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

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.

Correlation of Head Impact Exposures With Vestibulo-Ocular Assessments

2020 ◽  
Vol 29 (3) ◽  
pp. 310-314 ◽  
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.

Comparison of Horizontal and Vertical Dynamic Visual Acuity in Patients with Vestibular Dysfunction and Nonvestibular Dizziness

2007 ◽  
Vol 18 (03) ◽  
pp. 236-244 ◽  
Author(s):  
Richard A. Roberts ◽  
Richard E. Gans
Keyword(s):  
Visual Acuity ◽  
Head Movement ◽  
Vestibular Function ◽  
Vestibular Dysfunction ◽  
Common Symptom ◽  
Dynamic Visual Acuity ◽  
Blurred Vision ◽  
Ocular Reflex ◽  
Vestibulo Ocular Reflex ◽  
Horizontal Head

Blurred vision with head movement is a common symptom reported by patients with vestibular dysfunction affecting the vestibulo-ocular reflex (VOR). Impaired VOR can be measured by comparing visual acuity in which there is no head movement to visual acuity obtained with head movement. A previous study demonstrated that dynamic visual acuity (DVA) testing using vertical head movement revealed deficits in impaired VOR. There is evidence that horizontal head movement is more sensitive to impaired VOR. The objective of this investigation was to compare horizontal and vertical DVA in participants with normal vestibular function (NVF), impaired vestibular function (IVF), and participants with nonvestibular dizziness (NVD). Participants performed the visual acuity task in a baseline condition with no movement and also in two dynamic conditions, horizontal head movement and vertical head movement. Horizontal DVA was twice as sensitive to impaired VOR than vertical DVA. Results suggest that horizontal volitional head movement should be incorporated into tasks measuring functional deficits of impaired VOR. Una visión borrosa con los movimientos de la cabeza es un síntoma común reportado por los pacientes con una disfunción vestibular que afecta el reflejo vestíbulo-ocular (VOR). La alteración en el VOR puede ser medida comparando la aguda visual no acompañada de movimientos de la cabeza, con la aguda visual obtenida con movimientos cefálicos. Un estudio previo demostró que la prueba de aguda visual dinámica (DVA) usando movimiento vertical de la cabeza revelaba deficiencias relacionados con un VOR alterado. Existe evidencia que el movimiento cefálico horizontal es más sensible a un VOR alterado. El objetivo de esta investigación fue comparar el DVA horizontal y vertical en participantes con funcional vestibular normal (NVF), con función vestibular alterada (IVF) y en sujetos con mareo no vestibular (NVD). Los participantes realizaron sus tareas de agudeza visual en una condición basal, sin movimiento, y también en dos condiciones dinámicas, con movimientos de cabeza horizontales y verticales. El DVA horizontal fue dos veces más sensible a un VOR alterado que el DVA vertical. Los resultados sugieren que los movimientos volitivos horizontales de la cabeza deben incorporarse en las tareas que midan deficiencias funcionales con un VOR alterado.

Effect of vestibular rehabilitation on passive dynamic visual acuity

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.

scholarly journals Ethanol consumption impairs vestibulo-ocular reflex function measured by the video head impulse test and dynamic visual acuity

2014 ◽  
Vol 24 (4) ◽  
pp. 289-295 ◽  
Author(s):  
Thomas N. Roth ◽  
Konrad P. Weber ◽  
Vincent G. Wettstein ◽  
Guy B. Marks ◽  
Sally M. Rosengren ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Ethanol Consumption ◽  
Head Impulse Test ◽  
Video Head Impulse Test ◽  
Dynamic Visual Acuity ◽  
Head Impulse ◽  
Ocular Reflex ◽  
Vestibulo Ocular Reflex

scholarly journals Clinical dynamic visual acuity in patients with cerebellar ataxia and vestibulopathy

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0255299
Author(s):  
Michaela Dankova ◽  
Jaroslav Jerabek ◽  
Dylan J. Jester ◽  
Alena Zumrova ◽  
Jaroslava Paulasova Schwabova ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Vestibular Function ◽  
Head Impulse Test ◽  
Dynamic Visual Acuity ◽  
Bilateral Vestibulopathy ◽  
Caloric Irrigation ◽  
Ocular Reflex ◽  
Vestibulo Ocular Reflex ◽  
Cerebellar Ataxias ◽  
Central Adaptation

Deterioration of dynamic visual acuity (DVA) as a result of impaired vestibulo-ocular reflex (VOR) has been well described in peripheral vestibulopathies, however, changes in DVA in patients with degenerative cerebellar ataxias (CA) and its relation to VOR impairment in these patients has not yet been evaluated. Our aim was to assess the alterations of DVA in CA and to evaluate its relation to vestibular function. 32 patients with CA and 3 control groups: 13 patients with unilateral and 13 with bilateral vestibulopathy and 21 age matched healthy volunteers were examined by clinical DVA test, VOR was assessed by video Head Impulse Test and caloric irrigation. The severity of ataxia in CA was assessed by Scale for the assessment and rating of ataxia (SARA). Relationship between DVA and vestibular function in CA patients was examined by linear regressions. DVA impairment was highly prevalent in CA patients (84%) and its severity did not differ between CA and bilateral vestibulopathy patients. The severity of DVA impairment in CA was linked mainly to VOR impairment and only marginally to the degree of ataxia. However, DVA impairment was present also in CA patients without significant vestibular lesion showing that central mechanisms such as impairment of central adaptation of VOR are involved. We suggest that the evaluation of DVA should be a standard part of clinical evaluation in patients with progressive CA, as this information can help to target vestibular and oculomotor rehabilitation.

scholarly journals Vestibulo-ocular reflex and the head impulse test

2012 ◽  
Vol 70 (12) ◽  
pp. 942-944 ◽  
Author(s):  
Eliana T. Maranhão ◽  
Péricles Maranhão-Filho
Keyword(s):  
Diagnostic Method ◽  
Vestibular Dysfunction ◽  
Head Impulse Test ◽  
Emergency Rooms ◽  
Brainstem Infarction ◽  
Head Impulse ◽  
Ocular Reflex ◽  
Peripheral Vestibulopathy ◽  
Vestibulo Ocular Reflex

The authors highlights the importance of the vestibulo-ocular reflex examination through the head impulse test as a diagnostic method for vestibular dysfunction as well as, and primarily, a bedside semiotic resource capable of differentiating between acute peripheral vestibulopathy and a cerebellar or brainstem infarction in emergency rooms.

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

2011 ◽  
Vol 33 (4) ◽  
pp. 600-603 ◽  
Author(s):  
Hiroyuki Morimoto ◽  
Yuji Asai ◽  
Eric G. Johnson ◽  
Everett B. Lohman ◽  
Keiko Khoo ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Young Adults ◽  
Postural Stability ◽  
Dynamic Visual Acuity ◽  
Gaze Stability
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