spielberg State-Trait Anxiety Inventory. We calculated the change in visual dependency (VD) [∆VD = VDtime pressure - VDbaseline ] and correlated it with participants' trait anxiety scores. We observed a significant negative correlation between trait anxiety and the change in VD (R2 = .393, p < .001) in healthy controls and a positive correlation in dizzy patients (R2 = .317, p < .001). That is, healthy individuals that were more anxious became less visually dependent under time pressure (i.e., more accurate), whereas less anxious individuals became more visually dependent. The reverse was observed in vestibular migraine patients. Our results illustrate that anxiety can differentially modulate task performance during spatial orientation judgements under time pressure in healthy individuals and dizzy patients. These findings have potential implications for individualised patient rehabilitation therapies.
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Affiliation(s)
- Nadja F Bednarczuk
- Division of Brain Sciences, Academic Department of Neuro-otology, Imperial College London, Charing Cross Hospital, London, UK
- inAmind Laboratory, Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
- King's College Hospital, London, UK
| | - Jacob M Bradshaw
- Division of Brain Sciences, Academic Department of Neuro-otology, Imperial College London, Charing Cross Hospital, London, UK
| | - Shan Y Mian
- Division of Brain Sciences, Academic Department of Neuro-otology, Imperial College London, Charing Cross Hospital, London, UK
| | - Efstratia Papoutselou
- Division of Brain Sciences, Academic Department of Neuro-otology, Imperial College London, Charing Cross Hospital, London, UK
| | - Sami Mahmoud
- Division of Brain Sciences, Academic Department of Neuro-otology, Imperial College London, Charing Cross Hospital, London, UK
| | - Keunhwi Ahn
- inAmind Laboratory, Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Ilya Chudenkov
- Division of Brain Sciences, Academic Department of Neuro-otology, Imperial College London, Charing Cross Hospital, London, UK
| | - Constanza Fuentealba
- Leiden University Ringgold Standard Institution - Medicine, Leiden, The Netherlands
| | - Shahvaiz Hussain
- Division of Brain Sciences, Academic Department of Neuro-otology, Imperial College London, Charing Cross Hospital, London, UK
| | - Patricia Castro
- Division of Brain Sciences, Academic Department of Neuro-otology, Imperial College London, Charing Cross Hospital, London, UK
| | - Adolfo M Bronstein
- Division of Brain Sciences, Academic Department of Neuro-otology, Imperial College London, Charing Cross Hospital, London, UK
| | - Diego Kaski
- Department of Neuro-otology, Royal National Throat Nose and Ear Hospital, University College London, London, UK
- Department of Clinical and Motor Neurosciences, Centre for Vestibular Neurosciences, London, UK
| | - Qadeer Arshad
- Division of Brain Sciences, Academic Department of Neuro-otology, Imperial College London, Charing Cross Hospital, London, UK
- inAmind Laboratory, Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
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15
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Hardeman LES, Kal EC, Young WR, van der Kamp J, Ellmers TJ. Visuomotor control of walking in Parkinson's disease: Exploring possible links between conscious movement processing and freezing of gait. Behav Brain Res 2020; 395:112837. [PMID: 32739286 DOI: 10.1016/j.bbr.2020.112837] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/10/2020] [Accepted: 07/24/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Changes in visual attention have been argued to influence freezing of gait (FOG) in people with Parkinson's Disease (PD). However, the specific visual search patterns of people with FOG pathology (PD + FOG) and potential underlying mechanisms are not well understood. The current study explored visual search behavior in PD + FOG while walking on a pathway featuring environmental features known to exacerbate FOG (e.g., narrow doorway and tripping hazards). Potential underpinning attentional mechanisms were also assessed, such as conscious movement processing. METHODS Visual search behavior of twelve people with PD + FOG tested in ON-state (Mage = 74.3) and twelve age-matched healthy controls (Mage = 72.5) were analyzed during a complex walking task. The task required participants to step over an obstacle and navigate through a narrow doorway, surrounded by clutter. RESULTS People with PD + FOG more frequently directed visual attention to ongoing and imminent steps compared to healthy controls (Mdn = 26% vs Mdn = 14%, respectively; p = 0.042). Self-reported conscious movement processing was also significantly higher in people with PD + FOG. The one participant who froze during the walking task fixated the future trip hazard (obstacle, approximately 6 steps ahead) almost exclusively during freezing trials (i.e., 60-100% of the trial). In contrast, during 'non-freeze' trials, this participant increased the duration of fixations towards ongoing and imminent steps. CONCLUSION Results suggest that people with PD + FOG strongly monitor/control ongoing and immediately upcoming stepping movements. However, prolonged fixations towards threats to future movements might prevent people with PD + FOG from processing the visual information needed to do this, thereby provoke freezing episodes.
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Affiliation(s)
- L E S Hardeman
- Faculty of Behavioral and Movement Sciences, VU University Amsterdam, Netherlands; College of Health, Medicine and Life Sciences, Brunel University London, UK
| | - E C Kal
- College of Health, Medicine and Life Sciences, Brunel University London, UK; Centre for Cognitive Neuroscience, Brunel University London, UK
| | - W R Young
- College of Health, Medicine and Life Sciences, Brunel University London, UK; School of Sport and Health Sciences, University of Exeter, UK
| | - J van der Kamp
- Faculty of Behavioral and Movement Sciences, VU University Amsterdam, Netherlands
| | - T J Ellmers
- College of Health, Medicine and Life Sciences, Brunel University London, UK; Centre for Cognitive Neuroscience, Brunel University London, UK.
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16
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Ehgoetz Martens KA, Peterson DS, Almeida QJ, Lewis SJG, Hausdorff JM, Nieuwboer A. Behavioural manifestations and associated non-motor features of freezing of gait: A narrative review and theoretical framework. Neurosci Biobehav Rev 2020; 116:350-364. [PMID: 32603716 DOI: 10.1016/j.neubiorev.2020.06.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 12/30/2022]
Abstract
Over the past decade, non-motor related symptoms and provocative contexts have offered unique opportunities to gain insight into the potential mechanisms that may underpin freezing of gait (FOG) in Parkinson's disease (PD). While this large body of work has informed several theoretical models, to date, few are capable of explaining behavioural findings across multiple domains (i.e. cognitive, sensory-perceptual and affective) and in different behavorial contexts. As such, the exact nature of these interrelationships and their neural basis remain quite enigmatic. Here, the non-motor, behavioural evidence for cognitive, sensory-perceptual and affective contributors to FOG are reviewed and synthesized by systematically examining (i) studies that manipulated contextual environments that provoke freezing of gait, (ii) studies that uncovered factors that have been proposed to contribute to freezing, and (iii) studies that longitudinally tracked factors that predict the future development of freezing of gait. After consolidating the evidence, we offer a novel perspective for integrating these multi-faceted behavioural patterns and identify key challenges that warrant consideration in future work.
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Affiliation(s)
| | - Daniel S Peterson
- College of Health Solutions, Arizona State University, Arizona, USA; Phoenix Veterans Affairs Medical Centre, Arizona, USA
| | - Quincy J Almeida
- Movement Disorders Research & Rehabilitation Centre, Laurier University, Waterloo, ON, Canada
| | - Simon J G Lewis
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Camperdown, New South Wales, Australia
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Dept of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Alice Nieuwboer
- Department of Rehabilitation Science, University of Leuven, Leuven, Belgium
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17
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Saman Y, Arshad Q, Dutia M, Rea P. Stress and the vestibular system. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2020; 152:221-236. [PMID: 32450997 DOI: 10.1016/bs.irn.2020.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In this chapter we review the existing literature regarding the interactions between stress and the mechanisms that maintain balance. Evidence suggests that the interplay between neuro-endocrine and psychological factors may have a significant role in balance function. For example, in healthy individuals vestibular stimulation has been shown to trigger the stress response as indicated by increased blood cortisol levels, whereas in patients with vestibular pathology factors such as resilience and anxiety may be the key focus of interactions with stress. Critically, factors such as anxiety are known to influence clinical outcomes, despite our mechanistic understanding of these processes remaining in their infancy.
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Affiliation(s)
- Yougan Saman
- ENT Department, Leicester Royal Infirmary, Leicester, United Kingdom; inAmind Laboratory, Department of Psychology, Neuroscience and Behaviour, University of Leicester, Leicester, United Kingdom.
| | - Qadeer Arshad
- ENT Department, Leicester Royal Infirmary, Leicester, United Kingdom; inAmind Laboratory, Department of Psychology, Neuroscience and Behaviour, University of Leicester, Leicester, United Kingdom; Academic Department of Neuro-otology, Charing Cross Hospital Campus, Imperial College London, London, United Kingdom
| | - Mayank Dutia
- Biomedical Sciences, Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom
| | - Peter Rea
- ENT Department, Leicester Royal Infirmary, Leicester, United Kingdom
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18
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Evaluation of anxiety sensitivity, depression, and personality characteristics in chronic subjective dizziness patients. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.605104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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19
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The effects of temporal pressure on obstacle negotiation and gaze behaviour in young adults with simulated vision loss. Sci Rep 2019; 9:15409. [PMID: 31659214 PMCID: PMC6817899 DOI: 10.1038/s41598-019-51926-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 10/10/2019] [Indexed: 12/26/2022] Open
Abstract
Individuals with vision loss adapt their locomotion and gaze behaviour to safely negotiate objects in temporally unconstrained situations. However, everyday activities are often performed under time-pressure. We investigated the effects of blur on anxiety, movement kinematics and gaze behaviour during the negotiation of a floor-based obstacle under three amounts of pressure: 1) no-pressure; 2) tonal-pressure: an intermittent tone was played at a constant frequency; 3) tonal + time pressure: the intermittent tone increased in frequency and participants had to walk 20% faster to reach the end of the lab. Irrespective of the amount of pressure, the blurred vs. normal vision group reported 32% more anxiety, lifted the lead foot 43% higher and 10% slower over the obstacle, and looked 6% longer and 6% more frequently ahead of the obstacle. In the tonal + time pressure vs. no-pressure condition, both groups were more anxious, showed adaptations in movement kinematics related to walking faster, and adopted a ‘checking strategy’ by shortening their fixation durations at the obstacle. These results show that irrespective of temporal pressure, the blurred vision group remained more cautious as to how the lead foot negotiated the obstacle, in order to reduce the chance of tripping during crossing.
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20
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Abstract
PURPOSE A case study of a 12-year-old boy with Irlen syndrome illustrates the overlapping symptoms of Irlen syndrome and vestibular-related dizziness. SUMMARY OF KEY POINTS Individuals with Irlen syndrome have eyestrain and headache, and often report visual perceptual distortions of blurring, doubling, and movement of print on the page. These symptoms can be relieved with the use of individually prescribed tinted lenses or overlays. Visually induced dizziness, also known as visual vertigo, is characterized by dizziness and/or unsteadiness that is triggered by complex, distorted, large field/moving visual stimuli. Visually induced dizziness can be effectively treated with progressive, controlled exposure to optokinetic visual stimuli. The child with Irlen syndrome had impaired balance, impaired gaze stability, and symptoms of visual vertigo. His complaint of visually induced dizziness resolved following vestibular rehabilitation. CONCLUSIONS AND RECOMMENDATIONS FOR CLINICAL PRACTICE When an individual with Irlen syndrome complains of dizziness, ruling out a concomitant diagnosis of a central and/or peripheral vestibular disorder is warranted. WHAT THIS ADDS TO THE EVIDENCE The visual symptoms associated with Irlen syndrome can overlap with those of visually induced dizziness. This case report is the first to describe overlapping visual and vestibular complaints of dizziness in an individual with Irlen syndrome.
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21
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Kaur R, Lin X, Layton A, Hernandez M, Sowers R. Virtual Reality, Visual Cliffs, and Movement Disorders. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:81-84. [PMID: 30440346 DOI: 10.1109/embc.2018.8512246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We outline an experimental setup designed to dynamically understand neural responses to visual cliffs while walking. The goal of our work is understanding and mitigating fear of falling, particularly among the elderly. In our setup, an EEG cap monitors a subject's neural activity while the subject is immersed in a virtual world and walking on an instrumented treadmill. The subject's response to visual stimuli is measured by both the EEG cap and by speed and pressure data from the treadmill. Based on this data, we can dynamically alter the landscape in the virtual world. We hope that our setup may be useful in helping subjects develop mechanisms to compensate for significant fear of falling while walking.
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22
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Morimoto H, Asai Y, Johnson EG, Koide Y, Niki J, Sakai S, Nakayama M, Kabaya K, Fukui A, Mizutani Y, Mizutani T, Ueki Y, Mizutani J, Ueki T, Wada I. Objective measures of physical activity in patients with chronic unilateral vestibular hypofunction, and its relationship to handicap, anxiety and postural stability. Auris Nasus Larynx 2018; 46:70-77. [PMID: 30691599 DOI: 10.1016/j.anl.2018.06.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 05/13/2018] [Accepted: 06/22/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Dizziness is one of the most common symptoms in the general population. Patients with dizziness experience balance problems and anxiety, which can lead to decreased physical activity levels and participation in their daily activities. Moreover, recovery of vestibular function from vestibular injury requires physical activity. Although there are reports that decreased physical activity is associated with handicap, anxiety, postural instability and reduced recovery of vestibular function in patients with chronic dizziness, these data were collected by self-report questionnaires. Therefore, the objective data of physical activity and the relationships between physical activity, handicap, anxiety and postural stability in patients with chronic dizziness are not clear. The purpose of this research was to objectively measure the physical activity of patients with chronic dizziness in daily living as well as handicap, anxiety and postural stability compared to healthy adults. Additionally, we aimed to investigate the relationships between physical activity, handicap, anxiety and postural stability in patients with chronic dizziness. METHODS Twenty-eight patients with chronic dizziness of more than 3 months caused by unilateral vestibular hypofunction (patient group) and twenty-eight age-matched community dwelling healthy adults (healthy group) participated in this study. The amount of physical activity including time of sedentary behavior, light physical activity, moderate to vigorous physical activity and total physical activity using tri-axial accelerometer, self-perceived handicap and anxiety using questionnaires, and postural stability were measured using computerized dynamic posturography. RESULTS The results showed worse handicap, anxiety and postural stability in the patient group compared to the healthy group. Objective measures of physical activity revealed that the patient group had significantly longer time of sedentary behavior, shorter time of light physical activity, and shorter time of total physical activity compared to the healthy group; however, time of moderate to vigorous physical activity was not significantly different between groups. Moreover, there were correlations between physical activity and postural stability in the patient group, while there were no correlations between physical activity, handicap or anxiety in the patient group. CONCLUSION These results suggest that objectively measured physical activity of the patients with chronic unilateral vestibular hypofunction is lower compared to the healthy adults, and less active patients showed decreased postural stability. However, the details of physical activity and causal effect between physical activity and postural stability were not clear and further investigation is needed.
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Affiliation(s)
- Hiroyuki Morimoto
- Department of Rehabilitation Medicine, Graduate School of Medical Sciences, Nagoya City University, 1, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan; Department of Rehabilitation, Mizutani Hospital, 3-4-1, Kanayama-cho, Atsuta-ku, Nagoya 456-0002, Japan
| | - Yuji Asai
- Department of Rehabilitation Medicine, Graduate School of Medical Sciences, Nagoya City University, 1, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan; Department of Physical Therapy, School of Health Science, Nihon Fukushi University, 2-26, Higashihaemi-cho, Handa 475-0012, Japan
| | - Eric G Johnson
- Department of Physical Therapy, School of Allied Health Professions, Loma Linda University, 24951, Circle Drive, Loma Linda, CA 92354, USA
| | - Yoshinori Koide
- Department of Rehabilitation Medicine, Graduate School of Medical Sciences, Nagoya City University, 1, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Junichi Niki
- Department of Rehabilitation, Mizutani Hospital, 3-4-1, Kanayama-cho, Atsuta-ku, Nagoya 456-0002, Japan
| | - Shigeki Sakai
- Department of Rehabilitation, Mizutani Hospital, 3-4-1, Kanayama-cho, Atsuta-ku, Nagoya 456-0002, Japan
| | - Meiho Nakayama
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medical Sciences, Nagoya City University, 1, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan.
| | - Kayoko Kabaya
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medical Sciences, Nagoya City University, 1, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Ayako Fukui
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medical Sciences, Nagoya City University, 1, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Yoko Mizutani
- Department of Orthopedics, Mizutani Hospital, 3-4-1, Kanayama-cho, Atsuta-ku, Nagoya 456-0002, Japan
| | - Takehiko Mizutani
- Department of Orthopedics, Mizutani Hospital, 3-4-1, Kanayama-cho, Atsuta-ku, Nagoya 456-0002, Japan
| | - Yoshino Ueki
- Department of Rehabilitation Medicine, Graduate School of Medical Sciences, Nagoya City University, 1, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Jun Mizutani
- Department of Rehabilitation Medicine, Graduate School of Medical Sciences, Nagoya City University, 1, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Takatoshi Ueki
- Department of Integrative Anatomy, Graduate School of Medical Sciences, Nagoya City University, 1, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Ikuo Wada
- Department of Rehabilitation Medicine, Graduate School of Medical Sciences, Nagoya City University, 1, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
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Bednarczuk NF, Casanovas Ortega M, Fluri AS, Arshad Q. Vestibulo-cortical hemispheric dominance: The link between anxiety and the vestibular system? Eur J Neurosci 2018; 47:1517-1524. [PMID: 29768682 PMCID: PMC6099323 DOI: 10.1111/ejn.13948] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 03/09/2018] [Accepted: 04/04/2018] [Indexed: 11/29/2022]
Abstract
Vestibular processing and anxiety networks are functionally intertwined, as demonstrated by reports of reciprocal influences upon each other. Yet whether there is an underlying link between these two systems remains unknown. Previous findings have highlighted the involvement of hemispheric lateralisation in processing of both anxiety and vestibular signals. Accordingly, we explored the interaction between vestibular cortical processing and anxiety by assessing the relationship between anxiety levels and the degree of hemispheric lateralisation of vestibulo-cortical processing in 64 right-handed, healthy individuals. Vestibulo-cortical hemispheric lateralisation was determined by gaging the degree of caloric-induced nystagmus suppression following modulation of cortical excitability using trans-cranial direct current stimulation targeted over the posterior parietal cortex, an area implicated in the processing of vestibular signals. The degree of nystagmus suppression yields an objective biomarker, allowing the quantification of the degree of right vestibulo-cortical hemisphere dominance. Anxiety levels were quantified using the Trait component of the Spielberger State-Trait Anxiety Questionnaire. Our findings demonstrate that the degree of an individual's vestibulo-cortical hemispheric dominance correlates with their anxiety levels. That is, those individuals with greater right hemispheric vestibulo-cortical dominance exhibited lower levels of anxiety. By extension, our results support the notion that hemispheric lateralisation determines an individual's emotional processing, thereby linking cortical circuits involved in processing anxiety and vestibular signals, respectively.
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Affiliation(s)
- Nadja F Bednarczuk
- Division of Brain Sciences, Academic Department of Neuro-Otology, Department of Medicine, Imperial College London, London, UK
| | - Marta Casanovas Ortega
- Division of Brain Sciences, Academic Department of Neuro-Otology, Department of Medicine, Imperial College London, London, UK
| | - Anne-Sophie Fluri
- Division of Brain Sciences, Academic Department of Neuro-Otology, Department of Medicine, Imperial College London, London, UK
| | - Qadeer Arshad
- Division of Brain Sciences, Academic Department of Neuro-Otology, Department of Medicine, Imperial College London, London, UK
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Pan Q, Zhang Y, Long T, He W, Zhang S, Fan Y, Zhou J. Diagnosis of Vertigo and Dizziness Syndromes in a Neurological Outpatient Clinic. Eur Neurol 2018; 79:287-294. [PMID: 29794430 DOI: 10.1159/000489639] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 04/22/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Dizziness and vertigo are frequent complaints of outpatients in the neurological department. Our objective was to explore the epidemiological category and clinical features of patients with dizziness or vertigo in the neurological outpatient department of a tertiary hospital. METHODS We consecutively recruited all patients with dizziness and/or vertigo visiting the neurological outpatient clinic of the First Affiliated Hospital of Chongqing Medical University from January 2016 to June 2017. All patients were interviewed by 4 neurologists and they completed self-administered questionnaires. General physical and standardized neuro-otology bedside examinations were performed in all participants. Instrumental examinations and other related examinations were prescribed as needed. RESULTS A total of 392 patients, 272 female and 120 male, were enrolled and the ratio of males to females was 1: 2.27. The mean age was 52.39 ± 13.87 years (range 11-90). Elderly patients (≥60 years) accounted for about one-third of the patients. Peripheral vestibular disorders accounted for 54.6% of patients, central vestibular disorders (including vestibular migraine [VM]) accounted for 22.4% of patients, psychogenic vertigo in 64 (16.3%), other reasons in 9 (2.3%) and unknown in 17 (4.3%). Benign paroxysmal positional vertigo (BPPV; 30.8%), psychiatric dizziness (20.5%), and VM (14.4%) were the 3 major vestibular diseases in patients under 60 years of age; however, BPPV (27.9%), central vertigo (21.7%), and Meniere's disease (11.7%) were more common in patients over 60 years of age. CONCLUSIONS This study provided a classification and clinical features of vestibular disorders in a neurological outpatient department of a tertiary hospital in China. The spectrum of vertigo or dizziness is different between different age groups and clinicians should pay attention to this difference in clinical reasoning.
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Sienko KH, Whitney SL, Carender WJ, Wall C. The role of sensory augmentation for people with vestibular deficits: Real-time balance aid and/or rehabilitation device? J Vestib Res 2018; 27:63-76. [PMID: 28387692 DOI: 10.3233/ves-170606] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This narrative review highlights findings from the sensory augmentation field for people with vestibular deficits and addresses the outstanding questions that are critical to the translation of this technology into clinical and/or personal use. Prior research has demonstrated that the real-time use of visual, vibrotactile, auditory, and multimodal sensory augmentation technologies can improve balance during static and dynamic stance tasks within a laboratory setting. However, its application in improving gait requires additional investigation, as does its efficacy as a rehabilitation device for people with vestibular deficits. In some locomotor studies involving sensory augmentation, gait velocity decreased and secondary task performance worsened, and subjects negatively altered their segmental control strategies when cues were provided following short training sessions. A further question is whether the retention and/or carry-over effects of training with a sensory augmentation technology exceed the retention and/or carry-over effects of training alone, thereby supporting its use as a rehabilitation device. Preliminary results suggest that there are short-term improvements in balance performance following a small number of training sessions with a sensory augmentation device. Long-term clinical and home-based controlled training studies are needed. It is hypothesized that sensory augmentation provides people with vestibular deficits with additional sensory input to promote central compensation during a specific exercise/activity; however, research is needed to substantiate this theory. Major obstacles standing in the way of its use for these critical applications include determining exercise/activity specific feedback parameters and dosage strategies. This paper summarizes the reported findings that support sensory augmentation as a balance aid and rehabilitation device, but does not critically examine efficacy or the quality of the research methods used in the reviewed studies.
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Affiliation(s)
- K H Sienko
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - S L Whitney
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA.,Rehabilitation Research Chair, Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - W J Carender
- Department of Otolaryngology, University of Michigan Health System, Ann Arbor, MI, USA
| | - C Wall
- Jenks Vestibular Diagnostic Laboratory, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.,Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA
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26
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Curzon-Jones BT, Hollands MA. Route previewing results in altered gaze behaviour, increased self-confidence and improved stepping safety in both young and older adults during adaptive locomotion. Exp Brain Res 2018; 236:1077-1089. [PMID: 29435606 PMCID: PMC5887007 DOI: 10.1007/s00221-018-5203-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 02/08/2018] [Indexed: 11/06/2022]
Abstract
Older adults with falls risk tend to look away prematurely from targets for safe foot placement to view future hazards; behaviour associated with increased anxiety and stepping inaccuracies. We aimed to determine the effectiveness of route previewing in reducing anxiety and optimizing gaze behaviour and stepping performance of younger and older adults. Nine younger and nine older adults completed six walks with three task complexities over two sessions. Each trial used either an isolated stepping target, or a target followed by either one or two obstacles. Participants with eyes closed, on hearing a signal, opened their eyes and initiated walking (go trials) or stood previewing the route for 10 s before starting (preview trials). Kinematic data were collected using a Vicon motion analysis system. Gaze behaviour was recorded using a Dikablis eye tracker. On average, both older and younger adults fixated the target for significantly longer during walking when they had previewed the route than when they had not. Self-confidence scores were also significantly higher following ‘preview trials’ than ‘go trials’. Stepping performance significantly improved following route previewing (reduced Medial lateral foot placement variability for both groups and reduced anterior/posterior foot placement error in older adults only). These findings implicate route previewing as a potential intervention to increase self-confidence and reduce the risk of tripping in older adults.
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Affiliation(s)
| | - Mark Andrew Hollands
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, L3 5AF, UK.
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Functional dizziness: from phobic postural vertigo and chronic subjective dizziness to persistent postural-perceptual dizziness. Curr Opin Neurol 2018; 30:107-113. [PMID: 28002123 DOI: 10.1097/wco.0000000000000417] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Functional dizziness is the new term for somatoform or psychogenic dizziness. The aim of this study is to review arguments for the new nomenclature, clinical features, possible pathomechanisms, and comorbidities of functional dizziness. RECENT FINDINGS The prevalence of functional dizziness as a primary cause of vestibular symptoms amounts to 10% in neuro-otology centers. Rates of psychiatric comorbidity in patients with structural vestibular syndromes are much higher with nearly 50% and with highest rates in patients with vestibular migraine, vestibular paroxysmia, and Ménière's disease. Pathophysiologic processes seem to include precipitating events that trigger anxiety-related changes in postural strategies with an increased attention to head and body motion and a cocontraction of leg muscles. Personality traits with high levels of neuroticism and low levels of extraversion appear as risk factors for anxiety and depressive disorders and increased morbidity in functional disorders. SUMMARY Correct and early diagnosis of functional dizziness, as primary cause or secondary disorder after a structural vestibular syndrome, is very important to prevent further chronification and enable adequate treatment. Treatment plans that include patient education, vestibular rehabilitation, cognitive and behavioral therapies, and medications substantially reduce morbidity and offer the potential for sustained remission when applied systematically.
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Naranjo EN, Cleworth TW, Allum JHJ, Inglis JT, Lea J, Westerberg BD, Carpenter MG. Threat effects on human oculo-motor function. Neuroscience 2017; 359:289-298. [PMID: 28733210 DOI: 10.1016/j.neuroscience.2017.07.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 06/11/2017] [Accepted: 07/11/2017] [Indexed: 11/27/2022]
Abstract
Neuro-anatomical evidence supports the potential for threat-related factors, such as fear, anxiety and vigilance, to influence brainstem motor nuclei controlling eye movements, as well as the vestibular nuclei. However, little is known about how threat influences human ocular responses, such as eye saccades (ES), smooth pursuit eye tracking (SP), and optokinetic nystagmus (OKN), and whether these responses can be facilitated above normal baseline levels with a natural source of threat. This study was designed to examine the effects of height-induced postural threat on the gain of ES, SP and OKN responses in humans. Twenty participants stood at two different surface heights while performing ES (ranging from 8° to 45° from center), SP (15, 20, 30°/s) and OKN (15, 30, 60°/s) responses in the horizontal plane. Height did not significantly increase the slope of the relationship between ES peak velocity and initial amplitude, or the gain of ES amplitude. In contrast height significantly increased SP and OKN gain. Significant correlations were found between changes in physiological arousal and OKN gain. Observations of changes with height in OKN and SP support neuro-anatomical evidence of threat-related mechanisms influencing both oculo-motor nuclei and vestibular reflex pathways. Although further study is warranted, the findings suggest that potential influences of fear, anxiety and arousal/alertness should be accounted for, or controlled, during clinical vestibular and oculo-motor testing.
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Affiliation(s)
- E N Naranjo
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - T W Cleworth
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - J H J Allum
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada; Department of ORL, University of Basel Hospital, Basel, Switzerland
| | - J T Inglis
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada; International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - J Lea
- BC Rotary Hearing and Balance Centre at St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - B D Westerberg
- BC Rotary Hearing and Balance Centre at St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - M G Carpenter
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada; International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.
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Prospective Study on the Impact of Fear of Falling on Functional Decline among Community Dwelling Elderly Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14050469. [PMID: 28448461 PMCID: PMC5451920 DOI: 10.3390/ijerph14050469] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 04/21/2017] [Accepted: 04/22/2017] [Indexed: 11/18/2022]
Abstract
Fear of falling (FOF) is expected to have effects on functional decline in the elderly. In this study, we examined over 2 years the effect of change in FOF on functional decline in community dwelling elderly. We conducted a secondary analysis using data from elderly women, 70 years of age and older, who participated in the Korean Longitudinal Study of Aging (KLoSA). Participants were divided into four categories according to change in FOF between the 2010 and 2012 surveys. Multiple logistic regression analysis was conducted regarding the effects of changes in FOF on functional decline after controlling for variables as known risk factors for functional decline. Rates of functional decline were highest in the “consistently having FOF” group, whereas they were lowest in the “consistently no FOF” group in both 2010 and 2012. Characteristics independently associated with functional decline were change in FOF, depressive symptoms, low frequency of meeting friends, and fear-induced activity avoidance. Longer exposure to FOF was associated with an increased risk of functional decline. FOF is an important health problem that deserves attention in its own right. Public health approaches for elderly persons should address early detection, prevention, and intervention programs for FOF.
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30
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Esin RG, Khairullin IK, Mukhametova ER, Esin OR. Persistent postural-perceptual dizziness. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:28-33. [DOI: 10.17116/jnevro20171174128-33] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Giannakakis G, Pediaditis M, Manousos D, Kazantzaki E, Chiarugi F, Simos P, Marias K, Tsiknakis M. Stress and anxiety detection using facial cues from videos. Biomed Signal Process Control 2017. [DOI: 10.1016/j.bspc.2016.06.020] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Riccelli R, Indovina I, Staab JP, Nigro S, Augimeri A, Lacquaniti F, Passamonti L. Neuroticism modulates brain visuo-vestibular and anxiety systems during a virtual rollercoaster task. Hum Brain Mapp 2016; 38:715-726. [PMID: 27677756 PMCID: PMC6866907 DOI: 10.1002/hbm.23411] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 08/10/2016] [Accepted: 09/16/2016] [Indexed: 02/02/2023] Open
Abstract
Different lines of research suggest that anxiety‐related personality traits may influence the visual and vestibular control of balance, although the brain mechanisms underlying this effect remain unclear. To our knowledge, this is the first functional magnetic resonance imaging (fMRI) study that investigates how individual differences in neuroticism and introversion, two key personality traits linked to anxiety, modulate brain regional responses and functional connectivity patterns during a fMRI task simulating self‐motion. Twenty‐four healthy individuals with variable levels of neuroticism and introversion underwent fMRI while performing a virtual reality rollercoaster task that included two main types of trials: (1) trials simulating downward or upward self‐motion (vertical motion), and (2) trials simulating self‐motion in horizontal planes (horizontal motion). Regional brain activity and functional connectivity patterns when comparing vertical versus horizontal motion trials were correlated with personality traits of the Five Factor Model (i.e., neuroticism, extraversion‐introversion, openness, agreeableness, and conscientiousness). When comparing vertical to horizontal motion trials, we found a positive correlation between neuroticism scores and regional activity in the left parieto‐insular vestibular cortex (PIVC). For the same contrast, increased functional connectivity between the left PIVC and right amygdala was also detected as a function of higher neuroticism scores. Together, these findings provide new evidence that individual differences in personality traits linked to anxiety are significantly associated with changes in the activity and functional connectivity patterns within visuo‐vestibular and anxiety‐related systems during simulated vertical self‐motion. Hum Brain Mapp 38:715–726, 2017. © 2016 The Authors Human Brain Mapping Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Roberta Riccelli
- Department of Medical and Surgical Sciences; University “Magna Graecia,”; Catanzaro Italy
| | - Iole Indovina
- Laboratory of Neuromotor Physiology; IRCCS Santa Lucia Foundation; Rome 00179 Italy
- Centre of Space BioMedicine, University of Rome Tor Vergata; Rome 00173 Italy
| | - Jeffrey P. Staab
- Departments of Psychiatry and Psychology and Otorhinolaryngology - Head and Neck Surgery; Mayo Clinic; Rochester Minnesota USA
| | - Salvatore Nigro
- Institute of Bioimaging and Molecular Physiology, National Research Council; Catanzaro 88100 Italy
| | - Antonio Augimeri
- Institute of Bioimaging and Molecular Physiology, National Research Council; Catanzaro 88100 Italy
| | - Francesco Lacquaniti
- Laboratory of Neuromotor Physiology; IRCCS Santa Lucia Foundation; Rome 00179 Italy
- Centre of Space BioMedicine, University of Rome Tor Vergata; Rome 00173 Italy
- Department of Systems Medicine; University of Rome Tor Vergata; Rome 00133 Italy
| | - Luca Passamonti
- Institute of Bioimaging and Molecular Physiology, National Research Council; Catanzaro 88100 Italy
- Department of Clinical Neurosciences; University of Cambridge; Cambridge United Kingdom
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Saman Y, Mclellan L, Mckenna L, Dutia MB, Obholzer R, Libby G, Gleeson M, Bamiou DE. State Anxiety Subjective Imbalance and Handicap in Vestibular Schwannoma. Front Neurol 2016; 7:101. [PMID: 27468274 PMCID: PMC4942454 DOI: 10.3389/fneur.2016.00101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 06/15/2016] [Indexed: 11/29/2022] Open
Abstract
Introduction Evidence is emerging for a significant clinical and neuroanatomical relationship between balance and anxiety. Research has suggested a potentially priming effect with anxiety symptoms predicting a worsening of balance function in patients with underlying balance dysfunction. We propose to show that a vestibular stimulus is responsible for an increase in state anxiety, and there is a relationship between increased state anxiety and worsening balance function. Aims (1) To quantify state anxiety following a vestibular stimulus in patients with a chronic vestibular deficit. (2) To determine if state anxiety during a vestibular stimulus would correlate with the severity of chronic balance symptoms and handicap. Methods Two separate cohorts of vestibular schwannoma (VS) patients underwent vestibular tests (electronystagmography, cervical and ocular vestibular evoked myogenic potentials, and caloric responses) and questionnaire assessments [vertigo handicap questionnaire (VHQ), vertigo symptom scale (VSS), and state-trait anxiety inventory (STAIY)]. Fifteen post-resection VS patients, with complete unilateral vestibular deafferentation, were assessed at a minimum of 6 months after surgery in Experiment 1 (Aim 1). Forty-five patients with VS in situ formed the cohort for Experiment 2 (Aim 2). Experiment 1: VS subjects (N = 15) with a complete post-resection unilateral vestibular deafferentation completed a state anxiety questionnaire before caloric assessment and again afterward with the point of maximal vertigo as the reference (Aim 1). Experiment 2: state anxiety measured at the point of maximal vertigo following a caloric assessment was compared between two groups of patients with VS in situ presenting with balance symptoms (Group 1, N = 26) and without balance symptoms (Group 2, N = 11) (Aim 2). The presence of balance symptoms was defined as having a positive score on the VSS–VER. Results In Experiment 1, a significant difference (p < 0.01) was found when comparing STAIY at baseline and at the peak of the subjective vertiginous response in post-resection patients with a unilateral vestibular deafferentation. In Experiment 2, VS in situ patients with balance symptoms had significantly worse state anxiety at the peak vertiginous response than patients without balance symptoms (p < 0.001), as did patients with a balance-related handicap (p < 0.001). Conclusion Anxiety symptoms during a vestibular stimulus may contribute to a priming effect that could explain worsening balance function.
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Affiliation(s)
- Yougan Saman
- Institute of Neurology, National Hospital for Neurology and Neurosurgery, UCL, London, UK; Nelson R. Mandela School of Medicine, UKZN, Durban, South Africa
| | - Lucie Mclellan
- Neuro-otology Department, National Hospital for Neurology and Neurosurgery , London , England
| | | | - Mayank B Dutia
- Centre for Integrative Physiology, University of Edinburgh , Edinburgh , UK
| | - Rupert Obholzer
- ENT and Skull Base Department, Guys Hospital, London, UK; ENT and Skull Base Department, Kings College Hospital, London, UK
| | - Gerald Libby
- Neurogastroenterology Group, Queen Mary University of London , London , UK
| | - Michael Gleeson
- Neuro-otology and Skull Base Department, National Hospital for Neurology and Neurosurgery , London , UK
| | - Doris-Eva Bamiou
- Neuro-otology Department, National Hospital for Neurology and Neurosurgery, London, England; Ear Institute, UCL, London, UK
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Synchrony of gaze and stepping patterns in people with Parkinson’s disease. Behav Brain Res 2016; 307:159-64. [DOI: 10.1016/j.bbr.2016.04.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 03/09/2016] [Accepted: 04/05/2016] [Indexed: 11/20/2022]
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Van Ombergen A, Lubeck AJ, Van Rompaey V, Maes LK, Stins JF, Van de Heyning PH, Wuyts FL, Bos JE. The Effect of Optokinetic Stimulation on Perceptual and Postural Symptoms in Visual Vestibular Mismatch Patients. PLoS One 2016; 11:e0154528. [PMID: 27128970 PMCID: PMC4851359 DOI: 10.1371/journal.pone.0154528] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 04/14/2016] [Indexed: 11/23/2022] Open
Abstract
Background Vestibular patients occasionally report aggravation or triggering of their symptoms by visual stimuli, which is called visual vestibular mismatch (VVM). These patients therefore experience discomfort, disorientation, dizziness and postural unsteadiness. Objective Firstly, we aimed to get a better insight in the underlying mechanism of VVM by examining perceptual and postural symptoms. Secondly, we wanted to investigate whether roll-motion is a necessary trait to evoke these symptoms or whether a complex but stationary visual pattern equally provokes them. Methods Nine VVM patients and healthy matched control group were examined by exposing both groups to a stationary stimulus as well as an optokinetic stimulus rotating around the naso-occipital axis for a prolonged period of time. Subjective visual vertical (SVV) measurements, posturography and relevant questionnaires were assessed. Results No significant differences between both groups were found for SVV measurements. Patients always swayed more and reported more symptoms than healthy controls. Prolonged exposure to roll-motion caused in patients and controls an increase in postural sway and symptoms. However, only VVM patients reported significantly more symptoms after prolonged exposure to the optokinetic stimulus compared to scores after exposure to a stationary stimulus. Conclusions VVM patients differ from healthy controls in postural and subjective symptoms and motion is a crucial factor in provoking these symptoms. A possible explanation could be a central visual-vestibular integration deficit, which has implications for diagnostics and clinical rehabilitation purposes. Future research should focus on the underlying central mechanism of VVM and the effectiveness of optokinetic stimulation in resolving it.
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Affiliation(s)
- Angelique Van Ombergen
- Antwerp University Research centre for Equilibrium and Aerospace (AUREA), University of Antwerp, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- * E-mail:
| | - Astrid J. Lubeck
- Research Institute MOVE, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, Netherlands
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology, Antwerp University Hospital, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Leen K. Maes
- Antwerp University Research centre for Equilibrium and Aerospace (AUREA), University of Antwerp, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium
| | - John F. Stins
- Research Institute MOVE, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, Netherlands
| | - Paul H. Van de Heyning
- Antwerp University Research centre for Equilibrium and Aerospace (AUREA), University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology, Antwerp University Hospital, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Floris L. Wuyts
- Antwerp University Research centre for Equilibrium and Aerospace (AUREA), University of Antwerp, Antwerp, Belgium
| | - Jelte E. Bos
- Research Institute MOVE, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, Netherlands
- TNO Perceptual and Cognitive Systems, Soesterberg, The Netherlands
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Hallford DJ, Nicholson G, Sanders K, McCabe MP. The Association Between Anxiety and Falls: A Meta-Analysis. J Gerontol B Psychol Sci Soc Sci 2016; 72:729-741. [DOI: 10.1093/geronb/gbv160] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 12/17/2015] [Indexed: 11/12/2022] Open
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Abstract
Functional and psychiatric disorders that cause vestibular symptoms (i.e., vertigo, unsteadiness, and dizziness) are common. In fact, they are more common than many well-known structural vestibular disorders. Neurologists and otologists are more likely to encounter patients with vestibular symptoms due to persistent postural-perceptual dizziness or panic disorder than Ménière's disease or bilateral vestibular loss. Successful approaches to identifying functional and psychiatric causes of vestibular symptoms can be incorporated into existing practices without much difficulty. The greatest challenge is to set aside dichotomous thinking that strongly emphasizes investigations of structural diseases in favor of a three-pronged approach that assesses structural, functional, and psychiatric disorders simultaneously. The pathophysiologic mechanisms underlying functional and psychiatric causes of vestibular symptoms are better understood than many clinicians realize. Research methods such as advanced posturographic analysis and functional brain imaging will push this knowledge further in the next few years. Treatment plans that include patient education, vestibular rehabilitation, cognitive and behavioral therapies, and medications substantially reduce morbidity and offer the potential for sustained remission when applied systematically. Diagnostic and therapeutic approaches are necessarily multidisciplinary in nature, but they are well within the purview of collaborative care teams or networks of clinicians coordinated with the neurologists and otologists whom patients consult first.
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Affiliation(s)
- M Dieterich
- Department of Neurology, Ludwig-Maximilians-University Munich, Klinikum Grosshadern, Munich, Germany; German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University Munich, Klinikum Grosshadern, Munich, Germany.
| | - J P Staab
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - T Brandt
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University Munich, Klinikum Grosshadern, Munich, Germany
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Indovina I, Riccelli R, Chiarella G, Petrolo C, Augimeri A, Giofrè L, Lacquaniti F, Staab JP, Passamonti L. Role of the Insula and Vestibular System in Patients with Chronic Subjective Dizziness: An fMRI Study Using Sound-Evoked Vestibular Stimulation. Front Behav Neurosci 2015; 9:334. [PMID: 26696853 PMCID: PMC4673311 DOI: 10.3389/fnbeh.2015.00334] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 11/19/2015] [Indexed: 11/16/2022] Open
Abstract
Chronic subjective dizziness (CSD) is a common vestibular disorder characterized by persistent non-vertiginous dizziness, unsteadiness, and heightened sensitivity to motion stimuli that may last for months to years after events that cause acute vestibular symptoms or disrupt balance. CSD is not associated with abnormalities of basic vestibular or oculomotor reflexes. Rather, it is thought to arise from persistent use of high-threat postural control strategies and greater reliance on visual cues for spatial orientation (i.e., visual dependence), long after triggering events resolve. Anxiety-related personality traits confer vulnerability to CSD. Anomalous interactions between the central vestibular system and neural structures related to anxiety may sustain it. Vestibular- and anxiety-related processes overlap in the brain, particularly in the insula and hippocampus. Alterations in activity and connectivity in these brain regions in response to vestibular stimuli may be the neural basis of CSD. We examined this hypothesis by comparing brain activity from 18 patients with CSD and 18 healthy controls measured by functional magnetic resonance imaging during loud short tone bursts, which are auditory stimuli that evoke robust vestibular responses. Relative to controls, patients with CSD showed reduced activations to sound-evoked vestibular stimulation in the parieto-insular vestibular cortex (PIVC) including the posterior insula, and in the anterior insula, inferior frontal gyrus, hippocampus, and anterior cingulate cortex. Patients with CSD also showed altered connectivity between the anterior insula and PIVC, anterior insula and middle occipital cortex, hippocampus and PIVC, and anterior cingulate cortex and PIVC. We conclude that reduced activation in PIVC, hippocampus, anterior insula, inferior frontal gyrus, and anterior cingulate cortex, as well as connectivity changes among these regions, may be linked to long-term vestibular symptoms in patients with CSD. Furthermore, altered connectivity between the anterior insula and middle occipital cortex may underlie the greater reliance on visual cues for spatial orientation in CSD patients relative to controls.
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Affiliation(s)
- Iole Indovina
- Centre of Space BioMedicine, University of Rome Tor VergataRome, Italy
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia FoundationRome, Italy
- *Correspondence: Iole Indovina
| | - Roberta Riccelli
- Department of Medical and Surgical Sciences, University “Magna Graecia,”Catanzaro, Italy
| | - Giuseppe Chiarella
- Department of Experimental and Clinical Medicine, University “Magna Graecia,”Catanzaro, Italy
| | - Claudio Petrolo
- Department of Experimental and Clinical Medicine, University “Magna Graecia,”Catanzaro, Italy
| | - Antonio Augimeri
- Department of Medical and Surgical Sciences, University “Magna Graecia,”Catanzaro, Italy
| | - Laura Giofrè
- Department of Medical and Surgical Sciences, University “Magna Graecia,”Catanzaro, Italy
| | - Francesco Lacquaniti
- Centre of Space BioMedicine, University of Rome Tor VergataRome, Italy
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia FoundationRome, Italy
- Department of Systems Medicine, University of Rome Tor VergataRome, Italy
| | - Jeffrey P. Staab
- Department of Psychiatry and Psychology, Mayo ClinicRochester, MN, USA
| | - Luca Passamonti
- Institute of Bioimaging and Molecular Physiology, National Research CouncilCatanzaro, Italy
- Department of Clinical Neurosciences, University of CambridgeCambridge, UK
- Luca Passamonti
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Brandt T, Kugler G, Schniepp R, Wuehr M, Huppert D. Acrophobia impairs visual exploration and balance during standing and walking. Ann N Y Acad Sci 2015; 1343:37-48. [DOI: 10.1111/nyas.12692] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Thomas Brandt
- German Center for Vertigo and Balance Disorders; Ludwig-Maximilians-University of Munich; Munich Germany
| | - Günter Kugler
- German Center for Vertigo and Balance Disorders; Ludwig-Maximilians-University of Munich; Munich Germany
| | - Roman Schniepp
- German Center for Vertigo and Balance Disorders; Ludwig-Maximilians-University of Munich; Munich Germany
- Department of Neurology; Ludwig-Maximilians-University of Munich; Munich Germany
| | - Max Wuehr
- German Center for Vertigo and Balance Disorders; Ludwig-Maximilians-University of Munich; Munich Germany
| | - Doreen Huppert
- German Center for Vertigo and Balance Disorders; Ludwig-Maximilians-University of Munich; Munich Germany
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Young WR, Mark Williams A. How fear of falling can increase fall-risk in older adults: applying psychological theory to practical observations. Gait Posture 2015; 41:7-12. [PMID: 25278464 DOI: 10.1016/j.gaitpost.2014.09.006] [Citation(s) in RCA: 205] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 08/19/2014] [Accepted: 09/13/2014] [Indexed: 02/02/2023]
Abstract
It is widely reported that fear of falling (FOF) has a profound and largely detrimental effect on balance performance in older adults. However, the mechanisms by which FOF influence postural stability are poorly understood. In the current article, we use psychological theory to explain FOF-related changes to postural control. First, we review literature describing associations between FOF and the 'stiffening' strategies observed during control of posture, including observations of eye and head movements. Second, we present a framework illustrating the interactions between increased age, FOF, and altered attentional processes, which in turn influence balance performance and fall-risk. Psychological theory predicts that anxiety can cause attentional bias for threatening and task-irrelevant stimuli and compromise the efficiency of working memory resources. We argue that while the adoption of stiffening strategies is likely to be beneficial in avoiding a loss of balance during simple postural tasks, it will ultimately compromise performance in dynamic and highly demanding functional tasks. The adoption of stiffening strategies leads to inadequate acquisition of the sensory information necessary to plan and execute dynamic and interactive movements. We conclude with some suggestions for future research.
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Affiliation(s)
- William R Young
- Centre for Sports Medicine and Human Performance, Brunel University, UB83PH, UK.
| | - A Mark Williams
- Centre for Sports Medicine and Human Performance, Brunel University, UB83PH, UK
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Personality traits modulate subcortical and cortical vestibular and anxiety responses to sound-evoked otolithic receptor stimulation. J Psychosom Res 2014; 77:391-400. [PMID: 25262497 DOI: 10.1016/j.jpsychores.2014.09.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 07/31/2014] [Accepted: 09/05/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Strong links between anxiety, space-motion perception, and vestibular symptoms have been recognized for decades. These connections may extend to anxiety-related personality traits. Psychophysical studies showed that high trait anxiety affected postural control and visual scanning strategies under stress. Neuroticism and introversion were identified as risk factors for chronic subjective dizziness (CSD), a common psychosomatic syndrome. This study examined possible relationships between personality traits and activity in brain vestibular networks for the first time using functional magnetic resonance imaging (fMRI). METHODS Twenty-six right-handed healthy individuals underwent fMRI during sound-evoked vestibular stimulation. Regional brain activity and functional connectivity measures were correlated with personality traits of the Five Factor Model (neuroticism, extraversion-introversion, openness, agreeableness, consciousness). RESULTS Neuroticism correlated positively with activity in the pons, vestibulo-cerebellum, and para-striate cortex, and negatively with activity in the supra-marginal gyrus. Neuroticism also correlated positively with connectivity between pons and amygdala, vestibulo-cerebellum and amygdala, inferior frontal gyrus and supra-marginal gyrus, and inferior frontal gyrus and para-striate cortex. Introversion correlated positively with amygdala activity and negatively with connectivity between amygdala and inferior frontal gyrus. CONCLUSIONS Neuroticism and introversion correlated with activity and connectivity in cortical and subcortical vestibular, visual, and anxiety systems during vestibular stimulation. These personality-related changes in brain activity may represent neural correlates of threat sensitivity in posture and gaze control mechanisms in normal individuals. They also may reflect risk factors for anxiety-related morbidity in patients with vestibular disorders, including previously observed associations of neuroticism and introversion with CSD.
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Bittar RSM, Lins EMDVS. Clinical characteristics of patients with persistent postural-perceptual dizziness. Braz J Otorhinolaryngol 2014; 81:276-82. [PMID: 25382427 PMCID: PMC9452260 DOI: 10.1016/j.bjorl.2014.08.012] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 05/24/2014] [Indexed: 12/30/2022] Open
Abstract
Introduction Persistent postural-perceptual dizziness is the dizziness that lasts for over three months with no clinical explanation for its persistence. The patient's motor response pattern presents changes and most patients manifest significant anxiety. Objective To evaluate the clinical characteristics of patients with persistent postural and perceptual dizziness. Methods statistical analysis of clinical aspects of patients with persistent postural-perceptual dizziness. Results 81 patients, average age: 50.06 ± 12.16 years; female/male ratio: 5.7/1; main reasons for dizziness: visual stimuli (74%), body movements (52%), and sleep deprivation (38%). The most prevalent comorbidities were hypercholesterolemia (31%), migraine headaches (26%), carbohydrate metabolism disorders (22%) and cervical syndrome (21%). DHI, State-Trait Anxiety Inventory – Trait, Beck Depression Inventory, and Hospital Anxiety and Depression Scale questionnaires were statistically different (p < 0.05) when compared to controls. 68% demonstrated clinical improvement after treatment with serotonin reuptake inhibitors. Conclusion Persistent postural-perceptual dizziness affects more women than men, with a high associated prevalence of metabolic disorders and migraine. Questionnaires help to identify the predisposition to persistent postural-perceptual dizziness. The prognosis is good with adequate treatment.
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Affiliation(s)
- Roseli Saraiva Moreira Bittar
- Division of Otoneurology, Hospital das Clínicas, Medical School, Universidade de São Paulo (USP), Cerqueira César, São Paulo, SP, Brazil
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Visual exploration during locomotion limited by fear of heights. PLoS One 2014; 9:e105906. [PMID: 25165822 PMCID: PMC4148313 DOI: 10.1371/journal.pone.0105906] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 07/28/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Visual exploration of the surroundings during locomotion at heights has not yet been investigated in subjects suffering from fear of heights. METHODS Eye and head movements were recorded separately in 16 subjects susceptible to fear of heights and in 16 non-susceptible controls while walking on an emergency escape balcony 20 meters above ground level. Participants wore mobile infrared eye-tracking goggles with a head-fixed scene camera and integrated 6-degrees-of-freedom inertial sensors for recording head movements. Video recordings of the subjects were simultaneously made to correlate gaze and gait behavior. RESULTS Susceptibles exhibited a limited visual exploration of the surroundings, particularly the depth. Head movements were significantly reduced in all three planes (yaw, pitch, and roll) with less vertical head oscillations, whereas total eye movements (saccade amplitudes, frequencies, fixation durations) did not differ from those of controls. However, there was an anisotropy, with a preference for the vertical as opposed to the horizontal direction of saccades. Comparison of eye and head movement histograms and the resulting gaze-in-space revealed a smaller total area of visual exploration, which was mainly directed straight ahead and covered vertically an area from the horizon to the ground in front of the feet. This gaze behavior was associated with a slow, cautious gait. CONCLUSIONS The visual exploration of the surroundings by susceptibles to fear of heights differs during locomotion at heights from the earlier investigated behavior of standing still and looking from a balcony. During locomotion, anisotropy of gaze-in-space shows a preference for the vertical as opposed to the horizontal direction during stance. Avoiding looking into the abyss may reduce anxiety in both conditions; exploration of the "vertical strip" in the heading direction is beneficial for visual control of balance and avoidance of obstacles during locomotion.
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