A conceptual model of the visual control of posture.

In order to isolate the visual contribution to the control of postural balance, experiments in which subjects are exposed to large-field visual motion (optokinetic) stimuli are reviewed. In these situations, at motion onset, the visual stimulus signals subject self-motion but inertial (vestibulo-proprioceptive) cues do not. Visually evoked postural responses (VEPR) thus induced can be quickly suppressed by cognitive status or simple repetition of the stimulus, if the inertial self-motion cues available to the subject are reliable. In the conceptual model presented here, the process of assessing the reliability, and degree of matching, of visual and inertial signals is carried out by a General comparator; in turn able to access the Gain control mechanism of the visuo-postural system. Complexity and congruency in the visual stimulus itself are assessed by a Visual comparator, e.g., the presence of motion parallax in the visual stimulus can reverse the sway response direction. VEPR can also be re-oriented according to the position of the eyes in the head and the head on the trunk. This indicates that ocular and cervical proprioceptors must also access the gain control mechanism so that visual stimuli can recruit and silence different postural muscles appropriately. The overall gain of the visuo-postural system is also influenced by less easily defined idiosyncratic factors, such as visual dependence and psychological traits; interestingly both these factors have been found to be associated with poor long term outcome in vestibular disorders. The experimental results and model presented illustrate that the visuo-postural system is a wonderful example of interaction between physics (e.g., stimuli geometry, body dynamics), neuroscience and the border zone between neurology and psycho-somatic medicine.