1
|
Cong L, Yu X, Huang M, Sun J, Lv H, Zhang T, Dang W, Teng C, Xiong K, Ma J, Hu W, Wang J, Cheng S. Enhancing emotion regulation: investigating the efficacy of transcutaneous electrical acupoint stimulation at PC6 in reducing fear of heights. Front Psychol 2024; 15:1371014. [PMID: 38633874 PMCID: PMC11021653 DOI: 10.3389/fpsyg.2024.1371014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/20/2024] [Indexed: 04/19/2024] Open
Abstract
This study investigated the impact of transcutaneous electrical acupoint stimulation (TEAS) at Neiguan acupoint (PC6) on the physiological and behavioral responses of participants exposed in virtual height. 40 participants were included in the study and were randomly assigned to either a control group or an intervention group. Participants had an immersive experience with a VR interactive platform that provided somatosensory interaction in height stimulation scenes. Psychological scores, behavioral and cognitive performance, and physiological responses were recorded and analyzed. The results indicated that the intervention group had significantly lower fear scores compared to the control group. Analysis of heart rate variability revealed that the intervention group exhibited improved heart rate variability, indicating enhanced cardiovascular function and emotion regulation. The behavioral and cognitive results demonstrated that the intervention group exhibited higher left eye openness, faster reaction times, and greater movement distance, suggesting enhanced attentional focus, cognitive processing, and reduced avoidance behaviors. These findings suggest that TEAS at PC6 can effectively reduce fear and improve the regulation of physiological and behavioral responses to negative emotional stimuli.
Collapse
Affiliation(s)
- Lin Cong
- School of Aerospace Medicine, Air Force Medical University, Xi’an, China
- School of Biomedical Engineering, Air Force Medical University, Xi’an, China
| | - Xiao Yu
- School of Biomedical Engineering, Air Force Medical University, Xi’an, China
| | - Meiqing Huang
- School of Aerospace Medicine, Air Force Medical University, Xi’an, China
| | - Jicheng Sun
- Center for Military Medicine Innovation, Air Force Medical University, Xi’an, China
| | - Hao Lv
- School of Biomedical Engineering, Air Force Medical University, Xi’an, China
| | - Taihui Zhang
- School of Aerospace Medicine, Air Force Medical University, Xi’an, China
| | - Weitao Dang
- School of Aerospace Medicine, Air Force Medical University, Xi’an, China
| | - Chaolin Teng
- School of Aerospace Medicine, Air Force Medical University, Xi’an, China
| | - Kaiwen Xiong
- School of Aerospace Medicine, Air Force Medical University, Xi’an, China
| | - Jin Ma
- School of Aerospace Medicine, Air Force Medical University, Xi’an, China
| | - Wendong Hu
- School of Aerospace Medicine, Air Force Medical University, Xi’an, China
| | - Jianqi Wang
- School of Biomedical Engineering, Air Force Medical University, Xi’an, China
| | - Shan Cheng
- School of Aerospace Medicine, Air Force Medical University, Xi’an, China
| |
Collapse
|
2
|
Wang D, Bargiotas I, Cao J, Vayatis N, Oudre L, Vidal PP. Heterogeneities of the perceptual-motor style during locomotion at height. Front Hum Neurosci 2024; 17:1228195. [PMID: 38283095 PMCID: PMC10810983 DOI: 10.3389/fnhum.2023.1228195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/21/2023] [Indexed: 01/30/2024] Open
Abstract
In a recent review, we summarized the characteristics of perceptual-motor style in humans. Style can vary from individual to individual, task to task and pathology to pathology, as sensorimotor transformations demonstrate considerable adaptability and plasticity. Although the behavioral evidence for individual styles is substantial, much remains to be done to understand the neural and mechanical substrates of inter-individual differences in sensorimotor performance. In this study, we aimed to investigate the modulation of perceptual-motor style during locomotion at height in 16 persons with no history of fear of heights or acrophobia. We used an inexpensive virtual reality (VR) video game. In this VR game, Richie's Plank, the person progresses on a narrow plank placed between two buildings at the height of the 30th floor. Our first finding was that the static markers (head, trunk and limb configurations relative to the gravitational vertical) and some dynamic markers (jerk, root mean square, sample entropy and two-thirds power law at head, trunk and limb level) we had previously identified to define perceptual motor style during locomotion could account for fear modulation during VR play. Our second surprising result was the heterogeneity of this modulation in the 16 young, healthy individuals exposed to moving at a height. Finally, 56% of participants showed a persistent change in at least one variable of their skeletal configuration and 61% in one variable of their dynamic control during ground locomotion after exposure to height.
Collapse
Affiliation(s)
- Danping Wang
- Plateforme d’Etude Sensorimotricité, Université Paris Cité, Paris, France
- Machine Learning and I-Health International Cooperation Base of Zhejiang Province, Hangzhou Dianzi University, Hangzhou, China
| | - Ioannis Bargiotas
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Cité, Université Paris Saclay, ENS Paris Saclay, Paris, France
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Saclay, Université Paris Cité, ENS Paris Saclay, Gif-sur-Yvette, France
| | - Jiuwen Cao
- Machine Learning and I-Health International Cooperation Base of Zhejiang Province, Hangzhou Dianzi University, Hangzhou, China
| | - Nicolas Vayatis
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Cité, Université Paris Saclay, ENS Paris Saclay, Paris, France
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Saclay, Université Paris Cité, ENS Paris Saclay, Gif-sur-Yvette, France
| | - Laurent Oudre
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Cité, Université Paris Saclay, ENS Paris Saclay, Paris, France
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Saclay, Université Paris Cité, ENS Paris Saclay, Gif-sur-Yvette, France
| | - Pierre-Paul Vidal
- Plateforme d’Etude Sensorimotricité, Université Paris Cité, Paris, France
- Machine Learning and I-Health International Cooperation Base of Zhejiang Province, Hangzhou Dianzi University, Hangzhou, China
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Cité, Université Paris Saclay, ENS Paris Saclay, Paris, France
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Saclay, Université Paris Cité, ENS Paris Saclay, Gif-sur-Yvette, France
| |
Collapse
|
3
|
Cheng X, Bao B, Cui W, Liu S, Zhong J, Cai L, Yang H. Classification and Analysis of Human Body Movement Characteristics Associated with Acrophobia Induced by Virtual Reality Scenes of Heights. SENSORS (BASEL, SWITZERLAND) 2023; 23:5482. [PMID: 37420652 DOI: 10.3390/s23125482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/26/2023] [Accepted: 06/08/2023] [Indexed: 07/09/2023]
Abstract
Acrophobia (fear of heights), a prevalent psychological disorder, elicits profound fear and evokes a range of adverse physiological responses in individuals when exposed to heights, which will lead to a very dangerous state for people in actual heights. In this paper, we explore the behavioral influences in terms of movements in people confronted with virtual reality scenes of extreme heights and develop an acrophobia classification model based on human movement characteristics. To this end, we used wireless miniaturized inertial navigation sensors (WMINS) network to obtain the information of limb movements in the virtual environment. Based on these data, we constructed a series of data feature processing processes, proposed a system model for the classification of acrophobia and non-acrophobia based on human motion feature analysis, and realized the classification recognition of acrophobia and non-acrophobia through the designed integrated learning model. The final accuracy of acrophobia dichotomous classification based on limb motion information reached 94.64%, which has higher accuracy and efficiency compared with other existing research models. Overall, our study demonstrates a strong correlation between people's mental state during fear of heights and their limb movements at that time.
Collapse
Affiliation(s)
- Xiankai Cheng
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215163, China
| | - Benkun Bao
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215163, China
| | - Weidong Cui
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215163, China
| | - Shuai Liu
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215163, China
| | - Jun Zhong
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215163, China
| | - Liming Cai
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215163, China
| | - Hongbo Yang
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215163, China
| |
Collapse
|
4
|
Bzdúšková D, Marko M, Hirjaková Z, Kimijanová J, Hlavačka F, Riečanský I. The Effects of Virtual Height Exposure on Postural Control and Psychophysiological Stress Are Moderated by Individual Height Intolerance. Front Hum Neurosci 2022; 15:773091. [PMID: 35095450 PMCID: PMC8789875 DOI: 10.3389/fnhum.2021.773091] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/14/2021] [Indexed: 12/21/2022] Open
Abstract
Virtual reality (VR) enables individuals to be exposed to naturalistic environments in laboratory settings, offering new possibilities for research in human neuroscience and treatment of mental disorders. We used VR to study psychological, autonomic and postural reactions to heights in individuals with varying intensity of fear of heights. Study participants (N = 42) were immersed in a VR of an unprotected open-air elevator platform in an urban area, while standing on an unstable ground. Virtual elevation of the platform (up to 40 m above the ground level) elicited robust and reliable psychophysiological activation including increased distress, heart rate, and electrodermal activity, which was higher in individuals suffering from fear of heights. In these individuals, compared with individuals with low fear of heights, the VR height exposure resulted in higher velocity of postural movements as well as decreased low-frequency (<0.5 Hz) and increased high-frequency (>1 Hz) body sway oscillations. This indicates that individuals with strong fear of heights react to heights with maladaptive rigidity of posture due to increased weight of visual input for balance control, while the visual information is less reliable at heights. Our findings show that exposure to height in a naturalistic VR environment elicits a complex reaction involving correlated changes of the emotional state, autonomic activity, and postural balance, which are exaggerated in individuals with fear of heights.
Collapse
Affiliation(s)
- Diana Bzdúšková
- Department of Behavioural Neuroscience, Institute of Normal and Pathological Physiology, Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Martin Marko
- Department of Behavioural Neuroscience, Institute of Normal and Pathological Physiology, Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovakia
- Department of Applied Informatics, Faculty of Mathematics, Physics and Informatics, Comenius University in Bratislava, Bratislava, Slovakia
| | - Zuzana Hirjaková
- Department of Behavioural Neuroscience, Institute of Normal and Pathological Physiology, Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Jana Kimijanová
- Department of Behavioural Neuroscience, Institute of Normal and Pathological Physiology, Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovakia
| | - František Hlavačka
- Department of Behavioural Neuroscience, Institute of Normal and Pathological Physiology, Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Igor Riečanský
- Department of Behavioural Neuroscience, Institute of Normal and Pathological Physiology, Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovakia
- Social, Cognitive and Affective Neuroscience Unit, Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
- Department of Psychiatry, Faculty of Medicine, Slovak Medical University in Bratislava, Bratislava, Slovakia
- *Correspondence: Igor Riečanský,
| |
Collapse
|
5
|
Becker-Bense S, Huppert D. [Less common, but clinically important episodic vertigo syndromes]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2021; 89:221-232. [PMID: 33652478 DOI: 10.1055/a-1353-4893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
ZusammenfassungDie Differentialdiagnostik der selteneren, episodischen Schwindelsyndrome kann im klinischen Alltag eine Herausforderung darstellen, insbesondere wenn sie keine im Intervall messbaren Befunde in der neuro-ophthalmologischen oder -otologischen Routinediagnostik hinterlassen. Ursächlich für diese episodischen Schwindelsyndrome können physiologische Reaktionen aufgrund intersensorischer Inkongruenzen oder angeborene bzw. erworbene neuroanatomische/neurophysiologische Varianten sein, die zu vestibulären Reizsyndromen führen. In dieser Übersicht fokussieren wir auf die folgenden, aus unserer Sicht wichtigen vestibulären Syndrome: Bewegungskrankheit, Mal de Debarquement Syndrom, Visuelle Höhenintoleranz, Vestibularisparoxysmie, Zervikaler Schwindel, Episodische Ataxie Typ II und Syndrome eines dritten mobilen Fensters wie das Syndrom der Dehiszenz des superioren Bogengangs. Die Ausprägung reicht von milden Symptomen mit geringer Belastung bis hin zu schweren Krankheitsbildern mit relevanter Alltagseinschränkung. Sie können vom Kindes- oder Jugendalter bis ins Senium auftreten, teilweise mit abweichender Symptomatik. Durch gezielte Anamnese und ggf. erweiterte vestibuläre Diagnostik in einem spezialisierten Zentrum lassen sich diese Syndrome oft klar herausarbeiten und einer erfolgreichen Therapie zuführen.
Collapse
Affiliation(s)
- Sandra Becker-Bense
- Deutsches Schwindel- und Gleichgewichtszentrum (DSGZ), Ludwig-Maximilians-Universität München Deutschland
| | - Doreen Huppert
- Deutsches Schwindel- und Gleichgewichtszentrum (DSGZ), Ludwig-Maximilians-Universität München Deutschland
| |
Collapse
|
6
|
Altmann U, Friemann C, Frank TS, Sittler MC, Schoenherr D, Singh S, Schurig S, Strauss B, Petrowski K. Movement and Emotional Facial Expressions during the Adult Attachment Interview: Interaction Effects of Attachment and Anxiety Disorder. Psychopathology 2021; 54:1-12. [PMID: 33626527 DOI: 10.1159/000512127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 10/04/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Adult attachment is commonly associated with emotion regulation. Less is known about the nonverbal embodiment of adult attachment. OBJECTIVE We hypothesized that dismissing attachment is related to less movement and fewer facial expressions of emotions, whereas preoccupied attachment is associated with more negative emotional facial expressions. Moreover, the interaction of attachment and the presence of an anxiety disorder (AD) was explored. METHODS The sample included 95 individuals, 21 with AD without comorbidity, 21 with AD and comorbid major depression (AD-CD), and 53 healthy controls. We analyzed nonverbal behavior during a part of the Adult Attachment Interview (AAI) asking about the family and parental figures. The movements of the interviewees were captured via Motion Energy Analysis. Facial expressions were coded according to the Facial Action Coding System using the OpenFace software. We compared individuals with secure, dismissing, and preoccupied states of mind (assessed with the AAI) with regard to the frequency and complexity of movements and the frequency of the facial expressions such as happy, sad, and contemptuous. RESULTS As expected, dismissingly attached individuals moved less often and with lower complexity than securely attached. For emotional facial expressions, a main effect of the disorder group and interaction effects of attachment by disorder were found. In the AD-CD group, dismissingly attached patients showed comparatively fewer happy facial expressions than securely attached individuals. CONCLUSIONS Reduced movement specifically seems to be related to dismissing attachment when interviewees talk about significant parental figures. Facial expressions of emotions related to attachment occurred when maladaptive emotion regulation strategies were intensified by a psychological disorder.
Collapse
Affiliation(s)
- Uwe Altmann
- Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Friedrich-Schiller-Universität, Jena, Germany,
| | - Catharina Friemann
- Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Friedrich-Schiller-Universität, Jena, Germany
| | - Theresa S Frank
- Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Friedrich-Schiller-Universität, Jena, Germany
| | - Mareike C Sittler
- Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Friedrich-Schiller-Universität, Jena, Germany
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich-Schiller-University Jena, Jena, Germany
| | - Désirée Schoenherr
- Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Friedrich-Schiller-Universität, Jena, Germany
| | - Sashi Singh
- Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Friedrich-Schiller-Universität, Jena, Germany
| | - Susan Schurig
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - Bernhard Strauss
- Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Friedrich-Schiller-Universität, Jena, Germany
| | - Katja Petrowski
- Medical Psychology and Medical Sociology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| |
Collapse
|
7
|
Wang Q, Wang H, Hu F, Hua C, Wang D. Using convolutional neural networks to decode EEG-based functional brain network with different severity of acrophobia. J Neural Eng 2021; 18. [DOI: 10.1088/1741-2552/abcdbd] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 11/25/2020] [Indexed: 12/11/2022]
|
8
|
Abstract
PURPOSE OF REVIEW To present evidence of a functional interrelation between the vestibular and the anxiety systems based on a complex reciprocally organized network. The review focuses on the differential effects of various vestibular disorders, on psychiatric comorbidity, and on anxiety related to vertigo. RECENT FINDINGS Episodic vertigo syndromes such as vestibular migraine, vestibular paroxysmia, and Menière's disease are associated with a significant increase of psychiatric comorbidity, in particular anxiety/phobic disorders and depression. Chronic unilateral and bilateral vestibulopathy (BVP) do not exhibit a higher than normal psychiatric comorbidity. Anxiety related to the vertigo symptoms is also increased in episodic structural vestibular disorders but not in patients with chronic unilateral or bilateral loss of vestibular function. The lack of vertigo-related anxiety in BVP is a novel finding. Several studies have revealed special features related to anxiety in patients suffering from BVP: despite objectively impaired postural balance with frequent falls, they usually do not complain about fear of falling; they do not report an increased susceptibility to fear of heights; they do not have an increased psychiatric comorbidity; and they do not report increased anxiety related to the perceived vertigo. Subtle or moderate vestibular stimulation (by galvanic currents or use of a swing) may have beneficial effects on stress or mood state in healthy adults, and promote sleep in humans and rodents. The intimate structural and functional linkage of the vestibular and anxiety systems includes numerous nuclei, provincial and connector hubs, the thalamocortical network, and the cerebellum with many neural transmitter systems. SUMMARY The different involvement of emotional processes and anxiety - to the extent of 'excess anxiety' or 'less anxiety' - in structural vestibular disorders may be due to the specific dysfunction and whether the system activity is excited or diminished. Both psychiatric comorbidity and vertigo-related anxiety are maximal with excitation and minimal with loss of peripheral vestibular function.
Collapse
|
9
|
Penkava J, Bardins S, Brandt T, Wuehr M, Huppert D. Spontaneous visual exploration during locomotion in patients with phobic postural vertigo. J Neurol 2020; 267:223-230. [PMID: 32852578 PMCID: PMC7718196 DOI: 10.1007/s00415-020-10151-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/23/2020] [Accepted: 08/07/2020] [Indexed: 11/29/2022]
Abstract
Background Earlier studies on stance and gait with posturographic and EMG-recordings and automatic gait analysis in patients with phobic postural vertigo (PPV) or visual height intolerance (vHI) revealed similar patterns of body stiffening with muscle co-contraction and a slow, cautious gait. Visual exploration in vHI patients was characterized by a freezing of gaze-in-space when standing and reduced horizontal eye and head movements during locomotion. Objective Based on the findings in vHI patients, the current study was performed with a focus on visual control of locomotion in patients with PPV while walking along a crowded hospital hallway. Methods Twelve patients with PPV and eleven controls were recruited. Participants wore a mobile infrared video eye-tracking system that continuously measured eye-in-head movements in the horizontal and vertical planes and head orientation and motion in the yaw, pitch, and roll planes. Visual exploration behavior of participants was recorded at the individually preferred speed for a total walking distance of 200 m. Gaze-in-space directions were determined by combining eye-in-head and head-in-space orientation. Walking speeds were calculated based on the trial duration and the total distance traversed. Participants were asked to rate their feelings of discomfort during the walk on a 4-point numeric rating scale. The examiners rated the crowdedness of the hospital hallway on a 4-point numeric rating scale. Results The major results of visual exploration behavior in patients with PPV in comparison to healthy controls were: eye and head positions were directed more downward in the vertical plane towards the ground ahead with increased frequency of large amplitude vertical orientation movements towards the destination, the end of the ground straight ahead. The self-adjusted speed of locomotion was significantly lower in PPV. Particularly those patients that reported high levels of discomfort exhibited a specific visual exploration of their horizontal surroundings. The durations of fixating targets in the visual surroundings were significantly shorter as compared to controls. Conclusion Gaze control of locomotion in patients with PPV is characterized by a preferred deviation of gaze more downward and by horizontal explorations for suitable auxiliary means for potential postural support in order to prevent impending falls. These eye movements have shorter durations of fixation as compared to healthy controls and patients with vHI. Finally, the pathological alterations in eye–head coordination during locomotion correlate with a higher level of discomfort and anxiety about falling.
Collapse
Affiliation(s)
- J Penkava
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany.
| | - S Bardins
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany
| | - T Brandt
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany
- Institute for Clinical Neurosciences, Ludwig-Maximilians-University, Munich, Germany
| | - M Wuehr
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany
| | - D Huppert
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany
- Institute for Clinical Neurosciences, Ludwig-Maximilians-University, Munich, Germany
- Department of Neurology, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| |
Collapse
|
10
|
Acrophobia and visual height intolerance: advances in epidemiology and mechanisms. J Neurol 2020; 267:231-240. [PMID: 32444982 PMCID: PMC7718183 DOI: 10.1007/s00415-020-09805-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 03/16/2020] [Accepted: 03/18/2020] [Indexed: 12/24/2022]
Abstract
Historical descriptions of fear at heights date back to Chinese and Roman antiquity. Current definitions distinguish between three different states of responses to height exposure: a physiological height imbalance that results from an impaired visual control of balance, a more or less distressing visual height intolerance, and acrophobia at the severest end of the spectrum. Epidemiological studies revealed a lifetime prevalence of visual height intolerance including acrophobia in 28% of adults (32% in women; 25% in men) and 34% among prepubertal children aged 8–10 years without gender preponderance. Visual height intolerance first occurring in adulthood usually persists throughout life, whereas an early manifestation in childhood usually shows a benign course with spontaneous relief within years. A high comorbidity was found with psychiatric disorders (e.g. anxiety and depressive syndromes) and other vertigo syndromes (e.g. vestibular migraine, Menière’s disease), but not with bilateral vestibulopathy. Neurophysiological analyses of stance, gait, and eye movements revealed an anxious control of postural stability, which entails a co-contraction of anti-gravity muscles that causes a general stiffening of the whole body including the oculomotor apparatus. Visual exploration is preferably reduced to fixation of the horizon. Gait alterations are characterized by a cautious slow walking mode with reduced stride length and increased double support phases. Anxiety is the critical factor in visual height intolerance and acrophobia leading to a motor behavior that resembles an atavistic primitive reflex of feigning death. The magnitude of anxiety and neurophysiological parameters of musculoskeletal stiffening increase with increasing height. They saturate, however, at about 20 m of absolute height above ground for postural symptoms and about 40 m for anxiety (70 m in acrophobic participants). With respect to management, a differentiation should be made between behavioral recommendations for prevention and therapy of the condition. Recommendations for coping strategies target behavioral advices on visual exploration, control of posture and locomotion as well as the role of cognition. Treatment of severely afflicted persons with distressing avoidance behavior mainly relies on behavioral therapy.
Collapse
|
11
|
Teggi R, Comacchio F, Fornasari F, Mira E. Height intolerance between physiological mechanisms and psychological distress: a review of literature and our experience. ACTA ACUST UNITED AC 2019; 39:263-268. [PMID: 31501618 PMCID: PMC6734202 DOI: 10.14639/0392-100x-2190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 10/06/2018] [Indexed: 11/23/2022]
Affiliation(s)
- R Teggi
- Department of Otolaryngology, Vita-Salute University, San Raffaele Hospital, Milan, Italy
| | - F Comacchio
- Otolaryngology and Otosurgery Unit, University Hospital of Padova, Italy
| | - F Fornasari
- Department of Otolaryngology, Vita-Salute University, San Raffaele Hospital, Milan, Italy
| | - E Mira
- Department of Otolaryngology, University of Pavia, Italy.,Department of Otolaryngology, Policlinico S. Matteo, Pavia, Italy
| |
Collapse
|
12
|
Schniepp R, Möhwald K, Wuehr M. Clinical and automated gait analysis in patients with vestibular, cerebellar, and functional gait disorders: perspectives and limitations. J Neurol 2019; 266:118-122. [PMID: 31134375 DOI: 10.1007/s00415-019-09378-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/09/2019] [Accepted: 05/15/2019] [Indexed: 02/01/2023]
Abstract
This article outlines recent developments in the clinical and automated assessment of neurological gait disorders. With a primary focus on vestibular, cerebellar, and functional gait disorders, we discuss how instrumented gait examination may assist clinical decision making in these disorders with respect to the initial differential diagnosis and prognosis as well as the objective monitoring of disease progression and therapeutic interventions. We delineate strategies for data handling and analysis of quantitative gait examinations that can facilitate the clinical characterization and interpretation of walking impairments. These strategies include data normalization and dimensionality reduction procedures. We further emphasize the value of a comprehensive, standardized gait assessment protocol. Accordingly, the examination of walking conditions that challenge patients with respect to their biomechanical, sensory, or cognitive resources are particularly helpful to disclose and characterize the causes underlying their gait impairment. Finally, we provide a perspective on the emerging implementation of pattern recognition approaches within the framework of clinical management of gait disorders and discuss their potential to assist clinical decision making with respect to the differential diagnosis and the prognosis of fall risk in individual patients.
Collapse
Affiliation(s)
- Roman Schniepp
- Department of Neurology, University of Munich, Marchioninistrasse 15, 81377, Munich, Germany. .,German Center for Vertigo and Balance Disorders (DSGZ), University of Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Ken Möhwald
- Department of Neurology, University of Munich, Marchioninistrasse 15, 81377, Munich, Germany.,German Center for Vertigo and Balance Disorders (DSGZ), University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Max Wuehr
- German Center for Vertigo and Balance Disorders (DSGZ), University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| |
Collapse
|
13
|
Wuehr M, Breitkopf K, Decker J, Ibarra G, Huppert D, Brandt T. Fear of heights in virtual reality saturates 20 to 40 m above ground. J Neurol 2019; 266:80-87. [PMID: 31102019 DOI: 10.1007/s00415-019-09370-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/06/2019] [Accepted: 05/08/2019] [Indexed: 01/22/2023]
Abstract
Recent epidemiological studies indicate that about one-third of the general population suffers from a more or less disabling height intolerance, with a relevant impact on quality of life in many of them. Acrophobia, the most severe form of visual height intolerance, has a life-time prevalence of around 5%. Although it is commonly believed that fear of heights should continuously aggravate with increasing elevation, this issue has not been systematically investigated yet. Here, we examined this topic using immersive virtual reality, an established tool in therapy for fear of heights, that allows to flexibly manipulate height stimuli. In a comprehensive cohort (including insusceptible subjects as well as subjects with height intolerance up to acrophobia) height intolerance severity was graded by an established metric scale (vHISS). Participants were randomly exposed to different virtual elevations using a head-mounted display. Behavioral responses to virtual height exposure were analogous to exposure in vivo. Participants exhibited increased anxiety and musculoskeletal stiffening with enhanced high-frequency body sway, to an extend that corresponded to the individual subjective height intolerance rating. For all behavioral responses, we observed a saturation above a certain altitude. Body sway and musculoskeletal stiffening became maximal at 20 m above ground, whereas anxiety saturated above 40 m. These results suggest that fear of heights is characterized by a nonlinear stimulus-response relationship and a dissociation between visual-height-induced bodily and emotional reactions.
Collapse
Affiliation(s)
- Max Wuehr
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, University Hospital, Marchioninistr. 15, 81377, Munich, Germany.
| | - Katharina Breitkopf
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Julian Decker
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Gerardo Ibarra
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Doreen Huppert
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, University Hospital, Marchioninistr. 15, 81377, Munich, Germany
- Institute for Clinical Neurosciences, Ludwig-Maximilians-University, University Hospital, Marchioninistr. 15, Munich, 81377, Germany
- Department of Neurology, Ludwig-Maximilians-University, University Hospital, Marchioninistr. 15, Munich, 81377, Germany
| | - Thomas Brandt
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, University Hospital, Marchioninistr. 15, 81377, Munich, Germany
- Institute for Clinical Neurosciences, Ludwig-Maximilians-University, University Hospital, Marchioninistr. 15, Munich, 81377, Germany
| |
Collapse
|
14
|
Kunel'skaya NL, Baybakova EV, Zaoeva ZO. Psychogenic vertigo. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:89-93. [DOI: 10.17116/jnevro201911910189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
15
|
Kaur R, Lin X, Layton A, Hernandez M, Sowers R. Virtual Reality, Visual Cliffs, and Movement Disorders. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:81-84. [PMID: 30440346 DOI: 10.1109/embc.2018.8512246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We outline an experimental setup designed to dynamically understand neural responses to visual cliffs while walking. The goal of our work is understanding and mitigating fear of falling, particularly among the elderly. In our setup, an EEG cap monitors a subject's neural activity while the subject is immersed in a virtual world and walking on an instrumented treadmill. The subject's response to visual stimuli is measured by both the EEG cap and by speed and pressure data from the treadmill. Based on this data, we can dynamically alter the landscape in the virtual world. We hope that our setup may be useful in helping subjects develop mechanisms to compensate for significant fear of falling while walking.
Collapse
|
16
|
Brandt T, Grill E, Strupp M, Huppert D. Susceptibility to Fear of Heights in Bilateral Vestibulopathy and Other Disorders of Vertigo and Balance. Front Neurol 2018; 9:406. [PMID: 29928252 PMCID: PMC5997824 DOI: 10.3389/fneur.2018.00406] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/17/2018] [Indexed: 12/23/2022] Open
Abstract
Aims: To determine the susceptibility to visual height intolerance (vHI) in patients with acquired bilateral vestibulopathy (BVP). The question was whether postural instability in BVP, which is partially compensated for by visual substitution of the impaired vestibular control of balance, leads to an increased susceptibility. This is of particular importance since fear of heights is dependent on body posture, and visual control of balance at heights can no longer substitute vestibular input. For comparison susceptibility to vHI was determined in patients with other vestibular or functional disorders. Methods: A total of 150 patients aged 18 or above who had been referred to the German Center for Vertigo and Balance Disorders and diagnosed to have BVP were surveyed with a standardized questionnaire by specifically trained neurological professionals. Further, 481 patients with other vestibular or functional disorders were included. Results: Susceptibility to vHI was reported by 29% (32 % in females, 25% in males) of the patients with BVP. Patients with vHI were slightly younger (67 vs. 71 years). Seventy percent of those with vHI reported avoidance of climbing, hiking, stairs, darkness, cycling or swimming (84% of those without vHI). Mean age for onset of vHI was 40 years. Susceptibility to vHI was higher in patients with other vertigo disorders than in those with BVP: 64% in those with phobic postural vertigo, 61% in vestibular migraine, 56% in vestibular paroxysmia, 54% in benign paroxysmal positional vertigo, 49% in unilateral vestibulopathy and 48% in Menière's disease. Conclusions: The susceptibility to vHI in BVP was not higher than that of the general population (28%).This allows two explanations that need not be alternatives but contribute to each other: (1) Patients with a bilateral peripheral vestibular deficit largely avoid exposure to heights because of their postural instability. (2) The irrational anxiety to fall from heights triggers increased susceptibility to vHI, not the objective postural instability. However, patients with BVP do not exhibit increased comorbid anxiety disorders. This view is supported by the significantly increased susceptibility to vHI in other vestibular syndromes, which are characterized by an increased comorbidity of anxiety disorders.
Collapse
Affiliation(s)
- Thomas Brandt
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, University Hospital, Munich, Germany
- Institute for Clinical Neurosciences, Ludwig-Maximilians-University, University Hospital, Munich, Germany
| | - Eva Grill
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, University Hospital, Munich, Germany
- Institute for Medical Information Processing, Biometrics and Epidemiology, Ludwig-Maximilians-University, Munich, Germany
| | - Michael Strupp
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, University Hospital, Munich, Germany
- Department of Neurology, Ludwig-Maximilians-University, University Hospital, Munich, Germany
| | - Doreen Huppert
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, University Hospital, Munich, Germany
- Institute for Clinical Neurosciences, Ludwig-Maximilians-University, University Hospital, Munich, Germany
| |
Collapse
|
17
|
Functional dizziness: from phobic postural vertigo and chronic subjective dizziness to persistent postural-perceptual dizziness. Curr Opin Neurol 2018; 30:107-113. [PMID: 28002123 DOI: 10.1097/wco.0000000000000417] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Functional dizziness is the new term for somatoform or psychogenic dizziness. The aim of this study is to review arguments for the new nomenclature, clinical features, possible pathomechanisms, and comorbidities of functional dizziness. RECENT FINDINGS The prevalence of functional dizziness as a primary cause of vestibular symptoms amounts to 10% in neuro-otology centers. Rates of psychiatric comorbidity in patients with structural vestibular syndromes are much higher with nearly 50% and with highest rates in patients with vestibular migraine, vestibular paroxysmia, and Ménière's disease. Pathophysiologic processes seem to include precipitating events that trigger anxiety-related changes in postural strategies with an increased attention to head and body motion and a cocontraction of leg muscles. Personality traits with high levels of neuroticism and low levels of extraversion appear as risk factors for anxiety and depressive disorders and increased morbidity in functional disorders. SUMMARY Correct and early diagnosis of functional dizziness, as primary cause or secondary disorder after a structural vestibular syndrome, is very important to prevent further chronification and enable adequate treatment. Treatment plans that include patient education, vestibular rehabilitation, cognitive and behavioral therapies, and medications substantially reduce morbidity and offer the potential for sustained remission when applied systematically.
Collapse
|
18
|
Hong YJ, Kim HE, Jung YH, Kyeong S, Kim JJ. Usefulness of the Mobile Virtual Reality Self-Training for Overcoming a Fear of Heights. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2017; 20:753-761. [DOI: 10.1089/cyber.2017.0085] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Yeon-Ju Hong
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hesun Erin Kim
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Young Hoon Jung
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sunghyon Kyeong
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jae-Jin Kim
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
- Department of Psychiatry, Yonsei University Gangnam Severance Hospital, Seoul, Korea
| |
Collapse
|
19
|
Benign course of episodic dizziness disorders in childhood. J Neurol 2017; 264:4-6. [DOI: 10.1007/s00415-017-8408-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 01/25/2017] [Accepted: 01/27/2017] [Indexed: 01/03/2023]
|
20
|
Misiewicz Z, Hiekkalinna T, Paunio T, Varilo T, Terwilliger JD, Partonen T, Hovatta I. A genome-wide screen for acrophobia susceptibility loci in a Finnish isolate. Sci Rep 2016; 6:39345. [PMID: 27996024 PMCID: PMC5171840 DOI: 10.1038/srep39345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 11/16/2016] [Indexed: 12/02/2022] Open
Abstract
Acrophobia, an abnormal fear of heights, is a specific phobia characterized as apprehension cued by the occurrence or anticipation of elevated spaces. It is considered a complex trait with onset influenced by both genetic and environmental factors. Identification of genetic risk variants would provide novel insight into the genetic basis of the fear of heights phenotype and contribute to the molecular-level understanding of its aetiology. Genetic isolates may facilitate identification of susceptibility alleles due to reduced genetic heterogeneity. We took advantage of an internal genetic isolate in Finland in which a distinct acrophobia phenotype appears to be segregating in pedigrees originally ascertained for schizophrenia. We conducted parametric, nonparametric, joint linkage and linkage disequilibrium analyses using a microsatellite marker panel, genotyped in families to search for chromosomal regions correlated with acrophobia. Our results implicated a few regions with suggestive evidence for linkage on chromosomes 4q28 (LOD = 2.17), 8q24 (LOD = 2.09) and 13q21-q22 (LOD = 2.22). We observed no risk haplotypes shared between different families. These results suggest that genetic predisposition to acrophobia in this genetic isolate is unlikely to be mediated by a small number of shared high-risk alleles, but rather has a complex genetic architecture.
Collapse
Affiliation(s)
- Zuzanna Misiewicz
- Department of Biosciences, University of Helsinki, Helsinki, Finland
| | - Tero Hiekkalinna
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland.,Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Tiina Paunio
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland.,Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Development of Work and Work Organizations, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Teppo Varilo
- Department of Medical Genetics, University of Helsinki, Helsinki, Finland
| | - Joseph D Terwilliger
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland.,Department of Psychiatry, Department of Genetics and Development, and Gertrude H. Sergievsky Center, Columbia University, New York NY, USA.,Division of Medical Genetics, New York State Psychiatric Institute, New York NY, USA
| | - Timo Partonen
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Iiris Hovatta
- Department of Biosciences, University of Helsinki, Helsinki, Finland.,Department of Health, National Institute for Health and Welfare, Helsinki, Finland
| |
Collapse
|
21
|
Kapfhammer HP, Fitz W, Huppert D, Grill E, Brandt T. Visual height intolerance and acrophobia: distressing partners for life. J Neurol 2016; 263:1946-53. [PMID: 27383642 PMCID: PMC5037147 DOI: 10.1007/s00415-016-8218-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 06/23/2016] [Accepted: 06/23/2016] [Indexed: 11/25/2022]
Abstract
The course of illness, the degree of social impairment, and the rate of help-seeking behavior was evaluated in a sample of individuals with visual height intolerance (vHI) and acrophobia. On the basis of a previously described epidemiological sample representative of the German general population, 574 individuals with vHI were identified, 128 fulfilled the DSM-5 diagnostic criteria of acrophobia. The illness of the majority of all susceptible individuals with vHI ran a year-long chronic course. Two thirds were in the category “persistent/worse”, whereas only one third was in the category “improved/remitted”. Subjects with acrophobia showed significantly more traumatic triggers of onset, more signs of generalization to other height stimuli, higher rates of increasing intensity of symptom load, higher grades of social impairment, and greater overall negative impact on the quality of life than those with pure vHI. An unfavorable course of illness in pure vHI was predicted by major depression, agoraphobia, social phobia, posttraumatic stress, initial traumatic trigger, and female sex; an unfavorable course in acrophobia was predicted by major depression, chronic fatigue, panic attacks, initial traumatic trigger, social phobia, other specific phobic fears, and female sex. Help-seeking behavior was astonishingly low in the overall sample of individuals with vHI. The consequences of therapeutic interventions if complied with at all were quite modest. In adults pure vHI and even more so acrophobia are by no means only transitionally distressing states. In contrast to their occurrence in children they are more often persisting and disabling conditions. Both the utilization of and adequacy of treatment of these illnesses pose major challenges within primary and secondary neurological and psychiatric medical care.
Collapse
Affiliation(s)
- Hans-Peter Kapfhammer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036, Graz, Austria.
| | - Werner Fitz
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036, Graz, Austria
| | - Doreen Huppert
- Institute for Clinical Neurosciences and German Dizziness Center, Ludwig-Maximilians University, Munich, Germany
| | - Eva Grill
- Institute for Medical Information Processing, Biometrics and Epidemiology (IBE), German Dizziness Center, Ludwig-Maximilians University, Munich, Germany
| | - Thomas Brandt
- Institute for Clinical Neurosciences and German Dizziness Center, Ludwig-Maximilians University, Munich, Germany
| |
Collapse
|
22
|
Van Ombergen A, Lubeck AJ, Van Rompaey V, Maes LK, Stins JF, Van de Heyning PH, Wuyts FL, Bos JE. The Effect of Optokinetic Stimulation on Perceptual and Postural Symptoms in Visual Vestibular Mismatch Patients. PLoS One 2016; 11:e0154528. [PMID: 27128970 PMCID: PMC4851359 DOI: 10.1371/journal.pone.0154528] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 04/14/2016] [Indexed: 11/23/2022] Open
Abstract
Background Vestibular patients occasionally report aggravation or triggering of their symptoms by visual stimuli, which is called visual vestibular mismatch (VVM). These patients therefore experience discomfort, disorientation, dizziness and postural unsteadiness. Objective Firstly, we aimed to get a better insight in the underlying mechanism of VVM by examining perceptual and postural symptoms. Secondly, we wanted to investigate whether roll-motion is a necessary trait to evoke these symptoms or whether a complex but stationary visual pattern equally provokes them. Methods Nine VVM patients and healthy matched control group were examined by exposing both groups to a stationary stimulus as well as an optokinetic stimulus rotating around the naso-occipital axis for a prolonged period of time. Subjective visual vertical (SVV) measurements, posturography and relevant questionnaires were assessed. Results No significant differences between both groups were found for SVV measurements. Patients always swayed more and reported more symptoms than healthy controls. Prolonged exposure to roll-motion caused in patients and controls an increase in postural sway and symptoms. However, only VVM patients reported significantly more symptoms after prolonged exposure to the optokinetic stimulus compared to scores after exposure to a stationary stimulus. Conclusions VVM patients differ from healthy controls in postural and subjective symptoms and motion is a crucial factor in provoking these symptoms. A possible explanation could be a central visual-vestibular integration deficit, which has implications for diagnostics and clinical rehabilitation purposes. Future research should focus on the underlying central mechanism of VVM and the effectiveness of optokinetic stimulation in resolving it.
Collapse
Affiliation(s)
- Angelique Van Ombergen
- Antwerp University Research centre for Equilibrium and Aerospace (AUREA), University of Antwerp, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- * E-mail:
| | - Astrid J. Lubeck
- Research Institute MOVE, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, Netherlands
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology, Antwerp University Hospital, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Leen K. Maes
- Antwerp University Research centre for Equilibrium and Aerospace (AUREA), University of Antwerp, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium
| | - John F. Stins
- Research Institute MOVE, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, Netherlands
| | - Paul H. Van de Heyning
- Antwerp University Research centre for Equilibrium and Aerospace (AUREA), University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology, Antwerp University Hospital, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Floris L. Wuyts
- Antwerp University Research centre for Equilibrium and Aerospace (AUREA), University of Antwerp, Antwerp, Belgium
| | - Jelte E. Bos
- Research Institute MOVE, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, Netherlands
- TNO Perceptual and Cognitive Systems, Soesterberg, The Netherlands
| |
Collapse
|
23
|
Abstract
Functional and psychiatric disorders that cause vestibular symptoms (i.e., vertigo, unsteadiness, and dizziness) are common. In fact, they are more common than many well-known structural vestibular disorders. Neurologists and otologists are more likely to encounter patients with vestibular symptoms due to persistent postural-perceptual dizziness or panic disorder than Ménière's disease or bilateral vestibular loss. Successful approaches to identifying functional and psychiatric causes of vestibular symptoms can be incorporated into existing practices without much difficulty. The greatest challenge is to set aside dichotomous thinking that strongly emphasizes investigations of structural diseases in favor of a three-pronged approach that assesses structural, functional, and psychiatric disorders simultaneously. The pathophysiologic mechanisms underlying functional and psychiatric causes of vestibular symptoms are better understood than many clinicians realize. Research methods such as advanced posturographic analysis and functional brain imaging will push this knowledge further in the next few years. Treatment plans that include patient education, vestibular rehabilitation, cognitive and behavioral therapies, and medications substantially reduce morbidity and offer the potential for sustained remission when applied systematically. Diagnostic and therapeutic approaches are necessarily multidisciplinary in nature, but they are well within the purview of collaborative care teams or networks of clinicians coordinated with the neurologists and otologists whom patients consult first.
Collapse
Affiliation(s)
- M Dieterich
- Department of Neurology, Ludwig-Maximilians-University Munich, Klinikum Grosshadern, Munich, Germany; German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University Munich, Klinikum Grosshadern, Munich, Germany.
| | - J P Staab
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - T Brandt
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University Munich, Klinikum Grosshadern, Munich, Germany
| |
Collapse
|
24
|
Abstract
Behavioral factors have long been recognized as affecting spatial orientation and balance function. Neuroanatomic and neurophysiologic studies conducted worldwide over the last 30 years have substantially advanced our knowledge about the inherently strong connectivity among threat/anxiety, vestibular, visual, and somatosensory systems in the brain. Clinical investigations have shed greater light on the nature of functional and psychiatric disorders that manifest or magnify vestibular morbidity. Concepts of these syndromes have changed over 150 years. Even their nomenclature has had different meanings in different eras. This chapter will review functional and psychiatric vestibular disorders. Terminology will follow the International Classification of Diseases, 11th edition, beta draft and the International Classification of Vestibular Disorders. Anxiety plays a central role in behavioral vestibular morbidity. Anxiety, traumatic stress, obsessive, and depressive disorders may be primary causes of episodic and chronic vestibular symptoms or secondary complications of other vestibular disorders. These psychiatric illnesses affect 30-50% of patients who consult neurologists or otologists for vestibular symptoms. Coexisting psychiatric disorders adversely affect treatment for patients with structural vestibular diseases, especially when unrecognized. Persistent postural-perceptual dizziness is the leading cause of long-term vestibular disability. Fortunately, pharmacologic, psychotherapeutic, and rehabilitative treatments of these illnesses have improved in recent years.
Collapse
Affiliation(s)
- J P Staab
- Department of Psychiatry and Psychology, and Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|