Mental representation of space in vestibular patients with otolithic or rotatory vertigo

Cognitive and balance functions of astronauts after spaceflight are comparable to those of individuals with bilateral vestibulopathy

Introduction

This study compares the balance control and cognitive responses of subjects with bilateral vestibulopathy (BVP) to those of astronauts immediately after they return from long-duration spaceflight on board the International Space Station.

Methods

Twenty-eight astronauts and thirty subjects with BVP performed five tests using the same procedures: sit-to-stand, walk-and-turn, tandem walk, duration judgment, and reaction time.

Results

Compared to the astronauts' preflight responses, the BVP subjects' responses were impaired in all five tests. However, the BVP subjects' performance during the walk-and-turn and the tandem walk tests were comparable to the astronauts' performance on the day they returned from space. Moreover, the BVP subjects' time perception and reaction time were comparable to those of the astronauts during spaceflight. The BVP subjects performed the sit-to-stand test at a level that fell between the astronauts' performance on the day of landing and 1 day later.

Discussion

These results indicate that the alterations in dynamic balance control, time perception, and reaction time that astronauts experience after spaceflight are likely driven by central vestibular adaptations. Vestibular and somatosensory training in orbit and vestibular rehabilitation after spaceflight could be effective countermeasures for mitigating these post-flight performance decrements.

Spaceflight alters reaction time and duration judgment of astronauts

We report a study on astronauts aimed at characterizing duration judgment before, during, and after long-duration stays on board the International Space Station. Ten astronauts and a control group of 15 healthy (non-astronaut) participants performed a duration reproduction task and a duration production task using a visual target duration ranging from 2 to 38 s. Participants also performed a reaction time test for assessing attention. Compared to control participants and preflight responses, the astronauts’ reaction time increased during spaceflight. Also, during spaceflight, time intervals were under-produced while counting aloud and under-reproduced when there was a concurrent reading task. We hypothesize that time perception during spaceflight is altered by two mechanisms: (a) an acceleration of the internal clock through the changes in vestibular inputs in microgravity, and (b) difficulties in attention and working memory when a concurrent reading task is present. Prolonged isolation in confined areas, weightlessness, stress related to workload, and high-performance expectations could account for these cognitive impairments.

Time perception in astronauts on board the International Space Station

We perceive the environment through an elaborate mental representation based on a constant integration of sensory inputs, knowledge, and expectations. Previous studies of astronauts on board the International Space Station have shown that the mental representation of space, such as the perception of object size, distance, and depth, is altered in orbit. Because the mental representations of space and time have some overlap in neural networks, we hypothesized that perception of time would also be affected by spaceflight. Ten astronauts were tested before, during, and after a 6-8-month spaceflight. Temporal tasks included judging when one minute had passed and how long it had been since the start of the workday, lunch, docking of a vehicle, and a spacewalk. Compared to pre-flight estimates, there is a relative overestimation for the 1-min interval during the flight and a relative underestimation of intervals of hours in duration. However, the astronauts quite accurately estimated the number of days since vehicle dockings and spacewalks. Prolonged isolation in confined areas, stress related to workload, and high-performance expectations are potential factors contributing to altered time perception of daily events. However, reduced vestibular stimulations and slower motions in weightlessness, as well as constant references to their timeline and work schedule could also account for the change in the estimation of time by the astronauts in space.

Hearing loss versus vestibular loss as contributors to cognitive dysfunction

In the last 5 years, there has been a surge in evidence that hearing loss (HL) may be a risk factor for cognitive dysfunction, including dementia. At the same time, there has been an increase in the number of studies implicating vestibular loss in cognitive dysfunction. Due to the fact that vestibular disorders often present with HL and other auditory disorders such as tinnitus, it has been suggested that, in many cases, what appears to be vestibular-related cognitive dysfunction may be due to HL (e.g., Dobbels et al. Front Neurol 11:710, 2020). This review analyses the studies of vestibular-related cognitive dysfunction which have controlled HL. It is suggested that despite the fact that many studies in the area have not controlled HL, many other studies have (~ 19/44 studies or 43%). Therefore, although there is certainly a need for further studies controlling HL, there is evidence to suggest that vestibular loss is associated with cognitive dysfunction, especially related to spatial memory. This is consistent with the overwhelming evidence from animal studies that the vestibular system transmits specific types of information about self-motion to structures such as the hippocampus.

Sensitivity of Visual System in 5-Day "Dry" Immersion With High-Frequency Electromyostimulation

The aim of this work was to study the sensitivity of the visual system in 5-day "dry" immersion with a course of high-frequency electromyostimulation (HFEMS) and without it. "Dry" immersion (DI) is one of the most effective models of microgravity. DI reproduces three basic effects of weightlessness: physical inactivity, support withdrawal and elimination of the vertical vascular gradient. The "dry" immersion included in the use of special waterproof and highly elastic fabric on of immersion in a liquid similar in density to the tissues of the human body. The sensitivity of the visual system was assessed by measuring contrast sensitivity and magnitude of the Müller-Lyer illusion. The visual contrast sensitivity was measured in the spatial frequency range from 0.4 to 10.0 cycles/degree. The strength of visual illusion was assessed by means of motor response using "tracking." Measurements were carried out before the start of immersion, on the 1st, 3rd, 5th days of DI, and after its completion. Under conditions of "dry" immersion without HFEMS, upon the transition from gravity to microgravity conditions (BG and DI1) we observed significant differences in contrast sensitivity in the low spatial frequency range, whereas in the experiment with HFEMS-in the medium spatial frequency range. In the experiment without HFEMS, the Müller-Lyer illusion in microgravity conditions was absent, while in the experiment using HFEMS it was significantly above zero at all stages. Thus, we obtained only limited evidence in favor of the hypothesis of a possible compensating effect of HFEMS on changes in visual sensitivity upon the transition from gravity to microgravity conditions and vice versa. The study is a pilot and requires further research on the effect of HFEMS on visual sensitivity.

The vestibular system modulates the contributions of head and torso to egocentric spatial judgements

Egocentric representations allow us to describe the external world as experienced from an individual's bodily location. We recently developed a novel method of quantifying the weight given to different body parts in egocentric judgments (the Misalignment Paradigm). We found that both head and torso contribute to simple alter-egocentric spatial judgments. We hypothesised that artificial stimulation of the vestibular system would provide a head-related signal, which might affect the weighting given to the head in egocentric spatial judgments. Bipolar Galvanic Vestibular Stimulation (GVS) was applied during the Misalignment Paradigm. A Sham stimulation condition was also included to control for non-specific effects. Our data show that the weight given to the head was increased during left anodal and right cathodal GVS, compared to the opposite GVS polarity (right anodal and left cathodal GVS) and Sham stimulation. That is, the polarity of GVS, which preferentially activates vestibular areas in the right cerebral hemisphere, influenced the relative weightings of head and torso in egocentric spatial judgments.

The interaction of the visuo-spatial and the vestibular system depends on sensory experience in development

In hearing individuals, vestibular and visuo-spatial functions seem to be functionally linked. Previous studies have suggested that congenitally deaf individuals are at a higher risk for vestibular problems, which in hearing adults have often been found to be associated with impairments in visuo-spatial processing. However, communicating in a sign language provides extensive practice in visuo-spatial processing, which might counteract negative effects of vestibular impairments. Here, we investigated whether the functional link between vestibular and visuo-spatial functions is mandatory, that is whether it is impenetrable to experience or context, or whether it is dependent on specific sensory and cognitive experiences. To this end, we tested a group of congenitally deaf native signers and a group of hearing nonsigners on mental rotation and balance tasks. Compared to hearing nonsigners, mental rotation was superior in the deaf signers in conditions crucial for sign language comprehension. By contrast, the balance performance of the group of deaf signers was impaired. While in the group of hearing nonsigners, balance skills correlated with mental rotation abilities, no such relationship was observed in the group of deaf signers. These results suggest that the link between vestibular and visuo-spatial functions is not fixed but can be altered or even cancelled out by certain sensory or cognitive experiences, such as the acquisition of a sign language.

Can jaw position affect the fine motor activity of the hand during writing?

BACKGROUND

Jaw and neck systems have been shown to be functionally related and changes in either system can modulate gross motor functions, such as posture control. It remains to be seen if any change in jaw position can affect fine motor skills. The objective of this study was to determine the effect of resting, open and clenched jaw positions on various handwriting parameters while standing on firm and unstable surfaces.

METHODS

Handwriting samples were collected from 36 healthy male participants (age, 15-35 years) using a digitizer tablet (WACOM Intuos 4) with noninking pen in the resting, open and clenched jaw positions while standing on firm and unstable surfaces. The measured handwriting parameters included duration, vertical size, horizontal size, absolute size, average absolute velocity, and absolute jerk. Recordings and analyses were performed using NeuroScript MovAlyzeR software.

RESULTS

All handwriting parameters varied among the resting, open, and clenched jaw positions on both the firm and unstable surfaces. However, based on statistical analyses, there were no significant differences in the handwriting parameters among three jaw positions on both surfaces (p > .05).

CONCLUSION

This study revealed that all handwriting parameters varied among the resting, open, and clenched jaw positions on both the firm and unstable surfaces, showing that change in the jaw motor system may potentially affect the fine motor skills. However, on statistical analysis, there was no significant effect of 3 studied jaw positions on fine motor skills as seen on gross motor skills among healthy individuals.

Horizontal and Vertical Distance Perception in Altered Gravity

The perception of the horizontal and vertical distances of a visual target to an observer was investigated in parabolic flight during alternating short periods of normal gravity (1 g). microgravity (0 g), and hypergravity (1.8 g). The methods used for obtaining absolute judgments of egocentric distance included verbal reports and visually directed motion toward a memorized visual target by pulling on a rope with the arms (blind pulling). The results showed that, for all gravity levels, the verbal reports of distance judgments were accurate for targets located between 0.6 and 6.0 m. During blind pulling, subjects underestimated horizontal distances as distances increased, and this underestimation decreased in 0 g. Vertical distances for up targets were overestimated and vertical distances for down targets were underestimated in both 1 g and 1.8 g. This vertical asymmetry was absent in 0 g. The results of the present study confirm that blind pulling and verbal reports are independently influenced by gravity. The changes in distance judgments during blind pulling in 0 g compared to 1 g support the view that, during an action-based task, subjects base their perception of distance on the estimated motor effort of navigating to the perceived object.

The aesthetics of verticality: A gravitational contribution to aesthetic preference

Verticality plays a fundamental role in the arts, portraying concepts such as power, grandeur, or even morality; however, it is unclear whether people have an aesthetic preference for vertical stimuli. The perception of verticality occurs by integrating vestibular-gravitational input with proprioceptive signals about body posture. Thus, these signals may influence the preference for verticality. Here, we show that people have a genuine aesthetic preference for stimuli aligned with the vertical, and this preference depends on the position of the body relative to the gravitational direction. Observers rated the attractiveness of lines that varied in inclination. Perfectly vertical lines were judged to be more attractive than those inclined clockwise or anticlockwise only when participants held an upright posture. Critically, this preference was not present when their body was tilted away from the gravitational vertical. Our results showed that gravitational signals make a contribution to the perception of attractiveness of environmental objects.

Up, Down, Near, Far: An Online Vestibular Contribution to Distance Judgement

Whether a visual stimulus seems near or far away depends partly on its vertical elevation. Contrasting theories suggest either that perception of distance could vary with elevation, because of memory of previous upwards efforts in climbing to overcome gravity, or because of fear of falling associated with the downwards direction. The vestibular system provides a fundamental signal for the downward direction of gravity, but the relation between this signal and depth perception remains unexplored. Here we report an experiment on vestibular contributions to depth perception, using Virtual Reality. We asked participants to judge the absolute distance of an object presented on a plane at different elevations during brief artificial vestibular inputs. Relative to distance estimates collected with the object at the level of horizon, participants tended to overestimate distances when the object was presented above the level of horizon and the head was tilted upward and underestimate them when the object was presented below the level of horizon. Interestingly, adding artificial vestibular inputs strengthened these distance biases, showing that online multisensory signals, and not only stored information, contribute to such distance illusions. Our results support the gravity theory of depth perception, and show that vestibular signals make an on-line contribution to the perception of effort, and thus of distance.

Multisensory effects on somatosensation: a trimodal visuo-vestibular-tactile interaction

Vestibular information about self-motion is combined with other sensory signals. Previous research described both visuo-vestibular and vestibular-tactile bilateral interactions, but the simultaneous interaction between all three sensory modalities has not been explored. Here we exploit a previously reported visuo-vestibular integration to investigate multisensory effects on tactile sensitivity in humans. Tactile sensitivity was measured during passive whole body rotations alone or in conjunction with optic flow, creating either purely vestibular or visuo-vestibular sensations of self-motion. Our results demonstrate that tactile sensitivity is modulated by perceived self-motion, as provided by a combined visuo-vestibular percept, and not by the visual and vestibular cues independently. We propose a hierarchical multisensory interaction that underpins somatosensory modulation: visual and vestibular cues are first combined to produce a multisensory self-motion percept. Somatosensory processing is then enhanced according to the degree of perceived self-motion.

Long-Duration Spaceflight Increases Depth Ambiguity of Reversible Perspective Figures

The objective of this study was to investigate depth perception in astronauts during and after spaceflight by studying their sensitivity to reversible perspective figures in which two-dimensional images could elicit two possible depth representations. Other ambiguous figures that did not give rise to a perception of illusory depth were used as controls. Six astronauts and 14 subjects were tested in the laboratory during three sessions for evaluating the variability of their responses in normal gravity. The six astronauts were then tested during four sessions while on board the International Space Station for 5–6 months. They were finally tested immediately after return to Earth and up to one week later. The reaction time decreased throughout the sessions, thus indicating a learning effect. However, the time to first percept reversal and the number of reversals were not different in orbit and after the flight compared to before the flight. On Earth, when watching depth-ambiguous perspective figures, all subjects reported seeing one three-dimensional interpretation more often than the other, i.e. a ratio of about 70–30%. In weightlessness this asymmetry gradually disappeared and after 3 months in orbit both interpretations were seen for the same duration. These results indicate that the perception of “illusory” depth is altered in astronauts during spaceflight. This increased depth ambiguity is attributed to the lack of the gravitational reference and the eye-ground elevation for interpreting perspective depth cues.

Vestibular Function and Depersonalization/Derealization Symptoms

Patients with an acquired sensory dysfunction may experience symptoms of detachment from self or from the environment, which are related primarily to nonspecific symptoms of common mental disorders and secondarily, to the specific sensory dysfunction. This is consistent with the proposal that sensory dysfunction could provoke distress and a discrepancy between the multi-sensory frame given by experience and the actual perception. Both vestibular stimuli and vestibular dysfunction can underlie unreal experiences. Vestibular afferents provide a frame of reference (linear and angular head acceleration) within which spatial information from other senses is interpreted. This paper reviews evidence that symptoms of depersonalization/derealization associated with vestibular dysfunction are a consequence of a sensory mismatch between disordered vestibular input and other sensory signals of orientation.

Distance and Size Perception in Astronauts during Long-Duration Spaceflight

Exposure to microgravity during spaceflight is known to elicit orientation illusions, errors in sensory localization, postural imbalance, changes in vestibulo-spinal and vestibulo-ocular reflexes, and space motion sickness. The objective of this experiment was to investigate whether an alteration in cognitive visual-spatial processing, such as the perception of distance and size of objects, is also taking place during prolonged exposure to microgravity. Our results show that astronauts on board the International Space Station exhibit biases in the perception of their environment. Objects' heights and depths were perceived as taller and shallower, respectively, and distances were generally underestimated in orbit compared to Earth. These changes may occur because the perspective cues for depth are less salient in microgravity or the eye-height scaling of size is different when an observer is not standing on the ground. This finding has operational implications for human space exploration missions.

Impaired mental rotation in benign paroxysmal positional vertigo and acute vestibular neuritis

Vestibular processing is fundamental to our sense of orientation in space which is a core aspect of the representation of the self. Vestibular information is processed in a large subcortical–cortical neural network. Tasks requiring mental rotations of human bodies in space are known to activate neural regions within this network suggesting that vestibular processing is involved in the control of mental rotation. We studied whether mental rotation is impaired in patients suffering from two different forms of unilateral vestibular disorders (vestibular neuritis – VN – and Benign Paroxysmal positional Vertigo – BPPV) with respect to healthy matched controls (C). We used two mental rotation tasks in which participants were required to: (i) mentally rotate their own body in space (egocentric rotation) thus using vestibular processing to a large extent and (ii) mentally rotate human figures (allocentric rotation) thus using own body representations to a smaller degree. Reaction times and accuracy of responses showed that VN and BPPV patients were impaired in both tasks with respect to C. Significantly, the pattern of results was similar in the three groups suggesting that patients were actually performing the mental rotation without using a different strategy from the control individuals. These results show that dysfunctional vestibular inflow impairs mental rotation of both own body and human figures suggesting that unilateral acute disorders of the peripheral vestibular input massively affect the cerebral processes underlying mental rotations.

Vestibular modulation of spatial perception

Vestibular inputs make a key contribution to the sense of one’s own spatial location. While the effects of vestibular stimulation on visuo-spatial processing in neurological patients have been extensively described, the normal contribution of vestibular inputs to spatial perception remains unclear. To address this issue, we used a line bisection task to investigate the effects of galvanic vestibular stimulation (GVS) on spatial perception, and on the transition between near and far space. Brief left-anodal and right-cathodal GVS or right-anodal and left-cathodal GVS were delivered. A sham stimulation condition was also included. Participants bisected lines of different lengths at six distances from the body using a laser pointer. Consistent with previous results, our data showed an overall shift in the bisection bias from left to right as viewing distance increased. This pattern suggests leftward bias in near space, and rightward bias in far space. GVS induced strong polarity dependent effects in spatial perception, broadly consistent with those previously reported in patients: left-anodal and right-cathodal GVS induced a leftward bisection bias, while right-anodal and left-cathodal GVS reversed this effect, and produced bisection bias toward the right side of the space. Interestingly, the effects of GVS were comparable in near and far space. We speculate that vestibular-induced biases in space perception may optimize gathering of information from different parts of the environment.

Ego-rotation and object-rotation in major depressive disorder

Mental rotation (MR) performance provides a direct insight into a prototypical higher-level visuo-spatial cognitive operation. Previous studies suggest that progressive slowing with an increasing angle of orientation indicates a specific wing of object-based mental transformations in the psychomotor retardation that occurs in major depressive disorder (MDD). It is still not known, however, whether the ability of object-rotation is associated with the ability of ego-rotation in MDD. The present study was designed to investigate the level of impairment of mental transformation abilities in MDD. For this purpose we tested 33 MDD (aged 18-52 years, 16 women) and 30 healthy control subjects (15 women, age and education matched) by evaluating the performance of MDD subjects with regard to ego-rotation and object-rotation tasks. First, MDD subjects were significantly slower and made more errors than controls in mentally rotating hands and letters. Second, MDD and control subjects displayed the same pattern of response times to stimuli at various orientations in the letter task but not the hand task. Third, in particular, MDD subjects were significantly slower and made more errors during the mental transformation of hands than letters relative to control subjects and were significantly slower and made more errors in physiologically impossible angles than physiologically possible angles in the mental rotation hand task. In conclusion, MDD subjects present with more serious mental rotation deficits specific to the hand than the letter task. Importantly, deficits were more present during the mental transformation in outward rotation angles, thus suggesting that the mental imagery for hands and letters relies on different processing mechanisms which suggest a module that is more complex for the processing of human hands than for letters during mental rotation tasks. Our study emphasises the necessity of distinguishing different levels of impairment of action in MDD subjects.

Geometric illusions in astronauts during long-duration spaceflight

In our previous studies, we have shown that the occurrence of geometric illusions was reduced in vestibular patients who presented signs of otolith disorders and when healthy observers were tilted relative to gravity. We hypothesized that the alteration in the gravitational (otolith) input was responsible for this change, presumably because of a connection between vestibular and visual-spatial cognitive functions. In this study, we repeated similar experiments in astronauts during long-duration spaceflight. In agreement with the data of otolithic patients, the inverted-T geometric illusion was less present in the astronauts in 0 g than in 1g. In addition, the vertical length of drawings made by astronauts in orbit was shorter than that on the ground. This result is also comparable with the otolithic patients who perceived the vertical length of line drawings to be smaller than healthy individuals. We conclude that the impairment in the processing of gravitational input in long-duration astronauts affects their mental representation of the vertical dimension similar to the otolithic patients. The astronauts, however, recover to baseline levels within 1 week after returning to Earth.

Perceptual reversal of bi-stable figures in microgravity and hypergravity during parabolic flight

This experiment investigated whether the perception of depth-reversible figures is altered when the observer is in microgravity or hypergravity. A set of five bi-stable ambiguous figures was presented to ten participants in 1g, 0 g, and 1.8 g during parabolic flight. The figures included static images such as the Necker cube; kinetic depth displays such as a moving plaid and a sphere cluster of moving dots appearing to rotate in one of two directions; and a silhouette photograph. For each stimulus figure, subjects reported which of the two possible perceptual configurations they saw first and then continuously indicated when perceptual reversals occurred for durations ranging from 20 to 30s. The same first percept was reported in 1g, 0 g, and 1.8 g. The time delay for the first reversal between the two possible image interpretations was longer and the number of reversals was fewer in 0 g as compared to 1g for four of the five figures. The opposite effects were seen when going from 0 g to 1.8 g. These findings confirm that, consistent with a multisensory approach to three-dimensional form perception, gravity has a clear effect on the interpretation of depth-based stimuli and this gravity-based component interferes with visual perception stability.

Mental transformation abilities in patients with unilateral and bilateral vestibular loss

Vestibular information helps to establish a reliable gravitational frame of reference and contributes to the adequate perception of the location of one's own body in space. This information is likely to be required in spatial cognitive tasks. Indeed, previous studies suggest that the processing of vestibular information is involved in mental transformation tasks in healthy participants. In this study, we investigate whether patients with bilateral or unilateral vestibular loss show impaired ability to mentally transform images of bodies and body parts compared to a healthy, age-matched control group. An egocentric and an object-based mental transformation task were used. Moreover, spatial perception was assessed using a computerized version of the subjective visual vertical and the rod and frame test. Participants with bilateral vestibular loss showed impaired performance in mental transformation, especially in egocentric mental transformation, compared to participants with unilateral vestibular lesions and the control group. Performance of participants with unilateral vestibular lesions and the control group are comparable, and no differences were found between right- and left-sided labyrinthectomized patients. A control task showed no differences between the three groups. The findings from this study substantiate that central vestibular processes are involved in imagined spatial body transformations; but interestingly, only participants with bilateral vestibular loss are affected, whereas unilateral vestibular loss does not lead to a decline in spatial imagery.

Perception of tilt and ocular torsion of vestibular patients during eccentric rotation

Four patients following unilateral vestibular loss and four patients complaining of otolith-dependent vertigo were tested during eccentric yaw rotation generating 1 x g centripetal acceleration directed along the interaural axis. Perception of body tilt in roll and in pitch was recorded in darkness using a somatosensory plate that the subjects maintained parallel to the perceived horizon. Ocular torsion was recorded by a video camera. Unilateral vestibular-defective patients underestimated the magnitude of the roll tilt and had a smaller torsion when the centrifugal force was towards the operated ear compared to the intact ear and healthy subjects. Patients with otolithic-dependent vertigo overestimated the magnitude of roll tilt in both directions of eccentric rotation relative to healthy subjects, and their ocular torsion was smaller than in healthy subjects. Eccentric rotation is a promising tool for the evaluation of vestibular dysfunction in patients. Eye torsion and perception of tilt during this stimulation are objective and subjective measurements, which could be used to determine alterations in spatial processing in the CNS.