Abstract
An acute unilateral peripheral vestibular loss (aUVL) initially causes severe gaze and balance control problems. However, vestibulo-ocular reflexes (VOR) and balance control are nearly normal 3 months later as a result of peripheral recovery and/or central compensation. As pre-existing vestibular sensory loss is assumed to be greater in the healthy elderly, this study investigated whether improvements in VOR and balance function over time after aUVL are different for the elderly than for the young. Thirty aUVL patients divided into three age-groups were studied (8 age range 23-35, 10 with range 43-58, and 12 with range 60-74 years). To measure VOR function eye movements were recorded during caloric irrigation, rotating chair (ROT), and head impulse tests. Balance control during stance and gait was recorded as lower trunk angular velocity in the pitch and roll planes. Measurements were taken at deficit onset, and 3, 6, and 13 weeks later. There was one difference in VOR improvements over time between the age-groups: Low acceleration ROT responses were less at onset in the elderly group. Deficit side VOR responses and asymmetries in each group improved to within ranges of healthy controls at 13 weeks. Trunk sway of the elderly was greater for stance and gait at onset when compared to healthy age-matched controls and the young and greater than that of the young and controls during gait tasks at 13 weeks. The sway of the young was not different from controls at either time point. Balance control for the elderly improved slower than for the young. These results indicate that VOR improvement after an aUVL does not differ with age, except for low accelerations. Recovery rates are different between age-groups for balance control tests. Balance control in the elderly is more abnormal at aUVL onset for stance and gait tasks with the gait abnormalities remaining after 13 weeks. Thus, we conclude that balance control in the elderly is more affected by the UVL than for the young, and the young overcome balance deficits more rapidly. These differences with age should be taken into account when planning rehabilitation.
Highlights
Because of its ability to detect linear and angular body accelerations, the vestibular system plays a crucial role in static and dynamic balance control [1]
The 30 subjects (13 females and 16 males) with an acute unilateral vestibular loss (aUVL) diagnosed as presumably vestibular neuritis on the basis of a pathological canal paresis, the presence of a spontaneous nystagmus beating toward the healthy ear, nausea, and the constant presence of symptoms over hours were subdivided into the following three groups: young (60 years)
At aUVL onset, vestibulo-ocular reflexes (VOR) deficit side values were outside of the range of healthy normal as indicated by the 95% limits shown in Figure 1, and the statistics of Table 1; likewise for the corresponding asymmetries
Summary
Because of its ability to detect linear and angular body accelerations, the vestibular system plays a crucial role in static and dynamic balance control [1]. This role includes stabilizing the head and trunk, especially on unstable surfaces [2]. Following acute unilateral vestibular loss (aUVL) due to acute vestibular neuritis or following eight nerve neurectomy, vestibular signals driving vestibulo-ocular reflexes (VOR) and vestibule-spinal reflexes (VSR) are inaccurate or absent causing postural instability [3, 4]. An acute unilateral peripheral vestibular loss (aUVL) initially causes severe gaze and balance control problems. Vestibulo-ocular reflexes (VOR) and balance control are nearly normal 3 months later as a result of peripheral recovery and/or central compensation. As pre-existing vestibular sensory loss is assumed to be greater in the healthy elderly, this study investigated whether improvements in VOR and balance function over time after aUVL are different for the elderly than for the young
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