Exploring the role of attention towards balance in chronic dizziness: Development of the Balance Vigilance Questionnaire

Ellmers, Toby J.; Kal, Elmar C.

doi:10.1111/ene.16148

Cited by 3 publications

(1 citation statement)

References 42 publications

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“…Alternatively, some vestibular self-report measures include separate subscales for affective components of vestibular dysfunction (e.g., DHI, VSS) which lend themselves to clinical contexts. A newly validated Balance Vigilance Questionnaire ( 169 ) and Updated Perceived Control over Falling Scale ( 170 ) are also freely available to identify maladaptive hypervigilant behaviors that may lead to avoidant behaviors that limit clinical engagement.…”

Section: Assessing Vestibular Cognitive Dysfunctionmentioning

confidence: 99%

Cognition in vestibular disorders: state of the field, challenges, and priorities for the future

Smith,

Wilkinson,

Bodani

et al. 2024

Front. Neurol.

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Vestibular disorders are prevalent and debilitating conditions of the inner ear and brain which affect balance, coordination, and the integration of multisensory inputs. A growing body of research has linked vestibular disorders to cognitive problems, most notably attention, visuospatial perception, spatial memory, and executive function. However, the mechanistic bases of these cognitive sequelae remain poorly defined, and there is a gap between our theoretical understanding of vestibular cognitive dysfunction, and how best to identify and manage this within clinical practice. This article takes stock of these shortcomings and provides recommendations and priorities for healthcare professionals who assess and treat vestibular disorders, and for researchers developing cognitive models and rehabilitation interventions. We highlight the importance of multidisciplinary collaboration for developing and evaluating clinically relevant theoretical models of vestibular cognition, to advance research and treatment.

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Section: Assessing Vestibular Cognitive Dysfunctionmentioning

confidence: 99%

Cognition in vestibular disorders: state of the field, challenges, and priorities for the future

Smith,

Wilkinson,

Bodani

et al. 2024

Front. Neurol.

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Psychological Variables Mediate Symptoms in Persistent Postural-Perceptual Dizziness (PPPD): A Cross-Sectional Self-Report Study

Sereda,

Lam,

Hazar

et al. 2024

Preprint

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Background: Persistent Postural-Perceptual Dizziness (PPPD) is a prevalent long-term functional neurological disorder characterised by non-spinning vertigo, perceived instability, and visual motion sensitivity. Current diagnostic criteria inadequately incorporate psychological variables widely associated with PPPD symptom onset and maintenance. Objectives: This study explored PPPD-specific psychological variables to differentiate PPPD patients from healthy controls and, exploratorily, from Bilateral Vestibulopathy (BVP) patients. We evaluated these variables as potential treatment targets through mediation analysis. Our aim was to inform more precise diagnostic criteria and guide targeted interventions for PPPD. Methods: We conducted a cross-sectional study with 164 participants, including 59 diagnosed cases of PPPD, 16 cases of BVP, and 89 healthy controls. Participants completed a series of questionnaires assessing negative illness perception, balance vigilance, anxiety, visual sensitivity, dizziness and other related metrics. Results: Psychological variables, particularly anxiety, cognitive fusion, and justice appraisal significantly mediated the relationship between key PPPD symptoms (dizziness, visual sensitivity, and balance vigilance) and PPPD diagnosis compared to healthy controls. Logistic regression suggested psychological differences between PPPD and BVP, but limited BVP sample size constrained generalisability. Between PPPD and healthy controls, psychological variables significantly improved classification accuracy compared to measures of dizziness alone. Conclusion: Incorporating psychological variables in the diagnosis and management of PPPD could enhance the understanding of the disorder and may aid in developing better-targeted interventions. The study supports revising existing diagnostic criteria to include validated psychological assessments and highlights the potential of treatments addressing cognitive and emotional aspects of PPPD to improve patient outcomes.

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A “Conscious” Loss of Balance: Directing Attention to Movement Can Impair the Cortical Response to Postural Perturbations

Parr,

Mills,

Kal

et al. 2024

J. Neurosci.

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‘Trying too hard’ is known to interfere with skilled movement, such as sports and music playing. Postural control can similarly suffer when conscious attention is directed towards it (termed ‘conscious movement processing’; CMP). However, the neural mechanisms through which CMP influences balance remain poorly understood. We explored the effects of CMP on electroencephalographic (EEG) perturbation-evoked cortical responses and subsequent balance performance. Twenty healthy young adults (age=25.1±5 years; 10 males and 10 females) stood on a force plate-embedded moveable platform whilst mobile EEG was recorded. Participants completed two blocks of 50 discrete perturbations, containing an even mix of slower (186 mm/s peak velocity) and faster (225 mm/s peak velocity) perturbations. One block was performed under conditions of CMP (i.e., instructions to consciously control balance), whilst the other was performed under ‘Control’ conditions with no additional instructions. For both slow and fast perturbations, CMP resulted in significantly smaller cortical N1 signals (a perturbation-evoked potential localised to the supplementary motor area), and lower sensorimotor beta EEG activity 200–400 ms post-perturbation. Significantly greater peak velocities of the centre of pressure (i.e., greater postural instability) were also observed during the CMP condition. Our findings provide the first evidence that disruptions to postural control during CMP may be a consequence of insufficient cortical activation relevant for balance (i.e., insufficient cortical N1 responses followed by enhanced beta suppression). We propose that conscious attempts to minimise postural instability through CMP acts as a cognitive dual-task that dampens the sensitivity of the sensorimotor system for future losses of balance.Significance statement‘Trying too hard’ is known to interfere with skilled movement, such as sports and music playing. Postural control can also paradoxically worsen when individuals direct conscious attention towards maintaining balance. Yet, the brain mechanisms underpinning the counterproductive effects of such conscious movement processing (CMP) remain unclear. Here, we show that impaired postural control when engaging in CMP is expressed by a reduction in the evoked cortical signal following a perturbation to balance. These findings imply that conscious attempts to minimise postural instability may act as a cognitive dual-task that dampens the sensitivity of the sensorimotor system for future losses of balance.

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Exploring the role of attention towards balance in chronic dizziness: Development of the Balance Vigilance Questionnaire

Cited by 3 publications

References 42 publications

Cognition in vestibular disorders: state of the field, challenges, and priorities for the future

Cognition in vestibular disorders: state of the field, challenges, and priorities for the future

Psychological Variables Mediate Symptoms in Persistent Postural-Perceptual Dizziness (PPPD): A Cross-Sectional Self-Report Study

A “Conscious” Loss of Balance: Directing Attention to Movement Can Impair the Cortical Response to Postural Perturbations

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