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Three Dimensional Vestibular Ocular Reflex Testing Using a Six Degrees of Freedom Motion Platform
Published on: May 23, 2013
Cervico-ocular reflex in normal subjects and patients with unilateral vestibular hypofunction
Michael C Schubert1, Vallabh Das, Ronald J Tusa
1Laboratory of Vestibular Neurophysiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Objective:
To determine whether the cervico-ocular reflex contributes to gaze stability in patients with unilateral vestibular hypofunction.
Study Design:
Prospective study.
Setting:
Tertiary referral center.
Patients:
Patients with unilateral vestibular hypofunction (n = 3) before and after vestibular rehabilitation and healthy subjects (n = 7).
Interventions:
Vestibular rehabilitation.
Main Outcome Measures:
We measured the cervico-ocular reflex in patients with unilateral vestibular hypofunction before and after vestibular rehabilitation and in healthy subjects. To measure the cervico-ocular reflex, we recorded eye movements with a scleral search coil while the trunk moved at 0.3, 1.0, and 1.5 Hz beneath a stabilized head. To determine whether the head was truly stabilized, we measured head movement using a search coil.
Results:
We found no evidence of cervico-ocular reflex in any of the seven healthy subjects or in two of the patients with unilateral vestibular hypofunction. In one patient with chronic unilateral vestibular hypofunction, the cervico-ocular reflex was present before vestibular rehabilitation only for leftward trunk rotation (relative head rotation toward the intact side). After 5 weeks of placebo exercises, there was no change in the cervico-ocular reflex. After an additional 5 weeks that included vestibular exercises, cervico-ocular reflex gain for leftward trunk rotation had increased threefold. In addition, there was now evidence of a cervico-ocular reflex for rightward trunk rotation, potentially compensating for the vestibular deficit.
Conclusion:
The cervico-ocular reflex appears to be a highly inconsistent mechanism. The change of the cervico-ocular reflex in one patient after vestibular exercises suggests that the cervico-ocular reflex may be adaptable in some patients.
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