The assessment of subjective visual vertical: comparison of two psychophysical paradigms and age-related performance

Clinical Assessment of Subjective Visual and Haptic Vertical Norms in Healthy Adults

BACKGROUND AND OBJECTIVE

Accurate verticality perception is essential for daily life activities, such as correctly estimating object orientation in space. This study established normative data for the subjective visual vertical (SVV) and subjective haptic vertical (SHV) using the portable and self-constructable modified Bucket test and Rotating-Column test. Additionally, the contribution of age, sex, and starting position of the line/ column on SVV and SHV accuracy were evaluated.

METHOD

This study, part of the PRECISE project (ClinicalTrials.gov ID NCT05978596), was conducted following the STROBE guidelines. Healthy adults without visual/neurological/vestibular disorders were recruited. Subjective visual vertical and SHV accuracy were described in terms of constant errors (i.e., mean deviation from 0° [true vertical] respecting its direction), unsigned errors (i.e., mean deviation from 0° irrespective of direction), and variability (i.e., intra-individual standard deviation).

RESULTS

Sixty participants were evaluated (mean age: 41.14 [SD = 16.74] years). Subjective visual vertical constant errors between -2.82° and 2.90°, unsigned errors up to 2.15°, and variability up to 1.61° are considered normal. Subjective haptic vertical constant errors ranged from -6.94° to 8.18°, unsigned errors up to 6.66° and variability up to 4.25°. Higher ages led to higher SVV unsigned errors and variability. SHV variability was higher in females compared to males. Certain starting positions led to higher SVV and SHV constants and SVV unsigned errors.

DISCUSSION

Normative data are provided for affordable, self-constructable, and portable SVV and SHV tools. These norms are consistent with more sophisticated equipment and can be used to distinguish between normal and abnormal values.

Do we need to consider head-on-body position, starting roll position and presence of visuospatial neglect when assessing perception of verticality after stroke?

BACKGROUND AND OBJECTIVE

Considering various factors that influence the accuracy of the Subjective Visual Vertical (SVV) and Subjective Postural Vertical (SPV), standardization of assessment methods is needed. This retrospective study examined the contribution of Head-on-Body (HOB) position, starting roll position (SRP) and visuospatial neglect (VSN) to SVV and SPV constant errors (i.e. deviation from true vertical). Also, the contribution of HOB position and VSN presence to SVV and SPV variability (i.e. intra-individual consistency between trials) was assessed.

METHODS

First-ever unilateral hemispheric stroke survivors (<85 years; <100 days post-stroke) were assessed with three HOB positions (neutral, contralesional, and ipsilesional) and seven starting positions (20°Contralesional to 20° ipsilesional) of the laser bar and tilt chair. Linear mixed models were selected to evaluate the contribution of HOB, SRP, and VSN to SVV/SPV constant errors and variability.

RESULTS

Thirty-four subjects (24 VSN-/10 VSN+) were assessed. A tilted HOB position led to significantly higher constant errors for the SVV and SPV (the latter only in the VSN- group), and an increased SVV variability. SRP only significantly contributed to the SVV constant errors and only in the VSN- group. Furthermore, the presence of VSN resulted in a significantly higher SVV and SPV variability.

CONCLUSIONS

HOB position and the presence of SRP and VSN are important factors to consider during SVV and SPV measurements. Assessment with a neutral HOB position leads to more accurate results. HOB position and SRP influence the results of SVV and SPV differently in individuals with and without VSN, which highlights the relevance of VSN assessment.

Specificity of tilt illusion reduction through perceptual learning

Human perceptual ability can be improved by perceptual learning through repeated exposure or training. Perceptual learning studies have focused on achieving accurate perception of stimuli by improving perceptual sensitivity. However, eliminating illusions can also be one of the ways of accurate perception. To determine whether the illusion can be attenuated by perceptual learning, the current study used a tilt illusion where the orientation of the grating presented in the center (central grating) was misperceived because of the orientation of the grating presented in the periphery (surrounding grating). In Experiment 1, participants were trained either in the illusion training condition, in which they trained with illusory stimuli presenting both surrounding and central gratings together, or in the control training condition, where only the central grating was presented. The results confirmed that the tilt illusion was reduced only in the illusion training condition. Experiment 2 tested the transfer effect of learning, which is not often observed in perceptual learning. During training, the orientation of the surrounding grating was fixed to see whether the elimination of the illusion also occurred in the surrounding grating with an orientation that was not used during training. A decrease in the illusion was found only in the case of a surrounding grating with trained orientations, and not in the case of surrounding gratings with untrained orientations. These results suggest that the reduction in tilt illusion through training is due to perceptual learning.

Visual Field Dependence Persists in Age-Related Central Visual Field Loss

Purpose

To examine whether the age-related increase in visual field dependence persists in older adults with central field loss (CFL).

Methods

Twenty individuals with CFL were grouped into participants with age-related binocular CFL (CFL, n = 9), age-related monocular CFL/relative scotomata (mCFL, n = 8), and CFL occurring at a young age (yCFL, n = 3). Seventeen controls were age-matched to the older CFL groups (OA) and three to the yCFL group (yOA). Participants judged the tilt direction of a rod presented at various orientations under conditions with and without a visual reference. Visual field dependence was determined as the difference in judgment bias between trials with and without the visual reference. Visual field dependence was examined between groups and relative to visual acuity and contrast sensitivity.

Results

All older groups performed similarly without the visual reference. The CFL group showed greater visual field dependence than the OA group (Mann-Whitney U test; U = 39, P = 0.045). However, there was no group difference when considering all three older groups (Kruskal-Wallis ANOVA; H(2, N = 34) = 4.31, P = 0.116). Poorer contrast sensitivity correlated with greater visual field dependence (P = 0.017; ρ = -0.43).

Conclusions

Visual field dependence persists in older adults with CFL and seems exacerbated in those with dense binocular scotomata. This could be attributed to the sensitivity of the spared peripheral retina to orientation and motion cues. The relationship with contrast sensitivity further suggests that a decline in visual function is associated with an increase in visual field dependence beyond the effects of normal aging. These observations can guide tailored care and rehabilitation in older adults with CFL.

Lateropulsion with active pushing in stroke patients: its link with lesion location and the perception of verticality. A systematic review

BACKGROUND

Lateropulsion with active Pushing (LwP) is characterized by impairments in postural control. Previous research suggests an association between LwP, lesion location and verticality misperception. This first-ever systematic review evaluates the association between LwP, lesion location and the perception of verticality (PROSPERO: CRD42020159248).

METHODS

PubMed, Web of Science, REHABDATA, Embase, Cochrane Library and PEDro were systematically searched on December 16, 2021. Studies were included when examining lesion location or perception of verticality (Subjective Haptic, Visual or Postural Vertical) in supratentorial stroke patients showing LwP. Two reviewers independently screened and assessed risk of bias using the Newcastle Ottawa Scale. Data were qualitatively analyzed and extracted.

RESULTS

Nineteen studies were included, examining a total of 340 LwP patients. Lesions in: the thalamus, internal capsule, inferior parietal lobule at the junction of the postcentral gyrus, the posterior insula and the superior temporal gyrus, were associated with LwP. Whereas all studies examining the Subjective Postural and Haptic Vertical (haptic only examined once) reported a significant increased deviation in LwP patients, inconsistent results were found for the Subjective Visual Vertical. Furthermore, the Subjective Visual and Postural Vertical showed inconsistent results for magnitude, direction and variability of this deviation.

DISCUSSION

A complex brain network, rather than only one brain region, seems responsible for body control with respect to gravity. A disruption within this network might lead to a bias in the construction of a correct internal reference frame, crucial for perceiving verticality. There was an association of LwP with verticality misperception in all three modalities.

Comparing the impact of the method of adjustment and forced-choice methodologies on subjective visual vertical bias and variability

BACKGROUND

Previous research suggested that the method of adjustment and forced choice variants of the subjective visual vertical (SVV) produce comparable estimates of both bias and variability. However, variants of the SVV that utilize a method of adjustment procedure are known to be heavily influenced by task parameters, including the stimulus rotation speed, which was not accounted for in previous SVV research comparing the method of adjustment to forced-choice.

OBJECTIVE

The aim of the present study was to determine if (1) the SVV with a forced-choice procedure produces both bias and variability estimates that are comparable to those obtained using a method of adjustment procedure, (2) to see if rotation speed impacts the comparability of estimates and (3) quantify correlations between the estimates produced by different procedures.

METHODS

Participants completed a variant of the SVV which utilized a forced-choice procedure as well as two variants of the SVV using a method of adjustment procedure with two different rotation speeds (6°/s and 12°/s).

RESULTS

We found that the bias estimates were similar across all three conditions tested and that the variability estimates were greater in the SVV variants that utilized a method of adjustment procedure. This difference was more pronounced when the rotation speed was slower (6°/s).

CONCLUSIONS

The results of this study suggest that forced-choice and method of adjustment methodologies yield similar bias estimates and different variability estimates. Given these results, we recommend utilizing forced-choice procedures unless (a) forced-choice is not feasible or (b) response variability is unimportant. We also recommend that clinicians consider the SVV methods when interpreting a patient's test results, especially for variability metrics.

Association Between Saccule and Semicircular Canal Impairments and Cognitive Performance Among Vestibular Patients

OBJECTIVES

Growing evidence suggests that vestibular function impacts higher-order cognitive ability such as visuospatial processing and executive functioning. Despite evidence demonstrating vestibular functional impairment impacting cognitive performance, it is unknown whether cognitive ability is differentially affected according to the type of vestibular impairment (semicircular canal [SCC] versus saccule) among patients with diagnosed vestibular disease.

DESIGN

Fifty-four patients who presented to an academic neurotologic clinic were recruited into the study. All patients received a specific vestibular diagnosis. Forty-one patients had saccule function measured with the cervical vestibular-evoked myogenic potential, and 43 had SCC function measured using caloric irrigation. Cognitive tests were administered to assess cognitive performance among patients. One hundred twenty-five matched controls were recruited from the Baltimore Longitudinal Study of Aging to compare cognitive performance in patients relative to age-matched healthy controls.

RESULTS

Using multivariate linear regression analyses, patients with bilaterally absent cervical vestibular-evoked myogenic potential responses (i.e., bilateral saccular impairments) were found to take longer in completing the Trail-Making test (β = 25.7 sec, 95% confidence interval = 0.3 to 51.6) and to make significantly more errors on the Benton Visual Retention test part-C (β = 4.5 errors, 95% confidence interval [CI] = 1.2 to 7.8). Patients with bilateral SCC impairment were found to make significantly more errors on the Benton Visual Retention test part-C (β = 9.8 errors, 95% CI = 0.2 to 19.4). From case-control analysis, for each SD difference in Trail-Making test part-B time, there was a corresponding 142% increase in odds of having vestibular impairment (odds ratio = 2.42, 95% CI = 1.44 to 4.07).

CONCLUSIONS

These data suggest that bilateral saccule and SCC vestibular impairments may significantly affect various domains of cognitive performance. Notably, the cognitive performance in patients in this study was significantly poorer relative to age-matched healthy adults. Cognitive assessment may be considered in patients with saccule and SCC impairments, and cognitive deficits in vestibular patients may represent an important target for intervention.

Impaired Subjective Visual Vertical and Increased Visual Dependence in Older Adults With Falls

Aging affects the vestibular system and may disturb the perception of verticality and lead to increased visual dependence (VD). Studies have identified that abnormal upright perception influences the risk of falling. The aim of our study was to evaluate subjective visual vertical (SVV) and VD using a mobile virtual reality-based system for SVV assessment (VIRVEST) in older adults with falls and evaluate its relationship with clinical balance assessment tools, dizziness, mental state, and depression level. This study included 37 adults >65 years who experienced falls and 40 non-faller age-matched controls. Three tests were performed using the VIRVEST system: a static SVV, dynamic SVV with clockwise and counter-clockwise background stimulus motion. VD was calculated as the mean of absolute values of the rod tilt from each trial of dynamic SVV minus the mean static SVV rod tilt. Older adults who experienced falls manifested significantly larger biases in static SVV (p = 0.012), dynamic SVV (p < 0.001), and VD (p = 0.014) than controls. The increase in static SVV (odds ratio = 1.365, p = 0.023), dynamic SVV (odds ratio = 1.623, p < 0.001) and VD (odds ratio = 1.460, p = 0.010) tilt by one degree significantly related to falls risk in the faller group. Fallers who had a high risk of falling according to the Tinetti test exhibited significantly higher tilts of dynamic SVV than those who had a low or medium risk (p = 0.037). In the faller group, the increase of the dynamic SVV tilt by one degree was significantly related to falls risk according to the Tinetti test (odds ratio = 1.356, p = 0.049). SVV errors, particularly with the dynamic SVV test (i.e., greater VD) were associated with an increased risk of falling in the faller group. The VIRVEST system may be applicable in clinical settings for SVV testing and predicting falls in older adults.

Reducing variability of perceptual decision making with offline theta-burst TMS of dorsal medial frontal cortex

BACKGROUND

Recent evidence suggests that the dorsal medial frontal cortex (dMFC) may make an important contribution to perceptual decision-making, and not only to motor control.

OBJECTIVE/HYPOTHESIS

By fitting psychometric functions to behavioural data after TMS we tested whether the dMFC is critical specifically for the precision and/or bias of perceptual judgements. Additionally we aimed to disentangle potential roles of the dMFC in dealing with perceptual versus response switching.

METHODS

A subjective visual vertical task (SVV) was used in which participants weight visual (and other, e.g., vestibular) information to establish whether a line is oriented vertically. To ensure a high perceptual demand (putatively necessary to demonstrate a dMFC involvement) SVV lines were presented inside pop-out targets within a visual search array. Distinct features of perceptual performance were analysed before as compared to following theta-burst TMS stimulation of the dMFC, a control site, or no stimulation, in three groups, each of 20 healthy participants.

RESULTS

dMFC stimulation improved the precision of verticality judgments. Moreover, dMFC stimulation improved accuracy, selectively when response switches occurred with perceptual repeats.

CONCLUSION

These findings point to a causal role of the dMFC in establishing the precision of perceptual decision making, demonstrably dissociable from an additional role in motor control in attentionally demanding contexts.

Young and Older Adults Differ in Integration of Sensory Cues for Vertical Perception

Introduction

The subjective visual vertical (SVV) measures the perception of a person's spatial orientation relative to gravity. Weighted central integration of vestibular, visual, and proprioceptive inputs is essential for SVV perception. Without any visual references and minimal proprioceptive contribution, the static SVV reflects balance of the otolith organs. Normal aging is associated with bilateral and progressive decline in otolith organ function, but age-dependent effects on SVV are inconclusive. Studies on sensory reweighting for visual vertical and multisensory integration strategies reveal age-dependent differences, but most studies have included elderly participants in comparison to younger adults. The aim of this study was to compare young adults with older adults, an age group younger than the elderly.

Methods

Thirty-three young and 28 older adults (50–65 years old) adjusted a tilted line accurately to their perceived vertical. The rod's final position from true vertical was recorded as tilt error in degrees. For otolithic balance, visual vertical was recorded in the dark without any visual references. The rod and frame task (RFT) with tilted disorienting visual frames was used for creating visuovestibular conflict. We adopted Nyborg's analysis method to derive the rod and frame effect (RFE) and trial-to-trial variability measures. Rod alignment times were also analyzed.

Results

There was no age difference in signed tilts of SVV without visual reference. There was an age effect on RFE and on overall trial-to-trial variability of rod tilt, with older adults displaying larger frame effects and greater variability in rod tilts. Alignment times were longer in the tilted-frame conditions for both groups and in the older adults compared to their younger counterparts. The association between tilt accuracy and tilt precision was significant for older adults only during visuovestibular conflict, revealing an increase in RFE with an increase in tilt variability. Correlation of σ_SVV, which represents vestibular input precision, with RFE yielded exactly the same contribution of σ_SVV to the variance in RFE for both age groups.

Conclusions

Older adults have balanced otolithic input in an upright position. Increased reliance on visual cues may begin at ages younger than what is considered elderly. Increased alignment times for older adults may create a broader time window for integration of relevant and irrelevant sensory information, thus enhancing their multisensory integration. In parallel with the elderly, older adults may differ from young adults in their integration of sensory cues for visual vertical perception.

Age-related visual dynamics in HIV-infected adults with cognitive impairment

OBJECTIVE

To investigate whether aging differentially affects neural activity serving visuospatial processing in a large functional neuroimaging study of HIV-infected participants and to determine whether such aging effects are attributable to differences in the duration of HIV infection.

METHODS

A total of 170 participants, including 93 uninfected controls and 77 HIV-infected participants, underwent neuropsychological assessment followed by neuroimaging with magnetoencephalography (MEG). Time-frequency analysis of the MEG data followed by advanced image reconstruction of neural oscillatory activity and whole-brain statistical analyses were used to examine interactions between age, HIV infection, and cognitive status. Post hoc testing for a mediation effect of HIV infection duration on the relationship between age and neural activity was performed using a quasi-Bayesian approximation for significance testing.

RESULTS

Cognitively impaired HIV-infected participants were distinguished from unimpaired HIV-infected and control participants by their unique association between age and gamma oscillations in the parieto-occipital cortex. This relationship between age and gamma was fully mediated by the duration of HIV infection in cognitively impaired participants. Impaired HIV-infected participants were also distinguished by their atypical relationship between alpha oscillations and age in the superior parietal cortex.

CONCLUSIONS

Impaired HIV-infected participants exhibited markedly different relationships between age and neural responses in the parieto-occipital cortices relative to their peers. This suggests a differential effect of chronological aging on the neural bases of visuospatial processing in a cognitively impaired subset of HIV-infected adults. Some of these relationships were fully accounted for by differences in HIV infection duration, whereas others were more readily associated with aging.

Frontal scalp potentials foretell perceptual choice confidence

When making decisions, people naturally ask two implicit questions: how soon can I make a decision, and how certain am I? In perception, people's confidence (how certain?) shows a nonmonotonic relationship with response time (how soon?), such that choice confidence can either increase or decrease with response time. Although a frontoparietal network has been implicated as a neural substrate that binds choice confidence and action (e.g., response time), the dynamic interplay between choice behaviors within such a network has not been clarified. Here, we show that frontal event-related potentials (ERPs) reflect choice confidence before a decision. Specifically, we report a second positive peak of the stimulus-locked frontal ERP at ~500 ms that scales with confidence but not stimulus level, whereas the centroparietal ERP amplitude covaries inversely with response time. This frontal ERP component occurs before the response, which helps explain the inverse relationship between choice confidence and response time (i.e., higher confidence for shorter response time) when choice accuracy is emphasized over speed. Our findings provide the first early neural representation of confidence, consistent with the temporal precedence for its causal role in the current decision-making task: "I decided earlier because I am confident."NEW & NOTEWORTHY We report novel neural correlates of predecisional choice confidence in frontal scalp potential in humans. In conjunction with the centroparietal choice-action event-related potential component, this new frontal choice confidence component further elucidates the dynamics of the frontoparietal decision-making neural circuitry.

Motor Planning of Vertical Arm Movements in Healthy Older Adults: Does Effort Minimization Persist With Aging?

Several sensorimotor modifications are known to occur with aging, possibly leading to adverse outcomes such as falls. Recently, some of those modifications have been proposed to emerge from motor planning deteriorations. Motor planning of vertical movements is thought to engage an internal model of gravity to anticipate its mechanical effects on the body-limbs and thus to genuinely produce movements that minimize muscle effort. This is supported, amongst other results, by direction-dependent kinematics where relative durations to peak accelerations and peak velocity are shorter for upward than for downward movements. The present study compares the motor planning of fast and slow vertical arm reaching movements between 18 young (24 ± 3 years old) and 17 older adults (70 ± 5 years old). We found that older participants still exhibit strong directional asymmetries (i.e., differences between upward and downward movements), indicating that optimization processes during motor planning persist with healthy aging. However, the size of these differences was increased in older participants, indicating that gravity-related motor planning changes with age. We discuss this increase as the possible result of an overestimation of gravity torque or increased weight of the effort cost in the optimization process. Overall, these results support the hypothesis that feedforward processes and, more precisely, optimal motor planning, remain active with healthy aging.

Mathematical models for dynamic, multisensory spatial orientation perception

Mathematical models have been proposed for how the brain interprets sensory information to produce estimates of self-orientation and self-motion. This process, spatial orientation perception, requires dynamically integrating multiple sensory modalities, including visual, vestibular, and somatosensory cues. Here, we review the progress in mathematical modeling of spatial orientation perception, focusing on dynamic multisensory models, and the experimental paradigms in which they have been validated. These models are primarily "black box" or "as if" models for how the brain processes spatial orientation cues. Yet, they have been effective scientifically, in making quantitative hypotheses that can be empirically assessed, and operationally, in investigating aircraft pilot disorientation, for example. The primary family of models considered, the observer model, implements estimation theory approaches, hypothesizing that internal models (i.e., neural systems replicating the behavior/dynamics of physical systems) are used to produce expected sensory measurements. Expected signals are then compared to actual sensory afference, yielding sensory conflict, which is weighted to drive central perceptions of gravity, angular velocity, and translation. This approach effectively predicts a wide range of experimental scenarios using a small set of fixed free parameters. We conclude with limitations and applications of existing mathematical models and important areas of future work.

Biases in the Visual and Haptic Subjective Vertical Reveal the Role of Proprioceptive/Vestibular Priors in Child Development

Investigation of the perception of verticality permits to disclose the perceptual mechanisms that underlie balance control and spatial navigation. Estimation of verticality in unusual body orientation with respect to gravity (e.g., laterally tilted in the roll plane) leads to biases that change depending on the encoding sensory modality and the amount of tilt. A well-known phenomenon is the A-effect, that is a bias toward the body tilt often interpreted in a Bayesian framework to be the byproduct of a prior peaked at the most common head and body orientation, i.e., upright. In this study, we took advantage of this phenomenon to study the interaction of visual, haptic sensory information with vestibular/proprioceptive priors across development. We tested children (5-13 y.o) and adults (>22 y.o.) in an orientation discrimination task laterally tilted 90° to their left-ear side. Experimental conditions differed for the tested sensory modality: visual-only, haptic-only, both modalities. Resulting accuracy depended on the developmental stage and the encoding sensory modality, showing A-effects in vision across all ages and in the haptic modality only for the youngest children whereas bimodal judgments show lack of multisensory integration in children. A Bayesian prior model nicely predicts the behavioral data when the peak of the prior distribution shifts across age groups. Our results suggest that vision is pivotal to acquire an idiotropic vector useful for improving precision when upright. The acquisition of such a prior might be related to the development of head and trunk coordination, a process that is fundamental for gaining successful spatial navigation.

Human perception of whole body roll-tilt orientation in a hypogravity analog: underestimation and adaptation

Overestimation of roll tilt in hypergravity ("G-excess" illusion) has been demonstrated, but corresponding sustained hypogravic conditions are impossible to create in ground laboratories. In this article we describe the first systematic experimental evidence that in a hypogravity analog, humans underestimate roll tilt. We studied perception of self-roll tilt in nine subjects, who were supine while spun on a centrifuge to create a hypogravity analog. By varying the centrifuge rotation rate, we modulated the centripetal acceleration (G_C) at the subject's head location (0.5 or 1 G_C) along the body axis. We measured orientation perception using a subjective visual vertical task in which subjects aligned an illuminated bar with their perceived centripetal acceleration direction during tilts (±11.5-28.5°). As hypothesized, based on the reduced utricular otolith shearing, subjects initially underestimated roll tilts in the 0.5 G_C condition compared with the 1 G_C condition (mean perceptual gain change = -0.27, P = 0.01). When visual feedback was given after each trial in 0.5 G_C, subjects' perceptual gain increased in approximately exponential fashion over time (time constant = 16 tilts or 13 min), and after 45 min, the perceptual gain was not significantly different from the 1 G_C baseline (mean gain difference between 1 G_C initial and 0.5 G_C final = 0.16, P = 0.3). Thus humans modified their interpretation of sensory cues to more correctly report orientation during this hypogravity analog. Quantifying the acute orientation perceptual learning in such an altered gravity environment may have implications for human space exploration on the moon or Mars. NEW & NOTEWORTHY Humans systematically overestimate roll tilt in hypergravity. However, human perception of orientation in hypogravity has not been quantified across a range of tilt angles. Using a centrifuge to create a hypogravity centripetal acceleration environment, we found initial underestimation of roll tilt. Providing static visual feedback, perceptual learning reduced underestimation during the hypogravity analog. These altered gravity orientation perceptual errors and adaptation may have implications for astronauts.

The impact of age and sex on the oscillatory dynamics of visuospatial processing

The ability to dynamically allocate neural resources within the visual space is supported by a number of spectrally-specific oscillatory responses, and such visuospatial processing has been found to decline moderately with age and differ by sex. However, the direct effects of age and sex on these oscillatory dynamics remains poorly understood. Using magnetoencephalography (MEG), structural magnetic resonance imaging, and advanced source reconstruction and statistical methods, we investigated the impact of aging and sex on behavioral performance and the underlying neural dynamics during visuospatial processing. In a large sample spanning a broad age range, we find that a number of prototypical attention and perception network components, both spectrally- and spatially-defined, exhibit complex and uniquely informative relationships with age and sex. Specifically, neural responses in the theta range (4-10 Hz) were found to covary with chronological age in prefrontal and motor cortices, signifying a possible relationship between age and cognitive control. Further, we found that beta (18-24 Hz) activity covaried with age across a large swath of the somato-motor strip, supporting previous findings of motor planning and execution deficits with increasing age. Finally, gamma-frequency (48-70 Hz) oscillations were found to exhibit robust covariance with age in superior parietal and temporo-parietal areas, indicating that the mapping of saliency in visual space is modulated by the normal aging process. Interestingly, behavioral performance and some of these oscillatory neural responses also exhibited interactions between age and sex, indicating sex differences in the evolution of the neural coding of visual perception as age increases. In particular, men were found to have stronger correlations between age and neural oscillatory responses during task performance than women in lateral occipital and superior temporal regions in the alpha band and in dorsolateral prefrontal cortex in the gamma band, while women exhibited more robust covariance between age and neural responses than men in inferior temporal and medial prefrontal cortex in the theta range.

Normative data for human postural vertical: A systematic review and meta-analysis

Perception of verticality is required for normal daily function, yet the typical human detection error range has not been well characterized. Vertical misperception has been correlated with poor postural control and functionality in patients after stroke and after vestibular disorders. Until now, all the published studies that assessed Subjective Postural Vertical (SPV) in the seated position used small groups to establish a reference value. However, this sample size does not represent the healthy population for comparison with conditions resulting in pathological vertical. Therefore, the primary objective was to conduct a systematic review with meta-analyses of Subjective Postural Vertical (SPV) data in seated position in healthy adults to establish the reference value with a representative sample. The secondary objective was to investigate the methodological characteristics of different assessment protocols of SPV described in the literature. A systematic literature search was conducted using Medline, EMBASE, and Cochrane libraries. Mean and standard deviation of SPV in frontal and sagittal planes were considered as effect size measures. Sixteen of 129 identified studies met eligibility criteria for our systematic review (n = 337 subjects in the frontal plane; n = 187 subjects in sagittal plane). The meta-analyses measure was estimated using the pooled mean as the estimator and its respective error. Mean reference values were 0.12°±1.49° for the frontal plane and 0.02°±1.82° for the sagittal plane. There was a small variability of the results and this systematic review resulted in representative values for SPV. The critical analysis of the studies and observed homogeneity in the sample suggests that the methodological differences used in the studies did not influence SPV assessment of directional bias in healthy subjects. These data can serve as a reference for clinical studies in disorders of verticality.

Psychophysical Evaluation of Sensory Reweighting in Bilateral Vestibulopathy

Perception of spatial orientation is thought to rely on the brain's integration of visual, vestibular, proprioceptive, and somatosensory signals, as well as internal beliefs. When one of these signals breaks down, such as the vestibular signal in bilateral vestibulopathy, patients start compensating by relying more on the remaining cues. How these signals are reweighted in this integration process is difficult to establish, since they cannot be measured in isolation during natural tasks, are inherently noisy, and can be ambiguous or in conflict. Here, we review our recent work, combining experimental psychophysics with a reverse engineering approach, based on Bayesian inference principles, to quantify sensory noise levels and optimal (re)weighting at the individual subject level, in both patients with bilateral vestibular deficits and healthy controls. We show that these patients reweight the remaining sensory information, relying more on visual and other nonvestibular information than healthy controls in the perception of spatial orientation. This quantification approach could improve diagnostics and prognostics of multisensory integration deficits in vestibular patients, and contribute to an evaluation of rehabilitation therapies directed toward specific training programs.

The Effect of Visual Experience on Perceived Haptic Verticality When Tilted in the Roll Plane

The orientation of the body in space can influence perception of verticality leading sometimes to biases consistent with priors peaked at the most common head and body orientation, that is upright. In this study, we investigate haptic perception of verticality in sighted individuals and early and late blind adults when tilted counterclockwise in the roll plane. Participants were asked to perform a stimulus orientation discrimination task with their body tilted to their left ear side 90° relative to gravity. Stimuli were presented by using a motorized haptic bar. In order to test whether different reference frames relative to the head influenced perception of verticality, we varied the position of the stimulus on the body longitudinal axis. Depending on the stimulus position sighted participants tended to have biases away or toward their body tilt. Visually impaired individuals instead show a different pattern of verticality estimations. A bias toward head and body tilt (i.e., Aubert effect) was observed in late blind individuals. Interestingly, no strong biases were observed in early blind individuals. Overall, these results posit visual sensory information to be fundamental in influencing the haptic readout of proprioceptive and vestibular information about body orientation relative to gravity. The acquisition of an idiotropic vector signaling the upright might take place through vision during development. Regarding early blind individuals, independent spatial navigation experience likely enhanced by echolocation behavior might have a role in such acquisition. In the case of participants with late onset blindness, early experience of vision might lead them to anchor their visually acquired priors to the haptic modality with no disambiguation between head and body references as observed in sighted individuals (Fraser et al., 2015). With our study, we aim to investigate haptic perception of gravity direction in unusual body tilts when vision is absent due to visual impairment. Insofar, our findings throw light on the influence of proprioceptive/vestibular sensory information on haptic perceived verticality in blind individuals showing how this phenomenon is affected by visual experience.

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

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

Unbounded evidence accumulation characterizes subjective visual vertical forced-choice perceptual choice and confidence

Humans can subjectively yet quantitatively assess choice confidence based on perceptual precision even when a perceptual decision is made without an immediate reward or feedback. However, surprisingly little is known about choice confidence. Here we investigate the dynamics of choice confidence by merging two parallel conceptual frameworks of decision making, signal detection theory and sequential analyses (i.e., drift-diffusion modeling). Specifically, to capture end-point statistics of binary choice and confidence, we built on a previous study that defined choice confidence in terms of psychophysics derived from signal detection theory. At the same time, we augmented this mathematical model to include accumulator dynamics of a drift-diffusion model to characterize the time dependence of the choice behaviors in a standard forced-choice paradigm in which stimulus duration is controlled by the operator. Human subjects performed a subjective visual vertical task, simultaneously reporting binary orientation choice and probabilistic confidence. Both binary choice and confidence experimental data displayed statistics and dynamics consistent with both signal detection theory and evidence accumulation, respectively. Specifically, the computational simulations showed that the unbounded evidence accumulator model fits the confidence data better than the classical bounded model, while bounded and unbounded models were indistinguishable for binary choice data. These results suggest that the brain can utilize mechanisms consistent with signal detection theory-especially when judging confidence without time pressure.NEW & NOTEWORTHY We found that choice confidence data show dynamics consistent with evidence accumulation for a forced-choice subjective visual vertical task. We also found that the evidence accumulation appeared unbounded when judging confidence, which suggests that the brain utilizes mechanisms consistent with signal detection theory to determine choice confidence.

Static Subjective Visual Vertical in Healthy Volunteers: The Effects of Different Preset Angle Deviations and Test-Retest Variability

The static subjective visual vertical (SVV) was assessed in 24 healthy volunteers with different preset angles (i.e., 10, 20, and 30 degrees), and in 20 other volunteers, the static SVV was tested and retested 1 week later. The static SVV results are influenced by the side of the preset angle (Wilcoxon test, p ≤ 0.001), but not by the preset angle deviation. The test-retest static SVV outcomes are stable at a group level; however, they show statistically relevant variability at an individual level (-0.240 ≤ intraclass correlation coefficient [ICC] ≤ 0.508). A robust static SVV protocol is described in this paper.

The Subjective Visual Vertical and the Subjective Haptic Vertical Access Different Gravity Estimates

The subjective visual vertical (SVV) and the subjective haptic vertical (SHV) both claim to probe the underlying perception of gravity. However, when the body is roll tilted these two measures evoke different patterns of errors with SVV generally becoming biased towards the body (A-effect, named for its discoverer, Hermann Rudolph Aubert) and SHV remaining accurate or becoming biased away from the body (E-effect, short for Entgegengesetzt-effect, meaning “opposite”, i.e., opposite to the A-effect). We compared the two methods in a series of five experiments and provide evidence that the two measures access two different but related estimates of gravitational vertical. Experiment 1 compared SVV and SHV across three levels of whole-body tilt and found that SVV showed an A-effect at larger tilts while SHV was accurate. Experiment 2 found that tilting either the head or the trunk independently produced an A-effect in SVV while SHV remained accurate when the head was tilted on an upright body but showed an A-effect when the body was tilted below an upright head. Experiment 3 repeated these head/body configurations in the presence of vestibular noise induced by using disruptive galvanic vestibular stimulation (dGVS). dGVS abolished both SVV and SHV A-effects while evoking a massive E-effect in the SHV head tilt condition. Experiments 4 and 5 show that SVV and SHV do not combine in an optimally statistical fashion, but when vibration is applied to the dorsal neck muscles, integration becomes optimal. Overall our results suggest that SVV and SHV access distinct underlying gravity percepts based primarily on head and body position information respectively, consistent with a model proposed by Clemens and colleagues.

Assessing the visual vertical: how many trials are required?

Background

The visual vertical (VV) consists of repeated adjustments of a luminous rod to the earth vertical. How many trials are required to reach consistency in this measure? This question has never been addressed despite the widespread clinical use of the measurement in stroke rehabilitation.

Methods

VV perception was assessed (10 trials) in 117 patients undergoing rehabilitation after a first hemisphere stroke. The intraclass correlation coefficient (ICC) and standard error of measurement (SEM) were calculated for each patient category: with contralesional VV bias (n = 48), ipsilesional VV bias (n = 17) and normal VV (n = 52).

Results

For patients with VV biases, 6 trials were required to reach high inter-trial reliability (contralesional: ICC = 0.9, SEM = 1.36°; ipsilesional: ICC = 0.896, SEM = 0.96°). For patients with normal VV, a minimum of 10 trials was required (ICC = 0.728, SEM = 1.13°). A set of 6 trials correctly classified 96 % of patients.

Conclusions

In the literature, 10 is the most frequently used number of trials used to assess VV orientation. Our study shows that 10 trials are required to adequately measure VV orientation in non-selected subacute stroke patients. For complex protocols imposing a decrease in the number of trials in each condition, 6 trials are needed to identify VV biases in most patients.

The right temporoparietal junction plays a causal role in maintaining the internal representation of verticality

Perception of the visual vertical is strongly based on our ability to match visual inflow with vestibular, proprioceptive, tactile, and even visceral information that contributes to maintaining an internal representation of the vertical. An important cortical region implicated in multisensory integration is the right temporoparietal junction (rTPJ), which also is involved in higher order forms of body- and space-related cognition. To test whether this region integrates body-related multisensory information necessary for establishing the subjective visual vertical, we combined a psychophysical task (the rod-and-frame test) with transient inhibition of the rTPJ via continuous theta burst stimulation (cTBS). A Gabor patch visual detection task was used as a control visual task. cTBS of early visual cortex (V1-V3) was used to test whether early visual cortices played any role in verticality estimation. We show that inhibition of rTPJ activity selectively impairs the ability to evaluate the rod's verticality when no contextual visual information, such as a frame surrounding the rod, is provided. Conversely, transient inhibition of V1-V3 selectively disrupts the ability to visually detect Gabor patch orientation. This anatomofunctional dissociation supports the idea that the rTPJ plays a causal role in integrating egocentric sensory information encoded in different reference systems (i.e., vestibular and somatic) to maintain an internal representation of verticality.

Association Between Visuospatial Ability and Vestibular Function in the Baltimore Longitudinal Study of Aging

OBJECTIVES

To investigate the relationship between vestibular loss associated with aging and age-related decline in visuospatial function.

DESIGN

Cross-sectional analysis within a prospective cohort study.

SETTING

Baltimore Longitudinal Study of Aging (BLSA).

PARTICIPANTS

Community-dwelling BLSA participants with a mean age of 72 (range 26-91) (N = 183).

MEASUREMENTS

Vestibular function was measured using vestibular-evoked myogenic potentials. Visuospatial cognitive tests included Card Rotations, Purdue Pegboard, Benton Visual Retention Test, and Trail-Making Test Parts A and B. Tests of executive function, memory, and attention were also considered.

RESULTS

Participants underwent vestibular and cognitive function testing. In multiple linear regression analyses, poorer vestibular function was associated with poorer performance on Card Rotations (P = .001), Purdue Pegboard (P = .005), Benton Visual Retention Test (P = 0.008), and Trail-Making Test Part B (P = .04). Performance on tests of executive function and verbal memory were not significantly associated with vestibular function. Exploratory factor analyses in a subgroup of participants who underwent all cognitive tests identified three latent cognitive abilities: visuospatial ability, verbal memory, and working memory and attention. Vestibular loss was significantly associated with lower visuospatial and working memory and attention factor scores.

CONCLUSION

Significant consistent associations between vestibular function and tests of visuospatial ability were observed in a sample of community-dwelling adults. Impairment in visuospatial skills is often one of the first signs of dementia and Alzheimer's disease. Further longitudinal studies are needed to evaluate whether the relationship between vestibular function and visuospatial ability is causal.

Association Between Vestibular and Cognitive Function in U.S. Adults: Data From the National Health and Nutrition Examination Survey

BACKGROUND

Vestibular function declines with age, and emerging evidence suggests that vestibular loss is associated with cognitive impairment. Whether vestibular dysfunction is associated with age-related cognitive decline is unknown.

METHODS

We used data from the 1999-2002 National Health and Nutrition Examination Surveys to evaluate the influence of vestibular function on cognitive performance in a nationally representative sample of U.S. adults aged ≥60 years (n = 1,303). Vestibular function was measured with the modified Romberg test, and cognitive function was measured by the digit symbol substitution (DSS) score test. We also developed structural equation models (SEMs) to explore whether vestibular dysfunction and associated cognitive impairment mediate the effect of age on falls and activities of daily living (ADL) difficulty.

RESULTS

Vestibular dysfunction was present in 58% of the study population. In multivariate analyses, vestibular dysfunction was associated with a 3.4-point lower DSS score (95% confidence interval: -5.2, -1.6; p < .0001), equivalent to the effect of 5 years of age. Vestibular dysfunction was also associated with a significantly higher odds of ADL difficulty (p = .001), and with a 2.6-fold increase in the odds of falling (p = .017). SEMs suggested that vestibular function mediates 14.3% of the effect of age on cognitive performance. Further SEMs suggested that lower cognitive performance mediates the association between vestibular loss and ADL difficulty as well as falls.

CONCLUSIONS

This study suggests that vestibular dysfunction partially mediates the association between age and cognitive impairment. Moreover, the cognitive impairment that results from vestibular loss may contribute to ADL difficulty and falls in older individuals.