Upright Perception and Ocular Torsion Change Independently during Head Tilt

Open Iris - An Open Source Framework for Video-Based Eye-Tracking Research and Development

Eye-tracking is an essential tool in many fields, yet existing solutions are often limited for customized applications due to cost or lack of flexibility. We present OpenIris, an adaptable and user-friendly open-source framework for video-based eye-tracking. OpenIris is developed in C# with modular design that allows further extension and customization through plugins for different hardware systems, tracking, and calibration pipelines. It can be remotely controlled via a network interface from other devices or programs. Eye movements can be recorded online from camera stream or offline post-processing recorded videos. Example plugins have been developed to track eye motion in 3-D, including torsion. Currently implemented binocular pupil tracking pipelines can achieve frame rates of more than 500Hz. With the OpenIris framework, we aim to fill a gap in the research tools available for high-precision and high-speed eye-tracking, especially in environments that require custom solutions that are not currently well-served by commercial eye-trackers.

Subjective visual vertical and head position in patients with idiopathic scoliosis

BACKGROUND

Idiopathic scoliosis (IS) is a structural spinal deformity that can affect the position of the head. One of the etiological hypotheses is that it can be caused by dysfunction of the vestibular system, which can cause abnormal perception of subjective visual vertical (SVV).

OBJECTIVE

This study aimed to evaluate the differences in head position and its possible correlation with the perception of SVV in children with IS.

METHODS

We examined 37 patients with IS and 37 healthy individuals. The position of the head was evaluated from digital photographs, where we compared the coronal head tilt and the coronal shoulder angle. Measurement of SVV perception was performed using the Bucket method.

RESULTS

Coronal head tilt values were significantly different between the groups (median 2.3° [interquartile range 1.8-4.2] vs 1.3° [0.9-2.3], p = 0.001; patients vs. controls). There was a significant difference in SVV between the groups (2.33° [1.40-3.25] vs 0.50° [0.41-1.10], p < 0.001; patients vs controls). There was a correlation between the side of head tilt and the side of SVV in patients with IS (χ2 = 5.6, p = 0.02).

CONCLUSIONS

Patients with IS had a greater head tilt in the coronal plane and impaired SVV perception.

Head Orientation Influences Saccade Directions during Free Viewing

When looking around a visual scene, humans make saccadic eye movements to fixate objects of interest. While the extraocular muscles can execute saccades in any direction, not all saccade directions are equally likely: saccades in horizontal and vertical directions are most prevalent. Here, we asked whether head orientation plays a role in determining saccade direction biases. Study participants (n = 14) viewed natural scenes and abstract fractals (radially symmetric patterns) through a virtual reality headset equipped with eye tracking. Participants' heads were stabilized and tilted at -30°, 0°, or 30° while viewing the images, which could also be tilted by -30°, 0°, and 30° relative to the head. To determine whether the biases in saccade direction changed with head tilt, we calculated polar histograms of saccade directions and cross-correlated pairs of histograms to find the angular displacement resulting in the maximum correlation. During free viewing of fractals, saccade biases largely followed the orientation of the head with an average displacement value of 24° when comparing head upright to head tilt in world-referenced coordinates (t ₍₁₃₎ = 17.63, p < 0.001). There was a systematic offset of 2.6° in saccade directions, likely reflecting ocular counter roll (OCR; t ₍₁₃₎ = 3.13, p = 0.008). When participants viewed an Earth upright natural scene during head tilt, we found that the orientation of the head still influenced saccade directions (t ₍₁₃₎ = 3.7, p = 0.001). These results suggest that nonvisual information about head orientation, such as that acquired by vestibular sensors, likely plays a role in saccade generation.

Perceptual Biases as the Side Effect of a Multisensory Adaptive System: Insights from Verticality and Self-Motion Perception

Perceptual biases can be interpreted as adverse consequences of optimal processes which otherwise improve system performance. The review presented here focuses on the investigation of inaccuracies in multisensory perception by focusing on the perception of verticality and self-motion, where the vestibular sensory modality has a prominent role. Perception of verticality indicates how the system processes gravity. Thus, it represents an indirect measurement of vestibular perception. Head tilts can lead to biases in perceived verticality, interpreted as the influence of a vestibular prior set at the most common orientation relative to gravity (i.e., upright), useful for improving precision when upright (e.g., fall avoidance). Studies on the perception of verticality across development and in the presence of blindness show that prior acquisition is mediated by visual experience, thus unveiling the fundamental role of visuo-vestibular interconnections across development. Such multisensory interactions can be behaviorally tested with cross-modal aftereffect paradigms which test whether adaptation in one sensory modality induces biases in another, eventually revealing an interconnection between the tested sensory modalities. Such phenomena indicate the presence of multisensory neural mechanisms that constantly function to calibrate self-motion dedicated sensory modalities with each other as well as with the environment. Thus, biases in vestibular perception reveal how the brain optimally adapts to environmental requests, such as spatial navigation and steady changes in the surroundings.

Psychophysical Haptic Measurement of Vertical Perception: Elucidating a Hand Sensory Bias

The primary sensory modality for probing spatial perception can vary among psychophysical paradigms. In the subjective visual vertical (SVV) task, the brain must account for the position of the eye within the orbit to generate an estimate of a visual line orientation, whereas in the subjective haptic vertical (SHV) task, the position of the hand is used to sense the orientation of a haptic bar. Here we investigated whether a hand sensory bias can affect SHV measurement. We measured SHV in 12 subjects (6 left-handed and 6 right-handed) with a forced-choice paradigm using their left and right hands separately. The SHV measurement was less accurate than the SVV measurements (-0.6 ± 0.7) and it was biased in the direction of the hand used in the task but was not affected by handedness; SHV left hand -6.8 ± 2.1° (left-handed -7.9 ± 3.6°, right-handed -5.8 ± 2.5°) and right hand 9.8 ± 1.5° (left-handed 7.4 ± 2.2°, right-handed 12.3 ± 1.8°). SHV measurement with the same hand was also affected by the haptic bar placement on the left or right side versus midline, showing a side effect (left vs midline -2.0 ± 1.3°, right vs midline 3.8 ± 1.7°). Midline SHV measures using the left and right hands were different, confirming a laterality effect (left hand -4.5 ± 1.7°, right hand 6.4 ± 2.0°). These results demonstrate a sensory bias in SHV measurement related to the effects of both hand-in-body (i.e., right vs left hand) and hand-in-space positions. Such modality-specific bias may result in disparity between SHV and SVV measurements, and therefore cannot be generalized to vertical or spatial perception.

Subjective visual vertical imprecision during lateral head tilt in patients with chronic dizziness

Most prior studies of the subjective visual vertical (SVV) focus on inaccuracy of subjects' SVV responses with the head in an upright position. Here we investigated SVV imprecision during lateral head tilt in patients with chronic dizziness compared to healthy controls. Forty-five dizzy patients and 45 healthy controls underwent SVV testing wearing virtual reality (VR) goggles, sitting upright (0°) and during head tilt in the roll plane (± 30°). Ten trials were completed in each of three static head positions. The SVV inaccuracy and SVV imprecision were analyzed and compared between groups, along with systematic errors during head tilt, i.e., A-effect and E-effect (E-effect is a typical SVV response during head tilts of ± 30°). The SVV imprecision was found to be affected by head position (upright/right head tilt/left head tilt, p < 0.001) and underlying dizziness (dizzy patients/healthy controls, p = 0.005). The SVV imprecision during left head tilt was greater in dizzy patients compared to healthy controls (p = 0.04). With right head tilt, there was a trend towards greater SVV imprecision in dizzy patients (p = 0.08). Dizzy patients were more likely to have bilateral (6.7%) or unilateral (22.2%) A-effect during lateral head tilt than healthy controls (bilateral (0%) or unilateral (6.7%) A-effect, p < 0.01). Greater SVV imprecision in chronically dizzy patients during head tilts may be attributable to increased noise of vestibular sensory afferents or disturbances of multisensory integration. Our findings suggest that SVV imprecision may be a useful clinical parameter of underlying dizziness measurable with bedside SVV testing in VR.

Evaluation of the Video Ocular Counter-Roll (vOCR) as a New Clinical Test of Otolith Function in Peripheral Vestibulopathy

Importance

Video-oculography (VOG) goggles have been integrated into the assessment of semicircular canal function in patients with vestibular disorders. However, a similar bedside VOG method for testing otolith function is lacking.

Objective

To evaluate the use of VOG-based measurement of ocular counter-roll (vOCR) as a clinical test of otolith function.

Design, Setting, and Participants

A case-control study was conducted to compare vOCR measurement among patients at various stages of unilateral loss of vestibular function with healthy controls. The receiver operating characteristic curve method was used to determine the diagnostic accuracy of the vOCR test in detecting loss of otolith function. Participants were recruited at a tertiary center including the Johns Hopkins outpatient clinic and Johns Hopkins Hospital, Baltimore, Maryland. Participants included 56 individuals with acute (≤4 weeks after surgery), subacute (4 weeks-6 months after surgery), and chronic (>6 months after surgery) unilateral vestibular loss as well as healthy controls. A simple bedside maneuver with en bloc, 30° lateral tilt of the head and trunk was used for vOCR measurement. The study was conducted from February 2, 2017, to March 10, 2019.

Intervention

In each participant vOCR was measured during static tilts of the head and trunk en bloc.

Main Outcomes and Measures

The vOCR measurements and diagnostic accuracy of vOCR in detecting patients with loss of vestibular function from healthy controls.

Results

Of the 56 participants, 28 (50.0%) were men; mean (SD) age was 53.5 (11.4) years. The mean (SD) time of acute unilateral vestibular loss was 9 (7) days (range, 2-17 days) in the acute group, 61 (39) days (range, 28-172 days) in the subacute group, and 985 (1066) days (range 185-4200 days) in the chronic group. The vOCR test showed reduction on the side of vestibular loss, and the deficit was greater in patients with acute and subacute vestibular loss than in patients with chronic loss and healthy controls (acute vs chronic: -1.81°; 95% CI, -3.45° to -0.17°; acute vs control: -3.18°; 95% CI, -4.83° to -1.54°; subacute vs chronic: -0.63°; 95% CI, -2.28° to 1.01°; subacute vs control: -2.01°; 95% CI, -3.65° to -0.36°; acute vs subacute: -1.17°; 95% CI, -2.88° to 0.52°; and chronic vs control: -1.37°; 95% CI, -2.96° to 0.21°). The asymmetry in vOCR between the side of vestibular loss and healthy side was significantly higher in patients with acute vs chronic loss (0.28; 95% CI, 0.06-0.51). Overall, the performance of the vOCR test in discriminating between patients with vestibular loss and healthy controls was 0.83 (area under the receiver operating characteristic curve). The best vOCR threshold to detect vestibular loss at the 30° tilt was 4.5°, with a sensitivity of 80% (95% CI, 0.62%-0.88%) and specificity of 82% (95% CI, 0.57%-1.00%).

Conclusions and Relevance

The findings of this case-control study suggest that the vOCR test can be performed with a simple bedside maneuver and may be used to detect or track loss of otolith function.

Influence of panoramic cues during prolonged roll-tilt adaptation on the percept of vertical

The percept of vertical, which mainly relies on vestibular and visual cues, is known to be affected after sustained whole-body roll tilt, mostly at roll positions adjacent to the position of adaptation. Here we ask whether the viewing of panoramic visual cues during the adaptation further influences the percept of the visual vertical. Participants were rotated in the frontal plane to a 90° clockwise tilt position, which was maintained for 4-minutes. During this period, the subject was either kept in darkness, or viewed panoramic pictures that were either veridical (aligned with gravity) or oriented along the body longitudinal axis. Errors of the subsequent subjective visual vertical (SVV), measured at various tilt angles, showed that the adaptation effect of panoramic cues is local, i.e. for a narrow range of tilts in the direction of the adaptation angle. This distortion was found irrespective of the orientation of the panoramic cues. We conclude that sustained exposure to panoramic and vestibular cues does not adapt the subsequent percept of vertical to the direction of the panoramic cue. Rather, our results suggest that sustained panoramic cues affect the SVV by an indirect effect on head orientation, with a 90° periodicity, that interacts with a vestibular cue to determine the percept of vertical.

Multisensory contribution in visuospatial orientation: an interaction between neck and trunk proprioception

A coherent perception of spatial orientation is key in maintaining postural control. To achieve this the brain must access sensory inputs encoding both the body and the head position and integrate them with incoming visual information. Here we isolated the contribution of proprioception to verticality perception and further investigated whether changing the body position without moving the head can modulate visual dependence-the extent to which an individual relies on visual cues for spatial orientation. Spatial orientation was measured in ten healthy individuals [6 female; 25-47 years (SD 7.8 years)] using a virtual reality based subjective visual vertical (SVV) task. Individuals aligned an arrow to their perceived gravitational vertical, initially against a static black background (10 trials), and then in other conditions with clockwise and counterclockwise background rotations (each 10 trials). In all conditions, subjects were seated first in the upright position, then with trunk tilted 20° to the right, followed by 20° to the left while the head was always aligned vertically. The SVV error was modulated by the trunk position, and it was greater when the trunk was tilted to the left compared to right or upright trunk positions (p < 0.001). Likewise, background rotation had an effect on SVV errors as these were greater with counterclockwise visual rotation compared to static background and clockwise roll motion (p < 0.001). Our results show that the interaction between neck and trunk proprioception can modulate how visual inputs affect spatial orientation.

Dynamic arm movements attenuate the perceptual distortion of visual vertical induced during prolonged whole-body tilt

Concurrent body movements have been shown to enhance the accuracy of spatial judgment, but it remains unclear whether they also contribute to perceptual estimates of gravitational space not involving body movements. To address this, we evaluated the effects of static or dynamic arm movements during prolonged whole-body tilt on the subsequent perceptual estimates of visual or postural vertical. In Experiment 1, participants were asked to continuously perform static or dynamic arm movements during prolonged tilt, and we assessed their effects on the prolonged tilt-induced shifts of subjective visual vertical (SVV) at a tilted position (during-tilt session) or near upright (post-tilt session). In Experiment 2, we evaluated how static or dynamic arm movements during prolonged tilt subsequently affected the subjective postural vertical (SPV). In Experiment 1, we observed that the SVV was significantly shifted toward the direction of prolonged tilt in both sessions. The SVV shifts decreased when performing dynamic arm movements in the during-tilt session, but not in the post-tilt session. In Experiment 2, as well as SVV, the SPV was shifted toward the direction of prolonged tilt, but it was not significantly attenuated by the performance of static or dynamic arm movements. The results of the during-tilt session suggest that the central nervous system utilizes additional information generated by dynamic body movements for perceptual estimates of visual vertical.

Effect of head roll-tilt on the subjective visual vertical in healthy participants: Towards better clinical measurement of gravity perception

OBJECTIVE

Gravity perception is an essential function for spatial orientation and postural stability; however, its assessment is not easy. We evaluated the head-tilt perception gain (HTPG, that is, mean perceptual gain [perceived/actual tilt angle] during left or right head roll-tilt conditions) and head-upright subjective visual vertical (SVV) using a simple method developed by us to investigate the characteristics of gravity perception in healthy participants.

METHODS

We measured the SVV and head roll-tilt angle during head roll-tilt within ±30° of vertical in the sitting and standing positions while the participant maintained an upright trunk (sitting, 434 participants; standing, 263 participants). We evaluated the head-upright SVV, HTPG, and laterality of the HTPG.

RESULTS

We determined the reference ranges of the absolute head-upright SVV (<2.5°), HTPG (0.80-1.25), and HTPG laterality (<10%) for the sitting position. The head-upright SVV and HTPG laterality were not influenced by sex or age. However, the HTPG was significantly greater in women than in men and in middle-aged (30-64 years) and elderly (65-88 years) participants than in young participants (18-29 years). The HTPG, but not the head-upright SVV or HTPG laterality, was significantly higher in the standing vs sitting position.

CONCLUSION

The HTPG is a novel parameter of gravity perception involving functions of the peripheral otolith and neck somatosensory systems to the central nervous system. The HTPG in healthy participants is influenced by age and sex in the sitting position and immediately increases after standing to reinforce the righting reflex for unstable posture, which was not seen in the head-upright SVV, previously considered the only parameter.

LEVEL OF EVIDENCE

4.

No handedness effect on spatial orientation or ocular counter-roll during lateral head tilts

Although vestibular inputs are bilaterally represented within the cerebral hemispheres, the higher level vestibular functions exhibit hemispheric asymmetries. Previous studies have suggested that such asymmetries are associated with handedness. Here, we studied the impact of handedness (i.e., hemispheric lateralization) on spatial orientation using a subjective visual vertical (SVV) task. We tested 22 right‐handed and 22 left‐handed subjects in upright position, during prolonged lateral head tilts of 20° (~15 min), and after the head returned to upright position. The corresponding changes in torsional eye position were measured simultaneously using video‐oculography. During lateral head tilts, both right‐ and left‐handers had initial SVV biases in the opposite direction of the head tilt (right‐handers: left tilt 3.0 ± 1.3°, right tilt −4.7 ± 1.5°; left‐handers: left tilt 3.4 ± 1.1°, right tilt −4.1 ± 1.0°). The SVV subsequently drifted in the direction of the head tilt, and there was an aftereffect in the same direction when the head was brought back upright. The ocular torsion initially changed in the opposite direction of the head tilt (right‐handers: left tilt 3.8 ± 0.4°, right tilt −3.8 ± 0.4°; left‐handers: left tilt 4.2 ± 0.5°, right tilt −4.5 ± 0.5°), and there were also drift and aftereffect in the same direction as the head tilt. The changes in upright perception and ocular torsion did not differ between right‐ and left‐handers. These findings show no functional laterality, neither in the higher level neural mechanisms that maintain spatial orientation, nor in the lower level mechanisms that generate the ocular torsion response during lateral head tilt.

Effect of dynamic visual motion on perception of postural vertical through the modulation of prior knowledge of gravity

To internally estimate gravitational direction and body orientation, the central nervous system considers several sensory inputs from the periphery and prior knowledge of gravity. It is hypothesized that the modulation of visual inputs, supplying indirect information of gravity, affects the prior knowledge established internally by other sensory inputs from vestibular and somatosensory systems, leading to the alteration of perceived body orientation relative to gravity. In order to test the hypothesis, we examined the effect of presenting a visual motion stimulus during a whole-body static tilt on the subsequent evaluation of the perceived postural vertical. Fifteen subjects watched a target moving along the body longitudinal axis directing from head to feet with constant downward acceleration (CA condition) or constant velocity (CV condition), or they did not receive any visual stimulation (NV condition) during the whole-body static tilt. Subsequently, the direction of the subjective postural vertical (SPV) was evaluated. The result showed that the SPV in the CA condition was significantly tilted toward the direction of the preceding tilt compared to that in the NV condition while those in the CV and NV conditions were not significantly different. The present result suggests that dynamic visual motion along body longitudinal axis with downward acceleration can modulate prior knowledge of gravity, and in turn this affects the perception of body verticality.

Spatial orientation: Model-based approach to multi-sensory mechanisms

Perception of spatial orientation is generated through multimodal sensory integration. In this process, there are systematic errors with changes in the head or body position, which reflect challenges for the brain in maintaining a common sensory reference frame for spatial orientation. Here, we focus on this multisensory aspect of spatial orientation. We review a Bayesian spatial perception model that can be used as a framework to study sensory contributions to spatial orientation during lateral head tilts and probe neural networks involved in this process.

Errors of Upright Perception in Patients With Vestibular Migraine

Patients with vestibular migraine (VM) often report dizziness with changes in the head or body position. Such symptoms raise the possibility of dysfunction in neural mechanisms underlying spatial orientation in these patients. Here we addressed this issue by investigating the effect of static head tilts on errors of upright perception in a group of 27 VM patients in comparison with a group of 27 healthy controls. Perception of upright was measured in a dark room using a subjective visual vertical (SVV) paradigm at three head tilt positions (upright, ±20°). VM patients were also surveyed about the quality of their dizziness and spatial symptoms during daily activities. In the upright head position, SVV errors were within the normal range for VM patients and healthy controls (within 2° from true vertical). During the static head tilts of 20° to the right, VM patients showed larger SVV errors consistent with overestimation of the tilt magnitude (i.e., as if they felt further tilted toward the right side) (VM: −3.21° ± 0.93 vs. Control: 0.52° ± 0.70; p = 0.002). During the head tilt to the left, SVV errors in VM patients did not differ significantly from controls (VM: 0.77° ± 1.05 vs. Control: −0.04° ± 0.68; p = 0.52). There was no significant difference in SVV precision between the VM patients and healthy controls at any head tilt position. Consistent with the direction of the SVV errors in VM patients, they largely reported spatial symptoms toward the right side. These findings suggest an abnormal sensory integration for spatial orientation in vestibular migraine, related to daily dizziness in these patients.

Exploring the Role of Temporoparietal Cortex in Upright Perception and the Link With Torsional Eye Position

Upright perception is a key aspect of orientation constancy, as we maintain a stable perception of the world despite continuous movements of our eyes, head, and body. Torsional position of the eyes can impact perception of upright by changing orientation of the images on the retina relative to gravity. Here, we investigated the role of temporoparietal cortex in upright perception with respect to ocular torsion, by means of the inhibitory effect of continuous theta burst transcranial magnetic stimulation (TMS). We used a subjective visual vertical (SVV) paradigm to track changes in upright perception, and a custom video method to track ocular torsion simultaneously. Twelve participants were tested during a lateral head tilt of 20° to the left. TMS at the posterior aspect of the supramarginal gyrus (SMGp) resulted in an average SVV shift in the opposite direction of the head tilt compared to a sham stimulation (1.8°). Ocular torsion following TMS at SMGp showed no significant change compared to the sham stimulation (-0.1°). Thus, changes in upright perception at SMGp were dissociated from ocular torsion. This finding suggests that perception of upright at SMGp is primarily related to sensory processing for spatial orientation, as opposed to subcortical regions that have direct influence on ocular torsion.

Perception of Upright: Multisensory Convergence and the Role of Temporo-Parietal Cortex

We inherently maintain a stable perception of the world despite frequent changes in the head, eye, and body positions. Such "orientation constancy" is a prerequisite for coherent spatial perception and sensorimotor planning. As a multimodal sensory reference, perception of upright represents neural processes that subserve orientation constancy through integration of sensory information encoding the eye, head, and body positions. Although perception of upright is distinct from perception of body orientation, they share similar neural substrates within the cerebral cortical networks involved in perception of spatial orientation. These cortical networks, mainly within the temporo-parietal junction, are crucial for multisensory processing and integration that generate sensory reference frames for coherent perception of self-position and extrapersonal space transformations. In this review, we focus on these neural mechanisms and discuss (i) neurobehavioral aspects of orientation constancy, (ii) sensory models that address the neurophysiology underlying perception of upright, and (iii) the current evidence for the role of cerebral cortex in perception of upright and orientation constancy, including findings from the neurological disorders that affect cortical function.