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Relationship Among Balance Impairments, Functional Performance, and Disability in People With Peripheral Vestibular Hypofunction

KM Gill-Body, PT, MS, NCS, is Assistant Professor, Graduate Programs in Physical Therapy, MGH Institute of Health Professions, 101 Merrimac St, Boston, MA 02114 (USA) (kgillbody{at}partners.org), and Clinical Consultant, Physical Therapy Services, Massachusetts General Hospital, Boston, Mass. Address all correspondence to Ms Gill-Body at the first address
M Beninato, PT, PhD, is Assistant Professor, Graduate Programs in Physical Therapy, MGH Institute of Health Professions
DE Krebs, PT, PhD, is Professor, MGH Institute of Health Professions; Director, Massachusetts General Hospital Biomotion Laboratory, Boston, Mass; Lecturer, Harvard Medical School; and Lecturer, Massachusetts Institute of Technology, Cambridge, Mass

Background and Purpose. Physical therapy interventions are often based on assumed relationships among impairments, functional performance, and disability. The purposes of this study were (1) to describe balance impairments, functional performance, and disability in subjects with unilateral peripheral vestibular hypofunction (UVH) and bilateral peripheral vestibular hypofunction (BVH), (2) to examine the relationship among these factors, and (3) to determine whether disability can be explained by commonly used tests of balance and functional performance. Subjects. Participants were 85 subjects (mean age=62.5 years, SD=16.5) with UVH (n=41) or BVH (n=44) diagnosed by vestibular function tests and clinical examination. Methods. Each subject completed the Dizziness Handicap Inventory (DHI) to obtain a measure of disability. Functional performance was measured with a modified Timed Up & Go Test (TUG). Balance impairments were measured with computerized posturography and balance tests. Descriptive statistics, correlational analyses, and stepwise regressions were performed. Results. Subjects with BVH had poorer balance but similar TUG scores and perceived levels of disability, as compared with subjects with UVH. Weak to moderate correlations existed among balance measurements, TUG scores, and DHI scores. Balance impairments and TUG scores together explained 78% of the variance in DHI scores of the subjects with BVH, whereas balance impairments alone explained 13% of the variance in DHI scores of the subjects with UVH. Conclusion and Discussion. Balance impairments and functional performance appear to be more closely related to disability in individuals with BVH as compared with those with UVH. Clinical tests of balance impairments and functional performance appear to be useful in explaining disability.

Key Words: Balance • Disability • Dizziness Handicap Inventory • Posturography • Vestibular hypofunction

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