Evaluation of subjective vertical perception among stroke patients: a systematic review

Background: Verticality misperception is relatively common among patients after stroke, and it may be evaluated in terms of (a) subjective visual vertical (SVV), (b) subjective haptic vertical (SHV) and (c) subjective postural vertical (SPV). To better understand these assessment methods, we conducted a systematic review of the methodological characteristics of different protocols for evaluating SVV, SHV and SPV among individuals after stroke. Objective: To standardize the methodological characteristics of protocols for evaluating verticality perception after stroke. Methods: We searched the following databases: PUBMED, regional BVS portal (MEDLINE, LILACS, IBECS, CUBMED, Psychology Index and LIS), CINAHL, SCOPUS, Web of Science, Science Direct, Cochrane Library and PEDro. Two review authors independently used the QUADAS method (Quality Assessment of Diagnostic Accuracy Studies) and extracted data. Results: We included 21 studies in the review: most (80.9%) used SVV, eight (38.1%) used SPV and four (19.0%) used SHV. We observed high variability in assessments of verticality perception, due to patient positions, devices used, numbers of repetitions and angle of inclination for starting the tests. Conclusion: This systematic review was one of the first to explore all the methods of assessing verticality perception after stroke, and it provides crucial information on how to perform the tests, in order to guide future researchers/clinicians.

Individual motion perception parameters and motion sickness frequency sensitivity in fore-aft motion

Previous literature suggests a relationship between individual characteristics of motion perception and the peak frequency of motion sickness sensitivity. Here, we used well-established paradigms to relate motion perception and motion sickness on an individual level. We recruited 23 participants to complete a two-part experiment. In the first part, we determined individual velocity storage time constants from perceived rotation in response to Earth Vertical Axis Rotation (EVAR) and subjective vertical time constants from perceived tilt in response to centrifugation. The cross-over frequency for resolution of the gravito-inertial ambiguity was derived from our data using the Multi Sensory Observer Model (MSOM). In the second part of the experiment, we determined individual motion sickness frequency responses. Participants were exposed to 30-minute sinusoidal fore-aft motions at frequencies of 0.15, 0.2, 0.3, 0.4 and 0.5 Hz, with a peak amplitude of 2 m/s2 in five separate sessions, approximately 1 week apart. Sickness responses were recorded using both the MIsery SCale (MISC) with 30 s intervals, and the Motion Sickness Assessment Questionnaire (MSAQ) at the end of the motion exposure. The average velocity storage and subjective vertical time constants were 17.2 s (STD = 6.8 s) and 9.2 s (STD = 7.17 s). The average cross-over frequency was 0.21 Hz (STD = 0.10 Hz). At the group level, there was no significant effect of frequency on motion sickness. However, considerable individual variability was observed in frequency sensitivities, with some participants being particularly sensitive to the lowest frequencies, whereas others were most sensitive to intermediate or higher frequencies. The frequency of peak sensitivity did not correlate with the velocity storage time constant (r = 0.32, p = 0.26) or the subjective vertical time constant (r = − 0.37, p = 0.29). Our prediction of a significant correlation between cross-over frequency and frequency sensitivity was not confirmed (r = 0.26, p = 0.44). However, we did observe a strong positive correlation between the subjective vertical time constant and general motion sickness sensitivity (r = 0.74, p = 0.0006). We conclude that frequency sensitivity is best considered a property unique to the individual. This has important consequences for existing models of motion sickness, which were fitted to group averaged sensitivities. The correlation between the subjective vertical time constant and motion sickness sensitivity supports the importance of verticality perception during exposure to translational sickness stimuli.

Predicting cybersickness based on user’s gaze behaviors in HMD-based virtual reality

Cybersickness refers to a group of uncomfortable symptoms experienced in virtual reality (VR). Among several theories of cybersickness, the subjective vertical mismatch (SVM) theory focuses on an individual’s internal model, which is created and updated through past experiences. Although previous studies have attempted to provide experimental evidence for the theory, most approaches are limited to subjective measures or body sway. In this study, we aimed to demonstrate the SVM theory on the basis of the participant’s eye movements and investigate whether the subjective level of cybersickness can be predicted using eye-related measures. 26 participants experienced roller coaster VR while wearing a head-mounted display with eye tracking. We designed four experimental conditions by changing the orientation of the VR scene (upright vs. inverted) or the controllability of the participant’s body (unrestrained vs. restrained body). The results indicated that participants reported more severe cybersickness when experiencing the upright VR content without controllability. Moreover, distinctive eye movements (e.g. fixation duration and distance between the eye gaze and the object position sequence) were observed according to the experimental conditions. On the basis of these results, we developed a regression model using eye-movement features and found that our model can explain 34.8% of the total variance of cybersickness, indicating a substantial improvement compared to the previous work (4.2%). This study provides empirical data for the SVM theory using both subjective and eye-related measures. In particular, the results suggest that participants’ eye movements can serve as a significant index for predicting cybersickness when considering natural gaze behaviors during a VR experience.

Radial basis function neural network for head roll prediction modelling in a motion sickness study

<span>Motion Sickness (MS) is the result of uneasy feelings that occurs when travelling. In MS mitigation studies, it is necessary to investigate and measure the occupant’s Motion Sickness Incidence (MSI) for analysis purposes. One way to mathematically calculate the MSI is by using a 6-DOF Subjective Vertical Conflict (SVC) model. This model utilises the information of the vehicle lateral acceleration and the occupant’s head roll angle to determine the MSI. The data of the lateral acceleration can be obtained by using a sensor. However, it is impractical to use a sensor to acquire the occupant’s head roll response. Therefore, this study presents the occupant’s head roll prediction model by using the Radial Basis Function Neural Network (RBFNN) method to estimate the actual head roll responses. The prediction model is modelled based on the correlation between lateral acceleration and head roll angle during curve driving. Experiments have been conducted to collect real naturalistic data for modelling purposes. The results show that the predicted responses from the model are similar with the real responses from the experiment. In future, it is expected that the prediction model will be useful in measuring the occupant’s MSI level by providing the estimated head roll responses.</span>

Subjective Vertical Position Allows Prediction of Postural Deterioration in Patients with Parkinson’s Disease

Background. We believe that, in patients with Parkinson’s disease (PD), a forward-directed increase in the subjective vertical position (SV) leads to prolonged worsening of forward flexion of the trunk (FFT) mainly because the body adjusts to the SV. We conducted a study to clarify the relation between the SV angle, FFT angle, and various other clinical measures by comparing baseline values against values obtained 1 year later. Methods. A total of 39 PD patients (mean age, 71.9 ± 10.1 years; disease duration, 7.2 ± 5.4 years; modified Hoehn & Yahr (mH&Y) score, 2.6 ± 0.7) were enrolled. The Unified Parkinson’s Disease Rating Scale score, Mini-Mental State Examination (MMSE) score, mH&Y score, FFT angle, SV angle, and levodopa-equivalent dose (LED) were assessed at the time of enrollment (baseline evaluation) and 1 year later. Results. Eighteen patients (46%) complied with the protocol and completed the study. Significant increases were observed in the 1-year SV angle (p=0.02), MMSE score (p=0.008), and LED (p=0.001) compared to baseline values. Correlation was observed between the baseline SV angle and baseline and 1-year FFT angles (r=0.64, p=0.008 and r=0.58, p=0.012, respectively) and between the 1-year SV angle and 1-year FFT angle (r=0.63, p=0.005). Conclusion. Our data suggest that the SV contributes to increased FFT.