Interaction between perceived self-motion and object-motion impairs vehicle guidance.

When one is riding in a vehicle, perceptual thresholds for motion of objects are significantly elevated above those determined under corresponding but simulated conditions in the laboratory without concurrent self-motion perception. Authorities on road traffic accidents should thus consider an additional perceptual time of at least 300 milliseconds for detecting critical changes in headway beyond the usual reaction time. Detection times thus corrected consequently lead to an alteration of our conception of safe intervehicle distances in a convoy. This elevation of thresholds for object-motion during self-motion, with its consequences for visual control of vehicle guidance, can be seen as a disadvantageous side effect of an otherwise beneficial space-constancy mechanism, which provides us with a stable world during locomotion.

The effect of nicotine on perceptual, ocular motor, postural, and vegetative functions at rest and in motion.

Nicotine has wellknown, unpleasant side effects, e.g., transient dizziness, nausea, and nicotine-induced nystagmus (NIN). To investigate factors influencing these effects, we addressed three questions: (1) Is the intensity of dizziness, nausea, NIN, and unsteadiness dependent on nicotine dosage? (2) Does the intensity of perceptual, ocular motor, vegetative effects, and postural imbalance correlate? (3) Do visual or vestibular motion stimuli produce and/or aggravate distressing dizziness and nausea? Sixty healthy non-smokers or occasional smokers participated; 40 were tested once before and six times after application of a nicotine nasal spray in doses of 1 mg or 2 mg with or without motion stimulation; 20 received a placebo nasal spray. Plasma nicotine concentrations were significantly related to nicotine dosage. Dizziness, nausea, NIN, and unsteadiness also depended on the nicotine dosage (p < 0.01).Nicotine blood concentration was a better predictor for the temporal dependence of nystagmus than nicotine dosage. Dizziness correlated highly with nausea (R = 0.63, p < 0.001). The degree of nicotine-induced nausea significantly correlated with postural imbalance. The time course of postural sway differed according to nicotine dosage and gender: for women, there was no clear relationship between sway magnitude and nicotine dosage, while men showed increased sway with higher dosage. Motion stimulation increased nicotine-induced dizziness and nausea, but did not significantly influence NIN or postural imbalance. Our data support the view that all measured adverse effects reflect dose-dependent nicotine-induced vestibular dysfunction. Additional motion stimulation aggravates dizziness and nausea, i.e., nicotine increases sensitivity to motion sickness.

Noise-Enhanced Vestibular Input Improves Dynamic Walking Stability in Healthy Subjects.

BACKGROUND: White noise galvanic vestibular stimulation (GVS) is thought to enhance the sensitivity of vestibular organs. OBJECTIVE: To examine the effects of noise-enhanced vestibular input on the walking performance in healthy subjects walking with eyes closed. METHODS: Walking performance of 17 healthy subjects (mean age 28.8 ± 1.7 years) at slow, preferred, and fast speeds was examined during three different conditions: (1) walking with eyes open (EO) as baseline condition, (2) walking with eyes closed and sham noisy GVS (EC), and (3) walking with eyes closed and non-zero amplitude noisy GVS set to 80% of the individual sensory threshold for GVS (EC-GVS). Ten gait parameters were examined: stride time, stride length, base of support, swing time percentage, double support time percentage as well as gait asymmetry, bilateral phase coordination and the coefficient of variation (CV) of stride time, stride length and base of support. RESULTS: Noisy GVS improved stride time CV by 36% (p < 0.034), stride length CV by 31% (p < 0.037), base of support CV by 14% (p < 0.009), and bilateral phase coordination by 23% (p < 0.034). The ameliorating effects of noisy GVS on locomotion function were primarily observable during slow walking speeds. CONCLUSION: Noise-enhanced vestibular input is effective in improving locomotion function and is accompanied by a subjectively felt improvement of walking balance. It predominantly targets the variability and bilateral coordination characteristics of the walking pattern, which are critically linked to dynamic walking stability. Noisy GVS might present an effective treatment option to improve walking performance in patients with bilateral vestibular dysfunction.

Long-term course of orthostatic tremor in serial posturographic measurement.

OBJECTIVE: Primary orthostatic tremor (OT) is a rare neurological disease of unknown pathophysiology characterized by a high-frequency tremor mainly of the legs when standing. The aim of this study was to examine its long-term course by subjective estimation and objective recording by serial posturography and to obtain further standardized epidemiological and clinical data on patients with OT. METHODS: A clinical cohort of 37 patients with the diagnosis of primary OT was screened for this longitudinal follow-up study. Eighteen patients consented to participate. During study visit all patients underwent a standardized neurological examination and completed subjective scales and scores. Posturographic recordings at follow-up were compared to prior clinical posturographic measurements in 15 cases. RESULTS: In our cohort the mean duration of symptoms was 14.1 ± 6.8 years. Subjectively, 78% of patients reported progression of the disease. Posturographic data (5.4 ± 4.0 years) revealed a significant increase of the total sway path (standing on firm ground with eyes open) from 2.4 ± 1.3 to 3.4 ± 1.4 m/min (p = 0.022) and of the total root mean square values from 9.8 ± 4.3 to 12.4 ± 4.8 mm (p = 0.028). None of these observations are explained by aging of the patients. Mean frequency of the tremor did not change over time (14.7 ± 1.9 Hz vs. 14.9 ± 2.0 Hz at follow-up). Clinically, most patients had signs of cerebellar dysfunction and a substantial portion also showed proprioceptive deficits in the long-term course. CONCLUSIONS: This long-term follow-up study indicates, that primary OT is a progressive disorder. Furthermore, the clinical observation of cerebellar dysfunction in most OT patients in the long-term course might indicate an important role of the cerebellum in its pathophysiology.

Appraisal of the signal-to-noise-ratio of uni- and bipolar recordings of ocular vestibular evoked myogenic potentials.

Ocular vestibular evoked myogenic potentials (oVEMPs) are a non-invasive method to investigate otolith function mediated via the superior vestibular nerve. However, the herein used recordings and protocols may alter within different studies. In particular the diverging use of electrode configuration regarding polarity or even electrode position varies across studies. Therefore, a systematic analysis and appraisal of the different electrode configuration seems mandatory. In this study we compared the quality of uni- and bipolar recordings based on the signal to noise ratio (SNR). We recoded oVEMPs using a uni- and bipolar electrode configuration simultaneously and compared the recorded amplitudes and latencies and calculated the SNR. The amplitudes recorded by the unipolar configurations were significantly (p < 0.01) increased compared to the bipolar configuration. However, the SNR of the bipolar setup was significantly better (p < 0.05) when compared to the unipolar setup. Additionally, we estimated a transfer function that enabled a comparison of uni- and bipolar recordings. To conclude, the variety of setups used for oVEMP recording hinder a comparison of results and unipolar electrode configurations have clear disadvantages.

Influence of magnetic resonance imaging on evoked potentials and nerve conduction velocities in humans.

The authors investigated the influence of a 1.0-T magnetic field of a magnetic resonance (MR) imaging device, as well as the possible effects of the changing magnetic field and the RF field, on somatosensory, visual, and auditory evoked potentials and on peripheral nerve conduction velocities. The neural potentials outside and inside the static magnetic field were recorded before and after MR imaging. The measured latencies before and after MR imaging were within the normal range for healthy volunteers. The magnetic field did not significantly alter central or peripheral conduction velocities.

Postural imbalance with head extension: improvement by training as a model for ataxia therapy.

Head extension may cause a physiological vertigo and postural imbalance separate and distinct from basilar insufficiency. This physiological imbalance mainly is due to a vestibular sensory deficiency when the utricular otoliths are beyond their working range because of the change in head position. Since the intact visual and somatosensory control hope widely compensate for the vestibular deficiency, head-extension vertigo is of particular concern only in certain stimulus situations or diseases in which the stabilizing input from the eyes or joint receptors is reduced. Balance training on foam rubber with head extension and closed eyes improved postural-sway activity up to 50% within five days. A daily short-term training effect and a long-term training effect together form a typical exponential sawtooth curve of postural stability over time. After termination of training, learned balance skill exponentially returns to the pretraining values within weeks. The percentage of improvement through training depends on the amount of initial instability. Clinicians should treat ataxia by exposing patients to stimulus situations producing increasing body instability in order to activate sensorimotor rearrangement.

Patients with somatoform phobic postural vertigo: the more difficult the balance task, the better the balance performance.

The objective was to test, whether the increased body sway activity, shown in patients with phobic postural vertigo (PPV) in a previous posturographic study, impairs postural balance during demanding balance tasks. In 17 patients with PPV and 15 normal subjects body sway was analyzed for two standing positions on a foam rubber-padded posturographic platform with the eyes open or closed: (a) normal upright stance, (b) tandem stance. During normal upright stance patients showed an increase in body sway activity between 0.1 and 19 Hz and in sway path values for lateral and fore/aft directions. During the most difficult balance task, i.e. tandem stance with the eyes closed, body sway activity and sway path values did not differ between patients and controls. Objective balance skills were not impaired in patients with PPV during balance tasks at the limits of postural control.

Increased body sway at 3.5-8 Hz in patients with phobic postural vertigo.

Postural sway during upright stance was analyzed in 12 patients with phobic postural vertigo (PPV) and in 12 age-matched healthy volunteers. Recordings were made under different conditions (with the eyes open or closed): when standing on a foam rubber pad with the head upright, turned 30 degrees to the right or left, or during 1 Hz horizontal head oscillations. Sway analysis included calculation of sway path, of root mean square values of sway and of the power spectrum of sway in fore/aft and lateral directions. There was a significant increase in sway activity in the 3.53-8 Hz frequency band in patients with PPV. This did not impair objective postural stability. Increase in higher frequency sway activity may simply reflect a change in postural strategy rather than a sensorimotor dysfunction. The patients' conscious control of stance may augment co-activation of anti-gravity muscles, a strategy applied by normal subjects when performing demanding balancing tasks.

[The electrical stimulation bicycle: a neuroprosthesis for the everyday use of paraplegic patients]. / Das Elektrostimulationsfahrrad als Neuroprothese. Querschnittgelähmte Patienten mit dem Fahrrad unterwegs.

Until recently, few patients with complete paraplegia could walk or stand with the help of functional electrical stimulation (FES) of the leg muscles regularly at home. In comparison, FES cycling with an adapted tricycle is easy to put into practice because the legs remain connected to the pedals and through the use of a tricycle or stationary bicycle, the balancing problems of the patient recedes into the background. In the first German feasibility studies for paraplegic cycling, eleven completely paraplegic patients have been tested so far. The goal is to make FES cycling a daily activity in the lives of as many patients as possible.

Inadequate interaction between open- and closed-loop postural control in phobic postural vertigo.

Phobic postural vertigo (PPV) is characterized by a subjective dizziness and postural imbalance. Changes in postural control strategy may cause the disturbed postural performance in PPV. A better understanding of the mechanisms behind this change in strategy is required to improve the diagnostic tools and therapeutic options for this prevalent disorder. Here we apply stabilogram diffusion analysis (SDA) to examine the characteristics and modes of interaction of open- and closed-loop processes that make up the postural control scheme in PPV. Twenty patients with PPV and 20 age-matched healthy controls were recorded on a stabilometer platform with eyes open and with eyes closed. Spatio-temporal changes of the center of pressure (CoP) displacement were analyzed by means of SDA and complementary CoP amplitude measures. (1) Open-loop control mechanisms in PPV were disturbed because of a higher diffusion activity (p < 0.001). (2) The interaction of open- and closed-loop processes was altered in that the sensory feedback threshold of the system was lowered (p = 0.010). These two changes were comparable to those observed in healthy subjects during more demanding balance conditions such as standing with eyes closed. These data indicate that subjective imbalance in PPV is associated with characteristic changes in the coordination of open- and closed-loop mechanisms of postural control. Patients with PPV use sensory feedback inadequately during undisturbed stance, and this impairs postural performance. These changes are compatible with higher levels of anti-gravity muscle activity and co-contraction during the conscious concentration on control of postural stability.

Disturbed vestibular-neck interaction in cerebellar disease.

Cerebellar dysfunction results in ataxia including postural deficits. Evidence from animal experiments suggests convergence of vestibular and neck-position related inputs in cerebellar midline structures. We investigated 20 ambulatory patients with cerebellar disease for disturbed postural control using posturography during static lateral head turns. Binaural bipolar sine-wave galvanic vestibular stimulation (GVS) was used to evoke specific body movements. The Klockgether clinical score was used to assess the severity of cerebellar dysfunction (4-17 of maximal 35 points). In 12 healthy controls and seven lightly affected patients (score <8), GVS elicited physiologic alternating body sway in the head-frontal plane in seven head-on-trunk positions (0°; 30°, 45° and 60° left and right). Body sway turning with head excursion was progressively attenuated or abolished in more severely affected patients (scores 9-17; r = 0.57, p = 0.008). With most severe impairment, body sway was always in the body-frontal plane irrespective of head turn. A simple clinical test with walking under maximal head turn and closed eyes correlated with posturography data (r = 0.87, p < 0.001) and with Klockgether scores (r = 0.71, p < 0.001). Thus in cerebellar disease, head on trunk position can have a pronounced effect on postural control.

Postural imbalance and falls in PSP correlate with functional pathology of the thalamus.

OBJECTIVE: To determine how postural imbalance and falls are related to regional cerebral glucose metabolism (PET) and functional activation of the cerebral postural network (fMRI) in patients with progressive supranuclear palsy (PSP). METHODS: Sixteen patients with PSP, who had self-monitored their frequency of falls, underwent a standardized clinical assessment, posturographic measurement of balance during modified sensory input, and a resting [¹8F]FDG-PET. In addition, patients performed an fMRI paradigm using mental imagery of standing. Results were compared to healthy controls (n = 16). RESULTS: The frequency of falls/month in patients (range 1-40) correlated with total PSP rating score (r = 0.90). Total sway path in PSP significantly correlated with frequency of falls, especially during modulated sensory input (eyes open: r = 0.62, eyes closed: r = 0.67, eyes open/head extended: r = 0.84, eyes open/foam-padded platform: r = 0.87). Higher sway path values and frequency of falls were associated with decreased regional glucose metabolism (rCGM) in the thalamus (sway path: r = -0.80, falls: r = -0.64) and increased rCGM in the precentral gyrus (sway path: r = 0.79, falls: r = 0.64). Mental imagery of standing during fMRI revealed a reduced activation of the mesencephalic brainstem tegmentum and the thalamus in patients with postural imbalance and falls. CONCLUSIONS: The new and clinically relevant finding of this study is that imbalance and falls in PSP are closely associated with thalamic dysfunction. Deficits in thalamic postural control get most evident when balance is assessed during modified sensory input. The results are consistent with the hypothesis that reduced thalamic activation via the ascending brainstem projections may cause postural imbalance in PSP.

Object-motion detection affected by concurrent self-motion perception: applied aspects for vehicle guidance.

Thresholds and response times for object-motion detection are significantly raised during concurrent real or visually induced self-motion perception. This was demonstrated by standardized laboratory experiments in which subjects had to react to a suprathreshold visual stimulus (1 degree-light spot moving with 5 degrees/s speed) under different stimulus conditions of simultaneously perceived self-motion. Elevated response times (mean elevation factor: 3.27) were also obtained for the detection of changes in inter-vehicle distance (headway) under real road conditions with the simultaneous involvement of self- and object-motion perception compared to a corresponding (object-motion perception) simulation in the laboratory without any self-motion. With regard to vehicle guidance, existing concepts of safe stopping distances, which depend upon adequate detection of a collision course and the corresponding reaction times, have to be recalculated.

Dependence of visual stabilization of postural sway on the cortical magnification factor of restricted visual fields.

Monocular visual stabilization of fore-aft and lateral body sway was tested posturographically in normal subjects (wearing visual field blinds) as a function of visual field size and location of the visual field on the central or peripheral retina. Body sway applied to a force- measuring platform is less with central (foveal) vision when central and peripheral visual fields have the same area. If, however, the peripheral field size is corrected by the cortical magnification factor of the retina in the primary cortex, body sway is stabilized by the peripheral retina to the same extent. Thus, there is no functional specialization of central and peripheral retina with respect to balance control. Visual stabilization of upright stance is a function of field size and cortical representation of the retina. The central and the peripheral retina have different thresholds to detect motion; this was surprisingly not reflected in measurements of normal fore-aft and lateral body sway.

[Visual prevention from motion sickness in cars]. / Visuelle Prävention der Bewegungskrankheit im Auto.

The differential effects of vision on motion sickness in cars were tested under real road conditions using linear accelerations, in order to confirm earlier laboratory results on visual modulation of vestibular nausea induced by angular accelerations of the body. The 18 voluntary subjects were exposed to repetitive braking maneuvers (linear accelerations: 0.1-1.2 g) on a highway. The simultaneous visual stimulus conditions for the 3 separate days were: I) eyes open, visual control of car motion; II) eyes closed; III) eyes open, artificial stationary visual field (reading). The severity of motion sickness (magnitude estimation 1-10) was a function of the visual stimulus condition with significant differences among these conditions: I) moderate nausea (less than 1) with adequate visual motion perception; II) medium nausea (approximately equal to 2) with eyes closed and somatosensory-vestibular excitation only; III) strong nausea (greater than 5) with conflicting sensory input, when vestibular acceleration is in disagreement with the visual information of no movement. Providing ample peripheral vision of the relatively moving surround is the best strategy to alleviate car sickness.