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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)

Fixed-base driving simulators are commonplace in research and training. Simulators provide safe and controlled environments to train users on vehicle and device operation, to evaluate the safety of devices and controls, and to conduct research on driving and driving behaviours. One drawback to simulators is simulator sickness. As with motion sickness, simulator sickness can cause nausea, but additionally it has symptoms such as headache and eyestrain. Simulator sickness is a problem for multiple reasons: it can skew experimental results, it can waste participants’ and experimenter’s time, and it can limit testable populations. In addition, participants may modify their behaviour to avoid sickness, affecting experimental results or impeding learning. While sickness can reduce over multiple exposures, it is not known if any observable behaviours accompany these reductions. It is also not known why there are such marked individual differences in susceptibility. To test for behaviours that could be responsible for reducing sickness, I examined participants across two sessions in a fixed-base driving simulator. I found that gaze behaviour (eye and head movements) changed along with sickness. To determine the cause for this finding I instructed participants (pre-drive) to fixate their gaze during the curves of a simulated drive. This gaze modification was effective in reducing sickness during a first-time experience in the simulator, supporting a causal link. Next, I attempted to replace the missing vestibular input in a fixed-base simulator, so that the visual and vestibular perceptions of motion matched. This experiment showed that by providing vestibular stimulation appropriate or opposite of what would occur in the real world reduced sickness. This provided support for the theory that distracting stimulation (electrical in this case) could reduce attention to visual motion cues and therefore reduce conflict, a novel finding for simulator sickness research. Finally, I tested for any correlations between individual differences and sickness. I found that history of motion sickness and current illness both correlated with sickness, potentially useful as a pre-screening tool. In addition, driving behaviours such as speed, braking, and acceleration all correlated with sickness, showing that how a person behaves in a simulation could also contribute to sickness. / CFI, OGS, Auto21

In this study we found out whether professional ice hockey players have better static and dynamic stability after vestibular stimulation after 20 seconds of spinning on a rotary chair compared to normal healthy population. A total of 21 probands, 8 professional men players, 1 professional woman player and 12 men from the ordinary healthy population underwent testing. Probands passed a total of 8 tests, 4 tests without vestibular stimulation and the same tests after vestibular stimulation on a rotary chair. For testing on a stabilometric platform, we used the variants parallel stance barefoot on plate, parallel stance on a foam pad, parallel stance barefoot on plate with head movement to extension, parallel stance on a foam pad with head movement to extension. The rotation time on the chair was 20 seconds at a rate of approximately 1 Hz (20 turns ± 2), followed by a stability measurement time of 30 seconds. Our measured results showed that there is not signifficant difference in static and dynamic stability between ice hockey players and healthy population after induction of vestibular stimulation.

Le système vestibulaire joue un rôle important pour plusieurs fonctions, notamment, la perception de mouvement et le maintien de l’équilibre par l’entremise du contrôle postural. Or, une dégradation de la fonction de ce système peut avoir un impact sur le contrôle postural et ainsi augmenter le risque de chutes. Au courant des dernières années, la stimulation vestibulaire galvanique noisy (nGVS) a été démontrée comme étant efficace pour stimuler le système vestibulaire et améliorer le contrôle postural. Toutefois, les données de la nGVS sont fragmentaires et les paramètres optimaux de stimulation n’ont pas été établis. L’objectif général de la thèse était d’examiner l’effet de la nGVS sur le contrôle postural. Plus précisément, cette thèse visait à déterminer la méthodologie optimale de la nGVS et l’influence de la nGVS sur le contrôle postural d’une population présentant une dégradation de la fonction vestibulaire, soit des personnes âgées. La première étude avait pour objectif d’examiner l’effet post-stimulation de la nGVS sur le contrôle postural comparativement à une stimulation placebo. Ainsi, 14 adultes ont reçu une stimulation nGVS alors que 14 autres adultes ont reçu une stimulation placebo (sham). Le contrôle postural a été examiné avant la stimulation, immédiatement après la fin de la stimulation et 1 heure post-stimulation. Les résultats ont démontré une amélioration posturale similaire chez le groupe nGVS et le groupe sham, suggérant donc l’absence d’effet de la nGVS et ainsi un biais expérimental. De ce fait, cette étude a souligné l’importance d’un groupe contrôle lors de l’étude des effets de la nGVS sur le contrôle postural. La seconde étude visait à examiner l’effet de la densité du courant de la nGVS sur le contrôle postural en manipulant la taille des électrodes de stimulation. 36 adultes ont été séparés en 2 groupes expérimentaux, recevant la nGVS, et 1 groupe contrôle, recevant une stimulation placebo. Les groupes expérimentaux recevaient la nGVS soit avec des électrodes 35 cm2 ou 3 cm2. Ainsi, une amélioration posturale significative a été induite par la nGVS appliquée avec les électrodes de 3 cm2, soit celles avec une densité de courant plus élevée, comparativement à la nGVS avec électrodes de 35 cm2 et la stimulation placebo. La troisième étude visait à examiner l’effet de la nGVS sur le contrôle postural de personnes âgées avec et sans atteinte vestibulaire. De plus, cette étude explorait également l’effet post-stimulation de la nGVS chez les personnes âgées en comparaison à une stimulation placebo. Pour ce faire, 24 personnes âgées ont reçu la nGVS, la moitié avait une atteinte vestibulaire et l’autre moitié avait une fonction vestibulaire normale, et 12 personnes âgées ont reçu une stimulation placebo. Les données ont révélé une amélioration significative du contrôle postural induite par la nGVS comparativement à la stimulation placebo. De plus, une plus grande amélioration posturale a été observée chez les personnes âgées avec atteinte vestibulaire que les sujets âgés avec fonction vestibulaire normale après l’arrêt de la stimulation. Les résultats ont également démontré que l’amélioration posturale induite par la nGVS était maintenue après l’arrêt de la stimulation. Globalement, ces études soulignent des considérations méthodologiques de la nGVS, précisément, l’importance d’une stimulation placebo et de la densité du courant. De plus, les résultats suggèrent également un effet bénéfique de la nGVS sur le contrôle postural de personnes âgées, et celles présentant une atteinte vestibulaire en bénéficieraient davantage. Toutefois, des études futures sont requises pour déterminer les effets à long terme de la nGVS et les applications cliniques. / The vestibular system plays an important role for self-motion perception and balance through postural control. Therefore, a vestibular impairment can notably lead to a decrease of postural control and a higher risk of falls. Recently, noisy galvanic vestibular stimulation has been shown to stimulate the vestibular system and thereby improves postural control. However, until now, the optimal methodology for nGVS has not been determined, and the influence of the vestibular function on the effect of nGVS on postural has not been studied. Therefore, the main objective of the thesis was to examine the effect of nGVS on postural control. More precisely, this thesis aimed at determining the optimal methodology to apply with nGVS and to examine the effect of nGVS in a population with a decreased vestibular function, namely older adults. The first study aimed at investigating the sustained effect of nGVS on postural control compared to a sham stimulation. 28 adults were recruited and they either received nGVS or a sham stimulation. Postural control was assessed before stimulation, immediately after stimulation and 1 hour post-stimulation. Results showed a similar improvement of postural control for nGVS and sham, therefore suggesting an experimental bias. This study underlined the importance of a sham stimulation in the exploration of the sustained effect of nGVS on postural stability. The second study aimed at examining the effect of nGVS current density on postural control. To manipulate current density, two different sizes of electrodes were used, therefore 12 adults received nGVS with 35 cm2 electrodes while 12 others received nGVS with 3 cm2 electrodes. The nGVS groups were compared to 12 adults receiving a sham stimulation. The results demonstrated that only nGVS applied with 3 cm2 induced a significant improvement of postural compared to nGVS applied with 35 cm2 and sham stimulation. Therefore, it suggested that higher current density is needed to improve vestibular function. The third study aimed at determining the effect of nGVS on postural control in older adults with and without vestibular impairment. Furthermore, a second objective was to examine the post-stimulation effect of nGVS in older adults compared to a sham stimulation. 36 older adults were recruited, and 24 received nGVS while 12 received a sham stimulation. The nGVS group was composed of 12 older adults with vestibular impairment and 12 with a normal vestibular function. The results revealed that nGVS significantly improved postural control of older adults compared to a sham stimulation. The improvement induced by nGVS was significantly greater in older adults with vestibular impairment compared to older adults with normal vestibular function after the end of stimulation. Furthermore, the effect of nGVS on postural control was sustained after the end of the stimulation period. In summary, these studies underlined important methodological parameters of nGVS and results showed that nGVS could be a promising approach to use with populations with a decreased vestibular function, such as older adults. However, further studies are needed to examine the extent of the sustained effect of nGVS on postural control and to evaluate clinical applications.

L’objectif général de ce travail doctoral était de étudier la résultante entre les bénéfices induits par l’activité physique chronique et les effets délétères de l’avancée en âge sur la fonction d’équilibration. Pour cela, différentes techniques de manipulations sensorielles (e.g. stimulation vestibulaire galvanique, vibration tendineuse, électromyostimulation, tapis de mousse) ont été employées dans le cadre de tâches posturales bipodales. Les principaux résultats montrent que les manipulations sensorielles affectent le contrôle postural quel que soit l’âge et le niveau de pratique physique du sujet. Par ailleurs, l’avancée en âge semble majorer les effets perturbateurs des manipulations sensorielles. Le comportement postural observé pourrait, en grande partie, résulter d’une dégradation de la proprioception. Lorsque l’information proprioceptive est manipulée (i.e. vibration tendineuse), le groupe de sujets âgés ne pratiquant aucune activité physique saturerait plus rapidement le système proprioceptif que les autre groupes de sujets. En revanche, l’activité physique chronique limiterait la dégradation de la capacité d’équilibration. Elle pourrait améliorer la capacité des sujets âgés à recalibrer l’information sensorielle erronée et renforcerait l’efficacité de la proprioception. En filigrane, une optimisation fonctionnelle du système postural permettrait de compenser partiellement les effets du vieillissement. En effet, les involutions qui s’opèrent au cours de l’avancée en âge au niveau des systèmes sensoriels et du système nerveux central s’avèrent inéluctables. Elles empêchent les sujets âgés pratiquant une activité physique régulière de maintenir une habileté à compenser une perturbation posturale similaire à celle de sujets jeunes sportifs. / The overall objective of this thesis was to analyse the benefits resulting from the chronic physical activity and the deleterious effects induced by aging on postural control. To this end, different sensory manipulation techniques (e.g. vestibular galvanic stimulation, tendon vibration, electromyostimulation, foam surface) were used in the context of bipedal postural tasks. The main results showed that sensory manipulations affect postural control whatever the age and the level of physical practice of the subject. In addition, the disruptive effects of the sensory manipulations on postural control seem to increase with aging. This postural behaviour could largely result from the involution of the proprioception. When proprioception is disrupted (i.e. tendon vibration), the non-active old subjects group would saturate the proprioceptive system more quickly than the other groups. In contrast, the chronic physical activity would limit the involution of the postural control effectiveness. It could improve the ability of the old subjects to reweight sensory information and enhance the proprioception effectiveness. Hence, a functional postural control optimization might partly compensate the aging effects. Indeed, age-related involutions of sensory systems and central nervous system occurring across life span are inevitable. They prevent the older subjects who practice regular physical activity to maintain a similar ability to cope with postural disruptions in comparison with young athletes.

Excerpt: Recently, clinical vestibular tests have been developed for assessing otolith function. Little is known about treatment for otolith dysfunction, and this case report offers a perspective on using otolith stimulation to treat vestibular loss.

INTRODUCTION: La stimulation vestibulaire galvanique (GVS) est utilisée pour évaluer l’intégrité du système vestibulaire et améliorer notre compréhension des mécanismes de l‘équilibre. Néanmoins les réponses évoquées montrent une grande variabilité interindividuelle ce qui rend la compréhension du rôle du système vestibulaire difficile. OBJECTIF: Développer un protocole d’évaluation d’un seuil vestibulaire objectif spécifique à la personne. MÉTHODES: Dix-huit sujets sains droitiers se tenaient debout sur une plate-forme de force, les yeux fermés, la tête vers l’avant. L’accélération de la tête était enregistrée lorsque la GVS (durée: 200 ms) était appliquée à des intensités de 1 à 4,5mA. Des courbes de recrutement ont été générées afin de déterminer le seuil objectif (T). Puis, les participants ont été stimulés à différentes intensités relatives au seuil (0,5T; 0,75T; 1T et 1,5T). L’aire de l’ellipse de confiance (AE) à 95%, la vitesse de déplacement du centre de pression (CoP) et l’activité électromyographique du soléaire (SOL) ont été mesurées. RÉSULTATS: 1) Un seuil objectif a été déterminé pour chaque sujet basé sur l’accélération de la tête. 2) L’aire de l’ellipse, pendant la stimulation, corrélait avec l’intensité de stimulation (r=0,95; p=0,03). 3) L’amplitude de la 1ère phase du patron triphasique de la vitesse de déplacement du CoP corrélait aussi avec l’intensité de stimulation (r=0,98; 0,04). 4) En plus, l’amplitude de la réponse musculaire à moyenne latence induite par la GVS sur le SOL montrait une corrélation significative avec l’intensité de stimulation (r=0,7; p=0,045). DISCUSSION: Un seuil objectif vestibulaire peut être identifié par un accéléromètre. Les réponses vestibulaires mesurées par l’AE et le CoP sont proportionnelles aux intensités de stimulation relatives au seuil objectif déterminé. / INTRODUCTION: Galvanic vestibular stimulation (GVS) is used to assess the integrity of the vestibular system and to improve our understanding of the mechanisms of balance. However, the GVS-induced responses show great inter-individual variability, which makes it difficult to understand the contribution of the vestibular system in maintaining balance. OBJECTIVE: To develop a protocol identifying an objective vestibular threshold for GVS in order to limit this variability observed on GVS-induced responses. METHODS: Eighteen healthy right-handed subjects stood on a force platform, eyes closed, head forward. The head acceleration was recorded when the GVS (duration: 200 ms) was applied at intensities varying between 1 and 4.5mA. Recruitment curves were reconstructed to determine the objective threshold (T). Then, the participants were stimulated at different intensities relative to threshold (0.5T; 0.75T; 1T and 1.5T). The 95% confidence ellipse area, the velocity of the center of pressure (CoP) displacement and the electromyographic activity of the soleus muscle (SOL) were measured. RESULTS: 1) An objective threshold was determined for each subject based on the acceleration of the head. 2) The area of the ellipse, during stimulation, correlated with the stimulation intensity (r = 0.95; p = 0.03). 3) The amplitude of the 1st peak of the three-phase CoP velocity pattern also correlated with the stimulation intensity (r = 0.98; 0.04). 4) In addition, the amplitude of the medium latency response induced by the GVS on the SOL showed a significant correlation with the stimulation intensity (r = 0.7; p = 0.045). DISCUSSION: An objective vestibular threshold can be identified by an accelerometer. The vestibular responses measured by the ellipse area and the CoP are proportional to the stimulation intensities relative to the determined objective threshold.

The first purpose of this thesis was to examine whether sensorimotor therapy utilizing the training program ”Retraining for Balance” might be an appropriate technique for sensorimotor proficiency. The second purpose was to gain increased understanding of the effects of sensorimotor therapy on the physical and psychological development of children and youth. A third purpose was to put sensorimotor therapy in a wider perspective through a somewhat novel extension of the theoretical framework. Two naturalistic studies were conducted. Paper I was quantitative and comprised 232 children (181 boys and 51 girls) divided into three groups (1) a younger group (7 years or younger, n=65), (2) a middle group (8 to 10 years old, n=91) and, (3) an older group (11 years old or older, n=76). The participants presented attentional and motor difficulties before starting therapy. The treatment period was in average close to 3 years. Results indicated significant improvements concerning sensorimotor skills in all age groups. Paper II was a qualitative study, which included the records of 8 children (7 boys and 1 girl) randomly selected from the cohort of 232 children. The analysis used the EPP-method and yielded 3 overarching themes, which together formed “the kinesthetic-vestibular developmental model”. The model illustrated how Introductions of sensorimotor exercises pushed the therapy process forward due to periods of Regression and Transformation. The results were generalized to the remaining 224 children in the cohort by comparing each participant’s records with “the kinesthetic-vestibular developmental model”. The tentative conclusion was that sensorimotor therapy according to the method “Retraining for Balance” might constitute a complement to treatment of ADHD, DCD and LD but controlled studies are necessary before more decisive conclusions can be drawn. / Baksidestext   This thesis had three purposes. (1) to examine whether sensorimotor therapy (SMT) using the training program ”Retraining for Balance” might be a proper technique for sensorimotor proficiency. (2) to gain increased understanding of the effects of SMT on physical and psychological development and, (3) to put SMT in a wider perspective by an extension of the theoretical framework. Two naturalistic studies were conducted. Paper I, which was quantitative, comprised 232 children who presented attentional and motor difficulties. The cohort was divided into three groups depending on age and results after therapy indicated improvements in all groups. Paper II, a qualitative study, selected records of 8 children from the cohort. Analysis yielded 3 overarching themes, which together formed “the kinesthetic-vestibular developmental model” illustrating how Introductions of exercises pushed the process forward due to Regressions and Transformations. The results were generalized to the remaining 224 children. The tentative conclusion of this thesis was that SMT might constitute a complement to treatment of ADHD, DCD and LD but controlled studies are necessary before decisive conclusions can be drawn.

Perceptual rivalry refers to visual phenomena that are characterised by alternations between different percepts, despite an unchanging sensory input. Two common types of perceptual rivalry are (i) reversible figures — two-dimensional stable images that when viewed, are perceived to switch between different interpretations, and (ii) binocular rivalry — the alternations in image dominance resulting from the presentation of conflicting stimuli, one to each eye. Several investigators have suggested that these rivalling phenomena are mediated by similar neural mechanisms. Such a view, however, has not only been inadequately substantiated, but has also yet to be assessed in the context of a directly testable neurophysiological model. Miller and Pettigrew have proposed a novel, high-level interhemispheric switch (IHS) explanatory model of binocular rivalry. This model conceptualises the perceptual alternations as being mediated by alternations between one hemisphere’s selected image and the other hemisphere’s selected (rival) image. To assess their hypothesis, caloric vestibular stimulation (CVS) was used. CVS is a simple, inexpensive, and non-invasive brain stimulation technique that unilaterally activates high-level attentional areas. In accordance with the IHS model, CVS was found to significantly affect predominance (the duration that one image is perceived relative to the other, within a given viewing period) during conventional binocular rivalry with horizontal/vertical gratings and with orthogonal oblique gratings. The present thesis therefore aims, through the use of CVS, to extend this IHS model of binocular rivalry to reversible-figure alternations and propose a general IHS model of perceptual rivalry. Chapter 1 provides a detailed literature review of the field within the context of comparing both perceptual rivalries. In Chapter 2, investigations are presented on two different reversible figures — the perspective-reversing Necker cube and the figure–ground reversing Rubin’s vase–faces illusion. In these experiments, CVS was found to significantly change observers’ predominance compared to their baseline predominance. These results demonstrate that interhemispheric switching also mediates the alternations of these visual phenomena, in addition to binocular rivalry, thereby extending the IHS model to one of perceptual rivalry in general. Moreover, the findings are interpreted in a cognitive neuroscience context, including a novel proposal of a forebrain framework for the IHS model. Chapter 3 presents CVS experiments that address the issue of percept–to–hemisphere selection and the reproducibility of CVS effects, following Miller’s initial work on two types of conventional binocular rivalry. In planned analyses, significant predominance changes were not found in horizontal/vertical rivalry, oblique rivalry and Necker-cube rivalry. In post-hoc analyses that accounted for study-design differences between Miller’s original experiments and the present experiment, CVS was again not shown to induce significant predominance changes in any of the rivalry types. Assessment of directional predominance changes following CVS appeared to suggest an arbitrary selection of percept–to–hemisphere in all rivalry types, although no firm conclusions could be drawn from the obtained data on this issue. Nevertheless, the experiments further extend upon Miller’s earlier work by examining the inter- and intra-individual reproducibility of CVS-induced effects on predominance. Such reproducibility was found to be low and potential reasons for this are discussed. The experiments in Chapter 4 examine a type of binocular rivalry in which dichoptic presentation of Díaz-Caneja stimuli yields rivalry among four different stable images: half-field rivalry between the images presented to the eyes, and coherence rivalry in which aspects of each eye’s presented image are perceptually regrouped into rivalling coherent images. Each of these rivalries was found to occur for about half the given viewing time. Furthermore, CVS significantly shifted the predominance of perceived coherent images (coherence rivalry) but not half-field images (eye rivalry). This finding suggests that coherence rivalry (like conventional rivalry according to previous experiments) is mediated by interhemispheric switching at a high level, while eye rivalry is mediated by intrahemispheric mechanisms, most likely at a low level. In addition, it is proposed that Díaz-Caneja stimuli induce ‘meta-rivalry’ whereby these discrete high- and low-level competitive processes themselves rival for visual consciousness. The current thesis thus presents a novel meta-rivalry model of multistable binocular rivalry. It also presents the first direct evidence that interhemispheric switching mediates reversible-figure alternations, thereby supporting a generalised IHS model of perceptual rivalry. It is argued that both models provide a parsimonious exploratory framework within which specific predictions can be made and readily tested. Finally, the findings of all experiments in the current thesis are summarised.