We apologise for not having noticed earlier Adrion and colleagues' comments on our study comparin... more We apologise for not having noticed earlier Adrion and colleagues' comments on our study comparing the effectiveness of intratympanic Methylprednisolone to Gentamicin in refractory Ménière's disease , covered by the BMJ [2]. Contrary to our expectations, both drugs were equally effective in controlling vertigo (primary outcome). Adrion's primary concerns were, (i) that negative studies pose the problem of "not knowing how to interpret the non-significant results in a clinically relevant way" and, (ii) the lack of a power calculation for the primary outcome.
CONCLUSION Elevated MSS in MD is likely to be a consequence of the onset of MD and not migraine p... more CONCLUSION Elevated MSS in MD is likely to be a consequence of the onset of MD and not migraine per se. OBJECTIVES Pathologies of the vestibular system influence motion sickness susceptibility (MSS). Bilateral vestibular deficits lower MSS, vestibular neuritis or benign paroxysmal positional vertigo have little overall effect, whereas vestibular migraine elevates MSS. However, less is known about MSS in Meniere's disease (MD), a condition in which many patients experience vestibular loss and migraine symptoms. We conducted an online survey that posed diagnostic and disease questions before addressing frequency of headaches, migraines, visual display dizziness (VDD), syncope, social life and work impact of dizziness (SWID4) and motion sickness susceptibility (MSSQ). The two groups were: diagnosed MD individuals with hearing loss (n=751) and non-MD individuals in the control group (n=400). The MD group showed significantly elevated MSS, more headache and migraine, increased VDD, higher SWID4 scores, and increased syncope. MSS was higher in MD than controls only after the development of MD but not before, nor in childhood. Although elevated in MD compared with controls, MSS was lower than migraine patients from past data. Multivariate analysis revealed VDD, SWID4 and MSS in adulthood as the strongest predictors of MD, but not headache nor migraine.
There are known links between the hypothalamic-pituitary-adrenal (HPA) axis and systems responsib... more There are known links between the hypothalamic-pituitary-adrenal (HPA) axis and systems responsible for regulating posture. Our aim was to explore directly, for the first time, whether an aspect of circadian HPA axis activity (the cortisol awakening response: CAR) was associated with greater visual dependency in postural control. For measurement of the CAR, electronically monitored saliva samples were collected by participants following morning awakening in their home environment. On the afternoons of the same days, postural sway was measured in the laboratory by exposing participants to static (control) and moving visual stimuli whilst standing still and upright on a force platform. Visual dependence was assessed as the increase in postural sway (path length) during exposure to the moving compared with the static condition. The 44 measurement days were derived from four days for each of eleven healthy participants (mean ± SD age: 51.18 ± 3.3 years). As expected, postural sway was greater when exposed to moving versus static cues. Mixed regression modelling showed that participants with smaller four day average CARs had greater deterioration in postural sway when presented with moving stimuli. These data are the first to document associations between the CAR and visual dependency in postural sway.
The widespread use of visual technologies such as Virtual Reality increases the risk of visually ... more The widespread use of visual technologies such as Virtual Reality increases the risk of visually induced motion sickness (VIMS). Previously, the 6-item short version of the Visually Induced Motion Sickness Susceptibility Questionnaire (VIMSSQ short form) has been validated for predicting individual variation in VIMS. The aim of the current study was to investigate how the susceptibility to VIMS is correlated with other relevant factors in the general population. A total of 440 participants (201 M, 239F), mean age 33.6 (SD 14.8) years, completed an anonymous online survey of various questionnaires including the VIMSSQ, Motion Sickness Susceptibility Questionnaire (MSSQ), Vertigo in City questionnaire (VIC), Migraine (scale), Social & Work Impact of Dizziness (SWID), Syncope (faintness), and Personality ('Big Five' TIPI). The VIMSSQ correlated positively with the MSSQ (r = 0.50), VIC (r = 0.45), Migraine (r = 0.44), SWID (r = 0.28), and Syncope (r = 0.15). The most efficient Multiple Linear Regression model for the VIMSSQ included the predictors MSSQ, Migraine, VIC, and Age and explained 40% of the variance. Factor analysis of strongest correlates with VIMSSQ revealed a single factor loading with VIMSSQ, MSSQ, VIC, Migraine, SWID, and Syncope, suggesting a common latent variable of sensitivity. The set of predictors for the VIMSSQ in the general population has similarity with those often observed in patients with vestibular disorders. Based on these correlational results, we suggest the existence of continuum of underlying risk factors for sensitivity, from healthy population to patients with extreme visual vertigo and perhaps Persistent Postural-Perceptual Dizziness.
Aerospace medicine and human performance, Sep 1, 2021
BACKGROUND: the objectives were to assess the prevalence, severity, and medication taken, and to ... more BACKGROUND: the objectives were to assess the prevalence, severity, and medication taken, and to look for predictive factors, in order to better identify characteristics of passengers at risk of motion sickness during transport from hobart in tasmania to the French polar stations in antarctica. METHODS: there were 239 passengers who were surveyed over 4 yr with 4 round trips per year using the Motion sickness susceptibility Questionnaire (MssQ), simulator sickness Questionnaire (ssQ), state-trait anxiety test (stai-trait and staistate), and general parameters (age, gender, number of trips, jet-lag, direction of the trip), medication, calculation of the distance of each passenger's cabin to the centre of Gravity (coG.). RESULTS: While the passengers had a low intrinsic sensitivity to motion sickness (MssQ), 94% reported at least one ssQ symptom of motion sickness, and 38% vomited. Five associated factors were discovered: greater initial sensitivity (MssQ), anticipation of being ill, younger age, higher level of anxiety at midtrip, and greater distance from the coG. Of the passengers, there were 54% who took anti-motion sickness medication at different times of the trip, however, these passengers experienced more nausea. this could be due to self-selection since they were more sensitive to motion sickness. CONCLUSION: We identified three predictive factors of motion sickness (greater intrinsic susceptibility, younger age, and greater cabin distance from the coG). For preventive purposes, two associated factors of Ms (anticipation of being ill, MssQ score) were determined to classify three groups of risk of Ms to improve passenger care during the trip.
Background: The present study investigated whether prochlorperazine affects vestibular-ocular ref... more Background: The present study investigated whether prochlorperazine affects vestibular-ocular reflex (VOR) and vestibulo-perceptual function. Methods: We studied 12 healthy naïve subjects 3 hours after a single dose of oral prochlorperazine 5mg in a randomised, placebo-controlled, double-blind, cross-over study in healthy young subjects. Two rotational tests in yaw were used: 1) a Threshold task investigating perceptual motion detection and nystagmic thresholds (acceleration steps of 0.5deg/s/s) and 2) Suprathreshold responses to velocity steps of 90deg/s in which vestibulo-ocular (VO) and vestibulo-perceptual (VP) time constants of decay, as well as VOR gain, were measured. Results: Prochlorperazine had no effect upon any measure of nystagmic or perceptual vestibular function compared to placebo. This lack of effects on vestibularmediated motion perception suggests that the drug is likely to act more as an antiemetic than as an anti-vertiginous agent.
Proceedings of the Human Factors and Ergonomics Society Annual Meeting, 2019
Visually induced motion sickness (VIMS) is a specific form of motion sickness caused by dynamic v... more Visually induced motion sickness (VIMS) is a specific form of motion sickness caused by dynamic visual content such as Virtual Reality applications. Predicting individual susceptibility to VIMS has proven to be difficult and a reliable method has yet to emerge. Here, we introduce the Visually Induced Motion Sickness Susceptibility Questionnaire (VIMSSQ), a modification of the Motion Sickness Susceptibility Questionnaire uniquely designed to predict the susceptibility to VIMS specifically. Scores on the VIMSSQ are based on incidences of nausea, headache, fatigue, dizziness, and eyestrain during the past use of visual devices. In this proof-of-concept study, 71 adult participants (34 younger, 37 older) engaged in a simulated driving task and VIMS was measured using the Fast Motion Sickness Scale. Strong correlations with the reported level of VIMS were found for the nausea aspects of the VIMSSQ, suggesting that the VIMSSQ may be a useful tool to estimate individuals’ susceptibility to...
The normal vestibular system may be adversely affected by environmental challenges which have cha... more The normal vestibular system may be adversely affected by environmental challenges which have characteristics that are unfamiliar or ambiguous in the patterns of sensory stimulation they provide. A disordered vestibular system lends susceptibility even to quotidian environmental experiences as the sufferer becomes dependent on potentially misleading, non-vestibular sensory stimuli. In both cases the sequela may be dizziness, incoordination, imbalance and unpleasant autonomic responses. Many forms of visual environmental motion, particularly busy places such as supermarkets, readily induce inappropriate sensations of sway or motion and imbalance referred to as visual vertigo. All people with intact vestibular function can become motion sick although individual susceptibility varies widely and is partially determined by inheritance. Motorists learn to interpret sensory stimuli in the context of the car stabilised by its suspension and guided by steering. A type of motorist disorientation occurs in some individuals that develop a heightened awareness of false perceptions of car orientation, readily experiencing stereotypical symptoms of threatened rolling over on corners and veering on open highways or in streaming traffic. This article discusses the putative mechanisms, consequences and approach to managing patients with visual vertigo, motion sickness and motorist disorientation syndrome in the context of chronic dizziness and motion sensitivity.
BACKGROUND: Although vestibular lesions degrade postural control we do not know the relative cont... more BACKGROUND: Although vestibular lesions degrade postural control we do not know the relative contributions of the magnitude of the vestibular loss and the subjective vestibular symptoms to locomotor adaptation in particular. OBJECTIVE: To study how dizzy symptoms interfere with adaptive locomotor learning. METHODS: We examined patients with contrasting peripheral vestibular deficits, vestibular neuritis in the chronic stable phase (n=20) and strongly symptomatic unilateral Meniere's disease (n=15), compared to age-matched healthy controls (n=15). We measured locomotor learning using the "broken escalator" aftereffect, simulated on a motorised moving sled. RESULTS: Patients with Meniere's disease had an enhanced "broken escalator" postural aftereffect. More generally, the size of the locomotor aftereffect was related to how symptomatic patients were across both groups. Contrastingly, the degree of peripheral vestibular loss was not correlated with symptom load or locomotor aftereffect size. During the MOVING trials, both patient groups had larger levels of instability (trunk sway) and reduced adaptation than normal controls. CONCLUSION: Dizziness symptoms influence locomotor adaptation and its subsequent expression through motor aftereffects. Given that the unsteadiness experienced during the "broken escalator" paradigm is internally driven, the enhanced aftereffect found represents a new type of self-generated postural challenge for vestibular/unsteady patients.
Objectives: 1) To determine whether long term (>48 months) symptomatic vertigo control is sustain... more Objectives: 1) To determine whether long term (>48 months) symptomatic vertigo control is sustained in patients with Menière's disease from a previous comparative trial of intratympanic methylprednisolone versus gentamicin, and 2) if the two treatments remain non significantly different at long-term follow-up.
Vestibular migraine is among the commonest causes of episodic vertigo. Chronically, patients with... more Vestibular migraine is among the commonest causes of episodic vertigo. Chronically, patients with vestibular migraine develop abnormal responsiveness to both vestibular and visual stimuli characterized by heightened self-motion sensitivity and visuallyinduced dizziness. Yet, the neural mechanisms mediating such symptoms remain unknown. We postulate that such symptoms are attributable to impaired visuo-vestibular cortical interactions, which in turn disrupts normal vestibular function. To assess this, we investigated whether prolonged, full-field visual motion exposure, which has been previously shown to modulate visual cortical excitability in both healthy individuals and avestibular patients, could disrupt vestibular ocular reflex and vestibular-perceptual thresholds of self-motion during rotations. Our findings reveal that vestibular migraine patients exhibited abnormally elevated reflexive and perceptual vestibular thresholds at baseline. Following visual motion exposure, both reflex and perceptual thresholds were significantly further increased in vestibular migraine patients relative to healthy controls, migraineurs without vestibular symptoms and patients with episodic vertigo due to a peripheral inner-ear disorder. Our results provide support for the notion of altered visuo-vestibular cortical interactions in vestibular migraine, as evidenced by vestibular threshold elevation following visual motion exposure.
Human Factors: The Journal of the Human Factors and Ergonomics Society, 2021
Objective Two studies were conducted to develop and validate a questionnaire to estimate individu... more Objective Two studies were conducted to develop and validate a questionnaire to estimate individual susceptibility to visually induced motion sickness (VIMS). Background VIMS is a common side-effect when watching dynamic visual content from various sources, such as virtual reality, movie theaters, or smartphones. A reliable questionnaire predicting individual susceptibility to VIMS is currently missing. The aim was to fill this gap by introducing the Visually Induced Motion Sickness Susceptibility Questionnaire (VIMSSQ). Methods A survey and an experimental study were conducted. Survey: The VIMSSQ investigated the frequency of nausea, headache, dizziness, fatigue, and eyestrain when using different visual devices. Data were collected from a survey of 322 participants for the VIMSSQ and other related phenomena such as migraine. Experimental study: 23 participants were exposed to a VIMS-inducing visual stimulus. Participants filled out the VIMSSQ together with other questionnaires and...
The widespread use of visual technologies such as Virtual Reality increases the risk of visually ... more The widespread use of visual technologies such as Virtual Reality increases the risk of visually induced motion sickness (VIMS). Previously, the 6-item short version of the Visually Induced Motion Sickness Susceptibility Questionnaire (VIMSSQ short form) has been validated for predicting individual variation in VIMS. The aim of the current study was to investigate how the susceptibility to VIMS is correlated with other relevant factors in the general population. A total of 440 participants (201 M, 239F), mean age 33.6 (SD 14.8) years, completed an anonymous online survey of various questionnaires including the VIMSSQ, Motion Sickness Susceptibility Questionnaire (MSSQ), Vertigo in City questionnaire (VIC), Migraine (scale), Social & Work Impact of Dizziness (SWID), Syncope (faintness), and Personality (‘Big Five’ TIPI). The VIMSSQ correlated positively with the MSSQ (r = 0.50), VIC (r = 0.45), Migraine (r = 0.44), SWID (r = 0.28), and Syncope (r = 0.15). The most efficient Multiple ...
Environmental circumstances that result in ambiguity or conflict with the patterns of sensory sti... more Environmental circumstances that result in ambiguity or conflict with the patterns of sensory stimulation may adversely affect the vestibular system. The effect of this conflict in sensory information may be dizziness, a sense of imbalance, nausea, and motion sickness sometimes even to seemingly minor daily head movement activities. In some, it is not only exposure to motion but also the observation of objects in motion around them such as in supermarket aisles or other places with visual commotion; this can lead to dizziness, nausea, or a feeling of motion sickness that is referred to as visual vertigo. All people with normal vestibular function can be made to experience motion sickness, although individual susceptibility varies widely and is at least partially heritable. Motorists learn to interpret sensory stimuli in the context of the car stabilized by its suspension and guided by steering. A type of motorist's disorientation occurs in some individuals who develop a heighten...
Spatial perspective-taking that involves imagined changes in one's spatial orientation is fac... more Spatial perspective-taking that involves imagined changes in one's spatial orientation is facilitated by vestibular stimulation inducing a congruent sensation of self-motion. We examined further the role of vestibular resources in perspective-taking by evaluating whether aberrant and conflicting vestibular stimulation impaired perspective-taking performance. Participants (N = 39) undertook either an "own body transformation" (OBT) task, requiring speeded spatial judgments made from the perspective of a schematic figure, or a control task requiring reconfiguration of spatial mappings from one's own visuo-spatial perspective. These tasks were performed both without and with vestibular stimulation by whole-body Coriolis motion, according to a repeated measures design, balanced for order. Vestibular stimulation was found to impair performance during the first minute post stimulus relative to the stationary condition. This disruption was task-specific, affecting only th...
Neurofibromatosis 1 (NF1) is an inherited, multi-system, tumour suppressor disorder with variable... more Neurofibromatosis 1 (NF1) is an inherited, multi-system, tumour suppressor disorder with variable complications that cause psychological distress and social isolation. The study aim was to develop and validate a disease-specific questionnaire to measure quality of life (QOL) in NF1 that is suitable both as an assessment tool in clinical practice and in clinical trials of novel therapy. The Impact of NF1 on Quality of Life (INF1-QOL) questionnaire was developed by a literature search for common terms, focus group (n = 6), semi-structured interviews (n = 21), initial drafts (n =50) and final 14 item questionnaire (n = 50). Bivariate correlations between items, exploratory factor analysis, correlations with severity and EuroQol were employed. INF1-QOL showed good internal reliability (Cronbach's alpha 0.87), mean total INF1-QOL score was 8.64 (SD 6.3), median 7.00, range 0-30 (possible range 0-42); no significant correlations with age or gender. The mean total EuroQol score was 7.3...
We apologise for not having noticed earlier Adrion and colleagues' comments on our study comparin... more We apologise for not having noticed earlier Adrion and colleagues' comments on our study comparing the effectiveness of intratympanic Methylprednisolone to Gentamicin in refractory Ménière's disease , covered by the BMJ [2]. Contrary to our expectations, both drugs were equally effective in controlling vertigo (primary outcome). Adrion's primary concerns were, (i) that negative studies pose the problem of "not knowing how to interpret the non-significant results in a clinically relevant way" and, (ii) the lack of a power calculation for the primary outcome.
CONCLUSION Elevated MSS in MD is likely to be a consequence of the onset of MD and not migraine p... more CONCLUSION Elevated MSS in MD is likely to be a consequence of the onset of MD and not migraine per se. OBJECTIVES Pathologies of the vestibular system influence motion sickness susceptibility (MSS). Bilateral vestibular deficits lower MSS, vestibular neuritis or benign paroxysmal positional vertigo have little overall effect, whereas vestibular migraine elevates MSS. However, less is known about MSS in Meniere's disease (MD), a condition in which many patients experience vestibular loss and migraine symptoms. We conducted an online survey that posed diagnostic and disease questions before addressing frequency of headaches, migraines, visual display dizziness (VDD), syncope, social life and work impact of dizziness (SWID4) and motion sickness susceptibility (MSSQ). The two groups were: diagnosed MD individuals with hearing loss (n=751) and non-MD individuals in the control group (n=400). The MD group showed significantly elevated MSS, more headache and migraine, increased VDD, higher SWID4 scores, and increased syncope. MSS was higher in MD than controls only after the development of MD but not before, nor in childhood. Although elevated in MD compared with controls, MSS was lower than migraine patients from past data. Multivariate analysis revealed VDD, SWID4 and MSS in adulthood as the strongest predictors of MD, but not headache nor migraine.
There are known links between the hypothalamic-pituitary-adrenal (HPA) axis and systems responsib... more There are known links between the hypothalamic-pituitary-adrenal (HPA) axis and systems responsible for regulating posture. Our aim was to explore directly, for the first time, whether an aspect of circadian HPA axis activity (the cortisol awakening response: CAR) was associated with greater visual dependency in postural control. For measurement of the CAR, electronically monitored saliva samples were collected by participants following morning awakening in their home environment. On the afternoons of the same days, postural sway was measured in the laboratory by exposing participants to static (control) and moving visual stimuli whilst standing still and upright on a force platform. Visual dependence was assessed as the increase in postural sway (path length) during exposure to the moving compared with the static condition. The 44 measurement days were derived from four days for each of eleven healthy participants (mean ± SD age: 51.18 ± 3.3 years). As expected, postural sway was greater when exposed to moving versus static cues. Mixed regression modelling showed that participants with smaller four day average CARs had greater deterioration in postural sway when presented with moving stimuli. These data are the first to document associations between the CAR and visual dependency in postural sway.
The widespread use of visual technologies such as Virtual Reality increases the risk of visually ... more The widespread use of visual technologies such as Virtual Reality increases the risk of visually induced motion sickness (VIMS). Previously, the 6-item short version of the Visually Induced Motion Sickness Susceptibility Questionnaire (VIMSSQ short form) has been validated for predicting individual variation in VIMS. The aim of the current study was to investigate how the susceptibility to VIMS is correlated with other relevant factors in the general population. A total of 440 participants (201 M, 239F), mean age 33.6 (SD 14.8) years, completed an anonymous online survey of various questionnaires including the VIMSSQ, Motion Sickness Susceptibility Questionnaire (MSSQ), Vertigo in City questionnaire (VIC), Migraine (scale), Social & Work Impact of Dizziness (SWID), Syncope (faintness), and Personality ('Big Five' TIPI). The VIMSSQ correlated positively with the MSSQ (r = 0.50), VIC (r = 0.45), Migraine (r = 0.44), SWID (r = 0.28), and Syncope (r = 0.15). The most efficient Multiple Linear Regression model for the VIMSSQ included the predictors MSSQ, Migraine, VIC, and Age and explained 40% of the variance. Factor analysis of strongest correlates with VIMSSQ revealed a single factor loading with VIMSSQ, MSSQ, VIC, Migraine, SWID, and Syncope, suggesting a common latent variable of sensitivity. The set of predictors for the VIMSSQ in the general population has similarity with those often observed in patients with vestibular disorders. Based on these correlational results, we suggest the existence of continuum of underlying risk factors for sensitivity, from healthy population to patients with extreme visual vertigo and perhaps Persistent Postural-Perceptual Dizziness.
Aerospace medicine and human performance, Sep 1, 2021
BACKGROUND: the objectives were to assess the prevalence, severity, and medication taken, and to ... more BACKGROUND: the objectives were to assess the prevalence, severity, and medication taken, and to look for predictive factors, in order to better identify characteristics of passengers at risk of motion sickness during transport from hobart in tasmania to the French polar stations in antarctica. METHODS: there were 239 passengers who were surveyed over 4 yr with 4 round trips per year using the Motion sickness susceptibility Questionnaire (MssQ), simulator sickness Questionnaire (ssQ), state-trait anxiety test (stai-trait and staistate), and general parameters (age, gender, number of trips, jet-lag, direction of the trip), medication, calculation of the distance of each passenger's cabin to the centre of Gravity (coG.). RESULTS: While the passengers had a low intrinsic sensitivity to motion sickness (MssQ), 94% reported at least one ssQ symptom of motion sickness, and 38% vomited. Five associated factors were discovered: greater initial sensitivity (MssQ), anticipation of being ill, younger age, higher level of anxiety at midtrip, and greater distance from the coG. Of the passengers, there were 54% who took anti-motion sickness medication at different times of the trip, however, these passengers experienced more nausea. this could be due to self-selection since they were more sensitive to motion sickness. CONCLUSION: We identified three predictive factors of motion sickness (greater intrinsic susceptibility, younger age, and greater cabin distance from the coG). For preventive purposes, two associated factors of Ms (anticipation of being ill, MssQ score) were determined to classify three groups of risk of Ms to improve passenger care during the trip.
Background: The present study investigated whether prochlorperazine affects vestibular-ocular ref... more Background: The present study investigated whether prochlorperazine affects vestibular-ocular reflex (VOR) and vestibulo-perceptual function. Methods: We studied 12 healthy naïve subjects 3 hours after a single dose of oral prochlorperazine 5mg in a randomised, placebo-controlled, double-blind, cross-over study in healthy young subjects. Two rotational tests in yaw were used: 1) a Threshold task investigating perceptual motion detection and nystagmic thresholds (acceleration steps of 0.5deg/s/s) and 2) Suprathreshold responses to velocity steps of 90deg/s in which vestibulo-ocular (VO) and vestibulo-perceptual (VP) time constants of decay, as well as VOR gain, were measured. Results: Prochlorperazine had no effect upon any measure of nystagmic or perceptual vestibular function compared to placebo. This lack of effects on vestibularmediated motion perception suggests that the drug is likely to act more as an antiemetic than as an anti-vertiginous agent.
Proceedings of the Human Factors and Ergonomics Society Annual Meeting, 2019
Visually induced motion sickness (VIMS) is a specific form of motion sickness caused by dynamic v... more Visually induced motion sickness (VIMS) is a specific form of motion sickness caused by dynamic visual content such as Virtual Reality applications. Predicting individual susceptibility to VIMS has proven to be difficult and a reliable method has yet to emerge. Here, we introduce the Visually Induced Motion Sickness Susceptibility Questionnaire (VIMSSQ), a modification of the Motion Sickness Susceptibility Questionnaire uniquely designed to predict the susceptibility to VIMS specifically. Scores on the VIMSSQ are based on incidences of nausea, headache, fatigue, dizziness, and eyestrain during the past use of visual devices. In this proof-of-concept study, 71 adult participants (34 younger, 37 older) engaged in a simulated driving task and VIMS was measured using the Fast Motion Sickness Scale. Strong correlations with the reported level of VIMS were found for the nausea aspects of the VIMSSQ, suggesting that the VIMSSQ may be a useful tool to estimate individuals’ susceptibility to...
The normal vestibular system may be adversely affected by environmental challenges which have cha... more The normal vestibular system may be adversely affected by environmental challenges which have characteristics that are unfamiliar or ambiguous in the patterns of sensory stimulation they provide. A disordered vestibular system lends susceptibility even to quotidian environmental experiences as the sufferer becomes dependent on potentially misleading, non-vestibular sensory stimuli. In both cases the sequela may be dizziness, incoordination, imbalance and unpleasant autonomic responses. Many forms of visual environmental motion, particularly busy places such as supermarkets, readily induce inappropriate sensations of sway or motion and imbalance referred to as visual vertigo. All people with intact vestibular function can become motion sick although individual susceptibility varies widely and is partially determined by inheritance. Motorists learn to interpret sensory stimuli in the context of the car stabilised by its suspension and guided by steering. A type of motorist disorientation occurs in some individuals that develop a heightened awareness of false perceptions of car orientation, readily experiencing stereotypical symptoms of threatened rolling over on corners and veering on open highways or in streaming traffic. This article discusses the putative mechanisms, consequences and approach to managing patients with visual vertigo, motion sickness and motorist disorientation syndrome in the context of chronic dizziness and motion sensitivity.
BACKGROUND: Although vestibular lesions degrade postural control we do not know the relative cont... more BACKGROUND: Although vestibular lesions degrade postural control we do not know the relative contributions of the magnitude of the vestibular loss and the subjective vestibular symptoms to locomotor adaptation in particular. OBJECTIVE: To study how dizzy symptoms interfere with adaptive locomotor learning. METHODS: We examined patients with contrasting peripheral vestibular deficits, vestibular neuritis in the chronic stable phase (n=20) and strongly symptomatic unilateral Meniere's disease (n=15), compared to age-matched healthy controls (n=15). We measured locomotor learning using the "broken escalator" aftereffect, simulated on a motorised moving sled. RESULTS: Patients with Meniere's disease had an enhanced "broken escalator" postural aftereffect. More generally, the size of the locomotor aftereffect was related to how symptomatic patients were across both groups. Contrastingly, the degree of peripheral vestibular loss was not correlated with symptom load or locomotor aftereffect size. During the MOVING trials, both patient groups had larger levels of instability (trunk sway) and reduced adaptation than normal controls. CONCLUSION: Dizziness symptoms influence locomotor adaptation and its subsequent expression through motor aftereffects. Given that the unsteadiness experienced during the "broken escalator" paradigm is internally driven, the enhanced aftereffect found represents a new type of self-generated postural challenge for vestibular/unsteady patients.
Objectives: 1) To determine whether long term (>48 months) symptomatic vertigo control is sustain... more Objectives: 1) To determine whether long term (>48 months) symptomatic vertigo control is sustained in patients with Menière's disease from a previous comparative trial of intratympanic methylprednisolone versus gentamicin, and 2) if the two treatments remain non significantly different at long-term follow-up.
Vestibular migraine is among the commonest causes of episodic vertigo. Chronically, patients with... more Vestibular migraine is among the commonest causes of episodic vertigo. Chronically, patients with vestibular migraine develop abnormal responsiveness to both vestibular and visual stimuli characterized by heightened self-motion sensitivity and visuallyinduced dizziness. Yet, the neural mechanisms mediating such symptoms remain unknown. We postulate that such symptoms are attributable to impaired visuo-vestibular cortical interactions, which in turn disrupts normal vestibular function. To assess this, we investigated whether prolonged, full-field visual motion exposure, which has been previously shown to modulate visual cortical excitability in both healthy individuals and avestibular patients, could disrupt vestibular ocular reflex and vestibular-perceptual thresholds of self-motion during rotations. Our findings reveal that vestibular migraine patients exhibited abnormally elevated reflexive and perceptual vestibular thresholds at baseline. Following visual motion exposure, both reflex and perceptual thresholds were significantly further increased in vestibular migraine patients relative to healthy controls, migraineurs without vestibular symptoms and patients with episodic vertigo due to a peripheral inner-ear disorder. Our results provide support for the notion of altered visuo-vestibular cortical interactions in vestibular migraine, as evidenced by vestibular threshold elevation following visual motion exposure.
Human Factors: The Journal of the Human Factors and Ergonomics Society, 2021
Objective Two studies were conducted to develop and validate a questionnaire to estimate individu... more Objective Two studies were conducted to develop and validate a questionnaire to estimate individual susceptibility to visually induced motion sickness (VIMS). Background VIMS is a common side-effect when watching dynamic visual content from various sources, such as virtual reality, movie theaters, or smartphones. A reliable questionnaire predicting individual susceptibility to VIMS is currently missing. The aim was to fill this gap by introducing the Visually Induced Motion Sickness Susceptibility Questionnaire (VIMSSQ). Methods A survey and an experimental study were conducted. Survey: The VIMSSQ investigated the frequency of nausea, headache, dizziness, fatigue, and eyestrain when using different visual devices. Data were collected from a survey of 322 participants for the VIMSSQ and other related phenomena such as migraine. Experimental study: 23 participants were exposed to a VIMS-inducing visual stimulus. Participants filled out the VIMSSQ together with other questionnaires and...
The widespread use of visual technologies such as Virtual Reality increases the risk of visually ... more The widespread use of visual technologies such as Virtual Reality increases the risk of visually induced motion sickness (VIMS). Previously, the 6-item short version of the Visually Induced Motion Sickness Susceptibility Questionnaire (VIMSSQ short form) has been validated for predicting individual variation in VIMS. The aim of the current study was to investigate how the susceptibility to VIMS is correlated with other relevant factors in the general population. A total of 440 participants (201 M, 239F), mean age 33.6 (SD 14.8) years, completed an anonymous online survey of various questionnaires including the VIMSSQ, Motion Sickness Susceptibility Questionnaire (MSSQ), Vertigo in City questionnaire (VIC), Migraine (scale), Social & Work Impact of Dizziness (SWID), Syncope (faintness), and Personality (‘Big Five’ TIPI). The VIMSSQ correlated positively with the MSSQ (r = 0.50), VIC (r = 0.45), Migraine (r = 0.44), SWID (r = 0.28), and Syncope (r = 0.15). The most efficient Multiple ...
Environmental circumstances that result in ambiguity or conflict with the patterns of sensory sti... more Environmental circumstances that result in ambiguity or conflict with the patterns of sensory stimulation may adversely affect the vestibular system. The effect of this conflict in sensory information may be dizziness, a sense of imbalance, nausea, and motion sickness sometimes even to seemingly minor daily head movement activities. In some, it is not only exposure to motion but also the observation of objects in motion around them such as in supermarket aisles or other places with visual commotion; this can lead to dizziness, nausea, or a feeling of motion sickness that is referred to as visual vertigo. All people with normal vestibular function can be made to experience motion sickness, although individual susceptibility varies widely and is at least partially heritable. Motorists learn to interpret sensory stimuli in the context of the car stabilized by its suspension and guided by steering. A type of motorist's disorientation occurs in some individuals who develop a heighten...
Spatial perspective-taking that involves imagined changes in one's spatial orientation is fac... more Spatial perspective-taking that involves imagined changes in one's spatial orientation is facilitated by vestibular stimulation inducing a congruent sensation of self-motion. We examined further the role of vestibular resources in perspective-taking by evaluating whether aberrant and conflicting vestibular stimulation impaired perspective-taking performance. Participants (N = 39) undertook either an "own body transformation" (OBT) task, requiring speeded spatial judgments made from the perspective of a schematic figure, or a control task requiring reconfiguration of spatial mappings from one's own visuo-spatial perspective. These tasks were performed both without and with vestibular stimulation by whole-body Coriolis motion, according to a repeated measures design, balanced for order. Vestibular stimulation was found to impair performance during the first minute post stimulus relative to the stationary condition. This disruption was task-specific, affecting only th...
Neurofibromatosis 1 (NF1) is an inherited, multi-system, tumour suppressor disorder with variable... more Neurofibromatosis 1 (NF1) is an inherited, multi-system, tumour suppressor disorder with variable complications that cause psychological distress and social isolation. The study aim was to develop and validate a disease-specific questionnaire to measure quality of life (QOL) in NF1 that is suitable both as an assessment tool in clinical practice and in clinical trials of novel therapy. The Impact of NF1 on Quality of Life (INF1-QOL) questionnaire was developed by a literature search for common terms, focus group (n = 6), semi-structured interviews (n = 21), initial drafts (n =50) and final 14 item questionnaire (n = 50). Bivariate correlations between items, exploratory factor analysis, correlations with severity and EuroQol were employed. INF1-QOL showed good internal reliability (Cronbach's alpha 0.87), mean total INF1-QOL score was 8.64 (SD 6.3), median 7.00, range 0-30 (possible range 0-42); no significant correlations with age or gender. The mean total EuroQol score was 7.3...
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Papers by John Golding