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Biomedical subjects

F Owen Black

Publications and source records attributed to F Owen Black.

14 recordsLinked to original sources

Roll rotation cues influence roll tilt perception assayed using a somatosensory technique.

We investigated how the nervous system processes ambiguous cues from the otolith organs by measuring roll tilt perception elicited by two motion paradigms. In one paradigm (tilt), eight subjects were sinusoidally tilted in roll with the axis of rotation near ear level. Stimulus frequencies ranged from 0.005 to 0.7 Hz, and the peak amplitude of tilt was 20 degrees . During this paradigm, subjects experienced a sinusoidal variation of interaural gravitational force with a peak of 0.34 g. The second motion paradigm (translation) was designed to yield the same sinusoidal variation in interaural force but did not include a roll canal cue. This was achieved by sinusoidally translating the subjects along their interaural axis. For the 0.7-Hz translation trial, the subjects were simply translated from side to side. A centrifuge was used for the 0.005- to 0.5-Hz translation trials; the subjects were rotated in yaw at 250 degrees /s for 5 min before initiating sinusoidal translations yielding an interaural otolith stimulus composed of both centrifugal and radial acceleration. Using a somatosensory task to measure roll tilt perception, we found substantial differences in tilt perception during the two motion paradigms. Because the primary difference between the two motion paradigms was the presence of roll canal cues during roll tilt trials, these perceptual differences suggest that canal cues influence tilt perception. Specifically, rotational cues provided by the semicircular canals help the CNS resolve ambiguous otolith cues during head tilt, yielding more accurate tilt perception.

Adult↗

Modeling postural instability with Galvanic vestibular stimulation.

In this study the effect of a pseudorandom binaural bipolar Galvanic stimulus generated by a sum of nonharmonically related sine waves on postural control was functionally assessed using computerized dynamic posturography (CDP), and the results compared to vestibulopathic patient populations and astronauts exposed to microgravity. The standardized CDP test battery comprised six sensory organization tests (SOTs) that combined three visual conditions (eyes open, eyes closed, and sway-referenced vision) with two proprioceptive conditions (fixed and sway-referenced support surfaces). Subjects (12) performed 18 randomized trials (three trials of each of the six SOTs) as a baseline, repeated the 18 trials with Galvanic vestibular stimulation (GVS), and then performed a post-GVS baseline. A 10 min rest period was inserted between each test battery. Anterioposterior postural sway increased significantly and was in the abnormal range (fifth percentile) during GVS for SOTs where visual input was compromised (sway-referenced surround) or absent. Postural stability returned to baseline when GVS was removed. An analysis of sensory input scores (somatosensory, visual, and vestibular) demonstrated the specificity of GVS in distorting vestibular input to postural control. The SOT scores observed in astronauts on landing day did not differ significantly to that generated by GVS in our normal subjects. GVS also induced a similar pattern of instability on CDP as profound bilateral vestibular loss, although not as severe. The results suggest that unpredictably varying GVS quantitatively and qualitatively models postural instability of vestibular origin.

Adult↗

Hearing loss in patients with vestibulotoxic reactions to gentamicin therapy.

OBJECTIVES: To determine whether patients with vestibulotoxic reactions to gentamicin have hearing thresholds worse than predicted by distributions of better-ear hearing thresholds in people of the same age and sex in the general population, and, if so, to measure the severity and audiometric pattern of that hearing loss. DESIGN: Retrospective case series from previously published prospective and retrospective studies of vestibular function in patients receiving gentamicin. SETTING: Tertiary neurotological practice. PATIENTS: Convenience sample of 33 consecutive patients seen for objective evidence of vestibulotoxic reactions after systemic gentamicin therapy. Twenty-five of 33 patients underwent valid and complete audiometry. MAIN OUTCOME MEASURES: Age- and sex-corrected better-ear pure tone thresholds, 0.5 to 6.0 kHz. The better-ear audiogram was defined in 2 ways: primarily, the audiogram of the ear with the better average threshold at 0.5, 1.0, and 2.0 kHz; secondarily, the composite audiogram taking the better threshold for each frequency. RESULTS: Patients exhibiting vestibulotoxic reactions to gentamicin therapy had hearing thresholds that were similar to those seen in the general population at 0.5, 3.0, and 6.0 kHz. Median thresholds were 6 to 7 dB worse than expected at 1.0 and 2.0 kHz (95% confidence intervals, 2-13 dB and 3-12 dB, respectively). The largest median difference was 15 dB at 4.0 kHz (95% confidence interval, 3-23 dB), but this difference was not significant for the more conservative composite definition of the better ear. CONCLUSIONS: Patients with vestibulotoxic reactions to gentamicin therapy have little additional hearing loss compared with the general population. Physicians should monitor both auditory and vestibular function when aminoglycosides, especially gentamicin, must be used.

Adult↗

Destabilization of human balance control by static and dynamic head tilts.

To better understand the effects of varying head movement frequencies on human balance control, 12 healthy adult humans were studied during static and dynamic (0.14, 0.33, 0.6 Hz) head tilts of +/- 30 degrees in the pitch and roll planes. Postural sway was measured during upright stance with eyes closed and altered somatosensory inputs provided by a computerized dynamic posturography (CDP) system. Subjects were able to maintain upright stance with static head tilts, although postural sway was increased during neck extension. Postural stability was decreased during dynamic head tilts, and the degree of destabilization varied directly with increasing frequency of head tilt. In the absence of vision and accurate foot support surface inputs, postural stability may be compromised during dynamic head tilts due to a decreased ability of the vestibular system to discern the orientation of gravity. This instability may compound the risk of falling following recovery from balance disorders or adaptation to altered gravity conditions such as space flight. Thus, dynamic head tilts may improve the diagnostic sensitivity of computerized dynamic posturography, particularly for healthy subjects recovering from temporary balance control deficits.

Adaptation, Physiological↗

Vestibular perception and action employ qualitatively different mechanisms. I. Frequency response of VOR and perceptual responses during Translation and Tilt.

To investigate the neural mechanisms that humans use to process the ambiguous force measured by the otolith organs, we measured vestibuloocular reflexes (VORs) and perceptions of tilt and translation. One primary goal was to determine if the same, or different, mechanisms contribute to vestibular perception and action. We used motion paradigms that provided identical sinusoidal inter-aural otolith cues across a broad frequency range. We accomplished this by sinusoidally tilting (20 degrees, 0.005-0.7 Hz) subjects in roll about an earth-horizontal, head-centered, rotation axis ("Tilt") or sinusoidally accelerating (3.3 m/s2, 0.005-0.7 Hz) subjects along their inter-aural axis ("Translation"). While identical inter-aural otolith cues were provided by these motion paradigms, the canal cues were substantially different because roll rotations were present during Tilt but not during Translation. We found that perception was dependent on canal cues because the reported perceptions of both roll tilt and inter-aural translation were substantially different during Translation and Tilt. These findings match internal model predictions that rotational cues from the canals influence the neural processing of otolith cues. We also found horizontal translational VORs at frequencies >0.2 Hz during both Translation and Tilt. These responses were dependent on otolith cues and match simple filtering predictions that translational VORs include contributions via simple high-pass filtering of otolith cues. More generally, these findings demonstrate that internal models govern human vestibular "perception" across a broad range of frequencies and that simple high-pass filters contribute to human horizontal translational VORs ("action") at frequencies above approximately 0.2 Hz.

Adult↗

Vestibular perception and action employ qualitatively different mechanisms. II. VOR and perceptual responses during combined Tilt&Translation.

To compare and contrast the neural mechanisms that contribute to vestibular perception and action, we measured vestibuloocular reflexes (VOR) and perceptions of tilt and translation. We took advantage of the well-known ambiguity that the otolith organs respond to both linear acceleration and tilt with respect to gravity and investigated the mechanisms by which this ambiguity is resolved. A new motion paradigm that combined roll tilt with inter-aural translation ("Tilt&Translation") was used; subjects were sinusoidally (0.8 Hz) roll tilted but with their ears above or below the rotation axis. This paradigm provided sinusoidal roll canal cues that were the same across trials while providing otolith cues that varied linearly with ear position relative to the earth-horizontal rotation axis. We found that perceived tilt and translation depended on canal cues, with substantial roll tilt and inter-aural translation perceptions reported even when the otolith organs measured no inter-aural force. These findings match internal model predictions that rotational cues from the canals influence the neural processing of otolith cues. We also found horizontal translational VORs that varied linearly with radius; a minimal response was measured when the otolith organs transduced little or no inter-aural force. Hence, the horizontal translational VOR was dependent on otolith cues but independent of canal cues. These findings match predictions that translational VORs are elicited by simple filtering of otolith signals. We conclude that internal models govern human perception of tilt and translation at 0.8 Hz and that high-pass filtering governs the human translational VOR at this same frequency.

Acceleration↗

Cerebral hypoperfusion precedes nausea during centrifugation.

INTRODUCTION: Nausea and motion sickness are important operational concerns for aviators and astronauts. Understanding the underlying mechanisms associated with motion sickness may lead to new treatments. The goal of this work was to determine if changes in cerebral blood flow precede the development of nausea in subjects susceptible to motion sickness. METHODS: Cerebral flow velocity in the middle cerebral artery (transcranial Doppler), BP, and end-tidal CO2 were measured while subjects were rotated on a centrifuge (250 degrees x s(-1)). Following 5 min of rotation, subjects were translated 51.5 cm off-center, creating a +1 Gx centripetal acceleration in the nasal-occipital plane. RESULTS: There were 10 subjects who completed the protocol without symptoms while 5 developed nausea (4 while off-center and 1 while rotating on-center). Prior to nausea, subjects had significant increases in BP (+13 +/- 3 mmHg, p < 0.05) and cerebrovascular resistance (+46 +/- 17%, p < 0.05) and decreases in cerebral flow velocity both in the second (-13 +/- 4%) and last minute (-22 +/- 5%) before symptoms (p < 0.05). In comparison, subjects resistant to motion sickness demonstrated no change in BP or cerebrovascular resistance in the last minute of off-center rotation and only a 7 +/- 2% decrease in cerebral flow velocity. All subjects had significant hypocapnia (-3.8 +/- 0.4 mmHg, p < 0.05); however, this hypocapnia could not fully explain the cerebral hypoperfusion associated with the development of nausea. CONCLUSIONS: These data indicate that reductions in cerebral blood flow precede the development of nausea. Further work is necessary to determine what role cerebral hypoperfusion plays in motion sickness and whether cerebral hypoperfusion can be used to predict the development of nausea in susceptible individuals.

Adult↗

Dynamic posturography in humans imagining a fixed spatial reference.

OBJECTIVE: To investigate the effect of imagining a fixed spatial reference on balance control. MATERIAL AND METHODS: Twenty-one healthy subjects were asked to remain as stable as possible while standing on a sway-referenced platform (NeuroCom Equitest posturography system). Subjects were instructed to keep their eyes open in the dark and to either look far into the distance without fixating on any particular point in space or to direct their gaze towards a remembered earth-fixed target (25-cm distant). Room lights were switched off immediately before each 20-s sway recording. Postural stability measures included equilibrium scores and root-mean-square sway amplitudes in the anterior-posterior plane. RESULTS: Postural sway was not influenced by the instruction to gaze towards a remembered target. CONCLUSION: Imagining a fixed spatial reference does not influence postural control, at least during sway-referenced dynamic posturography.

Adolescent↗

Postflight balance control recovery in an elderly astronaut: a case report.

OBJECTIVE: To examine the sensorimotor adaptive response of a 77-year-old man exposed to the gravito-inertial challenges of orbital space flight. STUDY DESIGN: Prospective case study with retrospective comparisons. SETTING: NASA Neurosciences Laboratory (Johnson Space Center) and Baseline Data Collection Facility (Kennedy Space Center). PRIMARY PARTICIPANT: One 77-year-old male shuttle astronaut. INTERVENTION: Insertion into low Earth orbit was used to remove gravitational stimuli and thereby trigger sensorimotor adaptation to the microgravity environment. Graviceptor stimulation was reintroduced at landing, and sensorimotor readaptation to the terrestrial environment was tracked to completion. MAIN OUTCOME MEASURES: Computerized dynamic posturography tests were administered before and after orbital flight to determine the magnitude and time course of recovery. RESULTS: The elderly astronaut exhibited balance control performance decrements on landing day; however, there were no significant differences between his performance and that of younger astronauts tested on the same shuttle mission or on previous shuttle missions of similar duration. CONCLUSIONS: These results demonstrate that the physiological changes attributed to aging do not necessarily impair adaptive sensorimotor control processes.

Adaptation, Physiological↗

Benign paroxysmal positional nystagmus in hospitalized subjects receiving ototoxic medications.

OBJECTIVE: To investigate the occurrence of benign paroxysmal positional nystagmus in subjects undergoing treatment with potentially ototoxic medications. STUDY DESIGN: Prospective and retrospective record reviews. SETTING: Tertiary referral neurotology clinic; clinical research and technology center. SUBJECTS: Ninety-nine hospitalized subjects undergoing treatment of infectious disease or carcinoma with potentially ototoxic medications. INTERVENTIONS: Records review, tests of vestibular function. MAIN OUTCOME MEASURE: Results of Hallpike positional tests for benign paroxysmal positional nystagmus (electro-oculography). RESULTS: Forty-one (41%) of 99 subjects were female and 58 (59%) were male. Age range was 15 to 73 years (mean, 47 years). Forty-nine (50%) of 99 subjects had an unequivocally positive Hallpike test for benign paroxysmal positional nystagmus in one or both ears. The occurrence of benign paroxysmal positional nystagmus in the Hallpike-positive population was distributed equally across age decades. Of the 49 subjects with benign paroxysmal positional nystagmus, 22 (44%) were female and 27 (56%) were male. CONCLUSIONS: Benign paroxysmal positional nystagmus is the most common cause of vertigo in the general population, including subjects receiving ototoxic drugs. Complaints of vertigo in subjects receiving ototoxic drugs therefore may or may not indicate onset of ototoxicity. Occurrence of benign paroxysmal positional nystagmus in subjects receiving ototoxic drugs was independent of gender or age. The high occurrence rate of benign paroxysmal positional nystagmus in subjects receiving potentially ototoxic medications is consistent with the observation that benign paroxysmal positional nystagmus occurs in combination with many pathologic conditions. Benign paroxysmal positional nystagmus presenting in subjects receiving ototoxic drugs may complicate the clinical identification of ototoxicity and obfuscate clinical decision-making processes.

Adolescent↗

Permanent gentamicin vestibulotoxicity.

OBJECTIVE: To determine the natural history of permanent gentamicin vestibulotoxicity. STUDY DESIGN: Retrospective; comparison of retrospective and prospective studies. SETTING: Tertiary neurotology clinic. Clinical research and technology center. SUBJECTS: Thirty-three subjects with permanent gentamicin-induced vestibulotoxicity. INTERVENTIONS: Medical records review, neurotologic examination, and vestibular and auditory function tests. MAIN OUTCOME MEASURES: Vestibular and auditory function test results at least 1 year after discontinuation of gentamicin, clinical examination results, serum gentamicin levels, and serum creatinine levels. RESULTS: Thirty-three subjects had vestibular function test results consistent with permanent gentamicin ototoxicity. All complained of dysequilibrium, 32 described oscillopsia, and 23 had tinnitus. All 33 subjects had complained of symptoms consistent with ototoxicity within 1 to 3 weeks of initiation of gentamicin therapy; however, gentamicin vestibulotoxicity was not recognized before hospital discharge in 32 of 33 subjects. Serum peak and trough gentamicin levels did not correlate with the development of vestibulotoxicity, nor did observance of recommended "safe" dosage ranges. Of 17 subjects whose serum creatinine levels were recorded, 6 experienced abnormal elevations in serum creatinine in conjunction with gentamicin use. CONCLUSION: Gentamicin can cause permanent vestibular and auditory ototoxicity. There is no safe dose of gentamicin. Serum gentamicin levels are of no value in predicting the onset, occurrence, or severity of vestibulotoxicity or cochleotoxicity. Termination of gentamicin on appearance of signs or symptoms of ototoxicity may reduce the incidence of permanent vestibular ototoxicity. When possible, other antibiotics should be administered.

Adult↗

Vestibular adaptation and rehabilitation.

PURPOSE OF REVIEW: This article reviews current literature pertaining to vestibular adaptation and rehabilitation. RECENT FINDINGS: Properly conducted and supervised vestibular rehabilitation therapy ameliorates a wide variety of peripheral and central balance disorders in patients of all ages. The best outcomes result from individualized vestibular rehabilitation therapy programs that correct or compensate for the negative impact of specific vestibular functional deficits and comorbid conditions on patient function. Comorbid conditions such as anxiety, depression, and cognitive dysfunction may affect vestibular rehabilitation therapy outcome. As objective postural instability improves in response to vestibular rehabilitation therapy, self-reported handicap lessens. SUMMARY: Successful vestibular rehabilitation therapy improves activities of daily living and reduces fall risk.

Activities of Daily Living↗

Eye movement responses to active, high-frequency pitch and yaw head rotations in subjects with unilateral vestibular loss or posterior semicircular canal occlusion.

This study assessed the eye movement responses to active head rotation in six subjects with complete unilateral vestibular loss (UVL), five subjects with posterior canal plugging (PCP) and age- and sex-matched normal subjects. Subjects performed head rotations in the pitch and yaw planes at frequencies ranging from 2 to 6 Hz, while looking at an earth-fixed target. Vertical eye movement gains obtained in UVL, PCP and normal subjects were not significantly different. Vertical phases decreased with increasing head movement frequencies in both UVL and PCP subjects. Although this decrease produced significantly different vertical phases between UVL and normal subjects for head movements above 3.9 Hz, vertical phases in some normal subjects were similar to those obtained in UVL subjects. We conclude that active head oscillations in the pitch plane are not clinically useful for the detection of vertical canal impairment limited to one ear. As expected, UVL subjects showed reduced horizontal gains, and eye velocity asymmetries during active head rotation in the yaw plane. Results in some PCP subjects suggested possible minor impairments of horizontal vestibulo-ocular reflexes.

Adolescent↗

Maternal susceptibility to nausea and vomiting of pregnancy: is the vestibular system involved?

Nausea and vomiting of pregnancy shares many characteristics with motion sickness, a vestibular dependent phenomenon. A number of physiologic changes that occur in normal pregnancy are also known to accompany nausea and vomiting in patients with motion sickness and certain vestibular disorders. This chapter summarizes some shared features of both phenomena. The unmasking of subclinical vestibular disorders may account for some cases of hyperemesis gravidarum. Hormonal effects on neurotransmitter function may also play a role in nausea and vomiting of pregnancy and in some vestibular disorders; however, the specific neural mechanisms of nausea and vomiting have not been identified. Until the neurochemical processes underlying these phenomena are understood, prevention and management will remain in the domain of astute, but so far limited, clinical observation.

Female↗