Search Results (90)

Introduction: Downbeat nystagmus (DBN) is an ocular motor disorder characterized by persistent to-and-fro eye movements with a slow phase directed upwards and a corrective fast phase downwards. DBN in the context of myelin oligodendrocyte glycoprotein-associated disorder (MOGAD) represents a rare clinical presentation. Case Presentation: A 24-year-old male with MOGAD presented with DBN, status epilepticus, and longitudinally extensive transverse myelitis (LETM). Intervention: The clinical course, diagnostic findings, and management approach are described in detail within the full report. Outcomes: The patient at follow-up was able to ambulate independently, and his nystagmus had improved. He continued to demonstrate transient DBN on supine positioning and head-shaking test. Conclusions: This case report contributes to the understanding of DBN as a manifestation of MOGAD. The accompanying literature review examines the neuroanatomy, pathophysiology, and emerging therapeutic approaches for DBN, providing context for this unusual presentation. Full article

Background: Clinical assessment of balance and postural disorders is usually carried out through several common practices including tests such as the Subjective Visual Vertical (SVV) and Limit of Stability (LOS). Nowadays, several cutting-edge technologies have been proposed as supporting tools for stability evaluation. Extended Reality (XR) emerges as a powerful instrument. This proof-of-concept study aims to assess the feasibility and potential clinical utility of a novel MR-based framework integrating HoloLens 2, Wii Balance Board, and Azure Kinect for multimodal balance assessment. An innovative test is also introduced, the Innovative Dynamic Balance Assessment (IDBA), alongside an MR version of the SVV test and the evaluation of their performance in a cohort of healthy individuals. Results: All participants reported SVV deviations within the clinically accepted ±2° range. The IDBA results revealed consistent sway and angular profiles across participants, with statistically significant differences in posture control between opposing target directions. System outputs were consistent, with integrated parameters offering a comprehensive representation of postural strategies. Conclusions: The MR-based framework successfully delivers integrated, multimodal measurements of postural control in healthy individuals. These findings support its potential use in future clinical applications for balance disorder assessment and personalized rehabilitation. Full article

Background: Persistent Postural-Perceptual Dizziness (PPPD) is a chronic vestibular disorder characterized by dizziness, instability, and visual hypersensitivity. Vestibular Physical Therapy (VPT) is commonly used, but its efficacy remains uncertain due to limited and heterogeneous evidence. Objective: This systematic review and meta-analysis aimed to evaluate the effectiveness of VPT in reducing dizziness and improving balance in individuals with PPPD. Methods: A systematic search of MEDLINE and PEDro was conducted in January 2025. Studies were selected following PRISMA guidelines and included if they assessed VPT interventions in patients diagnosed with PPPD. Risk of bias was assessed using the PEDro scale and the modified Newcastle–Ottawa Scale. The meta-analysis focused on pre- and post-intervention changes in Dizziness Handicap Inventory (DHI) scores using a random-effects model. Results: Six studies met the inclusion criteria. VPT significantly reduced DHI scores (pooled Hedges’ g = 1.60; 95% CI: 0.75–2.45), indicating a moderate to large improvement. Additional outcomes included improvements in postural control (e.g., mini-BESTest and posturography) and psychological well-being (anxiety and depression questionnaires). However, high heterogeneity (I² = 92%) was present across studies. Conclusions: VPT may improve dizziness and balance in PPPD, though evidence is limited. Further high-quality trials with standardized protocols are needed. Full article

Vestibular migraine (VM) commonly causes recurrent vertigo, but diagnosing and managing it can be difficult due to symptom overlap with other vestibular and headache disorders. This review provides a comprehensive update on VM, beginning with the diagnostic criteria established by the International Headache Society and the Bárány Society, who have increased awareness of this condition. While the pathophysiology is not yet completely understood, there is evidence of a complex interaction between the nociceptive and vestibular systems. Treatment approaches are primarily empirical and lack robust, high-quality evidence. Often, antihistamines and benzodiazepines are used for quick symptom relief, while the efficacy of triptans is still uncertain. Preventive measures include lifestyle changes, vestibular rehabilitation, oral migraine prophylactics, Botulinum toxin type A, and, more recently, CGRP-targeted therapies. Due to diagnostic uncertainties and the absence of standardised treatment protocols, further research—particularly randomised controlled trials—is crucial for establishing evidence-based guidelines. Full article

Objectives: Assessing balance in highly trained individuals, such as military pilots, poses challenges, as deficits may be underestimated when compared to general population norms. To address this, several studies have proposed tailored databases providing reference values for specific populations. This study retrospectively analyzed balance characteristics in active-duty military pilots of the Italian Air Force. Methods: We enrolled 106 subjects split into two groups: 53 military pilots from the Italian Air Force and 53 civilians without flight experience or exposure to specific vestibular stimuli. All participants underwent ENT examinations with audiometric testing to exclude related pathologies, followed by a personal history collection. Subsequently, they completed the EquiTest protocol across six standard conditions. Results: Significant differences were observed between Army Aviators and Non-Aviators. The PREF variable showed the most consistent distinction, with military pilots demonstrating a superior performance (p < 0.01). Additionally, borderline differences were noted in Condition 6 of the equilibrium scores (p = 0.056), and in the Centre of Gravity (COG) analysis along the X-axis for Conditions 1 and 5 (p = 0.090), and for Condition 2 (p = 0.050). These findings suggest enhanced postural control strategies among Army Aviators under conditions of sensory conflict. Conclusions: These findings suggest that normative balance values specific to military pilots should be used when evaluating aviators recovering from balance deficits. Such tailored benchmarks can help determine the need for rehabilitation before returning to duty, ensuring optimal performance under demanding conditions. Further research is necessary to explore the underlying mechanisms responsible for these adaptations and to identify the specific stimuli that contribute to the enhanced balance capabilities observed in this highly trained population. Full article

Background: Vagus nerve stimulation (VNS) is a frequently used neuromodulation method in recent years. While the mechanism of improvement in diseases such as epilepsy, dementia, and depression is being studied, its potential effect on vestibular dysfunction is also being investigated. The aim of our study was to investigate the effect of transcutaneous auricular VNS (taVNS) on the vestibular symptoms of unilateral vestibular hypofunction (UVH). Methods: Forty patients diagnosed with UVH were randomly divided into two groups. Group 1 received vestibular rehabilitation. Group 2 received taVNS and vestibular rehabilitation. Both groups received treatment one day a week for eight weeks. Before and after the treatment, balance of the participants was assessed with modified-CTSIB (m-CTSIB), limit of stability (LOS), Tandem and One-Leg Stance (OLS) tests; visual acuity was assessed with dynamic visual acuity (DVA), dizziness severity, and fatigue severity with a visual analog scale (VAS); kinesiophobia was assessed with the Tampa Scale for Kinesiophobia (TSK); depression and anxiety was assessed with the Hospital Anxiety and Depression Scale (HADS); and quality of life was assessed with the Dizziness Handicap Inventory (DHI). Results: At the end of eight weeks, patients in Group 2 showed significantly greater improvement in balance, dizziness, fatigue, kinesiophobia, anxiety, and depression. There was no significant difference in visual acuity and quality of life between the groups. Conclusions: The positive effects of taVNS on vestibular symptoms have been observed. As a new approach, taVNS can be included in the treatment of patients with UVH in addition to vestibular rehabilitation. Full article

Background/Objectives: This study aimed to analyze the psychophysiological effects of functional neurology intervention on dysfunction in vestibular saccadic stimuli, focusing on its impact on muscle performance, psychophysiological arousal, and pain perception. Methods: Seventy-five healthy volunteer participants were randomly divided into two groups: an experimental group that received functional neurology treatment and a control group that did not. Both groups underwent the same evaluations at four distinct time points. Key measurements included pressure pain threshold (PPT), hand strength, critical flicker fusion threshold (CFFT), blood oxygen saturation, heart rate, and the number of saccadic stimuli tolerated until dysfunction in an indicator muscle (anterior deltoid). The functional neurology intervention involved proprioceptive reflexes, trigger point desensitization, and systemic approaches to rectify neuromuscular dysfunctions. Results: The results showed that the functional neurology intervention significantly increased the number of saccadic stimuli tolerated, from 3.6 ± 3.3 to 26.1 ± 8.7, indicating an improvement in neuromuscular endurance. Additionally, PPT readings exhibited an upward trend from baseline to post-intervention, with the final reading averaging at 10.2 ± 5.3 kgf, and hand strength measurements showed a modest but significant increase post-intervention. Notably, CFFT and blood oxygen saturation levels remained relatively stable, suggesting that the intervention’s primary impact was on neuromuscular performance and pain perception rather than on cognitive arousal or systemic oxygenation. Heart rate data indicated a decrease post-intervention, implying potential improvements in autonomic nervous system function. In contrast, the control group did not present significant changes in any of the psychophysiological parameters evaluated. These findings underscore the potential of targeted functional neurology treatments to enhance physical performance and provide valuable therapeutic benefits for neuromuscular and cognitive dysfunctions. Conclusions: Functional neurology interventions can effectively improve muscle endurance, pain management, and overall neuromuscular health, highlighting its relevance as a therapeutic modality in sports performance optimization and rehabilitation contexts. Full article

Purpose: This paper investigates the biomechanical effect of thermoformed aligners equipped with complementary biomechanical attachments (CBAs) on periodontal ligaments (PDLs) during the expansion process of the maxillary arch. The analysis was conducted using advanced simulations based on the finite element method (FEM). Methods: High-resolution 3D CAD models were created for four tooth types: canine, first premolar, second premolar, and first molar. Additional 3D models were developed for aligners, CBAs, and PDLs. These were integrated into a comprehensive FEM model to simulate clinical rehabilitation scenarios. Validation was achieved through comparative analysis with empirical medical data. Results: The FEM simulations revealed the following: for canine, the displacement was 0.134 mm with a maximum stress of 4.822 KPa in the amelocemental junction. For the first premolar, the displacement was 0.132 mm at a maximum stress of 3.273 KPa in the amelocemental junction. The second premolar had a displacement of 0.129 mm and a stress of 1.358 KPa at 1 mm from the amelocemental junction; and first molar had a displacement of 0.124 mm and a maximum stress of 2.440 KPa. Conclusions: The inclusion of CBAs significantly reduced tooth tipping during maxillary arch expansion. Among the models tested, the vestibular CBA demonstrated superior performance, delivering optimal tooth movement when combined with thermoformed aligners. Significance: FEM techniques provide a robust and cost-effective alternative to in vivo experimentation, offering precise and reliable insights into the biomechanical efficacy of CBAs in thermoformed aligners. This approach minimizes experimental variability and accelerates the evaluation of innovative orthodontic configurations. Full article

Background and Clinical Significance: Vestibular schwannomas (VS) are benign tumors arising from Schwann cells of the eighth cranial nerve. They represent approximately 8% of all intracranial tumors and have an increasing incidence. Larger VS can cause brainstem compression and hydrocephalus, and magnetic resonance imaging (MRI) is the diagnostic modality of choice. Individuals with VS and an elevated body mass index (BMI) can have more postoperative complications due to their weight, which can also negatively impact the preoperative diagnostic process and planning, as well as the surgery itself, as compromises must be made since optimal positioning of the patient is often not feasible. Increased BMI is a recognized risk factor for cerebrospinal fluid (CSF) leak after microscopic resection of a VS. Case Presentation: This report presents a case of a patient with class III obesity who had to undergo a right VS resection with preexisting hydrocephalus and the obstacles encountered by the surgical team throughout the diagnostics process since MRI could not be performed and preoperative planning had to be based on computed tomography (CT) scan; operative treatment, where suboptimal patient placement was achieved for a planned retrosigmoid approach to the pontocerebellar angle (PCA) and postoperative rehabilitation, which was hindered by his high BMI (55 kg/m²) with several complications, such as CSF leak, due to his extreme weight. Conclusions: Despite barriers, optimal tumor resection was obtained with a long neurorehabilitation process, with a favorable outcome, emphasizing the role of a multidisciplinary team. Full article

Background: Vestibular physical therapy is a specific type of exercise intervention that is designed to treat symptoms caused by vestibular disorders and to enhance postural control. The level of expertise in the practice of vestibular rehabilitation therapy (VRT) varies widely around the world. The practice of VRT is advanced in some countries, yet practice may be less advanced in others. No previous studies have evaluated the knowledge and beliefs of vestibular rehabilitation in the Kingdom of Saudi Arabia (KSA) to date. Objective. This study aimed to evaluate the knowledge and beliefs about VRT among physical therapists in the KSA. Methods: We used an electronic cross-sectional survey containing 25 questions and divided into four sections: demographics, clinical experience, vestibular rehabilitation knowledge, and physical therapists’ beliefs. The survey was answered by 219 licensed physical therapists. Results: Of the 219 responders, 59 (27%) physical therapists reported having experience with VRT. A total of 119 (54%) participants felt confident talking to other medical members when managing persons with dizziness. Only 59 (26%) clinicians were using vestibular assessment techniques, and 103 (47%) clinicians used VRT if they had patients with vestibular disorders. The majority of physical therapists believed in the efficacy of vestibular rehabilitation. Conclusions: Although the majority of physical therapists consider vestibular rehabilitation a crucial aspect of their practice, they acknowledge having limited knowledge of vestibular disorders and treatment techniques. Full article

Objective: Mental fatigue (MF) induced by prolonged cognitive tasks poses significant risks to postural stability, yet its effects on multi-sensory integration remain poorly understood. Method: This study investigated how MF alters sensory reweighting and postural control in 27 healthy young males. A 45 min incongruent Stroop task was employed to induce MF, validated via subjective Visual Analog Scale (VAS) scores and psychomotor vigilance tests. Postural stability was assessed under four sensory perturbation conditions (O-H: no interference; C-H: visual occlusion; O-S: proprioceptive perturbation; C-S: combined perturbations) using a Kistler force platform. Center of pressure (COP) signals were analyzed through time-domain metrics, sample entropy (SampEn), and Discrete Wavelet Transform (DWT) to quantify energy distributions across sensory-related frequency bands (visual: 0–0.1 Hz; vestibular: 0.1–0.39 Hz; cerebellar: 0.39–1.56 Hz; proprioceptive: 1.56–6.25 Hz). Results: MF significantly reduced proprioceptive energy contributions (p < 0.05) while increasing vestibular reliance under O-S conditions (p < 0.05). Time-domain metrics showed no significant changes in COP velocity or displacement, but SampEn decreased under closed-eye conditions (p < 0.001), indicating reduced postural adaptability. DWT analysis highlighted MF’s interaction with visual occlusion, altering cerebellar and proprioceptive energy dynamics (p < 0.01). Conclusion: These findings demonstrate that MF disrupts proprioceptive integration, prompting compensatory shifts toward vestibular and cerebellar inputs. The integration of nonlinear entropy and frequency-domain analyses advances methodological frameworks for fatigue research, offering insights into real-time sensor-based fatigue monitoring and balance rehabilitation strategies. This study underscores the hierarchical interplay of sensory systems under cognitive load and provides empirical evidence for optimizing interventions in high-risk occupational and clinical settings. Full article

Background/Objectives: Children with congenital or early onset sensorineural hearing loss (SNHL) are at a greater risk of vestibular dysfunction (VD), hypothesized to occur from the close embryological relationship between the cochlear and vestibular systems. Even with increasing focus on early detection and rehabilitation through Universal Newborn Hearing Screening (UNHS) programmes in many countries, few studies have focused on the prevalence and feasibility of vestibular assessment in infant populations. The objectives of this review are to 1. identify the prevalence of VD infants with congenital or early onset (<12 months old) SNHL, 2. identify which vestibular assessment tests/protocols are conducted on this population, 3. report sensitivity and specificity values for identified vestibular assessment tests/protocols. Methods: Studies that included infants aged 0–12 months, with congenital or early onset SNHL of any laterality, degree, or configuration, and who underwent any method of vestibular assessment were included. The review adhered to the Joanna Briggs Institute (JBI) guidance and the PRISMA-ScR extension statement. Results: A total of 18 studies were included in the review. All articles reported that infants with congenital or early onset SNHL are at a greater risk of VD, particularly those with bilateral severe–profound SNHL. The cervical vestibular-evoked myogenic potentials (cVEMP) test was the most frequently identified vestibular assessment tool for this age demographic. Conclusions: Results from the included articles coincide with results from literature assessing older paediatric populations. cVEMPs have been reported to be a feasible, sensitive, and specific screening tool in infants with congenital or early onset SNHL. The prevalence of VD in infants with congenital or early onset SNHL justify further investigation on the feasibility of establishing a pathway for vestibular assessment for all infants referred by UNHS programmes. Full article

Background/Objectives: This study aims to evaluate the feasibility of the angular vestibulo-ocular reflex (aVOR) function assessment in children with cerebral palsy (CP) using the video Head Impulse Test (vHIT) and to investigate how vestibular impairments correlate with functional motor ability. Methods: This cross-sectional study included children diagnosed with CP who attempted a vestibular function assessment with the vHIT. Descriptive statistics and a subgroup analysis based on clinical expression were performed. Finally, the correlation between aVOR gain and functional motor ability was investigated. Results: Thirteen children underwent assessments of the horizontal semicircular canals. Six out of thirteen children presented at least one dysfunctional canal; overall, eight out of twenty-six horizontal semicircular canals were dysfunctional in the HIMP paradigm. A subgroup analysis revealed a dysfunctional aVOR gain in all the children presenting ataxia. The correlation analysis demonstrated a strong negative association between aVOR gain and the Gross Motor Function Classification System (−0.73 and −0.68 for the left and right horizontal canal, respectively; p < 0.05). Conclusions: Vestibular dysfunctions are prevalent in children with CP and strongly correlate with motor function. An instrumental vestibular assessment in children with cognitive-motor disability seems feasible, in particular for horizontal canals and the HIMP paradigm. This could be important for better framing a child’s function and enhancing the management of balance and motor impairments with more specific strategies for children with CP. Full article

Background/Objectives: Vestibular Physical Therapy (VPT) plays a crucial role in the rehabilitation of patients with vestibular disorders by promoting vestibular compensation through adaptation, habituation, and substitution mechanisms. While traditional VPT approaches have demonstrated effectiveness in restoring balance and gaze stability, some patients with chronic vestibular dysfunction continue to experience persistent deficits. Methods: review of recent advancements in neuroplasticity research suggest the need for updated rehabilitation strategies that integrate sensorimotor substitution, saccadic training, optokinetic stimulation, and cognitive–motor dual-task training to optimize vestibular compensation. Results: This perspective article explores innovative VPT approaches aimed at improving dynamic gaze and postural stability in a more challenging way. We emphasize the importance of personalized rehabilitation strategies that leverage multisensory integration to enhance neuroplastic recovery. Conclusions: By refining VPT interventions, we can maximize functional outcomes and improve the quality of life for individuals with vestibular disorders. Full article

Introduction: In patients refractory to vestibular rehabilitation in the management of bilateral vestibulopathy, the cochleo-vestibular implant has emerged as a viable alternative to enhance both audiovestibular function and quality of life. The main objective of this study is to pioneer the use of PET to assess cortical modifications in patients with cochleo-vestibular implants, aiming to evaluate the safety and functional improvements in individuals with bilateral vestibulopathy and severe to profound hearing loss. Methods: A phase I pilot clinical trial was conducted with participants who received a BIONIC-VEST CI24RE cochleo-vestibular implant, with pre- and post-implantation assessments conducted for twelve months. Audiovestibular testing and two PET studies with 18F-FDG under baseline conditions and with active stimulus to observe cortical-level differences were performed. Results: Five patients were included in the study, all of them treated with a cochleo-vestibular implant, none of whom presented postoperative adverse effects. Audiologically, the mean post-implant gain was 56.63 ± 14.53 dB and 50.40 ± 35.54% in terms of speech intelligibility. From a vestibular perspective, the most remarkable findings were observed at the graviceptive pathway level, where a mean posturographic improvement was observed, with a sensory organization test score of 24.20 ± 13.74 and a subjective visual vertical of 1.57° ± 0.79°, achieving, in most cases, results within the normal range (<2.3°) by the end of the follow-up. PET images confirmed that with the electrical stimulus active (implant ON), there was a supratentorial activation pattern, particularly in areas related to somatosensory integration, emotional regulation, and autonomic control. Conclusions: The BIONIC-VEST implant significantly improved the vestibular system, particularly the graviceptive pathway, enhancing balance and SVV and reducing fall risk. PET revealed distinct uptake patterns in baseline and activated conditions, highlighting a cortical-level response with the use of the cochleo-vestibular implant. Full article