Vestibular contributions to a right-hemisphere network for bodily awareness: combining galvanic vestibular stimulation and the "Rubber Hand Illusion"

Multisensory mechanisms of gait and balance in Parkinson's disease: an integrative review

Understanding the neural underpinning of human gait and balance is one of the most pertinent challenges for 21st-century translational neuroscience due to the profound impact that falls and mobility disturbances have on our aging population. Posture and gait control does not happen automatically, as previously believed, but rather requires continuous involvement of central nervous mechanisms. To effectively exert control over the body, the brain must integrate multiple streams of sensory information, including visual, vestibular, and somatosensory signals. The mechanisms which underpin the integration of these multisensory signals are the principal topic of the present work. Existing multisensory integration theories focus on how failure of cognitive processes thought to be involved in multisensory integration leads to falls in older adults. Insufficient emphasis, however, has been placed on specific contributions of individual sensory modalities to multisensory integration processes and cross-modal interactions that occur between the sensory modalities in relation to gait and balance. In the present work, we review the contributions of somatosensory, visual, and vestibular modalities, along with their multisensory intersections to gait and balance in older adults and patients with Parkinson's disease. We also review evidence of vestibular contributions to multisensory temporal binding windows, previously shown to be highly pertinent to fall risk in older adults. Lastly, we relate multisensory vestibular mechanisms to potential neural substrates, both at the level of neurobiology (concerning positron emission tomography imaging) and at the level of electrophysiology (concerning electroencephalography). We hope that this integrative review, drawing influence across multiple subdisciplines of neuroscience, paves the way for novel research directions and therapeutic neuromodulatory approaches, to improve the lives of older adults and patients with neurodegenerative diseases.

Are blind individuals immune to bodily illusions? Somatic rubber hand illusion in the blind revisited

Multisensory awareness of one's own body relies on the integration of signals from various sensory modalities such as vision, touch, and proprioception. But how do blind individuals perceive their bodies without visual cues, and does the brain of a blind person integrate bodily senses differently from a sighted person? To address this question, we aimed to replicate the only two previous studies on this topic, which claimed that blind individuals do not experience the somatic rubber hand illusion, a bodily illusion triggered by the integration of correlated tactile and proprioceptive signals from the two hands. We used a larger sample size than the previous studies and added Bayesian analyses to examine statistical evidence in favor of the lack of an illusion effect. Moreover, we employed tests to investigate whether enhanced tactile acuity and cardiac interoceptive accuracy in blind individuals could also explain the weaker illusion. We tested 36 blind individuals and 36 age- and sex-matched sighted volunteers. The results show that blind individuals do not experience the somatic rubber hand illusion based on questionnaire ratings and behavioral measures that assessed changes in hand position sense toward the location of the rubber hand. This conclusion is supported by Bayesian evidence in favor of the null hypothesis. The findings confirm that blind individuals do not experience the somatic rubber hand illusion, indicating that lack of visual experience leads to permanent changes in multisensory bodily perception. In summary, our study suggests that changes in multisensory integration of tactile and proprioceptive signals may explain why blind individuals are "immune" to the nonvisual version of the rubber hand illusion.

Active self-touch restores bodily proprioceptive spatial awareness following disruption by 'rubber hand illusion'

Bodily self-awareness relies on a constant integration of visual, tactile, proprioceptive, and motor signals. In the 'rubber hand illusion' (RHI), conflicting visuo-tactile stimuli lead to changes in self-awareness. It remains unclear whether other, somatic signals could compensate for the alterations in self-awareness caused by visual information about the body. Here, we used the RHI in combination with robot-mediated self-touch to systematically investigate the role of tactile, proprioceptive and motor signals in maintaining and restoring bodily self-awareness. Participants moved the handle of a leader robot with their right hand and simultaneously received corresponding tactile feedback on their left hand from a follower robot. This self-touch stimulation was performed either before or after the induction of a classical RHI. Across three experiments, active self-touch delivered after-but not before-the RHI, significantly reduced the proprioceptive drift caused by RHI, supporting a restorative role of active self-touch on bodily self-awareness. The effect was not present during involuntary self-touch. Unimodal control conditions confirmed that both tactile and motor components of self-touch were necessary to restore bodily self-awareness. We hypothesize that active self-touch transiently boosts the precision of proprioceptive representation of the touched body part, thus counteracting the visual capture effects that underlie the RHI.

Quantifying virtual self-motion sensations induced by galvanic vestibular stimulation

BACKGROUND

The vestibular system provides a comprehensive estimate of self-motion in 3D space. Widely used to artificially stimulate the vestibular system, binaural-bipolar square-wave Galvanic Vestibular Stimulation (GVS) elicits a virtual sensation of roll rotation. Postural responses to GVS have been clearly delineated, however quantifying the perceived virtual rotation vector has not been fully realised.

OBJECTIVE

We aimed to quantify the perceived virtual roll rotation vector elicited by GVS using a psychophysical approach on a 3D turntable.

METHODS

Participants were placed supine on the 3D turntable and rotated around the naso-occipital axis while supine and received square-wave binaural-bipolar GVS or sham stimulation. GVS amplitudes and intensities were systematically manipulated. The turntable motion profile consisted of a velocity step of 20°/s2 until the trial velocity between 0-20°/s was reached, followed by a 1°/s ramp until the end of the trial. In a psychophysical adaptive staircase procedure, we systematically varied the roll velocity to identify the exact velocity that cancelled the perceived roll sensation induced by GVS.

RESULTS

Participants perceived a virtual roll rotation towards the cathode of approximately 2°/s velocity for 1 mA GVS and 6°/s velocity for 2.5 mA GVS. The observed values were stable across repetitions.

CONCLUSIONS

Our results quantify for the first time the perceived virtual roll rotations induced by binaural-bipolar square-wave GVS. Importantly, estimates were based on perceptual judgements, in the absence of motor or postural responses and in a head orientation where the GVS-induced roll sensation did not interact with the perceived direction of gravity. This is an important step towards applications of GVS in different settings, including sensory substitution or Virtual Reality.

Combination of visuo-tactile and visuo-vestibular correlations in illusory body ownership and self-motion sensations

Previous studies have shown that illusory ownership over a mannequin's body can be induced through synchronous visuo-tactile stimulation as well as through synchronous visuo-vestibular stimulation. The current study aimed to elucidate how three-way combinations of correlated visual, tactile and vestibular signals contribute to the senses of body ownership and self-motion. Visuo-tactile temporal congruence was manipulated by touching the mannequin's body and the participant's unseen real body on the trunk with a small object either synchronously or asynchronously. Visuo-vestibular temporal congruence was manipulated by synchronous or asynchronous presentation of a visual motion cue (the background rotating around the mannequin in one direction) and galvanic stimulation of the vestibular nerve generating a rotation sensation (in the same direction). The illusory experiences were quantified using a questionnaire; threat-evoked skin-conductance responses (SCRs) provided complementary indirect physiological evidence for the illusion. Ratings on the illusion questionnaire statement showed significant main effects of synchronous visuo-vestibular and synchronous visuo-tactile stimulations, suggesting that both of these pairs of bimodal correlations contribute to the ownership illusion. Interestingly, visuo-tactile synchrony dominated because synchronous visuo-tactile stimulation combined with asynchronous visuo-vestibular stimulation elicited a body ownership illusion of similar strength as when both bimodal combinations were synchronous. Moreover, both visuo-tactile and visuo-vestibular synchrony were associated with enhanced self-motion perception; self-motion sensations were even triggered when visuo-tactile synchrony was combined with visuo-vestibular asynchrony, suggesting that ownership enhanced the relevance of visual information as a self-motion cue. Finally, the SCR results suggest that synchronous stimulation of either modality pair led to a stronger illusion compared to the asynchronous conditions. Collectively, the results suggest that visuo-tactile temporal correlations have a stronger influence on body ownership than visuo-vestibular correlations and that ownership boosts self-motion perception. We present a Bayesian causal inference model that can explain how visuo-vestibular and visuo-tactile information are combined in multisensory own-body perception.

The rubber hand illusion in microgravity and water immersion

Our body has evolved in terrestrial gravity and altered gravitational conditions may affect the sense of body ownership (SBO). By means of the rubber hand illusion (RHI), we investigated the SBO during water immersion and parabolic flights, where unconventional gravity is experienced. Our results show that unconventional gravity conditions remodulate the relative weights of visual, proprioceptive, and vestibular inputs favoring vision, thus inducing an increased RHI susceptibility.

Sensorimotor Underpinnings of Mathematical Imagination: Qualitative Analysis

Many mathematicians have a rich internal world of mental imagery. Using elementary mathematical skills, this study probes the mathematical imagination's sensorimotor foundations. Mental imagery is perturbed using body position: having the head and vestibular system in different positions with respect to gravity. No two mathematicians described the same imagery. Eight out of 11 habitually visualize, one uses sensorimotor imagery, and two do not habitually used mental imagery. Imagery was both intentional and partly autonomous. For example, coordinate planes rotated, drifted, wobbled, or slid down from vertical to horizontal. Parabolae slid into place or, on one side, a parabola arm reached upward in gravity. The sensorimotor foundation of imagery was evidenced in several ways. The imagery was placed with respect to the body. Further, the imagery had a variety of relationships to the body, such as the body being the coordinate system or the coordinate system being placed in front of the eyes for easy viewing by the mind's eye. The mind's eye, mind's arm, and awareness almost always obeyed the geometry of the real eye and arm. The imagery and body behaved as a dyad, so that the imagery moved or placed itself for the convenience of the mind's eye or arm, which in turn moved to follow the imagery. With eyes closed, participants created a peripersonal imagery space, along with the peripersonal space of the unseen environment. Although mathematics is fundamentally abstract, imagery was sometimes concrete or used a concrete substrate or was placed to avoid being inside concrete objects, such as furniture. Mathematicians varied in the numbers of components of mental imagery and the ways they interacted. The autonomy of the imagery was sometimes of mathematical interest, suggesting that the interaction of imagery habits and autonomy can be a source of mathematical creativity.

Asymmetrical influence of bi-thermal caloric vestibular stimulation on a temporal order judgment task

Recent evidences suggest that binaural vestibular stimulation affects tactile temporal processing. However, it remains difficult to determine the physiological mechanisms supporting the vestibular-somatosensory interactions observed during a TOJ task. Controlling the activation of the right or left vestibular system separately could allow to better understand the physiological bases of these findings and reconcile previous studies. The objective of the present study was to examine tactile temporal processing using a temporal order judgment task following selective stimulation of the right and left vestibular system with bi-thermal caloric vestibular stimulation (CVS). A total of 24 right-handed participants received bi-thermal CVS either in the right ear (n = 12) or the left ear (n = 12). Participants held vibrators in both hands which delivered a signal temporally separated by a variable asynchrony. Participants had to report the hand where the vibration was perceived first. The task was performed in three different CVS conditions: (1) baseline, (2) warm CVS, and (3) cold CVS. Analysis of the logistics curve parameters-just noticeable difference (JND) and point of subjective simultaneity (PSS)-for each participant in each CVS conditions revealed an increase in JND greater following warm CVS. A significant increase in JND following warm CVS was measured bilaterally. However, cold CVS increased JND only when CVS was applied in the left ear, but not in the right ear. Finally, no influence of CVS on PSS was observed.

The disappearing hand: vestibular stimulation does not improve hand localisation

Background

Bodily self-consciousness depends on the coherent integration of sensory information. In addition to visual and somatosensory information processing, vestibular contributions have been proposed and investigated. Vestibular information seems especially important for self-location, but remains difficult to study.

Methods

This randomised controlled experiment used the MIRAGE multisensory illusion box to induce a conflict between the visually- and proprioceptively-encoded position of one hand. Over time, the perceived location of the hand slowly shifts, due to the fact that proprioceptive input is progressively weighted more heavily than the visual input. We hypothesised that left cold caloric vestibular stimulation (CVS) augments this shift in hand localisation.

Results

The results from 24 healthy participants do not support our hypothesis: CVS had no effect on the estimations with which the perceived position of the hand shifted from the visually- to the proprioceptively-encoded position. Participants were more likely to report that their hand was 'no longer there' after CVS. Taken together, neither the physical nor the subjective data provide evidence for vestibular enhanced self-location.

Visual perception of one's own body under vestibular stimulation using biometric self-avatars in virtual reality

Background and purpose

Vestibular input is projected to "multisensory (vestibular) cortex" where it converges with input from other sensory modalities. It has been assumed that this multisensory integration enables a continuous perception of state and presence of one’s own body. The present study thus asked whether or not vestibular stimulation may impact this perception.

Methods

We used an immersive virtual reality setup to realistically manipulate the length of extremities of first person biometric avatars. Twenty-two healthy participants had to adjust arms and legs to their correct length from various start lengths before, during, and after vestibular stimulation.

Results

Neither unilateral caloric nor galvanic vestibular stimulation had a modulating effect on the perceived size of own extremities.

Conclusion

Our results suggest that vestibular stimulation does not directly influence the explicit somatosensory representation of our body. It is possible that in non-brain-damaged, healthy subjects, changes in whole body size perception are principally not mediated by vestibular information. Alternatively, visual feedback and/or memory may dominate multisensory integration and thereby override possibly existing modulations of body perception by vestibular stimulation. The present observations suggest that multisensory integration and not the processing of a single sensory input is the crucial mechanism in generating our body representation in relation to the external world.

Balancing body ownership: Visual capture of proprioception and affectivity during vestibular stimulation

The experience of our body as our own (i.e. body ownership) involves integrating different sensory signals according to their contextual relevance (i.e. multisensory integration). Until recently, most studies of multisensory integration and body ownership concerned only vision, touch and proprioception; the role of other modalities, such as the vestibular system and interoception, has been neglected and remains poorly understood. In particular, no study to date has directly explored the combined effect of vestibular and interoceptive signals on body ownership. Here, we investigated for the first time how Galvanic Vestibular Stimulation (left, right, sham), tactile affectivity (a reclassified interoceptive modality manipulated by applying touch at C-tactile optimal versus non-optimal velocities), and their combination, influence proprioceptive and subjective measures of body ownership during a rubber hand illusion paradigm with healthy participants (N = 26). Our results show that vestibular stimulation (left GVS) significantly increased proprioceptive drift towards the rubber hand during mere visual exposure to the rubber hand. Moreover, it also enhanced participants’ proprioceptive drift towards the rubber hand during manipulations of synchronicity and affective touch. These findings suggest that the vestibular system influences multisensory integration, possibly by re-weighting both the two-way relationship between proprioception and vision, as well as the three-way relationship between proprioception, vision and affective touch. We discuss these findings in relation to current predictive coding models of multisensory integration and body ownership.

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We studied vestibular and affective contributions to body ownership.

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We stimulated the vestibular system in a Rubber Hand paradigm with affective touch.

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Right-hemisphere stimulation increased proprioceptive drift during vision of a RH.

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Applying affective touch further increased proprioceptive drift.

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Affective and vestibular signals may favour vision in multisensory integration.

From multisensory integration in peripersonal space to bodily self-consciousness: from statistical regularities to statistical inference

Integrating information across sensory systems is a critical step toward building a cohesive representation of the environment and one's body, and as illustrated by numerous illusions, scaffolds subjective experience of the world and self. In the last years, classic principles of multisensory integration elucidated in the subcortex have been translated into the language of statistical inference understood by the neocortical mantle. Most importantly, a mechanistic systems-level description of multisensory computations via probabilistic population coding and divisive normalization is actively being put forward. In parallel, by describing and understanding bodily illusions, researchers have suggested multisensory integration of bodily inputs within the peripersonal space as a key mechanism in bodily self-consciousness. Importantly, certain aspects of bodily self-consciousness, although still very much a minority, have been recently casted under the light of modern computational understandings of multisensory integration. In doing so, we argue, the field of bodily self-consciousness may borrow mechanistic descriptions regarding the neural implementation of inference computations outlined by the multisensory field. This computational approach, leveraged on the understanding of multisensory processes generally, promises to advance scientific comprehension regarding one of the most mysterious questions puzzling humankind, that is, how our brain creates the experience of a self in interaction with the environment.

Distorted own-body representations in patients with dizziness and during caloric vestibular stimulation

There is increasing evidence that vestibular disorders evoke deficits reaching far beyond imbalance, oscillopsia and spatial cognition. Yet, how vestibular disorders affect own-body representations, in particular the perceived body shape and size, has been overlooked. Here, we explored vestibular contributions to own-body representations using two approaches. Study 1 measured the occurrence and severity of distorted own-body representations in 60 patients with dizziness and 60 healthy controls using six items from the Cambridge Depersonalization Scale. 12% of the patients have experienced distorted own-body representations (their hands or feet felt larger or smaller), 37% reported abnormal sense of agency, 35% reported disownership for the body, and 22% reported disembodiment. These proportions were larger in patients than controls. Study 2 aimed at testing whether artificial stimulation of the vestibular apparatus produced comparable distortions of own-body representations in healthy volunteers. We compared the effects of right-warm/left-cold caloric vestibular stimulation (CVS), left-warm/right-cold CVS and sham CVS on internal models of the left and right hands using a pointing task. The perceived length of the dorsum of the hand was increased specifically during left-warm/right-cold CVS, and this effect was found for both hands. Our studies show a vestibular contribution to own-body representations and should help understand the complex symptomatology of patients with dizziness.

Current diagnostic procedures for diagnosing vertigo and dizziness

Vertigo is a multisensory syndrome that otolaryngologists are confronted with every day. With regard to the complex functions of the sense of orientation, vertigo is considered today as a disorder of the sense of direction, a disturbed spatial perception of the body. Beside the frequent classical syndromes for which vertigo is the leading symptom (e.g. positional vertigo, vestibular neuritis, Menière’s disease), vertigo may occur as main or accompanying symptom of a multitude of ENT-related diseases involving the inner ear. It also concerns for example acute and chronic viral or bacterial infections of the ear with serous or bacterial labyrinthitis, disorders due to injury (e.g. barotrauma, fracture of the oto-base, contusion of the labyrinth), chronic-inflammatory bone processes as well as inner ear affections in the perioperative course. In the last years, diagnostics of vertigo have experienced a paradigm shift due to new diagnostic possibilities. In the diagnostics of emergency cases, peripheral and central disorders of vertigo (acute vestibular syndrome) may be differentiated with simple algorithms. The introduction of modern vestibular test procedures (video head impulse test, vestibular evoked myogenic potentials) in the clinical practice led to new diagnostic options that for the first time allow a complex objective assessment of all components of the vestibular organ with relatively low effort. Combined with established methods, a frequency-specific assessment of the function of vestibular reflexes is possible. New classifications allow a clinically better differentiation of vertigo syndromes. Modern radiological procedures such as for example intratympanic gadolinium application for Menière’s disease with visualization of an endolymphatic hydrops also influence current medical standards. Recent methodical developments significantly contributed to the possibilities that nowadays vertigo can be better and more quickly clarified in particular in otolaryngology.

The vestibular body: Vestibular contributions to bodily representations

Vestibular signals are integrated with signals from other sensory modalities. This convergence could reflect an important mechanism for maintaining the perception of the body. Here we review the current literature in order to develop a framework for understanding how the vestibular system contributes to body representation. According to recent models, we distinguish between three processes for body representation, and we look at whether vestibular signals might influence each process. These are (i) somatosensation, the primary sensory processing of somatic stimuli, (ii) somatoperception, the processes of constructing percepts and experiences of somatic objects and events and (iii) somatorepresentation, the knowledge about the body as a physical object in the world. Vestibular signals appear to contribute to all three levels in this model of body processing. Thus, the traditional view of the vestibular system as a low-level, dedicated orienting module tends to underestimate the pervasive role of vestibular input in bodily self-awareness.

Multimodal Contributions to Body Representation

Our body is a unique entity by which we interact with the external world. Consequently, the way we represent our body has profound implications in the way we process and locate sensations and in turn perform appropriate actions. The body can be the subject, but also the object of our experience, providing information from sensations on the body surface and viscera, but also knowledge of the body as a physical object. However, the extent to which different senses contribute to constructing the rich and unified body representations we all experience remains unclear. In this review, we aim to bring together recent research showing important roles for several different sensory modalities in constructing body representations. At the same time, we hope to generate new ideas of how and at which level the senses contribute to generate the different levels of body representations and how they interact. We will present an overview of some of the most recent neuropsychological evidence about multisensory control of pain, and the way that visual, auditory, vestibular and tactile systems contribute to the creation of coherent representations of the body. We will focus particularly on some of the topics discussed in the symposium on Multimodal Contributions to Body Representation held on the 15th International Multisensory Research Forum (2015, Pisa, Italy).

Maladaptive change of body representation in the brain after damage to central or peripheral nervous system

Our brain has great flexibility to cope with various changes in the environment. Use-dependent plasticity, a kind of functional plasticity, plays the most important role in this ability to cope. For example, the functional recovery of paretic limb motor movement during post-stroke rehabilitation depends mainly on how much it is used. Patients with hemiparesis, however, tend to gradually disuse the paretic limb because of its motor impairment. Decreased use of the paretic hand then leads to further functional decline brought by use-dependent plasticity. To break this negative loop, body representation, which is the conscious and unconscious information regarding body state stored in the brain, is key for using the paretic limb because it plays an important role in selecting an effector while a motor program is generated. In an attempt to understand body representation in the brain, we reviewed animal and human literature mainly on the alterations of the sensory maps in the primary somatosensory cortex corresponding to the changes in limb usage caused by peripheral or central nervous system damage.