view of the meadow from a car.
Sense of Direction in Vestibular Disorders
In this article, published in the Journal of Vestibular Research, the current research regarding the impact of vestibular impairment on sense of direction (SOD) is explored.
SOD refers to our ability to navigate ourselves from one place to another in relation to objects in our environment. SOD requires complex spatial cognitive processes that task us to understand both external environmental information through use of maps, landmarks, and spatial memory as well as internal information from sensory inputs that allow us to perceive self-motion, such as direction and speed (Wolbers and Hegarty, 2010). The integration of input from the vestibular, visual, and spinal/proprioceptive systems are responsible for our perception of self-motion. This multisensory system not only results in our ability maintain balance and keep our visual field in focus when we are moving, but also significantly contributes to our SOD. Although the physiologic contribution of both the peripheral and central vestibular system to SOD is well documented (Cullen and Taube, 2017), the impact of vestibular disorders on our ability to navigate is not clear.
Moore et al (2024) address SOD in patients with a variety of vestibular disorders, including both central and/or functional (involving the brain, including vestibular migraines-VM and persistent postural perceptual dizziness-PPPD) and peripheral (involving the inner ear organs, including bilateral vestibular failure-BVF and benign paroxysmal positional vertigo) disorders, as well as Meniere’s Disease.
Overall, results suggest that SOD is most affected in participants with central and/or functional vestibular disorders, including VM and PPPD. Surprisingly, the authors found that those participants with BVF, a peripheral finding in which the both the left and right inner ear organs provide little or no detection of motion, reported normal perceived SOD based on questionnaires. Also notable was an association of reduced perception of SOD and higher spatial-specific anxiety in participants with and without vestibular disorders. Also notable is that spatial anxiety was not associated with general anxiety.
Although both the peripheral and central components of the vestibular system have key roles in the process of navigation, it was central/functional vestibular disorders that impacted SOD in the above study. There are also other influences that reduce SOD, as demonstrated in the association between poor self-perceived SOD and higher spatial anxiety not specific to vestibular function. Spatial anxiety, a factor associated with poor self-perceived SOD is also associated with a disturbance in the central process.
The authors in the above study, as well as others, recognize the need for the development of physical assessment tools for future research to improve our understanding of the complexities of real-world physical aspects associated with navigation. Fortunately, both peripheral and central components of the vestibular system are often a part of larger multisensory and central systems, which have built-in redundancies that provide the opportunity for rewiring pathways to maximize adaptation and substitution strategies to achieve successful functional outcomes, if needed.
And if you are wondering how to get to Carnegie Hall, as the old joke states, it is practice, practice, practice!
Summary written by Christine Strange, AuD
References
- Moore AIG, Golding JF, Alenova A, Castro P, Bronstein AM. Sense of direction in vestibular disorders. J Vestib Res. 2024;34(2-3):113-123. doi: 10.3233/VES-230082. PMID: 38489201.
- Cullen KE, Taube JS. Our sense of direction: progress, controversies and challenges. Nat Neurosci. 2017 Oct 26;20(11):1465-1473. doi: 10.1038/nn.4658. PMID: 29073639; PMCID: PMC10278035.
- Wolbers T, Hegarty M. What determines our navigational abilities? Trends Cogn Sci. 2010 Mar;14(3):138-46. doi: 10.1016/j.tics.2010.01.001. Epub 2010 Feb 6. PMID: 20138795.