Using mastoid vibration can detect the uni/bilateral vestibular deterioration by aging during standing

Comparison Between Effects of Galvanic and Vibration-Based Vestibular Stimulation on Postural Control and Gait Performance in Healthy Participants: A Systematic Review of Cross-Sectional Studies

Electricity and vibration were two commonly used physical agents to provide vestibular stimulation in previous studies. This study aimed to systematically review the effects of galvanic (GVS) and vibration-based vestibular stimulation (VVS) on gait performance and postural control in healthy participants. Five bioscience and engineering databases, including MEDLINE via PubMed, CINAHL via EBSCO, Cochrane Library, Scopus, and Embase, were searched until March 19th, 2023. Studies published between 2000 and 2023 in English involving GVS and VVS related to gait performance and postural control were included. The procedure was followed via the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. The methodological quality of included studies was assessed using the NIH study quality assessment tool for observational cohort and cross-sectional studies. A total of 55 cross-sectional studies met the inclusion criteria and were included in this study. Five studies were good-quality while 49 were moderate-quality and 1 was poor-quality. There were 50 included studies involving GVS and 5 included studies involving VVS. GVS and VVS utilized different physical agents to provide vestibular stimulation and demonstrated similar effects on vestibular perception. Supra-threshold GVS and VVS produced vestibular perturbation that impaired gait performance and postural control, while sub-threshold GVS and VVS induced stochastic resonance phenomenon that led to an improvement. Bilateral vestibular stimulation demonstrated a greater effect on gait and posture than unilateral vestibular stimulation. Compared to GVS, VVS had the characteristics of better tolerance and fewer side effects, which may substitute GVS to provide more acceptable vestibular stimulation.

The sex effect on balance control while standing on vestibular-demanding tasks with/without vestibular simulations: implication for sensorimotor training for future space missions

Background: Anatomical differences between sexes in the vestibular system have been reported. It has also been demonstrated that there is a sex difference in balance control while standing on vestibular-demanding tasks. In 2024, NASA expects to send the first female to the Moon. Therefore, to extend the current knowledge, this study attempted to examine whether different sexes respond differently to vestibular-disrupted and vestibular-demanding environments. Method: A total of fifteen males and fifteen females participated in this study. The vestibular function was quantified through different SOT conditions (SOT1: baseline; SOT5: vestibular demanding by standing with blindfolded and sway reference surface). The vestibular stimulation (VS) was applied either unilaterally or bilaterally to vestibular system to induce the sensory-conflicted and challenging tasks. Thus, a total of 6 conditions (2 SOT conditions X 3 VSs: no-VS, unilateral VS, and bilateral VS) were randomly given to these participants. Three approaches can be quantified the balance control: 1) the performance ratio (PR) of center of gravity trajectories (CoG), 2) the sample entropy measure (SampEn) of CoG, and 3) the total traveling distance of CoG. A mixed three-way repeated ANOVA measure was used to determine the interaction among the sex effect, the effect of SOT, and the effect of VS on balance control. Results: A significant sex effect on balance control was found in the PR of CoG in the anterior-posterior (AP) direction (p = 0.026) and in the SampEn of CoG in both AP and medial-lateral (ML) directions (p = 0.025, p < 0.001, respectively). Also, a significant interaction among the sex effect, the effect of SOT, and the effect of VS on balance control was observed in PR of CoG in the ML direction (p < 0.001), SampEn of CoG in the AP and ML directions (p = 0.002, p < 0.001, respectively), and a traveling distance in AP direction (p = 0.041). Conclusion: The findings in the present study clearly revealed the necessity to take sex effect into consideration while standing in vestibular-perturbed or/and vestibular demanding tasks. Also, the results in the present study could be a fundamental reference for future sensorimotor training.

Vibrations on mastoid process alter the gait characteristics during walking on different inclines

Background

Eighty-eight percent of the persons with bilateral vestibular dysfunction have reported at least one fall within the past 5 years. The apparent alternations due to the bilateral vestibular dysfunctions (BVD) are the gait characteristics, such as slower walking speed, prolonged stance phase, and shorter step length. Unexpectedly, due to the prevalence of this BVD being relatively low, attention is not obtained as same as in other vestibular disorders. Moreover, how does walking on different inclines, part of daily activities, alter the gait characteristics under the unreliable bilateral vestibular systems? Previous studies used vibration-based stimulations (VS) as a perturbation to understand the postural control during walking while the bilateral vestibular systems were perturbed. Therefore, this study attempted to extend the knowledge to understand the alternations in spatial-temporal gait characteristics under perturbed bilateral vestibular systems while walking on different inclines.

Methods

Nineteen healthy young adults participated in this study. Eight walking conditions were randomly assigned to each participant: 0%, 3%, 6%, and 9% grade of inclines with/without VS. The preferred walking speed was used for gait analysis. The dependent variables were stance time, double support time, step length, step time, step width, foot clearance, and respective variabilities. All dependent variables were defined by two critical gait events: heel-strike and toe-off. Pre-Hoc paired comparisons with Bonferroni corrections were used to prioritize the dependent variables. A two-way repeated measure was used to investigate the effect of VS and the effect of inclines on the selected dependent variables from Pre-Hoc analysis. Post-Hoc comparisons were also corrected by the Bonferroni method.

Results

The step length, step time, foot clearance, and foot clearance variability were selected by the Pre-Hoc analysis because the corrected paired t-test demonstrated a significant VS effect (p < 0.05) on these gait parameters at least one of four inclines. The significant interaction between the effect of VS and the effect of inclines was found in step length (p = 0.005), step time (p = 0.028), and foot clearance variability (p = 0.003). The results revealed that implementing a VS increased step length and step time when walking on 0%, 3%, and 9% of grade inclines. In particular, the foot clearance variability was found when walking on 9% of grade inclines.

Conclusion

The observations in the current study suggested that VS increased the step length, step time, foot clearance, and foot clearance variability while walking on inclines. These results suggested that these gait parameters might be promising targets for future clinical investigations in patients with BVD while walking on different inclines. Importantly, the increases in spatial-temporal gait performance under bilateral VS might be an indicator of gait improvement while walking on different inclines.

Different Types of Visual Perturbation Induced Different Demands and Patterns in Active Control: Implication for Future Sensorimotor Training

Background: Sensorimotor training using visual perturbations has been widely applied to astronauts for rapidly handling and adapting to unpredictable environments. However, these visual perturbations might not be strong enough to trigger long-term effects. Therefore, this study aimed to develop a novel sensorimotor training paradigm using pseudo-random visual perturbations and to determine the demands and patterns of active control under different types of visual perturbations.

Method: Thirty healthy young adults participated in this study. Four walking conditions were randomly assigned to these participants: 1) walking without optic flow (NoOptic), 2) walking with the optic flow (Optic), 3) walking under reduced visual capability (Vre), and 4) walking under perturbed optic flow (Vpe). The dependent variables were the step length variability, the step width variability, the 95% confidence interval ellipse area, the long axis of the ellipse, and the short axis of the ellipse.

Results: The results indicated that 1) the step length variability and the ellipse area were greater in Vre compared to Optic (p < 0.001, p < 0.001). Moreover, the step width variability and ellipse area were greater in Vpe than Optic (p < 0.001, p = 0.002).

Conclusion: The abovementioned results demonstrated that 1) walking in both Vre and Vpe conditions required greater demands and different patterns in active controls compared to the Optic condition, suggesting both Vre and Vpe conditions could be applied for sensorimotor training; 2) the Vre condition would be the first choice if there were no concerns in potential trips on the treadmill.

Different Types of Mastoid Process Vibrations Affect Dynamic Margin of Stability Differently

The vestibular system is critical for human locomotion. Any deteriorated vestibular system leads to gait instability. In the past decades, these alternations in gait patterns have been majorly measured by the spatial-temporal gait parameters and respective variabilities. However, measuring gait characteristics cannot capture the full aspect of motor controls. Thus, to further understand the effects of deteriorated vestibular system on gait performance, additional measurement needs to be taken into consideration. This study proposed using the margin of stability (MOS) to identify the patterns of dynamic control under different types of mastoid vibrations in walking. This study hypothesized that (1) using the MOS method could facilitate the understanding of another aspect of motor control induced by different types of mastoid vibrations, and (2) applying the mastoid vibrations could induce the asymmetric MOS. Twenty healthy young adults were recruited. Two electromechanical vibrotactile transducers were placed on the bilateral mastoid process to apply different types of vestibular vibrations (bilateral, unilateral, and no vibration). A motion capture system with eight cameras was used to measure the MOSap (margin of stability in the anterior-posterior direction), MOSml (margin of stability in the medial-lateral direction), and respective variabilities. The results were in line with the hypotheses that both bilateral and unilateral mastoid vibrations significantly increased MOSap (p = 0.036, p < 0.001), MOSml (p = 0.012, p < 0.001), and respective variabilities p = 0.001, p < 0.001; p = 0.001, p < 0.01 when compared to the no vibration condition. Also, significantly larger MOSml (p = 0.001), MOSml variability (p < 0.023), MOSap (p < 0.001), and MOSap variability (p = 0.002) were observed under the unilateral vibration condition than that observed under the bilateral vibration condition. The above-mentioned result found that different types of mastoid vibrations affected the MOS differently, suggesting different patterns of control mechanisms under different sensory-conflicted situations. Besides, a significant difference between the dominant and non-dominant legs was observed in MOSml. Moreover, applying the unilateral mastoid vibrations induced a greater symmetric index of MOSml, suggesting that more active control in balance was needed in the medial-lateral than in the anterior-posterior direction.

Fifty Years of Development of the Skull Vibration-Induced Nystagmus Test

This review enumerates most of the studies on the Skull Vibration-Induced Nystagmus Test (SVINT) in the past 50 years from different research groups around the world. It is an attempt to demonstrate the evolution of this test and its increased interest around the globe. It explores clinical studies and animal studies, both permitting a better understanding of the importance of SVINT and its pathophysiology.