Direction of galvanically-induced vestibulo-postural responses during active and passive neck torsion

Mastoid vibration affects dynamic postural control during gait in healthy older adults

Vestibular disorders are difficult to diagnose early due to the lack of a systematic assessment. Our previous work has developed a reliable experimental design and the result shows promising results that vestibular sensory input while walking could be affected through mastoid vibration (MV) and changes are in the direction of motion. In the present paper, we wanted to extend this work to older adults and investigate how manipulating sensory input through mastoid vibration (MV) could affect dynamic postural control during walking. Three levels of MV (none, unilateral, and bilateral) applied via vibrating elements placed on the mastoid processes were combined with the Locomotor Sensory Organization Test (LSOT) paradigm to challenge the visual and somatosensory systems. We hypothesized that the MV would affect sway variability during walking in older adults. Our results revealed that MV significantly not only increased the amount of sway variability but also decreased the temporal structure of sway variability only in anterior-posterior direction. Importantly, the bilateral MV stimulation generally produced larger effects than the unilateral. This is an important finding that confirmed our experimental design and the results produced could guide a more reliable screening of vestibular system deterioration.

Mastoid Vibration Affects Dynamic Postural Control During Gait

Our objective was to investigate how manipulating sensory input through mastoid vibration (MV) could affect dynamic postural control during walking, with and without simultaneous manipulation of the visual and the somatosensory systems. We used three levels of MV (none, unilateral, and bilateral) via vibrating elements placed on the mastoid processes. We combined this with the six conditions of the Locomotor Sensory Organization Test (LSOT) paradigm to challenge the visual and somatosensory systems. We hypothesized that MV would affect both amount and temporal structure measures of sway variability during walking and that, in combination with manipulations of the visual and the somatosensory inputs, MV would augment the effects previously observed. The results confirmed that MV produced a significant increase in the amount of sway variability in both anterior-posterior and medial-lateral directions. Significant changes in the temporal structure of sway variability were only observed in the anterior-posterior direction. Bilateral MV produced larger effects than unilateral stimulation. We concluded that sensory input while walking could be affected using MV. Combining MV with manipulations of visual and somatosensory input could allow us to better understand the contributions of the sensory systems during locomotion.

Abnormal postural reflexes in a patient with pontine ischaemia

The control of body posture is a complex activity that needs a very close relationship between different structures, such as the vestibular system, and the muscle and joint receptors of the neck. Damage of even one of these structures can lead to abnormal postural reflexes. We describe a case of a woman with a left pontine ischaemia who developed a 'dystonic' extensor posture of the left limbs while turned on the right side. This clinical picture differs from previous reports on the subject, and may relate to ischaemic damage of a pontine structure involved in posture control, or of adjacent neural connections to be yet identified. To the best of our knowledge, this is the first case reported in the literature. Clinical examples of an altered interplay between vestibular and neck receptors are rare.

Long-lasting effects of neck muscle vibration and contraction on self-motion perception of vestibular origin

OBJECTIVE

To show that neck proprioceptive input can induce long-term effects on vestibular-dependent self-motion perception.

METHODS

Motion perception was assessed by measuring the subject's error in tracking in the dark the remembered position of a fixed target during whole-body yaw asymmetric rotation of a supporting platform, consisting in a fast rightward half-cycle and a slow leftward half-cycle returning the subject to the initial position. Neck muscles were relaxed or voluntarily contracted, and/or vibrated. Whole-body rotation was administered during or at various intervals after the vibration train. The tracking position error (TPE) at the end of the platform rotation was measured during and after the muscle conditioning maneuvers.

RESULTS

Neck input produced immediate and sustained changes in the vestibular perceptual response to whole-body rotation. Vibration of the left sterno-cleido-mastoideus (SCM) or right splenius capitis (SC) or isometric neck muscle effort to rotate the head to the right enhanced the TPE by decreasing the perception of the slow rotation. The reverse effect was observed by activating the contralateral muscle. The effects persisted after the end of SCM conditioning, and slowly vanished within several hours, as tested by late asymmetric rotations. The aftereffect increased in amplitude and persistence by extending the duration of the vibration train (from 1 to 10min), augmenting the vibration frequency (from 5 to 100Hz) or contracting the vibrated muscle. Symmetric yaw rotation elicited a negligible TPE, upon which neck muscle vibrations were ineffective.

CONCLUSIONS

Neck proprioceptive input induces enduring changes in vestibular-dependent self-motion perception, conditional on the vestibular stimulus feature, and on the side and the characteristics of vibration and status of vibrated muscles. This shows that our perception of whole-body yaw-rotation is not only dependent on accurate vestibular information, but is modulated by proprioceptive information related to previously experienced position of head with respect to trunk.

SIGNIFICANCE

Tonic proprioceptive inflow, as might occur as a consequence of enduring or permanent head postures, can induce adaptive plastic changes in vestibular-dependent motion sensitiveness. These changes might be counteracted by vibration of selected neck muscles.

Neck proprioception shapes body orientation and perception of motion

This review article deals with some effects of neck muscle proprioception on human balance, gait trajectory, subjective straight-ahead (SSA), and self-motion perception. These effects are easily observed during neck muscle vibration, a strong stimulus for the spindle primary afferent fibers. We first remind the early findings on human balance, gait trajectory, SSA, induced by limb, and neck muscle vibration. Then, more recent findings on self-motion perception of vestibular origin are described. The use of a vestibular asymmetric yaw-rotation stimulus for emphasizing the proprioceptive modulation of motion perception from the neck is mentioned. In addition, an attempt has been made to conjointly discuss the effects of unilateral neck proprioception on motion perception, SSA, and walking trajectory. Neck vibration also induces persistent aftereffects on the SSA and on self-motion perception of vestibular origin. These perceptive effects depend on intensity, duration, side of the conditioning vibratory stimulation, and on muscle status. These effects can be maintained for hours when prolonged high-frequency vibration is superimposed on muscle contraction. Overall, this brief outline emphasizes the contribution of neck muscle inflow to the construction and fine-tuning of perception of body orientation and motion. Furthermore, it indicates that tonic neck-proprioceptive input may induce persistent influences on the subject's mental representation of space. These plastic changes might adapt motion sensitiveness to lasting or permanent head positional or motor changes.

Can imagery become reality?

Previous studies showed that highly hypnotizable persons imagining a specific sensory context behave according to the corresponding real stimulation and perceive their behaviour as involuntary. The aim of the study was to confirm the hypothesis of a translation of sensory imagery into real perception and, thus, of a true involuntary response. We studied the imagery-induced modulation of the vestibulospinal (VS) reflex earlier component in highly (Highs) and low hypnotizable subjects (Lows), as it is not affected by voluntary control, its amplitude depends on the stimulus intensity, and the plane of body sway depends on the position of the head with respect to the trunk. Results showed that the effects of the "obstructive" imagery of anaesthesia are different from those elicited by the "constructive" imagery of head rotation. Indeed, both Highs and Lows having their face forward and reporting high vividness of imagery experienced anaesthesia and reduced their VS reflex amplitude in the frontal plane, while only Highs changed the plane of body sway according to the imagined head rotation that is from the frontal to the sagittal one. These effects cannot be voluntary and should be attributed to translation of sensory imagery into the corresponding real perception.

Tuning of human vestibulospinal reflexes by leg rotation

Changing the foot position modifies the mechanical action exerted by the ankle extensor and flexor muscles over the body. We verified, in two groups of healthy subjects standing with the heels touching or apart, whether a 90° external rotation of the right leg and foot also changes the pattern of vestibulospinal reflexes elicited by electrical stimulation of the labyrinth. With the head oriented forward, leg rotation did not modify the labyrinthine-driven displacements of the center of pressure (CoP). When the head was rotated in the horizontal plane, either to the right or to the left, the CoP displacement increased along the y axis in all subjects. Changes in the x component in most instances appropriate to preserve unmodified the direction of body sway elicited by the stimulus were observed. Right leg rotation increased the basal EMG activity of ankle extensors and flexors on the left side, while the right side activity was unaffected. The EMG responses to labyrinthine stimulation were modified only on the left side, in a way appropriate to correct the effects of the altered torque pattern exerted on the body by right leg muscles. It appears, therefore, that somatosensory signals related to leg rotation and/or copy of the corresponding voluntary motor commands modify the pattern of vestibulospinal reflexes and maintain the postural response appropriate to counteract a body sway in the direction inferred by labyrinthine signals.

Multimodal integration in rostral fastigial nucleus provides an estimate of body movement

The ability to accurately control posture and perceive self-motion and spatial orientation requires knowledge of the motion of both the head and body. However, whereas the vestibular sensors and nuclei directly encode head motion, no sensors directly encode body motion. Instead, the convergence of vestibular and neck proprioceptive inputs during self-motion is generally believed to underlie the ability to compute body motion. Here, we provide evidence that the brain explicitly computes an internal estimate of body motion at the level of single cerebellar neurons. Neuronal responses were recorded from the rostral fastigial nucleus, the most medial of the deep cerebellar nuclei, during whole-body, body-under-head, and head-on-body rotations. We found that approximately half of the neurons encoded the motion of the body in space, whereas the other half encoded the motion of the head in space in a manner similar to neurons in the vestibular nuclei. Notably, neurons encoding body motion responded to both vestibular and proprioceptive stimulation (accordingly termed bimodal neurons). In contrast, neurons encoding head motion were sensitive only to vestibular inputs (accordingly termed unimodal neurons). Comparison of the proprioceptive and vestibular responses of bimodal neurons further revealed similar tuning in response to changes in head-on-body position. We propose that the similarity in nonlinear processing of vestibular and proprioceptive signals underlies the accurate computation of body motion. Furthermore, the same neurons that encode body motion (i.e., bimodal neurons) most likely encode vestibular signals in a body-referenced coordinate frame, since the integration of proprioceptive and vestibular information is required for both computations.

Vestibular-neck interaction in cerebellar patients

Vestibulospinal reflexes are important for upright stance and locomotor control. Information from both the vestibular and the proprioceptive system must be combined centrally to guarantee appropriate compensation for a physical disturbance. Recent single-unit recordings from the monkey demonstrated vestibulo-proprioceptive interaction in the fastigial nucleus (deep cerebellar nucleus). The present study investigated whether integration of vestibular and proprioceptive signals is compromised in humans with cerebellar degeneration. Control subjects and patients were exposed to binaural, sinusoidal galvanic vestibular stimulation at 0.16 Hz, while their static head-on-trunk position was systematically altered in the head-horizontal plane from 60 degrees left to 60 degrees right. Controls responded to different head-on-trunk positions with fully compensatory changes in the direction of galvanically induced body sway, keeping it aligned with the head-frontal plane. In patients, this compensatory change was lacking. Findings support the assumption that the cerebellum plays a central role in the integration of vestibular and proprioceptive signals in humans. This form of impaired sensory interaction is probably a clinically important component of cerebellar stance and gait ataxia.

Cervical proprioception is sufficient for head orientation after bilateral vestibular loss

The aim was to investigate the relative importance of cervical proprioception compared to vestibular input for head movements on trunk. Subjects with bilateral vestibulopathy (n = 11) were compared to healthy controls (n = 15). We studied their ability to move the head accurately to reproduce four specified target positions in the horizontal yaw plane (neutral head position, 10 degrees target, 30 degrees target, and 30 degrees target with oscillating movements applied during target introduction). Repositioning ability was calculated as accuracy (constant error, the mean of signed differences between introduced and reproduced target) and precision (variable error, the standard deviation of differences between introduced and reproduced targets). Subjects with bilateral vestibulopathy did not differ significantly from controls in their ability to reproduce different target positions. When the 30 degrees target position was introduced with oscillating movements, overshoot diminished and accuracy improved in both groups, although only statistically significantly when performed towards the right side. The results suggest that at least in some conditions, accurate head on trunk orientation can be achieved without vestibular information and that cervical somato-sensory input is either up-regulated as a compensatory mechanism after bilateral vestibular loss or is important for such tasks.

Artificial vestibular feedback in conditions of a modified body scheme

Subjects standing in the dark on a rigid immobile support maintained a vertical posture, which was destabilized by vibrostimulation of both Achilles tendons. Feedback was created via the vestibular pathway using transmastoid galvanic stimulation. Changes in the current in the feedback envelope were made using a linear function based on the amplitude and rate of head displacement. Changes in the body scheme were produced using rotation of the head relative to the trunk, rotation of the trunk with the relative head position fixed, and simultaneous rotation of the head and trunk. The result of these manipulations was that the head could be rotated through essentially 90 degrees relative to the feet. In addition, rotation of one foot relative to the other through 90 degrees was used. Artificial feedback damped head oscillations induced by vibration, but only those in the vertical plane passing through the interaural axis of the head. It is suggested that changes in the vectorial characteristics of vestibular responses and the results of applying artificial feedback on the background of modified orientation of the head relative to the feet may be associated with substitution of the ensembles of vestibular hair sets providing the dominant signals in the responses of vestibulospinal neurons.

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.

Neck muscle fatigue and spatial orientation during stepping in place in humans

Neck proprioceptive input, as elicited by muscle vibration, can produce destabilizing effects on stance and locomotion. Neck muscle fatigue produces destabilizing effects on stance, too. Our aim was to assess whether neck muscle fatigue can also perturb the orientation in space during a walking task. Direction and amplitude of the path covered during stepping in place were measured in 10 blindfolded subjects, who performed five 30-s stepping trials before and after a 5-min period of isometric dorsal neck muscle contraction against a load. Neck muscle electromyogram amplitude and median frequency during the head extensor effort were used to compute a fatigue index. Head and body kinematics were recorded by an optoelectronic system, and stepping cadence was measured by sensorized insoles. Before the contraction period, subjects normally stepped on the spot or drifted forward. After contraction, some subjects reproduced the same behavior, whereas others reduced their forward progression or even stepped backward. The former subjects showed minimal signs of fatigue and the latter ones marked signs of fatigue, as quantified by the dorsal neck electromyogram index. Head position and cadence were unaffected in either group of subjects. We argue that the abnormal fatigue-induced afferent input originating in the receptors transducing the neck muscle metabolic state can modulate the egocentric spatial reference frame. Notably, the effects of neck muscle fatigue on orientation are opposite to those produced by neck proprioception. The neck represents a complex source of inputs capable of modifying our orientation in space during a locomotor task.

Trunk position influences vestibular responses of fastigial nucleus neurons in the alert monkey

Vestibulospinal reflexes play an important role for body stabilization during locomotion and for postural control. For an appropriate distribution of vestibular signals to spinal motoneurons, the orientation of the body relative to the head needs to be taken into account. For different trunk positions, identical vestibular stimuli must activate different sets of muscles to ensure body stabilization. Because the cerebellar vermis and the underlying fastigial nucleus (FN) might be involved in this task, vestibular neurons in the rostral FN of alert rhesus monkeys were recorded during sinusoidal vestibular stimulation (0.1-1.0 Hz) in the roll and pitch planes at different trunk-re-head positions (center and +/-45 degrees ). From the sensitivity and phase values measured in these planes, the response properties in the intermediate planes and the stimulus orientation eliciting the optimal response [response vector orientation (RVO)] were calculated. In most neurons, the RVOs rotated systematically with respect to the head, when trunk-re-head position was altered, so that they tended to maintain their orientation with respect to the trunk. Sensitivity and phase at the RVO were not affected. This pattern was the same for neurons in the right and left FN and independent of stimulus frequency. The average sensitivity of this partially compensatory RVO shift in response to trunk-re-head displacements, evaluated by linear regression analyses, was 0.59 degrees / degrees (n = 73 neurons). These data show that FN neurons may encode vestibular information in a coordinate system that is closer to a trunk-centered than to a head-centered reference frame. They indicate an important role of this nucleus in motor programs related to posture and gait control.

Background on methods of stimulation in galvanic-induced body sway in young healthy adults

The aim of this study was to develop a standardized procedure for reproducible quantification of galvanic-induced body sway (GBS). This was a prospective experimental study conducted in a tertiary referral centre. An exploratory study was first conducted to define the galvanic vestibular stimulation (GVS) method that resulted in the best reproducible responses. Ten subjects underwent computer-controlled GVS using five different types of monaural and binaural stimulation with 2-mA currents. Cosinusoidal stimulation gave the most reproducible responses. The frequency and current variability of this stimulus type were then tested in the same 10 subjects. A monaural continuous 1-cosinusoidal current of 0.5 Hz and 2 mA gave the most reproducible responses (< 20% test-retest variation) and the largest GBS amplitude. The other (sinusoidal) stimuli resulted in variabilities exceeding 50%. This stimulus was thus used for further testing in our normative study. In this study we measured GBS amplitude at 0.5 Hz in 60 subjects, with eyes closed and an inter-feet distance of 0 cm, using a force platform. In addition to body sway, responses included slight dizziness, taste sensations and a tingling sensation at the site of stimulation. Habituation to the applied stimulus was seen. Binaural prestimulation, performed in 50/60 test subjects, is necessary to reduce habituation and achieve optimal reproducibility in order to be able to compare the sensitivity of the left and right vestibular systems. The test-retest variability was determined in detail in 12 additional subjects. Prestimulation reduced habituation, but improved the sensitivity of the method; some test-retest variability persisted (< 20%).

Neck muscle fatigue affects postural control in man

We hypothesised that, since anomalous neck proprioceptive input can produce perturbing effects on posture, neck muscle fatigue could alter body balance control through a mechanism connected to fatigue-induced afferent inflow. Eighteen normal subjects underwent fatiguing contractions of head extensor muscles. Sway during quiet stance was recorded by a dynamometric platform, both prior to and after fatigue and recovery, with eyes open and eyes closed. After each trial, subjects were asked to rate their postural control. Fatigue was induced by having subjects stand upright and exert a force corresponding to about 35% of maximal voluntary effort against a device exerting a head-flexor torque. The first fatiguing period lasted 5 min (F1). After a 5-min recovery period (R1), a second period of fatiguing contraction (F2) and a second period of recovery (R2) followed. Surface EMG activity from dorsal neck muscles was recorded during the contractions and quiet stance trials. EMG median frequency progressively decreased and EMG amplitude progressively increased during fatiguing contractions, demonstrating that muscle fatigue occurred. After F1, subjects swayed to a larger extent compared with control conditions, recovering after R1. Similar findings were obtained after F2 and after R2. Although such behaviour was detectable under both visual conditions, the effects of fatigue reached significance only without vision. Subjective scores of postural control diminished when sway increased, but diminished more, for equal body sway, after fatigue and recovery. Contractions of the same duration, but not inducing EMG signs of fatigue, had much less influence on body sway or subjective scoring. We argue that neck muscle fatigue affects mechanisms of postural control by producing abnormal sensory input to the CNS and a lasting sense of instability. Vision is able to overcome the disturbing effects connected with neck muscle fatigue.

Vestibular actions on back and lower limb muscles during postural tasks in man

The vestibular system was activated by galvanic electrical stimulation in 19 normal subjects. With the head turned to one side so that the stimulating anode was on the posterior mastoid process, stimulation caused standing subjects to sway backwards in the sagittal plane. Electromyography showed bilateral activation of erector spinae, gluteus maximus, biceps femoris, soleus and intrinsic foot (toe flexor) muscles. When head direction or electrode polarity was reversed so that the anode was anterior, all those muscles became less active and the subjects swayed forwards. With the head facing forward, stimulation caused sideways sway in the coronal plane, towards the anode, with excitation of the erector spinae on the anode side and reduced activity on the cathode side. The limb muscles were activated on the side opposite the anode and showed complex responses on the anode side. Responses were detectable in the erectores spinae muscles in sitting subjects. No responses in limb muscles were detected in the sitting posture. Subject responses in erector spinae recorded at L3/L4 had latencies from 59 to 110 ms, using a 2 mA stimulus. Latencies in lower limb muscles were longer. The results suggest a role for the vestibular system and descending brain stem motor pathways to the erectores spinae muscles in the control of postural orientation of the back when sitting and standing. The conduction velocity in the motor pathway was estimated to be 13 +/- 10 m s(-1) (mean +/- S.D., n = 12 subjects).

Neck vibration causes short-latency electromyographic activation of lower leg muscles in postural reactions of the standing human

To study how quickly cervical proprioceptive information induced muscular responses in the lower leg to control posture in the standing human we investigated lower leg muscle electromyography and force-plate data from 10 healthy normal subjects, when perturbed by posterior neck muscle vibration. At the onset of vibration the tibialis anterior muscle was activated at latencies of 70-100 ms whilst the triceps surae muscle was inhibited at the same latencies. At offset the opposite pattern was observed. These findings suggest that a short-latency integrative system, rather than a direct reflex, mediates the cervical influence on posture. The short latencies also imply that activation of postural muscles in response to vibration towards the neck muscles occurs faster than would be expected if it was caused only by a perceptive illusion of movement.