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Wuehr M, Peto D, Fietzek UM, Katzdobler S, Nübling G, Zaganjori M, Brendel M, Levin J, Höglinger GU, Zwergal A. Low-intensity vestibular noise stimulation improves postural symptoms in progressive supranuclear palsy. J Neurol 2024; 271:4577-4586. [PMID: 38722328 PMCID: PMC11233287 DOI: 10.1007/s00415-024-12419-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 03/01/2024] [Accepted: 04/29/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Postural imbalance and falls are an early disabling symptom in patients with progressive supranuclear palsy (PSP) of multifactorial origin that may involve abnormal vestibulospinal reflexes. Low-intensity noisy galvanic vestibular stimulation (nGVS) is a non-invasive treatment to normalize deficient vestibular function and attenuate imbalance in Parkinson's disease. The presumed therapeutic mode of nGVS is stochastic resonance (SR), a mechanism by which weak sensory noise stimulation can enhance sensory information processing. OBJECTIVE To examine potential treatment effects of nGVS on postural instability in 16 patients with PSP with a clinically probable and [18F]PI-2620 tau-PET-positive PSP. METHODS Effects of nGVS of varying intensity (0-0.7 mA) on body sway were examined, while patients were standing with eyes closed on a posturographic force plate. We assumed a bell-shaped response curve with maximal sway reductions at intermediate nGVS intensities to be indicative of SR. An established SR-curve model was fitted on individual patient outcomes and three experienced human raters had to judge whether responses to nGVS were consistent with the exhibition of SR. RESULTS We found nGVS-induced reductions of body sway compatible with SR in 9 patients (56%) with optimal improvements of 31 ± 10%. In eight patients (50%), nGVS-induced sway reductions exceeded the minimal clinically important difference (improvement: 34 ± 5%), indicative of strong SR. CONCLUSION nGVS yielded clinically relevant reductions in body sway compatible with the exhibition of SR in vestibular sensorimotor pathways in at least half of the assessed patients. Non-invasive vestibular noise stimulation may be thus a well-tolerated treatment strategy to ameliorate postural symptoms in PSP.
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Affiliation(s)
- Max Wuehr
- German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Daniela Peto
- German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Urban M Fietzek
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
- Schön Klinik München Schwabing, Munich, Germany
- Deutsches Zentrum Für Neurodegenerative Erkrankungen (DZNE) E.V., Munich, Germany
| | - Sabrina Katzdobler
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
- Deutsches Zentrum Für Neurodegenerative Erkrankungen (DZNE) E.V., Munich, Germany
- Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
| | - Georg Nübling
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
- Deutsches Zentrum Für Neurodegenerative Erkrankungen (DZNE) E.V., Munich, Germany
| | - Mirlind Zaganjori
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Matthias Brendel
- Deutsches Zentrum Für Neurodegenerative Erkrankungen (DZNE) E.V., Munich, Germany
- Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Johannes Levin
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
- Deutsches Zentrum Für Neurodegenerative Erkrankungen (DZNE) E.V., Munich, Germany
- Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
| | - Günter U Höglinger
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
- Deutsches Zentrum Für Neurodegenerative Erkrankungen (DZNE) E.V., Munich, Germany
- Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
| | - Andreas Zwergal
- German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
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Xie H, Liang M, Mo Y, Schmidt C, Wang C, Chien JH. 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. Ann Biomed Eng 2024; 52:757-793. [PMID: 38148425 DOI: 10.1007/s10439-023-03425-5] [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] [Received: 07/20/2023] [Accepted: 12/08/2023] [Indexed: 12/28/2023]
Abstract
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.
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Affiliation(s)
- Haoyu Xie
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Meizhen Liang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yujia Mo
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Cindy Schmidt
- Leon S. McGoogan Health Sciences Library, University of Nebraska Medical Center, Omaha, NE, USA
| | - Chuhuai Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.
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Mitsutake T, Sonobe M. Noisy galvanic vestibular stimulation influences head stability in young healthy adults while standing on a moving platform. Gait Posture 2024; 107:177-181. [PMID: 37840004 DOI: 10.1016/j.gaitpost.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 08/29/2023] [Accepted: 09/26/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND The ability to stand with eyes closed on a sinusoidal translational moving platform may be affected by spatial orientation owing to vestibular input information. Moreover, changes in the frequency of the moving platform may affect the sensory reweighting through somatosensory and vestibular sensations. However, it is unclear whether noisy galvanic vestibular stimulation (nGVS), which activates vestibular-related brain regions, affects the stability of individuals standing on a platform moving at different frequencies. RESEARCH QUESTION Do vestibular stimulation by nGVS and changes in the frequency of translationally moving platforms affect the standing stability of individuals? METHODS Thirty-one healthy young adult participants were provided both sham and nGVS interventions while they maintained a static standing position, with their eyes closed, on an anterior-posterior sinusoidal translation platform. The nGVS was adapted to an optimal intensity below the perceptual threshold (frequency band: 100-640 Hz), and the sham stimulus was adapted to 0 µA. The participants were randomly assessed for postural stability at 0.2, 0.6, and 1.2 Hz moving platform frequencies for 80 s each under both stimulus conditions. Postural stability was calculated as the root mean square (RMS) sway from head accelerations in the anteroposterior (AP) and mediolateral (ML) directions for 50 s between 20 and 70 s during the 80 s period, measured using an inertial sensor placed on the external occipital ridge. RESULTS nGVS significantly reduced the RMS sway of head acceleration in the AP direction compared with sham stimulation. Furthermore, nGVS significantly reduced RMS sway in the ML direction compared with sham stimulation at a 1.2 Hz moving platform oscillation. SIGNIFICANCE These findings suggest that postural adjustment by the vestibular system influences head stability on a moving platform at specific sinusoidal translation frequencies, suggesting that nGVS may reduce head sway.
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Affiliation(s)
- Tsubasa Mitsutake
- Department of Physical Therapy, Faculty of Medical Science, Fukuoka International University of Health and Welfare, Fukuoka, Japan.
| | - Motomichi Sonobe
- Department of Intelligent Mechanical Systems Engineering, Kochi University of Technology, Kochi, Japan
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Mitsutake T, Nakazono H, Shiozaki T, Fujita D, Sakamoto M. Changes in vestibular-related responses to combined noisy galvanic vestibular stimulation and cerebellar transcranial direct current stimulation. Exp Brain Res 2024; 242:99-108. [PMID: 37966504 DOI: 10.1007/s00221-023-06731-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/25/2023] [Indexed: 11/16/2023]
Abstract
Vestibular nuclei and cerebellar function comprise vestibular neural networks that control vestibular-related responses. However, the vestibular-related responses to simultaneous stimulation of these regions are unclear. This study aimed to examine whether the combination of noisy galvanic vestibular stimulation (nGVS) and cerebellar transcranial direct current stimulation (ctDCS) using a complex transcranial electrical stimulation device alters vestibular-dominant standing stability and vestibulo-ocular reflex (VOR) function. The center of foot pressure (COP) sway and VOR of participants (28 healthy, young adults) were assessed under four conditions of transcranial electrical stimulation using nGVS and ctDCS. The COP was calculated with the participant standing on a soft-foam surface with eyes closed using a force plate to evaluate body sway. VOR measurements were collected via passive head movements and fixation on a target projected onto the front wall using a video head impulse test (vHIT). VOR gain was calculated in six directions using a semicircular canal structure based on the ratio of eye movement to head movement. The nGVS + ctDCS and nGVS + sham ctDCS conditions decreased COP sway compared to the sham nGVS + ctDCS and sham nGVS + sham ctDCS conditions. No significant differences were observed in the main effect of stimulation or the interaction of stimulation and direction on the vHIT parameters. The results of this study suggest that postural stability may be independently affected by nGVS. Our findings contribute to the basic neurological foundation for the clinical application of neurorehabilitation using transcranial electrical stimulation of the vestibular system.
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Affiliation(s)
- Tsubasa Mitsutake
- Department of Physical Therapy, Faculty of Medical Science, Fukuoka International University of Health and Welfare, 3-6-40 Momochihama, Sawara-Ku, Fukuoka, 814-0001, Japan.
| | - Hisato Nakazono
- Department of Occupational Therapy, Faculty of Medical Science, Fukuoka International University of Health and Welfare, Fukuoka, Japan
| | - Tomoyuki Shiozaki
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Nara, Japan
| | - Daisuke Fujita
- Department of Physical Therapy, Faculty of Medical Science, Fukuoka International University of Health and Welfare, 3-6-40 Momochihama, Sawara-Ku, Fukuoka, 814-0001, Japan
| | - Maiko Sakamoto
- Education and Research Centre for Community Medicine, Faculty of Medicine, Saga University, Saga, Japan
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Jostrup E, Nyström M, Claesdotter-Knutsson E, Tallberg P, Gustafsson P, Paulander O, Söderlund G. Effects of stochastic vestibular stimulation on cognitive performance in children with ADHD. Exp Brain Res 2023; 241:2693-2703. [PMID: 37812230 PMCID: PMC10635964 DOI: 10.1007/s00221-023-06713-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/22/2023] [Indexed: 10/10/2023]
Abstract
Previous work has shown that exposure to auditory white noise (WN) can improve cognitive performance in children with ADHD, but it is unknown whether this improvement generalizes to other sensory modalities. To address this knowledge gap, we tested the effect of Stochastic Vestibular Stimulation (SVS) on cognitive performance and reaction time (RT) variability in two groups: children with ADHD and typically developing children (TDC). Children with ADHD (N=42) and TDC (N=28) performed three cognitive tasks (Spanboard, Word Recall and N-back tasks) at two different occasions, with and without exposure to SVS, in a double blinded design. The results showed no main effects of SVS on neither performance nor RT variability for children in any of the groups, and no interactions between SVS and group. Based on these results we conclude that, using our stimulation protocol, the positive effects of WN exposure on cognition in children with ADHD do not generalize to Stochastic Vestibular Stimulation.
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Affiliation(s)
- Erica Jostrup
- Child and Adolescent Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden.
| | - Marcus Nyström
- Child and Adolescent Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden
- Lund University Humanities Lab, Lund, Sweden
| | - Emma Claesdotter-Knutsson
- Child and Adolescent Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden
- Outpatient Department, Child and Adolescent Psychiatry Clinic, Region Skåne, Lund, Sweden
| | - Pia Tallberg
- Child and Adolescent Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden
- Outpatient Department, Child and Adolescent Psychiatry Clinic, Region Skåne, Lund, Sweden
| | - Peik Gustafsson
- Child and Adolescent Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden
| | | | - Göran Söderlund
- Faculty of Teacher Education Arts and Sports, Western Norway University of Applied Sciences, Sogndal, Norway
- Department of Education and Special Education, University of Gothenburg, Gothenburg, Sweden
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Sherman SO, Greenstein M, Basner M, Clark TK, Anderson AP. Effects of additive sensory noise on cognition. Front Hum Neurosci 2023; 17:1092154. [PMID: 37333835 PMCID: PMC10270290 DOI: 10.3389/fnhum.2023.1092154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 05/15/2023] [Indexed: 06/20/2023] Open
Abstract
Background Adding noise to a system to improve a weak signal's throughput is known as stochastic resonance (SR). SR has been shown to improve sensory perception. Some limited research shows noise can also improve higher order processing, such as working memory, but it is unknown whether SR can broadly improve cognition. Objective We investigated cognitive performance while applying auditory white noise (AWN) and/or noisy galvanic vestibular stimulation (nGVS). Methods We measured cognitive performance (n = 13 subjects) while completing seven tasks in the cognition test battery (CTB). Cognition was assessed with and without the influence of AWN, nGVS, and both simultaneously. Performance in speed, accuracy, and efficiency was observed. A subjective questionnaire regarding preference for working in noisy environments was collected. Results We did not find broad cognitive performance improvement under the influence of noise (p > 0.1). However, a significant interaction was found between subject and noise condition for accuracy (p = 0.023), indicating that some subjects exhibited cognitive changes with the addition of noise. Across all metrics, noisy environment preference may trend to be a potential indicator of whether subjects will exhibit SR cognitive benefits with a significant predictor in efficiency (p = 0.048). Conclusion This study investigated using additive sensory noise to induce SR in overall cognition. Our results suggest that using noise to improve cognition is not applicable for a broad population; however, the effect of noise differs across individuals. Further, subjective questionnaires may be a means to identify which individuals are sensitive to SR cognitive benefits, but further investigation is needed.
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Affiliation(s)
- Sage O. Sherman
- Ann and H.J. Smead Department of Aerospace Engineering Sciences, University of Colorado, Boulder, Boulder, CO, United States
| | - Maya Greenstein
- Ann and H.J. Smead Department of Aerospace Engineering Sciences, University of Colorado, Boulder, Boulder, CO, United States
| | - Mathias Basner
- Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Torin K. Clark
- Ann and H.J. Smead Department of Aerospace Engineering Sciences, University of Colorado, Boulder, Boulder, CO, United States
| | - Allison P. Anderson
- Ann and H.J. Smead Department of Aerospace Engineering Sciences, University of Colorado, Boulder, Boulder, CO, United States
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Lacquaniti F, La Scaleia B, Zago M. Noise and vestibular perception of passive self-motion. Front Neurol 2023; 14:1159242. [PMID: 37181550 PMCID: PMC10169592 DOI: 10.3389/fneur.2023.1159242] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 03/29/2023] [Indexed: 05/16/2023] Open
Abstract
Noise defined as random disturbances is ubiquitous in both the external environment and the nervous system. Depending on the context, noise can degrade or improve information processing and performance. In all cases, it contributes to neural systems dynamics. We review some effects of various sources of noise on the neural processing of self-motion signals at different stages of the vestibular pathways and the resulting perceptual responses. Hair cells in the inner ear reduce the impact of noise by means of mechanical and neural filtering. Hair cells synapse on regular and irregular afferents. Variability of discharge (noise) is low in regular afferents and high in irregular units. The high variability of irregular units provides information about the envelope of naturalistic head motion stimuli. A subset of neurons in the vestibular nuclei and thalamus are optimally tuned to noisy motion stimuli that reproduce the statistics of naturalistic head movements. In the thalamus, variability of neural discharge increases with increasing motion amplitude but saturates at high amplitudes, accounting for behavioral violation of Weber's law. In general, the precision of individual vestibular neurons in encoding head motion is worse than the perceptual precision measured behaviorally. However, the global precision predicted by neural population codes matches the high behavioral precision. The latter is estimated by means of psychometric functions for detection or discrimination of whole-body displacements. Vestibular motion thresholds (inverse of precision) reflect the contribution of intrinsic and extrinsic noise to perception. Vestibular motion thresholds tend to deteriorate progressively after the age of 40 years, possibly due to oxidative stress resulting from high discharge rates and metabolic loads of vestibular afferents. In the elderly, vestibular thresholds correlate with postural stability: the higher the threshold, the greater is the postural imbalance and risk of falling. Experimental application of optimal levels of either galvanic noise or whole-body oscillations can ameliorate vestibular function with a mechanism reminiscent of stochastic resonance. Assessment of vestibular thresholds is diagnostic in several types of vestibulopathies, and vestibular stimulation might be useful in vestibular rehabilitation.
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Affiliation(s)
- Francesco Lacquaniti
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy
- Department of Systems Medicine, Centre of Space Bio-medicine, University of Rome Tor Vergata, Rome, Italy
| | - Barbara La Scaleia
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Myrka Zago
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy
- Department of Civil Engineering and Computer Science Engineering, Centre of Space Bio-medicine, University of Rome Tor Vergata, Rome, Italy
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La Scaleia B, Lacquaniti F, Zago M. Enhancement of Vestibular Motion Discrimination by Small Stochastic Whole-body Perturbations in Young Healthy Humans. Neuroscience 2023; 510:32-48. [PMID: 36535577 DOI: 10.1016/j.neuroscience.2022.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/05/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022]
Abstract
Noisy galvanic vestibular stimulation has been shown to improve vestibular perception in healthy subjects. Here, we sought to obtain similar results using more natural stimuli consisting of small-amplitude motion perturbations of the whole body. Thirty participants were asked to report the perceived direction of antero-posterior sinusoidal motion on a MOOG platform. We compared the baseline perceptual thresholds with those obtained by applying small, stochastic perturbations at different power levels along the antero-posterior axis, symmetrically distributed around a zero-mean. At the population level, we found that the thresholds for all but the highest level of noise were significantly lower than the baseline threshold. At the individual level, the threshold was lower with at least one noise level than the threshold without noise in 87% of participants. Thus, small, stochastic oscillations of the whole body can increase the probability of recognizing the direction of motion from low, normally subthreshold vestibular signals, possibly due to stochastic resonance mechanisms. We suggest that, just as the external noise of the present experiments, also the spontaneous random oscillations of the head and body associated with standing posture are beneficial by enhancing vestibular thresholds with a mechanism similar to stochastic resonance.
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Affiliation(s)
- Barbara La Scaleia
- Laboratory of Visuomotor Control and Gravitational Physiology, IRCCS Fondazione Santa Lucia, 00179 Rome, Italy.
| | - Francesco Lacquaniti
- Laboratory of Neuromotor Physiology, IRCCS Fondazione Santa Lucia, 00179 Rome, Italy; Department of Systems Medicine and Center of Space Biomedicine, University of Rome Tor Vergata, 00133 Rome, Italy.
| | - Myrka Zago
- Laboratory of Visuomotor Control and Gravitational Physiology, IRCCS Fondazione Santa Lucia, 00179 Rome, Italy; Department of Civil Engineering and Computer Science Engineering and Center of Space Biomedicine, University of Rome Tor Vergata, 00133 Rome, Italy.
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McLaren R, Smith PF, Taylor RL, Niazi IK, Taylor D. Scoping out noisy galvanic vestibular stimulation: a review of the parameters used to improve postural control. Front Neurosci 2023; 17:1156796. [PMID: 37205050 PMCID: PMC10187481 DOI: 10.3389/fnins.2023.1156796] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/04/2023] [Indexed: 05/21/2023] Open
Abstract
Objective Noisy galvanic vestibular stimulation (nGVS) has been used to facilitate vestibular function and improve gait and balance in people with poor postural control. The aim of this scoping review is to collate, summarize and report on the nGVS parameters that have been used to augment postural control. Method A systematic scoping review was conducted up to December 2022. Data were extracted and synthesized from 31 eligible studies. Key nGVS parameters were identified, and the importance of these parameters and their influence on postural control evaluated. Results A range of nGVS parameters have been used to augment postural control, including; noise waveform, amplitude, frequency band, duration of stimulation, method of amplitude optimization, size and composition of electrodes and the electrode skin interface. Conclusion Systematic evaluation of the individual parameters that can be manipulated in the nGVS waveform identified that a broad array of settings have been utilized in each parameter across the studies. Choices made around the electrode and electrode-skin interface, as well as the amplitude, frequency band, duration and timing of the waveform are likely to influence the efficacy of nGVS. The ability to draw robust conclusions about the selection of optimal nGVS parameters to improve postural control, is hindered by a lack of studies that directly compare parameter settings or consider the variability in individuals' response to nGVS. We propose a guideline for the accurate reporting of nGVS parameters, as a first step toward establishing standardized stimulation protocols.
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Affiliation(s)
- Ruth McLaren
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
- Eisdell Moore Centre for Hearing and Balance Research, University of Auckland, Auckland, New Zealand
- *Correspondence: Ruth McLaren,
| | - Paul F. Smith
- Eisdell Moore Centre for Hearing and Balance Research, University of Auckland, Auckland, New Zealand
- Department of Pharmacology and Toxicology, School of Biomedical Sciences, The Brain Health Research Centre, University of Otago, Dunedin, New Zealand
| | - Rachael L. Taylor
- Eisdell Moore Centre for Hearing and Balance Research, University of Auckland, Auckland, New Zealand
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Imran Khan Niazi
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
- Centre of Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand
- Centre for Sensory-Motor Interactions, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Denise Taylor
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
- Eisdell Moore Centre for Hearing and Balance Research, University of Auckland, Auckland, New Zealand
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McLaren R, Smith PF, Taylor RL, Ravindran S, Rashid U, Taylor D. Efficacy of nGVS to improve postural stability in people with bilateral vestibulopathy: A systematic review and meta-analysis. Front Neurosci 2022; 16:1010239. [PMID: 36248647 PMCID: PMC9553993 DOI: 10.3389/fnins.2022.1010239] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/24/2022] [Indexed: 11/25/2022] Open
Abstract
Objective Noisy galvanic vestibular stimulation (nGVS) has been used to boost vestibular afferent information to the central nervous system. This has the potential to improve postural control for people for whom vestibular signals are weak, such as in bilateral vestibulopathy (BVP). The aim of this systematic review and meta-analysis is to investigate the evidence for nGVS as a modality to improve postural control in people with BVP. Methods A comprehensive systematic search was conducted of five databases up to July 2022 to find studies applying nGVS to people with BVP, with the aim of improving postural control. Two independent reviewers screened and identified eligible studies, completed a risk of bias evaluation (Cochrane) and extracted relevant data. The standardized mean difference (SMD) based on Hedges' g was calculated as a measure of effect size for the primary outcome measure that best identified postural control, and a forest plot generated. Results Seven studies met the eligibility criteria, with five being suitable for meta-analysis. Meta-analysis revealed a moderate effect in favor of nGVS improving postural control during standing and walking [pooled SMD = 0.47 95% CI (0.25, 0.7)]. nGVS-mediated improvements in postural control were most evident in observations of reduced sway velocity when standing on a firm surface with eyes closed, and in the reduced variability of gait parameters, particularly those measuring lateral stability. Conclusions Coincident nGVS in people with BVP improves postural control during standing and walking. This improvement appears to be context specific, in that vestibular augmentation is most effective in situations where visual inputs are limited, and where reliable context specific proprioceptive cues are available. Further research is warranted investigating additional circumstances in which nGVS improves postural control, including investigating the residual, and sustained effects of nGVS. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=342147, identifier: 342147.
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Affiliation(s)
- Ruth McLaren
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, School of Clinical Science, Auckland University of Technology, Auckland, New Zealand
- *Correspondence: Ruth McLaren
| | - Paul F. Smith
- Department of Pharmacology and Toxicology, School of Biomedical Sciences, The Brain Health Research Centre, University of Otago, Dunedin, New Zealand
- Eisdell Moore Centre for Hearing and Balance Research, University of Auckland, Auckland, New Zealand
| | - Rachael L. Taylor
- Eisdell Moore Centre for Hearing and Balance Research, University of Auckland, Auckland, New Zealand
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Shobika Ravindran
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, School of Clinical Science, Auckland University of Technology, Auckland, New Zealand
| | - Usman Rashid
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, School of Clinical Science, Auckland University of Technology, Auckland, New Zealand
| | - Denise Taylor
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, School of Clinical Science, Auckland University of Technology, Auckland, New Zealand
- Eisdell Moore Centre for Hearing and Balance Research, University of Auckland, Auckland, New Zealand
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Nguyen TT, Kang JJ, Oh SY. Thresholds for vestibular and cutaneous perception and oculomotor response induced by galvanic vestibular stimulation. Front Neurol 2022; 13:955088. [PMID: 36034303 PMCID: PMC9413160 DOI: 10.3389/fneur.2022.955088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 07/18/2022] [Indexed: 12/04/2022] Open
Abstract
Objectives In this study, the specific threshold intensities and response characteristics of galvanic vestibular stimulation (GVS) on vestibular (conscious) and cutaneous (detrimental) perception as well as oculomotor nystagmus (reflex) were determined. Methods The threshold intensities for vestibular and cutaneous perception and oculomotor response induced by GVS were determined in 25 right-handed healthy subjects (32.6 ± 7.2 years of age; 56% female). The subjects were seated upright, and eye movements were recorded while a direct GVS current was applied with paradigms of cathode on the right and anode on the left (CRAL) and also cathode on the left and anode on the right (CLAR). Results Subjects experienced dizziness, sense of spinning, or fall tendency, which was more frequently directed to the cathode (76%) than the anode (24%, p < 0.001, chi-square one-variable test) at mean current greater than 0.98 ± 0.29 mA (mean vestibular threshold). The current also triggered a more frequent mild tingling sensation at the cathode (56%) than the anode (30%) or on both sides (14%; p = 0.001, chi-square one-variable test) when above the mean cutaneous threshold of 0.9 ± 0.29 mA. Above the mean oculomotor threshold of 1.61 ± 0.35 mA, combined horizontal and torsional nystagmus was more frequent toward the cathode (86%) than toward the anode (p < 0.001, chi-square one-variable test). The mean oculomotor threshold was significantly higher than both the vestibular (p < 0.001, Mann–Whitney U-test) and cutaneous (p < 0.001, Mann–Whitney U-test) thresholds, which were comparable (p = 0.317, Mann–Whitney U-test). There was no significant disparity in these specific thresholds between the two GVS paradigms. The vestibular threshold was significantly higher in males than in females [1 (0.5–1.25) mA vs. 0.75 (0.625–1.125) mA, Z = −2.241, p = 0.025, Mann–Whitney U-test]. However, the thresholds of cutaneous perception and oculomotor response did not differ by sex. Conclusion The findings indicate that thresholds for vestibular and somatosensory perception are lower than the oculomotor threshold. Therefore, a strategy to reduce GVS current intensity to the level of vestibular or somatosensory perception threshold could elicit beneficial vestibular effects while avoiding undesirable effects such as oculomotor consequences.
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Affiliation(s)
- Thanh Tin Nguyen
- Jeonbuk National University College of Medicine, Jeonju, South Korea
- Department of Neurology, Jeonbuk National University Hospital and School of Medicine, Jeonju, South Korea
- Department of Pharmacology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Jin-Ju Kang
- Department of Neurology, Jeonbuk National University Hospital and School of Medicine, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - Sun-Young Oh
- Jeonbuk National University College of Medicine, Jeonju, South Korea
- Department of Neurology, Jeonbuk National University Hospital and School of Medicine, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
- *Correspondence: Sun-Young Oh
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12
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Wuehr M, Schmidmeier F, Katzdobler S, Fietzek UM, Levin J, Zwergal A. Effects of Low-Intensity Vestibular Noise Stimulation on Postural Instability in Patients with Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2022; 12:1611-1618. [PMID: 35491798 DOI: 10.3233/jpd-213127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Postural instability is a major disabling factor in patients with advanced Parkinson's disease (PD) and often resistant to treatment. Previous studies indicated that imbalance in PD may be reduced by low-intensity noisy galvanic vestibular stimulation (nGVS). OBJECTIVE To investigate the potential mode of action of this therapeutic effect. In particular, we examined whether nGVS-induced reductions of body sway in PD are compatible with stochastic resonance (SR), a mechanism by which weak sensory noise stimulation can paradoxically enhance sensory information transfer. METHODS Effects of nGVS of varying intensities (0-0.7 mA) on body sway were examined in 15 patients with PD standing with eye closed on a posturographic force plate. We assumed a bell-shaped response curve with maximal reductions of sway at intermediate nGVS intensities to be indicative of SR. An established SR-curve model was fitted on individual patient outcomes and three experienced human raters had to judge whether responses to nGVS were consistent with the exhibition of SR. RESULTS nGVS-induced reductions of body sway compatible with SR were found in 10 patients (67%) with optimal improvements of 23±13%. In 7 patients (47%), nGVS-induced sway reductions exceeded the minimally important clinical difference (optimal improvement: 30±10%), indicative of strong SR. This beneficial effect was more likely in patients with advanced PD (R = 0.45; p = 0.045). CONCLUSIONS At least half of the assessed patients showed robust improvements in postural balance compatible with SR when treated with low-intensity nGVS. In particular, patients with more advanced disease stages and imbalance may benefit from the non-invasive and well-tolerated treatment with nGVS.
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Affiliation(s)
- Max Wuehr
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Florian Schmidmeier
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Sabrina Katzdobler
- Department of Neurology, Ludwig-Maximilians-University of Munich, Munich, Germany.,Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) e.V., Munich, Germany
| | - Urban M Fietzek
- Department of Neurology, Ludwig-Maximilians-University of Munich, Munich, Germany.,Department of Neurology and Clinical Neurophysiology, Schön Klinik München Schwabing, Munich, Germany
| | - Johannes Levin
- Department of Neurology, Ludwig-Maximilians-University of Munich, Munich, Germany.,Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) e.V., Munich, Germany.,Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
| | - Andreas Zwergal
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-University of Munich, Munich, Germany.,Department of Neurology, Ludwig-Maximilians-University of Munich, Munich, Germany
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13
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Putman EJ, Galvan-Garza RC, Clark TK. The Effect of Noisy Galvanic Vestibular Stimulation on Learning of Functional Mobility and Manual Control Nulling Sensorimotor Tasks. Front Hum Neurosci 2021; 15:756674. [PMID: 34803637 PMCID: PMC8595260 DOI: 10.3389/fnhum.2021.756674] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/11/2021] [Indexed: 11/13/2022] Open
Abstract
Galvanic vestibular stimulation (GVS) is a non-invasive method of electrically stimulating the vestibular system. We investigated whether the application of GVS can alter the learning of new functional mobility and manual control tasks and whether learning can be retained following GVS application. In a between-subjects experiment design, 36 healthy subjects performed repeated trials, capturing the learning of either (a) a functional mobility task, navigating an obstacle course on a compliant surface with degraded visual cues or (b) a manual control task, using a joystick to null self-roll tilt against a pseudo-random disturbance while seated in the dark. In the “learning” phase of trials, bilateral, bipolar GVS was applied continuously. The GVS waveform also differed between subjects in each task group: (1) white noisy galvanic vestibular stimulation (nGVS) at 0.3 mA (2) high-level random GVS at 0.7 mA (selected from pilot testing as destabilizing, but not painful), or (3) with the absence of stimulation (i.e., sham). Following the “learning” trials, all subjects were blindly transitioned to sham GVS, upon which they immediately completed another series of trials to assess any aftereffects. In the functional mobility task, we found nGVS significantly improved task learning (p = 0.03, mean learning metric 171% more than the sham group). Further, improvements in learning the functional mobility task with nGVS were retained, even once the GVS application was stopped. The benefits in learning with nGVS were not observed in the manual control task. High level GVS tended to inhibit learning in both tasks, but not significantly so. Even once the high-level stimulation was stopped, the impaired performance remained. Improvements in learning with nGVS may be due to increased information throughput resulting from stochastic resonance. The benefit of nGVS for functional mobility, but not manual control nulling, may be due to the multisensory (e.g., visual and proprioceptive), strategic, motor coordination, or spatial awareness aspects of the former task. Learning improvements with nGVS have the potential to benefit individuals who perform functional mobility tasks, such as astronauts, firefighters, high performance athletes, and soldiers.
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Affiliation(s)
- Esther J Putman
- Ann and H.J. Smead Aerospace Engineering Sciences, University of Colorado, Boulder, Boulder, CO, United States
| | | | - Torin K Clark
- Ann and H.J. Smead Aerospace Engineering Sciences, University of Colorado, Boulder, Boulder, CO, United States
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14
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An Overview of Noninvasive Brain Stimulation: Basic Principles and Clinical Applications. Can J Neurol Sci 2021; 49:479-492. [PMID: 34238393 DOI: 10.1017/cjn.2021.158] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The brain has the innate ability to undergo neuronal plasticity, which refers to changes in its structure and functions in response to continued changes in the environment. Although these concepts are well established in animal slice preparation models, their application to a large number of human subjects could only be achieved using noninvasive brain stimulation (NIBS) techniques. In this review, we discuss the mechanisms of plasticity induction using NIBS techniques including transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), transcranial alternating current stimulation (tACS), random noise stimulation (RNS), transcranial ultrasound stimulation (TUS), vagus nerve stimulation (VNS), and galvanic vestibular stimulation (GVS). We briefly introduce these techniques, explain the stimulation parameters and potential clinical implications. Although their mechanisms are different, all these NIBS techniques can be used to induce plasticity at the systems level, to examine the neurophysiology of brain circuits and have potential therapeutic use in psychiatric and neurological disorders. TMS is the most established technique for the treatment of brain disorders, and repetitive TMS is an approved treatment for medication-resistant depression. Although the data on the clinical utility of the other modes of stimulation are more limited, the electrical stimulation techniques (tDCS, tACS, RNS, VNS, GVS) have the advantage of lower cost, portability, applicability at home, and can readily be combined with training or rehabilitation. Further research is needed to expand the clinical utility of NIBS and test the combination of different modes of NIBS to optimize neuromodulation induced clinical benefits.
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15
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Voros JL, Sherman SO, Rise R, Kryuchkov A, Stine P, Anderson AP, Clark TK. Galvanic Vestibular Stimulation Produces Cross-Modal Improvements in Visual Thresholds. Front Neurosci 2021; 15:640984. [PMID: 33867923 PMCID: PMC8044370 DOI: 10.3389/fnins.2021.640984] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 03/03/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Stochastic resonance (SR) refers to a faint signal being enhanced with the addition of white noise. Previous studies have found that vestibular perceptual thresholds are lowered with noisy galvanic vestibular stimulation (i.e., "in-channel" SR). Auditory white noise has been shown to improve tactile and visual thresholds, suggesting "cross-modal" SR. OBJECTIVE We investigated galvanic vestibular white noise (nGVS) (n = 9 subjects) to determine the cross-modal effects on visual and auditory thresholds. METHODS We measured auditory and visual perceptual thresholds of human subjects across a swath of different nGVS levels in order to determine if some individual-subject determined best nGVS level elicited a reduction in thresholds as compared the no noise condition (sham). RESULTS We found improvement in visual thresholds (by an average of 18%, p = 0.014). Subjects with higher (worse) visual thresholds with no stimulation (sham) improved more than those with lower thresholds (p = 0.04). Auditory thresholds were unchanged by vestibular stimulation. CONCLUSION These results are the first demonstration of cross-modal improvement with galvanic vestibular stimulation, indicating galvanic vestibular white noise can produce cross-modal improvements in some sensory channels, but not all.
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Affiliation(s)
- Jamie L. Voros
- Ann & H.J. Smead Department of Aerospace Engineering Sciences, University of Colorado-Boulder, Boulder, CO, United States
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16
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Valdés BA, Lajoie K, Marigold DS, Menon C. Cortical Effects of Noisy Galvanic Vestibular Stimulation Using Functional Near-Infrared Spectroscopy. SENSORS 2021; 21:s21041476. [PMID: 33672519 PMCID: PMC7923808 DOI: 10.3390/s21041476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/03/2021] [Accepted: 02/16/2021] [Indexed: 11/25/2022]
Abstract
Noisy galvanic vestibular stimulation (nGVS) can improve different motor, sensory, and cognitive behaviors. However, it is unclear how this stimulation affects brain activity to facilitate these improvements. Functional near-infrared spectroscopy (fNIRS) is inexpensive, portable, and less prone to motion artifacts than other neuroimaging technology. Thus, fNIRS has the potential to provide insight into how nGVS affects cortical activity during a variety of natural behaviors. Here we sought to: (1) determine if fNIRS can detect cortical changes in oxygenated (HbO) and deoxygenated (HbR) hemoglobin with application of subthreshold nGVS, and (2) determine how subthreshold nGVS affects this fNIRS-derived hemodynamic response. A total of twelve healthy participants received nGVS and sham stimulation during a seated, resting-state paradigm. To determine whether nGVS altered activity in select cortical regions of interest (BA40, BA39), we compared differences between nGVS and sham HbO and HbR concentrations. We found a greater HbR response during nGVS compared to sham stimulation in left BA40, a region previously associated with vestibular processing, and with all left hemisphere channels combined (p < 0.05). We did not detect differences in HbO responses for any region during nGVS (p > 0.05). Our results suggest that fNIRS may be suitable for understanding the cortical effects of nGVS.
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Affiliation(s)
- Bulmaro A. Valdés
- Menrva Research Group, Schools of Mechatronic Systems and Engineering Science, Simon Fraser University, 250-13450 102nd Avenue, Surrey, BC V5A 1S6, Canada; (B.A.V.); (K.L.)
| | - Kim Lajoie
- Menrva Research Group, Schools of Mechatronic Systems and Engineering Science, Simon Fraser University, 250-13450 102nd Avenue, Surrey, BC V5A 1S6, Canada; (B.A.V.); (K.L.)
| | - Daniel S. Marigold
- Sensorimotor Neuroscience Lab, Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada;
| | - Carlo Menon
- Menrva Research Group, Schools of Mechatronic Systems and Engineering Science, Simon Fraser University, 250-13450 102nd Avenue, Surrey, BC V5A 1S6, Canada; (B.A.V.); (K.L.)
- Biomedical and Mobile Health Technology Laboratory, Department of Health Sciences and Technology, ETH Zurich, 8008 Zurich, Switzerland
- Correspondence:
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17
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Chen PY, Jheng YC, Wang CC, Huang SE, Yang TH, Hsu PC, Kuo CH, Lin YY, Lai WY, Kao CL. Effect of noisy galvanic vestibular stimulation on dynamic posture sway under visual deprivation in patients with bilateral vestibular hypofunction. Sci Rep 2021; 11:4229. [PMID: 33608568 PMCID: PMC7896086 DOI: 10.1038/s41598-021-83206-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/27/2021] [Indexed: 01/31/2023] Open
Abstract
A single-blind study to investigate the effects of noisy galvanic vestibular stimulation (nGVS) in straight walking and 2 Hz head yaw walking for healthy and bilateral vestibular hypofunction (BVH) participants in light and dark conditions. The optimal stimulation intensity for each participant was determined by calculating standing stability on a force plate while randomly applying six graded nGVS intensities (0-1000 µA). The chest-pelvic (C/P) ratio and lateral deviation of the center of mass (COM) were measured by motion capture during straight and 2 Hz head yaw walking in light and dark conditions. Participants were blinded to nGVS served randomly and imperceivably. Ten BVH patients and 16 healthy participants completed all trials. In the light condition, the COM lateral deviation significantly decreased only in straight walking (p = 0.037) with nGVS for the BVH. In the dark condition, both healthy (p = 0.026) and BVH (p = 0.017) exhibited decreased lateral deviation during nGVS. The C/P ratio decreased significantly in BVH for 2 Hz head yaw walking with nGVS (p = 0.005) in light conditions. This study demonstrated that nGVS effectively reduced walking deviations, especially in visual deprived condition for the BVH. Applying nGVS with different head rotation frequencies and light exposure levels may accelerate the rehabilitation process for patients with BVH.Clinical Trial Registration This clinical trial was prospectively registered at www.clinicaltrials.gov with the Unique identifier: NCT03554941. Date of registration: (13/06/2018).
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Affiliation(s)
- Po-Yin Chen
- Department of Physical Therapy and Assistive Technology, National Yang-Ming Chiao-Tung University, Taipei, 11221, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, 11217, Taiwan
- School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, 11221, Taiwan
| | - Ying-Chun Jheng
- Department of Physical Therapy and Assistive Technology, National Yang-Ming Chiao-Tung University, Taipei, 11221, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, 11217, Taiwan
- School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, 11221, Taiwan
| | - Chien-Chih Wang
- School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, 11221, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital Yuli Branch, Hualien, 98142, Taiwan
| | - Shih-En Huang
- Department of Physical Therapy and Assistive Technology, National Yang-Ming Chiao-Tung University, Taipei, 11221, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, 11217, Taiwan
- School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, 11221, Taiwan
| | - Ting-Hua Yang
- Department of Otolaryngology, College of Medicine, National Taiwan University, Taipei, 106216, Taiwan
| | - Po-Cheng Hsu
- Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, 10845, Taiwan
| | - Chia-Hua Kuo
- Department of Sports Sciences, University of Taipei, Taipei, 11153, Taiwan
| | - Yi-Ying Lin
- School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, 11221, Taiwan
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, 11217, Taiwan
| | - Wei-Yi Lai
- School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, 11221, Taiwan
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, 11217, Taiwan
| | - Chung-Lan Kao
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, 11217, Taiwan.
- School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, 11221, Taiwan.
- Center for Intelligent Drug Systems and Smart Bio-Devices (IDS2B), National Yang-Ming Chiao-Tung University, Hsinchu, 30093, Taiwan.
- Institute of Clinical Medicine, National Yang-Ming Chiao-Tung University, Taipei, 11221, Taiwan.
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18
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Lajoie K, Marigold DS, Valdés BA, Menon C. The potential of noisy galvanic vestibular stimulation for optimizing and assisting human performance. Neuropsychologia 2021; 152:107751. [PMID: 33434573 DOI: 10.1016/j.neuropsychologia.2021.107751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 12/17/2022]
Abstract
Noisy galvanic vestibular stimulation (nGVS) is an emerging non-invasive brain stimulation technique. It involves applying alternating currents of different frequencies and amplitudes presented in a random, or noisy, manner through electrodes on the mastoid bones behind the ears. Because it directly activates vestibular hair cells and afferents and has an indirect effect on a variety of brain regions, it has the potential to impact many different functions. The objective of this review is twofold: (1) to review how nGVS affects motor, sensory, and cognitive performance in healthy adults; and (2) to discuss potential clinical applications of nGVS. First, we introduce the technique. We then describe the regions receiving and processing vestibular information. Next, we discuss the effects of nGVS on motor, sensory, and cognitive function in healthy adults. Subsequently, we outline its potential clinical applications. Finally, we highlight other electrical stimulation technologies and discuss why nGVS offers an alternative or complementary approach. Overall, nGVS appears promising for optimizing human performance and as an assistive technology, though further research is required.
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Affiliation(s)
- Kim Lajoie
- Menrva Research Group, Schools of Mechatronic Systems Engineering and Engineering Science, Simon Fraser University, Metro Vancouver, BC, Canada
| | - Daniel S Marigold
- Sensorimotor Neuroscience Lab, Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada.
| | - Bulmaro A Valdés
- Menrva Research Group, Schools of Mechatronic Systems Engineering and Engineering Science, Simon Fraser University, Metro Vancouver, BC, Canada
| | - Carlo Menon
- Menrva Research Group, Schools of Mechatronic Systems Engineering and Engineering Science, Simon Fraser University, Metro Vancouver, BC, Canada.
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19
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Choudhury S, Singh R, Shobhana A, Sen D, Anand SS, Shubham S, Gangopadhyay S, Baker MR, Kumar H, Baker SN. A Novel Wearable Device for Motor Recovery of Hand Function in Chronic Stroke Survivors. Neurorehabil Neural Repair 2020; 34:600-608. [PMID: 32452275 PMCID: PMC8207486 DOI: 10.1177/1545968320926162] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. In monkey, reticulospinal connections to hand and forearm muscles are spontaneously strengthened following corticospinal lesions, likely contributing to recovery of function. In healthy humans, pairing auditory clicks with electrical stimulation of a muscle induces plastic changes in motor pathways (probably including the reticulospinal tract), with features reminiscent of spike-timing dependent plasticity. In this study, we tested whether pairing clicks with muscle stimulation could improve hand function in chronic stroke survivors. Methods. Clicks were delivered via a miniature earpiece; transcutaneous electrical stimuli at motor threshold targeted forearm extensor muscles. A wearable electronic device (WD) allowed patients to receive stimulation at home while performing normal daily activities. A total of 95 patients >6 months poststroke were randomized to 3 groups: WD with shock paired 12 ms before click; WD with clicks and shocks delivered independently; standard care. Those allocated to the device used it for at least 4 h/d, every day for 4 weeks. Upper-limb function was assessed at baseline and weeks 2, 4, and 8 using the Action Research Arm Test (ARAT), which has 4 subdomains (Grasp, Grip, Pinch, and Gross). Results. Severity across the 3 groups was comparable at baseline. Only the paired stimulation group showed significant improvement in total ARAT (median baseline: 7.5; week 8: 11.5; P = .019) and the Grasp subscore (median baseline: 1; week 8: 4; P = .004). Conclusion. A wearable device delivering paired clicks and shocks over 4 weeks can produce a small but significant improvement in upper-limb function in stroke survivors.
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Affiliation(s)
| | - Ravi Singh
- Institute of Neurosciences, Kolkata, West Bengal, India
| | - A Shobhana
- Institute of Neurosciences, Kolkata, West Bengal, India
| | - Dwaipayan Sen
- Institute of Neurosciences, Kolkata, West Bengal, India
| | | | | | | | - Mark R Baker
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK.,Royal Victoria Infirmary, Newcastle upon Tyne, Tyne and Wear, UK
| | | | - Stuart N Baker
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
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20
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Impact of galvanic vestibular stimulation-induced stochastic resonance on the output of the vestibular system: A systematic review. Brain Stimul 2020; 13:533-535. [DOI: 10.1016/j.brs.2020.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 11/21/2022] Open
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21
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Piccolo C, Bakkum A, Marigold DS. Subthreshold stochastic vestibular stimulation affects balance-challenged standing and walking. PLoS One 2020; 15:e0231334. [PMID: 32275736 PMCID: PMC7147773 DOI: 10.1371/journal.pone.0231334] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/20/2020] [Indexed: 11/19/2022] Open
Abstract
Subthreshold stochastic vestibular stimulation (SVS) is thought to enhance vestibular sensitivity and improve balance. However, it is unclear how SVS affects standing and walking when balance is challenged, particularly when the eyes are open. It is also unclear how different methods to determine stimulation intensity influence the effects. We aimed to determine (1) whether SVS affects stability when balance is challenged during eyes-open standing and overground walking tasks, and (2) how the effects differ based on whether optimal stimulation amplitude is derived from sinusoidal or cutaneous threshold techniques. Thirteen healthy adults performed balance-unchallenged and balance-challenged standing and walking tasks with SVS (0–30 Hz zero-mean, white noise electrical stimulus) or sham stimulation. For the balance-challenged condition, participants had inflatable rubber hemispheres attached to the bottom of their shoes to reduce the control provided by moving the center of pressure under their base of support. In different blocks of trials, we set SVS intensity to either 50% of participants’ sinusoidal (motion) threshold or 80% of participants’ cutaneous threshold. SVS reduced medial-lateral trunk velocity root mean square in the balance-challenged (p < 0.05) but not in the balance-unchallenged condition during standing. Regardless of condition, SVS decreased step-width variability and marginally increased gait speed when walking with the eyes open (p < 0.05). SVS intensity had minimal effect on the standing and walking measures. Taken together, our results provide insight into the effectiveness of SVS at improving balance-challenged, eyes-open standing and walking performance in healthy adults.
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Affiliation(s)
- Chiara Piccolo
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Amanda Bakkum
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Daniel S. Marigold
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
- * E-mail:
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22
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Dixon JB, Clark TK. Sensorimotor impairment from a new analog of spaceflight-altered neurovestibular cues. J Neurophysiol 2020; 123:209-223. [PMID: 31747329 DOI: 10.1152/jn.00156.2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Exposure to microgravity during spaceflight causes central reinterpretations of orientation sensory cues in astronauts, leading to sensorimotor impairment upon return to Earth. Currently there is no ground-based analog for the neurovestibular system relevant to spaceflight. We propose such an analog, which we term the "wheelchair head-immobilization paradigm" (WHIP). Subjects lie on their side on a bed fixed to a modified electric wheelchair, with their head restrained by a custom facemask. WHIP prevents any head tilt relative to gravity, which normally produces coupled stimulation to the otoliths and semicircular canals, but does not occur in microgravity. Decoupled stimulation is produced through translation and rotation on the wheelchair by the subject using a joystick. Following 12 h of WHIP exposure, subjects systematically felt illusory sensations of self-motion when making head tilts and had significant decrements in balance and locomotion function using tasks similar to those assessed in astronauts postspaceflight. These effects were not observed in our control groups without head restraint, suggesting the altered neurovestibular stimulation patterns experienced in WHIP lead to relevant central reinterpretations. We conclude by discussing the findings in light of postspaceflight sensorimotor impairment, WHIP's uses beyond a spaceflight analog, limitations, and future work.NEW & NOTEWORTHY We propose, implement, and demonstrate the feasibility of a new analog for spaceflight-altered neurovestibular stimulation. Following extended exposure to the analog, we found subjects reported illusory self-motion perception. Furthermore, they demonstrated decrements in balance and locomotion, using tasks similar to those used to assess astronaut sensorimotor performance postspaceflight.
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Affiliation(s)
- Jordan B Dixon
- Smead Aerospace Engineering Sciences, University of Colorado, Boulder, Colorado
| | - Torin K Clark
- Smead Aerospace Engineering Sciences, University of Colorado, Boulder, Colorado
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Samoudi G, Nilsson A, Carlsson T, Bergquist F. c-Fos Expression after Stochastic Vestibular Stimulation and Levodopa in 6-OHDA Hemilesioned Rats. Neuroscience 2020; 424:146-154. [DOI: 10.1016/j.neuroscience.2019.10.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 11/25/2022]
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Noisy galvanic vestibular stimulation has a greater ameliorating effect on posture in unstable subjects: a feasibility study. Sci Rep 2019; 9:17189. [PMID: 31748596 PMCID: PMC6868214 DOI: 10.1038/s41598-019-53834-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 11/04/2019] [Indexed: 01/28/2023] Open
Abstract
Ameliorating effect of noisy galvanic vestibular stimulation (nGVS) on posture varies among subjects. In this feasibility study, we investigated the association between original postural instability and the ameliorating effect of nGVS on posture. Data were collected in a previously published study. Thirty healthy elderly were recruited. Two nGVS sessions (30 min or 3 h) were performed in a randomised order. The optimal intensity of nGVS, the most effective intensity for improving posture, was determined before each session. Posture was measured for 30 s during and after nGVS in the eyes-closed/foam rubber condition. The velocity, envelopment area, and root mean square of the centre of pressure movement without nGVS were significantly larger in the group with an optimal intensity than those in the group without an optimal intensity. There was a significant positive correlation between these values and the long-term ameliorating effects. The ratio of the values in the eyes-closed/foam rubber condition to those in the eyes-open condition was significantly larger in the group with an optimal intensity, and had a significant correlation with the long-term ameliorating effects. The ameliorating effects are greater in subjects who were originally unstable and in those whose postural stability was relatively independent of vestibular input.
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Sluydts M, Curthoys I, Vanspauwen R, Papsin BC, Cushing SL, Ramos A, Ramos de Miguel A, Borkoski Barreiro S, Barbara M, Manrique M, Zarowski A. Electrical Vestibular Stimulation in Humans: A Narrative Review. Audiol Neurootol 2019; 25:6-24. [PMID: 31533097 DOI: 10.1159/000502407] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/29/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND In patients with bilateral vestibulopathy, the regular treatment options, such as medication, surgery, and/or vestibular rehabilitation, do not always suffice. Therefore, the focus in this field of vestibular research shifted to electrical vestibular stimulation (EVS) and the development of a system capable of artificially restoring the vestibular function. Key Message: Currently, three approaches are being investigated: vestibular co-stimulation with a cochlear implant (CI), EVS with a vestibular implant (VI), and galvanic vestibular stimulation (GVS). All three applications show promising results but due to conceptual differences and the experimental state, a consensus on which application is the most ideal for which type of patient is still missing. SUMMARY Vestibular co-stimulation with a CI is based on "spread of excitation," which is a phenomenon that occurs when the currents from the CI spread to the surrounding structures and stimulate them. It has been shown that CI activation can indeed result in stimulation of the vestibular structures. Therefore, the question was raised whether vestibular co-stimulation can be functionally used in patients with bilateral vestibulopathy. A more direct vestibular stimulation method can be accomplished by implantation and activation of a VI. The concept of the VI is based on the technology and principles of the CI. Different VI prototypes are currently being evaluated regarding feasibility and functionality. So far, all of them were capable of activating different types of vestibular reflexes. A third stimulation method is GVS, which requires the use of surface electrodes instead of an implanted electrode array. However, as the currents are sent through the skull from one mastoid to the other, GVS is rather unspecific. It should be mentioned though, that the reported spread of excitation in both CI and VI use also seems to induce a more unspecific stimulation. Although all three applications of EVS were shown to be effective, it has yet to be defined which option is more desirable based on applicability and efficiency. It is possible and even likely that there is a place for all three approaches, given the diversity of the patient population who serves to gain from such technologies.
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Affiliation(s)
- Morgana Sluydts
- European Institute for Otorhinolaryngology, GZA Hospitals Antwerp, Wilrijk, Belgium,
| | - Ian Curthoys
- Vestibular Research Laboratory, University of Sydney, Sydney, New South Wales, Australia
| | - Robby Vanspauwen
- European Institute for Otorhinolaryngology, GZA Hospitals Antwerp, Wilrijk, Belgium
| | - Blake Croll Papsin
- Department of Otolaryngology - Head and Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sharon Lynn Cushing
- Department of Otolaryngology - Head and Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Angel Ramos
- Hearing Loss Unit, Otorhinolaryngology, Head and Neck Department, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas of Gran Canaria, Spain
| | - Angel Ramos de Miguel
- Hearing Loss Unit, Otorhinolaryngology, Head and Neck Department, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas of Gran Canaria, Spain
| | - Silvia Borkoski Barreiro
- Hearing Loss Unit, Otorhinolaryngology, Head and Neck Department, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas of Gran Canaria, Spain
| | | | - Manuel Manrique
- Otorhinolaryngology Department, Clinica Universidad de Navarra, Pamplona, Spain
| | - Andrzej Zarowski
- European Institute for Otorhinolaryngology, GZA Hospitals Antwerp, Wilrijk, Belgium
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Abstract
Purpose of review Bilateral vestibular deficits exist and their prevalence is more important than believed by the medical community. Their severe impact has inspired several teams to develop technical solutions in an attempt to rehabilitate patients. A particularly promising pathway is the vestibular implant. This article describes the main milestones in this field, mainly focusing on work conducted in human patients. Recent findings There have been substantial research efforts, first in animals and more recently in humans, toward the development of vestibular implants. Humans have demonstrated surprising adaptation capabilities to the artificial vestibular signal. Today, the possibility of restoring vestibular reflexes, particularly the vestibulo-ocular reflex, and even achieving useful function in close-to-reality tasks (i.e. improving visual abilities while walking) have been demonstrated in humans. Summary The vestibular implant opens new perspectives, not only as an effective therapeutic tool, but also pushes us to go beyond current knowledge and well-established clinical concepts.
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Kuatsjah E, Khoshnam M, Menon C. Investigation on the effect of noisy galvanic vestibular stimulation on fine motor skills during a visuomotor task in healthy participants. PLoS One 2019; 14:e0216214. [PMID: 31048906 PMCID: PMC6497271 DOI: 10.1371/journal.pone.0216214] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 04/16/2019] [Indexed: 11/24/2022] Open
Abstract
Noisy galvanic vestibular stimulation (nGVS) has been shown to improve dynamic walking stability, affect postural responses, enhance balance in healthy subjects, and influence motor performance in individuals with Parkinson’s disease. Although the studies to fully characterize the effect of nGVS are still ongoing, stochastic resonance theory which states that the addition of noisy signal may enhance a weak sensory input signals transmission in a non-linear system may provide a possible explanation for the observed positive effects of nGVS. This study explores the effect of nGVS on fine tracking behavior in healthy subjects. Ten healthy participants performed a computer-based visuomotor task by controlling an object with a joystick to follow an amplitude-modulated signal path while simultaneously receiving a sham or pink noise nGVS. The stimulation was generated to have a zero-mean, linearly detrended 1/f-type power spectrum, Gaussian distribution within 0.1–10 Hz range, and a standard deviation (SD) set to 90% based on each participant’s cutaneous threshold value. Results show that simultaneous nGVS delivery statistically improved the tracking performance with a decreased root-mean-squared error of 5.71±6.20% (mean±SD), a decreased time delay of 11.88±9.66% (mean±SD), and an increased signal-to-noise ratio of 2.93% (median, interquartile range (IQR) 3.31%). This study showed evidence that nGVS may be beneficial in improving sensorimotor performance during a fine motor tracking task requiring fine wrist movement in healthy subjects. Further research with a more comprehensive subset of tasks is required to fully characterize the effects of nGVS on fine motor skills.
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Affiliation(s)
- Eunice Kuatsjah
- Menrva Research Group, Schools of Mechatronic Systems Engineering and Engineering Science, Simon Fraser University, Metro Vancouver, British Columbia, Canada
| | - Mahta Khoshnam
- Menrva Research Group, Schools of Mechatronic Systems Engineering and Engineering Science, Simon Fraser University, Metro Vancouver, British Columbia, Canada
| | - Carlo Menon
- Menrva Research Group, Schools of Mechatronic Systems Engineering and Engineering Science, Simon Fraser University, Metro Vancouver, British Columbia, Canada
- * E-mail:
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Keywan A, Jahn K, Wuehr M. Noisy Galvanic Vestibular Stimulation Primarily Affects Otolith-Mediated Motion Perception. Neuroscience 2019; 399:161-166. [DOI: 10.1016/j.neuroscience.2018.12.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 10/27/2022]
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Nobusako S, Osumi M, Matsuo A, Fukuchi T, Nakai A, Zama T, Shimada S, Morioka S. Stochastic resonance improves visuomotor temporal integration in healthy young adults. PLoS One 2018; 13:e0209382. [PMID: 30550570 PMCID: PMC6294379 DOI: 10.1371/journal.pone.0209382] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 12/04/2018] [Indexed: 01/28/2023] Open
Abstract
Mechanical and electrical noise stimulation to the body is known to improve the sensorimotor system. This improvement is related to stochastic resonance (SR), a phenomenon described as a "noise benefit" to various sensory and motor systems. The current study investigated the influence of SR on visuomotor temporal integration and hand motor function under delayed visual feedback in healthy young adults. The purpose of this study was to measure the usefulness of SR as a neurorehabilitation device for disorders of visuomotor temporal integration. Thirty healthy volunteers underwent detection tasks and hand motor function tests under delayed visual feedback, with or without SR. Of the 30 participants, 15 carried out the tasks under delayed visual feedback in the order of SR on-condition, off-condition, off-condition, and on-condition. The remaining 15 participants conducted the experimental tasks in the order of SR off-condition, on-condition, on-condition, and off-condition. Comparisons of the delay detection threshold (DDT), steepness of the delay detection probability curves, box and block test (BBT) scores, and nine-hole peg test (NHPT) scores between the SR on- and off-conditions were performed. The DDT under the SR on-condition was significantly shortened compared with the SR off-condition. There was no significant difference between the SR on- and off-conditions for the steepness of the delay detection probability curves, BBT scores, and NHPT scores. SR improved visuomotor temporal integration in healthy young adults, and may therefore improve movement disorders in patients with impaired visuomotor temporal integration. However, because the current results showed that SR did not improve hand motor function under delayed visual feedback, it may not improve motor function when a large distortion of visuomotor temporal integration is present. Further studies are required considering several limitations of the current study, and future clinical trials are necessary to verify the effects of motor training using SR for the treatment of visuomotor temporal integration disorders.
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Affiliation(s)
- Satoshi Nobusako
- Neurorehabilitation Research Center, Kio University, Nara, Japan
- Graduate School of Health Science, Kio University, Nara, Japan
- * E-mail:
| | - Michihiro Osumi
- Neurorehabilitation Research Center, Kio University, Nara, Japan
- Graduate School of Health Science, Kio University, Nara, Japan
| | - Atsushi Matsuo
- Neurorehabilitation Research Center, Kio University, Nara, Japan
- Graduate School of Health Science, Kio University, Nara, Japan
- Department of Physical Therapy, Faculty of Health Sciences, Kio University, Nara, Japan
| | | | - Akio Nakai
- Graduate School of Clinical Education & The Center for the Study of Child Development, Institute for Education, Mukogawa Women’s University, Hyogo, Japan
| | - Takuro Zama
- Rhythm-Based Brain Information Processing Unit, RIKEN CBS-TOYOTA Collaboration Center, RIKEN Center for Brain Science, Saitama, Japan
| | - Sotaro Shimada
- Department of Electronics and Bioinformatics School of Science and Technology, Meiji University, Kanagawa, Japan
| | - Shu Morioka
- Neurorehabilitation Research Center, Kio University, Nara, Japan
- Graduate School of Health Science, Kio University, Nara, Japan
- Department of Physical Therapy, Faculty of Health Sciences, Kio University, Nara, Japan
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Fujimoto C, Egami N, Kawahara T, Uemura Y, Yamamoto Y, Yamasoba T, Iwasaki S. Noisy Galvanic Vestibular Stimulation Sustainably Improves Posture in Bilateral Vestibulopathy. Front Neurol 2018; 9:900. [PMID: 30405522 PMCID: PMC6204397 DOI: 10.3389/fneur.2018.00900] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/03/2018] [Indexed: 11/26/2022] Open
Abstract
Patients with bilateral vestibulopathy (BV) suffer from persistent postural imbalance, leading to a marked decrease in quality of life and a higher risk of falls. However, so far, the effective treatments for BV are very limited. We examined whether long-term noisy galvanic vestibular stimulation (nGVS) keeps improving body balance after the cessation of the stimulus in BV patients. Thirteen BV patients received nGVS for 30 min with a lower intensity than the intensity at which they feel any cutaneous sensations, and their postural movement was monitored for 6 h after the stimuli. The same session was repeated at 14-day intervals. Stance tasks on two legs were performed with eyes closed. The velocity of the center of pressure (COP) movement, the area enclosed by the COP movement, and the root mean square of the displacement of the COP were measured. The power spectrum of the COP movement was assessed. Subjective improvement of body balance was graded as worsened (−2), slightly worsened (−1), unchanged (0), slightly improved (+1) and improved (+2) in comparison with that without nGVS. In each session, the velocity of the COP movement was significantly improved for 6 h after the stimulus had ceased (P < 0.01). Concomitantly, the mean frequency of the COP power spectrum was significantly reduced in the anterior-posterior axis (P < 0.05). Subjective symptoms of imbalance were improved during the post-stimulation effect (P < 0.05). nGVS leads to an improvement in body balance that lasts for several hours after the end of the stimulus in BV patients with a reduction in the high-frequency components of their postural movement. This trial was registered with the University Hospital Medical Information Network (UMIN) Clinical Trials Registry (UMINCTR: UMIN000028054).
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Affiliation(s)
- Chisato Fujimoto
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Naoya Egami
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Takuya Kawahara
- Biostatistics Division, Clinical Research Support Center, University of Tokyo Hospital, Tokyo, Japan
| | - Yukari Uemura
- Biostatistics Division, Clinical Research Support Center, University of Tokyo Hospital, Tokyo, Japan
| | - Yoshiharu Yamamoto
- Educational Physiology Laboratory, Graduate School of Education, University of Tokyo, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Shinichi Iwasaki
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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Goel R, Rosenberg MJ, Cohen HS, Bloomberg JJ, Mulavara AP. Calibrating balance perturbation using electrical stimulation of the vestibular system. J Neurosci Methods 2018; 311:193-199. [PMID: 30339880 DOI: 10.1016/j.jneumeth.2018.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 09/19/2018] [Accepted: 10/10/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Supra-threshold galvanic vestibular stimulation (GVS) can be used to challenge the balance control system by disrupting vestibular inputs. The goal of this study was to propose an objective method to assess variability across subjects in the minimum safe GVS level that causes maximum balance degradation. New method: Thirteen healthy young subjects stood on a compliant foam surface with their eyes closed and tried to maintain a stable upright stance. Variables related to the stability of the trunk and whole body were quantified to characterize the relationship between postural responses and GVS at amplitudes from 0 to 4.5 mA in 0.5 mA increments. The relationship between decrements in postural responses and GVS was linear up to a minimum GVS level (called KNEE). An increase in the stimulation level above that did not lead to any further degradation of balance performance. The KNEE was determined by iteratively performing linear fits to the performance measure at different stimulation levels. RESULTS There were individual differences in KNEE; it was in the range of 1-2.5 mA across subjects. GVS caused an average performance decrement of 27-99% across six variables at the KNEE level compared to a no-stimulus condition. Comparison to existing methods: We propose a method to consistently attain the maximum level of impairment across subjects using the minimum current intensity, to minimize all types of adverse effects usually observed at high intensities. CONCLUSIONS Individual differences in the disruption of posture control in response to GVS have important implications for testing and training paradigms.
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Affiliation(s)
- R Goel
- University of Houston, Houston, TX, United States
| | - M J Rosenberg
- Baylor College of Medicine, Houston, TX, United States
| | - H S Cohen
- Baylor College of Medicine, Houston, TX, United States
| | - J J Bloomberg
- NASA Johnson Space Center, Houston, TX, United States
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Koppelmans V, Scott JM, Downs ME, Cassady KE, Yuan P, Pasternak O, Wood SJ, De Dios YE, Gadd NE, Kofman I, Riascos R, Reuter-Lorenz PA, Bloomberg JJ, Mulavara AP, Ploutz-Snyder LL, Seidler RD. Exercise effects on bed rest-induced brain changes. PLoS One 2018; 13:e0205515. [PMID: 30308004 PMCID: PMC6181401 DOI: 10.1371/journal.pone.0205515] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 09/26/2018] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Spaceflight negatively affects sensorimotor behavior; exercise mitigates some of these effects. Head down tilt bed rest (HDBR) induces body unloading and fluid shifts, and is often used to investigate spaceflight effects. Here, we examined whether exercise mitigates effects of 70 days HDBR on the brain and if fitness and brain changes with HDBR are related. METHODS HDBR subjects were randomized to no-exercise (n = 5) or traditional aerobic and resistance exercise (n = 5). Additionally, a flywheel exercise group was included (n = 8). Exercise protocols for exercise groups were similar in intensity, therefore these groups were pooled in statistical analyses. Pre and post-HDBR MRI (structure and structural/functional connectivity) and physical fitness measures (lower body strength, muscle cross sectional area, VO2 max, body composition) were collected. Voxel-wise permutation analyses were used to test group differences in brain changes, and their associations with fitness changes. RESULTS Comparisons of exercisers to controls revealed that exercise led to smaller fitness deterioration with HDBR but did not affect brain volume or connectivity. Group comparisons showed that exercise modulated post-HDBR recovery of brain connectivity in somatosensory regions. Posthoc analysis showed that this was related to functional connectivity decrease with HDBR in non-exercisers but not in exercisers. Correlational analyses between fitness and brain changes showed that fitness decreases were associated with functional connectivity and volumetric increases (all r >.74), potentially reflecting compensation. Modest brain changes or even decreases in connectivity and volume were observed in subjects who maintained or showed small fitness gains. These results did not survive Bonferroni correction, but can be considered meaningful because of the large effect sizes. CONCLUSION Exercise performed during HDBR mitigates declines in fitness and strength. Associations between fitness and brain connectivity and volume changes, although unadjusted for multiple comparisons in this small sample, suggest that supine exercise reduces compensatory HDBR-induced brain changes.
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Affiliation(s)
- Vincent Koppelmans
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Psychiatry, University of Utah, Salt Lake City, Utah, United States of America
| | - Jessica M. Scott
- Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
- Universities Space Research Association, NASA Johnson Space Center, Houston, Texas, United States of America
| | | | - Kaitlin E. Cassady
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Peng Yuan
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Ofer Pasternak
- Department of Psychiatry and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Scott J. Wood
- NASA Johnson Space Center, Houston, Texas, United States of America
| | | | | | - Igor Kofman
- KBRwyle, Houston, Texas, United States of America
| | - Roy Riascos
- The University of Texas Health Science Center, Houston, Texas, United States of America
| | - Patricia A. Reuter-Lorenz
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, United States of America
- Neuroscience Program, University of Michigan, Ann Arbor, Michigan, United States of America
| | | | | | - Lori L. Ploutz-Snyder
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, United States of America
- Universities Space Research Association, NASA Johnson Space Center, Houston, Texas, United States of America
| | - Rachael D. Seidler
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Applied Physiology & Kinesiology, University of Florida, Gainesville, Florida, United States of America
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Subthreshold stochastic vestibular stimulation induces complex multi-planar effects during standing in Parkinson's disease. Brain Stimul 2018; 11:1180-1182. [DOI: 10.1016/j.brs.2018.04.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 04/24/2018] [Indexed: 11/20/2022] Open
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Galvan-Garza R, Clark T, Mulavara A, Oman C. Exhibition of stochastic resonance in vestibular tilt motion perception. Brain Stimul 2018; 11:716-722. [DOI: 10.1016/j.brs.2018.03.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 03/25/2018] [Accepted: 03/30/2018] [Indexed: 10/17/2022] Open
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Temple DR, De Dios YE, Layne CS, Bloomberg JJ, Mulavara AP. Efficacy of Stochastic Vestibular Stimulation to Improve Locomotor Performance During Adaptation to Visuomotor and Somatosensory Distortion. Front Physiol 2018; 9:301. [PMID: 29651250 PMCID: PMC5885191 DOI: 10.3389/fphys.2018.00301] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 03/13/2018] [Indexed: 11/13/2022] Open
Abstract
Astronauts exposed to microgravity face sensorimotor challenges affecting balance control when readapting to Earth's gravity upon return from spaceflight. Small amounts of electrical noise applied to the vestibular system have been shown to improve balance control during standing and walking under discordant sensory conditions in healthy subjects, likely by enhancing information transfer through the phenomenon of stochastic resonance. The purpose of this study was to test the hypothesis that imperceptible levels of stochastic vestibular stimulation (SVS) could improve short-term adaptation to a locomotor task in a novel sensory discordant environment. Healthy subjects (14 males, 10 females, age = 28.7 ± 5.3 years, height = 167.2 ± 9.6 cm, weight = 71.0 ± 12.8 kg) were tested for perceptual thresholds to sinusoidal currents applied across the mastoids. Subjects were then randomly and blindly assigned to an SVS group receiving a 0–30 Hz Gaussian white noise electrical stimulus at 50% of their perceptual threshold (stim) or a control group receiving zero stimulation during Functional Mobility Tests (FMTs), nine trials of which were done under conditions of visual discordance (wearing up/down vision reversing goggles). Time to complete the course (TCC) was used to test the effect of SVS between the two groups across the trials. Adaptation rates from the normalized TCCs were also compared utilizing exponent values of power fit trendline equations. A one-tailed independent-samples t-test indicated these adaptation rates were significantly faster in the stim group (n = 12) than the control (n = 12) group [t(16.18) = 2.00, p = 0.031]. When a secondary analysis was performed comparing “responders” (subjects who showed faster adaptation rates) of the stim (n = 7) group to the control group (n = 12), independent-samples t-tests revealed significantly faster trial times for the last five trials with goggles in the stim group “responders” than the controls. The data suggests that SVS may be capable of improving short-term adaptation to a locomotion task done under sensory discordance in a group of responsive subjects.
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Affiliation(s)
- David R Temple
- Department of Health and Human Performance, University of Houston, Houston, TX, United States.,Center for Neuromotor and Biomechanics Research, University of Houston, Houston, TX, United States
| | | | - Charles S Layne
- Department of Health and Human Performance, University of Houston, Houston, TX, United States.,Center for Neuromotor and Biomechanics Research, University of Houston, Houston, TX, United States.,Center for Neuro-Engineering and Cognitive Science, University of Houston, Houston, TX, United States
| | - Jacob J Bloomberg
- Johnson Space Center, National Aeronautics and Space Administration, Houston, TX, United States
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Iwasaki S, Fujimoto C, Egami N, Kinoshita M, Togo F, Yamamoto Y, Yamasoba T. Noisy vestibular stimulation increases gait speed in normals and in bilateral vestibulopathy. Brain Stimul 2018; 11:709-715. [PMID: 29563049 DOI: 10.1016/j.brs.2018.03.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/06/2018] [Accepted: 03/07/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Galvanic vestibular stimulation delivered as zero-mean current noise (noisy GVS) has been shown to improve static and dynamic postural stability probably by enhancing vestibular information. OBJECTIVE /Hypothesis: To examine the effect of an imperceptible level of noisy GVS on dynamic locomotion in normal subjects as well as in patients with bilateral vestibulopathy. METHODS Walking performance of 19 healthy subjects and 12 patients with bilateral vestibulopathy at their preferred speed was examined during application of noisy GVS with an amplitude ranging from 0 to 1000 μA. The gait velocity, stride length and stride time were analyzed. RESULTS Noisy GVS had significant effects on gait velocity, stride length and stride time in healthy subjects as well as in patients with bilateral vestibulopathy (p < 0.05). The optimal amplitude of noisy GVS improved gait velocity by 10.9 ± 1.2%, stride length by 5.7 ± 1.2% and stride time by 4.6 ± 7% (p < 0.0001) compared to the control session in healthy subjects. The optimal stimulus improved gait velocity by 12.8 ± 1.3%, stride length by 8.3 ± 1.1% and stride time by 3.7 ± 7% (p < 0.0001) in patients with bilateral vestibulopathy. The improved values of these parameters of locomotion by noisy GVS in the patients were not significantly different from those in healthy subjects in the control condition (p > 0.4). CONCLUSION Noisy GVS is effective in improving gait performance in healthy subjects as well as in patients with bilateral vestibulopathy.
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Affiliation(s)
- Shinichi Iwasaki
- Department of Otolaryngology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - Chisato Fujimoto
- Department of Otolaryngology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Naoya Egami
- Department of Otolaryngology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Makoto Kinoshita
- Department of Otolaryngology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Fumiharu Togo
- Educational Physiological Laboratory, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yoshiharu Yamamoto
- Educational Physiological Laboratory, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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Keywan A, Wuehr M, Pradhan C, Jahn K. Noisy Galvanic Stimulation Improves Roll-Tilt Vestibular Perception in Healthy Subjects. Front Neurol 2018; 9:83. [PMID: 29545766 PMCID: PMC5837962 DOI: 10.3389/fneur.2018.00083] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/06/2018] [Indexed: 11/13/2022] Open
Abstract
It has recently been demonstrated that noisy galvanic vestibular stimulation (nGVS) delivered as imperceptible white noise can improve balance control via the induction of stochastic resonance. However, it is unclear whether these balance improvements are accompanied by simultaneous enhancement to vestibular motion perception. In this study, 15 healthy subjects performed 8 quiet-stance tasks on foam with eyes closed at 8 different nGVS amplitudes ranging from 0 mA (baseline) to 0.5 mA. The nGVS amplitude that improved balance performance most compared to baseline was assigned as the optimal nGVS amplitude. Optimal nGVS amplitudes could be determined for 13 out of 15 subjects, who were included in the subsequent experimental procedures. The effect of nGVS delivered at the determined optimal intensity on vestibular perceptual thresholds was examined using direction-recognition tasks on a motion platform, testing roll rotations at 0.2, 0.5, and 1.0 Hz, both with active and sham nGVS stimulations. nGVS significantly reduced direction-recognition thresholds compared to the sham condition at 0.5 and 1.0 Hz, while no significant effect of nGVS was found at 0.2 Hz. Interestingly, no correlation was found between nGVS-induced improvements in balance control and vestibular motion perception at 0.5 and 1 Hz, which may suggest different mechanisms by which nGVS affects both modalities. For the first time, we show that nGVS can enhance roll vestibular motion perception. The outcomes of this study are likely to be relevant for the potential therapeutic use of nGVS in patients with balance problems.
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Affiliation(s)
- Aram Keywan
- German Center for Vertigo and Balance Disorders, Munich University Hospital, Munich, Germany
| | - Max Wuehr
- German Center for Vertigo and Balance Disorders, Munich University Hospital, Munich, Germany
| | - Cauchy Pradhan
- German Center for Vertigo and Balance Disorders, Munich University Hospital, Munich, Germany
| | - Klaus Jahn
- German Center for Vertigo and Balance Disorders, Munich University Hospital, Munich, Germany.,Department of Neurology, Schön Klinik Bad Aibling, Bad Aibling, Germany
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Milton J, Meyer R, Zhvanetsky M, Ridge S, Insperger T. Control at stability's edge minimizes energetic costs: expert stick balancing. J R Soc Interface 2017; 13:rsif.2016.0212. [PMID: 27278361 DOI: 10.1098/rsif.2016.0212] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 05/17/2016] [Indexed: 01/04/2023] Open
Abstract
Stick balancing on the fingertip is a complex voluntary motor task that requires the stabilization of an unstable system. For seated expert stick balancers, the time delay is 0.23 s, the shortest stick that can be balanced for 240 s is 0.32 m and there is a [Formula: see text]° dead zone for the estimation of the vertical displacement angle in the saggital plane. These observations motivate a switching-type, pendulum-cart model for balance control which uses an internal model to compensate for the time delay by predicting the sensory consequences of the stick's movements. Numerical simulations using the semi-discretization method suggest that the feedback gains are tuned near the edge of stability. For these choices of the feedback gains, the cost function which takes into account the position of the fingertip and the corrective forces is minimized. Thus, expert stick balancers optimize control with a combination of quick manoeuvrability and minimum energy expenditures.
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Affiliation(s)
- John Milton
- W. M. Keck Science Department, The Claremont Colleges, Claremont, CA 91711, USA
| | - Ryan Meyer
- Pomona College, Claremont, CA 91711, USA
| | | | | | - Tamás Insperger
- Department of Applied Mechanics, Budapest University of Technology and Economics, 1521 Budapest, Hungary
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Hallemans A, Mertens G, Van de Heyning P, Van Rompaey V. Playing Music May Improve the Gait Pattern in Patients with Bilateral Caloric Areflexia Wearing a Cochlear Implant: Results from a Pilot Study. Front Neurol 2017; 8:404. [PMID: 28861034 PMCID: PMC5562687 DOI: 10.3389/fneur.2017.00404] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 07/27/2017] [Indexed: 12/26/2022] Open
Abstract
Hypothesis Auditory information through an active cochlear implant (CI) influences gait parameters in adults with bilateral caloric areflexia and profound sensorineural hearing loss. Background Patients with bilateral caloric areflexia suffer from imbalance, resulting in an increased risk of falling. In case of simultaneous deafness, the lack of auditory feedback results in less awareness of the auditory scene. This combination might produce significant challenges while walking and navigating. Auditory cues can be restored to some extent with a CI. Electrical stimulation through a CI can also produce a vestibulocollic reflex through current spread, which can be measured as cervical vestibular-evoked myogenic potentials. Methods Adults (seven males, one female, mean age 61 ± 14 years), wearing a CI to treat profound sensorineural hearing loss and presenting with bilateral caloric areflexia walked barefoot, over ground, at self-selected speed in three different conditions: with CI turned on, while listening to music and with CI turned off. Spatiotemporal and kinematic parameters of gait were calculated using the conventional gait model. Results Removing auditory feedback by turning off the CI decreased stride time (mean difference 0.03 ± 0.15 s) and slightly increased stride length (mean difference 0.5 ± 1.2 cm) compared to the control condition with the CI on. Walking while playing music positively affected gait compared to walking with the CI on but without auditory feedback. By increasing the motion of the pelvis (mean difference 1.3° ± 0.4°), the knee (mean difference 3.9° ± 0.8°) and the ankle (mean difference 2.2° ± 0.2°), stride length increased (7.8 ± 1.2 cm), while stride time decreased (0.059 ± 0.016 s). Conclusion Although a practice effect cannot be completely ruled out, this pilot study suggests that playing music while wearing an active CI may improve gait in patients with bilateral otovestibular loss. It remains unclear if the musical cues boost balance control or the CI might produce current spread and electrical stimulation to the vestibular afferents, thereby boosting its detection threshold, through stochastic resonance, and improving gait.
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Affiliation(s)
- Ann Hallemans
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium.,Multidisciplinary Motor Center Antwerp, University of Antwerp, Antwerp, Belgium
| | - Griet Mertens
- Faculty of Medicine and Health Sciences, Department of Translational Neurosciences, University of Antwerp, Antwerp, Belgium.,Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Paul Van de Heyning
- Multidisciplinary Motor Center Antwerp, University of Antwerp, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, Department of Translational Neurosciences, University of Antwerp, Antwerp, Belgium.,Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Vincent Van Rompaey
- Faculty of Medicine and Health Sciences, Department of Translational Neurosciences, University of Antwerp, Antwerp, Belgium.,Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium
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Noisy galvanic vestibular stimulation: an emerging treatment option for bilateral vestibulopathy. J Neurol 2017; 264:81-86. [DOI: 10.1007/s00415-017-8481-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 03/31/2017] [Accepted: 04/01/2017] [Indexed: 01/22/2023]
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Noisy galvanic vestibular stimulation induces a sustained improvement in body balance in elderly adults. Sci Rep 2016; 6:37575. [PMID: 27869225 PMCID: PMC5116631 DOI: 10.1038/srep37575] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 10/31/2016] [Indexed: 11/09/2022] Open
Abstract
Vestibular dysfunction causes postural instability, which is prevalent in the elderly. We previously showed that an imperceptible level of noisy galvanic vestibular stimulation (nGVS) can improve postural stability in patients with bilateral vestibulopathy during the stimulus, presumably by enhancing vestibular information processing. In this study, we investigated the after-effects of an imperceptible long-duration nGVS on body balance in elderly adults. Thirty elderly participants underwent two nGVS sessions in a randomised order. In Session 1, participants received nGVS for 30 min twice with a 4-h interval. In Session 2, participants received nGVS for 3 h. Two-legged stance tasks were performed with eyes closed while participants stood on a foam rubber surface, with and without nGVS, and parameters related to postural stability were measured using posturography. In both sessions, the postural stability was markedly improved for more than 2 h after the cessation of the stimulus and tended to decrease thereafter. The second stimulation in Session 1 caused a moderate additional improvement in body balance and promoted the sustainability of the improvement. These results suggest that nGVS can lead to a postural stability improvement in elderly adults that lasts for several hours after the cessation of the stimulus, probably via vestibular neuroplasticity.
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Wuehr M, Nusser E, Decker J, Krafczyk S, Straube A, Brandt T, Jahn K, Schniepp R. Noisy vestibular stimulation improves dynamic walking stability in bilateral vestibulopathy. Neurology 2016; 86:2196-202. [PMID: 27164706 DOI: 10.1212/wnl.0000000000002748] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 03/04/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine the effects of imperceptible levels of white noise galvanic vestibular stimulation (nGVS) on dynamic walking stability in patients with bilateral vestibulopathy (BVP). METHODS Walking performance of 13 patients with confirmed BVP (mean age 50.1 ± 5.5 years) at slow, preferred, and fast speeds was examined during walking with zero-amplitude nGVS (sham trial) and nonzero-amplitude nGVS set to 80% of the individual cutaneous threshold for GVS (nGVS trial). Eight standard gait measures were analyzed: stride time, stride length, base of support, double support time percentage as well as the bilateral phase coordination index, and the coefficient of variation (CV) of stride time, stride length, and base of support. RESULTS Compared to the sham trial, nGVS improved stride time CV by 26.0% ± 8.4% (p < 0.041), stride length CV by 26.0% ± 7.7% (p < 0.029), base of support CV by 27.8% ± 2.9% (p < 0.037), and phase coordination index by 8.4% ± 8.8% (p < 0.013). The nGVS effects on walking performance were correlated with subjective ratings of walking balance (ρ = 0.79, p < 0.001). Effect of nGVS on walking stability was most pronounced during slow walking. CONCLUSIONS In patients with BVP, nGVS is effective in improving impaired gait performance, predominantly during slower walking speeds. It primarily targets the variability and bilateral coordination characteristics of the walking pattern, which are linked to dynamic walking stability. nGVS might present an effective treatment option to immediately improve walking performance and reduce the incidence of falls in patients with BVP. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that in patients with BVP, an imperceptible level of nGVS improves dynamic walking stability.
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Affiliation(s)
- Max Wuehr
- From the German Center for Vertigo and Balance Disorders (M.W., J.D., S.K., A.S., T.B., K.J., R.S.), Department of Neurology (E.N., S.K., A.S., R.S.), and Institute for Clinical Neuroscience (T.B.), University of Munich; and Schoen Klinik Bad Aibling (K.J.), Germany.
| | - Eva Nusser
- From the German Center for Vertigo and Balance Disorders (M.W., J.D., S.K., A.S., T.B., K.J., R.S.), Department of Neurology (E.N., S.K., A.S., R.S.), and Institute for Clinical Neuroscience (T.B.), University of Munich; and Schoen Klinik Bad Aibling (K.J.), Germany
| | - Julian Decker
- From the German Center for Vertigo and Balance Disorders (M.W., J.D., S.K., A.S., T.B., K.J., R.S.), Department of Neurology (E.N., S.K., A.S., R.S.), and Institute for Clinical Neuroscience (T.B.), University of Munich; and Schoen Klinik Bad Aibling (K.J.), Germany
| | - Siegbert Krafczyk
- From the German Center for Vertigo and Balance Disorders (M.W., J.D., S.K., A.S., T.B., K.J., R.S.), Department of Neurology (E.N., S.K., A.S., R.S.), and Institute for Clinical Neuroscience (T.B.), University of Munich; and Schoen Klinik Bad Aibling (K.J.), Germany
| | - Andreas Straube
- From the German Center for Vertigo and Balance Disorders (M.W., J.D., S.K., A.S., T.B., K.J., R.S.), Department of Neurology (E.N., S.K., A.S., R.S.), and Institute for Clinical Neuroscience (T.B.), University of Munich; and Schoen Klinik Bad Aibling (K.J.), Germany
| | - Thomas Brandt
- From the German Center for Vertigo and Balance Disorders (M.W., J.D., S.K., A.S., T.B., K.J., R.S.), Department of Neurology (E.N., S.K., A.S., R.S.), and Institute for Clinical Neuroscience (T.B.), University of Munich; and Schoen Klinik Bad Aibling (K.J.), Germany
| | - Klaus Jahn
- From the German Center for Vertigo and Balance Disorders (M.W., J.D., S.K., A.S., T.B., K.J., R.S.), Department of Neurology (E.N., S.K., A.S., R.S.), and Institute for Clinical Neuroscience (T.B.), University of Munich; and Schoen Klinik Bad Aibling (K.J.), Germany
| | - Roman Schniepp
- From the German Center for Vertigo and Balance Disorders (M.W., J.D., S.K., A.S., T.B., K.J., R.S.), Department of Neurology (E.N., S.K., A.S., R.S.), and Institute for Clinical Neuroscience (T.B.), University of Munich; and Schoen Klinik Bad Aibling (K.J.), Germany
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Flores A, Manilla S, Huidobro N, De la Torre-Valdovinos B, Kristeva R, Mendez-Balbuena I, Galindo F, Treviño M, Manjarrez E. Stochastic resonance in the synaptic transmission between hair cells and vestibular primary afferents in development. Neuroscience 2016; 322:416-29. [PMID: 26926966 DOI: 10.1016/j.neuroscience.2016.02.051] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 02/22/2016] [Indexed: 10/22/2022]
Abstract
The stochastic resonance (SR) is a phenomenon of nonlinear systems in which the addition of an intermediate level of noise improves the response of such system. Although SR has been studied in isolated hair cells and in the bullfrog sacculus, the occurrence of this phenomenon in the vestibular system in development is unknown. The purpose of the present study was to explore for the existence of SR via natural mechanical-stimulation in the hair cell-vestibular primary afferent transmission. In vitro experiments were performed on the posterior semicircular canal of the chicken inner ear during development. Our experiments showed that the signal-to-noise ratio of the afferent multiunit activity from E15 to P5 stages of development exhibited the SR phenomenon, which was characterized by an inverted U-like response as a function of the input noise level. The inverted U-like graphs of SR acquired their higher amplitude after the post-hatching stage of development. Blockage of the synaptic transmission with selective antagonists of the NMDA and AMPA/Kainate receptors abolished the SR of the afferent multiunit activity. Furthermore, computer simulations on a model of the hair cell - primary afferent synapse qualitatively reproduced this SR behavior and provided a possible explanation of how and where the SR could occur. These results demonstrate that a particular level of mechanical noise on the semicircular canals can improve the performance of the vestibular system in their peripheral sensory processing even during embryonic stages of development.
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Affiliation(s)
- A Flores
- Instituto de Fisiología, Benemérita Universidad Autónoma de Puebla, Mexico.
| | - S Manilla
- Instituto de Fisiología, Benemérita Universidad Autónoma de Puebla, Mexico
| | - N Huidobro
- Instituto de Fisiología, Benemérita Universidad Autónoma de Puebla, Mexico
| | | | - R Kristeva
- Department of Neurology, University of Freiburg, Breisacherstraße 64, 79106 Freiburg, Germany
| | - I Mendez-Balbuena
- Facultad de Psicología, Benemérita Universidad Autónoma de Puebla, Mexico
| | - F Galindo
- Instituto de Fisiología, Benemérita Universidad Autónoma de Puebla, Mexico
| | - M Treviño
- Laboratorio de Plasticidad Cortical y Aprendizaje Perceptual, Instituto de Neurociencias, Universidad de Guadalajara, Mexico
| | - E Manjarrez
- Instituto de Fisiología, Benemérita Universidad Autónoma de Puebla, Mexico.
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