Cognitive Rehabilitation in Bilateral Vestibular Patients: A Computational Perspective

Abstract

There is evidence that vestibular sensory processing affects, and is affected by, higher cognitive processes. This is highly relevant from a clinical perspective, where there is evidence for cognitive impairments in patients with peripheral vestibular deficits. The vestibular system performs complex probabilistic computations, and we claim that understanding these is important for investigating interactions between vestibular processing and cognition. Furthermore, this will aid our understanding of patients’ self-motion perception and will provide useful information for clinical interventions. We propose that cognitive training is a promising way to alleviate the debilitating symptoms of patients with complete bilateral vestibular loss (BVP), who often fail to show improvement when relying solely on conventional treatment methods. We present a probabilistic model capable of processing vestibular sensory data during both passive and active self-motion. Crucially, in our model, knowledge from multiple sources, including higher-level cognition, can be used to predict head motion. This is the entry point for cognitive interventions. Despite the loss of sensory input, the processing circuitry in BVP patients is still intact, and they can still perceive self-motion when the movement is self-generated. We provide computer simulations illustrating self-motion perception of BVP patients. Cognitive training may lead to more accurate and confident predictions, which result in decreased weighting of sensory input, and thus improved self-motion perception. Using our model, we show the possible impact of cognitive interventions to help vestibular rehabilitation in patients with BVP.

Head impulse compensatory saccades: Visual dependence is most evident in bilateral vestibular loss

“…Sensori-motor learning of both the VOR and saccades requires time and exposure to errors [63,64], suggesting that saccades characteristics could be of value in determining the age of a lesion e.g. useful when seeking to separate old and new vestibular lesions in sequential vestibular insults [65], as well as tracking vestibular rehabilitation intervention [57,66,67] and generally probing cognitive factors [68,69] involved in compensating for the loss of a congenital reflex arc.…”

The Virtual Morris Water Task in 64 Patients With Bilateral Vestibulopathy and the Impact of Hearing Status

“…Although the utility of cognitive training has been demonstrated to enhance balance in the elderly and in patients with mild cognitive impairment and dementia, cognitive training is not included in the current treatment of BVP ( 13 , 14 ). According to a recent computational model, cognitive training facilitates the central compensation process in BVP patients by increasing the knowledge about self-motion ( 15 ).…”

Beyond sensory conflict: The role of beliefs and perception in motion sickness

“…As discussed by Mast & Ellis [ 33 ], it is likely that cognitive, top-down influences of sensory processing are related to the prediction mechanism of the model. The same authors recently proposed that the understanding of vestibular cognition could benefit from dynamic probabilistic models, which use Bayesian inference [ 34 , 35 ]. Bayesian inference describes how the state is estimated based on noisy sensory data and prior expectations, and this technique has been applied in self-motion perception models [ 36 – 38 ].…”

“…However, it can also stem from different sources, which makes it very suitable for modeling cognitive influences on vestibular processing. This was shown by Ellis and colleagues [35], who used dynamic Bayesian inference to illustrate how cognition could affect motion perception. They proposed that this cognitive influence could be utilized in rehabilitation for vestibular loss patients, to improve their motion perception using cognitive sources like mental imagery.…”