ROCKEFELLER MEDICAL LIBRARY INSTITUTE OF NEUROLOGY, THE NATIONAL HOSPITAL. QUEEN SQUARE, LONDON, ■ PSYCHOLOGICAL AND PSYCHOPHYSICAL ASPECTS OF SPATIAL ORIENTATION ELIZABETH ALICE GRUNFELD MRC Human Movement and Balance Unit National Hospital For Neurology and Neurosurgery Queen Square London Thesis submitted for the degree of PhD in the Faculty of Clinical Sciences of the University of London 1998 ProQuest Number: 10630776 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a com plete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. uest ProQuest 10630776 Published by ProQuest LLC(2017). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States C ode Microform Edition © ProQuest LLC. ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106- 1346 ABSTRACT These studies were undertaken to investigate the psychological and psychophysical factors that mediate spatial orientation/disorientation in both healthy and patient populations. PERCEPTION OF ANGULAR VELOCITY: Using a new method of examining perception of rotation this study found a similarity between the sensation and ocular responses following velocity step stimuli. Both decayed exponentially with a time constant of circa 15 seconds following rotation in yaw; circa 7 seconds following rotation in roll. Both the ocular and sensation responses were significantly reduced following repeated vestibular and optokinetic stimulation. The test was conducted with patients suffering from congenital nystagmus, ophthalmoplegia or cerebellar lesions, all of whom had markedly reduced post-rotational sensation responses of approximately 7 to 9 seconds. ADAPTATION TO OSCILLOPSIA: Labyrinthine defective subjects were found to prefer less self- motion when viewing a moving video-image than either ophthalmoplegia subjects or normal controls. The results suggest that adaptation to oscillopsia may be related to an active approach to recovery (i.e. high external locus of control) and also to increased tolerance to retinal slip. This serves to illustrate the coactive role of psychological and psychophysical mechanisms in adaptation to vestibular disorders. INVESTIGATION OF PSYCHOLOGICAL AND PSYCHOSOCIAL FACTORS: This questionnaire- based study aimed to examine adjustment to illness in patients with balance disorders and with congenital nystagmus. The study identified a greater use of emotion-focused coping strategies than problem-focused strategies. It highlighted the prevalence of anxiety and depression among these patients and pointed towards several psychosocial variables (locus of control, self-esteem and social support) that play a significant role in the coping behaviour of these patients. MENSTRUATION, MIGRAINE AND MOTION SICKNESS: The relationship between hormonal cycles and migraine and motion sickness is poorly understood. The study demonstrated that motion sickness and headache occurred independently although exposure to rough seas could be a specific migraine trigger in certain individuals who did not otherwise suffer attacks. Female subjects were more prone to motion sickness around the period of menstruation and less so around ovulation. 2 ACKNOWLEDGEMENTS Michael Gresty & Adolfo Bronstein My supervisors - for their knowledge, guidance and encouragement Josephine Shallo-Hoffmann, Marjan Jahanshahi, Mary Faldon, Peter Goadsby, Tom Okada For their invaluable assistance and helpful comments Sarah Brocklehurst & David Buckwell For statistical and technical advice The Patients & Staff at The National Hospital For their willingness to participate in these studies Bill Cameron & Tony Morland Bill for making (and modifying) all the equipment used in these studies; Tony for being a constant source of reference and to both of you for making the past three years so much fun Helen, Alison, Laura, Karen, Clive & Ruth For their friendship and optimism My Family For their continued support Angus For all your advice (and proof-reading skills) 3 CONTENTS Title page 1 Abstract 2 Acknowledgements 3 Contents 4 List of Figures 9 List of Tables 12 Abbreviations 15 CHAPTER ONE: GENERAL INTRODUCTION 1.1 The vestibular system 16 1.2 Functional anatomy of vestibular perception 19 1.3 Vestibular autonomic connections 20 1.4 The vestibulo-ocular reflex 20 1.5 Disorders affecting the VOR 22 1.5.1 Abnormalities of the vestibularsystem 22 Unilateral hypofunction 22 Bilateral hypofunction 23 1.5.2 Congenital nystagmus 23 1.5.3 Ophthalmoplegia 24 1.6 Investigation of vestibular disorders 25 1.6.1 Caloric testing 25 1.6.2 Rotational testing 26 1.6.3 Sources of error 26 1.6.4 The advent of perceptual testing 27 1.7 Vestibular symptoms in the absence of pathology 27 1.8 Individual differences 28 1.9 General aims of the thesis 29 4 CONTENTS CHAPTER TWO: SENSATION AND THE VELOCITY STORAGE MECHANISM: PART ONE ■ GENERAL INVESTIGATIONS 2.1 General Introduction 31 2.2 Study One: The Role of Velocity Storage in Vestibular Sensation 33 2.2.1 Introduction 33 Cupulometry 33 Azimuth estimation 34 Magnitude estimation 35 2.2.2 Aims of the study 36 2.2.3 Methods 36 Subjects 36 Materials 36 Procedure 38 Data analysis 38 2.2.4 Results 40 2.2.5 Discussion 43 2.3 Study Two: Examination of Habituation and Optokinetic Training 46 2.3.1 Introduction 46 2.3.2 Rationale 47 2.3.3 Methods 47 Subjects 47 Materials 48 Procedure 48 Vestibular habituation condition 48 Optokinetic condition 49 2.3.4 Results 49 2.3.5 Discussion 53 2.4 Study Three: Examination Of Vestibular Sensation In Roll and Yaw 56 2.4.1 Introduction 56 2.4.2 Aims of the present study 57 2.4.3 Methods 57 Subjects 57 Materials and procedure 57 2.4.4 Results 60 2.4.5 Discussion 62 2.5 General Summary 64 5 CONTENTS CHAPTER THREE: SENSATION AND THE VELOCITY STORAGE MECHANISM: PART TWO - PATIENT INVESTIGATIONS 3.1 Background 65 3.1.1 Pathophysiology of CN 65 3.1.2 Vestibular testing in CN 67 3.1.3 Vestibular responses in ophthalmoplegia 69 3.1.4 Vestibular responses in lesions of the cerebellum 69 3.2 Rationale 70 3.3 Methods 70 3.3.1 Subjects 70 3.3.2 Materials and procedure 72 3.4 Results 72 3.5 Discussion 79 3.5.1 Vestibular function in CN 79 3.5.2 Vestibular perception in ophthalmoplegia 80 3.5.3 Vestibular perception in lesions of the cerebellum 81 3.6 Summary 82 CHAPTER FOUR: ADAPTATION TO OSCILLOPSIA: AN INVESTIGATION OF TOLERANCE TO SELF- MOTION AND PSYCHOLOGICAL VARIABLES 4.1 Background 83 4.1.1 Adaptive changes that occur after loss of labyrinthine function 84 4.1.1.1 Cervico-ocular reflex 84 4.1.1.2 Ocular-motor and perceptual adaptation 85 4.1.2 Adaptation to oscillopsia in patients with congenital nystagmus 86 4.1.3 Ophthalmoplegia 87 4.1.4 The influence of psychological and psychosocial factors 88 4.2 Purpose of this study 88 4.3 Materials and methods 88 4.3.1 Subjects 88 4.3.2 Psychophysical study 89 Test set-up 89 Procedure 91 4.3.3 Questionnaires 91 4.3.4 Data analysis 92 4.4 Results 92 4.4.1 Distribution of data 92 4.4.2 Preliminary analysis 95 4.4.3 Psychophysical data 95 4.4.4 Questionnaire analysis 97 4.5 Discussion 101 LD subjects 101 Ophthalmoplegia subjects 104 4.6 Summary 105 6 CONTENTS CHAPTER FIVE: COPING AND ADJUSTMENT IN CONGENITAL NYSTAGMUS AND VESTIBULAR DISORDER PATIENTS 5.1 Background 106 5.1.1 The nature of coping 107 5.1.2 Criticisms of previous approaches 108 5.1.3 Previous studies with vestibular subjects 110 5.1.4 Research in subjects with congenital nystagmus (CN) 111 5.2 Focus of this study 111 5.3 Methods 112 5.3.1 Subjects 112 5.3.2 Materials 113 5.3.2.1 Coping strategies 113 5.3.2.2 Primary outcome measures 114 5.3.2.3 Higher-order outcome measures 114 5.3.2.4 Personality and attributional style 116 5.3.2.5 External/social variables 117 5.3.3 Procedure 117 5.4 Results 118 5.4.1 Demographic information 118 5.4.2 Past history of the disorder 118 5.4.3 Clinical test results and reports of symptoms 123 5.4.4 Effects of the disorder 127 5.4.5 Higher-order outcomes 127 5.4.6 Personality and personal attributional style 128 5.4.7 Coping strategies 132 5.4.8 External social variables 133 5.4.9 Inter-relationship of variables 134 5.4.9.1 Vestibular group 134 The influence of depression on the relationships between variables 135 Predictors of depression in the vestibular group 136 5.4.9.2 CN group 136 5.5 Discussion 137 5.5.1 Vestibular test results and primary order outcomes 137 5.5.2 Coping strategies 138 5.5.3 Secondary order outcomes 139 5.5.4 Personality and personal attributional style 140 5.5.5 External resource 141 5.6 Final comments 141 7 CONTENTS CHAPTER SIX: MENSTRUATION, MIGRAINE AND MOTION SICKNESS 6.1 Background 145 6.2 Aims of the study 148 6.3 Methods 148 6.3.1 The race 148 6.3.2 Subjects 149 6.3.3 Data collection methods 149 6.4 Results 150 6.4.1 Pre-race questionnaires 150 6.4.2 Logbooks 152 6.4.2.1 Data analysis 152 Missing or inaccurate data 152 Statistical advice 152 6.4.2.2 The occurrence of motion sickness and headache 153 6.4.2.3 Relationship between motion sickness and migraine 155 6.4.2.4 Relationship with menstruation 155 6.4.2.5 Headache and motion sickness among male subjects 159 6.4.3 Post-race questionnaires 159 6.5 Case studies 160 Case One: RB 160 Case Two: DK 161 Case Three: RH 161 6.6 Discussion 162 6.7 Conclusions 165 CHAPTER SEVEN: GENERAL OVERVIEW 166 References 170 Appendices 8