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Le Roy B, Jouvencel A, Friedl-Werner A, Renel L, Cherchali Y, Osseiran R, Sanz-Arigita E, Cazalets JR, Guillaud E, Altena E. Is sleep affected after microgravity and hypergravity exposure? A pilot study. J Sleep Res 2024:e14279. [PMID: 38923005 DOI: 10.1111/jsr.14279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/24/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024]
Abstract
Sleep is known to be affected in space travel and in residents of the international space station. But little is known about the direct effects of gravity changes on sleep, if other factors, such as sleep conditions, are kept constant. Here, as a first exploration, we investigated sleep before and after exposure to short bouts of microgravity and hypergravity during parabolic flights. Sleep was measured through actigraphy and self-report questionnaires in 20 healthy men and women before and after parabolic flight. Higher sleep fragmentation and more awakenings were found in the night after the flight as compared with the night before, which was discrepant from participants' reports showing better and longer sleep after the parabolic flight. Variable levels of experience with parabolic flights did not affect the results, nor did levels of scopolamine, a medication typically taken against motion sickness. Pre-existing sleep problems were related to sleep fragmentation and wake after sleep onset by a quadratic function such that participants with more sleep problems showed lower levels of sleep fragmentation and nighttime awakenings than those with few sleep problems. These novel findings, though preliminary, have important implications for future research, directed at prevention and treatment of sleep problems and their daytime consequences in situations of altered gravity, and possibly in the context of other daytime vestibular challenges as well.
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Affiliation(s)
- Barbara Le Roy
- Stress Neurophysiology Unit, French Armed Forces Biomedical Research Institute, Brétigny-sur-Orge Cedex, CNES, Paris, France
- APEMAC/EPSAM, EA 4360 Metz Cedex, Metz Cedex, France
| | - Aurore Jouvencel
- INCIA, EPHE, Université PSL, Univ. Bordeaux, CNRS, Bordeaux, France
| | - Anika Friedl-Werner
- Charité-Universitätsmedizin Berlin, a Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Berlin, Germany
- Université de Normandie, INSERM U1075 COMETE, Caen, France
| | - Ludmila Renel
- Université de Bordeaux, CNRS UMR 5287, INCIA, Bordeaux, France
| | | | - Raouf Osseiran
- Université de Bordeaux, CNRS UMR 5287, INCIA, Bordeaux, France
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Stahn AC, Bucher D, Zu Eulenburg P, Denise P, Smith N, Pagnini F, White O. Paving the way to better understand the effects of prolonged spaceflight on operational performance and its neural bases. NPJ Microgravity 2023; 9:59. [PMID: 37524737 PMCID: PMC10390562 DOI: 10.1038/s41526-023-00295-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 06/15/2023] [Indexed: 08/02/2023] Open
Abstract
Space exploration objectives will soon move from low Earth orbit to distant destinations like Moon and Mars. The present work provides an up-to-date roadmap that identifies critical research gaps related to human behavior and performance in altered gravity and space. The roadmap summarizes (1) key neurobehavioral challenges associated with spaceflight, (2) the need to consider sex as a biological variable, (3) the use of integrative omics technologies to elucidate mechanisms underlying changes in the brain and behavior, and (4) the importance of understanding the neural representation of gravity throughout the brain and its multisensory processing. We then highlight the need for a variety of target-specific countermeasures, and a personalized administration schedule as two critical strategies for mitigating potentially adverse effects of spaceflight on the central nervous system and performance. We conclude with a summary of key priorities for the roadmaps of current and future space programs and stress the importance of new collaborative strategies across agencies and researchers for fostering an integrative cross- and transdisciplinary approach from cells, molecules to neural circuits and cognitive performance. Finally, we highlight that space research in neurocognitive science goes beyond monitoring and mitigating risks in astronauts but could also have significant benefits for the population on Earth.
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Affiliation(s)
- A C Stahn
- Unit of Experimental Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Physiology, Berlin, Germany.
| | - D Bucher
- IZN-Neurobiology, University of Heidelberg, Heidelberg, Germany
| | - P Zu Eulenburg
- Institute for Neuroradiology & German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University Munich, Munich, Germany
| | - P Denise
- Normandie Univ. UNICAEN, INSERM, COMETE, CYCERON, Caen, France
| | - N Smith
- Protective Security and Resilience Centre, Coventry University, Coventry, United Kingdom
| | - F Pagnini
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - O White
- Université de Bourgogne INSERM-U1093 Cognition, Action, and Sensorimotor Plasticity, Dijon, France.
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Kuldavletova O, Navarro Morales DC, Quarck G, Denise P, Clément G. Spaceflight alters reaction time and duration judgment of astronauts. Front Physiol 2023; 14:1141078. [PMID: 37007995 PMCID: PMC10063900 DOI: 10.3389/fphys.2023.1141078] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/03/2023] [Indexed: 03/19/2023] Open
Abstract
We report a study on astronauts aimed at characterizing duration judgment before, during, and after long-duration stays on board the International Space Station. Ten astronauts and a control group of 15 healthy (non-astronaut) participants performed a duration reproduction task and a duration production task using a visual target duration ranging from 2 to 38 s. Participants also performed a reaction time test for assessing attention. Compared to control participants and preflight responses, the astronauts’ reaction time increased during spaceflight. Also, during spaceflight, time intervals were under-produced while counting aloud and under-reproduced when there was a concurrent reading task. We hypothesize that time perception during spaceflight is altered by two mechanisms: (a) an acceleration of the internal clock through the changes in vestibular inputs in microgravity, and (b) difficulties in attention and working memory when a concurrent reading task is present. Prolonged isolation in confined areas, weightlessness, stress related to workload, and high-performance expectations could account for these cognitive impairments.
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Kolev OI, Clement G, Reschke MF. Astronauts eye-head coordination dysfunction over the course of twenty space shuttle flights. J Vestib Res 2023; 33:313-324. [PMID: 37248929 DOI: 10.3233/ves-220127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Coordination of motor activity is adapted to Earth's gravity (1 g). However, during space flight the gravity level changes from Earth gravity to hypergravity during launch, and to microgravity (0 g) in orbit. This transition between gravity levels may alter the coordination between eye and head movements in gaze performance. OBJECTIVE We explored how weightlessness during space flight altered the astronauts' eye-head coordination (EHC) with respect to flight day and target eccentricity. METHODS Thirty-four astronauts of 20 Space Shuttle missions had to acquire visual targets with angular offsets of 20°, 30°, and 49°. RESULTS Measurements of eye, head, and gaze positions collected before and during flight days 1 to 15 indicated changes during target acquisition that varied as a function of flight days and target eccentricity. CONCLUSIONS The in-flight alterations in EHC were presumably the result of a combination of several factors, including a transfer from allocentric to egocentric reference for spatial orientation in absence of a gravitational reference, the generation of slower head movements to attenuate motion sickness, and a decrease in smooth pursuit and vestibulo-ocular reflex performance. These results confirm that humans have several strategies for gaze behavior, between which they switch depending on the environmental conditions.
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Affiliation(s)
- Ognyan I Kolev
- Neuroscience Laboratories, NASA Johnson Space Center, Houston, TX, USA
- Institute of Neurobiology, Bulgarian Academy of Sciences, Sofia, Bulgaria
| | - Gilles Clement
- COMETE, INSERM & University of Caen Normandy, Caen, France
- KBRwyle, Houston, TX, USA
| | - Millard F Reschke
- Neuroscience Laboratories, NASA Johnson Space Center, Houston, TX, USA
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Seidler RD, Stern C, Basner M, Stahn AC, Wuyts FL, zu Eulenburg P. Future research directions to identify risks and mitigation strategies for neurostructural, ocular, and behavioral changes induced by human spaceflight: A NASA-ESA expert group consensus report. Front Neural Circuits 2022; 16:876789. [PMID: 35991346 PMCID: PMC9387435 DOI: 10.3389/fncir.2022.876789] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
A team of experts on the effects of the spaceflight environment on the brain and eye (SANS: Spaceflight-Associated Neuro-ocular Syndrome) was convened by NASA and ESA to (1) review spaceflight-associated structural and functional changes of the human brain and eye, and any interactions between the two; and (2) identify critical future research directions in this area to help characterize the risk and identify possible countermeasures and strategies to mitigate the spaceflight-induced brain and eye alterations. The experts identified 14 critical future research directions that would substantially advance our knowledge of the effects of spending prolonged periods of time in the spaceflight environment on SANS, as well as brain structure and function. They used a paired comparison approach to rank the relative importance of these 14 recommendations, which are discussed in detail in the main report and are summarized briefly below.
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Affiliation(s)
- Rachael D. Seidler
- Department of Applied Physiology & Kinesiology, Health and Human Performance, University of Florida, Gainesville, FL, United States
| | - Claudia Stern
- Department of Clinical Aerospace Medicine, German Aerospace Center (DLR) and ISS Operations and Astronauts Group, European Astronaut Centre, European Space Agency (ESA), Cologne, Germany
- *Correspondence: Claudia Stern,
| | - Mathias Basner
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Alexander C. Stahn
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Floris L. Wuyts
- Department of Physics, University of Antwerp, Antwerp, Belgium
- Laboratory for Equilibrium Investigations and Aerospace (LEIA), Antwerp, Belgium
| | - Peter zu Eulenburg
- German Vertigo and Balance Center, University Hospital, Ludwig-Maximilians-Universität München (LMU), Munich, Germany
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Lu SY, Guo S, Chai SB, Yang JQ, Yue Y, Li H, Yan HF, Zhang T, Sun PM, Sun HW, Zhou JL, Yang JW, Li ZP, Cui Y. Proteomic analysis of the effects of simulated microgravity in human gastric mucosal cells. LIFE SCIENCES IN SPACE RESEARCH 2022; 32:26-37. [PMID: 35065758 DOI: 10.1016/j.lssr.2021.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/30/2021] [Accepted: 10/06/2021] [Indexed: 06/14/2023]
Abstract
Microgravity is an ecological factor that affects the environment of the body. In this study, quantitative isobaric labeling (tandem mass tag) method was used to study the changes in human gastric mucosal cells under simulated microgravity for the first time. Comparative proteomic analysis identified 394 (202 upregulated and 192 downregulated) and 542 (286 upregulated and 256 downregulated) proteins differentially regulated by simulated microgravity after 3 and 7 days, respectively. Then the identified proteins were subjected to Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses for further exploration. The results of the analysis showed that the ribosomes of gastric mucosal cells were significantly impacted after exposure to simulated microgravity for 3 days, and the cells appeared to be in a state of stress and inflammation. Exposure to simulated microgravity for 7 days significantly affected the mitochondria of the cells, oxidative stress became more evident, while inflammation and weakened connections were observed in the cells. The results of this study highlighted the temporal response trend of gastric mucosal cells to the stressor of microgravity at the two time points of 3 and 7 days. These findings will provide insights into the development of methods to protect the gastric mucosa during space flight.
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Affiliation(s)
- Sheng-Yu Lu
- Department of General Surgery, The 306th Hospital of PLA-Peking University Teaching Hospital, Beijing 100101, China; Department of General Surgery, Strategic Support Force Medical Center, Beijing 100101, China
| | - Song Guo
- Department of General Surgery, The 306th Hospital of PLA-Peking University Teaching Hospital, Beijing 100101, China; Department of General Surgery, Strategic Support Force Medical Center, Beijing 100101, China
| | - Shao-Bin Chai
- Department of General Surgery, Strategic Support Force Medical Center, Beijing 100101, China
| | - Jia-Qi Yang
- Department of General Surgery, The 306th Hospital of PLA-Peking University Teaching Hospital, Beijing 100101, China; Department of General Surgery, Strategic Support Force Medical Center, Beijing 100101, China
| | - Yuan Yue
- Department of General Surgery, The 306th Hospital of PLA-Peking University Teaching Hospital, Beijing 100101, China; Department of General Surgery, Strategic Support Force Medical Center, Beijing 100101, China
| | - Hao Li
- Department of General Surgery, Strategic Support Force Medical Center, Beijing 100101, China
| | - Hong-Feng Yan
- Department of General Surgery, Strategic Support Force Medical Center, Beijing 100101, China
| | - Tao Zhang
- Department of General Surgery, Strategic Support Force Medical Center, Beijing 100101, China
| | - Pei-Ming Sun
- Department of General Surgery, Strategic Support Force Medical Center, Beijing 100101, China
| | - Hong-Wei Sun
- Department of General Surgery, Strategic Support Force Medical Center, Beijing 100101, China
| | - Jin-Lian Zhou
- Department of Pathology, Strategic Support Force Medical Center, Beijing 100101, China
| | - Jian-Wu Yang
- Department of General Surgery, Strategic Support Force Medical Center, Beijing 100101, China
| | - Zheng-Peng Li
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
| | - Yan Cui
- Department of General Surgery, The 306th Hospital of PLA-Peking University Teaching Hospital, Beijing 100101, China; Department of General Surgery, Strategic Support Force Medical Center, Beijing 100101, China.
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Shoshina I, Zelenskaya I, Karpinskaia V, Shilov Y, Tomilovskaya E. Sensitivity of Visual System in 5-Day "Dry" Immersion With High-Frequency Electromyostimulation. Front Neural Circuits 2021; 15:702792. [PMID: 35002633 PMCID: PMC8740068 DOI: 10.3389/fncir.2021.702792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 11/26/2021] [Indexed: 11/13/2022] Open
Abstract
The aim of this work was to study the sensitivity of the visual system in 5-day "dry" immersion with a course of high-frequency electromyostimulation (HFEMS) and without it. "Dry" immersion (DI) is one of the most effective models of microgravity. DI reproduces three basic effects of weightlessness: physical inactivity, support withdrawal and elimination of the vertical vascular gradient. The "dry" immersion included in the use of special waterproof and highly elastic fabric on of immersion in a liquid similar in density to the tissues of the human body. The sensitivity of the visual system was assessed by measuring contrast sensitivity and magnitude of the Müller-Lyer illusion. The visual contrast sensitivity was measured in the spatial frequency range from 0.4 to 10.0 cycles/degree. The strength of visual illusion was assessed by means of motor response using "tracking." Measurements were carried out before the start of immersion, on the 1st, 3rd, 5th days of DI, and after its completion. Under conditions of "dry" immersion without HFEMS, upon the transition from gravity to microgravity conditions (BG and DI1) we observed significant differences in contrast sensitivity in the low spatial frequency range, whereas in the experiment with HFEMS-in the medium spatial frequency range. In the experiment without HFEMS, the Müller-Lyer illusion in microgravity conditions was absent, while in the experiment using HFEMS it was significantly above zero at all stages. Thus, we obtained only limited evidence in favor of the hypothesis of a possible compensating effect of HFEMS on changes in visual sensitivity upon the transition from gravity to microgravity conditions and vice versa. The study is a pilot and requires further research on the effect of HFEMS on visual sensitivity.
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Affiliation(s)
- Irina Shoshina
- Laboratory of Physiology of Vision, Pavlov Institute of Physiology, Russian Academy of Sciences, Saint-Petersburg, Russia
| | - Inna Zelenskaya
- Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia
| | | | - Yuri Shilov
- Department of Psychology, Samara University, Samara, Russia
| | - Elena Tomilovskaya
- Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia
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Stahn AC, Kühn S. Extreme environments for understanding brain and cognition. Trends Cogn Sci 2021; 26:1-3. [PMID: 34711517 DOI: 10.1016/j.tics.2021.10.005] [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: 12/15/2020] [Revised: 10/03/2021] [Accepted: 10/04/2021] [Indexed: 10/20/2022]
Abstract
Can life in extreme environments foster our understanding of the limits and adaptability of cognition and brain plasticity? We review characteristics of spaceflight and spaceflight analogues, such as bed rest, dry immersion, parabolic flights, and isolated and controlled confinement, and discuss the potential of utilizing these research settings to advance cognitive neuroscience.
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Affiliation(s)
- Alexander C Stahn
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Physiology, 10117 Berlin, Germany.
| | - Simone Kühn
- Lise Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, 14195 Berlin, Germany; Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
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9
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Stahn AC, Kühn S. Brains in space: the importance of understanding the impact of long-duration spaceflight on spatial cognition and its neural circuitry. Cogn Process 2021; 22:105-114. [PMID: 34409546 PMCID: PMC8423699 DOI: 10.1007/s10339-021-01050-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 07/21/2021] [Indexed: 01/02/2023]
Abstract
Fifty years after the first humans stepped on the Moon, space faring nations have entered a new era of space exploration. NASA’s reference mission to Mars is expected to comprise 1100 days. Deep space exploratory class missions could even span decades. They will be the most challenging and dangerous expeditions in the history of human spaceflight and will expose crew members to unprecedented health and performance risks. The development of adverse cognitive or behavioral conditions and psychiatric disorders during those missions is considered a critical and unmitigated risk factor. Here, we argue that spatial cognition, i.e., the ability to encode representations about self-to-object relations and integrate this information into a spatial map of the environment, and their neural bases will be highly vulnerable during those expeditions. Empirical evidence from animal studies shows that social isolation, immobilization, and altered gravity can have profound effects on brain plasticity associated with spatial navigation. We provide examples from historic spaceflight missions, spaceflight analogs, and extreme environments suggesting that spatial cognition and its neural circuitry could be impaired during long-duration spaceflight, and identify recommendations and future steps to mitigate these risks.
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Affiliation(s)
- Alexander C Stahn
- Department of Psychiatry, Unit of Experimental Psychiatry, Perelman School of Medicine, University of Pennsylvania, 4233 Guardian Dr, 1016 Blockley Hall, Philadelphia, PA, 19104, USA.
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Physiology, Charitéplatz 1, 10117, Berlin, Germany.
| | - Simone Kühn
- Lise Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, 14195, Berlin, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
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10
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Friedl-Werner A, Machado ML, Balestra C, Liegard Y, Philoxene B, Brauns K, Stahn AC, Hitier M, Besnard S. Impaired Attentional Processing During Parabolic Flight. Front Physiol 2021; 12:675426. [PMID: 34054584 PMCID: PMC8155259 DOI: 10.3389/fphys.2021.675426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/09/2021] [Indexed: 11/19/2022] Open
Abstract
Previous studies suggest that altered gravity levels during parabolic flight maneuvers affect spatial updating. Little is known about the impact of the experimental setting and psychological stressors associated with parabolic flight experiments on attentional processes. To address this gap, we investigated the level of alertness, selective and sustained attention in 1 and 0 g using a Go/No-Go Continuous Performance Task. We also identified several parameters associated with the experimental set-up of a parabolic flight that could be expected to affect attentional processing. These included the use of scopolamine, sleep quality prior to the flight day, participant’s stress level as well as mood and anxiety state before and after the parabolic flight. We observed a deterioration in attentional processing prior to the first parabola that was further aggravated in weightlessness and returned to baseline after the last parabola. Reaction Time, Hit and False Alarm Rate were moderately correlated with self-reported anxiety state, but not cortisol levels or emotional states. The use of scopolamine had minor effects on Reaction Time. Our results confirm previous studies reporting impairments of cognitive performance in 0 g, and highlight important aspects that should be considered for the design of behavioral research experiments in future parabolic flight campaigns.
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Affiliation(s)
- Anika Friedl-Werner
- Charité - Universitätsmedizin Berlin, a Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Berlin, Germany.,Université de Normandie, INSERM U1075 COMETE, Caen, France
| | | | - Costantino Balestra
- Environmental, Occupational & Ageing "Integrative Physiology" Laboratory, Haute Ecole Bruxelles-Brabant, Brussels, Belgium.,DAN Europe Research Division (Roseto (It)-Brussels (B)), Brussels, Belgium
| | | | | | - Katharina Brauns
- Charité - Universitätsmedizin Berlin, a Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Berlin, Germany
| | - Alexander C Stahn
- Charité - Universitätsmedizin Berlin, a Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Berlin, Germany.,Unit of Experimental Psychiatry, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Martin Hitier
- Université de Normandie, INSERM U1075 COMETE, Caen, France.,Department of Otolaryngology Head and Neck Surgery, Centre Hospitalier Universitaire de Caen Normandie, Caen, France.,Department of Anatomy, Université de Normandie, Caen, France
| | - Stephane Besnard
- Université de Normandie, INSERM U1075 COMETE, Caen, France.,Aix Marseille Université, CNRS, UMR 7260, Laboratoire de Neurosciences Sensorielles et Cognitives - Equipe Physiopathologie et Thérapie des Désordres Vestibulaires, Marseille, France
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