The role of the vestibular system in eye-head coordination and the generation of vestibular nystagmus

The Effect of Different Head Movement Paradigms on Vestibulo-Ocular Reflex Gain and Saccadic Eye Responses in the Suppression Head Impulse Test in Healthy Adult Volunteers

Objective: This study aimed to identify differences in vestibulo-ocular reflex gain (VOR gain) and saccadic response in the suppression head impulse paradigm (SHIMP) between predictable and less predictable head movements, in a group of healthy subjects. It was hypothesized that higher prediction could lead to a lower VOR gain, a shorter saccadic latency, and higher grouping of saccades. Methods: Sixty-two healthy subjects were tested using the video head impulse test and SHIMPs in four conditions: active and passive head movements for both inward and outward directions. VOR gain, latency of the first saccade, and the level of saccade grouping (PR-score) were compared among conditions. Inward and active head movements were considered to be more predictable than outward and passive head movements. Results: After validation, results of 57 tested subjects were analyzed. Mean VOR gain was significantly lower for inward passive compared with outward passive head impulses (p < 0.001), and it was higher for active compared with passive head impulses (both inward and outward) (p ≤ 0.024). Mean latency of the first saccade was significantly shorter for inward active compared with inward passive (p ≤ 0.001) and for inward passive compared with outward passive head impulses (p = 0.012). Mean PR-score was only significantly higher in active outward than in active inward head impulses (p = 0.004). Conclusion: For SHIMP, a higher predictability in head movements lowered gain only in passive impulses and shortened latencies of compensatory saccades overall. For active impulses, gain calculation was affected by short-latency compensatory saccades, hindering reliable comparison with gains of passive impulses. Predictability did not substantially influence grouping of compensatory saccades.

Cerebellum-mediated trainability of eye and head movements for dynamic gazing

Objective

To investigate whether gaze stabilization exercises (GSEs) improve eye and head movements and whether low-frequency cerebellar repetitive transcranial magnetic stimulation (rTMS) inhibits GSE trainability.

Methods

25 healthy adults (real rTMS, n = 12; sham rTMS, n = 13) were recruited. Real or sham rTMS was performed for 15 min (1 Hz, 900 stimulations). The center of the butterfly coil was set 1 cm below the inion in the real rTMS. Following stimulation, 10 trials of 1 min of a GSE were conducted at 1 min intervals. In the GSE, the subjects were instructed to stand upright and horizontally rotate their heads according to a beeping sound corresponding to 2 Hz and with a gaze point ahead of them. Electrooculograms were used to estimate the horizontal gaze direction of the right eye, and gyroscopic measurements were performed to estimate the horizontal head angular velocity during the GSE trials. The percentage change from the first trial of motion range of the eye and head was calculated for each measurement. The percent change of the eye/head range ratio was calculated to assess the synchronous changes of the eye and head movements as the exercise increased.

Results

Bayesian two-way analysis of variance showed that cerebellar rTMS affected the eye motion range and eye/head range ratio. A post hoc comparison (Bayesian t-test) showed evidence that the eye motion range and eye/head range ratio were reduced in the fifth, sixth, and seventh trials compared with the first trial sham stimulation condition.

Conclusions

GSEs can modulate eye movements with respect to head movements, and the cerebellum may be associated with eye–head coordination trainability for dynamic gazing during head movements.

Automatic classification and robust identification of vestibulo-ocular reflex responses: from theory to practice: introducing GNL-HybELS

The Vestibulo-Ocular Reflex (VOR) stabilizes images of the world on our retinae when our head moves. Basic daily activities are thus impaired if this reflex malfunctions. During the past few decades, scientists have modeled and identified this system mathematically to diagnose and treat VOR deficits. However, traditional methods do not analyze VOR data comprehensively because they disregard the switching nature of nystagmus; this can bias estimates of VOR dynamics. Here we propose, for the first time, an automated tool to analyze entire VOR responses (slow and fast phases), without a priori classification of nystagmus segments. We have developed GNL-HybELS (Generalized NonLinear Hybrid Extended Least Squares), an algorithmic tool to simultaneously classify and identify the responses of a multi-mode nonlinear system with delay, such as the horizontal VOR and its alternating slow and fast phases. This algorithm combines the procedures of Generalized Principle Component Analysis (GPCA) for classification, and Hybrid Extended Least Squares (HybELS) for identification, by minimizing a cost function in an optimization framework. It is validated here on clean and noisy VOR simulations and then applied to clinical VOR tests on controls and patients. Prediction errors were less than 1 deg for simulations and ranged from .69 deg to 2.1 deg for the clinical data. Nonlinearities, asymmetries, and dynamic parameters were detected in normal and patient data, in both fast and slow phases of the response. This objective approach to VOR analysis now allows the design of more complex protocols for the testing of oculomotor and other hybrid systems.