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Journal of Neurology
Published in: Journal of Neurology 1/2020

Open Access 01-12-2020 | Original Communication

Spontaneous visual exploration during locomotion in patients with phobic postural vertigo

Authors: J. Penkava, S. Bardins, T. Brandt, M. Wuehr, D. Huppert

Published in: Journal of Neurology | Special Issue 1/2020

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Abstract

Background

Earlier studies on stance and gait with posturographic and EMG-recordings and automatic gait analysis in patients with phobic postural vertigo (PPV) or visual height intolerance (vHI) revealed similar patterns of body stiffening with muscle co-contraction and a slow, cautious gait. Visual exploration in vHI patients was characterized by a freezing of gaze-in-space when standing and reduced horizontal eye and head movements during locomotion.

Objective

Based on the findings in vHI patients, the current study was performed with a focus on visual control of locomotion in patients with PPV while walking along a crowded hospital hallway.

Methods

Twelve patients with PPV and eleven controls were recruited. Participants wore a mobile infrared video eye-tracking system that continuously measured eye-in-head movements in the horizontal and vertical planes and head orientation and motion in the yaw, pitch, and roll planes. Visual exploration behavior of participants was recorded at the individually preferred speed for a total walking distance of 200 m. Gaze-in-space directions were determined by combining eye-in-head and head-in-space orientation. Walking speeds were calculated based on the trial duration and the total distance traversed. Participants were asked to rate their feelings of discomfort during the walk on a 4-point numeric rating scale. The examiners rated the crowdedness of the hospital hallway on a 4-point numeric rating scale.

Results

The major results of visual exploration behavior in patients with PPV in comparison to healthy controls were: eye and head positions were directed more downward in the vertical plane towards the ground ahead with increased frequency of large amplitude vertical orientation movements towards the destination, the end of the ground straight ahead. The self-adjusted speed of locomotion was significantly lower in PPV. Particularly those patients that reported high levels of discomfort exhibited a specific visual exploration of their horizontal surroundings. The durations of fixating targets in the visual surroundings were significantly shorter as compared to controls.

Conclusion

Gaze control of locomotion in patients with PPV is characterized by a preferred deviation of gaze more downward and by horizontal explorations for suitable auxiliary means for potential postural support in order to prevent impending falls. These eye movements have shorter durations of fixation as compared to healthy controls and patients with vHI. Finally, the pathological alterations in eye–head coordination during locomotion correlate with a higher level of discomfort and anxiety about falling.
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Metadata
Title
Spontaneous visual exploration during locomotion in patients with phobic postural vertigo
Authors
J. Penkava
S. Bardins
T. Brandt
M. Wuehr
D. Huppert
Publication date
01-12-2020
Publisher
Springer Berlin Heidelberg
Published in
Journal of Neurology / Issue Special Issue 1/2020
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI
https://doi.org/10.1007/s00415-020-10151-8

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