Vestibular-dependent spinal reflexes evoked by brief lateral accelerations of the heads of standing subjects

An impulsive acceleration stimulus, previously shown to activate vestibular afferents, was applied to the mastoid. Evoked EMG responses from the soleus muscles in healthy subjects (n = 10) and patients with bilateral vestibular dysfunction (n = 3) were recorded and compared with the effects of galvanic stimulation (GVS). Subjects were stimulated while having their eyes closed, head rotated, and while tonically activating their soleus muscles. Rectified EMG responses were recorded from the leg contralateral to the direction of head rotation. Responses were characterized by triphasic potentials that consisted of short-latency (SL), medium-latency (ML), and long-latency (LL) components beginning at (mean ± SD) 54.2 ± 4.8, 88.4 ± 4.7, and 121 ± 7.1 ms, respectively. Mean amplitudes for the optimum stimulus rise times were 9.05 ± 3.44% for the SL interval, 16.70 ± 4.41% for the ML interval, and 9.75 ± 4.89% for the LL interval compared with prestimulus values. Stimulus rise times of 14 and 20 ms evoked the largest ML amplitudes. GVS evoked biphasic responses (SL and ML) with similar latencies. Like GVS, the polarity of the initial interval was determined by the polarity of the stimulus and the evoked EMG response was attenuated when subjects were seated. There was no significant EMG response evoked when subjects were stimulated using 500-Hz vibration or in patients with bilateral vestibular dysfunction. Our study demonstrates that a brief lateral acceleration, likely to activate the utricle, can evoke spinal responses with properties similar to those previously shown for vestibular activation by GVS. The triphasic nature of the responses may allow the nervous system to respond differently to short compared with long-duration linear accelerations, consistent with their differing significance.     

Probing the human vestibular system with galvanic stimulation.

Galvanic vestibular stimulation (GVS) is a simple, safe, and specific way to elicit vestibular reflexes. Yet, despite a long history, it has only recently found popularity as a research tool and is rarely used clinically. The obstacle to advancing and exploiting GVS is that we cannot interpret the evoked responses with certainty because we do not understand how the stimulus acts as an input to the system. This paper examines the electrophysiology and anatomy of the vestibular organs and the effects of GVS on human balance control and develops a model that explains the observed balance responses. These responses are large and highly organized over all body segments and adapt to postural and balance requirements. To achieve this, neurons in the vestibular nuclei receive convergent signals from all vestibular receptors and somatosensory and cortical inputs. GVS sway responses are affected by other sources of information about balance but can appear as the sum of otolithic and semicircular canal responses. Electrophysiological studies showing similar activation of primary afferents from the otolith organs and canals and their convergence in the vestibular nuclei support this. On the basis of the morphology of the cristae and the alignment of the semicircular canals in the skull, rotational vectors calculated for every mode of GVS agree with the observed sway. However, vector summation of signals from all utricular afferents does not explain the observed sway. Thus we propose the hypothesis that the otolithic component of the balance response originates from only the pars medialis of the utricular macula.     

Enhancing human balance control with galvanic vestibular stimulation

 With galvanic vestibular stimulation (GVS), electrical current is delivered transcutaneously to the vestibular afferents through electrodes placed over the mastoid bones. This serves to modulate the continuous firing levels of the vestibular afferents, and causes a standing subject to lean in different directions depending on the polarity of the current. Our objective in this study was to test the hypothesis that the sway response elicited by GVS can be used to reduce the postural sway resulting from a mechanical perturbation. Nine subjects were tested for their postural responses to both galvanic stimuli and support-surface translations. Transfer-function models were fit to these responses and used to calculate a galvanic stimulus that would act to counteract sway induced by a support-surface translation. The subjects' responses to support-surface translations, without and with the stabilizing galvanic stimulus, were then measured. With the stabilizing galvanic stimulus, all subjects showed significant reductions in both sway amplitude and sway latency. Thus, with GVS, subjects maintained a more erect stance and followed the support-surface displacement more closely. These findings suggest that GVS could possibly form the basis for a vestibular prosthesis by providing a means through which an individual's posture can be systematically controlled. Received: 11 May 2000 / Accepted in revised form: 20 November 2000     

Motoneuron projection patterns in chick embryonic limbs with a double complement of dorsal thigh musculature

During the normal development of the chick, lateral motoneurons within the lumbosacral motor column of the spinal cord consistently project to muscles of dorsal origin within the limb while medial motoneurons project to muscles of ventral origin. To determine if specific cues arising from each type of target are the dominant guidance cues used by lateral and medial motoneurons to create this pattern, I examined motoneuron projections in embryonic chick limbs with a double complement of dorsal thigh musculature and no ventral musculature. Results indicate that cues associated with muscles of a specific developmental origin do not invariably dominate. Before and after the major period of motoneuron death, all muscles in dorsal limb regions (host) were innervated by lateral or dorsal pool neurons. Most ventrally positioned (donor) muscles were innervated by medial or ventral pool neurons. Only the donor iliofibularis, a muscle located very near to its original source of innervation, received projections from some lateral neurons. Within the limb proper, medial or ventral pool neurons projected to donor muscles in a patterned manner suggesting that they were following nonspecific regional cues and perhaps also responding to the availability of uninnervated target tissue. I conclude that axon sorting into distinct lateral and medial classes is independent of limb target complement and that subsequent pathway choice is a separate event governed by both specific target cues and other guidance mechanisms.     

Hierarchy of Dysfunction Related to Dressing Performance in Stroke Patients: A Path Analysis Study

Previous reports indicated that various dysfunctions caused by stroke affect the level of independence in dressing. These dysfunctions can be hierarchical, and these effects on dressing performance can be complicated in stroke patients. However, there are no published reports focusing on the hierarchical structure of the relationships between the activities of daily living and balance function, motor and sensory functions of the affected lower limb, strength of the abdominal muscles and knee extension on the unaffected side, and visuospatial deficits. The purpose of this study was to elucidate the hierarchical and causal relationships between dressing performance and these dysfunctions in stroke patients. This retrospective study included 104 first-time stroke patients. The causal relationship between the dressing performance and age, time post stroke, balance function, motor and sensory functions of the affected lower limb, strength of the abdominal muscles and knee extension on the unaffected side, and visuospatial deficits were examined using path analysis. A hypothetical path model was created based on previous studies, and the goodness of fit between the data and model were verified. A modified path model was created that achieved an almost perfect fit to the data. Balance function and abdominal muscle strength have direct effects on dressing performance, with standardized direct effect estimates of 0.78 and 0.15, respectively. Age, motor and sensory functions of the affected lower limb, and strength of abdominal muscle and knee extension on the unaffected side have indirect effects on dressing by influencing balance function. Our results suggest that dressing performance depends strongly on balance function, and it is mainly influenced by the motor function of the affected lower limb.     

Cross-Modal Calibration of Vestibular Afference for Human Balance

To determine how the vestibular sense controls balance, we used instantaneous head angular velocity to drive a galvanic vestibular stimulus so that afference would signal that head movement was faster or slower than actual. In effect, this changed vestibular afferent gain. This increased sway 4-fold when subjects (N = 8) stood without vision. However, after a 240 s conditioning period with stable balance achieved through reliable visual or somatosensory cues, sway returned to normal. An equivalent galvanic stimulus unrelated to sway (not driven by head motion) was equally destabilising but in this situation the conditioning period of stable balance did not reduce sway. Reflex muscle responses evoked by an independent, higher bandwidth vestibular stimulus were initially reduced in amplitude by the galvanic stimulus but returned to normal levels after the conditioning period, contrary to predictions that they would decrease after adaptation to increased sensory gain and increase after adaptation to decreased sensory gain. We conclude that an erroneous vestibular signal of head motion during standing has profound effects on balance control. If it is unrelated to current head motion, the CNS has no immediate mechanism of ignoring the vestibular signal to reduce its influence on destabilising balance. This result is inconsistent with sensory reweighting based on disturbances. The increase in sway with increased sensory gain is also inconsistent with a simple feedback model of vestibular reflex action. Thus, we propose that recalibration of a forward sensory model best explains the reinterpretation of an altered reafferent signal of head motion during stable balance.     

Simulations of the alpha motoneuron pool electromyogram reflex at different preactivation levels in man

The alpha motoneuron pool and the surface electromyogram (EMG) of the human soleus muscle are modelled, respectively, by an alpha motoneuron pool model generating the firing patterns in the motor units of e muscle and by a muscle model using these discharge patterns to simulate the surface EMG. In the alpha motoneuron pool model, we use a population of motoneurons in which cellular properties like cell size and membrane conductance are distributed according to experimentally observed data. By calculating the contribution from each motor unit, the muscle model predicts the EMG. Wave forms of the motor unit action potentials in the surface EMG are obtained from experimental data. Using the model, we are able to give a quantitative prediction of the motoneuron pool activity and the reflex EMG output at different preactivation levels. The simulated data are consistent with experimentally obtained results in healthy humans. During static isometric muscle preactivations, the simulations show that the reflex strength is highly dependent on the intrinsic threshold properties of the alpha motoneuron pool. Received: 27 April 1993/Accepted in revised form: 8 September 1993     

Central Adaptation to Repeated Galvanic Vestibular Stimulation: Implications for Pre-Flight Astronaut Training

Healthy subjects (N = 10) were exposed to 10-min cumulative pseudorandom bilateral bipolar Galvanic vestibular stimulation (GVS) on a weekly basis for 12 weeks (120 min total exposure). During each trial subjects performed computerized dynamic posturography and eye movements were measured using digital video-oculography. Follow up tests were conducted 6 weeks and 6 months after the 12-week adaptation period. Postural performance was significantly impaired during GVS at first exposure, but recovered to baseline over a period of 7–8 weeks (70–80 min GVS exposure). This postural recovery was maintained 6 months after adaptation. In contrast, the roll vestibulo-ocular reflex response to GVS was not attenuated by repeated exposure. This suggests that GVS adaptation did not occur at the vestibular end-organs or involve changes in low-level (brainstem-mediated) vestibulo-ocular or vestibulo-spinal reflexes. Faced with unreliable vestibular input, the cerebellum reweighted sensory input to emphasize veridical extra-vestibular information, such as somatosensation, vision and visceral stretch receptors, to regain postural function. After a period of recovery subjects exhibited dual adaption and the ability to rapidly switch between the perturbed (GVS) and natural vestibular state for up to 6 months.     

Strong galvanic vestibular stimulation obscures arterial pressure response to gravitational change in conscious rats.

Galvanic vestibular stimulation (GVS) is known to create an imbalance in the vestibular inputs; thus it is possible that the simultaneously applied GVS obscures adequate gravity-based inputs to the vestibular organs or modifies an input-output relationship of the vestibular system and then impairs the vestibular-mediated response. To examine this, arterial pressure (AP) response to gravitational change was examined in conscious rats with and without GVS. Free drop-induced microgravity and centrifugation-induced hypergravity were employed to elicit vestibular-mediated AP response. GVS itself induced pressor response in an intensity-dependent manner. This pressor response was completely abolished by vestibular lesion, suggesting that the GVS-induced response was mediated by the vestibular system. The pressor response to microgravity (35 +/- 3 mmHg) was significantly reduced by simultaneously applied GVS (19 +/- 1 mmHg), and pressor response to 3-G load was also significantly reduced by GVS. However, GVS had no effect on air jet-induced pressor response. The effects of GVS on pressor response to gravitational change were qualitatively and quantitatively similar to that caused by the vestibular lesion, effects of which were demonstrated in our previous studies (Gotoh TM, Fujiki N, Matsuda T, Gao S, Morita H. Am J Physiol Regul Integr Comp Physiol 286: R25-R30, 2004; Matsuda T, Gotoh TM, Tanaka K, Gao S, Morita H. Brain Res 1028: 140-147, 2004; Tanaka K, Gotoh TM, Awazu C, Morita H. Neurosci Lett 397: 40-43, 2006). These results indicate that GVS reduced the vestibular-mediated pressor response to gravitational change but has no effect on the non-vestibular-mediated pressor response. Thus GVS might be employed for the acute interruption of the AP response to gravitational change.     

Vestibular and somatosensory interaction during recovery of balance instability after spaceflight

The aim of our contribution was to characterize vestibular and somatosensory influence on human balance recovery during readaptation to the earth conditions after spaceflight. We tested how post-spaceflight postural reactions to galvanic stimulus (related to vestibular input) and to vibration of the lower leg muscles (somatosensory input) were changed.     

Galvanic vestibular stimulation improves the results of vestibular rehabilitation

Here, we present findings from a three-step investigation of the effect of galvanic vestibular stimulation (GVS) in normal subjects and in subjects undergoing vestibular rehabilitation (VR). In an initial study, we examined the body sway of 10 normal subjects after one minute of 2 mA GVS. The effect of the stimulation lasted for at least 20 minutes in all subjects and up to two hours in 70% of the subjects. We then compared a group of patients who received conventional VR (40 patients) with a group that received a combination of VR and GVS. Results suggest a significant improvement in the second group. Finally, we attempted to establish the optimal number of GVS sessions and to rule out a placebo effect. Fifteen patients received "systematic" GVS: five sessions, once a week. Five patients received "nonsystematic" galvanic stimulation in a sham protocol, which included two stimulations of the clavicle. These data were analyzed with Fisher's exact test and indicated that the best results were obtained after three sessions of GVS and no placebo effect was observed.     

Human motoneuron firing behavior and single motor unit F-wave

In motor control studies, the F-wave (a recurrent discharge evoked by an axonal antidromic volley) widely used for obtaining information on motoneuron pool behavior. However, such F-wave using is a matter of discussion and still has been not validated experimentally. The aim of the present study was investigation of F-wave properties of single firing motor units (MUs) in healthy humans, the properties, which could give evidence for F-wave origin in motoneuron soma and, therefore, could be used for estimation of a relation between MU firing and motoneuron firing behavior. In total, 91 MUs in five muscles of six healthy subjects, during gentle voluntary contractions, were studied. Peri-stimulus time histograms of single MUs were plotted. None of them revealed statistically significant increasing in MU firing probability at the F-wave latency. Analysis of relationships between characteristics of motoneuron firing behavior (mean firing frequency and target interspike interval duration) and properties of F-waves showed their independence. At the same time, it was found that F-waves were recorded in MUs, whose axons possessed the marked supernormal period in excitability recovery cycle after a discharge. Thus, the present results are in contrast to that which should be expected if the F-wave originated in the motoneuronal soma and could provide evidence for motoneuron firing behavior.     

Responses of Hoffman-reflex in human soleus to gravity and/or fluid shift

Responses of Hoffman (H)-reflex in human soleus to changes in the levels of gravity, activities of skeletal muscles, and/or fluid distribution of lower limbs during the parabolic flight of a jet airplane and/or using a tilting table were studied. The time interval between the electrical stimulation and the appearance of either M- or H-wave and the amplitude of M-wave were not influenced by the changes in gravity and fluid distribution levels. However, the H-wave amplitude was increased when the subjects were exposed to microgravity (microgravity-G). Hypergravity at 1.5- or 2-G had no effect on the H-wave amplitude. The H-reflex had no relation with the changes of electromyogram activities of skeletal muscles and fluid volume in lower limbs. Further, the H-wave amplitude was even decreased insignificantly when the distribution of lower limb fluid was reduced at head-down position on the table. It is suggested that an acute exposure to microgravity-G increases the excitability of soleus motor pool, but the mechanism is still unclear.     

Dependence of the Magnitude of Postural Reactions in Humans on the Strength of Unilateral Galvanic Anodal and Cathodal Vestibular Stimulations

In 13 healthy volunteers, we recorded stabilographic postural reactions (side inclinations of the body) to unilateral galvanic vestibular stimulation (GVS) by rectangular current pulses (4 sec long, 2, 3, 4, 5, or 6 mA). For the cathodal GVS, the dependence of the magnitude of reaction was linear within this range. The corresponding dependence for the anodal GVS was close to linear at small currents, but the increment of the magnitude became smaller with further increase in the stimulation intensity, and a plateau was formed. A significant divergence between the two curves was observed with stimulation currents 4 mA and higher. This difference can be explained considering modern concepts on the mechanism of GVS-induced effects (an increase or a decrease in the level of tonic impulsation in fibers of the vestibular nerve under the influence of polarization). Anodal GVS continues to suppress tonic activity up to the moment where all GVS-sensitive vestibular afferents stop to generate impulses; a further increase in the intensity of hyperpolarizing current is not accompanied by a decrease in the activity in the vestibular nerve and, consequently, by an increase in the magnitude of postural reactions. The tested approach can be used for qualitative estimation of the vestibular tone in humans. Neirofiziologiya/Neurophysiology, Vol. 37, No. 2, pp. 169–176, March–April, 2005.     

Oro-facial muscles: internal structure,function and ageing

Structure and function are reviewed in the masticatory muscles and in the muscles of the lower face and tongue. The enormous strength of jaw closure is in large part due to the pinnated arrangement of the muscle fibres in the masseter. This muscle, like other masticatory muscles, is unusual in that the cell bodies of the muscle spindle afferents lie in the brain stem rather than in an external ganglion; spindles are absent in the lower facial muscles. Although few data are available, the numbers of motor units in the masticatory muscles, and probably in the lower facial muscles also, appear to he much greater than in limb muscles. The motor units in the facial and tongue muscles are largely composed of histochemical type II (‘fast-twitch’) fibres, but in the masticatory muscles there are substantial numbers of fibres intermediate between type I (‘slow twitch’) and type II, and fibre type grouping is present. In comparison with limb muscles, there is little information on ageing changes in oro-facial muscles. The masticatory muscles do, however, show some atrophy and loss of X-ray density, while motor unit twitches are prolonged. Strength is reduced in the tongue and masticatory muscles. It is known that limb muscle properties are largely governed by their innervation, both through the pattern and amount of impulse activity, and the delivery of trophic messengers; the situation for oro-facial muscles is unclear. The structural and functional differences between the two types of muscle indicate the need for conducting ageing studies on the oro-facial muscles, rather than relying on extrapolations from limb muscles.     

Short- and long-term effects of ciliary neurotrophic factor on androgen-sensitive motoneurons in the lumbar spinal cord

Motoneuron death in the spinal nucleus of the bulbocavernosus (SNB) and the dorsolateral nucleus (DLN) of the lumbar spinal cord is androgen regulated. As a result, many more SNB and DLN motoneurons die in perinatal female rats than in males, whereas treatment of newborn females with androgen results in a permanent sparing of the motoneurons and their target muscles. We previously observed that a neurotrophic molecule, ciliary neurotrophic factor (CNTF), also arrests the death of SNB motoneurons and their target musculature, at least in the short term. The present study compares the short- and long-term consequences of perinatal CNTF treatment on motoneuron number in the SNB, the DLN, and the retrodorsolateral nucleus (RDLN), a motor pool in the lower lumbar cord that does not exhibit hormone-regulated cell death. Female pups were treated with CNTF or vehicle alone from embryonic day 22 through postnatal day 6 (P6). Motoneuron number in each nucleus was then determined immediately after treatment on P7, or 10 weeks later (P77). CNTF treatment significantly elevated motoneuron number in the SNB and DLN on P7; the volume of SNB target muscles on P7 was also greater in the CNTF-treated group. These effects were transient, however, as motoneuron number and ratings of muscle size were not different in CNTF- and vehicle-treated females on P77. Perinatal CNTF treatment did not alter cell number in the RDLN at either age. The finding that effects of CNTF on SNB and DLN motoneuron number are short lived contrasts with the permanent effects of early androgen treatment, and has implications for molecular models of the actions of androgen and neurotrophic factors on the developing spinal cord. © 1996 John Wiley & Sons, Inc.     

Normal gait is differentially influenced by the otoliths

Postural control depends on the integration of vestibular, somatosensory and visual orientation signals. The otolith contribution to postural control is achieved by the integration of otolith inputs and peripheral afferent inputs involved in crossed reflex pathways. This study shows that a functional linkage between otolith signals and activity in lower limb muscles is detectable in normal human gait. The otolith input appears to dominate particularly the neck proprioceptive and gaze motor influences during normal gait. This is demonstrated by an increase of tibialis anterior muscle activity during retroflexion of the head/neck, leading to an increased stability and counteracting possible perturbations. It is also shown by decrease of coordination during the movement caused by larger displacement of the centre of gravity demonstrated in vector diagrams.     

Increased Muscle Activation Following Motor Imagery During the Rehabilitation of the Anterior Cruciate Ligament

Motor imagery (MI) is the mental representation of an action without any concomitant movement. MI has been used frequently after peripheral injuries to decrease pain and facilitate rehabilitation. However, little is known about the effects of MI on muscle activation underlying the motor recovery. This study aimed to assess the therapeutic effects of MI on the activation of lower limb muscles, as well as on the time course of functional recovery and pain after surgery of the anterior cruciate ligament (ACL). Twelve patients with a torn ACL were randomly assigned to a MI or control group, who both received a series of physiotherapy. Electromyographic activity of the quadriceps, pain, anthropometrical data, and lower limb motor ability were measured throughout a 12-session therapy. The data provided evidence that MI elicited greater muscle activation, even though imagery practice did not result in pain decrease. Muscle activation increase might originate from a redistribution of the central neuronal activity, as there was no anthropometric change in lower limb muscles after imagery practice. This study confirmed the effectiveness of integrating MI in a rehabilitation process by facilitating muscular properties recovery following motor impairment. MI may thus be considered a reliable adjunct therapy to help injured patients to recover motor functions after reconstructive surgery of ACL.     

Simulation system of spinal cord motor nuclei and associated nerves and muscles,in a Web-based architecture

A Web-based simulation system of the spinal cord circuitry responsible for muscle control is described. The simulator employs two-compartment motoneuron models for S, FR and FF types, with synaptic inputs acting through conductance variations. Four motoneuron pools with their associated interneurons are represented in the simulator, with the possibility of inclusion of more than 2,000 neurons and 2,000,000 synapses. Each motoneuron action potential is followed, after a conduction delay, by a motor unit potential and a motor unit twitch. The sums of all motor unit potentials and twitches result in the electromyogram (EMG), and the muscle force, respectively. Inputs to the motoneuron pool come from populations of interneurons (Ia reciprocal inhibitory interneurons, Ib interneurons, and Renshaw cells) and from stochastic point processes associated with descending tracts. To simulate human electrophysiological experiments, the simulator incorporates external nerve stimulation with orthodromic and antidromic propagation. This provides the mechanisms for reflex generation and activation of spinal neuronal circuits that modulate the activity of another motoneuron pool (e.g., by reciprocal inhibition). The generation of the H-reflex by the Ia-motoneuron pool system and its modulation by spinal cord interneurons is included in the simulation system. Studies with the simulator may include the statistics of individual motoneuron or interneuron spike trains or the collective effect of a motor nucleus on the dynamics of muscle force control. Properties associated with motor-unit recruitment, motor-unit synchronization, recurrent inhibition and reciprocal inhibition may be investigated.