Patients with chronic peripheral vestibular hypofunction compared to healthy subjects exhibit differences in gaze and gait behaviour when walking on stairs and ramps

Jaap Swanenburg, Edith Bäbler, Rolf Adelsberger, Dominik Straumann, Eling D de Bruin, Jaap Swanenburg, Edith Bäbler, Rolf Adelsberger, Dominik Straumann, Eling D de Bruin

Abstract

Objective: The aim of this study was to compare gaze behaviour during stair and ramp walking between patients with chronic peripheral vestibular hypofunction and healthy human subjects.

Methods: Twenty four (24) patients with chronic peripheral vestibular hypofunction (14 unilateral and 10 bilateral) and 24 healthy subjects performed stair and ramp up and down walks at self-selected speed. The walks were repeated five times. A mobile eye tracker was used to record gaze behaviour (defined as time directed to pre-defined areas) and an insole measurement device assessed gait (speed, step time, step length). During each walk gaze behaviour relative to i) detection of first transition area "First TA", ii) detection of steps of the mid-staircase area and the handrail "Structure", iii) detection of second transition area "Second TA", and iv) looking elsewhere "Elsewhere" was assessed and expressed as a percentage of the walk duration. For all variables, a one-way ANOVA followed by contrast tests was conducted.

Results: Patients looked significantly longer at the "Structure" (p<0.001) and "Elsewhere" (p<0.001) while walking upstairs compared to walking downstairs (p<0.013). Patients looked significantly longer at the "Structure" (p<0.001) and "Elsewhere" (p<0.001) while walking upstairs compared to walking downstairs (p<0.013). No differences between groups were observed for the transition areas with exception of stair ascending. Patients were also slower going downstairs (p = 0.002) and presented with an increased step time (p = 0.003). Patients were walking faster up the ramp (p = 0.014) with longer step length (p = 0.008) compared to walking down the ramp (p = 0.050) with shorter step length (p = 0.024).

Conclusions: Patients with chronic peripheral vestibular hypofunction differed in time directed to pre-defined areas during stair and ramp walking and looked longer at stair and ramp areas of interest during walking compared to healthy subjects. Patients did not differ in time directed to pre-defined areas during the stair-floor transition area while going downstairs, an area where accidents may frequently occur.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Stairs looking upwards.
Fig 1. Stairs looking upwards.
Fig 2. Stairs looking downwards.
Fig 2. Stairs looking downwards.
Fig 3. Ramp looking upwards.
Fig 3. Ramp looking upwards.
Fig 4. Ramp looking downwards.
Fig 4. Ramp looking downwards.
Fig 5. Areas of interest stair looking…
Fig 5. Areas of interest stair looking upwards.
Fig 6. Areas of interest stair looking…
Fig 6. Areas of interest stair looking downwards.
Fig 7. Areas of interest ramp looking…
Fig 7. Areas of interest ramp looking upwards.
Fig 8. Areas of interest ramp looking…
Fig 8. Areas of interest ramp looking downwards.
Fig 9. Insole gait measurement device.
Fig 9. Insole gait measurement device.

References

    1. Kool B, Ameratunga S, Hazell W, Ng A. Unintentional falls at home among young and middle-aged New Zealanders resulting in hospital admission or death: context and characteristics. N Z Med J. 2010;123(1316):75–84. .
    1. Malta DC, Silva MM, Mascarenhas MD, Sa NN, Morais Neto OL, Bernal RT, et al. The characteristics and factors of emergency service visits for falls. Rev Saude Publica. 2012;46(1):128–37. .
    1. Talbot LA, Musiol RJ, Witham EK, Metter EJ. Falls in young, middle-aged and older community dwelling adults: perceived cause, environmental factors and injury. BMC Public Health. 2005;5:86 doi: ; PubMed Central PMCID: PMCPMC1208908.
    1. Startzell JK, Owens DA, Mulfinger LM, Cavanagh PR. Stair negotiation in older people: a review. Journal of the American Geriatrics Society. 2000;48(5):567–80. .
    1. Sheehan RC, Gottschall JS. Stair walking transitions are an anticipation of the next stride. Journal of electromyography and kinesiology: official journal of the International Society of Electrophysiological Kinesiology. 2011;21(3):533–41. doi: .
    1. Startzell JK, Owens DA, Mulfinger LM, Cavanagh PR. Stair negotiation in older people: a review. Journal of the American Geriatrics Society. 2000;48(5):567–80.
    1. Brechter JH, Powers CM. Patellofemoral joint stress during stair ascent and descent in persons with and without patellofemoral pain. Gait Posture. 2002;16(2):115–23. doi: Pii S0966-6362(02)00090-5 doi: PubMed PMID: WOS:000178902200002.
    1. Herdman SJ, Blatt P, Schubert MC, Tusa RJ. Falls in patients with vestibular deficits. The American journal of otology. 2000;21(6):847–51. Epub 2000/11/15. .
    1. Agrawal Y, Migliaccio AA, Minor LB, Carey JP. Vestibular hypofunction in the initial postoperative period after surgical treatment of superior semicircular canal dehiscence. O tology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology. 2009;30(4):502–6. doi: .
    1. Herdman SJ, Blatt P, Schubert MC, Tusa RJ. Falls in patients with vestibular deficits. American Journal of Otolaryngology 2000;21(6):847–51. Epub 2000/11/15. .
    1. Cohen H. Vestibular rehabilitation reduces functional disability. Otolaryngology—head and neck surgery: official journal of American Academy of Otolaryngology-Head and Neck Surgery. 1992;107(5):638–43. Epub 1992/11/01. doi: .
    1. Svanstrom L. Falls on stairs: an epidemiological accident study. Scandinavian journal of social medicine. 1974;2(3):113–20. .
    1. Swanenburg J, Zurbrugg A, Straumann D, Hegemann SCA, Palla A, de Bruin ED. A pilot study investigating the association between chronic bilateral vestibulopathy and components of a clinical functional assessment tool. Physiother Theory Pract. 2017;33(6):454–61. doi: .
    1. Gazzola JM, Gananca FF, Aratani MC, Perracini MR, Gananca MM. Circumstances and consequences of falls in elderly people with vestibular disorder. Braz J Otorhinolaryngol. 2006;72(3):388–92. .
    1. Horak FB. Postural compensation for vestibular loss. Ann N Y Acad Sci. 2009;1164:76–81. doi: ; PubMed Central PMCID: PMC3224857.
    1. Lacour M, Bernard-Demanze L. Interaction between Vestibular Compensation Mechanisms and Vestibular Rehabilitation Therapy: 10 Recommendations for Optimal Functional Recovery. Front Neurol 2014; 5: 285 2014;5.
    1. Timmis MA, Bennett SJ, Buckley JG. Visuomotor control of step descent: evidence of specialised role of the lower visual field. Experimental brain research. 2009;195(2):219–27. doi: .
    1. Zietz D, Hollands M. Gaze behavior of young and older adults during stair walking. Journal of motor behavior. 2009;41(4):357–65. doi: .
    1. Miyasike-daSilva V, Allard F, McIlroy WE. Where do we look when we walk on stairs? Gaze behaviour on stairs, transitions, and handrails. Experimental brain research. 2011;209(1):73–83. doi: .
    1. Peng J, Fey NP, Kuiken TA, Hargrove LJ. Anticipatory kinematics and muscle activity preceding transitions from level-ground walking to stair ascent and descent. Journal of biomechanics. 2016;49(4):528–36. Epub 2016/02/03. doi: .
    1. MacDougall HG, Weber KP, McGarvie LA, Halmagyi GM, Curthoys IS. The video head impulse test: diagnostic accuracy in peripheral vestibulopathy. Neurology. 2009;73(14):1134–41. Epub 2009/10/07. doi: ; PubMed Central PMCID: PMC2890997.
    1. Lee HJ, Chou LS. Balance control during stair negotiation in older adults. Journal of biomechanics. 2007;40(11):2530–6. doi: .
    1. Lay AN, Hass CJ, Gregor RJ. The effects of sloped surfaces on locomotion: a kinematic and kinetic analysis. Journal of biomechanics. 2006;39(9):1621–8. doi: .
    1. Kawamura K, Tokuhiro A, Takechi H. Gait analysis of slope walking: a study on step length, stride width, time factors and deviation in the center of pressure. Acta medica Okayama. 1991;45(3):179–84. doi: .
    1. Jacobs JV. A review of stairway falls and stair negotiation: Lessons learned and future needs to reduce injury. Gait Posture. 2016;49:159–67. doi: .
    1. Kasneci E, Black AA, Wood JM. Eye-Tracking as a Tool to Evaluate Functional Ability in Everyday Tasks in Glaucoma. J Ophthalmol. 2017;2017:6425913 doi: ; PubMed Central PMCID: PMCPMC5331274 publication of this paper.
    1. Tapiro H, Borowsky A, Oron-Gilad T, Parmet Y. Where do older pedestrians glance before deciding to cross a simulated two-lane road? A pedestrian simulator paradigm. Proceedings of the Human Factors and Ergonomics Society Annual Meeting. 2016;60(1):11–5. doi:
    1. Sotirakis H, Kyvelidou A, Mademli L, Stergiou N, Hatzitaki V. Aging affects postural tracking of complex visual motion cues. Experimental brain research. 2016;234(9):2529–40. doi: ; PubMed Central PMCID: PMCPMC5253232.
    1. Adelsberger R, Valko Y, Straumann D, Troster G. Automated Romberg testing in patients with benign paroxysmal positional vertigo and healthy subjects. IEEE transactions on bio-medical engineering. 2015;62(1):373–81. doi: .
    1. Adelsberger A, Tröster G. Unobtrusive assessment of bipedal balance performance. 8th International Conference on Body Area Networks; September 30—October 02; Boston, Massachusetts: EDUL; 2013. p. 229–32.
    1. Field A. Discovering Statistics Using SPSS. Third ed. Los Angeles: Sage; 2009.
    1. Horak FB. Postural compensation for vestibular loss and implications for rehabilitation. Restor Neurol Neurosci. 2010;28(1):57–68. doi: ; PubMed Central PMCID: PMC2965039.
    1. Miyasike-daSilva V, McIlroy WE. Does it really matter where you look when walking on stairs? Insights from a dual-task study. PLoS One. 2012;7(9):e44722 doi: ; PubMed Central PMCID: PMCPMC3435292.
    1. Den Otter AR, Hoogwerf M, Van Der Woude LH. The role of tread fixations in the visual control of stair walking. Gait Posture. 2011;34(2):169–73. doi: .
    1. Corbetta M, Akbudak E, Conturo TE, Snyder AZ, Ollinger JM, Drury HA, et al. A common network of functional areas for attention and eye movements. Neuron. 1998;21(4):761–73. .
    1. Adolphe RM, Vickers JN, Laplante G. The effects of training visual attention on gaze behaviour and accurcy: A pilot Study. International Journal of Sports Vision. 1997;4(1):28–33.
    1. Young WR, Hollands MA. Can telling older adults where to look reduce falls? Evidence for a causal link between inappropriate visual sampling and suboptimal stepping performance. Experimental brain research. 2010;204(1):103–13. doi: .
    1. Swanenburg J, Hegemann SC, Zurbrugg A, Palla A, de Bruin ED. Reliability and validity of the extended timed-get-up-and-go test in patients with bilateral vestibular loss. NeuroRehabilitation. 2014;34(4):799–807. doi: .
    1. Schmidheiny A, Swanenburg J, Straumann D, de Bruin ED, Knols RH. Discriminant validity and test re-test reproducibility of a gait assessment in patients with vestibular dysfunction. BMC Ear Nose Throat Disord. 2015;15:6 doi: ; PubMed Central PMCID: PMCPMC4619276.
    1. Gill-Body KM, Krebs DE, Parker SW, Riley PO. Physical therapy management of peripheral vestibular dysfunction: two clinical case reports. Physical Therapy. 1994;74(2):129–42. Epub 1994/02/01. .
    1. Krebs DE, Gill-Body KM, Parker SW, Ramirez JV, Wernick-Robinson M. Vestibular rehabilitation: useful but not universally so. Otolaryngology-Head and Neck Surgery. 2003;128(2):240–50. Epub 2003/02/26. doi: S0194599802232143 [pii]. .
    1. Brandt T, Strupp M, Benson J. You are better off running than walking with acute vestibulopathy. Lancet. 1999;354(9180):746 Epub 1999/09/04. doi: .
    1. Schniepp R, Wuehr M, Neuhaeusser M, Kamenova M, Dimitriadis K, Klopstock T, et al. Locomotion speed determines gait variability in cerebellar ataxia and vestibular failure. Movement Disorders. 2012;27(1):125–31. Epub 2011/10/15. doi: .
    1. Jahn K, Strupp M, Brandt T. Both actual and imagined locomotion suppress spontaneous vestibular nystagmus. Neuroreport. 2002;13(16):2125–8. Epub 2002/11/20. .
    1. Mori S, Matsui T, Kuze B, Asanome M, Nakajima K, Matsuyama K. Cerebellar-induced locomotion: reticulospinal control of spinal rhythm generating mechanism in cats. Annals of the New York Academy of Sciences. 1998;860:94–105. Epub 1999/02/03. .
    1. Prentice SD, Hasler EN, Groves JJ, Frank JS. Locomotor adaptations for changes in the slope of the walking surface. Gait Posture. 2004;20(3):255–65. doi: .
    1. Stuart S, Alcock L, Godfrey A, Lord S, Rochester L, Galna B. Accuracy and re-test reliability of mobile eye-tracking in Parkinson's disease and older adults. Med Eng Phys. 2016;38(3):308–15. doi: .
    1. Aquaroni Ricci N, Aratani MC, Caovilla HH, Freitas Gananca F. Effects of conventional versus multimodal vestibular rehabilitation on functional capacity and balance control in older people with chronic dizziness from vestibular disorders: design of a randomized clinical trial. Trials. 2012;13:246 doi: ; PubMed Central PMCID: PMC3551791.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren