The "broken escalator" phenomenon: Vestibular dizziness interferes with locomotor adaptation

Research output: Contribution to journalArticlepeer-review

  • Mitesh Patel
    Imperial College London
  • Ed Roberts
    Imperial College London
  • Qadeer Arshad
    Imperial College London
  • Karen Bunday
    University of Westminster, London
  • John F Golding
    University of Westminster, London
  • Diego Kaski
    Imperial College London
  • Adolfo M Bronstein
    Imperial College LondonImperial College Healthcare NHS Trust
BACKGROUND:Although vestibular lesions degrade postural control we do not know the relative contributions of the magnitude of the vestibular loss and subjective vestibular symptoms to locomotor adaptation. OBJECTIVE:To study how dizzy symptoms interfere with adaptive locomotor learning. METHODS:We examined patients with contrasting peripheral vestibular deficits, vestibular neuritis in the chronic stable phase (n = 20) and strongly symptomatic unilateral Meniere’s disease (n = 15), compared to age-matched healthy controls (n = 15). We measured locomotor adaptive learning using the “broken escalator” aftereffect, simulated on a motorised moving sled. RESULTS:Patients with Meniere’s disease had an enhanced “broken escalator” postural aftereffect. More generally, the size of the locomotor aftereffect was related to how symptomatic patients were across both groups. Contrastingly, the degree of peripheral vestibular loss was not correlated with symptom load or locomotor aftereffect size. During the MOVING trials, both patient groups had larger levels of instability (trunk sway) and reduced adaptation than normal controls. CONCLUSION:Dizziness symptoms influence locomotor adaptation and its subsequent expression through motor aftereffects. Given that the unsteadiness experienced during the “broken escalator” paradigm is internally driven, the enhanced aftereffect found represents a new type of self-generated postural challenge for vestibular/unsteady patients.
Original languageEnglish
Pages (from-to)81-94
JournalJournal of Vestibular Research
Volume30
Issue number2
Publication statusPublished - 18 May 2020
Externally publishedYes
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