Bilateral vestibulopathy causes selective deficits in recombining novel routes in real space

Schöberl, Florian; Pradhan, Cauchy; Grosch, Maximilian; Brendel, Matthias; Jostes, Florian; Obermaier, Katrin; Sowa, Chantal; Jahn, Klaus; Bartenstein, Peter; Brandt, Thomas; Dieterich, Marianne; Zwergal, Andreas

doi:10.1038/s41598-021-82427-6

Cited by 29 publications

(24 citation statements)

References 74 publications

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“…The peripheral vestibular system senses motion and orientation of the head with respect to gravity and provides a central reference frame for spatial orientation, regulation of upright posture, and stabilization of gaze during head movements [1]. The primary complaints of patients with a chronic bilateral vestibular hypofunction (BVH) are consequently related to a chronic postural unsteadiness during stance and gait [2], an impaired gaze stabilization with oscillopsia during head turns and locomotion [3], and deficits in spatial memory and navigation [4]. Deficits in the balance and ocular-motor domain in BVH have been further associated to an increased risk of falling [5][6][7] and a reduced quality of life [8].…”

Section: Introductionmentioning

confidence: 99%

Impact on daily mobility and risk of falling in bilateral vestibulopathy

et al. 2022

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Objective To study the behavioral relevance of postural and ocular-motor deficits on daily activity and risk of falling in patients with bilateral vestibular hypofunction (BVH). Methods Thirty patients with BVH and 30 age- and gender-matched healthy controls participated in a continuous 2-week assessment of daily activities and mobility using a body-worn inertial sensor and a 6-month prospective fall risk assessment. At inclusion, patients and controls further underwent a multi-modal clinical, score- and instrument-based assessment of general health and balance status. We analyzed the relationship between clinical, lab-, and sensor-based measures and their validity to identify those patients at a risk of general, frequent, and severe falling. Results Patients exhibited impairments in daily activity in particular in terms of reduced ambulatory activity (p = 0.009). 43% of patients experienced falls (13% in controls, p = 0.008) and 70% of these patients reported recurrent falling (0% in controls, p = 0.001) during prospective assessment. Severe fall-related injuries that would require medical attention neither occurred in patients nor in controls. Classificatory models based on multi-modal clinical, lab-, and sensor-based measures of balance and mobility identified patients who fell with an accuracy of 93% and patients who recurrently fell with an accuracy of 89%. Conclusion BVH is linked to particular impairments of patients’ daily activities which in turn are related to patients’ fall risk. Hence, off-laboratory measures of daily mobility may supplement standard clinical assessment in BVH to more adequately capture the burden of disease and to reliably identify those patients at a specific risk of falling.

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Section: Introductionmentioning

confidence: 99%

Impact on daily mobility and risk of falling in bilateral vestibulopathy

et al. 2022

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“…Previous literature demonstrated that BVP also results in cognitive or emotional complaints ( 3 – 6 ). In particular, an association between BVP and symptoms such as sadness, fear, anger, difficulties with dual tasking and spatial anxiety was described ( 3 – 11 ). This ultimately results in behavioral changes such as avoiding activities or performing activities more slowly and with greater attention ( 6 ).…”

Section: Introductionmentioning

confidence: 99%

Development and Content Validity of the Bilateral Vestibulopathy Questionnaire

et al. 2022

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BackgroundTo date, the burden and severity of the full spectrum of bilateral vestibulopathy (BVP) symptoms has not yet been measured in a standardized manner. Since therapeutic interventions aiming to improve BVP symptoms are emerging, the need for a new standardized assessment tool that encompasses the specific aspects of BVP arises. Therefore, the aim of this study was to develop a multi-item Patient Reported Outcome Measure (PROM) that captures the clinically important symptoms of BVP and assesses its impact on daily life.MethodsThe development of the Bilateral Vestibulopathy Questionnaire (BVQ) consisted of two phases: (I) initial item generation and (II) face and content validity testing. Items were derived from a literature review and individual semi-structured interviews focusing on the full spectrum of reported BVP symptoms (I). Subsequently (IIa), individual patient interviews were conducted using “thinking aloud” and concurrent verbal probing techniques to assess the comprehensibility of the instructions, questions and response options, and the relevance, missing domains, or missing items. Interviews continued until saturation of input was reached. Finally, international experts with experience in the field of the physical, emotional, and cognitive symptoms of BVP participated in an online focus group to assess the relevance and comprehensiveness of the BVQ (IIb).ResultsThe BVQ consisted of two sections. The first section included 50 items scored on a six-point Likert scale arranged into seven constructs (i.e., imbalance, oscillopsia, other physical symptoms, cognitive symptoms, emotional symptoms, limitations and behavioral changes and social life). The second section consisted of four items, scored on a visual analog scale from 0 to 100, to inquire about limitations in daily life, perceived health and expectations regarding future recovery. Interviews with BVP patients [n = 8, 50% female, mean age 56 years (range 24–88 years)] and the expert meeting confirmed face and content validity of the developed BVQ.ConclusionThe BVQ, which was developed to assess the spectrum of BVP symptoms and its impact on daily life, proved to have good face and content validity. It can be used to characterize current self-reported symptoms and disability and to evaluate symptom burden before and after therapeutic interventions in future research and clinical practice.

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“…Questionnaires can only give a broad estimate of one’s ability to navigate in a given environment [ 2 ]. Wayfinding studies usually require a complex setup that isn’t feasible as a clinical routine [ 3 , 4 ]. However, it is desirable to include a bedside tests of spatial orientation in a neurologic assessment to uncover deficits to prevent from potentially dangerous situations [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Different strategies in pointing tasks and their impact on clinical bedside tests of spatial orientation

2022

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Deficits in spatial memory, orientation, and navigation are often early or neglected signs of degenerative and vestibular neurological disorders. A simple and reliable bedside test of these functions would be extremely relevant for diagnostic routine. Pointing at targets in the 3D environment is a basic well-trained common sensorimotor ability that provides a suitable measure. We here describe a smartphone-based pointing device using the built-in inertial sensors for analysis of pointing performance in azimuth and polar spatial coordinates. Interpretation of the vectors measured in this way is not trivial, since the individuals tested may use at least two different strategies: first, they may perform the task in an egocentric eye-based reference system by aligning the fingertip with the target retinotopically or second, by aligning the stretched arm and the index finger with the visual line of sight in allocentric world-based coordinates similar to using a rifle. The two strategies result in considerable differences of target coordinates. A pilot test with a further developed design of the device and an app for a standardized bedside utilization in five healthy volunteers revealed an overall mean deviation of less than 5° between the measured and the true coordinates. Future investigations of neurological patients comparing their performance before and after changes in body position (chair rotation) may allow differentiation of distinct orientational deficits in peripheral (vestibulopathy) or central (hippocampal or cortical) disorders.

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Bilateral vestibulopathy causes selective deficits in recombining novel routes in real space

Cited by 29 publications

References 74 publications

Impact on daily mobility and risk of falling in bilateral vestibulopathy

Impact on daily mobility and risk of falling in bilateral vestibulopathy

Development and Content Validity of the Bilateral Vestibulopathy Questionnaire

Different strategies in pointing tasks and their impact on clinical bedside tests of spatial orientation

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