Horizontal vestibuloocular reflex evoked by high-acceleration rotations in the squirrel monkey. IV. Responses after spectacle-induced adaptation.

The horizontal angular vestibuloocular reflex (VOR) evoked by sinusoidal rotations from 0.5 to 15 Hz and acceleration steps up to 3,000 degrees /s(2) to 150 degrees /s was studied in six squirrel monkeys following adaptation with x2.2 magnifying and x0.45 minimizing spectacles. For sinusoidal rotations with peak velocities of 20 degrees /s, there were significant changes in gain at all frequencies; however, the greatest gain changes occurred at the lower frequencies. The frequency- and velocity-dependent gain enhancement seen in normal monkeys was accentuated following adaptation to magnifying spectacles and diminished with adaptation to minimizing spectacles. A differential increase in gain for the steps of acceleration was noted after adaptation to the magnifying spectacles. The gain during the acceleration portion, G(A), of a step of acceleration (3,000 degrees /s(2) to 150 degrees /s) increased from preadaptation values of 1.05 +/- 0.08 to 1.96 +/- 0.16, while the gain during the velocity plateau, G(V), only increased from 0.93 +/- 0.04 to 1.36 +/- 0.08. Polynomial fits to the trajectory of the response during the acceleration step revealed a greater increase in the cubic than the linear term following adaptation with the magnifying lenses. Following adaptation to the minimizing lenses, the value of G(A) decreased to 0.61 +/- 0.08, and the value of G(V) decreased to 0.59 +/- 0.09 for the 3,000 degrees /s(2) steps of acceleration. Polynomial fits to the trajectory of the response during the acceleration step revealed that there was a significantly greater reduction in the cubic term than in the linear term following adaptation with the minimizing lenses. These findings indicate that there is greater modification of the nonlinear as compared with the linear component of the VOR with spectacle-induced adaptation. In addition, the latency to the onset of the adapted response varied with the dynamics of the stimulus. The findings were modeled with a bilateral model of the VOR containing linear and nonlinear pathways that describe the normal behavior and adaptive processes. Adaptation for the linear pathway is described by a transfer function that shows the dependence of adaptation on the frequency of the head movement. The adaptive process for the nonlinear pathway is a gain enhancement element that provides for the accentuated gain with rising head velocity and the increased cubic component of the responses to steps of acceleration. While this model is substantially different from earlier models of VOR adaptation, it accounts for the data in the present experiments and also predicts the findings observed in the earlier studies.

Outcome measures for assessment of treatment of the dizzy and balance disorder patient.

There are a variety of measurement tools available for assessing the treatment outcomes for patients with dizziness and imbalance. Some of these tools, however, may not be appropriate or valid for the patients in question. In this article, the various outcome measures are described and evaluated in terms of their reliability, validity, and sensitivity. There is no clearly superior outcome measure at this time, and the choice of the measurement tool depends on the patient and the aims of the treatment.

The effect of the canalith repositioning maneuver on resolving postural instability in patients with benign paroxysmal positional vertigo.

OBJECTIVE: Patients with benign paroxysmal positional vertigo (BPPV) often experience postural instability as well as brief episodes of vertigo. The purpose of this study was to determine whether successful resolution of the episodic vertigo, through use of the canalith repositioning treatment, would be accompanied by improvement in postural stability. STUDY DESIGN: Prospective clinical study. SETTING: Outpatient tertiary care facility in a university. PATIENTS: Thirty-three patients with a diagnosis of the canalithiasis form of BPPV affecting the posterior canal unilaterally. All patients had complete remission of the positional vertigo after treatment. Patients with abnormal caloric or rotary chair test results were excluded from the study. INTERVENTION: The posterior canal BPPV was treated by the canalith repositioning treatment. MAIN OUTCOME MEASURES: Postural stability was assessed by computerized dynamic posturography before and 1 to 2 weeks after treatment. Six different subtests were used. RESULTS: A significant number of patients had abnormal stability, as measured with computerized dynamic posturography, before treatment. After treatment there was a significant increase in the number of subjects with normal results on the different subtests; however, not all patients had normal postural stability. Younger subjects were more likely to show improved stability. CONCLUSIONS: Treatment of BPPV using the canalith repositioning treatment results in improved postural stability in patients with BPPV. Not all patients have normal stability after treatment, however, and assessment and treatment of the balance problems may be necessary.

Vestibular rehabilitation strategies in Meniere's disease.

Once the episodic spells of vertigo associated with Meniere's disease have abated, vestibular rehabilitation exercises play an important role in promoting adaptation to the decreased vestibular input. Outlines of different treatment approaches for three types of patients with Meniere's disease are presented. The exercise approaches advocated here consist of exercises to foster adaptation of the vestibular system in cases of unilateral loss or hypofunction and exercises to promote the substitution of alternative strategies and to enhance remaining function in cases of bilateral vestibular hypofunction. The selection of the appropriate exercises is based on the nature of the vestibular loss, the patient's symptoms, and the functional capabilities of the patient. Based on an understanding of the vestibular system, the balance system, and normal functional capabilities, appropriate rehabilitative exercises can be designed for this group of patients.

Vestibular adaptation exercises and recovery: acute stage after acoustic neuroma resection.

The use of exercises in the treatment of patients with vestibular deficits has become increasingly popular, and evidence exists that these exercises are beneficial in patients with chronic vestibular deficits. The question as to whether patients with acute unilateral vestibular loss would benefit from vestibular adaptation exercises is particularly compelling, however, because animal studies have demonstrated that the acute stage after unilateral vestibular loss is a critical period for recovery. Deprivation of visuomotor experience during that period can delay the onset of recovery as well as prolong the recovery period. Patients often avoid movement during the early stage because, with movement, they experience an increase in dysequilibrium and nausea. We examined the recovery of postural stability in patients during the acute stage after resection of acoustic neuroma to determine whether vestibular adaptation exercises facilitate the onset of recovery and improve the rate of recovery. The results suggest that vestibular adaptation exercises result in improved postural stability and in a diminished perception of dysequilibrium.

Behavior of identified Edinger-Westphal neurons during ocular accommodation.

1. The present study used single-unit recording and antidromic activation techniques in alert rhesus monkeys to examine the static and dynamic behavior of 21 parasympathetic, preganglionic neurons of the Edinger-Westphal nucleus (EW) during ocular accommodation. 2. All identified EW neurons were active when viewing at optical infinity with an average firing rate of 11.6 spikes/s. During near viewing, there was a linear relationship between firing rate and accommodation with an overall gain for the population of preganglionic EW neurons of 3.3 (spikes/s)/diopter. 3. The activity of eight identified EW neurons was studied during viewing of targets with conflicting vergence and accommodative demands to dissociate their vergence and accommodation responses. With normal viewing these responses are so closely matched that it cannot be determined if the activity of a cell is related to vergence or to accommodation, but with dissociated viewing these relationships can be determined. Under this viewing condition, six preganglionic EW neurons showed the same relationship to accommodation as they did during normal viewing. However, the activity of two cells could not be explained solely by accommodation, and they showed some activity related to vergence. 4. Microstimulation at the sites of identified EW neurons produced accommodation in the ipsilateral eye. Repeated measures of the effect of microstimulation yielded a value of 75 ms for the latency of the response. This latency was essentially the same in both animals tested. 5. The activity of identified EW neurons is related to the velocity of accommodation as well as to static accommodation. The relationship between accommodation velocity and firing rate was studied for 15 identified EW neurons during sine-wave tracking of targets moving in depth. All of these cells showed a clear relationship between firing rate and accommodation velocity. Overall, this group of identified EW neurons showed a velocity sensitivity of 1.2 (spikes/s)/(diopter/s) and an estimated neural time constant of 380 ms. 6. Eleven neurons encountered near to preganglionic EW neurons could not be antidromically activated by stimulation of the oculomotor nerve. These neurons had statistically higher gains with respect to the near response; indeed, there was no overlap between the gains of these neurons and the gains of preganglionic EW neurons. Upon dissociation of vergence from accommodation, they were found to be related to either vergence or to vergence and accommodation but not solely to accommodation.

Characteristics of antidromically identified oculomotor internuclear neurons during vergence and versional eye movements.

1. Previous studies have shown that midbrain near response cells that increase their activity during convergent eye movements project to medial rectus motoneurons, which also increase their activity during convergence. Most neurons in the abducens nucleus decrease their firing rate during convergence, and the source of this vergence signal is unknown. Oculomotor internuclear neurons (OINs) in monkeys project primarily from the medial rectus subdivisions of the oculomotor nucleus to the contralateral abducens nucleus, although there is a smaller ipsilateral projection as well. Because of these anatomic connections, it has been suggested that the OIN input may be responsible for the vergence signal seen on abducens neurons. The behavior of the OINs during eye movements and their synaptic drive are not known. Thus the goal of this study is to determine the behavior of these neurons during conjugate and disjunctive eye movements and to determine if these neurons have an excitatory or inhibitory drive on the abducens neurons. 2. Single-unit recording studies in alert rhesus monkeys were used to characterize the behavior of OINs. Eighteen OINs were identified by antidromic activation and collision testing. The recorded OINs displayed a burst-tonic pattern of activity during adducting saccades, and the majority of these cells displayed an increase in tonic activity with convergent eye movements. 3. Identified OINs were compared with a large sample of non-activated and untested horizontal burst-tonic cells in the medial rectus subdivisions of the oculomotor nucleus. The results indicate that the OINs behave similarly to medial rectus motoneurons during vergence and versional eye movements. None of the OINs displayed vertical eye position sensitivity. 4. Microstimulation of the oculomotor nucleus where both the OINs and medial rectus motoneurons were located resulted in a large adducting twitch of the ipsilateral eye and a smaller abducting twitch of the contralateral eye. The latter effect was presumed to be the result of OIN innervation of the contralateral abducens nucleus. This result suggests that the crossed OIN pathway is predominately, if not entirely, excitatory. 5. Injection of 10% lidocaine HCl into the medial rectus subdivision of the oculomotor nucleus caused a reversible inactivation of the medial rectus motoneurons and OINs. As expected, the inactivation of medial rectus motoneurons resulted in an exophoria and weakness of adduction for the eye ipsilateral to the lidocaine injection. In addition, the lidocaine injection resulted in hypometric and slowed abducting saccades in the eye contralateral to the injection site. This result also suggest that the crossed OIN pathway is excitatory.(ABSTRACT TRUNCATED AT 400 WORDS)