Efficacy of nGVS to improve postural stability in people with bilateral vestibulopathy: A systematic review and meta-analysis

McLaren, Ruth; Smith, Paul F.; Taylor, Rachael L.; Ravindran, Shobika; Rashid, Usman; Taylor, Denise

doi:10.3389/fnins.2022.1010239

Cited by 12 publications

(14 citation statements)

References 68 publications

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“…However, several recent investigations have failed to provide consistent support for this view (e.g. [32 ▪▪ ,33], reviewed in [34–36]). Importantly, an open question is whether the stimuli used in studies demonstrating positive outcomes have employed suprathreshold rather than subthreshold stimuli.…”

Section: Galvanic Vestibular Stimulationmentioning

confidence: 99%

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Electrical stimulation of the peripheral and central vestibular system

Lopez,

Cullen

2023

Current Opinion in Neurology

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Purpose of review Electrical stimulation of the peripheral and central vestibular system using noninvasive (galvanic vestibular stimulation, GVS) or invasive (intracranial electrical brain stimulation, iEBS) approaches have a long history of use in studying self-motion perception and balance control. The aim of this review is to summarize recent electrophysiological studies of the effects of GVS, and functional mapping of the central vestibular system using iEBS in awake patients. Recent findings The use of GVS has become increasingly common in the assessment and treatment of a wide range of clinical disorders including vestibulopathy and Parkinson's disease. The results of recent single unit recording studies have provided new insight into the neural mechanisms underlying GVS-evoked improvements in perceptual and motor responses. Furthermore, the application of iEBS in patients with epilepsy or during awake brain surgery has provided causal evidence of vestibular information processing in mostly the middle cingulate cortex, posterior insula, inferior parietal lobule, amygdala, precuneus, and superior temporal gyrus. Summary Recent studies have established that GVS evokes robust and parallel activation of both canal and otolith afferents that is significantly different from that evoked by natural head motion stimulation. Furthermore, there is evidence that GVS can induce beneficial neural plasticity in the central pathways of patients with vestibular loss. In addition, iEBS studies highlighted an underestimated contribution of areas in the medial part of the cerebral hemispheres to the cortical vestibular network.

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Section: Galvanic Vestibular Stimulationmentioning

confidence: 99%

“…,33], reviewed in [34][35][36]). Importantly, an open question is whether the stimuli used in studies demonstrating positive outcomes have employed suprathreshold rather than subthreshold stimuli.…”

Section: Andandmentioning

confidence: 99%

Electrical stimulation of the peripheral and central vestibular system

Lopez,

Cullen

2023

Current Opinion in Neurology

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“…While recent reviews have confirmed the beneficial effect of nGVS in healthy people ( Stefani et al, 2020 ), people with BVP ( McLaren et al, 2022 ), and Parkinson’s disease ( Mahmud et al, 2022 ), improvements have not been uniform. Sprenger et al (2020) , and Nooristani et al (2019b) found no improvement in standing balance with nGVS compared to sham controls, and Matsugi et al (2020) and Sprenger et al (2020) even found nGVS increased sway while standing on foam.…”

Section: Introductionmentioning

confidence: 99%

Scoping out noisy galvanic vestibular stimulation: a review of the parameters used to improve postural control

et al. 2023

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ObjectiveNoisy galvanic vestibular stimulation (nGVS) has been used to facilitate vestibular function and improve gait and balance in people with poor postural control. The aim of this scoping review is to collate, summarize and report on the nGVS parameters that have been used to augment postural control.MethodA systematic scoping review was conducted up to December 2022. Data were extracted and synthesized from 31 eligible studies. Key nGVS parameters were identified, and the importance of these parameters and their influence on postural control evaluated.ResultsA range of nGVS parameters have been used to augment postural control, including; noise waveform, amplitude, frequency band, duration of stimulation, method of amplitude optimization, size and composition of electrodes and the electrode skin interface.ConclusionSystematic evaluation of the individual parameters that can be manipulated in the nGVS waveform identified that a broad array of settings have been utilized in each parameter across the studies. Choices made around the electrode and electrode-skin interface, as well as the amplitude, frequency band, duration and timing of the waveform are likely to influence the efficacy of nGVS. The ability to draw robust conclusions about the selection of optimal nGVS parameters to improve postural control, is hindered by a lack of studies that directly compare parameter settings or consider the variability in individuals’ response to nGVS. We propose a guideline for the accurate reporting of nGVS parameters, as a first step toward establishing standardized stimulation protocols.

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“…First, GVS is likely to affect the spatiotemporal parameters of gait, but the nature of its effects remains unclear. Low-intensity noisy GVS, which consists of a noisy, alternating electrical current was shown to decrease variability in the gait cycle timing and trunk acceleration during perturbed treadmill walking (Wuehr et al, 2016a , b ; Lajoie et al, 2021 ; McLaren et al, 2022 ). During overground walking with eyes closed, reduced variability in stride time and stride length have also been reported (Wuehr et al, 2016b ; Iwasaki et al, 2018 ; Piccolo et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

“…Third, most studies apply nGVS continuously throughout the gait cycle to assess the modulation of spatio-temporal parameters (see Lajoie et al, 2021 ; McLaren et al, 2022 ). However, vestibular inputs might be required at specific phase of the gait cycle, mainly at heel strike or early stance (Bent et al, 2004 ; Iles et al, 2007 ).…”

Section: Introductionmentioning

confidence: 99%

Effect of galvanic vestibular stimulation applied at the onset of stance on muscular activity and gait cycle duration in healthy individuals

Abbariki

Mikhail²,

Hamadjida³

et al. 2023

Front. Neural Circuits

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Locomotion requires the complex involvement of the spinal and supraspinal systems. So far, the role of vestibular input in gait has been assessed mainly with respect to gait stability. The noninvasive technique of galvanic vestibular stimulation (GVS) has been reported to decrease gait variability and increase gait speed, but the extent of its effect on spatiotemporal gait parameters is not fully known.Objective: Characterize vestibular responses during gait and determine the influence of GVS on cycle duration in healthy young participants.Methods: Fifteen right-handed individuals participated in the study. Electromyography (EMG) recordings of the bilateral soleus (SOL) and tibialis anterior muscles (TA) were performed. First, to determine stimulation intensity, an accelerometer placed on the vertex recorded the amplitude of the head tilts evoked by the GVS (1–4 mA, 200 ms) to establish a motor threshold (T). Second, while participants walked on a treadmill, GVS was applied at the onset of the stance phase during the treadmill gait with an intensity of 1 and 1.5 T with the cathode behind the right (RCathode) or left ear (LCathode). EMG traces were rectified, averaged (n = 30 stimuli), and analyzed. Latency, duration, and amplitude of vestibular responses as well as the mean duration of the gait cycles were measured.Results: GVS mainly induced long-latency responses in the right SOL, right TA and left TA. Only short-latency responses were triggered in the left SOL. Responses in the right SOL, left SOL and left TA were polarity dependent, being facilitatory with RCathode and inhibitory with LCathode, whereas responses in the right TA remained facilitatory regardless of the polarity. With the RCathode configuration, the stimulated cycle was prolonged compared with the control cycle at both 1 and 1.5 T, due to prolonged left SOL and TA EMG bursts, but no change was observed in right SOL and TA. With LCathode, GVS did not modify the cycle duration.Conclusion: During gait, a brief, low-intensity GVS pulse delivered at the right stance onset induced mainly long-latency polarity-dependent responses. Furthermore, a RCathode configuration increased the duration of the stimulated gait cycle by prolonging EMG activity on the anodic side. A similar approach could be explored to influence gait symmetry in individuals with neurological impairment.

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Efficacy of nGVS to improve postural stability in people with bilateral vestibulopathy: A systematic review and meta-analysis

Cited by 12 publications

References 68 publications

Electrical stimulation of the peripheral and central vestibular system

Electrical stimulation of the peripheral and central vestibular system

Scoping out noisy galvanic vestibular stimulation: a review of the parameters used to improve postural control

Effect of galvanic vestibular stimulation applied at the onset of stance on muscular activity and gait cycle duration in healthy individuals

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