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Postural Training using Augmented Visual Feedback and Vestibular Activation in Healthy Adults

Kwadwo O. Appiah-Kubi1* and W. G. Wright1
  • 1 Temple University, Physical Therapy, United States

Background: Postural stability depends on the integration of the somatosensory, visual and vestibular inputs to produce motor outputs. When visual and somatosensory input is available and reliable, this reduces reliance on the vestibular system. Despite this, vestibular loss can still cause severe postural dysfunction. Training one or more of the three sensory systems using a visual feedback and headshaking activities can alter sensory weighting and change postural behavior via vestibular adaptation and habituation. The purpose of this study was to assess sensory re-weighting of postural control processing after combined augmented visual feedback during voluntary weight-shift training (WST) using a specialized training module from the NeuroCom SMART Balance Master, and rhythmic vestibular activation in healthy adults. We hypothesized that the effect of this training protocol would significantly alter the pattern of sensory weighting by changing the ratio of visual, somatosensory, and vestibular dependence needed to maintain postural stability. Methods: Thirty-three healthy individuals (18 males; 24.5+4.4 years [18-35 years]; 1.7+0.2 meters) were randomly assigned to one of three groups: (1) No training (CTL), (2) augmented visual feedback WST coupled with an active horizontal headshake (HS) activity, or (3) the same WST without HS (No-HS). The rhythmic headshake activity at 30° in each direction to the midline was performed in synchronization with a metronome at 80 or 100 beats/minute. The WST included 15 one-minute limit of stability (LOS) exercises on a flat force-plate platform, rocker board or foam at three different levels (Fig. 1). The exercises entailed participants leaning towards a particular direction to reach a target that lights up randomly on the screen every 4 seconds. In nine of the exercises, the HS group was asked to perform the horizontal headshake activities concurrently. Training was performed 2x/day, every other day, 3x/week. Pre- and post-assessments on the Sensory Organization Test (SOT) were performed. Separate repeated measures ANOVAs were used to analyze the SOT equilibrium scores, composite scores, sensory ratios and transformed center of pressure (COP) sway variables by comparing baseline to post-training. Results: There were significant training effects (p=0.028) observed in the COP medio-lateral standard deviation (ML Std) sway across the groups especially in condition 6, with HS exhibiting better stability (Fig. 2, A-C). COP multiscale entropy (MSE) velocity also showed significant training effects (p=0.012) across groups and in conditions, with HS performing better in stability, particularly in conditions 5 and 6 (Fig. 2, D-F). Conditions 5 and 6 heavily rely on vestibular and visual-vestibular weighting, respectively. SOT equilibrium and composite scores were not significant, although mean differences may depict slight improvement in HS group and little or no change in No-HS and CTL groups. The training effect was related to the visual conditions as it relates to vestibular weighting. Conclusion: Postural training can alter sensory organization after a visual feedback-vestibular activation training protocol. The benefits cannot be explained by a practice effect since the CTL and No-HS groups showed minimal or no improvement. The study suggests a possible sensory reweighting through adaptation and habituation, induced by the visual feedback-vestibular training. Translating these findings into a vestibular-impaired population can stimulate the design of an augmented visual-vestibular feedback rehabilitation protocol.

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Keywords: Vestibular Rehabilitation, visual feedback (VF), weight-shift training, Sensory weighting, headshake movements, Sensory organization test (SOT), Vestibular adaptation and compensation, vestibular habituation

Conference: 2nd International Neuroergonomics Conference, Philadelphia, PA, United States, 27 Jun - 29 Jun, 2018.

Presentation Type: Oral Presentation

Topic: Neuroergonomics

Citation: Appiah-Kubi KO and Wright WG (2019). Postural Training using Augmented Visual Feedback and Vestibular Activation in Healthy Adults. Conference Abstract: 2nd International Neuroergonomics Conference. doi: 10.3389/conf.fnhum.2018.227.00046

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Received: 02 Apr 2018; Published Online: 27 Sep 2019.

* Correspondence: Mr. Kwadwo O Appiah-Kubi, Temple University, Physical Therapy, Philadelphia, PA, 19122, United States, appiah@temple.edu