Functional and anatomical correlates of impaired velocity storage

Normative data for rotational chair considering motion susceptibility

Objective

Rotational Chair Test (RCT) is considered one of the most critical measures for vestibular functionality, which generally includes the sinusoidal harmonic acceleration test (SHAT), velocity step test (VST), and visual suppression (VS). The purpose of this study was to establish normal values for different age groups on the RCT and investigate whether motion susceptibility, such as with a history of motion sickness or migraine, has any effects on test metrics.

Methods

One hundred and nine subjects aged from 20 to 59 years who were free from neurotological and vestibular disorders were enrolled. According to the history of motion sickness or migraine, participants were divided into four groups: the motion sickness (MS) group (n = 13), the migraine group (n = 8), comorbidity group (n = 11), and the control group (n = 77). The 77 subjects without any history of MS and migraine were then further separated into four age groups: youth group (20–29 years), young and middle-aged group (30–39 years), middle-age group (40–49 years), and middle-age and elderly group (50–59 years). All participants underwent SHAT, VST, and VS, and a comprehensive set of metrics including gain, phase, asymmetry, time constant (TC), and Fixation Index were recorded.

Results

Regarding the VST and VS, no significant differences were observed either across the four groups (MS, migraine, comorbidity, and control group) or four age categories within the control group. For SHAT, VOR gain at the frequency of 0.01 Hz, VOR phase from 0.08 to 0.64 Hz, and asymmetry at 0.01, 0.16, and 0.64 Hz indicated significant differences among various age groups (P < 0.05 for all comparisons). The VOR phase lead was lower in the migraine and comorbidity group than that in the control group at 0.64 Hz (P = 0.027, P = 0.003, respectively).

Conclusions

Age slightly affects the result of SHAT, but not for VST and VS. VOR gain is more susceptible to aging at low frequency, while the phase is opposite. Subjects with both migraine and motion sickness show abnormal velocity storage mechanisms. Phase bias should be considered when assessing motion susceptibility with the RCT. SHAT is more sensitive than VST in terms of reflecting motion susceptibility.

Reduced Gain and Shortened Time Constant of Vestibular Velocity Storage as a Source of Balance and Movement Sensitivities in Gravitational Insecurity

Gravitational insecurity (GrI) involves lifetime movement and balance concerns whose pathophysiological origins are unclear. We tested whether balance symptoms in mild GrI might involve anomalies in vestibular velocity storage (VVS), a brainstem/cerebellar circuit that amplifies gain and prolongs the persistence of weak vestibular signals from small/slow head movements. A Provisional Gravitational Insecurity Index (PGrI) was developed, evaluated for psychometrics/demographics, and used to identify otherwise healthy adults with life-long balance challenges as well as sex, age, and ethnicity-matched comparison adults without such challenges. Balance confidence, sensory hypersensitivities, spatial orientation, anxiety, and hearing loss were self-reported. Standing balance under visual/proprioceptive restrictions and perrotary vestibulo-ocular nystagmus were evaluated. The PGrI showed approximated test-retest reliability and convergent and discriminant validity. When only vestibular input was available, mild GrI participants on a tilting platform used effortful hip strategies for balance significantly more than did comparison participants. Rotation testing revealed that mild GrI participants had significantly less low frequency gain and shortened VVS persistence. Combined, these two parameters correlated significantly with PGrI. The PGrI also correlated with problematic spatial orientation, but surprisingly, not to anxiety. Balance/movement issues in GrI are likely due to VVS deficiencies. Additional mechanisms may account for other GrI symptoms. Better understanding of GrI’s pathophysiological basis will be useful in informing the larger health-provider community about this condition.

Measuring Vestibular Contributions to Age-Related Balance Impairment: A Review

Aging is associated with progressive declines in both the vestibular and human balance systems. While vestibular lesions certainly contribute to imbalance, the specific contributions of age-related vestibular declines to age-related balance impairment is poorly understood. This gap in knowledge results from the absence of a standardized method for measuring age-related changes to the vestibular balance pathways. The purpose of this manuscript is to provide an overview of the existing body of literature as it pertains to the methods currently used to infer vestibular contributions to age-related imbalance.

Vestibular impact of Friedreich ataxia in early onset patients

Background

Friedreich ataxia (FRDA) is the most frequent form of inherited ataxias. Vestibular and auditory assessments are not commonly part of the check up for these patients despite hearing and balance complaints. Screening of vestibular and auditory function was performed in a large group of young patients with genetically confirmed FRDA.

Methods

Our study included 43 patients (7–24 years of age). A complete vestibular assessment was performed including the canals function evaluation at 3 head velocities (bithermal caloric test, earth vertical axis rotation (EVAR) and head impulse test (HIT)) and otolith function evaluation (cervical vestibular evoked myogenic potentials). Information regarding the hearing evaluation of the patients were also retrieved including impedance tympanometry, distortion product otoacoustic emissions (DPOAEs), air and bone conduction audiometry and auditory brainstem response (ABR).

Results

Vestibular responses were impaired for canal responses (only at high and middle head velocities) and vestibulospinal otolithic responses. Abnormal neural conduction in the central auditory pathways was frequently observed. Oculomotor abnormalities were frequent, mostly hypermetric saccades and gaze instability. Inhibition of the vestibulo-ocular reflex by fixation was normal.

Conclusions

We show that Friedreich ataxia, even at onset, frequently associate saccadic intrusions, abnormal ABRs and decreased vestibulo-ocular and vestibulospinal responses progressing over time. These sensory impairments combined with ataxia further impair patient’s autonomy. These vestibular, auditory and visual impairments could be used as markers of the severity and progression of the disease. Adding vestibular and auditory testing to Friedreich patient’s evaluation may help physicians improve patient’s management.

Aging of the Human Vestibular System

Aging affects every sensory system in the body, including the vestibular system. Although its impact is often difficult to quantify, the deleterious impact of aging on the vestibular system is serious both medically and economically. The deterioration of the vestibular sensory end organs has been known since the 1970s; however, the measurable impact from these anatomical changes remains elusive. Tests of vestibular function either fall short in their ability to quantify such anatomical deterioration, or they are insensitive to the associated physiologic decline and/or central compensatory mechanisms that accompany the vestibular aging process. When compared with healthy younger individuals, a paucity of subtle differences in test results has been reported in the healthy older population, and those differences are often observed only in response to nontraditional and/or more robust stimuli. In addition, the reported differences are often clinically insignificant insomuch that the recorded physiologic responses from the elderly often fall within the wide normative response ranges identified for normal healthy adults. The damaging economic impact of such vestibular sensory decline manifests itself in an exponential increase in geriatric dizziness and a subsequent higher prevalence of injurious falls. An estimated $10 to $20 billion dollar annual cost has been reported to be associated with falls-related injuries and is the sixth leading cause of death in the elderly population, with a 20% mortality rate. With an estimated 115% increase in the geriatric population over 65 years of age by the year 2050, the number of balanced-disordered patients with a declining vestibular system is certain to reach near epidemic proportions. An understanding of the effects of age on the vestibular system is imperative if clinicians are to better manage elderly patients with balance disorders, dizziness, and vestibular disease.