Allum John H J, Adkin Allan L
Department of ORL, University Hospital of Basel, Basel, Switzerland.
Audiol Neurootol. 2003 Sep-Oct;8(5):286-302. doi: 10.1159/000071999.
Our aim was to track improvements in postural control during recovery from an acute unilateral peripheral vestibular deficit (UVL), presumably due to vestibular neuritis, and to determine if recovery rates were different for stance and gait tasks. Postural control was quantified using simple measurements of trunk sway: amplitudes of trunk sway angle and angular velocity, in the roll and pitch directions as well as task duration, were examined for a battery of stance and gait tasks. These measures were collected at the onset of the deficit and then 3 weeks and 3 months later.
A repeated-measures design was used for UVL subjects and age-matched healthy controls. Stance tasks involved standing on 1 or 2 legs with eyes open or closed. Gait tasks consisted of tandem gait, walking normally with eyes closed, or with the head rotating or head pitching, walking up and down stairs and walking over a series of low barriers. Stance and tandem gait tasks were repeated using a foam support surface instead of a normal floor.
Twenty-eight patients with acute UVL were examined.
The range of trunk sway angular displacement and angular velocity in the pitch and roll directions was measured for each task in addition to task duration. The measures were compared with those of normal subjects.
The amplitudes of pitch trunk sway for 2-legged stance tasks with eyes closed underwent the greatest reduction 3 weeks after UVL onset. At 3 months, trunk sway was almost normal for all 2-legged stance tasks. One-legged stance tasks with eyes open showed a similar but slower improvement. Stance time without a fall showed a very rapid improvement for 1-legged tasks but was still shorter than that of normal subjects at 3 months. Trunk sway for the simple gait tasks was within normal range at 3 months; however, task duration was still longer than normal. More complex gait tasks, such as walking 8 tandem steps on foam or walking up and down stairs, showed no improvement in trunk roll sway at 3 months. A mix of variables from mainly gait tasks best identified a balance deficit due to UVL, with complex gait tasks becoming more important for identification purposes as compensation progressed. The accuracy of UVL identification with durations alone was 75% of the accuracy with combined trunk sway and duration measures.
These data suggest that recovery of normal trunk control during the compensation process for unilateral vestibular hypofunction is more rapid for stance tasks than gait tasks. Even at 3 months, trunk sway for complex gait tasks was not normal. Thus, trunk sway for gait tasks provides a better insight into remaining deficits in balance control of vestibular-loss patients than the sway of stance tasks.
我们的目的是追踪急性单侧外周前庭功能缺损（UVL）（推测由前庭神经炎引起）恢复过程中姿势控制的改善情况，并确定姿势和步态任务的恢复率是否存在差异。使用简单的躯干摆动测量来量化姿势控制：检查了一系列姿势和步态任务中躯干摆动角度和角速度在横滚和俯仰方向上的幅度以及任务持续时间。这些测量值在缺损发作时以及之后3周和3个月时收集。
对UVL受试者和年龄匹配的健康对照采用重复测量设计。姿势任务包括单腿或双腿站立，睁眼或闭眼。步态任务包括串联步态、闭眼正常行走、头部旋转或俯仰时行走、上下楼梯以及跨过一系列低障碍物行走。使用泡沫支撑表面而非正常地面重复进行姿势和串联步态任务。
检查了28例急性UVL患者。
除任务持续时间外，还测量了每个任务中躯干在俯仰和横滚方向上的摆动角位移和角速度范围。将这些测量值与正常受试者的进行比较。
UVL发作3周后，闭眼双腿站立任务中俯仰方向的躯干摆动幅度减小最为明显。3个月时，所有双腿站立任务的躯干摆动几乎恢复正常。睁眼单腿站立任务显示出类似但较慢的改善。单腿任务中无跌倒的站立时间在1个月时改善非常迅速，但3个月时仍短于正常受试者。简单步态任务的躯干摆动在3个月时处于正常范围内；然而，任务持续时间仍长于正常。更复杂的步态任务，如在泡沫上串联行走8步或上下楼梯，3个月时躯干横滚摆动无改善。主要来自步态任务的多种变量组合最能识别出由于UVL导致的平衡缺陷，随着代偿进展，复杂步态任务对于识别目的变得更为重要。仅使用持续时间进行UVL识别的准确性是结合躯干摆动和持续时间测量准确性的75%。
这些数据表明，在单侧前庭功能减退的代偿过程中，姿势任务的正常躯干控制恢复比步态任务更快。即使在3个月时，复杂步态任务的躯干摆动也未恢复正常。因此，与姿势任务的摆动相比，步态任务的躯干摆动能更好地洞察前庭功能丧失患者平衡控制中剩余的缺陷。
