Head movement restriction and postural stability in patients with compensated unilateral vestibular loss

Abstract

Objective: To study whether restriction of head-neck movements improves postural performance in patients with compensated unilateral total vestibular loss. Design: Randomized controlled experimental study. Setting: Laboratory for clinical and experimental vestibular testing at a tertiary referral center. Patients: Fifteen consecutive patients (seven men, eight women, mean age 53 years) at routine follow-up, 6 months after translabyrinthine extirpation of acoustic neurinomas (mean tumor size 13.5mm, range 5 to 25mm). None of the patients had signs or symptoms of central nervous system dysfunction. Intervention: Posturographic tests comparing patients with and without a semirigid neck collar. Test order was randomized between patients to reduce training effects. Main Outcome Measure: Posturography measuring velocity and variance of quiet stance and measuring body sway induced by vibration at 60, 80, and 100Hz to the calf muscles. Tests were conducted with eyes open and closed. Results: In tests with vibration at 100Hz to the calf muscles and with eyes open, body sway velocity was significantly higher when patients were wearing a neck collar. No significant difference was found in any other test. Conclusion: Restricting head-neck movements with a neck collar does not improve postural stability in patients with compensated unilateral total vestibular loss. A tendency toward impaired postural performance leads to the conclusion that it is not appropriate to treat such patients with neck collars to improve their balance.