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Published on: May 15, 2016
Video Head Impulse Test in Survivors From Severe Traumatic Brain Injury: New Perspectives for Implementation of
Nicola Ferri1,2,3,4,5,6, Susan L Whitney1,2,3,4,5,6, Luca Verrecchia1,2,3,4,5,6
1Author Affiliations: Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy (Mr Ferri, Mr Pillastrini, Dr Turolla and Dr Tramontano); Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA (Dr Whitney); ENT Unit, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden (Dr Verrecchia); Santa Lucia Foundation IRCCS, Scientific Institute for Research and Health Care, Rome, Italy (Mrs Casagrande Conti, Mr Lelli, Dr Buzzi and Dr Formisano); Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (Mr Pillastrini, Dr Turolla and Dr Tramontano); MSA ENT Academy Center, Cassino, Italy (Dr Manzari).
Objective:
This study aims to evaluate vestibular function by instrumental assessment of the angular vestibulo-ocular reflex (aVOR) in survivors from severe traumatic brain injury (sTBI) and analyze related clinical characteristics and functional balance scales.
Setting:
This study was conducted on inpatients accepted at Santa Lucia Foundation-Neurorehabilitation Hospital for Research and Healthcare (Rome, Italy), from January to September 2023.
Participants:
Twenty-one survivors from sTBI with a median age of 48 years (IQR = 27) were included in this study, recruited through the neurorehabilitation services. Participants were included if they had a Glasgow Coma Scale Score ≤ 8 at the time of injury, Level of Cognitive Functioning ≥ 7, static and dynamic balance impairments, ability to understand verbal commands, and Functional Ambulation Classification > 3.
Design:
Cross-sectional study.
Main Measures:
Two expert physiotherapists performed an aVOR assessment using the video Head ImpulseTest by both head impulse and suppression paradigms. Furthermore, all participants completed a balance assessment using the Berg Balance Scale and the Mini-Balance Evaluation Systems Test (Mini-BESTest) scale. Descriptive statistical analyses were performed, and the relationship between aVOR function and balance outcomes was investigated.
Results:
Nineteen participants (90%) displayed aVOR with an abnormal gain at least in 1 canal. Thirty percent of all canals analyzed had abnormal gains, with a clear prevalence of the right posterior canal (71%), which presents aVOR gain lower than the functional threshold on average (mean 0.70; CI, 0.62-0.78). No correlations were found between the aVOR gain and the clinical outcome measure scores.
Conclusion:
Low aVOR gains were evident in people who experienced sTBI. A comprehensive evaluation of the vestibular peripheral system may detect vestibular impairments in these patients that may otherwise be unrecognized.
