Postural impairments in unilateral and bilateral vestibulopathy

Julie Corre; Jean-François Cugnot; Anissa Boutabla; Samuel Cavuscens; Maurizio Ranieri; Raymond van de Berg; Robert J Peterka; Nils Guinand; Angélica Pérez Fornos

doi:10.3389/fneur.2024.1324868

Postural impairments in unilateral and bilateral vestibulopathy

Front Neurol. 2024 Feb 21:15:1324868. doi: 10.3389/fneur.2024.1324868. eCollection 2024.

Affiliations

¹ Division of Otorhinolaryngology Head and Neck Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.
² Division of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland.
³ Division of Vestibular Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands.
⁴ National Center for Rehabilitative Auditory Research, Veterans Administration Portland Health Care System and Department of Neurology, Oregon Health & Science University, Portland, OR, United States.

^# Contributed equally.

Abstract

Chronic imbalance is a major complaint of patients suffering from bilateral vestibulopathy (BV) and is often reported by patients with chronic unilateral vestibulopathy (UV), leading to increased risk of falling. We used the Central SensoriMotor Integration (CSMI) test, which evaluates sensory integration, time delay, and motor activation contributions to standing balance control, to determine whether CSMI measures could distinguish between healthy control (HC), UV, and BV subjects and to characterize vestibular, proprioceptive, and visual contributions expressed as sensory weights. We also hypothesized that sensory weight values would be associated with the results of vestibular assessments (vestibulo ocular reflex tests and Dizziness Handicap Inventory scores). Twenty HCs, 15 UVs and 17 BVs performed three CSMI conditions evoking sway in response to pseudorandom (1) surface tilts with eyes open or, (2) surface tilts with eyes closed, and (3) visual surround tilts. Proprioceptive weights were identified in surface tilt conditions and visual weights were identified in the visual tilt condition. BVs relied significantly more on proprioception. There was no overlap in proprioceptive weights between BV and HC subjects and minimal overlap between UV and BV subjects in the eyes-closed surface-tilt condition. Additionally, visual sensory weights were greater in BVs and were similarly able to distinguish BV from HC and UV subjects. We found no significant correlations between sensory weights and the results of vestibular assessments. Sensory weights from CSMI testing could provide a useful measure for diagnosing and for objectively evaluating the effectiveness of rehabilitation efforts and future treatments designed to restore vestibular function such as hair cell regeneration and vestibular implants.

Keywords: balance; bilateral vestibulopathy; posturography; sensory integration; unilateral vestibulopathy; vestibular.

Grants and funding

The authors declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the Swiss National Science Foundation (BRIDGE Nos. 40B2-0_20356), which do not necessarily endorse opinions, interpretations, and conclusions of the authors. JC, AB, RvdB, NG, and APF have received either research or travel grants from MED-EL Elektromedizinische Geräte (Innsbruck, Austria). The funders were not involved in the study design, collection, analysis, interpretation of data, the writing of this article, or the decision to submit it for publication.