Assessment of dynamic stability and identification of key tasks and parameters in patients with unilateral and bilateral vestibulopathy: a laboratory-based study

Gautier Grouvel^1,2,3*Anissa Boutabla¹Julie Corre¹Romain Bechet⁴Samuel Cavuscens¹Maurizio Ranieri¹Jean-François Cugnot⁵Christopher McCrum⁶Raymond Van De Berg⁷Nils Guinand¹Stéphane Armand^2,3Angelica Perez Fornos¹

• ¹Division of Otorhinolaryngology Head and Neck Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
• ²Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
• ³Research Center of skeletal Muscle and Movement, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
• ⁴Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC – Institut de Biomécanique Humaine Georges Charpak, Paris, France
• ⁵Clinical Neurosciences Department, Neurorehabilitation Department, Geneva University Hospitals, Geneva, Switzerland
• ⁶Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, Netherlands
• ⁷Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center+, Maastricht, Netherlands

Chronic imbalance is the cardinal symptom in bilateral vestibulopathy patients (BV), and in a subset of symptomatic unilateral vestibulopathy patients (UV), leading to a significant impact on their daily lives. Despite these profound effects, such as the risk of falls, the mechanism of imbalance remains complex, posing challenges both for monitoring patients' functional status and for evaluating rehabilitation therapies. The aim of this study was to assess the dynamic stability of patients with BV and UV during multiple motor tasks and to provide a summary of the most relevant tasks and biomechanical parameters. The purpose was to propose a "short-form FGA" (Functional Gait Assessment) test to reduce the length and complexity of tests, to be able to evaluate future therapies longitudinally, and to monitor functional follow-up of patients. Dynamic stability, spatio-temporal and kinematic parameters were calculated for 10 BV patients, 10 UV patients and 10 asymptomatic controls while walking at three self-selected walking speeds, while performing dual tasks and while completing the ten tasks of the FGA battery. Two (validity and interpretability) of the four COSMIN domains and clinical applicability were evaluated to identify relevant tasks and parameters to the study population, i.e. good discriminant and convergent validity, and good clinical applicability. The comfortable and slow gait, as well as the turn pivot, eyes closed, and tandem walk tasks were identified as the most relevant for characterizing dynamic stability in these patients. Easily interpretable and visually assessable parameters, such as walking speed, center of mass displacement, step width, trunk movement, stiffness of the head/trunk, and number of steps, were identified as the most relevant. In contrast, stability parameters such as margin of stability or whole body angular momentum did not prove to be effective parameters. These relevant parameters should enable future studies to evaluate rehabilitation therapies such as vestibular implants or physiotherapy, as well as to monitor patients' functional status. Future studies should validate these results and assess the missing psychometric properties of these parameters.