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Original Investigation
July 1, 2021

Instrumented Gait Analysis to Identify Persistent Deficits in Gait Stability in Adults With Chronic Vestibular Loss

Author Affiliations
  • 1Department of Surgery, University of Wisconsin–Madison
  • 2Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
  • 3Department of Orthopedics and Rehabilitation, University of Wisconsin–Madison
JAMA Otolaryngol Head Neck Surg. Published online July 1, 2021. doi:10.1001/jamaoto.2021.1276
Key Points

Question  Is chronic peripheral vestibular hypofunction associated with enduring gait deficits?

Findings  In this cross-sectional study, 13 adults with chronic vestibular loss had mean stride lengths that were 0.17 m shorter and mean peak whole-body turning velocity that was 50.4°/s slower when compared with 17 healthy adults. Instrumented gait analysis detected deficits even when observational testing suggested low fall risk.

Meaning  The results of this study suggest that adults with chronic vestibular loss have clinically and functionally meaningful gait deficits.

Abstract

Importance  Regaining the ability to walk safely is a high priority for adults with vestibular loss. Thus, practitioners need comprehensive knowledge of vestibulopathic gait to design, provide, and/or interpret outcomes of interventions. To date, few studies have characterized the effects of vestibular loss on gait.

Objectives  To investigate the use of an instrumented 2-minute walk test in adults with vestibular loss, to further characterize vestibulopathic gait, and to assess whether those with chronic vestibular loss have enduring gait deficits.

Design, Setting, and Participants  This cross-sectional study, conducted between April 3, 2018, and June 27, 2019, recruited adults 20 to 79 years of age from an academic, tertiary, hospital-based, ambulatory care setting who were healthy or had confirmed unilateral or bilateral vestibular hypofunction. Of the 43 adults who were screened from convenience and referred samples, 2 declined, and 7 were excluded because of health conditions.

Exposures  The main exposure was the instrumented 2-minute walk test, which was conducted with participants using wearable inertial measurement units while they walked a 10-m path at their self-selected speed and turned 180° in their self-selected direction at either end.

Main Outcomes and Measures  The primary measures were spatiotemporal gait metrics (eg, stride length [SL] and peak whole-body turning velocity). Multivariate analysis of variance was used to assess between-group differences. Validity was assessed using the area under the curve from receiver operator characteristic analyses.

Results  Data from 17 healthy adults (mean [SD] age, 39.27 [11.20] years; 13 [76%] female) and 13 adults with vestibular loss (mean [SD] age, 60.50 [10.81] years; 6 [46%] female) were analyzed. Very large between-group differences were found for SL (left) (estimated marginal mean [SE] for healthy vs vestibular groups, 1.47 [0.04] m vs 1.31 [0.04] m; Cohen d, 1.35; 95% CI, 0.18-2.52), SL (right) (estimated marginal mean [SE] for healthy vs vestibular groups, 1.46 [0.04] m vs 1.29 [0.04] m; Cohen d, 1.44; 95% CI, 0.25-2.62), and peak turn velocity (estimated marginal mean [SE] for healthy vs vestibular groups, 240.17 [12.78]°/s vs 189.74 [14.70]°/s; Cohen d, 1.23; 95% CI, 0.07-2.40). The area under the curve was 0.79 (95% CI, 0.62-0.95) for SL (left), 0.81 (95% CI, 0.64-0.97) for SL (right), and 0.86 (95% CI, 0.72-0.99) for peak turn velocity.

Conclusions and Relevance  In this cross-sectional study, instrumented gait analysis had good discriminative validity and revealed persistent deficits in gait stability in those with chronic vestibular loss. The findings of this study suggest that these clinically and functionally meaningful deficits could be targets for vestibular rehabilitation.

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