Sensation Of Rotation Research Articles

Effectiveness of Sub-occipital Release In Cervicogenic Vertigo

Background: Cervicogenic vertigo is defined as a sensation of rotation, resulting from an alteration of the neck proprioceptive afferents of the upper cervical spine. Sub-occipital Release, a type of Myofascial Release (MFR) is a form of manual therapy technique which can be used for the treatment of cervicogenic vertigo. Purpose: The purpose of this study is to minimize the use of equipment and patient positioning, thus making it easy for providers to treat by using the suboccipital myofascial release technique and find the effects of this technique on cervicogenic vertigo. Objective: To determine whether sub-occipital myofascial release technique in upper cervical region is more effective than the use of conventional exercises in improvement of the symptoms of cervicogenic vertigo. Setting: Otolaryngology(ENT) and orthopaedic clinics of Pune city. Method: We carried out a prospective, randomized controlled, in 60 subjects with cervicogenic vertigo who were assigned randomly to an Exercise group (N = 17) and Sub-occipital Release group (N = 17). Subjects received treatment three times a week, for 2 weeks. By the end of session, pre‑ and post‑comparison was done for the signs and symptoms of cervicogenic vertigo. Participants: Age group 20-40 years were taken for the study. Patients with other types or causes of vertigo, acute cervical fractures or atlanto-axial joint instability were excluded from the study. Outcome measure: The primary outcome measure of this study was to find the intensity of the signs and symptoms of cervicogenic vertigo by using a Dizziness Handicap Inventory-NDI Questionnaire[6] . Results: Statistical significance was found between and within the groups with respect to the signs and symptoms of cervicogenic vertigo. The results showed a statistically significant difference (P<0.05) between the pre-treatment and post-treatment values for both the groups. Also, a significant improvement of signs and symptoms of cervicogenic vertigo was found in the sub-occipital group as compared to the exercise group. Conclusion: This study concluded that sub-occipital release technique is significantly effective for the treatment of cervicogenic vertigo.

A Novel Decoupled Model Predictive Control-Based Motion Cueing Algorithm for Driving Simulators

The motion cueing algorithm (MCA) is used to reproduce the driving/flying motion sensation of the real land or air vehicles for the users of motion simulator. Highly accurate MCAs are required for the motion simulators to create realistic sensation for the simulator users, otherwise, they might cause motion sickness and user discomfort. Model predictive control (MPC) is a popular technique in development of the high-fidelity MCAs as it is able to consider the motion sensation as well as the workspace constraints of the simulator platform. Tilt coordination in MCA is in charge of creating sustained linear acceleration feeling through tilting the platform cabin and exploiting gravitational acceleration under human motion threshold, to not allow the user to perceive this as a rotational motion. However, the existing MPC-based MCAs have not considered the rate limit to constrain the tilt motion under human threshold which causes violations of the rotational sensation threshold during generating sustained acceleration feeling. Instead, some researchers increase the penalty weights of rotational motions in order to slow down rotational motions. Using this strategy slows down all the simulator rotational motions not only the ones coming from tilt coordination, to generate sustained acceleration feeling, but also from rotational channel (due to real vehicle rotation) which causes motion sensation error and consequently motion sickness. Therefore, as the existing MPC-based MCAs cannot differentiate the rotations of tilt coordination channel (due to sustained acceleration feeling generation), from rotational channel (due to vehicle rotational motions), they are not able to produce accurate rotational motion sensations because of insufficient rotational motions. In this research, a novel decoupled MPC-based MCA is developed to systematically address the issues related to the existing MPC-based MCAs, in terms of inaccurate motion generation, by redesigning the MPC-based MCA using a series of vestibular system-based MPC models and considering tilt rate limit in tilt coordination. The simulation study using MATLAB software is used to verify and validate the proposed MCA compared to the existing MCAs. The proposed decoupled MPC-based MCA is able to generate accurate motion cues compared to those of the existing MCAs.

Orientation Comes First: Becoming Aware of Spatial Disorientation Interferes with Cognitive Performance.

Previous research has shown that experiencing motion stimuli negatively impacts cognitive performance. In the current study, we investigate whether this impact relates to Type-II spatial disorientation (SD), to motion stimulus magnitude, or to an interaction of these factors. Stimuli for participants (n = 23) consisted of Earth-vertical yaw rotations on a rotating chair in a completely darkened room. In the surprise condition, the stimulus started with subthreshold acceleration, followed by suprathreshold deceleration to a non-zero velocity, inducing a sensation of rotation that is opposite to the actual rotation revealed when the lights were switched on. In the no-surprise condition, the same changes in velocity were used, but starting from (almost) zero velocity, which induced a sensation of rotation in the same direction as the actual rotation. Participants performed a self-paced arithmetic task and measurement of their cognitive performance started after the environment was revealed. Stimulus magnitude was operationalized through higher or lower peak suprathreshold deceleration. The results revealed that counting speed decreased significantly when participants were surprised, constituting a large effect size. The proportion of counting errors likewise increased significantly when participants were surprised, but only in the high-magnitude condition. The findings suggest that surprise caused by the recognition of SD has an involuntary disruptive effect on cognition, which may impact performance of piloting tasks. These results are relevant when modeling motion stimuli effects on performance, and when developing SD awareness training for pilots.

Relationship between the Effect of Severity Vertigo and Demographic Characteristic for Iraqi Patients

Background: Vertigo, an illusory sensation of self or environmental rotation is a common presentation to the emergency department, affecting approximately 20–30% of the general population. Despite its frequency, most clinicians find acute vertigo challenging. An easy way of approaching it is to have in mind the most common causes and to consider them all during history taking and examination. Patients and Methods:A cross-sectional study involved 150 adult participants, who complained of vertigo and attended the vertigo center in Baghdad Medical City, using a 25-item Vertigo Handicap Questionnaire. During period (February – June) 2020. Results of Current study showed no effect of vertigo in (17.9%) of patients in age group (20-29) years. The effect of vertigo is more severe in female (3.3%) than in male (1.8%), so vertigo is more severe in patients with primary education (6.5%) and Mild effect of vertigo is more in retired patients (71.0%), while moderate effect of vertigo as (50.0%) in students and (35.0%) in governmental employed patients. As well as vertigo is more severe in patients live in rural area, Patients who have duration of symptom less than one year have no effect of vertigo in (3.8%), and severe effect in (3.8%), Also patients who currently employed (9.0%) had slight or no effect of vertigo. Conclusion: There is no significant correlation found between the severity of the effect of vertigo and demographic characteristic of studied individuals. The vertigo handicap questionnaire may be a useful tool for screening patients, counseling, and charting treatment progress.

The Efficacy and Safety of Cinnarizine in the Treatment of Vertigo in a Sample of Iraqi Patients in Al-Diwaniyah Province

Background: Vertigo is acoomon vestibular disorder in daily clinical practice that is frequently described as rotational sensation by patients and caused by a variety of causes that can be central or peripheral in origin. Treatment should be directed toward underlying etiology, but symptomatic relief is required to improve patients’ quality of life. Cinnarizine is frequently prescribed to relieve symptoms associated with vertigo; however little is known about its efficacy in daily clinical practice in Al-Diwaniyah province.Aim of the study: To evaluate the safety and efficacy of cinnarizne in the treatment of vertigo in patients visiting ENT unit at Al-Diwaniayh teaching hospital.Patients and method: The present cohort study included 66 patients of vertigo who were treated medically by cinarrizine (stugeron) and followed up for treatment response evaluation. The study was carried out in Ear Nose and Throat (ENT) unit in Al-Diwaniyah Teaching Hospital, Mid-Euphrates region, Iraq. The study started on June 2018 and ended on July 2019. The main variables included in the study were age, residency, level of education, occupation, other associated ENT manifestations and chronic illnesses. The primary outcome was response to treatment classified into satisfactory and unsatisfactory.Results: Mean age of patients with satisfactory response was significantly less than that of patients with unsatisfactory response, 45.73 ±13.31 years versus 54.95 ±15.67 years, respectively (P = 0.016). Response to treatment was not significantly associated to gender, residency, occupation and education (P > 0.05). Response to treatment was not significantly associated to bilateral ear wax, acute otitis media, chronic suppurative otitis media, Meniere’s disease and common cold (P > 0.05); however, it was significantly in the absence of hearing impairment and tinnitus (P 0.05), but significantly better in the absence of diabetes mellitus and hypertension (P < 0.05).

Pain modulation by illusory body rotation: A new way to disclose the interaction between the vestibular system and pain processing.

Clinical and experimental evidence advocates a structural and functional link between the vestibular and other sensory systems. For instance, visuo-vestibular and vestibular-somatosensory interactions have been widely reported. However, whether visual inputs carrying vestibular information can modulate pain is not yet clear. Recent evidence using natural vestibular stimulation or moving visual stimuli, points at an unspecific effect of distraction. By using immersive virtual reality (VR), we created a new way to prompt the vestibular system through the vision of static visual cues, studying the possible interaction with pain. Twenty-four healthy participants were visually immersed in a virtual room which could appear with five different degrees of rotation in the sagittal axis, either towards the right, left or with no rotation. Participants' heat pain thresholds and subjective reports of perceived body rotation, sense of presence and attention were measured. 'Being' in a tilted room induced the sensation of body rotation in our participants, even though they were always in an upright position. We also found that rotating the visual scenario can modulate the participants' pain thresholds, determining a significant increase when a left tilt is displayed. In addition,a positive correlation between the perceived body midline rotation and pain threshold wasfoundwhen the virtual room was titled 15 degrees toward the left. Importantly, all VR conditions were found to beequally distractive. Vestibular information present in static visual cues can modulate experimentally-induced acute pain according to a side-dependent manner and bypassing supramodal attentional mechanisms. These findings may help refining pain management approaches based on multimodal stimulation. This study explored how the visualization ofstatic environments in immersive virtual reality can lead to pain threshold modulation through the activation of the vestibular system. Immersion into rotated virtualenvironments led to the illusorysensation of body rotation, and this sensation was found to be related witha modulationof pain perception. Possible analgesic effectsdue to distractioncould beruled out.These results expandour current knowledge about how the visual, vestibular and somatosensory (pain) systems interact. These findings may influence future pain treatmentstrategies based on multisensory stimulation.

Nonhuman primate vestibuloocular reflex responses to prosthetic vestibular stimulation are robust to pulse timing errors caused by temporal discretization.

Electrical stimulation of vestibular afferent neurons to partially restore semicircular canal sensation of head rotation and the stabilizing reflexes that sensation supports has potential to effectively treat individuals disabled by bilateral vestibular hypofunction. Ideally, a vestibular implant system using this approach would be integrated with a cochlear implant, which would provide clinicians with a means to simultaneously treat loss of both vestibular and auditory sensation. Despite obvious similarities, merging these technologies poses several challenges, including stimulus pulse timing errors that arise when a system must implement a pulse frequency modulation-encoding scheme (as is used in vestibular implants to mimic normal vestibular nerve encoding of head movement) within fixed-rate continuous interleaved sampling (CIS) strategies used in cochlear implants. Pulse timing errors caused by temporal discretization inherent to CIS create stair step discontinuities of the vestibular implant's smooth mapping of head velocity to stimulus pulse frequency. In this study, we assayed electrically evoked vestibuloocular reflex responses in two rhesus macaques using both a smooth pulse frequency modulation map and a discretized map corrupted by temporal errors typical of those arising in a combined cochlear-vestibular implant. Responses were measured using three-dimensional scleral coil oculography for prosthetic electrical stimuli representing sinusoidal head velocity waveforms that varied over 50-400°/s and 0.1-5 Hz. Pulse timing errors produced negligible effects on responses across all canals in both animals, indicating that temporal discretization inherent to implementing a pulse frequency modulation-coding scheme within a cochlear implant's CIS fixed pulse timing framework need not sacrifice performance of the combined system's vestibular implant portion. NEW & NOTEWORTHY Merging a vestibular implant system with existing cochlear implant technology can provide clinicians with a means to restore both vestibular and auditory sensation. Pulse timing errors inherent to integration of pulse frequency modulation vestibular stimulation with fixed-rate, continuous interleaved sampling cochlear implant stimulation would discretize the smooth head velocity encoding of a combined device. In this study, we show these pulse timing errors produce negligible effects on electrically evoked vestibulo-ocular reflex responses in two rhesus macaques.

A decade of magnetic vestibular stimulation: from serendipity to physics to the clinic.

For many years, people working near strong static magnetic fields of magnetic resonance imaging (MRI) machines have reported dizziness and sensations of vertigo. The discovery a decade ago that a sustained nystagmus can be observed in all humans with an intact labyrinth inside MRI machines led to a possible mechanism: a Lorentz force occurring in the labyrinth from the interactions of normal inner ear ionic currents and the strong static magnetic fields of the MRI machine. Inside an MRI, the Lorentz force acts to induce a constant deflection of the semicircular canal cupula of the superior and lateral semicircular canals. This inner ear stimulation creates a sensation of rotation, and a constant horizontal/torsional nystagmus that can only be observed when visual fixation is removed. Over time, the brain adapts to both the perception of rotation and the nystagmus, with the perception usually diminishing over a few minutes, and the nystagmus persisting at a reduced level for hours. This observation has led to discoveries about how the central vestibular mechanisms adapt to a constant vestibular asymmetry and is a useful model of set-point adaptation or how homeostasis is maintained in response to changes in the internal milieu or the external environment. We review what is known about the effects of stimulation of the vestibular system with high-strength magnetic fields and how the understanding of the mechanism has been refined since it was first proposed. We suggest future ways that magnetic vestibular stimulation might be used to understand vestibular disease and how it might be treated.

Twirling Triplets: The Qualia of Rotation and Musical Rhythm

While musicologists have long noted that triplet rhythms evoke sensations of rotation in listeners, no theory has been proposed to account for this apparent association. To investigate this phenomenon, 33 excerpts of “spinning, rotating, twirling, or swirling” music were crowd-sourced from an online discussion forum. Analysis revealed a prominence of fast, repeated, isochronous patterns using stepwise pitch movement, with significantly more compound meters than generally found in Western music. Inspired by ecological acoustics, an Ecological Theory of Rotating Sounds (ETRoS) is proposed to explain these associations. The theory maps patterns of loudness fluctuations to trajectories of rotating sound sources. Two experiments tested the theory. In Experiment A, listeners rated how much binary, ternary, quaternary, and quinary figures (of 2–5 notes) evoked sensations of rotation. Experiment B used a two-alternative forced-choice paradigm pitting ecological quaternary stimuli (strong-medium-weak-medium) against unecological stimuli with permuted stress values more typical of Western music (strong-weak-medium-weak). Results indicate that perceived rotation increases with tempo and is poorly evoked by binary rhythms. Loudness patterns consistent with rotating trajectories were perceived as more rotating than unecological patterns—but only when pitch was also moving. Altogether, moderate support is provided for an acoustic-ecological account of rotating sounds.

Model-Based Vestibular Afferent Stimulation: Evaluating Selective Electrode Locations and Stimulation Waveform Shapes.

A dysfunctional vestibular system can be a severe detriment to the quality of life of a patient. Recent studies have shown the feasibility for a vestibular implant to restore rotational sensation via electrical stimulation of vestibular ampullary nerves. However, the optimal stimulation site for selective elicitation of the desired nerve is still unknown. We realized a finite element model on the basis of μCT scans of a human inner ear and incorporated naturally distributed, artificial neural trajectories. A well-validated neuron model of myelinated fibers was incorporated to predict nerve responses to electrical stimulation. Several virtual electrodes were placed in locations of interest inside the bony labyrinth (intra-labyrinthine) and inside the temporal bone, near the target nerves (extra-labyrinthine), to determine preferred stimulation sites and electrode insertion depths. We investigated various monopolar and bipolar electrode configurations as well as different pulse waveform shapes for their ability to selectively stimulate the target nerve and for their energy consumption. The selectivity was evaluated with an objective measure of the fiber recruitment. Considerable differences of required energy and achievable selectivity between the configurations were observed. Bipolar, intra-labyrinthine electrodes provided the best selectivities but also consumed the highest amount of energy. Bipolar, extra-labyrinthine configurations did not offer any advantages compared to the monopolar approach. No selective stimulation could be performed with the monopolar, intra-labyrinthine approach. The monopolar, extra-labyrinthine electrodes required the least energy for satisfactory selectivities, making it the most promising approach for functional vestibular implants. Different pulse waveform shapes did not affect the achieved selectivity considerably but shorter pulse durations showed consistently a more selective activation of the target nerves. A cathodic, centered triangular waveform shape was identified as the most energy-efficient of the tested shapes. Based on these simulations we are able to recommend the monopolar, extra-labyrinthine stimulation approach with cathodic, centered triangular pulses as good trade-off between selectivity and energy consumption. Future implant designs could benefit from the findings presented here.

Why acute unilateral vestibular midbrain lesions rarely manifest with rotational vertigo: a clinical and modelling approach to head direction cell function

A retrospective clinical study focused on the frequency of rotational vertigo in 63 patients with acute unilateral midbrain strokes involving the vestibular and ocular motor systems. In contrast to unilateral pontomedullary brainstem lesions, rotational vertigo in midbrain lesions occurred with a low frequency (14%) and transient (< 1 day) course. Swaying vertigo or unspecific dizziness (22%) and postural imbalance (31%) were more frequent. Midbrain strokes with transient rotational vertigo manifested with lesions chiefly in the caudal midbrain tegmentum, while manifestations with swaying, unspecific, or no vertigo chiefly occurred in rostral mesencephalic or meso-diencephalic lesions. We hypothesize that these different manifestations can be explained by the distribution of two separate cell systems based on semicircular canal function: the angular head-velocity cells and the head direction cells, both of which code for head rotation. Animal experiments have shown that angular head-velocity cells are located mainly in the lower brainstem up to the midbrain, whereas the head direction cells are found from the midbrain and thalamic level up to cortical regions. Due to the differences in coding, unilateral dysfunction of the angular velocity cell system should result in the sensation of rotation, while unilateral dysfunction of the head direction cell system should result in dizziness and unsteadiness. We simulated the different manifestations of vestibular dysfunction using a mathematical neural network model of the head direction cell system. This model predicted and confirmed our clinical findings that unilateral caudal and rostral brainstem lesions have different effects on vestibular function.

Influence of waveform components derived from the transmission error of a face gear pair on a fishing reel based on tactile sensibility

This paper discusses the relationship between the rotational sensation of the handle of a fishing reel and the transmission error (TE) using a vibration-generating machine. A vibration based on gear-pair engagement in a fishing reel occurs when the handle of the reel rotates. The vibration is transmitted to the tips of the fingers via the handle. When a large vibration is present, the angler feels discomfort. It is widely accepted that the rotational sensation in the handle depends on the amplitude of the TE at a particular speed in terms of the mesh frequency of the gear pair, and the TE includes the harmonics of the mesh frequency and different wave patterns. The TE waveform is subdivided into unit TEs with the time defined as the individual tooth-to-tooth mesh period. The TE units can be classified into several specific shapes. The variation in these unit TEs affects the sensation of the angler. In this study, a vibration-generating machine is introduced to simulate vibration in commercial products. The relationship between the TE of the classified patterns and the rotational sensation in the handle was investigated using the vibration-generating machine. The vibration patterns were classified into six types of fluctuation components, and the influence of each type was investigated. The results confirmed that the amplitude and waveform fluctuations significantly influenced the rotational sensation of the handle. Moreover, we discovered that the mesh frequency is the most significant influencing factor for the rotational sensation in the handle.

Habituation of self-motion perception following unidirectional angular velocity steps.

We investigated whether the perceived angular velocity following velocity steps of 80°/s in the dark decreased with the repetition of the stimulation in the same direction. The perceptual response to velocity steps in the opposite direction was also compared before and after this unidirectional habituation training. Participants indicated their perceived angular velocity by clicking on a wireless mouse every time they felt that they had rotated by 90°. The prehabituation perceptual response decayed exponentially with a time constant of 23.9 s. After 100 velocity steps in the same direction, this time constant was 12.9 s. The time constant after velocity steps in the opposite direction was 13.4 s, indicating that the habituation of the sensation of rotation is not direction specific. The peak velocity of the perceptual response was not affected by the habituation training. The differences between the habituation characteristics of self-motion perception and eye movements confirm that different velocity storage mechanisms mediate ocular and perceptual responses.

FV 2. Modulation of the cortical vestibular network by means of rTMS and its neural correlate

Repetitive transcranial magnetic stimulation (rTMS) has been applied to sensory research and for the treatment of disorders in psychiatry and neurology since 1993 ( Wassermann and Zimmermann, 2012 ). The widespread cortical vestibular system, however, has to date not been targeted. Aim of our study was to manipulate vestibular regions in the human cortex by temporary virtual lesioning through rTMS and analyse the changes in the perception of a galvanic vestibular stimulation (GVS) as well as the differing activation patterns in functional neuroimaging. The effects of rectangular and sinusoidal bimastoidal GVS were studied in 16 healthy volunteers (8 F; mean age 23 years) in a 3T scanner. Data was analysed with SPM12. Results of the baseline fMRI session were used as functional localizers for three rTMS target regions: (1) cingulate sulcus visual (CSv) bilaterally, (2) the right inferior parietal lobule (BA40), and (3) the right polysensory superior temporal sulcus area (STP) ( Smith, 2012 ). The vestibular fMRI sessions with GVS were repeated within minutes after virtual lesioning of the target regions with low-frequency rTMS (1 Hz, 1800 pulses, 90% active motor threshold) followed by a psychophysical debriefing and a clinical neurootological examination. Generally speaking virtual lesioning of vestibular cortex areas by means of rTMS resulted in a reduced, never in a more pronounced, activation pattern of the cortical vestibular regions. (1) RTMS of area CSv bilaterally led to a reduction in vestibular activation of area 6, area MST, and the inferior parietal lobule in both hemispheres. For unilateral galvanic stimuli this effect was constricted to the cerebral hemisphere ipsilateral to the side of excitation. More subjects perceived their head to be rotating in space during sinusoidal GVS instead of the sensation of the whole body twirling compared to all other sessions (72% vs 30%). (2) Virtual lesioning of the right inferior parietal lobule lead to reduced activation of the target region itself and area 6 in the same hemisphere during GVS. Here, subjects showed the largest reduction in grading the perceived amount of rotation induced by rectangular GVS (mean reduction of 45 ± 7° compared to the baseline session). The effect of a significantly reduced sensation of head rotation during GVS was seen in all target areas. (3) RTMS of area STP lead to a significant isolated deactivation of the left midbrain during GVS. There were no pathological findings in our healthy subjects after the virtual lesioning in the ensuing clinical neurootological examinations. The realignment parameters of the vestibular stimulations as a correlate for a potential vestibular motor response also gave no significant differences between the four sessions. This is the first demonstration by means of psychophysics, fMRI and rTMS that points at the potential for a manipulation of vestibular cortex regions. Global cerebral network effects within the vestibular system were only seen after rTMS lesioning of the vestibular midline structure CSv bilaterally. The resulting shift from body to isolated head rotation in space in the perception after GVS for the lesioned area CSv could reflect its role in egomotion processing. The quantitative perceptual findings for the right inferior parietal lobule as an rTMS lesion site on the other hand might suggest a leading role for this region in egocentric referencing within the confines of a three-dimensional environment.

16. Psychophysical assessment of vestibular function and vestibular disorders

Vestibular disorders usually present with vertigo, a subjective symptom characterised by altered motion perception. Current clinical investigation probes the integrity of the labyrinth and brainstem pathways. While caloric and head impulse tests and vestibular evoked myogenic potentials, can identify specific anatomical deficits and assist diagnosis of certain specific disorders, many patients with vertigo have negative results on these tests. A direct approach to examining disordered motion perception might provide important insights into pathophysiology and clinical diagnosis. To quantify perception of movement we rotated seated subjects by 30–180° over 5 s and had them indicate their start position. To isolate vestibular input we evoked illusory rotation using bipolar galvanic vestibular stimulation (GVS). In 10 normal subjects, exposure to whole-body motion (10 min stochastic yaw) produced a long-lasting reduction in the perception of imposed movements, and the size of GVS-evoked balance reflexes. Importantly, conditioning reduced sensations of illusory rotation of pure vestibular origin (mean 113°with 1 mA GVS for 10 s) by 44% and they remained low after one hour. The same conditioning had no or minimal effect on the vestibulo-ocular reflex gain (measured by slow-phase eye velocity during sinusoidal yaw and by head impulse testing). Vestibular migraine and mal de debarquement syndrome (MDS) are important vestibular disorders where vertigo and imbalance are associated with normal results on routine vestibular tests. We studied 10 MDS patients all of whom had normal vestibular examination and routine test results. Compared with controls, these patients perceived imposed real yaw rotation to be 47% greater and illusory rotation (GVS-evoked) to be 128% greater. Low amplitude sinusoidal rocking (roll at 1 o -4°, 0.5 Hz) and illusory rocking (GVS 0.5–2 mA) were perceived to be 147% and 130% greater respectively. Despite normal balance by posturography, the MDS group showed a 5-fold increase in the size of the galvanic-evoked balance reflex. We conclude that psychophysical tests can help corroborate and quantify vestibular symptoms in disorders not identified by standard vestibular tests. We conjecture that failure of appropriate vestibular adaptation could underlie such disorders of motion perception.

Multimodal neurorehabilitation of a patient with chronic headache syndrome

Event Abstract Back to Event Multimodal neurorehabilitation of a patient with chronic headache syndrome Matthew M. Antonucci1, Alexis Jahangiri2 and Susan E. Esposito2* 1 Plasticity Brain Centers, United States 2 Life University, United States Background: A 33-year-old male patient presented with a previous diagnosis of chronic headache syndrome. His primary care physician had previously diagnosed the patient and diagnosis was confirmed through his medical neurologist and chiropractor. The patient had a chief complaint of decreased ability to concentrate, memory loss, and brain fog. The patient reported a constant pounding pressure of the left temporal region, which started 3 years prior and has progressively gotten worse. Additionally, the patient reported that he felt a "constant sensation of rotation of his eyes" which kept him awake at night. Methods: The patient underwent a comprehensive neurologic examination including cognitive testing through the C3 Logix™ program utilizing digital symbol matching and Trails A & B. Examination revealed an anisocoria, a V:A ratio of 3:1 on the left, a leftward drift of the eyes and a left hypertropia. A normal optokinetic response was present with horizontal stimulation bilaterally, however a decreased response was noted in the downward direction. Anti-saccades were successful in six out of ten attempts, although processing speed was delayed. The patient was treated daily, throughout the day, for one week. Treatments included orthodromic somatosensory nerve stimulation without head recording on the ophthalmic branch of the trigeminal nerve bilaterally to maximum tolerance and to the mandibular branch of the trigeminal nerve to the point where fasciculations were generated. Additionally, neuromuscular re-education therapy, vestibular rehabilitation exercises, vision therapy, therapeutic activities, and multi-axis rotational therapy were included as treatments. Results: Following this treatment protocol, the patient's V:A ratio was reduced to 1:1 bilaterally. Anti-saccades were successful in all ten out of ten attempts, with increased processing speed. The patient reported that his headaches had decreased and mental clarity had improved, which was evidenced by repeated cognitive testing through the C3 logix™ program. Trails A improved from 40.4 seconds to 19.7 seconds, while Trails B improved from 65.0 seconds to 43.0 seconds. Conclusion: The improvement of neurological function and subsequent decrease in headache symptoms in this case indicates that brain-based treatment can potentially be effective in the management of chronic headache syndrome. These results promote the need for further research in this area. Keywords: Chronic headache syndrome, Neurorehabilitation, Vestibular Rehabilitation, chiropractic neurology, occulomotor Conference: International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function, Orlando, United States, 7 Oct - 9 Oct, 2016. Presentation Type: Poster Presentation Topic: Abstracts ISCN 2016 Citation: Antonucci MM, Jahangiri A and Esposito SE (2016). Multimodal neurorehabilitation of a patient with chronic headache syndrome. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function. doi: 10.3389/conf.fneur.2016.59.00022 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 28 Aug 2016; Published Online: 07 Sep 2016. * Correspondence: Dr. Susan E Esposito, Life University, Marietta, United States, susanesposito@gmail.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Matthew M Antonucci Alexis Jahangiri Susan E Esposito Google Matthew M Antonucci Alexis Jahangiri Susan E Esposito Google Scholar Matthew M Antonucci Alexis Jahangiri Susan E Esposito PubMed Matthew M Antonucci Alexis Jahangiri Susan E Esposito Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Passive motion reduces vestibular balance and perceptual responses.

With the hypothesis that vestibular sensitivity is regulated to deal with a range of environmental motion conditions, we explored the effects of passive whole-body motion on vestibular perceptual and balance responses. In 10 subjects, vestibular responses were measured before and after a period of imposed passive motion. Vestibulospinal balance reflexes during standing evoked by galvanic vestibular stimulation (GVS) were measured as shear reaction forces. Perceptual tests measured thresholds for detecting angular motion, perceptions of suprathreshold rotation and perceptions of GVS-evoked illusory rotation. The imposed conditioning motion was 10 min of stochastic yaw rotation (0.5-2.5 Hz ≤ 300 deg s(-2) ) with subjects seated. This conditioning markedly reduced reflexive and perceptual responses. The medium latency galvanic reflex (300-350 ms) was halved in amplitude (48%; P = 0.011) but the short latency response was unaffected. Thresholds for detecting imposed rotation more than doubled (248%; P < 0.001) and remained elevated after 30 min. Over-estimation of whole-body rotation (30-180 deg every 5 s) before conditioning was significantly reduced (41.1 to 21.5%; P = 0.033). Conditioning reduced illusory vestibular sensations of rotation evoked by GVS (mean 113 deg for 10 s at 1 mA) by 44% (P < 0.01) and the effect persisted for at least 1 h (24% reduction; P < 0.05). We conclude that a system of vestibular sensory autoregulation exists and that this probably involves central and peripheral mechanisms, possibly through vestibular efferent regulation. We propose that failure of these regulatory mechanisms at different levels could lead to disorders of movement perception and balance control during standing.

Histopathologic Changes of the Inner ear in Rhesus Monkeys After Intratympanic Gentamicin Injection and Vestibular Prosthesis Electrode Array Implantation.

Bilateral vestibular deficiency (BVD) due to gentamicin ototoxicity can significantly impact quality of life and result in large socioeconomic burdens. Restoring sensation of head rotation using an implantable multichannel vestibular prosthesis (MVP) is a promising treatment approach that has been tested in animals and humans. However, uncertainty remains regarding the histopathologic effects of gentamicin ototoxicity alone or in combination with electrode implantation. Understanding these histological changes is important because selective MVP-driven stimulation of semicircular canals (SCCs) depends on persistence of primary afferent innervation in each SCC crista despite both the primary cause of BVD (e.g., ototoxic injury) and surgical trauma associated with MVP implantation. Retraction of primary afferents out of the cristae and back toward Scarpa's ganglion would render spatially selective stimulation difficult to achieve and could limit utility of an MVP that relies on electrodes implanted in the lumen of each ampulla. We investigated histopathologic changes of the inner ear associated with intratympanic gentamicin (ITG) injection and/or MVP electrode array implantation in 11 temporal bones from six rhesus macaque monkeys. Hematoxylin and eosin-stained 10-μm temporal bone sections were examined under light microscopy for four treatment groups: normal (three ears), ITG-only (two ears), MVP-only (two ears), and ITG + MVP (four ears). We estimated vestibular hair cell (HC) surface densities for each sensory neuroepithelium and compared findings across end organs and treatment groups. In ITG-only, MVP-only, and ITG + MVP ears, we observed decreased but persistent ampullary nerve fibers of SCC cristae despite ITG treatment and/or MVP electrode implantation. ITG-only and ITG + MVP ears exhibited neuroepithelial thinning and loss of type I HCs in the cristae but little effect on the maculae. MVP-only and ITG + MVP ears exhibited no signs of trauma to the cochlea or otolith end organs except in a single case of saccular injury due to over-insertion of the posterior SCC electrode. While implanted electrodes reached to within 50-760 μm of the target cristae and were usually ensheathed in a thin fibrotic capsule, dense fibrotic reaction and osteoneogenesis were each observed in only one of six electrode tracts examined. Consistent with physiologic studies that have demonstrated directionally appropriate vestibulo-ocular reflex responses to MVP electrical stimulation years after implantation in these animals, histologic findings in the present study indicate that although intralabyrinthine MVP implantation causes some inner ear trauma, it can be accomplished without destroying the distal afferent fibers an MVP is designed to excite.

Rate of Hanger Reflex Occurrence: Unexpected Head Rotation on Fronto-temporal Head Compression.

When the head is encircled with a wire clothes hanger and the unilateral fronto-temporal region is compressed, the head rotates unexpectedly. As the mechanism is unclear, however, we have temporarily named this phenomenon as the “hanger reflex.” We previously reported a case wherein this phenomenon was applied to treat cervical dystonia. Because little is known about this phenomenon, we determined how often this phenomenon is observed in healthy subjects. Study participants were 120 healthy Japanese adults (60 men and 60 women) aged 19–65 years. A wire clothes hanger was applied to each subject’s head. The longer side of the hanger was attached over the volunteer’s fronto-temporal regions on both sides of the head in succession (i.e., two applications per volunteer). We evaluated whether the subjects felt the sensation of head rotation by using a questionnaire. The sensation of head rotation was observed in 95.8% of subjects. There were five non-responders (4.2%). In 85.4% of the trials, head rotation was observed in the direction that coincided with the side compressed by the hanger. There were no differences in responses between genders. The incident rate of the hanger reflex was remarkably high and most likely represents a prevalent phenomenon in humans. The mechanism underlying the reflex remains unknown. Further research should be performed to elucidate the underlying causes of the hanger reflex, which represents a potential treatment for cervical dystonia.

The Diagnosis and Treatment of the Cervical Vertigo

Received June 13, 2014 Revised September 3, 2014 Accepted September 8, 2014 Address for correspondence Dong Jin Choi, MD Department of OtolaryngologyHead and Neck Surgery, Kwangju Christian Hospital, 37 Yangnim-ro, Nam-gu, Gwangju 503-715, Korea Tel +82-62-650-5095 Fax +82-62-650-5090 E-mail brok-kim@hanmail.net Background and ObjectivesZZVertigo is an illusion of environmental movement due to various causes, thus it is hard for medical doctors to determine the exact kind of dizziness in the final diagnosis. Recently, cervical vertigo was reported from several vertigo cases. Cervical vertigo is defined as sensation of rotation, resulting from an alteration of the neck proprioceptive afferents of the upper cervical spine. The aim of our study is to document the clinical features and the treatment outcomes in vertigo patients with myofascial pain syndrome (MPS). Subjects and MethodZZA total of 488 patients, excluding 18 patients who received other diagnosis, were examined to investigate the reasons for dizziness. We evaluated 34 patients, who were diagnosed with cervical vertigo by questionnaire after MPS treatments. Clinical evaluations for cervical vertigo were performed on all subjects, and vestibular function tests were also performed in patients with vertigo symptoms. All patients received a total of 4 treatments including trigger point injection, physical therapy or medication, and then followed up, respectively. The symptom changes of dizziness, patient satisfaction and cervical pain were checked before and treatment 1, 2, 4 times by Visual Analogue Scale (VAS) score. ResultsZZThere were significant improvement in the VAS score of dizziness, patient satisfaction and cervical pain after treatment for MPS. ConclusionZZTreatment for MPS could improve dizziness in cervical vertigo with MPS patients, but further study is needed to clearly confirm the cervical vertigo with MPS for improving patient’s quality of life. Korean J Otorhinolaryngol-Head Neck Surg 2015;58(3):177-81