Comparison of Incremental Vestibulo-ocular Reflex Adaptation Training Versus x1 Training in Patients With Chronic Peripheral Vestibular Hypofunction: A Two-Year Randomized Controlled Trial. Issue 4 (October 2021)

• Record Type: Journal Article
• Authors: Rinaudo, Carlo N.; Schubert, Michael C.; Cremer, Phillip D.; Figtree, William V. C.; Todd, Christopher J.; Migliaccio, Americo A.
• Is Part Of: Journal of neurologic physical therapy. Volume 45:Issue 4(2021)
• Publication Date: 2021-10
• Subjects: gaze stability -- vestibular hypofunction -- vestibular rehabilitation -- vestibulo-ocular reflex; Nervous system -- Diseases -- Physical therapy -- Periodicals; Nervous system -- Diseases -- Treatment -- Periodicals; 616.80462
• DOI: 10.1097/NPT.0000000000000369
• Languages: English
• ISSNs: 1557-0576

Abstract

Abstract : Background and Purpose: A crossover, double-blinded randomized controlled trial to investigate once-daily incremental vestibulo-ocular reflex (VOR) adaptation (IVA) training over 2 years in people with stable and chronic peripheral vestibular hypofunction. Methods: Twenty-one patients with peripheral vestibular hypofunction were randomly assigned to intervention-then-control (n = 12) or control-then-intervention (n = 9) groups. The task consisted of either x1 (control) or IVA training, once daily every day for 15 minutes over 6-months, followed by a 6-month washout, then repeated for arm 2 of the crossover. Primary outcome : vestibulo-ocular reflex gain. Secondary outcomes : compensatory saccades, dynamic visual acuity, static balance, gait, and subjective symptoms. Multiple imputation was used for missing data. Between-group differences were analyzed using a linear mixed model with repeated measures. Results: On average patients trained once daily 4 days per week. IVA training resulted in significantly larger VOR gain increase (active: 20.6% ± 12.08%, P = 0.006; passive: 30.6% ± 25.45%, P = 0.016) compared with x1 training (active: −2.4% ± 12.88%, P = 0.99; passive: −0.6% ± 15.31%, P = 0.68) ( P < 0.001). The increased IVA gain did not significantly reduce with approximately 27% persisting over the washout period. x1 training resulted in greater reduction of compensatory saccade latency ( P = 0.04) and increase in amplitude ( P = 0.02) compared with IVA training. There was no difference between groups in gait and balance measures; however, only the IVA group had improved total Dizziness Handicap Inventory ( P = 0.006). Discussion and Conclusions: Our results suggest IVA improves VOR gain and reduces perception of disability more than conventional x1 training. We suggest at least 4 weeks of once-daily 4 days-per-week IVA training should be part of a comprehensive vestibular rehabilitation program. Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A356 ). Abstract : Supplemental Digital Content is Available in the Text.