An exploratory investigation on spatiotemporal parameters, margins of stability, and their interaction in bilateral vestibulopathy

Abstract

Integration of accurate vestibular, visual, and proprioceptive information is crucial in managing the centre of mass in relation to the base of support during gait. Therefore, bilateral loss of peripheral vestibular function can be highly debilitating when performing activities of daily life. To further investigate the influence of an impaired peripheral vestibular system on gait stability, spatiotemporal parameters, step-to-step variability, and mechanical stability parameters were examined in 20 patients with bilateral vestibulopathy and 20 matched healthy controls during preferred overground walking. Additionally, using a partial least squares analysis the relationship between spatiotemporal parameters of gait and the margins of stability was explored in both groups. Patients with bilateral vestibulopathy showed an increased cadence compared to healthy controls (121 ± 9 vs 115 ± 8 steps/min; p = 0.02; d = 0.77). In addition, although not significant (p = 0.07), a moderate effect size (d = 0.60) was found for step width variability (Coefficient of Variation (%); Bilateral vestibulopathy: 19 ± 11%; Healthy controls: 13 ± 5%). Results of the partial least squares analysis suggest that patients with peripheral vestibular failure implement a different balance control strategy. Instead of altering the step parameters, as is the case in healthy controls, they use the single and double support phases to control the state of the centre of mass to improve the mechanical stability.

Stabilization demands of walking modulate the vestibular contributions to gait

“…The current results therefore suggest that vestibular contributions may also decrease under walking conditions with reduced control effort to maintain mediolateral stability. This is in line with recent findings in patients with vestibular hypofunction who walk slower, with increased cadence and wider steps 81 – 85 . Our results suggest that they may adopt these changes in walking behavior to be less dependent on vestibular input.…”

Stabilization demands of walking modulate the vestibular contributions to gait

“…The current results therefore suggest that vestibular contributions may also decrease under walking conditions with reduced control effort to maintain mediolateral stability. This is in line with recent findings in patients with vestibular hypofunction who walk slower, with increased cadence and wider steps 82-86 . Our results suggest that they may adopt these changes in walking behavior to be less dependent on vestibular input.…”

Falls Among People With Bilateral Vestibulopathy

“…[56][57][58][59][60][61] However, the evaluation of the effectiveness of such interventions, in particular in association with falls and improving patients' mobility in daily life, requires more investigation. In addition to the causes mentioned previously that imply a pathological vestibular-ocular reflex and/or visual dependence as a contributing factor to falls in BVP, several potential physiological mechanisms may also be considered in future research, including attention deficits, 62 increased walking variability, 9,34 and altered stability control during steady state 63 and perturbed walking, 7 that may contribute to increased risk of stability loss and decreased ability to recover stability once lost.…”