Falls Among People With Bilateral Vestibulopathy

Objectives: Bilateral vestibulopathy is a clinical syndrome in which laboratory testing plays a crucial diagnostic role. We aimed to establish the frequency of detection of that finding in a tertiary level hospital considering the new methods of laboratory vestibular examination nowadays in use, with respect to the conventional caloric and rotatory chair test approaches. Design: Two similar time periods (5 years) were retrospectively evaluated, and the demographic, clinical data and test results from 4,576 patients were reviewed. In the first period, the diagnosis was based on caloric and rotatory chair tests and, in the second, on the video head impulse test. Results: Of the patients included, 3.77% in the first period and 4.58% in the second met the criteria for bilateral vestibular hypofunction; there was no significant difference between both periods. Conclusions: The functional vestibular evaluation to detect bilateral deficiency makes no significant difference to the number of patients diagnosed with a bilateral vestibulopathy. New diagnostic categories probably depend not only on the availability and accessibility of complete vestibular and visual-vestibular evaluation, but also on recent advances in defining vestibular disorders. Bilateral vestibular hypofunction manifests with very different patterns. Progress in more detailed definition (clinical and laboratory) is needed, in particular when all 6 semicircular canals and both maculae are available for testing.

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Paving the Way Toward Distinguishing Fallers From Non-fallers in Bilateral Vestibulopathy: A Wide Pilot Observation

Frontiers in Neurology ◽

10.3389/fneur.2021.611648 ◽

2021 ◽

Vol 12 ◽

Author(s):

Nolan Herssens ◽

Bieke Dobbels ◽

Julie Moyaert ◽

Raymond Van de Berg ◽

Wim Saeys ◽

...

Keyword(s):

Outcome Measures ◽

Fear Of Falling ◽

Daily Life ◽

Contextual Information ◽

Vestibular Function ◽

Future Research ◽

Risk Of Falling ◽

Bilateral Vestibulopathy ◽

Activities Of Daily Life ◽

Increased Risk

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.

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Bilateral Vestibulopathy

Encyclopedia of Otolaryngology, Head and Neck Surgery ◽

10.1007/978-3-642-23499-6_100127 ◽

2013 ◽

pp. 327-327

Keyword(s):

Bilateral Vestibulopathy

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Acrophobia and visual height intolerance: advances in epidemiology and mechanisms

Journal of Neurology ◽

10.1007/s00415-020-09805-4 ◽

2020 ◽

Vol 267 (S1) ◽

pp. 231-240

Author(s):

Doreen Huppert ◽

Max Wuehr ◽

Thomas Brandt

Keyword(s):

Motor Behavior ◽

Behavioral Therapy ◽

Critical Factor ◽

Epidemiological Studies ◽

Visual Exploration ◽

Whole Body ◽

Bilateral Vestibulopathy ◽

Double Support ◽

Roman Antiquity ◽

Visual Height Intolerance

AbstractHistorical descriptions of fear at heights date back to Chinese and Roman antiquity. Current definitions distinguish between three different states of responses to height exposure: a physiological height imbalance that results from an impaired visual control of balance, a more or less distressing visual height intolerance, and acrophobia at the severest end of the spectrum. Epidemiological studies revealed a lifetime prevalence of visual height intolerance including acrophobia in 28% of adults (32% in women; 25% in men) and 34% among prepubertal children aged 8–10 years without gender preponderance. Visual height intolerance first occurring in adulthood usually persists throughout life, whereas an early manifestation in childhood usually shows a benign course with spontaneous relief within years. A high comorbidity was found with psychiatric disorders (e.g. anxiety and depressive syndromes) and other vertigo syndromes (e.g. vestibular migraine, Menière’s disease), but not with bilateral vestibulopathy. Neurophysiological analyses of stance, gait, and eye movements revealed an anxious control of postural stability, which entails a co-contraction of anti-gravity muscles that causes a general stiffening of the whole body including the oculomotor apparatus. Visual exploration is preferably reduced to fixation of the horizon. Gait alterations are characterized by a cautious slow walking mode with reduced stride length and increased double support phases. Anxiety is the critical factor in visual height intolerance and acrophobia leading to a motor behavior that resembles an atavistic primitive reflex of feigning death. The magnitude of anxiety and neurophysiological parameters of musculoskeletal stiffening increase with increasing height. They saturate, however, at about 20 m of absolute height above ground for postural symptoms and about 40 m for anxiety (70 m in acrophobic participants). With respect to management, a differentiation should be made between behavioral recommendations for prevention and therapy of the condition. Recommendations for coping strategies target behavioral advices on visual exploration, control of posture and locomotion as well as the role of cognition. Treatment of severely afflicted persons with distressing avoidance behavior mainly relies on behavioral therapy.

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Chronic Electrical Stimulation of the Otolith Organ: Preliminary Results in Humans with Bilateral Vestibulopathy and Sensorineural Hearing Loss

Audiology and Neurotology ◽

10.1159/000503600 ◽

2019 ◽

Vol 25 (Suppl. 1-2) ◽

pp. 79-90 ◽

Cited By ~ 3

Author(s):

Angel Ramos Macias ◽

Angel Ramos de Miguel ◽

Isaura Rodriguez Montesdeoca ◽

Silvia Borkoski Barreiro ◽

Juan Carlos Falcón González

Keyword(s):

Electrical Stimulation ◽

Vestibular Evoked Myogenic Potentials ◽

Head Impulse Test ◽

Clinical Test ◽

Otolith Organ ◽

Bilateral Vestibulopathy ◽

Vestibular Loss ◽

Bilateral Vestibular Loss ◽

Chronic Electrical Stimulation ◽

Stimulation Of

Introduction: Bilateral vestibulopathy is an important cause of imbalance that is misdiagnosed. The clinical management of patients with bilateral vestibular loss remains difficult as there is no clear evidence for an effective treatment. In this paper, we try to analyze the effect of chronic electrical stimulation and adaptation to electrical stimulation of the vestibular system in humans when stimulating the otolith organ with a constant pulse train to mitigate imbalance due to bilateral vestibular dysfunction (BVD). Methods: We included 2 patients in our study with BVD according to Criteria Consensus of the Classification Committee of the Bárány Society. Both cases were implanted by using a full-band straight electrode to stimulate the otoliths organs and simultaneously for the cochlear stimulation we use a perimodiolar electrode. Results: In both cases Vestibular and clinical test (video head impulse test, videonistagmography cervical vestibular evoked myogenic potentials, cVEMP and oVEMP), subjective visual vertical test, computerized dynamic posturography, dynamic gait index, Time UP and Go test and dizziness handicap index) were performed. Posture and gait metrics reveal important improvement if compare with preoperartive situation. Oscillopsia, unsteadiness, independence and quality of life improved to almost normal situation. Discussion/Conclusion: Prosthetic implantation of the otolith organ in humans is technically feasible. Electrical stimulation might have potential effects on balance and this is stable after 1 year follow-up. This research provides new possibilities for the development of vestibular implants to improve gravito-inertial acceleration sensation, in this case by the otoliths stimulation.

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