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Kelly JL, Cosetti M, Lubetzky AV. Can head sway patterns differentiate between patients with Meniere's disease vs. peripheral vestibular hypofunction? Front Neurol 2024; 15:1347335. [PMID: 38487324 PMCID: PMC10937734 DOI: 10.3389/fneur.2024.1347335] [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: 11/30/2023] [Accepted: 02/19/2024] [Indexed: 03/17/2024] Open
Abstract
Background Meniere's disease (MD) is defined by episodic vertigo, unilateral sensorineural hearing loss and fluctuating aural symptoms. Due to the variable clinical presentation, objective tests of MD may have significant diagnostic utility. Head kinematics derived from a head-mounted display (HMD) have demonstrated to be sensitive to vestibular dysfunction. The purpose of this pilot study was to investigate whether head sway can differentiate between patients with MD, vestibular hypofunction (VH) and healthy controls. Materials/methods 80 adults (30 healthy controls, 32 with VH, and 18 with MD) were recruited from a tertiary vestibular clinic. All underwent a postural control assessment using the HTC Vive Pro Eye HMD that recorded head sway in the anterior-posterior (AP), medio-lateral (ML), pitch, yaw and roll direction. Participants were tested with 2 levels of visual load: a static versus oscillating star display. Each scene lasted 60 s and was repeated twice. Sway in each direction was quantified using root mean square velocity (VRMS) for the first 20 s and full 60 s of each scene. Results Static visual: participants with VH showed significantly larger head VRMS than controls in the AP (60 s and 20 s) and pitch (20 s) directions. Dynamic visual: participants with VH showed significantly larger head VRMS than controls all directions for both the 60 and 20 s analysis. Participants with MD did not differ significantly from the control or the VH group. Conclusion While limited in numbers, Patients with MD had a high variability in head sway in all directions, and their average head sway was between controls and those with VH. A larger sample as well as patients with worse symptoms at time of testing could elucidate whether head sway via HMD could become a viable test in this population. A similar finding between 20- and 60-s scene and the full portability of the system with an in-clinic testing setup could help these future endeavors. Head sway derived from HMD is sensitive to VH and can be clinically useful as an outcome measure to evaluate sensory integration for postural control.
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Affiliation(s)
- Jennifer L. Kelly
- Ear Institute, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, United States
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Maura Cosetti
- Ear Institute, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, United States
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Anat V. Lubetzky
- Department of Physical Therapy, Steinhardt School of Culture, Education and Human Development, New York University, New York, NY, United States
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Van Laer L, Hallemans A, Janssens de Varebeke S, De Somer C, Van Rompaey V, Vereeck L. Compensatory strategies after an acute unilateral vestibulopathy: a prospective observational study. Eur Arch Otorhinolaryngol 2024; 281:743-755. [PMID: 37642710 DOI: 10.1007/s00405-023-08192-6] [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: 05/29/2023] [Accepted: 08/14/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE In case of an acute unilateral vestibulopathy (UVP), compensatory strategies such as restoration and adaptation will lead to a decrease in intensity of the symptoms. Although measurements of compensatory strategies are available, currently, an overview taking the different strategies into account is lacking. The objectives of this study are to explore compensatory strategies and to investigate the association between compensatory strategies and patient characteristics. METHODS Restoration was objectified by the vestibulo-ocular reflex (VOR) gain on the video head impulse test, and adaptation-consisting of visual, multisensory, and behavioral substitution-was objectified by the Visual Vertigo Analog Scale (VVAS), Antwerp Vestibular Compensation Index (AVeCI), and Perez and Rey score (PR score), respectively. Adequate restoration and adaptation levels were interpreted as follows: VOR gain > 0.80, VVAS ≤ 40%, AVeCI > 0 and PR score ≤ 55. RESULTS Sixty-two UVP patients, 34 men and 28 women, were included with an average age of 52.1 ± 17.3 years. At 10.5 ± 1.4 weeks after onset, 41.9% of the UVP patients reached adequate restoration levels and 58.1-86.9% reached adequate adaptation levels. Furthermore, significant associations were found between (1) restoration status and UVP etiology [Odds Ratio (OR) with 95% CI: 4.167 {1.353;12.828}] and balance performance (OR: 4.400 {1.258;15.386}), (2) visual sensory substitution status and perceived handicap (OR: 8.144 {1.644;40.395}), anxiety (OR: 10.000 {1.579;63.316}) and depression (OR: 16.667 {2.726;101.896}), and (3) behavioral substitution status and balance performance (OR: 4.143 {1.341;12.798}). CONCLUSION UVP patients with adequate compensatory strategies presented with better balance performance, lower perceived handicap, and lower anxiety and depression scores.
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Affiliation(s)
- Lien Van Laer
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium.
- Multidisciplinary Motor Centre Antwerp (M2OCEAN), University of Antwerp, Antwerp, Belgium.
| | - Ann Hallemans
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
- Multidisciplinary Motor Centre Antwerp (M2OCEAN), University of Antwerp, Antwerp, Belgium
| | | | - Clara De Somer
- Rehabilitation Center Sint-Lievenspoort Ghent, Ghent, Belgium
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital Edegem, Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Luc Vereeck
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
- Multidisciplinary Motor Centre Antwerp (M2OCEAN), University of Antwerp, Antwerp, Belgium
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Li XX, Yu HY, Li JJ, Liu XL, Zheng HY, Li YF, Li Q, Liu SY. Cross-cultural adaptation and construct validity of the Chinese Version of Visual Vertigo Analogue Scale by using structural equation modeling. J Vestib Res 2024; 34:125-132. [PMID: 38042999 DOI: 10.3233/ves-220102] [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] [Indexed: 12/04/2023]
Abstract
BACKGROUND Visual vertigo (VV) is a disease characterized by various visual signal-induced discomforts, including dizziness, unsteady balance, activity avoiding, and so forth. Distinguishing it from other kinds of dizziness is important because it needs the combination of visual training and vestibular rehabilitation together. However, there is no appropriate tool to diagnose VV in China, thus we would like to introduce an effective tool to China. OBJECTIVE The aim of this study was to establish the reliability and validity of the Chinese version of visual vertigo analogue scale (VVAS-CH) and to achieve its cross-cultural adaptation in order to promote its further usage in China. METHODS A total of 1681 patients complaining of vertigo or dizziness were enrolled and they were asked to complete the VVAS-CH. The cross-cultural adaptation, reliability and construct validity of the VVAS-CH were determined. RESULTS Split-half reliability was 0.939, showing a good reliability. Factor analysis identified only one common factor for the nine items that explained 64.83% of the total variance. Most fit indices reached acceptable levels, proving the good fit of the VVAS-CH model. CONCLUSIONS The VVAS-CH validated in this study can be used as an effective tool for diagnosing and evaluating VV in patients whose native language is Chinese.
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Affiliation(s)
- Xiao-Xiao Li
- Department of Otolaryngology, Head and Neck Surgery, Nan-fang Hospital, Southern Medical University, Guang-Zhou, Guangdong, China
- Institute of Sound and Vibration Research, University of Southampton, Southampton, UK
| | - Hai-Yun Yu
- Teaching and Researching Section of Physiology, School of Basic Medical Sciences, Southern Medical University, Guang-Zhou, Guangdong, China
| | - Jing-Jing Li
- Department of Otolaryngology, Head and Neck Surgery, Nan-fang Hospital, Southern Medical University, Guang-Zhou, Guangdong, China
- Distinct Health Care, Cheng-Du, Si-Chuan, China
| | - Xiao-Long Liu
- Department of Otolaryngology, Head and Neck Surgery, Nan-fang Hospital, Southern Medical University, Guang-Zhou, Guangdong, China
| | - Hang-Yu Zheng
- Department of Otolaryngology, Head and Neck Surgery, Nan-fang Hospital, Southern Medical University, Guang-Zhou, Guangdong, China
| | - Yan-Fei Li
- Department of Otolaryngology, Head and Neck Surgery, Nan-fang Hospital, Southern Medical University, Guang-Zhou, Guangdong, China
| | - Qi Li
- Department of Otolaryngology, Head and Neck Surgery, Nan-fang Hospital, Southern Medical University, Guang-Zhou, Guangdong, China
| | - Si-Yuan Liu
- Department of Otolaryngology, Head and Neck Surgery, Nan-fang Hospital, Southern Medical University, Guang-Zhou, Guangdong, China
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Whitney SL, Ou V, Hovareshti P, Costa CM, Cassidy AR, Dunlap PM, Roeder S, Holt L, Tolani D, Klatt BN, Hoppes CW. Utility of VestAid to Detect Eye-Gaze Accuracy in a Participant Exposed to Directed Energy. Mil Med 2023; 188:e1795-e1801. [PMID: 36208334 DOI: 10.1093/milmed/usac294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/24/2022] [Accepted: 09/19/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The VestAid is a tablet-based application that provides feedback about a patient's eye/head movements during exercise after concussion. The goal of this case series was to determine if VestAid could be used to detect eye-gaze accuracy in a participant exposed to directed energy (DE). MATERIALS AND METHODS The VestAid results of a participant with DE were compared to an age- and gender-matched healthy control, a participant post-concussion, and a participant with vestibular neuritis. A tablet with VestAid software was utilized to record eye-gaze accuracy and head speed during VORx1 exercises using eye and facial recognition as participants were exposed to 12 visual scenes. RESULTS The participant with DE consistently had difficulty with eye-gaze accuracy when the head was rotated towards the right for all trials. The participant with DE had poor eye-gaze accuracy during all phases of the head turn cycle compared to the control participant (mean 47.91%, [SD = 7.32%] for the DE participant versus mean 94.28%, [SD = 5.87%] for the control participant). Post-exercise dizziness and perceived difficulty in the 12 exercises completed by the participant with DE were strongly related (Spearman's rho = 0.7372, P = .0062). The participant with DE had the lowest scores on 10 of the 12 head movement trials. CONCLUSIONS VestAid provided unique information about eye-gaze accuracy that detected eye movement abnormalities in the participants with DE exposure, concussion, and vestibular neuritis. The objective metrics of eye-gaze stability correlate with participants' symptoms and perceived difficulty of the eye/head movements.
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Affiliation(s)
- Susan L Whitney
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | - Victoria Ou
- Intelligent Automation dba BlueHalo, Rockville, MD 20855, USA
| | | | | | - Amy R Cassidy
- UPMC Centers for Rehab Services, Pittsburgh, PA 15213, USA
| | - Pamela M Dunlap
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | - Shamus Roeder
- Intelligent Automation dba BlueHalo, Rockville, MD 20855, USA
| | - Lisa Holt
- Intelligent Automation dba BlueHalo, Rockville, MD 20855, USA
| | - Devendra Tolani
- Intelligent Automation dba BlueHalo, Rockville, MD 20855, USA
| | - Brooke N Klatt
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | - Carrie W Hoppes
- Army-Baylor University Doctoral Program in Physical Therapy, Joint Base San Antonio-Fort Sam Houston, TX 78234, USA
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