Turning Toward Monitoring of Gaze Stability Exercises: The Utility of Wearable Sensors (2020)

Loyd B, et al. (2020). Turning Toward Monitoring of Gaze Stability Exercises: The Utility of Wearable Sensors. Journal of Neurologic Physical Therapy, 44(4), 261-267.

The aim of the study was to determine the effectiveness of wearable sensors for individuals with vestibular dysfunction. This collected data was meant to help determine effectiveness of vestibular exercise programs as well as provide information on appropriate timing of progressions. Specifically this article followed individuals with Multiple Sclerosis and complaints of dizziness.

Design/Methods/Participants: 
Researchers in Utah selected 28 subjects to participate in the study. Subjects had a diagnosis of Multiple Sclerosis and had complaints of dizziness or falls. All subjects were between the age of 18 and 75. Individuals with other neurologic complications were excluded from the study.

The 28 subjects were divided into two groups. The first group participated in guided gaze and postural stability exercises (GPS). The other group was a control group that participated in a generic strength and aerobic exercise control group (SAE). The two groups performed their appropriate protocol with a trained research assistant three times/week for 6 weeks. 

The GPS group’s gaze stability exercise included angular vestibular ocular reflex (aVOR) exercises in both the yaw and pitch planes. Subjects were tasked with maintaining gaze stability on a target while turning their head. Head turns were performed in a 30 degree arc: 15 degrees from neutral in both directions. Head turns were performed initially at a rate of 60 beats per minute and progressed to a goal of 120 beats per minute. Training was further progressed to include more challenging bases of support.

Initially, at 3 weeks, and at 6 weeks subjects wore a head-worn inertial measurement unit (IMU) for 15 min. The IMU collected data regarding the velocity, amplitude and frequency of head turns. Measures were taken for both yaw and pitch. The sensors were worn during the GPS gaze stabilization exercises and during the SAE group’s lower extremity exercise.

Results
Results showed a significant increase in the velocity and the amplitude of head turns in the GPS group compared to the SAE group. This difference was present in both the yaw and pitch. The frequency of head turns was not significantly different between groups.

Clinical Takeaways

  • Classic VOR exercises provided for 15 minutes 3 times per week for 6 weeks is an effective dose for improving head turn velocity and amplitude for an individual with balance deficits and Multiple Sclerosis.
  • The use of wearable sensors to capture progress of vestibular treatment is effective and may benefit clinicians in directing plans of care and progressions of vestibular exercise.
  • General exercise for individuals with dizziness or balance impairments and Multiple sclerosis is not as effective as specific vestibular exercises. As shown in a recent CPG 15 minutes of vestibular training several days per week is an effective dose.

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