The long-term goal of this project is to understand how balance and gait disorders can be helped by using dynamic visual environments to facilitate sensorimotor relearning during locomotion and stance postural control. When vestibular inputs become unreliable, either from labyrinthine loss or dysfunction, individuals must learn to rely upon visual and proprioceptive pathways to produce appropriate responses for changes in postural orientation or equilibrium. Attempts to produce sensory relearning through practicing postural and purposeful activities in static environments have not proved to be a fully successful intervention, possibly because the controlled inputs do not place the necessary demands on the functionality of the postural system. Individuals may become fixed on one pattem of response and be unable to match the range of disturbances encountered in the environment. We propose to study changes in postural responses and spatial orientation during locomotion within a dynamic visual environment in normal subjects and in patients with bilateral labyrinthine loss. We hypothesize that individuals _ with vestibular loss become fixed on one strategy of compensation and can not compensate for the fluctuating demands of a dynamic environment. We will examine whether providing strategies for using visual information assists these individuals in compensating for destabilization. Subjects will be tested during quiet stance and walking on a treadmill while we manipulate the velocity or contextual contrast of a dynamic virtual environment. Segmental excursions and center of pressure will be measured and analyzed with repeated measures ANOVAs to determine if postural organization and orientation is influenced by specific parameters of the peripheral field of view. The parameters that emerge as most destabilizing will be applied in a training program where subjects will be instructed to focus on a distant target or on internal feedback to determine if active performance in a dynamic visual environment increases the response repertoire of individuals with labyrinthine loss. Finally, we will assess whether there is functional carryover from training within a dynamic visual environment. Subjects will perform a simulated physical world task in which they must retrieve and place an object while the world moves around them and obstacles appear in their path. Results from these studies will provide insight into the dynamics of the visual- vestibular interaction and identify specific quantitative protocols for therapeutic interventions with balance disorders.
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