Effect of oculo-motor and gaze stability exercises on postural stability and dynamic visual acuity in healthy young adults

BACKGROUND: Disruption of visual-vestibular interaction after concussion can cause gaze instability with head movements. The long-term impact of concussion on gaze stability is unknown. OBJECTIVE: This cross-sectional comparative pilot study examined gaze stability in the chronic stage after concussion (greater than one year). A secondary objective was to examine the relationship between gaze stability and sleep. METHODS: Outcome measures included: 1. Gaze stability in logMAR (mean loss of dynamic visual acuity (DVA) in the yaw and pitch planes); 2. Pittsburgh Sleep Quality Index (PSQI); 3. Epworth Sleepiness Scale (ESS). Post-Concussion Symptom Scale (PCSS), time since injury, and number of concussions were collected for the people with concussion. RESULTS: The study sample included thirty-four adults (mean age 23.35±1.3 years). Seventeen had a history of 1–9 concussions, with a mean duration of 4.4±1.9 years since last concussion; and 17 were age and sex-matched controls. Mean pitch plane DVA loss was greater in the concussion group compared to the control group (p = 0.04). Participants with previous concussion had lower sleep quality based on the PSQI (p = 0.01) and increased daytime sleepiness based on the ESS (p = 0.01) compared to healthy controls. Mean DVA loss in the pitch plane was significantly correlated with the PSQI (r = 0.43, p = 0.01) and the ESS (r = 0.41, p = 0.02). CONCLUSION: Significant differences in dynamic visual acuity may be found in young adults long after a concussion, compared with those who have no concussion history. Furthermore, loss of dynamic visual acuity was associated with poorer sleep quality and higher daytime sleepiness.

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Differences in postural stability and dynamic visual acuity among healthy young adults in relation to sports activity: a cross sectional study

Journal of Physical Therapy Science ◽

10.1589/jpts.31.53 ◽

2019 ◽

Vol 31 (1) ◽

pp. 53-56 ◽

Cited By ~ 2

Author(s):

Yoshinori Koide ◽

Yoshino Ueki ◽

Yuji Asai ◽

Hiroyuki Morimoto ◽

Hayato Asai ◽

...

Keyword(s):

Visual Acuity ◽

Young Adults ◽

Postural Stability ◽

Cross Sectional Study ◽

Sectional Study ◽

Dynamic Visual Acuity ◽

Sports Activity ◽

Cross Sectional

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Correlation of Head Impact Exposures With Vestibulo-Ocular Assessments

Journal of Sport Rehabilitation ◽

10.1123/jsr.2017-0282 ◽

2020 ◽

Vol 29 (3) ◽

pp. 310-314 ◽

Cited By ~ 2

Author(s):

Theresa L. Miyashita ◽

Paul A. Ullucci

Keyword(s):

Visual Acuity ◽

Cumulative Effect ◽

Head Impact ◽

Division I ◽

Dynamic Visual Acuity ◽

Head Impacts ◽

Ocular Reflex ◽

Gaze Stability ◽

Vestibulo Ocular Reflex ◽

Subconcussive Impacts

Context: Managing a concussion injury should involve the incorporation of a multifaceted approach, including a vision assessment. The frontoparietal circuits and subcortical nuclei are susceptible to trauma from a concussion injury, leading to dysfunction of the vestibulo-ocular system. Research investigating the effect of cumulative subconcussive impacts on neurological function is still in its infancy, but repetitive head impacts may result in vestibular system dysfunction. This dysfunction could create visual deficits, predisposing the individual to further head trauma. Objective: The purpose of this study was to investigate the cumulative effect of subconcussive impacts on minimum perception time, static visual acuity, gaze stability, and dynamic visual acuity scores. Design: Prospective cohort. Setting: Division I university. Patients: Thirty-three Division I men’s lacrosse players (age = 19.52 [1.20] y). Intervention: Competitive lacrosse season. Main Outcome Measures: At the beginning and end of the season, the players completed a vestibulo-ocular reflex assessment, using the InVision™ system by Neurocom® to assess perception, static acuity, gaze stability, and dynamic visual acuity. Score differentials were correlated with the head impact exposure data collected via instrumented helmets. Results: A significant correlation was found between change in perception scores and total number of head impacts (r = .54), and between changes in dynamic visual acuity loss scores on the rightside and maximum rotational acceleration (r = .36). No statistical differences were found between preseason and postseason vestibulo-ocular reflex variables. Conclusions: Cumulative subconcussive impacts may negatively affect vestibulo-ocular reflex scores, resulting in decreased visual performance. This decrease in vestibulo-ocular function may place the athlete at risk of sustaining additional head impacts or other injuries.

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Age-Related Vestibular Dysfunction; Vestibulo-Ocular Reflex, Dynamic Visual Acuity, Dizziness and Falls: A Review

Vision Development & Rehabilitation ◽

10.31707/vdr2021.7.4.p279 ◽

2021 ◽

pp. 279-292

Keyword(s):

Visual Acuity ◽

Balance Control ◽

Vestibular Dysfunction ◽

Posture Control ◽

Complex Nature ◽

Dynamic Visual Acuity ◽

Ocular Reflex ◽

Gaze Stability ◽

Age Related ◽

Vestibulo Ocular Reflex

Background: Vestibular and vision functions are important contributors to posture control and fall avoidance. This review examines how the vestibulo-ocular reflex can be rehabilitated to help restore postural control. Methods: PubMed searches (7th April 2021) using the terms ‘vestibulo-ocular reflex’, ‘imbalance and vestibular dysfunction’, ‘vestibular dysfunction and dizziness’, ‘dynamic visual acuity’, ‘vestibular dysfunction rehabilitation’, and ‘gaze stabilization exercises’ yielded 4986, 495, 3576,1830, 3312, and 137 potentially useful publications respectively. Selections of those which were found to be the most relevant and representative of a balanced and current account of these topics, as well as selections from the most relevant reports referenced in those publications, were included in this review. Results: Just as there are age-related losses of static visual acuity even when there are no specific visual pathologies diagnosed, patients may also present with age-related loss of vestibular functions in the absence of specific vestibular pathologies. For example, cases of dizziness which are diagnosed as idiopathic might be usefully classified as age-related as the basis for the initiation of rehabilitation exercises. Conclusions: Apart from age-related loss of vestibular functions, cases diagnosed as having a particular form of vestibular pathology may have that condition exacerbated by age-related losses of vestibular functions. The effects of vestibular rehabilitation gaze stability exercises in patients with vestibular dysfunction are well established and include both improved dynamic acuity and postural stability. Improvements in posture control following rehabilitation of the vestibulo-ocular reflex are apparently due to improved peripheral and/or central vestibular balance control which has occurred in conjunction with enhanced gaze stability. The complex nature of increased fall risk suggests that an interdisciplinary approach to rehabilitation that includes vestibulo-ocular reflex rehabilitation appears likely to be associated with optimum outcomes for both pathological and age-related cases.

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‘Gaze shift dynamic visual acuity: A functional test of gaze stability that distinguishes unilateral vestibular hypofunction

Journal of Vestibular Research ◽

10.3233/ves-201506 ◽

2020 ◽

pp. 1-10

Author(s):

Po-Yin Chen ◽

Ying-Chun Jheng ◽

Shih-En Huang ◽

Lieber Po-Hung Li ◽

Shun-Hwa Wei ◽

...

Keyword(s):

Visual Acuity ◽

Head Rotation ◽

Measurement Unit ◽

Healthy Controls ◽

Dynamic Visual Acuity ◽

Gaze Shifts ◽

Gaze Shift ◽

Gaze Stability ◽

Vestibular Hypofunction ◽

Field Of Vision

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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Determine the effect of neck muscle fatigue on dynamic visual acuity in healthy young adults

Journal of Physical Therapy Science ◽

10.1589/jpts.27.259 ◽

2015 ◽

Vol 27 (1) ◽

pp. 259-263 ◽

Cited By ~ 6

Author(s):

Amer A. Al Saif ◽

Samira Al Senany

Keyword(s):

Visual Acuity ◽

Young Adults ◽

Muscle Fatigue ◽

Neck Muscle ◽

Dynamic Visual Acuity ◽

Neck Muscle Fatigue

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Effect of vestibular rehabilitation on passive dynamic visual acuity

Journal of Vestibular Research ◽

10.3233/ves-2008-182-308 ◽

2008 ◽

Vol 18 (2-3) ◽

pp. 147-157

Author(s):

Matthew Scherer ◽

Americo A. Migliaccio ◽

Michael C. Schubert

Keyword(s):

Visual Acuity ◽

Exercise Program ◽

Home Exercise ◽

Dynamic Visual Acuity ◽

Gaze Stabilization ◽

Ocular Reflex ◽

Gaze Stability ◽

Before And After ◽

Vestibulo Ocular Reflex ◽

Head Impulses

While active dynamic visual acuity (DVA) has been shown to improve with gaze stabilization exercises, we sought to determine whether DVA during {passive} head impulses (pDVA) would also improve following a rehabilitation course of vestibular physical therapy (VPT) in patients with unilateral and bilateral vestibular hypofunction. VPT consisted of gaze and gait stabilization exercises done as a home exercise program. Scleral search coil was used to characterize the angular vestibulo-ocular reflex (aVOR) during pDVA before and after VPT. Mean duration of VPT was 66 ± 24 days, over a total of 5 ± 1.4 outpatient visits. Two of three subjects showed improvements in pDVA with a mean reduction of 43% (LogMAR 0.58 to 0.398 and 0.92 to 0.40). Our data suggest improvements in pDVA may be due in part to improvements in aVOR velocity and acceleration gains or reduced latency of the aVOR. Each subject demonstrated a reduction in the ratio of compensatory saccades to head impulses after VPT. Preliminary data suggest that active gaze stability exercises may contribute to improvements in pDVA in some individuals.

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