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Grove CR, Klatt BN, Wagner AR, Anson ER. Vestibular perceptual testing from lab to clinic: a review. Front Neurol 2023; 14:1265889. [PMID: 37859653 PMCID: PMC10583719 DOI: 10.3389/fneur.2023.1265889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
Not all dizziness presents as vertigo, suggesting other perceptual symptoms for individuals with vestibular disease. These non-specific perceptual complaints of dizziness have led to a recent resurgence in literature examining vestibular perceptual testing with the aim to enhance clinical diagnostics and therapeutics. Recent evidence supports incorporating rehabilitation methods to retrain vestibular perception. This review describes the current field of vestibular perceptual testing from scientific laboratory techniques that may not be clinic friendly to some low-tech options that may be more clinic friendly. Limitations are highlighted suggesting directions for additional research.
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Affiliation(s)
- Colin R. Grove
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Division of Physical Therapy, Department of Physical Medicine and Rehabilitation School of Medicine, Emory University, Atlanta, GA, United States
| | - Brooke N. Klatt
- Physical Therapy Department, University of Pittsburgh, Pittsburgh, PA, United States
| | - Andrew R. Wagner
- Department of Otolaryngology—Head and Neck Surgery, Ohio State University Wexner Medical Center, Columbus, OH, United States
- School of Health and Rehabilitation Sciences, Ohio State University, Columbus, OH, United States
| | - Eric R. Anson
- Department of Otolaryngology, University of Rochester, Rochester, NY, United States
- Physical Therapy Department, University of Rochester, Rochester, NY, United States
- Department of Neuroscience, University of Rochester, Rochester, NY, United States
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Wagner AR, Kobel MJ, Merfeld DM. Increased roll tilt thresholds are associated with subclinical postural instability in asymptomatic adults aged 21 to 84 years. Front Aging Neurosci 2023; 15:1207711. [PMID: 37637958 PMCID: PMC10448770 DOI: 10.3389/fnagi.2023.1207711] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/17/2023] [Indexed: 08/29/2023] Open
Abstract
Background Balance assessments that intentionally alter the reliability of visual and proprioceptive feedback (e.g., standing on foam with eyes closed) have become a standard approach for identifying vestibular mediated balance dysfunction in older adults. However, such assessments cannot discern which specific element of the vestibular system (e.g., semicircular canal, otolith, or combined canal-otolith) underlies the observed age-related changes in balance performance. The present study was designed to determine the associations between specific sources of vestibular noise and quantitative measures of quiet stance postural control measured during standard "vestibular" balance conditions. Methods A group of 52 asymptomatic adults (53.21 ± 19.7, 21 to 84 years) without a history of vestibular or neurologic disorders volunteered for this study. We measured a battery of five vestibular perceptual thresholds that assay vestibular noise with predominant contributions from the vertical canals, lateral canals, utricles, saccules, and the centrally integrated canal-otolith signal. In addition, participants completed two standard balance assessments that were each designed to prioritize the use of vestibular cues for quiet stance postural control-eyes closed on foam (Condition 4 of the Modified Romberg Balance Test) and eyes closed, on a sway referenced support surface (Condition 5 of the Sensory Organization Test). Results In age adjusted models, we found strong positive associations between roll tilt vestibular thresholds, a measure of noise in the centrally integrated canal-otolith signal, and the root mean square distance (RMSD) of the anteroposterior and mediolateral center of pressure (CoP) captured during eyes closed stance on a sway referenced support surface. The strength of the association between roll tilt thresholds and the RMSD of the CoP was between 3-times and 30-times larger than the association between postural sway and each of the other vestibular thresholds measured. Conclusion We posit that noise in the centrally estimated canal-otolith "tilt" signal may be the primary driver of the subclinical postural instability experienced by older adults during the "vestibular" conditions of balance assessments. Additional testing in adults with clinical balance impairment are needed to identify if roll tilt thresholds may also serve as a surrogate metric by which to detect vestibular mediated balance dysfunction and/or fall risk.
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Affiliation(s)
- Andrew R. Wagner
- Department of Otolaryngology – Head and Neck Surgery, Ohio State University Wexner Medical Center, Columbus, OH, United States
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, United States
| | - Megan J. Kobel
- Department of Otolaryngology – Head and Neck Surgery, Ohio State University Wexner Medical Center, Columbus, OH, United States
- Department of Speech and Hearing Science, The Ohio State University, Columbus, OH, United States
| | - Daniel M. Merfeld
- Department of Otolaryngology – Head and Neck Surgery, Ohio State University Wexner Medical Center, Columbus, OH, United States
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, United States
- Department of Speech and Hearing Science, The Ohio State University, Columbus, OH, United States
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, United States
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Lacquaniti F, La Scaleia B, Zago M. Noise and vestibular perception of passive self-motion. Front Neurol 2023; 14:1159242. [PMID: 37181550 PMCID: PMC10169592 DOI: 10.3389/fneur.2023.1159242] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 03/29/2023] [Indexed: 05/16/2023] Open
Abstract
Noise defined as random disturbances is ubiquitous in both the external environment and the nervous system. Depending on the context, noise can degrade or improve information processing and performance. In all cases, it contributes to neural systems dynamics. We review some effects of various sources of noise on the neural processing of self-motion signals at different stages of the vestibular pathways and the resulting perceptual responses. Hair cells in the inner ear reduce the impact of noise by means of mechanical and neural filtering. Hair cells synapse on regular and irregular afferents. Variability of discharge (noise) is low in regular afferents and high in irregular units. The high variability of irregular units provides information about the envelope of naturalistic head motion stimuli. A subset of neurons in the vestibular nuclei and thalamus are optimally tuned to noisy motion stimuli that reproduce the statistics of naturalistic head movements. In the thalamus, variability of neural discharge increases with increasing motion amplitude but saturates at high amplitudes, accounting for behavioral violation of Weber's law. In general, the precision of individual vestibular neurons in encoding head motion is worse than the perceptual precision measured behaviorally. However, the global precision predicted by neural population codes matches the high behavioral precision. The latter is estimated by means of psychometric functions for detection or discrimination of whole-body displacements. Vestibular motion thresholds (inverse of precision) reflect the contribution of intrinsic and extrinsic noise to perception. Vestibular motion thresholds tend to deteriorate progressively after the age of 40 years, possibly due to oxidative stress resulting from high discharge rates and metabolic loads of vestibular afferents. In the elderly, vestibular thresholds correlate with postural stability: the higher the threshold, the greater is the postural imbalance and risk of falling. Experimental application of optimal levels of either galvanic noise or whole-body oscillations can ameliorate vestibular function with a mechanism reminiscent of stochastic resonance. Assessment of vestibular thresholds is diagnostic in several types of vestibulopathies, and vestibular stimulation might be useful in vestibular rehabilitation.
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Affiliation(s)
- Francesco Lacquaniti
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy
- Department of Systems Medicine, Centre of Space Bio-medicine, University of Rome Tor Vergata, Rome, Italy
| | - Barbara La Scaleia
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Myrka Zago
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy
- Department of Civil Engineering and Computer Science Engineering, Centre of Space Bio-medicine, University of Rome Tor Vergata, Rome, Italy
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La Scaleia B, Lacquaniti F, Zago M. Enhancement of Vestibular Motion Discrimination by Small Stochastic Whole-body Perturbations in Young Healthy Humans. Neuroscience 2023; 510:32-48. [PMID: 36535577 DOI: 10.1016/j.neuroscience.2022.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/05/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022]
Abstract
Noisy galvanic vestibular stimulation has been shown to improve vestibular perception in healthy subjects. Here, we sought to obtain similar results using more natural stimuli consisting of small-amplitude motion perturbations of the whole body. Thirty participants were asked to report the perceived direction of antero-posterior sinusoidal motion on a MOOG platform. We compared the baseline perceptual thresholds with those obtained by applying small, stochastic perturbations at different power levels along the antero-posterior axis, symmetrically distributed around a zero-mean. At the population level, we found that the thresholds for all but the highest level of noise were significantly lower than the baseline threshold. At the individual level, the threshold was lower with at least one noise level than the threshold without noise in 87% of participants. Thus, small, stochastic oscillations of the whole body can increase the probability of recognizing the direction of motion from low, normally subthreshold vestibular signals, possibly due to stochastic resonance mechanisms. We suggest that, just as the external noise of the present experiments, also the spontaneous random oscillations of the head and body associated with standing posture are beneficial by enhancing vestibular thresholds with a mechanism similar to stochastic resonance.
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Affiliation(s)
- Barbara La Scaleia
- Laboratory of Visuomotor Control and Gravitational Physiology, IRCCS Fondazione Santa Lucia, 00179 Rome, Italy.
| | - Francesco Lacquaniti
- Laboratory of Neuromotor Physiology, IRCCS Fondazione Santa Lucia, 00179 Rome, Italy; Department of Systems Medicine and Center of Space Biomedicine, University of Rome Tor Vergata, 00133 Rome, Italy.
| | - Myrka Zago
- Laboratory of Visuomotor Control and Gravitational Physiology, IRCCS Fondazione Santa Lucia, 00179 Rome, Italy; Department of Civil Engineering and Computer Science Engineering and Center of Space Biomedicine, University of Rome Tor Vergata, 00133 Rome, Italy.
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Keywan A, Yassin G, Jahn K, Wuehr M. Subliminal conditioning of vestibular perception generalizes within otolith organs. J Neurol 2022; 269:5258-5261. [PMID: 35113258 PMCID: PMC9468040 DOI: 10.1007/s00415-022-10982-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/12/2022] [Accepted: 01/19/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Aram Keywan
- German Center for Vertigo and Balance Disorders, University Hospital of Munich, Munich, Germany
| | - Gharam Yassin
- German Center for Vertigo and Balance Disorders, University Hospital of Munich, Munich, Germany
| | - Klaus Jahn
- German Center for Vertigo and Balance Disorders, University Hospital of Munich, Munich, Germany.,Schön Klinik Bad Aibling, Bad Aibling, Germany
| | - Max Wuehr
- German Center for Vertigo and Balance Disorders, University Hospital of Munich, Munich, Germany.
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Diaz-Artiles A, Karmali F. Vestibular Precision at the Level of Perception, Eye Movements, Posture, and Neurons. Neuroscience 2021; 468:282-320. [PMID: 34087393 DOI: 10.1016/j.neuroscience.2021.05.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 05/20/2021] [Accepted: 05/24/2021] [Indexed: 11/18/2022]
Abstract
Precision and accuracy are two fundamental properties of any system, including the nervous system. Reduced precision (i.e., imprecision) results from the presence of neural noise at each level of sensory, motor, and perceptual processing. This review has three objectives: (1) to show the importance of studying vestibular precision, and specifically that studying accuracy without studying precision ignores fundamental aspects of the vestibular system; (2) to synthesize key hypotheses about precision in vestibular perception, the vestibulo-ocular reflex, posture, and neurons; and (3) to show that groups of studies that are thoughts to be distinct (e.g., perceptual thresholds, subjective visual vertical variability, neuronal variability) are actually "two sides of the same coin" - because the methods used allow results to be related to the standard deviation of a Gaussian distribution describing the underlying neural noise. Vestibular precision varies with age, stimulus amplitude, stimulus frequency, body orientation, motion direction, pathology, medication, and electrical/mechanical vestibular stimulation, but does not vary with sex. The brain optimizes precision during integration of vestibular cues with visual, auditory, and/or somatosensory cues. Since a common concern with precision metrics is time required for testing, we describe approaches to optimize data collection and provide evidence that fatigue and session effects are minimal. Finally, we summarize how precision is an individual trait that is correlated with clinical outcomes in patients as well as with performance in functional tasks like balance. These findings highlight the importance of studying vestibular precision and accuracy, and that knowledge gaps remain.
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Affiliation(s)
- Ana Diaz-Artiles
- Bioastronautics and Human Performance Laboratory, Department of Aerospace Engineering, Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843-3141, USA. https://bhp.engr.tamu.edu
| | - Faisal Karmali
- Jenks Vestibular Physiology Laboratory, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston MA, USA.
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