TY - JOUR
T1 - Once-daily incremental vestibular-ocular reflex adaptation training in patients with chronic peripheral vestibular hypofunction
T2 - A 1-week randomized controlled study
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 - Funding Information:
A.A.M. supported by The Garnett Passe and Rodney Williams Memorial Foundation Senior/Principal Research Fellowship and Project Grant (2013- 15), and NHMRC Development Grant APP105550. C.N.R. supported by an Australian Postgraduate Award, Chiropractors Association of Australia, and Neuroscience Research Australia scholarship. A.A.M. and M.C.S. hold US and Australian patents on the StableEyes device through their respective employers (NeuRA and Johns Hopkins). The authors report no conflict of interest. Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (www.jnpt.org).
Funding Information:
A.A.M. supported by The Garnett Passe and Rodney Williams Memorial Foundation Senior/Principal Research Fellowship and Project Grant (2013-15), and NHMRC Development Grant APP105550. C.N.R. supported by an Australian Postgraduate Award, Chiropractors Association of Australia, and Neuroscience Research Australia scholarship.
Publisher Copyright:
Copyright © 2021 Academy of Neurologic Physical Therapy, APTA.
PY - 2021/4
Y1 - 2021/4
N2 - Background and Purpose: This was a double-blinded randomized controlled study to investigate the effects of once-daily incremental vestibulo-ocular reflex (VOR) training over 1 week in people with chronic peripheral vestibular hypofunction. Methods: A total of 24 patients with peripheral vestibular hypofunction were randomly assigned to intervention (n = 13) or control (n = 11) groups. Training consisted of either x1 (control) or incremental VOR adaptation exercises, delivered once daily for 15 minutes over 4 days in 1 week. Primary outcome: VOR gain with video-oculography. Secondary outcomes: Compensatory saccades measured using scleral search coils, dynamic visual acuity, static balance, gait, and subjective symptoms. Between-group differences were analyzed with a linear mixed-model with repeated measures. Results: There was a difference in the VOR gain increase between groups (P < 0.05). The incremental training group gain increased during active (13.4% ± 16.3%) and passive (12.1% ± 19.9%) head impulse testing (P < 0.02), whereas it did not for the control group (P = 0.59). The control group had reduced compensatory saccade latency (P < 0.02). Both groups had similarly improved dynamic visual acuity scores (P < 0.05). Both groups had improved dynamic gait index scores (P < 0.002); however, only the incremental group had improved scores for the 2 walks involving head oscillations at approximately 2 Hz (horizontal: P < 0.05; vertical: P < 0.02), increased gait speed (P < 0.02), and step length (P < 0.01) during normal gait, and improved total Dizziness Handicap Inventory (P < 0.05). Conclusions: Our results suggest incremental VOR adaptation significantly improves gain, gait with head rotation, balance during gait, and symptoms in patients with chronic peripheral vestibular hypofunction more so than conventional x1 gaze-stabilizing exercises. Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A336).
AB - Background and Purpose: This was a double-blinded randomized controlled study to investigate the effects of once-daily incremental vestibulo-ocular reflex (VOR) training over 1 week in people with chronic peripheral vestibular hypofunction. Methods: A total of 24 patients with peripheral vestibular hypofunction were randomly assigned to intervention (n = 13) or control (n = 11) groups. Training consisted of either x1 (control) or incremental VOR adaptation exercises, delivered once daily for 15 minutes over 4 days in 1 week. Primary outcome: VOR gain with video-oculography. Secondary outcomes: Compensatory saccades measured using scleral search coils, dynamic visual acuity, static balance, gait, and subjective symptoms. Between-group differences were analyzed with a linear mixed-model with repeated measures. Results: There was a difference in the VOR gain increase between groups (P < 0.05). The incremental training group gain increased during active (13.4% ± 16.3%) and passive (12.1% ± 19.9%) head impulse testing (P < 0.02), whereas it did not for the control group (P = 0.59). The control group had reduced compensatory saccade latency (P < 0.02). Both groups had similarly improved dynamic visual acuity scores (P < 0.05). Both groups had improved dynamic gait index scores (P < 0.002); however, only the incremental group had improved scores for the 2 walks involving head oscillations at approximately 2 Hz (horizontal: P < 0.05; vertical: P < 0.02), increased gait speed (P < 0.02), and step length (P < 0.01) during normal gait, and improved total Dizziness Handicap Inventory (P < 0.05). Conclusions: Our results suggest incremental VOR adaptation significantly improves gain, gait with head rotation, balance during gait, and symptoms in patients with chronic peripheral vestibular hypofunction more so than conventional x1 gaze-stabilizing exercises. Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A336).
KW - Gaze stability
KW - Vestibular hypofunction
KW - Vestibular rehabilitation
KW - Vestibulo-ocular reflex
UR - http://www.scopus.com/inward/record.url?scp=85102906655&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85102906655&partnerID=8YFLogxK
U2 - 10.1097/NPT.0000000000000348
DO - 10.1097/NPT.0000000000000348
M3 - Article
C2 - 33675600
AN - SCOPUS:85102906655
SN - 1557-0576
VL - 45
SP - 87
EP - 100
JO - Journal of Neurologic Physical Therapy
JF - Journal of Neurologic Physical Therapy
IS - 2
ER -