Vestibular Rehabilitation for Acoustic Neuroma

Recruiting in Palo Alto (17 mi)

Age: Any Age

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Waitlist Available

Sponsor: Massachusetts Eye and Ear Infirmary

No Placebo Group

Trial Summary

What is the purpose of this trial?

Multiple sensory cues are typically generated by discrete events, and while they do not reach the cerebrum simultaneously, the brain can bind them temporally if they are interpreted as corresponding to a single event. The temporal binding of vestibular and non-vestibular sensory cues is poorly understood and has not been studied in detail, despite the fact that the vestibular system operates in an inherently multimodal environment. In this study, the researchers are investigating the physiology and pathophysiology of vestibular temporal binding by studying normal subjects, patients with peripheral and central vestibular dysfunction, and patients with vestibular and cochlear signals provided by prosthetic implants in the inner ear.

Research Team

Eligibility Criteria

This trial is for individuals with migraines, vestibular disorders like vertigo, or those planning cochlear implant surgery due to deafness. Participants must meet specific criteria including normal hearing and vestibular function tests, and not have had a migraine or vestibular episode in the last two weeks. Pregnant women, people on certain medications, or those with other neurological conditions are excluded.

Inclusion Criteria

People with migraines who fit the specific rules for migraines and have not had a migraine in the past two weeks.

You have passed tests for balance, eye movement, and hearing.

You have vestibular migraines that match specific criteria, including having balance issues during migraines, and are being tested more than 2 weeks after your last migraine or balance episode.

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Exclusion Criteria

You have migraines and have experienced certain symptoms related to balance or dizziness, or are taking specific medications for migraines or balance issues.

People who have vestibular migraine and are taking certain medications for migraine prevention or to suppress dizziness.

You are a healthy person without a history of ear or brain problems, not taking certain medications, and not pregnant or recently pregnant.

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Treatment Details

Interventions

Chronic Motion-modulated Stimulation (Behavioral Intervention)
Temporal Binding Adaptation - PSS adaptation with VI stimulation (Behavioral Intervention)
Temporal Binding Adaptation - PSS training (Behavioral Intervention)
Temporal Binding Adaptation - TBW training (Behavioral Intervention)

Trial OverviewThe study explores how the brain combines different sensory signals related to balance and movement. It includes patients with various conditions affecting balance (vestibular disorders) as well as healthy subjects. The interventions involve specialized training techniques designed to improve the brain's ability to process these signals.

Participant Groups

4Treatment groups

Experimental Treatment

Group I: Peripheral Vestibular DysfunctionExperimental Treatment2 Interventions

Vestibular Schwannoma patients The basic approach is to characterize the precision of their vestibular information (perceptual thresholds for spatial precision, reaction times for temporal precision), and their temporal binding characteristics for vestibular (yaw rotation or y-translation)-visual inputs, in three states: pre-op, sub-acute post-op (2-6 weeks), and chronic post-op (6 months+). At each state the investigators will also assess the quality of their vestibular-mediated behaviors through questionnaires (e.g. DHI), postural sway, functional gait analysis, and standard rotational testing (VOR gain, time constant, and asymmetry).

Group II: Normal ControlsExperimental Treatment2 Interventions

normal control subjects - no history of neurologic or inner ear disease The investigators will characterize vestibular spatial and temporal precision by calculating perceptual thresholds and reaction times for vestibular (yaw rotation, ytranslation) stimuli in normal subjects over a wide age range. Vestibular-visual temporal binding is then performed on each subject and the relationship between the principal parameters (vestibular perceptual thresholds \[inversely related to spatial precision\], vestibular reaction time variability \[inverse of temporal precision\], and the PSS and TBW from the temporal binding paradigm) will be examined. The investigators will collect qualitative assessments of dizziness/disbalance (DHI: dizziness handicap index) and quantitative measurements of balance and vestibular function (FGA: functional gait analysis, postural sway, and standard rotational testing - VOR gain, time constant, asymmetry).

Group III: Implant SubjectsExperimental Treatment2 Interventions

Cochlear Implant (CI)/Vestibular Implant (VI) patients A causative role for vestibular precision in temporal binding will be investigated in the VI patients, since the noise characteristics of the vestibular channel will be varied and to determine how this affects thresholds and temporal binding. As part of a second aim, the investigators will use VI and CI prosthetic signals in patients who have never received them together to see how the brain process sensory cues to which it is essentially naïve. Finally, after the acute experiments the investigators will provide 8 hours of 'physiologic' VI and CI stimulation by turning both implants on, sound modulates activity in the CI as usual, and angular head motion modulates activity in the VI while the subject actively explores the hospital environment.

Group IV: Central Vestibular DysfunctionExperimental Treatment2 Interventions

Migraine and Vestibular Migraine patients The investigators intend to evaluate vestibular (yaw rotation or y-translation) - visual temporal binding in people with a wide range of motion sickness sensitivities (as quantified with standard questionnaires), including normal subjects, people with migraine and with vestibular migraine. The investigators will use our standard adaption method to narrow the TBW in these subjects, and will also employ PSS adaptation if a consistent pattern emerges that relates MS sensitivity to the PSS. The investigators will induce motion sickness using a pseudo-Coriolis task (so susceptibility can be quantified pre and post training).