Action-perception coupling in kinesthesia: a new approach

According to recent findings, intentional motor actions are controlled by resetting the referent position, R, at which neuromuscular elements, including reflexes, begin to act. It is suggested that somatosensory afferents inform the brain about the deviation (P) of body segments from the centrally set referent position. To perceive the actual position (Q) of body segments and form the position sense (PS), the central and afferent signals are combined: Q=R+P. In previous studies, the R has been shown to remain invariant during involuntary changes in the wrist position elicited by sudden unloading of muscles, suggesting that only the afferent component is responsible for the PS during this reflex. In contrast, the central PS component, R, is predominantly responsible for PS during intentional motion in isotonic conditions. We tested the hypothesis that the R and P are interchangeable PS components such that involuntary changes in wrist position elicited by the unloading reflex can easily be reproduced by making intentional changes in wrist position in isotonic conditions, in the absence of vision. The PS rule also suggests that PS is independent of sense of effort, which was tested by asking subjects to reproduce elbow joint angles under different constant loads. We also tested the hypothesis that tendon vibration may elicit motion that may not be perceived by subjects (no-motion illusion). These hypotheses were confirmed in three experiments. It is concluded that the R and P are additive components of PS and that, contrary to the conventional view, PS is independent of the sense of effort or efference copy. The PS rule also explains kinesthetic illusions and the phantom limb phenomenon. This study advances the understanding of action-perception coupling in kinesthesia.

Effects of walking speed on gait stability and interlimb coordination in younger and older adults

Many falls in older adults occur during walking following trips. Following a trip, older adults take longer than younger adults to recover steady-state walking. Although faster gait speed may improve interlimb coordination, it may also increase fall risk in older adults. We hypothesized that older adults would take longer than younger adults to recover from an unexpected perturbation during gait especially when walking faster. Twelve younger (26.3 ± 4.4 years) and 12 older adults (68.5 ± 3.4 years) walked at comfortable, faster and slower speeds when movement of the dominant leg was unexpectedly arrested for 250 ms at 20% swing length. Gait stability was evaluated using the short- and longer-term response to perturbation. In both groups, walking faster diminished the occurrence of elevation and increased that of leg lowering. Older adults took longer than younger adults to recover steady-state walking at all speeds (3.36 ± 0.11 vs. 2.89 ± 0.08 strides) but longer-term recovery of gait stability was not related to gait speed. Arm-leg and inter-arm coordination improved with increasing gait speed in both groups, but older adults had weaker inter-leg coupling following perturbation at all speeds. Although both younger and older adults used speed appropriate responses immediately following perturbation, longer duration of recovery of steady-state walking in older adults may increase fall risk in uncontrolled situations, regardless of gait speed. Recovery from perturbation when walking faster was associated with better interlimb coordination, but not with better gait stability. This indicates that interlimb coordination and gait stability may be distinct features of locomotion.

Stretch reflex spatial threshold measure discriminates between spasticity and rigidity

OBJECTIVE

Muscle spasticity following stroke has been shown to result from limitations in the range of regulation of the tonic reflex spatial threshold (ST), i.e., the joint angle at which the stretch reflex begins to act due to descending and segmental influences on motoneurons. The purpose of this study was to determine whether spasticity due to stroke and rigidity due to parkinsonism can be discriminated based on the ST measure.

METHODS

Elbow muscles were stretched at different velocities in healthy, stroke (spasticity) and parkinsonism (rigidity) subjects. The elbow angle at which muscle activation began for each stretch velocity (dynamic ST) and the velocity sensitivity of the ST were measured. Dynamic ST values extrapolated to zero velocity defined the tonic ST.

RESULTS

Compared to healthy subjects, spasticity and rigidity were associated with a decrease in the range of central regulation of tonic STs. STs were hypersensitive in spastic muscles and either hypo- or inversely sensitive to stretch velocity in rigid muscles.

CONCLUSIONS

ST characteristics discriminate between neurological deficits of muscle tone.

SIGNIFICANCE

Results suggest that spasticity and rigidity result from deficits in descending facilitatory control combined with deficits in dynamic fusimotor or/and presynaptic control of Ia inputs to motoneurons.

Reduced gait stability in high-functioning poststroke individuals

Falls during walking are a major cause of poststroke injury, and walking faster may decrease the ability to recover following a gait perturbation. We compared gait stability between high-functioning poststroke individuals and controls and evaluated the effect of gait speed on gait stability. Ten stroke subjects and ten age-matched controls walked on a self-paced treadmill at two speeds (matched/faster). Movement of the nonparetic/dominant leg was arrested unexpectedly at early swing. Poststroke individuals lowered the perturbed leg following perturbation (58% of cases) while controls maintained the leg elevated (49% of cases; P < 0.01). In poststroke individuals, double-support duration was restored later than in controls (4.6 ± 0.8 vs. 3.2 ± 0.3 strides; P < 0.007), and long-term phase shifts of arm and leg movements were larger and less coordinated on the paretic side. A moderate speed increase (~20%) enhanced the incidence of leg lowering in controls but not in stroke subjects. Faster walkers in both groups had a more coordinated response, limited to the nonparetic side in the stroke group. However, faster walkers were not more stable following perturbation. Our results suggest that gait perturbations can target basic control processes and identify neurological locomotor deficits in individuals with fall risk. Central regulation of body translation in space is involved in recovery of steady-state walking. Impaired descending control (stroke) decreases the ability of the motor system to recover from perturbations and regulate interlimb phase relationships, especially when changing gait speed. However, interlimb coordination may not be a major factor in the recovery of gait stability.

Corticospinal control strategies underlying voluntary and involuntary wrist movements

The difference between voluntary and involuntary motor actions has been recognized since ancient times, but the nature of this difference remains unclear. We compared corticospinal influences at wrist positions established before and after voluntary motion with those established before and after involuntary motion elicited by sudden removal of a load (the unloading reflex). To minimize the effect of motoneuronal excitability on the evaluation of corticospinal influences, motor potentials from transcranial magnetic stimulation of the wrist motor cortex area were evoked during an EMG silent period produced by brief muscle shortening. The motoneuronal excitability was thus equalized at different wrist positions. Results showed that the unloading reflex was generated in the presence of a corticospinal drive, rather than autonomously by the spinal cord. Although the tonic EMG levels were substantially different, the corticospinal influences remained the same at the pre- and post-unloading wrist positions. These influences however changed when subjects voluntarily moved the wrist to another position. Previous studies showed that the corticospinal system sets the referent position (R) at which neuromuscular posture-stabilizing mechanisms begin to act. In self-initiated actions, the corticospinal system shifts the R to relay these mechanisms to a new posture, thus converting them from mechanisms resisting to those assisting motion. This solves the classical posture-movement problem. In contrast, by maintaining the R value constant, the corticospinal system relies on these posture-stabilizing mechanisms to allow involuntary responses to occur after unloading. Thus, central control strategies underlying the two types of motor actions are fundamentally different.

Stability of gait and interlimb coordination in older adults

Most falls in older adults occur when walking, specifically following a trip. This study investigated the short- and longer term responses of young (n = 24, 27.6 ± 4.5 yr) and older adults (n = 18, 69.1 ± 4.2 yr) to a trip during gait at comfortable speed and the role of interlimb coordination in recovery from tripping. Subjects walked on a self-paced treadmill when forward movement of their dominant leg was unexpectedly arrested for 250 ms. Recovery of center of mass (COM) movements and of double-support duration following perturbation was determined. In addition, the disruption and recovery of interlimb coordination of the arms and legs was evaluated. Although young and older subjects used similar lower limb strategies in response to the trip, older adults had less stable COM movement patterns before perturbation, had longer transient destabilization (>25%) after perturbation, required more gait cycles to recover double-support duration (older, 3.48 ± 0.7 cycles; young, 2.88 ± 0.4 cycles), and had larger phase shifts that persisted after perturbation (older, -83° to -90°; young, -39° to -42°). Older adults also had larger disruptions to interlimb coordination of the arms and legs. The timing of the initial disruption in coordination was correlated with the disturbance in gait stability only in young adults. In older adults, greater initial COM instability was related to greater longer term arm incoordination. These results suggest a relationship between interlimb coordination and gait stability, which may be associated with fall risk in older adults. Reduced coordination and gait stability suggest a need for stability-related functional training even in high-functioning older adults.

Control of wrist position and muscle relaxation by shifting spatial frames of reference for motoneuronal recruitment: possible involvement of corticospinal pathways

It has previously been established that muscles become active in response to deviations from a threshold (referent) position of the body or its segments, and that intentional motor actions result from central shifts in the referent position. We tested the hypothesis that corticospinal pathways are involved in threshold position control during intentional changes in the wrist position in humans. Subjects moved the wrist from an initial extended to a final flexed position (and vice versa). Passive wrist muscle forces were compensated with a torque motor such that wrist muscle activity was equalized at the two positions. It appeared that motoneuronal excitability tested by brief muscle stretches was also similar at these positions. Responses to mechanical perturbations before and after movement showed that the wrist threshold position was reset when voluntary changes in the joint angle were made. Although the excitability of motoneurons was similar at the two positions, the same transcranial magnetic stimulus (TMS) elicited a wrist extensor jerk in the extension position and a flexor jerk in the flexion position. Extensor motor-evoked potentials (MEPs) elicited by TMS at the wrist extension position were substantially bigger compared to those at the flexion position and vice versa for flexor MEPs. MEPs were substantially reduced when subjects fully relaxed wrist muscles and the wrist was held passively in each position. Results suggest that the corticospinal pathway, possibly with other descending pathways, participates in threshold position control, a process that pre-determines the spatial frame of reference in which the neuromuscular periphery is constrained to work. This control strategy would underlie not only intentional changes in the joint position, but also muscle relaxation. The notion that the motor cortex may control motor actions by shifting spatial frames of reference opens a new avenue in the analysis and understanding of brain function.

Joint coordination during bimanual transport of real and imaginary objects

We studied multi-joint coordination during tasks of transporting real and imaginary objects with two arms. One of the arms was unexpectedly arrested in one-third of trials performed. In the absence of perturbation, multi-joint synergies stabilizing the distance between the arms early and late in the movement were seen in both conditions and even were stronger in the imaginary object condition. However, quick adjustments in the non-perturbed arm were seen only in the real object condition, whereas the non-perturbed arm did not react to the perturbation in the imaginary object condition. We conclude that tactile information is important for the central nervous system to quickly respond to perturbations in bimanual tasks. The results underscore potential differences between stability in the absence of external perturbations that may be ensured by setting a reference aperture between the hands and stability that requires adjustments in this reference aperture following a major perturbation.

The equilibrium-point hypothesis--past, present and future

This chapter is a brief account of fundamentals of the equilibrium-point hypothesis or more adequately called the threshold control theory (TCT). It also compares the TCT with other approaches to motor control. The basic notions of the TCT are reviewed with a major focus on solutions to the problems of multi-muscle and multi-degrees of freedom redundancy. The TCT incorporates cognitive aspects by explaining how neurons recognize that internal (neural) and external (environmental) events match each other. These aspects as well as how motor learning occurs are subjects of further development of the TCT hypothesis.

Virtual reality environments for post-stroke arm rehabilitation

INTRODUCTION

Optimal practice and feedback elements are essential requirements for maximal motor recovery in patients with motor deficits due to central nervous system lesions.

METHODS

A virtual environment (VE) was created that incorporates practice and feedback elements necessary for maximal motor recovery. It permits varied and challenging practice in a motivating environment that provides salient feedback.

RESULTS

The VE gives the user knowledge of results feedback about motor behavior and knowledge of performance feedback about the quality of pointing movements made in a virtual elevator. Movement distances are related to length of body segments.

CONCLUSION

We describe an immersive and interactive experimental protocol developed in a virtual reality environment using the CAREN system. The VE can be used as a training environment for the upper limb in patients with motor impairments.

Vestibular system may provide equivalent motor actions regardless of the number of body segments involved in the task

The vestibulospinal system likely plays an essential role in motor equivalence--the ability to reach the desired motor goal despite intentional or imposed changes in the number of body segments involved in the task. To test this hypothesis, we compared the ability of healthy subjects and patients with unilateral vestibular lesions (surgical acoustic neuroma resection 0.6 to 6.7 yr before the study) to maintain either the same hand position or the same trajectory of within arm reach movements while flexing the trunk, in the absence of vision. In randomly selected trials, the trunk motion was prevented by an electromagnetic device. Healthy subjects were able to preserve the hand position or trajectory by modifying the elbow and shoulder joint rotations in a condition-dependent way, at a minimal latency of about 60 ms after the trunk movement onset. In contrast, six of seven patients showed deficits in the compensatory angular modifications at least in one of two tasks so that 30-100% of the trunk displacement was not compensated and thus influenced the hand position or trajectory. Results suggest that vestibular influences evoked by the head motion during trunk flexion play a major role in maintaining the consistency of arm motor actions in external space despite changes in the number of body segments involved. Our findings also suggest that despite long-term plasticity in the vestibular system and related neural structures, unilateral vestibular lesion may reduce the capacity of the nervous system to achieve motor equivalence.

Threshold position control of arm movement with anticipatory increase in grip force

The grip force holding an object between fingers usually increases before or simultaneously with arm movement thus preventing the object from sliding. We experimentally analyzed and simulated this anticipatory behavior based on the following notions. (1) To move the arm to a new position, the nervous system shifts the threshold position at which arm muscles begin to be recruited. Deviated from their activation thresholds, arm muscles generate activity and forces that tend to minimize this deviation by bringing the arm to a new position. (2) To produce a grip force, with or without arm motion, the nervous system changes the threshold configuration of the hand. This process defines a threshold (referent) aperture (R(a)) of appropriate fingers. The actual aperture (Q(a)) is constrained by the size of the object held between the fingers whereas, in referent position R(a), the fingers virtually penetrate the object. Deviated by the object from their thresholds of activation, hand muscles generate activity and grip forces in proportion to the gap between the Q(a) and R(a). Thus, grip force emerges since the object prevents the fingers from reaching the referent position. (3) From previous experiences, the system knows that objects tend to slide off the fingers when arm movements are made and, to prevent sliding, it starts narrowing the referent aperture simultaneously with or somewhat before the onset of changes in the referent arm position. (4) The interaction between the fingers and the object is accomplished via the elastic pads on the tips of fingers. The pads are compressed not only due to the grip force but also due to the tangential inertial force ("load") acting from the object on the pads along the arm trajectory. Compressed by the load force, the pads move back and forth in the gap between the finger bones and object, thus inevitably changing the normal component of the grip force, in synchrony with and in proportion to the load force. Based on these notions, we simulated experimental elbow movements and grip forces when subjects rapidly changed the elbow angle while holding an object between the index finger and the thumb. It is concluded that the anticipatory increase in the grip force with or without correlation with the tangential load during arm motion can be explained in neurophysiological and biomechanical terms without relying on programming of grip force based on an internal model.

A stretch reflex in extraocular muscles of species purportedly lacking muscle spindles

It is generally assumed that proprioceptive feedback plays a crucial role in limb posture and movement. However, the role of afferent signals from extraocular muscles (EOM) in the control of eye movement has been a matter of continuous debate. These muscles have atypical sensory receptors in several species and it has been proposed that they are not supported by stretch reflexes. We recorded electromyographic activity of EOM during passive rotations of the eye in sedated rats and squirrel monkeys and observed typical stretch reflexes in these muscles. Results suggest that there is a similarity in the reflexive control of limb and eye movement, despite substantial differences in their biomechanics and sensory receptors. Like in some limb skeletal muscles, the stretch reflex in EOM in the investigated species might be mediated by other length-sensitive receptors, rather than muscle spindles.

Conversion of red bone marrow into yellow – Cause and mechanisms

Marrow cavities in all the bones of newborn mammals contain active hematopoietic tissue, known as red bone marrow. From the early postnatal period onwards, the hematopoietic tissue, mainly in the bones of the extremities, is gradually replaced by non-hematopoietic mesenchymal cells that accumulate lipid drops, known as yellow or fatty bone marrow. For its maintenance, hematopoietic tissue depends on the support of special mesenchymal cells in the bone marrow cavity, known as hematopoietic microenvironment. Both bone-forming cells and hematopoietic microenvironment cells have common progenitors - mesenchymal stem cells (MSCs). We hypothesize that: (1) Hematopoietic microenvironment cells advance along a three stage differentiation/maturation pathway. In the first stage, they support hematopoiesis and contain no fat. In the second stage, cells accumulate fat and no longer support steady state hematopoiesis; however, under conditions of increased hematopoietic requirement, they lose fat and regain their ability to support hematopoiesis. In the last stage, hematopoietic microenvironment cells retain the appearance of yellow bone marrow and do not support hematopoiesis regardless of the state of hematopoietic requirement.(2) Since MSCs are bound to endosteal and trabecular surfaces, in tubular bones their number is relatively small, compared to cancellous bones that have much larger areas of internal bone surface. MSCs are exposed to proliferative and differentiative pressures, leading to gradual reduction of their number. Consequently, the MSC population in tubular bones becomes exhausted rather early, and the post-maturation compartment of mesenchymal cells finally consists of unipotential bone precursors maintaining bone tissue and hematopoietic microenvironment advancing towards the last (fatty) stage of differentiation. In contrast, in cancellous bones the relatively large number of MSCs does not suffer exhaustion and continues to provide newly differentiated hematopoietic microenvironment, thus maintaining red bone marrow throughout the organism's life.(3) Osteogenic and hematopoietic microenvironment differentiation pathways compete with each other for their common precursor. During the organism's growth period osteogenic stimuli prevail, while in the post-maturation period, MSC differentiation into hematopoietic microenvironment increases at the expense of differentiation into bone. This results in the reduction of bone volume and expansion of marrow cavities in hematopoietically active cancellous bones, but not in tubular bones already depleted of MSCs and not participating in hematopoiesis. Experimental and clinical data supporting these hypotheses are discussed.

Threshold position control and the principle of minimal interaction in motor actions

The answer to the question of how the nervous system controls multiple muscles and body segments while solving the redundancy problem in choosing a unique action from the set of many possible actions is still a matter of controversy. In an attempt to clarify the answer, we review data showing that motor actions emerge from central resetting of the threshold position of appropriate body segments, i.e. the virtual position at which muscles are silent but deviations from it will elicit activity and resistive forces (threshold position control). The difference between the centrally-set threshold position and the sensory-signaled actual position is responsible for the activation of neuromuscular elements and interactions between them and the environment. These elements tend to diminish the evoked activity and interactions by minimizing the gap between the actual position and the threshold position (the principle of minimal interaction). Threshold control per se does not solve the redundancy problem: it only limits the set of possible actions. The principle of minimal interaction implies that the system relies on the natural capacity of neuromuscular elements to interact between themselves and with the environment to reduce this already restricted set to a unique action, thus solving the redundancy problem in motor control. This theoretical framework appears to be helpful in the explanation of the control and production of a variety of actions (reaching movements, specification of different hand configurations, grip force generation, and whole-body movements such as sit-to-stand or walking). Experimental tests of this theory are provided. The prediction that several types of neurons specify referent control variables for motor actions may be tested in future studies. The theory may also be advanced by applying the notion of threshold control to perception and cognition.

Central Resetting of Neuromuscular Steady States May Underlie Rhythmical Arm Movements

Changing the steady-state configuration of the body or its segments may be an important function of central pattern generators for locomotion and other rhythmical movements. Thereby, muscle activation, forces, and movement may emerge following a natural tendency of the neuromuscular system to achieve the current steady-state configuration. To verify that transitions between different steady states occur during rhythmical movements, we asked standing subjects to swing one or both arms synchronously or reciprocally at ∼0.8 Hz from the shoulder joints. In randomly selected cycles, one arm was transiently arrested by an electromagnetic device. Swinging resumed after some delay and phase resetting. During bilateral swinging, the nonperturbed arm often stopped before resuming swinging at a position that was close to either the extreme forward or the extreme backward arm position observed before the perturbation. Oscillations usually resumed when both arms arrived at similar extreme positions when a synchronous bilateral pattern was initially produced or at the opposite positions if the initial pattern was reciprocal. Results suggest that a central generator controls both arms as a coherent unit by producing transitions between its steady state (equilibrium) positions. By controlling these positions, the system may define the spatial boundaries of movement. At these positions, the system may halt the oscillations, resume them at a new phase (as observed in the present study), or initiate a new motor action. Our findings are relevant to locomotion and suggest that walking may also be generated by transitions between several equilibrium configurations of the body, possibly accomplished by modulation and gating of proprioceptive reflexes.

Threshold control of arm posture and movement adaptation to load

We addressed the fundamental questions of which variables underlie the control of arm movement and how they are stored in motor memory, reproduced and modified in the process of adaptation to changing load conditions. Such variables are defined differently in two major theories of motor control (internal models and threshold control). To resolve the controversy, these theories were tested (experiment 1) based on their ability to explain why active movement away from a stable posture is not opposed by stabilizing mechanisms (the posture-movement problem). The internal model theory suggests that the system counteracts the opposing forces by increasing the muscle activity in proportion to the distance from the initial posture (position-dependent EMG control). In contrast, threshold control fully excludes these opposing forces by shifting muscle activation thresholds and thus resetting the stabilizing mechanisms to a new posture. Subjects were sitting, holding the vertical handle of a double-joint manipulandum with their right hand and were facing a computer screen on which the handle and target to be reached were displayed. In response to an auditory signal, subjects quickly moved the handle from an initial position to one of two (frontal and sagittal) targets. No load was applied during the movement but in separate trials, a brief perturbation was applied to the handle by torque motors controlling the manipulandum. Perturbations were applied prior to or 3 s after movement offset, in the latter case in one of eight directions. The EMG activity of the majority of the seven recorded muscles was at zero level before movement onset and returned to zero level after movement offset. Those muscles that remained active before or after the movement could be made silent whereas previously silent muscles could be activated after a small passive displacement (several millimeters) elicited by perturbations in appropriate directions. Results showed that the activation thresholds of motoneurons of arm muscles were reset from the initial to a final position and that EMG activity was not position-dependent. These results were inconsistent with the internal model theory but confirmed the threshold control theory. Then the ability of threshold control theory to explain rapid movement adaptation to a position-dependent load was investigated (experiment 2 and 3). Subjects produced fast movement to the frontal target with and without a position-dependent load applied to the handle. Trials were organized in blocks alternating between the load and no-load condition (20 blocks in total, with randomly chosen number of five to ten trials in each). Subjects were instructed "do not correct" in experiment 2 and "correct" movement errors during the trial in experiment 3. Five threshold arm configurations underlying the movement production and adaptation were identified. When instructed "do not correct", movement precision was fully restored on average after two trials. No significant improvement was observed as the experiment progressed despite the fact that the same load condition was repeated after one block of trials. Thus, in each block, the adaptation was made anew, implying that subjects relied on short-term memory and could not recall the threshold arm configurations they specified to accurately reach the same target in the same load condition in previous blocks. When instructed to "correct" within each trial, precision was restored faster, on average after one trial. Major aspects of the production and adaptation of arm movement (including the kinematics, movement errors, instruction-dependent behavior, and absence of position-related EMG activity) are explained in terms of threshold control.

Threshold control of motor actions prevents destabilizing effects of proprioceptive delays

It is usually assumed that proprioceptive feedback comes to motoneurons too late to contribute to the initial activity of agonist muscles during fast arm movements, leading to the suggestion that this feedback is only efficient in slow movements and postural control. The argument does not take into account that the changes in the motoneuronal membrane potentials and the associated changes in the state of spinal neurons preceding the initial activity of muscles deeply affect, in a forward way, the state of reflex systems by shifting their thresholds, as suggested in the lambda model for motor control. As a result, the initial muscle activity emerges with full contribution of these systems so that the effects of reflex delays become negligible. We tested the hypothesis that threshold control of muscle activation may be instrumental in preventing destabilizing effects of proprioceptive delays in spinal and trans-cortical pathways to motoneurons. The analysis was made by recording fast elbow movements (peak velocity approximately 300-500 degrees/s) and simulating them in a dynamic model that incorporates the notion of threshold control of intrinsic and reflex muscle properties. The model was robust in reproducing experimental movement patterns (R (2)>0.95). It generated stable output despite substantial proprioceptive (up to 100 ms) and electromechanical (40 ms) delays. Stability was thus ensured for delays not only in segmental (about 25-50 ms) but also in trans-cortical loops (50-70 ms). Our study illustrates that a natural physiological process--threshold control--may manifest feed-forward properties hitherto attributed to hypothetical internal neural models.

Optimal parameters for the clinical test of dynamic visual acuity in patients with a unilateral vestibular deficit

OBJECTIVE

To determine the influence of frequency and direction of head movement and type of vision chart on the score of a clinical test of dynamic visual acuity (DVA).

METHODS

The subjects were 31 healthy individuals (22 to 79 years old) and 10 patients (19 to 70 years old) with a unilateral vestibular deficit owing to surgical resection of an acoustic neuroma. They read a Snellen or an E-chart while their head was passively moved +/- 20 degrees back and forth in the horizontal or vertical direction at one of four frequencies (0.5, 1.0, 1.5, and 2.0 Hz). The DVA score was the difference in the number of lines on the vision chart that could be read with the head passively moved versus with the head immobile.

RESULTS

Four healthy subjects had a low DVA score during horizontal head movements at the fastest frequency (2.0 Hz) with the Snellen chart. In patients, DVA scores significantly decreased as head movement frequency increased from 0.5 to 1.0 Hz and from 1.0 to 1.5 Hz, during horizontal and vertical movements, and with both vision charts (p < .001). The DVA scores of healthy subjects were more consistent across three trials with the E-chart than with the Snellen chart at 1.0 and 0.5 Hz (horizontal movements, p < .01) and at 1.5 and 1.0 Hz (vertical movements, p < .01).

CONCLUSIONS

This study provides new indications on the optimal parameters for the clinical test of DVA. From the results, it is recommended that DVA be tested during horizontal and vertical head movements at a frequency of 1.5 Hz with the E-chart.