Anti-Compensatory Saccades Changes After Visuo-Vestibular Physical Therapy in People With Acute Unilateral Vestibulopathy: A Prospective Observational Study.
Marco Boldreghini, Andrea Canale, Andrea Albera and 8 others
92 people with vestibular neuritis showed large gains in a gaze-stabilization eye movement and a drop in dizziness scores from 51 to 26 after 8 weeks of vestibular therapy, but VOR gain barely moved.
No control group means natural recovery may explain much of this.
Key findings
1The primary outcome, anti-compensatory saccade (AcS) amplitude measured by the SHIMP paradigm on the affected side, increased significantly over 8 weeks, with the median rising from 189.5° to 239.0° (p < 0.001, rank-biserial r = −0.961).
2VOR gain on the affected side showed only a modest increase (median 0.37 to 0.40, p < 0.001, r = −0.505) and remained below 0.90, while the Dizziness Handicap Inventory score dropped from a median of 51 to 26 (p < 0.001, r = 0.999).
3There was no significant correlation between the change in AcS amplitude and the change in VOR gain (r = 0.085), and baseline VOR gain did not predict the magnitude of AcS change (R² = 0.001, p = 0.723).
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What it does not show
No control group: the authors state explicitly that spontaneous vestibular compensation after AUVP may account for much or all of the observed changes, and that the results cannot be attributed to VVPT specifically. Exercise intensity and progression were individualised per patient, so treatment exposure varied and cannot be compared across participants. Adherence to the home exercise programme was checked by patient report at each session but was not objectively quantified. AcS extraction relied on a proprietary software algorithm (ICS Impulse / Otosuite Vestibular), with visual quality checks by one examiner. Correlation and regression analyses were exploratory; the authors note they should not be read as definitive evidence of a VOR-independent central mechanism. Single site, single operator, single time-point pair (T0 and T1 only); no intermediate assessments to track the trajectory of change. DHI is a subjective patient-reported measure and may reflect expectation, emotional state, or natural symptom adaptation rather than a physiological change.
Declared interests
The authors declare no conflicts of interest and report no funding source.
The easy way to misread this
Do not read the large increase in AcS amplitude as proof that this specific 8-week VVPT programme caused it. The study had no untreated or alternative-treatment control group, the authors themselves state that spontaneous vestibular compensation after unilateral vestibular loss may have driven the changes, and the VOR gain barely moved (0.37 to 0.40), so the AcS change is dissociated from reflex recovery. Without a comparator, you cannot separate the therapy effect from the natural 8-week recovery trajectory of vestibular neuritis.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →