Relation Between Head Impulse Tests, Rotating Chair Tests, and Stance and Gait Posturography After an Acute Unilateral Peripheral Vestibular Deficit

Abstract

Vestibulo-ocular reflex (VOR) deficits and balance instability during stance and gait are typical for an acute unilateral peripheral vestibular deficit (AUPVD). The relation between different VOR measures with recovery is unknown, as is the relation of VOR measures to balance control. To answer these questions, we examined changes over time in caloric canal paresis (CP), head impulse tests (HIT), whole body rotation (ROT) tests of the horizontal VOR, and changes in trunk sway during stance and gait tests, for cases of presumed vestibular neuritis. HIT was performed with short ca. 200 degrees per second head turns, ROT with triangular 24-second velocity profiles (peak 120 degrees per second, acceleration 20 degrees per second squared). To measure balance control, body-worn gyroscopes measured pitch (anterior-posterior) and roll (lateral) sway angles and angular velocities at lumbar 1 to 3. Changes during recover in ROT and HIT responses to the deficit side were equally well related (R = 0.8, p < 0.001) to changes in caloric CP values. ROT but not HIT responses to the normal side were also related to CP responses (R = 0.53, p = 0.02). Spontaneous nystagmus levels were related to changes instance balance control (R = 0.52, p = 0.001). Balance during gait improved over time but was not well correlated with changes in VOR measures (R = 0.26 max., p > 0.05). Both HIT and ROT track VOR recovery on the deficit side due to central compensation and peripheral recovery. However, only ROT track changes in the central compensation of normal side responses. The weak correlations between VOR and stance and gait tests suggest that the latter should also be tested to judge the effect of an AUPVD on balance control.