Impact on daily mobility and risk of falling in bilateral vestibulopathy

• Published in: Journal of neurology 2022-11, Vol.269 (11), p.5746-5754
• Main Authors: Wuehr, M., Decker, J., Schenkel, F., Jahn, K., Schniepp, R.
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Balance; Bilateral Vestibulopathy - complications; Bilateral Vestibulopathy - diagnosis; Humans; Medicine; Medicine & Public Health; Mobility; Neurology; Neuroradiology; Neurosciences; Original Communication; Patients; Postural Balance; Prospective Studies; Risk Assessment; Sensors; Vestibular system
• ISSN: 0340-5354; 1432-1459; 1432-1459
• DOI: 10.1007/s00415-022-11043-9

Objective To study the behavioral relevance of postural and ocular-motor deficits on daily activity and risk of falling in patients with bilateral vestibular hypofunction (BVH). Methods Thirty patients with BVH and 30 age- and gender-matched healthy controls participated in a continuous 2-week assessment of daily activities and mobility using a body-worn inertial sensor and a 6-month prospective fall risk assessment. At inclusion, patients and controls further underwent a multi-modal clinical, score- and instrument-based assessment of general health and balance status. We analyzed the relationship between clinical, lab-, and sensor-based measures and their validity to identify those patients at a risk of general, frequent, and severe falling. Results Patients exhibited impairments in daily activity in particular in terms of reduced ambulatory activity ( p  = 0.009). 43% of patients experienced falls (13% in controls, p  = 0.008) and 70% of these patients reported recurrent falling (0% in controls, p  = 0.001) during prospective assessment. Severe fall-related injuries that would require medical attention neither occurred in patients nor in controls. Classificatory models based on multi-modal clinical, lab-, and sensor-based measures of balance and mobility identified patients who fell with an accuracy of 93% and patients who recurrently fell with an accuracy of 89%. Conclusion BVH is linked to particular impairments of patients’ daily activities which in turn are related to patients’ fall risk. Hence, off-laboratory measures of daily mobility may supplement standard clinical assessment in BVH to more adequately capture the burden of disease and to reliably identify those patients at a specific risk of falling.