Comparison of Incremental Vestibulo-ocular Reflex Adaptation Training Versus x1 Training in Patients With Chronic Peripheral Vestibular Hypofunction

Abstract Background and Purpose. The head thrust test (HTT) is used to assess the vestibulo-ocular reflex. Sensitivity and specificity for diagnosing unilateral vestibular hypofunction (UVH) in patients following vestibular ablation is excellent (100%), although sensitivity is lower (35%–39%) for patients with nonsurgically induced UVH. The variability of the test results may be from moving the subject's head outside the plane of the lateral semicircular canals as well as using a head thrust of predictable timing and direction. The purpose of this study was to examine sensitivity and specificity of the horizontal HTT in identifying patients with UVH and bilateral vestibular hypofunction (BVH) when the head was flexed 30 degrees in attempt to induce acceleration primarily in the lateral semicircular canal and the head was moved unpredictably. Subjects. The medical records of 176 people with and without vestibular dysfunction (n=79 with UVH, n=32 with BVH, and n=65 with nonvestibular dizziness) were studied. Methods. Data were retrospectively tabulated from a de-identified database (ie, with health information stripped of all identifiers). Results. Sensitivity of the HTT for identifying vestibular hypofunction was 71% for UVH and 84% for BVH. Specificity was 82%. Discussion and Conclusion. Ensuring the head is pitched 30 degrees down and thrust with an unpredictable timing and direction appears to improve sensitivity of the HTT.

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The Vestibulo-Ocular Reflex during Self-Generated Head Movements by Human Subjects with Unilateral Vestibular Hypofunction

Annals of the New York Academy of Sciences ◽

10.1111/j.1749-6632.2001.tb03766.x ◽

2006 ◽

Vol 942 (1) ◽

pp. 465-466 ◽

Cited By ~ 8

Author(s):

CHARLEY C. SANTINA ◽

PHILIP D. CREMER ◽

JOHN P. CAREY ◽

LLOYD B. MINOR

Keyword(s):

Human Subjects ◽

Head Movements ◽

Ocular Reflex ◽

Vestibular Hypofunction ◽

Vestibulo Ocular Reflex

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Long-term effects of vestibular rehabilitation and head-mounted gaming task procedure in unilateral vestibular hypofunction: a 12-month follow-up of a randomized controlled trial

Clinical Rehabilitation ◽

10.1177/0269215518788598 ◽

2018 ◽

Vol 33 (1) ◽

pp. 24-33 ◽

Cited By ~ 9

Author(s):

Andrea Viziano ◽

Alessandro Micarelli ◽

Ivan Augimeri ◽

Domenico Micarelli ◽

Marco Alessandrini

Keyword(s):

Power Spectra ◽

Vestibular Rehabilitation ◽

Performance Measure ◽

Self Report ◽

Long Term Effects ◽

Ocular Reflex ◽

Vestibular Hypofunction ◽

Vestibulo Ocular Reflex ◽

Reflex Gain

Objective: To investigate the long-term effects of adding virtual reality–based home exercises to vestibular rehabilitation in people with unilateral vestibular hypofunction. Design: Follow-up otoneurological examination in two randomized groups following a previous one-month trial. Setting: Tertiary rehabilitation center. Subjects: A total of 47 patients with unilateral vestibular hypofunction, one group ( n = 24) undergoing conventional vestibular rehabilitation and the other one ( n = 23) implementing, in addition, head-mounted gaming home exercises, 20 minutes per day for one month. Interventions: One year after completing rehabilitation, patients underwent testing with static posturography, video head impulse test, self-report questionnaires, and a performance measure. Main measures: Vestibulo-ocular reflex gain, posturographic parameters such as length, surface, and fast Fourier transform power spectra, self-report, and gait performance measure scores. Results: Vestibulo-ocular reflex gain was significantly better with respect to pretreatment in both groups. The mixed-method group showed significantly higher gain scores: mean (standard deviation (SD)) at 12 months was 0.71 (0.04), versus 0.64 (0.03) for the vestibular rehabilitation–only group ( P < 0.001). Accordingly, some classical posturography scores such as surface with eyes open and length with eyes closed and low-frequency power spectra were significantly different between groups, with the virtual reality group showing improvement ( P < 0.001). Self-report measures were significantly better in both groups compared to pretreatment, with significant improvement in the mixed-method group as compared to conventional rehabilitation alone: Dizziness Handicap Inventory mean total score was 24.34 (2.8) versus 35.73 (5.88) with a P-value <0.001. Conclusion: Results suggest that head-mounted gaming home exercises are a viable, effective, additional measure to improve long-term vestibular rehabilitation outcomes.

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Relationship between vestibulo-ocular reflex gain and dizziness handicap inventory score to predict effectiveness of vestibular rehabilitation

Auditory and Vestibular Research ◽

10.18502/avr.v30i4.7445 ◽

2021 ◽

Author(s):

Morteza Hamidi Nahrani ◽

Mehdi Akbari ◽

Mohammad Maarefvand

Keyword(s):

Vestibular Rehabilitation ◽

Head Impulse Test ◽

Dizziness Handicap Inventory ◽

Strong Negative Correlation ◽

Ocular Reflex ◽

Vestibular Hypofunction ◽

Before And After ◽

Vestibulo Ocular Reflex ◽

Reflex Gain

Background and Aim: Evaluating the effectiveness of vestibular rehabilitation (VR) in patients with vestibular lesions has always been a challenge. The questionnaires that are used for this purpose mostly show the degree of vestibular disability rather than providing information about improvement of vestibular dysfunction. This study aimed to evaluate whether video head impulse test (vHIT) that is used for the examination of vestibulo-ocular reflex (VOR), is a useful method for predicting the effectiveness of VR and has a correlation with dizziness handicap inventory (DHI) score. Methods: Participants were 42 patients with unilateral peripheral vestibular hypofunction (UPVH) undergoing VR. Patients were assessed before and after rehabilitation by the vHIT in all ipsilesional and contralesional semicircular canals (SCCs) and the DHI. The changes in DHI score and VOR gain before and after rehabilitation, were shown as ΔDHI and ΔVOR and their correlation was evaluated. Results: VOR gain from ipsilesional and contralesional SCCs was improved significantly after VR. There was a significant strong negative correlation between ΔVOR gain from ipsilesional SCCs and ΔDHI score but no significant correlation was found between the ΔDHI score and ΔVOR gain from contralesional SCCs. Conclusion: vHIT test is a useful tool to evaluate the effectiveness of VR. VOR gain is correlated with the DHI score. Therefore, the improvement in vHIT results in all three SCCs after VR may be a good predictor of the degree of improvement in dizziness-related disability. Keywords: Vestibular rehabilitation; follow-up; unilateral vestibular hypofunction; video head impulse test; dizziness handicap inventory

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