Improvements in Trunk Sway Observed for Stance and Gait Tasks during Recovery from an Acute Unilateral Peripheral Vestibular Deficit

Abstract

Objectives: Our aim was to track improvements in postural control during recovery from an acute unilateral peripheral vestibular deficit (UVL), presumably due to vestibular neuritis, and to determine if recovery rates were different for stance and gait tasks. Postural control was quantified using simple measurements of trunk sway: amplitudes of trunk sway angle and angular velocity, in the roll and pitch directions as well as task duration, were examined for a battery of stance and gait tasks. These measures were collected at the onset of the deficit and then 3 weeks and 3 months later. Study Design: A repeated-measures design was used for UVL subjects and age-matched healthy controls. Stance tasks involved standing on 1 or 2 legs with eyes open or closed. Gait tasks consisted of tandem gait, walking normally with eyes closed, or with the head rotating or head pitching, walking up and down stairs and walking over a series of low barriers. Stance and tandem gait tasks were repeated using a foam support surface instead of a normal floor. Patients: Twenty-eight patients with acute UVL were examined. Main Outcome Measures: The range of trunk sway angular displacement and angular velocity in the pitch and roll directions was measured for each task in addition to task duration. The measures were compared with those of normal subjects. Results: The amplitudes of pitch trunk sway for 2-legged stance tasks with eyes closed underwent the greatest reduction 3 weeks after UVL onset. At 3 months, trunk sway was almost normal for all 2-legged stance tasks. One-legged stance tasks with eyes open showed a similar but slower improvement. Stance time without a fall showed a very rapid improvement for 1-legged tasks but was still shorter than that of normal subjects at 3 months. Trunk sway for the simple gait tasks was within normal range at 3 months; however, task duration was still longer than normal. More complex gait tasks, such as walking 8 tandem steps on foam or walking up and down stairs, showed no improvement in trunk roll sway at 3 months. A mix of variables from mainly gait tasks best identified a balance deficit due to UVL, with complex gait tasks becoming more important for identification purposes as compensation progressed. The accuracy of UVL identification with durations alone was 75% of the accuracy with combined trunk sway and duration measures. Conclusions: These data suggest that recovery of normal trunk control during the compensation process for unilateral vestibular hypofunction is more rapid for stance tasks than gait tasks. Even at 3 months, trunk sway for complex gait tasks was not normal. Thus, trunk sway for gait tasks provides a better insight into remaining deficits in balance control of vestibular-loss patients than the sway of stance tasks.

The influence of artificially increased hip and trunk stiffness on balance control in man

“…Tests with the full-corset were performed a day later. All subjects were tested for a lack of orthopaedic or balance problems using techniques described in Allum and Adkin (2003) and then gave witnessed informed and written consent to participate in the experiments according to the Declaration of Helsinki. The Institutional Review Board of the University Hospital in Basel approved the study.…”

Visual and proprioceptive contributions to postural control of upright stance in unilateral vestibulopathy

“…Due to these processes and observed changes with different sensory disturbances, deficiencies in stability control during functional motor tasks could be expected if the vestibular, visual or somatosensory systems are dysfunctional and these sensory deficits have not been compensated for. A reweighting of sensory input may occur quickly and acutely in response to sensory disturbance ) or chronically to compensate for persistent dysfunction of one system (Allum and Adkin 2003), and in some cases, compensation may not be complete. Therefore, static posturography represents a tool in order to objectivise dysfunction and compensation of the sensory systems due to conditions such as vestibulopathy (Corriveau et al 2001, Di Fabio 1995.…”

Postural Control in Patients with Unilateral Vestibular Lesions Is More Impaired in the Roll than in the Pitch Plane: A Static and Dynamic Posturography Study

“…Vestibular infl uences appear earlier in the pitch plane and are directed to leg muscles, whereas roll control occurs later and is focused on trunk muscles . After unilateral vestibular loss (UVL), a defi cit of trunk stabilization in the roll plane had been demonstrated Allum and Adkin, 2003;Borel et al, 2002]. In particular, subjects with UVL were unable to control trunk roll oscillations within normal limits during complex gait tasks at 3 months [Allum and Adkin, 2003].…”