Gaze Stability Exercises Research Articles

Comparative Effects of Backward Walk Training and Vestibular Therapy on Balance in Patients with Vestibular Disorders

Objective: To compare the effects of backward walking program and vestibular therapy on balance in patients with vestibular disorders. Method: A randomized clinical trial was conducted on 46 patients into 2 groups that were allocated randomly. Group A consisted of 23 participants and were asked for backward walk across the room, by asking the patient to backward walk on a slope and steps in upward and downward direction with open eyes for the duration of 30 minutes, 3 sessions per week for about 6 weeks along with routine physical therapy treatment which included postural training while 23 participants of Group B received vestibular therapy that included gaze stabilization exercises, and Brandt-Daroff exercises along with routine physical therapy which included postural and balance trainings for the duration of 6 weeks for 3 sessions/week for 30 minutes. Statistics scrutiny was done by SPSS software version 23. Results: Post treatment analysis indicated that a statistically significant difference was there in across the group comparison, and within the group comparison. An improvement was seen in the outcome measures of Berg Balance Scale that was statistically considerable within the group. Time for completing the task in Timed Up and Go Test also showed improvement within the groups (p< 0.05). The subjective estimation of the sign and symptoms evaluated with the usage of Visual Vertigo Analogue Scale showed a considerable improvement in each group. Practical Implication: Backward walk training was found to be beneficial in enhancing the balance amongst people with excessive hazard of fall whereas vestibular rehabilitation improved signs associated with vestibular disorders such as dizziness, lightheadedness, vertigo and imbalance. Conclusion: This study concluded that backward walk training and vestibular therapy were equally effective in dealing with vestibular related signs and symptoms and complications of the sufferers. Backward walk training was found to be beneficial in enhancing the balance amongst people with excessive hazard of fall whereas vestibular rehabilitation improved signs associated with vestibular disorders such as dizziness, lightheadedness, vertigo and imbalance. The results of this study helps the physiotherapist that they will add the vestibular therapy interventions and backward walk training for the patients having vestibular issue to reduce their balance issues and other symptoms such as dizziness , lightheadedness , gaze stabilization and vertigo for better results. Keywords: Balance, Backward walk training, Vestibular therapy, Gaze stabilization exercises, Cawthorne-Cooksey exercises.

Effects of Gaze Stabilization Exercises on Gait, Plantar Pressure, and Balance Function in Post-Stroke Patients: A Randomized Controlled Trial.

This study aims to explore the effects of gaze stabilization exercises (GSEs) on gait, plantar pressure, and balance function in post-stroke patients (≤6 months). Forty post-stroke patients were randomly divided into an experimental group (n = 20) and a control group (n = 20). The experimental group performed GSEs combined with physical therapy, while the control group only performed physical therapy, once a day, 5 days a week, for 4 weeks. The Berg Balance Scale (BBS) was used to test the balance function and the risk of falling, which was the primary outcome. The Timed Up and Go test (TUGT) evaluated the walking ability and the fall risk. The envelope ellipse area and the plantar pressure proportion of the affected side were used to measure the patient's supporting capacity and stability in static standing. The anterior-posterior center of pressure displacement velocity was used to test the weight-shifting capacity. Compared to the control group, the swing phase of the affected side, swing phase's absolute symmetric index, envelope ellipse area when eyes closed, and TUGT of the experimental group had significantly decreased after GSEs (p < 0.05); the BBS scores, TUGT, the anterior-posterior COP displacement velocity, and the plantar pressure proportion of the affected side had significantly increased after 4 weeks of training (p < 0.05). In conclusion, GSEs combined with physical therapy can improve the gait and balance function of people following stroke. Furthermore, it can enhance the weight-shifting and one-leg standing capacity of the affected side, thus reducing the risk of falling.

To Design and Investigate the Effectiveness of a Gaze Stabilization Application on Patients with Impaired Visual Vestibulo-ocular Reflex

Purpose: Vestibulo-ocular Reflex is the main vision stabilizing system during rapid head movements. In keeping the eyes still during head motion which is referred to as the gaze stability, the VOR has a censorious role. Loss of this vestibular function produces instability of gaze which worsens on motion and activity. Vestibular rehabilitation is one of the treatment modalities for patients with vestibular insufficiency. These exercises include gaze stability, central programming and balance exercise. Here this study is an instrument-based study and this device focuses on visually tracking, using smooth pursuit eye movements on a moving object. It shall not only provide a combined gaze stability adaptive exercise but it will also provide various progressions and biofeedback to the patients. Methods: An interventional study, with a sum of 30 participants having significant vestibular hypofunction or dysfunction who voluntarily participated in the study. It was a comparative study and it took place in Krishna Institute of Medical Sciences deemed to be University, Karad city in Maharashtra, India. 6 months was the total time span required to complete this trial. Consecutive sampling with random allocation was done. Those fulfilling the inclusion criteria were recruited and divided into two groups: control and interventional. Results and Conclusion: Vestibular dysfunction significantly affected the quality of life and lead to serious disability. Virtual mode of rehabilitation training by tracking the object with the eye, built interest and motivated the patient to regularly exercise as well as to perform smooth eye movements with lower range of saccades.

Effects of balance training with and without gaze stabilization exercises on clinical outcomes in elderly patients with chronic dizziness: A randomized controlled trial

ObjectiveTo compare the effects of balance training with and without Gaze Stabilization exercises on clinical outcomes in elderly patient with chronic dizziness. MethodTotal 64 participants after referral from neurologist at Lahore General Hospital were recruited in this study. These participants were randomly assigned into two groups i.e. Group A (Gaze group) and Group B (control group) with 32 participants in each group by sealed envelope method. Gaze group performed balance exercises with gaze stability exercise whereas, group B performed balance exercises with saccade eye exercises. Berg Balance Scale, Disability Handicapped Inventory, and Activity Specific Balance Confidence Scale were used to measure outcome variables. ResultsDemographic variables were represented by mean, standard deviation and frequency distribution. Results showed that there was no baseline difference between gaze and control group (p > 0.05). Both groups showed improved results with the gaze group showing significantly more improvement as compare to the control group on balance (p < 0.05, Mean Group A = 44.1, Mean group B = 40.91), perceived disability (p < 0.05, Mean Group A = 52.84, Group B = 56.09), and risk of fall (p < 0.05, Mean Group A = 53.84, Mean Group B = 50.72) respectively. ConclusionThis study concluded that gaze stability exercises with balance training are effective in improving balance, level of perceived disability, and risk of fall prevention among elderly patients with chronic dizziness.

Use of Stakeholder Feedback to Develop an App for Vestibular Rehabilitation-Input From Clinicians and Healthy Older Adults.

Close to half people over 60 years of age experience vestibular dysfunction. Although vestibular rehabilitation has been proven effective in reducing dizziness and falls in older adults, adherence to exercise programs is a major issue and reported to be below 50%. Therefore, this research aimed to develop an app with gaming elements to improve adherence to exercises that are part of vestibular rehabilitation, and to provide feedback to increase the accuracy during exercise performance. A clinician-informed design was used where five physical therapists were asked identical questions about the exercises they would like to see in the app, including their duration and frequency. Games were developed to train the vestibulo-ocular (VOR) reflex using VOR and gaze shifting exercises; and to train the vestibulo-spinal system using weight shifting and balance exercises. The games were designed to progress from simple to more complex visuals. The games were controlled by an Inertial Measurement Unit placed on the head or anterior waist. The app was tested on ten healthy females (69.1 ± 5.1 years) with no prior history of vestibular dysfunction or complaints of dizziness. Participants completed gaze stabilization and balance exercises using the app and provided feedback on the user interface, ease of use, usefulness and enjoyment using standardized questionnaires and changes they would like to see in the form of open-ended questions. In general, participants reported that they found the app easy to use, the user interface was friendly, and they enjoyed playing the games due to the graphics and colors. They reported that the feedback provided during the exercise session helped them recognize their mistakes and motivated them to do better. However, some elements of the app were frustrating due to incomplete instructions and inability to distinguish game objects due to insufficient contrast. Feedback received will be implemented in a revised version which will be trialed in older adults with dizziness due to vestibular hypofunction. We have demonstrated that the “Vestibular AppTM” created for rehabilitation with gaming elements was found to be enjoyable, useful, and easy to use by healthy older adults. In the long term, the app may increase adherence to vestibular rehabilitation.

The effect of gaze stability exercises on balance and gait in elderly population-A comparative study

Aim: The Aim of this study is to compare the effect of Gaze Stability Exercises and Placebo Eye Movements in Improving balance, confidence and gait among elderly population. Materials and Methods: A Quasi Experimental study design consisting of reviews of charts healthy elderly population. Thirty persons were included, (60%) were females, (40%) were males; the average age was 66 years. All of them are presented with balance disorders, loss of confidence and gait abnormalities. Pre- and post-Treatment of (GSE) and (PE) scores on the severity of balance, functional activities and gait were analyzed by the BBS, ABC and TUG. Results: The pre and post-test values were assessed by BBS, ABC and TUG in Group A and Group B. The Calculated &lsquo;t&rsquo; values by Unpaired &lsquo;t&rsquo; test of BBS is 10.81, ABC is 9.61, and TUG is 7.81 respectively The calculated &lsquo;t&rsquo; values were more than the table value 2.05 for 5% level of significance at 28 degrees of freedom. Conclusion: In the present sample, Gaze Stability Exercises had a positive and significant effect on balance, confidence and gait among the elderly population and also it increases the quality of life in elderly, as measured by the BBS, ABC and TUG scores before and after therapy.

Effects of Progressive Gaze Stability Exercises on Balance and Gait in Vestibular Neuritis Patients: A Quasi-experimental Study

Introduction: Gaze stability exercises are the exercises that are used effectively to improve gaze stability during head movement in various vestibular disorders patients, and to improve balance in in static and dynamic movements the same. Aim: To compare the effectiveness of progressive gaze stability exercises to improve balance and gait in patients with vestibular neuritis. Materials and Methods: This quasi-experimental study was conducted at Outpatient Department of SGT hospital, Gurugram, Haryana, India, from November 2018 to March 2019. A total of 26 subjects were randomly assigned into two groups, Group A received progressive gaze stability exercises with conventional therapy (n=13) and Group B received conventional therapy (n=13). Group A received Vestibular Rehabilitation Therapy (VRT) for 25 minutes a day 5 times a week for 4 weeks. Group B conventional training which consisted of balance exercises. Participants were assessed with Mini Balance Evaluation Systems Test (Mini-BESTest) and dizziness handicap inventory to access the performance of balance and functional limitation, respectively. Data was analysed by using the Statistical Package for the Social Sciences (SPSS) version 20.0 for statistical analysis. A level of significance was set at p-value &lt;0.05. Results: The finding of the study showed no significant change for baseline parameters between the experimental and conventional groups with respect to age (p-value=0.097), gender (p-value=0.573), height (p-value=0.682), weight (p-value=0.945), duration of illness (p-value=0.579). Both the groups showed significant improvement with in group, when measured using dependent t-test for Mini-BESTest and Wisconsin Gait Scale. The comparison of postintervention scores of Mini-BESTest and WGS between Group A and Group B showed significant difference (p-value=0.001) and (p-value=0.002) respectively. Conclusion: The present study has provided preliminary evidence that progressive gaze stability exercises when coupled with conventional balance exercises may improve gait and balance in patients with vestibular neuritis.

Effects of Gaze Stability Exercises with Proprioception Training to Improve Gait and Functional Independence in Cerebellar Ataxic Patients

Objective: To compare the effects of gaze stability exercises with proprioception training to improve gait and functional independence in cerebellar ataxic patients. Methods: A Quasi experimental study was conducted in the physiotherapy department in Lahore General Hospital, Lahore, Pakistan from January 2018 to June 2018.All patients were diagnosed with cerebellar ataxia and referred by neurophysician to physiotherapy department. Forty-six (46) patients were divided into two equal groups by lottery method. (Group A =proprioception training), (Group B =gaze stability with proprioception training). Data was analyzed by using statistical package for social sciences (SPSS) 21. Results: In group A, males were 13(56.5%) and females 10(43.5%) while in Group B, males were 12(52.2%) and females 11(47.8%). Mean ages were (71.3±8.47) years in Group A and (70±7.67) years in Group B. Pre and Post Functional Independence Measure (FIM)score in groups A and B with mean and standard deviation were 13.08±1.86 and 15.43±1.74 respectively. Pre and Post Timed Up and Go (TUG) test score in groups A and B with mean and standard deviation were 0.79± 0.26 and 0.97 ±0.39 respectively. Both groups were statistically significant (P value ≤ 0.05) but on the basis of mean ± standard deviation Group B method was more effective than Group A. Conclusion: Gaze stability exercises added the effects of proprioception training in improving gait and functional independence in cerebellar ataxic patients. Keywords: Cerebellar ataxia, gaze, patients, proprioception

Age-Related Vestibular Dysfunction; Vestibulo-Ocular Reflex, Dynamic Visual Acuity, Dizziness and Falls: A Review

Background: Vestibular and vision functions are important contributors to posture control and fall avoidance. This review examines how the vestibulo-ocular reflex can be rehabilitated to help restore postural control. Methods: PubMed searches (7th April 2021) using the terms ‘vestibulo-ocular reflex’, ‘imbalance and vestibular dysfunction’, ‘vestibular dysfunction and dizziness’, ‘dynamic visual acuity’, ‘vestibular dysfunction rehabilitation’, and ‘gaze stabilization exercises’ yielded 4986, 495, 3576,1830, 3312, and 137 potentially useful publications respectively. Selections of those which were found to be the most relevant and representative of a balanced and current account of these topics, as well as selections from the most relevant reports referenced in those publications, were included in this review. Results: Just as there are age-related losses of static visual acuity even when there are no specific visual pathologies diagnosed, patients may also present with age-related loss of vestibular functions in the absence of specific vestibular pathologies. For example, cases of dizziness which are diagnosed as idiopathic might be usefully classified as age-related as the basis for the initiation of rehabilitation exercises. Conclusions: Apart from age-related loss of vestibular functions, cases diagnosed as having a particular form of vestibular pathology may have that condition exacerbated by age-related losses of vestibular functions. The effects of vestibular rehabilitation gaze stability exercises in patients with vestibular dysfunction are well established and include both improved dynamic acuity and postural stability. Improvements in posture control following rehabilitation of the vestibulo-ocular reflex are apparently due to improved peripheral and/or central vestibular balance control which has occurred in conjunction with enhanced gaze stability. The complex nature of increased fall risk suggests that an interdisciplinary approach to rehabilitation that includes vestibulo-ocular reflex rehabilitation appears likely to be associated with optimum outcomes for both pathological and age-related cases.

Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Updated Clinical Practice Guideline From the Academy of Neurologic Physical Therapy of the American Physical Therapy Association.

Background:Uncompensated vestibular hypofunction can result in symptoms of dizziness, imbalance, and/or oscillopsia, gaze and gait instability, and impaired navigation and spatial orientation; thus, may negatively impact an individual's quality of life, ability to perform activities of daily living, drive, and work. It is estimated that one-third of adults in the United States have vestibular dysfunction and the incidence increases with age. There is strong evidence supporting vestibular physical therapy for reducing symptoms, improving gaze and postural stability, and improving function in individuals with vestibular hypofunction. The purpose of this revised clinical practice guideline is to improve quality of care and outcomes for individuals with acute, subacute, and chronic unilateral and bilateral vestibular hypofunction by providing evidence-based recommendations regarding appropriate exercises.Methods:These guidelines are a revision of the 2016 guidelines and involved a systematic review of the literature published since 2015 through June 2020 across 6 databases. Article types included meta-analyses, systematic reviews, randomized controlled trials, cohort studies, case-control series, and case series for human subjects, published in English. Sixty-seven articles were identified as relevant to this clinical practice guideline and critically appraised for level of evidence.Results:Based on strong evidence, clinicians should offer vestibular rehabilitation to adults with unilateral and bilateral vestibular hypofunction who present with impairments, activity limitations, and participation restrictions related to the vestibular deficit. Based on strong evidence and a preponderance of harm over benefit, clinicians should not include voluntary saccadic or smooth-pursuit eye movements in isolation (ie, without head movement) to promote gaze stability. Based on moderate to strong evidence, clinicians may offer specific exercise techniques to target identified activity limitations and participation restrictions, including virtual reality or augmented sensory feedback. Based on strong evidence and in consideration of patient preference, clinicians should offer supervised vestibular rehabilitation. Based on moderate to weak evidence, clinicians may prescribe weekly clinic visits plus a home exercise program of gaze stabilization exercises consisting of a minimum of: (1) 3 times per day for a total of at least 12 minutes daily for individuals with acute/subacute unilateral vestibular hypofunction; (2) 3 to 5 times per day for a total of at least 20 minutes daily for 4 to 6 weeks for individuals with chronic unilateral vestibular hypofunction; (3) 3 to 5 times per day for a total of 20 to 40 minutes daily for approximately 5 to 7 weeks for individuals with bilateral vestibular hypofunction. Based on moderate evidence, clinicians may prescribe static and dynamic balance exercises for a minimum of 20 minutes daily for at least 4 to 6 weeks for individuals with chronic unilateral vestibular hypofunction and, based on expert opinion, for a minimum of 6 to 9 weeks for individuals with bilateral vestibular hypofunction. Based on moderate evidence, clinicians may use achievement of primary goals, resolution of symptoms, normalized balance and vestibular function, or plateau in progress as reasons for stopping therapy. Based on moderate to strong evidence, clinicians may evaluate factors, including time from onset of symptoms, comorbidities, cognitive function, and use of medication that could modify rehabilitation outcomes.Discussion:Recent evidence supports the original recommendations from the 2016 guidelines. There is strong evidence that vestibular physical therapy provides a clear and substantial benefit to individuals with unilateral and bilateral vestibular hypofunction.Limitations:The focus of the guideline was on peripheral vestibular hypofunction; thus, the recommendations of the guideline may not apply to individuals with central vestibular disorders. One criterion for study inclusion was that vestibular hypofunction was determined based on objective vestibular function tests. This guideline may not apply to individuals who report symptoms of dizziness, imbalance, and/or oscillopsia without a diagnosis of vestibular hypofunction.Disclaimer:These recommendations are intended as a guide to optimize rehabilitation outcomes for individuals undergoing vestibular physical therapy. The contents of this guideline were developed with support from the American Physical Therapy Association and the Academy of Neurologic Physical Therapy using a rigorous review process. The authors declared no conflict of interest and maintained editorial independence.Video available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A369).

PENGARUH OTAGO EXERCISE DAN GAZE STABILITY EXERCISE TERHADAP KESEIMBANGAN PADA LANJUT USIA

The aging process is one of the life cycles experienced by every human being. However, it is a process of slowly diminishing the ability of body tissues to maintain normal structure and function. Increasing one's age has an effect on decreasing balance function. Otago Exercise and Gaze Stability Exercise to improve balance in the elderly. This research is a quantitative study with a quasi-experimental approach with a research design using pre-test and post-test. Determination of the number using purposive sampling method and obtained a sample of 14 people. Data collection was carried out by direct interviews using observation sheets. The independent variable in this study was the Otago Exercise and Gaze Stability Exercise, while the dependent variable was balance. Balance assessment using TUG&gt; 12 seconds experienced a balance of 14 people. Statistical test using wilcoxon signed ranked test with α = 0.05. The results of the analysis show that there is a significant effect between giving Otago Exercise and Gaze Stability Exercise on the balance of the elderly, with a p value (0.001≤0.005). The conclusion of this study is that there is an effect between the provision of Otago Exercise and Gaze Stability Exercise on the balance of the elderly. The advice that can be given is that it is hoped that the patient should always do exercises to maintain body balance.

Two conditions to fully recover dynamic canal function in unilateral peripheral vestibular hypofunction patients.

The crucial role of early vestibular rehabilitation (VR) to recover a dynamic semicircular canal function was recently highlighted in patients with unilateral vestibular hypofunction (UVH). However, wide inter-individual differences were observed, suggesting that parameters other than early rehabilitation are involved. The aim of the study was to determine to what extent the degree of vestibular loss assessed by the angular vestibulo-ocular reflex (aVOR) gain could be an additional parameter interfering with rehabilitation in the recovery process. And to examine whether different VR protocols have the same effectiveness with regard to the aVOR recovery. The aVOR gain and the percentage of compensatory saccades were recorded in 81 UVH patients with the passive head impulse test before and after early VR (first two weeks after vertigo onset: N = 43) or late VR (third to sixth week after onset: N = 38) performed twice a week for four weeks. VR was performed either with the unidirectional rotation paradigm or gaze stability exercises. Supplementary outcomes were the dizziness handicap inventory (DHI) score, and the static and dynamic subjective visual vertical. The cluster analysis differentiated two distinct populations of UVH patients with pre-rehab aVOR gain values on the hypofunction side below 0.20 (N = 42) or above 0.20 (N = 39). The mean gain values were respectively 0.07±0.05 and 0.34±0.12 for the lateral canal (p < 0.0001), 0.09±0.06 and 0.44±0.19 for the anterior canal (p < 0.0001). Patients with aVOR gains above 0.20 and early rehab fully recovered dynamic horizontal canal function (0.84±0.14) and showed very few compensatory saccades (18.7% ±20.1%) while those with gains below 0.20 and late rehab did not improve their aVOR gain value (0.16±0.09) and showed compensatory saccades only (82.9% ±23.7%). Similar results were found for the anterior canal function. Recovery of the dynamic function of the lateral canal was found with both VR protocols while it was observed with the gaze stability exercises only for the anterior canal. All the patients reduced their DHI score, normalized their static SVV, and exhibited uncompensated dynamic SVV. Early rehab is a necessary but not sufficient condition to fully recover dynamic canal function. The degree of vestibular loss plays a crucial role too, and to be effective rehabilitation protocols must be carried out in the plane of the semicircular canals.

Effect of Yogasanas Versus Gaze Stability and Habituation Exercises on Dizziness in Vestibular Dysfunction.

Dizziness is a typical manifestation of vestibular pathologies. Clinical studies have shown that it affects 1.82% of young adults to more than 30% older adults. Habituation and compensation are some traditional rehabilitation protocols. Yoga is also known to have a significant effect on vestibulopathy. Hence, a need arises to compare the above two maneuvers. Participants were recruited (n = 32) after screening using the Dix-Hallpike and head impulse test. They were then divided into two groups (n = 16). The first one, Group A, received yogasanas, and the second one, Group B, received gaze stabilization and habituation exercises for 4 days a week for 3 weeks. Pre- and post intervention outcome measures were taken using the motion sensitivity quotient (MSQ) score and Dizziness Handicap Inventory (DHI) scale. In reducing symptoms of dizziness, the between-group comparison shows that Group A has shown greater improvement (12.37% ±1.43%) in MSQ and Group B has shown greater improvement (16.12 ± 3.56) in DHI. Within-group comparison shows that both the interventions are effective in reducing symptoms of dizziness (P < 0.05). Both gaze stabilization along with habituation exercises and yogasanas are effective in improving the symptoms of dizziness in patients with peripheral vestibular dysfunction. When compared between the groups, yogasanas had a superior hand in the MSQ score, whereas gaze stabilization and habituation exercises had a superior hand in the DHI scale.

Continuous Head Motion is a Greater Motor Control Challenge than Transient Head Motion in Patients with Loss of Vestibular Function

Background. The vestibular system is vital for gaze stability via the vestibulo-ocular reflex, which generates compensatory eye motion in the direction opposite to head motion. Consequently, individuals with peripheral vestibular loss demonstrate impaired gaze stability that reduces functional capacity and quality of life. To facilitate patients’ compensatory strategies, two classes of gaze stabilization exercises are often prescribed: (i) transient (eg, ballistic) and (ii) continuous. However, the relative benefits of these two classes of exercises are not well understood. Objective. To quantify head motion kinematics in patients with vestibular loss while they performed both classes of exercises. Methods. Using inertial measurement units, head movements of 18 vestibular schwannoma patients were measured before and after surgical deafferentation and compared with age-matched controls. Results. We found that the head movement during both classes of exercises paralleled those of natural head movement recorded during daily activities. However, head movement patterns were more informative for continuous than transient exercises in distinguishing patients from healthy controls. Specifically, we observed coupling between kinematic measures in control subjects that was absent in patients for continuous but not transient head motion exercises. In addition, kinematic measures (eg, cycle duration) were predictive of standard clinical measures for continuous but not transient head motion exercises. Conclusions. Our data suggest that performing continuous head motion is a greater motor control challenge than transient head motion in patients with less reliable vestibular feedback during the sub-acute stage of recovery, which may also prove to be a reliable measure of progression in vestibular rehabilitation protocols.

Head movement kinematics are altered during gaze stability exercises in vestibular schwannoma patients

Gaze stability is the ability of the eyes to fixate a stable point when the head is moving in space. Because gaze stability is impaired in peripheral vestibular loss patients, gaze stabilization exercises are often prescribed to facilitate compensation. However, both the assessment and prescription of these exercises are subjective. Accordingly, here we quantified head motion kinematics in patients with vestibular loss while they performed the standard of care gaze stability exercises, both before and after surgical deafferentation. We also correlate the head kinematic data with standard clinical outcome measures. Using inertial measurement units, we quantified head movements in patients as they transitioned through these two vestibular states characterized by different levels of peripheral damage. Comparison with age-matched healthy control subjects revealed that the same kinematic measurements were significantly abnormal in patients both pre- and post-surgery. Regardless of direction, patients took a longer time to move their heads during the exercises. Interestingly, these changes in kinematics suggest a strategy that existed preoperatively and remained symmetric after surgery although the patients then had complete unilateral vestibular loss. Further, we found that this kinematic assessment was a good predictor of clinical outcomes, and that pre-surgery clinical measures could predict post-surgery head kinematics. Thus, together, our results provide the first experimental evidence that patients show significant changes in head kinematics during gaze stability exercises, even prior to surgery. This suggests that early changes in head kinematic strategy due to significant but incomplete vestibular loss are already maladaptive as compared to controls.

A Protocol on Effect of Gaze Exercises and Balance Regimen on Quality of Life of Patients with Peripheral-Vertigo

Background: As vertigo is been one of the most common condition affecting the individual functionally,physically and emotionally and result in some form of disability. Most of physiotherapy interventionproves to be effective in vestibular rehabilitation of patients with vestibular disorders. Gaze stabilizationexercises are effective and some suggest balance training is also effective in vestibular rehabilitation. Butthere is minimal literature on combination of both exercise protocol. Aim: To find out the effect of Gazestabilization Exercises and balance training on quality of life of patients with Peripheral Vertigo. Methods:30 participants with vertigo due to peripheral pathology will be selected on the basis of inclusion, exclusionand head impulse test. The patient will be evaluating using Visual analogue scale, Dizziness HandicapInventory, Berg Balance Scale and Dynamic Gait Index Scale. The participants will be distributed into twocategories. Group- A will receive gaze stabilization exercise and Group- B will receive balance trainingalong with gaze stabilization exercise. Participants will be evaluating post-treatment. Conclusion: Thisstudy concluded that there may be significant reduction in vertigo symptoms and improved Quality of Lifein peripheral vertigo by using combine effect of Gaze Exercise with Balance Training

Turning Towards Monitoring of Gaze Stability Exercises: The Utility of Wearable Sensors: Corrigendum.

Turning Towards Monitoring of Gaze Stability Exercises: The Utility of Wearable Sensors: Corrigendum.

Convergence Vestibulo-ocular Reflex in Unilateral Vestibular Hypofunction: Behavioral Evidence in Support of a Novel Gaze Stability Exercise

Convergence of the eyes during head rotation increases the gain (eye velocity/head velocity) of the vestibulo-ocular reflex (VOR). We sought to know whether convergence would increase the VOR gain (mean + SD) in unilateral vestibular hypofunction (UVH). Vestibulo-ocular reflex gain during ipsi- and contralesional horizontal head rotation at near (15 cm) and far (150 cm) targets was measured in 22 subjects with UVH and 12 healthy controls. Retinal slip was estimated (retinal slip index [RSI]) as the difference between ideal VOR gain (no retinal slip) and the actual VOR gain. Convergence did not significantly enhance VOR gain for ipsilesional rotation (mean difference, 0.04; 95% confidence interval [CI], -0.01 to 0.09), near viewing (0.77 ± 0.34) versus far viewing (0.72 ± 0.29), yet the VOR gain during contralesional rotation was greater for near viewing (1.20 ± 0.23) than for far viewing (0.97 ± 0.21; mean difference, 0.23; 95% CI, 0.13-0.32). In the 36% of subjects with recovery of their ipsilesional VOR gain, the vergence effect trended to recover (far VOR gain: 1.06 ± 0.17 vs near VOR gain 1.16 ± 0.21; mean difference, 0.10; 95% CI, -0.02 to 0.22). Ipsilesional head rotation induced greater retinal slip for near (RSI = 0.90 ± 0.34) targets than for far targets (RSI = 0.35 ± 0.29; mean difference, 0.56; 95% CI, 0.51-0.61). The convergence-mediated VOR gain enhancement is preserved during contralesional but impaired during ipsilesional head rotation. Recovery of ipsilesional passive VOR gain does not equate to restored convergence enhancement, although it did increase ∼10%. These data suggest head motion viewing near targets will increase retinal slip, which warrants consideration as a gaze stability exercise for subjects with UVH.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A325).

Turning Toward Monitoring of Gaze Stability Exercises: The Utility of Wearable Sensors.

Few tools are currently available to quantify gaze stability retraining exercises. This project examined the utility of a head-worn inertial measurement unit (IMU) to quantify head movement frequency, velocity, and amplitude during gaze stability exercises. Twenty-eight individuals with multiple sclerosis and complaints of dizziness or a history of falls were randomly assigned to either a strength and aerobic exercise (SAE) or gaze and postural stability (GPS) group. During a 6-week intervention, participants wore a head-mounted IMU 3 times (early, middle, and late). For aim 1, the frequency, mean peak velocity, and mean peak amplitude of head turns during equivalent duration components of group-specific exercises were compared using general linear models. For aim 2, the progression of treatment in the GPS group was examined using general linear regression models for each outcome. Aim 1 revealed the GPS group demonstrated significantly greater velocity and amplitude head turns during treatment than the SAE group. The frequency of head turns did not significantly differ between the 2 groups. The aim 2 analyses demonstrated that the yaw and pitch frequency of head turns significantly increased during gaze stability exercises over the 6-week intervention. Velocity and amplitude of head turns during yaw and pitch gaze stability exercises did not significantly change. A head-worn IMU during rehabilitation distinguished between groups. Furthermore, within the GPS group, the IMU quantified the progression of the frequency of head movements during gaze stability exercises over time.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A320).

Better balance: a randomised controlled trial of oculomotor and gaze stability exercises to reduce risk of falling after stroke

Objective: To assess the effect of a domiciliary program of oculomotor and gaze stability exercises on the incidence of falls and risk of fall in stroke survivors. Design: Two-arm, non-blinded parallel randomized controlled trial. Subjects: Stroke survivors older than 60 years, with positive Romberg test and autonomous gait after the stroke. Setting: Physiotherapy outpatient clinic of a tertiary care hospital. Interventions: Every participant accomplished the current rehabilitation program; the intervention group was randomly allocated into an additional three weeks intervention with a domiciliary program of oculomotor and gaze stability exercises. Main measures: Primary outcome was the incidence of falls through the three weeks after the intervention started; in addition, the variation of the estimated risk for falling assessed by both Berg Balance Scale (four points) and Timed Up and Go Test (four seconds) was the secondary outcome. Results: 79 patients were recruited and 68 completed the protocol (control group 35; intervention group 33). During the follow up, falls were registered in 4/35 participants in the control group and no event occurred in the intervention group (P = 0.064). The estimated risk for falling decreased in 11/35 control group participants and in 28/33 intervention group participants (RR 0.37; 95%CI 0.22–0.62; P < 0.001). Conclusion: After three weeks of a domiciliary program of oculomotor and gaze stability exercises, the estimated risk of falling significantly diminished and no falls occurred among the intervention group. These findings encourage further exploration of this promising intervention. Trial Registration: ClinicalTrials.gov Identifier: NCT02280980.