A common symptom for people with vestibulopathy is dizziness induced by dynamic visual input, known as visual vertigo (VV). The goal of this study is to present a novel method to assess VV, using a nine-item analog scale. The subjects rated the intensity of their dizziness on each item of the Visual Vertigo Analogue Scale (VVAS), which represented a daily situation typically inducing VV. The questionnaire was completed by participants with vestibulopathy (n = 102) and by subjects receiving out-patient orthopaedic physiotherapy (n = 102). The dizziness handicap inventory (DHI) was also completed by the vestibulopathic group. The Cronbach's Alpha index indicated the VVAS is internally consistent and reliable (Cronbach's Alpha = 0.94). The study also found that the VVAS severity scores from vestibular and a non-vestibular population were significantly different (Wilcoxon-Mann Whitney test p < 0.0001). Spearman correlation analysis conducted between DHI and VVAS scores for the clients with vestibulopathy showed positive moderate correlations between the VVAS score and the total DHI score (r = 0.67, p < 0.0001). This study showed that the VVAS scale may be useful in providing a quantitative evaluation scale of visual vertigo.

The vestibulospinal system likely plays an essential role in motor equivalence--the ability to reach the desired motor goal despite intentional or imposed changes in the number of body segments involved in the task. To test this hypothesis, we compared the ability of healthy subjects and patients with unilateral vestibular lesions (surgical acoustic neuroma resection 0.6 to 6.7 yr before the study) to maintain either the same hand position or the same trajectory of within arm reach movements while flexing the trunk, in the absence of vision. In randomly selected trials, the trunk motion was prevented by an electromagnetic device. Healthy subjects were able to preserve the hand position or trajectory by modifying the elbow and shoulder joint rotations in a condition-dependent way, at a minimal latency of about 60 ms after the trunk movement onset. In contrast, six of seven patients showed deficits in the compensatory angular modifications at least in one of two tasks so that 30-100% of the trunk displacement was not compensated and thus influenced the hand position or trajectory. Results suggest that vestibular influences evoked by the head motion during trunk flexion play a major role in maintaining the consistency of arm motor actions in external space despite changes in the number of body segments involved. Our findings also suggest that despite long-term plasticity in the vestibular system and related neural structures, unilateral vestibular lesion may reduce the capacity of the nervous system to achieve motor equivalence.

Vestibular dysfunction resulting from peripheral vestibular disorders, head trauma, and other central nervous system disorders can lead to imbalance and falls. [1][2][3] Balance impairment can have a significant impact on an individual's ability to perform activities of daily living or participate in work and leisure activities. A thorough assessment of balance includes examination of the sensory systems that contribute to postural control. The Clinical Test of Sensory Interaction on Balance (CTSIB) was developed to assess the contribution of the visual, somatosensory, and vestibular systems to postural control. 4 The original test evaluates static postural stability in 6 distinct standing conditions with eyes open, with eyes closed, and with the use of a dome to alter visual input on both firm and foam surfaces. This test has been modified to include eyes open and eyes closed on both firm and foam surfaces, given the finding that altered visual inputs from the dome were not different from those in the eyes closed condition. 5 This test can be administered in less than 15 minutes with minimal equipment (stopwatch and foam pad). The CTSIB and modified CTSIB have excellent reliability and validity in adults with vestibular disorders and can be easily administered in all clinical settings. This Rehabilitation Measures Database summary provides a review of the psychometric properties of the CTSIB and modified CTSIB in adults with vestibular dysfunction. A full review of the CTSIB and modified CTSIB as well as reviews of more than 100 other instruments can be found at www.rehabmeasures.org.

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Subjects with UVH manifest impaired DVA. The frequency of head motion has an impact on clinical DVA scores in UVH subjects.

Anxiety is a characteristic of subjects with visual vertigo (VV) and vestibulopathy. Anxiety in subjects with VV is not related to age. VV should be considered when subjects with anxiety complain of imbalance. Anxiety and vestibulopathy are often interrelated and should be considered in diagnostic evaluations.

When arm and trunk segments are involved in reaching for objects within arm's reach, vestibulospinal pathways compensate for trunk motion influence on arm movement. This compensatory arm-trunk synergy is characterised by a gain coefficient of 0 to 1. Vestibular patients have less efficient arm-trunk synergies and lower gains. To assess the clinical usefulness of the gain measure, we used a portable ultrasound-based device to characterize arm-trunk coordination deficits in vestibular patients. Arm-trunk coordination without vision was measured in a Stationary Hand Task where hand position was maintained during trunk movement, and a Reaching Task with and without trunk motion. Twenty unilateral vestibular patients and 16 controls participated. For the Stationary Hand task, patient gains ranged from g = 0.94 (good compensation) to 0.31 (poor compensation) and, on average, were lower than in controls (patients: 0.67 ± 0.19; controls: 0.85 ± 0.07; p < 0.01). Gains were significantly correlated with clinical tests (Sensory Organization; r = 0.62, p < 0.01, Foam Romberg Eyes Closed; r = 0.65, p < 0.01). For the Reaching Task, blocking trunk movement during reaching modified hand position significantly more in patients (8.2 ± 4.3 cm) compared to controls (4.5 ± 1.7 cm, p < 0.02) and the amount of hand position deviation was correlated with the degree of vestibular loss in a sub-group (n = 14) of patients. Measurement of the Stationary Task arm-trunk gain and hand deviations during the Reaching Task can help characterize sensorimotor problems in vestibular-deficient patients and track recovery following therapeutic interventions. The ultrasound-based portable device is suitable for measuring vestibulospinal deficits in arm-trunk coordination in a clinical setting.

Background: In children with neurological or neurodevelopmental conditions, vestibular disorders may co-exist with the primary condition and further contribute to disability and restriction in functional independence and participation. Awareness of their existence may favor an early diagnosis and better treatment outcomes. Objectives: To determine the prevalence of vestibular dysfunction in children and adolescents (3-21 years old) diagnosed with either cerebral palsy (CP), traumatic brain injury (TBI), sensorineural hearing loss (SNHL), or cochlear implantations (CI). Methods: Four researchers systematically reviewed the literature from three databases (EMBASE, MEDLINE, CINAHL) until June 2018. Results: Twenty-four studies were analyzed in this systematic review. A single, high-quality study reports a prevalence of 48.4% of spastic CP children having a saccular dysfunction. Three fair-quality studies report a prevalence of 14.6-81%, 21 days post-TBI. Twelve poor-to-high quality studies demonstrate a prevalence of 18.7-96.1% in children with SNHL. A prevalence range of 3-84% in children with CI is reported by nine fair-to-high quality studies. Conclusion: Clinicians should be aware of the prevalence of vestibular dysfunction in these populations and implement appropriate assessments to improve treatment outcomes.