The effects of visual context on visual-vestibular mismatch revealed by electrodermal and postural response measures

Doaa S. Al-Sharif, Carole A. Tucker, Donna L. Coffman, Emily A. Keshner

Research output: Contribution to journalArticlepeer-review


Background: No objective criteria exist for diagnosis and treatment of visual-vestibular mismatch (VVM). Objective: To determine whether measures of electrodermal activity (EDA) and trunk acceleration will identify VVM when exposed to visual-vestibular conflict. Methods: A modified VVM questionnaire identified the presence of VVM (+ VVM) in 13 of 23 young adults (34 ± 8 years) diagnosed with vestibular migraine. Rod and frame tests and outcome measures for dizziness and mobility were administered. Participants stood on foam while viewing two immersive virtual environments. Trunk acceleration in three planes and electrodermal activity (EDA) were assessed with wearable sensors. Linear mixed effect (LME) models were used to examine magnitude and smoothness of trunk acceleration and tonic and phasic EDA. Welch’s t-test and associations between measures were assessed with a Pearson Correlation Coefficient. Effect sizes of group mean differences were calculated. Results: Greater than 80% of all participants were visually dependent. Outcome measures were significantly poorer in the + VVM group: tonic EDA was lower (p < 0.001) and phasic EDA higher (p < 0.001). Postural accelerations varied across groups; LME models indicated a relationship between visual context, postural, and ANS responses in the + VVM group. Conclusions: Lower tonic EDA with + VVM suggests canal-otolith dysfunction. The positive association between vertical acceleration, tonic EDA, and visual dependence suggests that increased vertical segmental adjustments are used to compensate. Visual context of the spatial environment emerged as an important control variable when testing or treating VVM.

Original languageEnglish (US)
Article number113
JournalJournal of NeuroEngineering and Rehabilitation
Issue number1
StatePublished - Dec 2022


  • Autonomic nervous system
  • Intervention
  • Vestibular migraine
  • Virtual environments
  • Virtual reality
  • Visual dependence

ASJC Scopus subject areas

  • Rehabilitation
  • Health Informatics


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