TY - JOUR
T1 - Comparison of incremental vestibulo-ocular reflex adaptation training versus x1 training in patients with chronic peripheral vestibular hypofunction
T2 - A two-year randomized controlled trial
AU - Rinaudo, Carlo N.
AU - Schubert, Michael C.
AU - Cremer, Phillip D.
AU - Figtree, William V.C.
AU - Todd, Christopher J.
AU - Migliaccio, Americo A.
N1 - Publisher Copyright:
Copyright © 2021 Academy of Neurologic Physical Therapy, APTA.
PY - 2021/10
Y1 - 2021/10
N2 - 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).
AB - 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).
KW - Gaze stability
KW - Vestibular hypofunction
KW - Vestibular rehabilitation
KW - Vestibulo-ocular reflex
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U2 - 10.1097/NPT.0000000000000369
DO - 10.1097/NPT.0000000000000369
M3 - Article
C2 - 34369452
AN - SCOPUS:85114619567
SN - 1557-0576
VL - 45
SP - 246
EP - 258
JO - Journal of Neurologic Physical Therapy
JF - Journal of Neurologic Physical Therapy
IS - 4
ER -