Visual-vestibular Interaction Research Articles

Image Stabilization in Central Vision Loss: The Horizontal Vestibulo-Ocular Reflex.

For patients with central vision loss and controls with normal vision, we examined the horizontal vestibulo-ocular reflex (VOR) in complete darkness and in the light when enhanced by vision (VVOR). We expected that the visual-vestibular interaction during VVOR would produce an asymmetry in the gain due to the location of the preferred retinal locus (PRL) of the patients. In the dark, we hypothesized that the VOR would not be affected by the loss of central vision. Nine patients (ages 67 to 92 years) and 17 controls (ages 16 to 81 years) were tested in 10-s active VVOR and VOR procedures at a constant frequency of 0.5 Hz while their eyes and head movements were recorded with a video-based binocular eye tracker. We computed the gain by analyzing the eye and head peak velocities produced during the intervals between saccades. In the light and in darkness, a significant proportion of patients showed larger leftward than rightward peak velocities, consistent with a PRL to the left of the scotoma. No asymmetries were found for the controls. These data support the notion that, after central vision loss, the preferred retinal locus (PRL) in eccentric vision becomes the centre of visual direction, even in the dark.

Functional correlate and delineated connectivity pattern of human motion aftereffect responses substantiate a subjacent visual-vestibular interaction

The visual motion aftereffect (MAE) is the most prominent aftereffect in the visual system. Regarding its function, psychophysical studies suggest its function to be a form of sensory error correction, possibly also triggered by incongruent visual-vestibular stimulation. Several observational imaging experiments have deducted an essential role for region MT+ in the perception of a visual MAE but not provided conclusive evidence. Potential confounders with the MAE such as ocular motor performance, attention, and vection sensations have also never been controlled for. Aim of this neuroimaging study was to delineate the neural correlates of MAE and its subjacent functional connectivity pattern.A rotational MAE (n = 22) was induced using differing visual stimuli whilst modulating ocular motor parameters in a 3T scanner. Data was analyzed with SPM12. Eye movements as a response to the same stimuli were studied by means of high-resolution videooculography.Analysis for all stimuli gave bilateral activations along the dorsal visual stream with an emphasis on area MT. The onset of a visual MAE revealed an additional response in the right medial superior temporal area (MST) and a concurrent deactivation of vestibular hub region OP2. There was no correlation for the BOLD effects during the MAE with either ocular motor or attention parameters.The functional correlate of a visual MAE in humans may be represented in the interaction between region MT and area MST. This MAE representation is independent of a potential afternystagmus, attention and the presence of egomotion sensations. Connectivity analyses showed that in the event of conflicting visual-vestibular motion information (here MAE) area MST and area OP2 may act as the relevant mediating network hubs.

Clinical approach and imaging of cortical vestibular disorders

The simple classification of vestibular disorders as “peripheral” or “central” disregards a third category: “higher vestibular dysfunctions”. In analogy to disorders of higher visual functions of the “what” and “where” pathways, a new category, namely disorders of higher vestibular functions, which include cognition and other non-vestibular modalities, has been proposed. The dominance of cortical activations of the vestibular network – seen in fMRI and PET studies - reflects several supratentorial neurological disorders involving higher vestibular function. Since they include impairment of spatial orientation, attention, and balance control, they are not only based on vestibular but on integration of multisensory input (visual, vestibular, somatosensory). Four conditions may serve to further elucidate the characteristics of disorders of cortical vestibular function: spatial hemineglect, room-tilt illusion, pusher syndrome, and also impairment of spatial memory and navigation associated with hippocampal atrophy in peripheral bilateral vestibular loss. Spatial hemineglect is a disorder caused by interrupted attention to visual stimuli within one hemifield contralateral to the acute lesion - mostly of the right temporo-parietal cortex. The rare disorder of paroxysmal transient upside-down vision, called the room-tilt illusion, reflects a cortical dysfunction of visual-vestibular interaction due to lesions within the brainstem or even the peripheral labyrinths. The pusher syndrome is characterized by an apparent tilt of the perceived body position in space which the patient attempts to counteract by actively pushing or tilting the body to the contralesional side; causative lesion sites are in the thalamus and posterior part of the insula.

Editorial introductions

Editorial introductions

Distributed Visual–Vestibular Processing in the Cerebral Cortex of Man and Macaque

Recent advances in understanding the neurobiological underpinnings of visual–vestibular interactions underlying self-motion perception are reviewed with an emphasis on comparisons between the macaque and human brains. In both species, several distinct cortical regions have been identified that are active during both visual and vestibular stimulation and in some of these there is clear evidence for sensory integration. Several possible cross-species homologies between cortical regions are identified. A key feature of cortical organization is that the same information is apparently represented in multiple, anatomically diverse cortical regions, suggesting that information about self-motion is used for different purposes in different brain regions.

Optometric Management of Sports-related Post-concussion Visual Symptoms in Teenagers with Vision Therapy: A Case Series

Background: Sports-related concussions are among the most common causes of mild traumatic brain injury (mTBI) in children and young adults. Post-concussion visual problems include: changes in refractive status, binocularity, accommodation, ocular motility, visual processing, and vestibular-visual interaction. Modifications to the traditional optometric exam, use of prisms, lenses, binasal occlusion, tints, filters, and a sequence of in-office vision therapy (VT) can successfully rehabilitate the visual symptoms and improve the quality of life (QoL) for this very unique patient population. Case Reports: 1) A 14 year old male presented with a history of a concussion from soccer. His symptoms included headaches, decreased concentration, difficulty copying form the board and difficulty transitioning from near to far activities. Clinical testing revealed an accommodative and oculomotor dysfunction (OMD). He was prescribed BU yoked prism glasses and vision therapy. 2) A 16 year old female presented with a history of two sports-related concussions from cheerleading. Her symptoms included headaches, blurry vision at near and difficulty keeping her place when reading. Clinical observation revealed OMD and accommodative insufficiency. She was prescribed reading glasses to relieve visual stress when reading while she completed vision therapy. 3) A 19 year old female presented with a history of multiple sports concussions while playing collegiate soccer, which resulted in headaches that became worse when reading, decreased reading stamina and difficulty keeping her place when reading. Clinical observation revealed accommodative insufficiency, binocular dysfunction and OMD. She was prescribed reading glasses and vision therapy. Conclusion: This case series outlines the exam procedures and therapy techniques used to manage three teenagers with postconcussive visual disorders. Symptoms such as blurred vision, headaches and difficulty reading can profoundly affect activities of daily living (ADLs). Optometric examinations and management through the use of prisms, tints, reading glasses, and in-office vision therapy can successfully resolve these visual complaints. Each patient described completed 10-12 sessions of in-office vision therapy [over a span of four to eight months], with home re-enforcement, and graduated with marked improvement of their visual signs and symptoms.

Balance Rehabilitation Unit (BRUTM) posturography in Menière's disease

AbstractPosturography has been used in the evaluation of patients with vestibular disorders. AimTo evaluate balance control with the Balance Rehabilitation Unit (BRUTM) posturography in patients with Menière's disease. Study designProspective case-control. Material and Method30 patients diagnosed with Menière's disease and a control group consisting of 40 healthy matching individuals in relation to age and gender, were submitted to a balance function evaluation by means of a Balance Rehabilitation Unit (BRUTM) posturography. ResultsComparing patients with Menière's disease and the control group, we found significant differences between the values of the sway speed in the static force plate, down optokinetic stimulation (p=0.038) and horizontal visual vestibular interaction (p=0.049); and of the ellipse area in the static force plate, eyes closed (p=0.001); left optokinetic stimulation (p=0.007); down optokinetic stimulation (p=0.003); horizontal visual vestibular interaction (p=0.003); and vertical visual vestibular interaction (p=0.028). ConclusionThe postural control assessment with the Balance Rehabilitation Unit (BRUTM) posturography enables the identification of sway speed and ellipse area abnormalities in patients with Menière's disease.

Motion Sickness: Current Knowledge and Recent Advance.

Motion sickness (MS) is a common physiological response to real or virtual motion. Numerous studies have investigated the neurobiological mechanism and the control measures of MS. This review summarizes the current knowledge about pathogenesis and pathophysiology, prediction, evaluation, and countermeasures of MS. The sensory conflict hypothesis is the most widely accepted theory for MS. Both the hippocampus and vestibular cortex might play a role in forming internal model. The pathophysiology focuses on the visceral afference, thermoregulation and MS-related neuroendocrine. Single-nucleotide polymorphisms (SNPs) in some genes and epigenetic modulation might contribute to MS susceptibility and habituation. Questionnaires, heart rate variability (HRV) and electrogastrogram (EGG) are useful for diagnosing and evaluating MS. We also list MS medications to guide clinical practice. Repeated real motion exposure and combined visual-vestibular interaction training accelerate the progress of habituation. Behavioral and dietary countermeasures, as well as physiotherapy, are also effective in alleviating MS symptoms.

Changes in postural control in patients with Parkinson's disease: a posturographic study

ObjectivesPostural instability is one of the most disabling features in Parkinson's disease (PD), and often leads to falls that reduce mobility and functional capacity. The objectives of this study were to analyse the limit of stability (LOS) and influence of the manipulation of visual, somatosensorial and visual–vestibular information on postural control in patients with PD and healthy subjects. DesignCross-sectional. SettingMovement Disorders Unit, university setting. ParticipantsEighty-two subjects aged between 37 and 83 years: 41 with Parkinson's disease in the ‘on’ state and 41 healthy subjects with no neurological disorders. Both groups were matched in terms of sex and age. Main outcome measuresUnified Parkinson's Disease Rating Scale (UPDRS)–motor score, modified Hoehn and Yahr staging, Dynamic Gait Index (DGI) and posturography with integrated virtual reality. The parameters analysed by posturography were LOS area, area of body centre of pressure excursion and balance functional reserve in the standing position in 10 conditions (open and closed eyes, unstable surface with eyes closed, saccadic and optokinetic stimuli, and visual–vestibular interaction). ResultsThe mean UPDRS motor score and DGI score were 27 [standard deviation (SD) 14] and 21 (SD 3), respectively. Thirteen participants scored between 0 and 19 points, indicating major risk of falls. Posturographic assessment showed that patients with PD had significantly lower LOS area and balance functional reserve values, and greater body sway area in all posturographic conditions compared with healthy subjects. ConclusionsPatients with PD have reduced LOS area and greater postural sway compared with healthy subjects. The deterioration in postural control was significantly associated with major risk of falls.

P102. Centres of optokinetic adaption control and their functional connectivity in brainstem–cerebellar networks

Several works have revealed a robust visual–vestibular interaction at the cortical level in humans. The same has been shown at an infratentorial level in other primates. Most stimuli applied in the context of ocular motor neuroimaging research are fixed and therefore highly artificial in nature for methodological reasons. Advances in imaging techniques now allow for robust brainstem fMRI, thus opening up a whole new terrain for investigation. The aim of this study was to investigate the neural correlate for ocular motor adaption control (AC) with changing stimulus parameters (speed/direction) and the functional connectivity (FC) of the localised governing hubs at the level of the brainstem and the cerebellum. The effects of constant and linear accelerating small-field optokinetic (OKN) stimuli in the horizontal and vertical direction were studied in 20 volunteers lying supine with their ears plugged in a clinical 3T scanner (Siemens Magnetom Trio, Erlangen, Germany). The protocol included two sessions, each consisting of a T2*-weighted EPI sequence (2mm isotropic resolution, TA 2.93s) in alternating blocks of visual fixation and during OKN stimulation (left/right, up/down). Horizontal (vertical) OKN speeds were either fixed at 30°/s (20°/s) or accelerated during stimulus blocks from 15° to 45°/s (10°/s–30°/s). Resting-state data was acquired prior to task fMRI for 5min (3mm isotropic resolution, 37 slices, TA 2.67s, whole-brain coverage). Data was analysed with SPM8 and DPARSFA after standard preprocessing. T-contrasts were calculated with respect to the rest condition and were considered significant at p . The task revealed a cerebellar network including the dorsal ocular motor vermis (OMV), the fastigial ocular motor region, the posterior inferior vermis, the flocculus and paraflocculus, the culmen (lobule VI) and the declive. In the brainstem, we were able to significantly activate the ocular motor and abducens nuclei, the paramedian pontine reticular formation (PPRF), the dorsolateral pontine nucleus (DLPN), the nucleus reticularis tegmenti pontis (NRTP), the prepositus nucleus (NPH), riMLF and the interstitial nucleus of Cajal (INC). AC was localised to the OMV and pontine structures (NTRB and PPRF). Activation clusters throughout all OKN tasks were significantly larger with higher peak maxima in the left cerebellar hemisphere. We found a significant deactivation of the ventral uvula and the cerebellar tonsils (lobule VIII) during constant more so than during accelerating OKN stimulation. FC maps with the dorsal ocular motor vermis as a seed region gave a significant connectivity with all other regions found in the task-based part of our experiment as well as the dorsal visual stream and all cortical eyefields. Our study gives in vivo evidence for the basic visual–vestibular interactions at the level of the infratentorial networks. Ocular motor areas of the human brainstem could be mapped at an unprecedented detail. AC for the OKN task itself independent of direction was found to be localised mainly in the OMV. Velocity-fixed more so than accelerating OKN stimuli lead to a significant deactivation of a cerebellar core vestibular area known to govern the velocity storage mechanism, the ventral uvula. Extending the cortical concept of a right-hemispheric predominance for visual-spatial processing we found a complementary left-sided dominance for OKN responses in the cerebellum (Dieterich et al., 2003). Taken together, these findings should open up another chapter in our understanding of visual–vestibular interactions in the human brain.

Gaze Stabilization Test Asymmetry Score as an Indicator of Previous Concussion in a Cohort of Collegiate Football Players.

Vestibular dysfunction may lead to decreased visual acuity with head movements, which may impede athletic performance and result in injury. The purpose of this study was to test the hypothesis that athletes with history of concussion would have differences in gaze stabilization test (GST) as compared with those without a history of concussion. Cross-sectional, descriptive. University Athletic Medicine Facility. Fifteen collegiate football players with a history of concussion, 25 collegiate football players without a history of concussion. Participants completed the dizziness handicap inventory (DHI), static visual acuity, perception time test, active yaw plane GST, stability evaluation test (SET), and a bedside oculomotor examination. Independent samples t test was used to compare GST, SET, and DHI scores per group, with Bonferroni-adjusted alpha at P < 0.01. Receiver operating characteristic curve analysis and area under the curve (AUC) were used to assess the clinical performance of the GST and SET. Athletes with previous concussion had a larger GST asymmetry score [mean (M) = 12.40, SD = 9.09] than those without concussion (M = 4.92, SD = 4.67; t (18.70) = -2.955, P = 0.008, 95% CI, -12.79 to -2.18, d = -1.37). Clinical performance of the GST (AUC = 0.77) was better than the SET (AUC = 0.61). Results suggest peripheral vestibular or vestibular-visual interaction deficits in collegiate athletes with a history of concussion. The results support further research on the use of GST for sport-related concussion evaluation and monitoring. Inclusion of objective vestibular tests in the concussion protocol may reveal the presence of peripheral vestibular or visual-vestibular deficits. Therefore, the GST may add an important perspective on the effects of concussion.

Why acute unilateral vestibular cortex lesions mostly manifest without vertigo.

The aim of the current study was, first, to determine the critical causative vestibular areas that in exceptional cases manifest with transient vertigo or dizziness in acute strokes of the middle cerebral artery, and second, to try to explain why in most cases unilateral lesions of these areas manifest without vertigo. We determined the ischemic areas of the 10 published cases by overlapping the CT/MRI lesions and attributed them to the temporoparietal vestibular network. These overlap areas were located either in the posterior retroinsular cortex (n = 8), i.e., the parieto-insular vestibular cortex, or the separate parietal vestibular cortex (n = 2). Thus, rare vestibular cortical vertigo is mostly elicited by acute lesions of the core region of the retroinsular vestibular network. However, the more interesting question is related to the lack of cortical vertigo when this area is affected. We propose a concept to explain how the unaffected opposite hemisphere can suppress vertigo. This is based on visual-vestibular interaction for motion perception and orientation. It is the hemisphere in which vestibular and visual inputs are in agreement, which is the more reliable and determines the global perception of body orientation and motion.

The Oculus Rift: a cost-effective tool for studying visual-vestibular interactions in self-motion perception.

For years now, virtual reality devices have been applied in the field of vision science in an attempt to improve our understanding of perceptual principles underlying the experience of self-motion. Some of this research has been concerned with exploring factors involved in the visually-induced illusory perception of self-motion, known as vection. We examined the usefulness of the cost-effective Oculus Rift in generating vection in seated observers. This device has the capacity to display optic flow in world coordinates by compensating for tracked changes in 3D head orientation. We measured vection strength in three conditions of visual compensation for head movement: compensated, uncompensated, and inversely compensated. During presentation of optic flow, the observer was instructed to make periodic head oscillations (±22° horizontal excursions at approximately 0.53 Hz). We found that vection was best in the compensated condition, and was weakest in the inversely compensated condition. Surprisingly, vection was always better in passive viewing conditions, compared with conditions where active head rotations were performed. These findings suggest that vection is highly dependent on interactions between visual, vestibular and proprioceptive information, and may be highly sensitive to limitations of temporal lag in visual-vestibular coupling using this system.

Thresholds for self-motion perception in roll without and with visual fixation target--the visualvestibular interaction effect.

The purpose of this study was to establish the selfmotion perception threshold, in roll, in the visualvestibular interaction (VVI) state, creating an oculogyral illusion, and to compare this threshold to the self-motion perception threshold in darkness. A further aim was to investigate the dynamics of the threshold at a low frequency range (0.1-1 Hz) of sinusoidal rotation. Seven healthy subjects were tested. A motion platform was used to generate motion. Single cycles of sinusoidal acceleration at four frequencies (0.1, 0.2, 0.5 and 1 Hz) were used as motion stimuli. To avoid otolith stimulation, subjects were rotated about a vertical axis in supine position. To evoke an oculogyral illusion subjects were instructed to fixate their gaze on a cross-shaped object aligned with their head, which rotated with them. The results show a lowering of the self-motion perception threshold in the VVI state, significant for the frequencies 0.1 and 0.2 Hz (p<0.05). In all the subjects, visual fixation on the cross evoked an oculogyral illusion. The threshold in both tested conditions was frequency dependent: it decreased with increasing frequency values. However, this effect was consistently stronger in darkness across all frequencies (p<0.05). In conclusion, the application of sinusoidal rotation during roll at low frequencies in the VVI condition evokes oculogyral illusion. This interaction lowers the self-motion perception threshold compared to that measured during rotation in darkness. This testing method could be of practical benefit in clinical application for revealing brain dysfunction involving integrative mechanisms of perception.

Influence of sensory information on static balance in older patients with vestibular disorder

IntroductionWith aging, the sensory systems suffer an accumulation of degenerative, infectious and/or traumatic processes that may hinder the body balance maintenance. ObjectiveTo assess the influence of sensory information on static body balance of elderly individuals with vestibular disorders. MethodsCross-sectional study of elderly individuals with vestibular disorders. The Clinical Test of Sensory Interaction and Balance and posturography integrated with virtual reality (Balance Rehabilitation Unit™) were used. Posturography parameters analyzed included center of pressure and velocity of body sway. Results123 individuals with mean age of 73.11 were assessed. Worst performance was observed in the Clinical Test of Sensory Interaction and Balance condition of visual dome-unstable surface. Differences between conditions were: firm surface-open eyes/firm surface-closed eyes, unstable surface-open eyes/unstable surface-closed eyes (p<0.001), and unstable surface-closed eyes/unstable surface-visual dome. Considering center of pressure and velocity of body sway, significant differences were observed between the following conditions: firm surface-open eyes/firm surface-closed eyes: firm surface-saccadic stimulus/firm surface-vertical optokinetic stimulus; firm surface-optokinetic stimuli/firm surface-visual–vestibular interaction; and firm surface-visual–vestibular interaction/unstable surface. Worse performances were observed in conditions firm surface-closed eyes, firm surface-vertical optokinetic stimulus, F-visual–vestibular interaction, and unstable surface-closed eyes. There was a difference in the center of pressure between firm surface-closed eyes/firm surface-saccadic stimulus, with a worse performance in the condition of firm surface-closed eyes, and of velocity of body sway, between firm surface-saccadic stimulus/firm surface-horizontal optokinetic stimulus (p<0.001). ConclusionStatic body balance in elderly individuals with vestibular disorders is worse when the sensory conditions are more challenging, i.e. stable and unstable surfaces, visual stimuli, such as optokinetic and visual–vestibular interaction, and with the eyes closed.

Interaction of brain areas of visual and vestibular simultaneous activity with fMRI.

Static body equilibrium is an essential requisite for human daily life. It is known that visual and vestibular systems must work together to support equilibrium. However, the relationship between these two systems is not fully understood. In this work, we present the results of a study which identify the interaction of brain areas that are involved with concurrent visual and vestibular inputs. The visual and the vestibular systems were individually and simultaneously stimulated, using flickering checkerboard (without movement stimulus) and galvanic current, during experiments of functional magnetic resonance imaging. Twenty-four right-handed and non-symptomatic subjects participated in this study. Single visual stimulation shows positive blood-oxygen-level-dependent (BOLD) responses (PBR) in the primary and associative visual cortices. Single vestibular stimulation shows PBR in the parieto-insular vestibular cortex, inferior parietal lobe, superior temporal gyrus, precentral gyrus and lobules V and VI of the cerebellar hemisphere. Simultaneous stimulation shows PBR in the middle and inferior frontal gyri and in the precentral gyrus. Vestibular- and somatosensory-related areas show negative BOLD responses (NBR) during simultaneous stimulation. NBR areas were also observed in the calcarine gyrus, lingual gyrus, cuneus and precuneus during simultaneous and single visual stimulations. For static visual and galvanic vestibular simultaneous stimulation, the reciprocal inhibitory visual-vestibular interaction pattern is observed in our results. The experimental results revealed interactions in frontal areas during concurrent visual-vestibular stimuli, which are affected by intermodal association areas in occipital, parietal, and temporal lobes.

Effects of aging on whole body and segmental control while obstacle crossing under impaired sensory conditions

The ability to safely negotiate obstacles is an important component of independent mobility, requiring adaptive locomotor responses to maintain dynamic balance. This study examined the effects of aging and visual–vestibular interactions on whole-body and segmental control during obstacle crossing. Twelve young and 15 older adults walked along a straight pathway and stepped over one obstacle placed in their path. The task was completed under 4 conditions which included intact or blurred vision, and intact or perturbed vestibular information using galvanic vestibular stimulation (GVS). Global task performance significantly increased under suboptimal vision conditions. Vision also significantly influenced medial–lateral center of mass displacement, irrespective of age and GVS. Older adults demonstrated significantly greater trunk pitch and head roll angles under suboptimal vision conditions. Similar to whole-body control, no GVS effect was found for any measures of segmental control. The results indicate a significant reliance on visual but not vestibular information for locomotor control during obstacle crossing. The lack of differences in GVS effects suggests that vestibular information is not up-regulated for obstacle avoidance. This is not differentially affected by aging. In older adults, insufficient visual input appears to affect ability to minimize anterior–posterior trunk movement despite a slower obstacle crossing time and walking speed. Combined with larger medial–lateral deviation of the body COM with insufficient visual information, the older adults may be at a greater risk for imbalance or inability to recover from a possible trip when stepping over an obstacle.

Motion aftereffect by means of circular vection depicts role of MST and OP2 in visual-vestibular interaction

Aim: Several works have revealed a robust visual-vestibular interaction at the cortical level. Functional neuroimaging with conflicting visual or vestibular stimuli have repeatedly demonstrated a reciprocal inhibition as the mode of action (1). Our hypothesis was that the occurrence of this interplay may be confined to a general (ego-)motion detection network. The aim of this fMRI and videooculography (VOG) study was to induce egomotion whilst at the same time being able to differentiate the phenomenons of torsional afternystagmus and the motion aftereffect (MAE).

Altered resting state – functional connectivity in patients with bilateral vestibular failure

Background: Patients with bilateral vestibular failure (BVF) suffer from gait unsteadiness and oscillopsia. Brain imaging studies applying vestibular stimulation in patients with BVF have shown altered neural activity of cortical visual-vestibular interaction: decreased bilateral neural activity in the posterior insula and parietal operculum and decreased deactivations in the visual cortex. It is unknown how this affects functional connectivity in the resting brain.

Postural control in underachieving students

Postural balance is a sensory-motor function resulting from a learning process. ObjectiveTo evaluate the postural control of underachieving students through static posturography together with virtual reality stimulation. MethodsThis was a controlled cross-sectional study of a group of 51 underachieving students and a control group of 60 students with good school performance, with no history of vestibular disorders or neurotological complaints, volunteers from the community, age- and gender-matched. The students were submitted to Balance Rehabilitation Unit (BRU™) posturography. ResultsA total of 111 students aged 7 to 12 years old were evaluated. At posturography evaluation, there was no significant difference between the limit of stability area (cm2) of the control group and the experimental group. The comparison between groups demonstrated a statistically significant difference (p<0.05) in the values of sway velocity (cm/s) and center of pressure area (cm2) in the ten sensory conditions evaluated. ConclusionPosturography with virtual reality stimulation, allows for the identification of incapacity to maintain postural control, with or without visual deprivation, and the assessment of visual, somatosensory, and vestibular-visual interaction conflict in underachieving students.© 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.