The interactive contribution of neck muscle proprioception and vestibular stimulation to subjective "straight ahead" orientation in man

Impact of subclinical neck pain on eye and hand movements in goal-directed upper limb aiming movements

Individuals with untreated, mild-to-moderate recurrent neck pain or stiffness (subclinical neck pain (SCNP)) have been shown to have impairments in upper limb proprioception, and altered cerebellar processing. It is probable that aiming trajectories will be impacted since individuals with SCNP cannot rely on accurate proprioceptive feedback or feedforward processing (body schema) for movement planning and execution, due to altered afferent input from the neck. SCNP participants may thus rely more on visual feedback, to accommodate for impaired cerebellar processing. This quasi-experimental study sought to determine whether upper limb kinematics and oculomotor processes were impacted in those with SCNP. 25 SCNP and 25 control participants who were right-hand dominant performed bidirectional aiming movements using two different weighted styli (light or heavy) while wearing an eye-tracking device. Those with SCNP had a greater time to and time after peak velocity, which corresponded with a longer upper limb movement and reaction time, seen as greater constant error, less undershoot in the upwards direction and greater undershoot in the downwards direction compared to controls. SCNP participants also showed a trend towards a quicker ocular reaction and movement time compared to controls, while the movement distance was fairly similar between groups. This study indicates that SCNP alters aiming performances, with greater reliance on visual feedback, likely due to altered proprioceptive input leading to altered cerebellar processing.

Young children can use their subjective straight-ahead to remap visuo-motor alterations

Young children and adults process spatial information differently: the former use their bodies as primary reference, while adults seem capable of using abstract frames. The transition is estimated to occur between the 6th and the 12th year of age. The mechanisms underlying spatial encoding in children and adults are unclear, as well as those underlying the transition. Here, we investigated the role of the subjective straight-ahead (SSA), the body antero-posterior half-plane mental model, in spatial encoding before and after the expected transition. We tested 6-7-year-old and 10-11-year-old children, and adults on a spatial alignment task in virtual reality, searching for differences in performance when targets were placed frontally or sideways. The performance differences were assessed both in a naturalistic baseline condition and in a test condition that discouraged using body-centered coordinates through a head-related visuo-motor conflict. We found no differences in the baseline condition, while all groups showed differences between central and lateral targets (SSA effect) in the visuo-motor conflict condition, and 6-7-year-old children showed the largest effect. These results confirm the expected transition timing; moreover, they suggest that children can abstract from the body using their SSA and that the transition underlies the maturation of a world-centered reference frame.

Effects of unilateral neck muscle vibration on standing postural orientation and spatial perception in healthy subjects based on stimulus duration and simultaneous stimulation of trunk muscles

Neck muscle vibration (NMV) influences proprioceptive sensations and modulates standing postural orientation and spatial perception. However, the effects of NMV in healthy participants would vary based on the influence of stimulus duration and combination with trunk muscle vibration. Therefore, this study with a cross-over design clarified these effects. Twenty-four healthy participants (mean age, 25.7±3.7 years) were enrolled. To assess standing postural orientation, standing center-of-pressure (COP) measurements were recorded on a COP platform, starting with closed eyes and then with open eyes. The mean mediolateral (ML) and anteroposterior (AP) position [mm] of COP and other parameters were calculated. To assess spatial perception, subjective straight ahead (SSA) measurements were recorded, wherein participants were instructed to point and project the position of the manubrium of sternum on the touch panel using their right index finger with their eyes closed. Measurements were taken before and after four conditions: no vibration (control), left NMV for 30 s, left NMV for 10 min, and left NMV and left lumbar back vibration for 10 min. Vibratory stimulation was performed with the eyes closed at 80 Hz. The measurements under the four conditions were conducted with random cross-over and 5-min resting period between the conditions. COP and SSA values were subtracted before and after each condition for standardized variation and compared. NMV combined with trunk muscle vibration for 10 min resulted in significant deviations of the ML-COP toward the stimulation side and AP-COP toward the anterior side compared to the control condition with closed eyes. SSA showed no significant differences. These findings suggest that NMV-induced nervous system modulation would be amplified by proprioceptive sensory input to trunk muscles. Therefore, this method could provide a new option for clinical trials on postural orientation using NMV. SSA based on proprioceptive sensation may not be biased without visual illusions.

The impact of subclinical neck pain on goal-directed upper limb movement in the horizontal plane

Subclinical neck pain (SCNP) refers to recurrent neck pain and/or stiffness for which individuals have not yet sought treatment. Prior studies have shown that individuals with SCNP have altered cerebellar processing that exhibits an altered body schema. The cerebellum also plays a vital role in upper limb reaching movements through refining internal models and integrating sensorimotor information. However, the impact of SCNP on these processes has yet to be examined in the context of a rapid goal-directed aiming response that relies on feedforward and feedback processes to guide the limb to the target. To address this, SCNP and control participants performed goal-directed upper limb movements with the dominant and non-dominant hands using light and heavy styli in the horizontal plane. The results show greater peak accelerations in SCNP participants using the heavy stylus. However, there were no other group differences seen, possibly due to the fact that reaching behavior predominantly relies on vision such that any proprioceptive deficits seen in those with SCNP can be compensated. This study illustrates the robust compensatory nature of the CNS when performing end-effector reaching tasks, suggesting studies altering visual feedback may be needed to see the full impact of SCNP on upper limb aiming.

Spatial orientation during gondola centrifugation with subjects upright versus supine: Evidence for Gestalt psychological mechanisms in vestibular perception

BACKGROUND

Recent theories suggest that perception of complex self-motion is governed by familiarity of the motion pattern as a whole in 3D.

OBJECTIVE

To explore how familiarity determines the perceived angular displacement with respect to the Earth during a simulated coordinated turn in a gondola centrifuge.

METHOD

The centrifuge was accelerated to 2G (gondola displacement 60°) within 12.5 s. Using visual indicators in darkness, responses to the gondola displacement were recorded with subjects (n = 10) in two positions: sitting-upright, facing-forward versus lying-supine, feet-forwards. Each subject underwent 2×2 6-minute runs.

RESULT

When upright, subjects indicated a tilt of initially 18.8±11.3°, declining with T = 66±37 s. In the supine position (subject's yaw plane coinciding with the plane of gondola displacement) the indicated displacement was negligible (-0.3±4.8°).

CONCLUSION

Since the canal system is most responsive to stimuli in yaw, these findings are difficult to explain by bottom-up models. Rather, the motion pattern during acceleration would be recognized as a familiar or meaningful whole (entering a co-ordinated turn) only when the subject is upright. Presumably, the degree of familiarity is reflected in the subject's ability to discern and estimate a single stimulus component. Findings are discussed in connection with human factors in aviation and the principles of Gestalt psychology.

Lying in a 3T MRI scanner induces neglect-like spatial attention bias

The static magnetic field of MRI scanners can induce a magneto-hydrodynamic stimulation of the vestibular organ (MVS). In common fMRI settings, this MVS effect leads to a vestibular ocular reflex (VOR). We asked whether - beyond inducing a VOR - putting a healthy subject in a 3T MRI scanner would also alter goal-directed spatial behavior, as is known from other types of vestibular stimulation. We investigated 17 healthy volunteers, all of which exhibited a rightward VOR inside the MRI-scanner as compared to outside-MRI conditions. More importantly, when probing the distribution of overt spatial attention inside the MRI using a visual search task, subjects scanned a region of space that was significantly shifted toward the right. An additional estimate of subjective straight-ahead orientation likewise exhibited a rightward shift. Hence, putting subjects in a 3T MRI-scanner elicits MVS-induced horizontal biases of spatial orienting and exploration, which closely mimic that of stroke patients with spatial neglect.

Perceptual post-effects of left neck muscle vibration with visuo-haptic feedback in healthy individuals: A potential approach for treating spatial neglect

Among the techniques used to reduce spatial neglect's symptoms, left neck muscle vibration (NMV) is alluring because it does not require the patient's attentional co-operation. The aim of this study was to determine the type of NMV-associated feedback that induced the most intense and longest-lasting egocentric post-effects. Eighty-seven healthy individuals were randomly assigned to four intervention groups: "neck muscle vibration, blindfolded" (NMV), "neck muscle vibration with vision" (NMV + V), "neck muscle vibration and visual finger-pointing" (NMV + P), and "visual finger-pointing" (P). An eyes-closed finger-pointing subjective straight-ahead (SSA) test was carried out before the intervention, immediately afterwards, and 30 min afterwards. The results showed that only the NMV + P intervention induced a lasting leftward bias of SSA. In addition, the deviation reported in this intervention group differed significantly from those observed in the other interventions. The combination of visuo-haptic feedback and neck-somatosensory stimulation may enable a full, lasting intermodal recalibration, which could be potentiated by the attention level engaged during voluntary pointing. These outcomes highlighted that the NMV technique could easily integrate into routine occupational therapy sessions for treating various aspects of neglect disorders.

The effects of repetitive neck-muscle vibration on postural disturbances after a chronic stroke

OBJECTIVE

We aimed to test a repeated program of vibration sessions of the neck muscles (rNMV) on postural disturbances and spatial perception in patients with right (RBD) versus left (LBD) vascular brain damage.

METHODS

Thirty-two chronic stroke patients (mean age 60.9±10 yrs and mean time since stroke 4.9±4 yrs), 16 RBD and 16 LBD, underwent a program of 10 sessions of NMV over two weeks. Posturography parameters (weight-bearing asymmetry (WBA), Xm, Ym, and surface), balance rating (Berg Balance Scale (BBS), Timed Up and Go (TUG)), space representation (subjective straight ahead (SSA), longitudinal body axis (LBA), subjective visual vertical (SVV)), and post-stroke deficiencies (motricity index, sensitivity, and spasticity) were tested and the data analyzed by ANOVA or a linear rank-based model, depending on whether the data were normally distributed, with lesion side and time factor (D-15, D0, D15, D21, D45).

RESULTS

The ANOVA revealed a significant interaction between lesion side and time for WBA (P<0.0001) with a significant shift towards the paretic lower limb in the RBD patients only (P=0.0001), whereas there was no effect in the LBD patients (P=0.98). Neither group showed a significant modification of spatial representation. Nonetheless, there was a significant improvement in motricity (P=0.02), TUG (P=0.0005), and BBS (P<0.0001) in both groups at the end of treatment and afterwards.

CONCLUSIONS

rNMV appeared to correct WBA in RBD patients only. This suggests that rNMV could be effective in treating sustainable imbalance due to spatial cognition disorders.

The 'Neglected' Personal Neglect

A review of patients with brain injury showing personal neglect is presented. The aim is to shed light on this aspect of neglect often unresearched or only indirectly investigated, and to discuss recent findings concerning the methods used to assess personal neglect, its neural correlates and its association with the more often explored aspect of extrapersonal neglect. The review was performed using PubMed and PsychInfo databases to search for papers published in the last 123 years (until January 2018). We reviewed 81 papers describing either single or group studies for a total of 2247 patients. The results of this review showed that various aspects of personal neglect are still controversial and outcomes potentially contradictory. Despite the data reported in the present review suggest that personal neglect is more frequently associated with lesions of the right hemisphere, the left hemisphere may also play an important role. Not surprisingly, personal neglect and extrapersonal neglect seem to co-occur. However double dissociations of these two forms of neglect have been reported, and they seem to dissociate both from a functional and an anatomical perspective. More recent interpretations of personal neglect suggest that it may result from a disrupted body representation. The development of reliable psychometric tools with shared diagnostic criteria is essential to identify different degrees of personal neglect for different body parts and to better refine personal neglect in comparison to extrapersonal neglect and disorders related to distortions of personal domain.

Is perception of visual verticality intact in patients with idiopathic cervical dystonia?

Idiopathic cervical dystonia (CD) is a focal dystonia characterized by an abnormal tilted or twisted head position. This abnormal head position could lead to a distorted perception of the visual vertical and spatial orientation. The aim of this cross-sectional study was to investigate whether the perception of the visual vertical is impaired in patients with CD. The subjective visual vertical test (SVV) was measured in 24 patients with CD and 30 controls. The SVV test is conducted in a completely darkened room. A laser bar is projected on an opposing white wall, which is deviated from the earth's gravitational vertical. Participants were seated with their head unrestrained and were instructed to position this bar vertically. The deviations in degrees (°) are corrected for the side of laterocollis in order to measure the E-effect. We found that patients were able to position the laser bar as equally close to the earth's gravitational vertical as controls (+ 0.67° SD ± 2.12 vs + 0.29° SD ± 1.08, p = 0.43). No E-effect was measured. Notwithstanding the abnormal position of the head, the perception of the visual vertical in patients with idiopathic CD is intact, possibly because of central neural compensatory mechanisms.

Probing the role of the vestibular system in motivation and reward-based attention

The vestibular system has widespread connections in the central nervous system. Several activation loci following vestibular stimulations have been notably reported in deep, limbic areas that are otherwise difficult to reach and modulate in healthy subjects. Following preliminary evidence, suggesting that such stimulations might affect mood and affective processing, we wondered whether the vestibular system is also involved in motivation. Evolutionary accounts suggest that visuo-vestibular mismatches might have a role in preventing the search for and exploitation of goods that previously resulted in aversive reactions, as they would be a fine warning signal which follows the contact with or ingestion of noxious neurotoxins. The first question was thus whether vestibular stimulation alters sensitivity to reward. Secondly, we sought to assess whether attention is allocated in space differently when cued by highly motivational stimuli, and if this interplay is further modulated by the vestibular system. In order to evaluate both motivational and attentional assets, we administered a Posner-like cueing task to 30 healthy subjects concurrently receiving sham or galvanic vestibular stimulation (GVS; Left-Anodal and Right-Anodal configurations). The participants had to discriminate targets appearing in either exogenously cued or uncued locations (50% validity); cues predicted the amount of points (0, 2, or 10) and thus money that they could earn for a correct response. The results highlight a robust inhibition of return (IOR) (faster responses for invalidly-cued targets) which was not modulated by different levels of reward or GVS. Across all stimulation sessions, rewards exerted a powerful beneficial effect over performance: reaction times were faster when rewards were at stake. However, this effect was largest in sham, but greatly reduced in GVS conditions, most notably with the Right-Anodal configuration. This is the first evidence for a decreased sensitivity to rewards causally induced by a perturbation of the vestibular system. While future studies will shed light on its neural underpinnings and clinical implications, here we argue that GVS could be a safe and promising way to enrich our understanding of reward processes and eventually tackle the management of patients with aberrant sensitivity to rewards.

Gravity estimation and verticality perception

Gravity is a defining force that governs the evolution of mechanical forms, shapes and anchors our perception of the environment, and imposes fundamental constraints on our interactions with the world. Within the animal kingdom, humans are relatively unique in having evolved a vertical, bipedal posture. Although a vertical posture confers numerous benefits, it also renders us less stable than quadrupeds, increasing susceptibility to falls. The ability to accurately and precisely estimate our orientation relative to gravity is therefore of utmost importance. Here we review sensory information and computational processes underlying gravity estimation and verticality perception. Central to gravity estimation and verticality perception is multisensory cue combination, which serves to improve the precision of perception and resolve ambiguities in sensory representations by combining information from across the visual, vestibular, and somatosensory systems. We additionally review experimental paradigms for evaluating verticality perception, and discuss how particular disorders affect the perception of upright. Together, the work reviewed here highlights the critical role of multisensory cue combination in gravity estimation, verticality perception, and creating stable gravity-centered representations of our environment.

Leftward Deviation and Asymmetric Speed of Egocentric Judgment between Left and Right Visual Fields

The egocentric reference frame is essential for body orientation and spatial localization of external objects. Recent neuroimaging and lesion studies have revealed that the right hemisphere of humans may play a more dominant role in processing egocentric information than the left hemisphere. However, previous studies of egocentric discrimination mainly focused on assessing the accuracy of egocentric judgment, leaving its timing unexplored. In addition, most previous studies never monitored the subjects' eye position during the experiments, so the influence of eye position on egocentric judgment could not be excluded. In the present study, we systematically assessed the processing of egocentric information in healthy human subjects by measuring the location of their visual subjective straight ahead (SSA) and their manual reaction time (RT) during fixation (monitored by eye tracker). In an egocentric discrimination task, subjects were required to judge the position of a visual cue relative to the subjective mid-sagittal plane and respond as quickly as possible. We found that the SSA of all subjects deviated to the left side of the body mid-sagittal plane. In addition, all subjects but one showed the longest RT at the location closest to the SSA; and in population, the RTs in the left visual field (VF) were longer than that in the right VF. These results might be due to the right hemisphere's dominant role in processing egocentric information, and its more prominent representation of the ipsilateral VF than that of the left hemisphere.

Mastoid Vibration Reduces Ipsilesional Shift of Subjective Visual Horizontal in Patients with Acute Stage of Unilateral Vestibulopathy

Background and Objectives

To investigate effect of the vibration on subjective visual horizontal (SVH) in patients with acute stage of unilateral vestibulopathy.

Subjects and Methods

Twenty-five unilateral vestibulopathy patients which analyzed into 42 cases at different time points and suffered from spinning vertigo for more than 24 hours without hearing loss and neurologic abnormality were enrolled. Thirteen subjects with spontaneous nystagmus (>3 degree/sec; averaged symptom onset <1 week) at the time of SVH measurement were classified into the acute unilateral vestibulopathy group (aVU). The other 29 subjects without spontaneous nystagmus were classified into the compensated vestibulopathy group (cVU). SVH was performed with vibration at either mastoid or sterocleidomastoid muscle.

Results

In the analysis of overall subjects, vibration did not significantly change the degree of shift of SVH. However, analyzed by group, the shift of SVH with vibration at ipsilesional mastoid was significantly decreased than baseline in aVU (p<0.05). The shift of SVH with vibration at contralesional mastoid was significantly increased than baseline in cVU (p=0.05).

Conclusions

The shift of SVH due to vibration in acute stage of unilateral vestibulopathy showed reduction of the shift, while in compensated stage it showed increase of the shift.

Vestibular disorders following different types of head and neck trauma

This review focuses on the published literature on vestibular disorders following different types of head and neck trauma. Current knowledge of the different causes and underlying mechanisms of vestibular disorders, as well as the sites of organic damage, is presented. Non-organic mechanisms are also surveyed. The frequency of occurrence of vestibular symptoms, and of other accompanying subjective complaints, associated with different types of trauma is presented and related to the specific causes. Hypotheses about the pathogenesis of traumatic vestibular disorders are presented, and the knowledge derived from animal experiments is also discussed. We believe this to be a very important topic, since vestibular complaints in traumatic patients often remain undiagnosed or underestimated in clinical practice. This review article aims to suggest directions for additional research and to provide guidance to both the scientific and clinical practice communities.

Stepping in Place While Voluntarily Turning Around Produces a Long-Lasting Posteffect Consisting in Inadvertent Turning While Stepping Eyes Closed

Training subjects to step in place on a rotating platform while maintaining a fixed body orientation in space produces a posteffect consisting in inadvertent turning around while stepping in place eyes closed (podokinetic after-rotation, PKAR). We tested the hypothesis that voluntary turning around while stepping in place also produces a posteffect similar to PKAR. Sixteen subjects performed 12 min of voluntary turning while stepping around their vertical axis eyes closed and 12 min of stepping in place eyes open on the center of a platform rotating at 60°/s (pretests). Then, subjects continued stepping in place eyes closed for at least 10 min (posteffect). We recorded the positions of markers fixed to head, shoulder, and feet. The posteffect of voluntary turning shared all features of PKAR. Time decay of angular velocity, stepping cadence, head acceleration, and ratio of angular velocity after to angular velocity before were similar between both protocols. Both postrotations took place inadvertently. The posteffects are possibly dependent on the repeated voluntary contraction of leg and foot intrarotating pelvic muscles that rotate the trunk over the stance foot, a synergy common to both protocols. We propose that stepping in place and voluntary turning can be a scheme ancillary to the rotating platform for training body segment coordination in patients with impairment of turning synergies of various origin.

Evidence of Impaired Proprioception in Chronic, Idiopathic Neck Pain: Systematic Review and Meta-Analysis

BACKGROUND

Despite common use of proprioceptive retraining interventions in people with chronic, idiopathic neck pain, evidence that proprioceptive dysfunction exists in this population is lacking. Determining whether proprioceptive dysfunction exists in people with chronic neck pain has clear implications for treatment prescription.

PURPOSE

The aim of this study was to synthesize and critically appraise all evidence evaluating proprioceptive dysfunction in people with chronic, idiopathic neck pain by completing a systematic review and meta-analysis.

DATA SOURCES

MEDLINE, CINAHL, PubMed, Allied and Complementary Medicine, EMBASE, Academic Search Premier, Scopus, Physiotherapy Evidence Database (PEDro), and Cochrane Collaboration databases were searched.

STUDY SELECTION

All published studies that compared neck proprioception (joint position sense) between a chronic, idiopathic neck pain sample and asymptomatic controls were included.

DATA EXTRACTION

Two independent reviewers extracted relevant population and proprioception data and assessed methodological quality using a modified Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement.

DATA SYNTHESIS

Thirteen studies were included in the present review. Meta-analysis on 10 studies demonstrated that people with chronic neck pain perform significantly worse on head-to-neutral repositioning tests, with a moderate standardized mean difference of 0.44 (95% confidence interval=0.25, 0.63). Two studies evaluated head repositioning using trunk movement (no active head movement thus hypothesized to remove vestibular input) and showed conflicting results. Three studies evaluated complex or postural repositioning tests; postural repositioning was no different between groups, and complex movement tests were impaired only in participants with chronic neck pain if error was continuously evaluated throughout the movement.

LIMITATIONS

A paucity of studies evaluating complex or postural repositioning tests does not permit any solid conclusions about them.

CONCLUSIONS

People with chronic, idiopathic neck pain are worse than asymptomatic controls at head-to-neutral repositioning tests.

Internally-represented space and its mirror-reversed image of the visuospatial representation: A possible association

The cognitive capacity for number representation is thought to be a functional isomorphism of space representation. Numbers are represented in a left-to-right-oriented mental number line and hemispatial neglect patients consistently demonstrate rightward midline shift of visuospace, the internal space and number representation. However, patients with pathologic pain in one limb showed a negative correlation between midline shift of the visuospace and number representation. The purpose of the present study is to ascertain whether such dissociation in accessing space and number representation is observed in another neuropathic pain condition, and then to propose a theoretical model regarding an intimate relationship between visuospace and internal space representations. Using patients with deafferentation pain caused by a nerve lesion in a limb, we investigated whether number representation is closely linked to space representation by evaluating visual subjective body-midline judgments in dark and light conditions (egocentric- and allocentric-spaces, respectively). We also used a number-interval-bisection task to analyze this question. All of the patients perceived allocentric-space accurately. Respective patients showed perceptual shifts in egocentric-space and number representation, however they did not demonstrate any trend of the shifted-direction. Direct comparison revealed that number representation is negatively correlated with not allocentric-space but egocentric-space: a leftward midline-shift of egocentric-space was linked with a rightward midline-shift of number bisection, and vice-versa. Internally-represented space demonstrated a mirror-reversed image of the visuospatial representation, similar to our previous finding. To explain the inverted representation, we can propose a theoretical model that spacing between mentally-aligned numbers in a left-to-right sequential line is anisometric.

Coordinates of Human Visual and Inertial Heading Perception

Heading estimation involves both inertial and visual cues. Inertial motion is sensed by the labyrinth, somatic sensation by the body, and optic flow by the retina. Because the eye and head are mobile these stimuli are sensed relative to different reference frames and it remains unclear if a perception occurs in a common reference frame. Recent neurophysiologic evidence has suggested the reference frames remain separate even at higher levels of processing but has not addressed the resulting perception. Seven human subjects experienced a 2s, 16 cm/s translation and/or a visual stimulus corresponding with this translation. For each condition 72 stimuli (360° in 5° increments) were delivered in random order. After each stimulus the subject identified the perceived heading using a mechanical dial. Some trial blocks included interleaved conditions in which the influence of ±28° of gaze and/or head position were examined. The observations were fit using a two degree-of-freedom population vector decoder (PVD) model which considered the relative sensitivity to lateral motion and coordinate system offset. For visual stimuli gaze shifts caused shifts in perceived head estimates in the direction opposite the gaze shift in all subjects. These perceptual shifts averaged 13 ± 2° for eye only gaze shifts and 17 ± 2° for eye-head gaze shifts. This finding indicates visual headings are biased towards retina coordinates. Similar gaze and head direction shifts prior to inertial headings had no significant influence on heading direction. Thus inertial headings are perceived in body-centered coordinates. Combined visual and inertial stimuli yielded intermediate results.

Prism adaptation and neck muscle vibration in healthy individuals: are two methods better than one?

Studies involving therapeutic combinations reveal an important benefit in the rehabilitation of neglect patients when compared to single therapies. In light of these observations our present work examines, in healthy individuals, sensorimotor and cognitive after-effects of prism adaptation and neck muscle vibration applied individually or simultaneously. We explored sensorimotor after-effects on visuo-manual open-loop pointing, visual and proprioceptive straight-ahead estimations. We assessed cognitive after-effects on the line bisection task. Fifty-four healthy participants were divided into six groups designated according to the exposure procedure used with each: 'Prism' (P) group; 'Vibration with a sensation of body rotation' (Vb) group; 'Vibration with a move illusion of the LED' (Vl) group; 'Association with a sensation of body rotation' (Ab) group; 'Association with a move illusion of the LED' (Al) group; and 'Control' (C) group. The main findings showed that prism adaptation applied alone or combined with vibration showed significant adaptation in visuo-manual open-loop pointing, visual straight-ahead and proprioceptive straight-ahead. Vibration alone produced significant after-effects on proprioceptive straight-ahead estimation in the Vl group. Furthermore all groups (except C group) showed a rightward neglect-like bias in line bisection following the training procedure. This is the first demonstration of cognitive after-effects following neck muscle vibration in healthy individuals. The simultaneous application of both methods did not produce significant greater after-effects than prism adaptation alone in both sensorimotor and cognitive tasks. These results are discussed in terms of transfer of sensorimotor plasticity to spatial cognition in healthy individuals.

Horizontal visual search in a large field by patients with unilateral spatial neglect

In this study, we investigated the horizontal visual search ability and pattern of horizontal visual search in a large space performed by patients with unilateral spatial neglect (USN). Subjects included nine patients with right hemisphere damage caused by cerebrovascular disease showing left USN, nine patients with right hemisphere damage but no USN, and six healthy individuals with no history of brain damage who were age-matched to the groups with brain right hemisphere damage. The number of visual search tasks accomplished was recorded in the first experiment. Neck rotation angle was continuously measured during the task and quantitative data of the measurements were collected. There was a strong correlation between the number of visual search tasks accomplished and the total Behavioral Inattention Test Conventional Subtest (BITC) score in subjects with right hemisphere damage. In both USN and control groups, the head position during the visual search task showed a balanced bell-shaped distribution from the central point on the field to the left and right sides. Our results indicate that compensatory strategies, including cervical rotation, may improve visual search capability and achieve balance on the neglected side.

Motor extinction in distinct reference frames: a double dissociation

OBJECTIVE

Test the hypothesis that right hemisphere stroke can cause extinction of left hand movements or movements of either hand held in left space, when both are used simultaneously, possibly depending on lesion site.

METHODS

93 non-hemiplegic patients with acute right hemisphere stroke were tested for motor extinction by pressing a counter rapidly for one minute with the right hand, left hand, or both simultaneously with their hands held at their sides, or crossed over midline.

RESULTS

We identified two distinct types of motor extinction in separate patients; 20 patients extinguished left hand movements held in left or right space (left canonical body extinction); the most significantly associated voxel cluster of ischemic tissue was in the right temporal white matter. Seven patients extinguished either hand held in left space (left space extinction), and the most significantly associated voxel cluster of ischemic tissue was in right parietal white matter.

CONCLUSIONS

There was a double dissociation between left canonical body extinction and left space motor extinction. Left canonical body extinction seems to be associated with more dorsal (parietal) ischemia, and left canonical body extinction seems to be associated with more ventral (temporal) ischemia.

Self-motion perception and vestibulo-ocular reflex during whole body yaw rotation in standing subjects: the role of head position and neck proprioception

Self-motion perception and vestibulo-ocular reflex (VOR) were studied during whole body yaw rotation in the dark at different static head positions. Rotations consisted of four cycles of symmetric sinusoidal and asymmetric oscillations. Self-motion perception was evaluated by measuring the ability of subjects to manually track a static remembered target. VOR was recorded separately and the slow phase eye position (SPEP) was computed. Three different head static yaw deviations (active and passive) relative to the trunk (0°, 45° to right and 45° to left) were examined. Active head deviations had a significant effect during asymmetric oscillation: the movement perception was enhanced when the head was kept turned toward the side of body rotation and decreased in the opposite direction. Conversely, passive head deviations had no effect on movement perception. Further, vibration (100 Hz) of the neck muscles splenius capitis and sternocleidomastoideus remarkably influenced perceived rotation during asymmetric oscillation. On the other hand, SPEP of VOR was modulated by active head deviation, but was not influenced by neck muscle vibration. Through its effects on motion perception and reflex gain, head position improved gaze stability and enhanced self-motion perception in the direction of the head deviation.

Podokinetic stimulation causes shifts in perception of straight ahead

Podokinetic after-rotation (PKAR) is a phenomenon in which subjects inadvertently rotate when instructed to step in place after a period of walking on a rotating treadmill. PKAR has been shown to transfer between different forms of locomotion, but has not been tested in a non-locomotor task. We conducted two experiments to assess effects of PKAR on perception of subjective straight ahead and on quiet standing posture. Twenty-one healthy young right-handed subjects pointed to what they perceived as their subjective straight ahead with a laser pointer while they were recorded by a motion capture system both before and after a training period on the rotating treadmill. Subjects performed the pointing task while standing, sitting on a chair without a back, and a chair with a back. After the training period, subjects demonstrated a significant shift in subjective straight ahead, pointing an average of 29.1 ± 10.6° off of center. The effect was direction-specific, depending on whether subjects had trained in the clockwise or counter-clockwise direction. Postures that limited subjects' ability to rotate the body in space resulted in reduction, but not elimination, of the effect. The effect was present in quiet standing and even in sitting postures where locomotion was not possible. The robust transfer of PKAR to non-locomotor tasks, and across locomotor forms as demonstrated previously, is in contrast to split-belt adaptations that show limited transfer. We propose that, unlike split-belt adaptations, podokinetic adaptations are mediated at supraspinal, spatial orientation areas that influences spinal-level circuits for locomotion.

Kinematics of sagittal spine and lower limb movement in healthy older adults during sit-to-stand from two seat heights

STUDY DESIGN

A cross-sectional study to examine the sagittal kinematics of spine and lower limb movement during sit-to-stand (STS).

OBJECTIVE

To describe the sagittal kinematics of the spine and lower limb in healthy older adults during STS from 2 seat heights.

SUMMARY OF BACKGROUND DATA

Older adults with age-related changes in the neuromusculoskeletal system are likely to have difficulty in STS. However, little is known about movement of the spinal regions and their interaction with the lower limb during STS, and the effect of seat height.

METHODS

Thirty-two healthy older adults aged over 60 years were videotaped performing STS from 2 seat heights. A 2-dimensional video motion analysis system with a revised sagittal model was used to measure angular displacement and velocity for the cervical, thoracic, lumbar spine, and the lower limb joints.

RESULTS

Concurrent flexion in the hip joint and lumbar spine was accompanied by extension in the thoracic, lower, and upper cervical spine as the trunk leaned forward. After the buttocks lifted off (LO) the chair, the movement interaction in the spine and hip joint was reversed. Some significant age-related changes during STS included downward head tilt at LO, decreased lumbar range of motion, and a large between-participant variation in the movement ratios. Statistically significant differences in the temporal parameters, angular displacement, and velocity were also found when standing from a lower chair.

CONCLUSION

This study provides a detailed description of STS in healthy older adults, which has implications for rehabilitation of elderly patients who have difficulty with this activity. Clinicians need to be aware of the concurrent contribution of the hip joint and lumbar spine to trunk forward lean, the importance of thoracic extension during the pre-LO phase and the downward gaze at LO in healthy older adults.

Complex Regional Pain Syndrome (CRPS) Impairs Visuospatial Perception, whereas Post-Herpetic Neuralgia does not: Possible Implications for Supraspinal Mechanism of CRPS

Introduction: Complex regional pain syndrome (CRPS) patients show impaired visuospatial perception in the dark, as compared to normal patients with acute nociceptive pain. The purpose of this study is 2-fold: (i) to ascertain whether this distorted visuospatial perception is related to the chronicity of pain, and (ii) to analyse visuospatial perception of CRPS in comparison with another neuropathic pain condition. Materials and Methods: We evaluated visual subjective body-midline (vSM) representation in 27 patients with post-herpetic neuralgia (PHN) and 22 with CRPS under light and dark conditions. A red laser dot was projected onto a screen and moved horizontally towards the sagittal plane of the objective body-midline (OM). Each participant was asked to direct the dot to a position where it crossed their vSM. The distance between the vSM and OM was analysed to determine how and in which direction the vSM deviated. Results: Under light condition, all vSM judgments approximately matched the OM. However, in the dark, CRPS patients, but not PHN patients, showed a shifted vSM towards the affected side. Conclusion: We demonstrated that chronic pain does not always impair visuospatial percep- tion. The aetiology of PHN is limited to the peripheral nervous system, whereas the distorted visuospatial perception suggests a supraspinal aetiology of CRPS. Key words: Cognitive dysfunction, Higher brain function, Multimodal disturbance, Neuro- pathic pain

How do people perceive and generate options?

This chapter examines the question of how people perceive and generate options. Although most current theoretical approaches explain option perception and option generation as requiring extensive and costly cognitive processes, we will argue that people perceive their possibilities for action and generate options without such elaborate means. Borrowing from the contributions of direct perception and bounded rationality, we present and analyze data from three sports tasks: the basketball jump shot, ball allocation in handball, and trampoline somersaulting. Data from kinematics, eye-tracking, and choice behavior experiments are presented and reanalyzed to draw the parallels and distinctions between the two approaches. In conclusion, integrating research on perception, action, and cognition provides a promising description of the bidirectional link between mind and motion.

Gaze and Postural Reorientation in the Control of Locomotor Steering After Stroke

Background. Steering of locomotion is a complex task involving stabilizing and anticipatory orienting behavior essential for the maintenance of balance and for establishing a stable frame of reference for future motor and sensory events. How these mechanisms are affected by stroke remains unknown. Objectives. To compare locomotor steering behavior between stroke and healthy individuals and to determine whether steering abilities are influenced by walking speed, turning direction and walking capacity in stroke individuals. Methods. Gaze and body kinematics were recorded in 8 stroke and 7 healthy individuals while walking and turning in response to a visual cue. Horizontal orientation of gaze, head, thorax, pelvis, and feet with respect to spatial and heading coordinates were examined. Results. Temporal and spatial coordination of gaze and body movements revealed stabilizing and anticipatory orienting mechanisms in the healthy individuals. Changing walking speed affected the onset time but not the sequencing of segment reorientation. In the individuals with stroke, abnormally large and uncoordinated head and gaze motion were observed. The sequence of gaze, head, thorax and pelvis horizontal reorientation also was also disrupted. Alterations in orienting behaviors were more pronounced at the slowest walking speeds and turning to the nonparetic side in 3 of the most severely disabled individuals. Conclusion. The results in this convenience sample of slow and faster walkers suggest that stroke alters the stabilizing and orienting behavior during steering of locomotion. Such alterations are not caused by the inherently slow walking speed, but rather by a combination of biomechanical factors and defective sensorimotor integration, including altered vestibulo-ocular reflexes.

Egocentric reference in bidirectional readers as measured by the straight-ahead pointing task

The present study aimed to show that bidirectional reading and language exposure influence the position of egocentric reference (ER), the perceived direction of the body's sagittal axis proposed to act as an anchor for movements in extracorporeal space. Directional factors (e.g., visual scanning bias and reading habits) have been proposed to influence visuospatial performance, such as in line bisection and figure drawing. In past studies, bidirectional readers have been less consistent in demonstrating a bias compared to unidirectional readers. Using a straight-ahead pointing task to assess egocentric reference, we compared 14 unidirectional left-to-right readers (Uni-LR) to three bidirectional reading groups that differed in the reading direction of their native language and/or the level of their second language literacy: 16 low-English literate, native right-to-left, bidirectional readers (Lo-Bi-RL), 13 high-English literate, native right-to-left, bidirectional readers (Hi-Bi-RL), and 15 native left-to-right, bidirectional readers (Bi-LR). Participants were asked to point straight-ahead while blindfolded using either a left-to-right or a right-to-left scanning direction to approach the subjective sagittal midline. Uni-LRs showed left-side spatial bias when scanning left-to-right and right-side bias during right-to-left scanning, Bi-LRs and Lo-Bi-RLs (i.e., intermediate level or less in their second language) demonstrated the opposite pattern, and Hi-Bi-RLs showed left-side spatial bias regardless of scanning direction. Results are discussed in terms of accuracy and spatial bias regarding the interaction between reading direction and spatial cognition based on the level of bidirectional literacy and language exposure.

Posture and equilibrium in orthopedic and rheumatologic diseases

Posture and balance may be affected in many spine or lower-limb disorders. An extensive evaluation including clinical tests and movement analysis techniques may be necessary to characterize how rheumatologic or orthopedic diseases are related to static or dynamic changes in postural control. In lower limbs, unbalance may be related to a decreased stability following arthrosis or ligament injuries at knee or ankle levels, while hip lesions appear less associated with such troubles. Spinal diseases at cervical level are frequently associated with postural changes and impaired balance control, related to the major role of sensory inputs during stance and gait. At lower levels, changes are noticed in major scoliosis and may be related to pain intensity in patients with chronic low-back pain. Whatever the initial lesion and the affected level, improvement in clinical or instrumental tests following rehabilitation or brace wearing provides argument for a close relationship between rheumatologic or orthopedic diseases and related impairments in posture and balance control.

The use of tDCS and CVS as methods of non-invasive brain stimulation

Transcranial direct current stimulation (tDCS) and caloric vestibular stimulation (CVS) are safe methods for selectively modulating cortical excitability and activation, respectively, which have recently received increased interest regarding possible clinical applications. tDCS involves the application of low currents to the scalp via cathodal and anodal electrodes and has been shown to affect a range of motor, somatosensory, visual, affective and cognitive functions. Therapeutic effects have been demonstrated in clinical trials of tDCS for a variety of conditions including tinnitus, post-stroke motor deficits, fibromyalgia, depression, epilepsy and Parkinson's disease. Its effects can be modulated by combination with pharmacological treatment and it may influence the efficacy of other neurostimulatory techniques such as transcranial magnetic stimulation. CVS involves irrigating the auditory canal with cold water which induces a temperature gradient across the semicircular canals of the vestibular apparatus. This has been shown in functional brain-imaging studies to result in activation in several contralateral cortical and subcortical brain regions. CVS has also been shown to have effects on a wide range of visual and cognitive phenomena, as well as on post-stroke conditions, mania and chronic pain states. Both these techniques have been shown to modulate a range of brain functions, and display potential as clinical treatments. Importantly, they are both inexpensive relative to other brain stimulation techniques such as electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS).

Human MST but not MT responds to tactile stimulation

Previous reports of tactile responses in human visual area MT/V5 have used complex stimuli, such as a brush stroking the arm. These complex moving stimuli are likely to induce imagery of visual motion, which is known to be a powerful activator of MT. The area described as "MT" in previous reports consists of at least two distinct cortical areas, MT and MST. Using functional magnetic resonance imaging, we separately localized human MT and MST and measured their response to vibrotactile stimuli unlikely to induce imagery of visual motion. Strong vibrotactile responses were observed in MST but not in MT. Vibrotactile responses in MST were approximately one-half as large as the response to visual motion and were distinct from those in another visual area previously reported to respond to tactile stimulation, the lateral occipital complex. To examine somatotopic organization, we separately stimulated the left and right hand and foot. No spatial segregation between hand and foot responses was observed in MST. The average response profile of MST was similar to that of somatosensory cortex, with a strong preference for the contralateral hand. These results offer evidence for the existence of somatosensory responses in MST, but not MT, independent of imagery of visual motion.

Proprioceptive deficits of the lower limb following anterior cruciate ligament deficiency affect whole body steering control

The role of lower limb proprioception in the steering control of locomotion is still unclear. The purpose of the current study was to determine whether steering control is altered in individuals with reduced lower limb proprioception. Anterior cruciate ligament deficiency (ACLD) results in a decrease in proprioceptive information from the injured knee joint (Barrack et al. 1989). Therefore the whole body kinematics were recorded for eight unilateral ACLD individuals and eight CONTROL individuals during the descent of a 20 degrees incline ramp followed by either a redirection using a side or cross cutting maneuver or a continuation straight ahead. Onset of head and trunk yaw, mediolateral displacement of a weighted center of mass (COM(HT)) and mediolateral displacement of the swing foot were analyzed to evaluate differences in the steering control. Timing analyses revealed that ACLD individuals delayed the reorientation of body segments compared to CONTROL individuals. In addition, ACLD did not use a typical steering synergy where the head leads whole body reorientation; rather ACLD individuals reoriented the head, trunk and COM(HT) in the new direction at the same time. These results suggest that when lower limb proprioceptive information is reduced, the central nervous system (CNS) may delay whole body reorientation to the new travel direction, perhaps in order to integrate existing sensory information (vision, vestibular and proprioception) with the reduced information from the injured knee joint. This control strategy is maintained when visual information is present or reduced in a low light environment. Additionally, the CNS may move the head and trunk segments as, effectively, one segment to decrease the number of degrees of freedom that must be controlled and increase whole body stability during the turning task.

Influence of vestibular and visual stimulation on split-belt walking

We investigated the influence of vestibular (caloric ear irrigation) and visual (optokinetic) stimulation on slow and fast split-belt walking. The velocity of one belt was fixed (1.5 or 5.0-6.0 km/h) and subjects (N = 8 for vestibular and N = 6 for visual experiments) were asked to adjust the velocity of the other belt to a level at which they perceived the velocity of both the belts as equal. Throughout all experiments, subjects bimanually held on to the space-fixed handles along the treadmill, which provided haptic information on body orientation. While the optokinetic stimulus (displayed on face-mounted virtual reality goggles) had no effect on belt velocity adjustments compared to control trials, cold-water ear irrigation during slow (but not fast) walking effectively influenced belt velocity adjustments in seven of eight subjects. Only two of these subjects decreased the velocity of the ipsilateral belt, consistent with the ipsilateral turning toward the irrigated ear in the Fukuda stepping test. The other five subjects, however, increased the velocity of the ipsilateral belt. A straight-ahead sense mechanism can explain both decreased and increased velocity adjustments. Subjects decrease or increase ipsilateral belt velocity depending on whether the vestibular stimulus is interpreted as an indicator of the straight-ahead direction (decreased velocity) or as an error signal relative to the straight-ahead direction provided by the haptic input from the space-fixed handles along the treadmill (increased velocity). The missing effect during fast walking corroborates the findings by others that the influence of vestibular tone asymmetry on locomotion decreases at higher gait velocities.

Vestibular contribution to the planning of reach trajectories

Reaching for an object while simultaneously rotating induces Coriolis and centrifugal inertial forces on the arm that require compensatory actions to maintain accuracy. We investigated whether the nervous system uses vestibular signals of head rotation to predict inertial forces. Human subjects reached in darkness to a remembered target 33 cm distant. Subjects were stationary, but experienced a strong vestibular rotation signal. We achieved this by rotating subjects at 360 degrees /s in yaw for 2 min and then stopping, and subjects reached during the 'post-rotary' period when the deceleration is interpreted by the vestibular system as a rotation in the opposite direction. Arm trajectories were straight in control trials without a rotary stimulus. With vestibular stimulation, trajectory curvature increased an average of 3 cm in the direction of the vestibular stimulation (e.g., to the right for a rightward yaw stimulus). Vestibular-induced curvature returned rapidly to normal, with an average time constant of 6 s. Movements also became longer as the vestibular stimulus diminished, and returned towards normal length with an average time constant of 5.6 s. In a second experiment we compared reaching with preferred and non-preferred hands, and found that they were similarly affected by vestibular stimulation. The reach curvatures were in the expected direction if the nervous system anticipated and attempted to counteract the presence of Coriolis forces based on the vestibular signals. Similarly, the shorter reaches may have occurred because the nervous system was attempting to compensate for an expected centrifugal force. Since vestibular stimulation also alters the perceived location of targets, vestibular signals probably influence all stages of the sensorimotor pathway transforming the desired goal of a reach into specific motor-unit innervation.

Stance- and Locomotion-Dependent Processing of Vibration-Induced Proprioceptive Inflow From Multiple Muscles in Humans

We performed a whole-body mapping study of the effect of unilateral muscle vibration, eliciting spindle Ia firing, on the control of standing and walking in humans. During quiet stance, vibration applied to various muscles of the trunk-neck system and of the lower limb elicited a significant tilt in whole body postural orientation. The direction of vibration-induced postural tilt was consistent with a response compensatory for the illusory lengthening of the stimulated muscles. During walking, trunk-neck muscle vibration induced ample deviations of the locomotor trajectory toward the side opposite to the stimulation site. In contrast, no significant modifications of the locomotor trajectory could be detected when vibrating various muscles of the lower as well as upper limb. The absence of correlation between the effects of muscle vibration during walking and standing dismisses the possibility that vibration-induced postural changes can account for the observed deviations of the locomotor trajectory during walking. We conclude that the dissimilar effects of trunk-neck and lower limb muscle vibration during walking and standing reflect a general sensory-motor plan, whereby muscle Ia input is processed according to both the performed task and the body segment from which the sensory inflow arises.

Mental rotation of body parts and non-corporeal objects in patients with idiopathic cervical dystonia

Mental rotation of body parts is performed through inner simulation of actual movements, and is likely to rely upon cortical and subcortical systems (e.g. motor and premotor areas and basal ganglia) involved in motor planning and execution. Studies indicate that sensory and motor deficits, such as for example pain, limb amputation or focal hand dystonia, bring about a specific impairment in mental rotation of the affected body parts. Here we explored the ability of patients affected by idiopathic cervical dystonia (CD) to mentally rotate affected (neck) and unaffected (hands and feet) body districts. The experimental stimuli consisted of realistic photos of left or right hands or feet and the head of a young men with a black patch on the left or the right eye. As non-corporeal stimulus the front view of a car with a black patch on the left or the right headlight was used. The stimuli were presented at six different degrees of orientations. Twelve CD patients and 12 healthy participants were asked to verbally report whether the hands or feet were left or right, or whether the patch was on the left or the right eye or headlight. Reaction times and accuracy in performing the laterality tasks on the four stimuli were collected. Results showed that CD patients are slow in mental rotation of stimuli representing body parts, namely hand, foot and head. This abnormality was not due to a general impairment in mental rotation per se, since patients' ability to rotate a non-corporeal object (a car) was not significantly different from that of healthy participants. We posit that the deficit in mental rotation of body parts in CD patients may derive from a defective integration of body- and world-related knowledge, a process that is likely to allow a general representation of "me in the external world".

The postural disorientation induced by neck muscle vibration subsides on lightly touching a stationary surface or aiming at it

The aim of this study was to investigate whether the standing body spatial disorientation, induced by neck muscle vibration, and the related post-effects can be suppressed by light finger touch (LFT) of a stationary surface. Continuous (60 s) vibration of dorsal neck or sternocleidomastoid muscle was administered with eyes closed. The center of foot pressure (CFP) displacement, measured by a stabilometric platform, indicated the degree of vibration-induced body tilt. We also investigated whether sensory information from LFT itself was necessary or anticipation of a more secure posture was enough for reducing vibration effects. To this aim, we administered a vibration pulse (5 s) to dorsal neck or sternocleidomastoid muscle and during reaching to the stationary surface. CFP was recorded during both vibration and post-vibration condition and during the aiming task. Neck vibration induced significant CFP displacement in the direction opposite to vibration site. Post-vibration, CFP slowly returned to control values with ample oscillations. LFT during vibration reduced body tilt. LFT was more effective when fingertip contact was in the plane of the greatest tilt. LFT applied during either vibration or post-vibration period reduced post-vibration effects. Reaching toward the stationary surface was enough for reducing vibration-induced body tilt to values close to those observed during actual LFT. The novel conclusions of this study are: 1) LFT is able to relieve the effects of vibration-induced abnormal proprioceptive input from the neck, a segment central to postural control and orientation; 2) LFT during vibration also attenuates vibration post-effects, further suggesting that its action is not merely mechanical; 3) the intention to stabilize the body generates a new postural 'set' sufficient for diminishing body tilt.

Galvanic Vestibular Stimulation Modifies Vection Paths in Healthy Subjects

The present study aimed at determining whether vestibular inputs contribute to the perception of the direction of self-motion. This question was approached by investigating the effects of binaural bipolar galvanic vestibular stimulation (GVS) on visually induced self-motion (i.e., vection) in healthy subjects. Stationary seated subjects were submitted to optokinetic stimulation inducing either forward or upward linear vection. While perceiving vection, they were administered trapezoidal GVS of different intensities and ramp durations. Subjects indicated the shape and direction of their perceived self-motion path throughout the experiment by a joystick, and after each trial by the manipulation of a 3D mannequin. Results show that: 1) GVS induced alterations of the path of vection; 2) these alterations occurred more often after GVS onset than after GVS offset; 3) the occurrence of vection path alterations after GVS onset depended on the intensity of GVS but not on the steepness of the GVS variation; 4) the vection path deviated laterally according to either an oblique or a curved path; and 5) the vection path deviated toward the cathode side after GVS onset. It is the first time that vestibular information, already known to contribute to the induction of vection, is shown to modify self-motion perception during the course of vection.

Otolith Function Assessed with the Subjective Postural Horizontal and Standardised Stance and Gait Tasks

If otolith function is essential to maintain upright standing while moving along slanted or uneven surfaces, subjects with an otolith deficit should have difficulty judging whether the inclination of the surface on which they are standing is tilted or not. We tested this judgement and compared it with the ability to control trunk sway during standardised stance and gait tests. Thirteen patients with unilateral vestibular nerve neurectomy at least 6 months prior to testing and 39 age-matched controls were asked to move a dynamic posturography platform on which they were standing back to their subjective 'horizontal' position after the platform had been slowly tilted at 0.4 degrees/s to 5 degrees in 8 different directions. Normal subjects left the platform deviated in pitch (forwards-backwards) at about 0.7 degrees on describing the platform as levelled off for all directions of tilt. Patients showed larger deviations of about 1.3 degrees in pitch with significant differences for forward right tilt (1.58+/-0.73 degrees compared to 0.73+/-0.11 degrees for normals; mean and SEM) and for forward left. Roll (lateral) deviations were about 0.4 degrees for normals and 0.5 degrees larger for the patients (for example, for backward left, 1.13+/-0.24 degrees compared to 0.4+/-0.07 degrees in normals). Except for a tendency towards greater deviations to the lesion side of patients with eyes closed, no differences were noted between tests under eyes open and closed conditions. However, for backward and roll tilts patients needed to steady themselves first by grasping a handrail when tested with eyes closed. Stance tests on foam showed increases in roll and pitch trunk sway with respect to controls. Patients had significantly larger trunk roll sway deviations during 1-legged stance tests and during gait trials. For stance trials, the patients lost their balance control prior to the end of the standard 20-second recording time. We conclude that a unilateral loss of otolith inputs due to nerve resection permanently impairs the ability to judge whether the support surface is horizontal, and leads to excessive trunk sway when standing on a compliant surface as well as excessive trunk roll sway during gait.