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Mohammed A, Li S, Liu X. Exploring the Potentials of Wearable Technologies in Managing Vestibular Hypofunction. Bioengineering (Basel) 2024; 11:641. [PMID: 39061723 PMCID: PMC11274252 DOI: 10.3390/bioengineering11070641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 05/26/2024] [Accepted: 05/31/2024] [Indexed: 07/28/2024] Open
Abstract
The vestibular system is dedicated to gaze stabilization, postural balance, and spatial orientation; this makes vestibular function crucial for our ability to interact effectively with our environment. Vestibular hypofunction (VH) progresses over time, and it presents differently in its early and advanced stages. In the initial stages of VH, the effects of VH are mitigated using vestibular rehabilitation therapy (VRT), which can be facilitated with the aid of technology. At more advanced stages of VH, novel techniques that use wearable technologies for sensory augmentation and sensory substitution have been applied to manage VH. Despite this, the potential of assistive technologies for VH management remains underexplored over the past decades. Hence, in this review article, we present the state-of-the-art technologies for facilitating early-stage VRT and for managing advanced-stage VH. Also, challenges and strategies on how these technologies can be improved to enable long-term ambulatory and home use are presented.
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Affiliation(s)
- Ameer Mohammed
- School of Information Science and Technology, Fudan University, Shanghai 200433, China; (A.M.); (S.L.)
- State Key Laboratory of Integrated Chips and Systems, Fudan University, Shanghai 201203, China
| | - Shutong Li
- School of Information Science and Technology, Fudan University, Shanghai 200433, China; (A.M.); (S.L.)
- State Key Laboratory of Integrated Chips and Systems, Fudan University, Shanghai 201203, China
| | - Xiao Liu
- School of Information Science and Technology, Fudan University, Shanghai 200433, China; (A.M.); (S.L.)
- State Key Laboratory of Integrated Chips and Systems, Fudan University, Shanghai 201203, China
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Li Q, Xu H, Chen W, Su A, Fu MJ, Walker MF. Short-term learning of the vestibulo-ocular reflex induced by a custom interactive computer game. J Neurophysiol 2024; 131:16-27. [PMID: 37964728 PMCID: PMC11305635 DOI: 10.1152/jn.00130.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 10/24/2023] [Accepted: 11/09/2023] [Indexed: 11/16/2023] Open
Abstract
Retinal image slip during head rotation drives motor learning in the rotational vestibulo-ocular reflex (VOR) and forms the basis of gaze-stability exercises that treat vestibular dysfunction. Clinical exercises, however, are unengaging, cannot easily be titrated to the level of impairment, and provide neither direct feedback nor tracking of the patient's adherence, performance, and progress. To address this, we have developed a custom application for VOR training based on an interactive computer game. In this study, we tested the ability of this game to induce VOR learning in individuals with normal vestibular function, and we compared the efficacy of single-step and incremental learning protocols. Eighteen participants played the game twice on different days. All participants tolerated the game and were able to complete both sessions. The game scenario incorporated a series of brief head rotations, similar to active head impulses, that were paired with a dynamic acuity task and with a visual-vestibular mismatch (VVM) intended to increase VOR gain (single-step: 300 successful trials at ×1.5 viewing; incremental: 100 trials each of ×1.13, ×1.33, and ×1.5 viewing). Overall, VOR gain increased by 15 ± 4.7% (mean ± 95% CI, P < 0.001). Gains increased similarly for active and passive head rotations, and, contrary to our hypothesis, there was little effect of the learning strategy. This study shows that an interactive computer game provides robust VOR training and has the potential to deliver effective, engaging, and trackable gaze-stability exercises to patients with a range of vestibular dysfunctions.NEW & NOTEWORTHY This study demonstrates the feasibility and efficacy of a customized computer game to induce motor learning in the high-frequency rotational vestibulo-ocular reflex. It provides a physiological basis for the deployment of this technology to clinical vestibular rehabilitation.
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Affiliation(s)
- Qi Li
- Department of Electrical, Computer, and Systems Engineering, Case Western Reserve University, Cleveland, Ohio, United States
| | - Honglu Xu
- Department of Computer and Data Sciences, Case Western Reserve University, Cleveland, Ohio, United States
| | - Weicong Chen
- Department of Electrical, Computer, and Systems Engineering, Case Western Reserve University, Cleveland, Ohio, United States
| | - Andrew Su
- Department of Electrical, Computer, and Systems Engineering, Case Western Reserve University, Cleveland, Ohio, United States
| | - Michael J Fu
- Department of Electrical, Computer, and Systems Engineering, Case Western Reserve University, Cleveland, Ohio, United States
- Functional Electrical Stimulation Center, VA Northeast Ohio Healthcare System, Cleveland, Ohio, United States
- MetroHealth Rehabilitation Institute, The MetroHealth System, Cleveland, Ohio, United States
| | - Mark F Walker
- Neurology Service, VA Northeast Ohio Healthcare System, Cleveland, Ohio, United States
- Department of Neurology, Case Western Reserve University, Cleveland, Ohio, United States
- Advanced Platform Technology Center, VA Northeast Ohio Healthcare System, Cleveland, Ohio, United States
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Neumann-Langen MV, Ochs BG, Lützner J, Postler A, Kirschberg J, Sehat K, Selig M, Grupp TM. Musculoskeletal Rehabilitation: New Perspectives in Postoperative Care Following Total Knee Arthroplasty Using an External Motion Sensor and a Smartphone Application for Remote Monitoring. J Clin Med 2023; 12:7163. [PMID: 38002775 PMCID: PMC10672501 DOI: 10.3390/jcm12227163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/11/2023] [Accepted: 11/17/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND The number of total knee replacements performed annually is steadily increasing. Parallel options for postoperative care are decreasing, which reduces patient satisfaction. External devices to support physical rehabilitation and health monitoring will improve patient satisfaction and postoperative care. METHODS In a prospective, international multicenter study, patients were asked to use an external motion sensor and a smartphone application during the postoperative course of primary total knee arthroplasty. The collected data were transferred to a data platform, allowing for the real-time evaluation of patient data. RESULTS In three participating centers, 98 patients were included. The general acceptance of using the sensor and app was high, with an overall compliance in study participation rate of up to 76%. The early results showed a significant improvement in the overall quality of life (p < 0.001) and significant reductions in pain (p < 0.01) and depression (p < 0.001). CONCLUSIONS The early results of this clinical and multicenter study emphasize that there is a high interest in and acceptance of digital solutions in patients' treatment pathways. Motion sensor and smartphone applications support patients in early rehabilitation.
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Affiliation(s)
| | - Björn Gunnar Ochs
- Klinikum Konstanz, Department of Orthopaedic and Trauma Surgery, Mainaustrasse 35, 78464 Konstanz, Germany;
| | - Jörg Lützner
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus Dresden, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany; (J.L.); (A.P.)
| | - Anne Postler
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus Dresden, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany; (J.L.); (A.P.)
| | - Julia Kirschberg
- Waldkliniken Eisenberg GmbH, Klosterlausnitzer Strasse 81, 07607 Eisenberg, Germany;
| | - Khosrow Sehat
- Department of Trauma and Orthopaedics, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK;
| | - Marius Selig
- Aesculap AG Research and Development and Medical Scientific Affairs, Am Aesculap-Platz, 78532 Tuttlingen, Germany; (M.S.); (T.M.G.)
| | - Thomas M. Grupp
- Aesculap AG Research and Development and Medical Scientific Affairs, Am Aesculap-Platz, 78532 Tuttlingen, Germany; (M.S.); (T.M.G.)
- Department of Orthopaedic and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMULudwigs Maximilian University, 81377 Munich, Germany
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Szabo DA, Neagu N, Teodorescu S, Apostu M, Predescu C, Pârvu C, Veres C. The Role and Importance of Using Sensor-Based Devices in Medical Rehabilitation: A Literature Review on the New Therapeutic Approaches. SENSORS (BASEL, SWITZERLAND) 2023; 23:8950. [PMID: 37960649 PMCID: PMC10648494 DOI: 10.3390/s23218950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/22/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023]
Abstract
Due to the growth of sensor technology, more affordable integrated circuits, and connectivity technologies, the usage of wearable equipment and sensing devices for monitoring physical activities, whether for wellness, sports monitoring, or medical rehabilitation, has exploded. The current literature review was performed between October 2022 and February 2023 using PubMed, Web of Science, and Scopus in accordance with P.R.I.S.M.A. criteria. The screening phase resulted in the exclusion of 69 articles that did not fit the themes developed in all subchapters of the study, 41 articles that dealt exclusively with rehabilitation and orthopaedics, 28 articles whose abstracts were not visible, and 10 articles that dealt exclusively with other sensor-based devices and not medical ones; the inclusion phase resulted in the inclusion of 111 articles. Patients who utilise sensor-based devices have several advantages due to rehabilitating a missing component, which marks the accomplishment of a fundamental goal within the rehabilitation program. As technology moves faster and faster forward, the field of medical rehabilitation has to adapt to the time we live in by using technology and intelligent devices. This means changing every part of rehabilitation and finding the most valuable and helpful gadgets that can be used to regain lost functions, keep people healthy, or prevent diseases.
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Affiliation(s)
- Dan Alexandru Szabo
- Department of Human Movement Sciences, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania;
- Department ME1, Faculty of Medicine in English, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Nicolae Neagu
- Department of Human Movement Sciences, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania;
| | - Silvia Teodorescu
- Department of Doctoral Studies, National University of Physical Education and Sports, 060057 Bucharest, Romania;
| | - Mihaela Apostu
- Department of Special Motor and Rehabilitation Medicine, National University of Physical Education and Sports, 060057 Bucharest, Romania; (M.A.); (C.P.)
| | - Corina Predescu
- Department of Special Motor and Rehabilitation Medicine, National University of Physical Education and Sports, 060057 Bucharest, Romania; (M.A.); (C.P.)
| | - Carmen Pârvu
- Faculty of Physical Education and Sports, “Dunărea de Jos” University, 63-65 Gării Street, 337347 Galati, Romania;
| | - Cristina Veres
- Department of Industrial Engineering and Management, University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania;
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Unidirectional Vertical Vestibuloocular Reflex Adaptation in Humans Using 1D and 2D Scenes. Otol Neurotol 2022; 43:e1039-e1044. [PMID: 36075099 DOI: 10.1097/mao.0000000000003684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
HYPOTHESIS The vertical vestibuloocular reflex (VOR) in response to pitch head impulses can be optimally trained to increase in one direction using a two-dimensional (2D) visual training target with minimal effect on the horizontal VOR. BACKGROUND We modified the incremental VOR adaptation (IVA) technique, shown to increase the horizontal VOR in patients with vestibular hypofunction, to drive vertical VOR adaptation in healthy control subjects. METHODS We measured the horizontal and vertical active (self-generated) and passive (imposed) head impulse VOR gains (eye velocity/head velocity) before and after 15 minutes of unidirectional downward IVA training. IVA training consisted of two sessions, one using a single-dot one-dimensional (1D) target, the other a grid-of-dots 2D target. RESULTS The downward head impulse VOR gain significantly increased because of training by 13.3%, whereas the upward VOR gain did not change. The addition of extraretinal (2D) feedback did not result in greater adaptation, i.e., 1D and 2D gain increases were 15.5% and 10.6%, respectively. The vertical VOR gain increase resulted in a 3.2% decrease in horizontal VOR gain. CONCLUSION This preliminary study is the first to show that physiologically relevant (high frequency) unidirectional increases in vertical VOR gain are possible with just 15 minutes of training. This study sets the basis for future clinical trials examining vertical IVA training in patients, which may provide the first practical rehabilitation treatment to functionally improve the vertical VOR.
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Zhang S, Liu D, Tian E, Wang J, Guo Z, Kong W. Central vestibular dysfunction: don't forget vestibular rehabilitation. Expert Rev Neurother 2022; 22:669-680. [PMID: 35912850 DOI: 10.1080/14737175.2022.2106129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Vestibular rehabilitation (VR) is now a subject of active studies and has been shown to be effective for multiple vestibular disorders, peripheral or central. VR is a physical therapy that helps train the central nervous system to compensate for vestibular dysfunction. There is moderate to strong evidence that VR is safe and effective for the management of peripheral vestibular dysfunction. Nonetheless, the studies on how VR works on central vestibular dysfunction remains scanty. AREAS COVERED This article addressed the rehabilitation strategies and possible mechanisms, including how central vestibular function might improve upon rehabilitation. In addition, it provides some examples concerning the effect of VR on central vestibular dysfunction. EXPERT OPINION VR works on the vestibular system through repetition of specific physical exercises that activate central neuroplastic mechanisms to achieve adaptive compensation of the impaired functions. VR has become a mainstay in the management of patients with dizziness and balance dysfunction. Individualized VR programs are a safe and effective treatment option for a large percentage of patients with central vestibular disease reporting imbalance and dizziness. Exploration of various treatment strategies and possible mechanisms will help develop the best and personalized VR treatment for patients with central vestibular dysfunction.
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Affiliation(s)
- Sulin Zhang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China.,Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - Dan Liu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - E Tian
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - Jun Wang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - Zhaoqi Guo
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - Weijia Kong
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China.,Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China.,Key Laboratory of Neurological Disorders of Education Ministry, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei, China
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Cole KR, Goodman K, Volland L. Reporting of exercise dose and dosage and outcome measures for gaze stabilisation in the literature: a scoping review. BMJ Open 2022; 12:e049560. [PMID: 35121596 PMCID: PMC8819788 DOI: 10.1136/bmjopen-2021-049560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The concept of this review is to examine and quantify the reporting of parameters of dose (duration, speed, head excursion) and dosage (daily and weekly frequency, duration) for gaze stabilisation exercises and to report on outcome measures used to assess change in gaze stabilisation following intervention. This review includes any population completing gaze stabilisation exercises. DESIGN Scoping review. METHODS We searched key terms in the following databases: PubMed, CINAHL, Scopus and Cochrane. Two researchers reviewed titles, abstracts and full-text articles for inclusion. Data retrieved included: patient diagnosis, specific interventions provided, dose and dosage of gaze stabilisation interventions and outcome measures. RESULTS From the initial 1609 results, 138 studies were included. Data extraction revealed that only 13 studies (9.4%) reported all parameters of dose and dosage. Most studies used other interventions in addition to gaze stabilisation exercises. Half of the studies did not use a clinical or instrumented outcome measure of gaze stability, using only patient-reported outcome measures. Clinical tests of gaze stability were used in 21.1% of studies, and instrumented measures of gaze stability were used in 14.7% of studies. CONCLUSIONS Full reporting of the dose and dosage of gaze stabilisation interventions is infrequent, impairing the ability to translate current evidence into clinical care. Most studies did not use a clinical or instrumented measure of gaze stabilisation as outcome measures, questioning the validity of intervention effects. Improved reporting and use of outcome measures are necessary to establish optimal intervention parameters for those with gaze stability impairments.
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Affiliation(s)
- Keith R Cole
- Health, Human Function, and Rehabilitation Science, The George Washington University, Washington, DC, USA
| | - Karen Goodman
- Health, Human Function, and Rehabilitation Science, The George Washington University, Washington, DC, USA
| | - Lena Volland
- Department of Clinical Research and Leadership, The George Washington University, Washington, DC, USA
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Hovareshti P, Roeder S, Holt LS, Gao P, Xiao L, Zalkin C, Ou V, Tolani D, Klatt BN, Whitney SL. VestAid: A Tablet-Based Technology for Objective Exercise Monitoring in Vestibular Rehabilitation. SENSORS 2021; 21:s21248388. [PMID: 34960480 PMCID: PMC8706065 DOI: 10.3390/s21248388] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/10/2021] [Accepted: 12/11/2021] [Indexed: 11/16/2022]
Abstract
(1) Background: Current vestibular rehabilitation therapy is an exercise-based approach aimed at promoting gaze stability, habituating symptoms, and improving balance and walking in patients with mild traumatic brain injury (mTBI). A major component of these exercises is the adaptation of the vestibulo-ocular reflex (VOR) and habituation training. Due to acute injury, the gain of the VOR is usually reduced, resulting in eye movement velocity that is less than head movement velocity. There is a higher chance for the success of the therapy program if the patient (a) understands the exercise procedure, (b) performs the exercises according to the prescribed regimen, (c) reports pre- and post-exercise symptoms and perceived difficulty, and (d) gets feedback on performance. (2) Methods: The development and laboratory evaluation of VestAid, an innovative, low-cost, tablet-based system that helps patients perform vestibulo-ocular reflex (VORx1) exercises correctly at home without therapist guidance, is presented. VestAid uses the tablet camera to automatically assess patient performance and compliance with exercise parameters. The system provides physical therapists (PTs) with near real-time, objective (head speed and gaze fixation compliance), and subjective (perceived difficulty and pre- and post- exercise symptoms) metrics through a web-based provider portal. The accuracy of the head-angle and eye-gaze compliance metrics was evaluated. The accuracy of estimated head angles calculated via VestAid’s low-complexity algorithms was compared to the state-of-the-art deep-learning method on a public dataset. The accuracy of VestAid’s metric evaluation during the VORx1 exercises was assessed in comparison to the output of an inertial measurement unit (IMU)-based system. (3) Results: There are low mean interpeak time errors (consistently below 0.1 s) across all speeds of the VORx1 exercise, as well as consistently matching numbers of identified peaks. The spatial comparison (after adjusting for the lag measured with the cross-correlation) between the VestAid and IMU-based systems also shows good matching, as shown by the low mean absolute head angle error, in which for all speeds, the mean is less than 10 degrees. (4) Conclusions: The accuracy of the system is sufficient to provide therapists with a good assessment of patient performance. While the VestAid system’s head pose evaluation model may not be perfectly accurate as a result of the occluded facial features when the head moves further towards an extreme in pitch and yaw, the head speed measurements and associated compliance measures are sufficiently accurate for monitoring patients’ VORx1 exercise compliance and general performance.
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Affiliation(s)
- Pedram Hovareshti
- NxtHealth Team, Intelligent Automation, Rockville, MD 20855, USA; (S.R.); (L.S.H.); (P.G.); (L.X.); (C.Z.); (V.O.); (D.T.)
- Correspondence:
| | - Shamus Roeder
- NxtHealth Team, Intelligent Automation, Rockville, MD 20855, USA; (S.R.); (L.S.H.); (P.G.); (L.X.); (C.Z.); (V.O.); (D.T.)
| | - Lisa S. Holt
- NxtHealth Team, Intelligent Automation, Rockville, MD 20855, USA; (S.R.); (L.S.H.); (P.G.); (L.X.); (C.Z.); (V.O.); (D.T.)
| | - Pan Gao
- NxtHealth Team, Intelligent Automation, Rockville, MD 20855, USA; (S.R.); (L.S.H.); (P.G.); (L.X.); (C.Z.); (V.O.); (D.T.)
| | - Lemin Xiao
- NxtHealth Team, Intelligent Automation, Rockville, MD 20855, USA; (S.R.); (L.S.H.); (P.G.); (L.X.); (C.Z.); (V.O.); (D.T.)
| | - Chad Zalkin
- NxtHealth Team, Intelligent Automation, Rockville, MD 20855, USA; (S.R.); (L.S.H.); (P.G.); (L.X.); (C.Z.); (V.O.); (D.T.)
| | - Victoria Ou
- NxtHealth Team, Intelligent Automation, Rockville, MD 20855, USA; (S.R.); (L.S.H.); (P.G.); (L.X.); (C.Z.); (V.O.); (D.T.)
| | - Devendra Tolani
- NxtHealth Team, Intelligent Automation, Rockville, MD 20855, USA; (S.R.); (L.S.H.); (P.G.); (L.X.); (C.Z.); (V.O.); (D.T.)
| | - Brooke N. Klatt
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA 15219, USA; (B.N.K.); (S.L.W.)
| | - Susan L. Whitney
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA 15219, USA; (B.N.K.); (S.L.W.)
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Ervin AM, Schubert MC, Migliaccio AA, Perin J, Coulibaly H, Millar JL, Roberts D, Shelhamer M, Gold D, Beauregard S, Pinto R, Brungart D, Ward BK. Incremental Velocity Error as a New Treatment in Vestibular Rehabilitation (INVENT VPT) Trial: study protocol for a randomized controlled crossover trial. Trials 2021; 22:908. [PMID: 34895314 PMCID: PMC8666079 DOI: 10.1186/s13063-021-05876-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 11/24/2021] [Indexed: 11/28/2022] Open
Abstract
Background A clinical pattern of damage to the auditory, visual, and vestibular sensorimotor systems, known as multi-sensory impairment, affects roughly 2% of the US population each year. Within the population of US military service members exposed to mild traumatic brain injury (mTBI), 15–44% will develop multi-sensory impairment following a mild traumatic brain injury. In the US civilian population, multi-sensory impairment-related symptoms are also a common sequela of damage to the vestibular system and affect ~ 300–500/100,000 population. Vestibular rehabilitation is recognized as a critical component of the management of multi-sensory impairment. Unfortunately, the current clinical practice guidelines for the delivery of vestibular rehabilitation are not evidence-based and primarily rely on expert opinion. The focus of this trial is gaze stability training, which represents the unique component of vestibular rehabilitation. The aim of the Incremental Velocity Error as a New Treatment in Vestibular Rehabilitation (INVENT VPT) trial is to assess the efficacy of a non-invasive, incremental vestibular adaptation training device for normalizing the response of the vestibulo-ocular reflex. Methods The INVENT VPT Trial is a multi-center randomized controlled crossover trial in which military service members with mTBI and civilian patients with vestibular hypofunction are randomized to begin traditional vestibular rehabilitation or incremental vestibular adaptation and then cross over to the alternate intervention after a prescribed washout period. Vestibulo-ocular reflex function and other functional outcomes are measured to identify the best means to improve the delivery of vestibular rehabilitation. We incorporate ecologically valid outcome measures that address the common symptoms experienced in those with vestibular pathology and multi-sensory impairment. Discussion The INVENT VPT Trial will directly impact the health care delivery of vestibular rehabilitation in patients suffering from multi-sensory impairment in three critical ways: (1) compare optimized traditional methods of vestibular rehabilitation to a novel device that is hypothesized to improve vestibulo-ocular reflex performance, (2) isolate the ideal dosing of vestibular rehabilitation considering patient burden and compliance rates, and (3) examine whether recovery of the vestibulo-ocular reflex can be predicted in participants with vestibular symptoms. Trial registration ClinicalTrials.gov NCT03846830. Registered on 20 February 2019.
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Affiliation(s)
- Ann-Margret Ervin
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Michael C Schubert
- Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD, 21287, USA
| | | | - Jamie Perin
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Hamadou Coulibaly
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Jennifer L Millar
- Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD, 21287, USA
| | - Dale Roberts
- Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, 21287, USA
| | - Mark Shelhamer
- Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD, 21287, USA
| | - Daniel Gold
- Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD, 21287, USA
| | - Stephanie Beauregard
- Intrepid Spirit Center, Fort Belvoir Community Hospital, Intrepid Pavilion, 5980 9th Street, Bldg. 1259, Fort Belvoir, VA, 22060, USA
| | - Robin Pinto
- National Military Audiology and Speech Center, Walter Reed National Military Medical Center, Building 19, Room 5600, 4954 North Palmer Rd, Bethesda, MD, 20889-5630, USA
| | - Douglas Brungart
- National Military Audiology and Speech Center, Walter Reed National Military Medical Center, Building 19, Room 5600, 4954 North Palmer Rd, Bethesda, MD, 20889-5630, USA
| | - Bryan K Ward
- Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD, 21287, USA
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Rinaudo CN, Schubert MC, Cremer PD, Figtree WVC, Todd CJ, Migliaccio AA. Comparison of Incremental Vestibulo-ocular Reflex Adaptation Training Versus x1 Training in Patients With Chronic Peripheral Vestibular Hypofunction: A Two-Year Randomized Controlled Trial. J Neurol Phys Ther 2021; 45:246-258. [PMID: 34369452 DOI: 10.1097/npt.0000000000000369] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE A crossover, double-blinded randomized controlled trial to investigate once-daily incremental vestibulo-ocular reflex (VOR) adaptation (IVA) training over 2 years in people with stable and chronic peripheral vestibular hypofunction. METHODS Twenty-one patients with peripheral vestibular hypofunction were randomly assigned to intervention-then-control (n = 12) or control-then-intervention (n = 9) groups. The task consisted of either x1 (control) or IVA training, once daily every day for 15 minutes over 6-months, followed by a 6-month washout, then repeated for arm 2 of the crossover. Primary outcome: vestibulo-ocular reflex gain. Secondary outcomes: compensatory saccades, dynamic visual acuity, static balance, gait, and subjective symptoms. Multiple imputation was used for missing data. Between-group differences were analyzed using a linear mixed model with repeated measures. RESULTS On average patients trained once daily 4 days per week. IVA training resulted in significantly larger VOR gain increase (active: 20.6% ± 12.08%, P = 0.006; passive: 30.6% ± 25.45%, P = 0.016) compared with x1 training (active: -2.4% ± 12.88%, P = 0.99; passive: -0.6% ± 15.31%, P = 0.68) (P < 0.001). The increased IVA gain did not significantly reduce with approximately 27% persisting over the washout period. x1 training resulted in greater reduction of compensatory saccade latency (P = 0.04) and increase in amplitude (P = 0.02) compared with IVA training. There was no difference between groups in gait and balance measures; however, only the IVA group had improved total Dizziness Handicap Inventory (P = 0.006). DISCUSSION AND CONCLUSIONS Our results suggest IVA improves VOR gain and reduces perception of disability more than conventional x1 training. We suggest at least 4 weeks of once-daily 4 days-per-week IVA training should be part of a comprehensive vestibular rehabilitation program.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A356).
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Affiliation(s)
- Carlo N Rinaudo
- Balance and Vision Laboratory, Neuroscience Research Australia, Sydney, Australia (C.N.R., M.C.S., P.D.C., W.V.C.F., C.J.T., A.A.M.); Graduate School of Biomedical Engineering, University of New South Wales, Sydney, Australia (C.N.R., A.A.M.); Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland (M.C.S.); Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland (M.C.S., A.A.M.); Royal North Shore Hospital, Sydney, Australia (P.D.C.); and School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia (A.A.M.)
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Once-Daily Incremental Vestibular-Ocular Reflex Adaptation Training in Patients With Chronic Peripheral Vestibular Hypofunction: A 1-Week Randomized Controlled Study. J Neurol Phys Ther 2021; 45:87-100. [PMID: 33675600 DOI: 10.1097/npt.0000000000000348] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND PURPOSE This was a double-blinded randomized controlled study to investigate the effects of once-daily incremental vestibulo-ocular reflex (VOR) training over 1 week in people with chronic peripheral vestibular hypofunction. METHODS A total of 24 patients with peripheral vestibular hypofunction were randomly assigned to intervention (n = 13) or control (n = 11) groups. Training consisted of either x1 (control) or incremental VOR adaptation exercises, delivered once daily for 15 minutes over 4 days in 1 week. Primary outcome: VOR gain with video-oculography. Secondary outcomes: Compensatory saccades measured using scleral search coils, dynamic visual acuity, static balance, gait, and subjective symptoms. Between-group differences were analyzed with a linear mixed-model with repeated measures. RESULTS There was a difference in the VOR gain increase between groups (P < 0.05). The incremental training group gain increased during active (13.4% ± 16.3%) and passive (12.1% ± 19.9%) head impulse testing (P < 0.02), whereas it did not for the control group (P = 0.59). The control group had reduced compensatory saccade latency (P < 0.02). Both groups had similarly improved dynamic visual acuity scores (P < 0.05). Both groups had improved dynamic gait index scores (P < 0.002); however, only the incremental group had improved scores for the 2 walks involving head oscillations at approximately 2 Hz (horizontal: P < 0.05; vertical: P < 0.02), increased gait speed (P < 0.02), and step length (P < 0.01) during normal gait, and improved total Dizziness Handicap Inventory (P < 0.05). CONCLUSIONS Our results suggest incremental VOR adaptation significantly improves gain, gait with head rotation, balance during gait, and symptoms in patients with chronic peripheral vestibular hypofunction more so than conventional x1 gaze-stabilizing exercises.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A336).
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Büki B, Tamás LT, Todd CJ, Schubert MC, Migliaccio AA. Absence of a vergence-mediated vestibulo-ocular reflex gain increase does not preclude adaptation. J Vestib Res 2021; 31:109-117. [PMID: 33427708 DOI: 10.3233/ves-201560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The gain (eye-velocity/head-velocity) of the angular vestibuloocular reflex (aVOR) during head impulses can be increased while viewing near-targets and when exposed to unilateral, incremental retinal image velocity error signals. It is not clear however, whether the tonic or phasic vestibular pathways mediate these gain increases. OBJECTIVE Determine whether a shared pathway is responsible for gain enhancement between vergence and adaptation of aVOR gain in patients with unilateral vestibular hypofunction (UVH). MATERIAL AND METHODS 20 patients with UVH were examined for change in aVOR gain during a vergence task and after 15-minutes of ipsilesional incremental VOR adaptation (uIVA) using StableEyes (a device that controls a laser target as a function of head velocity) during horizontal passive head impulses. A 5 % aVOR gain increase was defined as the threshold for significant change. RESULTS 11/20 patients had >5% vergence-mediated gain increase during ipsi-lesional impulses. For uIVA, 10/20 patients had >5% ipsi-lesional gain increase. There was no correlation between the vergence-mediated gain increase and gain increase after uIVA training. CONCLUSION Vergence-enhanced and uIVA training gain increases are mediated by separate mechanisms and/or vestibular pathways (tonic/phasic). The ability to increase the aVOR gain during vergence is not prognostic for successful adaptation training.
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Affiliation(s)
- Béla Büki
- Department of Otolaryngology, Karl Landsteiner University Hospital Krems, Krems an der Donau, Austria
| | - László T Tamás
- Department of Otolaryngology, Petz Aladár Teaching Hospital, Györ, Hungary
| | - Christopher J Todd
- Balance and Vision Laboratory, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Michael C Schubert
- Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland.,Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
| | - Americo A Migliaccio
- Balance and Vision Laboratory, Neuroscience Research Australia, Sydney, NSW, Australia.,Graduate School of Biomedical Engineering, University of New South Wales, Sydney, Australia.,Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA.,School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia
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Galgon AK, Holmberg JM. Commentary on: Convergence Vestibulo-ocular Reflex in Unilateral Vestibular Hypofunction: Behavioral Evidence in Support for a Novel Gaze Stability Exercise. J Neurol Phys Ther 2021; 45:12-13. [PMID: 33315833 DOI: 10.1097/npt.0000000000000346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Anne K Galgon
- Physical Therapy Department (A.K.G.), University of the Sciences, Philadelphia, Pennsylvania; and Intermountain Hearing & Balance Center (J.M.H.), Salt Lake City, Utah
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Convergence Vestibulo-ocular Reflex in Unilateral Vestibular Hypofunction: Behavioral Evidence in Support of a Novel Gaze Stability Exercise. J Neurol Phys Ther 2020; 45:3-11. [PMID: 33065632 DOI: 10.1097/npt.0000000000000335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Convergence of the eyes during head rotation increases the gain (eye velocity/head velocity) of the vestibulo-ocular reflex (VOR). We sought to know whether convergence would increase the VOR gain (mean + SD) in unilateral vestibular hypofunction (UVH). METHODS Vestibulo-ocular reflex gain during ipsi- and contralesional horizontal head rotation at near (15 cm) and far (150 cm) targets was measured in 22 subjects with UVH and 12 healthy controls. Retinal slip was estimated (retinal slip index [RSI]) as the difference between ideal VOR gain (no retinal slip) and the actual VOR gain. RESULTS Convergence did not significantly enhance VOR gain for ipsilesional rotation (mean difference, 0.04; 95% confidence interval [CI], -0.01 to 0.09), near viewing (0.77 ± 0.34) versus far viewing (0.72 ± 0.29), yet the VOR gain during contralesional rotation was greater for near viewing (1.20 ± 0.23) than for far viewing (0.97 ± 0.21; mean difference, 0.23; 95% CI, 0.13-0.32). In the 36% of subjects with recovery of their ipsilesional VOR gain, the vergence effect trended to recover (far VOR gain: 1.06 ± 0.17 vs near VOR gain 1.16 ± 0.21; mean difference, 0.10; 95% CI, -0.02 to 0.22). Ipsilesional head rotation induced greater retinal slip for near (RSI = 0.90 ± 0.34) targets than for far targets (RSI = 0.35 ± 0.29; mean difference, 0.56; 95% CI, 0.51-0.61). DISCUSSION AND CONCLUSIONS The convergence-mediated VOR gain enhancement is preserved during contralesional but impaired during ipsilesional head rotation. Recovery of ipsilesional passive VOR gain does not equate to restored convergence enhancement, although it did increase ∼10%. These data suggest head motion viewing near targets will increase retinal slip, which warrants consideration as a gaze stability exercise for subjects with UVH.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A325).
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do Nascimento LMS, Bonfati LV, Freitas MLB, Mendes Junior JJA, Siqueira HV, Stevan SL. Sensors and Systems for Physical Rehabilitation and Health Monitoring-A Review. SENSORS (BASEL, SWITZERLAND) 2020; 20:E4063. [PMID: 32707749 PMCID: PMC7436073 DOI: 10.3390/s20154063] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/09/2020] [Accepted: 07/12/2020] [Indexed: 01/03/2023]
Abstract
The use of wearable equipment and sensing devices to monitor physical activities, whether for well-being, sports monitoring, or medical rehabilitation, has expanded rapidly due to the evolution of sensing techniques, cheaper integrated circuits, and the development of connectivity technologies. In this scenario, this paper presents a state-of-the-art review of sensors and systems for rehabilitation and health monitoring. Although we know the increasing importance of data processing techniques, our focus was on analyzing the implementation of sensors and biomedical applications. Although many themes overlap, we organized this review based on three groups: Sensors in Healthcare, Home Medical Assistance, and Continuous Health Monitoring; Systems and Sensors in Physical Rehabilitation; and Assistive Systems.
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Affiliation(s)
- Lucas Medeiros Souza do Nascimento
- Graduate Program in Electrical Engineering (PPGEE), Federal University of Technology of Parana (UTFPR), Ponta Grossa (PR) 84016-210, Brazil; (L.M.S.d.N.); (L.V.B.); (M.L.B.F.); (H.V.S.)
| | - Lucas Vacilotto Bonfati
- Graduate Program in Electrical Engineering (PPGEE), Federal University of Technology of Parana (UTFPR), Ponta Grossa (PR) 84016-210, Brazil; (L.M.S.d.N.); (L.V.B.); (M.L.B.F.); (H.V.S.)
| | - Melissa La Banca Freitas
- Graduate Program in Electrical Engineering (PPGEE), Federal University of Technology of Parana (UTFPR), Ponta Grossa (PR) 84016-210, Brazil; (L.M.S.d.N.); (L.V.B.); (M.L.B.F.); (H.V.S.)
| | - José Jair Alves Mendes Junior
- Graduate Program in Electrical Engineering and Industrial Informatics (CPGEI), Federal University of Technology of Parana (UTFPR), Curitiba (PR) 80230-901, Brazil;
| | - Hugo Valadares Siqueira
- Graduate Program in Electrical Engineering (PPGEE), Federal University of Technology of Parana (UTFPR), Ponta Grossa (PR) 84016-210, Brazil; (L.M.S.d.N.); (L.V.B.); (M.L.B.F.); (H.V.S.)
| | - Sergio Luiz Stevan
- Graduate Program in Electrical Engineering (PPGEE), Federal University of Technology of Parana (UTFPR), Ponta Grossa (PR) 84016-210, Brazil; (L.M.S.d.N.); (L.V.B.); (M.L.B.F.); (H.V.S.)
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Retinal Image Slip Must Pass the Threshold for Human Vestibulo-Ocular Reflex Adaptation. J Assoc Res Otolaryngol 2020; 21:277-285. [PMID: 32232608 DOI: 10.1007/s10162-020-00751-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/12/2020] [Indexed: 10/24/2022] Open
Abstract
We sought to determine whether repeated vestibulo-ocular reflex (VOR) adaptation training to increase the VOR gain (eye/head velocity) had a lasting effect in normal subjects and whether there was a retinal image slip tolerance threshold for VOR adaptation. We used the unilateral incremental VOR adaptation technique and horizontal active (self-generated, predictable) head impulses as the vestibular stimulus. Both active and passive (imposed, unpredictable) head impulse VOR gains were measured before and after unilateral incremental VOR adaptation training. The adapting side was pseudo-randomized for left or right. We tested ten normal subjects over one block (10 sessions over 12 days) of VOR adaptation training and testing, immediately followed by a second block (5 sessions over 19 days) of testing only without training. Our findings show robust short-term VOR adaptation of ~ 10 % immediately after each 15-min training session, but that the daily pre-adaptation gain was most different on days 1 and 2, and for subsequent training days before saturating to ~ 5 % greater than the pre-adaptation gain on day 1. This increase was partially retained for 19 days after regular training stopped. The data suggest that stable vision in normal subjects is maintained when there is < 5 % deviation in VOR gain from the original baseline, which corresponds to < 9°/s retinal image slip. Below this threshold, there is poor adaptive drive to return the gain to its original baseline value.
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Rinaudo CN, Schubert MC, Cremer PD, Figtree WVC, Todd CJ, Migliaccio AA. Improved Oculomotor Physiology and Behavior After Unilateral Incremental Adaptation Training in a Person With Chronic Vestibular Hypofunction: A Case Report. Phys Ther 2019; 99:1326-1333. [PMID: 31197314 DOI: 10.1093/ptj/pzz083] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 02/20/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND PURPOSE Traditional vestibular rehabilitation therapies are effective in reducing vestibular hypofunction symptoms, but changes to the vestibulo-ocular reflex (VOR) are minimal. This controlled case report describes an increase in VOR after 6 months of incremental VOR adaptation (IVA) training in a person with chronic unilateral vestibular hypofunction. CASE DESCRIPTION The participant was a 58-year-old female with a confirmed (Neurologist P.D.C.) left vestibular lesion stable for 2 years prior to entering a clinical trial examining the effects of daily IVA training. She was evaluated monthly for self-reported symptoms (dizziness handicap inventory), VOR function (video head impulse test), and VOR behavior (Dynamic Visual Acuity test). Intervention consisted of 6 months of 15 minutes per day unassisted training using the IVA training regime with a device developed in our laboratory. The take-home device enables the VOR response to gradually normalize on the ipsilesional side via visual-vestibular mismatch training. The intervention was followed by a 6-month wash-out and 3-month control period. The control condition used the same training device set to function like standard VOR training indistinguishable to the participant. OUTCOMES After the intervention, ipsilesional VOR function improved substantially. The VOR adapted both via a 52% increase in slow-phase response and via 43% earlier onset compensatory saccades for passive head movements. In addition, the participant reported fewer symptoms and increased participation in sports and daily activities. DISCUSSION Here, a participant with chronic vestibular hypofunction showing improved oculomotor performance atypical for traditional vestibular rehabilitation therapies, subsequent to using the newly developed IVA technique, is presented. It is the first time to our knowledge an improvement of this magnitude has been demonstrated as well as sustained over an extended period of time.
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Affiliation(s)
- Carlo N Rinaudo
- MChiro, Balance and Vision Laboratory, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Michael C Schubert
- Department of Otolaryngology-Head and Neck Surgery, Laboratory of Vestibular Neuro-Adaptation, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Phillip D Cremer
- Balance and Vision Laboratory, Neuroscience Research Australia, and Royal North Shore Hospital, Sydney, Australia
| | - William V C Figtree
- Balance and Vision Laboratory, Neuroscience Research Australia, and University of New South Wales
| | - Christopher J Todd
- Balance and Vision Laboratory, Neuroscience Research Australia, and University of New South Wales
| | - Americo A Migliaccio
- Balance and Vision Laboratory, Neuroscience Research Australia, Cnr Barker Street & Easy Street, Randwick NSW 2031, Sydney, Australia
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18
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Gaze stabilisation exercises in vestibular rehabilitation: review of the evidence and recent clinical advances. J Neurol 2019; 266:11-18. [DOI: 10.1007/s00415-019-09459-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/04/2019] [Accepted: 07/06/2019] [Indexed: 10/26/2022]
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Rinaudo CN, Schubert MC, Figtree WVC, Todd CJ, Migliaccio AA. Human vestibulo-ocular reflex adaptation is frequency selective. J Neurophysiol 2019; 122:984-993. [PMID: 31339801 DOI: 10.1152/jn.00162.2019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The vestibulo-ocular reflex (VOR) is the only system that maintains stable vision during rapid head rotations. The VOR gain (eye/head velocity) can be trained to increase using a vestibular-visual mismatch stimulus. We sought to determine whether low-frequency (sinusoidal) head rotation during training leads to changes in the VOR during high-frequency head rotation testing, where the VOR is more physiologically relevant. We tested eight normal subjects over three sessions. For training protocol 1, subjects performed active sinusoidal head rotations at 1.3 Hz while tracking a laser target, whose velocity incrementally increased relative to head velocity so that the VOR gain required to stabilize the target went from 1.1 to 2 over 15 min. Protocol 2 was the same as protocol 1, except that head rotations were at 0.5 Hz. For protocol 3, head rotation frequency incrementally increased from 0.5 to 2 Hz over 15 min, while the VOR gain required to stabilize the target was kept at 2. We measured the active and passive, sinusoidal (1.3Hz) and head impulse VOR gains before and after each protocol. Sinusoidal and head impulse VOR gains increased in protocols 1 and 3; however, although the sinusoidal VOR gain increase was ~20%, the related head impulse gain increase was only ~10%. Protocol 2 resulted in no-gain adaptation. These data show human VOR adaptation is frequency selective, suggesting that if one seeks to increase the higher-frequency VOR response, i.e., where it is physiologically most relevant, then higher-frequency head movements are required during training, e.g., head impulses.NEW & NOTEWORTHY This study shows that human vestibulo-ocular reflex adaptation is frequency selective at frequencies >0.3 Hz. The VOR in response to mid- (1.3 Hz) and high-frequency (impulse) head rotations were measured before and after mid-frequency sinusoidal VOR adaptation training, revealing that the mid-frequency gain change was higher than high-frequency gain change. Thus, if one seeks to increase the higher-frequency VOR response, where it is physiologically most relevant, then higher-frequency head movements are required during training.
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Affiliation(s)
- Carlo N Rinaudo
- Balance and Vision Laboratory, Neuroscience Research Australia, Sydney, Australia.,Graduate School of Biomedical Engineering, University of New South Wales, Sydney, Australia
| | - Michael C Schubert
- Laboratory of Vestibular NeuroAdaptation, Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland.,Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
| | - William V C Figtree
- Balance and Vision Laboratory, Neuroscience Research Australia, Sydney, Australia
| | - Christopher J Todd
- Balance and Vision Laboratory, Neuroscience Research Australia, Sydney, Australia
| | - Americo A Migliaccio
- Balance and Vision Laboratory, Neuroscience Research Australia, Sydney, Australia.,Graduate School of Biomedical Engineering, University of New South Wales, Sydney, Australia.,Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland.,School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia
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Schubert MC, Migliaccio AA. New advances regarding adaptation of the vestibulo-ocular reflex. J Neurophysiol 2019; 122:644-658. [PMID: 31215309 DOI: 10.1152/jn.00729.2018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
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.
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Affiliation(s)
- Michael C Schubert
- Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland.,Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
| | - Americo A Migliaccio
- Balance and Vision Laboratory, Neuroscience Research Australia, Sydney, New South Wales, Australia.,Graduate School of Biomedical Engineering, University of New South Wales, Sydney, New South Wales, Australia.,Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland.,School of Biomedical Sciences, University of Newcastle, Newcastle, New South Wales, Australia
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Incremental Vestibulo-ocular Reflex Adaptation Training Dynamically Tailored for Each Individual. J Neurol Phys Ther 2019; 43 Suppl 2:S2-S7. [DOI: 10.1097/npt.0000000000000269] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gimmon Y, Migliaccio AA, Todd CJ, Figtree WVC, Schubert MC. Simultaneous and opposing horizontal VOR adaptation in humans suggests functionally independent neural circuits. J Neurophysiol 2018; 120:1496-1504. [DOI: 10.1152/jn.00134.2018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The healthy vestibulo-ocular reflex (VOR) ensures that images remain on the fovea of the retina during head rotation to maintain stable vision. VOR behavior can be measured as a summation of linear and nonlinear properties although it is unknown whether asymmetric VOR adaptation can be performed synchronously in humans. The purpose of the present study is twofold. First, examine whether the right and left VOR gains can be synchronously adapted in opposing directions. Second, to investigate whether the adaptation context transfers between both sides. Three separate VOR adaptation sessions were randomized such that the VOR was adapted Up-bilaterally, Down-bilaterally, or Mixed (one side up, opposite side down). Ten healthy subjects completed the study. Subjects were tested while seated upright, 1 meter in front of a wall in complete dark. Each subject made active (self-generated) head impulse rotations for 15 min while viewing a gradually increasing amount of retinal slip. VOR training demand changed by 10% every 90 s. The VOR changed significantly for all training conditions. No significant differences in the magnitude of VOR gain changes between training conditions were found. The human VOR can be simultaneously driven in opposite directions. The similar magnitude of VOR gain changes across training conditions suggests functionally independent VOR circuits for each side of head rotation that mediate simultaneous and opposing VOR adaptations. NEW & NOTEWORTHY Our results indicate that humans have the adaptive capacity for concurrent and opposing directions of vestibulo-ocular reflex (VOR) motor learning. Context specificity of VOR adaptation is dependent on the error signal being unilateral or bilateral, which we illustrate via a lack of VOR gain transfer using unique adaptive demands.
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Affiliation(s)
- Yoav Gimmon
- Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Americo A. Migliaccio
- Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Balance and Vision Laboratory, Neuroscience Research Australia, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Christopher J. Todd
- Balance and Vision Laboratory, Neuroscience Research Australia, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - William V. C. Figtree
- Balance and Vision Laboratory, Neuroscience Research Australia, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Michael C. Schubert
- Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland
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