The regulation of vestibular afferent information during monocular vision while standing

Comparison Between Effects of Galvanic and Vibration-Based Vestibular Stimulation on Postural Control and Gait Performance in Healthy Participants: A Systematic Review of Cross-Sectional Studies

Electricity and vibration were two commonly used physical agents to provide vestibular stimulation in previous studies. This study aimed to systematically review the effects of galvanic (GVS) and vibration-based vestibular stimulation (VVS) on gait performance and postural control in healthy participants. Five bioscience and engineering databases, including MEDLINE via PubMed, CINAHL via EBSCO, Cochrane Library, Scopus, and Embase, were searched until March 19th, 2023. Studies published between 2000 and 2023 in English involving GVS and VVS related to gait performance and postural control were included. The procedure was followed via the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. The methodological quality of included studies was assessed using the NIH study quality assessment tool for observational cohort and cross-sectional studies. A total of 55 cross-sectional studies met the inclusion criteria and were included in this study. Five studies were good-quality while 49 were moderate-quality and 1 was poor-quality. There were 50 included studies involving GVS and 5 included studies involving VVS. GVS and VVS utilized different physical agents to provide vestibular stimulation and demonstrated similar effects on vestibular perception. Supra-threshold GVS and VVS produced vestibular perturbation that impaired gait performance and postural control, while sub-threshold GVS and VVS induced stochastic resonance phenomenon that led to an improvement. Bilateral vestibular stimulation demonstrated a greater effect on gait and posture than unilateral vestibular stimulation. Compared to GVS, VVS had the characteristics of better tolerance and fewer side effects, which may substitute GVS to provide more acceptable vestibular stimulation.

Static monocular visual cues can decrease the vestibular-evoked balance response at low frequencies

BACKGROUND

The balance system continually integrates and processes diverse sensorimotor cues to maintain upright posture. Yet, little is known about how monocular visual cues may modulate the vestibular control of standing balance.

RESEARCH QUESTION

To determine how visual cues, specifically monocular vision, modulate the vestibular-evoked myogenic and whole-body balance response.

METHODS

Seventeen (12 female) healthy subjects (age: 24.8 ± 5.3years) were exposed to a random, continuous electrical vestibular stimulation (EVS) signal (±3.5 mA, 0-20 Hz). Subjects stood quietly during four experimental (no vision, non-dominant eye, dominant eye, binocular) conditions. The EVS-medial-lateral ground reaction force (ML GRF) acting on the body and EVS-medial gastrocnemius electromyography (EMG, bilateral) responses were evaluated in the frequency (coherence) and time (cumulant density) domains.

RESULTS

Coherence was increased for no vision compared to binocular, dominant eye, and non-dominant eye visual cues, respectively, with the most pronounced increases occurring at lower frequencies. For cumulant density, the EVS-ML GRF medium-latency peak amplitude was increased 45, 26 and 18% with no vision compared to binocular, dominant eye and non-dominant eye visual cues, respectively (p < .05). The EVS-EMG medium-latency peak amplitude during no vision was greater than binocular (p < .05) for both gastrocnemii, but binocular and dominant eye monocular vision was not different (p > .05). The EVS-ML GRF and EVS-EMG (right medial gastrocnemius) medium-latency peak amplitude was greater for non-dominant eye monocular vision compared to binocular vision (p < .05).

SIGNIFICANCE

Monocular visual cues, at least for the dominant eye, can depress the vestibular-evoked balance response at low frequencies akin to binocular vision with limited differences exhibited between dominant and non-dominant eye.

The internal representation of head orientation differs for conscious perception and balance control

KEY POINTS

We tested perceived head-on-feet orientation and the direction of vestibular-evoked balance responses in passively and actively held head-turned postures. The direction of vestibular-evoked balance responses was not aligned with perceived head-on-feet orientation while maintaining prolonged passively held head-turned postures. Furthermore, static visual cues of head-on-feet orientation did not update the estimate of head posture for the balance controller. A prolonged actively held head-turned posture did not elicit a rotation in the direction of the vestibular-evoked balance response despite a significant rotation in perceived angular head posture. It is proposed that conscious perception of head posture and the transformation of vestibular signals for standing balance relying on this head posture are not dependent on the same internal representation. Rather, the balance system may operate under its own sensorimotor principles, which are partly independent from perception.

ABSTRACT

Vestibular signals used for balance control must be integrated with other sensorimotor cues to allow transformation of descending signals according to an internal representation of body configuration. We explored two alternative models of sensorimotor integration that propose (1) a single internal representation of head-on-feet orientation is responsible for perceived postural orientation and standing balance or (2) conscious perception and balance control are driven by separate internal representations. During three experiments, participants stood quietly while passively or actively maintaining a prolonged head-turned posture (>10 min). Throughout the trials, participants intermittently reported their perceived head angular position, and subsequently electrical vestibular stimuli were delivered to elicit whole-body balance responses. Visual recalibration of head-on-feet posture was used to determine whether static visual cues are used to update the internal representation of body configuration for perceived orientation and standing balance. All three experiments involved situations in which the vestibular-evoked balance response was not orthogonal to perceived head-on-feet orientation, regardless of the visual information provided. For prolonged head-turned postures, balance responses consistent with actual head-on-feet posture occurred only during the active condition. Our results indicate that conscious perception of head-on-feet posture and vestibular control of balance do not rely on the same internal representation, but instead treat sensorimotor cues in parallel and may arrive at different conclusions regarding head-on-feet posture. The balance system appears to bypass static visual cues of postural orientation and mainly use other sensorimotor signals of head-on-feet position to transform vestibular signals of head motion, a mechanism appropriate for most daily activities.

Quality of Visual Cue Affects Visual Reweighting in Quiet Standing

Sensory reweighting is a characteristic of postural control functioning adopted to accommodate environmental changes. The use of mono or binocular cues induces visual reduction/increment of moving room influences on postural sway, suggesting a visual reweighting due to the quality of available sensory cues. Because in our previous study visual conditions were set before each trial, participants could adjust the weight of the different sensory systems in an anticipatory manner based upon the reduction in quality of the visual information. Nevertheless, in daily situations this adjustment is a dynamical process and occurs during ongoing movement. The purpose of this study was to examine the effect of visual transitions in the coupling between visual information and body sway in two different distances from the front wall of a moving room. Eleven young adults stood upright inside of a moving room in two distances (75 and 150 cm) wearing a liquid crystal lenses goggles, which allow individual lenses transition from opaque to transparent and vice-versa. Participants stood still during five minutes for each trial and the lenses status changed every one minute (no vision to binocular vision, no vision to monocular vision, binocular vision to monocular vision, and vice-versa). Results showed that farther distance and monocular vision reduced the effect of visual manipulation on postural sway. The effect of visual transition was condition dependent, with a stronger effect when transitions involved binocular vision than monocular vision. Based upon these results, we conclude that the increased distance from the front wall of the room reduced the effect of visual manipulation on postural sway and that sensory reweighting is stimulus quality dependent, with binocular vision producing a much stronger down/up-weighting than monocular vision.

Motion parallax from microscopic head movements during visual fixation

Under normal viewing conditions, adjustments in body posture and involuntary head movements continually shift the eyes in space. Like all translations, these movements may yield depth information in the form of motion parallax, the differential motion on the retina of objects at different distances from the observer. However, studies on depth perception rarely consider the possible contribution of this cue, as the resulting changes in viewpoint appear too small to be of perceptual significance. Here, we quantified the parallax present during fixation in normally standing observers. We measured the trajectories followed by the eyes in space by means of a high-resolution head-tracking system and used an optical model of the eye to reconstruct the stimulus on the observer's retina. We show that, within several meters from the observer, relatively small changes in depth yield changes in the velocity of the retinal stimulus that are well above perceivable thresholds. Furthermore, relative velocities are little influenced by fixation distance, target eccentricity, and the precise oculomotor strategy followed by the observer to maintain fixation. These results demonstrate that the parallax available during normal head-free fixation is a reliable source of depth information, which the visual system may use in a variety of tasks.

Monocular vision and increased distance reducing the effects of visual manipulation on body sway

The goal of this study was to examine the coupling between visual information and body sway with binocular and monocular vision at two distances from the front wall of a moving room. Ten participants stood as still as possible inside of a moving room facing the front wall in conditions that combined room movement with monocular/binocular vision and distance from the front wall (75 and 150cm). Visual information effect on body sway decreased with monocular vision and with increased distance from the front wall. In addition, the combination of monocular vision with the farther distance resulted in the smallest body sway response to the driving stimulus provided by the moving room. These results suggest that binocular vision near the front wall provides visual information of a better quality than the monocular vision far from the front wall. We discuss the results with respect to two modes of visual detection of body sway: ocular and extraocular.