Ferri Nicola [Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy]
Casagrande Conti Laura [Santa Lucia Foundation, Scientific Institute for Research and Health Care, Rome, Italy]
Turolla Andrea [Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy]
Orejel Bustos Amaranta Soledad [Santa Lucia Foundation, Scientific Institute for Research and Health Care, Rome, Italy]
Sorge Chiara [Santa Lucia Foundation, Scientific Institute for Research and Health Care, Rome, Italy]
Pillastrini Paolo [Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy]
Manzari Leonardo [MSA ENT Academy Center, Cassino, Italy]
Tramontano Marco [Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy]
Rehabilitation of persons with stroke (PwS) involves multidisciplinary care as defined in the most recent guidelines. Posture and balance disturbance are prevalent aspects that impact function and autonomy and are a primary focus of physiotherapy treatment in PwS. Indeed, the vestibular system plays a central role in balance disorders, and some studies assessed the peripheral semicircular canal’s function in CNS pathologies using the video Head Impulse Test (vHIT). The vHIT is a safe, valid and reliable tool, but current literature reported heterogeneous findings in the CNS population, leading to uncertainty in clinical implications. In this context, an objective assessment of peripheral vestibular function in a neurorehabilitation setting has never been published. The aim of the present study is to fill this gap by providing some preliminary data on semicircular canal function among PwS.
This is a cross-sectional study, conducted at the neurorehabilitation service of the Santa Lucia Foundation in Rome from January 2023 to September 2023. PwS were consecutively recruited based on the following inclusion criteria: first-time strokes with hemiparesis and Functional Ambulation Classification score > 3. PwS were excluded if they had severe cognitive impairment, unilateral spatial neglect, or aphasia. The peripheral vestibular function was the primary outcome, objectively assessed using the vHIT through both HIMP (Head Impulse Paradigm) and SHIMP (Suppression Head Impulse Paradigm) paradigms. Then, the participants were assessed for balance function using the Berg Balance Scale and Mini-BESTest. STATA 17 was used for statistical analyses; the Shapiro-Wilk test was performed to test data normality, and Spearman’s rank correlation tests were used to investigate correlations between outcomes. The STROBE checklist for conference abstracts was followed.
A total of 36 PwS were recruited (11 women; age range: 18-78 years); twenty-two were in the subacute stage (< 6 months from stroke), and 14 were in the chronic stage. Overall, 288 semicircular canals were assessed using the vHIT, of which 216 through HIMP, and 72 through the SHIMP paradigm. The mean VOR (vestibulo-ocular reflex) gain showed confidence intervals lower than the expected functional value of 1 in the overall analyses for almost every canal and paradigm. Applying the normative cut-offs for canal function, the left anterior and the right posterior were the canals with the highest prevalence of dysfunctional VOR gain in the analyzed sample, affecting 38.9% and 33.3% of the participants, respectively. No differences were found according to the disease stage (subacute vs chronic) or functional balance outcomes (Berg Balance Scale and Mini-BESTest).
This study is the first to objectively analyze the vestibular canal function in PwS in a neurorehabilitation setting. Isolated canal dysfunction was very prevalent in our sample, involving 75% of participants; this indicates that patients with central lesions may present peripheral vestibular dysfunction that does not necessarily involve the entire vestibular system and does not follow a clearly defined pattern. Furthermore, the VOR gain confidence intervals lower than the expected value imply a general peripheral vestibular hypofunction in our sample. Our findings suggest that routinely assessing vestibular function in PwS could give valuable information about a crucial sensory input for the balance system and thus provide new insights for neurosensory integration modalities.
Tramontano M, Ferri N, Turolla A, Orejel Bustos AS, Casagrande Conti L, Sorge C, Pillastrini P, Manzari L. Video head impulse test in subacute and chronic stroke survivors: new perspectives for implementation of assessment in rehabilitation. Eur Arch Otorhinolaryngol. 2024 May 17. doi: 10.1007/s00405-024-08721-x. Epub ahead of print. PMID: 38758244.
