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Xavier F, Chouin E, Tighilet B, Chabbert C, Besnard S. Innovative approaches for managing patients with chronic vestibular disorders: follow-up indicators and predictive markers for studying the vestibular error signal. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1414198. [PMID: 39220608 PMCID: PMC11362045 DOI: 10.3389/fresc.2024.1414198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 07/08/2024] [Indexed: 09/04/2024]
Abstract
Introduction Despite significant advancements in understanding the biochemical, anatomical, and functional impacts of vestibular lesions, developing standardized and effective rehabilitation strategies for patients unresponsive to conventional therapies remains a challenge. Chronic vestibular disorders, characterized by permanent or recurrent imbalances and blurred vision or oscillopsia, present significant complexity in non-pharmacological management. The complex interaction between peripheral vestibular damage and its impact on the central nervous system (CNS) raises questions about neuroplasticity and vestibular compensation capacity. Although fundamental research has examined the consequences of lesions on the vestibular system, the effect of a chronic peripheral vestibular error signal (VES) on the CNS remains underexplored. The VES refers to the discrepancy between sensory expectations and perceptions of the vestibular system has been clarified through recent engineering studies. This deeper understanding of VES is crucial not only for vestibular physiology and pathology but also for designing effective measures and methods of vestibular rehabilitation, shedding light on the importance of compensation mechanisms and sensory integration. Methods This retrospective study, targeting patients with chronic unilateral peripheral vestibulopathy unresponsive to standard treatments, sought to exclude any interference from pre-existing conditions. Participants were evaluated before and after a integrative vestibular exploratory and rehabilitation program through questionnaires, posturographic tests, and videonystagmography. Results The results indicate significant improvements in postural stability and quality of life, demonstrating positive modulation of the CNS and an improvement of vestibular compensation. Discussion Successful vestibular rehabilitation likely requires a multifaceted approach that incorporates the latest insights into neuroplasticity and sensory integration, tailored to the specific needs and clinical progression of each patient. Focusing on compensating for the VES and enhancing sensory-perceptual-motor integration, this approach aims not just to tailor interventions but also to reinforce coherence among the vestibular, visual, and neurological systems, thereby improving the quality of life for individuals with chronic vestibular disorders.
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Affiliation(s)
- Frédéric Xavier
- Sensory and Cognitive Neuroscience Unit LNC UMR 7231 CNRS, Aix-Marseille University, Marseille, France
- Pathophysiology and Therapy of Vestibular Disorders Unit GDR 2074, Aix-Marseille University, Marseille, France
| | - Emmanuelle Chouin
- Pathophysiology and Therapy of Vestibular Disorders Unit GDR 2074, Aix-Marseille University, Marseille, France
| | - Brahim Tighilet
- Sensory and Cognitive Neuroscience Unit LNC UMR 7231 CNRS, Aix-Marseille University, Marseille, France
- Pathophysiology and Therapy of Vestibular Disorders Unit GDR 2074, Aix-Marseille University, Marseille, France
| | - Christian Chabbert
- Sensory and Cognitive Neuroscience Unit LNC UMR 7231 CNRS, Aix-Marseille University, Marseille, France
- Pathophysiology and Therapy of Vestibular Disorders Unit GDR 2074, Aix-Marseille University, Marseille, France
| | - Stéphane Besnard
- Pathophysiology and Therapy of Vestibular Disorders Unit GDR 2074, Aix-Marseille University, Marseille, France
- UNICAEN, INSERM U1075, COMETE, Normandie Université, Caen, France
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Corre J, Cugnot JF, Boutabla A, Cavuscens S, Ranieri M, van de Berg R, Peterka RJ, Guinand N, Fornos AP. Postural impairments in unilateral and bilateral vestibulopathy. Front Neurol 2024; 15:1324868. [PMID: 38450076 PMCID: PMC10915085 DOI: 10.3389/fneur.2024.1324868] [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: 10/20/2023] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
Chronic imbalance is a major complaint of patients suffering from bilateral vestibulopathy (BV) and is often reported by patients with chronic unilateral vestibulopathy (UV), leading to increased risk of falling. We used the Central SensoriMotor Integration (CSMI) test, which evaluates sensory integration, time delay, and motor activation contributions to standing balance control, to determine whether CSMI measures could distinguish between healthy control (HC), UV, and BV subjects and to characterize vestibular, proprioceptive, and visual contributions expressed as sensory weights. We also hypothesized that sensory weight values would be associated with the results of vestibular assessments (vestibulo ocular reflex tests and Dizziness Handicap Inventory scores). Twenty HCs, 15 UVs and 17 BVs performed three CSMI conditions evoking sway in response to pseudorandom (1) surface tilts with eyes open or, (2) surface tilts with eyes closed, and (3) visual surround tilts. Proprioceptive weights were identified in surface tilt conditions and visual weights were identified in the visual tilt condition. BVs relied significantly more on proprioception. There was no overlap in proprioceptive weights between BV and HC subjects and minimal overlap between UV and BV subjects in the eyes-closed surface-tilt condition. Additionally, visual sensory weights were greater in BVs and were similarly able to distinguish BV from HC and UV subjects. We found no significant correlations between sensory weights and the results of vestibular assessments. Sensory weights from CSMI testing could provide a useful measure for diagnosing and for objectively evaluating the effectiveness of rehabilitation efforts and future treatments designed to restore vestibular function such as hair cell regeneration and vestibular implants.
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Affiliation(s)
- Julie Corre
- Division of Otorhinolaryngology Head and Neck Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Jean-François Cugnot
- Division of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Anissa Boutabla
- Division of Otorhinolaryngology Head and Neck Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Samuel Cavuscens
- Division of Otorhinolaryngology Head and Neck Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Maurizio Ranieri
- Division of Otorhinolaryngology Head and Neck Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Raymond van de Berg
- Division of Vestibular Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Robert J. Peterka
- National Center for Rehabilitative Auditory Research, Veterans Administration Portland Health Care System and Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Nils Guinand
- Division of Otorhinolaryngology Head and Neck Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Angélica Pérez Fornos
- Division of Otorhinolaryngology Head and Neck Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
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Gonzalez ELC, King SA, Karmali F. Your Vestibular Thresholds May Be Lower Than You Think: Cognitive Biases in Vestibular Psychophysics. Am J Audiol 2023; 32:730-738. [PMID: 37084775 PMCID: PMC10721247 DOI: 10.1044/2023_aja-22-00186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/23/2022] [Accepted: 02/08/2023] [Indexed: 04/23/2023] Open
Abstract
PURPOSE Recently, there has been a surge of interest in measuring vestibular perceptual thresholds, which quantify the smallest motion that a subject can reliably perceive, to study physiology and pathophysiology. These thresholds are sensitive to age, pathology, and postural performance. Threshold tasks require decisions to be made in the presence of uncertainty. Since humans often rely on past information when making decisions in the presence of uncertainty, we hypothesized that (a) perceptual responses are affected by their preceding trial; (b) perceptual responses tend to be biased opposite of the "preceding response" because of cognitive biases but are not biased by the "preceding stimulus"; and (c) when fits do not account for this cognitive bias, thresholds are overestimated. To our knowledge, these hypotheses are unaddressed in vestibular and direction-recognition tasks. CONCLUSIONS Results in normal subjects supported each hypothesis. Subjects tended to respond opposite of their preceding response (not the preceding stimulus), indicating a cognitive bias, and this caused an overestimation of thresholds. Using an enhanced model (MATLAB code provided) that considered these effects, average thresholds were lower (5.5% for yaw, 7.1% for interaural). Since the results indicate that the magnitude of cognitive bias varies across subjects, this enhanced model can reduce measurement variability and potentially improve the efficiency of data collection.
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Affiliation(s)
- Elena Lopez-Contreras Gonzalez
- Jenks Vestibular Physiology Laboratory, Massachusetts Eye and Ear, Boston
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, MA
| | - Susan A. King
- Jenks Vestibular Physiology Laboratory, Massachusetts Eye and Ear, Boston
| | - Faisal Karmali
- Jenks Vestibular Physiology Laboratory, Massachusetts Eye and Ear, Boston
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, MA
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Xavier F, Chouin E, Tighilet B, Lavieille JP, Chabbert C. Identification of Follow-Up Markers for Rehabilitation Management in Patients with Vestibular Schwannoma. J Clin Med 2023; 12:5947. [PMID: 37762888 PMCID: PMC10531600 DOI: 10.3390/jcm12185947] [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: 06/29/2023] [Revised: 08/30/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
This study delves into the absence of prognostic or predictive markers to guide rehabilitation in patients afflicted with vestibular schwannomas. The objective is to analyze the reweighting of subjective and instrumental indicators following surgery, at 7 days and 1 month postoperatively. This retrospective cohort encompasses 32 patients who underwent unilateral vestibular schwannoma surgery at the Marseille University Hospital between 2014 and 2019. Variations in 54 indicators and their adherence to available norms are calculated. After 1 month, one-third of patients do not regain the norm for all indicators. However, the rates of variation unveil specific responses linked to a preoperative error signal, stemming from years of tumor adaptation. This adaptation is reflected in a postoperative visual or proprioceptive preference for certain patients. Further studies are needed to clarify error signals according to lesion types. The approach based on variations in normative indicators appears relevant for post-surgical monitoring and physiotherapy.
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Affiliation(s)
- Frédéric Xavier
- Team Pathophysiology and Therapy of Vestibular Disorders, Laboratory of Cognitive Neurosciences, UMR7291, Aix Marseille University-CNRS, 13331 Marseille, France; (B.T.); (C.C.)
- Unit GDR2074, CNRS, Research Group on Vestibular Pathophysiology, 13331 Marseille, France;
| | - Emmanuelle Chouin
- Unit GDR2074, CNRS, Research Group on Vestibular Pathophysiology, 13331 Marseille, France;
| | - Brahim Tighilet
- Team Pathophysiology and Therapy of Vestibular Disorders, Laboratory of Cognitive Neurosciences, UMR7291, Aix Marseille University-CNRS, 13331 Marseille, France; (B.T.); (C.C.)
- Unit GDR2074, CNRS, Research Group on Vestibular Pathophysiology, 13331 Marseille, France;
| | - Jean-Pierre Lavieille
- Department of Otorhinolaryngology, Head and Neck Surgery, Hospital la Conception, Aix Marseille University, 13005 Marseille, France
| | - Christian Chabbert
- Team Pathophysiology and Therapy of Vestibular Disorders, Laboratory of Cognitive Neurosciences, UMR7291, Aix Marseille University-CNRS, 13331 Marseille, France; (B.T.); (C.C.)
- Unit GDR2074, CNRS, Research Group on Vestibular Pathophysiology, 13331 Marseille, France;
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Cregg JM, Mirdamadi JL, Fortunato C, Okorokova EV, Kuper C, Nayeem R, Byun AJ, Avraham C, Buonocore A, Winner TS, Mildren RL. Highlights from the 31st Annual Meeting of the Society for the Neural Control of Movement. J Neurophysiol 2023; 129:220-234. [PMID: 36541602 PMCID: PMC9844973 DOI: 10.1152/jn.00500.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Jared M Cregg
- Department of Neuroscience, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jasmine L Mirdamadi
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Cátia Fortunato
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | | | - Clara Kuper
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
- School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Rashida Nayeem
- Department of Electrical Engineering, Northeastern University, Boston, Massachusetts
| | - Andrew J Byun
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
| | - Chen Avraham
- Department of Biomedical Engineering, Ben-Gurion University of the Negev, Beersheva, Israel
| | - Antimo Buonocore
- Werner Reichardt Centre for Integrative Neuroscience, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Department of Educational, Psychological and Communication Sciences, Suor Orsola Benincasa University, Naples, Italy
| | - Taniel S Winner
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, Georgia
| | - Robyn L Mildren
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Madhani A, Lewis RF, Karmali F. How Peripheral Vestibular Damage Affects Velocity Storage: a Causative Explanation. J Assoc Res Otolaryngol 2022; 23:551-566. [PMID: 35768706 PMCID: PMC9437187 DOI: 10.1007/s10162-022-00853-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 05/30/2022] [Indexed: 10/17/2022] Open
Abstract
Velocity storage is a centrally-mediated mechanism that processes peripheral vestibular inputs. One prominent aspect of velocity storage is its effect on dynamic responses to yaw rotation. Specifically, when normal human subjects are accelerated to constant angular yaw velocity, horizontal eye movements and perceived angular velocity decay exponentially with a time constant circa 15-30 s, even though the input from the vestibular periphery decays much faster (~ 6 s). Peripheral vestibular damage causes a time constant reduction, which is useful for clinical diagnoses, but a mechanistic explanation for the relationship between vestibular damage and changes in these behavioral dynamics is lacking. It has been hypothesized that Bayesian optimization determines ideal velocity storage dynamics based on statistics of vestibular noise and experienced motion. Specifically, while a longer time constant would make the central estimate of angular head velocity closer to actual head motion, it may also result in the accumulation of neural noise which simultaneously degrades precision. Thus, the brain may balance these two effects by determining the time constant that optimizes behavior. We applied a Bayesian optimal Kalman filter to determine the ideal velocity storage time constant for unilateral damage. Predicted time constants were substantially lower than normal and similar to patients. Building on our past work showing that Bayesian optimization explains age-related changes in velocity storage, we also modeled interactions between age-related hair cell loss and peripheral damage. These results provide a plausible mechanistic explanation for changes in velocity storage after peripheral damage. Results also suggested that even after peripheral damage, noise originating in the periphery or early central processing may remain relevant in neurocomputations. Overall, our findings support the hypothesis that the brain optimizes velocity storage based on the vestibular signal-to-noise ratio.
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Affiliation(s)
- Amsal Madhani
- Jenks Vestibular Physiology Lab, Massachusetts Eye and Ear Infirmary, Boston, MA USA
| | - Richard F. Lewis
- Jenks Vestibular Physiology Lab, Massachusetts Eye and Ear Infirmary, Boston, MA USA
- Department of Otolaryngology, Harvard Medical School, Boston, MA USA
- Department of Neurology, Harvard Medical School, Boston, MA USA
| | - Faisal Karmali
- Jenks Vestibular Physiology Lab, Massachusetts Eye and Ear Infirmary, Boston, MA USA
- Department of Otolaryngology, Harvard Medical School, Boston, MA USA
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Glasauer S, Straka H. Low Gain Values of the Vestibulo-Ocular Reflex Can Optimize Retinal Image Slip. Front Neurol 2022; 13:897293. [PMID: 35903124 PMCID: PMC9314766 DOI: 10.3389/fneur.2022.897293] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/21/2022] [Indexed: 11/30/2022] Open
Abstract
The angular vestibulo-ocular reflex (aVOR) stabilizes retinal images by counter-rotating the eyes during head rotations. Perfect compensatory movements would thus rotate the eyes exactly opposite to the head, that is, eyes vs. head would exhibit a unity gain. However, in many species, but also in elderly humans or patients with a history of vestibular damage, the aVOR is far from compensatory with gains that are in part considerably lower than unity. The reason for this apparent suboptimality is unknown. Here, we propose that low VOR gain values reflect an optimal adaptation to sensory and motor signal variability. According to this hypothesis, gaze stabilization mechanisms that aim at minimizing the overall retinal image slip must consider the effects of (1) sensory and motor noise and (2) dynamic constraints of peripheral and central nervous processing. We demonstrate that a computational model for optimizing retinal image slip in the presence of such constraints of signal processing in fact predicts gain values smaller than unity. We further show specifically for tadpoles of the clawed toad, Xenopus laevis with particularly low gain values that previously reported VOR gains quantitatively correspond to the observed variability of eye movements and thus constitute an optimal adaptation mechanism. We thus hypothesize that lower VOR gain values in elderly human subjects or recovered patients with a history of vestibular damage may be the sign of an optimization given higher noise levels rather than a direct consequence of the damage, such as an inability of executing fast compensatory eye movements.
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Affiliation(s)
- Stefan Glasauer
- Computational Neuroscience, Institute of Medical Technology, Brandenburg University of Technology Cottbus-Senftenberg, Cottbus, Germany
- Brandenburg Faculty for Health Sciences, Brandenburg University of Technology Cottbus-Senftenberg, Cottbus, Germany
- *Correspondence: Stefan Glasauer
| | - Hans Straka
- Faculty of Biology, Ludwig-Maximilians-University Munich, Planegg, Germany
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