Susan I. Fuhrman

Functional brain imaging of multi-sensory vestibular processing during computerized dynamic posturography using near-infrared spectroscopy

Functional near-infrared spectroscopy (fNIRS) is a non-invasive brain imaging method that uses light to record regional changes in cerebral blood flow in the cortex during activation. fNIRS uses portable wearable sensors to allow measurements of brain activation during tasking. In this study, fNIRS was used to investigate how the brain processes information from multiple sensory modalities during dynamic posturography. Fifteen healthy volunteers (9M/6F; ages 28+/-9 yrs) participated in the posturography study while undergoing fNIRS brain imaging. Four standard conditions from the sensory organization test (SOT) were performed and a bilateral fNIRS probe was used to examine the cortical brain responses from the frontal, temporal, and parietal brain regions. We found that there was bilateral activation in the temporal-parietal areas (superior temporal gyrus, STG, and supramarginal gyrus, SMG) when both vision and proprioceptive information were degraded; forcing reliance on primarily vestibular information in the control of balance. This is consistent with previous reports of the role of these regions in vestibular control and demonstrates the potential utility of fNIRS in the study of cortical control of vestibular function during standing balance tasks.

Postural adjustment errors reveal deficits in inhibition during lateral step initiation in older adults.

Postural dual-task studies have demonstrated effects of various executive function components on gait and postural control in older adults. The purpose of the study was to explore the role of inhibition during lateral step initiation. Forty older adults participated (range 70-94 yr). Subjects stepped to the left or right in response to congruous and incongruous visual cues that consisted of left and right arrows appearing on left or right sides of a monitor. The timing of postural adjustments was identified by inflection points in the vertical ground reaction forces (VGRF) measured separately under each foot. Step responses could be classified into preferred and nonpreferred step behavior based on the number of postural adjustments that were made. Delays in onset of the first postural adjustment (PA1) and liftoff (LO) of the step leg during preferred steps progressively increased among the simple, choice, congruous, and incongruous tasks, indicating interference in processing the relevant visuospatial cue. Incongruous cues induced subjects to make more postural adjustments than they typically would (i.e., nonpreferred steps), representing errors in selection of the appropriate motor program. During these nonpreferred steps, the onset of the PA1 was earlier than during the preferred steps, indicating a failure to inhibit an inappropriate initial postural adjustment. The functional consequence of the additional postural adjustments was a delay in the LO compared with steps in which they did not make an error. These results suggest that deficits in inhibitory function may detrimentally affect step decision processing, by delaying voluntary step responses.

Neuroimaging to detect cortical projection of vestibular response to caloric stimulation in young and older adults using functional near-infrared spectroscopy (fNIRS)

Functional near-infrared spectroscopy (fNIRS) is a non-invasive and portable neuroimaging technique. The method uses non-ionizing laser light in the range of red to near-infrared to detect changes in cerebral blood oxygenation. In this study, we used fNIRS to investigate cortical hemodynamic changes in the temporo-parietal and frontal regions during caloric vestibular stimulation. Caloric stimulation has previously been investigated using functional magnetic resonance imaging (fMRI) and positron emission tomography (PET), which serves as a validation of the fNIRS imaging modality toward the measurement of vestibular related brain regions. To date, only a single study has used fNIRS during caloric irrigations, which observed blood volume changes in the temporal-parietal area in healthy younger subjects. In this current study, fNIRS was used to measure cortical vestibular activation in 10 right-handed younger subjects (5 male and 5 female, age 25+/-6 years) and 10 right-handed older subjects (6 male and 4 female, age 74+/-5 years). We investigated both warm (44 °C) and cool (30 °C) unilateral caloric vestibular stimulation. Consistent with previous reports, we found that warm (44 °C) caloric irrigation caused a bilateral activation. In addition, we found that cool (30 °C) caloric irrigation caused contralateral activation of the temporo-parietal area. This study is the first to investigate age effects of the caloric stimulation on brain activity. We found that the older subjects had stronger bilateral effects than the younger subjects. Our results confirm previous fMRI and PET studies that showed cortical activation during caloric vestibular irrigation is dependent on side of irrigation, and temperature of irrigation. Furthermore, our results demonstrate that fNIRS is a viable technique in measuring cortical effects during vestibular tasks.

Effect of wheelchair headrest use on pediatric head and neck injury risk outcomes during rear impact

Comparative risks or benefits to wheelchair-seated pediatric occupants in motor vehicles associated with wheelchair headrest use during rear impact were evaluated using pediatric head and neck injury outcome measures. A Hybrid III 6-year-old anthropomorphic test device (ATD), seated in identical WC19-compliant pediatric manual wheelchairs, was used to measure head and neck response during a 25 km/h (16 mph), 11 g rear impact. ATD responses were evaluated across two test scenarios: three sled tests conducted without headrests, and three with slightly modified commercial headrests. Head and neck injury outcomes measures included: linear head acceleration, head injury criteria (HIC) values, neck injury criteria (N(ij)) values, and combined rotational head velocity and acceleration. Neck and head injury outcome measures improved by 34-70% in sled tests conducted with headrests compared to tests without headrests. Headrest use reduced N(ij) values and the likelihood of concussion from values above established injury thresholds to values below injury thresholds. Injury measure outcome reductions suggest lower head and neck injury risks for wheelchair-seated children using wheelchair-mounted headrests as compared to non-headrest users in rear impact. Use of relative comparisons across two test scenarios served to minimize effects of ATD biofidelity limitations.

State of the Science Workshop on Wheelchair Transportation Safety

ABSTRACT The Rehabilitation Engineering Research Center on Wheelchair Transportation Safety held a state-of-the-science workshop on wheelchair transportation. The workshop had three purposes: reviewing and documenting the status of wheelchair transportation safety, identifying deficiencies, and formulating, discussing, and prioritizing recommendations for future action. The final goal was to disseminate the workshop outcomes for utilization in formatting future research priorities. A nominal group technique was used to facilitate focused open discussion by knowledgeable persons, resulting in the identification and ranking of existing deficiencies according to priority. Participants then formulated potential short-term solutions and speculated what wheelchair transportation safety should be in the future. This document presents four white papers, prepared prior to the workshop and modified according to participant feedback, and summarizes the outcomes of the workshop. The results identify and prioritize recommendations for future action.

Characterization of Pediatric Wheelchair Kinematics and Wheelchair Tiedown and Occupant Restraint System Loading During Rear Impact

This study characterizes pediatric wheelchair kinematic responses and wheelchair tiedown and occupant restraint system (WTORS) loading during rear impact. It also examines the kinematic and loading effects of wheelchair headrest inclusion in rear impact. In two separate rear-impact test scenarios, identical WC19-compliant manual pediatric wheelchairs were tested using a seated Hybrid III 6-year-old anthropomorphic test device (ATD) to evaluate wheelchair kinematics and WTORS loading. Three wheelchairs included no headrests, and three were equipped with slightly modified wheelchair-mounted headrests. Surrogate WTORS properly secured the wheelchairs; three-point occupant restraints properly restrained the ATD. All tests used a 26km/h, 11g rear-impact test pulse. Headrest presence affected wheelchair kinematics and WTORS loading; headrest-equipped wheelchairs had greater mean seatback deflections, mean peak front and rear tiedown loads and decreased mean lap belt loads. Rear-impact tiedown loads differed from previously measured loads in frontal impact, with comparable tiedown load levels reversed in frontal and rear impacts. The front tiedowns in rear impact had the highest mean peak loads despite lower rear-impact severity. These outcomes have implications for wheelchair and tiedown design, highlighting the need for all four tiedowns to have an equally robust design, and have implications in the development of rear-impact wheelchair transportation safety standards.

Interference between postural control and spatial vs. non-spatial auditory reaction time tasks in older adults

This study investigated whether spatial aspects of an information processing task influence dual-task interference. Two groups (Older/Young) of healthy adults participated in dual-task experiments. Two auditory information processing tasks included a frequency discrimination choice reaction time task (non-spatial task) and a lateralization choice reaction time task (spatial task). Postural tasks included combinations of standing with eyes open or eyes closed on either a fixed floor or a sway-referenced floor. Reaction times and postural sway via center of pressure were recorded. Baseline measures of reaction time and sway were subtracted from the corresponding dual-task results to calculate reaction time task costs and postural task costs. Reaction time task cost increased with eye closure (p = 0.01), sway-referenced flooring (p < 0.0001), and the spatial task (p = 0.04). Additionally, a significant (p = 0.05) task x vision x age interaction indicated that older subjects had a significant vision X task interaction whereas young subjects did not. However, when analyzed by age group, the young group showed minimal differences in interference for the spatial and non-spatial tasks with eyes open, but showed increased interference on the spatial relative to non-spatial task with eyes closed. On the contrary, older subjects demonstrated increased interference on the spatial relative to the non-spatial task with eyes open, but not with eyes closed. These findings suggest that visual-spatial interference may occur in older subjects when vision is used to maintain posture.

Guidelines for the use of wheelchair postural support devices during travel in motor vehicles

Questions are often raised about whether the use of postural support devices while seated in a wheelchair during travel in a motor vehicle can have potential benefits or result in harm. The benefits or harm are generally unknown as current crash-test dummies are not designed to evaluate postural supports, and there are little to no injury data for these devices in the motor-vehicle environment. Despite these limitations, guidelines and best practices can be developed for use of postural support devices during travel in a motor vehicle using basic principles of occupant protection and knowledge about injury biomechanics. This document presents guidelines and recommendations for postural support devices used on wheelchairs that also serve as seats in motor vehicles. It addresses the basic principles of safe transportation for wheelchair-seated occupants and provides guidelines and recommendations for use of specific devices during transportation.