Effects of Vestibular Training on Postural Control of Healthy Adults
Authors: Appiah-Kubi Kwadwo Osei , Galgon Anne , Tierney Ryan , Lauer Richard , Wright W. Geoffrey 
Published: April 2020

Background: Postural stability depends on the integration of multisensory inputs to drive motor outputs. When visual and somatosensory input is available and reliable, this reduces the postural control system’s reliance on the vestibular system. Despite this, vestibular loss can still cause severe postural dysfunction (1,2). Training one or more of the three sensory systems can alter sensory weighting and change postural behavior. Vestibular activation exercises, including horizontal and vertical headshaking, influence vestibular-ocular and -motor responses and have been showed to be effective in vestibular rehabilitation (3–8).
Purpose/Hypothesis: To assess sensory reweighting of postural control processing and vestibular-ocular and -motor responses after concurrent vestibular activation with postural training. It was hypothesized that the effect of this training would significantly alter the pattern of sensory weighting by changing the ratio of visual, somatosensory and vestibular dependence needed to maintain postural stability, and significantly decrease vestibular responses.
Methods: Forty-two young healthy individuals (22 females; 23.0+3.9 years; 1.6+0.1 meters) were randomly assigned into four groups: 1) visual feedback weight shift training (WST) coupled with an active horizontal headshake (HHS), 2) same WST with vertical headshake (VHS), 3) WST with no headshake (NHS) and 4) no training/headshake control (CTL) groups. The headshake groups performed an intensive body WST together with horizontal or vertical rhythmic headshake at 80 to 120 beats/minute. The NHS group performed the WST with no headshake while the controls did not perform any training. Five 15-minute training sessions were performed on consecutive days for one week with the weight shift exercises involving upright limits of stability activities on a flat surface, foam or rocker board (Fig. 1). All groups performed baseline- and post-assessments including sensory organization test (SOT) and force platform ramp perturbations, coupled with electromyographic (EMG) recordings. A video head impulse test was also used to record horizontal vestibulo-ocular reflex (VOR) gain. A between- and within-group repeated measures ANOVA was used to analyze five COP sway variables, the equilibrium and composite scores and sensory ratios of the SOT as well as EMG signals and horizontal VOR gain. Similarly, COP variables, EMG, as well as vestibular reflex data (vertical VOR, vestibulo-collic reflex [VCR] and vestibulo-spinal [VSR] gains) during ramp perturbations were analyzed. Alpha level was set at p<.05.
Results: The training showed a significant somatosensory downweighting (p=.050) in the headshake groups compared to the other groups. Training also showed significant decreased horizontal VOR gain (p=.040), faster automatic postural response (p=.003) (Figs. 2-4) with improved flexibility (p=.010) in the headshake groups. Muscle activation pattern in medial gastrocnemius (p=.033) was significantly decreased in the headshake.
Conclusion: The concurrent vestibular activation and weight shift training modifies vestibular-dependent responses after the training intervention as evidenced in somatosensory downweighting, decreased VOR gain, better postural flexibility and faster automatic postural response. Findings suggest this is predominantly due to vestibular adaptation and habituation of VOR, VCR and VSR which induced sensory reweighting.
Clinical relevance: Findings may be used to guide the development of a vestibular-postural rehabilitation intervention in impaired neurological populations, such as with vestibular disorders or sensory integration problems.