Leveraging virtual reality for vestibular testing: Clinical outcomes from tests of dynamic visual acuity

BACKGROUND: Virtual reality (VR) use as a platform for vestibular rehabilitation is widespread. However, the utility of VR based vestibular assessments remains unknown. OBJECTIVE: To compare dynamic visual acuity (DVA) scores, perceived balance, and perceived dizziness when using traditional versus VR environments for DVA testing among healthy individuals. METHODS: DVA testing occurred for both a traditional clinical protocol and in a VR variant. Horizontal, vertical, and no head motion conditions were conducted for both clinical and VR test protocols. DVA scores, balance ratings, and dizziness ratings were obtained per condition. Two-way ANOVAs with repeated measures were used to assess differences in DVA scores, balance, and dizziness ratings. RESULTS: No differences in DVA results, balance or dizziness ratings were observed when comparing traditional clinical protocol versus the VR variant. Differences across head motion conditions were observed, with no motion trials exhibiting significantly higher DVA scores and perceived balance, and lower perceived dizziness compared to vertical and horizontal head motion. Vertical head motion exhibited this same trend compared to horizontal. CONCLUSION: DVA testing conducted in VR demonstrated clinical utility for each measure. Effects of head motion were similar across test variants, indicating DVA testing in VR produces similar effects on vestibular function than traditional clinical testing. Additional research should be conducted to assess the feasibility of VR assessment in individuals with vestibular disorder.

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Sleep Deprivation Has No Effect on Dynamic Visual Acuity in Military Service Members Who Are Healthy

Physical Therapy ◽

10.2522/ptj.20120144 ◽

2013 ◽

Vol 93 (9) ◽

pp. 1185-1196 ◽

Cited By ~ 2

Author(s):

Matthew R. Scherer ◽

Pedro J. Claro ◽

Kristin J. Heaton

Keyword(s):

Visual Acuity ◽

Sleep Deprivation ◽

Repeated Measures ◽

Military Service ◽

Intraclass Correlation ◽

Vestibular Function ◽

Service Members ◽

Behavioral Measure ◽

Dynamic Visual Acuity ◽

Repeated Measures Design

Background The risk of traumatic brain injury (TBI) and comorbid posttraumatic dizziness is elevated in military operational environments. Sleep deprivation is known to affect a service member's performance while deployed, although little is known about its effects on vestibular function. Recent findings suggest that moderate acceleration step rotational stimuli may elicit a heightened angular vestibulo-ocular reflex (aVOR) response relative to low-frequency sinusoidal stimuli after 26 hours of sleep deprivation. There is concern that a sleep deprivation–mediated elevation in aVOR function could confound detection of comorbid vestibular pathology in service members with TBI. The term “dynamic visual acuity” (DVA) refers to an individual's ability to see clearly during head movement and is a behavioral measure of aVOR function. The Dynamic Visual Acuity Test (DVAT) assesses gaze instability by measuring the difference between head-stationary and head-moving visual acuity. Objective The purpose of this study was to investigate the effects of 26 hours of sleep deprivation on DVA as a surrogate for aVOR function. Design This observational study utilized a repeated-measures design. Methods Twenty soldiers with no history of vestibular insult or head trauma were assessed by means of the DVAT at angular head velocities of 120 to 180°/s. Active and passive yaw and pitch impulses were obtained before and after sleep deprivation. Results Yaw DVA remained unchanged as the result of sleep deprivation. Active pitch DVA diminished by −0.005 LogMAR (down) and −0.055 LogMAR (up); passive pitch DVA was degraded by −0.06 LogMAR (down) and −0.045 LogMAR (up). Limitations Sample homogeneity largely confounded accurate assessment of test-retest reliability in this study, resulting in intraclass correlation coefficients lower than those previously reported. Conclusions Dynamic visual acuity testing in soldiers who are healthy revealed no change in gaze stability after rapid yaw impulses and subclinical changes in pitch DVA after sleep deprivation. Findings suggest that DVA is not affected by short-term sleep deprivation under clinical conditions.

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Faculty Opinions recommendation of A new dynamic visual acuity test to assess peripheral vestibular function.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.5430957.5389055 ◽

2010 ◽

Author(s):

Detlef Kömpf ◽

Christoph Helmchen ◽

Björn Machner

Keyword(s):

Visual Acuity ◽

Vestibular Function ◽

Dynamic Visual Acuity ◽

Visual Acuity Test ◽

Acuity Test

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Bilateral Vestibulopathy: Vestibular Function, Dynamic Visual Acuity and Functional Impact

Frontiers in Neurology ◽

10.3389/fneur.2018.00555 ◽

2018 ◽

Vol 9 ◽

Cited By ~ 8

Author(s):

Ruben Hermann ◽

Eugen C. Ionescu ◽

Olivier Dumas ◽

Stephane Tringali ◽

Eric Truy ◽

...

Keyword(s):

Visual Acuity ◽

Vestibular Function ◽

Dynamic Visual Acuity ◽

Bilateral Vestibulopathy ◽

Functional Impact

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

Journal of the American Academy of Audiology ◽

10.3766/jaaa.18.3.5 ◽

2007 ◽

Vol 18 (03) ◽

pp. 236-244 ◽

Cited By ~ 4

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.

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Peran Tes Dynamic Visual Acuity dan Tes Kalori dalam Menilai Gangguan Keseimbangan pada Pasien Tuberkulosis yang Mendapat Terapi Streptomisin

Oto Rhino Laryngologica Indonesiana ◽

10.32637/orli.v48i2.249 ◽

2019 ◽

Vol 48 (2) ◽

pp. 112

Author(s):

Widayat Alviandi ◽

Brashto Bramantyo ◽

Jenny Bashiruddin ◽

Novra Widayanti

Keyword(s):

Visual Acuity ◽

Likelihood Ratio ◽

Predictive Value ◽

Positive Likelihood Ratio ◽

Vestibular Function ◽

Negative Likelihood Ratio ◽

Mean Value ◽

Caloric Test ◽

Dynamic Visual Acuity ◽

Vestibular Function Test

Latar belakang: Gangguan keseimbangan merupakan efek samping pemberian streptomisin yang dapat menurunkan kualitas hidup. Saat ini belum didapatkan penelitian gangguan keseimbangan pada pasien tuberkulosis yang mendapat terapi streptomisin diperiksa menggunakan tes dynamic visual acuity (DVA) dan tes kalori. Tujuan: Penelitian ini bertujuan untuk melihat akurasi pemeriksaan keseimbangan dengan DVA pada pasien TB yang mendapatkan streptomisin dibandingkan dengan elektronistagmografi (ENG). Metode: Penelitian ini merupakan penelitian pra-eksperimental untuk mengetahui perubahan hasil pemeriksaan fungsi keseimbangan vestibuler pada suatu kelompok pasien TB sebelum dan setelah 56 kali pemberian streptomisin, atau bila timbul keluhan gangguan keseimbangan dengan tes DVA dan tes kalori selama April-Oktober 2014. Digunakan rancangan uji diagnostik untuk membandingkan kedua cara pengukuran setelah pengobatan. Hasil: Setelah pemberian terapi didapatkan 31 (77,5%) dari 40 subjek dengan pemeriksaan kalori dan 30 (75%) dengan pemeriksaan DVA. Rerata nilai kalori sebelum terapi sebesar 93,5±32,07°/detik dan setelah terapi sebesar 82,30±38,43°/detik, terjadi perubahan sebesar -11,25±50,55°/detik. Median nilai kenaikan DVA sebelum terapi adalah 0 (minimal 0-maksimal 2) baris dan setelah terapi adalah 3 (minimal 0-maksimal 6) baris, terjadi perubahan sebesar 3 (minimal 0-maksimal 5) baris. Sensitivitas pemeriksaan DVA 83%, spesifisitas 27%, nilai duga positif 17%, nilai duga negatif 90%, rasio kemungkinan positif 1,13, dan rasio kemungkinan negatif 0,63 dengan pemeriksaan kalori sebagai baku emas. Kesimpulan: Pemeriksaan DVA dapat digunakan sebagai skrining pemeriksaan kelemahan vestibuler perifer bilateral pada pasien tuberkulosis yang mendapat terapi streptomisin.Background: Impaired balance is the side effect of Streptomycin administration which can decrease the quality of life Up till now, there is no research yet on dynamic visual acuity (DVA) and caloric test in tuberculosis (TB) patients receiving streptomycin therapy. Objective: This study aims to look at the accuracy of the examination using DVA in TB patients receiving Streptomycin, compared to using electronistagmography (ENG). Methods: A pre-experimental study was used to determine changes in the vestibular function test results in a group of TB patients before and after56times administrationof Streptomycin, or when subjects complained of balance disorders, with DVA test and caloric test during April-October 2014. Designed diagnostic test was used after treatment to compare the two methods of measurement. Result: After therapy there was 31 (77.5%) out of 40 subjects with caloric examination and in 30 (75%) with DVA examination. The mean value of caloric examination before therapy was 93.5±32.07°/sec and after therapy was 82.30±38.43°/sec, the change was -11.25±50.55°/sec. The median value of increased DVA line before therapy was 0 line and after therapy was 3 line, there was a change of 3 (minimum 0-maximum 5) line. DVA examination has a sensitivity of 83%, a specificity of 27%, positive predictive value 17%, negative predictive value 90%, a positive likelihood ratio 1.13 and a negative likelihood ratio 0.63 with caloric examination as the gold standard. Conclusion: DVA examination can be used as a screening tool in bilateral peripheral vestibular weakness in TB patients who received Streptomycin therapy.

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Clinical dynamic visual acuity in patients with cerebellar ataxia and vestibulopathy

PLoS ONE ◽

10.1371/journal.pone.0255299 ◽

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.

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Oscillopsia in Patients with Loss of Vestibular Function

Otolaryngology ◽

10.1177/019459989310900122 ◽

1993 ◽

Vol 109 (1) ◽

pp. 120-125 ◽

Cited By ~ 36

Author(s):

Sanjay A. Bhansali ◽

Charles W. Stockwell ◽

Dennis I. Bojrab

Keyword(s):

Visual Acuity ◽

High Frequency ◽

Treatment Strategies ◽

Vestibular Function ◽

Test Results ◽

Dynamic Visual Acuity ◽

Vestibular Loss ◽

Bilateral Vestibular Loss ◽

The Absolute ◽

Poor Relationship

Contrary to standard teaching, many patients with bilateral vestibular loss clearly deny oscillopsia or imbalance in darkness. In an attempt to characterize these patients within the larger population of all patients with bilateral vestibular loss, the rotation and posturography test results of 22 patients with bilateral vestibular loss were reviewed. In addition, dynamic visual acuity was assessed with an eye chart test. There was a poor relationship between oscillopsia and dynamic visual acuity or rotation testing. There were three patterns of response on rotation testing, and loss of high-frequency gain was seen in as many patients who reported oscillopsia as did not. There were some patients with normal gain values at all frequencies tested who reported oscillopsia. It may be that the change in the VOR, rather than the absolute VOR loss, is responsible for the production of oscillopsia. On the basis of this and other studies, treatment strategies for patients with bilateral vestibular loss are suggested.

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A New Dynamic Visual Acuity Test to Assess Peripheral Vestibular Function

Archives of Otolaryngology - Head and Neck Surgery ◽

10.1001/archoto.2010.99 ◽

2010 ◽

Vol 136 (7) ◽

pp. 686 ◽

Cited By ~ 38

Author(s):

Domenic Vital ◽

Stefan C. A. Hegemann ◽

Dominik Straumann ◽

Oliver Bergamin ◽

Christopher J. Bockisch ◽

...

Keyword(s):

Visual Acuity ◽

Vestibular Function ◽

Dynamic Visual Acuity ◽

Visual Acuity Test ◽

Acuity Test

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Vision Theory: Spatial and Temporal Factors

Proceedings of the Human Factors and Ergonomics Society Annual Meeting ◽

10.1177/154193129503901311 ◽

1995 ◽

Vol 39 (13) ◽

pp. 902-906

Author(s):

Alysia D. Ritter ◽

Joel Royalty ◽

Robert S. Kennedy

Keyword(s):

Visual Acuity ◽

Psychometric Properties ◽

Repeated Measures ◽

Dynamic Visual Acuity ◽

Spatial Factors ◽

Temporal Factors ◽

Stable Measures ◽

Letter Search

The psychometric properties of seven temporal factors (TFT) and five spatial factors (SFT) tests were assessed in a sample of 20 undergraduates. Subjects completed six repeated measures sessions of the TFTs and four trials of SFTs. All tests except Neisser's letter search produced stable measures. Reliabilities ranged from .81 to .98 for Simultaneity, Flicker, Search, and Bistable Stroboscopic Motion and from .59 to .71 for Masking, Phi, and Dynamic Visual Acuity. Of the 70 possible correlations between spatial and temporal batteries (7 TFTs X 5 SFTs X 2 distances), only four were significant. The moderate to high retest reliabilities, combined with the negligible correlations between spatial and temporal tests suggest that the two processes are largely independent.

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