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. 2016 Apr 29;11(4):e0154528.
doi: 10.1371/journal.pone.0154528. eCollection 2016.

The Effect of Optokinetic Stimulation on Perceptual and Postural Symptoms in Visual Vestibular Mismatch Patients

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Free PMC article

The Effect of Optokinetic Stimulation on Perceptual and Postural Symptoms in Visual Vestibular Mismatch Patients

Angelique Van Ombergen et al. PLoS One. .
Free PMC article

Abstract

Background: Vestibular patients occasionally report aggravation or triggering of their symptoms by visual stimuli, which is called visual vestibular mismatch (VVM). These patients therefore experience discomfort, disorientation, dizziness and postural unsteadiness.

Objective: Firstly, we aimed to get a better insight in the underlying mechanism of VVM by examining perceptual and postural symptoms. Secondly, we wanted to investigate whether roll-motion is a necessary trait to evoke these symptoms or whether a complex but stationary visual pattern equally provokes them.

Methods: Nine VVM patients and healthy matched control group were examined by exposing both groups to a stationary stimulus as well as an optokinetic stimulus rotating around the naso-occipital axis for a prolonged period of time. Subjective visual vertical (SVV) measurements, posturography and relevant questionnaires were assessed.

Results: No significant differences between both groups were found for SVV measurements. Patients always swayed more and reported more symptoms than healthy controls. Prolonged exposure to roll-motion caused in patients and controls an increase in postural sway and symptoms. However, only VVM patients reported significantly more symptoms after prolonged exposure to the optokinetic stimulus compared to scores after exposure to a stationary stimulus.

Conclusions: VVM patients differ from healthy controls in postural and subjective symptoms and motion is a crucial factor in provoking these symptoms. A possible explanation could be a central visual-vestibular integration deficit, which has implications for diagnostics and clinical rehabilitation purposes. Future research should focus on the underlying central mechanism of VVM and the effectiveness of optokinetic stimulation in resolving it.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1
a. The dot pattern, b. The subjective visual vertical, and c. Flow chart of the procedure. Participants took part in two sessions following this procedure. In one session the dot pattern remained stationary during exposure (still session), while in the other session the dot pattern rotated (moving session).
Fig 2
Fig 2
a. The sway path length (SPL) in mm (±SEM) and b. Standard deviation in mediolateral direction (SDML) in mm (±SEM) for both groups and all measurement types. VVM patients always exhibited a higher SPL and SDML than healthy controls. VVM patients were significantly more affected by visual deprivation (i.e. eyes closed versus eyes open) than healthy controls. Significant differences at p < .05, p < .01 and p < .0001 are indicated with *, **, and ***, respectively. EC: eyes closed; EO: eyes open; OK: optokinetic.
Fig 3
Fig 3
a. The sway path length (SPL) in mm (±SEM) and b. Standard deviation in mediolateral direction (SDML) in mm (±SEM) for both groups and sessions. VVM patients always exhibited a higher SPL and SDML than healthy controls. Both VVM patients and controls had a higher SPL and SDML due to exposure to optokinetic stimulation compared to eyes open. Significant differences at p < .05 are indicated with *.
Fig 4
Fig 4
a. Median MISC rate and b. Median SSQ total score (TS) with the symptom cluster scores depicted in the inset. VVM patients always reported more severe symptoms than controls. Both VVM patients and controls reported an increase in symptom severity due to exposure to optokinetic stimulation. Significant differences at p < .05 and p < .01 are indicated with * and **, respectively

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Grant support

This work was supported by the Netherlands Organization for Scientific Research (NWO: grant 406-11-020). Angelique Van Ombergen is a research fellow for the Research Foundation Flanders (FWO Vlaanderen, grant 11U6414N and 11U6416N). This study was performed at the Multidisciplinary Motor Centre Antwerp (M2OCEAN) that was established by means of a Hercules Grant type 2 for medium-sized research infrastructure from the Flemish Research Council (AUHA/09/006).
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