Using Low Levels of Stochastic Vestibular Stimulation to Improve Balance Function

Noisy Galvanic Stimulation Improves Roll-Tilt Vestibular Perception in Healthy Subjects

It has recently been demonstrated that noisy galvanic vestibular stimulation (nGVS) delivered as imperceptible white noise can improve balance control via the induction of stochastic resonance. However, it is unclear whether these balance improvements are accompanied by simultaneous enhancement to vestibular motion perception. In this study, 15 healthy subjects performed 8 quiet-stance tasks on foam with eyes closed at 8 different nGVS amplitudes ranging from 0 mA (baseline) to 0.5 mA. The nGVS amplitude that improved balance performance most compared to baseline was assigned as the optimal nGVS amplitude. Optimal nGVS amplitudes could be determined for 13 out of 15 subjects, who were included in the subsequent experimental procedures. The effect of nGVS delivered at the determined optimal intensity on vestibular perceptual thresholds was examined using direction-recognition tasks on a motion platform, testing roll rotations at 0.2, 0.5, and 1.0 Hz, both with active and sham nGVS stimulations. nGVS significantly reduced direction-recognition thresholds compared to the sham condition at 0.5 and 1.0 Hz, while no significant effect of nGVS was found at 0.2 Hz. Interestingly, no correlation was found between nGVS-induced improvements in balance control and vestibular motion perception at 0.5 and 1 Hz, which may suggest different mechanisms by which nGVS affects both modalities. For the first time, we show that nGVS can enhance roll vestibular motion perception. The outcomes of this study are likely to be relevant for the potential therapeutic use of nGVS in patients with balance problems.

Multivariate Analyses of Balance Test Performance, Vestibular Thresholds, and Age

We previously published vestibular perceptual thresholds and performance in the Modified Romberg Test of Standing Balance in 105 healthy humans ranging from ages 18 to 80 (1). Self-motion thresholds in the dark included roll tilt about an earth-horizontal axis at 0.2 and 1 Hz, yaw rotation about an earth-vertical axis at 1 Hz, y-translation (interaural/lateral) at 1 Hz, and z-translation (vertical) at 1 Hz. In this study, we focus on multiple variable analyses not reported in the earlier study. Specifically, we investigate correlations (1) among the five thresholds measured and (2) between thresholds, age, and the chance of failing condition 4 of the balance test, which increases vestibular reliance by having subjects stand on foam with eyes closed. We found moderate correlations (0.30–0.51) between vestibular thresholds for different motions, both before and after using our published aging regression to remove age effects. We found that lower or higher thresholds across all threshold measures are an individual trait that account for about 60% of the variation in the population. This can be further distributed into two components with about 20% of the variation explained by aging and 40% of variation explained by a single principal component that includes similar contributions from all threshold measures. When only roll tilt 0.2 Hz thresholds and age were analyzed together, we found that the chance of failing condition 4 depends significantly on both (p = 0.006 and p = 0.013, respectively). An analysis incorporating more variables found that the chance of failing condition 4 depended significantly only on roll tilt 0.2 Hz thresholds (p = 0.046) and not age (p = 0.10), sex nor any of the other four threshold measures, suggesting that some of the age effect might be captured by the fact that vestibular thresholds increase with age. For example, at 60 years of age, the chance of failing is roughly 5% for the lowest roll tilt thresholds in our population, but this increases to 80% for the highest roll tilt thresholds. These findings demonstrate the importance of roll tilt vestibular cues for balance, even in individuals reporting no vestibular symptoms and with no evidence of vestibular dysfunction.

Improved proprioceptive function by application of subsensory electrical noise: Effects of aging and task-demand

The application of subsensory noise stimulation over the lower limbs has been shown to improve proprioception and postural control under certain conditions. Whereas the effect specificity seems to depend on several factors, studies are still needed to determine the appropriate method for training and rehabilitation purposes. In the current study, we investigated whether the application of subsensory electrical noise over the legs improves proprioceptive function in young and older adults. We aimed to provide evidence that stronger and age-related differential effects occur in more demanding tasks. Proprioceptive function was initially assessed by testing the detection of passive ankle movement (kinesthetic perception) in twenty-eight subjects (14 young and 14 older adults). Thereafter, postural control was assessed during tasks with different sensory challenges: i) by removing visual information (eyes closed) and; ii) by moving the visual scene (moving room paradigm). Tests performed with the application of electrical noise stimulation were compared to those performed without noise. The results showed that electrical noise applied over the legs led to a reduction in the response time to kinesthetic perception in both young and older adults. On the other hand, the magnitude of postural sway was reduced by noise stimulation only during a more challenging task, namely, when the optical flow was changing in an unpredictable (nonperiodic) manner. No differential effects of stimulation between groups were observed. These findings suggest that the relevance of proprioceptive inputs in tasks with different challenges, but not the subjects' age, is a determining factor for sensorimotor improvements due to electrical noise stimulation.

Vestibular implants studied in animal models: clinical and scientific implications

Damage to the peripheral vestibular system can result in debilitating postural, perceptual, and visual symptoms. A potential new treatment for this clinical problem is to replace some aspects of peripheral vestibular function with an implant that senses head motion and provides this information to the brain by stimulating branches of the vestibular nerve. In this review I consider animal studies performed at our institution over the past 15 years, which have helped elucidate how the brain processes information provided by a vestibular (semicircular canal) implant and how this information could be used to improve the problems experienced by patients with peripheral vestibular damage.

Do Aging and Tactile Noise Stimulation Affect Responses to Support Surface Translations in Healthy Adults?

Appropriate neuromuscular responses to support surface perturbations are crucial to prevent falls, but aging-related anatomical and physiological changes affect the appropriateness and efficiency of such responses. Low-level noise application to sensory receptors has shown to be effective for postural improvement in a variety of different balance tasks, but it is unknown whether this intervention may have value for improvement of corrective postural responses. Ten healthy younger and ten healthy older adults were exposed to sudden backward translations of the support surface. Low-level noise (mechanical vibration) to the foot soles was added during random trials and temporal (response latency) and spatial characteristics (maximum center-of-pressure excursion and anterior-posterior path length) of postural responses were assessed. Mixed-model ANOVA was applied for analysis of postural response differences based on age and vibration condition. Age affected postural response characteristics, but older adults were well able to maintain balance when exposed to a postural perturbation. Low-level noise application did not affect any postural outcomes. Healthy aging affects some specific measures of postural stability, and in high-functioning older individuals, a low-level noise intervention may not be valuable. More research is needed to investigate if recurring fallers and neuropathy patients could benefit from the intervention in postural perturbation tasks.

Improving postural control by applying mechanical noise to ankle muscle tendons

The application of subthreshold mechanical vibrations with random frequencies (white mechanical noise) to ankle muscle tendons is known to increase muscle proprioceptive information and to improve the detection of ankle movements. The aim of the present study was to analyze the effect of this mechanical noise on postural control, its possible modulation according to the sensory strategies used for postural control, and the consequences of increasing postural difficulty. The upright stance of 20 healthy young participants tested with their eyes closed was analyzed during the application of four different levels of noise and compared to that in the absence of noise (control) in three conditions: static, static on foam, and dynamic (sinusoidal translation). The quiet standing condition was conducted with the eyes open and closed to determine the subjects' visual dependency to maintain postural stability. Postural performance was assessed using posturographic and motion analysis evaluations. The results in the static condition showed that the spectral power density of body sway significantly decreased with an optimal level of noise and that the higher the spectral power density without noise, the greater the noise effect, irrespective of visual dependency. Finally, noise application was ineffective in the foam and dynamic conditions. We conclude that the application of mechanical noise to ankle muscle tendons is a means to improve quiet standing only. These results suggest that mechanical noise stimulation may be more effective in more impaired populations.

Stochastic resonance in the synaptic transmission between hair cells and vestibular primary afferents in development

The stochastic resonance (SR) is a phenomenon of nonlinear systems in which the addition of an intermediate level of noise improves the response of such system. Although SR has been studied in isolated hair cells and in the bullfrog sacculus, the occurrence of this phenomenon in the vestibular system in development is unknown. The purpose of the present study was to explore for the existence of SR via natural mechanical-stimulation in the hair cell-vestibular primary afferent transmission. In vitro experiments were performed on the posterior semicircular canal of the chicken inner ear during development. Our experiments showed that the signal-to-noise ratio of the afferent multiunit activity from E15 to P5 stages of development exhibited the SR phenomenon, which was characterized by an inverted U-like response as a function of the input noise level. The inverted U-like graphs of SR acquired their higher amplitude after the post-hatching stage of development. Blockage of the synaptic transmission with selective antagonists of the NMDA and AMPA/Kainate receptors abolished the SR of the afferent multiunit activity. Furthermore, computer simulations on a model of the hair cell - primary afferent synapse qualitatively reproduced this SR behavior and provided a possible explanation of how and where the SR could occur. These results demonstrate that a particular level of mechanical noise on the semicircular canals can improve the performance of the vestibular system in their peripheral sensory processing even during embryonic stages of development.