2BALANCE: a cognitive-motor dual-task protocol for individuals with vestibular dysfunction

Maya Danneels, Ruth Van Hecke, Laura Leyssens, Sofie Degeest, Dirk Cambier, Raymond van de Berg, Vincent Van Rompaey, Leen Maes, Maya Danneels, Ruth Van Hecke, Laura Leyssens, Sofie Degeest, Dirk Cambier, Raymond van de Berg, Vincent Van Rompaey, Leen Maes

Abstract

Introduction: Aside from primary vestibular symptoms such as vertigo and dizziness, persons with vestibular dysfunction frequently express cognitive and motor problems. These symptoms have mainly been assessed in single-task setting, which might not represent activities of daily living accurately. Therefore, a dual-task protocol, consisting of the simultaneous performance of cognitive and motor tasks, was developed. This protocol assesses cognitive and motor performance in general, as well as cognitive-motor interference in specific.

Methods and analysis: The motor component of the 2BALANCE protocol consists of a static and dynamic postural task. These motor tasks are combined with different cognitive tasks assessing visuospatial cognition, processing speed, working memory and response inhibition. First, test-retest reliability will be assessed with an interval of 2 weeks in a group of young adults. Second, the 2BALANCE protocol will be validated in persons with bilateral vestibulopathy. Finally, the protocol will be implemented in persons with unilateral vestibular loss.

Discussion and conclusions: The 2BALANCE project aims to elucidate the impact of vestibular dysfunction on cognitive and motor performance in dual-task setting. This protocol represents everyday situations better than single-task protocols, as dual-tasks such as reading street signs while walking are often encountered during daily activities. Ultimately, this project could enable individualised and holistic clinical care in these patients, taking into account single as well as dual-task performance.

Ethics and dissemination: The current study was approved by the ethics committee of Ghent University Hospital on 5 July 2019 with registration number B670201940465. All research findings will be disseminated in peer-reviewed journals and presented at vestibular as well as multidisciplinary international conferences and meetings.

Trials registration number: NCT04126798, pre-results phase.

Keywords: adult neurology; adult otolaryngology; audiology; neurotology; protocols & guidelines.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Set-up and timeline of the 2BALANCE project: (1) assessment of test–retest reliability (TR), (2) validation in persons with bilateral vestibulopathy and (3) implementation of 2BALANCE protocol in persons with unilateral vestibular loss and various vestibular disorders. HC, healthy controls.
Figure 2
Figure 2
Primary and secondary outcome measures. cVEMP, cervical vestibular evoked myogenic potentials; DVA, dynamic visual acuity; MOCA, Montreal cognitive assessment; oVEMP, ocular vestibular evoked myogenic potentials; SVA, static visual acuity; vHIT, video head impulse test.
Figure 3
Figure 3
2BALANCE protocol consisting of five different cognitive tasks in combination with a static and dynamic postural task.
Figure 4
Figure 4
Example of Corsi block stimuli and raster for indicating responses.
Figure 5
Figure 5
Example of the mental rotation task.
Figure 6
Figure 6
Symbols and their respective numerical digit for the coding task; coding set 1.
Figure 7
Figure 7
Visual Analogue Scale for strenuousness.

References

    1. Kennedy PM, Carlsen AN, Inglis JT, et al. . Relative contributions of visual and vestibular information on the trajectory of human gait. Exp Brain Res 2003;153:113–7. 10.1007/s00221-003-1633-z
    1. Strupp M, Feil K, Dieterich M, et al. . Bilateral vestibulopathy. Handb Clin Neurol 2016;137:235–40. 10.1016/B978-0-444-63437-5.00017-0
    1. Fujimoto C, Murofushi T, Chihara Y, et al. . Assessment of diagnostic accuracy of foam posturography for peripheral vestibular disorders: analysis of parameters related to visual and somatosensory dependence. Clin Neurophysiol 2009;120:1408–14. 10.1016/j.clinph.2009.05.002
    1. Nishi T, Kamogashira T, Fujimoto C, et al. . Effects of peripheral vestibular dysfunction on dynamic postural stability measured by the functional reach test and timed up and go test. Ann Otol Rhinol Laryngol 2017;126:438–44. 10.1177/0003489417700439
    1. Karmali F, Lim K, Merfeld DM. Visual and vestibular perceptual thresholds each demonstrate better precision at specific frequencies and also exhibit optimal integration. J Neurophysiol 2014;111:2393–403. 10.1152/jn.00332.2013
    1. Lucieer F, Duijn S, Van Rompaey V, et al. . Full spectrum of reported symptoms of bilateral vestibulopathy needs further investigation-a systematic review. Front Neurol 2018;9:352. 10.3389/fneur.2018.00352
    1. Kingma H, Janssen M. Biophysics of the vestibular system. Oxford textbook of vertigo and imbalance. Oxford, UK: Oxford University Press, 2013.
    1. Agrawal Y, Carey JP, Della Santina CC, et al. . Disorders of balance and vestibular function in US adults: data from the National health and nutrition examination survey, 2001-2004. Arch Intern Med 2009;169:938–44. 10.1001/archinternmed.2009.66
    1. Herdman SJ, Blatt P, Schubert MC, et al. . Falls in patients with vestibular deficits. Am J Otol 2000;21:847–51.
    1. Dobbels B, Lucieer F, Mertens G, et al. . Bilateral vestibulopathy: who will fall? Plos One 2019.
    1. Schlick C, Schniepp R, Loidl V, et al. . Falls and fear of falling in vertigo and balance disorders: a controlled cross-sectional study. J Vestib Res 2015;25:241–51. 10.3233/VES-150564
    1. Popp P, Wulff M, Finke K, et al. . Cognitive deficits in patients with a chronic vestibular failure. J Neurol 2017;264:554–63. 10.1007/s00415-016-8386-7
    1. Bigelow RT, Agrawal Y. Vestibular involvement in cognition: visuospatial ability, attention, executive function, and memory. J Vestib Res 2015;25:73–89. 10.3233/VES-150544
    1. Hanes DA, McCollum G. Cognitive-vestibular interactions: a review of patient difficulties and possible mechanisms. J Vestib Res 2006;16:75–91.
    1. Hitier M, Besnard S, Smith PF. Vestibular pathways involved in cognition. Front Integr Neurosci 2014;8:59. 10.3389/fnint.2014.00059
    1. Brandt T, Schautzer F, Hamilton DA, et al. . Vestibular loss causes hippocampal atrophy and impaired spatial memory in humans. Brain 2005;128:2732–41. 10.1093/brain/awh617
    1. Schautzer F, Hamilton D, Kalla R, et al. . Spatial memory deficits in patients with chronic bilateral vestibular failure. Ann N Y Acad Sci 2003;1004:316–24. 10.1196/annals.1303.029
    1. Hüfner K, Hamilton DA, Kalla R, et al. . Spatial memory and hippocampal volume in humans with unilateral vestibular deafferentation. Hippocampus 2007;17:471–85. 10.1002/hipo.20283
    1. Dobbels B, Peetermans O, Boon B, et al. . Impact of bilateral vestibulopathy on spatial and nonspatial cognition: a systematic review. Ear Hear 2019;40:757–65. 10.1097/AUD.0000000000000679
    1. Deroualle D, Borel L, Tanguy B, et al. . Unilateral vestibular deafferentation impairs embodied spatial cognition. J Neurol 2019;266:149–59. 10.1007/s00415-019-09433-7
    1. Bronstein A. Oxford textbook of vertigo and imbalance. Oxford: OUP, 2013.
    1. Lajoie Y, Teasdale N, Bard C, et al. . Attentional demands for static and dynamic equilibrium. Exp Brain Res 1993;97:139–44. 10.1007/BF00228824
    1. Kahneman D. Attention and effort. Englewood Cliffs, NJ: Prentice-Hall, 1973.
    1. McIsaac TL, Lamberg EM, Muratori LM. Building a framework for a dual task taxonomy. Biomed Res Int 2015;2015:1–10. 10.1155/2015/591475
    1. Prosperini L, Castelli L, De Luca F, et al. . Task-dependent deterioration of balance underpinning cognitive-postural interference in MS. Neurology 2016;87:1085–92. 10.1212/WNL.0000000000003090
    1. Tamura K, Kocher M, Finer L, et al. . Reliability of clinically feasible dual-task tests: Expanded timed get up and go test as a motor task on young healthy individuals. Gait Posture 2018;60:22–7. 10.1016/j.gaitpost.2017.11.002
    1. Roberts JC, Cohen HS, Sangi-Haghpeykar H. Vestibular disorders and dual task performance: impairment when walking a straight path. J Vestib Res 2011;21:167–74. 10.3233/VES-2011-0415
    1. Sprenger A, Wojak JF, Jandl NM, et al. . Postural control in bilateral vestibular failure: its relation to visual, proprioceptive, vestibular, and cognitive input. Front Neurol 2017;8:444. 10.3389/fneur.2017.00444
    1. Yogev-Seligmann G, Hausdorff JM, Giladi N. Do we always prioritize balance when walking? Towards an integrated model of task prioritization. Mov Disord 2012;27:765–70. 10.1002/mds.24963
    1. Friedman A, Polson MC, Dafoe CG, et al. . Dividing attention within and between hemispheres: testing a multiple resources approach to limited-capacity information processing. J Exp Psychol Hum Percept Perform 1982;8:625. 10.1037//0096-1523.8.5.625
    1. Tombu M, Jolicoeur P. A central capacity sharing model of dual-task performance. J Exp Psychol Hum Percept Perform 2003;29:3. 10.1037//0096-1523.29.1.3
    1. Pashler H. Dual-Task interference in simple tasks: data and theory. Psychol Bull 1994;116:220–44. 10.1037/0033-2909.116.2.220
    1. Lundin-Olsson L, Nyberg L, Gustafson Y. "Stops walking when talking" as a predictor of falls in elderly people. Lancet 1997;349:617. 10.1016/S0140-6736(97)24009-2
    1. Navon D, Miller J. Role of outcome conflict in Dual-task interference. J Exp Psychol Hum Percept Perform 1987;13:435–48. 10.1037/0096-1523.13.3.435
    1. Danneels M, Van Hecke R, Keppler H, et al. . Psychometric properties of cognitive-motor Dual-task studies with the aim of developing a test protocol for persons with vestibular disorders: a systematic review. Ear Hear 2020;41:3–16. 10.1097/AUD.0000000000000748
    1. Andersson G, Hagman J, Talianzadeh R, et al. . Dual-task study of cognitive and postural interference in patients with vestibular disorders. Otol Neurotol 2003;24:289–93. 10.1097/00129492-200303000-00026
    1. Nascimbeni A, Gaffuri A, Penno A, et al. . Dual task interference during gait in patients with unilateral vestibular disorders. J Neuroeng Rehabil 2010;7:47. 10.1186/1743-0003-7-47
    1. Bessot N, Denise P, Toupet M, et al. . Interference between walking and a cognitive task is increased in patients with bilateral vestibular loss. Gait Posture 2012;36:319–21. 10.1016/j.gaitpost.2012.02.021
    1. Yardley L, Gardner M, Bronstein A, et al. . Interference between postural control and mental task performance in patients with vestibular disorder and healthy controls. J Neurol Neurosurg Psychiatry 2001;71:48–52. 10.1136/jnnp.71.1.48
    1. Redfern MS, Talkowski ME, Jennings JR, et al. . Cognitive influences in postural control of patients with unilateral vestibular loss. Gait Posture 2004;19:105–14. 10.1016/S0966-6362(03)00032-8
    1. Standardization IOf Acoustics: statistical distribution of hearing thresholds as a function of age (iso 7029: 2000). ISO, 2000.
    1. Strupp M, Kim J-S, Murofushi T, et al. . Bilateral vestibulopathy: diagnostic criteria consensus document of the classification Committee of the Bárány Society. J Vestib Res 2017;27:177–89. 10.3233/VES-170619
    1. Hollman JH, Childs KB, McNeil ML, et al. . Number of strides required for reliable measurements of PACE, rhythm and variability parameters of gait during normal and dual task walking in older individuals. Gait Posture 2010;32:23–8.
    1. Degeest S, Keppler H, Corthals P. The effect of age on listening effort. J Speech Lang Hear Res 2015;58:1592–600. 10.1044/2015_JSLHR-H-14-0288
    1. Kessels RP, van Zandvoort MJ, Postma A, et al. . The Corsi block-tapping task: standardization and normative data. Appl Neuropsychol 2000;7:252–8. 10.1207/S15324826AN0704_8
    1. Benedict RH, DeLuca J, Phillips G, et al. . Validity of the symbol digit modalities test as a cognition performance outcome measure for multiple sclerosis. Mult Scler 2017;23:721–33. 10.1177/1352458517690821
    1. Pascoe M, Alamri Y, Dalrymple-Alford J, et al. . The Symbol-Digit modalities test in mild cognitive impairment: evidence from Parkinson's disease patients. Eur Neurol 2018;79:206–10. 10.1159/000485669
    1. Smith A. Symbol digit modalities test. Los Angeles, CA: Western Psychological Services, 1982.
    1. Stroop JR. Studies of interference in serial verbal reactions. J Exp Psychol 1935;18:643–62. 10.1037/h0054651
    1. Diagnostic and Statistical Manual of Mental Disorders FE Diagnostic and statistical manual of mental disorders. Arlington: American Psychiatric Publishing, 2013.
    1. Clark RA, Mentiplay BF, Pua Y-H, et al. . Reliability and validity of the Wii balance board for assessment of standing balance: a systematic review. Gait Posture 2018;61:40–54. 10.1016/j.gaitpost.2017.12.022
    1. Schaefer S. The ecological approach to cognitive-motor dual-tasking: findings on the effects of expertise and age. Front Psychol 2014;5:1167. 10.3389/fpsyg.2014.01167
    1. Jacobson GP, Newman CW. The development of the dizziness handicap inventory. Arch Otolaryngol Head Neck Surg 1990;116:424–7. 10.1001/archotol.1990.01870040046011
    1. Newman CW, Jacobson GP, Spitzer JB. Development of the tinnitus handicap inventory. Arch Otolaryngol Head Neck Surg 1996;122:143–8. 10.1001/archotol.1996.01890140029007
    1. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983;67:361–70. 10.1111/j.1600-0447.1983.tb09716.x
    1. Kosinski M, Bayliss MS, Bjorner JB, et al. . A six-item short-form survey for measuring headache impact: the HIT-6. Qual Life Res 2003;12:963–74. 10.1023/A:1026119331193
    1. Bayliss MS, Dewey JE, Dunlap I, et al. . A study of the feasibility of Internet administration of a computerized health survey: the headache impact test (HIT). Qual Life Res 2003;12:953–61. 10.1023/A:1026167214355
    1. Powell LE, Myers AM. The Activities-specific balance confidence (ABC) scale. J Gerontol A Biol Sci Med Sci 1995;50A:M28–34. 10.1093/gerona/50A.1.M28
    1. Yardley L, Beyer N, Hauer K, et al. . Development and initial validation of the falls efficacy Scale-International (FES-I). Age Ageing 2005;34:614–9. 10.1093/ageing/afi196
    1. Kempen GIJM, Yardley L, van Haastregt JCM, et al. . The short FES-I: a shortened version of the falls efficacy scale-international to assess fear of falling. Age Ageing 2008;37:45–50. 10.1093/ageing/afm157
    1. Denollet J. DS14: standard assessment of negative affectivity, social inhibition, and type D personality. Psychosom Med 2005;67:89–97. 10.1097/01.psy.0000149256.81953.49
    1. Bosscher R. De algemene toestand lijst (ATL). Amersfoort: AOS, 2011.
    1. Dault MC, Yardley L, Frank JS. Does articulation contribute to modifications of postural control during Dual-task paradigms? Brain Res Cogn Brain Res 2003;16:434–40. 10.1016/S0926-6410(03)00058-2

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