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      Patients with chronic peripheral vestibular hypofunction compared to healthy subjects exhibit differences in gaze and gait behaviour when walking on stairs and ramps

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          Abstract

          Objective

          The aim of this study was to compare gaze behaviour during stair and ramp walking between patients with chronic peripheral vestibular hypofunction and healthy human subjects.

          Methods

          Twenty four (24) patients with chronic peripheral vestibular hypofunction (14 unilateral and 10 bilateral) and 24 healthy subjects performed stair and ramp up and down walks at self-selected speed. The walks were repeated five times. A mobile eye tracker was used to record gaze behaviour (defined as time directed to pre-defined areas) and an insole measurement device assessed gait (speed, step time, step length). During each walk gaze behaviour relative to i) detection of first transition area “First TA”, ii) detection of steps of the mid-staircase area and the handrail “Structure”, iii) detection of second transition area “Second TA”, and iv) looking elsewhere “Elsewhere” was assessed and expressed as a percentage of the walk duration. For all variables, a one-way ANOVA followed by contrast tests was conducted.

          Results

          Patients looked significantly longer at the “Structure” (p<0.001) and “Elsewhere” (p<0.001) while walking upstairs compared to walking downstairs (p<0.013). Patients looked significantly longer at the “Structure” (p<0.001) and “Elsewhere” (p<0.001) while walking upstairs compared to walking downstairs (p<0.013). No differences between groups were observed for the transition areas with exception of stair ascending. Patients were also slower going downstairs (p = 0.002) and presented with an increased step time (p = 0.003). Patients were walking faster up the ramp (p = 0.014) with longer step length (p = 0.008) compared to walking down the ramp (p = 0.050) with shorter step length (p = 0.024).

          Conclusions

          Patients with chronic peripheral vestibular hypofunction differed in time directed to pre-defined areas during stair and ramp walking and looked longer at stair and ramp areas of interest during walking compared to healthy subjects. Patients did not differ in time directed to pre-defined areas during the stair-floor transition area while going downstairs, an area where accidents may frequently occur.

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          Most cited references43

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          A common network of functional areas for attention and eye movements.

          Functional magnetic resonance imaging (fMRI) and surface-based representations of brain activity were used to compare the functional anatomy of two tasks, one involving covert shifts of attention to peripheral visual stimuli, the other involving both attentional and saccadic shifts to the same stimuli. Overlapping regional networks in parietal, frontal, and temporal lobes were active in both tasks. This anatomical overlap is consistent with the hypothesis that attentional and oculomotor processes are tightly integrated at the neural level.
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            The video head impulse test: diagnostic accuracy in peripheral vestibulopathy.

            The head impulse test (HIT) is a useful bedside test to identify peripheral vestibular deficits. However, such a deficit of the vestibulo-ocular reflex (VOR) may not be diagnosed because corrective saccades cannot always be detected by simple observation. The scleral search coil technique is the gold standard for HIT measurements, but it is not practical for routine testing or for acute patients, because they are required to wear an uncomfortable contact lens. To develop an easy-to-use video HIT system (vHIT) as a clinical tool for identifying peripheral vestibular deficits. To validate the diagnostic accuracy of vHIT by simultaneous measures with video and search coil recordings across healthy subjects and patients with a wide range of previously identified peripheral vestibular deficits. Horizontal HIT was recorded simultaneously with vHIT (250 Hz) and search coils (1,000 Hz) in 8 normal subjects, 6 patients with vestibular neuritis, 1 patient after unilateral intratympanic gentamicin, and 1 patient with bilateral gentamicin vestibulotoxicity. Simultaneous video and search coil recordings of eye movements were closely comparable (average concordance correlation coefficient r(c) = 0.930). Mean VOR gains measured with search coils and video were not significantly different in normal (p = 0.107) and patients (p = 0.073). With these groups, the sensitivity and specificity of both the reference and index test were 1.0 (95% confidence interval 0.69-1.0). vHIT measures detected both overt and covert saccades as accurately as coils. The video head impulse test is equivalent to search coils in identifying peripheral vestibular deficits but easier to use in clinics, even in patients with acute vestibular neuritis.
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              Falls in young, middle-aged and older community dwelling adults: perceived cause, environmental factors and injury

              Background Falls in older people have been characterized extensively in the literature, however little has been reported regarding falls in middle-aged and younger adults. The objective of this paper is to describe the perceived cause, environmental influences and resultant injuries of falls in 1497 young (20–45 years), middle-aged (46–65 years) and older (> 65 years) men and women from the Baltimore Longitudinal Study on Aging. Methods A descriptive study where participants completed a fall history questionnaire describing the circumstances surrounding falls in the previous two years. Results The reporting of falls increased with age from 18% in young, to 21% in middle-aged and 35% in older adults, with higher rates in women than men. Ambulation was cited as the cause of the fall most frequently in all gender and age groups. Our population reported a higher percentage of injuries (70.5%) than previous studies. The young group reported injuries most frequently to wrist/hand, knees and ankles; the middle-aged to their knees and the older group to their head and knees. Women reported a higher percentage of injuries in all age groups. Conclusion This is the first study to compare falls in young, middle and older aged men and women. Significant differences were found between the three age groups with respect to number of falls, activities engaged in prior to falling, perceived causes of the fall and where they fell.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Writing – original draft
                Role: Data curationRole: Formal analysisRole: InvestigationRole: Writing – original draft
                Role: MethodologyRole: ResourcesRole: SoftwareRole: Validation
                Role: MethodologyRole: ResourcesRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                18 December 2017
                2017
                : 12
                : 12
                : e0189037
                Affiliations
                [1 ] Physiotherapy and Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, University of Zurich, Zurich, Switzerland
                [2 ] Interdisciplinary Spinal Research ISR, Department of Chiropractic Medicine, Balgrist University Hospital, Zurich, Switzerland
                [3 ] Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
                [4 ] Wearable Computing Lab Zurich, ETH Zurich, Zurich, Switzerland
                [5 ] Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
                Tokai University, JAPAN
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-6542-7385
                Article
                PONE-D-17-19124
                10.1371/journal.pone.0189037
                5734743
                29253883
                5d378f64-2f52-471c-b7bd-36a4b0a8dac4
                © 2017 Swanenburg et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 18 May 2017
                : 19 November 2017
                Page count
                Figures: 9, Tables: 3, Pages: 18
                Funding
                This study was financially supported by the university Zurich medical faculty. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Biology and Life Sciences
                Physiology
                Biological Locomotion
                Walking
                Medicine and Health Sciences
                Physiology
                Biological Locomotion
                Walking
                Biology and Life Sciences
                Physiology
                Biological Locomotion
                Gait Analysis
                Medicine and Health Sciences
                Physiology
                Biological Locomotion
                Gait Analysis
                Medicine and Health Sciences
                Public and Occupational Health
                Traumatic Injury Risk Factors
                Falls
                Biology and Life Sciences
                Behavior
                Biology and Life Sciences
                Physiology
                Sensory Physiology
                Visual System
                Eye Movements
                Medicine and Health Sciences
                Physiology
                Sensory Physiology
                Visual System
                Eye Movements
                Biology and Life Sciences
                Neuroscience
                Sensory Systems
                Visual System
                Eye Movements
                Medicine and Health Sciences
                Public and Occupational Health
                Behavioral and Social Aspects of Health
                People and Places
                Population Groupings
                Age Groups
                Elderly
                Biology and Life Sciences
                Physiology
                Biological Locomotion
                Medicine and Health Sciences
                Physiology
                Biological Locomotion
                Custom metadata
                All relevant data are within the paper and its Supporting Information files.

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