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At least 19 records

Evaluation of tests for vestibular function

Vestibular testing methodologies are examined in terms of their clinical value and applicability to the assessment of astronaut candidates and human responses to microgravity. Classical and novel testing approaches are examined in terms of nine functions such as otolith organs, vestibular neural processing, and ocular motor systems. The tests reviewed include the basic vestibular-function test battery, postural stability testing, visual-vestibular interaction, reactions to off-axis rotation, and vestibular evoked responses. The basic test battery is shown to be essential for astronaut and inertial-environment baseline-data evaluations, whereas the newer and research tests are only recommended in special cases. Stimulus rearrangement and motion-sickness tests are indicated for testing adaptation to inertial environments. Postural stability and visual-vestibular interaction are recommended for evaluating one's suitability for being an astronaut.

Source record

To develop behavioral tests of vestibular functioning in the Wistar rat

Two tests of vestibular functioning in the rat were developed. The first test was the water maze. In the water maze the rat does not have the normal proprioceptive feedback from its limbs to help it maintain its orientation, and must rely primarily on the sensory input from its visual and vestibular systems. By altering lighting conditions and visual cues the vestibular functioning without visual cues was assessed. Whether there was visual compensation for some vestibular dysfunction was determined. The second test measured vestibular functioning of the rat's behavior on a parallel swing. In this test the rat's postural adjustments while swinging on the swing with the otoliths being stimulated were assessed. Less success was achieved in developing the parallel swing as a test of vestibular functioning than with the water maze. The major problem was incorrect initial assumptions of what the rat's probable behavior on the parallel swing would be.

Nielson, H. C.

Metrics of Balance Control for Use in Screening Tests of Vestibular Function

Decrements in balance control have been documented in astronauts after space flight. Reliable measures of balance control are needed for use in postflight field tests at remote landing sites. Diffusion analysis (DA) is a statistical mechanical tool that shows the average difference of the dependent variable on varying time scales. These techniques have been shown to measure differences in open-loop and closed-loop postural control in astronauts and elderly subjects. The goal of this study was to investigate the reliability of these measures of balance control. Eleven subjects were tested using the Clinical Test of Sensory Interaction on Balance: the subject stood with feet together and arms crossed on a stable or compliant surface, with eyes open or closed and with or without head movements in the pitch or yaw plane. Subjects were instrumented with inertial motion sensors attached to their trunk segment. The DA curves for linear acceleration measures were characterized by linear fits measuring open- (Ds) and closed-loop (Dl) control, and their intersection point (X-int, Y-int). Ds and Y-int showed significant differences between the test conditions. Additionally, Ds was correlated with the root mean square (RMS) of the signal, indicating that RMS was dominated by open-loop events (< 0.5 seconds). The Y-int was found to be correlated with the average linear velocity of trunk movements. Thus DA measures could be applied to derive reliable metrics of balance stability during field tests.

Fiedler, Matthew

Statistical prediction of space motion sickness

Studies designed to empirically examine the etiology of motion sickness to develop a foundation for enhancing its prediction are discussed. Topics addressed include early attempts to predict space motion sickness, multiple test data base that uses provocative and vestibular function tests, and data base subjects; reliability of provocative tests of motion sickness susceptibility; prediction of space motion sickness using linear discriminate analysis; and prediction of space motion sickness susceptibility using the logistic model.

Reschke, Millard F.

Vestibular ontogeny: Measuring the influence of the dynamic environment

In comparison to other special senses, we are only meagerly informed about the development of vestibular function and the mechanisms that may operate to control or influence the course of vestibular ontogeny. Perhaps one contributing factor to this disparity is the difficulty of evaluating vestibular sense organs directly and noninvasively. The present report describes a recently developed direct noninvasive vestibular function test that can be used to address many basic questions about the developing vestibular system. More particularly, the test can be used to examine the effects of the dynamic environment (e.g. gravitational field and vibration) on vestibular ontogeny.

Jones, Timothy A.

Dynamic visual acuity using "far" and "near" targets

CONCLUSIONS: DVA may be useful for assessing the functional consequences of an impaired gaze stabilization mechanism or for testing the effectiveness of a rehabilitation paradigm. Because target distance influences the relative contributions of canal and otolith inputs, the ability to measure DVA at near and far viewing distances may also lead to tests that will independently assess canal and otolith function. OBJECTIVE: To present and test a methodology that uses dynamic visual acuity (DVA) to assess the efficacy of compensatory gaze mechanisms during a functionally relevant activity that differentially measures canal and otolith function. MATERIAL AND METHODS: The effect of treadmill walking at a velocity of 1.79 m/s on subjects' visual acuity was assessed at each of two viewing distances. A custom-written threshold determination program was used to display Landolt C optotypes on a laptop computer screen during a "far" (4 m) target condition and on a micro-display for a "near" (50 cm) target condition. The walking acuity scores for each target distance were normalized by subtracting a corresponding acuity measure obtained while standing still on the treadmill belt. RESULTS: As predicted by subjective reports of relative target motion, the decrease in visual acuity was significantly greater (p < 0.00001) for the near compared to the far condition.

Pattern Recognition, Visual/physiology

Vestibulo-ocular and vestibulospinal function before and after cochlear implant surgery

Vestibular function in cochlear implant candidates varies from normal to total absence of function. In patients with intact vestibular function preoperatively, invasion of the otic capsule places residual vestibular function at risk. Speech-processing strategies that result in large amplitude electrical transients or strategies that employ high amplitude broad frequency carrier signals have the potential for disrupting vestibular function. Five patients were tested with and without electrical stimulation via cochlear electrodes. Two patients experienced subjective vestibular effects that were quickly resolved. No long-term vestibular effects were noted for the two types of second generation cochlear implants evaluated. Histopathological findings from another patient, who had electrically generated vestibular reflex responses to intramodiolar electrodes, indicated that responses elicited were a function of several variables including electrode location, stimulus intensity, stimulus amplitude, and stimulus frequency. Differential auditory, vestibulocolic, and vestibulospinal reflexes were demonstrated from the same electrode as a function of stimulus amplitude, frequency, and duration.

Case Reports

A vestibular phenotype for Waardenburg syndrome?

OBJECTIVE: To investigate vestibular abnormalities in subjects with Waardenburg syndrome. STUDY DESIGN: Retrospective record review. SETTING: Tertiary referral neurotology clinic. SUBJECTS: Twenty-two adult white subjects with clinical diagnosis of Waardenburg syndrome (10 type I and 12 type II). INTERVENTIONS: Evaluation for Waardenburg phenotype, history of vestibular and auditory symptoms, tests of vestibular and auditory function. MAIN OUTCOME MEASURES: Results of phenotyping, results of vestibular and auditory symptom review (history), results of vestibular and auditory function testing. RESULTS: Seventeen subjects were women, and 5 were men. Their ages ranged from 21 to 58 years (mean, 38 years). Sixteen of the 22 subjects sought treatment for vertigo, dizziness, or imbalance. For subjects with vestibular symptoms, the results of vestibuloocular tests (calorics, vestibular autorotation, and/or pseudorandom rotation) were abnormal in 77%, and the results of vestibulospinal function tests (computerized dynamic posturography, EquiTest) were abnormal in 57%, but there were no specific patterns of abnormality. Six had objective sensorineural hearing loss. Thirteen had an elevated summating/action potential (>0.40) on electrocochleography. All subjects except those with severe hearing loss (n = 3) had normal auditory brainstem response results. CONCLUSION: Patients with Waardenburg syndrome may experience primarily vestibular symptoms without hearing loss. Electrocochleography and vestibular function tests appear to be the most sensitive measures of otologic abnormalities in such patients.

NASA Discipline Neuroscience

Estimation of Optimum Stimulus Amplitude for Balance Training using Electrical Stimulation of the Vestibular System

Sensorimotor changes such as posture and gait instabilities can affect the functional performance of astronauts after gravitational transitions. Sensorimotor Adaptability (SA) training can help alleviate decrements on exposure to novel sensorimotor environments based on the concept of 'learning to learn' by exposure to varying sensory challenges during posture and locomotion tasks (Bloomberg 2015). Supra-threshold Stochastic Vestibular Stimulation (SVS) can be used to provide one of many challenges by disrupting vestibular inputs. In this scenario, the central nervous system can be trained to utilize veridical information from other sensory inputs, such as vision and somatosensory inputs, for posture and locomotion control. The minimum amplitude of SVS to simulate the effect of deterioration in vestibular inputs for preflight training or for evaluating vestibular contribution in functional tests in general, however, has not yet been identified. Few studies (MacDougall 2006; Dilda 2014) have used arbitrary but fixed maximum current amplitudes from 3 to 5 mA in the medio-lateral (ML) direction to disrupt balance function in healthy adults. Giving this high level of current amplitude to all the individuals has a risk of invoking side effects such as nausea and discomfort. The goal of this study was to determine the minimum SVS level that yields an equivalently degraded balance performance. Thirteen subjects stood on a compliant foam surface with their eyes closed and were instructed to maintain a stable upright stance. Measures of stability of the head, trunk, and whole body were quantified in the ML direction. Duration of time they could stand on the foam surface was also measured. The minimum SVS dosage was defined to be that level which significantly degraded balance performance such that any further increase in stimulation level did not lead to further balance degradation. The minimum SVS level was determined by performing linear fits on the performance variable at different stimulation levels. Results from the balance task suggest that there are inter-individual differences and the minimum SVS amplitude was found to be in the range of 1 mA to 2.5 mA across subjects. SVS resulted in an average decrement of balance task performance in the range of 62%-73% across different measured variables at the minimum SVS amplitude in comparison to the control trial (no stimulus). Training using supra-threshold SVS stimulation is one of the sensory challenges used for preflight SA training designed to improve adaptability to novel gravitational environments. Inter-individual differences in response to SVS can help customize the SA training paradigms using minimal dosage required. Another application of using SVS is to simulate acute deterioration of vestibular sensory inputs in the evaluation of tests for assessing vestibular function.

Goel, R.

Visual Vestibular Interaction in the Dynamic Visual Acuity Test during Voluntary Head Rotation

Although intact vestibular function is essential in maintaining spatial orientation, no good screening tests of vestibular function are available to the aviation community. High frequency voluntary head rotation was selected as a vestibular stimulus to isolate the vestibulo-ocular reflex (VOR) from visual influence. A dynamic visual acuity test that incorporates voluntary head rotation was evaluated as a potential vestibular function screening tool. Twenty-seven normal subjects performed voluntary sinusoidal head rotation at frequencies from 0.7-4.0 Hz under three different visual conditions: visually-enhanced VOR, normal VOR, and visually suppressed VOR. Standardized Baily-Lovie chart letters were presented on a computer monitor in front of the subject, who then was asked to read the letters while rotating his head horizontally. The electro-oculogram and dynamic visual acuity score were recorded and analyzed. There were no significant differences in gain or phase shift among three visual conditions in the frequency range of 2.8 to 4.0 Hz. The dynamic visual acuity score shifted less than 0.3 logMAR at frequencies under 2.0 Hz. The dynamic visual acuity test at frequencies a round 2.0 Hz can be recommended for evaluating vestibular function.

VISUAL ACUITY

Application of multivariate statistics to vestibular testing: discriminating between Meniere's disease and migraine associated dizziness

Meniere's disease (MD) and migraine associated dizziness (MAD) are two disorders that can have similar symptomatologies, but differ vastly in treatment. Vestibular testing is sometimes used to help differentiate between these disorders, but the inefficiency of a human interpreter analyzing a multitude of variables independently decreases its utility. Our hypothesis was that we could objectively discriminate between patients with MD and those with MAD using select variables from the vestibular test battery. Sinusoidal harmonic acceleration test variables were reduced to three vestibulo-ocular reflex physiologic parameters: gain, time constant, and asymmetry. A combination of these parameters plus a measurement of reduced vestibular response from caloric testing allowed us to achieve a joint classification rate of 91%, independent quadratic classification algorithm. Data from posturography were not useful for this type of differentiation. Overall, our classification function can be used as an unbiased assistant to discriminate between MD and MAD and gave us insight into the pathophysiologic differences between the two disorders.

NASA Discipline Neuroscience

Effect of vergence on the gain of the linear vestibulo-ocular reflex

We measured the linear vestibulo-ocular reflex (LVOR) and vergence, using binocular search coils, in 3 humans. The subjects were accelerated sinusoidally at 0.5 Hz and 0.2 g peak acceleration, in complete darkness, while performing three different tasks: i) mental arithmetic; ii) tracking a remembered target at either 0.34 m or 0.14 m distance; and iii) maintaining vergence at either of these distances by means of audio biofeedback based on vergence. Subjects could control vergence using the audio feedback; there was greater convergence with the near audio target. However, there was no significant difference in vergence between the near and far remembered target conditions. With audio feedback, the amplitude of smooth tracking was not consistently different for the near and the far conditions. However, the amplitude of tracking (saccades and smooth component) in the remembered target conditions was greater for near than for far targets. These results suggest that linear VOR amplitude is not determined by vergence alone.

NASA Program Space Physiology and Countermeasures

Modeling human vestibular responses during eccentric rotation and off vertical axis rotation

A mathematical model has been developed to help explain human multi-sensory interactions. The most important constituent of the model is the hypothesis that the nervous system incorporates knowledge of sensory dynamics into an "internal model" of these dynamics. This internal model allows the nervous system to integrate the sensory information from many different sensors into a coherent estimate of self-motion. The essence of the model is unchanged from a previously published model of monkey eye movement responses; only a few variables have been adjusted to yield the prediction of human responses. During eccentric rotation, the model predicts that the axis of eye rotation shifts slightly toward alignment with gravito-inertial force. The model also predicts that the time course of the perception of tilt following the acceleration phase of eccentric rotation is much slower than that during deceleration. During off vertical axis rotation (OVAR) the model predicts a small horizontal bias along with small horizontal, vertical, and torsional oscillations. Following OVAR stimulation, when stopped right- or left-side down, a small vertical component is predicted that decays with the horizontal post-rotatory response. All of the predictions are consistent with measurements of human responses.

NASA Discipline Neuroscience

Outcome analysis of individualized vestibular rehabilitation protocols

OBJECTIVE: To determine the outcome of vestibular rehabilitation protocols in subjects with peripheral vestibular disorders compared with normal and abnormal control subjects. STUDY DESIGN: Prospective study using repeated measure, matched control design. Subjects were solicited consecutively according to these criteria: vestibular disorder subjects who had abnormal results of computerized dynamic posturography (CDP) sensory organization tests (SOTs) 5 and 6 and underwent rehabilitation; vestibular disorder subjects who had abnormal results of SOTs 5 and 6 and did not undergo rehabilitation; and normal subjects (normal SOTs). SETTING: Tertiary neurotology clinic. SUBJECTS: Men and women over age 18 with chronic vestibular disorders and chief complaints of unsteadiness, imbalance, and/or motion intolerance, and normal subjects. INTERVENTIONS: Pre- and post-rehabilitation assessment included CDP, vestibular disability, and activities of daily living questionnaires. Individualized rehabilitation plans were designed and implemented to address the subject's specific complaints and functional deficits. Supervised sessions were held at weekly intervals, and self-administered programs were devised for daily home use. MAIN OUTCOME MEASURES: CDP composite and SOT scores, number of falls on CDP, and self-assessment questionnaire results. RESULTS: Subjects who underwent rehabilitation (Group A) showed statistically significant improvements in SOTs, overall composite score, and reduction in falls compared with abnormal (Group B) control groups. Group A's performances after rehabilitation were not significantly different from those of normal subjects (Group C) in SOTs 3 through 6, and close to normal on SOTs 1 and 2. Subjects in Group A also reported statistically significant symptomatic improvement. CONCLUSIONS: Outcome measures of vestibular protocol physical therapy confirmed objective and subjective improvement in subjects with chronic peripheral vestibular disorders. These findings support results reported by other investigators.

NASA Discipline Neuroscience

A new light on caloric test--what was disclosed by three dimensional analysis of caloric nystagmus?

For better understanding of caloric nystagmus, this phenomenon will be reviewed historically in three stages. 1) The first light on caloric nystagmus was thrown by Barany 1906. Through direct observation of eye movements, Barany established the caloric test as an important tool to determine the side of lesion for vertigo. 2) The second light is shed by electrooculogram (EOG) from the late 1950th. EOG enabled qualitative analysis of caloric nystagmus, and proved Barany's convection theory, but resulted in neglect of vertical and roll eye movements. 3) The third light is gained by 3D recording of eye movements started from the late 1980th. 3D recordings of eye movements enabled us to analyze the spatial orientation of caloric nystagmus, and disclose the close correlation of the nystagmus components in the head vertical and the space vertical planes, suggesting a contribution of the velocity storage integrator. The 3D property of caloric nystagmus will be explained in detail.

Caloric Tests/history

Recovery trajectories of vestibulopathic subjects after perturbations during locomotion

We compared the mediolateral (M/L) responses to perturbations during locomotion of vestibulopathic (VP) subjects to those of controls. Eight subjects with unilateral vestibular loss (100% Reduced Vestibular Response from the caloric test) resulting from surgery for vestibular schwannoma and 11 controls were selected for this study. Despite their known vestibulopathy, all VP subjects scored within the normal range on computerized dynamic posturography Sensory Organization Tests. During gait, subjects were given surface perturbations of the right support-phase foot in two possible directions (forward-right and backward-left) at two possible magnitudes (5 and 10 cm) that were randomly mixed with trials having no perturbations. M/L stability was quantified by estimating the length of the M/L moment arm between the support foot and the trunk, and the M/L accelerations of the sternum and the head. The VP group had greater changes (p < 0.05) in their moment arm responses compared to controls. The number of steps that it took for the moment arm oscillations to return to normal and the variability in the moment arms were greater for the VP group. Differences in the sternum and head accelerations between VP and control groups were not as consistent, but there was a trend toward greater response deviations in the VP group for all 4 perturbation types. Increased response magnitude and variability of the VP group is consistent with an increase in their sensory noise of vestibular inputs due to the surgical lesion. Another possibility is a reduced sensitivity to motion inputs. This perturbation approach may prove useful for characterizing subtle vestibulopathies and similar changes in the human orientation mechanism after exposure to microgravity.

NASA Discipline Neuroscience