Electrical Vestibular Stimulation after Vestibular Deafferentation and in Vestibular Schwannoma

Background

Vestibular reflexes, evoked by human electrical (galvanic) vestibular stimulation (EVS), are utilized to assess vestibular function and investigate its pathways. Our study aimed to investigate the electrically-evoked vestibulo-ocular reflex (eVOR) output after bilateral and unilateral vestibular deafferentations to determine the characteristics for interpreting unilateral lesions such as vestibular schwannomas.

Methods

EVOR was recorded with dual-search coils as binocular three-dimensional eye movements evoked by bipolar 100 ms-step at EVS intensities of [0.9, 2.5, 5.0, 7.5, 10.0]mA and unipolar 100 ms-step at 5 mA EVS intensity. Five bilateral vestibular deafferented (BVD), 12 unilateral vestibular deafferented (UVD), four unilateral vestibular schwannoma (UVS) patients and 17 healthy subjects were tested with bipolar EVS, and five UVDs with unipolar EVS.

Results

After BVD, bipolar EVS elicited no eVOR. After UVD, bipolar EVS of one functioning ear elicited bidirectional, excitatory eVOR to cathodal EVS with 9 ms latency and inhibitory eVOR to anodal EVS, opposite in direction, at half the amplitude with 12 ms latency, exhibiting an excitatory-inhibitory asymmetry. The eVOR patterns from UVS were consistent with responses from UVD confirming the vestibular loss on the lesion side. Unexpectedly, unipolar EVS of the UVD ear, instead of absent response, evoked one-third the bipolar eVOR while unipolar EVS of the functioning ear evoked half the bipolar response.

Conclusions

The bidirectional eVOR evoked by bipolar EVS from UVD with an excitatory-inhibitory asymmetry and the 3 ms latency difference between normal and lesion side may be useful for detecting vestibular lesions such as UVS. We suggest that current spread could account for the small eVOR to 5 mA unipolar EVS of the UVD ear.     

Benefit of Bi-Ocular Visual Stimulation for Postural Control in Children with Strabismus

Vision is important for postural control as is shown by the Romberg quotient (RQ): with eyes closed, postural instability increases relative to eyes open (RQ = 2). Yet while fixating at far distance, postural stability is similar with eyes open and eyes closed (RQ = 1). Postural stability can be better with both eyes viewing than one eye, but such effect is not consistent among healthy subjects. The first goal of the study is to test the RQ as a function of distance for children with convergent versus divergent strabismus. The second goal is to test whether vision from two eyes relative to vision from one eye provides better postural stability. Thirteen children with divergent strabismus and eleven with convergent strabismus participated in this study. Posturtography was done with the Techno concept device. Experiment 1, four conditions: fixation at 40 cm and at 200 cm both with eyes open and eyes covered (evaluation of RQ). Experiment 2, six conditions: fixation at 40 cm and at 200 cm, with both eyes viewing or under monocular vision (dominant and non-dominant eye). For convergent strabismus, the groups mean value of RQ was 1.3 at near and 0.94 at far distance; for divergent, it was 1.06 at near and 1.68 at far. For all children, the surface of body sway was significantly smaller under both eyes viewing than monocular viewing (either eye). Increased RQ value at near for convergent and at far for divergent strabismus is attributed to the influence of the default strabismus angle and to better use of ocular motor signals. Vision with the two eyes improves postural control for both viewing distances and for both types of strabismus. Such benefit can be due to complementary mechanisms: larger visual field, better quality of fixation and vergence angle due to the use of visual inputs from both eyes.     

Adaptational Modifications of the Vestibular Postural Response in Humans under Conditions of Horizontal Visual Reversal

In healthy volunteers, we recorded stabilograms and studied postural responses evoked by galvanic stimulation of the labyrinth (binaurally applied 1-mA current, 4 sec) with the subjects' eyes open and closed and under conditions of reversed visual perception. Horizontal reversal of the visual space was provided by using spectacles with the Dove's prisms. In series consisting of 10 sequential tests with eyes open, we observed a gradual drop in the response amplitude, while there were practically no changes in the maximum velocity of the displacement. Postural responses with eyes closed were considerably greater than those with eyes open, but their amplitude and velocity demonstrated no changes with sequential tests. Under conditions of reversal of the visual perception, both the amplitude and maximum velocity of the postural responses decreased with successive testing. Under the above conditions, at the beginning of a test series responses to vestibular stimulation were greater than those with eyes closed, but in repeated tests they decreased and attained the same magnitude as in the tests with eyes closed. Therefore, the effect of short-term adaptation to visual reversal on the system controlling vertical posture resulted in simple rejection of the information coming via the visual input. In another experimental mode, we studied the adaptation effects at longer (3 h long) visual reversal. Postural responses to galvanic stimulation of the labyrinth (monaurally applied, 2-mA current, 4 sec) were tested with 1-h-long intervals; tests with visual reversal and with eyes closed were made in a random order with each other. A 3-h-long interval with the prismatic spectacles on did not modify the amplitude and velocity of the vestibular postural responses when the tests were made with the eyes closed. When the tests were performed with the eyes open, but in the inverting spectacles, postural responses significantly decreased (by about 50-60%) to the 2nd and 3rd h of the experiment. Such selective suppression of the vestibular input under conditions of visual reversal can be interpreted as a result of adaptational transformation of the visual-vestibular relation directed toward minimization of the visual-vestibular conflict.     

Effects of Near-Threshold Stimulation of the Vestibular Apparatus on Postural Responses Evoked by Displacements of the Visualized Surrounding

In healthy subjects in the relaxed upward stance and perceiving a virtual visual environment (VVE), we recorded postural reactions to isolated visual and vestibular stimulations or their combinations. Lateral displacements of the visualized virtual scene were used as visual stimuli. The vestibular apparatus was stimulated by application of near-threshold galvanic current pulses to the proc. mastoidei of the temporal bones. Isolated VVE shifts evoked mild, nonetheless clear, body tilts readily distinguished in separate trials; at the same time, postural effects of isolated vestibular stimulation could be detected only after averaging of several trials synchronized with respect to the beginning of stimulation. Under conditions of simultaneous combined presentation of visual and vestibular stimuli, the direction of the resulting postural responses always corresponded to the direction of responses induced by VVE shifts. The contribution of an afferent volley from the vestibular organ depended on the coincidence/mismatch of the direction of motor response evoked by such a volley with the direction of response to visual stimulation. When both types of stimulations evoked unidirectional body tilts, postural responses were facilitated, and the resulting effect was greater than that of simple summation of the reactions to isolated actions of the above stimuli. In the case where isolated galvanic stimulation evoked a response opposite with respect to that induced by visual stimulation, the combined action of these stimuli of different modalities evoked postural responses identical in their magnitude, direction, and shape to those evoked by isolated visual stimulation. The above findings allow us to conclude that the effects of visual afferent input on the vertical posture under conditions of our experiments clearly dominate. In general, these results confirm the statement that neuronal structures involved in integrative processing of different afferent volleys preferably select certain type of afferentation carrying more significant or more detailed information on displacements (including oscillations) of the body in space.     

Head Movements Evoked in Alert Rhesus Monkey by Vestibular Prosthesis Stimulation: Implications for Postural and Gaze Stabilization

The vestibular system detects motion of the head in space and in turn generates reflexes that are vital for our daily activities. The eye movements produced by the vestibulo-ocular reflex (VOR) play an essential role in stabilizing the visual axis (gaze), while vestibulo-spinal reflexes ensure the maintenance of head and body posture. The neuronal pathways from the vestibular periphery to the cervical spinal cord potentially serve a dual role, since they function to stabilize the head relative to inertial space and could thus contribute to gaze (eye-in-head + head-in-space) and posture stabilization. To date, however, the functional significance of vestibular-neck pathways in alert primates remains a matter of debate. Here we used a vestibular prosthesis to 1) quantify vestibularly-driven head movements in primates, and 2) assess whether these evoked head movements make a significant contribution to gaze as well as postural stabilization. We stimulated electrodes implanted in the horizontal semicircular canal of alert rhesus monkeys, and measured the head and eye movements evoked during a 100ms time period for which the contribution of longer latency voluntary inputs to the neck would be minimal. Our results show that prosthetic stimulation evoked significant head movements with latencies consistent with known vestibulo-spinal pathways. Furthermore, while the evoked head movements were substantially smaller than the coincidently evoked eye movements, they made a significant contribution to gaze stabilization, complementing the VOR to ensure that the appropriate gaze response is achieved. We speculate that analogous compensatory head movements will be evoked when implanted prosthetic devices are transitioned to human patients.     

Human Postural Responses to Vibratory Stimulation of Calf Muscles under Conditions of Visual Inversion

The authors studied postural responses to bilateral vibratory stimulation (70 Hz, 1 mm, 2 s) of the calf triceps proprioceptors or anterior tibial muscles. Anteroposterior body tilts evoked by vibration were recorded by stabilography. The authors compared the values of postural responses under various conditions of visual control, namely, with normal vision, eyes closed, right–left inversion of the visual space by prismatic spectacles, central vision, and diffuse light. Visual inversion influenced the subjects' proprioceptive postural responses. The amplitude of vibration-evoked shifts of the feet pressure center was minimal with eyes open and significantly increased with eyes closed and inverted vision. Postural responses with visual inversion were significantly stronger than with eyes closed. Since inversion spectacles enabled a subject to see only the central part of the visual field (20°), the reference point was the condition of central vision, i.e., spectacles with same visual angle and without prisms. Postural responses were significantly weaker under these conditions than with visual inversion and eyes closed. Visual field inversion by prismatic spectacles made it impossible to use visual information for stabilizing the human upright posture and, moreover, destabized it. True, this holds only for a randomized experimental protocol, which prevents adaptation to prisms.     

前庭电刺激联合前庭康复治疗周围性眩晕的疗效观察

目的：观察前庭电刺激联合前庭康复治疗周围性眩晕的疗效。方法：在常规药物治疗基础上将2008年5月．2012年5月我科眩晕门诊收治的226例诊断明确的单侧前庭周围性眩晕患者随机分成两组：前庭康复组和前庭康复＋前庭电刺激组。前庭康复组行常规前庭康复治疗,前庭康复＋前庭电刺激组在药物治疗及前庭康复基础上加用前庭电刺激,即在双侧乳突采取双极直流电刺激,每次15-20分钟,每天2次,共6周。治疗前及治疗后第2、4、6周行BBS评分及计时平衡试验时间测定以评判和比较两组的疗效。结果：两组患者治疗后第2、4、6周BBS评分及计时平衡试验时间较治疗前均明显增加（P〈0．05）,且B组各时点BBS评分及计时平衡试验时间均明显高于A组（P〈0．05）。结论：前庭电刺激联合前庭康复是较单纯前庭康复治疗前庭周围性眩晕更加有效的方法,其简单、无创、值得推广。     

The Optokinetic Response as a Quantitative Measure of Visual Acuity in Zebrafish

Zebrafish are a proven model for vision research, however many of the earlier methods generally focused on larval fish or demonstrated a simple response. More recently adult visual behavior in zebrafish has become of interest, but methods to measure specific responses are new coming. To address this gap, we set out to develop a methodology to repeatedly and accurately utilize the optokinetic response (OKR) to measure visual acuity in adult zebrafish. Here we show that the adult zebrafish''s visual acuity can be measured, including both binocular and monocular acuities. Because the fish is not harmed during the procedure, the visual acuity can be measured and compared over short or long periods of time. The visual acuity measurements described here can also be done quickly allowing for high throughput and for additional visual procedures if desired. This type of analysis is conducive to drug intervention studies or investigations of disease progression.     

The Effect of Visual Stimulation on GABA and Macromolecule Levels in the Human Brain in vivo

Biophysics - Abstract—Gamma-aminobutyric acid (GABA) is the main inhibitory neurotransmitter in the brain; it plays an important role in various types of synaptic plasticity and...     

Postural Responses Evoked by Vibrational Stimulation of the Shin Muscles under Conditions of Virtual Visual Environment

We studied the effects of unexpected shifts of the visually perceived artificial surroundings (virtual visual environment, VVE) on postural reactions evoked by vibrational stimulation of proprioceptors of the shin muscles; tests were performed in a standing position of the subject. The VVE possessed two planes, a mobile foreground, whose displacements correlated with oscillations of the body, and a stationary background. The subjects were asked to use the latter as a reference system in corrections of the posture. The VVE parameters were controlled by a computer; shifts of the VVE foreground were combined with similar, in their duration and profile, stimulation-evoked displacements of the body. Despite the fact that the subjects had a possibility to use the stationary background as the reference system, the magnitudes of the evoked postural responses under conditions of perception of the VVE significantly exceeded the respective magnitudes upon standing with the eyes open in front of a completely stationary visual image. Postural responses progressively increased with increases in relative values of the shifts of the VVE foreground but always remained smaller than the responses under conditions of testing with the eyes closed. Augmentation of the postural responses at a synphase pattern of interrelations between the body movements and VVE shifts was more significant than at antiphase relations. Thus, shifts of the VVE foreground, on the one hand, destabilized the maintenance of the vertical posture, which resulted in intensification of the postural responses. On the other hand, such shifts allowed the subject to use them as feedback signals and to modulate the magnitude of postural responses when there was a change in the direction of interrelations between the body movements and the perceived visual image.     

Effect of Chlorprothixene in Patients with Paranoid Symptoms

Chlorprothixene, a thioxanthine derivative, claimed to have broad-spectrum antipsychotic properties, was compared with phenothiazine derivatives in the setting of a psychiatric admission service and aftercare clinic.In 32 female patients with paranoid symptoms, chlorprothixene in high dosage ranges (200 to 1200 mg. daily) was found to be as effective as similar doses of chlorpromazine in controlling the symptoms; fewer side effects were noted.     

Reliability-Based Weighting of Visual and Vestibular Cues in Displacement Estimation

When navigating through the environment, our brain needs to infer how far we move and in which direction we are heading. In this estimation process, the brain may rely on multiple sensory modalities, including the visual and vestibular systems. Previous research has mainly focused on heading estimation, showing that sensory cues are combined by weighting them in proportion to their reliability, consistent with statistically optimal integration. But while heading estimation could improve with the ongoing motion, due to the constant flow of information, the estimate of how far we move requires the integration of sensory information across the whole displacement. In this study, we investigate whether the brain optimally combines visual and vestibular information during a displacement estimation task, even if their reliability varies from trial to trial. Participants were seated on a linear sled, immersed in a stereoscopic virtual reality environment. They were subjected to a passive linear motion involving visual and vestibular cues with different levels of visual coherence to change relative cue reliability and with cue discrepancies to test relative cue weighting. Participants performed a two-interval two-alternative forced-choice task, indicating which of two sequentially perceived displacements was larger. Our results show that humans adapt their weighting of visual and vestibular information from trial to trial in proportion to their reliability. These results provide evidence that humans optimally integrate visual and vestibular information in order to estimate their body displacement.     

The Role of Cervical and Ocular Vestibular Evoked Myogenic Potentials in the Assessment of Patients with Vestibular Schwannomas

Objectives

To investigate the clinical utility of VEMPs in patients suffering from unilateral vestibular schwannoma (VS) and to determine the optimal stimulation parameter (air conducted sound, bone conducted vibration) for evaluating the function of the vestibular nerve.

Methods

Data were obtained in 63 patients with non-operated VS, and 20 patients operated on VS. Vestibular function was assessed by caloric, cervical and ocular VEMP testing. 37/63 patients with conclusive ACS ocular VEMPs responses were studied separately.

Results

In the 63 non-operated VS patients, cVEMPs were abnormal in 65.1% of patients in response to AC STB and in 49.2% of patients to AC clicks. In the 37/63 patients with positive responses from the unaffected side, oVEMPs were abnormal in 75.7% of patients with ACS, in 67.6% with AFz and in 56.8% with mastoid BCV stimulation. In 16% of the patients, VEMPs were the only abnormal test (normal caloric and normal hearing). Among the 26 patients who did not show oVEMP responses on either side with ACS, oVEMPs responses could be obtained with AFz (50%) and with mastoid stimulation (89%).

Conclusions

The VEMP test demonstrated significant clinical value as it yielded the only abnormal test results in some patients suffering from a unilateral vestibular schwannoma. For oVEMPs, we suggest that ACS stimulation should be the initial test. In patients who responded to ACS and who had normal responses, BCV was not required. In patients with abnormal responses on the affected side using ACS, BCV at AFz should be used to confirm abnormal function of the superior vestibular nerve. In patients who exhibited no responses on either side to ACS, BCV was the only approach allowing assessment of the function of the superior vestibular nerve. We favor using AFz stimulation first because it is easier to perform in clinical practice than mastoid stimulation.     

Subjective Visual Vertical and Postural Capability in Children Born Prematurely

Purpose

We compared postural stability and subjective visual vertical performance in a group of very preterm-born children aged 3-4 years and in a group of age-matched full-term children.

Materials and Methods

A platform (from TechnoConcept) was used to measure postural control in children. Perception of subjective visual vertical was also recorded with posture while the child had to adjust the vertical in the dark or with visual perturbation. Two other conditions (control conditions) were also recorded while the child was on the platform: for a fixation of the vertical bar, and in eyes closed condition.

Results

Postural performance was poor in preterm-born children compared to that of age-matched full-term children: the surface area, the length in medio-lateral direction and the mean speed of the center of pressure (CoP) were significantly larger in the preterm-born children group (p < 0.04, p < 0.01, and p < 0.04, respectively). Dual task in both groups of children significantly affected postural control. The subjective visual vertical (SVV) values were more variable and less precise in preterm-born children.

Discussion-Conclusions

We suggest that poor postural control as well as perception of verticality observed in preterm-born children could be due to immaturity of the cortical processes involved in the motor control and in the treatment of perception and orientation of verticality.     

The Effect of 10 Hz Repetitive Transcranial Magnetic Stimulation of Posterior Parietal Cortex on Visual Attention

Repetitive transcranial magnetic stimulation (rTMS) of the posterior parietal cortex (PPC) at frequencies lower than 5 Hz transiently inhibits the stimulated area. In healthy participants, such a protocol can induce a transient attentional bias to the visual hemifield ipsilateral to the stimulated hemisphere. This bias might be due to a relatively less active stimulated hemisphere and a relatively more active unstimulated hemisphere. In a previous study, Jin and Hilgetag (2008) tried to switch the attention bias from the hemifield ipsilateral to the hemifield contralateral to the stimulated hemisphere by applying high frequency rTMS. High frequency rTMS has been shown to excite, rather than inhibit, the stimulated brain area. However, the bias to the ipsilateral hemifield was still present. The participants’ performance decreased when stimuli were presented in the hemifield contralateral to the stimulation site. In the present study we tested if this unexpected result was related to the fact that participants were passively resting during stimulation rather than performing a task. Using a fully crossed factorial design, we compared the effects of high frequency rTMS applied during a visual detection task and high frequency rTMS during passive rest on the subsequent offline performance in the same detection task. Our results were mixed. After sham stimulation, performance was better after rest than after task. After active 10 Hz rTMS, participants’ performance was overall better after task than after rest. However, this effect did not reach statistical significance. The comparison of performance after rTMS with task and performance after sham stimulation with task showed that 10 Hz stimulation significantly improved performance in the whole visual field. Thus, although we found a trend to better performance after rTMS with task than after rTMS during rest, we could not reject the hypothesis that high frequency rTMS with task and high frequency rTMS during rest equally affect performance.     

Direction Specific Biases in Human Visual and Vestibular Heading Perception

Heading direction is determined from visual and vestibular cues. Both sensory modalities have been shown to have better direction discrimination for headings near straight ahead. Previous studies of visual heading estimation have not used the full range of stimuli, and vestibular heading estimation has not previously been reported. The current experiments measure human heading estimation in the horizontal plane to vestibular, visual, and spoken stimuli. The vestibular and visual tasks involved 16 cm of platform or visual motion. The spoken stimulus was a voice command speaking a heading angle. All conditions demonstrated direction dependent biases in perceived headings such that biases increased with headings further from the fore-aft axis. The bias was larger with the visual stimulus when compared with the vestibular stimulus in all 10 subjects. For the visual and vestibular tasks precision was best for headings near fore-aft. The spoken headings had the least bias, and the variation in precision was less dependent on direction. In a separate experiment when headings were limited to ±45°, the biases were much less, demonstrating the range of headings influences perception. There was a strong and highly significant correlation between the bias curves for visual and spoken stimuli in every subject. The correlation between visual-vestibular and vestibular-spoken biases were weaker but remained significant. The observed biases in both visual and vestibular heading perception qualitatively resembled predictions of a recent population vector decoder model (Gu et al., 2010) based on the known distribution of neuronal sensitivities.     

模拟飞行任务负荷对人体姿势控制的影响

目的:研究在机体不同站立姿势下,模拟飞行任务负荷对姿势控制能力的影响,并初步总结其变化规律。方法:从某航空院校学员中随机抽取30名,要求其持续进行4小时的模拟飞行任务负荷,并同时在0 h、1 h、2 h、3 h与4 h时,测试4种不同站立姿势下的静态立位平衡参数,比较不同姿势晃动的变化规律。结果:随着模拟飞行任务的持续,4种站立姿势下,被试的立位平衡能力发生了不同程度的变化,并呈现出一定的变化趋势。其中睁眼站立于脚垫上的姿势晃动程度变化最明显,并有重心前倾的趋势;另外,在暴露于飞行任务负荷下,机体视觉信息通道的关闭有可能激发视觉、前庭、本体与肌肉控制等系统对平衡维持能力的代偿性增强作用,而下肢本体感觉信息的阻碍又同时会损坏视觉、前庭、本体等系统对立位平衡能力的控制作用。结论:模拟飞行任务负荷下,机体的姿势晃动会呈现一定的变化规律,即身体可能会代偿性的向前倾斜,来维持身体的立位平衡状态。同时,视觉通道与下肢本体感觉通道对任务负荷条件下立位平衡功能的代偿能力发挥不同的作用。这种变化规律的初步阐述对我们下一步的立位平衡与飞行疲劳评估的研究打下一定的理论基础。     

Altered Visual and Feet Proprioceptive Feedbacks during Quiet Standing Increase Postural Sway in Patients with Severe Knee Osteoarthritis

Objective

The objective was to investigate how postural control in knee osteoarthritis (KOA) patients, with different structural severities and pain levels, is reorganized under different sensory conditions.

Methods

Forty-two obese patients (BMI range from 30.1 to 48.7 kg*m⁻², age range from 50 to 74 years) with KOA were evaluated. One minute of quiet standing was assessed on a force platform during 4 different sensory conditions, applied 3 times at random: Eyes open (EO) and eyes closed (EC) standing on firm and soft (foam) surfaces (EO-soft and EC-soft). Centre of pressure (Cop) standard deviation, speed, range and Cop mean position in both directions (anterior-posterior and medial-lateral) were extracted from the force platform data. Structural disease severity was assessed from semiflexed standing radiographs and graded by the Kellgren and Lawrence (KL) score. Pain intensity immediately before the measurements was assessed by numeric rating scale (range: 0–10).

Results

The patients were divided into “less severe” (KL 1 and 2, n = 24) and “severe” (KL>2, n = 18) group. The CoP range in the medial-lateral direction was larger in the severe group when compared with the less severe group during EC-soft condition (P<0.01). Positive correlation between pain intensity and postural sway (range in medial-lateral direction) was found during EC condition, indicating that the higher the pain intensity, the less effective is the postural control applied to restore an equilibrium position while standing without visual information.

Conclusion

The results support that: (i) the postural reorganization under manipulation of the different sensory information is worse in obese KOA patients with severe degeneration and/or high pain intensity when compared with less impaired patients, and (ii) higher pain intensity is related to worse body balance in obese KOA patients.