Posture control in vestibular-loss patients.

Patients with chronic bilateral loss of vestibular functions normally replace these by visual or haptic referencing to stationary surroundings, resulting in an almost normal stance control. But with eyes closed, they show abnormally large body sway, and may tend to fall when there are external disturbances to the body or when standing on an unstable support surface. Patients' postural responses depend on joint angle proprioception and ground reaction-force cues (occasionally referred to as "somatosensory graviception"). It is asked why the force cues do not allow patients to fully substitute loss of the vestibular cues. In recent years, four sets of observations of experimental situations where patients, eyes closed, show impaired stance control or even may fall were identified: (1) with unstable or compliant support ("inevitable falls"); (2) with large external disturbances such as support surface tilts or pull stimuli impacting on their bodies (leading to abnormally large body movements); (3) with fast body-support tilts (also abnormally large body movements); and (4) with transient support tilt (overshooting body-support stabilization and abnormaly late body-space [BS] stabilization). When patients' data were modeled, it was found that their problems stem mainly from the force cues. It was hypothesized that patients have difficulties decomposing this sensory information into its constituents in order to be able to get rid of an active force component. Normals do not have this difficulty, because the vestibular system performs the decomposition.