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Perceptual Postural Imbalance and Visual Vertigo

  • Jeffrey R. Hebert
  • Prem S. SubramanianEmail author
Neuro-Ophthalmology (R. Mallery, Section Editor)
  • 63 Downloads
Part of the following topical collections:
  1. Topical Collection on Neuro-Ophthalmology

Abstract

Purpose of Review

Disorders of posture and balance cause significant patient morbidity, with reduction of quality of life as patients refrain from critical activities of daily living such as walking outside the home and driving. This review describes recent efforts to characterize visual disorders that interact with the neural integrators of positional maintenance and emerging therapies for these disorders.

Recent Findings

Abnormalities of gait and body position sense may be unrecognized by patients but are correlated with focal neurological injury (stroke). Patients with traumatic brain injury can exhibit visual vertigo despite otherwise normal visual functioning.

Summary

The effect of visual neglect on posture and balance, even in the absence of a demonstrable visual field defect, has been characterized quantitatively through gait analysis and validates the potential therapeutic value of prism treatment in some patients. In addition, the underlying neural dysfunction in visual vertigo has been explored further using functional imaging, and these observations may allow discrimination of patients with structural causes from those whose co-morbid psychosocial disorders may be primarily contributory.

Keywords

Postural instability Vestibular imbalance Hemianopia Visual neglect Optic flow Visual vertigo 

Notes

Acknowledgments

Jeffrey R. Hebert and Prem S. Subramanian would like to thank Aki Kawasaki for providing them with this topic.

Funding

This work was supported in part by a Challenge Grant to the Department of Ophthalmology, University of Colorado School of Medicine.

Compliance with Ethical Standards

Conflict of Interest

Jeffrey R. Hebert and Prem S. Subramanian each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Mira E. Improving the quality of life in patients with vestibular disorders: the role of medical treatments and physical rehabilitation. Int J Clin Pract. 2008;62:109–14.CrossRefGoogle Scholar
  2. 2.
    Pollock A, Hazelton C, Henderson CA, et al. Interventions for disorders of eye movement in patients with stroke. Cochrane Db Syst Rev. 2011;41:CD008389.Google Scholar
  3. 3.
    Chen C-C, Bockisch CJ, Olasagasti I, Weber KP, Straumann D, Huang M. Positive or negative feedback of optokinetic signals: degree of the misrouted optic flow determines system dynamics of human ocular motor behavior. Invest Ophth Vis Sci. 2014;55:2297–306.CrossRefGoogle Scholar
  4. 4.
    Bonan I, Hubeaux K, Gellez-Leman M, Guichard J, Vicaut E, Yelnik A. Influence of subjective visual vertical misperception on balance recovery after stroke. J Neurol Neurosurg Psychiatry. 2007;78:49–55.CrossRefGoogle Scholar
  5. 5.
    Rousseaux M, Honoré J, Vuilleumier P, Saj A. Neuroanatomy of space, body, and posture perception in patients with right hemisphere stroke. Neurology. 2013;81(1291):1297.Google Scholar
  6. 6.
    Nijboer T, Olthoff L, der Stigchel S, Visser-Meily J. Prism adaptation improves postural imbalance in neglect patients. Neuroreport. 2014;25:307.CrossRefGoogle Scholar
  7. 7.
    Bowen A, Hazelton C, Pollock A, Lincoln NB. Cognitive rehabilitation for spatial neglect following stroke. Cochrane Db Syst Rev. 2013;9:CD003586.Google Scholar
  8. 8.
    Kondiles BR, Starr CR, Larson EB, Zollman F. Method of assessment and symptom reporting in veterans with mild traumatic brain injury. Heal Psychol Behav Med. 2015;3:1–11.CrossRefGoogle Scholar
  9. 9.
    Caeyenberghs K, Leemans A, Geurts M, Taymans T, Linden C, its-Engelsman BC, et al. Brain-behavior relationships in young traumatic brain injury patients: DTI metrics are highly correlated with postural control. Hum Brain Mapp. 2010;31(992):1002.Google Scholar
  10. 10.
    Ksenia UI. Decomposition of postural movements in individuals with mild TBI while reaching to intercept a moving virtual target. Physiother Theor Pr. 2017:1–8.Google Scholar
  11. 11.
    Saj A, Cojan Y, Vocat R, Luauté J, Vuilleumier P. Prism adaptation enhances activity of intact fronto-parietal areas in both hemispheres in neglect patients. Cortex. 2013;49:107-119.Google Scholar
  12. 12.
    • Vaes N, Nys G, Lafosse C, Dereymaeker L, Oostra K, Hemelsoet D, et al. Rehabilitation of visuospatial neglect by prism adaptation: effects of a mild treatment regime. A randomised controlled trial. Neuropsychol Rehabil. 2016;57:1–20 This masked trial showed that short-term prism therapy may have persistent benefits for patients. Google Scholar
  13. 13.
    Padula W, Argyris S. Post trauma vision syndrome and visual midline shift syndrome. Neurorehabilitation. 1996;6:165–71.CrossRefGoogle Scholar
  14. 14.
    Dieterich M, Brandt T. Wallenberg’s syndrome: Lateropulsion, cyclorotation, and subjective visual vertical in thirty-six patients. Ann Neurol. 1992;31:399–408.CrossRefGoogle Scholar
  15. 15.
    Padula WV, Nelson CA, Padula WV, Benabib R, Yilmaz T, Krevisky S. Modifying postural adaptation following a CVA through prismatic shift of visuo-spatial egocenter. Brain Inj. 2009;23:566–76.CrossRefGoogle Scholar
  16. 16.
    • Padula WV, Subramanian P, Spurling A, Padula WV, Jenness J. Risk of fall (RoF) intervention by affecting visual egocenter through gait analysis and yoked prisms. Neurorehabilitation. 2015;37:305–14 This prospective study demonstrated objective changes in gait and postural station using quantitative methods, in contrast to prior qualitative investigations. CrossRefGoogle Scholar
  17. 17.
    Bense S, Janusch B, Vucurevic G, Bauermann T, Schlindwein P, Brandt T, et al. Brainstem and cerebellar fMRI-activation during horizontal and vertical optokinetic stimulation. Exp Brain Res. 2006;174:312–23.CrossRefGoogle Scholar
  18. 18.
    Ishida M, Fushiki H, Nishida H, Watanabe Y. Self-motion perception during conflicting visual-vestibular acceleration. J Vestib Res Equilib Orientat. 2008;18:267–72.Google Scholar
  19. 19.
    •• Hoppes CW, Sparto PJ, Whitney SL, Furman JM, Huppert TJ. Changes in cerebral activation in individuals with and without visual vertigo during optic flow: a functional near-infrared spectroscopy study. Neuroimage Clin. 2018;20:655–63 This study is among the first to show differences in cerebral activation in patients with visual vertigo as compared to control subjects when viewing optic flow stimuli. CrossRefGoogle Scholar
  20. 20.
    Ruehl R, Hinkel C, Bauermann T, zu Eulenburg P. Delineating function and connectivity of optokinetic hubs in the cerebellum and the brainstem. Brain Struct Funct. 2017;222:4163–85.CrossRefGoogle Scholar
  21. 21.
    Fushiki H, Takata S, Watanabe Y. Influence of fixation on circular vection. J Vestib Res Equilib Orientat. 2000;10:151–5.Google Scholar
  22. 22.
    Deutschländer A, Bense S, Stephan T, Schwaiger M, Brandt T, Dieterich M. Sensory system interactions during simultaneous vestibular and visual stimulation in PET. Hum Brain Mapp. 2002;16:92–103.CrossRefGoogle Scholar
  23. 23.
    Becker-Bense S, Buchholz H-G, zu Eulenburg P, Best C, Bartenstein P, Schreckenberger M, et al. Ventral and dorsal streams processing visual motion perception (FDG-PET study). BMC Neurosci. 2012;13:81.CrossRefGoogle Scholar
  24. 24.
    Cha Y-H, Cui Y, Baloh RW. Comprehensive clinical profile of Mal de debarquement syndrome. Front Neurol. 2018;9:261.CrossRefGoogle Scholar
  25. 25.
    Mucci V, Canceri J, Brown R, et al. Mal de debarquement syndrome: a survey on subtypes, misdiagnoses, onset and associated psychological features. J Neurol. 2018;265:486–99.CrossRefGoogle Scholar
  26. 26.
    • Cohen B, Yakushin SB, Cho C. Hypothesis: the vestibular and cerebellar basis of the Mal de debarquement syndrome. Front Neurol. 2018;9:28 This paper expands upon work by the authors and proposes new mechanisms for understanding this challenging condition. CrossRefGoogle Scholar
  27. 27.
    Seno T. Vection is not determined by the retinal coordinate. Psychology. 2014;05:12–4.CrossRefGoogle Scholar
  28. 28.
    Tamada Y, Seno T. Roles of size, position, and speed of stimulus in vection with stimuli projected on a ground surface. Aerosp Med Hum Perf. 2015;86(9):794–802.CrossRefGoogle Scholar
  29. 29.
    Keshavarz B, Speck M, Haycock B, Berti S. Effect of different display types on vection and its interaction with motion direction and field dependence. I-perception. 2017;8:2041669517707768.CrossRefGoogle Scholar
  30. 30.
    Lubeck AJ, Bos JE, Stins JF. Interaction between depth order and density affects vection and postural sway. PLoS One. 2015;10:e0144034.CrossRefGoogle Scholar
  31. 31.
    Keshavarz B, Hettinger LJ, Vena D, Campos JL. Combined effects of auditory and visual cues on the perception of vection. Exp Brain Res. 2014;232:827–36.CrossRefGoogle Scholar
  32. 32.
    Pollak L, Osherov M, Berkovitz N, Beckerman I, Stryjer R, Tal S. Magnetic resonance brain imaging in patients with visual vertigo. Brain Behav. 2015;5.  https://doi.org/10.1002/brb3.402.
  33. 33.
    Dimitriadis P, Saad M, Igra MS, Mandavia R, Bowes C, Hoggard N, et al. White matter lesions in magnetic resonance imaging of the brain in 56 patients with visual vertigo. J Laryngol Otol. 2018;132:550–3.CrossRefGoogle Scholar
  34. 34.
    Basford JR, Chou L-S, Kaufman KR, Brey RH, Walker A, Malec JF, et al. An assessment of gait and balance deficits after traumatic brain injury. Arch Phys Med Rehab. 2003;84:343–9.CrossRefGoogle Scholar
  35. 35.
    • Cheever KM, vitt J, Tierney R, Wright GW. Concussion Recovery Phase Affects Vestibular and Oculomotor Symptom Provocation. Int J Sports Med. 2017;39:141–7 This large study of collegiate athletes provides real-world, longitudinal data on a battery of tests that may be useful both for diagnosis and therapeutic planning. PubMedGoogle Scholar
  36. 36.
    •• Wright WG, Tierney RT, McDevitt J. Visual-vestibular processing deficits in mild traumatic brain injury. J Vestib Res. 2017;27:27–37 Systematic assessment that demonstrates functional deficits in the absence of nystagmus or other ocular motor disorders, implying involvement of higher order processing centers. CrossRefGoogle Scholar
  37. 37.
    Pavlou M, Davies RA, Bronstein AM. The assessment of increased sensitivity to visual stimuli in patients with chronic dizziness. J Vestib Res Equilib Orientat. 2006;16:223–31.Google Scholar
  38. 38.
    Zur O, Schoen G, Dickstein R, Feldman J, Berner Y, Dannenbaum E, et al. Anxiety among individuals with visual vertigo and vestibulopathy. Disabil Rehabil. 2015;37:2197–202.CrossRefGoogle Scholar
  39. 39.
    Bronstein AM. Vision and vertigo. J Neurol. 2004;251:381–7.CrossRefGoogle Scholar
  40. 40.
    Tilikete C, Vighetto A. Oscillopsia: causes and management. Curr Opin Neurol. 2011;24:38–43.CrossRefGoogle Scholar
  41. 41.
    Sluch IM, Elliott MS, Dvorak J, Ding K, Farris BK. Acetazolamide: a new treatment for visual vertigo. Neuro-ophthalmology. 2017;41:1–6.CrossRefGoogle Scholar
  42. 42.
    • Nooij SA, Pretto P, Oberfeld D, Hecht H, Bülthoff HH. Vection is the main contributor to motion sickness induced by visual yaw rotation: implications for conflict and eye movement theories. PLoS ONE. 2017;12:e0175305 This work attempted to control for multiple variables in visually induced motion sickness and identified vection as an important component of this condition. CrossRefGoogle Scholar
  43. 43.
    Pavlou M, Lingeswaran A, Davies R, Gresty M, Bronstein A. Simulator based rehabilitation in refractory dizziness. J Neurol. 2004;251:983–95.CrossRefGoogle Scholar
  44. 44.
    Pavlou M, Bronstein AM, Davies RA. Randomized trial of supervised versus unsupervised optokinetic exercise in persons with peripheral vestibular disorders. Neurorehab Neural Re. 2013;27:208–18.CrossRefGoogle Scholar
  45. 45.
    Pavlou M, Kanegaonkar R, Swapp D, Bamiou D, Slater M, Luxon L. The effect of virtual reality on visual vertigo symptoms in patients with peripheral vestibular dysfunction: a pilot study. J Vestib Res Equilib Orientat. 2012;22:273–81.Google Scholar
  46. 46.
    Fuzaro AC, Guerreiro CT, Galetti FC, Jucá RB, de Araujo JE. Modified constraint-induced movement therapy and modified forced-use therapy for stroke patients are both effective to promote balance and gait improvements. Braz J Phys Ther. 2012;16:157–65.CrossRefGoogle Scholar
  47. 47.
    Rucker JC, Phillips PH. Efferent vision therapy. J Neuroophthalmol. 2018;38:230–6.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Physical Medicine and RehabilitationUniversity of Colorado School of MedicineAuroraUSA
  2. 2.Department of NeurologyUniversity of Colorado School of MedicineAuroraUSA
  3. 3.Marcus Institute for Brain HealthUniversity of Colorado School of MedicineAuroraUSA
  4. 4.Department of OphthalmologyUniversity of Colorado School of MedicineAuroraUSA
  5. 5.Department of NeurosurgeryUniversity of Colorado School of MedicineAuroraUSA
  6. 6.Sue Anschutz-Rodgers UCHealth Eye CenterAuroraUSA

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