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Korkmaz H, Aydin E, Ocal FCA, Satar B. Evaluation of the Effects of Optokinetic Stimuli and Dual-Task Performance on Vestibulo-Ocular Reflex Function in Children With Attention Deficit and Hyperactivity Disorder. Clin Otolaryngol 2024; 49:754-764. [PMID: 39105387 DOI: 10.1111/coa.14201] [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: 11/23/2023] [Revised: 05/07/2024] [Accepted: 07/06/2024] [Indexed: 08/07/2024]
Abstract
OBJECTIVES This study investigated the effects of optokinetic stimuli and dual-task performance on vestibulo-ocular reflex (VOR) function. The study primarily focused on understanding the effects of attention deficit and hyperactivity disorder (ADHD) and its subtypes. STUDY DESIGN A case-control study. SETTING Tertiary medical centre. METHODS Thirty-eight children diagnosed with ADHD and 40 typically developing (TD) children aged 8-18 were included in the study. According to their diagnostic reports, children diagnosed with ADHD were also examined in three subtypes: predominantly inattentive (ADHD-PI), predominantly hyperactive-impulsive (ADHD-HI) and the combined type. Functional head impulse test (fHIT) was applied to all participants in three conditions-with no additional stimulus, optokinetic stimulation and dual-task. Correct responses (CR) were determined for each group, and the conditions were compared. For the dual-task test performance, children were given a counting task. RESULTS The findings of the study are significant. The CR values obtained from the fHIT tests applied under three different conditions were lower in the ADHD group compared to the control group. CR values for all fHIT conditions and all semicircular canals were lower in the ADHD-PI subtype and higher in the ADHD-HI subtype compared to other subgroups. CONCLUSION This study has significant practical implications underscoring its relevance. fHIT, when applied with different protocols, can provide valuable information about the vestibular and cognitive states of children with ADHD. These results are particularly significant as the diagnosis of ADHD often relies on subjective interpretations, and fHIT offers a more objective and reliable method of evaluation.
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Affiliation(s)
- Hanifi Korkmaz
- Medical Health Services and Vocational School, Malatya Turgut Ozal University, Battalgazi/Malatya, Turkey
| | - Emine Aydin
- Gulhane Faculty of Medicine, Department of Ear Nose Throat, University of Health Sciences, Ankara, Turkey
| | - Fatma Ceyda Akin Ocal
- Gulhane Faculty of Medicine, Department of Ear Nose Throat, University of Health Sciences, Ankara, Turkey
| | - Bulent Satar
- Gulhane Faculty of Medicine, Department of Ear Nose Throat, University of Health Sciences, Ankara, Turkey
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Kirazli G, Balayeva F, Kacan Yilmaz M, Kaya I, Kirazli T, Gokcay F, Celebisoy N. vHIT and fHIT in Patients With Migraine, Vestibular Migraine, and Persistent Postural-Perceptual Dizziness. Laryngoscope 2024. [PMID: 39268858 DOI: 10.1002/lary.31758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 08/06/2024] [Accepted: 08/23/2024] [Indexed: 09/15/2024]
Abstract
OBJECTIVE Impairment in the integration of different vestibular stimuli is the proposed mechanisms in vestibular migraine (VM). In this study, it was aimed to assess the vestibulo-ocular reflex (VOR) and dynamic visual acuity (DVA) in patients with VM and to compare the results with migraine without vestibular symptoms (MwoV), and persistent postural-perceptual dizziness (PPPD) to find out if there are discriminative differences and search for a correlation with the levels of anxiety. METHODS Twenty-two patients with MwoV, 23 patients with VM, 22 patients with PPPD, and 23 healthy controls (HC) were studied. Video head impulse test (vHIT) and functional head impulse test (fHIT) without and with an optokinetic background (OB) were performed. Percentage of correctly identified optotypes (CA%) was considered for the fHIT test. Beck anxiety inventory (BAI) was used to assess anxiety. RESULTS Lateral canal vHIT gain of the patient groups were not different from the healthy controls (p > 0.05). fHIT and fHIT/OB CA% results of all patient groups were lower than the HC (p < 0.005), and VM patients had the lowest scores for both tests. BAI scores of the PPPD patients were the highest and a correlation between anxiety levels, and fHIT results could not be identified (p > 0.05). CONCLUSION Prominent CA% drop by the use of an OB was the main finding in patients with VM. This discriminative feature was not correlated with anxiety scores. Difficulty in resolving the conflict between visual and vestibular inputs seem to be the underlying mechanism. LEVEL OF EVIDENCE 3 Laryngoscope, 2024.
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Affiliation(s)
- Gulce Kirazli
- Department of Audiology, Ege University Faculty of Health Sciences, Izmir, Turkey
| | - Fidan Balayeva
- Department of Neurology, Ege University Medical School, Izmir, Turkey
| | - Melis Kacan Yilmaz
- Department of Clinical Neuroscience, Ege University Institute of Health Sciences, Izmir, Turkey
| | - Isa Kaya
- Department of Otorhinolaryngology Head & Neck Surgery, Ege University Medical School, Izmir, Turkey
| | - Tayfun Kirazli
- Department of Otorhinolaryngology Head & Neck Surgery, Ege University Medical School, Izmir, Turkey
| | - Figen Gokcay
- Department of Neurology, Ege University Medical School, Izmir, Turkey
| | - Nese Celebisoy
- Department of Neurology, Ege University Medical School, Izmir, Turkey
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Kirazli G, Erbek HS. A comparison of the video head impulse test and the functional head impulse test in chronic unilateral vestibular loss. J Laryngol Otol 2024; 138:43-51. [PMID: 37667906 PMCID: PMC10772026 DOI: 10.1017/s0022215123001536] [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: 02/04/2023] [Revised: 07/19/2023] [Accepted: 08/01/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE To examine the correlation of video head impulse test, functional head impulse test and Dizziness Handicap Inventory results in patients with chronic unilateral vestibular loss, and to compare the results with healthy controls. METHODS Forty-eight patients diagnosed with chronic unilateral vestibular loss and 35 healthy individuals, aged 18-65 years, were included. The video head impulse test, functional head impulse test and Dizziness Handicap Inventory were administered. RESULTS A significant positive correlation was found between functional head impulse test and video head impulse test results for the study group in all semicircular canals (p < 0.05). There was no significant correlation between Dizziness Handicap Inventory, functional head impulse test and video head impulse test results (p > 0.05). The functional head impulse test and video head impulse test results of the control group were significantly higher than those of the study group in all semicircular canals planes (p < 0.05). CONCLUSION In chronic unilateral vestibular loss patients, with high head accelerations, the functional head impulse test indicates deterioration in vestibulo-ocular reflex functionality. It would be beneficial to include the video head impulse test and functional head impulse test in clinical practice as complementary tests in vestibulo-ocular reflex evaluation.
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Affiliation(s)
- Gulce Kirazli
- Department of Audiology, Faculty of Health Sciences, Ege University, Izmir, Turkey
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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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Kızılay F, Cengiz DU. A comparison of functional vestibulo-ocular reflex and proprioception in athletes of combat sports and ball sports. Heliyon 2023; 9:e17540. [PMID: 37455947 PMCID: PMC10338297 DOI: 10.1016/j.heliyon.2023.e17540] [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: 03/26/2023] [Revised: 06/20/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023] Open
Abstract
Background The contribution and role of sensory systems in providing postural control may vary depending on the condition or activity. Vestibulo-ocular reflex (VOR) and proprioception might be affected by the type of sport. Objective This study aimed to compare athletes engaged in combat sports and ball sports in terms of functional VOR and proprioception. Design This study is a cross-sectional, comperative research. Method Twenty-four athletes engaged in combat sports and 20 in ball sports were included in the study. Functional examination of VOR in athletes was performed with a novel Functional Head Impulse Test (fHIT). Proprioception analysis was evaluated using Laser Pointer Assisted Angle Reproduction Test (LPA-ART) in 90° shoulder flexion and abduction. Results fHIT lateral and posterior % Correct Answer (CA) values and anterior SCC 6000°/s2 values of athletes engaged in ball sports were found to be statistically significantly higher than athletes in combat sports (p < 0.05). Except for anterior SCC 4000°/s2 value, scores of the ball players in all accelerations and directions were higher than combat sports athletes, although it was not statistically significant. The 90° shoulder flexion and abduction angle deviation values obtained from the LI-ATT were statistically lower in those who played ball sports (p < 0.05). Conclusions Participation in sports branches played with the ball is expected to provide gains for athletes who want to reach high-level performance in proprioceptive and vestibular functioning and those with vestibular/proprioceptive pathology. Maintaining clear vision in dynamic sports branches can be improved by training VOR function.
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Affiliation(s)
- Fatma Kızılay
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Inonu University, 44280, Malatya, Turkey
| | - Deniz Uğur Cengiz
- Department of Audiology, Faculty of Health Sciences, Inonu University, 44280, Malatya, 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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Balayeva F, Kirazlı G, Celebisoy N. Vestibular test results in patients with vestibular migraine and Meniere's Disease. Acta Otolaryngol 2023:1-5. [PMID: 37267063 DOI: 10.1080/00016489.2023.2213723] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/28/2023] [Accepted: 05/03/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Vestibular migraine (VM) and Meniere's Disease (MD) are episodic vestibular disorders, sometimes difficult to differentiate from each other on clinical grounds. OBJECTIVE To evaluate vestibular test results of the two groups that may help in the differential diagnosis. METHODS Twenty-two patients with VM, 21 patients with definite MD and 21 healthy volunteers (HC) were studied. Pure tone hearing thresholds (PTHT), cervical vestibular evoked myogenic potentials (cVEMPs), video head impulse test (vHIT) and functional head impulse test (fHIT) were performed. RESULTS PTHT of the MD-affected ears were significantly higher than VM and HC groups (p < .001 for both) when cVEMP amplitudes were lower (p = .005 for HC), (p = .006 for VM). Lateral canal vHIT gain of the MD-affected ears were lower than VM patients (p = .003) and the HC (p < .001). The percentage of correctly identified optotypes (CA%) on fHIT was low for both patient groups when compared with the HC (p < .001). CONCLUSION In addition to hearing loss, low cVEMP amplitudes on the affected side with decreased gain on vHIT indicate disturbed saccular and lateral semicircular canal functions in MD patients differentiating them from VM. A functional deficit in gaze stabilization detected by fHIT is the only abnormality found in patients with VM.
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Affiliation(s)
- Fidan Balayeva
- Department of Neurology, Ege University Medical School, Bornova, Izmir, Turkey
| | - Gülce Kirazlı
- Department of Audiology, Ege University Faculty of Health Sciences, Izmir, Turkey
| | - Nese Celebisoy
- Department of Neurology, Ege University Medical School, Bornova, Izmir, Turkey
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Sjögren J, Karlberg M, Hickson C, Magnusson M, Fransson PA, Tjernström F. Short-Latency Covert Saccades - The Explanation for Good Dynamic Visual Performance After Unilateral Vestibular Loss? Front Neurol 2021; 12:695064. [PMID: 34531814 PMCID: PMC8439257 DOI: 10.3389/fneur.2021.695064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Functional head impulse test (fHIT) tests the ability of the vestibulo-ocular reflex (VOR) to allow visual perception during head movements. Our previous study showed that active head movements to the side with a vestibular lesion generated a dynamic visual performance that were as good as during movements to the intact side. Objective: To examine the differences in eye position during the head impulse test when performed with active and passive head movements, in order to better understand the role of the different saccade properties in improving visual performance. Method: We recruited 8 subjects with complete unilateral vestibular loss (4 men and 4 women, mean age 47 years) and tested them with video Head Impulse Test (vHIT) and Functional Head Impulse Test (fHIT) during passive and active movements while looking at a target. We assessed the mean absolute position error of the eye during different time frames of the head movement, the peak latency and the peak velocity of the first saccade, as well as the visual performance during the head movement. Results: Active head impulses to the lesioned side generated dynamic visual performances that were as good as when testing the intact side. Active head impulses resulted in smaller position errors during the visual perception task (p = 0.006) compared to passive head-impulses and the position error during the visual perception time frame correlated with shorter latencies of the first saccade (p < 0.001). Conclusion: Actively generated head impulses toward the side with a complete vestibular loss resulted in a position error within or close to the margin necessary to obtain visual perception for a brief period of time in patients with chronic unilateral vestibular loss. This seems to be attributed to the appearance of short-latency covert saccades, which position the eyes in a more favorable position during head movements.
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Affiliation(s)
- Julia Sjögren
- Department of Clinical Sciences, Otorhinolaryngology Head and Neck Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Mikael Karlberg
- Department of Clinical Sciences, Otorhinolaryngology Head and Neck Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Craig Hickson
- Department of Otorhinolaryngology Head and Neck Surgery, William Harvey Hospital, East Kent Hospitals University Foundation Trust, Ashford, United Kingdom
| | - Måns Magnusson
- Department of Clinical Sciences, Otorhinolaryngology Head and Neck Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Per-Anders Fransson
- Department of Clinical Sciences, Otorhinolaryngology Head and Neck Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Fredrik Tjernström
- Department of Clinical Sciences, Otorhinolaryngology Head and Neck Surgery, Skåne University Hospital, Lund University, Lund, Sweden
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The Role of the Functional Head Impulse Test with and without Optokinetic Stimuli in Vestibular Migraine and Acute Unilateral Vestibulopathy: Discovering a Dynamic Visual Dependence. J Clin Med 2021; 10:jcm10173787. [PMID: 34501235 PMCID: PMC8432176 DOI: 10.3390/jcm10173787] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/16/2021] [Accepted: 08/18/2021] [Indexed: 11/29/2022] Open
Abstract
(1) Background: Visually induced vertigo (i.e., vertigo provoked by moving visual scenes) can be considered a noticeable feature of vestibular migraines (VM) and can be present in patients suffering from acute unilateral vestibulopathy (AUV). Hypersensitivity to moving or conflicting visual stimulation is named visual dependence. (2) Methods: Visuo-vestibular interactions were analyzed via the functional Head Impulse Test (fHIT) with and without optokinetic stimulation (o-fHIT) in 25 patients with VM, in 20 subjects affected by AUV, and in 20 healthy subjects. We calculated the percentage of correct answers (%CA) without and with the addition of the optokinetic background (OB). (3) In VM groups, the %CA on the fHIT was 92.07% without OB and 73.66% with OB. A significant difference was found between %CA on the deficit side and that on the normal side in AUV, both without OB and with OB. (4) Conclusions: The fHIT results in terms of %CA with and without OB could be useful to identify the presence of a dynamic visual dependence, especially in patients suffering from VM. The difference in %CA with and without OB could provide instrumental support to help correctly identify subjects suffering from VM. We propose the use of the fHIT in clinical practice whenever there is a need to highlight a condition of dynamic visual dependence.
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Chen PY, Jheng YC, Huang SE, Po-Hung Li L, Wei SH, Schubert MC, Kao CL. Gaze shift dynamic visual acuity: A functional test of gaze stability that distinguishes unilateral vestibular hypofunction. J Vestib Res 2021; 31:23-32. [PMID: 33325420 PMCID: PMC9249280 DOI: 10.3233/ves-201506] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Embedded within most rapid head rotations are gaze shifts, which is an initial eye rotation to a target of interest, followed by a head rotation towards the same target. Gaze shifts are used to acquire an image that initially is outside of the participant’s current field of vision. Currently, there are no tools available that evaluate the functional relevance of a gaze shift. OBJECTIVE: The purpose of our study was to measure dynamic visual acuity (DVA) while performing a gaze shift. METHODS: Seventy-one healthy participants (42.79±16.89 years) and 34 participants with unilateral vestibular hypofunction (UVH) (54.59±20.14 years) were tested while wearing an inertial measurement unit (IMU) sensor on the head and walking on a treadmill surrounded by three monitors. We measured visual acuity during three subcomponent tests: standing (static visual acuity), while performing an active head rotation gaze shift, and an active head rotation gaze shift while walking (gsDVAw). RESULTS: While doing gsDVAw, patients with Left UVH (n = 21) had scores worse (p = 0.023) for leftward (0.0446±0.0943 LogMAR) head rotation compared with the healthy controls (–0.0075±0.0410 LogMAR). Similarly, patients with right UVH (N = 13) had worse (p = 0.025) gsDVAw for rightward head motion (0.0307±0.0481 LogMAR) compared with healthy controls (–0.0047±0.0433 LogMAR). As a whole, gsDVAw scores were worse in UVH compared to the healthy controls when we included the ipsilesional head rotation on both sides gsDVAw (0.0061±0.0421 LogMAR healthy vs. 0.03926±0.0822 LogMAR UVH, p = 0.003). Controlling for age had no effect, the gsDVAw scores of the patients were always worse (p < 0.01). CONCLUSION: The gaze shift DVA test can distinguish gaze stability in patients with UVH from healthy controls. This test may be a useful measure of compensation for patients undergoing various therapies for their vestibular hypofunction.
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Affiliation(s)
- Po-Yin Chen
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.,School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.,Center for Intelligent Drug Systems and Smart Bio-devices-IDS2B, National Chiao Tung University, Hsinchu, Taiwan, ROC.,Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Ying-Chun Jheng
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.,School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.,Center for Intelligent Drug Systems and Smart Bio-devices-IDS2B, National Chiao Tung University, Hsinchu, Taiwan, ROC.,Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Shih-En Huang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.,School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.,Center for Intelligent Drug Systems and Smart Bio-devices-IDS2B, National Chiao Tung University, Hsinchu, Taiwan, ROC.,Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Lieber Po-Hung Li
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.,Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan, ROC.,Faculty of Medicine and Institute of Brain Science, School of Medicine, National Yang Ming University, Taipei, Taiwan, ROC
| | - Shun-Hwa Wei
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Michael C Schubert
- Laboratory of Vestibular NeuroAdaptation, Johns Hopkins University School of Medicine, Department of Otolaryngology Head and Neck Surgery, Department of Physical Medicine and Rehabilitation, Baltimore MD USA
| | - Chung-Lan Kao
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.,School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.,Center for Intelligent Drug Systems and Smart Bio-devices-IDS2B, National Chiao Tung University, Hsinchu, Taiwan, ROC
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Starkov D, Strupp M, Pleshkov M, Kingma H, van de Berg R. Diagnosing vestibular hypofunction: an update. J Neurol 2021; 268:377-385. [PMID: 32767115 PMCID: PMC7815536 DOI: 10.1007/s00415-020-10139-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/31/2020] [Accepted: 08/01/2020] [Indexed: 12/13/2022]
Abstract
Unilateral or bilateral vestibular hypofunction presents most commonly with symptoms of dizziness or postural imbalance and affects a large population. However, it is often missed because no quantitative testing of vestibular function is performed, or misdiagnosed due to a lack of standardization of vestibular testing. Therefore, this article reviews the current status of the most frequently used vestibular tests for canal and otolith function. This information can also be used to reach a consensus about the systematic diagnosis of vestibular hypofunction.
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Affiliation(s)
- Dmitrii Starkov
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
- Faculty of Physics, Tomsk State Research University, Tomsk, Russia.
- Maastricht University ENT Department, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - Michael Strupp
- German Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, Germany
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
| | - Maksim Pleshkov
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- Faculty of Physics, Tomsk State Research University, Tomsk, Russia
| | - Herman Kingma
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- Faculty of Physics, Tomsk State Research University, Tomsk, Russia
| | - Raymond van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- Faculty of Physics, Tomsk State Research University, Tomsk, Russia
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12
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Starkov D, Snelders M, Lucieer F, Janssen AML, Pleshkov M, Kingma H, van Rompaey V, Herssens N, Hallemans A, Vereeck L, McCrum C, Meijer K, Guinand N, Perez-Fornos A, van de Berg R. Bilateral vestibulopathy and age: experimental considerations for testing dynamic visual acuity on a treadmill. J Neurol 2020; 267:265-272. [PMID: 33113022 PMCID: PMC7718189 DOI: 10.1007/s00415-020-10249-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/25/2020] [Accepted: 09/28/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Bilateral vestibulopathy (BVP) can affect visual acuity in dynamic conditions, like walking. This can be assessed by testing Dynamic Visual Acuity (DVA) on a treadmill at different walking speeds. Apart from BVP, age itself might influence DVA and the ability to complete the test. The objective of this study was to investigate whether DVA tested while walking, and the drop-out rate (the inability to complete all walking speeds of the test) are significantly influenced by age in BVP-patients and healthy subjects. METHODS Forty-four BVP-patients (20 male, mean age 59 years) and 63 healthy subjects (27 male, mean age 46 years) performed the DVA test on a treadmill at 0 (static condition), 2, 4 and 6 km/h (dynamic conditions). The dynamic visual acuity loss was calculated as the difference between visual acuity in the static condition and visual acuity in each walking condition. The dependency of the drop-out rate and dynamic visual acuity loss on BVP and age was investigated at all walking speeds, as well as the dependency of dynamic visual acuity loss on speed. RESULTS Age and BVP significantly increased the drop-out rate (p ≤ 0.038). A significantly higher dynamic visual acuity loss was found at all speeds in BVP-patients compared to healthy subjects (p < 0.001). Age showed no effect on dynamic visual acuity loss in both groups. In BVP-patients, increasing walking speeds resulted in higher dynamic visual acuity loss (p ≤ 0.036). CONCLUSION DVA tested while walking on a treadmill, is one of the few "close to reality" functional outcome measures of vestibular function in the vertical plane. It is able to demonstrate significant loss of DVA in bilateral vestibulopathy patients. However, since bilateral vestibulopathy and age significantly increase the drop-out rate at faster walking speeds, it is recommended to use age-matched controls. Furthermore, it could be considered to use an individual "preferred" walking speed and to limit maximum walking speed in older subjects when testing DVA on a treadmill.
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Affiliation(s)
- D Starkov
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands. .,Faculty of Physics, Tomsk State Research University, Tomsk, Russia. .,Maastricht University ENT Department, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - M Snelders
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - F Lucieer
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - A M L Janssen
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - M Pleshkov
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.,Faculty of Physics, Tomsk State Research University, Tomsk, Russia
| | - H Kingma
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.,Faculty of Physics, Tomsk State Research University, Tomsk, Russia
| | - V van Rompaey
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - N Herssens
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium.,Multidisciplinary Motor Centre Antwerp (M2OCEAN), University of Antwerp, Antwerp, Belgium
| | - A Hallemans
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium.,Multidisciplinary Motor Centre Antwerp (M2OCEAN), University of Antwerp, Antwerp, Belgium.,The Research Group MOVANT (MOVement ANTwerp), University of Antwerp, Antwerp, Belgium
| | - L Vereeck
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium.,Multidisciplinary Motor Centre Antwerp (M2OCEAN), University of Antwerp, Antwerp, Belgium
| | - C McCrum
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - K Meijer
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - N Guinand
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.,Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - A Perez-Fornos
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - R van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.,Faculty of Physics, Tomsk State Research University, Tomsk, Russia
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13
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Martellucci S, Ralli M, Attanasio G, Russo FY, Marcelli V, Greco A, Gallo A, Fiore M, Petrella C, Ferraguti G, Ceccanti M, de Vincentiis M. Alcohol binge-drinking damage on the vestibulo-oculomotor reflex. Eur Arch Otorhinolaryngol 2020; 278:41-48. [PMID: 32449024 DOI: 10.1007/s00405-020-06052-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/12/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Binge drinking is associated with several adverse effects in multiple organs. This study aimed at evaluating the effects of a binge-like-drinking on the vestibulo-oculomotor reflex (VOR) using the video Head Impulse Test (vHIT) and the functional Head Impulse Test (fHIT). METHODS Eleven healthy men (age range 32-35 years) with moderate drinking habits and no history of vestibular dysfunction were enrolled. A preliminary assessment of breath alcohol concentration (BrAC) to check for zero alcohol value and a pre-intake evaluation of VOR using the vHIT and the fHIT were carried on. Then, the subjects were asked to take drinks with different alcohol content (8-40% ethanol by volume) according to their choice, consuming at least 5 standard drinks. Volunteers stopped drinking after 3 h. After a further 30 min, post-intake BrAC measurements and VOR analysis were repeated. RESULTS After alcohol intake, vHIT recorded an overall significant reduction of VOR gain (0.82 ± 0.07 on both sides) although the outcomes were below the normal range only in the four subjects with the highest blood alcohol levels. The post-intake fHIT outcomes were substandard in 9 participants, with a significant deterioration in performance (% of exact answers = 84.54 ± 11.05% on the left, 83.18 ± 14.53 on the right). CONCLUSIONS Binge drinking severely affects VOR; fHIT seems more sensitive than vHIT in the assessment of VOR function for complex vestibular lesions, such as those determined by ethanol, suggesting that fHIT could support vHIT in vestibular dysfunction assessment.
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Affiliation(s)
- Salvatore Martellucci
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00100, Rome, Italy
| | - Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00100, Rome, Italy.
| | - Giuseppe Attanasio
- Head and Neck Department, ENT Clinic, Policlinico Umberto I, Rome, Italy
| | - Francesca Yoshie Russo
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00100, Rome, Italy
| | | | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00100, Rome, Italy
| | - Andrea Gallo
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00100, Rome, Italy
| | - Marco Fiore
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00100, Rome, Italy. .,Section of Neurobiology, Institute of Biochemistry and Cell Biology, National Research Council (IBBC-CNR), Rome, Italy.
| | - Carla Petrella
- Section of Neurobiology, Institute of Biochemistry and Cell Biology, National Research Council (IBBC-CNR), Rome, Italy
| | - Giampiero Ferraguti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Mauro Ceccanti
- Centro Alcologico della Regione Lazio, Asl Roma 1, Rome, Italy
| | - Marco de Vincentiis
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
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14
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Versino M, Mandalà M, Colnaghi S, Ricci G, Faralli M, Ramat S. The integration of multisensory motion stimuli is impaired in vestibular migraine patients. J Neurol 2020; 267:2842-2850. [PMID: 32448951 DOI: 10.1007/s00415-020-09905-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 05/07/2020] [Accepted: 05/09/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Vestibular migraine (VM) is a relatively recently acknowledged vestibular syndrome with a very relevant prevalence of about 10% among patients complaining of vertigo. The diagnostic criteria for VM have been recently published by the Bárány Society, and they are now included in the latest version of the International Classification of Headache Disorders, yet there is no instrumental test that supports the diagnosis of VM. OBJECTIVE In the hypothesis that the integration of different vestibular stimuli is functionally impaired in VM, we tested whether the combination of abrupt vestibular stimuli and full-field, moving visual stimuli would challenge vestibular migraine patients more than controls and other non-vestibular migraineurs. METHODS In three clinical centers, we compared the performance in the functional head impulse test (fHIT) without and with an optokinetic stimulus rotating in the frontal plane in a group of 44 controls (Ctrl), a group of 42 patients with migraine (not vestibular migraine, MnoV), a group of 39 patients with vestibular migraine (VM) and a group of 15 patients with vestibular neuritis (VN). RESULTS The optokinetic stimulation reduced the percentage of correct answers (%CA) in all groups, and in about 33% of the patients with migraine, in as many as 87% of VM patients and 60% of VN patients, this reduction was larger than expected from controls' data. CONCLUSIONS The comparison of the fHIT results without and with optokinetic stimulation unveils a functional vestibular impairment in VM that is not as large as the one detectable in VN, and that, in contrast with all the other patient groups, mainly impairs the capability to integrate different vestibular stimuli.
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Affiliation(s)
- Maurizio Versino
- Neurology Unit, ASST Settelaghi, Insubria University, DMC, Varese, Italy.,Neuro-Otology and Neuro-Ophthalmology Lab, IRCCS Mondino Foundation, Pavia, Italy
| | - Marco Mandalà
- Department of Otology and Skull Base Surgery, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Silvia Colnaghi
- Neuro-Otology and Neuro-Ophthalmology Lab, IRCCS Mondino Foundation, Pavia, Italy.,Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Giampietro Ricci
- Department of Surgery and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Mario Faralli
- Department of Surgery and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Stefano Ramat
- Department of Computer, Electric and Biomedical Engineering, University of Pavia, Via Ferrata, 5, 27100, Pavia, Italy.
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15
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Positive Relations Between Vision and Posture in the Fixation Task Performed Upright. Motor Control 2020; 24:1-16. [PMID: 31170867 DOI: 10.1123/mc.2018-0094] [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: 10/09/2018] [Revised: 01/14/2019] [Accepted: 02/23/2019] [Indexed: 11/18/2022]
Abstract
In an upright stance, individuals sway in unpredictable ways. Their eyes also move in unpredictable ways in fixation tasks. The objective of this study was to analyze visual functions, postural control, and cognitive involvement in stationary gaze. A total of 14 healthy young adults performed a fixation task and a free-viewing task (three trials per task, 45 s per trial). As expected, the results showed many (n = 32) significant positive Pearson correlation coefficients between the eye and center of pressure/body (head, neck, and lower back) movements in the fixation task. In the free-viewing task, the correlations were nonsignificant. Only 3 of the 32 significant correlations (9.4%) were significantly related to cognitive involvement (measured with a subjective questionnaire). These results indirectly strengthened the validity of the synergistic model of postural control.
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16
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Functional Head Impulse Test With and Without Optokinetic Stimulation in Subjects With Persistent Postural Perceptual Dizziness (PPPD): Preliminary Report. Otol Neurotol 2019; 41:e70-e75. [PMID: 31789799 DOI: 10.1097/mao.0000000000002446] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Persistent postural perceptual dizziness (PPPD) is a clinical condition characterized by unsteadiness present on most days for a period of at least 3 months. The aim of our work was to assess vestibular function, the role of anxiety, and possible interactions between visual and vestibular systems in patients with PPPD. STUDY DESIGN Cross-sectional prospective study. SETTING Tertiary referral center. PATIENTS Twenty-five PPPD patients. INTERVENTIONS Clinical history was collected before examination; vestibular function was assessed through bedside examination, video and functional head impulse test (video-HIT, f-HIT). The latter test was based on having the patient identify an optotype displayed on a computer screen during passive head rotations. The test was repeated while optokinetic stimulation (OKS) was given on the screen. Results were compared with those of 25 controls. State and trait anxiety levels were measured with the State-Trait Anxiety Inventory (STAI) questionnaire. Anxiety before and after vestibular examination was assessed using a VAS scale. MAIN OUTCOME MEASURE Results of video and functional HIT with and without OKS. RESULTS Video-HIT and f-HIT showed normal values in all subjects. f-HIT with OKS provoked more reading errors in patients than in controls. The interaction of group per time detected different decreasing trends between the two groups (p = 0.0002).Patients presented a reduction in anxiety levels after examination. Nine patients fulfilled diagnostic criteria for vestibular migraine, eight of whom presented nystagmus either to positional tests or vibration test. Only anxiety levels before testing were predictive of worsening of f-HIT with optokinetic stimulation (p = 0.0007). CONCLUSIONS Our data support the hypothesis that increased anxiety may play a role in visuo-vestibular interactions; moreover, they are not inconsistent with the hypothesis that OKS might provoke a "threatening effect," leading to gaze bias during examination.
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17
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Starkov D, Guinand N, Lucieer F, Ranieri M, Cavuscens S, Pleshkov M, Guyot JP, Kingma H, Ramat S, Perez-Fornos A, van de Berg R. Restoring the High-Frequency Dynamic Visual Acuity with a Vestibular Implant Prototype in Humans. Audiol Neurootol 2019; 25:91-95. [PMID: 31661687 DOI: 10.1159/000503677] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 09/18/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The vestibular implant could become a clinically useful device in the near future. This study investigated the feasibility of restoring the high-frequency dynamic visual acuity (DVA) with a vestibular implant, using the functional Head Impulse Test (fHIT). METHODS A 72-year-old female, with bilateral vestibulopathy and fitted with a modified cochlear implant incorporating three vestibular electrodes (MED-EL, Innsbruck, Austria), was available for this study. Electrical stimulation was delivered with the electrode close to the lateral ampullary nerve in the left ear. The high-frequency DVA in the horizontal plane was tested with the fHIT. After training, the patient underwent six trials of fHIT, each with a different setting of the vestibular implant: (1) System OFF before stimulation; (2) System ON, baseline stimulation; (3) System ON, reversed stimulation; (4) System ON, positive stimulation; (5) System OFF, without delay after stimulation offset; and (6) System OFF, 25 min delay after stimulation offset. The percentage of correct fHIT scores for right and left head impulses were compared between trials. RESULTS Vestibular implant stimulation improved the high-frequency DVA compared to no stimulation. This improvement was significant for "System ON, baseline stimulation" (p = 0.02) and "System ON, positive stimulation" (p < 0.001). fHIT scores changed from 19 to 44% (no stimulation) to maximum 75-94% (System ON, positive stimulation). CONCLUSION The vestibular implant seems capable of improving the high-frequency DVA. This functional benefit of the vestibular implant illustrates again the feasibility of this device for clinical use in the near future.
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Affiliation(s)
- Dmitrii Starkov
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, The Netherlands, .,Faculty of Physics, Tomsk State Research University, Tomsk, Russian Federation,
| | - Nils Guinand
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Florence Lucieer
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, The Netherlands
| | - Maurizio Ranieri
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Samuel Cavuscens
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Maksim Pleshkov
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, The Netherlands.,Faculty of Physics, Tomsk State Research University, Tomsk, Russian Federation
| | - Jean-Philippe Guyot
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Herman Kingma
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, The Netherlands.,Faculty of Physics, Tomsk State Research University, Tomsk, Russian Federation
| | - Stefano Ramat
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Angelica Perez-Fornos
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Raymond van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, The Netherlands.,Faculty of Physics, Tomsk State Research University, Tomsk, Russian Federation
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18
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Versino M, Colnaghi S, Corallo G, Mandalà M, Ramat S. The functional head impulse test: Comparing gain and percentage of correct answers. PROGRESS IN BRAIN RESEARCH 2019; 248:241-248. [PMID: 31239135 DOI: 10.1016/bs.pbr.2019.04.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The video head impulse test (vHIT) provides as output a gain value that summarizes the behavior of the vestibulo-ocular reflex as the ratio of a measure of eye movement to the corresponding measure of head movement and is not directly informative of the functional effectiveness of the motor response. The functional HIT (fHIT) is based on the ability to recognize the orientation of a Landolt C optotype that briefly appears on a computer screen during passive head impulses imposed by the examiner over a range of head accelerations; accordingly fHIT is a functional measurement of the vestibular-ocular reflex since it measures the capability to keep clear vision and to read during head movement. METHODS We compared the results of the fHIT with those of the vHIT and the results of the Dizziness Handicap Inventory (DHI) questionnaire in a group of 27 vestibular neuritis patients recorded acutely and at 3-months follow-up. RESULTS Both the vHIT and fHIT exams correctly classified all patients as abnormal on the affected side when tested in the acute phase. After a 3-month follow-up, both were able to show that compensation phenomena had occurred. Otherwise the data from the two techniques were not correlated. More specifically, the fHIT detected more abnormalities than the vHIT, for head rotation toward the healthy side, both in the acute phase and after 3 months, and for head rotation toward the affected side after 3 months. The asymmetry indices, that compare the performance of the healthy to the affected side, also were larger for the fHIT than for the vHIT both at onset and after 3 months. There was no significant correlation between the different vHIT and fHIT parameters and indices, or with the DHI values after 3 months. CONCLUSIONS The fHIT data are able to detect a difference between the healthy and the affected side in the acute phase, and they show an improvement after 3 months. fHIT detects more abnormalities than vHIT, but both these techniques lack a correlation with the DHI score.
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Affiliation(s)
- Maurizio Versino
- Neurology Unit, ASST Settelaghi-Insubria University-DMC, Varese, Italy; Neuro-Otology and Neuro-Ophthalmology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
| | - Silvia Colnaghi
- Neuro-Otology and Neuro-Ophthalmology Laboratory, IRCCS Mondino Foundation, Pavia, Italy; Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.
| | - Giulia Corallo
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Siena, Siena, Italy
| | - Marco Mandalà
- Department of Otology and Skull Base Surgery, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Stefano Ramat
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
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19
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Romano F, Bertolini G, Agostino D, Straumann D, Ramat S, Feddermann-Demont N. Functional Head Impulse Test in Professional Athletes: Sport-Specific Normative Values and Implication for Sport-Related Concussion. Front Neurol 2019; 10:387. [PMID: 31130909 PMCID: PMC6509415 DOI: 10.3389/fneur.2019.00387] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 03/29/2019] [Indexed: 02/05/2023] Open
Abstract
Dizziness, slow visual tracking, or blurred vision following active head (or body) movements are among the most common symptoms reported following sport-related concussion, often related to concurrent dysfunctions of the vestibular system. In some cases, symptoms persist even if bedside and auxiliary standard vestibular tests are unremarkable. New functional tests have been developed in recent years to objectify neurological alterations that are not captured by standard tests. The functional head impulse test (fHIT) requires the patient to recognize an optotype that is briefly flashed during head rotations with various angular accelerations (2,001–6,000 deg/s2) and assesses the proportion if correct answers (pca). 268 active professional athletes (23.70 ± 5.32y) from six different sports were tested using fHIT. Pca were analyzed both pooling head acceleration in the range of 2,001–6,000 deg/s2 and computing a single pca value for each 1,000 deg/s2 bin in the range 2,001–8,000 deg/s2. No significant difference (p = 0.159) was found between responses to head impulses in the plane of horizontal (pca: 0.977) and vertical semicircular canals (pca: 0.97). The sport practiced had a major effect on the outcome of the fHIT. Handball players achieved a better performance (p < 0.001) than the whole athlete group, irrespective of the direction of head impulses. The pca achieved by athletes practicing snowboard, bob and skeleton were instead significantly below those of the whole athlete group (p < 0.001) but only when vertical head impulses were tested. Overall, pca declined with increasing head acceleration. The decline was particularly evident in the range not included in the standard fHIT exam, i.e., 6,001–8,000 deg/s2 for horizontal and 5,001–8,000 deg/s2 for vertical head impulses. When vertical head impulses were tested, athletes practicing snowboard, bob and skeleton (non-ball sports) showed, beside the lower overall pca, also a steeper decline as a function of vertical head acceleration. The findings suggest that: (1) functional VOR testing can help understanding sport-specific VOR requirements; (2) the fHIT is able to detect and objectify subtle, sport-specific changes of functional VOR performance; (3) if sport-specific normative values are used, the fHIT test procedure needs to be optimized, starting from the highest acceleration to minimize the number of head impulses.
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Affiliation(s)
- Fausto Romano
- Department of Neurology, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital of Zürich, Zurich, Switzerland.,Swiss Concussion Center, Zurich, Switzerland
| | - Giovanni Bertolini
- Department of Neurology, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital of Zürich, Zurich, Switzerland.,Swiss Concussion Center, Zurich, Switzerland
| | | | - Dominik Straumann
- Department of Neurology, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital of Zürich, Zurich, Switzerland.,Swiss Concussion Center, Zurich, Switzerland
| | - Stefano Ramat
- Department of Computer, Electric and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Nina Feddermann-Demont
- Department of Neurology, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital of Zürich, Zurich, Switzerland.,Swiss Concussion Center, Zurich, Switzerland
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20
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van Dooren TS, Lucieer FMP, Duijn S, Janssen AML, Guinand N, Pérez Fornos A, Van Rompaey V, Kingma H, Ramat S, van de Berg R. The Functional Head Impulse Test to Assess Oscillopsia in Bilateral Vestibulopathy. Front Neurol 2019; 10:365. [PMID: 31105632 PMCID: PMC6499172 DOI: 10.3389/fneur.2019.00365] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 03/25/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction: Bilateral vestibulopathy (BV) is a chronic condition in which vestibular function is severely impaired or absent on both ears. Oscillopsia is one of the main symptoms of BV. Oscillopsia can be quantified objectively by functional vestibular tests, and subjectively by questionnaires. Recently, a new technique for testing functionally effective gaze stabilization was developed: the functional Head Impulse Test (fHIT). This study compared the fHIT with the Dynamic Visual Acuity assessed on a treadmill (DVAtreadmill) and Oscillopsia Severity Questionnaire (OSQ) in the context of objectifying the experience of oscillopsia in patients with BV. Methods: Inclusion criteria comprised: (1) summated slow phase velocity of nystagmus of <20°/s during bithermal caloric tests, (2) torsion swing tests gain of <30% and/or phase <168°, and (3) complaints of oscillopsia and/or imbalance. During the fHIT (Beon Solutions srl, Italy) patients were seated in front of a computer screen. During a passive horizontal head impulse a Landolt C optotype was shortly displayed. Patients reported the seen optotype by pressing the corresponding button on a keyboard. The percentage correct answers was registered for leftwards and rightwards head impulses separately. During DVAtreadmill patients were positioned on a treadmill in front of a computer screen that showed Sloan optotypes. Patients were tested in static condition and in dynamic conditions (while walking on the treadmill at 2, 4, and 6 km/h). The decline in LogMAR between static and dynamic conditions was registered for each speed. Every patient completed the Oscillopsia Severity Questionnaire (OSQ). Results: In total 23 patients were included. This study showed a moderate correlation between OSQ outcomes and the fHIT [rightwards head rotations (rs = −0.559; p = 0.006) leftwards head rotations (rs = −0.396; p = 0.061)]. No correlation was found between OSQ outcomes and DVAtreadmill, or between DVAtreadmill and fHIT. All patients completed the fHIT, 52% of the patients completed the DVAtreadmill on all speeds. Conclusion: The fHIT seems to be a feasible test to quantify oscillopsia in BV since, unlike DVAtreadmill, it correlates with the experienced oscillopsia measured by the OSQ, and more BV patients are able to complete the fHIT than DVAtreadmill.
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Affiliation(s)
- T S van Dooren
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - F M P Lucieer
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - S Duijn
- Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, Netherlands
| | - A M L Janssen
- Department of ENT/Audiology, School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Centre, Maastricht, Netherlands.,Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - N Guinand
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, Netherlands.,Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - A Pérez Fornos
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - V Van Rompaey
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - H Kingma
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, Netherlands.,Faculty of Physics, Tomsk State Research University, Tomsk, Russia
| | - S Ramat
- Department of Computer, Electric and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - R van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, Netherlands.,Faculty of Physics, Tomsk State Research University, Tomsk, Russia
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21
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Ramaioli C, Cuturi LF, Ramat S, Lehnen N, MacNeilage PR. Vestibulo-Ocular Responses and Dynamic Visual Acuity During Horizontal Rotation and Translation. Front Neurol 2019; 10:321. [PMID: 31024422 PMCID: PMC6467074 DOI: 10.3389/fneur.2019.00321] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 03/14/2019] [Indexed: 11/13/2022] Open
Abstract
Dynamic visual acuity (DVA) provides an overall functional measure of visual stabilization performance that depends on the vestibulo-ocular reflex (VOR), but also on other processes, including catch-up saccades and likely visual motion processing. Capturing the efficiency of gaze stabilization against head movement as a whole, it is potentially valuable in the clinical context where assessment of overall patient performance provides an important indication of factors impacting patient participation and quality of life. DVA during head rotation (rDVA) has been assessed previously, but to our knowledge, DVA during horizontal translation (tDVA) has not been measured. tDVA can provide a valuable measure of how otolith, rather than canal, function impacts visual acuity. In addition, comparison of DVA during rotation and translation can shed light on whether common factors are limiting DVA performance in both cases. We therefore measured and compared DVA during both passive head rotations (head impulse test) and translations in the same set of healthy subjects (n = 7). In addition to DVA, we computed average VOR gain and retinal slip within and across subjects. We observed that during translation, VOR gain was reduced (VOR during rotation, mean ± SD: position gain = 1.05 ± 0.04, velocity gain = 0.97 ± 0.07; VOR during translation, mean ± SD: position gain = 0.21 ± 0.08, velocity gain = 0.51 ± 0.16), retinal slip was increased, and tDVA was worse than during rotation (average rDVA = 0.32 ± 0.15 logMAR; average tDVA = 0.56 ± 0.09 logMAR, p = 0.02). This suggests that reduced VOR gain leads to worse tDVA, as expected. We conclude with speculation about non-oculomotor factors that could vary across individuals and affect performance similarly during both rotation and translation.
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Affiliation(s)
- Cecilia Ramaioli
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Munich, Germany.,Institute of Medical Technology, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Luigi F Cuturi
- Unit for Visually Impaired People, Italian Institute of Technology, Genoa, Italy
| | - Stefano Ramat
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Nadine Lehnen
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Munich, Germany.,Institute of Medical Technology, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Paul R MacNeilage
- Department of Psychology, Cognitive and Brain Sciences, University of Nevada, Reno, NV, United States
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22
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Lehnen N, Kellerer S, Knorr AG, Schlick C, Jahn K, Schneider E, Heuberger M, Ramaioli C. Head-Movement-Emphasized Rehabilitation in Bilateral Vestibulopathy. Front Neurol 2018; 9:562. [PMID: 30065695 PMCID: PMC6057116 DOI: 10.3389/fneur.2018.00562] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 06/22/2018] [Indexed: 11/13/2022] Open
Abstract
Objective: Although there is evidence that vestibular rehabilitation is useful for treating chronic bilateral vestibular hypofunction (BVH), the mechanisms for improvement, and the reasons why only some patients improve are still unclear. Clinical rehabilitation results and evidence fromeye-head control in vestibular deficiency suggest that headmovement is a crucial element of vestibular rehabilitation. In this study, we assess the effects of a specifically designed head-movement-based rehabilitation program on dynamic vision, and explore underlying mechanisms. Methods: Two adult patients (patients 1 and 2) with chronic BVH underwent two 4-week interventions: (1) head-movement-emphasized rehabilitation (HME) with exercises based on active head movements, and (2) eye-movement-only rehabilitation (EMO), a control intervention with sham exercises without head movement. In a double-blind crossover design, the patients were randomized to first undergo EMO (patient 1) and–after a 4-week washout–HME, and vice-versa (patient 2). Before each intervention and after a 4-week follow-up patients’ dynamic vision, vestibulo-ocular reflex (VOR) gain, as well as re-fixation saccade behavior during passive headmotion were assessed with the head impulse testing device–functional test (HITD-FT). Results: HME, not EMO, markedly improved perception with dynamic vision during passive head motion (HITD-FT score) increasing from 0 to 60% (patient 1) and 75% (patient 2). There was a combination of enhanced VOR, as well as improved saccadic compensation. Conclusion: Head movement seems to be an important element of rehabilitation for BVH. It improves dynamic vision with a combined VOR and compensatory saccade enhancement.
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Affiliation(s)
- Nadine Lehnen
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar,Technical University of Munich, Munich, Germany.,German Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, Germany.,Institute of Medical Technology, Brandenburgische Technische Universität, Cottbus, Germany
| | - Silvy Kellerer
- German Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, Germany
| | - Alexander G Knorr
- Center for Sensorimotor Research, Ludwig Maximilians University, Munich, Germany.,Department of Electrical and Computer Engineering, Institute for Cognitive Systems, Technical University of Munich, Munich, Germany
| | - Cornelia Schlick
- German Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, Germany
| | - Klaus Jahn
- German Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, Germany.,Department of Neurology,Schoen Clinic Bad Aibling, Bad Aibling, Germany
| | - Erich Schneider
- Institute of Medical Technology, Brandenburgische Technische Universität, Cottbus, Germany
| | - Maria Heuberger
- German Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, Germany.,Department of Neurology, Ludwig Maximilians University, Munich, Germany
| | - Cecilia Ramaioli
- German Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, Germany.,Institute of Medical Technology, Brandenburgische Technische Universität, Cottbus, Germany
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23
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Hermann R, Ionescu EC, Dumas O, Tringali S, Truy E, Tilikete C. Bilateral Vestibulopathy: Vestibular Function, Dynamic Visual Acuity and Functional Impact. Front Neurol 2018; 9:555. [PMID: 30042725 PMCID: PMC6048872 DOI: 10.3389/fneur.2018.00555] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 06/20/2018] [Indexed: 11/16/2022] Open
Abstract
Introduction: Patients suffering from bilateral vestibular hypofunction (BVH) often experience ataxia as well as visual instability. Even though progress has been made in vestibular testing, insights regarding vestibular deficit in BVH remain incomplete since no method allows evaluation of frequency ranges of vestibular sensors in a continuous way. The aim of our study was to give a detailed description of the level of vestibular deficit in different ranges of vestibular stimulation and an exhaustive evaluation of the functional impact including dynamic visual acuity (DVA) in a cohort of BVH patients in different etiologies. Methods: We prospectively included 20 patients with chronic BVH. All patients underwent clinical evaluation and functional assessment including evaluation of their symptoms related to BVH, quality of life questionnaire and DVA in the horizontal and vertical plane. Patients underwent vestibulo-ocular reflex (VOR) testing using rotatory chair, caloric stimulation and video head impulse (vHIT) in the plane of the 6 canals, and cervical and ocular Vestibular evoked myogenic potentials. Results: Mean rotatory VOR gain was 0.07 (SD = 0.07). Mean rotatory VOR gain during vHIT for the lateral, anterior and posterior canals was respectively < 0.28, < 0.34, and < 0.20. Mean loss of DVA in the 4 directions was >0.30 LogMAR. In our population fall frequency was significantly higher in patients with lower UniPedal Stance Test (UPST), higher Dizziness Handicap Inventory and Ataxia Numeric Scale (ANS) scores, as well as greater loss of upwards DVA. Patients with ototoxic BVH had a significantly higher residual VOR gain during vHIT in the anterior canal plane and lower DHI than other patients. In the general population anterior canal function was significantly higher than lateral or posterior canal function. Conclusions: This study gives extensive descriptive results of residual vestibular function, DVA and quality of life in a population of patients suffering from severe BVH. UPST and ANS are good indicators for fall risk in case of BVH. Gentamicin induced BVH seems to have a lesser impact on quality of life than other etiologies.Anterior semi-circular canal function seems less deteriorated than lateral and posterior function.
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Affiliation(s)
- Ruben Hermann
- ENT and Cervico-Facial Surgery Department, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, Equipe IMPACT, Lyon, France.,University Lyon 1, Lyon, France
| | - Eugen C Ionescu
- Department of Audiology and Otoneurological Evaluation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Olivier Dumas
- Société Française de Kinésithérapie Vestibulaire, Lyon, France
| | - Stephane Tringali
- University Lyon 1, Lyon, France.,Department of Otology and Otoneurology, Hôpital Lyon Sud, Hospice Civils de Lyon, Lyon, France
| | - Eric Truy
- ENT and Cervico-Facial Surgery Department, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, Equipe IMPACT, Lyon, France.,University Lyon 1, Lyon, France
| | - Caroline Tilikete
- INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, Equipe IMPACT, Lyon, France.,University Lyon 1, Lyon, France.,Neuro-Ophthalmology Unit, Hopital Neurologique et Neurochirurgical P Wertheimer, Hospices Civils de Lyon, Lyon, France
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24
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Bilateral vestibular impairment in Vogt Koyanagi Harada syndrome: a case report. Neurol Sci 2018; 39:1609-1611. [PMID: 29654419 DOI: 10.1007/s10072-018-3410-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 04/06/2018] [Indexed: 10/17/2022]
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25
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Consensus Paper: Neurophysiological Assessments of Ataxias in Daily Practice. THE CEREBELLUM 2018; 17:628-653. [DOI: 10.1007/s12311-018-0937-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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26
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Anson ER, Gimmon Y, Kiemel T, Jeka JJ, Carey JP. A Tool to Quantify the Functional Impact of Oscillopsia. Front Neurol 2018; 9:142. [PMID: 29599743 PMCID: PMC5862789 DOI: 10.3389/fneur.2018.00142] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 02/26/2018] [Indexed: 11/13/2022] Open
Abstract
Background Individuals with bilateral vestibular hypofunction (BVH) often report symptoms of oscillopsia during walking. Existing assessments of oscillopsia are limited to descriptions of severity and symptom frequency, neither of which provides a description of functional limitations attributed to oscillopsia. A novel questionnaire, the Oscillopsia Functional Impact scale (OFI) was developed to describe the impact of oscillopsia on daily life activities. Questions on the OFI ask how often individuals are able to execute specific activities considered to depend on gaze stability in an effort to link functional mobility impairments to oscillopsia for individuals with vestibular loss. Methods Subjective reports of oscillopsia and balance confidence were recorded for 21 individuals with BVH and 48 healthy controls. Spearman correlation coefficients were calculated to determine the relationship between the OFI and oscillopsia visual analog scale (OS VAS), oscillopsia severity questionnaire (OSQ), and Activities-Specific Balance Confidence scale to demonstrate face validity. Chronbach’s α was calculated to determine internal validity for the items of the OFI. A one-way MANOVA was conducted with planned post hoc paired t-tests for group differences on all oscillopsia questionnaires using a corrected α = 0.0125. Results The OFI was highly correlated with measures of oscillopsia severity (OS VAS; r = 0.69, p < 0.001) and frequency (OSQ; r = 0.84, p < 0.001) and also with the Activities-Specific Balance Confidence scale (r = −0.84, p < 0.001). Cronbach’s α for the OFI was 0.97. Individuals with BVH scored worse on all measures of oscillopsia and balance confidence compared to healthy individuals (p’s < 0.001). Conclusion The OFI appears to capture the construct of oscillopsia in the context of functional mobility. Combining with oscillopsia metrics that quantify severity and frequency allows for a more complete characterization of the impact of oscillopsia on an individual’s daily behavior. The OFI discriminated individuals with BVH from healthy individuals.
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Affiliation(s)
- Eric R Anson
- Department of Otolaryngology Head and Neck Surgery and the David M. Rubinstein Hearing Center, Johns Hopkins Medical Institutes, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Otolaryngology, University of Rochester, Rochester, NY, United States
| | - Yoav Gimmon
- Department of Otolaryngology Head and Neck Surgery and the David M. Rubinstein Hearing Center, Johns Hopkins Medical Institutes, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Tim Kiemel
- Kinesiology Department, University of Maryland, College Park, College Park, MD, United States
| | - John J Jeka
- Kinesiology Department, University of Delaware, Newark, DE, United States
| | - John P Carey
- Department of Otolaryngology Head and Neck Surgery and the David M. Rubinstein Hearing Center, Johns Hopkins Medical Institutes, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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27
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Colnaghi S, Rezzani C, Gnesi M, Manfrin M, Quaglieri S, Nuti D, Mandalà M, Monti MC, Versino M. Validation of the Italian Version of the Dizziness Handicap Inventory, the Situational Vertigo Questionnaire, and the Activity-Specific Balance Confidence Scale for Peripheral and Central Vestibular Symptoms. Front Neurol 2017; 8:528. [PMID: 29066999 PMCID: PMC5641311 DOI: 10.3389/fneur.2017.00528] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 09/22/2017] [Indexed: 11/24/2022] Open
Abstract
Neurophysiological measurements of the vestibular function for diagnosis and follow-up evaluations provide an objective assessment, which, unfortunately, does not necessarily correlate with the patients' self-feeling. The literature provides many questionnaires to assess the outcome of rehabilitation programs for disequilibrium, but only for the Dizziness Handicap Inventory (DHI) is an Italian translation available, validated on a small group of patients suffering from a peripheral acute vertigo. We translated and validated the reliability and validity of the DHI, the Situational Vertigo Questionnaire (SVQ), and the Activities-Specific Balance Confidence Scale (ABC) in 316 Italian patients complaining of dizziness due either to a peripheral or to a central vestibular deficit, or in whom vestibular signs were undetectable by means of instrumental testing or clinical evaluation. Cronbach's coefficient alpha, the homogeneity index, and test-retest reproducibility, confirmed reliability of the Italian version of the three questionnaires. Validity was confirmed by correlation test between questionnaire scores. Correlations with clinical variables suggested that they can be used as a complementary tool for the assessment of vestibular symptoms. In conclusion, the Italian versions of DHI, SVQ, and ABC are reliable and valid questionnaires for assessing the impact of dizziness on the quality of life of Italian patients with peripheral or central vestibular deficit.
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Affiliation(s)
- Silvia Colnaghi
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
- Laboratory of Neuro-otology and Neuro-ophthalmology, C. Mondino National Neurological Institute, Pavia, Italy
| | - Cristiana Rezzani
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Marco Gnesi
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Marco Manfrin
- ENT Unit, Policlinico San Matteo Fondazione (IRCCS), Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Silvia Quaglieri
- ENT Unit, Policlinico San Matteo Fondazione (IRCCS), Pavia, Italy
| | - Daniele Nuti
- Department of Otology and Skull Base, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Marco Mandalà
- Department of Otology and Skull Base, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Maria Cristina Monti
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Maurizio Versino
- Laboratory of Neuro-otology and Neuro-ophthalmology, C. Mondino National Neurological Institute, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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28
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Colagiorgio P, Versino M, Colnaghi S, Quaglieri S, Manfrin M, Zamaro E, Mantokoudis G, Zee DS, Ramat S. New insights into vestibular-saccade interaction based on covert corrective saccades in patients with unilateral vestibular deficits. J Neurophysiol 2017; 117:2324-2338. [PMID: 28404827 DOI: 10.1152/jn.00864.2016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 04/10/2017] [Accepted: 04/10/2017] [Indexed: 11/22/2022] Open
Abstract
In response to passive high-acceleration head impulses, patients with low vestibulo-ocular reflex (VOR) gains often produce covert (executed while the head is still moving) corrective saccades in the direction of deficient slow phases. Here we examined 23 patients using passive, and 9 also active, head impulses with acute (< 10 days from onset) unilateral vestibular neuritis and low VOR gains. We found that when corrective saccades are larger than 10°, the slow-phase component of the VOR is inhibited, even though inhibition increases further the time to reacquire the fixation target. We also found that 1) saccades are faster and more accurate if the residual VOR gain is higher, 2) saccades also compensate for the head displacement that occurs during the saccade, and 3) the amplitude-peak velocity relationship of the larger corrective saccades deviates from that of head-fixed saccades of the same size. We propose a mathematical model to account for these findings hypothesizing that covert saccades are driven by a desired gaze position signal based on a prediction of head displacement using vestibular and extravestibular signals, covert saccades are controlled by a gaze feedback loop, and the VOR command is modulated according to predicted saccade amplitude. A central and novel feature of the model is that the brain develops two separate estimates of head rotation, one for generating saccades while the head is moving and the other for generating slow phases. Furthermore, while the model was developed for gaze-stabilizing behavior during passively induced head impulses, it also simulates both active gaze-stabilizing and active gaze-shifting eye movements.NEW & NOTEWORTHY During active or passive head impulses while fixating stationary targets, low vestibulo-ocular gain subjects produce corrective saccades when the head is still moving. The mechanisms driving these covert saccades are poorly understood. We propose a mathematical model showing that the brain develops two separate estimates of head rotation: a lower level one, presumably in the vestibular nuclei, used to generate the slow-phase component of the response, and a higher level one, within a gaze feedback loop, used to drive corrective saccades.
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Affiliation(s)
- Paolo Colagiorgio
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Maurizio Versino
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Laboratory of Neuro-otology and Neuro-ophthalmology, C. Mondino National Neurological Institute, Pavia, Italy
| | - Silvia Colnaghi
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.,Inter-Department Multiple Sclerosis Research Centre, C. Mondino National Neurological Institute, Pavia, Italy
| | - Silvia Quaglieri
- UOC Otorinolaringoiatria, Fondazione IRCCS San Matteo and University of Pavia, Pavia, Italy
| | - Marco Manfrin
- UOC Otorinolaringoiatria, Fondazione IRCCS San Matteo and University of Pavia, Pavia, Italy
| | - Ewa Zamaro
- Department of Otorhinolaryngology, Head and Neck Surgery, lnselspital, Bern University Hospital, University of Bern, Bern, Switzerland; and
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, lnselspital, Bern University Hospital, University of Bern, Bern, Switzerland; and
| | - David S Zee
- Department of Neurology, Otolaryngology-Head and Neck Surgery, Neuroscience, Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stefano Ramat
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy;
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29
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Colagiorgio P, Bertolini G, Bockisch CJ, Straumann D, Ramat S. Multiple timescales in the adaptation of the rotational VOR. J Neurophysiol 2015; 113:3130-42. [PMID: 25744882 DOI: 10.1152/jn.00688.2014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 02/27/2015] [Indexed: 11/22/2022] Open
Abstract
Goal-directed movements, such as pointing and saccades, have been shown to share similar neural architectures, in spite of the different neuromuscular systems producing them. Such structure involve an inverse model of the actuator being controlled, which produces the commands innervating the muscles, and a forward model of the actuator, which predicts the sensory consequences of such commands and allows online movement corrections. Recent studies have shown that goal-directed movements also share similar motor-learning and motor-memory mechanisms, which are based on multiple timescales. The hypothesis that also the rotational vestibulo-ocular reflex (rVOR) may be based on a similar architecture has been presented recently. We hypothesize that multiple timescales are the brain's solution to the plasticity-stability dilemma, allowing adaptation to temporary and sudden changes while keeping stable motor-control abilities. If that were the case, then we would also expect the adaptation of reflex movements to follow the same principles. Thus we studied rVOR gain adaptation in eight healthy human subjects using a custom paradigm aimed at investigating the existence of spontaneous recovery, which we considered as the hallmark of multiple timescales in motor learning. Our experimental results show that spontaneous recovery occurred in six of eight subjects. Thus we developed a mathematical model of rVOR adaptation based on two hidden-states processes, which adapts the cerebellar-forward model of the ocular motor plant, and show that it accurately simulates our experimental data on rVOR gain adaptation, whereas a single timescale learning process fails to do so.
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Affiliation(s)
- Paolo Colagiorgio
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Giovanni Bertolini
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy; Department of Neurology, University Hospital Zurich, Zurich, Switzerland; and
| | - Christopher J Bockisch
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland; and Departments of Ophthalmology and Otorhinolaryngology, University Hospital Zurich, Zurich, Switzerland
| | - Dominik Straumann
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland; and
| | - Stefano Ramat
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy;
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30
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Ramaioli C, Colagiorgio P, Sağlam M, Heuser F, Schneider E, Ramat S, Lehnen N. The effect of vestibulo-ocular reflex deficits and covert saccades on dynamic vision in opioid-induced vestibular dysfunction. PLoS One 2014; 9:e110322. [PMID: 25329150 PMCID: PMC4203781 DOI: 10.1371/journal.pone.0110322] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 09/21/2014] [Indexed: 11/18/2022] Open
Abstract
Patients with bilateral vestibular dysfunction cannot fully compensate passive head rotations with eye movements, and experience disturbing oscillopsia. To compensate for the deficient vestibulo-ocular reflex (VOR), they have to rely on re-fixation saccades. Some can trigger “covert” saccades while the head still moves; others only initiate saccades afterwards. Due to their shorter latency, it has been hypothesized that covert saccades are particularly beneficial to improve dynamic visual acuity, reducing oscillopsia. Here, we investigate the combined effect of covert saccades and the VOR on clear vision, using the Head Impulse Testing Device – Functional Test (HITD-FT), which quantifies reading ability during passive high-acceleration head movements. To reversibly decrease VOR function, fourteen healthy men (median age 26 years, range 21–31) were continuously administrated the opioid remifentanil intravenously (0.15 µg/kg/min). VOR gain was assessed with the video head-impulse test, functional performance (i.e. reading) with the HITD-FT. Before opioid application, VOR and dynamic reading were intact (head-impulse gain: 0.87±0.08, mean±SD; HITD-FT rate of correct answers: 90±9%). Remifentanil induced impairment in dynamic reading (HITD-FT 26±15%) in 12/14 subjects, with transient bilateral vestibular dysfunction (head-impulse gain 0.63±0.19). HITD-FT score correlated with head-impulse gain (R = 0.63, p = 0.03) and with gain difference (before/with remifentanil, R = −0.64, p = 0.02). One subject had a non-pathological head-impulse gain (0.82±0.03) and a high HITD-FT score (92%). One subject triggered covert saccades in 60% of the head movements and could read during passive head movements (HITD-FT 93%) despite a pathological head-impulse gain (0.59±0.03) whereas none of the 12 subjects without covert saccades reached such high performance. In summary, early catch-up saccades may improve dynamic visual function. HITD-FT is an appropriate method to assess the combined gaze stabilization effect of both VOR and covert saccades (overall dynamic vision), e.g., to document performance and progress during vestibular rehabilitation.
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Affiliation(s)
- Cecilia Ramaioli
- German Center for Vertigo and Balance Disorders, Munich University Hospital, Munich, Germany
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
- * E-mail:
| | - Paolo Colagiorgio
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Murat Sağlam
- German Center for Vertigo and Balance Disorders, Munich University Hospital, Munich, Germany
| | - Fabian Heuser
- Department of Anesthesiology, Klinikum rechts der Isar, TU Munich, Munich, Germany
| | - Erich Schneider
- German Center for Vertigo and Balance Disorders, Munich University Hospital, Munich, Germany
- Clinical Neurosciences, Munich University Hospital, Munich, Germany
- Brandenburg University of Technology, Cottbus-Senftenberg, Germany
| | - Stefano Ramat
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Nadine Lehnen
- German Center for Vertigo and Balance Disorders, Munich University Hospital, Munich, Germany
- Department of Neurology, Munich University Hospital, Munich, Germany
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