Optokinetic Stimulation Research Articles

The comparison between intratympanic gentamicin prehabilitation and postoperative virtual reality exposure to standard vestibular training in patients with vestibular schwannoma.

Resection of the vestibular schwannoma causes acute peripheral vestibular loss. The process of central compensation starts immediately afterward. The rehabilitation goal is to support this process and restore the quality of life. In this prospective single-center study, 67 consecutive patients underwent vestibular schwannoma resection (40 females, mean age 52 ± 12 years). The patients were divided into three groups: the prehabilitation with intratympanic gentamicin group, the virtual reality group (optokinetic stimulation via virtual reality goggles in the first ten days after the surgery), and the control group. All patients were examined with objective methods and completed questionnaires before the prehabilitation, before the surgery, at the hospital discharge, and after three months. Intratympanic gentamicin prehabilitation leads ipsilaterally to a significant aVOR reduction in all semicircular canals (p < 0.050), the increase of the unilateral weakness in air calorics (p = 0.026), and loss of cVEMPs responses (p = 0.017). Prehabilitation and postoperative exposure to virtual reality scenes improved the patient's perception of vertigo problems according to Dizziness Handicap Inventory (p = 0.039 and p = 0.076, respectively). These findings conform with the optokinetic testing results, which showed higher slow phase velocities at higher speeds (40deg/s) in both targeted groups compared to the control group. Preoperative intratympanic gentamicin positively affects peripheral vestibular function, influencing balance perception after VS resection. In long-term follow-up, prehabilitation and postoperative exposure to virtual reality improve patients' quality of life in the field of vertigo problems.

Evaluation of the Effects of Optokinetic Stimuli and Dual-Task Performance on Vestibulo-Ocular Reflex Function in Children With Attention Deficit and Hyperactivity Disorder.

This study investigated the effects of optokinetic stimuli and dual-task performance on vestibulo-ocular reflex (VOR) function. The study primarily focused on understanding the effects of attention deficit and hyperactivity disorder (ADHD) and its subtypes. A case-control study. Tertiary medical centre. Thirty-eight children diagnosed with ADHD and 40 typically developing (TD) children aged 8-18 were included in the study. According to their diagnostic reports, children diagnosed with ADHD were also examined in three subtypes: predominantly inattentive (ADHD-PI), predominantly hyperactive-impulsive (ADHD-HI) and the combined type. Functional head impulse test (fHIT) was applied to all participants in three conditions-with no additional stimulus, optokinetic stimulation and dual-task. Correct responses (CR) were determined for each group, and the conditions were compared. For the dual-task test performance, children were given a counting task. The findings of the study are significant. The CR values obtained from the fHIT tests applied under three different conditions were lower in the ADHD group compared to the control group. CR values for all fHIT conditions and all semicircular canals were lower in the ADHD-PI subtype and higher in the ADHD-HI subtype compared to other subgroups. This study has significant practical implications underscoring its relevance. fHIT, when applied with different protocols, can provide valuable information about the vestibular and cognitive states of children with ADHD. These results are particularly significant as the diagnosis of ADHD often relies on subjective interpretations, and fHIT offers a more objective and reliable method of evaluation.

Gaze and attention: mechanisms underlying the therapeutic effect of optokinetic stimulation in spatial neglect

Left smooth pursuit eye movement training in response to large-field visual motion (optokinetic stimulation) has become a promising rehabilitation method in left spatial inattention or neglect. The mechanisms underlying the therapeutic effect, however, remain unknown. During optokinetic stimulation, there is an error in visual localization ahead of the line of sight. This could indicate a change in the brain’s estimate of one’s own direction of gaze. We hypothesized that optokinetic stimulation changes the brain’s estimate of gaze. Because this estimate is critical for coding the locus of attention in the visual space relative to the body and across sensory modalities, its change might underlie the change in spatial attention. Here, we report that in healthy participants optokinetic stimulation causes not only a directional bias in the proprioceptive signal from the extraocular muscles, but also a corresponding shift of the locus of attention. Both changes outlasted the period of stimulation. This result forms a step in investigating a causal link between the adaptation in the sensorimotor gaze signals and the recovery in spatial neglect.

Temporal dynamics of ocular torsion and vertical vergence during visual, vestibular, and visuovestibular rotations.

Ocular torsion and vertical divergence reflect the brain's sensorimotor integration of motion through the vestibulo-ocular reflex (VOR) and the optokinetic reflex (OKR) to roll rotations. Torsion and vergence however express different response patterns depending on several motion variables, but research on their temporal dynamics remains limited. This study investigated the onset times of ocular torsion (OT) and vertical vergence (VV) during visual, vestibular, and visuovestibular motion, as well as their relative decay rates following prolonged optokinetic stimulations. Temporal characteristics were retrieved from three separate investigations where the level of visual clutter and acceleration were controlled. Video eye-tracking was used to retrieve the eye-movement parameters from a total of 41 healthy participants across all trials. Ocular torsion consistently initiated earlier than vertical vergence, particularly evident under intensified visual information density, and higher clutter levels were associated with more balanced decay rates. Additionally, stimulation modality and accelerations affected the onsets of both eye movements, with visuovestibular motion triggering earlier responses compared to vestibular motion, and increased accelerations leading to earlier onsets for both movements. The present study showed that joint visuovestibular responses produced more rapid onsets, indicating a synergetic sensorimotor process. It also showed that visual content acted as a fusional force during the decay period, and imposed greater influence over the torsional onset compared to vergence. Acceleration, by contrast, did not affect the temporal relationship between the two eye movements. Altogether, these findings provide insights into the sensorimotor integration of the vestibulo-ocular and optokinetic reflex arcs.

Optokinetic stimulation in the rehabilitation of visually induced dizziness in people with vestibular disorders: A systematic review

Objective This systematic review and meta-analysis investigates the effects optokinetic stimulation in people with vestibular disorders, with a specific focus on people with visually induced dizziness. Data sources A systematic review was conducted using three electronic databases, CINAHL, PubMed and Physiotherapy Evidence Database (PEDro), from 2000 up to February 2024. Review methods Randomised controlled trials were included, which compared: (a) adults above 18 years old with vestibular disorders, (b) the study evaluated interventions using optokinetic stimulation, (c) the intervention was compared with usual care; placebo or to no intervention, (d) the study included at least one outcome measure evaluating vestibular symptoms and (e) published in English. The methodological quality of the included studies was assessed using the PEDro scale and PROSPERO's registration number ID: CRD42021273382). Results Eleven randomised control trials, reported in 12 records, fulfilled the inclusion criteria. All of the studies were considered to have ‘good’ methodological quality according to the PEDro scale. All studies showed significant improvement in vestibular symptoms in both the intervention and control groups. A meta-analysis performed on six of the records found a preference towards the addition of OKS to conventional vestibular rehabilitation helped to further reduce dizziness symptoms for patients, but the results were not statistically significant. Conclusion No optimal duration or frequency for OKS has been determined. The addition of OKS to conventional vestibular rehabilitation may be beneficial in further improving vestibular symptoms in patients with dizziness. OKS could help to improve enjoyment and adherence to vestibular rehabilitation.

Guideline for standardized approach in the treatment of the Mal de Debarquement syndrome.

Mal de Debarquement Syndrome (MdDS) is a debilitating neuro-otological disorder. Patients experience almost continuously a perception of self-motion. This syndrome can be motion-triggered (MT-MdDS), such as on a boat, or occur spontaneously or have other triggers (SO-MdDS) in the absence of such motion. Because the pathophysiological mechanism is unknown, treatment options and symptom management strategies are limited. One available treatment protocol involves a readaptation of the vestibular ocular reflex (VOR). This study assesses the effectiveness of vestibulo-ocular reflex (VOR) readaptation in 131 consecutive patients with a fixed protocol. We administered 131 treatments involving optokinetic stimulation (OKS) paired with a fixed head roll at 0.167 Hz over two to five consecutive days. Each day, four-minute treatment blocks were scheduled twice in the morning and afternoon. Treatment effectiveness was evaluated through questionnaires and posturography. We observed significant improvements in the visual analog scale (VAS), MdDS symptom questionnaire, and posturography measures from pre- to post-treatment. No significant differences were found in outcome variables between MT- and SO-MdDS onsets. Symptoms improved subjectively and objectively in patients' post-treatment. The overall success rate was 64.1%, with no significant difference between MT (64.2%) and SO (63.3%). This study supports the conclusion that VOR readaptation treatment provides relief for two-thirds of MdDS patients, irrespective of the onset type. Based on consistency in the findings, we propose a standardized method for treatment of MdDS based on the OKS with head roll paradigm.

Evaluation of the vestibulo-ocular reflex with the functional head impulse test in people with motion sickness

Abstract Background In this study, we aimed to examine functional VOR values with and without optokinetic background stimulation in fHIT (functional head impulse test) in individuals with motion sickness. Methods Forty-two individuals between the ages of 18–50 years were included in study. The lateral fHIT test was applied to the motion sickness group and the control group with and without dynamic optokinetic (OKN) background stimulation. Results In the control group, no significant difference was observed in the correct response percentages (% CA) for fHIT and OKN-fHIT for the right and left lateral canals (p &gt; 0.05). In the MS group, a significant difference was observed when comparing fHIT and OKN-fHIT correct response percentages for the right and left lateral canals (p &lt; 0.05). Conclusions It has been observed that the optokinetic background triggers the disease in individuals with MS, and there is a decrease in the percentage of correct readings in the fHIT.

Comparative effectiveness of non- pharmacological treatments in patients with persistent postural-perceptual dizziness: a systematic review and effect sizes analyses.

The patho-psychological mechanisms of persistent postural-perceptual dizziness (PPPD) appear to be very complex, and a multimodal, multidisciplinary approach is suggested for treating patients with PPPD. The aim of this review was to provide a comprehensive overview of non-pharmacological treatments and their comparative effectiveness in patients with PPPD. Scopus, Web of Science, PsycINFO, Medline, Embase, CINAHL, Cochrane Library and ClinicalTrials.gov were searched in April 2022 with a search update in August 2023. Only randomized controlled trials (RCTs) were included. There was no restrictions regarding publication date. Two reviewers independently identified eligible trials, extracted data, double-checked all extracted information from the included articles and assessed the risk of bias using the Cochrane risk of bias tool. A qualitative synthesis was performed, considering methodological heterogeneity between trials. Finally, an effect size analysis was performed for each treatment comparison. The standardized mean differences (SMD) and their corresponding 95% confidence intervals (95%CI) were calculated for each trial using Review Manager 5.4. Thirteen RCTs (618 patients with moderate or mild dizziness) out of 1,362 references describing seven different non-pharmacological comparisons were selected. Nine trials included patients with PPPD, and four trials included patients with functional dizziness. The trials used different interventions that were classified as: (1) psychotherapeutic interventions (cognitive behavioral therapy, patient education), (2) physiotherapeutic interventions/training (vestibular rehabilitation, optokinetic stimulation), (3) stimulation procedures (vagus nerve stimulation, transcranial direct current stimulation) and (4) device application (visual desensitization using personalized glasses). However, most of the trials investigated the effects of single interventions, rather than multimodal interdisciplinary treatment of patients with PPPD. The SMD for dizziness handicap and severity was between 0.04 and 0.52 in most trials. In one trial using visual desensitization, the SMD was 1.09 (strong effect on the severity of dizziness) and 1.05 (strong effect on dizziness handicap). Several individual interventions have shown benefits in the treatment of patients with PPPD with small to moderate effects. However, the multimodal treatment or a combination of vestibular rehabilitation with visual desensitization, cognitive behavioral therapy including patient education, and medication support should be further investigated. Future trials should include a large sample size with severe dizziness, and provide a longer follow-up period. PROSPERO CRD42022320344.

Modulation of Visually Induced Self-motion Illusions by α Transcranial Electric Stimulation over the Superior Parietal Cortex.

The growing popularity of virtual reality systems has led to a renewed interest in understanding the neurophysiological correlates of the illusion of self-motion (vection), a phenomenon that can be both intentionally induced or avoided in such systems, depending on the application. Recent research has highlighted the modulation of α power oscillations over the superior parietal cortex during vection, suggesting the occurrence of inhibitory mechanisms in the sensorimotor and vestibular functional networks to resolve the inherent visuo-vestibular conflict. The present study aims to further explore this relationship and investigate whether neuromodulating these waves could causally affect the quality of vection. In a crossover design, 22 healthy volunteers received high amplitude and focused α-tACS (transcranial alternating current stimulation) over the superior parietal cortex while experiencing visually induced vection triggered by optokinetic stimulation. The tACS was tuned to each participant's individual α peak frequency, with θ-tACS and sham stimulation serving as controls. Overall, participants experienced better quality vection during α-tACS compared with control θ-tACS and sham stimulations, as quantified by the intensity of vection. The observed neuromodulation supports a causal relationship between parietal α oscillations and visually induced self-motion illusions, with their entrainment triggering overinhibition of the conflict within the sensorimotor and vestibular functional networks. These results confirm the potential of noninvasive brain stimulation for modulating visuo-vestibular conflicts, which could help to enhance the sense of presence in virtual reality environments.

Poster Session I: Dissociation of torsional eye movements and perception during optokinetic stimulation by visual cues of gravity.

An optokinetic stimulus rotating about the naso-occipital axis drives torsional eye movements and causes a bias in perception of upright measured with a subjective visual vertical (SVV) task. In addition, a static image with tilted visual cues of gravity orientation will induce optostatic torsion and biases SVV. We posit that a visual gravity cue provided by a frame combined with a torsional optokinetic stimulus would increase measured torsion and further bias SVV. We use a VR headset with eye-tracking to place the subject in a virtual room with circles forming either a rectangular room (frame condition) or a tubular room (no-frame condition). We place a fixation point at the center of the room while the subject performs a SVV task. The room either rotates about the naso-occipital axis at 0.05 Hz, 0.1 Hz, or 0.2 Hz, with an amplitude of ±20°, or has a static tilt of 0° or ±30°. Static frame conditions had the expected bias of SVV and optostatic torsion compared to the control no-frame condition. In sinusoidal rotation conditions, for SVV, there was a significant difference in the amplitude of the response between the frame (5.4 ± 2.6°; mean ± std) and no-frame (3.0 ± 1.3°) condition, while there was no significant difference for torsion, frame (0.8 ± 0.6°) and no-frame (0.7 ± 0.6°). Our results indicate that while perception integrates a moving visual cue into its estimation of upright orientation, the ocular motor system is only affected by those cues when they are static.

Optokinetic stimulation effects in the management of unilateral spatial neglect in patients with chronic stroke: study protocol for a randomised controlled trial

IntroductionUnilateral spatial neglect (USN) is a stroke complication of stroke. Optokinetic stimulation (OKS) is one of the treatments, but its effects on motor symptoms, such as poverty or alterations in...

A quantitative approach to study the adaptation of rhythmic eye movements and the resulting tonic eye deviation in larval zebrafish.

To optimize performance during vital tasks, animals are capable of tuning rhythmic neural signals that drive repetitive behaviors, such as motor reflexes under constant sensory stimuli. In the oculomotor system, animals track the moving image during slow phases while repetitively resetting the eye position from the eccentricity during quick phases. During optokinetic response (OKR), larval zebrafish occasionally show a delayed quick phase; thus, the eyes remain tonically deviated from the center. In this study, we scrutinized OKR in larval zebrafish under a broad range of stimulus velocities to determine the parametric property of the quick-phase delay. A prolonged stimulation revealed that the slow-phase (SP) duration-the interval between two quick phases-was tuned increasingly over time toward a homeostatic range, regardless of stimulus velocity. Attributed to this rhythm control, larval zebrafish exhibited a tonic eye deviation following slow phases, which was especially pronounced when tracking a fast stimulus over an extended time period. In addition to the SP duration, the fixation duration between spontaneous saccades in darkness also revealed a similar adaptive property after the prolonged optokinetic stimulation. Our results provide a quantitative description of the adaptation of rhythmic eye movements in developing animals and pave the way for potential animal models for eye movement disorders.

Combined optokinetic stimulation and cueing-assisted reading therapy to treat hemispatial neglect: A randomized controlled crossover trial.

Hemispatial neglect is a disabling cognitive disorder following stroke and effective therapies are required. To evaluate the effects of combined optokinetic stimulation (OKS) and cueing-assisted reading therapy (READ) on the remission of hemispatial neglect following stroke. Randomized, controlled, two-period, crossover trial conducted at a German neurorehabilitation center. Twenty participants with left neglect following right hemispheric stroke (mean age 66 years (SD 11), mean time since stroke 50 days (SD 33)) finished the trial (12 received OKSREAD first, 8 CONTROL first). The intervention consisted of 15 daily sessions of OKS (20 min) and text reading assisted by a therapist providing cues (20 min). The control treatment was a same-number, same-length neuropsychological treatment not targeting visuospatial attention. Primary outcomes were the change in performance of a customized neuropsychological test battery for neglect (0% worst - 100% best) and a test of neglect-related functional disability (Catherine Bergego Scale, 0 no impairment - 30 severest impairment), assessed before and after each treatment period. Secondary outcomes were performance in the 6 single tests composing the battery (e.g., omissions in text reading, center of cancellation in the Bells test, spatial bias of fixations when freely viewing photographs) and a clinical test of anosognosia. Overall performance in the neglect test battery improved slightly more after OKSREAD than after CONTROL (d=6%; p=0.002). The remission of neglect-related functional disability did not differ between treatments (d=-2; p=0.291). Ipsilesional fixation bias during free viewing was the only secondary outcome that was improved by OKSREAD as compared to CONTROL (d= -2.8°; p=0.005). At the applied intensity, the combined OKSREAD intervention slightly attenuated the ipsilesional attention bias in persons with neglect, but it did not improve neglect-related functional disability, anosognosia, or other neglect symptoms to a clinically meaningful degree. URL: http://www. gov. Unique identifier: NCT04273620.

Effectiveness of non-pharmacological treatments for vestibular and oculomotor dysfunction in patients with persistent post-concussive symptoms: protocol for a systematic review and meta-analysis

IntroductionConcussion is a form of mild traumatic brain injury that disrupts brain function. Although symptoms are mostly transient, recovery can be delayed and result in persistent postconcussive symptoms (PPCS). Vestibular...

Vestibular rehabilitation potential of commercially available virtual reality video games

BackgroundPeripheral vestibular disorders affect 2.8–6.5% of people. Standard treatment is vestibular rehabilitation therapy, and virtual reality (VR) could improve outcomes. The objective of this study was to identify the commercially available VR video game that is most congruent to vestibular rehabilitation therapy.MethodsA term search “virtual reality racing” was performed on the App Store in March 2022. Results were screened for free point-of-view racing games compatible with Android and iOS devices. An investigator was filmed playing each game and videos were distributed to 237 physiotherapists. Physiotherapists completed a survey of 5-point Likert scale questions that assessed the video games vestibular rehabilitation potential. Survey responses were analyzed using Friedman Two-Way ANOVA (alpha = 0.05) and paired samples sign test with Bonferroni correction.ResultsThe search yielded 58 games, 4 were included. Forty physiotherapists participated. VR Tunnel Race (VRTR) and VR Real World Bike Racing (VRWBR) had the greatest vestibular rehabilitation potential (median global scores = 18.00). VRTR replicated habituation exercises significantly (p < 0.001) better than Derby VR, and VRWBR replicated physiotherapist-prescribed exercises significantly (p < 0.001) better than VR X-Racer. There were no discernable significant differences between VRWBR and VRTR.ConclusionsVRTR and VRWBR are the most congruent VR games to standard vestibular rehabilitation. VRWBR is preferable to VRTR with respect to ease of use and the ability to alter the amount of optokinetic stimulation. Prospective studies are needed to confirm the efficacy of these videos games and to determine if they could be used as solitary treatments.Trial registration: Not applicable.Graphical abstract

The integrated optokinetic nystagmus inter-saccadic interval scales statistical different in a group of vertigo patients depended on the stimulation velocity, but not for healthy subjects

Optokinetic nystagmus is rhythmic eye movements, back and forth, with a slow and fast phase, when the eyes are presented for full-field visual stimulus. OKN was recorded in 10 healthy subjects and 10 patients suffering from vertigo, for four conditions: stripes moving 30 o/s left and right and 60 o/s left and right. The aim of the present study was to analyze if the optokinetic stimulation intensity, stripes moving with angular velocity of 30 and 60 o/s, below and above the normal threshold for smooth pursuit function, influences the scaling properties of the integrated optokinetic nystagmus inter-saccadic intervals in a group of patients suffering from vertigo and a group of healthy subjects. Calculating the scaling, the spread over time, for the integrated optokinetic nystagmus inter-saccadic intervals, the time intervals between the onsets of consecutive fast components, shows lower Hurst exponent for velocity stimulation of 30o/s compared to 60o/s for both patients and health subjects, but only reach statistical significance for the group of patients. This result is a novel finding.

Optokinetic set-point adaptation functions as an internal dynamic calibration mechanism for oculomotor disequilibrium

Experience-dependent brain circuit plasticity underlies various sensorimotor learning and memory processes. Recently, a novel set-point adaptation mechanism was identified that accounts for the pronounced negative optokinetic afternystagmus (OKAN) following a sustained period of unidirectional optokinetic nystagmus (OKN) in larval zebrafish. To investigate the physiological significance of optokinetic set-point adaptation, animals in the current study were exposed to a direction-alternating optokinetic stimulation paradigm that better resembles their visual experience in nature. Our results reveal that not only was asymmetric alternating stimulation sufficient to induce the set-point adaptation and the resulting negative OKAN, but most strikingly, under symmetric alternating stimulation some animals displayed an inherent bias of the OKN gain in one direction, and that was compensated by the similar set-point adaptation. This finding, supported by mathematical modeling, suggests that set-point adaptation allows animals to cope with asymmetric optokinetic behaviors evoked by either external stimuli or innate oculomotor biases.

Tandem Walk in Simulated Martian Gravity and Visual Environment.

Astronauts returning from long-duration spaceflights experience visual-vestibular conflicts that causes motion sickness, perceptions that the environment is moving when it is not, and problems with walking and other functional tasks. To evaluate whether astronauts will have similar decrements after they land on Mars following exposure to weightlessness, participants were held by a device that offloads their weight, first entirely (0 G), and then partially (0.38 G) or not at all (1 G). Tandem (heel-to-toe) walk on a medium-density foam surface was used to assess the subject’s walking performance. Two visual conditions in virtual reality were investigated: normal vision and a visual-vestibular conflict generated by disorienting optokinetic stimulation (DOS). Tandem walking performance with DOS was better in 0.38 G compared to 1 G. Tandem walking performance in DOS in 1 G was not significantly different from tandem walking performance after spaceflight or bed rest. The increased tandem walking performance in 0.38 G compared to 1 G was presumably due to an increased cone of stability, allowing a larger amplitude of body sway without resulting in a fall. Tandem walking on a compliant foam surface with a visual-vestibular conflict is a potential analog for simulating postflight dynamic balance deficits in astronauts.

Slower velocity perception with stronger optokinetic nystagmus: A paradoxical perception in virtual reality

BackgroundOptokinetic nystagmus (OKN) was studied in an immersive virtual reality (VR) environment with both typical optokinetic stimulation (OKs) wherein the head-tracking is active (similar to be sitting in front of a rotating drum) or a unique stimulus (VR-OKs) wherein the head-tracking is turned off, so head movements do not update the visual image (which moves with the head). ObjectiveTo study both the perception of the stimulus velocity and eye movements while subjects rotated their head from side to side and the visual scene was either a typical OKs or VR-OKs. Methods9 healthy participants (aged 23 ± 2.4 y/o) had head and eye movements recorded under typical OKs and VR-OKS while smoothly rotating their head horizontally from side to side. Stimulation was delivered using a virtual reality setup on top of an eye movements recording system. ResultsUnder VR-OKs participants perceived faster stimulus velocity when the head and stimulus had the same direction as compared to the head and stimulus in opposite directions. When the head turned in the same direction as the stimulus, there were fewer fast phase eye movements than when it rotated counter to stimulus motion direction. Conversely, with typical OKs, participants perceived faster stimulus velocity when the head and stimulus had opposite directions as compared to the head and stimulus having the same direction. ConclusionsThe seemingly paradoxical results in which slower stimulus velocity is perceived in tandem with stronger nystagmus can be explained by the simultaneous activation of the Vestibulo-Ocular Reflex and OKN in accordance with the various visual and vestibular stimuli.

The effects of acoustic and optokinetic stimulus on the postural stability.

ObjectivesThis article addresses the question of whether the simultaneous auditory and optokinetic stimulation affects the postural stability differently than only the stimulation with a single auditory or optokinetic stimulus.MethodsThe study involved 30 volunteers. The postural stability was evaluated by means of the posturography platform, which allows for both stable and dynamic posturography tests as well as for applying optokinetic stimulus. Three series of measurements were performed in each patient: measurements on an only with the optokinetic stimulus, measurements using only the acoustic stimulus, and finally measurements with both stimuli applied simultaneously.ResultsThe results indicate that there are statistically significant differences in the findings obtained with the simultaneous auditory and visual stimulation and the observed results with only one of the stimuli on the dynamic platform. Hence, on the basis of the results obtained, it is possible to conclude that the acoustic stimulus has the potential to help maintain a stable posture. However, this process is not sufficiently compensated with the optokinetic stimulation alone.ConclusionThe sense of sight may be essential for the maintenance of a stable posture. The presence of a sound stimulus improves the postural stability, although this improvement does not compensate for the disturbance caused by the optokinetic stimulus. Hence, functioning of auditory and visual system can influence patients posture.Level of Evidence4