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Background Falls are the leading cause of injury-related hospitalizations among older adults, often linked to vestibular dysfunction. While vestibular rehabilitation therapy is a standard intervention, designed to compensate for vestibular impairment with proprioceptive and visual cues, potential cumulative effects of noisy Electrical Vestibular Stimulation (nEVS) on balance improvement in older adults are not well understood. Objective This study evaluated the efficacy of cumulative nEVS dosing in improving static balance, its potential mechanisms, and clinical significance. Methods A single-blind, pilot randomized controlled trial enrolled 40 older adults (mean age: 77.7 ± 11.8 years). Participants were randomly assigned to a Stimulation group (nEVS intervention) or Sham group. The nEVS regimen included low-amplitude wideband stimulation (± 0.35 mA, 0.001–300 Hz) for 20 min, three times weekly for six weeks. Balance performance was assessed immediately before and after nEVS using a head-mounted sensor to measure physiological vibration acceleration (‘Phybrata’) power as a measure of postural stability in four conditions: Floor Eyes Open, Floor Eyes Closed, Foam Eyes Open, and Foam Eyes Closed. Follow-ups occurred at 3 months and 6 months post-intervention. Results The Stimulation group exhibited significant and sustained reductions in Phybrata power with improvements observed as early as Session 3 and persisting through 6 months in Foam EC. Additionally, the Sham group demonstrated smaller reductions in Phybrata power, potentially reflecting a learning effect. Conclusion nEVS may be a safe and effective intervention for improving balance in older adults. Its benefits in addressing age-related deficits in balance and sensory integration highlight its potential for fall prevention and rehabilitation. This study was retrospectively registered as a clinical trial on February 25, 2025 (NCT06846047).

Sleep deprivation alters cognitive and sensorimotor function, but its effects on the control of standing balance are inconclusive. The vestibular system is critical for standing balance, and is modified by sleep deprivation; however, how sleep deprivation affects vestibular-evoked balance responses is unknown. Thus, this study aimed to examine the effect of 24 h of sleep deprivation on the vestibular control of standing balance. During both a well-rested (i.e., control) and sleep deprivation condition, nine females completed two 90-s trials of bilateral, binaural stochastic electrical vestibular stimulation (EVS) and two 120-s trials of quiet stance on a force plate. Quiet stance performance was assessed by center of pressure displacement parameters. Mediolateral ground reaction force (ML force) and surface electromyography (EMG) of the right medial gastrocnemius (MG) were sampled simultaneously with the EVS signal to quantify vestibular control of balance within the frequency (gain and coherence) and time (cumulant density) domains. Twenty-four hours of sleep deprivation did not affect quiet stance performance. Sleep deprivation also had limited effect on EVS-MG EMG and EVS-ML Force coherence (less than control at 8–10.5 Hz, greater at ~ 16 Hz); however, gain of EVS-MG EMG (< 8, 11–24 Hz) and EVS-ML force (0.5–9 Hz) was greater for sleep deprivation than control. Sleep deprivation did not alter peak-to-peak amplitude of EVS-MG EMG (p = 0.51) or EVS-ML force (p = 0.06) cumulant density function responses. Despite no effect on quiet stance parameters, the observed increase in vestibular-evoked balance response gain suggests 24-h sleep deprivation may lead to greater sensitivity of the central nervous system when transforming vestibular-driven signals for standing balance control.

In Magnetic Resonance Imaging scanner environments, the continuous Lorentz Force is a potent vestibular stimulation. It is nowadays so well known that it is now identified as Magnetic vestibular stimulation (MVS). Alongside MVS, some authors argue that through induced electric fields, electromagnetic induction could also trigger the vestibular system. Indeed, for decades, vestibular-specific electric stimulations (EVS) have been known to precisely impact all vestibular pathways. Here, we go through the literature, looking at potential time varying magnetic field induced vestibular outcomes in MRI settings and comparing them with EVS-known outcomes. To date, although theoretically induction could trigger vestibular responses the behavioral evidence remains poor. Finally, more vestibular-specific work is needed.

Electricity and vibration were two commonly used physical agents to provide vestibular stimulation in previous studies. This study aimed to systematically review the effects of galvanic (GVS) and vibration-based vestibular stimulation (VVS) on gait performance and postural control in healthy participants. Five bioscience and engineering databases, including MEDLINE via PubMed, CINAHL via EBSCO, Cochrane Library, Scopus, and Embase, were searched until March 19th, 2023. Studies published between 2000 and 2023 in English involving GVS and VVS related to gait performance and postural control were included. The procedure was followed via the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. The methodological quality of included studies was assessed using the NIH study quality assessment tool for observational cohort and cross-sectional studies. A total of 55 cross-sectional studies met the inclusion criteria and were included in this study. Five studies were good-quality while 49 were moderate-quality and 1 was poor-quality. There were 50 included studies involving GVS and 5 included studies involving VVS. GVS and VVS utilized different physical agents to provide vestibular stimulation and demonstrated similar effects on vestibular perception. Supra-threshold GVS and VVS produced vestibular perturbation that impaired gait performance and postural control, while sub-threshold GVS and VVS induced stochastic resonance phenomenon that led to an improvement. Bilateral vestibular stimulation demonstrated a greater effect on gait and posture than unilateral vestibular stimulation. Compared to GVS, VVS had the characteristics of better tolerance and fewer side effects, which may substitute GVS to provide more acceptable vestibular stimulation.

The vestibular system encodes motion and orientation of the head in space and is essential for negotiating in and interacting with the world. Recently, random waveform electric vestibular stimulation has become an increasingly common means of probing the vestibular system. However, many of the methods used to analyze the behavioral response to this type of stimulation assume a linear relationship between frequencies in the stimulus and its associated response. Here we examine this stimulus-response frequency linearity to determine the validity of this assumption. Forty-five university-aged subjects stood on a force-plate for 4 min while receiving vestibular stimulation. To determine the linearity of the stimulus-response relationship we calculated the cross-frequency power coupling between a 0 and 25 Hz bandwidth limited white noise stimulus and induced postural responses, as measured using the horizontal forces acting at the feet. Ultimately, we found that, on average, the postural response to a random stimulus is linear across stimulation frequencies. This result supports the use of analysis methods that depend on the assumption of stimulus-response frequency linearity, such as coherence and gain, which are commonly used to analyze the body’s response to random waveform electric stimuli.

Background Insomnia affects over 850 million adults globally, representing a significant public health burden. Current treatments, including cognitive behavioral therapy for insomnia (CBT-I) and pharmacological interventions, face accessibility barriers and safety concerns, respectively. Electrical vestibular nerve stimulation (VeNS) has emerged as a promising non-invasive neuromodulation technique, leveraging connections between the vestibular system and sleep-regulating brain regions. This systematic review and meta-analysis aimed to evaluate the effect of VeNS on insomnia severity in adults with clinically significant insomnia. Methods Following PRISMA guidelines, we systematically searched multiple databases up to July 19, 2025. Eligible studies included adults (≥ 18 years) with clinically significant insomnia (ISI ≥ 15) receiving transcutaneous VeNS versus sham stimulation. The primary outcome was the change in Insomnia Severity Index (ISI), a validated subjective measure scale. Secondary outcomes included the Pittsburgh Sleep Quality Index (PSQI) and quality of life measures, all assessed through self-reported instruments. Results Three randomized controlled trials encompassing 289 participants met the inclusion criteria. VeNS demonstrated a statistically significant reduction in insomnia severity compared to sham control (ISI mean difference: -3.65 [95% CI: -6.84, -0.46]). Secondary analysis revealed significant improvements in sleep quality (PSQI mean difference: -0.98 [95% CI: -1.88, -0.08]). Conclusions VeNS demonstrated statistically significant improvements in insomnia and sleep quality. However, the findings should be interpreted cautiously given the small number of available trials, reliance on subjective outcome measures, considerable heterogeneity, and limited safety data. Larger standardized trials are needed to establish its clinical utility and optimal implementation. Clinical trial number Not applicable.

Dopaminergic replacement therapy remains the mainstay of symptomatic treatment for Parkinson’s disease (PD), but many unmet needs and gaps remain. Device-based treatments or device-aided non-oral therapies are typically used in the advanced stages of PD, ranging from stereotactic deep brain stimulation to levodopa or apomorphine infusion therapies. But there are concerns associated with these late-stage therapies due to a number of procedural, hardware, or long-term treatment-related side effects of these treatments, and their limited nonmotor benefit in PD. Therefore, there is an urgent unmet need for low-risk adjuvants or standalone therapies which can address the range of burdensome motor and nonmotor symptoms that occur in PD. Recent studies suggest that non-invasive neurostimulation of the vestibular system may be able to address these gaps through the stimulation of the vestibular brainstem sensory network which extensively innervates brain regions, regulating both motor and a range of nonmotor functions. Therapeutic non-invasive vestibular stimulation is a relatively modern concept that may potentially improve a broad range of motor and nonmotor symptoms of PD, even at early stages of the disease. Here, we review previous studies supporting the therapeutic potential of vestibular stimulation for the treatment of PD and discuss ongoing clinical trials and potential areas for future investigations.

Postural imbalance, abnormal axial posture, and axial rigidity are the characteristic features of Parkinson’s disease (PD), and they are referred to as axial symptoms. The symptoms are difficult to manage since they are often resistant to both L-DOPA and deep brain stimulation. Hence, other treatments that can improve Parkinsonian axial symptoms without adverse effects are required. Vestibular dysfunction occurs in PD since neuropathological changes and reflex abnormalities are involved in the vestibular nucleus complex. Galvanic vestibular stimulation (GVS), which activates the vestibular system, is a noninvasive method. This review aimed to assess the clinical effect of GVS on axial symptoms in PD. To date, studies on the effects of GVS on postural instability, anterior bending posture, lateral bending posture, and trunk rigidity and akinesia in PD had yielded interesting data, and none of the patients presented with severe adverse events, and the others had mild reactions. GVS indicated a possible novel therapy. However, most included a small number of patients, and the sample sizes were not similar in some studies that included controls. In addition, there was only one randomized controlled clinical trial, and it did not perform an objective evaluation of axial symptoms. In this type of research, vestibular contributions to balance should be distinguished from others such as proprioceptive inputs or nonmotor symptoms of PD.

Originally conceived as a primary system embedded into reflex generation for spinal and ocular-motor control, there is now an exciting and rapidly growing line of research showing that the vestibular system—which is intrinsically highly convergent with other sensory and motor signals (Angelaki and Cullen, 2008)—interacts with various cognitive processes such as spatial navigation (Angelaki et al., 2009), space perception (Ferre et al., 2013a), body representation (Lopez et al., 2010; Ferre et al., 2013c), mental imagery (Lenggenhager et al., 2008; Falconer and Mast, 2012; Van Elk and Blanke, 2014), attention (e.g., Figliozzi et al., 2005), memory (e.g., Smith et al., 2010), risk perception (Mckay et al., 2013), and even social cognition (Lopez et al., 2013). Notably, such stimulations have to our best knowledge not been used in cognitive research. [...]it is not known if and what sensations are exactly generated by VEMP stimulation, as up to know VEMPS have only been used to diagnose and confirm otolithic dysfunction (Rosengren et al., 2010). [...]linear motion simulators equipped with six actuators allowing the motion and positioning in space following the 6° of freedom are now increasingly publicized for otolithic stimulation and already used in some laboratory. The cognitive processes with a clear spatial component include mental space representation such as the mental number line (Hartmann et al., 2012; Ferre et al., 2013b) and mental body transformation or perspective-taking (Lenggenhager et al., 2008; Falconer and Mast, 2012; Van Elk and Blanke, 2014).

Caloric vestibular stimulation (CVS) and galvanic vestibular stimulation (GVS) act primarily on the peripheral vestibular system. Although the electrical current applied during GVS is thought to flow through peripheral vestibular organs, some current may spread into areas within the central nervous system, particularly when the bilateral galvanic vestibular stimulation (bGVS) method is used. According to Alexander’s law, the magnitude of nystagmus increases with eccentric gaze movement, due to the function of the neural integrator (NI); thus, if the information for vestibular stimulation corresponds to Alexander’s law, the peripheral vestibular organ is stimulated. Therefore, it would appear that if CVS results comply with Alexander’s law, and bGVS results do not, the sites stimulated by bGVS are not perfectly located in the peripheral vestibular area. In our experiments on normal human subjects, the magnitude of nystagmus under CVS increased with rising gaze eccentricity in the direction that the magnitude of the nystagmus increases, and this change was found to follow Alexander’s law. However, in the case of nystagmus under bGVS, results did not follow Alexander’s law. In addition, study of the influences of bGVS at different current intensities on nystagmus magnitude showed that bGVS at 5 mA distorted nystagmus magnitude more than at 3 mA, which suggests bGVS acts not only on the peripheral vestibular nerves, but also on some areas of the central nervous system, particularly the NI. According to our experiments, bGVS directly affects neural integrator function.