The Effect of Age on Improvements in Vestibulo-Ocular Reflexes and Balance Control after Acute Unilateral Peripheral Vestibular Loss

Abstract

BackgroundAn acute unilateral peripheral vestibular loss (aUVL) initially causes severe gaze and balance control problems. However, vestibulo-ocular reflexes (VOR) and balance control are nearly normal 3 months later as a result of peripheral recovery and/or central compensation. As pre-existing vestibular sensory loss is assumed to be greater in the healthy elderly, this study investigated whether improvements in VOR and balance function over time after aUVL are different for the elderly than for the young.MethodsThirty aUVL patients divided into three age-groups were studied (8 age range 23–35, 10 with range 43–58, and 12 with range 60–74 years). To measure VOR function eye movements were recorded during caloric irrigation, rotating chair (ROT), and head impulse tests. Balance control during stance and gait was recorded as lower trunk angular velocity in the pitch and roll planes. Measurements were taken at deficit onset, and 3, 6, and 13 weeks later.ResultsThere was one difference in VOR improvements over time between the age-groups: Low acceleration ROT responses were less at onset in the elderly group. Deficit side VOR responses and asymmetries in each group improved to within ranges of healthy controls at 13 weeks. Trunk sway of the elderly was greater for stance and gait at onset when compared to healthy age-matched controls and the young and greater than that of the young and controls during gait tasks at 13 weeks. The sway of the young was not different from controls at either time point. Balance control for the elderly improved slower than for the young.ConclusionThese results indicate that VOR improvement after an aUVL does not differ with age, except for low accelerations. Recovery rates are different between age-groups for balance control tests. Balance control in the elderly is more abnormal at aUVL onset for stance and gait tasks with the gait abnormalities remaining after 13 weeks. Thus, we conclude that balance control in the elderly is more affected by the UVL than for the young, and the young overcome balance deficits more rapidly. These differences with age should be taken into account when planning rehabilitation.

Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Updated Clinical Practice Guideline From the Academy of Neurologic Physical Therapy of the American Physical Therapy Association

“…Some additional more nuanced information has been added to our knowledge base on VPT for acute UVH. For example, in individuals younger than 50 years without other comorbidities, the prognosis is good almost regardless of the treatment rendered 147,149,155. Ismail et al147 found no difference among treatment with steroids, VPT, or both steroids and VPT in individuals younger than 50 years with acute UVH due to vestibular neuritis.…”

5‐HT1A receptor‐mediated attenuation of synaptic transmission in rat medial vestibular nucleus impacts on vestibular‐related motor function

“…This is in line with the suggestion of age‐related increase of 5‐HT in the vestibular nuclear complex (Smith, 2016) as the cause of deterioration of vestibular function and slow recovery after vestibular injury in the elderly (Arshad & Seemungal, 2016; Scheltinga et al . 2016). It would be interesting to investigate whether 5‐HT 1A receptor agonists may be used to dampen the circuit for aberrant vestibular inputs that would otherwise lead to motion sickness, while 5‐HT 1 receptor antagonists may be utilized to enhance sensitivity of vestibular circuits to improve vestibular function to combat ageing and vestibular trauma.…”

Compensation vestibulaire et vieillissement

“…Les altérations de la transmission GABAergique et du profil comportemental après une lésion vestibulaire périphérique unilatérale sont donc impactées par le vieillissement. Les effets d'une perte vestibulaire périphérique unilatérale aiguë, due vraisemblablement à une névrite vestibulaire, ont été examinés par Scheltinga et al chez des sujets adultes jeunes (23 à 35 ans), d'âge intermédiaire (43 à 58 ans), ou âgés (60 à 74 ans) [55]. Chez ces individus, les résultats indiquent que l'atteinte vestibulaire unilatérale de survenue brutale provoque une aggravation relative du contrôle de la posture et de l'équilibre de la marche chez les personnes âgées par rapport aux jeunes adultes.…”