Medical Research Council Spatial Disorientation Group

Michael A Gresty BA PhD,
Medical Research Council ESS,
Visiting Professor Imperial College London.
Honorary Professor University Pierre Mèndes Grenoble.
Conseil Permanante, Universites PM France.

The Medical Research Council Spatial Disorientation Group researches systems-physiological and behavioural aspects of spatial disorientation as it affects normal people in a modern environment, pilots and vehicle operators in extreme environments and patients with sensory neurological diseases.
A special aspect of the group's modus operandi is transfer of ideas and technology from military and vehicular engineering to normal subjects and patients.

The group works in collaboration with Prof A Bronstein here in the Department of Movement and Balance and has co-operative research programmes with:
Dr John Golding, University of Westminster.
Profs T Ohlmann and C Graff, University of Grenoble Pierre Mendes.
Dr W Bles and J Bos, The Netherlands Technical Organisation (TNO) Soesterberg.
Prof Katherine Jauregui-Renaud, Research Council of the Mexican Social Security Institute, Mexico City.


Current Research Topics

Psychophysics in the moving, active observer.
Psychophysics of the special senses are usually evaluated with the observer stationary and even restrained. In such circumstance differences in performance (acuity, orientational judgements) are unrelated to susceptibility to imbalance or spatial disorientation. We have shown that psychophysical performance is enhanced when the subject is a protagonist dealing actively with challenging environments (Bray et al 2004). A current hypothesis under evaluation is that individuals susceptible to disorientation, such as fallers, are unable to enhance perception appropriately to environmental challenges.

Cardiological and respiratory challenges due to buffeting in vehicles such as ambulances and heavy transport.
Buffeting and motion characteristics in ambulances and buses and trains provokes motion sickness and may exceed ISA limits for exposure, both of which may compromise the patient under transport. We are undertaking a study of the sickness, cardiovascular changes and discomfort produced by vehicles with different suspension characteristics with a view to delineating the provoked physiological stress and optimising suspension design.



Impact of disorientation on cognitive processes.
Pilots experiencing spatial disorientation and patients with vertigo report impaired ability to concentrate. We are identifying the characteristics of environmental situations which affect cognitive processes, evaluating the degree of impact on thinking and identifying ways in which subjects may manage the impact of disorientation. Traditional thinking in this area is that the subject suffers a draw on attention resources as he multi-tasks cognitive tasks and manages disorientation however we have identified an ability to 'quarantine' a disorienting sensory input and also shown that the novelty of a disorienting stimulus has a significant contribution to degrading cognitive performance, both of which have implications for disorientation training.



Psychological and Physiological Factors determining Susceptibility to disorientation.
Both vehicle operators who become susceptible to disorientation and patients with otological disease differ greatly, both in how much they are affected by experiences of disorientation and vertigo and in how long it may take for them to recover.Understanding the reasons for individual differences would have profound implications for personnel selection, rehabilitation and training. We have an extensive programme of questionnaire survey which seeks to determine the major factors differentiating individual responses to disorientation challenge. Major factors targeted for analysis are migraine, alcohol smoking, anisometropia, state and trait anxiety, experiences of derealisation (termed 'break off' in aerospace contexts), patient information and self image. A significant recent finding which has implications for pathophysiology is that there is a much greater concurrence of Migraine in patients with Ménière's disease than one would expect from chance population intersection (Radtke et al 2002).

Evaluation of vibrotactile prostheses for indicating spatial orientation in patients with balance disorders and sensory deficits.
This project is partially funded as an MRC Component Grant to COG 'Disorders of spatial Disorientation'. The US Navy has shown that a pilot can fly a 'plane blindfolded, from take off to landing, using tactile cues delivered to the skin of the upper torso to indicate his spatial orientation (Rupert 2000). Such a device has recently been used by the UK Navy to assist a blind pilot in setting the world water speed record in Z-class power boats. We propose to explore the possibility that vibrotactile channels for indicating spatial orientation can be exploited as as sensory prostheses. The specific research applications will be for guiding visual orientation, to provide alternative feedback to vision and vestibular signals for controlling balance and for directional and lateralisation cueing in patients with neglect syndromes. The programme will study whether vibro-tactile feedback improves performance and also whether it speeds rehabilitation when adjunct to conventional therapy.




Publications 2003-2009

DENISE P, VOURIOT A, NORMAND H, GOLDING JF, GRESTY MA. Effect of temporal relationship between respiration and body motion on motion sickness. P., Autonomic Neuroscience: Basic and Clinical 151 (2009) 142-146.

GRESTY MA, GOLDING JF, Impact of Vertigo and Spatial Disorientation on Concurrent Cognitive Tasks. Basic and Clinical Aspects of Vertigo and Dizziness: Ann. N.Y. Acad. Sci. 1164: 263-267 (2009). doi: 10.1111/j.1749-6632.2008.03744.x C_ 2009 New York Academy of Sciences.

DUPIERRIX E, GRESTY M, OHLMANN T, CHOKRON S. Long lasting egocentric disorientation induced by normal sensori-motor spatial interaction. PLoS ONE. 2009;4(2):e4465.

GRESTY M. Motion Sickness. British Medical Journal 'Point of Care' http://epocrates.com 2009.

GOLDING JF, SMITHA A, WORTLEY E, BSc; WOTTON-HAMRIOUI K, COUSINS S, GRESTY MA. Off Vertical Axis Rotation of the Visual Field and Nauseogenicity.  Aviation, Space, and Environmental Medicine. 2009;80:516-521.

BARRA J, BENAIM C, CHAUVINEAU V, OHLMANN T, GRESTY M, PERENNOU D. Are Rotations in Perceived Visual Vertical and Body Axis After Stroke Caused by the Same Mechanism? Stroke. 2008 Aug 14. Nov;39(11):3099-101.

SEEMUNGAL BM, RIZZO V, GRESTY MA, ROTHWELL JC, BRONSTEIN AM Cortical processing in vestibular navigation. Prog Brain Res. 2008;171:339-463.

GREEN DA, GOLDING JF, MANDIP A, FALDON MC, MURPHY KG, BRONSTEIN AM, GRESTY MA. Adaptation of ventilation to 'buffeting' in vehicles.Clin Auton Res. 2008 Dec;18(6):346-51.

BIJVELD MM, BRONSTEIN AM, GOLDING JF, GRESTY MA. Nauseogenicity of off-vertical axis rotation vs. equivalent visual motion. Aviat Space Environ Med. 2008 Jul;79(7):661-5.

PERENNOU DA, MAZIBRADA G, CHAUVINEAU V, GREENWOOD R, ROTHWELL J, GRESTY MA, BRONSTEIN aM. Lateropulsion, pushing and verticality perception in hemisphere stroke: a causal relationship? Brain. 2008 Sep;131(Pt 9):2401-13.

GRESTY MA. BPPV and fitness to fly--or drive. Aviat Space Environ Med. 2008 May;79(5):541; author reply 541-2.

SEEMUNGAL BM, RIZZO V, GRESTY MA, ROTHWELL JC, BRONSTEIN AM. Posterior parietal rTMS disrupts human Path Integration during a vestibular navigation task. Neurosci Lett. 2008 May 30;437(2):88-92.

GRESTY MA, GOLDING JF, LE H, NIGHTINGALE K. Cognitive impairment by spatial disorientation. viat Space Environ Med. 2008 Feb;79(2):105-11.

KERR TP, LIN JP, GRESTY MA, MORLEY T, ROBB SA.Spinal stability is improved by inducing a lumbar lordosis in boys with Duchenne Muscular Dystrophy: a pilot study. Gait Posture. 2008 Jul;28(1):108-12.

ASSEMAN F, BRONSTEIN AM, GRESTY MA.Guidance of visual direction by topographical vibrotactile cues on the torso. Exp Brain Res. 2008 Mar;186(2):283-92.

GOLDING JF, SMITHA A, WORTLEY E, WOTTON-HAMRIOUI K, Gresty MA. The effects of frequency and tilt on motion sickness induced by optokinetic stimuli. In: The First International Symposium on Visually Induced Motion Sickness, Fatigue, and Photosensitive Epileptic Seizures (VIMS2007). Ed Richard HY So. pp. 77-88. The Hong Kong University of Science & Technology, Hong Kong, China.

BARRA J, CHAUVINEAU V, OHLMANN Th, GRESTY MA, PERENNOU D. Perception of longitudinal body axis in patients with stroke: a pilot study. J Neurol Neurosurg Psychiatry. 2007 Jan;78(1):43-8. Epub 2006 Jul 25.

ASSEMAN F, BRONSTEIN AM, GRESTY MA.Using vibrotactile feedback of instability to trigger a forward compensatory stepping response.J Neurol. 2007 Nov;254(11):1555-61.

SEEMUNGAL BM, GLASAUER S, GRESTY MA, BRONSTEIN AM. Vestibular perception and navigation in the congenitally blind. J Neurophysiol. 2007 Jun;97(6):4341-56. Epub 2007 Mar 28.

JAUREGUI-RENAUD K, YEN PIK SANG F, GRESTY MA, GREEN DA, BRONSTEIN AM. Links  Depersonalisation/derealisation symptoms and updating orientation in patients with vestibular disease. J Neurol Neurosurg Psychiatry. 2007; mar;79 (3):276-83.

ASSEMAN, F.; BRONSTEIN, A.M.; GRESTY, M.A. Effectiveness of a vibro-tactile feedback to cue a stepping response to a balance challenge. In IEEE International Workshop on Haptic, Audio and Visual Environments and their Applications, HAVE 2006. November 2006; Page(s): 2 - 4.

MAZIBRADA G, TARIQ S, PERENNOU D, GRESTY M, GREENWOOD R, BRONSTEIN AM. The peripheral nervous system and the perception of verticality. Gait Posture. 2007: Feb;27(2):202-8.

BRINGOUX L, MEZEY LE, FALDON M, GRESTY MA, BRONSTEIN AM. Influence of pitch tilts on the perception of gravity-referenced eye level in labyrinthine defective subjects. Neuropsychologia. 2007;45(2):350-356. Epub 2006 Nov 13.

JAUREGUI-RENAUD K, REYNOLDS R, BRONSTEIN AM, GRESTY MA. Cardio-respiratory responses evoked by transient linear acceleration. Aviat Space Environ Med. 2006: 77(2); 114-120.

SEEMUNGAL B, RUDGE P, DAVIES R, GRESTY M, BRONSTEIN A. Three patients with migraine following caloric-induced vestibular stimulation. J Neurology 2006; 415: 1-3.

BARRA J, BRAY A, SAHNI V, GOLDING JF, GRESTY MA. Increasing cognitive load with increasing balance challenge: recipe for catastrophe. Exp Brain Res. 2006 Oct;174(4):734-45. Epub 2006 May 24.

GREEN DA, BRAY A, J.F. GOLDING JF, BRONSTEIN AM, GRESTY MA. Tachypnoea and hypocapnia are induced by 'buffeting' in vehicles. Clinical Autonomic Research 2006 Aug;16(4):281-5.

PETZOLD A; PAINE MA; RIORDAN-EVA P; GRESTY MA; PLANT GT. Acetazolamide responsive paroxysmal ocular tilt reaction synchronised with focal limb dystonia: Discussion of the likely anatomical substrate. J Neurol Neurosurg Psychiatry 2006; 77; 128-129.

YEN PIK SANG F, JAUREGUI-RENAUD, GREEN DA, BRONSTEIN AM, GRESTY MA. Depersonalization/derealization symptoms in vestibular disease. J Neurol Neurosurg Psychiatry. 2006 Jun;77(6):760-6. Epub 2006 Feb 7.

YEN PIK SANG F, BILLAR J, GRESTY MA, GOLDING JF. Effect of a novel motion desensitisation training regime and controlled breathing on habituation to motion sickness. Perceptual & Motor Skills. 2005; 101: 244-256.

GOLDING JF, KADZERE P, GRESTY MA. Motion sickness susceptibility fluctuates through the menstrual cycle. Aviat Space Environ Med. 2005 Oct;76(10):970-3.

GOLDING JF, KADZERE P, GRESTY MA. Motion sickness susceptibility fluctuates through the menstrual cycle. Aviat Space Environ Med. 2005 Oct;76(10):970-3.

GOLDING JF, GRESTY MA. Motion sickness. Curr Opin Neurol. 2005 18(1):29-34.

B.SEEMUNGAL, GUNARATNE IA, FLEMING IO, GRESTY MA, BRONSTEIN AM. Perceptual and nystagmic thresholds of vestibular function in yaw. J Vestibular Res 2004;14(6):461-6.

PAVLOU M, LINGESWAREN A, DAVIES R, GRESTY MA, BRONSTEIN AM. Simulator based rehabilitation in refractory dizziness. J Neurology 2005; 251(8) 983-995.

GOLDING J, KADZERE P, GRESTY M. Motion sickness and the menstrual cycle. Aviat Space Environ Med. 2004; 75 (4II, 488) B105

YEN PIK SANG F, JAUREGUI-RENAUD K, GREEN D, BRONSTEIN AM, GRESTY MA. Depersonalisation/derealisation symptoms in patients with peripheral vestibular disease. P008 192. J Vestib Res. 14, 2004.

JAUREGUI-RENAUD K, YEN PIK SANG F, BRONSTEIN AM, GRESTY MA. Depersonalisation/derealisation symptoms and self orientation with respect to the environment in patients with vestibular disease. P009 192. J Vestib Res. 14, 2004.

BRAY A, SUBANANDAN A, GRESTY M, ISABLEU B, OHLMANN T, GOLDING J. Instability improves perception of spatial orientation. P017, 196. J Vestib Res. 14, 2004.

JAUREGUI-RENAUD K, REYNOLDS R, BRONSTEIN AM, GRESTY MA. Vestibular and non-vestibular influences on the autonomic response to linear acceleration. P021 198. J Vestib Res. 14, 2004.

SEEMUNGAL BM, GRESTY MA, BRONSTEIN AM. Ultra-short vestibular perceptual time constants and its association with vestibular navigatory performance in the congenitally blind. P031 203. J Vestib Res. 14, 2004.

GRESTY MA, GOLDING JF, WE H, PSILOGENIS I, NIGHTINGALE K. Cognitive impairment by spatial disorientation. P092 234. J Vestib Res. 14, 2004.

BRAY A, SUBANANDAN A, ISABLEU B, OHLMANN T, GOLDING JF, GRESTY MA.  We are most aware of our place in the world when about to fall. Curr Biol. 14(15):R609-10 2004.

BRINGOUX L, TAMURA K, FALDON M, GRESTY MA, BRONSTEIN A. Influence of whole-body pitch tilt and kinesthetic cues on the perceived gravity-referenced eye level. Exp Brain Res. 155(3):385-92 2004.

GRAFF C, KAMINSKI G, GRESTY M, OHLMANN TH. Fish perform spatial pattern recognition and abstraction by exclusive use of active electrolocation. Curr Biol. 14(9):818-23 2004.

GRESTY MA, WATERS S, BRAY A, BUNDAY K, GOLDING JF. Impairment of spatial cognitive function with preservation of verbal performance during spatial disorientation. Curr Biol. 13(21):R829-30 2003.

RADTKE A, POPOV K, BRONSTEIN AM, GRESTY MA. Vestibulo-autonomic control in man: Short- and long-latency vestibular effects on cardiovascular function. J Vestib Res. 13(1):25-37 2003.

YEN PIK SANG FD, GOLDING JF, GRESTY MA. Suppression of sickness by controlled breathing during mildly nauseogenic motion. Aviat Space Environ Med. 74(9):998-1002.  Reported in Minerva, BMJ  2003;327:818 (4 October 2003).

ZIAFRA N, YEN PIK SANG FD, GOLDING JF, BRONSTEIN AM, GRESTY MA. Effect of breathing supplemental Oxygen on motion sickness in healthy adults. Mayo Clinic Proceedings. 78(5):574-8 2003.
THILO KV, KLEINSCHMIDT A, GRESTY MA. Perception of self-motion from peripheral optokinetic stimulation suppresses visual evoked responses to central stimuli. J Neurophysiol. 90(2):723-30 2003.

THURRELL A, JAUREGUI-RENAUD K, GRESTY MA, BRONSTEIN AM. Vestibular influence on the cardiorespiratory responses to whole-body oscillation after standing. Exp Brain Res. 150(3):325-31 2003.

YEN PIK SANG FD, BILLAR JP, GOLDING JF, GRESTY MA. Behavioral methods of alleviating motion sickness: effectiveness of controlled breathing and a music audiotape. J Travel Med. 10(2):108-11 2003.
EHRENFRIED T, GUERRAZ M, THILO KV, YARDLEY L, GRESTY MA. Posture and mental task performance when viewing a moving visual field. Cog Brain Research.17: 140-153 2003.

GRUNFELD EA, GRESTY MA, BRONSTEIN AM JAHANSHAHI M Screening for depression among neuro-otology patients with and without identifiable vestibular lesions.  International Journal of Audiology. 42(3):161-5 2003.

GRUNFELD EA, JAHANSHAHI M, GRESTY MA, BRONSTEIN AM. Using locus of control measures with patients experiencing vertigo. Psychology, Health and Medicine. 8(3) 335-342 2003.

GOLDING JF, BLES W, BOS JE, HAYNES T, GRESTY MA. Motion sickness and tilts of the inertial force environment: active suspension systems versus active passengers. Aviat Space Environ Med. 74: 220-227 2003.

GRESTY MA, OHLMANN TH. Motorists Vestibular Disorientation Syndrome Revisited. RTO/NATO. RT-MPO-086. Spatial Disorientation in Military Vehicles, Causes, Consequences and Cures. 13.1-13.7 2003.