Is activation of the vestibular system by electromagnetic induction a possibility in an MRI context?

In recent years, an increasing number of studies have discussed the mechanisms of vestibular activation in strong magnetic field settings such as occur in a magnetic resonance imaging scanner environment. Amid the different hypotheses, the Lorentz force explanation currently stands out as the most plausible mechanism, as evidenced by activation of the vestibulo-ocular reflex. Other hypotheses have largely been discarded. Nonetheless, both human data and computational modeling suggest that electromagnetic induction could be a valid mechanism which may coexist alongside the Lorentz force. To further investigate the induction hypothesis, we provide, herein, a first of its kind dosimetric analysis to estimate the induced electric fields at the vestibular system and compare them with what galvanic vestibular stimulation would generate. We found that electric fields strengths from induction match galvanic vestibular stimulation strengths generating vestibular responses. This review examines the evidence in support of electromagnetic induction of vestibular responses, and whether movement-induced time-varying magnetic fields should be further considered and investigated.

The headshake enhances oculomotor response to galvanic vestibular stimulation in healthy subjects

OBJECTIVE

To investigate whether a headshake applied during galvanic vestibular stimulation (GVS) can enhance GVS-induced nystagmus in healthy subjects.

METHODS

In nineteen healthy participants, we evaluated an average slow-phase velocity (aSPV) of nystagmus in a head-still and after the headshake conditions, with/out the bitemporal 2 mA GVS. The GVS was applied also with polarity congruent (supporting) or incongruent (suppressing) to any preexisting spontaneous nystagmus.

RESULTS

The orientation of GVS-induced nystagmus depended on GVS polarity. In the head-still condition, the GVS-induced nystagmus in 14 subjects (74%) for congruent and in 12 subjects (63%) for incongruent GVS. During headshake, we recorded nystagmus in 16 subjects (84%) for congruent and 15 subjects (79%) for incongruent GVS. The aSPV of congruent GVS-induced nystagmus was higher (p = 0.0003) by 1.33 (SE 0.26) deg/s for headshake compared to head-still condition. The aSPV of incongruent GVS also induced higher nystagmus (p = 0.0014) by 1.24 (SE 0.28) deg/s for the headshake condition.

CONCLUSION

Our study adds a new principle to the knowledge of the central processing of a GVS response in healthy subjects. The GVS-safety profile of current up to 2 mA was sufficient to elicit a significant GVS nystagmus response in a head-still position in 63% and after a headshake in 79%. Compared to the GVS head-still condition, a headshake enhanced the GVS-induced nystagmus more than twice.

SIGNIFICANCE

The headshake helps to identify GVS-induced nystagmus, which can be weak or absent during the head-still condition.

Vestibular compensation: Neural mechanisms and clinical implications for the treatment of vertigo

After unilateral peripheral vestibular lesions, the neural activity of neurons in the ipsi-lesional medial vestibular nucleus (ipsi-MVe) are markedly decreased, resulting in static and dynamic asymmetries of the vestibulo-ocular and vestibulo-spinal reflexes. Consequently, static vestibular symptoms such as spontaneous nystagmus and postural deviation and dynamic vestibular symptoms such as oscillopsia and swaying gait are induced. However, these behavioral asymmetries gradually recover after the lesion. Progressive balance restoration is termed vestibular compensation, which is divided into two phases: static and dynamic. Static vestibular compensation is further divided into initial and late processes. In the initial process of static vestibular compensation after unilateral labyrinthectomy (UL) in rats, plastic changes in the cerebello-vestibular and vestibular commissural inhibitory pathways suppress neurons in the contra-lesional MVe (contra-MVe), resulting in the restoration of symmetrical resting activity of MVe neurons on both sides at low levels. The declining frequency of spontaneous nystagmus after UL is an index of the initial process, and short-term administration of diazepam, a GABAA receptor agonist, has been shown to accelerate the initial process in rats. Accordingly, short-term administration of diazepam is recommended for the treatment of acute vertigo in patients with unilateral vestibular dysfunction. In the late process of static vestibular compensation after UL in rats, the resting activity of ipsi-MVe neurons gradually recovers due to changes in cell membrane properties, resulting in the reinforcement of balanced intervestibular nuclear activities to nearly normal levels without the suppression of contra-MVe neurons. The declining number of MK801-induced Fos-positive neurons in contra-MVe after UL is an index of the late process, and long-term administration of betahistine, a histamine H3 receptor antagonist, has been shown to accelerate the late process in rats. Accordingly, long-term administration of betahistine is recommended for the treatment of subacute vertigo in patients who were not compensated for unilateral vestibular dysfunction. In the process of dynamic vestibular compensation after UL, the sensitivity of ipsi-MVe neurons to head velocity and acceleration is restored due to synaptic changes such as long-term potentiation and sprouting of commissures, resulting in the restoration of the dynamic vestibulo-ocular and vestibulo-spinal reflexes. To facilitate dynamic vestibular compensation, early ambulation and subsequent vestibular rehabilitation exercise are recommended for the treatment of chronic vertigo in patients with uncompensated unilateral vestibular dysfunction. Although vestibular compensation after bilateral vestibular loss is not expected, vestibular rehabilitation with a sensory-substitution strategy can improve imbalance in patients with bilateral vestibular lesions.

Effects of galvanic vestibular stimulation on postural righting reactions in hemiplegia

Patients with post-stroke hemiplegia often exhibit reduced ability to maintain sitting balance, a crucial factor for predicting prognosis. Galvanic vestibular stimulation (GVS) influences postural control by stimulating vestibular organ. Although several studies have focused on GVS in static postures, no studies have demonstrated the influence of GVS on righting reactions. Therefore, we aimed to investigate the effects of GVS on postural righting reactions in seated patients with stroke-induced hemiplegia. Using a vertical board (VB), righting reactions were induced by tilting the VB at 10° after patients sat for 1 min. Patients adjusted their bodies until feeling vertical upon prompt. Twenty-two left hemiplegic patients with cerebrovascular disease participated, divided into two groups undergoing right cathode GVS (RC-GVS) followed by left cathode GVS or vice versa, preceded by sham stimulation. Centre of pressure and the joint angle were measured. During the postural righting reactions towards the paralysed side, RC-GVS enhanced the righting reactions and moved the mean position on the x-axis (COPx) to the right and the mean position on the y-axis (COPy) to the front. During the postural righting reaction towards the right side, RC-GVS induced resistance against the righting reaction, COPx was deflected to the right, COPy was deflected backward, and the angle of the neck tilt increased. The findings revealed that GVS with anodal stimulation on the paralysed side could promote righting reactions in patients with post-stroke hemiplegia. SIGNIFICANCE STATEMENT: The study findings suggest that using the contralesional placement of the anode promotes righting reactions, and galvanic vestibular stimulation can induce joint movements in the neck and trunk by polarising it to act as resistance against righting reactions.

Efficacy of Galvanic Vestibular Stimulation as a Display Modality Dissociated from Self-Orientation

OBJECTIVE

We propose and assess galvanic vestibular stimulation (GVS) as a novel means to provide information dissociated from self-orientation.

BACKGROUND

In modern user interfaces, visual and auditory modalities dominate information transfer so much that these "processing channels" become overloaded with information. Fortunately, the brain is capable of processing separate sensory sources in parallel enabling alternative display modalities to inform operators more effectively and without increasing cognitive strain. To date, the vestibular system, normally responsible for sensing self-orientation and helping with balance, has not been considered as a display modality.

METHOD

Bilateral GVS was provided at 0.6 mA for 1-second intervals with moderately high-frequency sinusoidal waveforms, designed to not elicit sensations of self-motion. We assessed subjects' ability to differentiate between two cues of different frequencies.

RESULTS

We found subjects were able to reliably distinguish between cues with an average just-noticeable difference threshold of only ±12 Hz (range across subjects: 5.4-19.6 Hz) relative to a pedestal cue of 50 Hz. Further, we found the GVS sensory modality to be robust to various environments: walking, standing, sitting, passive motion, and loud background noise. Finally, the application of the GVS cues did not have significant destabilizing effects when standing or walking.

CONCLUSION

These results show that GVS may be an effective alternative display modality, using varying frequency to encode information. It is robust to various operational environments and non-destabilizing.

APPLICATION

A fully functional display can convey information to operators of vehicles and other machinery as well as high-performance operators like astronauts and soldiers.

Mechanisms underlying treatment effects of vestibular noise stimulation on postural instability in patients with bilateral vestibulopathy

BACKGROUND

Previous studies indicate that imbalance in patients with bilateral vestibulopathy (BVP) may be reduced by treatment with low-intensity noisy galvanic vestibular stimulation (nGVS).

OBJECTIVE

To elucidate the potential mechanisms underlying this therapeutic effect. In particular, we determined whether nGVS-induced balance improvements in patients are compatible with stochastic resonance (SR)-a mechanism by which weak noise stimulation can paradoxically enhance sensory signal processing.

METHODS

Effects of nGVS of varying intensities (0-0.7 mA) on body sway were examined in 19 patients with BVP standing with eye closed on a posturographic force plate. We assumed a bell-shaped response curve with maximal sway reductions at intermediate nGVS intensities to be indicative of SR. An established SR curve model was fitted on individual patient outcomes, and three experienced human raters had to judge whether responses to nGVS were consistent with the exhibition of SR.

RESULTS

nGVS-induced reductions of body sway compatible with SR were found in 12 patients (63%) with optimal improvements of 31 ± 21%. In 10 patients (53%), nGVS-induced sway reductions exceeded the minimally important clinical difference (optimal improvement: 35 ± 21%), indicative of strong SR. This beneficial effect was more likely in patients with severe vestibular loss (i.e. lower video head impulse test gain; R = 0.663; p = 0.002) and considerable postural imbalance (baseline body sway; R = 0.616; p = 0.005).

CONCLUSIONS

More than half of the assessed patients showed robust improvements in postural balance compatible with SR when treated with nGVS. In particular, patients with a higher burden of disease may benefit from the non-invasive and well-tolerated treatment with nGVS.

Noisy galvanic vestibular stimulation influences head stability in young healthy adults while standing on a moving platform

BACKGROUND

The ability to stand with eyes closed on a sinusoidal translational moving platform may be affected by spatial orientation owing to vestibular input information. Moreover, changes in the frequency of the moving platform may affect the sensory reweighting through somatosensory and vestibular sensations. However, it is unclear whether noisy galvanic vestibular stimulation (nGVS), which activates vestibular-related brain regions, affects the stability of individuals standing on a platform moving at different frequencies.

RESEARCH QUESTION

Do vestibular stimulation by nGVS and changes in the frequency of translationally moving platforms affect the standing stability of individuals?

METHODS

Thirty-one healthy young adult participants were provided both sham and nGVS interventions while they maintained a static standing position, with their eyes closed, on an anterior-posterior sinusoidal translation platform. The nGVS was adapted to an optimal intensity below the perceptual threshold (frequency band: 100-640 Hz), and the sham stimulus was adapted to 0 µA. The participants were randomly assessed for postural stability at 0.2, 0.6, and 1.2 Hz moving platform frequencies for 80 s each under both stimulus conditions. Postural stability was calculated as the root mean square (RMS) sway from head accelerations in the anteroposterior (AP) and mediolateral (ML) directions for 50 s between 20 and 70 s during the 80 s period, measured using an inertial sensor placed on the external occipital ridge.

RESULTS

nGVS significantly reduced the RMS sway of head acceleration in the AP direction compared with sham stimulation. Furthermore, nGVS significantly reduced RMS sway in the ML direction compared with sham stimulation at a 1.2 Hz moving platform oscillation.

SIGNIFICANCE

These findings suggest that postural adjustment by the vestibular system influences head stability on a moving platform at specific sinusoidal translation frequencies, suggesting that nGVS may reduce head sway.

Changes in vestibular-related responses to combined noisy galvanic vestibular stimulation and cerebellar transcranial direct current stimulation

Vestibular nuclei and cerebellar function comprise vestibular neural networks that control vestibular-related responses. However, the vestibular-related responses to simultaneous stimulation of these regions are unclear. This study aimed to examine whether the combination of noisy galvanic vestibular stimulation (nGVS) and cerebellar transcranial direct current stimulation (ctDCS) using a complex transcranial electrical stimulation device alters vestibular-dominant standing stability and vestibulo-ocular reflex (VOR) function. The center of foot pressure (COP) sway and VOR of participants (28 healthy, young adults) were assessed under four conditions of transcranial electrical stimulation using nGVS and ctDCS. The COP was calculated with the participant standing on a soft-foam surface with eyes closed using a force plate to evaluate body sway. VOR measurements were collected via passive head movements and fixation on a target projected onto the front wall using a video head impulse test (vHIT). VOR gain was calculated in six directions using a semicircular canal structure based on the ratio of eye movement to head movement. The nGVS + ctDCS and nGVS + sham ctDCS conditions decreased COP sway compared to the sham nGVS + ctDCS and sham nGVS + sham ctDCS conditions. No significant differences were observed in the main effect of stimulation or the interaction of stimulation and direction on the vHIT parameters. The results of this study suggest that postural stability may be independently affected by nGVS. Our findings contribute to the basic neurological foundation for the clinical application of neurorehabilitation using transcranial electrical stimulation of the vestibular system.

RPM: An open-source Rotation Platform for open- and closed-loop vestibular stimulation in head-fixed Mice

Head fixation allows the recording and presentation of controlled stimuli and is used to study neural processes underlying spatial navigation. However, it disrupts the head direction system because of the lack of vestibular stimulation. To overcome this limitation, we developed a novel rotation platform which can be driven by the experimenter (open-loop) or by animal movement (closed-loop). The platform is modular, affordable, easy to build and open source. Additional modules presented here include cameras for monitoring eye movements, visual virtual reality, and a micro-manipulator for positioning various probes for recording or optical interference. We demonstrate the utility of the platform by recording eye movements and showing the robust activation of head-direction cells. This novel experimental apparatus combines the advantages of head fixation and intact vestibular activity in the horizontal plane. The open-loop mode can be used to study e.g., vestibular sensory representation and processing, while the closed-loop mode allows animals to navigate in rotational space, providing a better substrate for 2-D navigation in virtual environments. The full build documentation is maintained at https://ranczlab.github.io/RPM/.

Top-down control of vestibular inputs by the dorsolateral prefrontal cortex

The vestibular apparatus provides spatial information on the position of the head in space and with respect to gravity. Low-frequency sinusoidal galvanic vestibular stimulation (sGVS), a means of selectively changing the firing of vestibular afferents, induces a frequency-dependent perception of sway and, in some individuals, induces nausea. Given that vestibular afferents project to the insular cortex-which forms part of the vestibular cortex-and that the insula receives inputs from the dorsolateral prefrontal cortex (dlPFC), we tested the hypothesis that electrical stimulation of the dlPFC can modulate vestibular inputs. Sinusoidal electrical stimulation (± 2 mA, 0.08 Hz, 100 cycles) was delivered via surface electrodes over (1) the mastoid processes alone (sGVS), (2) electroencephalogram (EEG) site F4 (right dlPFC) and the nasion or (3) to each site concurrently (sGVS + dlPFC) in 23 participants. The same stimulation protocol was used in a separate study to investigate EEG site F3 (left dlPFC) instead of F4 in 13 participants. During sGVS, all participants reported perceptions of sway and 13 participants also reported nausea, neither sensation of which occurred as a result of dlPFC stimulation. Interestingly, when sGVS and dlPFC stimulations were delivered concurrently, vestibular perceptions and sensations of nausea were almost completely abolished. We conclude that the dlPFC provides top-down control of vestibular inputs and further suggests that dlPFC stimulation may provide a novel means of controlling nausea.

Unraveling the Twist: Spatial Navigational Challenges in Cervical Dystonia

BACKGROUND

Cervical dystonia (CD) is an intricate neurological condition with motor and nonmotor symptoms. These include disruptions in visual perception, self-orientation, visual working memory, and vestibular functions. However, the specific impact of CD on perceiving self-motion direction, especially with isolated visual or vestibular stimuli, remains largely unexplored.

OBJECTIVE

This study aimed to examine the effects of CD on linear motion perception, hypothesizing impaired heading discrimination in both vestibular and visual tasks, and that such deficits correlate with the disease severity.

METHODS

We employed a cutting-edge motion platform to precisely control whole-body linear motion. Through repeated two-alternative forced-choice tasks, we assessed vestibular heading direction discrimination. Participants observed dynamic star clouds in immersive virtual reality and indicated their perceived self-motion direction, evaluating visual heading direction discrimination. Sensitivity to direction variations and response accuracy errors were analyzed using robust Gaussian cumulative distribution psychometric functions.

RESULTS

Heading perception is impaired in individuals with CD, particularly evident in vestibular heading discrimination. CD severity correlated with elevated thresholds for both vestibular and visual heading discrimination. Surprisingly, lateralized CD did not introduce bias in either system, suggesting widespread disruption over localized effects.

CONCLUSIONS

Contrary to previous beliefs, our findings challenge the idea that CD-related heading discrimination issues mainly arise from peripheral vestibular effects. Instead, abnormal proprioceptive input from dystonic neck muscles introduces noise into the central mechanism integrating visual, vestibular, and proprioceptive signals. These insights into spatial navigation deficits have implications for future CD research. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.

Vestibular contribution to spatial encoding

Determining the spatial relation between objects and our location in the surroundings is essential for survival. Vestibular inputs provide key information about the position and movement of our head in the three-dimensional space, contributing to spatial navigation. Yet, their role in encoding spatial localisation of environmental targets remains to be fully understood. We probed the accuracy and precision of healthy participants' representations of environmental space by measuring their ability to encode the spatial location of visual targets (Experiment 1). Participants were asked to detect a visual light and then walk towards it. Vestibular signalling was artificially disrupted using stochastic galvanic vestibular stimulation (sGVS) applied selectively during encoding targets' location. sGVS impaired the accuracy and precision of locating the environmental visual targets. Importantly, this effect was specific to the visual modality. The location of acoustic targets was not influenced by vestibular alterations (Experiment 2). Our findings indicate that the vestibular system plays a role in localising visual targets in the surrounding environment, suggesting a crucial functional interaction between vestibular and visual signals for the encoding of the spatial relationship between our body position and the surrounding objects.

Your Vestibular Thresholds May Be Lower Than You Think: Cognitive Biases in Vestibular Psychophysics

PURPOSE

Recently, there has been a surge of interest in measuring vestibular perceptual thresholds, which quantify the smallest motion that a subject can reliably perceive, to study physiology and pathophysiology. These thresholds are sensitive to age, pathology, and postural performance. Threshold tasks require decisions to be made in the presence of uncertainty. Since humans often rely on past information when making decisions in the presence of uncertainty, we hypothesized that (a) perceptual responses are affected by their preceding trial; (b) perceptual responses tend to be biased opposite of the "preceding response" because of cognitive biases but are not biased by the "preceding stimulus"; and (c) when fits do not account for this cognitive bias, thresholds are overestimated. To our knowledge, these hypotheses are unaddressed in vestibular and direction-recognition tasks.

CONCLUSIONS

Results in normal subjects supported each hypothesis. Subjects tended to respond opposite of their preceding response (not the preceding stimulus), indicating a cognitive bias, and this caused an overestimation of thresholds. Using an enhanced model (MATLAB code provided) that considered these effects, average thresholds were lower (5.5% for yaw, 7.1% for interaural). Since the results indicate that the magnitude of cognitive bias varies across subjects, this enhanced model can reduce measurement variability and potentially improve the efficiency of data collection.

Internal models of self-motion: neural computations by the vestibular cerebellum

The vestibular cerebellum plays an essential role in maintaining our balance and ensuring perceptual stability during activities of daily living. Here I examine three key regions of the vestibular cerebellum: the floccular lobe, anterior vermis (lobules I-V), and nodulus and ventral uvula (lobules X-IX of the posterior vermis). These cerebellar regions encode vestibular information and combine it with extravestibular signals to create internal models of eye, head, and body movements, as well as their spatial orientation with respect to gravity. To account for changes in the external environment and/or biomechanics during self-motion, the neural mechanisms underlying these computations are continually updated to ensure accurate motor behavior. To date, studies on the vestibular cerebellum have predominately focused on passive vestibular stimulation, whereas in actuality most stimulation is the result of voluntary movement. Accordingly, I also consider recent research exploring these computations during active self-motion and emerging evidence establishing the cerebellum's role in building predictive models of self-generated movement.

Vestibular CCK signaling drives motion sickness-like behavior in mice

Travel can induce motion sickness (MS) in susceptible individuals. MS is an evolutionary conserved mechanism caused by mismatches between motion-related sensory information and past visual and motion memory, triggering a malaise accompanied by hypolocomotion, hypothermia, hypophagia, and nausea. Vestibular nuclei (VN) are critical for the processing of movement input from the inner ear. Motion-induced activation of VN neurons recapitulates MS-related signs. However, the genetic identity of VN neurons mediating MS-related autonomic and aversive responses remains unknown. Here, we identify a central role of cholecystokinin (CCK)-expressing VN neurons in motion-induced malaise. Moreover, we show that CCK VN inputs onto the parabrachial nucleus activate Calca-expressing neurons and are sufficient to establish avoidance to novel food, which is prevented by CCK-A receptor antagonism. These observations provide greater insight into the neurobiological regulation of MS by identifying the neural substrates of MS and providing potential targets for treatment.

Repetitive Low-Intensity Vestibular Noise Stimulation Partly Reverses Behavioral and Brain Activity Changes following Bilateral Vestibular Loss in Rats

Low-intensity noisy galvanic vestibular stimulation (nGVS) can improve static and dynamic postural deficits in patients with bilateral vestibular loss (BVL). In this study, we aimed to explore the neurophysiological and neuroanatomical substrates underlying nGVS treatment effects in a rat model of BVL. Regional brain activation patterns and behavioral responses to a repeated 30 min nGVS treatment in comparison to sham stimulation were investigated by serial whole-brain 18F-FDG-PET measurements and quantitative locomotor assessments before and at nine consecutive time points up to 60 days after the chemical bilateral labyrinthectomy (BL). The 18F-FDG-PET revealed a broad nGVS-induced modulation on regional brain activation patterns encompassing biologically plausible brain networks in the brainstem, cerebellum, multisensory cortex, and basal ganglia during the entire observation period post-BL. nGVS broadly reversed brain activity adaptions occurring in the natural course post-BL. The parallel behavioral locomotor assessment demonstrated a beneficial treatment effect of nGVS on sensory-ataxic gait alterations, particularly in the early stage of post-BL recovery. Stimulation-induced locomotor improvements were finally linked to nGVS brain activity responses in the brainstem, hemispheric motor, and limbic networks. In conclusion, combined 18F-FDG-PET and locomotor analysis discloses the potential neurophysiological and neuroanatomical substrates that mediate previously observed therapeutic nGVS effects on postural deficits in patients with BVL.

Sustained deviation of torsional eye position associated with transient semicircular canal stimulation

BACKGROUND

Vestibular stimulation causes postural unsteadiness accompanied by a sensation of tilt.

AIMS/OBJECTIVES

The mechanism of the sensation of tilt needs to be assessed by accurate calculation of the rotational axis of torsional eye position under various vestibular stimulations.

MATERIAL AND METHODS

Twenty-two healthy subjects participated in the study. Thirteen subjects underwent bilateral vestibular stimulation by on-axis yaw rotation under various head positions, and eighteen subjects underwent unilateral vestibular stimulation by caloric irrigation under various head positions. Listing's Plane was plotted for the eye movement data obtained by three-dimensional video-oculography.

RESULTS

The offset of Listing's Plane showed sustained deviation of torsional eye position that was more prominent in head positions that stimulated lateral semicircular canals more than vertical semicircular canals. There was a less prominent and directionally reversed offset in head positions that stimulated vertical canals more than lateral semicircular canals.

CONCLUSION AND SIGNIFICANCE

The sustained torsional eye position was validated by accurate assessment using Listing's Plane. The mechanism behind the deviation may be due to a combination of multiple anatomical components within the vestibular apparatus, with potentially stronger influence from lateral semicircular canals.

Visuo-vestibular heading perception: a model system to study multi-sensory decision making

Integrating noisy signals across time as well as sensory modalities, a process named multi-sensory decision making (MSDM), is an essential strategy for making more accurate and sensitive decisions in complex environments. Although this field is just emerging, recent extraordinary works from different perspectives, including computational theory, psychophysical behaviour and neurophysiology, begin to shed new light onto MSDM. In the current review, we focus on MSDM by using a model system of visuo-vestibular heading. Combining well-controlled behavioural paradigms on virtual-reality systems, single-unit recordings, causal manipulations and computational theory based on spiking activity, recent progress reveals that vestibular signals contain complex temporal dynamics in many brain regions, including unisensory, multi-sensory and sensory-motor association areas. This challenges the brain for cue integration across time and sensory modality such as optic flow which mainly contains a motion velocity signal. In addition, new evidence from the higher-level decision-related areas, mostly in the posterior and frontal/prefrontal regions, helps revise our conventional thought on how signals from different sensory modalities may be processed, converged, and moment-by-moment accumulated through neural circuits for forming a unified, optimal perceptual decision. This article is part of the theme issue 'Decision and control processes in multisensory perception'.

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'.

High-current galvanic vestibular stimulation impairs working memory span, but not other executive functions

Patients with peripheral vestibular dysfunction (PVD) suffer not only from physical problems such as imbalance or vertigo but also from neuropsychological difficulties, including executive deficits. However, it is unclear whether the PVD directly causes executive problems. To examine the causal vestibular influence on executive functions, we induced either high-current (2 mA), low-current (0.8 mA), or sham current (0 mA) galvanic vestibular stimulation (GVS) in 79 healthy participants. Participants solved three tasks, measuring the core executive components (working memory, inhibition, cognitive flexibility) before and during GVS. High-current GVS impaired working memory span, but not inhibition and cognitive flexibility performance. Low-current GVS did not influence executive performance. Results indicate a causal vestibular influence on working memory span. Joint cortical areas of vestibular and working memory processing are discussed. Since high-current GVS in healthy participants serves as a model for an artificial vestibular dysfunction, our results could improve the diagnostics and therapy of patients with PVD.

Frequency-dependent tuning of the human vestibular "sixth sense" by transcranial oscillatory currents

OBJECTIVE

The vestibular cortex is a multisensory associative region that, in neuroimaging investigations, is activated by slow-frequency (1-2 Hz) galvanic stimulation of peripheral receptors. We aimed to directly activate the vestibular cortex with biophysically modeled transcranial oscillatory current stimulation (tACS) in the same frequency range.

METHODS

Thirty healthy subjects and one rare patient with chronic bilateral vestibular deafferentation underwent, in a randomized, double-blind, controlled trial, to tACS at slow (1 or 2 Hz) or higher (10 Hz) frequency and sham stimulations, over the Parieto-Insular Vestibular Cortex (PIVC), while standing on a stabilometric platform. Subjective symptoms of motion sickness were scored by Simulator Sickness Questionnaire and subjects' postural sways were monitored on the platform.

RESULTS

tACS at 1 and 2 Hz induced symptoms of motion sickness, oscillopsia and postural instability, that were supported by posturographic sway recordings. Both 10 Hz-tACS and sham stimulation on the vestibular cortex did not affect vestibular function. As these effects persisted in a rare patient with bilateral peripheral vestibular areflexia documented by the absence of the Vestibular-Ocular Reflex, the possibility of a current spread toward peripheral afferents is unlikely. Conversely, the 10 Hz-tACS significantly reduced his chronic vestibular symptoms in this patient.

CONCLUSIONS

Weak electrical oscillations in a frequency range corresponding to the physiological cortical activity of the vestibular system may generate motion sickness and postural sways, both in healthy subjects and in the case of bilateral vestibular deafferentation.

SIGNIFICANCE

This should be taken into account as a new side effect of tACS in future studies addressing cognitive functions. Higher frequencies of stimulation applied to the vestibular cortex may represent a new interventional option to reduce motion sickness in different scenarios.

Establishing cervical vestibular evoked myogenic potential (cVEMP) normative data in Singapore school-aged children

OBJECTIVES

The Cervical Vestibular Evoked Myogenic Potential (cVEMP) is often employed in routine clinical practice as part of the vestibular test battery assessments. However, there is currently no well-established paediatric cVEMP normative data in Singapore. Additionally, limited literature has examined the relationship between neck length and cVEMP parameters. The main aims of this study are to 1) establish cVEMP normative data from Singaporean school-aged children aged 6-12 years old, and 2) examine if there is a significant correlation between neck length and cVEMP parameters.

METHODS

31 healthy children participated in this study. Every participant was screened to ensure that they had normal auditory and vestibular profiles before completing the cVEMP procedure, which involved 500 Hz tone burst through insertphones and head elevation from supine position as the method of neck contraction.

RESULTS

The response rate in 62 ears was 98.4% at 95 dBnHL and 100% at 100 dBnHL. The mean P1 and N1 latencies were 13.96 ± 1.17 m s and 21.50 ± 1.66 m s, with a mean corrected P1-N1 amplitude of 0.88 ± 0.34, and mean asymmetry ratio of 13 ± 10%. Median threshold was 80 dBnHL. Significant positive correlation between neck length and both P1, N1 latencies, and significant negative correlation between neck length and corrected P1-N1 amplitude were observed.

CONCLUSIONS

cVEMP paediatric normative data has been established for Singaporean school-aged children. The study also confirmed that neck length did have a significant influence on both latencies and corrected amplitude.

Behavioral and neural responses to high-strength magnetic fields are reduced in otolith mutant mice

Static high magnetic fields (MFs) interact with the vestibular system of humans and rodents. In rats and mice, exposure to MFs causes perturbations such as head movements, circular locomotion, suppressed rearing, nystagmus, and conditioned taste aversion acquisition. To test the role of otoconia, two mutant mouse models were examined, head-tilt Nox3het (het) and tilted Otop1 (tlt), with mutations, respectively, in Nox3, encoding the NADPH oxidase 3 enzyme, and Otop1, encoding the otopetrin 1 proton channel, which are normally expressed in the otolith organs, and are critical for otoconia formation. Consequently, both mutants show a near complete loss of otoconia in the utricle and saccule, and are nonresponsive to linear acceleration. Mice were exposed to a 14.1 Tesla MF for 30 min. After exposure, locomotor activity, conditioned taste aversion and c-Fos (in het) were assessed. Wild-type mice exposed to the MF showed suppressed rearing, increased latency to rear, locomotor circling, and c-Fos in brainstem nuclei related to vestibular processing (prepositus, spinal vestibular, and supragenual nuclei). Mutant het mice showed no response to the magnet and were similar to sham animals in all assays. Unlike het, tlt mutants exposed to the MF showed significant locomotor circling and suppressed rearing compared with sham controls, although they failed to acquire a taste aversion. The residual responsiveness of tlt versus het mice might reflect a greater semicircular deficit in het mice. These results demonstrate the necessity of the otoconia for the full effect of exposure to high MFs, but also suggest a semicircular contribution.

The Next Challenges of Vestibular Implantation in Humans

Patients with bilateral vestibulopathy suffer from a variety of complaints, leading to a high individual and social burden. Available treatments aim to alleviate the impact of this loss and improve compensatory strategies. Early experiments with electrical stimulation of the vestibular nerve in combination with knowledge gained by cochlear implant research, have inspired the development of a vestibular neuroprosthesis that can provide the missing vestibular input. The feasibility of this concept was first demonstrated in animals and later in humans. Currently, several research groups around the world are investigating prototype vestibular implants, in the form of vestibular implants as well as combined cochlear and vestibular implants. The aim of this review is to convey the presentations and discussions from the identically named symposium that was held during the 2021 MidWinter Meeting of the Association for Research in Otolaryngology, with researchers involved in the development of vestibular implants targeting the ampullary nerves. Substantial advancements in the development have been made. Yet, research and development processes face several challenges to improve this neuroprosthesis. These include, but are not limited to, optimization of the electrical stimulation profile, refining the surgical implantation procedure, preserving residual labyrinthine functions including hearing, as well as gaining regulatory approval and establishing a clinical care infrastructure similar to what exists for cochlear implants. It is believed by the authors that overcoming these challenges will accelerate the development and increase the impact of a clinically applicable vestibular implant.

Effects of noisy galvanic vestibular stimulation on functional reach test

Balance disorders are a risk factor for falls in older individuals, and an increased center of pressure (COP) sway path length during standing and decreased reach distance in the functional reach test (FRT) predispose them to falls. Reportedly, noisy galvanic vestibular stimulation (nGVS) reduces COP sway path length during standing in young and community-dwelling older individuals and suggested to be a promising approach to improve balance function. However, the effect of nGVS on FRT remains unclear. Therefore, this study aimed to clarify the effect of nGVS on the FRT reach distance. This study has a cross-over design and included 20 healthy young adults. Interventions under nGVS (stimulation intensity: 0.2 mA) and sham (stimulation intensity: 0 mA) conditions were randomly administered to each participant. The participants underwent COP sway during standing measurements and FRT pre-intervention and post-intervention under each condition, and COP sway path length and the FRT reach distance were calculated. Statistical analysis revealed a significant decrease in post-intervention COP sway path length compared with pre-intervention COP sway path length under the nGVS condition. Conversely, the FRT reach distance remained the same under both nGVS and sham conditions. Thus, nGVS may improve the standing balance function but cannot change the FRT reach distance in healthy young individuals.

Modeling orientation perception adaptation to altered gravity environments with memory of past sensorimotor states

Transitioning between gravitational environments results in a central reinterpretation of sensory information, producing an adapted sensorimotor state suitable for motor actions and perceptions in the new environment. Critically, this central adaptation is not instantaneous, and complete adaptation may require weeks of prolonged exposure to novel environments. To mitigate risks associated with the lagging time course of adaptation (e.g., spatial orientation misperceptions, alterations in locomotor and postural control, and motion sickness), it is critical that we better understand sensorimotor states during adaptation. Recently, efforts have emerged to model human perception of orientation and self-motion during sensorimotor adaptation to new gravity stimuli. While these nascent computational frameworks are well suited for modeling exposure to novel gravitational stimuli, they have yet to distinguish how the central nervous system (CNS) reinterprets sensory information from familiar environmental stimuli (i.e., readaptation). Here, we present a theoretical framework and resulting computational model of vestibular adaptation to gravity transitions which captures the role of implicit memory. This advancement enables faster readaptation to familiar gravitational stimuli, which has been observed in repeat flyers, by considering vestibular signals dependent on the new gravity environment, through Bayesian inference. The evolution and weighting of hypotheses considered by the CNS is modeled via a Rao-Blackwellized particle filter algorithm. Sensorimotor adaptation learning is facilitated by retaining a memory of past harmonious states, represented by a conditional state transition probability density function, which allows the model to consider previously experienced gravity levels (while also dynamically learning new states) when formulating new alternative hypotheses of gravity. In order to demonstrate our theoretical framework and motivate future experiments, we perform a variety of simulations. These simulations demonstrate the effectiveness of this model and its potential to advance our understanding of transitory states during which central reinterpretation occurs, ultimately mitigating the risks associated with the lagging time course of adaptation to gravitational environments.

An Exploratory Study of Cervical Vestibular-Evoked Myogenic Potential in Users of Personal Listening Devices

Context

The use of personal listening devices (PLDs) is becoming increasingly popular, particularly among young people. Numerous studies have demonstrated that being exposed to PLDs can have adverse effects on the auditory system. Owing to the similarities between the auditory and vestibular systems, it is possible that the negative effects of PLD use may extend to the vestibular system, an area that has not been extensively studied.

Aim

The study aimed to investigate the impact of exposure to PLDs on the vestibular system, specifically the sacculo-collic reflex assessed by the cervical vestibular-evoked myogenic potential.

Settings and Design

The current study used a cross-sectional study design.

Materials and Methods

A total of 80 participants were divided into four groups based on the history of PLD exposure. Each group consisted of 20 participants who underwent cervical vestibular-evoked myogenic potential (cVEMP) testing using alternating polarity 500 Hz tone bursts.

Statistical Analysis Used

Analysis of variance (ANOVA) and Bonferroni post hoc test were used to obtain the statistically significant difference among the group.

Results

The results showed that the amplitude of p1-n1 of cVEMP was significantly reduced in individuals with longer PLD exposure duration.

Conclusion

The study suggests that listening to music through a PLD at high levels of volume controls could be deleterious to the vestibular well-being of an individual. The study highlights the importance of being aware of the adverse effects of using PLDs to prevent potential damage to the vestibular systems.

Stimulus Onset Asynchrony Affects Weighting-related Event-related Spectral Power in Self-motion Perception

Self-motion perception relies primarily on the integration of the visual, vestibular, proprioceptive, and somatosensory systems. There is a gap in understanding how a temporal lag between visual and vestibular motion cues affects visual-vestibular weighting during self-motion perception. The beta band is an index of visual-vestibular weighting, in that robust beta event-related synchronization (ERS) is associated with visual weighting bias, and robust beta event-related desynchronization is associated with vestibular weighting bias. The present study examined modulation of event-related spectral power during a heading judgment task in which participants attended to either visual (optic flow) or physical (inertial cues stimulating the vestibular, proprioceptive and somatosensory systems) motion cues from a motion simulator mounted on a MOOG Stewart Platform. The temporal lag between the onset of visual and physical motion cues was manipulated to produce three lag conditions: simultaneous onset, visual before physical motion onset, and physical before visual motion onset. There were two main findings. First, we demonstrated that when the attended motion cue was presented before an ignored cue, the power of beta associated with the attended modality was greater than when visual-vestibular cues were presented simultaneously or when the ignored cue was presented first. This was the case for beta ERS when the visual-motion cue was attended to, and beta event-related desynchronization when the physical-motion cue was attended to. Second, we tested whether the power of feature-binding gamma ERS (demonstrated in audiovisual and visual-tactile integration studies) increased when the visual-vestibular cues were presented simultaneously versus with temporal asynchrony. We did not observe an increase in gamma ERS when cues were presented simultaneously, suggesting that electrophysiological markers of visual-vestibular binding differ from markers of audiovisual and visual-tactile integration. All event-related spectral power reported in this study were generated from dipoles projecting from the left and right motor areas, based on the results of Measure Projection Analysis.

Using macular velocity measurements to relate parameters of bone conduction to vestibular compound action potential responses

To examine mechanisms responsible for vestibular afferent sensitivity to transient bone conducted vibration, we performed simultaneous measurements of stimulus-evoked vestibular compound action potentials (vCAPs), utricular macula velocity, and vestibular microphonics (VMs) in anaesthetized guinea pigs. Results provide new insights into the kinematic variables of transient motion responsible for triggering mammalian vCAPs, revealing synchronized vestibular afferent responses are not universally sensitive to linear jerk as previously thought. For short duration stimuli (< 1 ms), the vCAP increases magnitude in close proportion to macular velocity and temporal bone (linear) acceleration, rather than other kinematic elements. For longer duration stimuli, the vCAP magnitude switches from temporal bone acceleration sensitive to linear jerk sensitive while maintaining macular velocity sensitivity. Frequency tuning curves evoked by tone-burst stimuli show vCAPs increase in proportion to onset macular velocity, while VMs increase in proportion to macular displacement across the entire frequency bandwidth tested between 0.1 and 2 kHz. The subset of vestibular afferent neurons responsible for synchronized firing and vCAPs have been shown previously to make calyceal synaptic contacts with type I hair cells in the striolar region of the epithelium and have irregularly spaced inter-spike intervals at rest. Present results provide new insight into mechanical and neural mechanisms underlying synchronized action potentials in these sensitive afferents, with clinical relevance for understanding the activation and tuning of neurons responsible for driving rapid compensatory reflex responses.

In Vivo Localization of the Human Velocity Storage Mechanism and Its Core Cerebellar Networks by Means of Galvanic-Vestibular Afternystagmus and fMRI

Humans are able to estimate head movements accurately despite the short half-life of information coming from our inner ear motion sensors. The observation that the central angular velocity estimate outlives the decaying signal of the semicircular canal afferents led to the concept of a velocity storage mechanism (VSM). The VSM can be activated via visual and vestibular modalities and becomes manifest in ocular motor responses after sustained stimulation like whole-body rotations, optokinetic or galvanic vestibular stimulation (GVS). The VSM has been the focus of many computational modelling approaches; little attention though has been paid to discover its actual structural correlates. Animal studies localized the VSM in the medial and superior vestibular nuclei. A significant modulation by cerebellar circuitries including the uvula and nodulus has been proposed. Nevertheless, the corresponding neuroanatomical structures in humans have not been identified so far. The aim of the present study was to delineate the neural substrates of the VSM using high-resolution infratentorial fMRI with a fast T2* sequence optimized for infratentorial neuroimaging and via video-oculography (VOG). The neuroimaging experiment (n=20) gave first in vivo evidence for an involvement of the vestibular nuclei in the VSM and substantiate a crucial role for cerebellar circuitries. Our results emphasize the importance of cerebellar feedback loops in VSM most likely represented by signal increases in vestibulo-cerebellar hubs like the uvula and nodulus and lobule VIIIA. The delineated activation maps give new insights regarding the function and embedment of Crus I, Crus II, and lobule VII and VIII in the human vestibular system.

Vestibular Contributions to Primate Neck Postural Muscle Activity during Natural Motion

To maintain stable posture of the head and body during our everyday activities, the brain integrates information across multiple sensory systems. Here, we examined how the primate vestibular system, independently and in combination with visual sensory input, contributes to the sensorimotor control of head posture across the range of dynamic motion experienced during daily life. We recorded activity of single motor units in the splenius capitis and sternocleidomastoid muscles in rhesus monkeys during yaw rotations spanning the physiological range of self-motion (up to 20 Hz) in darkness. Splenius capitis motor unit responses continued to increase with frequency up to 16 Hz in normal animals, and were strikingly absent following bilateral peripheral vestibular loss. To determine whether visual information modulated these vestibular-driven neck muscle responses, we experimentally controlled the correspondence between visual and vestibular cues of self-motion. Surprisingly, visual information did not influence motor unit responses in normal animals, nor did it substitute for absent vestibular feedback following bilateral peripheral vestibular loss. A comparison of muscle activity evoked by broadband versus sinusoidal head motion further revealed that low-frequency responses were attenuated when low- and high-frequency self-motion were experienced concurrently. Finally, we found that vestibular-evoked responses were enhanced by increased autonomic arousal, quantified via pupil size. Together, our findings directly establish the vestibular system's contribution to the sensorimotor control of head posture across the dynamic motion range experienced during everyday activities, as well as how vestibular, visual, and autonomic inputs are integrated for postural control.SIGNIFICANCE STATEMENT Our sensory systems enable us to maintain control of our posture and balance as we move through the world. Notably, the vestibular system senses motion of the head and sends motor commands, via vestibulospinal pathways, to axial and limb muscles to stabilize posture. By recording the activity of single motor units, here we show, for the first time, that the vestibular system contributes to the sensorimotor control of head posture across the dynamic motion range experienced during everyday activities. Our results further establish how vestibular, autonomic, and visual inputs are integrated for postural control. This information is essential for understanding both the mechanisms underlying the control of posture and balance, and the impact of the loss of sensory function.

Vestibular modulation of the tail of the rat striatum

Fragmented and piecemeal evidence from animal and human studies suggests that vestibular information is transmitted to the striatum, a part of the basal ganglia that degenerates in Parkinson's Disease. Nonetheless, surprisingly little is known about the precise effects of activation of the vestibular system on the striatum. Electrophysiological studies have yielded inconsistent results, with many studies reporting only sparse responses to vestibular stimulation in the dorsomedial striatum. In this study, we sought to elucidate the effects of electrical stimulation of the peripheral vestibular system on electrophysiological responses in the tail of the rat striatum, a newly discovered region for sensory input. Rats were anaesthetised with urethane and a bipolar stimulating electrode was placed in the round window in order to activate the peripheral vestibular system. A recording electrode was positioned in the tail of the striatum. Local field potentials (LFPs) were recorded ipsilaterally and contralaterally to the stimulation using a range of current parameters. In order to confirm that the vestibular system was activated, video-oculography was used to monitor vestibular nystagmus. At current amplitudes that evoked vestibular nystagmus, clear triphasic LFPs were evoked in the bilateral tail of the striatum, with the first phase of the waveform exhibiting latencies of less than 22 ms. The LFP amplitude increased with increasing current amplitude (P ≤ 0.0001). In order to exclude the possibility that the LFPs were evoked by the activation of the auditory system, the cochlea was surgically lesioned in some animals. In these animals the LFPs persisted despite the cochlear lesions, which were verified histologically. Overall, the results obtained suggest that there are vestibular projections to the tail of the striatum, which could possibly arise from projections via the vestibular nucleus or cerebellum and the parafasicular nucleus of the thalamus.

The Neural Basis for Biased Behavioral Responses Evoked by Galvanic Vestibular Stimulation in Primates

Noninvasive electrical stimulation of the vestibular system in humans has become an increasingly popular tool with a broad range of research and clinical applications. However, common assumptions regarding the neural mechanisms that underlie the activation of central vestibular pathways through such stimulation, known as galvanic vestibular stimulation (GVS), have not been directly tested. Here, we show that GVS is encoded by VIIIth nerve vestibular afferents with nonlinear dynamics that differ markedly from those predicted by current models. GVS produced asymmetric activation of both semicircular canal and otolith afferents to the onset versus offset and cathode versus anode of applied current, that in turn produced asymmetric eye movement responses in three awake-behaving male monkeys. Additionally, using computational methods, we demonstrate that the experimentally observed nonlinear neural response dynamics lead to an unexpected directional bias in the net population response when the information from both vestibular nerves is centrally integrated. Together our findings reveal the neural basis by which GVS activates the vestibular system, establish that neural response dynamics differ markedly from current predictions, and advance our mechanistic understanding of how asymmetric activation of the peripheral vestibular system alters vestibular function. We suggest that such nonlinear encoding is a general feature of neural processing that will be common across different noninvasive electrical stimulation approaches.SIGNIFICANCE STATEMENT Here, we show that the application of noninvasive electrical currents to the vestibular system (GVS) induces more complex responses than commonly assumed. We recorded vestibular afferent activity in macaque monkeys exposed to GVS using a setup analogous to human studies. GVS evoked notable asymmetries in irregular afferent responses to cathodal versus anodal currents. We developed a nonlinear model explaining these GVS-evoked afferent responses. Our model predicts that GVS induces directional biases in centrally integrated head motion signals and establishes electrical stimuli that recreate physiologically plausible sensations of motion. Altogether, our findings provide new insights into how GVS activates the vestibular system, which will be vital to advancing new clinical and biomedical applications.

Impact of galvanic vestibular stimulation electrode current density on brain current flow patterns: Does electrode size matter?

BACKGROUND

Galvanic vestibular stimulation (GVS) uses at least one electrode placed on the mastoid process with one or multiple placed over other head areas to stimulate the vestibular system. The exact electrode size used is not given much importance in the literature and has not been reported in several studies. In a previous study, we compared the clinical effects of using different electrode sizes (3 cm2 and 35 cm2) with placebo but with the same injected current, on postural control. We observed significant improvement using the smaller size electrode but not with the bigger size electrode. The goal of this study was to simulate the current flow patterns with the intent to shed light and potentially explain the experimental outcome.

METHODS

We used an ultra-high-resolution structural dataset and developed a model to simulate the application of different electrode sizes. We considered current flow in the brain and in the vestibular labyrinth.

RESULTS

Our simulation results verified the focality increase using smaller electrodes that we postulated as the main reason for our clinical effect. The use of smaller size electrodes in combination with the montage employed also result in higher induced electric field (E-field) in the brain.

CONCLUSIONS

Electrode size and related current density is a critical parameter to characterize any GVS administration as the choice impacts the induced E-field. It is evident that the higher induced E-field likely contributed to the clinical outcome reported in our prior study.

Tilt perception is different in the pitch and roll planes in human

Neurophysiological tests probing the vestibulo-ocular, colic and spinal pathways are the gold standard to evaluate the vestibular system in clinics. In contrast, vestibular perception is rarely tested despite its potential usefulness in professional training and for the longitudinal follow-up of professionals dealing with complex man-machine interfaces, such as aircraft pilots. This is explored here using a helicopter flight simulator to probe the vestibular perception of pilots. The vestibular perception of nine professional helicopter pilots was tested using a full flight helicopter simulator. The cabin was tilted six times in roll and six times in pitch (-15°, -10°, -5°, 5°, 10° and 15°) while the pilots had no visual cue. The velocities of the outbound displacement of the cabin were kept below the threshold of the semicircular canal perception. After the completion of each movement, the pilots were asked to put the cabin back in the horizontal plane (still without visual cues). The order of the 12 trials was randomized with two additional control trials where the cabin stayed in the horizontal plane but rotated in yaw (-10° and +10°). Pilots were significantly more precise in roll (average error in roll: 1.15 ± 0.67°) than in pitch (average error in pitch: 2.89 ± 1.06°) (Wilcoxon signed-rank test: p < 0.01). However, we did not find a significant difference either between left and right roll tilts (p = 0.51) or between forward and backward pitch tilts (p = 0.59). Furthermore, we found that the accuracies were significantly biased with respect to the initial tilt. The greater the initial tilt was, the less precise the pilots were, although maintaining the direction of the tilt, meaning that the error can be expressed as a vestibular error gain in the ability to perceive the modification in the orientation. This significant result was found in both roll (Friedman test: p < 0.01) and pitch (p < 0.001). However, the pitch trend error was more prominent (gain = 0.77 vs gain = 0.93) than roll. This study is a first step in the determination of the perceptive-motor profile of pilots, which could be of major use for their training and their longitudinal follow-up. A similar protocol may also be useful in clinics to monitor the aging process of the otolith system with a simplified testing device.

Inter-day and intra-day variations in effective intensity of noisy galvanic vestibular stimulation to improve postural stability in bilateral vestibulopathy

BACKGROUND

The reproducibility of the effective intensity of noisy galvanic vestibular stimulation (nGVS) to improve postural stability is not well known.

OBJECTIVE

We aimed to investigate inter-day and intra-day variations in effective intensity in patients with bilateral vestibulopathy (BVP).

METHODS

Thirteen BVP patients were measured for center-of-pressure movements in the standing posture at five time points: morning of the first test day, morning and evening of the second test day, and morning and evening of the third test day. The mean velocity, the envelopment area, and the root mean square were measured in the eyes-closed condition for 30 s during nGVS application ranging from 0 to 1000μA. The effective intensity was defined as the intensity at which all the three parameters measured during the stimulation were simultaneously smaller than the values at baseline (0μA).

RESULTS

Seven of the 13 patients had a common effective intensity throughout the three test days. Six patients on the second test day and five patients on the third test day had no common effective intensity between morning and evening.

CONCLUSIONS

The effective intensity of nGVS changes depending on the time during the day as well as between the days.

Neurological mechanisms involved in idiopathic scoliosis. Systematic review of the literature

The literature that explains the neurological mechanisms underlying the development or compensation of idiopathic scoliosis is limited. The objective of the article is to describe and integrate the mechanisms and nerve pathways through which idiopathic scoliosis is compensated and/or developed. A narrative systematic review in different databases of the studies published between January 1, 1967 and April 1, 2021 was performed, using the following terms: "scoliosis", "vision", "eye", "vestibule", "labyrinth" "posture", "balance", "eye movements", "cerebellum", "proprioception", and "physiological adaptation". In the search, 1112 references were identified, of which 50 were finally included: 46 observational analytical clinical studies-descriptive (between cohorts, report and series of cases) and 4 experimental studies. In the neurological response to idiopathic scoliosis, the sensory-cortical integration of the afferences in the visual-oculomotor-vestibular-proprioceptive systems, allows modifications at the postural level in order to achieve an initial compensation on the sagittal balance and the centre of body mass; however, over time these compensation mechanisms may be exhausted causing progression of the initial deformity.

Vestibular mapping of the naturalistic head-centered motion spectrum

BACKGROUND

Naturalistic head accelerations can be used to elicit vestibular evoked potentials (VestEPs). These potentials allow for analysis of cortical vestibular processing and its multi-sensory integration with a high temporal resolution.

METHODS

We report the results of two experiments in which we compared the differential VestEPs elicited by randomized translations, rotations, and tilts in healthy subjects on a motion platform.

RESULTS

An event-related potential (ERP) analysis revealed that established VestEPs were verifiable in all three acceleration domains (translations, rotations, tilts). A further analysis of the VestEPs showed a significant correlation between rotation axes (yaw, pitch, roll) and the amplitude of the evoked potentials. We found increased amplitudes for rotations in the roll compared to the pitch and yaw plane. A distributed source localization analysis showed that the activity in the cingulate sulcus visual (CSv) area best explained direction-dependent amplitude modulations of the VestEPs, but that the same cortical network (posterior insular cortex, CSv) is involved in processing vestibular information, regardless of the motion direction.

CONCLUSION

The results provide evidence for an anisotropic, direction-dependent processing of vestibular input by cortical structures. The data also suggest that area CSv plays an integral role in ego-motion perception and interpretation of spatial features such as acceleration direction and intensity.

The human brain networks mediating the vestibular sensation of self-motion

Vestibular Agnosia - where peripheral vestibular activation triggers the usual reflex nystagmus response but with attenuated or no self-motion perception - is found in brain disease with disrupted cortical network functioning, e.g. traumatic brain injury (TBI) or neurodegeneration (Parkinson's Disease). Patients with acute focal hemispheric lesions (e.g. stroke) do not manifest vestibular agnosia. Thus, brain network mapping techniques, e.g. resting state functional MRI (rsfMRI), are needed to interrogate functional brain networks mediating vestibular agnosia. Hence, we prospectively recruited 39 acute TBI patients with preserved peripheral vestibular function and obtained self-motion perceptual thresholds during passive yaw rotations in the dark and additionally acquired whole-brain rsfMRI in the acute phase. Following quality-control checks, 26 patient scans were analyzed. Using self-motion perceptual thresholds from a matched healthy control group, 11 acute TBI patients were classified as having vestibular agnosia versus 15 with normal self-motion perception thresholds. Using independent component analysis on the rsfMRI data, we found altered functional connectivity in bilateral lingual gyrus and temporo-occipital fusiform cortex in the vestibular agnosia patients. Moreover, regions of interest analyses showed both inter-hemispheric and intra-hemispheric network disruption in vestibular agnosia. In conclusion, our results show that vestibular agnosia is mediated by bilateral anterior and posterior network dysfunction and reveal the distributed brain mechanisms mediating vestibular self-motion perception.

Sensory system-specific associations between brain structure and balance

Nearly 75% of older adults in the US report balance problems. Although it is known that aging results in widespread brain atrophy, less is known about how brain structure relates to balance in aging. We collected T1- and diffusion-weighted MRI scans and measured postural sway of 36 young (18-34 years) and 22 older (66-84 years) adults during eyes open, eyes closed, eyes open-foam, and eyes closed-foam conditions. We calculated summary measures indicating visual, proprioceptive, and vestibular contributions to balance. Across both age groups, thinner cortex in multisensory integration regions was associated with greater reliance on visual inputs for balance. Greater gyrification within sensorimotor and parietal cortices was associated with greater reliance on proprioceptive inputs. Poorer vestibular function was correlated with thinner vestibular cortex, greater gyrification within sensorimotor, parietal, and frontal cortices, and lower free water-corrected axial diffusivity across the corona radiata and corpus callosum. These results expand scientific understanding of how individual differences in brain structure relate to balance and have implications for developing brain stimulation interventions to improve balance.

The Role of the Cerebellar and Vestibular Networks in Anxiety Disorders and Depression: the Internal Model Hypothesis

Clinical data and animal studies confirmed that the cerebellum and the vestibular system are involved in emotions. Nowadays, no real consensus has really emerged to explain the clinical symptoms in humans and behavioral deficits in the animal models. We envisage here that the cerebellum and the vestibular system play complementary roles in emotional reactivity. The cerebellum integrates a large variety of exteroceptive and proprioceptive information necessary to elaborate and to update the internal model: in emotion, as in motor processes, it helps our body and self to adapt to the environment, and to anticipate any changes in such environment in order to produce a time-adapted response. The vestibular system provides relevant environmental stimuli (i.e., gravity, self-position, and movement) and is involved in self-perception. Consequently, cerebellar or vestibular disorders could generate « internal fake news» (due to lack or false sensory information and/or integration) that could, in turn, generate potential internal model deficiencies. In this case, the alterations provoke false anticipation of motor command and external sensory feedback, associated with unsuited behaviors. As a result, the individual becomes progressively unable to cope with the environmental solicitation. We postulate that chronically unsuited, and potentially inefficient, behavioral and visceral responses to environmental solicitations lead to stressful situations. Furthermore, this inability to adapt to the context of the situation generates chronic anxiety which could precede depressive states.

Neurosensory development of the four brainstem-projecting sensory systems and their integration in the telencephalon

Somatosensory, taste, vestibular, and auditory information is first processed in the brainstem. From the brainstem, the respective information is relayed to specific regions within the cortex, where these inputs are further processed and integrated with other sensory systems to provide a comprehensive sensory experience. We provide the organization, genetics, and various neuronal connections of four sensory systems: trigeminal, taste, vestibular, and auditory systems. The development of trigeminal fibers is comparable to many sensory systems, for they project mostly contralaterally from the brainstem or spinal cord to the telencephalon. Taste bud information is primarily projected ipsilaterally through the thalamus to reach the insula. The vestibular fibers develop bilateral connections that eventually reach multiple areas of the cortex to provide a complex map. The auditory fibers project in a tonotopic contour to the auditory cortex. The spatial and tonotopic organization of trigeminal and auditory neuron projections are distinct from the taste and vestibular systems. The individual sensory projections within the cortex provide multi-sensory integration in the telencephalon that depends on context-dependent tertiary connections to integrate other cortical sensory systems across the four modalities.

Visual Vestibular Conflict Mitigation in Virtual Reality Using Galvanic Vestibular Stimulation

BACKGROUND: Virtual reality (VR) is an effective technique to reduce cost and increase fidelity in training programs. In VR, visual and vestibular cues are often in conflict, which may result in simulator-induced motion sickness. The purpose of this study is to investigate the integration of Galvanic Vestibular Stimulation (GVS) with a VR flight training simulator by assessing flight performance, secondary task performance, simulator sickness and presence.METHODS: There were 20 participants who performed 2 separate VR flight simulation sessions, with and without GVS (control). Flight performance, secondary task performance, and electrogastrogram were measured during VR flight simulation. The standardized simulator sickness and presence questionnaires were administered.RESULTS: Electrogastrogram measures such as dominant power instability coefficient (DPIC) and percentages of bradygastric waves (%B) were lower in the GVS session than the control session in the flight simulation (DPIC: 0.44 vs. 0.54; %B: 21.2% vs. 30.5%) and postflight (DPIC: 0.38 vs. 0.53; %B: 22.8% vs. 31.4%) periods. Flight performance (#hit-gates) was improved in the GVS session compared to the control (GVS: 17, Control: 15.5). Secondary task performance (%hits) was improved with GVS for the Easy task (GVS: 55.5%, Control: 43.1%).DISCUSSION: This study demonstrates the potential of synchronizing GVS with visual stimuli in VR flight training to reduce visual-vestibular sensory conflict to improve fidelity and performance. These results provide initial evidence, but continued research is warranted to further understand the benefits and applications of GVS in VR simulator training.Pradhan GN, Galvan-Garza RC, Perez AM, Stepanek J, Cevette MJ. Visual vestibular conflict mitigation in virtual reality using galvanic vestibular stimulation. Aerosp Med Hum Perform. 2022; 93(5):406-414.

Exploring emotional-modulation of visually evoked postural responses through virtual reality

Exposure to postural threat has been documented to influence the sensory contributions of proprioceptive and vestibular information in standing balance control. Contributions from the visual system to balance are also crucial, yet the degree to which postural threat may modulate visual control of balance is not well characterized. Therefore, the aims of this study were to assess the feasibility of eliciting visual evoked postural responses (VEPRs) using head-mounted virtual reality (VR) and use this method to examine the potential influence of virtual postural threat on the visual control of balance. 36 healthy young adults were exposed to a pseudorandom, translational visual stimulus of a real-world environment in VR. The visual stimulus was presented in virtual conditions of LOW and HIGH postural threat in which participants stood at ground level, and on a 7m elevated platform, respectively. VEPRs were successfully produced in both postural threat conditions. When exposed to the visual stimulus while at an elevated surface height, participants demonstrated significant changes to their physiological arousal and emotional state. Despite significant coherence across the stimulus' frequency range, stimulus correlated VEPRs were not significantly modulated during exposure to the visual stimulus under virtual postural threat. This study supports the future utility of VR head-mounted displays in examining emotional influences on the visual control of balance.

The behavior of the optokinetic system

Optokinetic responses in several species are compared, describing differences in afoveate and foveate animals, and the effects of visual testing conditions, including directions of stimulus motion. Smooth pursuit contributes to responses to full-field visual motion in foveate species; in the latter, measurement of optokinetic after-nystagmus in darkness allows investigation of the optokinetic system. The concept of optokinetic-vestibular symbiosis and velocity storage are discussed, pertinent electrophysiological studies (such as vestibular nucleus neurons that respond to both optokinetic and vestibular stimuli) are reviewed and a model is developed. The different purposes and properties of optokinetic responses (to maintain clear vision during self-rotation) and smooth pursuit (to visually track a moving target) are clarified.

Mapping vestibular and visual contributions to angular head velocity tuning in the cortex

Neurons that signal the angular velocity of head movements (AHV cells) are important for processing visual and spatial information. However, it has been challenging to isolate the sensory modality that drives them and to map their cortical distribution. To address this, we develop a method that enables rotating awake, head-fixed mice under a two-photon microscope in a visual environment. Starting in layer 2/3 of the retrosplenial cortex, a key area for vision and navigation, we find that 10% of neurons report angular head velocity (AHV). Their tuning properties depend on vestibular input with a smaller contribution of vision at lower speeds. Mapping the spatial extent, we find AHV cells in all cortical areas that we explored, including motor, somatosensory, visual, and posterior parietal cortex. Notably, the vestibular and visual contributions to AHV are area dependent. Thus, many cortical circuits have access to AHV, enabling a diverse integration with sensorimotor and cognitive information.

Delineating neural responses and functional connectivity changes during vestibular and nociceptive stimulation reveal the uniqueness of cortical vestibular processing

Vestibular information is ubiquitous and often processed jointly with visual, somatosensory and proprioceptive information. Among the cortical brain regions associated with human vestibular processing, area OP2 in the parietal operculum has been proposed as vestibular core region. However, delineating responses uniquely to vestibular stimulation in this region using neuroimaging is challenging for several reasons: First, the parietal operculum is a cytoarchitectonically heterogeneous region responding to multisensory stimulation. Second, artificial vestibular stimulation evokes confounding somatosensory and nociceptive responses blurring responses contributing to vestibular perception. Furthermore, immediate effects of vestibular stimulation on the organization of functional networks have not been investigated in detail yet. Using high resolution neuroimaging in a task-based and functional connectivity approach, we compared two equally salient stimuli—unilateral galvanic vestibular (GVS) and galvanic nociceptive stimulation (GNS)—to disentangle the processing of both modalities in the parietal operculum and characterize their effects on functional network architecture. GNS and GVS gave joint responses in area OP1, 3, 4, and the anterior and middle insula, but not in area OP2. GVS gave stronger responses in the parietal operculum just adjacent to OP3 and OP4, whereas GNS evoked stronger responses in area OP1, 3 and 4. Our results underline the importance of considering this common pathway when interpreting vestibular neuroimaging experiments and underpin the role of area OP2 in central vestibular processing. Global network changes were found during GNS, but not during GVS. This lack of network reconfiguration despite the saliency of GVS may reflect the continuous processing of vestibular information in the awake human.

Impact of gravity on the perception of linear motion

Accurate perception of gravity and translation is fundamental for balance, navigation, and motor control. Previous studies have reported that perceptual thresholds for earth-vertical (i.e., parallel to gravity) and earth-horizontal (i.e., perpendicular to gravity) translations are equivalent in healthy adults, suggesting that the nervous system compensates for the presence of gravity. However, past study designs were not able to fully separate the effect of gravity from the potential effects of motion direction and body orientation. To quantify the effect of gravity on translation perception relative to these alternative factors, we measured vestibular perceptual thresholds for three motion directions (inter-aural, naso-occipital, and superior-inferior) and three body orientations (upright, supine, and ear-down). In contrast to prior reports, our data suggest that the nervous system does not universally compensate for the effects of gravity during translation, instead, we show that the colinear effect of gravity significantly decreases the sensitivity to stimuli for motions sensed by the utricles (inter-aural and naso-occipital translation), but this effect was not significant for motions sensed by the saccules (superior-inferior translations). We also identified increased thresholds for superior-inferior translation, suggesting decreased sensitivity of motions sensed predominantly by the saccule. An overall effect of body orientation on perception was seen; however, post hoc analyses suggest that this orientation effect may reflect the impact of gravity on self-motion perception. Overall, our data provide fundamental insights into the manner by which the nervous system processes vestibular self-motion cues, showing that the effect of gravity on translation perception is impacted by the direction of motion.NEW & NOTEWORTHY Perception of gravity and translation are fundamental for self-motion perception, balance, and motor control. The central nervous system must accurately disambiguate peripheral otolith signals encoding both linear acceleration and gravity. In contrast to past reports, we show that perception of translation depends on both motion relative to gravity and motion relative to the head. These results provide fundamental insights into otolith-mediated perception and suggest that the nervous system must compensate for the presence of gravity.

Galvanic Vestibular Stimulation Improves Subnetwork Interactions in Parkinson's Disease

Background

Activating vestibular afferents via galvanic vestibular stimulation (GVS) has been recently shown to have a number of complex motor effects in Parkinson's disease (PD), but the basis of these improvements is unclear. The evaluation of network-level connectivity changes may provide us with greater insights into the mechanisms of GVS efficacy.

Objective

To test the effects of different GVS stimuli on brain subnetwork interactions in both health control (HC) and PD groups using fMRI.

Methods

FMRI data were collected for all participants at baseline (resting state) and under noisy, 1 Hz sinusoidal, and 70-200 Hz multisine GVS. All stimuli were given below sensory threshold, blinding subjects to stimulation. The subnetworks of 15 healthy controls and 27 PD subjects (on medication) were identified in their native space, and their subnetwork interactions were estimated by nonnegative canonical correlation analysis. We then determined if the inferred subnetwork interaction changes were affected by disease and stimulus type and if the stimulus-dependent GVS effects were influenced by demographic features.

Results

At baseline, interactions with the visual-cerebellar network were significantly decreased in the PD group. Sinusoidal and multisine GVS improved (i.e., made values approaching those seen in HC) subnetwork interactions more effectively than noisy GVS stimuli overall. Worsening disease severity, apathy, depression, impaired cognitive function, and increasing age all limited the beneficial effects of GVS.

Conclusions

Vestibular stimulation has widespread system-level brain influences and can improve subnetwork interactions in PD in a stimulus-dependent manner, with the magnitude of such effects associating with demographics and disease status.