Vestibular System and Self-Motion

Skull vibration induced nystagmus, velocity storage and self-stability

In this paper we give an introduction to the area, followed by brief reviews of the neural response to sound and vibration, and then the velocity storage integrator, before putting forward our hypothesis about the neural input to the velocity storage integrator. Finally we discuss some of the implications of our hypothesis. There are two pathways conveying neural information from the vestibular periphery (the semicircular canals and the otoliths) to central neural mechanisms-a direct and an indirect pathway. Within the indirect pathway there is a unique neural mechanism called the velocity storage integrator (VSI) which is part of a neural network generating prolonged nystagmus, afternystagmus and the sensation of self-motion and its converse self-stability. It is our hypothesis that only neural input from primary afferent neurons with irregular resting discharge projects in the direct pathway, whereas the primary afferent input in the indirect pathway consists of neurons with regular resting discharge. The basis for this hypothesis is that vibration is a selective stimulus for vestibular neurons with irregular resting discharge. 100 Hz mastoid vibration, while capable of generating nystagmus (skull vibration induced nystagmus SVIN), is ineffective in generating afternystagmus (in the condition of an encased labyrinth) which is a marker of the action of the VSI, leading to the conclusion that irregular afferents bypass the indirect pathway and the VSI. In order to present this hypothesis we review the evidence that irregular neurons are selectively activated by sound and vibration, whereas regular neurons are not so activated. There are close similarities between the temporal characteristics of the irregular afferent neural response to vibration and the temporal characteristics of SVIN. SVIN is a simple clinical indicator of whether a patient has an imbalance between the two vestibular labyrinths and our hypothesis ties SVIN to irregular primary vestibular neurons.

Intra-rater and test-retest reliability of videography observation method to check diversion time in Fukuda step test among college going students

PURPOSE

The Fukuda step test is a valuable tool for identifying vestibular dysfunction in humans. This study evaluated the intra-rater and test-retest reliabilities of videograph observations to determine the diversion time while performing the Fukuda test. This study aimed to determine the use of videographic observation as a beneficial tool for recording real-time assessment procedures in clinical settings.

METHODS

Fifty college students who were selected based on the inclusion criteria performed three consecutive sessions of the Fukuda step test. Intra-rater and test-retest reliabilities of the videograph observations were identified using the intraclass correlation coefficient (ICC).

RESULTS

We noted both, good intra-rater (ICC= 0.78) and moderate-to-good test-retest reliabilities (ICC= 0.69) of the videograph observations.

CONCLUSION

Videographic observation can be used in clinical settings to identify diversion times while performing the Fukuda step test.

Measuring vection: a review and critical evaluation of different methods for quantifying illusory self-motion

The sensation of self-motion in the absence of physical motion, known as vection, has been scientifically investigated for over a century. As objective measures of, or physiological correlates to, vection have yet to emerge, researchers have typically employed a variety of subjective methods to quantify the phenomenon of vection. These measures can be broadly categorized into the occurrence of vection (e.g., binary choice yes/no), temporal characteristics of vection (e.g., onset time/latency, duration), the quality of the vection experience (e.g., intensity rating scales, magnitude estimation), or indirect (e.g., distance travelled) measures. The present review provides an overview and critical evaluation of the most utilized vection measures to date and assesses their respective merit. Furthermore, recommendations for the selection of the most appropriate vection measures will be provided to assist with the process of vection research and to help improve the comparability of research findings across different vection studies.

Neuroimaging evidence of visual-vestibular interaction accounting for perceptual mislocalization induced by head rotation

Significance

A fleeting flash aligned vertically with an object remaining stationary in the head-centered space would be perceived as lagging behind the object during the observer's horizontal head rotation. This perceptual mislocalization is an illusion named head-rotation-induced flash-lag effect (hFLE). While many studies have investigated the neural mechanism of the classical visual FLE, the hFLE has been hardly investigated.

Aim

We measured the cortical activity corresponding to the hFLE on participants experiencing passive head rotations using functional near-infrared spectroscopy.

Approach

Participants were asked to judge the relative position of a flash to a fixed reference while being horizontally rotated or staying static in a swivel chair. Meanwhile, functional near-infrared spectroscopy signals were recorded in temporal-parietal areas. The flash duration was manipulated to provide control conditions.

Results

Brain activity specific to the hFLE was found around the right middle/inferior temporal gyri, and bilateral supramarginal gyri and superior temporal gyri areas. The activation was positively correlated with the rotation velocity of the participant around the supramarginal gyrus and negatively related to the hFLE intensity around the middle temporal gyrus.

Conclusions

These results suggest that the mechanism underlying the hFLE involves multiple aspects of visual-vestibular interactions including the processing of multisensory conflicts mediated by the temporoparietal junction and the modulation of vestibular signals on object position perception in the human middle temporal complex.

Psychometrics of inertial heading perception

BACKGROUND

Inertial self-motion perception is thought to depend primarily on otolith cues. Recent evidence demonstrated that vestibular perceptual thresholds (including inertial heading) are adaptable, suggesting novel clinical approaches for treating perceptual impairments resulting from vestibular disease.

OBJECTIVE

Little is known about the psychometric properties of perceptual estimates of inertial heading like test-retest reliability. Here we investigate the psychometric properties of a passive inertial heading perceptual test.

METHODS

Forty-seven healthy subjects participated across two visits, performing in an inertial heading discrimination task. The point of subjective equality (PSE) and thresholds for heading discrimination were identified for the same day and across day tests. Paired t-tests determined if the PSE or thresholds significantly changed and a mixed interclass correlation coefficient (ICC) model examined test-retest reliability. Minimum detectable change (MDC) was calculated for PSE and threshold for heading discrimination.

RESULTS

Within a testing session, the heading discrimination PSE score test-retest reliability was good (ICC = 0. 80) and did not change (t(1,36) = -1.23, p = 0.23). Heading discrimination thresholds were moderately reliable (ICC = 0.67) and also stable (t(1,36) = 0.10, p = 0.92). Across testing sessions, heading direction PSE scores were moderately correlated (ICC = 0.59) and stable (t(1,46) = -0.44, p = 0.66). Heading direction thresholds had poor reliability (ICC = 0.03) and were significantly smaller at the second visit (t(1,46) = 2.8, p = 0.008). MDC for heading direction PSE ranged from 6-9 degrees across tests.

CONCLUSION

The current results indicate moderate reliability for heading perception PSE and provide clinical context for interpreting change in inertial vestibular self-motion perception over time or after an intervention.

Self-motion perception and sequential decision-making: where are we heading?

To navigate and guide adaptive behaviour in a dynamic environment, animals must accurately estimate their own motion relative to the external world. This is a fundamentally multisensory process involving integration of visual, vestibular and kinesthetic inputs. Ideal observer models, paired with careful neurophysiological investigation, helped to reveal how visual and vestibular signals are combined to support perception of linear self-motion direction, or heading. Recent work has extended these findings by emphasizing the dimension of time, both with regard to stimulus dynamics and the trade-off between speed and accuracy. Both time and certainty-i.e. the degree of confidence in a multisensory decision-are essential to the ecological goals of the system: terminating a decision process is necessary for timely action, and predicting one's accuracy is critical for making multiple decisions in a sequence, as in navigation. Here, we summarize a leading model for multisensory decision-making, then show how the model can be extended to study confidence in heading discrimination. Lastly, we preview ongoing efforts to bridge self-motion perception and navigation per se, including closed-loop virtual reality and active self-motion. The design of unconstrained, ethologically inspired tasks, accompanied by large-scale neural recordings, raise promise for a deeper understanding of spatial perception and decision-making in the behaving animal. This article is part of the theme issue 'Decision and control processes in multisensory perception'.

Temporal and spatial properties of vestibular signals for perception of self-motion

It is well recognized that the vestibular system is involved in numerous important cognitive functions, including self-motion perception, spatial orientation, locomotion, and vector-based navigation, in addition to basic reflexes, such as oculomotor or body postural control. Consistent with this rationale, vestibular signals exist broadly in the brain, including several regions of the cerebral cortex, potentially allowing tight coordination with other sensory systems to improve the accuracy and precision of perception or action during self-motion. Recent neurophysiological studies in animal models based on single-cell resolution indicate that vestibular signals exhibit complex spatiotemporal dynamics, producing challenges in identifying their exact functions and how they are integrated with other modality signals. For example, vestibular and optic flow could provide congruent and incongruent signals regarding spatial tuning functions, reference frames, and temporal dynamics. Comprehensive studies, including behavioral tasks, neural recording across sensory and sensory-motor association areas, and causal link manipulations, have provided some insights into the neural mechanisms underlying multisensory self-motion perception.

Motorist's Vestibular Disorientation Syndrome (MVDS)-Proposed Diagnostic Criteria

Motorist's vestibular disorientation syndrome (MVDS) is a disorder in which patients experience dizziness while driving. MVDS is under-reported in the literature, and in clinical practice, it often goes unrecognized. We identified clinical characteristics of patients with MVDS using data from 24 patients who faced difficulties while driving and were diagnosed with MVDS. Their symptoms, duration of illness, precipitating factors, co-morbidities, history of other neuro-otological disorders, severity of symptoms, and associated anxiety and depression were reviewed. Ocular motor movements were recorded using video-nystagmography. Patients with vestibular disorders that can cause similar symptoms while driving were excluded. The mean age of the patients was 45.7 ± 8.7 years, and most were professional drivers (90.5%). The duration of the illness ranged from eight days to ten years. Most patients presented with disorientation (79.2%) exclusively while driving. The most common triggers for symptoms were higher speeds, i.e., >80 km/h (66.7%), multi-lane roads (58.3%), bends and turns (50%), and looking at other vehicles or signals while driving (41.7%). A history of migraines was reported in 62.5% of the patients, and motion sickness was reported in 50% of the patients. Anxiety was reported in 34.3% of patients, and 15.7% had depression. The video-nystagmography did not show any specific abnormalities. Patients responded to drugs used in prophylactic treatments for migraines such as Amitriptyline, Venlafaxine, Bisoprolol, and Magnesium, and to Pregabalin and Gabapentin. Based on these findings, a classification system and a diagnostic criterion for MVDS were proposed.

Being active over one's own motion: Considering predictive mechanisms in self-motion perception

Self-motion perception is a key element guiding pilots' behavior. Its importance is mostly revealed when impaired, leading in most cases to spatial disorientation which is still today a major factor of accidents occurrence. Self-motion perception is known as mainly based on visuo-vestibular integration and can be modulated by the physical properties of the environment with which humans interact. For instance, several studies have shown that the respective weight of visual and vestibular information depends on their reliability. More recently, it has been suggested that the internal state of an operator can also modulate multisensory integration. Interestingly, the systems' automation can interfere with this internal state through the loss of the intentional nature of movements (i.e., loss of agency) and the modulation of associated predictive mechanisms. In this context, one of the new challenges is to better understand the relationship between automation and self-motion perception. The present review explains how linking the concepts of agency and self-motion is a first approach to address this issue.

Active self-motion control and the role of agency under ambiguity

Purpose

Self-motion perception is a key factor in daily behaviours such as driving a car or piloting an aircraft. It is mainly based on visuo-vestibular integration, whose weighting mechanisms are modulated by the reliability properties of sensory inputs. Recently, it has been shown that the internal state of the operator can also modulate multisensory integration and may sharpen the representation of relevant inputs. In line with the concept of agency, it thus appears relevant to evaluate the impact of being in control of our own action on self-motion perception.

Methodology

Here, we tested two conditions of motion control (active/manual trigger versus passive/ observer condition), asking participants to discriminate between two consecutive longitudinal movements by identifying the larger displacement (displacement of higher intensity). We also tested motion discrimination under two levels of ambiguity by applying acceleration ratios that differed from our two "standard" displacements (i.e., 3 s; 0.012 m.s^-2 and 0.030 m.s^-2).

Results

We found an effect of control condition, but not of the level of ambiguity on the way participants perceived the standard displacement, i.e., perceptual bias (Point of Subjective Equality; PSE). Also, we found a significant effect of interaction between the active condition and the level of ambiguity on the ability to discriminate between displacements, i.e., sensitivity (Just Noticeable Difference; JND).

Originality

Being in control of our own motion through a manual intentional trigger of self-displacement maintains overall motion sensitivity when ambiguity increases.

Vestibular contribution to path integration deficits in 'at-genetic-risk' for Alzheimer's disease

Path integration changes may precede a clinical presentation of Alzheimer's disease by several years. Studies to date have focused on how spatial cell changes affect path integration in preclinical AD. However, vestibular input is also critical for intact path integration. Here, we developed the vestibular rotation task that requires individuals to manually point an iPad device in the direction of their starting point following rotational movement, without any visual cues. Vestibular features were derived from the sensor data using feature selection. Machine learning models illustrate that the vestibular features accurately classified Apolipoprotein E ε3ε4 carriers and ε3ε3 carrier controls (mean age 62.7 years), with 65% to 79% accuracy depending on task trial. All machine learning models produced a similar classification accuracy. Our results demonstrate the cross-sectional role of the vestibular system in Alzheimer's disease risk carriers. Future investigations should examine if vestibular functions explain individual phenotypic heterogeneity in path integration among Alzheimer's disease risk carriers.

From thinking fast to moving fast: motor control of fast limb movements in healthy individuals

The ability to produce high movement speeds is a crucial factor in human motor performance, from the skilled athlete to someone avoiding a fall. Despite this relevance, there remains a lack of both an integrative brain-to-behavior analysis of these movements and applied studies linking the known dependence on open-loop, central control mechanisms of these movements to their real-world implications, whether in the sports, performance arts, or occupational setting. In this review, we cover factors associated with the planning and performance of fast limb movements, from the generation of the motor command in the brain to the observed motor output. At each level (supraspinal, peripheral, and motor output), the influencing factors are presented and the changes brought by training and fatigue are discussed. The existing evidence of more applied studies relevant to practical aspects of human performance is also discussed. Inconsistencies in the existing literature both in the definitions and findings are highlighted, along with suggestions for further studies on the topic of fast limb movement control. The current heterogeneity in what is considered a fast movement and in experimental protocols makes it difficult to compare findings in the existing literature. We identified the role of the cerebellum in movement prediction and of surround inhibition in motor slowing, as well as the effects of fatigue and training on central motor control, as possible avenues for further research, especially in performance-driven populations.

Egomotion-related visual areas respond to goal-directed movements

Integration of proprioceptive signals from the various effectors with visual feedback of self-motion from the retina is necessary for whole-body movement and locomotion. Here, we tested whether the human visual motion areas involved in processing optic flow signals simulating self-motion are also activated by goal-directed movements (as saccades or pointing) performed with different effectors (eye, hand, and foot), suggesting a role in visually guiding movements through the external environment. To achieve this aim, we used a combined approach of task-evoked activity and effective connectivity (PsychoPhysiological Interaction, PPI) by fMRI. We localized a set of six egomotion-responsive visual areas through the flow field stimulus and distinguished them into visual (pIPS/V3A, V6+ , IPSmot/VIP) and visuomotor (pCi, CSv, PIC) areas according to recent literature. We tested their response to a visuomotor task implying spatially directed delayed eye, hand, and foot movements. We observed a posterior-to-anterior gradient of preference for eye-to-foot movements, with posterior (visual) regions showing a preference for saccades, and anterior (visuomotor) regions showing a preference for foot pointing. No region showed a clear preference for hand pointing. Effective connectivity analysis showed that visual areas were more connected to each other with respect to the visuomotor areas, particularly during saccades. We suggest that visual and visuomotor egomotion regions can play different roles within a network that integrates sensory-motor signals with the aim of guiding movements in the external environment.

Synaptic transmission at the vestibular hair cells of amniotes

A harmonized interplay between the central nervous system and the five peripheral end organs is how the vestibular system helps organisms feel a sense of balance and motion in three-dimensional space. The receptor cells of this system, much like their cochlear equivalents, are the specialized hair cells. However, research over the years has shown that the vestibular endorgans and hair cells evolved very differently from their cochlear counterparts. The structurally unique calyceal synapse, which appeared much later in the evolutionary time scale, and continues to intrigue researchers, is now known to support several forms of synaptic neurotransmission. The conventional quantal transmission is believed to employ the ribbon structures, which carry several tethered vesicles filled with neurotransmitters. However, the field of vestibular hair cell synaptic molecular anatomy is still at a nascent stage and needs further work. In this review, we will touch upon the basic structure and function of the peripheral vestibular system, with the focus on the various modes of neurotransmission at the type I vestibular hair cells. We will also shed light on the current knowledge about the molecular anatomy of the vestibular hair cell synapses and vestibular synaptopathy.

A New Coordinate System for Magnetic Resonance Imaging of the Vestibular System

Objectives: To develop and evaluate a new coordinate system for MRI of the vestibular system.

Methods: In this study, 53 internal auditory canal MRI and 78 temporal bone CT datasets were analyzed. Mimics Medical software version 21.0 was used to visualize and three-dimensionally reconstruct the image data. We established a new coordinate system, named W–X, based on the center of the bilateral eyeballs and vertex of the bilateral superior semicircular canals. Using the W–X coordinate system and Reid's coordinate system, we measured the orientations of the planes of the anterior semicircular canal (ASCC), the lateral semicircular canal (LSCC), and the posterior semicircular canal (PSCC).

Results: No significant differences between the angles measured using CT and MRI were found for any of the semicircular canal planes (p > 0.05). No statistical differences were found between the angles measured using Reid's coordinate system (CT) and the W–X coordinate system (MRI). The mean values of ∠ASCC & LSCC, ∠ASCC & PSCC, and ∠LSCC & PSCC were 84.67 ± 5.76, 94.21 ± 3.81, and 91.79 ± 5.22 degrees, respectively. The angle between the LSCC plane and the horizontal imaging plane was 15.64 ± 3.92 degrees, and the angle between the PSCC plane and the sagittal imaging plane was 48.79 ± 4.46 degrees.

Conclusion: A new W–X coordinate system was developed for MRI studies of the vestibular system and can be used to measure the orientations of the semicircular canals.

Automatic Semicircular Canal Segmentation of CT Volumes Using Improved 3D U-Net with Attention Mechanism

The vestibular system is the sensory apparatus that helps the body maintain its postural equilibrium, and semicircular canal is an important organ of the vestibular system. The semicircular canals are three membranous tubes, each forming approximately two-thirds of a circle with a diameter of approximately 6.5 mm, and segmenting them accurately is of great benefit for auxiliary diagnosis, surgery, and treatment of vestibular disease. However, the semicircular canal has small volume, which accounts for less than 1% of the overall computed tomography image. Doctors have to annotate the image in a slice-by-slice manner, which is time-consuming and labor-intensive. To solve this problem, we propose a novel 3D convolutional neural network based on 3D U-Net to automatically segment the semicircular canal. We added the spatial attention mechanism of 3D spatial squeeze and excitation modules, as well as channel attention mechanism of 3D global attention upsample modules to improve the network performance. Our network achieved an average dice coefficient of 92.5% on the test dataset, which shows competitive performance in semicircular canals segmentation task.

Overcoming navigational challenges: A novel approach to the study and assessment of topographical orientation

Several studies investigating environmental navigation require participants to navigate in virtual environments, in which the proprioceptive and vestibular components present during real environmental navigation are lost. Here, we aimed to provide a novel computerized ecological navigational battery, investigating whether the absence of proprioceptive and vestibular inputs yields a representation of the navigational space comparable to that acquired ecologically. In Study 1, 38 participants underwent two sets of tasks, one performed in a laboratory-based setting (LBS) and the other in an ecological environment (EE), with both including evaluation of route, landmark, and survey knowledge and a landmark ordering task. All tasks, except the route task, significantly correlated between EE and LBS. In LBS, performance in the landmark ordering task was predicted by that in the survey task, but not by those in the route and landmark tasks. Results of Study 1 were replicated in Study 2, in which 44 participants completed a modified and shorter online version of LBS tests. Reliability of the online LBS tests was also tested and showed a moderate-to-high internal consistency. Overall, results show that the conditions in which tasks are performed affect the acquisition of route knowledge, likely due to the lack of proprioceptive and vestibular information in LBS. However, LBS tasks presented here provide a standard battery of tests that can overcome the replicability problems encountered by ecological navigation tests, while taking into consideration all the complexities of navigational processes in terms of the use of landmark, route, and survey strategies.

The Impact of Optical Illusions on the Vestibular System

Background and Objectives

Balance control is maintained in stationary and dynamic conditions, with coordinated muscle responses generated by somatosensory, vestibular, and visual inputs. This study aimed to investigate how the vestibular system is affected in the presence of an optical illusion to better understand the interconnected pathways of the visual and vestibular systems.

Subjects and Methods

The study involved 54 young adults (27 males and 27 females) aged 18-25 years. The recruited participants were subjected to the cervical vestibular evoked myogenic potentials (cVEMP) test and video head impulse test (vHIT). The cVEMP and vHIT tests were performed once each in the absence and presence of an optical illusion. In addition, after each test, whether the individuals felt balanced was determined using a questionnaire.

Results

cVEMP results in the presence of the optical illusion showed shortened latencies and increased amplitudes for the left side in comparison to the results in the absence of the optical illusion (p≤0.05). When vHIT results were compared, it was seen that the right lateral and bilateral anterior canal gains were increased, almost to 1.0 (p<0.05).

Conclusions

It is thought that when the visual-vestibular inputs are incompatible with each other, the sensory reweighting mechanism is activated, and this mechanism strengthens the more reliable (vestibular) inputs, while suppressing the less reliable (visual) inputs. As long as the incompatible condition persists, the sensory reweighting mechanism will continue to operate, thanks to the feedback loop from the efferent vestibular system.

Robust vestibular self-motion signals in macaque posterior cingulate region

Self-motion signals, distributed ubiquitously across parietal-temporal lobes, propagate to limbic hippocampal system for vector-based navigation via hubs including posterior cingulate cortex (PCC) and retrosplenial cortex (RSC). Although numerous studies have indicated posterior cingulate areas are involved in spatial tasks, it is unclear how their neurons represent self-motion signals. Providing translation and rotation stimuli to macaques on a 6-degree-of-freedom motion platform, we discovered robust vestibular responses in PCC. A combined three-dimensional spatiotemporal model captured data well and revealed multiple temporal components including velocity, acceleration, jerk, and position. Compared to PCC, RSC contained moderate vestibular temporal modulations and lacked significant spatial tuning. Visual self-motion signals were much weaker in both regions compared to the vestibular signals. We conclude that macaque posterior cingulate region carries vestibular-dominant self-motion signals with plentiful temporal components that could be useful for path integration.

Effects of Virtual Reality Locomotion Techniques on Distance Estimations

Mental representations of geographic space are based on knowledge of spatial elements and the spatial relation between these elements. Acquiring such mental representations of space requires assessing distances between pairs of spatial elements. In virtual reality (VR) applications, locomotion techniques based on real-world movement are constrained by the size of the available room and the used room scale tracking system. Therefore, many VR applications use additional locomotion techniques such as artificial locomotion (continuous forward movement) or teleporting (“jumping” from one location to another). These locomotion techniques move the user through virtual space based on controller input. However, it has not yet been investigated how different established controller-based locomotion techniques affect distance estimations in VR. In an experiment, we compared distance estimations between artificial locomotion and teleportation before and after a training phase. The results showed that distance estimations in both locomotion conditions improved after the training. Additionally, distance estimations were found to be more accurate when teleportation locomotion was used.

Echolocating bats can adjust sensory acquisition based on internal cues

Background

Sensory systems acquire both external and internal information to guide behavior. Adjustments based on external input are much better documented and understood than internal-based sensory adaptations. When external input is not available, idiothetic—internal—cues become crucial for guiding behavior. Here, we take advantage of the rapid sensory adjustments exhibited by bats in order to study how animals rely on internal cues in the absence of external input. Constant frequency echolocating bats are renowned for their Doppler shift compensation response used to adjust their emission frequency in order to optimize sensing. Previous studies documented the importance of external echoes for this response.

Results

We show that the Doppler compensation system works even without external feedback. Bats experiencing accelerations in an echo-free environment exhibited an intact compensation response. Moreover, using on-board GPS tags on free-flying bats in the wild, we demonstrate that the ability to perform Doppler shift compensation response based on internal cues might be essential in real-life when echo feedback is not available.

Conclusions

We thus show an ecological need for using internal cues as well as an ability to do so. Our results illustrate the robustness of one particular sensory behavior; however, we suggest this ability to rely on different streams of information (i.e., internal or external) is probably relevant for many sensory behaviors.

EMDR Versus Treatment-as-Usual in Patients With Chronic Non-Malignant Pain: A Randomized Controlled Pilot Study

In recent years, different studies have observed a strong association between chronic pain (CP) and psychological trauma. Therefore, a trauma-focused psychotherapy, such as eye movement desensitization and reprocessing (EMDR), could be an innovative treatment option. The aim of this pilot study was to assess whether a specific EMDR protocol for CP leads to (a) a reduction in pain intensity, (b) an improvement in anxiety and depressive symptoms, and (c) an improvement in quality of life. 28 CP patients were randomly assigned to EMDR + treatment as usual (TAU; n = 14) or to TAU alone (n = 14). Patients in the EMDR group received 12 psychotherapeutic sessions of 90 minutes over 3 months. Pain intensity was measured using the Visual Analog Scale and the Pain Disability index, quality of life using the EQ-5D-5L, and anxiety and depressive symptoms using the Hamilton Anxiety and Depression Scale. Measures were taken for both conditions at pre- and post-treatment, and a follow-up in the EMDR condition was taken at 3 months post-treatment. Patients in the EMDR group showed significantly reduced pain intensity and improved quality of life and anxiety and depressive symptoms compared to TAU alone at post-treatment. Improvements were largely maintained at 3-month follow-up. This study suggests that EMDR may be an effective and safe psychological intervention to be used within the multidisciplinary treatment plan of patients with CP.

Cerebral Hemodynamic Responses to the Sensory Conflict Between Visual and Rotary Vestibular Stimuli: An Analysis With a Multichannel Near-Infrared Spectroscopy (NIRS) System

Sensory conflict among visual, vestibular, and somatosensory information induces vertiginous sensation and postural instability. To elucidate the cognitive mechanisms of the integration between the visual and vestibular cues in humans, we analyzed the cortical hemodynamic responses during sensory conflict between visual and horizontal rotatory vestibular stimulation using a multichannel near-infrared spectroscopy (NIRS) system. The subjects sat on a rotatory chair that was accelerated at 3°/s² for 20 s to the right or left, kept rotating at 60°/s for 80 s, and then decelerated at 3°/s² for 20 s. The subjects were instructed to watch white stripes projected on a screen surrounding the chair during the acceleration and deceleration periods. The white stripes moved in two ways; in the "congruent" condition, the stripes moved in the opposite direction of chair rotation at 3°/s² (i.e., natural visual stimulation), whereas in the "incongruent" condition, the stripes moved in the same direction of chair rotation at 3°/s² (i.e., conflicted visual stimulation). The cortical hemodynamic activity was recorded from the bilateral temporoparietal regions. Statistical analyses using NIRS-SPM software indicated that hemodynamic activity increased in the bilateral temporoparietal junctions (TPJs) and human MT+ complex, including the medial temporal (MT) area and medial superior temporal (MST) area in the incongruent condition. Furthermore, the subjective strength of the vertiginous sensation was negatively correlated with hemodynamic activity in the dorsal part of the supramarginal gyrus (SMG) in and around the intraparietal sulcus (IPS). These results suggest that sensory conflict between the visual and vestibular stimuli promotes cortical cognitive processes in the cortical network consisting of the TPJ, the medial temporal gyrus (MTG), and IPS, which might contribute to self-motion perception to maintain a sense of balance or equilibrioception during sensory conflict.