The vestibular system: multimodal integration and encoding of self-motion for motor control

Habitat use and vestibular system's dimensions in lacertid lizards

The vestibular system is crucial for movement control during locomotion. As the dimensions of the vestibular system determine the fluid dynamics of the endolymph and, as such, the system's function, we investigate the interaction between vestibular system size, head size and microhabitat use in lizards. We grouped 24 lacertid species in three microhabitat types, we acquired three-dimensional models of the bony vestibular systems using micro-computer tomography scanning, and we performed linear and surface measurements. All vestibular measurements scale with a negative allometry with head size, suggesting that smaller heads house disproportionally large ears. As the sensitivity of the vestibular system is positively related to size, a sufficiently large vestibular system in small-headed animals may meet the sensitivity demands during challenged locomotion. We also found that the microhabitat affects the locomotor dynamics: lizards inhabiting open microhabitats run at higher dimensionless speeds. On the other hand, no statistical relationship exists between dimensionless speed and the vestibular system dimensions. Hence, if the vestibular size would differ between microhabitats, this would be a direct effect (i.e. imposed, for instance, by requirements for manoeuvring, balance control, etc.), rather than depending on the lizards' intrinsic running speed. However, we found no effect of the microhabitat on the allometric relationship between head and vestibular system size. The finding that microhabitat is not reflected in the vestibular system size (hence sensitivity) of the lacertids in this study is possibly due to spatial constraints of the skull.

New advances regarding adaptation of the vestibulo-ocular reflex

This is a review summarizing the development of vestibulo-ocular reflex (VOR) adaptation behavior with relevance to rehabilitation over the last 10 years and examines VOR adaptation using head-on-body rotations, specifically the influence of training target contrast, position and velocity error signal, active vs. passive head rotations, and sinusoidal vs. head impulse rotations. This review discusses optimization of the single VOR adaptation training session, consolidation between repeated training sessions, and dynamic incremental VOR adaptation. Also considered are the effects of aging and the roles of the efferent vestibular system, cerebellum, and otoliths on angular VOR adaptation. Finally, this review examines VOR adaptation findings in studies using whole body rotations.

Predictive Sensing: The Role of Motor Signals in Sensory Processing

The strategy of integrating motor signals with sensory information during voluntary behavior is a general feature of sensory processing. It is required to distinguish externally applied (exafferent) from self-generated (reafferent) sensory inputs. This distinction, in turn, underlies our ability to achieve both perceptual stability and accurate motor control during everyday activities. In this review, we consider the results of recent experiments that have provided circuit-level insight into how motor-related inputs to sensory areas selectively cancel self-generated sensory inputs during active behaviors. These studies have revealed both common strategies and important differences across systems. Sensory reafference is suppressed at the earliest stages of central processing in the somatosensory, vestibular, and auditory systems, with the cerebellum and cerebellum-like structures playing key roles. Furthermore, motor-related inputs can also suppress reafferent responses at higher levels of processing such as the cortex-a strategy preferentially used in visual processing. These recent findings have important implications for understanding how the brain achieves the flexibility required to continuously calibrate relationships between motor signals and the resultant sensory feedback, a computation necessary for our subjective awareness that we control both our actions and their sensory consequences.

Coding strategies in the otolith system differ for translational head motion vs. static orientation relative to gravity

The detection of gravito-inertial forces by the otolith system is essential for our sense of balance and accurate perception. To date, however, how this system encodes the self-motion stimuli that are experienced during everyday activities remains unknown. Here, we addressed this fundamental question directly by recording from single otolith afferents in monkeys during naturalistic translational self-motion and changes in static head orientation. Otolith afferents with higher intrinsic variability transmitted more information overall about translational self-motion than their regular counterparts, owing to stronger nonlinearities that enabled precise spike timing including phase locking. By contrast, more regular afferents better discriminated between different static head orientations relative to gravity. Using computational methods, we further demonstrated that coupled increases in intrinsic variability and sensitivity accounted for the observed functional differences between afferent classes. Together, our results indicate that irregular and regular otolith afferents use different strategies to encode naturalistic self-motion and static head orientation relative to gravity.

Vestibular processing during natural self-motion: implications for perception and action

How the brain computes accurate estimates of our self-motion relative to the world and our orientation relative to gravity in order to ensure accurate perception and motor control is a fundamental neuroscientific question. Recent experiments have revealed that the vestibular system encodes this information during everyday activities using pathway-specific neural representations. Furthermore, new findings have established that vestibular signals are selectively combined with extravestibular information at the earliest stages of central vestibular processing in a manner that depends on the current behavioural goal. These findings have important implications for our understanding of the brain mechanisms that ensure accurate perception and behaviour during everyday activities and for our understanding of disorders of vestibular processing.

Optogenetic fMRI interrogation of brain-wide central vestibular pathways

Blood oxygen level-dependent functional MRI (fMRI) constitutes a powerful neuroimaging technology to map brain-wide functions in response to specific sensory or cognitive tasks. However, fMRI mapping of the vestibular system, which is pivotal for our sense of balance, poses significant challenges. Physical constraints limit a subject's ability to perform motion- and balance-related tasks inside the scanner, and current stimulation techniques within the scanner are nonspecific to delineate complex vestibular nucleus (VN) pathways. Using fMRI, we examined brain-wide neural activity patterns elicited by optogenetically stimulating excitatory neurons of a major vestibular nucleus, the ipsilateral medial VN (MVN). We demonstrated robust optogenetically evoked fMRI activations bilaterally at sensorimotor cortices and their associated thalamic nuclei (auditory, visual, somatosensory, and motor), high-order cortices (cingulate, retrosplenial, temporal association, and parietal), and hippocampal formations (dentate gyrus, entorhinal cortex, and subiculum). We then examined the modulatory effects of the vestibular system on sensory processing using auditory and visual stimulation in combination with optogenetic excitation of the MVN. We found enhanced responses to sound in the auditory cortex, thalamus, and inferior colliculus ipsilateral to the stimulated MVN. In the visual pathway, we observed enhanced responses to visual stimuli in the ipsilateral visual cortex, thalamus, and contralateral superior colliculus. Taken together, our imaging findings reveal multiple brain-wide central vestibular pathways. We demonstrate large-scale modulatory effects of the vestibular system on sensory processing.

Neural substrates, dynamics and thresholds of galvanic vestibular stimulation in the behaving primate

Galvanic vestibular stimulation (GVS) uses the external application of electrical current to selectively target the vestibular system in humans. Despite its recent popularity for the assessment/treatment of clinical conditions, exactly how this non-invasive tool activates the vestibular system remains an open question. Here we directly investigate single vestibular afferent responses to GVS applied to the mastoid processes of awake-behaving monkeys. Transmastoid GVS produces robust and parallel activation of both canal and otolith afferents. Notably, afferent activation increases with intrinsic neuronal variability resulting in constant GVS-evoked neuronal detection thresholds across all afferents. Additionally, afferent tuning differs for GVS versus natural self-motion stimulation. Using a stochastic model of repetitive activity in afferents, we largely explain the main features of GVS-evoked vestibular afferent dynamics. Taken together, our results reveal the neural substrate underlying transmastoid GVS-evoked perceptual, ocular and postural responses-information that is essential to advance GVS applicability for biomedical uses in humans.

Interhemispheric control of sensory cue integration and self-motion perception

Spatial orientation necessitates the integration of visual and vestibular sensory cues, in-turn facilitating self-motion perception. However, the neural mechanisms underpinning sensory integration remain unknown. Recently we have illustrated that spatial orientation and vestibular thresholds are influenced by interhemispheric asymmetries associated with the posterior parietal cortices (PPC) that predominantly house the vestibulo-cortical network. Given that sensory integration is a prerequisite to both spatial orientation and motion perception, we hypothesized that sensory integration is similarly subject to interhemispheric influences. Accordingly, we explored the relationship between vestibulo-cortical dominance - assessed using a biomarker, the degree of vestibular-nystagmus suppression following transcranial direct current stimulation over the PPC - with visual dependence measures obtained during performance of a sensory integration task (the rod-and-disk task). We observed that the degree of visual dependence was correlated with vestibulo-cortical dominance. Specifically, individuals with greater right hemispheric vestibulo-cortical dominance had reduced visual dependence. We proceeded to assess the significance of such dominance on behavior by correlating measures of visual dependence with self-motion perception in healthy subjects. We observed that right-handed individuals experienced illusionary self-motion (vection) quicker than left-handers and that the degree of vestibular cortical dominance was correlated with the time taken to experience vection, only during conditions that induced interhemispheric conflict. To conclude, we demonstrate that interhemispheric asymmetries associated with vestibulo-cortical processing in the PPC functionally and mechanistically link sensory integration and self-motion perception, facilitating spatial orientation. Our findings highlight the importance of dynamic interhemispheric competition upon control of vestibular behavior in humans.

Improved balance performance accompanied by structural plasticity in blind adults after training

Postural control requires the sensory integration of visual, vestibular, and proprioceptive signals. In the absence of vision, either by blindfolding or in blind individuals, balance performance is typically poorer than with sight. Previous research has suggested that despite showing compensatory vestibular and proprioceptive processing during upright standing, balance performance in blind individuals is overall lower than in sighted controls with eyes open. The present study tested whether balance training, which places demands on vestibular and proprioceptive self-motion perception, improves balance performance in blind adults, and whether we find similar structural correlates in cortical and subcortical brain areas as have been reported in sighted individuals. Fourteen congenitally or late blind adults were randomly assigned to either a balance or a relaxation group and exercised twice a week for 12 weeks. Assessments prior to and after training included balance tests and the acquisition of T1-weighted MRI images. The blind balance group significantly improved in dynamic, static, and functional balance performance compared to the blind relaxation group. The balance performance improvement did not differ from that of age- and gender matched sighted adults after balance training. Cortical thickness increased in the left parahippocampus and decreased in the inferior insula bilaterally in the blind balance group compared to the blind relaxation group. Thickness decreases in the insula were related to improved static and functional balance. Gray matter volume was reduced in the left hippocampus proper and increased in the right subiculum in the blind balance group. The present data suggest that impaired balance performance in blind adults can be significantly improved by a training inducing plasticity in brain regions associated with vestibular and proprioceptive self-motion processing.

Inertial Sensing and Encoding of Self-Motion: Structural and Functional Similarities across Metazoan Taxa

To properly orient and navigate, moving animals must obtain information about the position and motion of their bodies. Animals detect inertial signals resulting from body accelerations and rotations using a variety of sensory systems. In this review, we briefly summarize current knowledge on inertial sensing across widely disparate animal taxa with an emphasis on neuronal coding and sensory transduction. We outline systems built around mechanosensory hair cells, including the chordate vestibular complex and the statocysts seen in many marine invertebrates. We next compare these to schemes employed by flying insects for managing inherently unstable aspects of flapping flight, built around comparable mechanosensory cells but taking unique advantage of the physics of rotating systems to facilitate motion encoding. Finally, we highlight fundamental similarities across taxa with respect to the partnering of inertial senses with visual senses and conclude with a discussion of the functional utility of maintaining a multiplicity of encoding schemes for self-motion information.

Vestibular rehabilitation has positive effects on balance, fatigue and activities of daily living in highly disabled multiple sclerosis people: A preliminary randomized controlled trial

BACKGROUND

Balance disorders are present in patients with Multiple Sclerosis and part of these disorders could be of vestibular origin. Vestibular Rehabilitation was found to be effective in improving balance in patients with central vestibular dysfunction.

OBJECTIVE

To investigate the clinical effects of vestibular rehabilitation on balance skills and secondly on fatigue and activity of daily living in highly disabled multiple sclerosis people.

METHODS

Thirty hospitalized participants with severe multiple sclerosis (EDSS 6-7) were randomly assigned to the experimental group (15 patients -9F-; mean age 50.64±11.73) and the control group (15 patients -8F-; mean age 45.77±10.91). All patients were evaluated before and after treatment with the Expanded Disability Status Scale, Barthel Index Tinetti Balance and Gait scale, Berg Balance Scale, Fatigue Severity Scale, Two Minute Walking Test and Timed 25-foot walk test. Two follow-ups (i.e., at 30 and 60 days after treatment) were carried out with Barthel Index.

RESULTS

Significant improvement was found in the experimental group with respect to the control group (p <  0,05) in balance, fatigue perception, activities of daily living and short distance gait. No significant improvements were found for gait endurance as measured by Two Minute Walking Test.

CONCLUSIONS

Four weeks of Vestibular Rehabilitation training results in less fatigue, improved balance and performance of the activities of daily living in patients with severe Multiple Sclerosis.

The Time Course of Motoneuronal Excitability during the Preparation of Complex Movements

For a simple RT task, movement complexity increases RT and also corticospinal excitability, as measured by the motor evoked potential (MEP) elicited by TMS of the motor cortex. However, it is unknown if complexity-related increases in corticospinal excitability during the preparation of movement are mediated at the cortical or spinal level. The purposes of this study were to establish a time course of motoneuronal excitability before prime mover activation and to assess task-dependent effects of complex movements on motoneuronal and cortical excitability in a simple RT paradigm. It was hypothesized that motoneuronal and cortical excitability would increase before prime mover activation and in response to movement complexity. In a seated position, participants completed ballistic elbow extension/flexion movements with their dominant arm to one, two, or three targets. TMS and transmastoid stimulation (TS) were delivered at 0%, 70%, 80% or 90% of mean premotor RT for each complexity level. Stimulus intensities were set to elicit MEPs and cervicomedullary MEPs (CMEPs) of ∼10% of the maximal M-wave in the triceps brachii. Compared with 0% RT, motoneuronal excitability (CMEP amplitude) was already 10% greater at 70% RT. CMEP amplitude also increased with movement complexity as both the two- and three-movement conditions had greater motoneuronal excitability than the one-movement condition (p < .038). Importantly, when normalized to the CMEP, there was no increase in MEP amplitude. This suggests that complexity-related increases in corticospinal excitability are likely to be mediated more by increased excitability at a motoneuronal than cortical level.

Cooperation of the vestibular and cerebellar networks in anxiety disorders and depression

The discipline of affective neuroscience is concerned with the neural bases of emotion and mood. The past decades have witnessed an explosion of research in affective neuroscience, increasing our knowledge of the brain areas involved in fear and anxiety. Besides the brain areas that are classically associated with emotional reactivity, accumulating evidence indicates that both the vestibular and cerebellar systems are involved not only in motor coordination but also influence both cognition and emotional regulation in humans and animal models. The cerebellar and the vestibular systems show the reciprocal connection with a myriad of anxiety and fear brain areas. Perception anticipation and action are also major centers of interest in cognitive neurosciences. The cerebellum is crucial for the development of an internal model of action and the vestibular system is relevant for perception, gravity-related balance, navigation and motor decision-making. Furthermore, there are close relationships between these two systems. With regard to the cooperation between the vestibular and cerebellar systems for the elaboration and the coordination of emotional cognitive and visceral responses, we propose that altering the function of one of the systems could provoke internal model disturbances and, as a result, anxiety disorders followed potentially with depressive states.

Vestibular and Multi-Sensory Influences Upon Self-Motion Perception and the Consequences for Human Behavior

In this manuscript, we comprehensively review both the human and animal literature regarding vestibular and multi-sensory contributions to self-motion perception. This covers the anatomical basis and how and where the signals are processed at all levels from the peripheral vestibular system to the brainstem and cerebellum and finally to the cortex. Further, we consider how and where these vestibular signals are integrated with other sensory cues to facilitate self-motion perception. We conclude by demonstrating the wide-ranging influences of the vestibular system and self-motion perception upon behavior, namely eye movement, postural control, and spatial awareness as well as new discoveries that such perception can impact upon numerical cognition, human affect, and bodily self-consciousness.

Neuronal variability and tuning are balanced to optimize naturalistic self-motion coding in primate vestibular pathways

It is commonly assumed that the brain's neural coding strategies are adapted to the statistics of natural stimuli. Specifically, to maximize information transmission, a sensory neuron's tuning function should effectively oppose the decaying stimulus spectral power, such that the neural response is temporally decorrelated (i.e. 'whitened'). However, theory predicts that the structure of neuronal variability also plays an essential role in determining how coding is optimized. Here, we provide experimental evidence supporting this view by recording from neurons in early vestibular pathways during naturalistic self-motion. We found that central vestibular neurons displayed temporally whitened responses that could not be explained by their tuning alone. Rather, computational modeling and analysis revealed that neuronal variability and tuning were matched to effectively complement natural stimulus statistics, thereby achieving temporal decorrelation and optimizing information transmission. Taken together, our findings reveal a novel strategy by which neural variability contributes to optimized processing of naturalistic stimuli.

Gravity Perception: The Role of the Cerebellum

The cerebellum is known to support motor behaviors, including postural stability, but new research supports the view that cerebellar function is also critical for perception of spatial orientation, particularly because of its role in vestibular processing.

No Gain No Pain: Relations Between Vestibulo-Ocular Reflexes and Motion Sickness in Mice

Motion sickness occurs when the vestibular system is subjected to conflicting sensory information or overstimulation. Despite the lack of knowledge about the actual underlying mechanisms, several drugs, among which scopolamine, are known to prevent or alleviate the symptoms. Here, we aim at better understanding how motion sickness affects the vestibular system, as well as how scopolamine prevents motion sickness at the behavioral and cellular levels. We induced motion sickness in adult mice and tested the vestibulo-ocular responses to specific stimulations of the semi-circular canals and of the otoliths, with or without scopolamine, as well as the effects of scopolamine and muscarine on central vestibular neurons recorded on brainstem slices. We found that both motion sickness and scopolamine decrease the efficacy of the vestibulo-ocular reflexes and propose that this decrease in efficacy might be a protective mechanism to prevent later occurrences of motion sickness. To test this hypothesis, we used a behavioral paradigm based on visuo-vestibular interactions which reduces the efficacy of the vestibulo-ocular reflexes. This paradigm also offers protection against motion sickness, without requiring any drug. At the cellular level, we find that depending on the neuron, scopolamine can have opposite effects on the polarization level and firing frequency, indicating the presence of at least two types of muscarinic receptors in the medial vestibular nucleus. The present results set the basis for future studies of motion sickness counter-measures in the mouse model and offers translational perspectives for improving the treatment of affected patients.

The parieto-insular vestibular cortex in humans: more than a single area?

Here, we review the structure and function of a core region in the vestibular cortex of humans that is located in the midposterior Sylvian fissure and referred to as the parieto-insular vestibular cortex (PIVC). Previous studies have investigated PIVC by using vestibular or visual motion stimuli and have observed activations that were distributed across multiple anatomical structures, including the temporo-parietal junction, retroinsula, parietal operculum, and posterior insula. However, it has remained unclear whether all of these anatomical areas correspond to PIVC and whether PIVC responds to both vestibular and visual stimuli. Recent results suggest that the region that has been referred to as PIVC in previous studies consists of multiple areas with different anatomical correlates and different functional specializations. Specifically, a vestibular but not visual area is located in the parietal operculum, close to the posterior insula, and likely corresponds to the nonhuman primate PIVC, while a visual-vestibular area is located in the retroinsular cortex and is referred to, for historical reasons, as the posterior insular cortex area (PIC). In this article, we review the anatomy, connectivity, and function of PIVC and PIC and propose that the core of the human vestibular cortex consists of at least two separate areas, which we refer to together as PIVC+. We also review the organization in the nonhuman primate brain and show that there are parallels to the proposed organization in humans.

Neck muscle spindle noise biases reaches in a multisensory integration task

Reference frame transformations (RFTs) are crucial components of sensorimotor transformations in the brain. Stochasticity in RFTs has been suggested to add noise to the transformed signal due to variability in transformation parameter estimates (e.g., angle) as well as the stochastic nature of computations in spiking networks of neurons. Here, we varied the RFT angle together with the associated variability and evaluated the behavioral impact in a reaching task that required variability-dependent visual-proprioceptive multisensory integration. Crucially, reaches were performed with the head either straight or rolled 30° to either shoulder, and we also applied neck loads of 0 or 1.8 kg (left or right) in a 3 × 3 design, resulting in different combinations of estimated head roll angle magnitude and variance required in RFTs. A novel three-dimensional stochastic model of multisensory integration across reference frames was fitted to the data and captured our main behavioral findings: 1) neck load biased head angle estimation across all head roll orientations, resulting in systematic shifts in reach errors; 2) increased neck muscle tone led to increased reach variability due to signal-dependent noise; and 3) both head roll and neck load created larger angular errors in reaches to visual targets away from the body compared with reaches toward the body. These results show that noise in muscle spindles and stochasticity in general have a tangible effect on RFTs underlying reach planning. Since RFTs are omnipresent in the brain, our results could have implications for processes as diverse as motor control, decision making, posture/balance control, and perception. NEW & NOTEWORTHY We show that increasing neck muscle tone systematically biases reach movements. A novel three-dimensional multisensory integration across reference frames model captures the data well and provides evidence that the brain must have online knowledge of full-body geometry together with the associated variability to plan reach movements accurately.

Single neuron activity and c-Fos expression in the rat striatum following electrical stimulation of the peripheral vestibular system

Connections between the vestibular system and the basal ganglia have been postulated since the early 20th century. However, the results of electrophysiological studies investigating neuronal responses to electrical stimulation of the vestibular system have been inconsistent. The aim of this study was to investigate the effects of electrical stimulation of the vestibular labyrinth on single neuron activity and c-Fos expression in the rat striatum. We used electrical stimulation of the vestibular labyrinth (various intensities delivered to the round window) to examine the electrophysiological response of striatal neurons and c-Fos expression. From 507 single neurons recorded (n = 20 rats), no vestibular-responsive neuron was found at 1× and 2× the nystagmus threshold; however, 6 neurons were found at 3× the threshold. These neurons were found bilaterally, with a response latency of ~50 msec from the end of the stimulus. For the c-Fos study, the number of neurons expressing c-Fos was quantified using stereological methods. Stimulation at 2× the threshold for nystagmus (n = 5 rats) resulted in a significant decrease in the number of neurons expressing c-Fos in the bilateral striatum compared to both the sham control group (n = 5) and the lower stimulus intensity group (n = 5) (P ≤ 0.0001 for both). The results of this study demonstrate that: (1) some single striatal neurons respond to electrical vestibular stimulation, however, these responses are circumscribed and infrequent; (2) electrical stimulation of the vestibular labyrinth results in a decrease in the number of striatal neurons expressing c-Fos, in a current-dependent manner.

Exercise-induced neuroplasticity: Balance training increases cortical thickness in visual and vestibular cortical regions

Physical exercise has been shown to induce structural plasticity in the human brain and to enhance cognitive functions. While previous studies focused on aerobic exercise, suggesting a link between increased cardiorespiratory fitness and exercise-induced neuroplasticity, recent findings have suggested that whole-body exercise with minor metabolic demands elicits beneficial effects on brain structure as well. In the present study, we tested if balance training, challenging the sensory-motor system and vestibular self-motion perception, induces structural plasticity. Thirty-seven healthy adults aged 19-65 years were randomly assigned to either a balance training or a relaxation training group. All participants exercised twice a week for 12 weeks. Assessments before and after the training included a balance test and the acquisition of high-resolution T1-weighted images to analyze morphological brain changes. Only the balance group significantly improved balance performance after training. Cortical thickness was increased in the superior temporal cortex, in visual association cortices, in the posterior cingulate cortex, in the superior frontal sulcus, and in the precentral gyri in the balance group, compared to the relaxation group. Moreover, there was evidence that the balance training resulted in decreased putamen volume. Improved balance performance correlated with the increase of precentral cortical thickness and the decrease in putamen volume. The results suggest that balance training elicits neuroplasticity in brain regions associated with visual and vestibular self-motion perception. As these regions are known for their role in spatial orienting and memory, stimulating visual-vestibular pathways during self-motion might mediate beneficial effects of physical exercise on cognition.

Animal Models of Vestibular Evoked Myogenic Potentials: The Past, Present, and Future

Vestibular-evoked myogenic potentials (VEMPs) provide a simple and cost-effective means to assess the patency of vestibular reflexes. VEMP testing constitutes a core screening method in a clinical battery that probes vestibular function. The confidence one has in interpreting the results arising from VEMP testing is linked to a fundamental understanding of the underlying functional anatomy and physiology. In this review, we will summarize the key role that studies across a range of animal models have fulfilled in contributing to this understanding, covering key findings regarding the mechanisms of excitation in the sensory periphery, the processing of sensory information in central networks, and the distribution of reflexive output to the motor periphery. Although VEMPs are often touted for their simplicity, work in animals models have emphasized how vestibular reflexes operate within a broader behavioral and functional context, and as such vestibular reflexes are influenced by multisensory integration, governed by task demands, and follow principles of muscle recruitment. We will conclude with considerations of future questions, and the ways in which studies in current and emerging animal models can contribute to further use and refinement of this test for both basic and clinical research purposes.

Active Rehabilitation of Concussion and Post-concussion Syndrome

Concussion is a physiological brain injury with physical, cognitive, and emotional sequelae. The macrophysiological insult to the brain affects the autonomic nervous system and its control of cerebral blood flow. Most patients recover within 2 weeks, but some do not. Persistence of symptoms beyond the generally accepted time frame for recovery is called post-concussion syndrome (PCS). PCS is not a single entity; it is a group of disorders that requires specific forms of therapy. Rest has been the mainstay of the treatment for concussion and PCS. This article discusses the rationale for the active treatment of concussion and PCS.

White Matter Connectivity of the Visual-Vestibular Cortex Examined by Diffusion-Weighted Imaging

The parieto-insular vestibular cortex (PIVC) and the posterior insular cortex (PIC) are key regions of the cortical vestibular network, both located in the midposterior section of the lateral sulcus. Little is known about the structural connectivity pattern of these areas. We used probabilistic fiber tracking based on diffusion-weighted magnetic resonance imaging (MRI) and compared the ipsilateral connectivity of PIVC and PIC. Seed areas for the tracking algorithm were identified in each brain by functional MRI activity during caloric and visual motion stimulation, respectively. Cortical track terminations were investigated by a surface-based approach. Both PIVC and PIC shared ipsilateral connections to the insular/lateral sulcus, superior temporal cortex, and inferior frontal gyrus. However, PIVC showed significantly more connections than PIC with the anterior insula and Heschl's gyrus in both hemispheres and with the precuneus, intraparietal sulcus, and posterior callosum of the right hemisphere. In contrast, PIC connectivity was more pronounced with the supramarginal gyrus and superior temporal sulcus. Subcortical tracks were examined by a region-of-interest-based approach, which was validated on cortico-thalamic motor tracts. Both PIVC and PIC were connected with lateral nuclei of the thalamus and the basal ganglia (primarily putamen). PIVC tracks but not PIC tracks showed a right-hemispheric lateralization in cortical and subcortical connectivity. Overall, these results suggest that human PIVC and PIC share cortical and even subcortical connections. Nevertheless, they also differ in their primary connectivity pattern: PIVC is linked with posterior parietal and inferior frontal cortex, whereas PIC is linked with superior temporal and inferior parietal cortex.

Treatment of vestibular disorders with weak asymmetric base-in prisms: An hypothesis with a focus on Ménière's disease

BACKGROUND:

Regular treatments of Ménière’s disease (MD) vary largely, and no single satisfactory treatment exists. A complementary treatment popular among Dutch and Belgian patients involves eyeglasses with weak asymmetric base-in prisms, with a perceived high success rate. An explanatory mechanism is, however, lacking.

OBJECTIVE:

To speculate on a working mechanism explaining an effectiveness of weak asymmetric base-in prims in MD, based on available knowledge.

METHODS:

After describing the way these prisms are prescribed using a walking test and its effect reported on, we give an explanation of its underlying mechanism, based on the literature.

RESULTS:

The presumed effect can be explained by considering the typical star-like walking pattern in MD, induced by a drifting after-image comparable to the oculogyral illusion. Weak asymmetric base-in prisms can furthermore eliminate the conflict between a net vestibular angular velocity bias in the efferent signal controlling the VOR, and a net re-afferent ocular signal.

CONCLUSIONS:

The positive findings with these glasses reported on, the fact that the treatment itself is simple, low-cost, and socially acceptable, and the fact that an explanation is at hand, speak in favour of elaborating further on this treatment.

Optic flow detection is not influenced by visual-vestibular congruency

Optic flow patterns generated by self-motion relative to the stationary environment result in congruent visual-vestibular self-motion signals. Incongruent signals can arise due to object motion, vestibular dysfunction, or artificial stimulation, which are less common. Hence, we are predominantly exposed to congruent rather than incongruent visual-vestibular stimulation. If the brain takes advantage of this probabilistic association, we expect observers to be more sensitive to visual optic flow that is congruent with ongoing vestibular stimulation. We tested this expectation by measuring the motion coherence threshold, which is the percentage of signal versus noise dots, necessary to detect an optic flow pattern. Observers seated on a hexapod motion platform in front of a screen experienced two sequential intervals. One interval contained optic flow with a given motion coherence and the other contained noise dots only. Observers had to indicate which interval contained the optic flow pattern. The motion coherence threshold was measured for detection of laminar and radial optic flow during leftward/rightward and fore/aft linear self-motion, respectively. We observed no dependence of coherence thresholds on vestibular congruency for either radial or laminar optic flow. Prior studies using similar methods reported both decreases and increases in coherence thresholds in response to congruent vestibular stimulation; our results do not confirm either of these prior reports. While methodological differences may explain the diversity of results, another possibility is that motion coherence thresholds are mediated by neural populations that are either not modulated by vestibular stimulation or that are modulated in a manner that does not depend on congruency.

The vestibular system and cognition

PURPOSE OF REVIEW

The last year has seen a great deal of new information published relating vestibular dysfunction to cognitive impairment in humans, especially in the elderly. The objective of this review is to summarize and critically evaluate this new evidence in the context of the previous literature.

RECENT FINDINGS

This review will address the recent epidemiological/survey studies that link vestibular dysfunction with cognitive impairment in the elderly; recent clinical investigations into cognitive impairment in the context of vestibular dysfunction, both in the elderly and in the cases of otic capsule dehiscence and partial bilateral vestibulopathy; recent evidence that vestibular impairment is associated with hippocampal atrophy; and finally recent evidence relating to the hypothesis that vestibular dysfunction could be a risk factor for dementia.

SUMMARY

The main implication of these recent studies is that vestibular dysfunction, possibly of any type, may result in cognitive impairment, and this could be especially so for the elderly. Such symptoms will need to be considered in the treatment of patients with vestibular disorders.

Investigating Head Movements Induced by 'Riloid' Patterns in Migraine and Control Groups Using a Virtual Reality Display

Certain striped patterns can induce illusory motion, such as those used in op-art. The visual system and the vestibular system work together closely, and so it is possible that illusory motion from a visual stimulus can result in uncertainty in the vestibular system. This increased uncertainty may be measureable in terms of the magnitude of head movements. Head movements were measured using a head-mounted visual display. Results showed that stimuli associated with illusory motion also seem to induce greater head movements when compared to similar stimuli. Individuals with migraine are more susceptible to visual discomfort, and this includes illusory motion from striped stimuli. However, there was no evidence of increased effect of illusory motion on those with migraine compared to those without, suggesting that while motion illusions may affect discomfort judgements, this is not limited to only those with migraine.

Sensorimotor anatomy of gait, balance, and falls

The review demonstrates that control of posture and locomotion is provided by systems across the caudal-to-rostral extent of the neuraxis. A common feature of the neuroanatomic organization of the postural and locomotor control systems is the presence of key nodes for convergent input of multisensory feedback in conjunction with efferent copies of the motor command. These nodes include the vestibular and reticular nuclei and interneurons in the intermediate zone of the spinal cord (Rexed's laminae VI-VIII). This organization provides both spatial and temporal coordination of the various goals of the system and ensures that the large repertoire of voluntary movements is appropriately coupled to either anticipatory or reactive postural adjustments that ensure stability and provide the framework to support the intended action. Redundancies in the system allow adaptation and compensation when sensory modalities are impaired. These alterations in behavior are learned through reward- and error-based learning processes implemented through basal ganglia and cerebellar pathways respectively. However, neurodegenerative processes or lesions of these systems can greatly compromise the capacity to sufficiently adapt and sometimes leads to maladaptive changes that impair movement control. When these impairments occur, the risk of falls can be significantly increased and interventions are required to reduce morbidity.

Vestibular dysfunction and concussion

The assessment and treatment of sport-related concussion (SRC) often requires a multifaceted approach. Vestibular dysfunction represents an important profile of symptoms and pathology following SRC, with high prevalence and association with prolonged recovery. Signs and symptoms of vestibular dysfunction may include dizziness, vertigo, disequilibrium, nausea, and visual impairment. Identifying the central and peripheral vestibular mechanisms responsible for pathology can aid in management of SRC. The most common vestibular disturbances after SRC include benign paroxysmal positional vertigo, vestibulo-ocular reflex impairment, visual motion sensitivity, and balance impairment. A variety of evidence-based screening and assessment tools can help to identify the various types of vestibular pathology in SRC. When vestibular dysfunction is identified, there is emerging support for applying targeted vestibular rehabilitation to manage this condition.

Expansion microscopy of zebrafish for neuroscience and developmental biology studies

Expansion microscopy (ExM) allows scalable imaging of preserved 3D biological specimens with nanoscale resolution on fast diffraction-limited microscopes. Here, we explore the utility of ExM in the larval and embryonic zebrafish, an important model organism for the study of neuroscience and development. Regarding neuroscience, we found that ExM enabled the tracing of fine processes of radial glia, which are not resolvable with diffraction-limited microscopy. ExM further resolved putative synaptic connections, as well as molecular differences between densely packed synapses. Finally, ExM could resolve subsynaptic protein organization, such as ring-like structures composed of glycine receptors. Regarding development, we used ExM to characterize the shapes of nuclear invaginations and channels, and to visualize cytoskeletal proteins nearby. We detected nuclear invagination channels at late prophase and telophase, potentially suggesting roles for such channels in cell division. Thus, ExM of the larval and embryonic zebrafish may enable systematic studies of how molecular components are configured in multiple contexts of interest to neuroscience and developmental biology.

Assessment of anxiety in adolescents involved in a study abroad program: a prospective study

Objective The aim of the study was to measure the effects on levels of anxiety in healthy teenagers caused by a temporary change of country and school during a study abroad program. Methods In a prospective study we gathered the data from six anxiety level related tests on high school participants in a study abroad program (age 15-17, n = 364, M 172, F 192). These volunteer participants were divided into two separate groups: with self-reported elevated levels of anxiety (n = 111; YES-group) and with self-reported normal levels of anxiety (n = 253; NO-group). Two control groups of schoolchildren drawn from two local schools were used for comparison (n = 100 each). Three tests were subjective, i.e. self-fill-out tests. The next three tests were objective psychological or neurophysiological tests designed to estimate reflex control, concentration and a feeling for the passage of time. Results The initial mean anxiety level score among the 364 participants was 41.5 ± 16.7 (min 16, max 80) on 5-110 scale. For the YES-group the score was 56.5 ± 15.9, and for the NO-group the score was 34.7 ± 17.4 (p = 0.05). The retesting after they had been in the same place for 7 weeks revealed that the mean anxiety level score of the participants decreased to 37.4 ± 16.9 (min 15, max 72). For the YES-group the score significantly decreased to 39.3 ± 15.5, and for the NO-group the score slightly elevated to 36.7 ± 16.4 producing similar results for both groups (p = 0.81). Conclusion A temporary change of country and school at first results in a rise in anxiety levels in about one third of participants. However, after an extended stay it falls to normal levels.

Our sense of direction: progress, controversies and challenges

In this Perspective, we evaluate current progress in understanding how the brain encodes our sense of direction, within the context of parallel work focused on how early vestibular pathways encode self-motion. In particular, we discuss how these systems work together and provide evidence that they involve common mechanisms. We first consider the classic view of the head direction cell and results of recent experiments in rodents and primates indicating that inputs to these neurons encode multimodal information during self-motion, such as proprioceptive and motor efference copy signals, including gaze-related information. We also consider the paradox that, while the head-direction network is generally assumed to generate a fixed representation of perceived directional heading, this computation would need to be dynamically updated when the relationship between voluntary motor command and its sensory consequences changes. Such situations include navigation in virtual reality and head-restricted conditions, since the natural relationship between visual and extravisual cues is altered.

A unified internal model theory to resolve the paradox of active versus passive self-motion sensation

Brainstem and cerebellar neurons implement an internal model to accurately estimate self-motion during externally generated (‘passive’) movements. However, these neurons show reduced responses during self-generated (‘active’) movements, indicating that predicted sensory consequences of motor commands cancel sensory signals. Remarkably, the computational processes underlying sensory prediction during active motion and their relationship to internal model computations during passive movements remain unknown. We construct a Kalman filter that incorporates motor commands into a previously established model of optimal passive self-motion estimation. The simulated sensory error and feedback signals match experimentally measured neuronal responses during active and passive head and trunk rotations and translations. We conclude that a single sensory internal model can combine motor commands with vestibular and proprioceptive signals optimally. Thus, although neurons carrying sensory prediction error or feedback signals show attenuated modulation, the sensory cues and internal model are both engaged and critically important for accurate self-motion estimation during active head movements.

When seated in a car, we can detect when the vehicle begins to move even with our eyes closed. Structures in the inner ear called the vestibular, or balance, organs enable us to sense our own movement. They do this by detecting head rotations, accelerations and gravity. They then pass this information on to specialized vestibular regions of the brain.

Experiments using rotating chairs and moving platforms have shown that passive movements – such as car journeys and rollercoaster rides – activate the brain’s vestibular regions. But recent work has revealed that voluntary movements – in which individuals start the movement themselves – activate these regions far less than passive movements. Does this mean that the brain ignores signals from the inner ear during voluntary movements? Another possibility is that the brain predicts in advance how each movement will affect the vestibular organs in the inner ear. It then compares these predictions with the signals it receives during the movement. Only mismatches between the two activate the brain’s vestibular regions.

To test this theory, Laurens and Angelaki created a mathematical model that compares predicted signals with actual signals in the way the theory proposes. The model accurately predicts the patterns of brain activity seen during both active and passive movement. This reconciles the results of previous experiments on active and passive motion. It also suggests that the brain uses similar processes to analyze vestibular signals during both types of movement.

These findings can help drive further research into how the brain uses sensory signals to refine our everyday movements. They can also help us understand how people recover from damage to the vestibular system. Most patients with vestibular injuries learn to walk again, but have difficulty walking on uneven ground. They also become disoriented by passive movement. Using the model to study how the brain adapts to loss of vestibular input could lead to new strategies to aid recovery.