Validation of centrifugation as a countermeasure for otolith deconditioning during spaceflight: preliminary data of the ESA SPIN study.

In the framework of further space exploration, countermeasures to combat the drawbacks of human space flights are essential. The present study focuses on the influence of microgravity on the otolith-ocular reflex and aims to test the hypothesis of artificial gravity being an adequate countermeasure for the deconditioning of the aforementioned reflex. The so-called SPIN study, commissioned by the European Space Agency, can be considered as a control experiment in the broad sense for the Neurolab mission (STS-90) during which 4 crewmembers of the space shuttle were subjected to in-flight centrifugation on the visual and vestibular investigation system (VVIS). After their nearly 16-day mission, they did not suffer from orthostatic intolerance and spatial disorientation. In addition, the relevant parameters of the otolith-ocular interaction remained unaffected. For this study cosmonauts from a long duration stay in the International Space Station that were not centrifuged in-flight were tested on the VVIS (1 g centripetal interaural acceleration) on 6 different days. Three measurements were taken about 1.5-2 months prior to launch and 3 were taken at 1, 4 and 9 days after return from space. Ocular counter-rolling was measured before, during and after rotation on the VVIS using infrared video goggles and compared pair wise using Friedman tests. The perception of verticality was monitored using an ultrasound system for perceptual evaluation. The preliminary results of 4 cosmonauts showed a surprisingly large inter-individual variability of the measurements. Although OCR and perception of verticality appeared to be influenced overall by the exposure to microgravity, the wide variability among the cosmonauts obscured any statistical significance, in particular due to one cosmonauts being inconsistent with the other 3. Despite the specificity of the tests under normal conditions, the diverse response to spaceflight of our subjects exposes the complexity of the peripheral and central neural adaptive processes.

Modeling freezing of gait in Parkinson's disease with a virtual reality paradigm.

Freezing of gait is a paroxysmal and disabling symptom that commonly affects patients in the latter stages of Parkinson's disease, however the intermittent nature of this symptom makes it difficult to study in the clinical setting. Our research group has previously reported a correlation between self-reported freezing of gait symptoms and performance on a seated virtual reality gait task. In this study, we sought to determine whether behavioral measures recorded on this task were correlated with actual clinical measures of freezing of gait recorded in a cohort of 38 Parkinson's disease patients whilst in their clinically defined 'off' state. Firstly, patients with freezing of gait had a significantly larger frequency of spontaneous motor arrests recorded on the virtual reality gait task than 'non-freezers'. In addition, in those 24 patients with clinically proven freezing of gait, the number and percentage of time spent with freezing on the virtual reality task were both moderately correlated with the duration of freezing of gait recorded on the timed up-and-go tasks. These findings suggest that the freezing behavior observed during a virtual reality gait task may share similar neural substrates to freezing of gait. Such a relationship could offer a potential avenue for modeling the phenomenon of freezing of gait in Parkinson's disease, allowing for the exploration of the neural correlates of freezing.

Assessing the utility of Freezing of Gait Questionnaires in Parkinson's Disease.

There are currently two validated questionnaires, the Freezing of Gait Questionnaire and the New Freezing of Gait Questionnaire, that are intended to assess the degree of freezing of gait in patients with Parkinson's disease. However, to date no study has attempted to determine whether ratings on these questionnaires accurately reflect the severity (frequency and duration) of actual freezing episodes experienced by patients. We studied twenty-four patients with Parkinson's disease who self-reported significant freezing while in their practically-defined 'off' state. Prior to clinical assessment they completed both freezing of gait questionnaires before being video-recorded while performing a series of timed up-and-go tasks, which incorporated turning, rotating and passing through narrow gaps. The rating of video recordings by two independent observers identified a total of 530 freezing events. The frequency and duration of freezing episodes for each patient were calculated and correlated with questionnaire ratings. Scores on either questionnaire did not correlate with either the frequency or duration of freezing episodes experienced by patients during objective assessment. These results suggest the need to re-evaluate the utility of questionnaires in the assessment of freezing of gait. Furthermore, these results highlight the need for accurate objective methods of identifying freezing events when assessing future clinical interventions aimed at reducing this potentially disabling symptom of Parkinson's disease.

Vestibular compensation and orientation during locomotion.

Body, head, and eye movements were studied in three dimensions while walking and turning to determine the role of the vestibular system in directing gaze and maintaining spatial orientation. The body, head, and eyes were represented as three-dimensional coordinate frames, and the movement of these frames was related to a trajectory frame that described the motion of the body on a terrestrial plane. The axis-angle of the body, head, and eye rotation were then compared to the axis-angle of the rotation of the gravitoinertial acceleration (GIA). We inferred the role of the vestibular system during locomotion and the contributions of the VCR and VOR by examining the interrelationship between these coordinate frames. Straight walking induced head and eye rotations in a compensatory manner to the linear accelerations, maintaining head pointing and gaze along the direction of forward motion. Turning generated a combination of compensation and orientation responses. The head leads and steers the turn while the eyes compensate to maintain stable horizontal gaze in space. Saccades shift horizontal gaze as the turn is executed. The head pitches, as during straight walking. It also rolls so that the head tends to align with the orientation of the GIA. Head orientation changes anticipate orientation changes of the GIA. Eye orientation follows the changes in GIA orientation so that the net orientation gaze is closer to the orientation of the GIA. The study indicates that the vestibular system utilizes compensatory and orienting mechanisms to stabilize spatial orientation and gaze during walking and turning.

The human vestibulo-ocular reflex during linear locomotion.

During locomotion, there is a translation and compensatory rotation of the head in both the vertical and horizontal planes. During moderate to fast walking (100 m/min), vertical head translation occurs at the frequency of stepping (2 Hz) and generates peak linear acceleration of 0.37 g. Lateral head translation occurs at the stride frequency (1 Hz) and generates peak linear acceleration of 0.1 g. Peak head pitch and yaw angular velocities are approximately 17 degrees/s. The frequency and magnitude of these head movements are within the operational range of both the linear and angular vestibulo-ocular reflex (IVOR and aVOR). Vertical eye movements undergo a phase reversal from near to far targets. When viewing a far (>1 m) target, vertical eye velocity is typical of an aVOR response; that is, it is compensatory for head pitch. At close viewing distances (<1 m), vertical eye velocity is in phase with head pitch and is compensatory for vertical head translation, suggesting that the IVOR predominantly generates the eye movement response. Horizontal head movements during locomotion occur at the stride frequency of 1 Hz, where the IVOR gain is low. Horizontal eye movements are compensatory for head yaw at all viewing distances and are likely generated by the aVOR.

Perception of tilt (somatogravic illusion) in response to sustained linear acceleration during space flight.

During the 1998 Neurolab mission (STS-90), four astronauts were exposed to interaural and head vertical (dorsoventral) linear accelerations of 0.5 g and 1 g during constant velocity rotation on a centrifuge, both on Earth and during orbital space flight. Subjects were oriented either left-ear-out or right-ear-out (Gy centrifugation), or lay supine along the centrifuge arm with their head off-axis (Gz centrifugation). Pre-flight centrifugation, producing linear accelerations of 0.5 g and 1 g along the Gy (interaural) axis, induced illusions of roll-tilt of 20 degrees and 34 degrees for gravito-inertial acceleration (GIA) vector tilts of 27 degrees and 45 degrees , respectively. Pre-flight 0.5 g and 1 g Gz (head dorsoventral) centrifugation generated perceptions of backward pitch of 5 degrees and 15 degrees , respectively. In the absence of gravity during space flight, the same centrifugation generated a GIA that was equivalent to the centripetal acceleration and aligned with the Gy or Gz axes. Perception of tilt was underestimated relative to this new GIA orientation during early in-flight Gy centrifugation, but was close to the GIA after 16 days in orbit, when subjects reported that they felt as if they were 'lying on side'. During the course of the mission, inflight roll-tilt perception during Gy centrifugation increased from 45 degrees to 83 degrees at 1 g and from 42 degrees to 48 degrees at 0.5 g. Subjects felt 'upside-down' during in-flight Gz centrifugation from the first in-flight test session, which reflected the new GIA orientation along the head dorsoventral axis. The different levels of in-flight tilt perception during 0.5 g and 1 g Gy centrifugation suggests that other non-vestibular inputs, including an internal estimate of the body vertical and somatic sensation, were utilized in generating tilt perception. Interpretation of data by a weighted sum of body vertical and somatic vectors, with an estimate of the GIA from the otoliths, suggests that perception weights the sense of the body vertical more heavily early in-flight, that this weighting falls during adaptation to microgravity, and that the decreased reliance on the body vertical persists early post-flight, generating an exaggerated sense of tilt. Since graviceptors respond to linear acceleration and not to head tilt in orbit, it has been proposed that adaptation to weightlessness entails reinterpretation of otolith activity, causing tilt to be perceived as translation. Since linear acceleration during in-flight centrifugation was always perceived as tilt, not translation, the findings do not support this hypothesis.

Ocular counterrolling induced by centrifugation during orbital space flight.

During the 1998 Neurolab mission (STS-90), four astronauts were exposed to interaural centripetal accelerations (Gy centrifugation) of 0.5 g and 1 g during rotation on a centrifuge, both on Earth and during orbital space flight. Subjects were oriented either left-ear out or right-ear out, facing or back to motion. Binocular eye movements were measured in three dimensions using a video technique. On Earth, tangential centrifugation that produces 1 g of interaural linear acceleration combines with gravity to tilt the gravitoinertial acceleration (GIA) vector 45 degrees in the roll plane relative to the head vertical, generating a summed vector of 1.4 g. Before flight, this elicited mean ocular counterrolling (OCR) of 5.7 degrees. Due to the relative absence of gravity during flight, there was no linear acceleration along the dorsoventral axis of the head. As a result, during in-flight centrifugation, gravitoinertial acceleration was strictly aligned with the centripetal acceleration along the interaural axis. There was a small but significant decrease (mean 10%) in the magnitude of OCR in space (5.1 degrees). The magnitude of OCR during postflight 1 g centrifugation was not significantly different from preflight OCR (5.9 degrees). Findings were similar for 0.5 g centrifugation, but the OCR magnitude was approximately 60% of that induced by centrifugation at 1 g. OCR during pre- and postflight static tilt was not significantly different and was always less than OCR elicited by centrifugation of Earth for an equivalent interaural linear acceleration. In contrast, there was no difference between the OCR generated by in-flight centrifugation and by static tilt on Earth at equivalent interaural linear accelerations. These data support the following conclusions: (1) OCR is generated predominantly in response to interaural linear acceleration; (2) the increased OCR during centrifugation on Earth is a response to the head dorsoventral 1 g linear acceleration component, which was absent in microgravity. The dorsoventral linear acceleration could have activated either the otoliths or body-tilt receptors that responded to the larger GIA magnitude (1.4 g), to generate the increased OCR during centrifugation on Earth. A striking finding was that magnitude of OCR was maintained throughout and after flight. This is in contrast to most previous postflight OCR studies, which have generally registered decreases in OCR. We postulate that intermittent exposure to artificial gravity, in the form of the centripetal acceleration experienced during centrifugation, acted as a countermeasure to deconditioning of this otolith-ocular orienting reflex during the 16-day mission.

Interaction of the body, head, and eyes during walking and turning.

Body, head, and eye movements were measured in five subjects during straight walking and while turning corners. The purpose was to determine how well the head and eyes followed the linear trajectory of the body in space and whether head orientation followed changes in the gravito-inertial acceleration vector (GIA). Head and body movements were measured with a video-based motion analysis system and horizontal, vertical, and torsional eye movements with video-oculography. During straight walking, there was lateral body motion at the stride frequency, which was at half the frequency of stepping. The GIA oscillated about the direction of heading, according to the acceleration and deceleration associated with heel strike and toe flexion, and the body yawed in concert with stepping. Despite the linear and rotatory motions of the head and body, the head pointed along the forward motion of the body during straight walking. The head pitch/roll component appeared to compensate for vertical and horizontal acceleration of the head rather than orienting to the tilt of the GIA or anticipating it. When turning corners, subjects walked on a 50-cm radius over two steps or on a 200-cm radius in five to seven steps. Maximum centripetal accelerations in sharp turns were ca.0.4 g, which tilted the GIA ca.21 degrees with regard to the heading. This was anticipated by a roll tilt of the head of up to 8 degrees. The eyes rolled 1-1.5 degrees and moved down into the direction of linear acceleration during the tilts of the GIA. Yaw head deviations moved smoothly through the turn, anticipating the shift in lateral body trajectory by as much as 25 degrees. The trunk did not anticipate the change in trajectory. Thus, in contrast to straight walking, the tilt axes of the head and the GIA tended to align during turns. Gaze was stable in space during the slow phases and jumped forward in saccades along the trajectory, leading it by larger angles when the angular velocity of turning was greater. The anticipatory roll head movements during turning are likely to be utilized to overcome inertial forces that would destabilize balance during turning. The data show that compensatory eye, head, and body movements stabilize gaze during straight walking, while orienting mechanisms direct the eyes, head, and body to tilts of the GIA in space during turning.

Effect of viewing distance on the generation of vertical eye movements during locomotion.

Vertical head and eye coordination was studied as a function of viewing distance during locomotion. Vertical head translation and pitch movements were measured using a video motion analysis system (Optotrak 3020). Vertical eye movements were recorded using a video-based pupil tracker (Iscan). Subjects (five) walked on a linear treadmill at a speed of 1.67 m/s (6 km/h) while viewing a target screen placed at distances ranging from 0.25 to 2.0 m at 0. 25-m intervals. The predominant frequency of vertical head movement was 2 Hz. In accordance with previous studies, there was a small head pitch rotation, which was compensatory for vertical head translation. The magnitude of the vertical head movements and the phase relationship between head translation and pitch were little affected by viewing distance, and tended to orient the naso-occipital axis of the head at a point approximately 1 m in front of the subject (the head fixation distance or HFD). In contrast, eye velocity was significantly affected by viewing distance. When viewing a far (2-m) target, vertical eye velocity was 180 degrees out of phase with head pitch velocity, with a gain of 0. 8. This indicated that the angular vestibulo-ocular reflex (aVOR) was generating the eye movement response. The major finding was that, at a close viewing distance (0.25 m), eye velocity was in phase with head pitch and compensatory for vertical head translation, suggesting that activation of the linear vestibulo-ocular reflex (lVOR) was contributing to the eye movement response. There was also a threefold increase in the magnitude of eye velocity when viewing near targets, which was consistent with the goal of maintaining gaze on target. The required vertical lVOR sensitivity to cancel an unmodified aVOR response and generate the observed eye velocity magnitude for near targets was almost 3 times that previously measured. Supplementary experiments were performed utilizing body-fixed active head pitch rotations at 1 and 2 Hz while viewing a head-fixed target. Results indicated that the interaction of smooth pursuit and the aVOR during visual suppression could modify both the gain and phase characteristics of the aVOR at frequencies encountered during locomotion. When walking, targets located closer than the HFD (1.0 m) would appear to move in the same direction as the head pitch, resulting in suppression of the aVOR. The results of the head-fixed target experiment suggest that phase modification of the aVOR during visual suppression could play a role in generating eye movements consistent with the goal of maintaining gaze on targets closer than the HFD, which would augment the lVOR response.

Effects of walking velocity on vertical head and body movements during locomotion.

Trunk and head movements were characterized over a wide range of walking speeds to determine the relationship between stride length, stepping frequency, vertical head translation, pitch rotation of the head, and pitch trunk rotation as a function of gait velocity. Subjects (26-44 years old) walked on a linear treadmill at velocities of 0.6-2.2 m/s. The head and trunk were modeled as rigid bodies, and rotation and translation were determined using a video-based motion analysis system. At walking speeds up to 1.2 m/s there was little head pitch movement in space, and the head pitch relative to the trunk was compensatory for trunk pitch. As walking velocity increased, trunk pitch remained approximately invariant, but a significant head translation developed. This head translation induced compensatory head pitch in space, which tended to point the head at a fixed point in front of the subject that remained approximately invariant with regard to walking speed. The predominant frequency of head translation and rotation was restricted to a narrow range from 1.4 Hz at 0.6 m/s to 2.5 Hz at 2.2 m/s. Within the range of 0.8-1.8 m/s, subjects tended to increase their stride length rather than step frequency to walk faster, maintaining the predominant frequency of head movement at close to 2.0 Hz. At walking speeds above 1.2 m/s, head pitch in space was highly coherent with, and compensatory for, vertical head translation. In the range 1.2-1.8 m/s, the power spectrum of vertical head translation was the most highly tuned, and the relationship between walking speed and head and trunk movements was the most linear. We define this as an optimal range of walking velocity with regard to head-trunk coordination. The coordination of head and trunk movement was less coherent at walking velocities below 1.2 m/s and above 1.8 m/s. These results suggest that two mechanisms are utilized to maintain a stable head fixation distance over the optimal range of walking velocities. The relative contribution of each mechanism to head orientation depends on the frequency of head movement and consequently on walking velocity. From consideration of the frequency characteristics of the compensatory head pitch, we infer that compensatory head pitch movements may be produced predominantly by the angular vestibulocollic reflex (aVCR) at low walking speeds and by the linear vestibulocollic reflex (1VCR) at the higher speeds.

Robust pupil center detection using a curvature algorithm.

Determining the pupil center is fundamental for calculating eye orientation in video-based systems. Existing techniques are error prone and not robust because eyelids, eyelashes, corneal reflections or shadows in many instances occlude the pupil. We have developed a new algorithm which utilizes curvature characteristics of the pupil boundary to eliminate these artifacts. Pupil center is computed based solely on points related to the pupil boundary. For each boundary point, a curvature value is computed. Occlusion of the boundary induces characteristic peaks in the curvature function. Curvature values for normal pupil sizes were determined and a threshold was found which together with heuristics discriminated normal from abnormal curvature. Remaining boundary points were fit with an ellipse using a least squares error criterion. The center of the ellipse is an estimate of the pupil center. This technique is robust and accurately estimates pupil center with less than 40% of the pupil boundary points visible.

How consumers evaluate health care quality: Part III.

This article is the third and final article in a series which examines the way in which consumers assess information regarding the quality of health care services. The previous article focused on consumers' perceptions of health care plans and health insurance companies. This article examines the views of health care consumers regarding hospitals and doctors.

How consumers evaluate health care quality: Part I.

Information is a critical factor in marketing health care services. Consumers evaluate information according to its source. This report is the first of a three-part series examining the way in which Americans evaluate the quality of consumer information as they make decisions on health care products and services. This report provides an overview of the study. The next two installations will focus, respectively, on health plans, hospital and doctors.

How consumers evaluate health care quality: Part II.

This article is the second in a series which examines the way in which consumers assess information regarding the quality of health care services. In the previous article it was demonstrated that, in the view of health care consumers, three major perceptions held by health care consumers, are: (1) substantial differences in quality exist among health care providers, (2) little information is available that allows for the comparison of health care providers on issues related to quality, and (3) when such information is available it is found to be useful and often serves as the basis for decision regarding the choice of health care providers. We further discussed the short coming of marketing strategies based on complex quality indicators and the difficulties of image advertising in an age of institutional mistrust. The reader is reminded that these findings relate to the subjective assessments of consumers, not to objective facts concerning health care delivery.

Social welfare in a managerial society.

Managerialism is a dominant ideology in the institution of social welfare and the profession of social work. Managerialism includes the tools and traditions of modern management. It is also a way of viewing the social world. Managerialism is a useful but limited ideology in social work and social welfare. The benefits of this perspective include the ordering and sanctioning of professional social workers and the application of sophisticated management tools in the institution of social welfare. Managerialism threatens the historic mission and identity of social work and social welfare. The field is challenged to find an institutional niche for those aspects that are outside the mainstream of the commercial culture.

A geometric basis for measurement of three-dimensional eye position using image processing.

Polar cross correlation is commonly used for determination of ocular torsion from video images, but breaks down at eccentric positions if the spherical geometry of the eye is not considered. We have extended this method to allow three-dimensional eye position measurement over a range of +/- 20 deg by determining the correct projection of the eye onto the image plane of the camera. We also determine the orientation of the camera with respect to the eye, allowing eye position to be represented in appropriate head-fixed coordinates. These algorithms have been validated using both in vitro and in vivo measures of eye position.

A theoretical analysis of three-dimensional eye position measurement using polar cross-correlation.

Polar cross-correlation is a commonly used technique for determination of torsional eye position from video images. At eccentric eye positions, the projection of the sampling window onto the image plane of the camera is translated and deformed due to the spherical shape of the eyeball. In this paper, we extend the polar cross-correlation technique by developing the formulas required to determine the correct location and shape of the sampling window at all eye positions. These formulas also allow the representation of three-dimensional eye position in Fick-angles, which are commonly used in oculomotor research. A numerical simulation shows the size of the errors in ocular torsion if the spherical geometry of the eye is not considered. Other effects which can affect the accuracy of video-based eye position measurements are also discussed.