Binocular counterrolling during sustained body tilt in normal humans and in a patient with unilateral vestibular nerve section

Prolonged Static Whole-Body Roll-Tilt and Optokinetic Stimulation Significantly Bias the Subjective Postural Vertical in Healthy Human Subjects

Background: Prolonged static whole-body roll-tilt has been shown to bias estimates of the direction of gravity when assessed by static paradigms such as the subjective visual vertical and the subjective haptic vertical.

Objective: We hypothesized that these shifts are paradigm-independent and thus predicted a post-tilt bias as well for self-adjustments along perceived vertical (subjective postural vertical, SPV). Likewise, rotatory optokinetic stimuli, which have been shown to shift the SPV when presented at the time of adjustments, may have an lasting effect on the SPV, predicting a shift in the perceived direction of gravity in the direction of the optokinetic rotatory stimulation.

Methods: Self-adjustments along perceived vertical by use of a motorized turntable were recorded at baseline and after 5 min of static whole-body roll-tilt (orientation = ±90°, adaptation period) in 10 healthy human subjects. During adaptation subjects were either in darkness (no OKN stimulation) or were presented a full-field rotatory optokinetic stimulus (velocity = ±60°/s). Statistical analysis of adjustment errors for the different conditions was performed using a generalized linear model.

Results: After 5 min of static whole-body roll-tilt in darkness, we observed significant (p < 0.001) shifts in the SPV averaging −2.8° (adaptation position: −90°) and 3.1° (+90°), respectively. Adding an optokinetic rotatory stimulus resulted in an additional, significant shift of SPV adjustments toward the direction of the previously presented optokinetic rotation (optokinetic clockwise rotation: 1.4°, p = 0.034; optokinetic counter-clockwise rotation: −1.3°, p = 0.037). Trial-to-trial variability of turntable adjustments was not significantly affected by adaptation.

Conclusions: Prolonged static roll-tilt results in a significant post-tilt bias of the perceived direction of gravity when assessed by the SPV, confirming previous findings from other vision-dependent and vision-independent paradigms. This finding emphasizes the impact of recent whole-body roll orientations relative to gravity. Such adaptational shifts in verticality estimates may be explained in the context of Bayesian optimal observer theory with a bias of prior knowledge (i.e., expectation biased by experience). Our findings also have clinical implications, as the observed post-tilt bias may contribute to postural instability when standing up in the morning with an increasing risk for falls and fall-related injuries in humans with preexisting balance disorders.

Otolithic Receptor Mechanisms for Vestibular-Evoked Myogenic Potentials: A Review

Air-conducted sound and bone-conduced vibration activate otolithic receptors and afferent neurons in both the utricular and saccular maculae, and trigger small electromyographic (EMG) responses [called vestibular-evoked myogenic potentials (VEMPs)] in various muscle groups throughout the body. The use of these VEMPs for clinical assessment of human otolithic function is built on the following logical steps: (1) that high-frequency sound and vibration at clinically effective stimulus levels activate otolithic receptors and afferents, rather than semicircular canal afferents, (2) that there is differential anatomical projection of otolith afferents to eye muscles and neck muscles, and (3) that isolated stimulation of the utricular macula induces short latency responses in eye muscles, and that isolated stimulation of the saccular macula induces short latency responses in neck motoneurons. Evidence supports these logical steps, and so VEMPs are increasingly being used for clinical assessment of otolith function, even differential evaluation of utricular and saccular function. The proposal, originally put forward by Curthoys in 2010, is now accepted: that the ocular vestibular-evoked myogenic potential reflects predominantly contralateral utricular function and the cervical vestibular-evoked myogenic potential reflects predominantly ipsilateral saccular function. So VEMPs can provide differential tests of utricular and saccular function, not because of stimulus selectivity for either of the two maculae, but by measuring responses which are predominantly determined by the differential neural projection of utricular as opposed to saccular neural information to various muscle groups. The major question which this review addresses is how the otolithic sensory system, with such a high density otoconial layer, can be activated by individual cycles of sound and vibration and show such tight locking of the timing of action potentials of single primary otolithic afferents to a particular phase angle of the stimulus cycle even at frequencies far above 1,000 Hz. The new explanation is that it is due to the otoliths acting as seismometers at high frequencies and accelerometers at low frequencies. VEMPs are an otolith-dominated response, but in a particular clinical condition, semicircular canal dehiscence, semicircular canal receptors are also activated by sound and vibration, and act to enhance the otolith-dominated VEMP responses.

Static roll-tilt over 5 minutes locally distorts the internal estimate of direction of gravity

The subjective visual vertical (SVV) indicates perceived direction of gravity. Even in healthy human subjects, roll angle-dependent misestimations, roll overcompensation (A-effect, head-roll > 60° and <135°) and undercompensation (E-effect, head-roll < 60°), occur. Previously, we demonstrated that, after prolonged roll-tilt, SVV estimates when upright are biased toward the preceding roll position, which indicates that perceived vertical (PV) is shifted by the prior tilt (Tarnutzer AA, Bertolini G, Bockisch CJ, Straumann D, Marti S. PLoS One 8: e78079, 2013). Hypothetically, PV in any roll position could be biased toward the previous roll position. We asked whether such a "global" bias occurs or whether the bias is "local". The SVV of healthy human subjects (N = 9) was measured in nine roll positions (-120° to +120°, steps = 30°) after 5 min of roll-tilt in one of two adaptation positions (±90°) and compared with control trials without adaptation. After adapting, adjustments were shifted significantly (P < 0.05) toward the previous adaptation position for nearby roll-tilted positions (±30°, ±60°) and upright only. We computationally simulated errors based on the sum of a monotonically increasing function (producing roll undercompensation) and a mixture of Gaussian functions (representing roll overcompensation centered around PV). In combination, the pattern of A- and E-effects could be generated. By shifting the function representing local overcompensation toward the adaptation position, the experimental postadaptation data could be fitted successfully. We conclude that prolonged roll-tilt locally distorts PV rather than globally shifting it. Short-term adaptation of roll overcompensation may explain these shifts and could reflect the brain's strategy to optimize SVV estimates around recent roll positions. Thus postural stability can be improved by visually-mediated compensatory responses at any sustained body-roll orientation.

Modulation of internal estimates of gravity during and after prolonged roll-tilts

Perceived direction of gravity, as assessed by the subjective visual vertical (SVV), shows roll-angle dependent errors that drift over time and a bias upon return to upright. According to Bayesian observer theory, the estimated direction of gravity is derived from the posterior probability distribution by combining sensory input and prior knowledge about earth-vertical in a statistically optimal fashion. Here we aimed to further characterize the stability of SVV during and after prolonged roll-tilts. Specifically we asked whether the post-tilt bias is related to the drift pattern while roll-tilted. Twenty-nine healthy human subjects (23-56 yo) repetitively adjusted a luminous arrow to the SVV over periods of 5 min while upright, roll-tilted (± 45°, ± 90°), and immediately after returning to upright. Significant (p<0.05) drifts (median absolute drift-amplitude: 10°/5 min) were found in 71% (± 45°) and 78% (± 90°) of runs. At ± 90° roll-tilt significant increases in absolute adjustment errors were more likely (76%), whereas significant increases (56%) and decreases (44%) were about equally frequent at ± 45°. When returning to upright, an initial bias towards the previous roll-position followed by significant exponential decay (median time-constant: 71 sec) was noted in 47% of all runs (all subjects pooled). No significant correlations were found between the drift pattern during and immediately after prolonged roll-tilt. We conclude that the SVV is not stable during and after prolonged roll-tilt and that the direction and magnitude of drift are individually distinct and roll-angle-dependent. Likely sensory and central adaptation and random-walk processes contribute to drift while roll-tilted. Lack of correlation between the drift and the post-tilt bias suggests that it is not the inaccuracy of the SVV estimate while tilted that determines post-tilt bias, but rather the previous head-roll orientation relative to gravity. We therefore favor central adaptation, most likely a shift in prior knowledge towards the previous roll orientation, to explain the post-tilt bias.

Temporal constancy of perceived direction of gravity assessed by visual line adjustments

Here we investigated how well internal estimates of direction of gravity are preserved over time and if the subjective visual vertical (SVV) and horizontal (SVH) can be used inter-changeably. Fourteen human subjects repetitively aligned a luminous line to SVV, SVH or subjective visual oblique (± 45°) over 5 min in otherwise complete darkness and also in dim light. Both accuracy (i.e., the degree of veracity as reflected by the median adjustment error) and precision (i.e., the degree of reproducability as reflected by the trial-to-trial variability) of adjustments along the principle axes were significantly higher than along the oblique axes. Orthogonality was only preserved in a minority of subjects. Adjustments were significantly different between SVV vs. SVH (7/14 subjects) and between ±45° vs. -45° (12/14) in darkness and in 6/14 and 14/14 subjects, respectively, in dim light. In darkness, significant drifts over 5min were observed in a majority of trials (33/56). Both accuracy and precision were higher if more time was taken to make the adjustment. These results introduce important caveats when interpreting studies related to graviception. The test re-test reliability of SVV and SVH can be influenced by drift of the internal estimate of gravity. Based on spectral density analysis we found a noise pattern consistent with 1/fβ noise, indicating that at least part of the trial-to-trial dynamics observed in our experiments is due to the dependence of the serial adjustments over time. Furthermore, using results from the SVV and SVH inter-changeably may be misleading as many subjects do not show orthogonality. The poor fidelity of perceived ± 45° indicates that the brain has limited ability to estimate oblique angles.

Roll-dependent modulation of the subjective visual vertical: contributions of head- and trunk-based signals

Precision and accuracy of the subjective visual vertical (SVV) modulate in the roll plane. At large roll angles, systematic SVV errors are biased toward the subject's body-longitudinal axis and SVV precision is decreased. To explain this, SVV models typically implement a bias signal, or a prior, in a head-fixed reference frame and assume the sensory input to be optimally tuned along the head-longitudinal axis. We tested the pattern of SVV adjustments both in terms of accuracy and precision in experiments in which the head and the trunk reference frames were not aligned. Twelve subjects were placed on a turntable with the head rolled about 28 degrees counterclockwise relative to the trunk by lateral tilt of the neck to dissociate the orientation of head- and trunk-fixed sensors relative to gravity. Subjects were brought to various positions (roll of head- or trunk-longitudinal axis relative to gravity: 0 degrees , +/-75 degrees ) and aligned an arrow with perceived vertical. Both accuracy and precision of the SVV were significantly (P < 0.05) better when the head-longitudinal axis was aligned with gravity. Comparing absolute SVV errors for clockwise and counterclockwise roll tilts, statistical analysis yielded no significant differences (P > 0.05) when referenced relative to head upright, but differed significantly (P < 0.001) when referenced relative to trunk upright. These findings indicate that the bias signal, which drives the SVV toward the subject's body-longitudinal axis, operates in a head-fixed reference frame. Further analysis of SVV precision supports the hypothesis that head-based graviceptive signals provide the predominant input for internal estimates of visual vertical.

Dissociated Hysteresis of Static Ocular Counterroll in Humans

In stationary head roll positions, the eyes are cyclodivergent. We asked whether this phenomenon can be explained by a static hysteresis that differs between the eyes contra- (CE) and ipsilateral (IE) to head roll. Using a motorized turntable, healthy human subjects ( n = 8) were continuously rotated about the earth-horizontal naso-occipital axis. Starting from the upright position, a total of three full rotations at a constant velocity (2°/s) were completed (acceleration = 0.05°/s2, velocity plateau reached after 40 s). Subjects directed their gaze on a flashing laser dot straight ahead (switched on 20 ms every 2 s). Binocular three-dimensional eye movements were recorded with dual search coils that were modified (wires exiting inferiorly) to minimize torsional artifacts by the eyelids. A sinusoidal function with a first and second harmonic was fitted to torsional eye position as a function of torsional whole body position at constant turntable velocity. The amplitude and phase of the first harmonic differed significantly between the two eyes (paired t-test: P < 0.05): on average, counterroll amplitude of IE was larger [CE: 6.6 ± 1.6° (SD); IE: 8.1 ± 1.7°), whereas CE showed more position lag relative to the turntable (CE: 12.5 ± 10.7°; IE: 5.1 ± 8.7°). We conclude that cyclodivergence observed during static ocular counterroll is mainly a result of hysteresis that depends on whether eyes are contra- or ipsilateral to head roll. Static hysteresis also explains the phenomenon of residual torsion, i.e., an incomplete torsional return of the eyes when the first 360° whole body rotation was completed and subjects were back in upright position (extorsion of CE: 2.0 ± 0.10°; intorsion of IE: 1.4 ± 0.10°). A computer model that includes asymmetric backlash for each eye can explain dissociated torsional hysteresis during quasi-static binocular counterroll. We hypothesize that ocular torsional hysteresis is introduced at the level of the otolith pathways because the direction-dependent torsional position lag of the eyes is related to the head roll position and not the eye position.

Residual Torsion Following Ocular Counterroll

A recent study on static ocular counterroll suggested the existence of residual torsion (RT): when healthy subjects repositioned their head to the upright position after sustained static tilt, eye position differed from the original ocular torsion measured prior to the static head tilt. Our experiments aimed at further characterizing this phenomenon. Using a three-dimensional motorized turntable, healthy human subjects (n = 8) were rotated quasi-statically (0.05 deg/s2, 2 deg/s velocity plateau reached after 40 s) from the upright position about the naso-occipital axis. Three full whole-body rotations were completed while subjects fixed upon a blinking laser dot straight ahead in otherwise complete darkness. Three-dimensional eye movements were recorded with modified dual search coils (wires exiting inferiorly). Torsional position of the right eye at consecutive upright body positions was analyzed. The torsional eye position before the beginning of the chair rotation was defined as zero torsion. On average, the right eye was intorted by 1.3 degrees or extorted by 2.0 degrees after the first full chair rotation in the clockwise or counterclockwise direction, respectively. These torsional offset values of the right eye did not significantly change after the two subsequent full chair rotations. We conclude that RT observed after static ocular counterroll is the result of static hysteresis, that is, a position lag of the eye, which depends on the direction of head roll. The fact that residual torsion did not further increase after the first rotation cycle emphasizes that RT is a static rather than a dynamic phenomenon.

Gravity modulates Listing's plane orientation during both pursuit and saccades

Previous studies have shown that the spatial organization of all eye orientations during visually guided saccadic eye movements (Listing's plane) varies systematically as a function of static and dynamic head orientation in space. Here we tested if a similar organization also applies to the spatial orientation of eye positions during smooth pursuit eye movements. Specifically, we characterized the three-dimensional distribution of eye positions during horizontal and vertical pursuit (0.1 Hz, +/-15 degrees and 0.5 Hz, +/-8 degrees) at different eccentricities and elevations while rhesus monkeys were sitting upright or being statically tilted in different roll and pitch positions. We found that the spatial organization of eye positions during smooth pursuit depends on static orientation in space, similarly as during visually guided saccades and fixations. In support of recent modeling studies, these results are consistent with a role of gravity on defining the parameters of Listing's law.

Studies on spatial orientation and posture control and changes in otolith function due to linear acceleration loading

Otolith function is directly affected by weightlessness at the time of movement in outer space, and changes occur in the mode of response. It has been known for some time that such changes occur in the posture and gait of astronauts just after they return from a trip into space. It is thought that the cause of these changes is disuse atrophy of the antigravity muscles. However, in the present study, experimental subjects underwent repeated linear acceleration loading over a long period of time, and instability of the head and a decrease in posture control, especially in relation to the gait, were observed for the first time. To date, it has been said that the otolith function has a close relationship with ocular counter rolling. However, when the otolith organ was stimulated, the response was seen to be head instability and an irregular effect on the gait. It is surmised that these findings will facilitate future research into the otolith function under gravity-free conditions.

Ocular torsion quantification with video images

The present paper describes a technique to quantify eye rotations about the visual axis (ocular torsion). Two digitized polar transformed images of the iris are displayed on a video monitor in order to facilitate a visual comparison and manual interaction. Emphasis is placed on error analysis and the method's simplicity when applied to static ocular torsion measurement. The implementation, applying averaging over ocular torsion determined in partitioned iris images, yields a theoretical resolution of 5' of arc. In a control experiment with an artificial eye, the accuracy showed to be better than 14' of arc. In practice, the measuring device was validated with the data from the literature by means of an experiment about ocular torsion in humans during tilt and hypergravity conditions (up to 3 g).

Visually induced cycloversion and cyclovergence

Binocular cyclorotatory (torsional) eye movements in response to visual patterns, which oscillated sinusoidally in the frontal plane, were recorded with scleral induction coils in human subjects. Conjugate cycloversion and disjunctive cyclovergence were directly compared by in-phase and out-of-phase oscillation of the same pattern. Stimulus motion had a frequency of 0.2 Hz and amplitudes of 2-8 deg. Both response types had a similar and low gain (about 0.2 averaged over all subjects). Cycloversion showed no time lag, while cyclovergence lagged by about 600 msec. Non-fusible patterns were effective in eliciting cycloversion, but not cyclovergence. Apart from this, the nature of the pattern (randomly distributed dots, regular rows of dots, horizontal or vertical grating, Julesz stereogram or images with a pictorial significance) had only the slightest effect on the magnitude of the responses.

The stability of human eye orientation during visual fixation

Using the magnetic search coil technique, gaze stability in the horizontal, vertical and torsional planes was measured binocularly in human subjects during visual fixation. Horizontal and vertical eye rotations exhibited a mixture of slow drifts and resetting microsaccades yielding an average standard deviation of 0.11 and 0.10 deg, respectively. In contrast, torsional rotations showed unsystematic smooth drifts with fewer saccades yielding an average standard deviation of 0.18 deg. The lower precision of gaze control in the torsional plane may reflect (i) a discrepancy between the encoding of retinal images in two dimensions but of ocular motor control signals in three dimensions, and (ii) the visual consequences of ocular drifts in the torsional plane, which differ from those in the horizontal and vertical planes.

Ocular torsion as a test of the asymmetry hypothesis of space motion sickness

Disconjugate eye torsion induced by 0 G and 1.8 G during parabolic flight was studied in nine former astronauts in 1990 and eight in 1991, four of whom were included in the previous experiment. The astronauts could be divided into two statistically significant groups on the basis of low and high scores of disconjugacy. When their histories of space motion sickness (SMS) were later revealed, all of the low scorers had not been sick on previous space flights; all the high scorers had had SMS. These data give support to the hypothesis that SMS in one-half or two-thirds of astronauts is due to an otolith, probably utricular, asymmetry in those persons.

Human ocular torsion during parabolic flights: an analysis with scleral search coil

Rotation of the eyes about the visual axis is known as ocular torsion. A lateral inclination (a "roll") of the head induces ocular torsion in the opposite direction, a response known as ocular counterrolling. For six subjects, we recorded the static (head still) and dynamic (head in oscillatory roll motion) ocular torsion in normal 1 g condition and also during the microgravity and hypergravity periods of parabolic flight, using the electromagnetic scleral search coil technique. With the head still, the direction and magnitude of torsion that occurred in response to microgravity and hypergravity differed substantially from one individual to another, but there was a significant difference in torsional magnitude between the microgravity and hypergravity periods, for all static head positions including the upright position. Under normal 1 g conditions, counterrolling compensated for about 16% of (voluntary) static head roll, while dynamic counterroll was much larger, up to 36% of head roll at 0.55 Hz. With increasing frequency of head oscillation between 0.33 Hz and 0.55 Hz, the gain of counterrolling increased and there was no change in the phase relationship. The gain of dynamic counterroll (in response to voluntary head rolling) was not significantly less in hypogravity, suggesting that on the ground at these frequencies the contribution of gravity and gravity receptors to this reflex is redundant: this reflex is probably driven by the semicircular canals. In some subjects, the torsional displacement in microgravity is accompanied by micro-torsional oscillatory motion.

Video-oculographic measurement of 3-dimensional eye rotations

An effective and relatively calibration-free method for the measurement of 3-dimensional eye rotations is described. The experimental method consists of recording with a video camera the positions of distinct globe markers provided by a tight-fitting, soft contact lens before and after an eye rotation. The mathematical analysis represents the eye rotation by a rotation vector (rotation axis and angle) and three, spherical Euler angles. The method is linear over the entire range of natural eye rotation, the resolution limited only by the video set-up used. Due to its easy applicability, the system is well suited for various eye movement measurements in clinical or research environments.

Stereopsis, cyclotorsional "noise" and the apparent vertical

In principle, stereopsis can be used to evaluate the subjective vertical in a sagittal plane, but temporal variation in cyclotorsion should degrade that ability. Video recordings of eye orientation during steady fixation were used to evaluate long-term instability in cyclotorsion. Torsion was measured simultaneously in each eye at 1-sec intervals during about 30 sequential fixations (5-sec duration) on the same target. For each eye separately, the standard deviation of torsion around its mean value averaged about 18 min arc. Some of this variation was conjugate, but the variability in torsional difference between the eyes averaged 17 min arc. Most of this second-to-second variation arose between fixations (average SD = 15 min arc). Such low-frequency, inter-fixational variation in torsional difference between the eyes must produce spurious horizontal disparities in the upper and lower visual fields, and should thereby limit the precision with which the vertical horopter can be evaluated. All subjects exceeded those theoretical limits on precision, however, in performance tests requiring that two vertically separated targets be adjusted to apparent equidistance--but only when permitted to shift fixation back and forth between the upper and lower targets. That latter result provides a challenge to current understanding of stereopsis.

Human gaze stability in the horizontal, vertical and torsional direction during voluntary head movements, evaluated with a three-dimensional scleral induction coil technique

The stability of gaze in three dimensions (horizontal, vertical and torsion) was measured with a new type of scleral search coil in eight emmetropic observers. Subjects held the head still or oscillated it at 0.16-0.67 Hz (amplitude about 10 deg) in the horizontal, vertical or torsional plane while fixating a point target at optical infinity. Veridical gaze and head coordinates were calculated with full correction for non-linear goniometric relations and for cross-coupling artifacts due to misalignments of the coil on the eye. The amount of gaze instability in the horizontal and vertical direction was virtually identical. With the head still, in either of these directions the mean standard deviation of gaze position (inclusive saccades) was about 7 min arc; mean non-saccadic retinal image speeds were 20-30 min arc/sec. During head oscillation these values increased to about 16 min arc and 1 deg/sec; a mean of about 2.5% of the head motion remained uncorrected by the compensatory eye movements. These findings agree well with our earlier results for the horizontal plane; the effect of the corrections was relatively small because the adventitious cross-coupling of horizontal and vertical to torsional head movements proved to be usually smaller than 10%. However, the corrections were important when head torsion was deliberately produced. Gaze stability in the torsional plane was considerably inferior to that in the horizontal and vertical plane. With the head held still, the mean SD of torsional gaze position was about 17 min arc; mean torsional non-saccadic retinal image speed was about 46 min arc/sec. Gain of the torsional compensatory eye movements was frequency dependent and rose from about 0.26 in static conditions (0 Hz) to about 0.42 at 0.16 Hz and 0.64 at 0.67 Hz. Accordingly, position instability and speed of the retinal image in torsion were about an order of magnitude larger than in the horizontal and vertical direction.