Vestibular function modulates the impact of nGVS on postural control in older adults

Nooristani, Mujda; Bigras, Charlotte; Lafontaine, Louise; Bacon, Benoît A.; Maheu, Maxime; Champoux, François

doi:10.1152/jn.00512.2020

Cited by 9 publications

(16 citation statements)

References 25 publications

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“…Clinical evidence supports this assertion. nGVS was not effective in people with complete bilateral loss (Schniepp et al, 2019 ), whereas people with incomplete vestibular loss exhibited a significant improvement in postural control with nGVS compared to those with normal vestibular function (Nooristani et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

“…These findings are consistent with conclusions drawn in other studies. Nooristani et al ( 2021 ) found older adults with vestibular impairment showed more responsiveness to nGVS stimulation than those with intact vestibular systems, and Inukai et al ( 2018a , b ); Inukai et al ( 2020c ) found nGVS was more effective at improving balance in people who present with some baseline postural instability.…”

Section: Discussionmentioning

confidence: 99%

“…As much of the initial nGVS research was exploratory there are some methodological issues that are only now being redressed. The research upon which our theoretical underpinnings are based has been primarily performed in young healthy adults whom we now understand respond differently to nGVS than those with higher postural sway or vestibular impairment (Fujimoto et al, 2019a ; Nooristani et al, 2021 ). These initial studies have often looked at multiple intensities, yet only reported on the intensity related to optimal performance (Goel et al, 2015 ; Mulavara et al, 2015 ; Fujimoto et al, 2016 ; Iwasaki et al, 2018 ) or have examined one intensity compared to sham stimulation (Inukai et al, 2018a , b , 2020a , b , c ; Nooristani et al, 2019a , b ; Matsugi et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

“…Noisy galvanic vestibular stimulation (nGVS) applied to the bilateral mastoid processes has been investigated over the past two decades as a treatment to improve balance and postural control (Iwasaki et al, 2014 , 2018 ; Fujimoto et al, 2016 , 2018 ; Wuehr et al, 2016a , b ; Inukai et al, 2018a , 2020a , b , c ; Ko et al, 2020 ; Chen et al, 2021 ; Nooristani et al, 2021 ). Delivered via electrodes placed bilaterally over the mastoid processes, nGVS is a zero mean, noisy galvanic current applied over a fixed bandwidth.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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ObjectiveNoisy galvanic vestibular stimulation (nGVS) has been used to boost vestibular afferent information to the central nervous system. This has the potential to improve postural control for people for whom vestibular signals are weak, such as in bilateral vestibulopathy (BVP). The aim of this systematic review and meta-analysis is to investigate the evidence for nGVS as a modality to improve postural control in people with BVP.MethodsA comprehensive systematic search was conducted of five databases up to July 2022 to find studies applying nGVS to people with BVP, with the aim of improving postural control. Two independent reviewers screened and identified eligible studies, completed a risk of bias evaluation (Cochrane) and extracted relevant data. The standardized mean difference (SMD) based on Hedges' g was calculated as a measure of effect size for the primary outcome measure that best identified postural control, and a forest plot generated.ResultsSeven studies met the eligibility criteria, with five being suitable for meta-analysis. Meta-analysis revealed a moderate effect in favor of nGVS improving postural control during standing and walking [pooled SMD = 0.47 95% CI (0.25, 0.7)]. nGVS-mediated improvements in postural control were most evident in observations of reduced sway velocity when standing on a firm surface with eyes closed, and in the reduced variability of gait parameters, particularly those measuring lateral stability.ConclusionsCoincident nGVS in people with BVP improves postural control during standing and walking. This improvement appears to be context specific, in that vestibular augmentation is most effective in situations where visual inputs are limited, and where reliable context specific proprioceptive cues are available. Further research is warranted investigating additional circumstances in which nGVS improves postural control, including investigating the residual, and sustained effects of nGVS.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=342147, identifier: 342147.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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“…There were some limitations to this study. First, only healthy young individuals were included, meaning that the effects of nGVS on VOR and body sway observed in this study may not apply to older populations and patients with vestibular disorders, as these effects may depend on vestibular function ( 42 ). Further, we tested the response to GVS before the examination, and further studies are required to determine the optimal intensity ( 20 ) of nGVS for the VOR in patients with vestibular disorders or healthy older individuals.…”

Section: Discussionmentioning

confidence: 99%

Vestibulo-Ocular Reflex Is Modulated by Noisy Galvanic Vestibular Stimulation

2022

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We investigated whether noisy galvanic vestibular stimulation (nGVS) modulates the vestibulo-ocular reflex (VOR) and whether this effect is correlated with the effect of nGVS on body sway. Thirty healthy young adults participated. The video head impulse test (vHIT) was used to estimate the ratio of eye motion velocity/head motion velocity to VOR-gain. The gain 60 ms after the start of head motion (VOR-gain-60 ms) and regression slope (RS) (i.e., gain in eye and head motion; VOR-gain-RS) were calculated. The total path length of the foot center of pressure (COP-TL) during upright standing was calculated to estimate body sway. Noisy Galvanic Vestibular Stimulation at 0.2, 0.6, 1.2 mA, or sham stimulation (direct current: 0 mA) was delivered to the bilateral mastoid process in random order during vHIT and COP measurements. Application of nGVS at 0.2 mA significantly reduced VOR-gain-RS, while application of nGVS at 0.6 mA significantly increased COP-TL. Vestibulo-ocular reflex-gain-60 ms differed significantly between 0.2 and 1.2 mA. There was no significant correlation between COP-TL and VOR-related parameters. These findings suggest that nGVS at 0.2 mA inhibits the VOR, while nGVS at 0.6 mA increases body sway during upright standing, although there may be no relationship between the respective effects in healthy individuals.

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Mechanisms underlying treatment effects of vestibular noise stimulation on postural instability in patients with bilateral vestibulopathy

Wuehr,

Eder,

Kellerer

et al. 2023

J Neurol

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Background Previous studies indicate that imbalance in patients with bilateral vestibulopathy (BVP) may be reduced by treatment with low-intensity noisy galvanic vestibular stimulation (nGVS). Objective To elucidate the potential mechanisms underlying this therapeutic effect. In particular, we determined whether nGVS-induced balance improvements in patients are compatible with stochastic resonance (SR)—a mechanism by which weak noise stimulation can paradoxically enhance sensory signal processing. Methods Effects of nGVS of varying intensities (0–0.7 mA) on body sway were examined in 19 patients with BVP standing with eye closed on a posturographic force plate. We assumed a bell-shaped response curve with maximal sway reductions at intermediate nGVS intensities to be indicative of SR. An established SR curve model was fitted on individual patient outcomes, and three experienced human raters had to judge whether responses to nGVS were consistent with the exhibition of SR. Results nGVS-induced reductions of body sway compatible with SR were found in 12 patients (63%) with optimal improvements of 31 ± 21%. In 10 patients (53%), nGVS-induced sway reductions exceeded the minimally important clinical difference (optimal improvement: 35 ± 21%), indicative of strong SR. This beneficial effect was more likely in patients with severe vestibular loss (i.e. lower video head impulse test gain; R = 0.663; p = 0.002) and considerable postural imbalance (baseline body sway; R = 0.616; p = 0.005). Conclusions More than half of the assessed patients showed robust improvements in postural balance compatible with SR when treated with nGVS. In particular, patients with a higher burden of disease may benefit from the non-invasive and well-tolerated treatment with nGVS.

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Vestibular function modulates the impact of nGVS on postural control in older adults

Cited by 9 publications

References 25 publications

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

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

Vestibulo-Ocular Reflex Is Modulated by Noisy Galvanic Vestibular Stimulation

Mechanisms underlying treatment effects of vestibular noise stimulation on postural instability in patients with bilateral vestibulopathy

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