Effect of breathing supplemental oxygen on motion sickness in healthy adults

OBJECTIVE: To compare the effects of breathing supplemental oxygen vs air on alleviating motion sickness in healthy adults. SUBJECTS AND METHODS: Between April and July 2002, 20 healthy subjects were exposed to a provocative motion on 2 occasions (1-week interval) according to a randomized, counterbalanced, crossover design. During motion, subjects rated their nausea (1, no symptoms, to 4, moderate nausea) every 30 seconds. Once mild nausea occurred, subjects began breathing supplemental oxygen or air through a face mask. Motion ceased when moderate nausea occurred, but subjects continued breathing study gases for 5 minutes while recovering. Recovery was assessed for 20 minutes after motion. RESULTS: There were no significant differences in the rate of increase in symptom severity or the rate of recovery between the 2 conditions. CONCLUSION: Breathing supplemental oxygen had no advantage over breathing air in reducing motion sickness in healthy adults.     

Assessment of unexplained falls and gait unsteadiness: the impact of age

When a patient with a balance disorder reports rotational vertigo, the clinician rightly focuses his or her attention on the vestibular system. This article reviews the possible diagnoses in the many patients who primarily report falls or gait disorder. Falls can be caused by predisposing neurologic conditions impairing gait, cardiovascular conditions, or epileptic episodes. The proportion of idiopathic falls, however, remains high. In the elderly, environmental circumstances, visual defects, psychotropic medication, and poor general health are additional risk factors. Clinical assessment of gait is more revealing and less expensive than computerized posture/ gait systems. The diagnosis of orthostatic tremor, however, requires either Fourier analysis of sway platform signals or electromyography.     

The human linear vestibulo-ocular reflex to transient accelerations: visual modulation of suppression and enhancement

Visual modulation of the linear vestibulo-ocular reflex (LVOR) was investigated in 4 normal subjects exposed to translational interaural transient accelerations of 0.08 g and 0.17 g. Binocular eye movements were recorded with the scleral search-coil technique. LVOR modulation with target proximity was studied using earth-fixed targets at distances of 30 and 60 cm (LVOR-E). LVOR suppression (LVOR-S) was provoked by similar targets which were head-fixed. For both conditions, linear acceleration evoked compensatory slow-phases whose velocities were, from onset, enhanced in proportion to acceleration and target proximity. At 80 ms after motion onset, i.e. before visually-guided eye movements could aid target fixation, gains (eye velocity/relative target velocity) during LVOR-E averaged 0.32 (S.D. 0.07) over all combinations of accelerations and target distances. At this time, eye velocities for LVOR-S were on average 33% lower than for LVOR-E (1.8 degrees/s vs. 2.7 degrees/s). During LVOR-S, a marked suppression of eye movements appeared at 102 ms (S.D. 10 ms). We conclude that mechanisms other than pursuit can be used to attenuate the LVOR at < 80 ms but their effect is weak. The marked suppression observed around 100 ms might be due to an early visual effect on vestibular pathways or by some independent voluntary control mechanism.     

The effect of habituation and plane of rotation on vestibular perceptual responses

A technique was applied to assess vestibular sensation without reference to external spatial, position cues. The stimuli were stopping responses to velocity-steps of 90 deg/s in the dark. Subjects indicated their perceived angular velocity by turning a flywheel connected to a tachogenerator. Two separate experiments were conducted. In one, subjects were rotated in yaw about an earth-vertical axis before and after prolonged rotational or visual (optokinetic) stimuli. In the second experiment, subjects were rotated in roll supine, with either the head ('roll centred') or the feet ('roll eccentric') on the axis of rotation. The two aims of the paper were to (i) examine the effect of repetitive vestibular and optokinetic stimulation on the time constant of decay of vestibular sensation in yaw; (ii) to compare vestibular sensation responses to rotation in roll both with and without the addition of a Z-axis centrifugal force. The pre-habituation sensation response in yaw decayed exponentially with a median time constant of 12.8 s. The duration of the sensation responses were significantly reduced following both prolonged vestibular and optokinetic stimulation. The reduction in vestibular responses following prolonged visual and vestibular stimuli, 1) is likely to occur in velocity storage mechanisms mediating ocular and perceptual responses, 2) may represent a mechanism for reducing the disorientating consequences of visual-vestibular conflict and 3) supports the use of optokinetic stimuli as a treatment for vestibular patients. The time constant of the sensation responses in roll was shorter and not significantly influenced by head position: 5.7 s in the head-centred position compared to 4.7 s in the eccentric head position. Therefore, perceptual as well as ocular responses to rotation in roll are determined primarily by cupula dynamics and not influenced by velocity storage.     

Evidence for a vestibulo-cardiac reflex in man

Changes in posture demand rapid cardiovascular adjustments to maintain blood pressure and volume distribution. We demonstrated a vestibulo-cardiac reflex in supine individuals by measuring electrocardiogram and arterial blood pressure after small backwards drops of the head triggered at varying intervals after the R-spike. In normal volunteers heart rate was accelerated by drops occurring within 500-600 ms of a beat, but no rapid effect was noted in patients with a vestibular defect. The speed at which the vestibular signal of head drop accelerated heart rate implies a direct reflex. Impairment of the vestibulo-cardiac reflex would help to explain the vaso-vagal consequences of labyrinthitis.     

The effect of gait approach velocity on the broken escalator phenomenon

Walking onto a stationary surface previously experienced as moving generates an after-effect commonly known as the “broken escalator” after-effect (AE). This AE represents an inappropriate expression of the locomotor adaptation necessary to step onto the moving platform (or escalator). It is characterised by two main biomechanical components, an increased gait approach velocity (GAV) and a forward trunk overshoot on gait termination. We investigated whether the trunk overshoot and other biomechanical measures are the direct inertial consequence of the increased GAV or whether these are the result of an independent adaptive mechanism. Forty-eight healthy young adults walked onto a movable sled. They performed 5 trials with the sled stationary at their preferred walking velocity (BEFORE trials), 5 with the sled moving (MOVING or adaptation trials), and 5 with the sled stationary again (AFTER trials). For the AFTER trials, subjects were divided into four groups. One group was instructed to walk slowly (“slower”), another with cueing at the BEFORE pace (“metronome”). The third group walked without cueing at the BEFORE pace (“normal”), and the fourth, fast (“faster”). We measured trunk pitch angle, trunk linear horizontal displacement, left shank pitch angular velocity and surface EMG from lower leg and trunk muscles. In the AFTER trials, an AE was observed in these biomechanical measures for all gait speeds, but these were not strongly dependent on GAV. An AE was present even when GAV was not different from that of BEFORE trials. Therefore, we conclude that, although contributary, the trunk overshoot is not the direct consequence of the increased GAV. Instead, it appears to be generated by anticipatory motor activity “just in case” the sled moves, herewith termed a “pre-emptive” postural adjustment.     

Vertical and horizontal motion perception in congenital nystagmus

We investigated whether individuals with congenital nystagmus (CN) have abnormalities in motion perception and whether any such abnormality could be due to their nystagmus or to adaptive mechanisms to avoid oscillopsia. CN and control subjects performed motion detection and discrimination tasks. In the detection tasks, subjects reported the onset of motion and drift direction in either a vertical or horizontal direction. In the discrimination task, the stimulus was a high-contrast grating and moved vertically. Subjects judged whether successively presented reference and test velocities were the same or different, using a forced choice instruction. Vertical velocity detection was normal in the patient group. The vertical velocity discrimination task showed that the patients were less accurate than the controls, especially when velocities were slow. Horizontal velocity detection thresholds were raised in the patient group regardless of the direction of the slow phase velocity (spv) of the nystagmus. Evaluation of eye movement recordings performed during the task demonstrated that detection velocity was highest when stimulus motion and spv were in the same direction. When nystagmus was absent due to a prolonged neutral zone, thresholds did not reduce to normal values. The findings show that the image motion caused by the nystagmus cannot account for all the abnormalities found. Deficits occurred in the absence of nystagmus and when motion was orthogonal to the meridian of the nystagmus suggesting that the suppression of motion perception is, in part, due to adaptive mechanisms used to avoid oscillopsia.