Not a general, symptom-unspecific, transdiagnostic marker for functional symptoms: sensorimotor processing of head control is intact in chronic pain

Introduction

Functional disorders are prevalent in all medical fields and pose a tremendous public health problem, with pain being one of the most common functional symptoms. Understanding the underlying, potentially unifying mechanism in functional (pain) disorders is instrumental in facilitating timely diagnosis, stigma reduction, and adequate treatment options. Neuroscientific models of perception suggest that functional symptoms arise due to dysregulated sensorimotor processing in the central nervous system, with brain-based predictions dominating the eventual percept. Experimental evidence for this transdiagnostic mechanism has been established in various functional symptoms. The goal of the current study was to investigate whether erroneous sensorimotor processing is an underlying transdiagnostic mechanism in chronic (functional) pain.

Method

A total of 13 patients with chronic (functional) pain [three patients with chronic (functional) pain disorder, F45.40, ICD-10; 10 patients with chronic pain disorder with somatic and psychological factors, F45.41, ICD-10]; and 15 healthy controls performed large combined eye-head gaze shifts toward visual targets, naturally and with increased head moment of inertia. We simultaneously measured participants' eye and head movements to assess head oscillations at the end of the gaze shift, which are an established indicator of (transdiagnostic) sensorimotor processing deficits of head control.

Results

Using a Bayesian analysis protocol, we found that patients with chronic (functional) pain and control participants stabilized their heads equally well (Bayes Factor 01 = 3.7, Bayes Factor exclusion = 5.23; corresponding to substantial evidence) during all sessions of the experiment.

Conclusion

Our results suggest that patients with chronic (functional) pain do not show measurable symptom-unspecific sensorimotor processing deficits. We discuss outcome parameter choice, organ system specificity, and selection of patient diagnoses as possible reasons for this result and recommend future avenues for research.

Altered sensorimotor processing in irritable bowel syndrome: Evidence for a transdiagnostic pathomechanism in functional somatic disorders

OBJECTIVE

A recent hypothesis suggests that functional somatic symptoms are due to altered information processing in the brain, with rigid expectations biasing sensorimotor signal processing. First experimental results confirmed such altered processing within the affected symptom modality, e.g., deficient eye-head coordination in patients with functional dizziness. Studies in patients with functional somatic symptoms looking at general, trans-symptomatic processing deficits are sparse. Here, we investigate sensorimotor processing during eye-head gaze shifts in irritable bowel syndrome (IBS) to test whether processing deficits exist across symptom modalities.

METHODS

Study participants were seven patients suffering from IBS and seven age- and gender-matched healthy controls who performed large gaze shifts toward visual targets. Participants performed combined eye-head gaze shifts in the natural condition and with experimentally increased head moment of inertia. Head oscillations as a marker for sensorimotor processing deficits were assessed. Bayes statistics was used to assess evidence for the presence or absence of processing differences between IBS patients and healthy controls.

RESULTS

With the head moment of inertia increased, IBS patients displayed more pronounced head oscillations than healthy controls (Bayes Factor 10 = 56.4, corresponding to strong evidence).

CONCLUSION

Patients with IBS show sensorimotor processing deficits, reflected by increased head oscillations during large gaze shifts to visual targets. In particular, patients with IBS have difficulties to adapt to the context of altered head moment of inertia. Our results suggest general transdiagnostic processing deficits in functional somatic disorders.

Gaze shift dynamic visual acuity: A functional test of gaze stability that distinguishes unilateral vestibular hypofunction

BACKGROUND:

Embedded within most rapid head rotations are gaze shifts, which is an initial eye rotation to a target of interest, followed by a head rotation towards the same target. Gaze shifts are used to acquire an image that initially is outside of the participant’s current field of vision. Currently, there are no tools available that evaluate the functional relevance of a gaze shift.

OBJECTIVE:

The purpose of our study was to measure dynamic visual acuity (DVA) while performing a gaze shift.

METHODS:

Seventy-one healthy participants (42.79±16.89 years) and 34 participants with unilateral vestibular hypofunction (UVH) (54.59±20.14 years) were tested while wearing an inertial measurement unit (IMU) sensor on the head and walking on a treadmill surrounded by three monitors. We measured visual acuity during three subcomponent tests: standing (static visual acuity), while performing an active head rotation gaze shift, and an active head rotation gaze shift while walking (gsDVAw).

RESULTS:

While doing gsDVAw, patients with Left UVH (n = 21) had scores worse (p = 0.023) for leftward (0.0446±0.0943 LogMAR) head rotation compared with the healthy controls (–0.0075±0.0410 LogMAR). Similarly, patients with right UVH (N = 13) had worse (p = 0.025) gsDVAw for rightward head motion (0.0307±0.0481 LogMAR) compared with healthy controls (–0.0047±0.0433 LogMAR). As a whole, gsDVAw scores were worse in UVH compared to the healthy controls when we included the ipsilesional head rotation on both sides gsDVAw (0.0061±0.0421 LogMAR healthy vs. 0.03926±0.0822 LogMAR UVH, p = 0.003). Controlling for age had no effect, the gsDVAw scores of the patients were always worse (p < 0.01).

CONCLUSION:

The gaze shift DVA test can distinguish gaze stability in patients with UVH from healthy controls. This test may be a useful measure of compensation for patients undergoing various therapies for their vestibular hypofunction.

The Influence of a Memory Delay on Spatial Coding in the Superior Colliculus: Is Visual Always Visual and Motor Always Motor?

The memory-delay saccade task is often used to separate visual and motor responses in oculomotor structures such as the superior colliculus (SC), with the assumption that these same responses would sum with a short delay during immediate "reactive" saccades to visual stimuli. However, it is also possible that additional signals (suppression, delay) alter visual and/or motor response in the memory delay task. Here, we compared the spatiotemporal properties of visual and motor responses of the same SC neurons recorded during both the reactive and memory-delay tasks in two head-unrestrained monkeys. Comparing tasks, visual (aligned with target onset) and motor (aligned on saccade onset) responses were highly correlated across neurons, but the peak response of visual neurons and peak motor responses (of both visuomotor (VM) and motor neurons) were significantly higher in the reactive task. Receptive field organization was generally similar in both tasks. Spatial coding (along a Target-Gaze (TG) continuum) was also similar, with the exception that pure motor cells showed a stronger tendency to code future gaze location in the memory delay task, suggesting a more complete transformation. These results suggest that the introduction of a trained memory delay alters both the vigor and spatial coding of SC visual and motor responses, likely due to a combination of saccade suppression signals and greater signal noise accumulation during the delay in the memory delay task.

Teaching Discrimination of Adult Gaze Direction to Children with Autism

Three young children diagnosed with autism did not reliably locate objects in the environment on the basis of an adult's gaze shifts. A training program designed to teach gaze following used the activation of remote controlled mechanical toys as both prompts and consequences. Over several training sessions, toy activation was progressively delayed following the adult's gaze-shift cues. All of the children eventually came to anticipate the toy activation and locate the target object on the basis of the adult's gaze-shift cue alone. Discrimination of another person's gaze direction is discussed in relation to joint attention deficits in children with autism.

Dissociating self-generated from passively applied head motion: neural mechanisms in the vestibular nuclei

The ability to distinguish sensory inputs that are a consequence of our own actions from those that result from changes in the external world is essential for perceptual stability and accurate motor control. To accomplish this, it has been proposed that an internal prediction of the consequences of our actions is compared with the actual sensory input to cancel the resultant self-generated activation. Here, we provide evidence for this hypothesis at an early stage of processing in the vestibular system. Previous studies have shown that neurons in the vestibular nucleus, which receive direct inputs from vestibular afferent fibers, are responsive to passively applied head movements. However, these same neurons do not reliably encode head velocity resulting from self-generated movements of the head on the body. In this study, we examined the mechanism that underlies the selective elimination of vestibular sensitivity to active head-on-body rotations. Individual neurons were recorded in monkeys making active head movements. The correspondence between intended and actual head movement was experimentally controlled. We found that a cancellation signal was gated into the vestibular nuclei only in conditions in which the activation of neck proprioceptors matched that expected on the basis of the neck motor command. This finding suggests that vestibular signals that arise from self-generated head movements are inhibited by a mechanism that compares the internal prediction of the sensory consequences by the brain to the actual resultant sensory feedback. Because self-generated vestibular inputs are selectively cancelled early in processing, we propose that this gating is important for the computation of spatial orientation and control of posture by higher-order structures.

Selective processing of vestibular reafference during self-generated head motion

The vestibular sensory apparatus and associated vestibular nuclei are generally thought to encode head-in-space motion. Angular head-in-space velocity is detected by vestibular hair cells that are located within the semicircular canals of the inner ear. In turn, the afferent fibers of the vestibular nerve project to neurons in the vestibular nuclei, which, in head-restrained animals, similarly encode head-in-space velocity during passive whole-body rotation. However, during the active head-on-body movements made to generate orienting gaze shifts, neurons in the vestibular nuclei do not reliably encode head-in-space motion. The mechanism that underlies this differential processing of vestibular information is not known. To address this issue, we studied vestibular nuclei neural responses during passive head rotations and during a variety of tasks in which alert rhesus monkeys voluntarily moved their heads relative to space. Neurons similarly encoded head-in-space velocity during passive rotations of the head relative to the body and during passive rotations of the head and body together in space. During all movements that were generated by activation of the neck musculature (voluntary head-on-body movements), neurons were poorly modulated. In contrast, during a task in which each monkey actively "drove" its head and body together in space by rotating a steering wheel with its arm, neurons reliably encoded head-in-space motion. Our results suggest that, during active head-on-body motion, an efferent copy of the neck motor command, rather than the monkey's knowledge of its self-generated head-in-space motion or neck proprioceptive information, gates the differential processing of vestibular information at the level of the vestibular nuclei.