Journal of Vestibular Research - Volume Pre-press, issue Pre-press

Authors: Hüfner, Katharina | Sperner-Unterweger, Barbara

Article Type: Research Article

Abstract: The Barany society published recently the consensus document for the diagnostic criteria of persistent postural perceptual dizziness (PPPD). In this commentary we highlight the benefits of this new diagnosis and possible problems that can arise during the use of the criteria in day to day clinical practice at a University Clinic for Psychosomatic Medicine. The diagnostic criteria of PPPD are compared to those of somatic symptom disorder and bodily distress disorder. We think that a discussion from a psychosomatic point of view is important to improve the understanding between different specialties and how PPPD fits into the broader framework of …psychosomatic medicine. Show more

DOI: 10.3233/VES-190679

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-3, 2019

Article Type: Letter

DOI: 10.3233/VES-190680

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-3, 2019

Authors: Dao-Ming, Tong | Ye-Ting, Zhou

Article Type: Research Article

Abstract: BACKGROUND: Whether the acute dizziness would be associated with potentially life-threatening event, which was previously unknown. METHODS: Between Jan 2014 and Dec 2016, We performed a retrospective survey to investigate the clinical data of patients with acute dizziness from an intensive care unit (ICU) in China. Inclusion criteria for all cases were presented with acute dizziness at onset, and then with a potentially life-threatening event. Baseline data and 30-days outcomes were collected. RESULTS: Approximately 1.0% of ICU patients had an acute dizziness with potentially life-threatening events. The median age of patients was 60 years (range 23 …to 81 years), male: female ratio was 1.8:1. The causes of acute dizziness included focal cerebral hemorrhage in 15 cases (60%), shock in 7cases (28%), and cerebral infarction in 3 cases (12%). The most frequent potentially life-threatening event was acute brain failure (24/25), and the most common cause leading to brain failure was the lesion enlarged (54.2%, including hematoma enlargement in 8 cases, large area infarction or new infarction in 3 cases, and intraventricular hemorrhage in 2 cases). The second potentially life-threatening event was septic shock/secondary sepsis (45.8%). The fatality rate for all life- threatening events was in 64%. Compared with the survival group, the patients with lesion enlarged (56.3% vs. 11.1%, p  <  0.05), acute respiratory failure (93.8% vs. 55.6% p  <  0.05), lactate level (5.3 mmol/l vs. 1.3 mmol/l, p  <  0.05), and Sequential Organ Failure Assessment (SOFA) score (6.9 vs. 3.4, p  <  0.0001) in the non-survival group were significantly higher, while late mean arterial blood pressure (84.6 mmHg vs.124 mmHg, p  <  0.0001), GCS score (5.0 score vs. 15 score, p  <  0.0001) in the non-survival group were significantly lower. CONCLUSION: Acute dizziness with potentially life-threatening events accounts for about 1% of adult ICU patients. Acute dizziness in ICU patients is associated with a high risk of death within 30 days of onset. Show more

Keywords: Acute dizziness or vertigo; life-threatening event, organ dysfunction, prognosis

DOI: 10.3233/VES-190677

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-7, 2019

Authors: Massingale, Shelly | Alexander, Amy | Gerkin, Richard | Leddon, Charles | McQueary, Elizabeth | Allred, Richard Cameron | Pardini, Jamie E.

Article Type: Research Article

Abstract: BACKGROUND: The ability to clearly perceive an object while the head is in motion is important in athletics, as it relates to performance and potentially to injury prevention. Normative data for healthy adults on measures of gaze stability have been established. However, data for elite athletes is scarce. OBJECTIVE: To describe performance of elite athletes on computerized gaze stability testing and establish normative data for reference. METHODS: Data were acquired via retrospective chart review. 134 male professional baseball players completed computerized Visual Acuity, Visual Perception Time Test and Gaze Stability Tests as part of a multi-modal …baseline testing session. RESULTS: Performance of all athletes was superior to general population norms reported in the literature. There were no significant differences between the optimal and suboptimal consistency groups or between English-speaking and non- or limited-English speaking players. CONCLUSIONS: Similar to prior studies with smaller samples that have examined GST in athletes, we found high levels of GST performance in professional baseball players relative to normative data for the general population. Normative data for elite athletes was established using this healthy sample. This study underscores the importance of understanding the unique abilities of elite athletes when providing therapy after injury. Show more

Keywords: Gaze stability, elite athlete, sport

DOI: 10.3233/VES-190678

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-8, 2019

Authors: Bretl, Kathrine N. | Sherman, Sage O. | Dixon, Jordan B. | Mitchell, Thomas R. | Clark, Torin K.

Article Type: Research Article

Abstract: BACKGROUND: Humans can adapt to the “Coriolis” cross-coupled illusion with repeated exposure, improving the tolerability of faster spin rates and enabling short-radius, intermittent centrifugation for artificial gravity implementation. OBJECTIVE: This investigation assesses the criticality of personalization in acclimation to the cross-coupled illusion. METHODS: We used the median stimulus sequence of our previous effective and tolerable personalized, threshold-based protocol to develop a standardized (non-personalized) approach. During each of 10, 25-minute sessions, the spin rate was incremented independent of whether each subject reported experiencing the cross-coupled illusion. RESULTS: In comparison to the previous personalized protocol, the …standardized protocol resulted in significantly reduced acclimation to the cross-coupled illusion (17.7 RPM threshold for the personalized protocol versus 11.8 RPM threshold for the standardized) and generally increased motion sickness reports (average reporting of 1.08/20 (personalized) versus 1.98/20 (standardized)), on average. However, the lack of individualization also leads to significantly less variance in subjects’ acclimation. CONCLUSIONS: These findings are critical for future missions that may require several astronauts to be acclimated concurrently, due to resource and time constraints. Assessing feasibility of fast spin rate, short-radius centrifugation is crucial for the future of artificial gravity implementation during spaceflight. Show more

Keywords: Artificial gravity, short-radius centrifuge, physiological countermeasure, standardized acclimation

DOI: 10.3233/VES-190673

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-12, 2019

Authors: Wu, Peixia | Yang, Mei | Hu, Yan | Li, Huawei

Article Type: Research Article

Abstract: BACKGROUND: The activities and participation component of the International Classification of Functioning, Disability and Health (ICF) has gained increasing recognition in rehabilitation field. The vestibular activities and participation measure (VAP) was the first instrument using the ICF to evaluate activities and participation outcomes for vestibular research and clinical practice. OBJECTIVES: This study aimed to cross-culturally adapt the VAP into Chinese language and to examine the psychometric properties of the Chinese version of VAP (VAP-C). METHODS: A standard “forward-backward” translation procedure was followed and the results were presented to the panel of experts and consensus was …sought. Internal consistency was assessed using Cronbach’s alpha and test-retest reliability examined by intraclass correlation coefficient (ICC). Convergent validity was determined by calculating the Pearson’s correlation coefficient between the VAP-C and the Visual Analog Scale (VAS) and the Dizziness Handicap Inventory (DHI). Discriminative validity for test subjects versus control subjects was evaluated by Receiver Operating Characteristic curve (ROC) analysis. RESULTS: Minor revisions were made during translation to ensure semantic equivalence and to suit Chinese culture. A total of 121 patients complaining of dizziness or vertigo due to peripheral vestibular disorders (test subjects) and 41 control subjects were enrolled. Cronbach’s alpha was 0.94 for the VAP-C total scale and greater than 0.80 for the two subscales. ICC for the VAP-C total scale was 0.78, and for subscale one was 0.77 and subscale two 0.76. The VAP-C had strong correlations (r  = 0.85–0.88) with the VAS and fair to moderate correlations (r  = 0.23–0.53) with DHI. Through ROC analysis, we found the VAP-C discriminated significantly between patients and control subjects. Based on the estimate of Youden J, the optimal cut-off values for VAP-C total and the two subscales were established. CONCLUSIONS: The VAP-C shows evidence of reliability and validity, which can be applied for evaluating the impact of the vestibular disorder on patients’ activities and participation in Chinese language populations. Show more

Keywords: Vestibular, activities and participation, reliability, validity, ICF

DOI: 10.3233/VES-190675

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-9, 2019

Authors: Anton, Kristina | Ernst, Arne | Basta, Dietmar

Article Type: Research Article

Abstract: BACKGROUND: Postural stability might be influenced by auditory input as humans utilize spatiotemporal information to localise sound sources. Earlier studies investigated the acoustic influence on posture but unfortunately experimental setup, room acoustics and conditions of participants varied widely. OBJECTIVE: This study aimed at recording body sway velocity under clearly defined acoustic conditions in a homogenous group of young healthy participants. METHODS: Thirty participants performed five stance tasks (standing eyes open/closed, standing on a foam support eyes open/closed, Tandem Romberg test eyes closed) under five acoustic conditions (in quiet, with a loudspeaker presenting continuous/interrupted noise, with ear …protectors) in two different rooms (long/short reverberation time). Body sway velocity was determined close to body’s centre of gravity. RESULTS: Postural stability decreased significantly when continuous noise was applied and increased significantly when interrupted noise was presented in the reverberant room. The usage of ear protectors increased body sway velocity compared to quietness in both rooms. CONCLUSIONS: An impaired auditory input by plugging/acoustic masking reduced postural control. Interrupted noise seems to provide a continuously repeated feedback about the postural position in a reverberant room. Hence, the effect of hearing on posture highly depends on the structure of the auditory signal, the sensorimotor condition and the acoustic environment. Show more

Keywords: Auditory influence, mobile posturography, postural control, body sway, spatial cues

DOI: 10.3233/VES-190674

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-8, 2019

Authors: Holly, Jan E. | Cohen, Helen S. | Masood, M. Arjumand

Article Type: Research Article

Abstract: BACKGROUND: Perception of self-motion is difficult for patients to describe. In addition, the relationship between perceived rotation and eye movements is poorly understood, because most studies of patients have investigated only static orientation. OBJECTIVE: First, to determine whether patients with benign paroxysmal positional vertigo (BPPV) can use visual images to report perceived rotation elicited by the Dix-Hallpike maneuver. Second, to determine if the direction of patients’ perceptions align with data on classical nystagmus direction. METHODS: After the Dix-Hallpike maneuver, BPPV patients viewed images – sketches or video animations – representing possible perceived motions. They selected one …or more images representing perception. RESULTS: All subjects could select images. The directions of the videos were most often backward pitch and/ or ipsilateral roll and yaw relative to body orientation in the supine Dix-Hallpike position, generally consistent with the canal stimulus. Perceived direction of rotation was statistically significantly different from the direction of eye movements as published previously, suggesting a difference in mechanisms for perception and eye movements. CONCLUSION: Patients can easily learn to use a video language to describe their experiences. Perception is generally aligned with canal stimulus and nystagmus, but not exactly. Show more

Keywords: Spatial orientation, vertigo, nystagmus, self-motion perception

DOI: 10.3233/VES-190676

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-9, 2019

Authors: Agrawal, Yuri | Van de Berg, Raymond | Wuyts, Floris | Walther, Leif | Magnusson, Mans | Oh, Esther | Sharpe, Margaret | Strupp, Michael

Article Type: Research Article

Abstract: This paper describes the diagnostic criteria for presbyvestibulopathy (PVP) by the Classification Committee of the Bárány Society. PVP is defined as a chronic vestibular syndrome characterized by unsteadiness, gait disturbance, and/or recurrent falls in the presence of mild bilateral vestibular deficits, with findings on laboratory tests that are between normal values and thresholds established for bilateral vestibulopathy. The diagnosis of PVP is based on the patient history, bedside examination and laboratory evaluation. The diagnosis of PVP requires bilaterally reduced function of the vestibulo-ocular reflex (VOR). This can be diagnosed for the high frequency range of the VOR with the …video-HIT (vHIT); for the middle frequency range with rotary chair testing; and for the low frequency range with caloric testing. For the diagnosis of PVP, the horizontal angular VOR gain on both sides should be < 0.8 and > 0.6, and/or the sum of the maximal peak velocities of the slow phase caloric-induced nystagmus for stimulation with warm and cold water on each side should be < 25°/s and > 6°/s, and/or the horizontal angular VOR gain should be > 0.1 and < 0.3 upon sinusoidal stimulation on a rotatory chair. PVP typically occurs along with other age-related deficits of vision, proprioception, and/or cortical, cerebellar and extrapyramidal function which also contribute and might even be required for the manifestation of the symptoms of unsteadiness, gait disturbance, and falls. These criteria simply consider the presence of these symptoms, along with documented impairment of vestibular function, in older adults. Show more

DOI: 10.3233/VES-190672

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-10, 2019

Authors: Clément, Gilles | Wood, Scott J. | Paloski, William H. | Reschke, Millard F.

Article Type: Research Article

Abstract: BACKGROUND: The vestibulo-ocular reflex (VOR) is a basic function of the vestibular system that stabilizes gaze during head movement. Investigations on how spaceflight affects VOR gain and phase are few, and the magnitude of observed changes varies considerably and depends on the protocols used. OBJECTIVE: We investigated whether the gain and phase of the VOR in darkness and the visually assisted VOR were affected during and after spaceflight. METHODS: We measured the VOR gain and phase of 4 astronauts during and after a Space Shuttle spaceflight while the subjects voluntary oscillated their …head around the yaw axis at 0.33 Hz or 1 Hz and fixed their gaze on a visual target (VVOR) or imagined this target when vision was occluded (DVOR). Eye position was recorded using electrooculography and angular velocity of the head was recorded with angular rate sensors. RESULTS: The VVOR gain at both oscillation frequencies remained near unity for all trials. DVOR gain was more variable inflight and postflight. Early inflight and immediately after the flight, DVOR gain was lower than before the flight. The phase between head and eye position was not altered by spaceflight. CONCLUSION: The decrease in DVOR gain early in the flight and after the flight reflects adaptive changes in central integration of vestibular and proprioceptive sensory inputs during active head movements. Show more

Keywords: Vestibular nystagmus, visual fixation, visual-vestibular interaction, microgravity, vestibulo-ocular reflex

DOI: 10.3233/VES-190670

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-11, 2019