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Reflexes Evoked by Electrical Vestibular Stimulation and Their Clinical Application

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Reflexes Evoked by Electrical Vestibular Stimulation and Their Clinical Application REFLEXES EVOKED BY ELECTRICAL VESTIBULAR STIMULATION AND THEIR CLINICAL APPLICATION by STUART WILLIAM MACKENZIE A Thesis submitted to the University of BirminghAm for the degree of DOCTOR OF PHILOSOPHY School of Sport, Exercise And RehAbilitAtion Sciences, College of Life And EnvironmentAl Sciences University of BirminghAm Date 15th June 2018 i University of Birmingham Research Archive e-theses repository This unpublished thesis/dissertation is copyright of the author and/or third parties. The intellectual property rights of the author or third parties in respect of this work are as defined by The Copyright Designs and Patents Act 1988 or as modified by any successor legislation. Any use made of information contained in this thesis/dissertation must be in accordance with that legislation and must be properly acknowledged. Further distribution or reproduction in any format is prohibited without the permission of the copyright holder. ABSTRACT The vestibulAr system provides vitAl informAtion About heAd position And heAd motion. This informAtion is used for the control of bAlAnce through vestibulospinAl reflexes. However, As the vestibulAr system is fixed within the skull, it must first be trAnsformed into body coordinAtes. ChApter 2 explores this trAnsformAtion process with And without vision. The results show thAt when vision is AvailAble, the evoked response is pArAdoxically less precise. ChApter 3 further explores the trAnsformAtion process before And After 60 dAys of bedrest. After this period of inActivity, pArticipAnts spontAneously swAyed more, and their EVS-evoked swAy response wAs less precise. This decrement in precision, however, appears to be showing signs of recovery, 6 dAys post bedrest. ChApter 4 switches focus from posturAl reflexes to vestibulo-oculAr reflexes. Here electrical vestibulAr stimulAtion is used to evoke meAsurAble torsionAl eye movements. The mAgnitude of the response is modulAted by stimulus frequency. Results Also suggest thAt the CNS interprets electrical vestibulAr stimulAtion As a velocity signAl rAther thAn A position or AccelerAtion signAl. As this technique is An ideAl meAsure of pure vestibulAr function, ChApter 5 utilised the technique in A clinical environment. VestibulAr schwAnnomA pAtients, who hAve A known unilAterAl vestibulAr deficit, were tested to identify if the proposed technique can in fAct detect this deficit. Results showed thAt Asymmetries could be detected, and, in fAct the test mAy be more sensitive thAn previously used meAsures of vestibulAr Asymmetries. ii ACKNOWLEDGMENTS Dr. Raymond Reynolds: ThAnk you for All of your help throughout my PhD. You were the one who initiAlly captured my interest in the vestibulAr system during my undergrAduAte studies And I Am glAd I hAve hAd the opportunity to further investigAte this fAscinAting field of reseArch. A pArticulAr highlight of my PhD was All those weeks we spent working together in Toulouse. I look forwArd to continuing working with you in the future. ENT Clinic at UHB: The prActical And clinical knowledge I leArned while Attending Mr. Irving’s And Mr. Monksfeild’s clinics wAs invaluAble to chApter 5. Mr. KumAr wAs vitAl in the meAsurements of tumor sizes for this chApter. I would Also like to thAnk All the pAtients who so enthusiAstically pArticipAted in my reseArch. MEDES: Bedrest studies can be notorious hArd to orgAnized but As A teAm you mAde the entire process seAmless And enjoyable. The pArticipAnts who, ultimAtely Are putting their lives on hold for 2 months, were A joy to work with And I thAnk them unreservedly. Motor Control Research group: ThAnks to All the members of the (now fAmously named) Wobblers. I hAve not only leArnt A lot from our critical discussion of work but Also enjoy mAny A pint in stAff house. iii Technical staff at the School of Sport, Exercise and Rehabilitation Sciences: You guys Are vitAl to the running of the school And I thAnk you for All your help. Postgraduate community: ThAnks to All those I hAve shAred An office with. We hAve been through highs And lows, and enjoyed countless unforgettAble moments together. ThAnks to the footbAll teAm, Anyone who Attended the legendAry ChristmAs pub crAwls, And All those I shAred A beer with in stAff house. Mum, Dad and Jess: You hAve helped me become the person I Am todAy. Your support through, whAt must seem like An eternity of student life, wAs invaluAble. ThAnk you for your unconditionAl support And love. Ashleigh: You were the one who pushed me to Apply for this PhD And set me off on this career trAjectory And for thAt I can never thAnk you enough. You hAve helped me with my studies where you cAn, especiAlly with proof reAding. Our holidAys throughout my studies were AmAzing And you AlwAys orgAnized them At time when I needed to relAx the most. You Are AlwAys there for me, And I will AlwAys be there for you. iv PUBLICATIONS AND PRESENTATIONS ChApters presented in this thesis have been published in the following journAls; Chapter 2 - MAckenzie, S. W., & Reynolds, R. F. (2018). DifferentiAl effects of vision upon the AccurAcy And precision of vestibulAr-evoked bAlAnce responses. Journal of Physiology. doi:10.1113/JP275645 Chapter 4 - MAckenzie, S. W., & Reynolds, R. F. (2018). OculAr torsion responses to sinusoidAl electrical vestibulAr stimulAtion. Journal of Neuroscience Methods, 294, 116-121. doi:10.1016/j.jneumeth.2017.11.012 Chapter 5 – Under review At JournAl of Clinical Neurophysiology. ReseArch within this thesis hAs been presented At the following conferences; • 7th InternAtionAl Posture Symposium 2015 (Smolenice, SlovakiA) • UK Sensory Motor Meeting 2016 (Newcastle, UK) • MRC-ARUK Student Meeting 2016 (NottinghAm, UK) • Society for the NeurAl Control of Movement AnnuAl Meeting 2016 (Montego BAy, JamAica) • Society for the NeurAl Control of Movement AnnuAl Meeting 2017 (Dublin, IrelAnd) • UK Sensory Motor Meeting 2017 (Bristol, UK) • InternAtionAl Society of Posture & GAit ReseArch World Congress 2017 (Fort LAuderdAle, USA) • The 30th Bárány Society meeting 2018 (UppsAlA, Sweden) v .)4/#4/'! ! !"#$%!&$''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''())! !&*+,-./012/+$#(''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''()))! 34".5&!$5,+#(!+0(3%/#/+$!$5,+#('''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''(6! .5#$(,7(7514%/#('''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''8))! .5#$(,7($!"./#(''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''(8)6! .5#$(,7(!""%595!$5,+#('''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''(86! 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