Anticipatory VOR Suppression Induced by Visual and Nonvisual Stimuli in Humans

Vestibulo-Ocular Reflex Suppression: Clinical Relevance and Assessment in the Digital Age

Background

Visual acuity and image stability are crucial for daily activities, particularly during head motion. The vestibulo-ocular reflex (VOR) and its suppression (VORS) support stable fixation of objects of interest. The VOR drives a reflexive eye movement to counter retinal slip of a stable target during head motion. In contrast, VORS inhibits this countermovement when the target stimulus is in motion. The VORS allows for object fixation when it aligns with the direction of the head's movement, or when an object within or outside the peripheral vision needs to be focused upon.

Summary

Deficits of the VORS have been linked to age-related diseases such as balance deficits associated with an increased fall risk. Therefore, the accurate assessment of the VORS is of particular clinical relevance. However, current clinical assessment methods for VORS are mainly qualitative and not sufficiently standardised. Recent advances in digital health technology, such as smartphone-based videooculography, offer a promising alternative for assessing VORS in a more accessible, efficient, and quantitative manner. Moreover, integrating mobile eye-tracking technology with virtual reality environments allows for the implementation of controlled VORS assessments with different visual inputs. These assessment approaches allow the extraction of novel parameters with potential pathomechanistic and clinical relevance.

Key Messages

We argue that researchers and clinicians can obtain a more nuanced understanding of this ocular stabilisation reflex and its associated pathologies by harnessing digital health technology for VORS assessment. Further research is warranted to explore the technologies' full potential and utility in clinical practice.

Differential saccade-pursuit coordination under sleep loss and low-dose alcohol

Introduction

Ocular tracking of a moving object requires tight coordination between smooth pursuit and saccadic eye movements. Normally, pursuit drives gaze velocity to closely match target velocity, with residual position offsets corrected by catch-up saccades. However, how/if common stressors affect this coordination is largely unknown. This study seeks to elucidate the effects of acute and chronic sleep loss, and low-dose alcohol, on saccade-pursuit coordination, as well as that of caffeine.

Methods

We used an ocular tracking paradigm to assess three metrics of tracking (pursuit gain, saccade rate, saccade amplitude) and to compute "ground lost" (from reductions in steady-state pursuit gain) and "ground recouped" (from increases in steady-state saccade rate and/or amplitude). We emphasize that these are measures of relative changes in positional offsets, and not absolute offset from the fovea.

Results

Under low-dose alcohol and acute sleep loss, ground lost was similarly large. However, under the former, it was nearly completely recouped by saccades, whereas under the latter, compensation was at best partial. Under chronic sleep restriction and acute sleep loss with a caffeine countermeasure, the pursuit deficit was dramatically smaller, yet saccadic behavior remained altered from baseline. In particular, saccadic rate remained significantly elevated, despite the fact that ground lost was minimal.

Discussion

This constellation of findings demonstrates differential impacts on saccade-pursuit coordination with low-dose alcohol impacting only pursuit, likely through extrastriate cortical pathways, while acute sleep loss not only disrupts pursuit but also undermines saccadic compensation, likely through midbrain/brainstem pathways. Furthermore, while chronic sleep loss and caffeine-mitigated acute sleep loss show little residual pursuit deficit, consistent with uncompromised cortical visual processing, they nonetheless show an elevated saccade rate, suggesting residual midbrain and/or brainstem impacts.

Effects of parameters of video head impulse testing on visually enhanced vestibulo-ocular reflex and vestibulo-ocular reflex suppression

OBJECTIVE

To investigate the main effects of some testing and analysis variables on clinically quantified visually enhanced vestibulo-ocular reflex (VVOR) and vestibulo-ocular reflex suppression (VORS) results using video head impulse test.

METHODS

This prospective observational clinical study included 19 healthy participants who underwent the VVOR and VORS tests. The effect of demographic variables, head oscillation frequency, rotation direction, visual acuity and analysis time window width and location of the recorded tests on the quantified results of both VVOR and VORS were evaluated. And specifically, for the VORS test the effect of cognitive reinforcement of the participant during testing was evaluated.

RESULTS

A statistically significant difference was observed among the VVOR, non-reinforced VORS, and reinforced VORS tests for mean gain values of 0.91 ± 0.09, 0.6 ± 0.15, and 0.57 ± 0.16, respectively (p < 0.001). The optimized linear mixed-effect model showed a significant influence of frequency on the gain values for the reinforced and non-reinforced VORS tests (p = 0.01 and p = 0.004, respectively). Regarding the gain analysis method, statistically significant differences were found according to the short time interval sample location of the records for the initial location of the VVOR test (p < 0.006) and final location of the reinforced VORS test (p < 0.023).

CONCLUSION

Significant differences were observed in the gain values according to VVOR and VORS testing. Head oscillation frequency is a significant factor that affects the gain values, especially in VORS testing. Moreover, in VORS testing, participant concentration has a significant effect on the test for obtaining suppression gain values. When a short time interval sample is considered for VVOR and VORS testing, intermediate time samples appear the most adequate for both tests.

SIGNIFICANCE

The quantified visually enhanced vestibulo-ocular reflex (VVOR) and vestibulo-ocular reflex suppression (VORS) tests have recently been added to the assortment of available clinical vestibular tests. However, despite the clinical validity of these quantified tests that appear to be of increasing clinical interest, the effects of most of the clinical testing methods and mathematical variables are not well defined. In this research we describe what are the main collecting and analysis variables that could influence to the VVOR and VORS tests. Specially for VORS test, participant concentration on test tasks will have positive effect on the measured vestibulo-ocular reflex (VOR) suppression.

Prediction in the Vestibular Control of Arm Movements

The contribution of vestibular signals to motor control has been evidenced in postural, locomotor, and oculomotor studies. Here, we review studies showing that vestibular information also contributes to the control of arm movements during whole-body motion. The data reviewed suggest that vestibular information is used by the arm motor system to maintain the initial hand position or the planned hand trajectory unaltered during body motion. This requires integration of vestibular and cervical inputs to determine the trunk motion dynamics. These studies further suggest that the vestibular control of arm movement relies on rapid and efficient vestibulomotor transformations that cannot be considered automatic. We also reviewed evidence suggesting that the vestibular afferents can be used by the brain to predict and counteract body-rotation-induced torques (e.g., Coriolis) acting on the arm when reaching for a target while turning the trunk.

Association between vestibulo-ocular reflex suppression, balance, gait, and fall risk in ageing and neurodegenerative disease: protocol of a one-year prospective follow-up study

Background

Falls frequency increases with age and particularly in neurogeriatric cohorts. The interplay between eye movements and locomotion may contribute substantially to the occurrence of falls, but is hardly investigated. This paper provides an overview of current approaches to simultaneously measure eye and body movements, particularly for analyzing the association of vestibulo-ocular reflex (VOR) suppression, postural deficits and falls in neurogeriatric risk cohorts. Moreover, VOR suppression is measured during head-fixed target presentation and during gaze shifting while postural control is challenged. Using these approaches, we aim at identifying quantitative parameters of eye-head-coordination during postural balance and gait, as indicators of fall risk.

Methods/Design

Patients with Progressive Supranuclear Palsy (PSP) or Parkinson’s disease (PD), age- and sex-matched healthy older adults, and a cohort of young healthy adults will be recruited. Baseline assessment will include a detailed clinical assessment, covering medical history, neurological examination, disease specific clinical rating scales, falls-related self-efficacy, activities of daily living, neuro-psychological screening, assessment of mobility function and a questionnaire for retrospective falls. Moreover, participants will simultaneously perform eye and head movements (fixating a head-fixed target vs. shifting gaze to light emitting diodes in order to quantify vestibulo-ocular reflex suppression ability) under different conditions (sitting, standing, or walking). An eye/head tracker synchronized with a 3-D motion analysis system will be used to quantify parameters related to eye-head-coordination, postural balance, and gait. Established outcome parameters related to VOR suppression ability (e.g., gain, saccadic reaction time, frequency of saccades) and motor related fall risk (e.g., step-time variability, postural sway) will be calculated. Falls will be assessed prospectively over 12 months via protocols and monthly telephone interviews.

Discussion

This study protocol describes an experimental setup allowing the analysis of simultaneously assessed eye, head and body movements. Results will improve our understanding of the influence of the interplay between eye, head and body movements on falls in geriatric high-risk cohorts.

Electronic supplementary material

The online version of this article (doi:10.1186/s12883-015-0447-5) contains supplementary material, which is available to authorized users.

A method to monitor eye and head tracking movements in college baseball players

PURPOSE

This study had two purposes. The first was to develop a method to measure horizontal gaze tracking errors (based on synchronized eye and head tracking recordings) as subjects viewed many pitched balls. The second was to assess horizontal eye, head, and gaze tracking strategies of a group of Division 1 college baseball players.

METHODS

Subjects viewed, but did not swing a bat at, tennis balls projected by a pneumatic pitching machine. Subjects were to call out numbers and the color of these numbers (black or red) on the balls. The trajectory of each pitch was very predictable. Eye and head movements were monitored with a video eye tracker and an inertial sensor, respectively, and these movements were synchronized with ball position using an analog recording device. Data were analyzed for 15 subjects.

RESULTS

Eye rotation, head rotation, gaze errors (GEs), and unsigned gaze errors (UGEs) were calculated at various elapsed times. On average, subjects tracked the pitched ball with the head throughout the pitch trajectory, while the eye was moved very little until late in the pitch trajectory. On average, gaze position matched the target position throughout the pitch trajectory. There was some variability in the mean amplitudes of head and eye movement between subjects. However, the eye and head were related by a common rule (partial rotational vestibulo-ocular reflex suppression) for all subjects. Although the mean amplitudes of the GE and UGE varied between subjects, these means were not consistent with anticipatory saccades for any subject.

CONCLUSIONS

On average, Division 1 college players tracked the pitched ball primarily with the head and maintained gaze close to the ball throughout much of the pitch trajectory. There was variability between subjects regarding the head and eye movement amplitudes and GEs, but, overall, all subjects maintained gaze close to the ball throughout the pitch trajectory despite the fact that these individuals were not batting.

Scaling of compensatory eye movements during translations: virtual versus real depth

Vestibulo-ocular reflexes are the fastest compensatory reflex systems. One of these is the translational vestibulo-ocular reflex (TVOR) which stabilizes the gaze at a given fixation point during whole body translations. For a proper response of the TVOR the eyes have to counter rotate in the head with a velocity that is inversely scaled to viewing distance of the target. It is generally assumed that scaling of the TVOR is automatically coupled to vergence angle at the brainstem level. However, different lines of evidence also argue that in humans scaling of the TVOR also depends on a mechanism that pre-sets gain on a priori knowledge of target distance. To discriminate between these two possibilities we used a real target paradigm with vergence angle coupled to distance and a virtual target paradigm with vergence angle dissociated from target distance. We compared TVOR responses in six subjects who underwent lateral sinusoidal whole-body translations at 1 and 2 Hz. Real targets varied between distance of 50 and 22.4 cm in front of the subjects, whereas the virtual targets consisting of a green and red light emitting diode (LED) were physically located at 50 cm from the subject. Red and green LED's were dichoptically viewed. By shifting the red LED relative to the green LED we created a range of virtual viewing distances where vergence angle changed but the ideal kinematic eye velocity was always the same. Eye velocity data recorded with virtual targets were compared to eye velocity data recorded with real targets. We also used flashing targets (flash frequency 1 Hz, duration 5 ms). During the real, continuous visible targets condition scaling of compensatory eye velocity with vergence angle was nearly perfect. During viewing of virtual targets, and with flashed targets compensatory eye velocity only weakly correlated to vergence angle, indicating that vergence angle is only partially coupled to compensatory eye velocity during translation. Our data suggest that in humans vergence angle as a measure of target distance estimation has only limited use for automatic TVOR scaling.

Insights into the control of arm movement during body motion as revealed by EMG analyses

Recent studies have revealed that vestibulomotor transformations contribute to maintain the hand stationary in space during trunk rotation. Here we tested whether these vestibulomotor transformations have the same latencies and whether they are subject to similar cognitive control than the visuomotor transformations during manual tracking of a visual target. We recorded hand displacement and shoulder-muscle activity in two tasks: a stabilization task in which subjects stabilized their hand during passive 30 degrees body rotations, and a tracking task in which subjects tracked with their finger a visual target as it moved 30 degrees around them. The EMG response times recorded in the stabilization task (approximately 165 ms) were twice as short as those observed for the tracking task (approximately 350 ms). Tested with the same paradigm, a deafferented subject showed EMG response times that closely matched those recorded in healthy subjects, thus, suggesting a vestibular origin of the arm movements. Providing advance information about the direction of the required arm movement reduced the response times in the tracking task (by approximately 115 ms) but had no significant effect in the stabilization task. Generally, when providing false information about movement direction in the tracking task, an EMG burst first appeared in the muscle moving the arm in the direction opposite to the actual target motion (i.e., in accord with the precueing). This behavior was rarely observed in the stabilization task. These results show that the sensorimotor transformations that move the arm relative to the trunk have shorter latencies when they originate from vestibular inputs than from visual information and that vestibulomotor transformations are more resistant to cognitive processes than visuomotor transformations.

Incremental angular vestibulo-ocular reflex adaptation to active head rotation

Studies on motor learning typically present a constant adaptation stimulus, corresponding to the desired final adaptive state. Studies of the auditory and optokinetic systems provide compelling evidence that neural plasticity is enhanced when the error signal driving adaptation is instead adjusted gradually throughout training. We sought to determine whether the angular vestibulo-ocular reflex (aVOR) may be adaptively increased using an incremental velocity error signal (IVE) compared with a conventional constant and large velocity-gain demand (x2). We compared the magnitude of aVOR gain change for these two paradigms across different motion contexts (active and passive). Seven individuals with normal vestibular function and six individuals with unilateral vestibular hypofunction (UVH) were exposed to the IVE and x2 ("control") aVOR demand tasks. Each subject participated in 10 epochs of 30 active head impulses over a 15 min aVOR gain increase training session separately for the IVE and x2 paradigms, separated by either seven days (normal subjects) or 14 days (UVH subjects). For both normal and UVH subjects, both paradigms led to aVOR gain increase during the training session. For the normal subjects, the IVE paradigm led to larger aVOR gain change after training compared to the x2 paradigm, for both active (mean 17.3 +/- 4% vs. mean 7.1 +/- 9%, P = 0.029) and passive (mean 14.2 +/- 5% vs. 4.5 +/- 8%, P = 0.018) head impulses. For subjects with UVH, IVE produced a greater change in aVOR gain for active head impulses (mean 18.2 +/- 9.2% vs. mean -6 +/- 3.8%, P = 0.003). However, aVOR gains for passive head impulses were less consistent after IVE, with only two subjects displaying greater aVOR gain with this incremental paradigm. Some individuals generated compensatory saccades that occurred in the same direction of the deficient aVOR during either training paradigm. Our data suggest that the aVOR is modifiable when the velocity error signal is presented incrementally, and that this adaptation stimulus is particularly effective in the case of unilateral vestibular hypofunction. This has implications for programs of vestibular rehabilitation, where active head rotation is prescribed as a means to improve gaze stability.

Physiology and pathology of eye–head coordination

Human head movement control can be considered as part of the oculomotor system since the control of gaze involves coordination of the eyes and head. Humans show a remarkable degree of flexibility in eye-head coordination strategies, nonetheless an individual will often demonstrate stereotypical patterns of eye-head behaviour for a given visual task. This review examines eye-head coordination in laboratory-based visual tasks, such as saccadic gaze shifts and combined eye-head pursuit, and in common tasks in daily life, such as reading. The effect of the aging process on eye-head coordination is then reviewed from infancy through to senescence. Consideration is also given to how pathology can affect eye-head coordination from the lowest through to the highest levels of oculomotor control, comparing conditions as diverse as eye movement restrictions and schizophrenia. Given the adaptability of the eye-head system we postulate that this flexible system is under the control of the frontal cortical regions, which assist in planning, coordinating and executing behaviour. We provide evidence for this based on changes in eye-head coordination dependant on the context and expectation of presented visual stimuli, as well as from changes in eye-head coordination caused by frontal lobe dysfunction.

Temporal facilitation of gaze in the presence of postural reactions triggered by sudden surface perturbations

Saccadic reaction times can be shortened by an additional sensory modality (e.g. auditory, tactile) presented in temporal proximity to the triggering cue. Whereas somatosensory cues given by sudden perturbations of the support surface can trigger appropriate postural adjustments to maintain upright stance, it is not known how gaze executions are affected by the dual task of maintaining upright balance while redirecting gaze. It was hypothesized that the onset latency of gaze movements toward visual targets will be shortened by sudden surface perturbations following visual target shifts to prompt a stable visual anchor for postural stabilization. Eight subjects stood on a movable platform with gaze fixated on a central target 2 m directly in front, and were instructed to shift their gaze to lateral targets located along a 63 degrees arc to the right and left. The trials began with the central target lit followed randomly by either the right, left or center target. Fifty or 250 ms following this target shift, balance was perturbed by a sudden yaw movement of the support surface (15.5 degrees over 210 ms at 130 degrees /s), with no stepping or large arm reactions observed. The latency of the gaze shifts was significantly shortened (by approximately 72 ms) when executed simultaneously with a surface perturbation. A decrease in excitation latency was also observed in the cervical paraspinals and sternocleidomastoid muscles. Postural responses in the ankle and knee muscles were not affected by gaze shifts. Pelvic horizontal angular motion closely followed surface motion whereas head motion was influenced by gaze shifts. During the combined gaze shift and surface motion conditions, thorax movement excursion was larger and not correlated with either the surface motion or visual target shift. In conclusion, postural adjustments in response to sudden surface yaws facilitate voluntary gaze shift execution and this enhancement may result from the sensory fusion of somatosensory and visual information.

Association between vestibuloocular reflex suppression during smooth movements of the head and attention deficit in progressive supranuclear palsy

With head movement, suppression of vestibular inputs during visual exploration is necessary not only for reorienting gaze, but also to direct attention to new visual targets. People with progressive supranuclear palsy (PSP) have difficulty suppressing the vestibuloocular reflex (VOR) and it was hypothesized that the magnitude of VOR suppression deficit correlates with the degree of degradation of attention and visuospatial performance. We evaluated cognitive and visuomotor function in 8 subjects with PSP (4 men and 4 women; ages 59-83 years). Gaze control was studied by measuring the accuracy of eye-head coordination during passive vertical and horizontal head-on-trunk movements. Fixation was assessed when subjects viewed either an earth-fixed or head-fixed target. A gaze fixation score (GFS) was calculated to represent the amount of error between eye and head movement in each plane (eye-head root mean square error normalized to the range of head rotation). The vertical but not horizontal GFS during attempted suppression of the VOR was significantly related to attention (r = -0.70; P = 0.05) and visuospatial ability (r = -0.76; P = 0.03). These findings suggest that the ability to suppress the VOR during vertical smooth movements of the head is associated with the magnitude of cognitive deficit in PSP.