Author(s)
Stephen Leong, BA
Bing M. Teh, MBBS
Ton Duong, MEng
Michael B. Sisti, MDTony J. C. Wang, MD
Damiano Zanotto, PhD
Anil K. Lalwani, MD
Affiliation(s)
Columbia University Vagelos College of Physicians & Surgeons;
Abstract:
Objective: Imbalance and gait disturbances are common in vestibular schwannoma (VS) patients and can result in significant morbidity. Here, we use custom-engineered instrumented insoles to evaluate the gait and balance of patients diagnosed with VS; we then compare our results to standardized gait assessments. We aim to validate instrumented insoles as a means of personalized gait analysis in VS patients.
Study Design: Prospective clinical study.
Setting: Otology, neurosurgery, and radiation oncology clinics at a tertiary referral center.
Patients: Inclusion criterion: diagnosis of active VS. Exclusion criteria: significant neurologic disorder, diagnosis of neurofibromatosis II, and age >80 years. Interventions: Functional gait assessment (FGA), 2-minute walk test (2MW), and uneven surface walk (USW) test with diagnostic instrumented insoles.
Main Outcome Measures: Scores on standardized gait assessments; mean and coefficient of variation (CV) of spatiotemporal gait parameters from instrumented insoles.
Results: FGA scores and insole data were obtained for 20 patients with untreated VS. The average FGA score was 25.1 ? 3.9. FGA scores were significantly correlated with metrics obtained from the 2MW and USW tests, including stride length, stride velocity, normalized stride length, normalized stride velocity, stride length CV, and stride velocity CV (p < 0.05). Compared to the 2MW, on the USW test, patients had significantly increased stride time, swing time, stance time, stride time CV, stride length CV, and stride velocity CV (p < 0.05).
Conclusions: VS patients have significant gait disturbance on uneven surfaces that cannot be detected by standard assessment (FGA). Instrumented insoles have high sensitivity for identifying gait dysfunction in VS patients and may be valuable in guiding interventions for this patient population.