Vestibular dysfunction is common in people with multiple sclerosis (PwMS), but responses to optokinetic stimulation (OKS) across different vestibular conditions remain unclear. This study examined the immediate effects of VR-based OKS on balance and motion sickness in PwMS.

Forty-one PwMS and 23 matched healthy controls were included. Participants were classified by videonystagmography into MS with central vestibular involvement (n = 20, Group 1), MS without vestibular involvement (n = 21, Group 2) and healthy controls (n = 23, Group 3). Postural control was assessed with the FreeMED forceplate and VR sickness with the VR Sickness Questionnaire. Individually tailored OKS was delivered using Oculus Quest 2, with assessments immediately before and after stimulation.

Significant group × time interactions were found for sway length (open eyes [OE] monopodal left p = 0.024, closed eyes [CE] monopodal left p = 0.012, CE monopodal right p = 0.009), average speed (OE bipodal p = 0.004, OE monopodal left p = 0.017, CE monopodal right p = 0.026), mediolateral sway (CE bipodal p = 0.014, OE monopodal right p = 0.038) and anteroposterior sway (OE monopodal left p = 0.013). Post hoc analyses showed reduced sway length in G2 (p = 0.047), reduced average speed in G1 (p = 0.002), increased mediolateral sway in G1, G3 and G2 (p = 0.031, p = 0.026, p = 0.010) and opposite anteroposterior responses, decreasing in G1/G2 but increasing in G3, with differences between G1–G2 and G2–G3 (p = 0.007, p = 0.004). VR sickness scores did not differ between groups (p > 0.05).

VR-based OKS induced immediate, well-tolerated balance changes in PwMS, with group-specific responses across conditions. Greater destabilization was seen in those with central vestibular involvement. Individualized OKS may promote vestibular adaptation and improve postural control in MS rehabilitation.

The aim of this study was to investigate the effects of central vestibular dysfunction on physical functionality and cognitive function in individuals with multiple sclerosis (MS).

Fifty-two fully ambulatory individuals with MS (Expanded Disability Status Scale [EDSS] ≤ 4) were included and divided into two groups: those with central vestibular involvement (Group 1; n = 25) and those without (Group 2; n = 27). Central vestibular involvement was assessed using videonystagmography. Physical and cognitive functions were evaluated in all participants using the Glittre Activities of Daily Living (ADL) test, Godin Leisure-Time Exercise Questionnaire (GLTEQ), and the physical dimension of the MSQoL-54 for physical functionality, and the BICAMS, Trail Making Test (TMT), Word List Generation test and the cognitive dimension of the MSQoL-54 for cognitive function.

According to the physical functionality assessment results, the time required to complete the Glittre ADL test was longer in group 1 than in group 2 (p = 0.01). The score for the physical dimension of the MSQoL-54 was lower in group 1 (p = 0.045). In the BICAMS Symbol Digit Modalities Test, Group 1 scored lower than Group 2 (p = 0.013). A significant difference between the groups was also observed in the time taken to complete the TMT (p = 0.017). Additionally, Group 1 exhibited lower scores on the cognitive dimension of the MSQoL-54 (p = 0.012).

Physical functionality and specific cognitive domains differed between MS participants with and without central vestibular involvement. It should be considered that vestibular dysfunction may adversely impact cognitive and physical functionality, even in low-moderate disability level.

Imbalance and gait disturbances are common in patients with vestibular schwannoma (VS) and can result in significant morbidity. Current methods for quantitative gait analysis are cumbersome and difficult to implement. Here, we use custom-engineered instrumented insoles to evaluate the gait of patients diagnosed with VS.

Twenty patients with VS were recruited from otology, neurosurgery, and radiation oncology clinics at a tertiary referral center. Functional gait assessment (FGA), 2-minute walk test (2MWT), and uneven surface walk test (USWT) were performed. Custom-engineered instrumented insoles, equipped with an 8-cell force sensitive resistor (FSR) and a 9-degree-of-freedom inertial measurement unit (IMU), were used to collect stride-by-stride spatiotemporal gait parameters, from which mean values and coefficients of variation (CV) were determined for each patient.

FGA scores were significantly correlated with gait metrics obtained from the 2MWT and USWT, including stride length, stride velocity, normalized stride length, normalized stride velocity, stride length CV, and stride velocity CV. Tumor diameter was negatively associated with stride time and swing time on the 2MWT; no such association existed between tumor diameter and FGA or DHI.

Instrumented insoles may unveil associations between VS tumor size and gait dysfunction that cannot be captured by standardized clinical assessments and self-reported questionnaires.