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This thesis deals with the evaluation of the vestibulo-ocular reflex in patients indicated for neurosurgical resection of vestibular schwannoma, executed at the Motol University Hospital. To evaluate the function of the vestibulo-ocular reflex, three types of clinical examinations were used. In periods before the surgery, early after the surgery and before leaving the hospital we monitored the patients' ability to perceive subjective visual vertical, which reflects tonic function of otolith organs. Before the surgery we also tested relative dynamic visual acuity during passive isolated head movements in the transversal plane, whose impairment is related to dysfunction of lateral semicircular canals. Furthermore, we obtained patients' preoperative values achieved in caloric reflex test. In the early postoperative period, bordered by the first day after the vestibular schwannoma surgery and the last day of the hospitalization, patients underwent specialized vestibular rehabilitation. Based on statistical analysis of acquired data, we found out that in some patients there was a lesion of the vestibulo-ocular reflex already before the surgery and moreover, there was a correlation between dysfunction of translational and rotational parts of the vestibulo-ocular reflex. Although variance of subjective...

The human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) is a worldwide pandemic that affects the lives of millions of people across all ages. Its devastating effects are far-reaching and affect all aspects of an individual’s daily life. HIV/AIDS is responsible for widespread clinical manifestations involving the head and neck. Disorders of the auditory and vestibular systems are often associated with HIV/AIDS, however the extent and nature of these vestibular manifestations is still largely unknown. The main aim of this research study was to investigate vestibular functioning and pathology in adults with HIV/AIDS. This was achieved through three main research steps: a systematic literature review of the body of peer-reviewed literature on HIV/AIDS related vestibular manifestations and pathology, a description and comparison of vestibular involvement in adults with and without HIV/AIDS and an investigation to determine if HIV/AIDS influence the vestibulocollic reflex (VCR) pathways. For the first study a systematic literature review related to vestibular findings in individuals with HIV infection and AIDS was conducted. A varied search strategy was used across several electronic databases to identify relevant peer-reviewed reports in English. Several databases (Medline, Scopus and PubMed) and search strategies were employed. Where abstracts were not available, the full paper was reviewed, and excluded if not directly relevant to the study’s aims. Articles were reviewed for any HIV/AIDS associated vestibular symptoms and pathologies reported. For the second and third study, a cross-sectional, quasi-experimental comparative research design was employed. A convenience sampling method was used to recruit subjects. The sample consisted of 53 adults (29 male, 24 female, aged 23-49 years, mean = 38.5, SD = 4.4) infected with HIV, compared to a control group of 38 HIV negative adults (18 male, 20 female, aged 20-49 years, mean = 36.9, SD = 8.2). A structured interview probed the subjective perception of vestibular complaints and symptoms. Medical records were reviewed for cluster of differentiation 4+ (CD4+) cell counts and the use of antiretroviral (ARV) medication. An otologic assessment and a comprehensive vestibular assessment (bedside assessments, vestibular evoked myogenic potentials, ocular motor and positional tests and bithermal caloric irrigation) were conducted on all subjects. The systematic literature review identified 442 records, reduced to 210 after excluding duplicates, reviews, editorials, notes, letters and short surveys. These were reviewed for relevance to the scope of the study. There were only 13 reports investigating vestibular functioning and pathology in individuals affected by HIV/AIDS. This condition can affect both the peripheral and central vestibular system, irrespective of age and viral disease stage. Post-mortem studies suggest direct involvement of the entire vestibular system, while opportunistic infections such as oto- and neurosyphilis and encephalitis cause secondary vestibular dysfunction resulting in vertigo, dizziness and imbalance. The second study showed an overall vestibular involvement in 79.2% of subjects with HIV in all categories of disease progression, compared to 18.4% in those without HIV. Vestibular involvement increased from 18.9% in the Centers for Disease Control and Prevention (CDC) category 1 to 30.2% in category 2. Vestibular involvement was 30.1% in category 3. There was vestibular involvement in 35.9% of symptomatic HIV positive subjects and 41.5% in asymptomatic HIV positive subjects. Individuals with HIV were 16.6 times more likely to develop vestibular involvement during their lifetime, than among individuals without this disease. Vestibular involvement may occur despite being asymptomatic. The third study showed that abnormal cervical vestibular evoked myogenic potentials and caloric results were significantly higher in the HIV positive group (p=.001), with an odds ratio of 10.2. Vestibulocollic reflex and vestibulo-ocular reflex involvement increased with progression of the disease. There were more abnormal test results in subjects using ARV therapies (66.7%) compared to those not using ARV therapies (63.6%), but this difference was not statistically significant. Vestibular involvement was significantly more common in subjects with HIV than among those without this disease. This disease and its associated risk profile include direct effects of the virus on the vestibular system as demonstrated by postmortem studies. Opportunistic infections may compromise the functioning of the sensory and neural structures of hearing and the vestibular system indirectly, causing vertigo, dizziness or disequilibrium. Ototoxicity may also be related to vestibular dysfunction, due to the ototoxic nature of certain ARV medications. HIV/AIDS influence not only the vestibulo-ocular reflex, but also the vestibulocollic reflex pathways. Primary health care providers could screen HIV positive patients to ascertain if there are symptoms of vestibular involvement. If there are any, then they may consider further vestibular assessments and subsequent vestibular rehabilitation therapy, to minimize functional limitations of quality of life. / Thesis (DPhil)--University of Pretoria, 2014. / lk2014 / Speech-Language Pathology and Audiology / DPhil / Unrestricted

Les insectes sont capables de prouesses remarquables lorsqu’il s’agit d’éviter des obstacles,voler en environnement perturbé ou poursuivre une cible. Cela laisse penser que leurs capacités de traitement, aussi minimalistes soient-elles, sont parfaitement optimisées pour le vol. A cela s’ajoute des mécanismes raffinés, comme la stabilisation de la vision par rapport au corps, permettant d’améliorer encore plus leurs capacités de vol.Ces travaux de thèse présentent l’élaboration d’un micro drone de type quadrirotor, qui ressemble fortement à un insecte sur le plan perceptif (vibration rétinienne) et reprend des points structurels clés, tels que le découplage mécanique entre le corps et le système visuel. La conception du quadrirotor (de type open-source), son pilotage automatique et son système occulo-moteur sont minutieusement détaillés.Des traitements adaptés permettent, malgré un très faible nombre de pixels (24 pixels seulement), de poursuivre finement du regard une cible en mouvement. A partir de là, nous avons élaboré des stratégies basées sur le pilotage par le regard, pour stabiliser le robot en vol stationnaire, à l’aplomb d’une cible et asservir sa position ; et ce, en se passant d’une partie des capteurs habituellement utilisés en aéronautique tels que les magnétomètres et les accéléromètres. Le quadrirotor décolle, se déplace et atterrit de façon autonome en utilisant seulement ses gyromètres, son système visuel original mimant l’oeil d’un insecte et une mesure de son altitude. Toutes les expérimentations ont été validées dans une arène de vol, équipée de caméras VICON.Enfin, nous décrivons une nouvelle toolbox qui permet d’exécuter en temps réel des modèles Matlab/Simulink sur des calculateurs Linux embarqués de façon complètement automatisée (http://www.gipsalab.fr/projet/RT-MaG/). Cette solution permet d’écrire les modèles, de les simuler, d’élaborer des lois de contrôle pour enfin, piloter en temps réel, le robot sous l’environnement Simulink. Cela réduit considérablement le "time-to-flight" et offre une grande flexibilité (possibilité de superviser l’ensemble des données de vol, de modifier en temps réel les paramètres des contrôleurs, etc.). / Insects, like hoverflies are able of outstanding performances to avoid obstacles, reject disturbances and hover or track a target with great accuracy. These means that fast sensory motor reflexes are at work, even if they are minimalist, they are perfectly optimized for the flapping flight at insect scale. Additional refined mechanisms, like gaze stabilization relative to the body, allow to increase their flight capacity.In this PhD thesis, we present the design of a quadrotor, which is highly similar to an insect in terms of perception (visual system) and implements a bio-inspired gaze control system through the mechanical decoupling between the body and the visual system. The design of the quadrotor (open-source), itspilot and its decoupled eye are thoroughly detailed. New visual processing algorithms make it possible to faithfully track a moving target, in spite of a very limited number of pixels (only 24 pixels). Using this efficient gaze stabilization, we developed new strategies to stabilize the robot above a target and finely control its position relative to the target. These new strategies do not need classical aeronautic sensors like accelerometers and magnetometers. As a result, the quadrotor is able to take off, move and land automatically using only its embedded rate-gyros, its insect-like eye, and an altitude measurement. All these experiments were validated in a flying arena equipped with a VICON system. Finally, we describe a new toolbox, called RT-MaG toolbox, which generate automatically a real-time standalone application for Linux systems from a Matlab/Simulink model (http://www.gipsalab.fr/projet/RT-MaG/). These make it possible to simulate, design control laws and monitor the robot’s flight in real-time using only Matlab/Simulink. As a result, the "time-to-flight" is considerably reduced and the final application is highly reconfigurable (real-time monitoring, parameter tuning, etc.).

L’instabilité posturale est fréquente chez les séniors et peut entrainer la chute. La chute chez les séniors est un problème majeur de santé publique. Les chiffres épidémiologiques sont éloquents : une personne sur trois âgées de plus de 70 ans fera une chute dans l’année. Les causes sont multifactorielles : ostéo-articulaire, visuelle, cognitive, vestibulaire…. Dans cette étude, nous nous sommes intéressés à l’évolution de la fonction des récepteurs vestibulaires périphériques avec l’âge et à la perception de rotation à partir des entrées canalaires horizontales (système vestibulaire central et projections vestibulaires corticales). Notre but est d’essayer de comprendre l’implication du vieillissement du système vestibulaire dans l’instabilité posturale des séniors. Au niveau périphérique, nous avons quantifié la fonction des canaux semi-circulaires horizontaux par le test calorique et le vidéo-head impulse test. La fonction des récepteurs otolithiques (utriculaire et sacculaire) a été évaluée par les potentiels évoqués myogéniques recueillis au niveau cervical (voies sacculo-spinales) et oculaire (voies utriculo-oculaires). Au niveau central, la perception de l’entrée vestibulaire canalaire horizontale a été appréciée après irrigation à l’eau chaude du conduit auditif externe en appliquant un score de perception (présence ou absence de sensation rotatoire). Finalement, l’équilibre a été quantifié grâce au test d’organisation sensorielle sur l’Equitest et grâce à un système que nous avons récemment mis au point en collaboration avec le Professeur Curthoys à Sydney, comprenant une Wii Balance Board, un tapis mousse et un masque de réalité virtuelle (Oculus Rift). Les résultats ont montré une diminution des réponses oculaires au test calorique après 70 ans mais une absence de baisse du gain du réflexe vestibulo-oculaire horizontal au vidéo-head impulse test. La fonction otolithique, sacculaire et utriculaire, est altérée avec l’âge quelle que soit la stimulation utilisée (aérienne ou osseuse). La perception de l’entrée vestibulaire canalaire horizontale induite par une stimulation calorique nous a permis de montrer pour la première fois que certains séniors ne percevaient pas la sensation de rotation malgré une réponse oculaire normale (vitesse maximale de la phase lente du nystagmus oculaire supérieure à 15°/s). Dans notre population, nous avons pu ainsi définir deux types de séniors : un groupe présentant une perception de vertige rotatoire et un groupe « négligeant » ne pouvant pas reconstruire une sensation rotatoire à partir des entrées vestibulaires canalaires horizontales. La comparaison de ces deux groupes de séniors appariés sur l’âge ne montre aucune différence de la fonction canalaire horizontale ni de la fonction otolithique sacculaire et utriculaire. Néanmoins, les séniors négligents présentent en majorité des performances anormales (chute ou score diminué) à l’Equitest notamment en conditions 5 et 6. De plus, leur score au DHI est plus élevé relevant ainsi le handicape ressenti par ces séniors à cause de leur instabilité. En conclusion, les troubles de l’équilibre chez certains seniors pourraient résulter en partie d’une dysfonction vestibulaire centrale. Des études ultérieures permettront de déterminer si l’augmentation du seuil de perception rotatoire est un bon facteur prédictif du risque de chute. / Postural instability is common in seniors and can lead to falls which seniors are a major problem for Public Health. Epidemiological studies clearly show the magnitude of this problem: one in three people aged than more 70 years will fall in a year. This is caused by multiple factors including: musculoskeletal, visual, cognition, vestibular… The present study concerns the effect of age on the vestibular peripheral receptors function and on the perception of rotation from horizontal canal inputs (central vestibular processing and vestibular cortical projection). The aim is to try to understand the vestibular mechanisms involved in postural instability and mobility with age. At the peripheral level, the horizontal canal function was assessed using caloric test and video-Head Impulse Test. Otolith function (saccular and utricular) was assessed using vestibular evoked myogenic potentials recorded at cervical level (sacculo-spinal pathways) and at ocular level (utriculo-ocular pathways). At the central level, perception of motion from vestibular horizontal canal inputs was studied after caloric stimulation with warm water using a subjective perceptual score (presence or absence of rotatory vertigo). Finally, postural equilibrium was assessed with the Sensory Organization Test on the Equitest machine and also with a new system developed in collaboration with Prof. Curthoys (Sydney) using a Wii Balance Board, a foam rubber pad and a virtual reality headset (Oculus Rift DK2). Results showed decreased ocular responses induced by caloric stimulation after 70 years of age but healthy horizontal gain of the vestibulo-ocular reflex assessed by video-head impulse testing. The otolithic (saccular and utricular) function is impaired with age for all the stimuli used (air or bone conducted). Perception of motion induced by caloric stimulation (vestibular horizontal canal inputs) allowed us to show for the first time that some seniors are unable to feel the induced rotatory vertigo even with normal ocular responses (peak of the slow phase eye velocity higher than 15°/s). We defined two types of seniors: one senior group having a normal feeling of vertigo and one senior ‘neglect’ group who did not feel any sensation of rotation from horizontal canal inputs. The comparison of these two age-matched groups showed no difference in horizontal canal function, or otolithic function. The majority of the ‘neglect’ seniors with an absence of perception exhibited falls or a decreased score in conditions 5 and 6 during the Equitest. Moreover, their DHI scores were higher, showing the handicap induced by postural instability in these seniors. In conclusion, postural instability and falls in seniors may result from central vestibular impairment (inadequate central processing). A prospective study is needed to determine whether the increase perceptual threshold of rotation could be a good predictor of fall risk in seniors.