Lateral Vestibulospinal Tract Research Articles

Cajal's contributions to vestibular research.

The Spanish neurohistologist Santiago Ramón y Cajal (1852-1934) is widely regarded as the father of modern Neuroscience. In addition to identifying the individuality of cells in the nervous system (the neuron theory) or the direction followed by nerve impulses (the principle of dynamic polarization), he described numerous details regarding the organization of the different structures of the nervous system. This task was compiled in his magnum opus, "Textura del Sistema Nervioso del Hombre y los Vertebrados," first published in Spanish between 1899 and 1904, and later revised and updated in French as "Histologie du système nerveux de l'homme et des vertébrés" between 1909 and 1911 for wider distribution among the international scientific community. Some of Cajal's findings are fundamental to our understanding of the anatomy and histology of the vestibular system. He depicted the nerve endings in the sensory epithelia, the structure of the vestibular nerve and Scarpa ganglion, afferent vestibular fibers, vestibular nuclei, lateral vestibulospinal tract, vestibulocerebellar connections, and the fine structure of the cerebellum. However, most of these pioneering descriptions were published years earlier in Spanish journals with limited circulation. Our study aimed to gather Cajal's findings on the vestibular system and identify his original publications. After this endeavor, we claim a place for Cajal among the founders of anatomy and histology of the vestibular system.

Vertebral level specific modulation of paraspinal muscle activity based on vestibular signals during walking.

Evoking muscle responses by electrical vestibular stimulation (EVS) may help to understand the contribution of the vestibular system to postural control. Although paraspinal muscles play a role in postural stability, the vestibulo-muscular coupling of these muscles during walking has rarely been studied. This study aimed to investigate how vestibular signals affect paraspinal muscle activity at different vertebral levels during walking with preferred and narrow step width. Sixteen healthy participants were recruited. Participants walked on a treadmill for 8min at 78steps/min and 2.8 km/h, at two different step width, either with or without EVS. Bipolar electromyography was recorded bilaterally from the paraspinal muscles at eight vertebral levels from cervical to lumbar. Coherence, gain, and delay of EVS and EMG responses were determined. Significant EVS-EMG coupling (P < 0.01) was found at ipsilateral and/or contralateral heel strikes. This coupling was mirrored between left and right relative to the midline of the trunk and between the higher and lower vertebral levels, i.e. a peak occurred at ipsilateral heel strike at lower levels, whereas it occurred at contralateral heel strike at higher levels. EVS-EMG coupling only partially coincided with peak muscle activity. EVS-EMG coherence slightly, but not significantly, increased when walking with narrow steps. No significant differences were found in gain and phase between the vertebral levels or step width conditions. In summary, vertebral level specific modulation of paraspinal muscle activity based on vestibular signals might allow a fast, synchronized, and spatially co-ordinated response along the trunk during walking. KEY POINTS: Mediolateral stabilization of gait requires an estimate of the state of the body, which is affected by vestibular afference. During gait, the heavy trunk segment is controlled by phasic paraspinal muscle activity and in rodents the medial and lateral vestibulospinal tracts activate these muscles. To gain insight in vestibulospinal connections in humans and their role in gait, we recorded paraspinal surface EMG of cervicalto lumbar paraspinal muscles, and characterized coherence, gain and delay between EMG and electrical vestibular stimulation, during slow walking. Vestibular stimulation caused phasic, vertebral level specific modulation of paraspinal muscle activity at delays of around 40ms, which was mirrored between left, lower and right, upper vertebral levels. Our results indicate that vestibular afference causesfast, synchronized, and spatially co-ordinated responses of the paraspinal muscles along the trunk, that simultaneously contribute to stabilizing the centre of mass trajectory and to keeping the head upright.

Contraversive Ocular Tilt Reaction, Body Lateropulsion and Gaze-Evoked Nystagmus After Inferior Cerebellar Peduncle and Dentate Nucleus Stroke

Contraversive Ocular Tilt Reaction, Body Lateropulsion and Gaze-Evoked Nystagmus After Inferior Cerebellar Peduncle and Dentate Nucleus Stroke

Relationships between changes in lateral vestibulospinal tract excitability and postural control by dynamic balance intervention in healthy individuals: A preliminary study.

We conducted dynamic balance or static intervention on healthy young adults to examine the changes in lateral vestibulospinal tract (LVST) excitability and postural control that ensued following dynamic balance intervention and to investigate the correlation between these changes. Twenty-eight healthy young adults were randomly assigned to either the dynamic balance group or the control group. They performed either a dynamic balance or static intervention for 10 trials of 30 s each and were assessed for head jerks during the intervention to confirm adaptation to the intervention. The dynamic balance intervention consisted of maintaining balance on a horizontally unstable surface, whereas the control intervention involved standing in the same foot position as the dynamic balance intervention on a stable surface while completing a maze task. LVST excitability and postural stability were assessed before and after the interventions. LVST excitability was assessed as the change rate in the soleus H-reflex amplitude with galvanic vestibular stimulation (GVSH). The velocity and area of the center of pressure (COP) were examined in the eyes closed/foam rubber condition. No significant main and interaction effects (task, time) were observed for GVSH and COP variables. In the dynamic balance intervention, head jerk significantly decreased, and GVSH-change and changes in head jerk and COP area were significantly negatively correlated. The LVST excitability change for the dynamic balance intervention varied among the participants, although increased LVST excitability may have been related to increased postural stability.

Perinatal development of central vestibular neurons in mice.

Central circuitry of the vestibular nuclei integrates sensory inputs in the adaptive control of motor behaviors such as posture, locomotion, and gaze stabilization. Thus far, such circuits have been mostly examined at mature stages, whereas their emergence and early development have remained poorly described. Here, we focused on the perinatal period of murine development, from embryonic day E14.5 to post-natal day P5, to investigate the ontogeny of two functionally distinct vestibular neuronal groups, neurons projecting to the spinal cord via the lateral vestibulospinal tract (LVST) and commissural neurons of the medial vestibular nucleus that cross the midline to the contralateral nucleus. Using transgenic mice and retrograde labeling, we found that network-constitutive GABAergic and glycinergic neurons are already established in the two vestibular groups at embryonic stages. Although incapable of repetitive firing at E14.5, neurons of both groups can generate spike trains from E15.5 onward and diverge into previously established A or B subtypes according to the absence (A) or presence (B) of a two-stage spike after hyperpolarization. Investigation of several voltage-dependent membrane properties indicated that solely LVST neurons undergo significant maturational changes in their electrophysiological characteristics during perinatal development. The proportions of A vs B subtypes also evolve in both groups, with type A neurons remaining predominant at all stages, and type B commissural neurons appearing only post-natally. Together, our results indicate that vestibular neurons acquire their distinct morpho-functional identities after E14.5 and that the early maturation of membrane properties does not emerge uniformly in the different functional subpopulations of vestibulo-motor pathways.

Lateral Medullary Syndrome Following Injury of Lateral Vestibulospinal Tract: Diffusion Tensor Imaging Study

BackgroundUnilateral lesions of vestibular nucleus can cause lateral medullary syndrome. Little is known about injury of medial and lateral vestibulospinal tract (VST) after dorsolateral medullary infarct. We investigated injury of the lateral VST in patients with typical central vestibular disorder using diffusion tensor tractography (DTT). MethodsSeven patients with lateral medullary syndrome and ten control subjects were recruited. For the medial VST, we determined seed region of interest (ROI) as medial vestibular nuclei of pons and target ROI on posteromedial medulla. For the lateral VST, the seed ROI was placed on lateral vestibular nuclei of pons, and the target ROI on posterolateral medulla. Fractional anisotropy (FA), mean diffusivity (MD), and tract volume were measured. ResultReconstructed lateral VST on both sides had significantly lower FA values in patients than controls (p<0.05). Tract volume of lateral VST in affected side was significantly lower than unaffected side and control group (p<0.05). However, no DTI parameters of the medial VST differed between patients and controls (p>0.05). ConclusionInjury of the lateral VST was demonstrated in patients with lateral vestibular syndrome following dorsolateral medullary infarct. Analysis of the lateral VST using DTT would be helpful in evaluation of patients with lateral medullary syndrome.

Effects of injuries to descending motor pathways on restoration of gait in patients with pontine hemorrhage

Background and PurposeGait disturbance due to injuries of the descending motor pathway, including corticospinal tract (CST), corticoreticular pathway (CRP), and medial and lateral vestibulospinal tracts (VSTs), are commonly encountered disabling sequelae of pontine hemorrhage. We investigated relations between changes in the CST, CRP, and medial and lateral VST and corresponding changes in gait function in patients with pontine hemorrhage. MethodNine consecutive stroke patients with pontine hemorrhage, and 6 age-matched normal subjects were recruited. Four patients were allocated to group A (can't walk independently) and 5 to group B (can walk independently). Diffusion tensor imaging (DTI) data were acquired twice at acute to subacute stage and chronic stage after stroke onset. Diffusion tensor tractography (DTT) was used to reconstruct CST, CRP, medial and lateral VST. ResultThe CRP shows a significantly different between groups A and B in both initial and follow up DTT (p > 0.05). In contrast, CST, medial VST and lateral VST did not show a significant difference (p > 0.05). Regarding DTI parameters of CRPs in group A, percentages of patients with fractional anisotropy (FA) and mean diffusivity (MD) values more than two standard deviation from normal were higher by follow up DTI than by initial DTI, however, the CRPs in group B only showed increased abnormal range of MD. ConclusionsThe CST does not play an essential role in recovery of independent walking and vestibulospinal tracts may not crucially affect recovery of independent walking in patients with pontine hemorrhage. In contrast, and intact CRP or changes of the CRP integrity appear to be related to the recovery of gait function.

Associations between Age-Related Changes in the Core Vestibular Projection Pathway and Balance Ability: A Diffusion Tensor Imaging Study.

Objective We investigated the changes of the vestibulospinal tract (VST) and parietoinsular vestibular cortex (PIVC) using diffusion tensor imaging (DTI) and relation to balance between old and young healthy adults. Methods This study recruited eleven old adults (6 males, 5 females; mean age 63.36 ± 4.25 years) and 12 young adults (7 males, 5 females; mean age 28.42 ± 4.40 years). The lateral and medial VST and PIVC were reconstructed using DTI. Fractional anisotropy (FA), mean diffusivity (MD), and tract volume were measured. The six-minute walk test (6-MWT), the timed up and go test (TUG), and the Berg balance scale (BBS) were conducted. Spatiotemporal parameters during tandem gait and values of sway during one-leg standing using the wearable sensors were measured. All parameters between two groups were analyzed by the Mann-Whitney U test and independent t-test. Results Statistically significant decrease in old adults was detected in the tract volume of lateral (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (Conclusion The results suggested that there was a relationship between DTI parameters in the vestibular neural pathway and balance according to aging.

Molecular Profiling Defines Evolutionarily Conserved Transcription Factor Signatures of Major Vestibulospinal Neuron Groups.

Vestibulospinal neurons are organized into discrete groups projecting from brainstem to spinal cord, enabling vertebrates to maintain proper balance and posture. The two largest groups are the lateral vestibulospinal tract (LVST) group and the contralateral medial vestibulospinal tract (cMVST) group, with different projection lateralities and functional roles. In search of a molecular basis for these differences, we performed RNA sequencing on LVST and cMVST neurons from mouse and chicken embryos followed by immunohistofluorescence validation. Focusing on transcription factor (TF)-encoding genes, we identified TF signatures that uniquely distinguish the LVST from the cMVST group and further parse different rhombomere-derived portions comprising the cMVST group. Immunohistofluorescence assessment of the CNS from spinal cord to cortex demonstrated that these TF signatures are restricted to the respective vestibulospinal groups and some neurons in their immediate vicinity. Collectively, these results link the combinatorial expression of TFs to developmental and functional subdivisions within the vestibulospinal system.

Three Dimensional Identification of Medial and Lateral Vestibulospinal Tract in the Human Brain: A Diffusion Tensor Imaging Study.

Purpose: The vestibulospinal tract (VST) is involved in balance control and gait function. No research has identified the VST in the human brain. In the current study, we attempted to identify the medial and lateral VST in the human brain, using diffusion tensor tractography (DTT).Materials and Methods: We recruited 40 healthy volunteers for this study. For reconstruction of the medial VST, a seed region of interest (ROI) was placed on the medial vestibular nuclei in the pons and target ROI on the posteromedial medulla. For reconstruction of the lateral VST, a seed ROI was placed on the lateral vestibular nuclei of pons and the target ROI on the posterolateral medulla. Values of fractional anisotropy (FA), mean diffusivity (MD), and tract volume of the medial and lateral VST were measured.Results: The medial VST, which originates from the medial vestibular nuclei, descends through the posteromedial medulla, and terminates at the anterior funiculus of the cervical spinal cord. The lateral VST originates from the lateral vestibular nuclei, and terminates in the anterior portion of lateral funiculus, through the posterolateral medulla. The FA value of medial VST was significantly higher than that of lateral VST. In contrast, the MD value and tract volume were significantly lower than those of lateral VST (p < 0.05).Conclusion: We identified the medial and lateral VST in the human brain using DTT and investigated the anatomical characteristics of the medial and lateral VST. The methodology and results of this study could be helpful to both clinicians and researchers in the neuroscience field.

Improvements in balance control in individuals with PCS detected following vestibular training: A case study

Concussed individuals have been found to experience balance deficits in the anterior-posterior (AP) direction as indicated by greater Center of Pressure (COP) displacement and velocity. One possible reason for this change in balance control could be due to damage to the lateral vestibulospinal tract which sends signals to control posterior muscles, specifically ankle extensors leading to compensatory torques about the ankle. The purpose of the study was to quantify balance assessments in individuals experiencing persistent post-concussion symptoms (PCS) to determine balance control changes following a vestibular training intervention. Participants (N=6,>26days symptomatic), were tested during their first appointment with a registered physiotherapist (PT) and during each follow up appointment. Participants were prescribed balance, visual, and neck strengthening exercises by the PT that were to be completed daily between bi-weekly appointments. Balance assessments were quantified using a Nintendo Wii board to record ground reaction forces. Participants completed 4 balance assessments: 1) Romberg stance eyes open (REO); 2) Romberg stance eyes closed (REC); 3) single leg stance eyes open (SEO); and 4) single leg stance eyes closed (SEC). The balance assessments were conducted on both a firm and compliant surfaces. Significant improvements in balance control were noted in ML/AP displacement and velocity of COP for both SEC and Foam REC conditions, with additional improvements in AP velocity of COP for Foam REC and in ML displacement of COP during Foam SEC. Overall, findings indicate that objectively quantifying balance changes for individuals experiencing persistent PCS allows for a more sensitive measure of balance and detects changes unrecognizable to the naked eye.

Nuclear derivatives and axonal projections originating from rhombomere 4 in the mouse hindbrain

The r4-derived territory is located in the pontine region of the brainstem, forming a wedge-shaped slice that broadens from the choroidal roof to the ventral midline. R4-derived neuronal populations migrate radially inside and tangentially outside this rhombomere, forming nuclei of the sensorimotor auditory, vestibular, trigeminal and reticular systems. R4-derived fibre tracts contribute to the lateral lemniscus, the trigeminothalamic tracts, the medial tegmental tract and the medial forebrain bundle, which variously project to the midbrain, thalamus, hypothalamus and telencephalon. Other tracts such as the trigeminocerebellar and vestibulocerebellar tracts reach the cerebellum, while the medial and lateral vestibulospinal tracts, and the reticulospinal and trigeminal oro-spinal tracts extend into the spinal cord. Many r4-derived fibres are crossed; they decussate to the contralateral side traversing the midline through the cerebellar, collicular and intercollicular commissures, as well as the supraoptic decussation. Moreover, some fibres enter into the posterior and anterior commissures and some terminals reach the septum. Overall, this study provides an overview of all r4 neuronal populations and axonal tracts from their embryonic origin to the adult final location and target.

Descending Influences on Vestibulospinal and Vestibulosympathetic Reflexes.

This review considers the integration of vestibular and other signals by the central nervous system pathways that participate in balance control and blood pressure regulation, with an emphasis on how this integration may modify posture-related responses in accordance with behavioral context. Two pathways convey vestibular signals to limb motoneurons: the lateral vestibulospinal tract and reticulospinal projections. Both pathways receive direct inputs from the cerebral cortex and cerebellum, and also integrate vestibular, spinal, and other inputs. Decerebration in animals or strokes that interrupt corticobulbar projections in humans alter the gain of vestibulospinal reflexes and the responses of vestibular nucleus neurons to particular stimuli. This evidence shows that supratentorial regions modify the activity of the vestibular system, but the functional importance of descending influences on vestibulospinal reflexes acting on the limbs is currently unknown. It is often overlooked that the vestibulospinal and reticulospinal systems mainly terminate on spinal interneurons, and not directly on motoneurons, yet little is known about the transformation of vestibular signals that occurs in the spinal cord. Unexpected changes in body position that elicit vestibulospinal reflexes can also produce vestibulosympathetic responses that serve to maintain stable blood pressure. Vestibulosympathetic reflexes are mediated, at least in part, through a specialized group of reticulospinal neurons in the rostral ventrolateral medulla that project to sympathetic preganglionic neurons in the spinal cord. However, other pathways may also contribute to these responses, including those that dually participate in motor control and regulation of sympathetic nervous system activity. Vestibulosympathetic reflexes differ in conscious and decerebrate animals, indicating that supratentorial regions alter these responses. However, as with vestibular reflexes acting on the limbs, little is known about the physiological significance of descending control of vestibulosympathetic pathways.

Neuroanatomy of Isolated Body Lateropulsion

Axial body lateropulsion, a phenomenon where the body is pulled toward the side of the lesion, with tendency of falling down, is the well-known transient feature of lateral medullary syndrome. In some cases, axial body lateropulsion occurs without vestibular and cerebellar symptoms (isolated body lateropulsion:[iBL]). Patients with iBL have a lesion located in the spinocerebellar tract, descending lateral vestibulospinal tract, vestibulo-thalamic pathway, dentatorubrothalamic pathway, or thalamocortical fascicle. This review deals with the anatomic basis and clinical significance of iBL.

Early postnatal maturation in vestibulospinal pathways involved in neck and forelimb motor control.

To assess the organization and functional development of vestibulospinal inputs to cervical motoneurons (MNs), we have used electrophysiology (ventral root and electromyographic [EMG] recording), calcium imaging, trans-synaptic rabies virus (RV) and conventional retrograde tracing and immunohistochemistry in the neonatal mouse. By stimulating the VIIIth nerve electrically while recording synaptically mediated calcium responses in MNs, we characterized the inputs from the three vestibulospinal tracts, the separate ipsilateral and contralateral medial vestibulospinal tracts (iMVST/cMVST) and the lateral vestibulospinal tract (LVST), to MNs in the medial and lateral motor columns (MMC and LMC) of cervical segments. We found that ipsilateral inputs from the iMVST and LVST were differentially distributed to the MMC and LMC in the different segments, and that all contralateral inputs to MMC and LMC MNs in each segment derive from the cMVST. Using trans-synaptic RV retrograde tracing as well as pharmacological manipulation of VIIIth nerve-elicited synaptic responses, we found that a substantial proportion of inputs to both neck and forelimb extensor MNs was mediated monosynaptically, but that polysynaptic inputs were also significant. By recording EMG responses evoked by natural stimulation of the vestibular apparatus, we found that vestibular-mediated motor output to the neck and forelimb musculature became more robust during the first 10 postnatal days, concurrently with a decrease in the latency of MN discharge evoked by VIIIth nerve electrical stimulation. Together, these results provide insight into the complexity of vestibulospinal connectivity in the cervical spinal cord and a cogent demonstration of the functional maturation that vestibulospinal connections undergo postnatally. © 2016 Wiley Periodicals, Inc. Develop Neurobiol 76: 1061-1077, 2016.

Loss of Projections, Functional Compensation, and Residual Deficits in the Mammalian Vestibulospinal System of Hoxb1-Deficient Mice.

The genetic mechanisms underlying the developmental and functional specification of brainstem projection neurons are poorly understood. Here, we use transgenic mouse tools to investigate the role of the gene Hoxb1 in the developmental patterning of vestibular projection neurons, with particular focus on the lateral vestibulospinal tract (LVST). The LVST is the principal pathway that conveys vestibular information to limb-related spinal motor circuits and arose early during vertebrate evolution. We show that the segmental hindbrain expression domain uniquely defined by the rhombomere 4 (r4) Hoxb1 enhancer is the origin of essentially all LVST neurons, but also gives rise to subpopulations of contralateral medial vestibulospinal tract (cMVST) neurons, vestibulo-ocular neurons, and reticulospinal (RS) neurons. In newborn mice homozygous for a Hoxb1-null mutation, the r4-derived LVST and cMVST subpopulations fail to form and the r4-derived RS neurons are depleted. Several general motor skills appear unimpaired, but hindlimb vestibulospinal reflexes, which are mediated by the LVST, are greatly reduced. This functional deficit recovers, however, during the second postnatal week, indicating a substantial compensation for the missing LVST. Despite the compensatory plasticity in balance, adult Hoxb1-null mice exhibit other behavioral deficits that manifest particularly in proprioception and interlimb coordination during locomotor tasks. Our results provide a comprehensive account of the developmental role of Hoxb1 in patterning the vestibular system and evidence for a remarkable developmental plasticity in the descending control of reflex limb movements. They also suggest an involvement of the lateral vestibulospinal tract in proprioception and in ensuring limb alternation generated by locomotor circuitry.

Deiters' Nucleus. Its Role in Cerebellar Ideogenesis : The Ferdinando Rossi Memorial Lecture.

Otto Deiters (1834–1863) was a promising neuroscientist who, like Ferdinando Rossi, died too young. His notes and drawings were posthumously published by Max Schultze in the book “Untersuchungen über Gehirn und Rückenmark.” The book is well-known for his dissections of nerve cells, showing the presence of multiple dendrites and a single axon. Deiters also made beautiful drawings of microscopical sections through the spinal cord and the brain stem, the latter showing the lateral vestibular nucleus which received his name. This nucleus, however, should be considered as a cerebellar nucleus because it receives Purkinje cell axons from the vermal B zone in its dorsal portion. Afferents from the labyrinth occur in its ventral part. The nucleus gives rise to the lateral vestibulospinal tract. The cerebellar B module of which Deiters’ nucleus is the target nucleus was used in many innovative studies of the cerebellum on the zonal organization of the olivocerebellar projection, its somatotopical organization, its microzones, and its role in posture and movement that are the subject of this review.

Segmental organization of vestibulospinal inputs to spinal interneurons mediating crossed activation of thoracolumbar motoneurons in the neonatal mouse.

Vestibulospinal pathways activate contralateral motoneurons (MNs) in the thoracolumbar spinal cord of the neonatal mouse exclusively via axons descending ipsilaterally from the vestibular nuclei via the lateral vestibulospinal tract (LVST; Kasumacic et al., 2010). Here we investigate how transmission from the LVST to contralateral MNs is mediated by descending commissural interneurons (dCINs) in different spinal segments. We test the polysynaptic nature of this crossed projection by assessing LVST-mediated ventral root (VR) response latencies, manipulating synaptic responses pharmacologically, and tracing the pathway transynaptically from hindlimb extensor muscles using rabies virus (RV). Longer response latencies in contralateral than ipsilateral VRs, near-complete abolition of LVST-mediated calcium responses in contralateral MNs by mephenesin, and the absence of transsynaptic RV labeling of contralateral LVST neurons within a monosynaptic time window all indicate an overwhelmingly polysynaptic pathway from the LVST to contralateral MNs. Optical recording of synaptically mediated calcium responses identifies LVST-responsive ipsilateral dCINs that exhibit segmental differences in proportion and dorsoventral distribution. In contrast to thoracic and lower lumbar segments, in which most dCINs are LVST responsive, upper lumbar segments stand out because they contain a much smaller and more ventrally restricted subpopulation of LVST-responsive dCINs. A large proportion of these upper lumbar LVST-responsive dCINs project to contralateral L5, which contains many of the hindlimb extensor MNs activated by the LVST. A selective channeling of LVST inputs through segmentally and dorsoventrally restricted subsets of dCINs provides a mechanism for targeting vestibulospinal signals differentially to contralateral trunk and hindlimb MNs in the mammalian spinal cord.

Recovery of static stability following a concussion

The purpose of this study was to use centre of pressure (COP) measurements to determine if static balance deficits had recovered when concussed athletes were cleared to return to play. Nine concussed varsity football players were matched with nine teammates who served as controls. Static balance in the anterior–posterior (A/P) and medial–lateral (M/L) directions was assessed during quiet stance with eyes open and eyes closed. Results showed that concussed football players displayed greater A/P COP displacements in the acute phase, which recovered by RTP; however, COP velocity remained elevated compared to controls even at RTP, particularly in the A/P direction. This balance control deficit in the A/P direction may suggest vestibular impairment, likely due to poor sensorimotor integration of the lateral vestibulospinal tract. The observed persistence of balance control deficits in concussed football players at RTP are usually undetected by traditional assessments because the current study used higher-order COP analysis. Future RTP balance measures may want to incorporate higher-order measures of balance.

Is abnormal vestibulomotor responses related to idiopathic scoliosis onset or severity?

Results from several studies have suggested that brainstem dysfunction occurs more often in adolescent with idiopathic scoliosis compared to healthy individuals. The vestibular nuclei occupy a prominent position in the brainstem. Because the lateral vestibulospinal tract controls axial muscles, alteration in the brainstem during body growth (i.e., preadolescent and adolescent period) may translate in abnormal trunk activation and thus cause permanent spinal deformities. We conceive that vestibular dysfunction may be observed only in AIS patients with severe spine deviation. Consequently, adolescent with severe idiopathic scoliosis (AIS) would exhibit abnormal vestibulomotor responses compared to healthy age-matched individuals and AIS patients with mild spine deformation. If this hypothesis is confirmed, it will suggest that abnormal vestibulomotor response may contribute to curve progression. On the other hand, if AIS patients with mild severity also show abnormal vestibulomotor response, it will indicate that impaired vestibulomotor may be related to scoliosis onset but is not necessarily related to curve progression. It is expected, however, that regardless of curve severity, not all patients would have abnormal vestibulomotor responses. For instance, in some cases, gene defects may lead to malformation of the semicircular canals or alteration of the vestibular cortical network and cause scoliosis or curve progression.