Adaptation to altered support and visual conditions during stance: patients with vestibular deficits

TLDR

Patients with vestibular disorders exhibit instability when standing on altered support surfaces or in changing visual environments, largely due to inappropriate weighting of proprioceptive and visual cues rather than a direct loss of vestibular input. The study aims to examine how vestibular input functions as an internal reference for orientation, guiding adaptive adjustments of proprioceptive and visual weighting. Using a six‑degree‑of‑freedom platform that independently moved each foot’s support surface and the visual surround, the authors recorded EMG, force, and body kinematics to quantify how patients altered the weighting of proprioceptive, vestibular, and visual inputs.

Abstract

Patients whose deficits were limited to clinically well qualified vestibular disorders have been exposed to a number of altered support surface and visual environments while standing unsupported. A six- degrees-of-freedom platform employing movable support surfaces for each foot and a movable visual surround deprived patients of normal inputs derived from a fixed level support surface and from an immobile surround. Various tests employing EMG, force, and body movement recording identified quantitative changes in the patients' strategy for the relative weighting of proprioceptive, vestibular, and visual inputs. The most dramatic performance deficit of patients was their inability to suppress the influence of visual and proprioceptive inputs appropriately whenever motions of external surface disturbed the orientation information provided by these inputs. Thus, the more mildly afflicted patients experienced instability not so much because of the loss of vestibular inputs directly to posture but because of their inappropriate responses to proprioceptive inputs and vision. Discussion is centered on the role of vestibular input as an internal reference system for orientation about which adaptive changes in proprioceptive and visual inputs are made.