Patients whose deficits were limited to clinically well qualified vestibular disorders have been exposed to a number of altered support surface and visual environments while standing unsupported. A six-degrees-of-freedom platform employing movable support surfaces for each foot and a movable visual surround deprived patients of normal inputs derived from a fixed level support surface and from an immobile surround. Various tests employing EMG, force, and body movement recording identified quantitative changes in the patients' strategy for the relative weighting of proprioceptive, vestibular, and visual inputs. The most dramatic performance deficit of patients was their inability to suppress the influence of visual and proprioceptive inputs appropriately whenever motions of external surface disturbed the orientation information provided by these inputs. Thus, the more mildly afflicted patients experienced instability not so much because of the loss of vestibular inputs directly to posture but because of their inappropriate responses to proprioceptive inputs and vision. Discussion is centered on the role of vestibular input as an internal reference system for orientation about which adaptive changes in proprioceptive and visual inputs are made.

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Assessment of postural control in vestibular deficient subjects with and without visual and ankle joint sway information permitted: 1) a quantitative assessment of the overall vestibular information used by the individual patient for control of upright posture; 2) an estimate of the extent to which the vestibular deficient subject can appropriately "select" and alternatively use visual and ankle joint somatosensory information for compensatory postural control and 3) quantification of adaptive changes in postural responses to visual and somatosensory inputs. Results from this study support the hypothesis that abnormal vestibular function disrupts the subject's reference to gravity (earth) vertical. This loss of an absolute spatial reference normally provided by vestibular input prevents the resolution of conflicting or inaccurate visual and somatosensory spatial references which may occur during active or passive body movements.