The Clinical Use of the Suppression Head Impulse Paradigm in Patients with Vestibulopathy: A Systematic Review

Manzari, Leonardo; Angelis, Stefania De; Princi, Alessandro Antonio; Tramontano, Marco

doi:10.3390/healthcare10071182

Cited by 13 publications

(11 citation statements)

References 26 publications

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“…Another limitation is the absence of an instrumental evaluation of the vestibular reflexes’ functions [ 55 , 56 ], but, even in a probable absence of specific vestibular damage for the enrolled sample, VR was not expected to lead to improvements in vestibular reflexes. In fact, it seems rather to act as a facilitator for improving a compensation strategy based on the enhancement of the vestibular network and sensory–motor integration for managing a correct trade-off between stability and advancement during gait.…”

Section: Limitationsmentioning

confidence: 99%

Vestibular Rehabilitation Improves Gait Quality and Activities of Daily Living in People with Severe Traumatic Brain Injury: A Randomized Clinical Trial

Tramontano

Belluscio

Bergamini

et al. 2022

Sensors

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Neurorehabilitation research in patients with traumatic brain injury (TBI) showed how vestibular rehabilitation (VR) treatments positively affect concussion-related symptoms, but no studies have been carried out in patients with severe TBI (sTBI) during post-acute intensive neurorehabilitation. We aimed at testing this effect by combining sensor-based gait analysis and clinical scales assessment. We hypothesized that integrating VR in post-acute neurorehabilitation training might improve gait quality and activity of daily living (ADL) in sTBI patients. A two-arm, single-blind randomized controlled trial with 8 weeks of follow-up was performed including thirty sTBI inpatients that underwent an 8-week rehabilitation program including either a VR or a conventional program. Gait quality parameters were obtained using body-mounted magneto-inertial sensors during instrumented linear and curvilinear walking tests. A 4X2 mixed model ANOVA was used to investigate session–group interactions and main effects. Patients undergoing VR exhibited improvements in ADL, showing early improvements in clinical scores. Sensor-based assessment of curvilinear pathways highlighted significant VR-related improvements in gait smoothness over time (p < 0.05), whereas both treatments exhibited distinct improvements in gait quality. Integrating VR in conventional neurorehabilitation is a suitable strategy to improve gait smoothness and ADL in sTBI patients. Instrumented protocols are further promoted as an additional measure to quantify the efficacy of neurorehabilitation treatments.

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Section: Limitationsmentioning

confidence: 99%

Vestibular Rehabilitation Improves Gait Quality and Activities of Daily Living in People with Severe Traumatic Brain Injury: A Randomized Clinical Trial

Tramontano

Belluscio

Bergamini

et al. 2022

Sensors

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“…24,25 Emerging evidence shows high sensitivity and specificity for measuring vestibular weakness, of more than 87 per cent and more than 83 per cent respectively, especially when paired with the video head impulse test. 26…”

Section: Video Head Impulse Testmentioning

confidence: 99%

Modernising vestibular assessment

Lennox-Bowley,

Dasgupta

2024

J. Laryngol. Otol.

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Background There is a high prevalence of dizziness, vertigo and balance symptoms in the general population. Symptoms can be generated by many inner-ear vestibular disorders and there are several diagnostic tests available that can help identify the site of the vestibular lesion. There is little consensus on what diagnostic tests are appropriate, with diagnostics either not completed or minimally performed, leading to missed diagnosis, unsatisfactory results for patients and costs to healthcare systems. Methods This study explored the literature for different neuro-vestibular diagnostic tests not currently considered in the traditional standard vestibular test battery, and examined how they fit effectively into a patient care pathway to help quickly and succinctly identify vestibular function. Results A vestibular patient care pathway is presented for acute and subacute presentation of vestibular disorders. Conclusion An accurate diagnosis following a rigorous anamnesis and vestibular testing is paramount for successful management and favourable outcomes.

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“…In a recent review of literature ( 13 ) on SHIMP, it was observed that the test not only complemented the HIMP but also yielded better values on the VOR gain as contaminating covert saccades contributing to VOR gain are far less. PSV and the percentage of saccades indicate compensating vestibular function which are useful to glean an idea about central pathways that govern the suppression mechanism.…”

Section: Introductionmentioning

confidence: 99%

“…PSV and the percentage of saccades indicate compensating vestibular function which are useful to glean an idea about central pathways that govern the suppression mechanism. The sensitivity and specificity are postulated to be nearly 100% to diagnose a vestibular weakness ( 13 ). SHIMP behaves differently in uncompensated and compensated vestibular deficits and may be useful to plan a rehabilitation program.…”

Section: Introductionmentioning

confidence: 99%

Suppression head impulse test in children—experiences in a tertiary paediatric vestibular centre

Dasgupta,

Crunkhorn,

Wong

et al. 2024

Front. Neurol.

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The suppression head impulse paradigm (SHIMP) involves suppression of the vestibulo-ocular reflex (VOR) and anticompensatory saccades generated thereof. SHIMP is gaining importance to understand vestibular compensation with its different parameters (VOR gain/peak saccadic velocity PSV/latency of saccades). SHIMP studies are emerging in adults, but pediatric studies have hardly been performed. This study is a retrospective case note audit over a period of 2 months in a tertiary pediatric vestibular center in the United Kingdom to investigate whether SHIMP is safe/robust to be used in children conforming to existing standards/norms in normal children and whether it yields any meaningful inferences in pediatric vestibular hypofunction. This is the largest pediatric SHIMP study to date. A total of 44 referred children (6–18 years, female children>male children) with a range of complaints from dizziness, imbalance, motor incoordination, postural instability, and hearing loss were included, and their SHIMP parameters were measured. All children underwent comprehensive functional/objective audiovestibular assessments. Two groups were defined—Group A with normal vestibular function and Group B with abnormal vestibular function. The normal population showed an average SHIMP VOR gain of 0.98+/−0.08 and latency of overt saccades at 215.68+/–46.16 milliseconds agreeing with published evidence. The PSV of overt saccades was 315.39+/−56.30/s, and there was a gain asymmetry of 7.42+/−4.68 between the sides. Statistically significant differences with moderate/large effect sizes were observed between the groups in terms of VOR gain and PSV but not in saccade latencies. Covert saccades were rare in SHIMP, while overt saccades were observed in 100% of children. VOR gain difference between the head impulse paradigm (HIMP) and the SHIMP was significant as well. We observed statistically significant differences in side asymmetry of VOR gain between the groups. Furthermore, we identified a group of children with cerebellar lesions where overt saccades in SHIMP were rather low in number. Further research is recommended to investigate pediatric PSV, asymmetry, and inability to generate overt saccades that may suggest useful means to assess compensation and central function. We conclude that SHIMP yields valuable information and is a safe, easy to perform, and a reliable test that should be used in children to supplement HIMP.

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The Clinical Use of the Suppression Head Impulse Paradigm in Patients with Vestibulopathy: A Systematic Review

Cited by 13 publications

References 26 publications

Vestibular Rehabilitation Improves Gait Quality and Activities of Daily Living in People with Severe Traumatic Brain Injury: A Randomized Clinical Trial

Vestibular Rehabilitation Improves Gait Quality and Activities of Daily Living in People with Severe Traumatic Brain Injury: A Randomized Clinical Trial

Modernising vestibular assessment

Suppression head impulse test in children—experiences in a tertiary paediatric vestibular centre

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