To determine whether subjects with somatosensory loss show a compensatory increase in sensitivity to vestibular stimulation, we compared the amplitude of postural lean in response to four different intensities of bipolar galvanic stimulation in subjects with diabetic peripheral neuropathy (PNP) and age-matched control subjects. To determine whether healthy and neuropathic subjects show similar increases in sensitivity to galvanic vestibular stimulation when standing on unstable surfaces, both groups were exposed to galvanic stimulation while standing on a compliant foam surface. In these experiments, a 3-s pulse of galvanic current was administered to subjects standing with eyes closed and their heads turned toward one shoulder (anodal current on the forward mastoid). Anterior body tilt, as measured by center of foot pressure (CoP), increased proportionately with increasing galvanic vestibular stimulation intensity for all subjects. Subjects with peripheral neuropathy showed larger forward CoP displacement in response to galvanic stimulation than control subjects. The largest differences between neuropathy and control subjects were at the highest galvanic intensities, indicating an increased sensitivity to vestibular stimulation. Neuropathy subjects showed a larger increase in sensitivity to vestibular stimulation when standing on compliant foam than control subjects. The effect of galvanic stimulation was larger on the movement of the trunk segment in space than on the body's center of mass (CoM) angle, suggesting that the vestibular system acts to control trunk orientation rather than to control whole body posture. This study provides evidence for an increase in the sensitivity of the postural control system to vestibular stimulation when somatosensory information from the surface is disrupted either by peripheral neuropathy or by standing on an unstable surface. Simulations from a simple model of postural orientation incorporating feedback from the vestibular and somatosensory systems suggest that the increase in body lean in response to galvanic current in subjects with neuropathy could be reproduced only if central vestibular gain was increased when peripheral somatosensory gain was decreased. The larger effects of galvanic vestibular stimulation on the trunk than on the body's CoM suggest that the vestibular system may act to control postural orientation via control of the trunk in space.
1. We investigated the role of the vestibular system in postural control by combining galvanic vestibular stimulation (0.2-0.5 mA) with platform translations in standing subjects. Vestibular stimulation delivered 500 ms before and continuously during the platform translation produced little change in the earliest center of pressure (COP) and center of mass (COM) movements in response to platform translations, but resulted in large changes during the execution of the postural movement and in the final equilibrium position. 2. Vestibular stimulation produced anterior or posterior shifts in the position of COP and COM, depending on the polarity of the galvanic current. These shifts were larger during platform translations than during quiet stance. The peak of these shifts in COP and COM occurred at 1.5-2.5 s after the onset of platform translation, and increased in magnitude with increasing platform velocity. The final equilibrium positions of COP and COM were also shifted, but these shifts were smaller and not dependent on platform velocity. 3. These results imply that a tonic step of galvanic current to the vestibular system can change the final equilibrium position for an automatic postural response. Furthermore, these results indicate that the vestibular system may play a larger role in interpreting sensory reafference during postural movements, and especially during fast postural movements, than in controlling quiet stance. Finally, these results indicate that the vestibular system does not play a critical role in triggering the earliest postural responses, but it may be critical in establishing an internal reference for verticality.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.