VISUAL PATTERN FEATURES INFLUENCING DIZZINESS: A QUALITATIVE STUDY USING ADVANCED TECHNOLOGY IN PERSONS WITH VESTIBULAR DISORDERS

C.M. Costa^1,2, B.N. Klatt³, P. Hovareshti⁴, L. Holt⁴, V. Ou⁴, P.M. Dunlap³, F. Alradady³, A.R. Cassidy⁵, S.L. Whitney³

¹Hospital Garcia de Orta, Almada, Portugal, ²University of Lisbon, Faculty of Medicine, Lisbon, Portugal, ³University of Pittsburgh, Department of Physical Therapy, Pittsburgh, United States, ⁴Intelligent Automation dba BlueHalo, Rockville, MD, United States, ⁵UPMC Centers for Rehab Services, Pittsburgh, PA, United States

Background: Visual vertigo (VV) is a common complaint among persons with dizziness¹. Visual vertigo is related to contrast sensitivity and correlates with visual dependence in persons with vestibular disorders². Despite being used in clinical reasoning to progress exercises³, little has been studied to address which of the visual pattern features trigger dizziness in persons with dizziness.

Purpose: To explore how visual patterns influence dizziness perception in persons with vestibular disorders.

Methods: A qualitative prospective exploratory study (semi-structured interview) was performed. Nineteen people with vestibular disorders, aged 18 to 88 years (52 ± 15 years, 10 women), were interviewed after being exposed to six visual scenes with moving or static patterns via an l an app on a tablet.The patterns had various colors and contrasts. Participants were recruited from a tertiary balance clinic, currently enrolled in vestibular rehabilitation, and were categorized into the following diagnoses: post-concussion, peripheral unilateral vestibular hypofunction, vestibular migraine, and nonspecific imbalance/dizziness.They were asked to rank the six patterns from easiest to look at, to the pattern that was hardest to look at (impacting or triggering their symptoms). Participants were asked to report whether the moving or static visual pattern was easier to view and was recorded to insure completeness. Descriptions about why participants felt that some patterns made them feel less or more symptomatic were recorded.

Results: Regarding the ranking, the blank white background with the pink target in the center was the easiest pattern and the pattern that most increased symptoms were the pattern where the participants were to focus on a pink target on a black background with pink shapes. The other patterns difficulty varied according to the diagnoses, with migraineurs having difficulty with the high contrast patterns. All 19 participants identified the moving patterns as worse than static patterns. High contrast patterns were more challenging for most but not all the subjects, and when the target and the surround were similar in color focusing on the target, it was generally more difficult to keep the target in focus.

Conclusions: There was unanimous consensus that that solid white background was easiest and that the pink lines that matched the pink target X on a black background was the most challenging exercise. There was not consensus related to the remaining 4 exercises as to their level of difficulty. Additional subjects are required to determine if diagnoses or other pre-morbid characteristics influence exercise difficulty.

Implications: Vestibular physical therapists should be aware that the visual background chosen when performing eye/head exercises impacts perceived exercise difficulty.

Funding acknowledgements: The author received a Fulbright research fellowship.

Keywords:
Vestibular Physiotherapy
Visual vertigo
Visual pattern features sensitivity

Topics:
Research methodology, knowledge translation & implementation science
Disability & rehabilitation
Innovative technology: information management, big data and artificial intelligence

Did this work require ethics approval? Yes

Institution: University of Pittsburgh

Committee: University of Pittsburgh Biomedical IRB

Ethics number: Study 21050062