Eye movement studies with a vestibular prosthesis/

Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Electrical Engineering and Computer Science, 2010.Cataloged from PDF version of thesis.Includes bibliographical references.Vestibular loss, which can manifest as dizziness, imbalance, or spatial disorientation, is widespread and often caused by inner ear hair cell malfunction. To address these problems, we are developing a vestibular implant analogous to cochlear implants for the deaf. This vestibular prosthesis provides pulsatile electrical stimulation to the vestibular nerve. Prosthesis effectiveness is assessed using the vestibulo-ocular reflex (VOR), since the VOR helps stabilize gaze in healthy individuals by evoking eye movements that compensate for head movements. In this thesis, the prosthesis was used to probe the high frequency VOR in squirrel monkeys and guinea pigs. In two studies, modulated stimulation was applied acutely to characterize the VOR between 1.5 and 701 Hz. A third study characterized the VOR response to chronic stimulation with a constant rate of 250 Hz. The VOR has previously been characterized up to 50 Hz in monkeys and 2 Hz in guinea pigs by physically rotating subjects. This range was extended in these studies, by using electrical stimulation from the prosthesis. Eye movement spectral peaks were used to characterize the VOR frequency response. The VOR was measurable up to 267 Hz in squirrel monkeys and 151 Hz in guinea pigs. The magnitude response was similar in both species - it increased gradually with frequency, peaked (at 140 Hz in squirrel monkeys and 50 Hz in guinea pigs), and then rolled off.(cont.) The high frequency fall-off was consistent with the low-pass nature of the oculomotor plant. The phase responses had a linear lag with frequency, consistent with a fixed 4 ms delay of the VOR three-neuronarc. Since the VOR responds at high frequencies, this raises the question whether the prosthesis causes eye movements at the prosthesis pulse rate, since electrical stimulation elicits neural responses that are phase-locked with the stimulation. Such responses might cause visual blurring for a patient using the device. This thesis shows that such eye movements are measurable, and have substantial velocity magnitude of 8.1 deg/s initially, but within 30 minutes the magnitude reduces by 80% and probably does not yield perceptible visual blurring.by Michael A. Saginaw.Ph.D

The effect of an external auditory stimulus on postural stability of participants with cochlear implants

Postural control was evaluated in cochlear implant participants with and without amplification under several auditory paradigms. Speed of sway was recorded in each condition by means of Computerized Dynamic Posturography. Results indicate that an external sound source significantly improves balance in patients with cochlear implants

The Vestibular Implant: Quo Vadis?

Objective: To assess the progress of the development of the vestibular implant (VI) and its feasibility short-term. Data sources: A search was performed in Pubmed, Medline, and Embase. Key words used were “vestibular prosth*” and “VI.” The only search limit was language: English or Dutch. Additional sources were medical books, conference lectures and our personal experience with per-operative vestibular stimulation in patients selected for cochlear implantation. Study selection: All studies about the VI and related topics were included and evaluated by two reviewers. No study was excluded since every study investigated different aspects of the VI. Data extraction and synthesis: Data was extracted by the first author from selected reports, supplemented by additional information, medical books conference lectures. Since each study had its own point of interest with its own outcomes, it was not possible to compare data of different studies. Conclusion: To use a basic VI in humans seems feasible in the very near future. Investigations show that electric stimulation of the canal nerves induces a nystagmus which corresponds to the plane of the canal which is innervated by the stimulated nerve branch. The brain is able to adapt to a higher baseline stimulation, while still reacting on a dynamic component. The best response will be achieved by a combination of the optimal stimulus (stimulus profile, stimulus location, precompensation), complemented by central vestibular adaptation. The degree of response will probably vary between individuals, depending on pathology and their ability to adapt

A study of the effects of sensory state on rhesus monkey postural control

Thesis (Ph. D. in Biomedical Engineering)--Harvard-MIT Program in Health Sciences and Technology, 2013.Cataloged from PDF version of thesis. "September 2013." Pages 215 and 216 blank.Includes bibliographical references (pages 208-214).Although many take the seemingly simple ability to balance in order to maintain posture for granted, approximately 8 million American adults have chronic balance impairment issues derived from vestibular dysfunction. For patients suffering from severe vestibular dysfunction, maintaining balance in daily activities, such as walking on an uneven surface at night, turning one's head, or attempting to stand on a moving surface, can prove extremely challenging. Unfortunately, many vestibular-loss sufferers are left with limited treatment options and can become permanently debilitated. In order to aid the vestibular-impaired population in partially restoring postural stability, it is important to develop rehabilitative solutions. For subjects suffering from severe bilateral vestibular loss, but with intact eighth nerve function, the invasive vestibular prosthesis is a potential rehabilitative solution. This must be developed and fully characterized in non-human primates in parallel with human implementation. In this research, we characterized the postural response of a severely vestibular-lesioned non-human primate instrumented with a prototype invasive vestibular prosthesis. We showed that the severely vestibular-impaired animal aided by the prosthesis was able to utilize the partially restored vestibular cues to increase its stability compared to the severely-impaired state. We also explored the impact on balance of (1) supplying an additional cue (light-touch) and (2) compensative strategies that the subject develops when suffering from mild or severe vestibular-impairment. We determined that the severely-impaired animal decreased its trunk sway when provided the light-touch cue, however a mildly-impaired animal did not. We also determined that an animal with mild vestibular impairment spontaneously compensated for its vestibular loss to stabilize itself both for stationary support surface conditions and for support surface perturbations. This thesis is the first time that animal posture measures for different levels of vestibular impairment have been used in conjunction with a feedback controller model to investigate the postural control mechanisms used. The results reported within this thesis begin to establish the baseline database of primate postural responses to a wide variety of test situations for different levels of vestibular impairment that will be needed for further investigation and evaluation of rehabilitative solutions, such as prototype vestibular implant systems.by Lara A. Thompson.Ph.D.in Biomedical Engineerin

Development of a Biomimetic Semicircular Canal with MEMS Sensors to Restore Balance

© 2001-2012 IEEE. A third of adults over the age of 50 suffer from chronic impairment of balance, posture, and/or gaze stability due to partial or complete impairment of the sensory cells in the inner ear responsible for these functions. The consequences of impaired balance organ can be dizziness, social withdrawal, and acceleration of the further functional decline. Despite the significant progress in biomedical sensing technologies, current artificial vestibular systems fail to function in practical situations and in very low frequencies. Herein, we introduced a novel biomechanical device that closely mimics the human vestibular system. A microelectromechanical systems (MEMS) flow sensor was first developed to mimic the vestibular haircell sensors. The sensor was then embedded into a three-dimensional (3D) printed semicircular canal and tested at various angular accelerations in the frequency range from 0.5Hz to 1.5Hz. The miniaturized device embedded into a 3D printed model will respond to mechanical deflections and essentially restore the sense of balance in patients with vestibular dysfunctions. The experimental and simulation studies of semicircular canal presented in this work will pave the way for the development of balance sensory system, which could lead to the design of a low-cost and commercially viable medical device with significant health benefits and economic potential

Electrical vestibular stimulation in humans. A narrative review

Background: In patients with bilateral vestibulopathy, the regular treatment options, such as medication, surgery, and/ or vestibular rehabilitation, do not always suffice. Therefore, the focus in this field of vestibular research shifted to electri- cal vestibular stimulation (EVS) and the development of a system capable of artificially restoring the vestibular func- tion. Key Message: Currently, three approaches are being investigated: vestibular co-stimulation with a cochlear im- plant (CI), EVS with a vestibular implant (VI), and galvanic vestibular stimulation (GVS). All three applications show promising results but due to conceptual differences and the experimental state, a consensus on which application is the most ideal for which type of patient is still missing. Summa- ry: Vestibular co-stimulation with a CI is based on “spread of excitation,” which is a phenomenon that occurs when the currents from the CI spread to the surrounding structures and stimulate them. It has been shown that CI activation can indeed result in stimulation of the vestibular structures. Therefore, the question was raised whether vestibular co- stimulation can be functionally used in patients with bilat- eral vestibulopathy. A more direct vestibular stimulation method can be accomplished by implantation and activa- tion of a VI. The concept of the VI is based on the technology and principles of the CI. Different VI prototypes are currently being evaluated regarding feasibility and functionality. So far, all of them were capable of activating different types of vestibular reflexes. A third stimulation method is GVS, which requires the use of surface electrodes instead of an implant- ed electrode array. However, as the currents are sent through the skull from one mastoid to the other, GVS is rather unspe- cific. It should be mentioned though, that the reported spread of excitation in both CI and VI use also seems to in- duce a more unspecific stimulation. Although all three ap- plications of EVS were shown to be effective, it has yet to be defined which option is more desirable based on applicabil- ity and efficiency. It is possible and even likely that there is a place for all three approaches, given the diversity of the pa- tient population who serves to gain from such technologies

Restoring Sensation of Gravitoinertial Acceleration through Prosthetic Stimulation of the Utricle and Saccule

Individuals with bilateral vestibular hypofunction suffer reduced quality of life due to loss of postural and ocular reflexes essential to maintaining balance and visual acuity during head movements. Vestibular stimulation has demonstrated success in restoring sensation of angular head rotations using electrical stimulation of the semi-circular canals (SCCs). Efforts toward utricle and saccule stimulation to restore sensation of gravitoinertial acceleration have been limited due to the complexity of the otolith end organs and otolith-ocular reflexes (OORs). Four key pieces of technology were developed to extend prosthetic stimulation to the utricle and saccule: a low-noise scleral coil system to record binocular 3D eye movements; a motion platform control system for automated presentation of rotational and translational stimuli; custom electrode arrays with fifty contacts targeting the SCCs, utricle and saccule; and a general-purpose neuroelectronic stimulator for vestibular and other neuromodulation applications. Using these new technologies, OORs were first characterized in six chinchillas to establish OOR norms during translations and static tilts. Results led to creation of a model that infers the axis of head tilt from measured binocular eye movements and thereby provides a context and means to assess the selectivity of prosthetic utricle and saccule stimulation. The model confirms the expectation that excitation of the left utricle and saccule primarily encodes tilts that bring the left ear down. Three of the chinchillas were implanted with electrode arrays in the left ear. Step changes in pulse rate were delivered to utricle and saccule electrodes near the maculae while measuring 3D binocular eye movements with the animal stationary in darkness. These stimuli elicited sustained ocular counter-roll responses that increased in magnitude as pulse rate or amplitude increased. Bipolar stimulation via neighboring electrodes elicited slow-rising or delayed onset of ocular counter-rolls (consistent with normal translational OOR low-pass filter behavior). Two chinchillas showed different direction of electrically-evoked ocular counter-roll between utricle versus saccule stimulation. Only near-neighbor bipolar electrode combinations elicited eye responses compensatory for tilts other than the ‘usual’ left ear down, suggesting the need for distributing multiple bipolar electrode pairs across the maculae to achieve selective stimulation and restore 3D sensation of gravitoinertial acceleration

Implante vestibular : ele realmente funciona? : uma revisão sistemática

Introdução: Pessoas com perda vestibular apresentam um déficit no sistema vestibular, o qual é o principal responsável pelo controle postural, pela estabilização do olhar e orientação espacial enquanto a cabeça se movimenta. Não há tratamento efetivo para uma perda vestibular bilateral. Recentemente, foi desenvolvido um implante vestibular para pessoas com perda vestibular bilateral para melhorar essa função e, consequentemente, a qualidade de vida desses pacientes. Objetivo: Identificar na literatura científica evidências de que o implante vestibular melhora a função vestibular de pessoas com déficit vestibular. Método: Cento e quarenta e seis artigos foram encontrados em cinco bases de dados e 323 artigos da literatura cinzenta, mencionando a relação entre implante vestibular e função vestibular em humanos. A estratégia PICOS (População, Intervenção, Comparação e Desfechos) foi utilizada para definir os critérios de elegibilidade. Os estudos que preencheram os critérios de inclusão para esta segunda etapa foram incluídos em uma síntese qualitativa, e cada tipo de estudo foi analisado de acordo com a avaliação de risco de viés do Joanna Briggs Institute através da critical appraisal checklist for quasi-experimental studies e da critical appraisa lchecklist for case reports. Resultados: Dos 21 artigos incluídos cujos textos completos foram lidos, 10 foram selecionados para a análise qualitativa na presente revisão sistemática. Todos os dez artigos analisados através da critical appraisal checklist mostraram um baixo risco de viés. O número total de amostras nos artigos avaliados foi de 18 pacientes com implantes vestibulares. Conclusões: Em conjunto, esses achados apoiam a viabilidade do implante vestibular para a restauração do reflexo vestíbulo-ocular em uma ampla faixa de frequências e ilustram novos desafios para o desenvolvimento desta tecnologia.Introduction: People with vestibular loss present a deficit in the vestibular system, which is primarily responsible for promoting postural control, gaze stabilization, and spatial orientation while the head moves. There is no effective treatment for a bilateral loss of vestibular function. Recently, a vestibular implant was developed for people with bilateral loss of vestibular function to improve this function and, consequently, the quality of life of these patients. Objective: To identify in the scientific literature evidence that vestibular implants in people with vestibular deficit improves vestibular function. Methods: One hundred and forty six articles were found from five databases and 323 articles from the gray literature mentioning the relationship between vestibular implant and vestibular function in humans. The PICOS strategy (Population, Intervention, Comparison and Outcome) was used to define the eligibility criteria. The studies that met the inclusion criteria for this second step were included in a qualitative synthesis, and each type of study was analyzed according to the bias risk assessment of the Joanna Briggs Institute through the critical assessment checklist Joanna Briggs institute for quasi-experimental studies and the Joanna Briggs institute critical assessment checklist for case reports. Results: Of the 21 articles included in reading the full text, 10 studies were selected for the qualitative analysis in the present systematic review. All ten articles analyzed through the critical assessment checklist Joanna Briggs institute showed a low risk of bias. The total number of samples in the evaluated articles was 18 patients with vestibular implants. Conclusions: Taken together, these findings support the feasibility of vestibular implant for restoration of the vestibulo-ocular reflex in a broad frequency range and illustrate new challenges for the development of this technology

Continuous Restoration of the Human Vestibulo-Ocular Reflex Using a Multichannel Vestibular Implant

Bilateral loss of vestibular sensation causes blurry vision during head movement, postural instability, chronic unsteadiness, and an increased fall risk. Individuals who fail to compensate despite rehabilitation therapy and cessation of exacerbating medications have no adequate treatment options. Inspired by the success of cochlear implants in restoring hearing, prosthetic stimulation of vestibular afferent neurons to encode head motion has been investigated as a potential treatment. Until now, no human had been continuously stimulated for more than a day, and human responses had not been assessed using 3-dimensional (3D) binocular oculography, without which one cannot determine whether an implant independently stimulates each of the implanted ear’s three semicircular canals. We report 3D binocular vestibulo-ocular reflex (VOR) responses in four human subjects with bilateral vestibular loss who were each implanted with a system designed to provide long-term motion-modulated prosthetic stimulation via electrodes in the semicircular canals of one ear. Initiation of prosthetic stimulation evoked nystagmus that decayed within 30 minutes. Stimulation targeting one canal produced 3D VOR responses aligned with that canal’s anatomic axis, while targeting canal pairs reliably yielded responses aligned with a vector sum of individual responses. Over 8 weeks of continuous use, modulated electrical stimulation produced robust and stable VOR responses that grew predictably with stimulus intensity and aligned approximately with any specified 3D head rotation axis. Combining mechanical and electrical stimulation enhanced low frequency responses. These results demonstrate that a vestibular implant can partially restore 3D inner ear sensation to individuals disabled by vestibular loss. Lastly, we show that temporal discretization inherent to cochlear implant signal processing has minimal effects on evoked responses, motivating a future combined device

A vestibular prosthesis with highly-isolated parallel multichannel stimulation.

This paper presents an implantable vestibular stimulation system capable of providing high flexibility independent parallel stimulation to the semicircular canals in the inner ear for restoring three-dimensional sensation of head movements. To minimize channel interaction during parallel stimulation, the system is implemented with a power isolation method for crosstalk reduction. Experimental results demonstrate that, with this method, electrodes for different stimulation channels located in close proximity ( mm) can deliver current pulses simultaneously with minimum inter-channel crosstalk. The design features a memory-based scheme that manages stimulation to the three canals in parallel. A vestibular evoked potential (VEP) recording unit is included for closed-loop adaptive stimulation control. The main components of the prototype vestibular prosthesis are three ASICs, all implemented in a 0.6- μm high-voltage CMOS technology. The measured performance was verified using vestibular electrodes in vitro