title: Clinical and neurophysiological risk factors for falls in patients with bilateral vestibulopathy.
abstract: Patients with bilateral vestibular failure (BVF) exhibit imbalance when standing and walking that is linked to a higher fall risk. The purpose of this study was to identify risk factors for falls in BVF. We therefore systematically investigated the interrelationship of clinical and demographic characteristics, gait impairments, and the fall frequency of these patients. Clinical and demographic characteristics as well as quantitative measures of gait performance on a pressure-sensitive gait carpet were collected from 55 patients with different etiologies of BVF. Clinical and demographic data as well as spatiotemporal gait characteristics were used for ANOVA testing and a logistic regression model with categorized fall events as dependent variables. The impairment of peripheral vestibular function, duration of disease, and the overall gait status were not associated with the history of falls in patients with BVF. In contrast, the most predictive factors for falls in BVF were an increase in temporal gait variability, especially at slow walking speeds (p < 0.001; OR = 1.3), and the presence of a concomitant peripheral neuropathy (p < 0.045; OR = 3.6). BVF patients with a high risk of falling exhibit specific gait alterations in a speed-dependent manner. In particular, increased gait fluctuations during slow walking are most predictive for an increased fall risk. The presence of a concomitant peripheral neuropathy further critically impairs postural stability in these patients. Clinical assessment of both these aspects is therefore important to identify those patients at a particularly high fall risk and to initiate preventive procedures early.
authors.affiliation: Department of Neurology, University of Munich, Campus Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany. roman.schniepp@med.uni-muenchen.de.|German Center for Vertigo and Balance Disorders (DSGZ), University of Munich, Munich, Germany. roman.schniepp@med.uni-muenchen.de.
authors.forename: Roman
authors.initials: R
authors.lastname: Schniepp
authors.affiliation: German Center for Vertigo and Balance Disorders (DSGZ), University of Munich, Munich, Germany.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Schlick
authors.affiliation: German Center for Vertigo and Balance Disorders (DSGZ), University of Munich, Munich, Germany.
authors.forename: Fabian
authors.initials: F
authors.lastname: Schenkel
authors.affiliation: German Center for Vertigo and Balance Disorders (DSGZ), University of Munich, Munich, Germany.
authors.forename: Cauchy
authors.initials: C
authors.lastname: Pradhan
authors.affiliation: German Center for Vertigo and Balance Disorders (DSGZ), University of Munich, Munich, Germany.|Schoen Klinik Bad Aibling, Bad Aibling, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Jahn
authors.affiliation: German Center for Vertigo and Balance Disorders (DSGZ), University of Munich, Munich, Germany.|Institute for Clinical Neurosciences, University of Munich, Campus Grosshadern, Munich, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Brandt
authors.affiliation: German Center for Vertigo and Balance Disorders (DSGZ), University of Munich, Munich, Germany.
authors.forename: Max
authors.initials: M
authors.lastname: Wuehr
mesh_terms: D000058:Accidental Falls; D000368:Aged; D000704:Analysis of Variance; D019540:Area Under Curve; D000071699:Bilateral Vestibulopathy / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology*; D001696:Biomechanical Phenomena; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D010045:Outpatients; D010523:Peripheral Nervous System Diseases / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology; D011379:Prognosis; D012307:Risk Factors; D016138:Walking / Q000502:physiology
keywords: Bilateral vestibulopathy; Falls; Gait disorder; Gait variability; Peripheral neuropathy