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Meldrum D, Kearney H, Hutchinson S, McCarthy S, Quinn G. Wearable sensor and smartphone assisted vestibular physical therapy for multiple sclerosis: usability and outcomes. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1406926. [PMID: 39050817 PMCID: PMC11267627 DOI: 10.3389/fresc.2024.1406926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/05/2024] [Indexed: 07/27/2024]
Abstract
Introduction Vertigo, dizziness, gaze instability and disequilibrium are highly prevalent in people with MS (PwMS) and head movement induced dizziness is commonly reported. Vestibular physical therapy (VPT) is a specialised, non-invasive and effective therapy for these problems but usually involves travel for the person to a specialist center with both personal and carbon costs. The use of wearable sensors to track head movement and smartphone applications to deliver and track programs has potential to improve VPT in MS. Methods This study investigated the usability and effects of a commercially available digital VPT system (wearable head sensor, smartphone app and clinician software) to deliver VPT to PwMS. A pre/post treatment design was employed and the primary outcome was the System Usability Scale (SUS). Other patient reported outcomes were the Service User Acceptability Questionnaire (SUTAQ), the Patient Enablement Instrument (PEI) and the Dizziness Handicap Inventory (DHI). Physical outcomes measurements included Mini-BESTest (MB), Modified Dynamic Gait Index (mDGI), Gait Speed (GS), Dynamic Visual Acuity (DVA) and head kinematics and symptoms during exercise. Results Sixteen PwMS (14 female), mean age 44(±14) years were recruited to the study and twelve completed VPT. Mean adherence to exercise, measured digitally was 60% (±18.4). SUS scores were high at 81 (±14) and SUTAQ scores also demonstrated high levels of satisfaction and acceptability of the system. Statistically significant improvements in MB (mean change 2.25; p = 0.004), mDGI (median change 1.00; p = 0.008), DVA (median change -1.00; p = 0.004) were found. Head frequencies significantly improved with concurrent decreased intensity of dizziness during head movements (mean change across 4 gaze stabilization exercises was 23 beats per minute; p < 0.05). Non-significant improvements were seen in DHI (p = 0.07) and GS (p = 0.15). 64.5% of follow up visits were conducted remotely (video or phone), facilitated by the system. Discussion This study had two main outcomes and benefits for PwMS. Firstly, we showed that the system used was both acceptable and could be used by PwMS. Secondly, we demonstrated an improvement in a range of dizziness, balance and gait metrics with remotely delivered care. This system has the potential to positively impact on MS physiotherapy service provision with the potential to deliver effective remote care.
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Affiliation(s)
- D. Meldrum
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - H. Kearney
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- MS Unit, Department of Neurology, St. James’s Hospital, Dublin, Ireland
| | - S. Hutchinson
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- MS Unit, Department of Neurology, St. James’s Hospital, Dublin, Ireland
| | - S. McCarthy
- Physiotherapy Department, St. James’s Hospital, Dublin, Ireland
| | - G. Quinn
- Physiotherapy Department, St. James’s Hospital, Dublin, Ireland
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Grove CR, Loyd BJ, Dibble LE, Schubert MC. Evidence for the differential efficacy of yaw and pitch gaze stabilization mechanisms in people with multiple sclerosis. Exp Brain Res 2024; 242:1797-1806. [PMID: 38839617 DOI: 10.1007/s00221-024-06864-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/24/2024] [Indexed: 06/07/2024]
Abstract
People with multiple sclerosis (PwMS) who report dizziness often have gaze instability due to vestibulo-ocular reflex (VOR) deficiencies and compensatory saccade (CS) abnormalities. Herein, we aimed to describe and compare the gaze stabilization mechanisms for yaw and pitch head movements in PwMS. Thirty-seven PwMS (27 female, mean ± SD age = 53.4 ± 12.4 years old, median [IQR] Expanded Disability Status Scale Score = 3.5, [1.0]. We analyzed video head impulse test results for VOR gain, CS frequency, CS latency, gaze position error (GPE) at impulse end, and GPE at 400 ms after impulse start. Discrepancies were found for median [IQR] VOR gain in yaw (0.92 [0.14]) versus pitch-up (0.71 [0.44], p < 0.001) and pitch-down (0.81 [0.44], p = 0.014]), CS latency in yaw (258.13 [76.8]) ms versus pitch-up (208.78 [65.97]) ms, p = 0.001] and pitch-down (132.17 [97.56] ms, p = 0.006), GPE at impulse end in yaw (1.15 [1.85] degs versus pitch-up (2.71 [3.9] degs, p < 0.001), and GPE at 400 ms in yaw (-0.25 [0.98] degs) versus pitch-up (1.53 [1.07] degs, p < 0.001) and pitch-down (1.12 [1.82] degs, p = 0.001). Compared with yaw (0.91 [0.75]), CS frequency was similar for pitch-up (1.03 [0.93], p = 0.999) but lower for pitch-down (0.65 [0.64], p = 0.023). GPE at 400 ms was similar for yaw and pitch-down (1.88 [2.76] degs, p = 0.400). We postulate that MS may have preferentially damaged the vertical VOR and saccade pathways in this cohort.
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Affiliation(s)
- Colin R Grove
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
- Division of Physical Therapy, Department of Rehabilitation Medicine, School of Medicine, Emory University, Atlanta, GA, USA.
- Applied Vestibular Physiology Laboratory, Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, 1441 Clifton Road, NE, Atlanta, GA, 30322, USA.
| | - Brian J Loyd
- School of Physical Therapy and Rehabilitation Sciences, College of Health, University of Montana, Missoula, MT, USA
- School of Integrative Physiology and Athletic Training, College of Health, University of Montana, Missoula, MT, USA
| | - Leland E Dibble
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Michael C Schubert
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Kirazli G, Emekci T, Inceoglu F, Pistav Akmese P, Celebisoy N. An evaluation of the test-retest reliability of the functional head impulse test in healthy young adults. Eur Arch Otorhinolaryngol 2023; 280:5339-5343. [PMID: 37341762 DOI: 10.1007/s00405-023-08063-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/09/2023] [Indexed: 06/22/2023]
Abstract
AIM To determine the test and retest reliability of the functional head impulse test (fHIT) in healthy young adults. MATERIALS AND METHODS Thirty-three healthy participants (17 women, 16 men) aged 18-30 years were included in the study. Each participant underwent the fHIT twice, 1 week apart, by the same experienced clinician. Intraclass correlation coefficients (ICCs) were used to determine test-retest reliability. RESULTS There was no statistically significant difference between the results of total percentage of correct answer (CA%) of the fHIT obtained in session 1 and session 2 measurements in the lateral, anterior, and posterior semicircular canals (SCCs) (p > 0.05). ICC values for test-retest reliability were found to range from 0.619 to 0.665 for the three semicircular canals (SCCs). CONCLUSION The test-retest reliability of the fHIT device was moderate. Attention, cognition, and fatigue may be the factors reducing reliability. In the diagnosis, follow-up, and rehabilitation processes of vestibular diseases in clinics, changes in the fHIT CA% can be used to assess vestibulo-ocular reflex (VOR) functionality.
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Affiliation(s)
- Gulce Kirazli
- Department of Audiology, Faculty of Health Sciences, Ege University, Izmir, Turkey
| | - Tugba Emekci
- Department of Audiology, Faculty of Health Sciences, Gülhane University of Health Sciences, Ankara, Turkey
| | - Feyza Inceoglu
- Department of Biostatistics, Faculty of Medicine, Malatya Turgut Ozal University, Malatya, Turkey
| | - Pelin Pistav Akmese
- Department of Audiology, Faculty of Health Sciences, Ege University, Izmir, Turkey.
| | - Nese Celebisoy
- Department of Neurology, Faculty of Medicine, Ege University, Izmir, Turkey
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Chen G, Zhang J, Qiao Q, Zhou L, Li Y, Yang J, Wu J, Huangfu H. Advances in dynamic visual acuity test research. Front Neurol 2023; 13:1047876. [PMID: 37426939 PMCID: PMC10328420 DOI: 10.3389/fneur.2022.1047876] [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: 09/19/2022] [Accepted: 10/17/2022] [Indexed: 07/11/2023] Open
Abstract
The dynamic visual acuity test (DVAT) is a functional evaluation tool for the impairment and compensation of the vestibular system, which could reflect the Vestibulo-ocular reflex (VOR) function. We present an overview of DVAT research, displaying recent advances in test methods, application, and influencing factors; and discussing the clinical value of DVAT to provide a reference for clinical application. There are two primary types of DVAT: dynamic-object DVAT and static-object DVAT. For the latter, in addition to the traditional bedside DVAT, there are numerous other approaches, including Computerized DVAT (cDVAT), DVAT on a treadmill, DVAT on a rotary, head thrust DVA (htDVA) and functional head impulse testing (fHIT), gaze shift dynamic visual acuity with walking (gsDVA), translational dynamic visual acuity test (tDVAT), pediatric DVAT. The results of DAVT are affected by subject [occupation, static visual acuity (SVA), age, eyeglass lenses], testing methods, caffeine, and alcohol. DVAT has numerous clinical applications, such as screening for vestibular impairment, assessing vestibular rehabilitation, predicting fall risk, and evaluating ophthalmology-related disorders, vestibular disorders, and central system disorders.
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Affiliation(s)
- Ganggang Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Jin Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Qi Qiao
- Department of Otorhinolaryngology-Head and Neck Surgery, Xijing Hospital of Air Force Military Medical University, Xi'an, China
| | - Liyuan Zhou
- Department of Otorhinolaryngology-Head and Neck Surgery, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Ying Li
- Department of Otorhinolaryngology-Head and Neck Surgery, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Jie Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Jiaxin Wu
- Department of Otorhinolaryngology-Head and Neck Surgery, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Hui Huangfu
- Department of Otorhinolaryngology-Head and Neck Surgery, First Hospital of Shanxi Medical University, Taiyuan, China
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Grove CR, Wagner A, Yang VB, Loyd BJ, Dibble LE, Schubert MC. Greater Disability Is Associated with Worse Vestibular and Compensatory Oculomotor Functions in People Living with Multiple Sclerosis. Brain Sci 2022; 12:1519. [PMID: 36358444 PMCID: PMC9688247 DOI: 10.3390/brainsci12111519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/01/2022] [Accepted: 11/06/2022] [Indexed: 08/15/2023] Open
Abstract
Globally, there are nearly three million people living with multiple sclerosis (PLW-MS). Many PLW-MS experience vertigo and have signs of vestibular dysfunction, e.g., low vestibulo-ocular reflex (VOR) gains or the presence of compensatory saccades (CSs), on video head impulse testing (vHIT). We examined whether the vestibular function and compensatory oculomotor behaviors in PLW-MS differed based on the level of MS-related disability. The VOR gain, CS frequency and latency, and gaze position error (GPE) were calculated from the individual traces obtained during six-canal vHIT for 37 PLW-MS (mean age 53.4 ± 12.4 years-old, 28 females) with vertigo and/or an imbalance. The subjects were grouped by their Expanded Disability Status Scale (EDSS) scores: PLW-min-MS (EDSS = 1.0-2.5, n = 8), PLW-mild-MS (EDSS = 3.0-4.5, n = 23), and PLW-moderate-MS (EDSS = 5.0-6.0, n = 6). The between-group differences were assessed with Kruskal-Wallis tests. The VOR gains for most of the canals were higher for PLW-min-MS compared to PLW-mild- and mod-MS, respectively. CS occurred less often in PLW-min-MS versus PLW-mild- and mod-MS, respectively. No clear trend in CS latency was found. The GPE was often lower for PLW-min-MS compared to PLW-mild- and mod-MS, respectively. Thus, our data demonstrate that worse VOR and compensatory oculomotor functions are associated with a greater MS-related disability. PLW-MS may benefit from personalized vestibular physical therapy.
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Affiliation(s)
- Colin R. Grove
- Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Andrew Wagner
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, OH 43212, USA
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH 43212, USA
| | - Victor B. Yang
- School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Brian J. Loyd
- School of Physical Therapy and Rehabilitation Sciences, University of Montana, Missoula, MT 59812, USA
| | - Leland E. Dibble
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT 84108, USA
| | - Michael C. Schubert
- Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD 21287, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD 21287, USA
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Loyd BJ, Fangman A, Peterson DS, Gappmaier E, Thackeray A, Schubert MC, Dibble LE. Rehabilitation to Improve Gaze and Postural Stability in People With Multiple Sclerosis: A Randomized Clinical Trial. Neurorehabil Neural Repair 2022; 36:678-688. [PMID: 36113117 PMCID: PMC10518217 DOI: 10.1177/15459683221124126] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND People with multiple sclerosis (PwMS) frequently experience dizziness and imbalance that may be caused by central vestibular system dysfunction. Vestibular rehabilitation may offer an approach for improving dysfunction in these people. OBJECTIVE To test the efficacy of a gaze and postural stability (GPS) retraining intervention compared to a strength and endurance (SAE) intervention in PwMS. METHODS About 41 PwMS, with complaints of dizziness or history of falls, were randomized to either the GPS or SAE groups. Following randomization participants completed 6-weeks of 3×/week progressive training, delivered one-on-one by a provider. Following intervention, testing was performed at the primary (6-weeks) and secondary time point (10-weeks). A restricted maximum likelihood estimation mixed effects model was used to examine changes in the primary outcome of the Dizziness Handicap Inventory (DHI) between the 2 groups at the primary and secondary time point. Similar models were used to explore secondary outcomes between groups at both timepoints. RESULTS Thirty-five people completed the study (17 GPS; 18 SAE). The change in the DHI at the primary time point was not statistically different between the GPS and SAE groups (mean difference = 2.33 [95% CI -9.18, 12.85]). However, both groups demonstrated significant improvement from baseline to 6-weeks (GPS -8.73; SAE -7.31). Similar results were observed for secondary outcomes and at the secondary timepoint. CONCLUSIONS In this sample of PwMS with complaints of dizziness or imbalance, 6-weeks of GPS training did not result in significantly greater improvements in dizziness handicap or balance compared to 6-weeks of SAE training.
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Affiliation(s)
- Brian J. Loyd
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, MT, USA
| | - Annie Fangman
- Department of Physical Therapy and Athletic Training, University of Utah College of Health, Salt Lake City, UT, USA
| | | | - Eduard Gappmaier
- Department of Physical Therapy and Athletic Training, University of Utah College of Health, Salt Lake City, UT, USA
| | - Anne Thackeray
- Department of Physical Therapy and Athletic Training, University of Utah College of Health, Salt Lake City, UT, USA
| | - Michael C. Schubert
- Department of Otolaryngology-Head and Neck Surgery, John Hopkins University School of Medicine, Baltimore, MD, USA
| | - Leland E. Dibble
- Department of Physical Therapy and Athletic Training, University of Utah College of Health, Salt Lake City, UT, USA
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Wagner AR, Grove CR, Loyd BJ, Dibble LE, Schubert MC. Compensatory saccades differ between those with vestibular hypofunction and multiple sclerosis pointing to unique roles for peripheral and central vestibular inputs. J Neurophysiol 2022; 128:934-945. [PMID: 36069428 PMCID: PMC9550564 DOI: 10.1152/jn.00220.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/22/2022] [Accepted: 09/03/2022] [Indexed: 11/22/2022] Open
Abstract
Individuals with peripheral or central vestibular dysfunction recruit compensatory saccades (CSs) in response to high acceleration, yaw head impulses. Although CSs have been shown to be an effective strategy for reducing gaze position error (GPE) in individuals with peripheral hypofunction, for individuals with central vestibular dysfunction, the effectiveness of CS is unknown. The purpose of our study was to compare the effectiveness of CS, defined as the ability to compensate for head velocity and eye position errors, between persons with central and peripheral vestibular dysfunction. We compared oculomotor responses during video head impulse testing between individuals with unilateral peripheral vestibular deafferentation, a disorder of the peripheral vestibular afferents, and individuals with multiple sclerosis, a condition affecting the central vestibular pathways. We hypothesized that relative to individuals with peripheral lesions, individuals with central dysfunction would recruit CSs that were delayed and inappropriately scaled to head velocity and GPE. We show that CSs recruited by persons with central vestibular pathology were not uniformly deficient but instead were of a sufficient velocity to compensate for reductions in VOR gain. Compared to those with peripheral vestibular lesions, individuals with central pathology also recruited earlier covert CS with amplitudes that were better corrected for GPE. Conversely, those with central lesions showed greater variability in the amplitude of overt CS relative to GPE. These data point to a unique role for peripheral and central vestibular inputs in the recruitment of CS and suggest that covert CSs are an effective oculomotor strategy for individuals with multiple sclerosis.NEW & NOTEWORTHY Compensatory saccades (CSs) are recruited by individuals with unilateral vestibular deafferentation (UVD) to compensate for an impaired vestibulo-ocular reflex (VOR). The effectiveness of CS in multiple sclerosis (MS), a central vestibular impairment, is unknown. We show that in UVD and in MS, covert CSs compensate for reduced VOR gain and minimize gaze position error (GPE), yet in >50% of individuals with MS, overt CS worsened GPE, suggesting unique roles for peripheral and central vestibular inputs.
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Affiliation(s)
- Andrew R Wagner
- Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio
| | - Colin R Grove
- Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Brian J Loyd
- School of Physical Therapy and Rehabilitation Sciences, University of Montana, Missoula, Montana
| | - Leland E Dibble
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah
| | - Michael C Schubert
- Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
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Characterizing gaze and postural stability deficits in people with multiple sclerosis. Mult Scler Relat Disord 2021; 55:103205. [PMID: 34438218 DOI: 10.1016/j.msard.2021.103205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/28/2021] [Accepted: 08/06/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND People with Multiple Sclerosis (PwMS) experience a wide range of symptoms that can alter function and limit activity and community participation. Symptoms including sensory changes, weakness, fatigue and others have been well documented. However, symptoms related to changes in vestibular related function, including gaze and postural stability have not been fully explored. While some recent studies have begun to provide insight into these deficits in PwMS and have explored the use of rehabilitation paradigms for their management, much remains unknown about the full extent of these deficits. Therefore, this study aimed to characterize the presence of gaze and postural stability deficits in measures across the World Health Organization International Classification of Functioning, Disability, and Health (WHO ICF) and to examine how deficits in domains of body structure and function and activity contribute to participation level limitations. METHODS Baseline data from 41 PwMS (mean(SD) age = 53.9(11.2), 78% female) enrolled as part of a randomized clinical trial were used in this analysis. Measures of gaze and postural stability from the ICF domains of body structure and function (Vestibular ocular reflex [VOR] gain and postural sway area), activity (computerized dynamic visual acuity [cDVA] and MiniBEST test), and participation (Dizziness handicap inventory [DHI] and Activities Balance Confidence [ABC] scale) along with demographic data were used to characterize the sample. To explore relationships between ICF domains for gaze and postural stability, univariate correlations were performed between measures from each domain using Pearson's correlations. Separate multivariate regression models examined how measures from the body structure and function and activity domains contributed to the variance in the participation level outcomes. Variance explained by the models was quantified using R-squared statistic and contribution of the independent variables were quantified using the beta coefficient (p < 0.05). RESULTS Correlation analysis demonstrated significant relationships in the postural stability measures across domains. Specifically, between postural sway area on a firm surface and MiniBEST test score (r = -.48;p < 0.01) and MiniBEST test score and ABC score (r = 0.5;p < 0.01). Significant correlations were also found between the gaze stability measures of horizontal and vertical VOR gain (r = .68;p < 0.001), horizontal VOR gain and dynamic visual acuity (r = .38;p = 0.02), and vertical VOR gain and dynamic visual acuity (r = .54;p < 0.001). Regression models assessing postural stability, found that only the MiniBEST score significantly contributed to the variance in ABC score (p = 0.01) and the full model explained 34% of the variance in ABC score. Regression modeling of gaze stability outcomes did not produce any variable that significantly contributed to the variance in DHI score and the full model explained 18% of the variance in DHI score. CONCLUSIONS PwMS in this sample demonstrated deficits in gaze and postural stability across the domains of the WHO ICF compared to past samples of PwMS and healthy cohorts. Correlation between measures in the different domains were present, but no strong relationship between measures of body structure and function, activity and participation level outcomes were observed. This lack of relationship across the domains is likely contributed to the relatively small sample size, the high level of variability observed in the outcomes, and the diverse presentation often seen in PwMS.
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Dankova M, Jerabek J, Jester DJ, Zumrova A, Paulasova Schwabova J, Cerny R, Kmetonyova S, Vyhnalek M. Clinical dynamic visual acuity in patients with cerebellar ataxia and vestibulopathy. PLoS One 2021; 16:e0255299. [PMID: 34324564 PMCID: PMC8320895 DOI: 10.1371/journal.pone.0255299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 07/13/2021] [Indexed: 11/18/2022] Open
Abstract
Deterioration of dynamic visual acuity (DVA) as a result of impaired vestibulo-ocular reflex (VOR) has been well described in peripheral vestibulopathies, however, changes in DVA in patients with degenerative cerebellar ataxias (CA) and its relation to VOR impairment in these patients has not yet been evaluated. Our aim was to assess the alterations of DVA in CA and to evaluate its relation to vestibular function. 32 patients with CA and 3 control groups: 13 patients with unilateral and 13 with bilateral vestibulopathy and 21 age matched healthy volunteers were examined by clinical DVA test, VOR was assessed by video Head Impulse Test and caloric irrigation. The severity of ataxia in CA was assessed by Scale for the assessment and rating of ataxia (SARA). Relationship between DVA and vestibular function in CA patients was examined by linear regressions. DVA impairment was highly prevalent in CA patients (84%) and its severity did not differ between CA and bilateral vestibulopathy patients. The severity of DVA impairment in CA was linked mainly to VOR impairment and only marginally to the degree of ataxia. However, DVA impairment was present also in CA patients without significant vestibular lesion showing that central mechanisms such as impairment of central adaptation of VOR are involved. We suggest that the evaluation of DVA should be a standard part of clinical evaluation in patients with progressive CA, as this information can help to target vestibular and oculomotor rehabilitation.
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Affiliation(s)
- Michaela Dankova
- Department of Neurology, Centre of Hereditary Ataxias, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Jaroslav Jerabek
- Department of Neurology, Centre of Hereditary Ataxias, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Dylan J. Jester
- School of Aging Studies, University of South Florida, Tampa, FL, United States of America
| | - Alena Zumrova
- Department of Paediatric Neurology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Jaroslava Paulasova Schwabova
- Department of Neurology, Centre of Hereditary Ataxias, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Rudolf Cerny
- Department of Neurology, Centre of Hereditary Ataxias, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Silvia Kmetonyova
- Department of Neurology, Centre of Hereditary Ataxias, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Martin Vyhnalek
- Department of Neurology, Centre of Hereditary Ataxias, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
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10
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Cochrane GD, Christy JB, Motl RW. Comprehensive Clinical Assessment of Vestibular Function in Multiple Sclerosis. J Neurol Phys Ther 2021; 45:228-234. [PMID: 33867456 PMCID: PMC8187291 DOI: 10.1097/npt.0000000000000358] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Balance disorders and dizziness are common in people with multiple sclerosis (MS), suggesting dysfunction of the vestibular system. Evaluating how people with MS perform on objective clinical vestibular tools will help broaden understanding of vestibular function in MS. This cross-sectional study's goal was to complete a robust battery of vestibular-ocular reflex (VOR), dynamic visual acuity (DVA), subjective visual vertical (SVV), and cervical and ocular vestibular-evoked myogenic potential (c/oVEMP) tests in people with and without MS. METHODS Forty people with relapsing-remitting MS (Expanded Disability Status Scale [EDSS] ≤6.5) and 20 controls completed the vestibular testing battery. Results were compared between groups and correlations with EDSS scores were calculated. RESULTS People with MS were less able to visually cancel their VOR and showed a larger variance in response on SVV. EDSS significantly correlated with VOR cancellation, SVV variance, and DVA lines lost; linear regression showed that VOR cancellation and SVV variance significantly predicted EDSS. DISCUSSION AND CONCLUSION Vestibular functions requiring central integration of vestibular information, but not reflexive vestibular functions like VEMP, were impaired in people with MS and correlated with EDSS, suggesting that clinical evaluation of functions requiring central integration best evaluates MS-related vestibular dysfunction. Measures assessing central vestibular integration and not vestibular reflexes may be more sensitive to detecting vestibular deficits in people with mild to moderate MS.Video Abstract available for more insight from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A344).
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Affiliation(s)
- Graham D. Cochrane
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
- Medical Scientist Training Program, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jennifer B. Christy
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert W. Motl
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
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Heravian Shandiz J, Jafarzadeh S, Fathi H, Foroughipour M, Karimpour M. Vestibulo ocular reflex in multiple sclerosis patients without any optic neuritis. JOURNAL OF OPTOMETRY 2021; 14:282-286. [PMID: 32868242 PMCID: PMC8258128 DOI: 10.1016/j.optom.2020.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/02/2020] [Accepted: 07/06/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE To investigate vestibulo ocular reflex (VOR) in MS patients without any history of optic neuritis. METHODS 26 MS patients without any previous history of optic neuritis and 13 age- matched control subjects were included in this study. Their age ranged from 22 to 50 years old. We evaluated monocular visual evoked potential (VEP), monocular and binocular best corrected static and dynamic visual acuity, near and distance phoria and VOR gain. RESULTS Mean spherical equivalent (SE) was - 0.40 ± 0.93 D and - 0.04 ± 0.14 D for study and control group, respectively (P = 0.060). There was a significant difference in dynamic visual acuity (DVA) between two groups (P = 0.029). VOR gain was not significantly different in both groups through vHIT measurements (P = 0.338). Duration of MS had a mean of 78.38 ± 75.94 months (ranged from 6 to 336 months). We found no significant correlation between disease duration and VOR (Rho 0.277, P = 0.171) or DVA (Rho 0.782, P = 0.057). CONCLUSION Our study showed that although vHIT results decreased in MS patients, there was no significant differences between two groups.
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Affiliation(s)
- Javad Heravian Shandiz
- Refractive Errors Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sadegh Jafarzadeh
- Department of Audiology, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Habibeh Fathi
- Refractive Errors Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Foroughipour
- Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
| | - Maliheh Karimpour
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.
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12
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Cochrane GD, Christy JB, Kicker ET, Kailey RP, England BK. Inter-rater and test-retest reliability of computerized clinical vestibular tools. J Vestib Res 2021; 31:365-373. [PMID: 33646190 DOI: 10.3233/ves-201522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Clinical vestibular technology is rapidly evolving to improve objective assessments of vestibular function. Understanding the reliability and expected score ranges of emerging clinical vestibular tools is important to gauge how these tools should be used as clinical endpoints. OBJECTIVE The objective of this study was to evaluate inter-rater and test-retest reliability intraclass correlation coefficients (ICCs) of four vestibular tools and to determine expected ranges of scores through smallest real difference (SRD) measures. METHODS Sixty healthy graduate students completed two 1-hour sessions, at most a week apart, consisting of two video head-impulse tests (vHIT), computerized dynamic visual acuity (cDVA) tests, and a smartphone-assisted bucket test (SA-SVV). Thirty students were tested by different testers at each session (inter-rater) and 30 by the same tester (test-retest). ICCs and SRDs were calculated for both conditions. RESULTS Most measures fell within the moderate ICC range (0.50-0.75). ICCs were higher for cDVA in the inter-rater subgroup and higher for vHITs in the test-retest subgroup. CONCLUSIONS Measures from the four tools evaluated were moderately reliable. There may be a tester effect on reliabilities, specifically vHITs. Further research should repeat these analyses in a patient population and explore methodological differences between vHIT systems.
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Affiliation(s)
- Graham D Cochrane
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham AL, USA
| | - Jennifer B Christy
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham AL, USA
| | - Ethan T Kicker
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham AL, USA
| | - Ryan P Kailey
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham AL, USA
| | - Brandon K England
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham AL, USA
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13
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Gil-Casas A, Piñero Llorens DP, Molina-Martin A. Ocular fixation and macular integrity by microperimetry in multiple sclerosis. Graefes Arch Clin Exp Ophthalmol 2020; 259:157-164. [PMID: 32975682 DOI: 10.1007/s00417-020-04948-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/08/2020] [Accepted: 09/18/2020] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To characterize the fixation and macular integrity of subjects with multiple sclerosis (MS) with and without previous optic neuritis (ON) using microperimetry (MP). METHODS Fifty-five eyes of MS patients, subdivided into three groups (28 eyes without ON, 16 with previous ON, and 11 eyes with previous ON in the contralateral eye), and 43 healthy eyes were enrolled (January-November 2018). All cases were evaluated using the MAIA microperimeter (Centervue), analyzing the following parameters: average macular threshold (AT), fixation indexes (P1 and P2), bivariate contour ellipse area (BCEA) for 95% and 63% of points, and horizontal (H) and vertical (V) axes of the ellipse of fixation. RESULTS All MS groups showed a significant reduced AT compared with the control group (p < 0.001). This reduction was more representative (p < 0.001) in eyes with previous ON. No statistically significant differences were found between MS patients with and without previous ON (p > 0.05). Mean AT was correlated with the examination time in all three groups (between ρ = - 0.798 p < 0.001 and ρ = - 0.49 p < 0.001). Significant differences in fixation parameters were only found between control and MS with ON groups (p < 0.02). The ratio of the disease showed a significant correlation with fixation parameters in MS groups (p < 0.02), but not with AT. CONCLUSIONS In MS patients, macular sensitivity is altered, especially in eyes with previous ON. Likewise, a fixational instability is present in MS patients with ON, with more increase of the V axis of the fixation area than of the H. The ratio of the disease also affects the patient fixation pattern.
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Affiliation(s)
- Amparo Gil-Casas
- Clínica Optométrica - Foundation Lluís Alcanyís, University of Valencia, Valencia, Spain.,Optics and Visual Perception Group (GOPV). Department of Optics, Pharmacology and Anatomy, University of Alicante, Crta San Vicente del Raspeig s/n 03016. San Vicente del Raspeig, Alicante, Spain
| | - David P Piñero Llorens
- Optics and Visual Perception Group (GOPV). Department of Optics, Pharmacology and Anatomy, University of Alicante, Crta San Vicente del Raspeig s/n 03016. San Vicente del Raspeig, Alicante, Spain.
| | - Ainhoa Molina-Martin
- Optics and Visual Perception Group (GOPV). Department of Optics, Pharmacology and Anatomy, University of Alicante, Crta San Vicente del Raspeig s/n 03016. San Vicente del Raspeig, Alicante, Spain
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14
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Tramontano M, Martino Cinnera A, Manzari L, Tozzi FF, Caltagirone C, Morone G, Pompa A, Grasso MG. Vestibular rehabilitation has positive effects on balance, fatigue and activities of daily living in highly disabled multiple sclerosis people: A preliminary randomized controlled trial. Restor Neurol Neurosci 2019; 36:709-718. [PMID: 30412513 DOI: 10.3233/rnn-180850] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Balance disorders are present in patients with Multiple Sclerosis and part of these disorders could be of vestibular origin. Vestibular Rehabilitation was found to be effective in improving balance in patients with central vestibular dysfunction. OBJECTIVE To investigate the clinical effects of vestibular rehabilitation on balance skills and secondly on fatigue and activity of daily living in highly disabled multiple sclerosis people. METHODS Thirty hospitalized participants with severe multiple sclerosis (EDSS 6-7) were randomly assigned to the experimental group (15 patients -9F-; mean age 50.64±11.73) and the control group (15 patients -8F-; mean age 45.77±10.91). All patients were evaluated before and after treatment with the Expanded Disability Status Scale, Barthel Index Tinetti Balance and Gait scale, Berg Balance Scale, Fatigue Severity Scale, Two Minute Walking Test and Timed 25-foot walk test. Two follow-ups (i.e., at 30 and 60 days after treatment) were carried out with Barthel Index. RESULTS Significant improvement was found in the experimental group with respect to the control group (p < 0,05) in balance, fatigue perception, activities of daily living and short distance gait. No significant improvements were found for gait endurance as measured by Two Minute Walking Test. CONCLUSIONS Four weeks of Vestibular Rehabilitation training results in less fatigue, improved balance and performance of the activities of daily living in patients with severe Multiple Sclerosis.
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Affiliation(s)
- Marco Tramontano
- Clinical Laboratory of Experimental Neurorehabilitation, Fondazione Santa Lucia (Scientific Institute for Research and Health Care), Rome, Italy
| | | | | | - Federico Francesco Tozzi
- IRCCS Santa Lucia Foundation, Rome, Italy.,Physiotherapy Degree, Tor Vergata University, Rome, Italy
| | - Carlo Caltagirone
- IRCCS Santa Lucia Foundation, Rome, Italy.,Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Giovanni Morone
- Clinical Laboratory of Experimental Neurorehabilitation, Fondazione Santa Lucia (Scientific Institute for Research and Health Care), Rome, Italy
| | - Alessandra Pompa
- Multiple Sclerosis Unit, IRCCS Santa Lucia Foundation, Rome, Italy
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15
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Vestibular rehabilitation: advances in peripheral and central vestibular disorders. Curr Opin Neurol 2019; 32:137-144. [DOI: 10.1097/wco.0000000000000632] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Mañago MM, Hebert JR, Kittelson J, Schenkman M. Contributions of Ankle, Knee, Hip, and Trunk Muscle Function to Gait Performance in People With Multiple Sclerosis: A Cross-Sectional Analysis. Phys Ther 2018; 98:595-604. [PMID: 29660080 DOI: 10.1093/ptj/pzy048] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 04/05/2018] [Indexed: 11/13/2022]
Abstract
BACKGROUND The relative importance of lower extremity and trunk muscle function to gait in people with multiple sclerosis (MS) is unknown. OBJECTIVE This study aimed to investigate the association of lower extremity and trunk muscle function with gait performance in people who have MS and mild-to-moderate disability. DESIGN This was a cross-sectional, observational study. METHODS Participants were people who had an Expanded Disability Status Scale score of ≤ 5.5. Eleven lower extremity and trunk muscles were assessed using handheld dynamometry or endurance tests. Gait performance was assessed with the Timed 25-Foot (7.62 m) Walk (T25FW) and 6-Minute Walk Test (6MWT). Regression analysis was used to quantify the association between gait outcomes and muscle variables. RESULTS Seventy-two participants with MS and a mean Expanded Disability Status Scale score of 3.5 (SD = 1.14) were enrolled. Adjusted for age and sex, the multivariate model including hip abduction, ankle plantar flexion, trunk flexion, and knee flexion explained 57% of the adjusted variance in the T25FW; hip abduction, ankle plantar flexion, and trunk flexion explained 61% of the adjusted variance in the 6MWT. The strongest predictors were ankle plantar flexion endurance for the T25FW and hip abduction strength for the 6MWT: a 1-SD increase in ankle plantar flexion (15.2 heel-raise repetitions) was associated with a 0.33-second reduction in the T25WT (95% CI = - 0.71 to - 0.14 seconds); a 1-SD increase in normalized hip abduction strength (0.14 kg/body mass index) was associated with a 54.4-m increase in the 6MWT (28.99 to 79.81 m). LIMITATIONS Different measurement scales for independent variables were included because the muscle function assessment used either force or endurance. CONCLUSIONS For the major muscles in the lower extremity and trunk, hip abduction, ankle plantar flexion, trunk flexion, and knee flexion were the strongest predictors of gait performance.
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Affiliation(s)
- Mark M Mañago
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Denver, Aurora, Colorado, and Department of Rehabilitation, University of Colorado Hospital, 1635 Aurora Ct, Aurora, CO 80045
| | - Jeffrey R Hebert
- Department of Physical Medicine and Rehabilitation and Department of Neurology, School of Medicine, University of Colorado Denver, Aurora. Dr. Hebert is a multiple sclerosis certified specialist through the Consortium of MS Centers
| | - John Kittelson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora
| | - Margaret Schenkman
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Denver, Aurora. Dr Schenkman is a Catherine Worthingham Fellow of the American Physical Therapy Association
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17
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Hebert JR, Corboy JR, Vollmer T, Forster JE, Schenkman M. Efficacy of Balance and Eye-Movement Exercises for Persons With Multiple Sclerosis (BEEMS). Neurology 2018; 90:e797-e807. [DOI: 10.1212/wnl.0000000000005013] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 11/08/2017] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo determine whether a multifaceted vestibular-related rehabilitation program (Balance and Eye-Movement Exercises for Persons with Multiple Sclerosis; BEEMS) improves balance in persons with MS and whether there are differences in outcomes based on brainstem/cerebellar lesion involvement.MethodsA 2-arm, examiner-blinded, stratified (involvement vs no involvement of brainstem/cerebellar structures), randomized controlled trial was implemented. Eighty-eight participants were allocated to BEEMS or no treatment control. Computerized Dynamic Posturography-Sensory Organization Test (CDP-SOT) measured balance control. The Dizziness Handicap Inventory (DHI), Modified Fatigue Impact Scale (MFIS), and Short Form-36 Health Status Questionnaire (SF-36) were also administered. Linear mixed models were used to investigate the primary and secondary aims.ResultsFrom baseline to 6 weeks, BEEMS participants experienced greater improvements compared to control participants in CDP-SOT composite (model-estimated difference in change 4.9, 95% confidence interval 1.39–8.38, p = 0.006), DHI total (−13.5, −17.7 to −7.25, p < 0.0001), MFIS total (−11.4, −15.7 to −7.0, p < 0.0001), SF-36 Mental (5.6, 2.43–8.71, p = 0.0006), and SF-36 Physical (3.5, 1.12–5.81, p = 0.004) scores and from baseline to 14 weeks in CDP-SOT composite (8.3, 4.73–11.9, p < 0.0001), DHI total (−13.9, −19.3 to −8.62, p < 0.0001), MFIS total (−12.3, −16.7 to −7.79, p < 0.0001), SF-36 Mental (3.9, 0.70–7.16, p = 0.02), and SF-36 Physical (3.2, 0.79–5.62, p = 0.01) scores. From baseline to 6 weeks, BEEMS participants with brainstem/cerebellar lesion involvement experienced greater improvements compared to those without in CDP-SOT composite (5.26, 0.34–10.2, p = 0.04) and MFIS total (−7.6, −14.0 to −1.33, p = 0.02) scores.ConclusionBEEMS improved multiple outcomes regardless of whether brainstem/cerebellar lesions were present, supporting the generalizability of BEEMS for ambulatory people with MS who have at least minimally impaired balance and fatigue.Clinical trials.gov identifierNCT01698086.Classification of evidenceThis study provides Class I evidence that BEEMS training improves dynamic posturography-based balance, dizziness, fatigue, and quality of life in persons with MS.
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Bernstein JPK, Calamia M, Pratt J, Mullenix S. Assessing the effects of concussion using the C3Logix Test Battery: An exploratory study. APPLIED NEUROPSYCHOLOGY-ADULT 2018; 26:275-282. [PMID: 29308917 DOI: 10.1080/23279095.2017.1416471] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The C3Logix is a computerized concussion assessment tool that measures a wider array of symptoms (i.e., balance and oculomotor functioning) than other computerized batteries. Although the C3Logix has been used increasingly by athletic organizations at all levels of play, its utility within the concussion population has not been extensively examined. The current study aimed to determine whether the C3Logix is sensitive to the effects of concussion. A total of 54 student-athletes enrolled at a large southern university completed the C3Logix at baseline and within days following a suspected concussion (mean = 2.93, SD = 3.14). Dependent-samples t-tests revealed that relative to their baselines, following concussion, athletes both reported significantly greater postconcussive symptoms and performed more poorly on measures of reaction time and computer-measured balance. Decrements in processing speed, visual acuity, and clinician-observed errors on tests of balance also trended toward significance. Results suggest that inclusion of measures of balance and oculomotor functioning in the assessment of concussion may provide additional clinical utility above and beyond domains typically measured by computerized concussion assessments.
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Affiliation(s)
- John P K Bernstein
- a Department of Psychology , Louisiana State University , Baton Rouge , Lousiana , USA
| | - Matthew Calamia
- a Department of Psychology , Louisiana State University , Baton Rouge , Lousiana , USA
| | - Joshua Pratt
- b Department of Athletics , Louisiana State University , Baton Rouge , Lousiana , USA
| | - Shelly Mullenix
- b Department of Athletics , Louisiana State University , Baton Rouge , Lousiana , USA
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