Postural behaviour responses to visual stimulation in patients with vestibular disorders

Patients with different vestibular disorders exhibit changes in postural behaviour when they receive visual stimuli, reproducing environmental stimulation. Postural control was studied using an AMTI Accusway platform, measuring the confidential ellipse (CE) and sway velocity (SV). Postural responses were recorded according to the following stimulation paradigm: i) without specific stimuli; ii) smooth pursuit with pure sinusoids of 0.2 Hz (foveal stimulation); and iii) optokinetic stimulation (retinal stimuli). Patients with central vestibular disorders (CVD), cerebellar damage and unilateral peripheral vestibular lesions (UPVL) in asymptomatic periods were studied. A group of normal subjects was studied as control. Signal processing was done with a scalogram by wavelets in order to observe the relation between time and frequency in postural control. While patients with CVD and cerebellar disease showed a significant increase in CE and SV in the three conditions of the paradigm compared to the normal group, the patients with UPVL showed no change. Wavelets processing showed that the main sway occurs in the Y axis (antero-posterior) and below at 0.4 Hz in normal subjects, while the CVD and cerebellar patients showed sway frequencies in both the X and Y axes. The clinical implications of these findings are discussed.     

Assessment of the risk of fall, related to visual stimulation, in patients with central vestibular disorders

In order to assess the influence of visual stimulation in the triggering of imbalance and falls in the elderly population, the postural responses of 18 elderly patients with central vestibular disorders and clinical evidence of instability and falls were studied while receiving different types of visual stimuli. The stimulation conditions were: (i) no specific stimuli; (ii) smooth pursuit with pure sinusoids of 0.2 Hz as foveal stimulation; and (iii) optokinetic stimulation (OK) as retinal stimuli. Using a platform AMTI Accusway platform, the 95% confidence ellipse (CE) and sway velocity (SV) were evaluated with a scalogram using wavelets in order to assess the relationship between time and frequency in postural control. Velocity histograms were also constructed in order to observe the distribution of velocity values during the recording. A non-homogeneous postural behavior after visual stimulation was found among this population. In five of the patients the OK stimulation generated: (i) significantly higher average values of CE ( > 3.4+/-0.69 cm2); (ii) a significant increase in the average values of the SV ( > 3.89+/-1.15 cm/s) and a velocity histogram with a homogeneous distribution between 0 and 18 cm/s; and (iii) a scalogram with sway frequencies of up to 4 Hz distributed in both the X and Y directions (backwards and forwards and lateral) during visual stimulation with arbitrary units of energy density > 5. These three qualitative and quantitative aspects could be "markers" of visual dependence in the triggering of the mechanism of lack of equilibrium and hence falls in some elderly patients and should be considered in order to prevent falls and also to assist in the rehabilitation program of these patients.     

Changes in postural control parameters after vestibular rehabilitation in patients with central vestibular disorders

OBJECTIVE: The aim of this study was to determine postural responses before and after a vestibular rehabilitation program (VRP) in 14 patients with central vestibular disorders (CVD). MATERIAL AND METHODS: The confidence ellipse (CE) of the center of pressure distribution area and the sway velocity (SV) were the parameters used for the quantitative assessment of postural control (PC). These two parameters were analyzed before and after a VRP for two visual conditions. Behavioral postural responses were studied by means of the time-frequency scalogram using wavelets and the sway frequency content was measured in arbitrary units of energy density. RESULTS: Ten patients showed a significant decrease in the CE and SV after the rehabilitative treatment, thus improving their PC. Seven of these patients were assessed again after a period of 12 +/- 5 months, during which they had not received any physical training. All of them showed increases in the CE and SV, indicating an impairment of PC. CONCLUSIONS: Many CVD patients damage the neural mechanisms involved in retaining the plastic changes in the PC parameters after rehabilitative treatment. Continuation of training may be necessary in order to maintain the improvement in PC obtained with a VRP.     

Balance sensory organization in children with profound hearing loss and cochlear implants

OBJECTIVES: (1) To determine the feasibility of the use of a modified postural control test under altered sensory conditions in children over 8 years of age, and (2) to assess how deaf children use sensory information for postural control when they have normal or abnormal vestibular responses, and if hearing input from a unilateral cochlear implant, changes their postural behavior. PATIENTS: We selected 36 children, 8 to 11 years of age, with congenital or early-acquired profound sensorineural hearing loss, 13 of them with unilateral cochlear implantation and 22 normal-hearing children. METHODS: The Postural Control (PC) test consists of a force platform with 2 stimulation paradigm conditions: (1) standing on the platform with opened eyes; (2) standing on foam placed on the force platform with closed eyes. Implanted children were tested with the implant turn on and turn off in this condition, in order to evaluate eventual change in the postural control parameters when they have hearing habilitation. The body center of pressure distribution area (COP) and the body sway velocity (SV) were the parameter to evaluate the postural control. RESULTS: Deaf children were classified into two groups according with the vestibular responses: group A (n=28) Children with normal vestibular rotary responses; group B (n=8) children with hypoactive responses. Children in group A had diagnoses of syndromic and non-syndromic hereditary deafness, and children in group B had inner ear malformations, post-meningitis deafness, and one child had non-syndromic hereditary deafness with hypoactive vestibular response. In condition 1, when vestibular, somatosensory and visual information were enabled, the COP and SV values did not show any statistically significant differences between groups A, B and control. In condition 2, when visual information was removed and the somatosensory input strongly modified by standing on the foam, group B showed significant higher COP and SV values than groups A and control (p<0.05). In addition, the scalograms by wavelets of children in group B had higher amplitudes increasing the sway frequencies contents up to 3 Hz, not allowing them to maintain the up right stance in similar stimulation than in condition. Implanted children of the group A and B with the implant turn on, in the condition 2, did not show any significant difference in the SV, comparing when they had the implanted turn off. Group A p=0.395 and group B p=0.465 (Wilcoxon ranked test). CONCLUSION: These findings allow us to confirm that this postural test can be performed in children over 8 years old. Also our results suggest that deaf children with associated hypoactive vestibular responses included in our study, despite the etiology of the deafness, primarily use visual and somatosensory information to maintain their postural control. Hearing habilitation with a unilateral cochlear implant has no effect on the observed sensory organization strategy.     

Effect of head orientation on human postural stability following unilateral vestibular ablation.

Effective interpretation of vestibular inputs to postural control requires that orientation of head on body is known. Postural stability might deteriorate when vestibular information and neck information are not properly coupled, as might occur with vestibular pathology. Postural sway was assessed in unilateral vestibulopathic patients before and acutely, 1, 4, and 18+ months after unilateral vestibular ablation (UVA) as well as in normal subjects. Postural equilibrium with eyes closed was quantified as scaled pk-pk sway during 20 s trials in which the support surface was modulated proportionally with sway. Subjects were tested with the head upright and facing forward, turned 45 degrees right, and 45 degrees left. Equilibrium was uninfluenced by head orientation in normal subjects. In contrast, patients after UVA showed both a general reduction in stability and a right/left head orientation-dependent asymmetry. These abnormalities adaptively recovered with time. It is concluded that vestibular inputs to postural control are interpreted within a sensory-motor context of head-on-body orientation.     

Changes in Postural Control in Healthy Elderly Subjects are Related to Vibration Sensation,Vision and Vestibular Asymmetry

The aim of this study was to analyze the composition of sway in adults and "healthy" elderly people and to evaluate the influence of vibration sensation and asymmetric vestibular function on the sway pattern. Ten adults with a mean age of 37.5 years and 40 healthy senior citizens with a mean age of 74.6 years living independently in the community were studied. Vibration-induced body sway was measured on a force platform. The sway was analyzed and separated into its high and low frequency components above and below 0.1 Hz, respectively. Additionally the elderly subjects were observed for the occurrence of spontaneous gaze and head shake-induced nystagmus using infrared charge-coupled device cameras and the vibration perception in the lower limbs was tested with a tuning fork. Vibration perception was the major determinant for postural control in the elderly subjects. Postural control among the elderly subjects with intact vibration perception in their lower limbs was very similar to that of the adults. The elderly subjects with impaired vibration sensation had increased high frequency sway compared to adults and the elderly subjects with intact sensation. Regardless of the strong influence of vibration sensation on postural control, asymmetric vestibular function might also be a contributing factor to postural instability in the elderly. Age per se had little effect on the outcome of the tests except that the elderly subjects had diminished ability to use visual cues to reduce postural sway. We concluded that sensory status in the lower limbs is of utmost importance for postural control in the elderly. Rehabilitation programs for senior citizens should therefore include exercises to preserve recognition of body motion by the lower limbs. Exercises to facilitate vestibular compensation could be useful for elderly people with vestibular dysfunction.     

Short-term Adaptation in the Peripheral Auditory System is Related to the AMPA Receptor

A pattern of sound-induced paroxysms of the eye and head and other spinal motor neuron synkinesis (Tullio's phenomenon) in human subjects always implies either a pathological contiguity of the tympano-ossicular chain and membranous labyrinth or a dehiscence of the bone overlying the superior semicircular canal. However, it has become clear in the last decade that sound-evoked vestibular stimulation is not only a sign of disease but also a physiological phenomenon. The examination of such physiologically sound-induced vestibular (saccular) responses contributes today to the clinical testing of the vestibular organ, mainly in the form of vestibular-evoked myogenic potentials. In this study it was observed that, in a group of 20 normal subjects, a 500 Hz tonal stimulus of high intensity (105 dB HL=118.5 dB SPL), applied monoaurally, elicited postural responses. Each subject was studied under 4 different conditions: (i) head facing forwards, eyes open; (ii) head facing forwards, eyes closed; (iii) head rotated &;#44 90° to the right, eyes closed; and (iv) head rotated 90° to the left, eyes closed. Body sway, measured using a force platform, was recorded in all subjects, with eyes either open or closed. Postural responses, which were also elicited with a 250 Hz tonal stimulus, were not observed with a tone of 2000 Hz, with legs slightly flexed or with binaural stimulation. The postural sway (head facing forwards, eyes open or closed) was in a lateral direction towards the stimulated ear: with the stimulus applied to the right ear the subject had postural sway towards the right, with the stimulus applied to the left ear towards the left. When the head was rotated &;#44 90° sideways and the stimulus was given facing forwards (i.e. head rotated contralaterally to stimulated ear) the postural sway was in a forward direction; when the head was rotated &;#44 90° sideways and the stimulus was given facing backwards (i.e. head rotated ipsilaterally to stimulated ear) the postural sway was in a backward direction. The mean values (mm) of body sway obtained with the head facing forwards and the eyes closed were higher than those with the eyes open (21.7 and 22.8 vs 15.7 and 14.7 for the right and left ears, respectively); higher mean values were obtained with the head turned to the side contralateral to the ear stimulated and the eyes closed (29.3 and 24.8 for the right and left ears, respectively). Under this condition the body sway was mainly in a forward direction. The sound-evoked vestibulopostural reflex seems to be a useful test for exploring the saccular function and, as a click-evoked vestibulocollic reflex, can be considered a physiological Tullio phenomenon.     

Sound-evoked postural responses in normal subjects

A pattern of sound-induced paroxysms of the eye and head and other spinal motor neuron synkinesis (Tullio's phenomenon) in human subjects always implies either a pathological contiguity of the tympano-ossicular chain and membranous labyrinth or a dehiscence of the bone overlying the superior semicircular canal. However, it has become clear in the last decade that sound-evoked vestibular stimulation is not only a sign of disease but also a physiological phenomenon, The examination of such physiologically sound-induced vestibular (saccular) responses contributes today to the clinical testing of the vestibular organ, mainly in the form of vestibular-evoked myogenic potentials. In this study it was observed that, in a group of 20 normal subjects, a 500 Hz tonal stimulus of high intensity (105 dB HL = 118.5 dB SPL), applied monoaurally, elicited postural responses. Each subject was studied under 4 different conditions: (i) head facing forwards, eyes open; (ii) head facing forwards, eyes closed; (iii) head rotated approximately 90 degrees to the right, eyes closed: and (iv) head rotated approximately 90 degrees to the left, eyes closed. Body sway, measured using a force platform, was recorded in all subjects, with eyes either open or closed. Postural responses, which were also elicited with a 250 Hz tonal stimulus, were not observed with a tone of 2000 Hz, with legs slightly flexed or with binaural stimulation. The postural sway (head facing forwards, eyes open or closed) was in a lateral direction towards the stimulated ear: with the stimulus applied to the right ear the subject had postural sway towards the right, with the stimulus applied to the left ear towards the left. When the head was rotated approximately 90 degrees sideways and the stimulus was given facing forwards (i.e. head rotated contralaterally to stimulated ear) the postural sway was in a forward direction; when the head was rotated approximately 90 degrees sideways and the stimulus was given facing backwards (i.e. head rotated ipsilaterally to stimulated ear) the postural sway was in a backward direction. The mean values (mm) of body sway obtained with the head facing forwards and the eyes closed were higher than those with the eyes open (21.7 and 22.8 vs 15.7 and 14.7 for the right and left ears, respectively); higher mean values were obtained with the head turned to the side contralateral to the ear stimulated and the eyes closed (29.3 and 24.8 for the right and left ears, respectively). Under this condition the body sway was mainly in a forward direction. The sound-evoked vestibulopostural reflex seems to be a useful test for exploring the saccular function and, as a click-evoked vestibulocollic reflex, can be considered a physiological Tullio phenomenon.     

Changes in postural control in healthy elderly subjects are related to vibration sensation, vision and vestibular asymmetry.

The aim of this study was to analyze the composition of sway in adults and "healthy" elderly people and to evaluate the influence of vibration sensation and asymmetric vestibular function on the sway pattern. Ten adults with a mean age of 37.5 years and 40 healthy senior citizens with a mean age of 74.6 years living independently in the community were studied. Vibration-induced body sway was measured on a force platform. The sway was analyzed and separated into its high and low frequency components above and below 0.1 Hz, respectively. Additionally the elderly subjects were observed for the occurrence of spontaneous gaze and head shake-induced nystagmus using infrared charge-coupled device cameras and the vibration perception in the lower limbs was tested with a tuning fork. Vibration perception was the major determinant for postural control in the elderly subjects. Postural control among the elderly subjects with intact vibration perception in their lower limbs was very similar to that of the adults. The elderly subjects with impaired vibration sensation had increased high frequency sway compared to adults and the elderly subjects with intact sensation. Regardless of the strong influence of vibration sensation on postural control, asymmetric vestibular function might also be a contributing factor to postural instability in the elderly. Age per se had little effect on the outcome of the tests except that the elderly subjects had diminished ability to use visual cues to reduce postural sway. We concluded that sensory status in the lower limbs is of utmost importance for postural control in the elderly. Rehabilitation programs for senior citizens should therefore include exercises to preserve recognition of body motion by the lower limbs. Exercises to facilitate vestibular compensation could be useful for elderly people with vestibular dysfunction.     

The effects of stochastic monopolar galvanic vestibular stimulation on human postural sway

Galvanic vestibular stimulation (GVS) is a technique in which small currents are delivered transcutaneously to the afferent nerve endings of the vestibular system through electrodes placed over the mastoid bones. The applied current alters the firing rates of the peripheral vestibular afferents, causing a shift in a standing subject's vestibular perception and a corresponding postural sway. Previously, we showed that in subjects who are facing forward, stochastic bipolar binaural GVS leads to coherent stochastic mediolateral postural sway. The goal of this pilot study was to extend that work and to test the hypothesis that in subjects who are facing forward, stochastic monopolar binaural GVS leads to coherent stochastic anteroposterior postural sway. Stochastic monopolar binaural GVS was applied to ten healthy young subjects. Twenty-four trials, each containing a different galvanic input stimulus from among eight different frequency ranges, were conducted on each subject. Postural sway was evaluated through analysis of the center-of-pressure (COP) displacements under each subject's feet. Spectral analysis was performed on the galvanic stimuli and the COP displacement time series to calculate the coherence spectra. Significant coherence was found between the galvanic input signal and the anteroposterior COP displacement in some of the trials (i.e., at least one) in nine of the ten subjects. In general, the coherence values were highest for the mid-range frequencies that were tested, and lowest for the low- and high-range frequencies. However, the coherence values we obtained were lower than those we previously reported for stochastic bipolar binaural GVS and mediolateral sway. These differences may be due to fundamental characteristics of the vestibular system such as lower sensitivity to symmetric changes in afferent firing dynamics, and/or differences between the biomechanics of anteroposterior and mediolateral sway.     

A quantitative analysis of postural control in elderly patients with vestibular disorders using visual stimulation by virtual reality

IntroductionPostural instability is one the most common disabling features in vestibular disorders.ObjectiveThis study aimed to analyze the limit of stability and the influence of manipulation of visual, somatosensorial and visual–vestibular information on postural control in older adults with vestibular disorder, with and without a history of falls.MethodsCross-sectional study. Participants – 76 elderly patients with vestibular disorder (G1, without falls; G2, with falls) and 41 healthy elderly subjects (control group; CG). Using posturography, analyzed were limit of stability area, body center of pressure, and velocity of oscillation in the standing position in 10 conditions, including open/closed eyes, unstable surface with eyes closed, saccadic and optokinetic stimuli, and visual–vestibular interaction.ResultsLimit of stability area in CG was better compared with G1-2, and center of pressure values were worse in G1 than in CG. Center of pressure area in all conditions and velocity of oscillation in the following conditions: open/closed eyes, optokinetic stimulation, and visual–vestibular interaction showed worse values in G2 than in CG. Center of pressure area in the following conditions: open/closed eyes, saccadic and optokinetic stimuli, visual–vestibular interaction, and unstable surface with eyes closed showed worse values in G2 than in G1.ConclusionOlder adults with vestibular disorder presented reduced limit of stability and increased postural sway in the following conditions: conflict between visual and somatosensory information and visual–vestibular interaction. Deterioration in postural control was significantly associated with history of falls.     

Motion sickness susceptibility associated with visually induced postural instability and cardiac autonomic responses in healthy subjects

Conclusions This study supports the hypothesis that postural sway and autonomic responses to moving visual stimuli may be associated with motion sickness susceptibility. Characteristics of the cardiac sympathovagal balance during exposure to provocative stimulation may be a marker of individual susceptibility to motion sickness.

Objective To assess the relationship between postural and autonomic responses to a simulated visual motion environment and reported susceptibility to motion sickness.

Material and methods Fifteen healthy subjects were exposed to sinusoidally oscillating visual motion in roll at frequencies of 0.1–0.4 Hz. Recordings were made of postural sway and respiratory frequency and electrocardiograms were obtained from which heart rate variability (HRV) was computed in order to probe cardiac sympathetic and parasympathetic activity.

Results In subjects with a low susceptibility to motion sickness as rated using a standardized questionnaire, there was no significant effect of visual stimulus on postural sway or HRV at any frequency of motion. Subjects with a high susceptibility to motion sickness showed significant postural instability induced by visual stimuli (p<0.01). Visual stimuli presented at a frequency of 0.1 Hz significantly increased the low-frequency power (LF) of HRV, decreased the high-frequency power (HF) of HRV and increased the LF:HF ratio in these subjects (p<0.05).     

Balance control in quiet upright standing in patients with panic disorder

The postural stability of 30 panic disorder (PD) patients and 30 sex- and age-matched healthy control subjects (age range 27–40 years) was investigated by static posturographic tests of quiet standing on stable and foam surfaces with open and closed eyes. Postural stability was evaluated by sway velocity (SV) and power density of relative power spectrum (RPS) in five frequency ranges. There were no differences of SV between two groups during stance with open eyes on both surfaces. The SV of the PD patients standing with closed eyes was significantly higher compared to controls for the stance on the stable surface (anterior–posterior plane) and on the foam surface (both anterior–posterior and medial–lateral planes). The stance on foam surface did not cause any significant changes in power density of postural sways of healthy subjects, while this parameter was significantly higher for PD patients, especially in closed eyes condition when a sensory conflict may exist. The higher value of SV and RPS (0.5–1.0 Hz) in patients compared to controls suggests that the visual information has more important role in the postural balance when sensory conflict exists during stance on foam surface. We proposed that the altered information from the visual and proprioceptive inputs may induce anxiety and panic symptoms in PD patients, which enhances the sensory conflict, leads to abnormal work of the vestibular system and disturbs the standing balance.     

Motion sickness susceptibility associated with visually induced postural instability and cardiac autonomic responses in healthy subjects

CONCLUSIONS: This study supports the hypothesis that postural sway and autonomic responses to moving visual stimuli may be associated with motion sickness susceptibility. Characteristics of the cardiac sympathovagal balance during exposure to provocative stimulation may be a marker of individual susceptibility to motion sickness. OBJECTIVE: To assess the relationship between postural and autonomic responses to a simulated visual motion environment and reported susceptibility to motion sickness. MATERIAL AND METHODS: Fifteen healthy subjects were exposed to sinusoidally oscillating visual motion in roll at frequencies of 0.1-0.4 Hz. Recordings were made of postural sway and respiratory frequency and electrocardiograms were obtained from which heart rate variability (HRV) was computed in order to probe cardiac sympathetic and parasympathetic activity. RESULTS: In subjects with a low susceptibility to motion sickness as rated using a standardized questionnaire, there was no significant effect of visual stimulus on postural sway or HRV at any frequency of motion. Subjects with a high susceptibility to motion sickness showed significant postural instability induced by visual stimuli (p < 0.01). Visual stimuli presented at a frequency of 0.1 Hz significantly increased the low-frequency power (LF) of HRV, decreased the high-frequency power (HF) of HRV and increased the LF:HF ratio in these subjects (p < 0.05).     

Effects of unilateral loss of vestibular function on the vestibulo-ocular reflex and postural control

Long-term recovery from surgically induced unilateral loss of vestibular function was studied in 14 patients. Seven patients underwent surgical extirpation or section of the vestibular nerve, and seven patients underwent labyrinthectomy without vestibular nerve section. The vestibulo-ocular reflex (VOR) and postural control were evaluated preoperatively and monitored for up to 4 years postoperatively with use of pseudorandom rotation (combined sinusoidal frequencies from 0.009 to 1.5 Hz) and moving platform posturography. Immediately following surgery all patients showed minimal reductions in the VOR gain constant, but marked reduction in the time constant, and marked increase in slow eye velocity bias. Bias returned to normal values within about 10 days, but time constants never returned to normal values. Results of standard Romberg tests in these patients were normal throughout the preoperative and postoperative periods. However, all patients showed marked postural control abnormalities in tests of the ability to maintain balance in unusual sensory environments in the immediate postoperative period. Seventy-five percent of the patients eventually recovered normal postural control. Postural control returned to near baseline performance with a time course similar to that of the VOR bias. However, postural control also continued to improve after the recovery of VOR bias was complete.     

Effect of proprioceptor stimulation on postural stability in patients with peripheral or central vestibular lesion

Body sway in upright stance at rest and after inducing proprioceptor stimulation, elicited by vibration applied to the calf or neck muscles, was studied in 11 patients with peripheral lesion and in 17 patients with central vestibular lesion. The responses were compared with those of 20 normal subjects. Vibratory stimulus was applied at five different frequencies, ranging from 32 to 150 Hz, and at a constant amplitude of 2.1 mm. Postural stability was measured with a force platform in terms of average deviation of body position (ADBP) analyzed in relation to the individual maximum support distance in the anterio-posterior direction. In patients with peripheral vestibular lesion ADBP was moderately increased, compared to normal subjects, when the calf muscles were exposed to vibration under eyes closed conditions (i.e. no visual information available); stimulation of neck muscles both under eyes open and eyes closed conditions and stimulation of calf muscles with open eyes produced an ADBP of the same magnitude as in controls. In patients with central vestibular lesion, proprioceptor stimulation of calf and neck muscles caused increased ADBP whether with eyes open or closed. The ADBP induced by stimulation of neck muscles was significantly greater in patients with a central lesion than in those with a peripheral vestibular lesion. The results indicate that patients with peripheral lesion differ from those with central vestibular lesion in their reaction to proprioceptor stimulus; and that in patients with central vestibular lesion proprioceptor stimulation of the neck muscles produces disproportionately powerful cervico-collic reflexes.     

Direction of Galvanically-induced Vestibulo-postural Responses during Active and Passive Neck Torsion

The direction of a postural response induced by galvanic vestibular stimulation depends on the head and trunk position. The relative importance of afferent information (proprioception) and efferent motor command/corollary discharge is unknown. We studied the direction of body sway evoked by galvanic vestibular stimulation in 9 healthy subjects during active and passive head positioning at 0° frontal position, 35° to the left, and 75° to the right, using a custom-built collar. At 0° and 75° there were no significant differences in sway direction between active and passive head positioning. The galvanic stimulation invoked sway toward the anode, mainly in the inter-aural direction. The sway direction differed significantly between active and passive positioning at 35° to the side (p&lt;0.05). When the head was actively kept in this position, the body sway was mainly in an inter-aural direction. The sway shifted to a naso-occipital direction when the head was passively positioned at 35°. Our results indicate that the afferent proprioceptive information has the largest influence on the direction of the galvanically-induced postural response, although some dependence on efferent motor commands and non-linear cervical proprioception cannot be ruled out entirely.     

Nonsequential vector analysis of body sway in Menière's disease]

Body sway test which examines the vestibulo-spinal reflex is sensitive for evaluating vestibular dysfunction in patients with vertigo, dizziness or unsteadiness. Body sway is usually evaluated by measuring the length and area of traces on the force platform. However, it is not necessarily possible to evaluate abnormal body sway with these indicators because there is a discrepancy between sway length and area. In the present study, 8 directional vectro-posturography was developed and applied to the patients with Meniere's disease. Averaging of measurements at moving 3 points was used to eliminate high frequency noise over 4.92Hz. The subjects consisted of 66 patients with unilateral Meniere's disease and 31 normal controls. Eight directional vectrogram allowed measurement of shift area and directionality, simultaneously. The patient's group showed statistically significant body sway in the right forward and left backward direction with eyes open, in all the directions with eyes closed, when compared with the control's group. The effect of vision on postural stability was studied by obtaining 8 directional Romberg's quotients. The patients with Meniere's disease had significantly in forward-backward, and left-forward and right-backward direction when compared with controls. However, laterality of the affected side was not detected from the vectrogram. The effect of endolymphatic sac operation on postural stability was evaluated in the patients of unilateral Meniere's disease who showed progressive hearing loss and resisted conservative medication therapy. The results showed unstable body sway in the condition with eyes closed until at least 4 months after the operation. The patients with Meniere's disease presented pathological body sway, even during symptom free periods, when examined with 8 directional vector posturography. Power spectral analysis of body sway indicated that most energy was distributed at frequencies lower than 0.5Hz. Nevertheless, directional preponderance of body sway was characterized by higher frequency components. The findings infers that postural stability at the frequency range over 0.5Hz, may be governed by the input of vestibular organs.     

Postural adaptation in elderly patients with instability and risk of falling after balance training using a virtual-reality system

Our aim in this study was to assess postural control adaptation quantitatively in unsteady elderly patients at risk of falls in open spaces and given balance training with a virtual-reality system reproducing environmental stimulation. Using a balance rehabilitation unit based on a virtual-reality system that changes sensory information (visual, vestibular, and somatosensory), we treated 26 elderly, unsteady patients who were prone to falling (age range, 73-82 years) and who were enrolled in a customized vestibular rehabilitation program. We assessed postural responses by posturography before and after 6 weeks in the vestibular rehabilitation program under two conditions: (1) standing, eyes open, static visual field, and (2) standing, eyes open, dynamic visual field through virtual-reality goggles, generating horizontal optokinetic stimulation (70 degrees per second angular velocity). We recorded postural responses with a platform measuring the confidential ellipse of the center-of-pressure distribution area and sway velocity with a scalogram analyzing postural behavior by wavelets. After 6 weeks of treatment, postural response confidential ellipse and sway velocity values were lower, evincing decreased amplitudes and sway frequency contents in the scalogram by wavelet under both stimulation paradigm conditions. These findings suggest postural adaptation under the two perceptual conditions when patients had static and dynamic visual fields. The possibility of treating elderly fallers with balance disorders using a virtual-reality environmental stimulation reproduction system is discussed.     

Head and body sway in response to vertical visual stimulation

Conclusions. Postural responses differed according to the stimulus direction, i.e. vertical visual stimulation induced head rather than trunk displacements. Accordingly, it could be that center of foot pressure (COP) responses tended to underestimate the postural sway during visual stimulation. Objectives. To investigate head and body sway in response to vertical visual surround motion, and to examine the correlation between the displacements of head and body segments derived from video-motion analysis and COP measurements. Material and methods. Postural sway was assessed in 10 young female subjects by video-motion analysis of four different head and body segments, and by use of force-plate posturography. Head and body sway in the pitch plane was induced by rotating a random pattern of dots about the subject's inter-aural axis at a constant acceleration of 1°/s² or a constant velocity of 60°/s in darkness. Results. Generally, head displacement was greater than that of other body parts during vertical optokinetic stimulation (OKS). In most subjects, maximum head displacements were induced in the same direction as the visual motion. Downward OKS induced a forward head and body sway. The COP trajectory correlated well with the displacements of each head and body segment during downward OKS. In contrast, postural responses to upward OKS were complicated in terms of their time course. The correlation coefficient between each head and body segment and the COP varied among individuals for upward OKS.