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Clinical and neurophysiological risk factors for falls in patients with bilateral vestibulopathy

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Abstract

Patients with bilateral vestibular failure (BVF) exhibit imbalance when standing and walking that is linked to a higher fall risk. The purpose of this study was to identify risk factors for falls in BVF. We therefore systematically investigated the interrelationship of clinical and demographic characteristics, gait impairments, and the fall frequency of these patients. Clinical and demographic characteristics as well as quantitative measures of gait performance on a pressure-sensitive gait carpet were collected from 55 patients with different etiologies of BVF. Clinical and demographic data as well as spatiotemporal gait characteristics were used for ANOVA testing and a logistic regression model with categorized fall events as dependent variables. The impairment of peripheral vestibular function, duration of disease, and the overall gait status were not associated with the history of falls in patients with BVF. In contrast, the most predictive factors for falls in BVF were an increase in temporal gait variability, especially at slow walking speeds (p < 0.001; OR = 1.3), and the presence of a concomitant peripheral neuropathy (p < 0.045; OR = 3.6). BVF patients with a high risk of falling exhibit specific gait alterations in a speed-dependent manner. In particular, increased gait fluctuations during slow walking are most predictive for an increased fall risk. The presence of a concomitant peripheral neuropathy further critically impairs postural stability in these patients. Clinical assessment of both these aspects is therefore important to identify those patients at a particularly high fall risk and to initiate preventive procedures early.

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References

  1. Brandt T, Huppert T, Hufner K, Zingler VC, Dieterich M, Strupp M (2010) Long-term course and relapses of vestibular and balance disorders. Restor Neurol Neurosci 28:69–82

    PubMed  Google Scholar 

  2. Brandt T, Strupp M, Benson J (1999) You are better off running than walking with acute vestibulopathy. Lancet 354:746

    Article  CAS  PubMed  Google Scholar 

  3. Callisaya ML, Blizzard L, Schmidt MD, Martin KL, McGinley JL, Sanders LM, Srikanth VK (2011) Gait, gait variability and the risk of multiple incident falls in older people: a population-based study. Age Ageing 40:481–487

    Article  PubMed  Google Scholar 

  4. Deshpande N, Patla AE (2005) Postural responses and spatial orientation to neck proprioceptive and vestibular inputs during locomotion in young and older adults. Exp Brain Res 167:468–474

    Article  PubMed  Google Scholar 

  5. Greenberg SA (2012) Analysis of measurement tools of fear of falling for high-risk, community-dwelling older adults. Clin Nurs Res 21:113–130

    Article  PubMed  Google Scholar 

  6. Guinand N, Boselie F, Guyot JP, Kingma H (2012) Quality of life of patients with bilateral vestibulopathy. Ann Otol Rhinol Laryngol 121:471–477

    Article  PubMed  Google Scholar 

  7. Hausdorff JM (2005) Gait variability: methods, modeling and meaning. J Neuroeng Rehabil 2:19

    Article  PubMed  PubMed Central  Google Scholar 

  8. Hausdorff JM, Cudkowicz ME, Firtion R, Wei JY, Goldberger AL (1998) Gait variability and basal ganglia disorders: stride-to-stride variations of gait cycle timing in Parkinson’s disease and Huntington’s disease. Mov Disord 13:428–437

    Article  CAS  PubMed  Google Scholar 

  9. Hausdorff JM, Rios DA, Edelberg HK (2001) Gait variability and fall risk in community-living older adults: a 1-year prospective study. Arch Phys Med Rehabil 82:1050–1056

    Article  CAS  PubMed  Google Scholar 

  10. Herdman SJ, Blatt P, Schubert MC, Tusa RJ (2000) Falls in patients with vestibular deficits. Am J Otol 21:847–851

    CAS  PubMed  Google Scholar 

  11. Holt KJ, Jeng SF, Rr RR, Hamill J (1995) Energetic cost and stability during human walking at the preferred stride velocity. J Mot Behav 27:164–178

    Article  CAS  PubMed  Google Scholar 

  12. Perring S, Summers T (2007) Laboratory-free measurement of gait rhythmicity in the assessment of the degree of impairment and the effectiveness of rehabilitation in patients with vertigo resulting from vestibular hypofunction. Physiol Meas 28:697–705

    Article  CAS  PubMed  Google Scholar 

  13. Powell LE, Myers AM (1995) The activities-specific balance confidence (ABC) scale. J Gerontol Ser A 50:M28–M34

    Article  Google Scholar 

  14. Schlick C, Schniepp R, Loidl V, Wuehr M, Hesselbarth K, Jahn K (2016) Falls and fear of falling in vertigo and balance disorders: a controlled cross-sectional study. J Vestib Res 25:241–251

    Article  PubMed  Google Scholar 

  15. Schniepp R, Wuehr M, Neuhaeusser M, Kamenova M, Dimitriadis K, Klopstock T, Strupp M, Brandt T, Jahn K (2012) Locomotion speed determines gait variability in cerebellar ataxia and vestibular failure. Mov Disord 27:125–131

    Article  PubMed  Google Scholar 

  16. Schniepp R, Wuehr M, Schlick C, Huth S, Pradhan C, Dieterich M, Brandt T, Jahn K (2014) Increased gait variability is associated with the history of falls in patients with cerebellar ataxia. J Neurol 261:213–223

    Article  PubMed  Google Scholar 

  17. Wrisley DM, Marchetti GF, Kuharsky DK, Whitney SL (2004) Reliability, internal consistency, and validity of data obtained with the functional gait assessment. Phys Ther 84:906–918

    PubMed  Google Scholar 

  18. Wuehr M, Nusser E, Decker J, Krafczyk S, Straube A, Brandt T, Jahn K, Schniepp R (2016) Noisy vestibular stimulation improves dynamic walking stability in bilateral vestibulopathy. Neurology 86:2196–2202

    Article  PubMed  Google Scholar 

  19. Wuehr M, Nusser E, Krafczyk S, Straube A, Brandt T, Jahn K, Schniepp R (2016) Noise-enhanced vestibular input improves dynamic walking stability in healthy subjects. Brain Stimul 9:109–116

    Article  CAS  PubMed  Google Scholar 

  20. Wuehr M, Schniepp R, Pradhan C, Ilmberger J, Strupp M, Brandt T, Jahn K (2013) Differential effects of absent visual feedback control on gait variability during different locomotion speeds. Exp Brain Res 224:287–294

    Article  CAS  PubMed  Google Scholar 

  21. Wuehr M, Schniepp R, Schlick C, Huth S, Pradhan C, Dieterich M, Brandt T, Jahn K (2014) Sensory loss and walking speed related factors for gait alterations in patients with peripheral neuropathy. Gait Posture 39:852–858

    Article  PubMed  Google Scholar 

  22. Zingler VC, Weintz E, Jahn K, Huppert D, Cnyrim C, Brandt T, Strupp M (2009) Causative factors, epidemiology, and follow-up of bilateral vestibulopathy. Ann N Y Acad Sci 1164:505–508

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors thank Judy Benson for copy-editing the manuscript. The work was supported by the German Research Foundation (Deutsche Forschungsgemeinschaft, DFG JA 1087/1-1), the German Hertie Foundation, and the Federal Ministry for Education and Science (BMBF, Nr. 80121000-49) of Germany.

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Authors and Affiliations

  1. Department of Neurology, University of Munich, Campus Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany

    Roman Schniepp

  2. German Center for Vertigo and Balance Disorders (DSGZ), University of Munich, Munich, Germany

    Roman Schniepp, Cornelia Schlick, Fabian Schenkel, Cauchy Pradhan, Klaus Jahn, Thomas Brandt & Max Wuehr

  3. Institute for Clinical Neurosciences, University of Munich, Campus Grosshadern, Munich, Germany

    Thomas Brandt

  4. Schoen Klinik Bad Aibling, Bad Aibling, Germany

    Klaus Jahn

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  1. Roman Schniepp
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  2. Cornelia Schlick
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  3. Fabian Schenkel
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  4. Cauchy Pradhan
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  5. Klaus Jahn
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  6. Thomas Brandt
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  7. Max Wuehr
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Correspondence to Roman Schniepp.

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The study protocol was approved by the local Ethics Committee. It was conducted in accordance to the ethical standards laid down in the declaration of Helsinki and its later amendments.

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The authors declare that they have no conflict of interest.

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Schniepp, R., Schlick, C., Schenkel, F. et al. Clinical and neurophysiological risk factors for falls in patients with bilateral vestibulopathy. J Neurol 264, 277–283 (2017). https://doi.org/10.1007/s00415-016-8342-6

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  • DOI: https://doi.org/10.1007/s00415-016-8342-6

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