Postural threat differentially affects the feedforward and feedback components of the vestibular-evoked balance response.

Circumstances may render the consequence of falling quite severe, thus maximising the motivation to control postural sway. This commonly occurs when exposed to height and may result from the interaction of many factors, including fear, arousal, sensory information and perception. Here, we examined human vestibular-evoked balance responses during exposure to a highly threatening postural context. Nine subjects stood with eyes closed on a narrow walkway elevated 3.85 m above ground level. This evoked an altered psycho-physiological state, demonstrated by a twofold increase in skin conductance. Balance responses were then evoked by galvanic vestibular stimulation. The sway response, which comprised a whole-body lean in the direction of the edge of the walkway, was significantly and substantially attenuated after ~800 ms. This demonstrates that a strong reason to modify the balance control strategy was created and subjects were highly motivated to minimise sway. Despite this, the initial response remained unchanged. This suggests little effect on the feedforward settings of the nervous system responsible for coupling pure vestibular input to functional motor output. The much stronger, later effect can be attributed to an integration of balance-relevant sensory feedback once the body was in motion. These results demonstrate that the feedforward and feedback components of a vestibular-evoked balance response are differently affected by postural threat. Although a fear of falling has previously been linked with instability and even falling itself, our findings suggest that this relationship is not attributable to changes in the feedforward vestibular control of balance.

Cautious gait in relation to knowledge and vision of height: is altered visual information the dominant influence?

For some people, visual exposure creates difficulty with movement and balance, yet the mechanisms causing this are poorly understood. The altered visual environment is an obvious possible cause of degraded balance. We studied locomotion in normal healthy adults along a 22-cm-wide walkway at ground level and at a height of 3.5 m. This produced substantial changes in gait progression (velocity reduced by 0.34 ms(-1), P <0.01), proportion of time spent in double support more than doubled (P <0.01), and galvanic skin conductance, a measure of physiological arousal, increased significantly (P <0.01). Since increasing visual distance is known to destabilize balance, our primary question was whether the disturbing effects of height could be eliminated by replacing sight of the drop with a visual surround comparable to ground level while retaining the danger and knowledge of the risk. Removing visual exposure did not significantly change the gait progression (P = 0.65) or double support duration (P = 0.58) but produced a small, significant reduction in physiological arousal (P = 0.04). In response to postural threat, knowledge of danger rather than current visual environment was the dominant cause of cautious gait and elevated physiological arousal in response to postural threat. We conclude that the mechanisms disturbing locomotion, balance, and autonomic response occur at a high task level which integrates cognition and prior experience with sensory input.