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Michael Strupp - One of the best experts on this subject based on the ideXlab platform.

  • Peripheral vestibular disorders: an update
    Current opinion in neurology, 2019
    Co-Authors: Michael Strupp, Marco Mandalà, Jose A. Lopez-escamez
    Abstract:

    Purpose of reviewTo provide an update on the most frequent peripheral vestibular disorders.Recent findingsThe on-going classification of vestibular disorders by the Barany Society represents major progress. The diagnosis of Bilateral Vestibulopathy (BVP) requires quantitative testing of vestibular f

  • Susceptibility to Fear of Heights in Bilateral Vestibulopathy and Other Disorders of Vertigo and Balance
    Frontiers Media S.A., 2018
    Co-Authors: Eva Grill, Doreen Huppert, Thomas Brandt, Michael Strupp
    Abstract:

    Aims: To determine the susceptibility to visual height intolerance (vHI) in patients with acquired Bilateral Vestibulopathy (BVP). The question was whether postural instability in BVP, which is partially compensated for by visual substitution of the impaired vestibular control of balance, leads to an increased susceptibility. This is of particular importance since fear of heights is dependent on body posture, and visual control of balance at heights can no longer substitute vestibular input. For comparison susceptibility to vHI was determined in patients with other vestibular or functional disorders.Methods: A total of 150 patients aged 18 or above who had been referred to the German Center for Vertigo and Balance Disorders and diagnosed to have BVP were surveyed with a standardized questionnaire by specifically trained neurological professionals. Further, 481 patients with other vestibular or functional disorders were included.Results: Susceptibility to vHI was reported by 29% (32 % in females, 25% in males) of the patients with BVP. Patients with vHI were slightly younger (67 vs. 71 years). Seventy percent of those with vHI reported avoidance of climbing, hiking, stairs, darkness, cycling or swimming (84% of those without vHI). Mean age for onset of vHI was 40 years. Susceptibility to vHI was higher in patients with other vertigo disorders than in those with BVP: 64% in those with phobic postural vertigo, 61% in vestibular migraine, 56% in vestibular paroxysmia, 54% in benign paroxysmal positional vertigo, 49% in unilateral Vestibulopathy and 48% in Menière's disease.Conclusions: The susceptibility to vHI in BVP was not higher than that of the general population (28%).This allows two explanations that need not be alternatives but contribute to each other: (1) Patients with a Bilateral peripheral vestibular deficit largely avoid exposure to heights because of their postural instability. (2) The irrational anxiety to fall from heights triggers increased susceptibility to vHI, not the objective postural instability. However, patients with BVP do not exhibit increased comorbid anxiety disorders. This view is supported by the significantly increased susceptibility to vHI in other vestibular syndromes, which are characterized by an increased comorbidity of anxiety disorders

  • susceptibility to fear of heights in Bilateral Vestibulopathy and other disorders of vertigo and balance
    Frontiers in Neurology, 2018
    Co-Authors: Thomas Brandt, Eva Grill, Michael Strupp, Doreen Huppert
    Abstract:

    Aims: To determine the susceptibility to visual height intolerance (vHI) in patients with acquired Bilateral Vestibulopathy (BVP). The question was whether postural instability in BVP, which is partially compensated for by visual substitution of the impaired vestibular control of balance, leads to an increased susceptibility. This is of particular importance since fear of heights is dependent on body posture, and visual control of balance at heights can no longer substitute vestibular input. For comparison susceptibility to vHI was determined in patients with other vestibular or functional disorders. Methods: A total of 150 patients aged 18 or above who had been referred to the German Center for Vertigo and Balance Disorders and diagnosed to have BVP were surveyed with a standardized questionnaire by specifically trained neurological professionals. Further, 481 patients with other vestibular or functional disorders were included. Results: Susceptibility to vHI was reported by 29% (32 % in females, 25% in males) of the patients with BVP. Patients with vHI were slightly younger (67 vs. 71 years). Seventy percent of those with vHI reported avoidance of climbing, hiking, stairs, darkness, cycling or swimming (84% of those without vHI). Mean age for onset of vHI was 40 years. Susceptibility to vHI was higher in patients with other vertigo disorders than in those with BVP: 64% in those with phobic postural vertigo, 61% in vestibular migraine, 56% in vestibular paroxysmia, 54% in benign paroxysmal positional vertigo, 49% in unilateral Vestibulopathy and 48% in Meniere's disease. Conclusions: The susceptibility to vHI in BVP was not higher than that of the general population (28%).This allows two explanations that need not be alternatives but contribute to each other: (1) Patients with a Bilateral peripheral vestibular deficit largely avoid exposure to heights because of their postural instability. (2) The irrational anxiety to fall from heights triggers increased susceptibility to vHI, not the objective postural instability. However, patients with BVP do not exhibit increased comorbid anxiety disorders. This view is supported by the significantly increased susceptibility to vHI in other vestibular syndromes, which are characterized by an increased comorbidity of anxiety disorders.

  • Comparison of the Bedside Head-Impulse Test with the Video Head-Impulse Test in a Clinical Practice Setting: A Prospective Study of 500 Outpatients
    Frontiers in neurology, 2016
    Co-Authors: Chun Wai Yip, Claudia Frenzel, M. Glaser, Otmar Bayer, Michael Strupp
    Abstract:

    Objectives: The primary aim was to determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the bedside head impulse test (bHIT) using the video HIT (vHIT) as the gold standard for quantifying the function of the vestibulo-ocular reflex (VOR). Secondary aims were to determine the bHIT inter-rater reliability, and sensitivity in detecting unilateral and Bilateral Vestibulopathy. Methods: In this prospective study, 500 consecutive outpatients presenting to a tertiary neuro-otology clinic with vertigo or dizziness of various vestibular etiologies who did not have any of the pre-defined exclusion criteria were recruited. Bedside HITs were done by three experienced neuro-otology clinicians masked to the diagnosis, and the results were compared with the vHIT. The patients were likewise blinded to the bHIT and vHIT findings. Patients with VOR deficits were identified on the vHIT by referencing to the pre-selected “pathological” gain of 40%, the bHIT sensitivity = 51.7% and 83%, respectively. For Bilateral Vestibulopathy, overall bHIT sensitivity = 66.3%, reaching 86.84% for severely reduced bidirectional gains. Conclusions: For the primary outcome, the bHIT had moderate sensitivity and low PPV. While the study did not elucidate the best choice for vHIT reference, it demonstrated how the bHIT test properties varied with vHIT thresholds: selecting a lower threshold improved the sensitivity but diminished the PPV, while a higher threshold had the opposite effect. The VOR was most likely normal if the bHIT was negative due to its high NPV. The bHIT was moderately sensitive for detecting unilateral and Bilateral Vestibulopathy overall, but better for certain subgroups.

  • Chapter 17 - Bilateral Vestibulopathy
    Handbook of clinical neurology, 2016
    Co-Authors: Michael Strupp, Marianne Dieterich, K. Feil, Thomas Brandt
    Abstract:

    The leading symptoms of Bilateral Vestibulopathy (BVP) are postural imbalance and unsteadiness of gait that worsens in darkness and on uneven ground. There are typically no symptoms while sitting or lying under static conditions. A minority of patients also have movement-induced oscillopsia, in particular while walking. The diagnosis of BVP is based on a Bilaterally reduced or absent function of the vestibulo-ocular reflex (VOR). This deficit is diagnosed for the high-frequency range of the angular VOR by a Bilaterally pathologic bedside head impulse test (HIT) and for the low-frequency range by a Bilaterally reduced or absent caloric response. If the results of the bedside HIT are unclear, angular VOR function should be quantified by a video-oculography system (vHIT). An additional test supporting the diagnosis is dynamic visual acuity. Cervical and ocular vestibular-evoked myogenic potentials (c/oVEMP) may also be reduced or absent, indicating impaired otolith function. There are different subtypes of BVP depending on the affected anatomic structure and frequency range of the VOR deficit: impaired canal function in the low- and/or high-frequency VOR range only and/or otolith function only; the latter is very rare. The etiology of BVP remains unclear in more than 50% of patients: in these cases neurodegeneration is assumed. Frequent known causes are ototoxicity mainly due to gentamicin, Bilateral Meniere's disease, autoimmune diseases, meningitis and Bilateral vestibular schwannoma, as well as an association with cerebellar degeneration (cerebellar ataxia, neuropathy, vestibular areflexia syndrome = CANVAS). In general, in the long term there is no improvement of vestibular function. There are four treatment options: first, detailed patient counseling to explain the cause, etiology, and consequences, as well as the course of the disease; second, daily vestibular exercises and balance training; third, if possible, treatment of the underlying cause, as in Bilateral Meniere's disease, meningitis, or autoimmune diseases; fourth, if possible, prevention, i.e., being very restrictive with the use of ototoxic substances, such as aminoglycosides. In the future vestibular implants may also be an option.

Thomas Brandt - One of the best experts on this subject based on the ideXlab platform.

  • Bilateral Vestibulopathy causes selective deficits in recombining novel routes in real space.
    Scientific reports, 2021
    Co-Authors: Florian Schöberl, Klaus Jahn, Cauchy Pradhan, M Grosch, Matthias Brendel, Florian Jostes, Katrin Obermaier, Chantal Sowa, Peter Bartenstein, Thomas Brandt
    Abstract:

    The differential impact of complete and incomplete Bilateral Vestibulopathy (BVP) on spatial orientation, visual exploration, and navigation-induced brain network activations is still under debate. In this study, 14 BVP patients (6 complete, 8 incomplete) and 14 age-matched healthy controls performed a navigation task requiring them to retrace familiar routes and recombine novel routes to find five items in real space. [18F]-fluorodeoxyglucose-PET was used to determine navigation-induced brain activations. Participants wore a gaze-controlled, head-fixed camera that recorded their visual exploration behaviour. Patients performed worse, when recombining novel routes (p 

  • Bilateral Vestibulopathy causes selective deficits in recombining novel routes in real space
    Scientific Reports, 2021
    Co-Authors: Florian Schöberl, Klaus Jahn, Cauchy Pradhan, M Grosch, Matthias Brendel, Florian Jostes, Katrin Obermaier, Chantal Sowa, Peter Bartenstein, Thomas Brandt
    Abstract:

    The differential impact of complete and incomplete Bilateral Vestibulopathy (BVP) on spatial orientation, visual exploration, and navigation-induced brain network activations is still under debate. In this study, 14 BVP patients (6 complete, 8 incomplete) and 14 age-matched healthy controls performed a navigation task requiring them to retrace familiar routes and recombine novel routes to find five items in real space. [18F]-fluorodeoxyglucose-PET was used to determine navigation-induced brain activations. Participants wore a gaze-controlled, head-fixed camera that recorded their visual exploration behaviour. Patients performed worse, when recombining novel routes (p < 0.001), whereas retracing of familiar routes was normal (p = 0.82). These deficits correlated with the severity of BVP. Patients exhibited higher gait fluctuations, spent less time at crossroads, and used a possible shortcut less often (p < 0.05). The right hippocampus and entorhinal cortex were less active and the Bilateral parahippocampal place area more active during navigation in patients. Complete BVP showed reduced activations in the pontine brainstem, anterior thalamus, posterior insular, and retrosplenial cortex compared to incomplete BVP. The navigation-induced brain activation pattern in BVP is compatible with deficits in creating a mental representation of a novel environment. Residual vestibular function allows recruitment of brain areas involved in head direction signalling to support navigation.

  • susceptibility to fear of heights in Bilateral Vestibulopathy and other disorders of vertigo and balance
    Frontiers in Neurology, 2018
    Co-Authors: Thomas Brandt, Eva Grill, Michael Strupp, Doreen Huppert
    Abstract:

    Aims: To determine the susceptibility to visual height intolerance (vHI) in patients with acquired Bilateral Vestibulopathy (BVP). The question was whether postural instability in BVP, which is partially compensated for by visual substitution of the impaired vestibular control of balance, leads to an increased susceptibility. This is of particular importance since fear of heights is dependent on body posture, and visual control of balance at heights can no longer substitute vestibular input. For comparison susceptibility to vHI was determined in patients with other vestibular or functional disorders. Methods: A total of 150 patients aged 18 or above who had been referred to the German Center for Vertigo and Balance Disorders and diagnosed to have BVP were surveyed with a standardized questionnaire by specifically trained neurological professionals. Further, 481 patients with other vestibular or functional disorders were included. Results: Susceptibility to vHI was reported by 29% (32 % in females, 25% in males) of the patients with BVP. Patients with vHI were slightly younger (67 vs. 71 years). Seventy percent of those with vHI reported avoidance of climbing, hiking, stairs, darkness, cycling or swimming (84% of those without vHI). Mean age for onset of vHI was 40 years. Susceptibility to vHI was higher in patients with other vertigo disorders than in those with BVP: 64% in those with phobic postural vertigo, 61% in vestibular migraine, 56% in vestibular paroxysmia, 54% in benign paroxysmal positional vertigo, 49% in unilateral Vestibulopathy and 48% in Meniere's disease. Conclusions: The susceptibility to vHI in BVP was not higher than that of the general population (28%).This allows two explanations that need not be alternatives but contribute to each other: (1) Patients with a Bilateral peripheral vestibular deficit largely avoid exposure to heights because of their postural instability. (2) The irrational anxiety to fall from heights triggers increased susceptibility to vHI, not the objective postural instability. However, patients with BVP do not exhibit increased comorbid anxiety disorders. This view is supported by the significantly increased susceptibility to vHI in other vestibular syndromes, which are characterized by an increased comorbidity of anxiety disorders.

  • Susceptibility to Fear of Heights in Bilateral Vestibulopathy and Other Disorders of Vertigo and Balance
    Frontiers Media S.A., 2018
    Co-Authors: Eva Grill, Doreen Huppert, Thomas Brandt, Michael Strupp
    Abstract:

    Aims: To determine the susceptibility to visual height intolerance (vHI) in patients with acquired Bilateral Vestibulopathy (BVP). The question was whether postural instability in BVP, which is partially compensated for by visual substitution of the impaired vestibular control of balance, leads to an increased susceptibility. This is of particular importance since fear of heights is dependent on body posture, and visual control of balance at heights can no longer substitute vestibular input. For comparison susceptibility to vHI was determined in patients with other vestibular or functional disorders.Methods: A total of 150 patients aged 18 or above who had been referred to the German Center for Vertigo and Balance Disorders and diagnosed to have BVP were surveyed with a standardized questionnaire by specifically trained neurological professionals. Further, 481 patients with other vestibular or functional disorders were included.Results: Susceptibility to vHI was reported by 29% (32 % in females, 25% in males) of the patients with BVP. Patients with vHI were slightly younger (67 vs. 71 years). Seventy percent of those with vHI reported avoidance of climbing, hiking, stairs, darkness, cycling or swimming (84% of those without vHI). Mean age for onset of vHI was 40 years. Susceptibility to vHI was higher in patients with other vertigo disorders than in those with BVP: 64% in those with phobic postural vertigo, 61% in vestibular migraine, 56% in vestibular paroxysmia, 54% in benign paroxysmal positional vertigo, 49% in unilateral Vestibulopathy and 48% in Menière's disease.Conclusions: The susceptibility to vHI in BVP was not higher than that of the general population (28%).This allows two explanations that need not be alternatives but contribute to each other: (1) Patients with a Bilateral peripheral vestibular deficit largely avoid exposure to heights because of their postural instability. (2) The irrational anxiety to fall from heights triggers increased susceptibility to vHI, not the objective postural instability. However, patients with BVP do not exhibit increased comorbid anxiety disorders. This view is supported by the significantly increased susceptibility to vHI in other vestibular syndromes, which are characterized by an increased comorbidity of anxiety disorders

  • Noisy vestibular stimulation improves dynamic walking stability in Bilateral Vestibulopathy
    Neurology, 2016
    Co-Authors: Max Wuehr, Thomas Brandt, Klaus Jahn, E. Nusser, Siegbert Krafczyk, J. Decker, Andreas Straube, Roman Schniepp
    Abstract:

    Objective: To examine the effects of imperceptible levels of white noise galvanic vestibular stimulation (nGVS) on dynamic walking stability in patients with Bilateral Vestibulopathy (BVP). Methods: Walking performance of 13 patients with confirmed BVP (mean age 50.1 ± 5.5 years) at slow, preferred, and fast speeds was examined during walking with zero-amplitude nGVS (sham trial) and nonzero-amplitude nGVS set to 80% of the individual cutaneous threshold for GVS (nGVS trial). Eight standard gait measures were analyzed: stride time, stride length, base of support, double support time percentage as well as the Bilateral phase coordination index, and the coefficient of variation (CV) of stride time, stride length, and base of support. Results: Compared to the sham trial, nGVS improved stride time CV by 26.0% ± 8.4% ( p p p p p Conclusions: In patients with BVP, nGVS is effective in improving impaired gait performance, predominantly during slower walking speeds. It primarily targets the variability and Bilateral coordination characteristics of the walking pattern, which are linked to dynamic walking stability. nGVS might present an effective treatment option to immediately improve walking performance and reduce the incidence of falls in patients with BVP. Classification of evidence: This study provides Class IV evidence that in patients with BVP, an imperceptible level of nGVS improves dynamic walking stability.

Nolan Herssens - One of the best experts on this subject based on the ideXlab platform.

  • An exploratory investigation on spatiotemporal parameters, margins of stability, and their interaction in Bilateral Vestibulopathy.
    Scientific reports, 2021
    Co-Authors: Nolan Herssens, Vincent Van Rompaey, Wim Saeys, Luc Vereeck, Kenneth Meijer, Raymond Van De Berg, Christopher Mccrum, Ann Hallemans
    Abstract:

    Integration of accurate vestibular, visual, and proprioceptive information is crucial in managing the centre of mass in relation to the base of support during gait. Therefore, Bilateral loss of peripheral vestibular function can be highly debilitating when performing activities of daily life. To further investigate the influence of an impaired peripheral vestibular system on gait stability, spatiotemporal parameters, step-to-step variability, and mechanical stability parameters were examined in 20 patients with Bilateral Vestibulopathy and 20 matched healthy controls during preferred overground walking. Additionally, using a partial least squares analysis the relationship between spatiotemporal parameters of gait and the margins of stability was explored in both groups. Patients with Bilateral Vestibulopathy showed an increased cadence compared to healthy controls (121 ± 9 vs 115 ± 8 steps/min; p = 0.02; d = 0.77). In addition, although not significant (p = 0.07), a moderate effect size (d = 0.60) was found for step width variability (Coefficient of Variation (%); Bilateral Vestibulopathy: 19 ± 11%; Healthy controls: 13 ± 5%). Results of the partial least squares analysis suggest that patients with peripheral vestibular failure implement a different balance control strategy. Instead of altering the step parameters, as is the case in healthy controls, they use the single and double support phases to control the state of the centre of mass to improve the mechanical stability.

  • Paving the Way Toward Distinguishing Fallers From Non-fallers in Bilateral Vestibulopathy: A Wide Pilot Observation
    Frontiers in neurology, 2021
    Co-Authors: Nolan Herssens, Bieke Dobbels, Wim Saeys, Luc Vereeck, Raymond Van De Berg, Ann Hallemans, Julie Moyaert, Vincent Van Rompaey
    Abstract:

    Patients with Bilateral Vestibulopathy (BVP) present with unsteadiness during standing and walking, limiting their activities of daily life, and more importantly, resulting in an increased risk of falling. In BVP-patients falls are considered one of the major complications, with patients having a 31-fold increased risk of falling compared to healthy subjects. Thus, highlighting objective measures that can easily and accurately assess the risk of falling in BVP patients is an important step in reducing the incidence of falls and the accompanied burdens. Therefore, this study investigated the interrelations between demographic characteristics, vestibular function, questionnaires on self-perceived handicap and balance confidence, clinical balance measures, gait variables and fall status in 27 BVP-patients. Based on the history of falls in the preceding 12 months, patients were subdivided in a “Faller” or “Non-faller” group. Results on the different outcome measures were compared between the “Faller” and “Non-faller” subgroups using the Pearson Chi-squared test in case for categorical data, for continuous data the Mann-Whitney U test was used. Performances on the clinical balance measures were comparable between fallers and non-fallers indicating that, independent from fall-status, BVP-patients present with an increased risk of falling. However, fallers tended to report a worse self-perceived handicap and confidence during performing activities of daily life. Spatiotemporal parameters of gait did not differ between fallers and non-fallers during walking at slow, preferred, or fast walking speeds. These results may thus imply that, when aiming to distinguish fallers from non-fallers, a BVP-patient’s beliefs concerning their capabilities may be more important than the moderate or severely affected physical performance within a clinical setting. Outcome measures addressing the self-efficacy and fear of falling in BVP-patients should therefore be incorporated in future research to investigate whether these are indeed able to distinguish fallers form non-fallers. Additionally, information regarding physical activity could provide valuable insights on the contextual information influencing behaviour and falls in BVP.

  • paving the way toward distinguishing fallers from non fallers in Bilateral Vestibulopathy a wide pilot observation
    Frontiers in Neurology, 2021
    Co-Authors: Bieke Dobbels, Nolan Herssens, Wim Saeys, Luc Vereeck, Raymond Van De Berg, Ann Hallemans, Julie Moyaert, Vincent Van Rompaey
    Abstract:

    Patients with Bilateral Vestibulopathy (BVP) present with unsteadiness during standing and walking, limiting their activities of daily life and, more importantly, resulting in an increased risk of falling. In BVP patients, falls are considered as one of the major complications, with patients having a 31-fold increased risk of falling compared to healthy subjects. Thus, highlighting objective measures that can easily and accurately assess the risk of falling in BVP patients is an important step in reducing the incidence of falls and the accompanying burdens. Therefore, this study investigated the interrelations between demographic characteristics, vestibular function, questionnaires on self-perceived handicap and balance confidence, clinical balance measures, gait variables, and fall status in 27 BVP patients. Based on the history of falls in the preceding 12 months, the patients were subdivided in a "faller" or "non-faller" group. Results on the different outcome measures were compared between the "faller" and "non-faller" subgroups using Pearson's chi-square test in the case of categorical data; for continuous data, Mann-Whitney U test was used. Performances on the clinical balance measures were comparable between fallers and non-fallers, indicating that, independent from fall status, the BVP patients present with an increased risk of falling. However, fallers tended to report a worse self-perceived handicap and confidence during performing activities of daily life. Spatiotemporal parameters of gait did not differ between fallers and non-fallers during walking at slow, preferred, or fast walking speed. These results may thus imply that, when aiming to distinguish fallers from non-fallers, the BVP patients' beliefs concerning their capabilities may be more important than the moderately or severely affected physical performance within a clinical setting. Outcome measures addressing the self-efficacy and fear of falling in BVP patients should therefore be incorporated in future research to investigate whether these are indeed able to distinguish fallers form non-fallers. Additionally, information regarding physical activity could provide valuable insights on the contextual information influencing behavior and falls in BVP.

  • Bilateral Vestibulopathy and age experimental considerations for testing dynamic visual acuity on a treadmill
    Journal of Neurology, 2020
    Co-Authors: Herman Kingma, Dmitrii Starkov, M Snelders, Floor Lucieer, A M L Janssen, M Pleshkov, Van Rompaey, Nolan Herssens
    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.

  • Bilateral Vestibulopathy and age: experimental considerations for testing dynamic visual acuity on a treadmill.
    Journal of neurology, 2020
    Co-Authors: Dmitrii Starkov, Herman Kingma, Nolan Herssens, Ann Hallemans, M Snelders, Floor Lucieer, A M L Janssen, M Pleshkov, Van Rompaey, Luc Vereeck
    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 

Shin-ichi Iwasaki - One of the best experts on this subject based on the ideXlab platform.

  • Minimally important differences for subjective improvement in postural stability in patients with Bilateral Vestibulopathy.
    Neuroscience letters, 2021
    Co-Authors: Chisato Fujimoto, Teru Kamogashira, Keiko Sugasawa, Makoto Kinoshita, Tatsuya Yamasoba, Kentaro Ichijo, Takuya Kawahara, Mineko Oka, Shin-ichi Iwasaki
    Abstract:

    Abstract Objective To determine minimally important differences (MIDs) for subjective improvement in postural stability after a therapeutic intervention in patients with Bilateral Vestibulopathy (BVP). Methods Thirteen BVP patients received noisy galvanic vestibular stimulation (nGVS) for 30 min and their static posture with eyes closed was monitored after the stimuli. The velocity of the center of pressure (COP) movement, the area enclosed by the COP movement, and the root mean square (RMS) of the displacement of the COP were measured for 30 s. Subjective evaluation of postural stability after nGVS was graded as worsened, slightly worsened, unchanged, slightly improved and improved in comparison with postural stability measured without nGVS. Anchor-based methods were used to estimate MIDs for subjective improvement. Velocity, area and RMS for each anchor-response group were averaged (2 sessions, each with 5 measurement periods during 3 h after the stimuli). The mean changes between the slightly improved group and unchanged group were used as estimates for MID for improvement. Results A total of 129 anchors were analyzed. Subjective evaluations numbered 83 (64%) for unchanged and 33 (26%) for slightly improved. Anchor-based methods yielded estimates for MIDs of -0.43 cm/s in velocity improvement (p  Conclusion The present study provides the estimation of MIDs for improving postural stability in BVP patients and may be useful for interpreting whether the results from clinical trials are meaningful in future studies.

  • Acute Bilateral Vestibulopathy with simultaneous involvement of both superior and inferior vestibular nerves.
    Auris nasus larynx, 2019
    Co-Authors: Kentaro Ichijo, Keiko Sugasawa, Chisato Fujimoto, Makoto Kinoshita, Tatsuya Yamasoba, Tsukasa Uranaka, Yayoi S. Kikkawa, Shin-ichi Iwasaki
    Abstract:

    Abstract We report a case of acute Vestibulopathy with the simultaneous involvement of both superior and inferior vestibular nerves on both sides. A 36-year-old female presented with dizziness, oscillopsia and a walking impairment subsequent to a high fever. Vestibular function tests including caloric testing, video head impulse testing (vHIT) and cervical and ocular vestibular evoked myogenic potentials (cVEMPs and oVEMPs) were performed. In the first examination, vHIT and caloric testing showed severe impairments in all three semicircular canals in each ear, and both cVEMPs and oVEMPs were absent on both sides. During a 1-year follow-up, the gain of vHIT gradually recovered by more than 0.5 to normal. cVEMPs also recovered to normal on both sides while oVEMPs remained absent on both sides. This is the first reported case of acute Bilateral Vestibulopathy with simultaneous involvement of both superior and inferior vestibular nerves on both sides. Repeated evaluation of vestibular function using vHIT, cVEMPs and oVEMPs is helpful to assess the time course of recovery in patients with Vestibulopathy.

  • Noisy vestibular stimulation increases gait speed in normals and in Bilateral Vestibulopathy
    Brain stimulation, 2018
    Co-Authors: Shin-ichi Iwasaki, Chisato Fujimoto, Naoya Egami, Makoto Kinoshita, Fumiharu Togo, Yoshiharu Yamamoto, Tatsuya Yamasoba
    Abstract:

    Abstract Background Galvanic vestibular stimulation delivered as zero-mean current noise (noisy GVS) has been shown to improve static and dynamic postural stability probably by enhancing vestibular information. Objective /Hypothesis: To examine the effect of an imperceptible level of noisy GVS on dynamic locomotion in normal subjects as well as in patients with Bilateral Vestibulopathy. Methods Walking performance of 19 healthy subjects and 12 patients with Bilateral Vestibulopathy at their preferred speed was examined during application of noisy GVS with an amplitude ranging from 0 to 1000 μA. The gait velocity, stride length and stride time were analyzed. Results Noisy GVS had significant effects on gait velocity, stride length and stride time in healthy subjects as well as in patients with Bilateral Vestibulopathy (p   0.4). Conclusion Noisy GVS is effective in improving gait performance in healthy subjects as well as in patients with Bilateral Vestibulopathy.

  • Noisy Galvanic Vestibular Stimulation Sustainably Improves Posture in Bilateral Vestibulopathy
    Frontiers Media S.A., 2018
    Co-Authors: Chisato Fujimoto, Naoya Egami, Tatsuya Yamasoba, Yoshiharu Yamamoto, Takuya Kawahara, Yukari Uemura, Shin-ichi Iwasaki
    Abstract:

    Patients with Bilateral Vestibulopathy (BV) suffer from persistent postural imbalance, leading to a marked decrease in quality of life and a higher risk of falls. However, so far, the effective treatments for BV are very limited. We examined whether long-term noisy galvanic vestibular stimulation (nGVS) keeps improving body balance after the cessation of the stimulus in BV patients. Thirteen BV patients received nGVS for 30 min with a lower intensity than the intensity at which they feel any cutaneous sensations, and their postural movement was monitored for 6 h after the stimuli. The same session was repeated at 14-day intervals. Stance tasks on two legs were performed with eyes closed. The velocity of the center of pressure (COP) movement, the area enclosed by the COP movement, and the root mean square of the displacement of the COP were measured. The power spectrum of the COP movement was assessed. Subjective improvement of body balance was graded as worsened (−2), slightly worsened (−1), unchanged (0), slightly improved (+1) and improved (+2) in comparison with that without nGVS. In each session, the velocity of the COP movement was significantly improved for 6 h after the stimulus had ceased (P < 0.01). Concomitantly, the mean frequency of the COP power spectrum was significantly reduced in the anterior-posterior axis (P < 0.05). Subjective symptoms of imbalance were improved during the post-stimulation effect (P < 0.05). nGVS leads to an improvement in body balance that lasts for several hours after the end of the stimulus in BV patients with a reduction in the high-frequency components of their postural movement. This trial was registered with the University Hospital Medical Information Network (UMIN) Clinical Trials Registry (UMINCTR: UMIN000028054)

  • characteristics of vertigo and the affected vestibular nerve systems in idiopathic Bilateral Vestibulopathy
    Acta Oto-laryngologica, 2016
    Co-Authors: Chisato Fujimoto, Teru Kamogashira, Keiko Sugasawa, Naoya Egami, Makoto Kinoshita, Tatsuya Yamasoba, Shin-ichi Iwasaki
    Abstract:

    AbstractConclusion: Vertigo attacks in IBV patients involving both the superior and inferior vestibular nerve systems were significantly more severe than vertigo attacks in patients with selective involvement of the inferior vestibular nerve system alone. Objective: To investigate the relationship between the frequency and duration of vertigo and the affected vestibular nerve system in idiopathic Bilateral Vestibulopathy (IBV). Methods: This study categorized 44 IBV patients into the following three sub-groups according to the affected vestibular nerve system: superior, inferior, and mixed type. These patients were also categorized into the following three sub-groups according to their clinical time course: progressive type showing no episodes of vertigo, sequential type showing recurrent vertigo attacks and single-attack type showing a single episode of vertigo. Results: Ten, 11 and 23 patients were classified as the superior, the inferior, and the mixed type, respectively. Seventeen, 23, and four patien...

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  • An exploratory investigation on spatiotemporal parameters, margins of stability, and their interaction in Bilateral Vestibulopathy.
    Scientific reports, 2021
    Co-Authors: Nolan Herssens, Vincent Van Rompaey, Wim Saeys, Luc Vereeck, Kenneth Meijer, Raymond Van De Berg, Christopher Mccrum, Ann Hallemans
    Abstract:

    Integration of accurate vestibular, visual, and proprioceptive information is crucial in managing the centre of mass in relation to the base of support during gait. Therefore, Bilateral loss of peripheral vestibular function can be highly debilitating when performing activities of daily life. To further investigate the influence of an impaired peripheral vestibular system on gait stability, spatiotemporal parameters, step-to-step variability, and mechanical stability parameters were examined in 20 patients with Bilateral Vestibulopathy and 20 matched healthy controls during preferred overground walking. Additionally, using a partial least squares analysis the relationship between spatiotemporal parameters of gait and the margins of stability was explored in both groups. Patients with Bilateral Vestibulopathy showed an increased cadence compared to healthy controls (121 ± 9 vs 115 ± 8 steps/min; p = 0.02; d = 0.77). In addition, although not significant (p = 0.07), a moderate effect size (d = 0.60) was found for step width variability (Coefficient of Variation (%); Bilateral Vestibulopathy: 19 ± 11%; Healthy controls: 13 ± 5%). Results of the partial least squares analysis suggest that patients with peripheral vestibular failure implement a different balance control strategy. Instead of altering the step parameters, as is the case in healthy controls, they use the single and double support phases to control the state of the centre of mass to improve the mechanical stability.

  • Paving the Way Toward Distinguishing Fallers From Non-fallers in Bilateral Vestibulopathy: A Wide Pilot Observation
    Frontiers in neurology, 2021
    Co-Authors: Nolan Herssens, Bieke Dobbels, Wim Saeys, Luc Vereeck, Raymond Van De Berg, Ann Hallemans, Julie Moyaert, Vincent Van Rompaey
    Abstract:

    Patients with Bilateral Vestibulopathy (BVP) present with unsteadiness during standing and walking, limiting their activities of daily life, and more importantly, resulting in an increased risk of falling. In BVP-patients falls are considered one of the major complications, with patients having a 31-fold increased risk of falling compared to healthy subjects. Thus, highlighting objective measures that can easily and accurately assess the risk of falling in BVP patients is an important step in reducing the incidence of falls and the accompanied burdens. Therefore, this study investigated the interrelations between demographic characteristics, vestibular function, questionnaires on self-perceived handicap and balance confidence, clinical balance measures, gait variables and fall status in 27 BVP-patients. Based on the history of falls in the preceding 12 months, patients were subdivided in a “Faller” or “Non-faller” group. Results on the different outcome measures were compared between the “Faller” and “Non-faller” subgroups using the Pearson Chi-squared test in case for categorical data, for continuous data the Mann-Whitney U test was used. Performances on the clinical balance measures were comparable between fallers and non-fallers indicating that, independent from fall-status, BVP-patients present with an increased risk of falling. However, fallers tended to report a worse self-perceived handicap and confidence during performing activities of daily life. Spatiotemporal parameters of gait did not differ between fallers and non-fallers during walking at slow, preferred, or fast walking speeds. These results may thus imply that, when aiming to distinguish fallers from non-fallers, a BVP-patient’s beliefs concerning their capabilities may be more important than the moderate or severely affected physical performance within a clinical setting. Outcome measures addressing the self-efficacy and fear of falling in BVP-patients should therefore be incorporated in future research to investigate whether these are indeed able to distinguish fallers form non-fallers. Additionally, information regarding physical activity could provide valuable insights on the contextual information influencing behaviour and falls in BVP.

  • paving the way toward distinguishing fallers from non fallers in Bilateral Vestibulopathy a wide pilot observation
    Frontiers in Neurology, 2021
    Co-Authors: Bieke Dobbels, Nolan Herssens, Wim Saeys, Luc Vereeck, Raymond Van De Berg, Ann Hallemans, Julie Moyaert, Vincent Van Rompaey
    Abstract:

    Patients with Bilateral Vestibulopathy (BVP) present with unsteadiness during standing and walking, limiting their activities of daily life and, more importantly, resulting in an increased risk of falling. In BVP patients, falls are considered as one of the major complications, with patients having a 31-fold increased risk of falling compared to healthy subjects. Thus, highlighting objective measures that can easily and accurately assess the risk of falling in BVP patients is an important step in reducing the incidence of falls and the accompanying burdens. Therefore, this study investigated the interrelations between demographic characteristics, vestibular function, questionnaires on self-perceived handicap and balance confidence, clinical balance measures, gait variables, and fall status in 27 BVP patients. Based on the history of falls in the preceding 12 months, the patients were subdivided in a "faller" or "non-faller" group. Results on the different outcome measures were compared between the "faller" and "non-faller" subgroups using Pearson's chi-square test in the case of categorical data; for continuous data, Mann-Whitney U test was used. Performances on the clinical balance measures were comparable between fallers and non-fallers, indicating that, independent from fall status, the BVP patients present with an increased risk of falling. However, fallers tended to report a worse self-perceived handicap and confidence during performing activities of daily life. Spatiotemporal parameters of gait did not differ between fallers and non-fallers during walking at slow, preferred, or fast walking speed. These results may thus imply that, when aiming to distinguish fallers from non-fallers, the BVP patients' beliefs concerning their capabilities may be more important than the moderately or severely affected physical performance within a clinical setting. Outcome measures addressing the self-efficacy and fear of falling in BVP patients should therefore be incorporated in future research to investigate whether these are indeed able to distinguish fallers form non-fallers. Additionally, information regarding physical activity could provide valuable insights on the contextual information influencing behavior and falls in BVP.

  • The Virtual Morris Water Task in 64 Patients With Bilateral Vestibulopathy and the Impact of Hearing Status.
    Frontiers in neurology, 2020
    Co-Authors: Bieke Dobbels, Griet Mertens, Paul Van De Heyning, Raymond Van De Berg, Annick Gilles, Julie Moyaert, Erik Fransen, Vincent Van Rompaey
    Abstract:

    Background: Previous studies have demonstrated spatial cognitive deficits in patients with Bilateral Vestibulopathy (BVP). However, BVP patients frequently present with a concomitant sensorineural hearing loss, which is a well-established risk factor of cognitive impairment and incident dementia. Nonetheless, previous research on spatial cognitive deficits in BVP patients have not taken hearing status into account. Objective: This study aims to compare spatial cognition of BVP patients with healthy controls, with analyses adjusting for hearing status. Methods: Spatial cognition was assessed in 64 BVP patients and 46 healthy controls (HC) by use of the Virtual Morris Water Task (VMWT). All statistical analyses were adjusted for hearing (dys)function, sex, age, education, and computer use. Results: Overall, patients with BVP performed worse on all outcome measures of the VMWT. However, these differences between BVP patients and healthy controls were not statistically significant. Nonetheless, a statistically significant link between sensorineural hearing loss and spatial cognition was observed. The worse the hearing, the longer subjects took to reach the hidden platform in the VMWT. Furthermore, the worse the hearing, the less time was spent by the subjects in the correct platform quadrant during the probe trial of the VMWT. Conclusion: In this study, no difference was found regarding spatial cognition between BVP patients and healthy controls. However, a statistically significant link was observed between sensorineural hearing loss and spatial cognition.

  • A Systematic Review on Balance Performance in Patients With Bilateral Vestibulopathy.
    Physical therapy, 2020
    Co-Authors: Nolan Herssens, Vincent Van Rompaey, Wim Saeys, Luc Vereeck, Kenneth Meijer, Raymond Van De Berg, Christopher Mccrum, Evi Verbecque, Ann Hallemans
    Abstract:

    Objective Patients with Bilateral Vestibulopathy (BVP) have severe balance deficits, but it is unclear which balance measures are best suited to quantify their deficits and approximate the diversity of their self-reports. The purpose of this study was to explore measures of balance control for quantifying the performance of patients with BVP related to different balance domains, allowing targeted assessment of response to intervention. Methods MEDLINE, Web of Science, and Embase were systematically searched on October 9, 2019. The Scottish Intercollegiate Guidelines Network (SIGN) checklist for case-control studies was applied to assess each individual study's risk of bias. Standardized mean differences (SMD) were calculated based on the extracted numeric data and reported according to the type of sensory perturbation in the balance tasks. Results Twelve studies (1.3%) met the eligibility criteria and were analyzed, including data of 176 patients with BVP, 196 patients with unilateral Vestibulopathy, and 205 healthy controls between 18 and 92 years old. In general, patients with BVP were either unable to maintain (or had reduced) balance during tasks with multisensory perturbations compared with healthy controls (range of mean SMD = 1.52 to 6.92) and patients with unilateral Vestibulopathy (range of absolute mean SMD = 0.86 to 1.66). Conclusions During clinical assessment to quantify balance control in patients with BVP, tasks involving multisensory perturbations should be implemented in the test protocol. Impact As patients with BVP show difficulties with movement strategies, control of dynamics, orientation in space and cognitive processing, clinicians should implement these aspects of balance control in their assessment protocol to fully comprehend the balance deficits in these patients.