Instrumented Gait Analysis to Identify Persistent Deficits in Gait Stability in Adults With Chronic Vestibular Loss

Abstract

IMPORTANCERegaining the ability to walk safely is a high priority for adults with vestibular loss. Thus, practitioners need comprehensive knowledge of vestibulopathic gait to design, provide, and/or interpret outcomes of interventions. To date, few studies have characterized the effects of vestibular loss on gait.OBJECTIVES To investigate the use of an instrumented 2-minute walk test in adults with vestibular loss, to further characterize vestibulopathic gait, and to assess whether those with chronic vestibular loss have enduring gait deficits. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study, conducted between April 3, 2018, and June 27, 2019, recruited adults 20 to 79 years of age from an academic, tertiary, hospital-based, ambulatory care setting who were healthy or had confirmed unilateral or bilateral vestibular hypofunction. Of the 43 adults who were screened from convenience and referred samples, 2 declined, and 7 were excluded because of health conditions. EXPOSURES The main exposure was the instrumented 2-minute walk test, which was conducted with participants using wearable inertial measurement units while they walked a 10-m path at their self-selected speed and turned 180°in their self-selected direction at either end. MAIN OUTCOMES AND MEASURESThe primary measures were spatiotemporal gait metrics (eg, stride length [SL] and peak whole-body turning velocity). Multivariate analysis of variance was used to assess between-group differences. Validity was assessed using the area under the curve from receiver operator characteristic analyses.RESULTS Data from 17 healthy adults (mean [SD] age, 39.27 [11.20] years; 13 [76%] female) and 13 adults with vestibular loss (mean [SD] age, 60.50 [10.81] years; 6 [46%] female) were analyzed. Very large between-group differences were found for SL (left) (estimated marginal mean [SE] for healthy vs vestibular groups, 1.47 [0.04] m vs 1.31 [0.04] m; Cohen d, 1.35; 95% CI, 0.18-2.52), SL (right) (estimated marginal mean [SE] for healthy vs vestibular groups, 1.46 [0.04] m vs 1.29 [0.04] m; Cohen d, 1.44; 95% CI, 0.25-2.62), and peak turn velocity (estimated marginal mean [SE] for healthy vs vestibular groups, 240.17 [12.78]°/s vs 189.74 [14.70]°/s; Cohen d, 1.23; 95% CI, 0.07-2.40). The area under the curve was 0.79 (95% CI, 0.62-0.95) for SL (left), 0.81 (95% CI, 0.64-0.97) for SL (right), and 0.86 (95% CI, 0.72-0.99) for peak turn velocity. CONCLUSIONS AND RELEVANCEIn this cross-sectional study, instrumented gait analysis had good discriminative validity and revealed persistent deficits in gait stability in those with chronic vestibular loss. The findings of this study suggest that these clinically and functionally meaningful deficits could be targets for vestibular rehabilitation.

Falls Among People With Bilateral Vestibulopathy

“…Eleven articles were reviewed, including a total of 359 patients (176 women [49%]) with ages ranging between 30 and 90 years (Table 1). The most commonly reported etiologies were idiopathic (115 [32%]), followed by unknown 38 [11%]) and ototoxic effects 34 [9%]), although 4 studies did not report any etiology (113 [31%]).…”

“…Eleven articles were reviewed, including a total of 359 patients (176 women [49%]) with ages ranging between 30 and 90 years (Table 1). The most commonly reported etiologies were idiopathic (115 [32%]), followed by unknown 38 [11%]) and ototoxic effects 34 [9%]), although 4 studies did not report any etiology (113 [31%]). Regarding diagnostic criteria, only 2 of the included studies used the Bárány Society Diagnostic Criteria, whereas the other studies most frequently used combinations of caloric testing with varying cutoffs, video head impulse testing, and rotary chair testing .…”

Association Between Hearing Loss and Impaired Physical Function, Frailty, and Disability in Older Adults

“…39 For example, adults with chronic vestibular loss have shown gait deficits. 40 Vestibular function is responsible for balance, a key component of physical function. Thus, the agerelated deterioration of the hair cells that participate in both the vestibular system and auditory system may imply that HL is a surrogate of vestibular dysfunction, 41 and the association observed in this study may not be causal.…”

Automatic ML-based vestibular gait classification: examining the effects of IMU placement and gait task selection

“…This classification performance was aligned with scores reported by Ikizoglu et al ranging from 0.82 to 0.86 for a similar ML-based binary classification for gait patterns from individuals vestibular deficits and controls based on kinematic data extracted from lower-body IMUs [ 33 ]. A recent study by Grove et al [ 21 ] examining the differences between gait patterns from individuals vestibular deficits and controls during the 2-Minute Walk Test using statistical methods reported AUROCs of 0.80 and 0.79 based on right and left stride lengths, respectively, and an AUROC of 0.86 for peak turn velocity. In a different ML-based study by Nguyen et al [ 34 ], higher test AUROC scores (AUROC = 0.98) were achieved when classifying vestibular gait.…”

“…IMUs have been used to detect gait events and estimate spatiotemporal gait parameters such as stride length, stride time, stance time, swing time and gait speed [ 19 ], as well as to estimate upper-body kinematics [ 20 ]. Wearable IMUs have been used to estimate spatiotemporal gait metrics of individuals with vestibular deficits during the 2-Minute Walk Test [ 21 ], and measure walking/turning times during conventional gait tests such as the FGA [ 22 ] and TUG [ 23 ], thus providing a quantitative measurement of kinematic changes that occur during gait tasks when the vestibular system is affected.…”