Effects of Vestibular Training on Postural Control of Healthy Adults

Background: Postural stability depends on the integration of multisensory inputs to drive motor outputs. When visual and somatosensory input is available and reliable, this reduces the postural control system’s reliance on the vestibular system. Despite this, vestibular loss can still cause severe postural dysfunction (1,2). Training one or more of the three sensory systems can alter sensory weighting and change postural behavior. Vestibular activation exercises, including horizontal and vertical headshaking, influence vestibular-ocular and -motor responses and have been showed to be effective in vestibular rehabilitation (3–8). Purpose/Hypothesis: To assess sensory reweighting of postural control processing and vestibular-ocular and -motor responses after concurrent vestibular activation with postural training. It was hypothesized that the effect of this training would significantly alter the pattern of sensory weighting by changing the ratio of visual, somatosensory and vestibular dependence needed to maintain postural stability, and significantly decrease vestibular responses. Methods: Forty-two young healthy individuals (22 females; 23.0+3.9 years; 1.6+0.1 meters) were randomly assigned into four groups: 1) visual feedback weight shift training (WST) coupled with an active horizontal headshake (HHS), 2) same WST with vertical headshake (VHS), 3) WST with no headshake (NHS) and 4) no training/headshake control (CTL) groups. The headshake groups performed an intensive body WST together with horizontal or vertical rhythmic headshake at 80 to 120 beats/minute. The NHS group performed the WST with no headshake while the controls did not perform any training. Five 15-minute training sessions were performed on consecutive days for one week with the weight shift exercises involving upright limits of stability activities on a flat surface, foam or rocker board (Fig. 1). All groups performed baseline- and post-assessments including sensory organization test (SOT) and force platform ramp perturbations, coupled with electromyographic (EMG) recordings. A video head impulse test was also used to record horizontal vestibulo-ocular reflex (VOR) gain. A between- and within-group repeated measures ANOVA was used to analyze five COP sway variables, the equilibrium and composite scores and sensory ratios of the SOT as well as EMG signals and horizontal VOR gain. Similarly, COP variables, EMG, as well as vestibular reflex data (vertical VOR, vestibulo-collic reflex [VCR] and vestibulo-spinal [VSR] gains) during ramp perturbations were analyzed. Alpha level was set at p<.05. Results: The training showed a significant somatosensory downweighting (p=.050) in the headshake groups compared to the other groups. Training also showed significant decreased horizontal VOR gain (p=.040), faster automatic postural response (p=.003) (Figs. 2-4) with improved flexibility (p=.010) in the headshake groups. Muscle activation pattern in medial gastrocnemius (p=.033) was significantly decreased in the headshake. Conclusion: The concurrent vestibular activation and weight shift training modifies vestibular-dependent responses after the training intervention as evidenced in somatosensory downweighting, decreased VOR gain, better postural flexibility and faster automatic postural response. Findings suggest this is predominantly due to vestibular adaptation and habituation of VOR, VCR and VSR which induced sensory reweighting. Clinical relevance: Findings may be used to guide the development of a vestibular-postural rehabilitation intervention in impaired neurological populations, such as with vestibular disorders or sensory integration problems.

Dissociation of muscle and cortical response scaling to balance perturbation acceleration

The role of cortical activity in standing balance is unclear. Here we tested whether perturbation-evoked cortical responses share sensory input with simultaneous balance-correcting muscle responses. We hypothesized that the acceleration-dependent somatosensory signals that drive the initial burst of the muscle automatic postural response also drive the simultaneous perturbation-evoked cortical N1 response. We measured in healthy young adults ( n = 16) the initial burst of the muscle automatic postural response (100–200 ms), startle-related muscle responses (100–200 ms), and the perturbation-evoked cortical N1 potential, i.e., a negative peak in cortical EEG activity (100–200 ms) over the supplementary motor area. Forward and backward translational support-surface balance perturbations were applied at four levels of acceleration and were unpredictable in timing, direction, and acceleration. Our results from averaged and single-trial analyses suggest that although cortical and muscle responses are evoked by the same perturbation stimulus, their amplitudes are independently modulated. Although both muscle and cortical responses increase with acceleration, correlations between single-trial muscle and cortical responses were very weak. Furthermore, across subjects, the scaling of muscle responses to acceleration did not correspond to scaling of cortical responses to acceleration. Moreover, we observed a reduction in cortical response amplitude across trials that was related to a reduction in startle-related—but not balance-correcting—muscle activity. Therefore, cortical response attenuation may be related to a reduction in perceived threat rather than motor adaptation or changes in sensory inflow. We conclude that the cortical N1 reflects integrated sensory inputs simultaneously related to brain stem-mediated balance-correcting muscle responses and startle reflexes. NEW & NOTEWORTHY Reactive balance recovery requires sensory inputs to be transformed into appropriate balance-correcting motor responses via brain stem circuits; these are accompanied by simultaneous and poorly understood cortical responses. We used single-trial analyses to dissociate muscle and cortical response modulation with perturbation acceleration. Although muscle and cortical responses share sensory inputs, they have independent scaling mechanisms. Attenuation of cortical responses with experience reflected attenuation of brain stem-mediated startle responses rather than the amplitude of balance-correcting motor responses.

Bilateral Vestibular Loss in Cats Leads to Active Destabilization of Balance During Pitch and Roll Rotations of the Support Surface

Although the balance difficulties accompanying vestibular loss are well known, the underlying cause remains unclear. We examined the role of vestibular inputs in the automatic postural response (APR) to pitch and roll rotations of the support surface in freely standing cats before and in the first week after bilateral labyrinthectomy. Support surface rotations accelerate the body center of mass toward the downhill side. The normal APR consists of inhibition in the extensors of the uphill limbs and excitation in the downhill limbs to decelerate the body and maintain the alignment of the limbs with respect to earth-vertical. After vestibular lesion, cats were unstable during rotation perturbations and actively pushed themselves downhill rather than uphill, using a postural response that was opposite to that seen in the control trials. The extensors of the uphill rather than downhill limbs were activated, whereas those of the downhill limbs were inhibited rather than being excited. We propose that vestibular inputs provide an important reference to earth-vertical, which is critical to computing the appropriate postural response during active orientation to the vertical. In the absence of this vestibular information, subjects orient to the support surface using proprioceptive inputs, which drives the body downhill resulting in instability and falling. This is consistent with current models of sensory integration for computation of body posture and orientation.

A Limited Set of Muscle Synergies for Force Control During a Postural Task

Recently developed computational techniques have been used to reduce muscle activation patterns of high complexity to a simple synergy organization and to bring new insights to the long-standing degrees of freedom problem in motor control. We used a nonnegative factorization approach to identify muscle synergies during postural responses in the cat and to examine the functional significance of such synergies for natural behaviors. We hypothesized that the simplification of neural control afforded by muscle synergies must be matched by a similar reduction in degrees of freedom at the biomechanical level. Electromyographic data were recorded from 8–15 hindlimb muscles of cats exposed to 16 directions of support surface translation. Results showed that as few as four synergies could account for >95% of the automatic postural response across all muscles and all directions. Each synergy was activated for a specific set of perturbation directions, and moreover, each was correlated with a unique vector of endpoint force under the limb. We suggest that, within the context of active balance control, postural synergies reflect a neural command signal that specifies endpoint force of a limb.

Ratio of Shear to Load Ground-Reaction Force May Underlie the Directional Tuning of the Automatic Postural Response to Rotation and Translation

This study sought to identify the sensory signals that encode perturbation direction rapidly enough to shape the directional tuning of the automatic postural response. We compared reactions to 16 directions of pitch and roll rotation and 16 directions of linear translation in the horizontal plane in freely standing cats. Rotations and translations that displaced the center of mass in the same direction relative to the feet evoked similar patterns of muscle activity and active ground-reaction force, suggesting the presence of a single, robust postural strategy for stabilizing the center of mass in both rotation and translation. Therefore we postulated there should be a common sensory input that encodes the direction of the perturbation and leads to the directional tuning of the early electromyographic burst in the postural response. We compared the mechanical changes induced by rotations and translations prior to the active, postural response. The only consistent feature common to the full range of rotation and translation directions was the initial change in ground-reaction force angle. Other variables including joint angles, ground-reaction force magnitudes, center of pressure, and center of mass in space showed opposite or nonsignificant changes for rotation and translation. Change in force angle at the paw reflects the ratio of loading force to slip force, analogous to slips during finger grip tasks. We propose that cutaneous sensors in the foot soles detect change in ground-reaction force angle and provide the critical input underlying the directional tuning of the automatic postural response for balance.