Altered gait kinematics and functional mobility in cochlear implant candidates with sensorineural hearing loss and frequent vestibular impairment

Abractst Although hearing loss is associated with impaired balance, gait, and fall risk, little is known about how gait-related movement differences are distributed across the head, trunk, and lower limbs or how they vary across gait tasks with different functional demands. Here we examined multi-segment movement during gait tasks in adults with hearing loss. Adults with unilateral or bilateral sensorineural hearing loss who were scheduled for cochlear implantation (CI) and age-matched healthy controls completed clinical assessments and 14 overground walking tasks while wearing six inertial measurement units (IMUs) placed on the head, trunk, upper limb, and lower limbs. Kinematic range, variability, gait timing, asymmetry, and global kinematic scores were compared between groups. Participants with hearing loss and frequent concomitant vestibular impairment showed compressed motion range and reduced across-stride variability across body segments, with increased cycle-to-cycle variability for selected measures and tasks. Differences were particularly apparent during walking with eyes closed, pivot turns, and obstacle negotiation. These tasks challenge gait by limiting visual information or requiring turning and obstacle avoidance. Overall, the pattern combined more restricted movement with less consistent movement across strides. Clinical testing also revealed group-level differences in vestibular and functional outcomes, including reduced vestibulo-ocular reflex (VOR) gain and greater dizziness, oscillopsia, and balance-related difficulty. Strikingly, global kinematic scores based on just three gait tasks and a single sensor—placed on the head, back, or ipsilateral ankle—captured the group differences despite the substantial reduction in instrumentation. Kinematic measures were also more closely linked to functional performance than to physiological vestibular measures, suggesting that wearable sensors provide information about functional mobility that complements conventional clinical testing. Together, these findings reveal a distributed, task-dependent gait signature in cochlear implant candidates with sensorineural hearing loss and frequent vestibular impairment, providing a more detailed picture of their mobility difficulties than clinical scores alone.