Trunk Instability in the Pitch, Yaw, and Roll Planes during Clinical Balance Tests: Axis Differences and Correlations to vHIT Asymmetries Following Acute Unilateral Vestibular Loss.

backgroundClinical dynamic posturography concentrates on the pitch and roll but not on the yaw plane instability measures. This emphasis may not represent the axis instability observed in clinical stance and gait tasks for patients with balance deficits in comparison to healthy control (HC) subjects, nor the expected instability based on correlations with vestibulo-ocular reflex (VOR) deficits. To examine the axis stability changes with vestibular loss, we measured trunk sway in all three directions (pitch, roll, and yaw) during the stance and gait tasks of patients with acute unilateral vestibular neuritis (aUVN) and compared the results with those of HC. Concurrent changes in VORs were also examined and correlated with trunk balance deficits.

methodsThe results of 11 patients (mean age of 61 years) recorded within 6 days of aUVN onset were compared within those of 8 age-matched healthy controls (HCs). All subjects performed a two-legged stance task-standing with eyes closed on foam (s2ecf), a semi-gait task-walking eight tandem steps (tan8), and four gait tasks-walking 3 m with head rotating laterally, pitching, or eyes closed (w3hr, w3hp, w3ec), and walking over four barriers 24 cm high, spaced 1 m apart (barr). The tasks' peak-to-peak yaw, pitch and roll angles, and angular velocities were measured with a gyroscope system (SwayStar

resultsYaw and pitch BCIs were significantly (

conclusionsThese results indicate that greater yaw than pitch and roll trunk motion during clinical balance tasks is common for aUVN patients and HCs. However, aUVN leads to a larger increase in pitch than yaw plane instability and a smaller increase in roll plane instability. This difference with respect to roll corresponds to the known greater yaw plane than roll plane asymmetry (40 vs. 22%) following aUVN observed in VOR responses. However, the lower pitch plane asymmetry (3.5%) in VOR responses does not correspond with the enhanced movements in the pitch plane, observed in balance control tasks. Whether asymmetries in vestibular-evoked myogenic potentials (Vemps) are better correlated with the deficits in pitch plane balance control remains to be investigated. The current results provide a strong rationale for the clinical testing of directional specific balance responses, especially yaw and pitch, and the linking of balance results for yaw and roll to VOR asymmetries.