Comparison of incremental vestibulo-ocular reflex adaptation training versus x1 training in patients with chronic peripheral vestibular hypofunction: A two-year randomized controlled trial

Carlo N. Rinaudo, Michael C. Schubert, Phillip D. Cremer, William V.C. Figtree, Christopher J. Todd, Americo A. Migliaccio

Research output: Contribution to journalArticlepeer-review

Abstract

Background and Purpose: A crossover, double-blinded randomized controlled trial to investigate once-daily incremental vestibulo-ocular reflex (VOR) adaptation (IVA) training over 2 years in people with stable and chronic peripheral vestibular hypofunction. Methods: Twenty-one patients with peripheral vestibular hypofunction were randomly assigned to intervention-then-control (n = 12) or control-then-intervention (n = 9) groups. The task consisted of either x1 (control) or IVA training, once daily every day for 15 minutes over 6-months, followed by a 6-month washout, then repeated for arm 2 of the crossover. Primary outcome: vestibulo-ocular reflex gain. Secondary outcomes: compensatory saccades, dynamic visual acuity, static balance, gait, and subjective symptoms. Multiple imputation was used for missing data. Between-group differences were analyzed using a linear mixed model with repeated measures. Results: On average patients trained once daily 4 days per week. IVA training resulted in significantly larger VOR gain increase (active: 20.6% ± 12.08%, P = 0.006; passive: 30.6% ± 25.45%, P = 0.016) compared with x1 training (active: −2.4% ± 12.88%, P = 0.99; passive: −0.6% ± 15.31%, P = 0.68) (P < 0.001). The increased IVA gain did not significantly reduce with approximately 27% persisting over the washout period. x1 training resulted in greater reduction of compensatory saccade latency (P = 0.04) and increase in amplitude (P = 0.02) compared with IVA training. There was no difference between groups in gait and balance measures; however, only the IVA group had improved total Dizziness Handicap Inventory (P = 0.006). Discussion and Conclusions: Our results suggest IVA improves VOR gain and reduces perception of disability more than conventional x1 training. We suggest at least 4 weeks of once-daily 4 days-per-week IVA training should be part of a comprehensive vestibular rehabilitation program. Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww. com/JNPT/A356).

Original languageEnglish (US)
Pages (from-to)246-258
Number of pages13
JournalJournal of Neurologic Physical Therapy
Volume45
Issue number4
DOIs
StatePublished - Oct 2021

Keywords

  • Gaze stability
  • Vestibular hypofunction
  • Vestibular rehabilitation
  • Vestibulo-ocular reflex

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation
  • Clinical Neurology

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