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Recovery of Visual Acuity in Vestibular Deficits

18 Years
80 Years
Not Enrolling
Vestibular Neuronitis, Vestibular Neuronitis, Bilateral, Vestibular Schwannoma

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Trial Information

Recovery of Visual Acuity in Vestibular Deficits

Decrements in visual acuity during head movement in patients with vestibular hypofunction
are potentially serious problems. This deficit could contribute to decreased activity
level, avoidance of driving with resultant diminished independence and, ultimately, limited
social interactions and increased isolation. Oscillopsia occurs because of inadequate
vestibulo-ocular reflex (VOR) gain and suggests that compensation for the vestibular loss
has not occurred. The purpose of this study was to examine the effect of an exercise
intervention on visual acuity during head movement in patients with unilateral and bilateral
vestibular hypofunction. We hypothesized that 1) patients performing vestibular exercises
would have improved visual acuity during head movement compared to patients performing
placebo exercises; 2) there would be no correlation between dynamic visual acuity (DVA) and
the patients' subjective complaints of oscillopsia; and 3) improvement in DVA would be
reflected by changes in residual vestibular function as indicated by an increase in VOR

Patients are assigned randomly to either the vestibular exercise or placebo exercise group.
The randomization schedule is generated using a computer program for 2-sample
randomization. The sequence was not concealed from the investigator who obtained consent
from the subjects and supervised the exercises (SJH). The group assignment (vestibular
exercise or placebo exercise) was concealed from the participants and from the investigator
who performed the outcome measures.

The vestibular exercise group practiced exercises that consisted of adaptation exercises and
eye-head exercises to targets (Table 1), which were designed to improve gaze stability 16.
They also performed gait and balance exercises. The placebo exercise group performed
exercises designed to be 'vestibular-neutral'.

Inclusion Criteria:

- Patient had to have either a unilateral vestibular or bilateral vestibular
hypofunction defined as follows: Unilateral vestibular deficits were defined by a >
25% difference in slow phase eye velocity between right and left sides on either the
caloric or rotary chair test. Bilateral vestibular deficits were defined included
refixation saccades made in response to unpredictable head thrusts to the right and
left, a gain < .1 on rotary chair step test and a peak slow phase eye movement of <5
degrees/sec during irrigation of each ear on bithermal water caloric testing

- Healthy subjects with normal vestibular function test results

- must be able to complete DVA test

Exclusion Criteria:

- Patients with central lesions will be omitted from the study because vestibular
adaptation or other compensatory mechanisms may be compromised and

- Patients with visual acuity when the head is stationary of 20/60 or worse.

- Patients on medication that suppress or facilitate vestibular function will not be
excluded from the study but data will be analyzed to assess the effect of medication.

- Patient who do not understand the purpose of the study and what it involves

Type of Study:


Study Design:

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Crossover Assignment, Masking: Single Blind (Subject), Primary Purpose: Treatment

Outcome Measure:

Visual acuity during head movement: Computerized Dynamic Visual Acuity test; measurement taken before intervention, at 2 and 4 weeks during intervention at at end of intervention

Outcome Description:

visual acuity is measured using a computerized system first with the head stationary and then with the head moving in yaw plane. Head velocity is measured using a rate sensor and optotype is displayed only when head velocity is between 120 and 180 degrees per second

Outcome Time Frame:

pre-intervention, 2 weeks, 4 weeks and at discharge

Safety Issue:


Principal Investigator

Susan J Herdman, PhD

Investigator Role:

Principal Investigator

Investigator Affiliation:

Emory University


United States: Institutional Review Board

Study ID:

RO1-DC 03196



Start Date:

August 2000

Completion Date:

December 2004

Related Keywords:

  • Vestibular Neuronitis
  • Vestibular Neuronitis, Bilateral
  • Vestibular Schwannoma
  • vestibular rehabilitation
  • vestibular hypofunction
  • Neurilemmoma
  • Neuroma, Acoustic
  • Guillain-Barre Syndrome
  • Neuritis
  • Vestibular Neuronitis



Center for Rehabilitation Medicine, Emory University Atlanta, Georgia  30322