Multisensory integration in balance control

This chapter provides an introduction to the topic of multisensory integration in balance control in, both, health and disease. One of the best-studied examples is that of visuo-vestibular interaction, which is the ability of the visual system to enhance or suppress the vestibulo-ocular reflex (VOR suppression). Of clinical relevance, examination of VOR suppression is clinically useful because only central, not peripheral, lesions impair VOR suppression. Visual, somatosensory (proprioceptive), and vestibular inputs interact strongly and continuously in the control of upright balance. Experiments with visual motion stimuli show that the visual system generates visually-evoked postural responses that, at least initially, can override vestibular and proprioceptive signals. This paradigm has been useful for the study of the syndrome of visual vertigo or vision-induced dizziness, which can appear after vestibular disease. These patients typically report dizziness when exposed to optokinetic stimuli or visually charged environments, such as supermarkets. The principles of the rehabilitation treatment of these patients, which use repeated exposure to visual motion, are presented. Finally, we offer a diagnostic algorithm in approaching the patient reporting oscillopsia - the illusion of oscillation of the visual environment, which should not be confused with the syndrome mentioned earlier of visual vertigo.