A quantitative analysis of postural control in elderly patients with vestibular disorders using visual stimulation by virtual reality

Gazzola, Juliana Maria; Caovilla, Heloísa Helena; Doná, Flávia; Ganança, Maurício Malavasi; Ganança, Fernando Freitas

doi:10.1016/j.bjorl.2019.03.001

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Brazilian Journal of Otorhinolaryngology

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Original articles • Braz. j. otorhinolaryngol. 86 (5) • Sep-Oct 2020 • https://doi.org/10.1016/j.bjorl.2019.03.001 copy

A quantitative analysis of postural control in elderly patients with vestibular disorders using visual stimulation by virtual reality^☆ ☆ Please cite this article as: Gazzola JM, Caovilla HH, Doná F, Ganança MM, Ganança FF. A quantitative analysis of postural control in elderly patients with vestibular disorders using visual stimulation by virtual reality. Braz J Otorhinolaryngol. 2019. https://doi.org/10.1016/j.bjorl.2019.03.001

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction:

Postural instability is one the most common disabling features in vestibular disorders.

Objective:

This study aimed to analyze the limit of stability and the influence of manipulation of visual, somatosensorial and visual-vestibular information on postural control in older adults with vestibular disorder, with and without a history of falls.

Methods:

Cross-sectional study. Participants - 76 elderly patients with vestibular disorder (G1, without falls; G2, with falls) and 41 healthy elderly subjects (control group; CG). Using posturography, analyzed were limit of stability area, body center of pressure, and velocity of oscillation in the standing position in 10 conditions, including open/closed eyes, unstable surface with eyes closed, saccadic and optokinetic stimuli, and visual-vestibular interaction.

Results:

Limit of stability area in CG was better compared with G1-2, and center of pressure values were worse in G1 than in CG. Center of pressure area in all conditions and velocity of oscillation in the following conditions: open/closed eyes, optokinetic stimulation, and visual-vestibular interaction showed worse values in G2 than in CG. Center of pressure area in the following conditions: open/closed eyes, saccadic and optokinetic stimuli, visual-vestibular interaction, and unstable surface with eyes closed showed worse values in G2 than in G1.

Conclusion:

Older adults with vestibular disorder presented reduced limit of stability and increased postural sway in the following conditions: conflict between visual and somatosensory information and visual-vestibular interaction. Deterioration in postural control was significantly associated with history of falls.

KEYWORDS
Aging; Accidental falls; Postural balance; Vestibular diseases

	Groups	Average (SD)	Minimum and maximum values	Comparative analysis (CG-G1-G2)
Age				CG-G1-G2 (p = 0.11)^a a ANOVA.
Average (SD)/Variation	CG (n = 41)	72.51 (6.84)	65-85
	G1 (n = 40)	71.90 (5.23)	65-85
	G2 (n = 36)	73.92 (6.27)	65-85
Height (meters)				CG-G1-G2 (p = 0.16)^a a ANOVA.
Average (SD)/Variation	CG (n = 41)	1.61 (0.07)	1.47-1.78
	G1 (n = 40)	1.58 (0.08)	1.40-1.75
	G2 (n = 36)	1.57 (0.08)	1.45-1.78
Number of diseases				CG-G1-G2 (p < 0.001)^a a ANOVA.
Average (SD)/Variation	CG (n = 41)	1.88 (1.26)	0-6	G1-CG (p < 0.001)^b b Bonferroni test.
	G1 (n = 40)	3.25 (1.48)	0-6	G2-CG (p < 0.001)^b b Bonferroni test.
	G2 (n = 36)	3.38 (1.61)	1-8	G1-G2 (p = 1.000)^b b Bonferroni test.
Number of medications				CG-G1-G2 (p < 0.001)^a a ANOVA.
Average (SD)/Variation	CG (n = 41)	1.63 (1.29)	0-5	G1-CG (p < 0.001)^b b Bonferroni test.
	G1 (n = 40)	3.88 (2.11)	0-10	G2-CG (p < 0.001)^b b Bonferroni test.
	G2 (n = 36)	4.17 (2.31)	0-9	G1-G2 (p = 1.000)^b b Bonferroni test.
Functional capacity BOMFAQ				CG-G1-G2 (p < 0.001)^a a ANOVA.
Average (SD)/Variation	CG (n = 41)	1.00 (1.05)	0-3	G1-CG (p < 0.001)^b b Bonferroni test.
	G1 (n = 40)	4.53 (2.61)	0-13	G2-CG (p < 0.001)^b b Bonferroni test.
	G2 (n = 36)	5.42 (3.69)	0-3	G1-G2 (p = 0.43)^b b Bonferroni test.
Gender, n (%)		Female	Male	CG-G1-G2 (p = 0.28)^c c Chi-square.
	CG (n = 41)	24 (30.4%)	17 (44.7%)
	G1 (n = 40)	28 (35.4%)	12 (31.6%)
	G2 (n = 36)	27 (34.2%)	9 (23.7%)
Physical activity, n (%)		Yes	No	CG -G1-G2 (p = 0.002)^c c Chi-square.
	CG (n = 41)	24 (51.1%)	17 (24.3%)	G1-CG (p = 0.10)^c c Chi-square.
	G1 (n = 40)	16 (34.0%)	24 (34.3%)	G2-CG (p < 0.001)^c c Chi-square.
	G2 (n = 36)	7 (14.9%)	29 (41.4%)	G1-G2 (p = 0.05)^c c Chi-square.

	Groups	Average (SD)	Minimum and maximum values	ANOVA/Bonferroni test (CG-G1-G2)
Stability limit area (cm²)				p = 0.013^a a ANOVA.
	CG (n = 41)	154.71 (55.10)	137.31-172.10	G1-CG (p = 0.038)^b b Bonferroni test.
	G1 (n = 40)	125.78 (51.05)	109.45-142.10	G2-CG (p = 0.024)^b b Bonferroni test.
	G2 (n = 36)	126.53 (49.44)	108.71-144.36	G1-G2 (p = 0.97)^b b Bonferroni test.
COP area (cm²) of conditions
FS/Open eyes/Without stimulus				p < 0.001^a a ANOVA.
	CG (n = 41)	1.86 (1.05)	1.53-2.19	G1-CG (p = 0.15)^b b Bonferroni test.
	G1 (n = 40)	2.48 (1.35)	2.05-2.90	G2-CG (p < 0.001)^b b Bonferroni test.
	G2 (n = 36)	5.16 (4.90)	3.35-6.29	G1-G2 (p = 0.002)^b b Bonferroni test.
FS/Closed eyes				p < 0.001^a a ANOVA.
	CG (n = 41)	1.77 (0.98)	1.45-2.08	G1-CG (p = 0.015)^b b Bonferroni test.
	G1 (n = 40)	3.03 (2.23)	2.31-3.75	G2-CG (p < 0.001)^b b Bonferroni test.
	G2 (n = 35)	6.69 (7.83)	3.85-9.73	G1-G2 (p = 0.003)^b b Bonferroni test.
Foam/Closed eyes				p < 0.001^a a ANOVA.
	CG (n = 41)	10.59 (7.94)	8.08-13.09	G1-CG (p = 0.20)^b b Bonferroni test.
	G1 (n = 40)	12.61 (7.03)	10.36-14.86	G2-CG (p < 0.001)^b b Bonferroni test.
	G2 (n = 32)	20.94 (13.73)	15.99-25.89	G1-G2 (p = 0.014)^b b Bonferroni test.
FS/Saccadic				p = 0.003^a a ANOVA.
	CG (n = 41)	2.16 (0.99)	1.84-2.46	G1-CG (p = 1.000)^b b Bonferroni test.
	G1 (n = 40)	2.42 (1.32)	1.99-2.84	G2-CG (p = 0.002)^b b Bonferroni test.
	G2 (n = 36)	3.90 (3.06)	2.68-4.83	G1-G2 (p = 0.040)^b b Bonferroni test.
FS/Bars/Right optokinetic				p = 0.010^a a ANOVA.
	CG (n = 41)	2.09 (1.03)	1.76-2.41	G1-CG (p = 0.35)^b b Bonferroni test.
	G1 (n = 40)	2.71 (1.82)	2.13-3.29	G2-CG (p = 0.007)^b b Bonferroni test.
	G2 (n = 36)	3.86 (3.04)	2.80-5.03	G1-G2 (p = 0.38)^b b Bonferroni test.
FS/Bars/Left optokinetic				p = 0.002^a a ANOVA.
	CG (n = 41)	2.27 (1.29)	1.86-2.67	G1-CG (p = 1.000)^b b Bonferroni test.
	G1 (n = 40)	2.60 (2.64)	1.75-3.44	G2-CG (p = 0.003)^b b Bonferroni test.
	G2 (n = 36)	4.07 (3.12)	2.78-4.88	G1-G2 (p = 0.019)^b b Bonferroni test.
FS/Bars/Downward optokinetic				p < 0.001^a a ANOVA.
	CG (n = 41)	2.06 (1.13)	1.69-2.41	G1-CG (p = 0.22)^b b Bonferroni test.
	G1 (n = 40)	2.93 (2.29)	2.12-3.66	G2-CG (p < 0.001)^b b Bonferroni test.
	G2 (n = 36)	4.01 (2.47)	2.99-4.72	G1-G2 (p = 0.06)^b b Bonferroni test.
FS/Bars/Upward optokinetic				p = 0.001^a a ANOVA.
	CG (n = 41)	2.30 (1.21)	1.91-2.68	G1-CG (p = 1.000)^b b Bonferroni test.
	G1 (n = 40)	2.86 (2.48)	2.06-3.65	G2-CG (p = 0.001)^b b Bonferroni test.
	G2 (n = 36)	4.98 (4.54)	3.39-6.33	G1-G2 (p = 0.017)^b b Bonferroni test.
SF/Bars/VVI/Horizontal				p < 0.001^a a ANOVA.
	CG (n = 41)	3.17 (1.83)	2.59-3.74	G1- CG (p = 0.018)^b b Bonferroni test.
	G1 (n = 40)	4.65 (3.10)	3.66-5.64	G2-CG (p < 0.001)^b b Bonferroni test.
	G2 (n = 36)	7.24 (5.09)	5.52-8.96	G1-G2 (p = 0.018)^b b Bonferroni test.
SF/Bars/VVI Vertical				p = 0.029^a a ANOVA.
	CG (n = 41)	3.62 (1.83)	3.04-4.19	G1-CG (p = 0.68)^b b Bonferroni test.
	G1 (n = 40)	4.63 (3.89)	3.38-5.87	G2-CG (p = 0.024)^b b Bonferroni test.
	G2 (n = 36)	5.60 (4.11)	4.20-6.98	G1-G2 (p = 0.41)^b b Bonferroni test.

Velocity of oscillation (cm/s) of conditions	Groups	Average (SD)	Minimum and maximum values	ANOVA/Bonferroni test (CG-G1-G2)
FS/Open eyes/Without stimulus				p = 0.002^a a ANOVA.
	CG (n = 41)	0.89 (0.26)	0.80-0.96	G1-CG (p = 1.000)^b b Bonferroni test.
	G1 (n = 40)	0.92 (0.25)	0.83-0.99	G2-CG (p < 0.001)^b b Bonferroni test.
	G2 (n = 36)	1.17 (0.46)	0.99-1.28	G1-G2 (p = 0.03)^b b Bonferroni test.
FS/Closed eyes				p = 0.001^a a ANOVA.
	CG (n = 41)	1.11 (0.41)	0.98-1.23	G1-CG (p = 0.59)^b b Bonferroni test.
	G1 (n = 40)	1.23 (0.43)	1.09-1.36	G2-CG (p < 0.001)^b b Bonferroni test.
	G2 (n = 35)	1.59 (0.67)	1.34-1.84	G1-G2 (p = 0.03)^b b Bonferroni test.
Foam/Closed eyes	CG (n = 41)	2.87 (1.36)	2.44-3.30	p = 0.05^a a ANOVA.
	G1 (n = 40)	3.06 (1.11)	2.71-3.41
	G2 (n = 32)	3.45 (1.15)	3.04-3.86
FS/Saccadic	CG (n = 41)	1.25 (0.63)	1.05-1.45	p = 0.14^a a ANOVA.
	G1 (n = 40)	1.35 (0.48)	1.20-1.50
	G2 (n = 36)	1.46 (0.59)	1.23-1.68
FS/Bars/Right optokinetic	CG (n = 41)	1.25 (0.55)	1.07-1.42	p = 0.42^a a ANOVA.
	G1 (n = 40)	1.23 (0.39)	1.10-1.35
	G2 (n = 36)	1.36 (0.49)	1.19-1.55
FS/Bars/Left optokinetic	CG (n = 41)	1.19 (0.52)	1.02-1.35	p = 0.24^a a ANOVA.
	G1 (n = 40)	1.17 (0.42)	1.03-1.30
	G2 (n = 36)	1.33 (0.47)	1.14-1.48
FS/Bars/Downward optokinetic				p = 0.030^a a ANOVA.
	CG (n = 41)	1.14 (0.47)	0.98-1.28	G1-CG (p = 1.000)^b b Bonferroni test.
	G1 (n = 40)	1.21 (0.47)	1.06-1.36	G2-CG (p = 0.03)^b b Bonferroni test.
	G2 (n = 36)	1.41 (0.54)	1.21-1.60	G1-G2 (p = 0.24)^b b Bonferroni test.
FS/Bars/Upward optokinetic				p = 0.014^a a ANOVA.
	CG (n = 41)	1.14 (0.46)	0.99-1.28	G1-CG (p = 1.000)^b b Bonferroni test.
	G1 (n = 40)	1.18 (0.40)	1.05-1.30	G2-CG (p = 0.015)^b b Bonferroni test.
	G2 (n = 36)	1.50 (0.72)	1.27-1.73	G1-G2 (p = 0.08)^b b Bonferroni test.
SF/Bars/VVI/Horizontal				p = 0.034^a a ANOVA.
	CG (n = 41)	1.47 (0.65)	1.26-1.67	G1-CG (p = 0.49)^b b Bonferroni test.
	G1 (n = 40)	1.64 (0.66)	1.42-1.85	G2-CG (p = 0.03)^b b Bonferroni test.
	G2 (n = 36)	1.86 (0.83)	1.61-2.22	G1-G2 (p = 0.63)^b b Bonferroni test.
SF/Bars/VVI/Vertical	CG (n = 41)	1.69 (0.69)	1.47-1.90	p = 0.62^a a ANOVA.
	G1 (n = 40)	1.67 (0.54)	1.49-1.83
	G2 (n = 36)	1.79 (0.60)	1.61-2.04

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[1] * Corresponding author. E-mail: fgananca@terra.com.br (F.F. Ganança).