The effect of refractive blur upon postural stability was investigated under three conditions: normal standing, standing with input from the somatosensory system disrupted and standing with input from the somatosensory and vestibular systems disrupted. Standing stability was assessed using the centre of pressure (COP) signal from force plate data in four young subjects (mean 23.9 ± 3.1 years) and five repeated sets of measurements were taken. The subjects looked straight ahead at a horizontal and vertical square wave pattern of 2.5 cycles (degree)¿1. Under each of the three test conditions, standing stability was measured with the optimal refractive correction and under binocular blur levels of 0, + 1, + 2, + 4, and + 8 D and with eyes closed. In the normal standing condition, dioptric blur had only a mild effect on postural stability. However refractive blur produced large increases in postural instability when input from one or both of the other two sensory systems were disrupted. We hypothesized that dioptric blur would have an even great effect on postural stability if the visual target used was of higher spatial frequency. This was confirmed by repeated measurements on one subject using a target of 8 cycles (degree)¿1. The study highlights the possible importance of an optimal correction to postural stability, particular in situations (or people) where input from the somatosensory and/or vestibular systems are disrupted, and where the visual surrounds are of high spatial frequency.

The diploma thesis summarizes physiology of vestibular system and disorders of vestibular system. In experimental part we observe the influence of vestibular stimulation on static postural stability. We achieve vestibular stimulation by active and repeated head and body movements. We measure the lenght of COP trajectory using stabilometry. We tested two groups of persons, 20 healthy persons aged 21 - 49 years and 6 patients with postural stability disorder from vestibular origin aged 40 - 76 years. The changes in lenght of trajectory COP after vestibular stimulation were not statistically significant in any group, but for each patient, there was a change in lenght of trajectory of COP. In patients, who have peripheral vestibular disorder, there was a reduction in lenght of trajectory of COP. Powered by TCPDF (www.tcpdf.org)

A avaliação da variabilidade inter-individual da atividade funcional é de grande importância na utilização da ressonância magnética funcional (fMRI) no contexto clínico. O objetivo principal desse estudo é analisar a variabilidade da ativação cerebral dos sistemas vestibular e oculomotor, através da fMRI em resposta à estimulação optocinética horizontal e aos movimentos de rastreio e sacade dos olhos. Para isso, imagens por ressonância magnética foram obtidas de vinte e três voluntários assintomáticos (treze para o estudo optocinético e dez para os estudos rastreio e sacade) em um scanner de 1.5 T Siemens (Magneton Vision) com seqüências do tipo EPI-BOLD. Os mapas estatísticos foram obtidos no programa Brain Voyager, utilizando o método Modelo Geral Linear. Encontramos ativação significante no córtex visual primário, ao longo do giro occipital médio e inferior, no giro temporal médio, superior e inferior, no giro pós- e pré-central, ao longo do giro frontal inferior, superior e médio, no giro supramarginal, no lobo parietal superior e inferior, na ínsula e no cíngulo anterior e posterior. Grupos de atividade também foram encontrados em estruturas subcorticais (putamen, globo pálido, corpo caloso e tálamo), além do cerebelo. A análise da freqüência de ativação revelou uma alta variabilidade entre voluntários. Contudo, as regiões com maior freqüência de ativação foram as áreas frontais e a área que compreende o giro temporal médio e médio superior. Utilizamos dois métodos para a análise dos índices de lateralização, o primeiro admite um valor estatístico fixo e o segundo leva em consideração a dependência do limiar estatístico com o número de pixels ativados, o segundo método mostrou-se mais confiável. Os índices mostraram uma dominância do hemisfério direito para o estudo optocinético. Já, para os estudos rastreio e sacade, não verificamos essa dominância. Esse estudo permitiu a caracterização das mais freqüentemente áreas envolvidas nas tarefas de estimulação optocinética e dos movimentos de rastreio e sacade dos olhos. A combinação dessas tarefas constitui uma grande ferramenta para determinar a lateralização dessas funções e mapear as maiores áreas envolvidas nos sistemas oculomotor e vestibular. / Assessing inter-variability of functional activations is of practical importance in the use of functional magnetic resonance imaging (fMRI) in clinical context. The main objective of this study is to analyze the variability of cerebral activation of the vestibular and oculomotor systems through an optokinetic horizontal, a pursuit and saccadic eye movement stimulations by means of fMRI. For this, images of magnetic resonance were acquired of twenty and three asymptomatic volunteers (thirteen for the optokinetic study and ten for the pursuit and saccade stimulations) in scanner of 1.5 T Siemens (Magneton Vision) with EPI-BOLD fMRI sequences. The statistical maps were analyzed in Brain Voyager software, using the method General Linear Model. We find significant activation in primary visual cortex, in middle and inferior occipital gyrus, in middle, superior and inferior temporal gyrus, in postcentral and precentral gyrus, in middle, inferior and superior frontal gyrus, in supramarginal gyrus, in superior and inferior parietal lobule, in insula and in anterior and posterior cingulate gyrus. Groups of activity had been also found in subcorticals structures (putamen, globus pallidus, corpus callosum and thalamus), beyond the cerebellum. The analysis of the activation frequency displays a high variability between volunteers. However, the most frequently activation regions were localized in areas frontals and in regions comprehending the middle and medial superior temporal gyrus. We use two methods for the analysis of the laterality index, the first admits a fixed statistical value and the second takes in consideration the dependence of the statistical threshold within the activated number of pixels, the second method revealed more reliability. The indices had shown a right hemisphere dominance for the optokinetic study but, for the pursuit and saccade stimulations, we do not verify this dominance. Our study allowed the characterization of the most frequently involved foci in tasks of optokinetic and pursuit and saccade eye movement stimulations. The combination of these tasks constitutes a suitable tool for determine the lateralization of these functions and for mapping major areas involved in the oculomotor and vestibular systems.

Book Summary: Balance Function Assessment and Management, now in its second edition, continues to comprehensively address the assessment and treatment of balance system impairments through contributions from top experts in the areas of dizziness and vertigo. Designed for use in graduate audiology programs and by practicing audiologists, this is also a valuable text for those in the fields of physical therapy, otolaryngology, and neurology. Assessment chapters focus on ocular motility testing, positional/positioning testing, caloric testing, rotational testing, computerized dynamic posturography, and vestibular evoked potentials. Treatment chapters examine nonmedical, medical, and surgical treatments of dizziness and vertigo, vestibular rehabilitation, and assessment of and intervention for risk of falls. Additionally, this text provides background information on the vestibular and ocular motor systems with corresponding sample cases. New topics addressed in this edition include: Development of the vestibular system Central compensation following peripheral vestibular system impairment Video head impulse test (vHIT) Biomechanics and physiology of balance Electrocochleography (ECochG) Pediatric vestibular system and balance assessment Effects of age on the vestibular and balance systems An added bonus to the second edition is the companion website that offers additional reference materials, such as video clips, associated with the text.

Book Summary: In two freestanding but linked volumes, Textbook of Neural Repair and Rehabilitation provides comprehensive coverage of the science and practice of neurological rehabilitation. This volume, Medical Neurorehabilitation, can stand alone as a clinical handbook for neurorehabilitation. It covers the practical applications of the basic science principles presented in volume 1, provides authoritative guidelines on the management of disabling symptoms, and describes comprehensive rehabilitation approaches for the major categories of disabling neurological disorders. Emphasizing the integration of basic and clinical knowledge, this book and its companion are edited and written by leading international authorities. Together they are an essential resource for neuroscientists and provide a foundation for the work of clinical neurorehabilitation professionals.

This thesis demonstrates how a model-based observer can be applied to estimate the reference pilot expectation that can be achieved with any instrument scanning behavior and established models of vestibular inputs. The MBO, developed by the Georgia Tech Cognitive Engineering Center, is applied here in both simple maneuvers examining spatial disorientation and full Air Traffic Control concepts of operations examining loss of energy state awareness. The computational experiments presented in this thesis examine how different effects (i.e., instrument scan pattern, accuracy of pilot perception of flight display information, and awareness of control surface deflections) can prevent or mitigate the susceptibility to spatial disorientation and loss of energy state awareness, thus setting requirements for intervention and countermeasure designs in terms of the scanning behavior they must foster.

Cervical vestibular evoked myogenic potential (cVEMP) testing is widely used in the assessment of vestibular disorders in clinical practice (Welgampola & Colebatch, 2003). Ocular vestibular evoked myogenic potentials (oVEMPs) are similar to the cervical VEMPs in that the vestibular system is also stimulated by a loud sound. The difference is that the response is measured on the inferior oblique muscle of the eye as opposed to the sternocleidomastoid muscle (SCM) of the neck (Chihara, Iwasaki, Ushio, & Murofushi, 2007). The current study compares the standard cervical VEMP to the ocular VEMP in both control subjects and participants with “clinically certain” Ménière’s disease. By investigating cervical VEMPs in comparison to ocular VEMPs we aimed to improve the ability to stage and diagnose Ménière’s disease using the ocular VEMP. 22 control participants and 19 participants with confirmed unilateral Ménière’s disease took part in the study. The peak latency and amplitudes of the ocular and cervical VEMP tests were recorded and analysed. In addition, the background electromyographic (EMG) activity of both the inferior oblique and sternocleidomastoid muscles was recorded throughout testing. A questionnaire was also distributed to all participants to compare the relative difficulty of the VEMP tests. Statistical analysis using the paired t-test, standard t-test and the one-way ANOVA on ranks test was applied to determine a difference between the control and patient groups for both the ocular and cervical VEMP tests. Overall, the threshold and IAD ratio measures did not produce any significant results when sound was presented to the affected ear for the cervical and ocular VEMP tests. A significant reduction in amplitude of the VEMPs from the Ménière’s groups was found compared to the control groups for the ocular the cervical VEMPs. Overall, an increase in P2 and N3 latency of the ocular VEMP response in Ménière’s patients was determined. Results from the questionnaire suggest that the ocular VEMP test was more tolerable to the cervical VEMP test in this current study. Furthermore, statistical analyses revealed no significant differences in EMG level between the control and Ménière’s group for both the ocular and cervical VEMP data. Overall, results suggest that both the cervical and ocular VEMP tests provide information regarding the integrity of the saccule, owing to the abnormal VEMP findings in the participants with Ménière’s disease. In addition, this study provides evidence that the ocular VEMP is as useful a tool in diagnosing Ménière’s disease as the cervical VEMP.

Cervical vestibular evoked myogenic potential (cVEMP) testing is widely used in the assessment of vestibular disorders in clinical practice (Welgampola & Colebatch, 2003). Ocular vestibular evoked myogenic potentials (oVEMPs) are similar to the cervical VEMPs in that the vestibular system is also stimulated by a loud sound. The difference is that the response is measured on the inferior oblique muscle of the eye as opposed to the sternocleidomastoid muscle (SCM) of the neck (Chihara, Iwasaki, Ushio, & Murofushi, 2007). The current study compares the standard cervical VEMP to the ocular VEMP in both control subjects and participants with “clinically certain” Ménière’s disease. By investigating cervical VEMPs in comparison to ocular VEMPs we aimed to improve the ability to stage and diagnose Ménière’s disease using the ocular VEMP. 22 control participants and 19 participants with confirmed unilateral Ménière’s disease took part in the study. The peak latency and amplitudes of the ocular and cervical VEMP tests were recorded and analysed. In addition, the background electromyographic (EMG) activity of both the inferior oblique and sternocleidomastoid muscles was recorded throughout testing. A questionnaire was also distributed to all participants to compare the relative difficulty of the VEMP tests. Statistical analysis using the paired t-test, standard t-test and the one-way ANOVA on ranks test was applied to determine a difference between the control and patient groups for both the ocular and cervical VEMP tests. Overall, the threshold and IAD ratio measures did not produce any significant results when sound was presented to the affected ear for the cervical and ocular VEMP tests. A significant reduction in amplitude of the VEMPs from the Ménière’s groups was found compared to the control groups for the ocular the cervical VEMPs. Overall, an increase in P2 and N3 latency of the ocular VEMP response in Ménière’s patients was determined. Results from the questionnaire suggest that the ocular VEMP test was more tolerable to the cervical VEMP test in this current study. Furthermore, statistical analyses revealed no significant differences in EMG level between the control and Ménière’s group for both the ocular and cervical VEMP data. Overall, results suggest that both the cervical and ocular VEMP tests provide information regarding the integrity of the saccule, owing to the abnormal VEMP findings in the participants with Ménière’s disease. In addition, this study provides evidence that the ocular VEMP is as useful a tool in diagnosing Ménière’s disease as the cervical VEMP.

A avaliação da variabilidade inter-individual da atividade funcional é de grande importância na utilização da ressonância magnética funcional (fMRI) no contexto clínico. O objetivo principal desse estudo é analisar a variabilidade da ativação cerebral dos sistemas vestibular e oculomotor, através da fMRI em resposta à estimulação optocinética horizontal e aos movimentos de rastreio e sacade dos olhos. Para isso, imagens por ressonância magnética foram obtidas de vinte e três voluntários assintomáticos (treze para o estudo optocinético e dez para os estudos rastreio e sacade) em um scanner de 1.5 T Siemens (Magneton Vision) com seqüências do tipo EPI-BOLD. Os mapas estatísticos foram obtidos no programa Brain Voyager, utilizando o método Modelo Geral Linear. Encontramos ativação significante no córtex visual primário, ao longo do giro occipital médio e inferior, no giro temporal médio, superior e inferior, no giro pós- e pré-central, ao longo do giro frontal inferior, superior e médio, no giro supramarginal, no lobo parietal superior e inferior, na ínsula e no cíngulo anterior e posterior. Grupos de atividade também foram encontrados em estruturas subcorticais (putamen, globo pálido, corpo caloso e tálamo), além do cerebelo. A análise da freqüência de ativação revelou uma alta variabilidade entre voluntários. Contudo, as regiões com maior freqüência de ativação foram as áreas frontais e a área que compreende o giro temporal médio e médio superior. Utilizamos dois métodos para a análise dos índices de lateralização, o primeiro admite um valor estatístico fixo e o segundo leva em consideração a dependência do limiar estatístico com o número de pixels ativados, o segundo método mostrou-se mais confiável. Os índices mostraram uma dominância do hemisfério direito para o estudo optocinético. Já, para os estudos rastreio e sacade, não verificamos essa dominância. Esse estudo permitiu a caracterização das mais freqüentemente áreas envolvidas nas tarefas de estimulação optocinética e dos movimentos de rastreio e sacade dos olhos. A combinação dessas tarefas constitui uma grande ferramenta para determinar a lateralização dessas funções e mapear as maiores áreas envolvidas nos sistemas oculomotor e vestibular. / Assessing inter-variability of functional activations is of practical importance in the use of functional magnetic resonance imaging (fMRI) in clinical context. The main objective of this study is to analyze the variability of cerebral activation of the vestibular and oculomotor systems through an optokinetic horizontal, a pursuit and saccadic eye movement stimulations by means of fMRI. For this, images of magnetic resonance were acquired of twenty and three asymptomatic volunteers (thirteen for the optokinetic study and ten for the pursuit and saccade stimulations) in scanner of 1.5 T Siemens (Magneton Vision) with EPI-BOLD fMRI sequences. The statistical maps were analyzed in Brain Voyager software, using the method General Linear Model. We find significant activation in primary visual cortex, in middle and inferior occipital gyrus, in middle, superior and inferior temporal gyrus, in postcentral and precentral gyrus, in middle, inferior and superior frontal gyrus, in supramarginal gyrus, in superior and inferior parietal lobule, in insula and in anterior and posterior cingulate gyrus. Groups of activity had been also found in subcorticals structures (putamen, globus pallidus, corpus callosum and thalamus), beyond the cerebellum. The analysis of the activation frequency displays a high variability between volunteers. However, the most frequently activation regions were localized in areas frontals and in regions comprehending the middle and medial superior temporal gyrus. We use two methods for the analysis of the laterality index, the first admits a fixed statistical value and the second takes in consideration the dependence of the statistical threshold within the activated number of pixels, the second method revealed more reliability. The indices had shown a right hemisphere dominance for the optokinetic study but, for the pursuit and saccade stimulations, we do not verify this dominance. Our study allowed the characterization of the most frequently involved foci in tasks of optokinetic and pursuit and saccade eye movement stimulations. The combination of these tasks constitutes a suitable tool for determine the lateralization of these functions and for mapping major areas involved in the oculomotor and vestibular systems.

Objetivo: Avaliar tipo e frequência de alteração vestibular por meio de vectoeletronistagmografia em indivíduos com Disfunção Temporomandibular (DTM) de origem muscular. Método: Foram incluídos neste estudo 25 pacientes do gênero feminino, com faixa etária de 18 a 44 anos de idade com DTM muscular, classificada de acordo com os critérios do questionário já validado Research Diagnostic Criteria for Temporomandibular Disorders (RDC). Todos os indivíduos foram submetidos à avaliação otoneurológica, composta por anamnese, meatoscopia e vectoeletronistagmografia computadorizada. Resultados: Foram encontrados apenas três sujeitos com alteração na vectoetronistagmografia (alteração do nistagmo pós-calórico). Houve elevada ocorrência de sintomas otoneurológicos, dentre eles: tontura (96%), intolerância a sons altos, cinetose (76%), insônia (72%), plenitudeaural (64%) e zumbido (52%). Os músculos que apresentaram prevalência de dor à palpação foram: tendão do músculo temporal (96%), pterigóideo lateral (96%), masseter médio (92%) e masseter Inferior (68%). Não houve diferença estaticamente significante entre indivíduos com e sem alteração na vectoeletronistagmografia em relação aos principais sintomas otoneurológicos. Também não foi observada diferença estaticamente significante entre mulheres com e sem vertigem com relação à dor à palpação nos músculos estudados. Conclusão: Indivíduos com DTM do tipo muscular apresentaram baixa taxa de alterações vestibulares evidenciadas pelo exame de vectoeletronistagmografia computadorizada, apesar da elevada ocorrência de sintomatologia otoneurológica. / Objective: To evaluate the type and frequency of vestibular alteration through vectoelectronystagmography in individuals with temporomandibular disorder (TMD) muscle. Method: The study included 25 female patients, aged 18 to 44 years old with muscular TMD, classified according to the criteria of the questionnaire that has been validated by Research Diagnostic Criteria for Temporomandibular Disorders (RDC). All subjects underwent otoneurologicalavaliation consisting of anamnesis, otoscopyand computerized vectoelectronystagmography. Results: There were only three subjects with altered vectoelectronystagmography (modification of post-caloric nystagmus). There was a high occurrence of otoneurological symptoms, including dizziness (96%), intolerance to loud sounds, motion sickness (76%), insomnia (72%), fullness (64%) and tinnitus (52%). The muscles that had a prevalence of pain on palpation were temporal muscle tendon (96%), lateral pterygoid (96%), the middle portion of masseter (92%) and the lower masseter (68%). There was no statistically significant difference between individuals with and without changes in vectonystagmography on the main otoneurological symptoms.There was also no statistically significant difference between women with and without vertigo with respect to pain on palpation in the muscles studied. Conclusion: Individuals with TMD of muscular type showed a low rate of vestibular disorders revealed by the computerized vectoelectronystagmography despite the high occurrence of otoneurological symptoms.