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J Am Acad Audiol 2022; 33(03): 134-141
DOI: 10.1055/s-0041-1739535
Research Article

The Influence of Motoric Maneuvers on Cervical Vestibular Evoked Myogenic Potentials (cVEMPs)

Kathleen M. McNerney
1   Department of Speech-Language Pathology, SUNY Buffalo State, Buffalo, NY
,
Kathiravan Kaliyappan
2   Department of Rehabilitation Science, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY
,
David S. Wack
1   Department of Speech-Language Pathology, SUNY Buffalo State, Buffalo, NY
3   Department of Biomedical Engineering, University at Buffalo, Buffalo, NY
,
Vijaya Prakash Krishnan Muthaiah
2   Department of Rehabilitation Science, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY
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Abstract

Background The cervical vestibular evoked myogenic potential (cVEMP) is a vestibular response that is produced by the saccule in response to intense, often low-frequency, short-duration auditory stimuli, and is typically recorded from a contracted sternocleidomastoid (SCM) muscle. Previous research has shown that the amplitude of the cVEMP is related to the amount of SCM electromyographic (EMG) activity.

Purpose The aim of this study was to determine the influence of various remote motoric maneuvers on the amplitude of the cVEMP, as well as whether they influence the level of SCM EMG activity.

Research Design The cVEMP was recorded from the left SCM muscle to left ear stimulation, in response to the SCM condition, as well as three different motoric maneuvers (jaw clench, eye closure, and the Jendrassik maneuver). EMG activity was also varied between 50, 75, and 100% of maximal EMG activity.

Study Sample Data from 14 healthy subjects, with a mean age of 25.57 years (standard deviation = 5.93 years), was included in the present study.

Data Collection and Analysis Mean latency and amplitude of the cVEMP were compared across the four conditions and varying magnitudes of EMG contraction. SPSS 26 was used to statistically analyze the results.

Results cVEMP latency did not vary across condition. cVEMP amplitude decreased with decreasing EMG magnitude. SCM contraction with jaw clench produced the largest increase in cVEMP amplitude; however, this condition was not significantly different from the SCM condition alone. SCM contraction with the Jendrassik maneuver produced a cVEMP amplitude that was similar and not statistically different from SCM contraction alone, and the addition of the eye closure maneuver to SCM contraction resulted in the lowest cVEMP amplitude, which was found to be statistically different from the standard SCM condition at 100 and 75% EMG activity. The amplitude relationship across the conditions was not found to vary with changes in EMG activity; however, a significant increase in EMG amplitude was found during the 50% muscle contraction condition when subjects performed the Jendrassik maneuver in addition to the standard SCM contraction.

Conclusions The addition of the eye closure maneuver to SCM contraction resulted in a significant decrease in cVEMP amplitude, while the addition of the Jendrassik maneuver resulted in a significant increase in EMG activity at the lowest level of SCM activation (i.e., 50%). Additional research is necessary to determine how motoric maneuvers influence the cVEMP amplitude, and whether the results are also dependent on how SCM contraction is being produced (e.g., while supine vs. sitting).

Keywords

saccule - vestibular System - vestibular Function Test - electromyography - sternocleidomastoid Muscle - cervical vestibular evoked myogenic potential (cVEMP)

Disclaimer

Any mention of a product, service, or procedure in the Journal of the American Academy of Audiology does not constitute an endorsement of the product, service, or procedure by the American Academy of Audiology.


Preliminary results of this study were presented in poster format at the annual conference of the American Physical Therapy Association (APTA) in January of 2019.




Publication History

Received: 19 January 2021

Accepted: 04 October 2021

Article published online:
10 October 2022

© 2022. American Academy of Audiology. This article is published by Thieme.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Colebatch JG, Halmagyi GM. Vestibular evoked potentials in human neck muscles before and after unilateral vestibular deafferentation. Neurology 1992; 42 (08) 1635-1636
    CrossrefPubMedGoogle Scholar
  • 2 Colebatch JG, Halmagyi GM, Skuse NF. Myogenic potentials generated by a click-evoked vestibulocollic reflex. J Neurol Neurosurg Psychiatry 1994; 57 (02) 190-197
    CrossrefPubMedGoogle Scholar
  • 3 Curthoys IS. A critical review of the neurophysiological evidence underlying clinical vestibular testing using sound, vibration and galvanic stimuli. Clin Neurophysiol 2010; 121 (02) 132-144
    CrossrefPubMedGoogle Scholar
  • 4 McCaslin DL, Jacobson GP. Vestibular-evoked myogenic potentials (VEMPs). In: Balance Function Assessment and Management. San Diego: Plural Publishing; 2020: 399-438
    Google Scholar
  • 5 Roberts L, Cacace AT. Jendrassik maneuver facilitates cVEMP amplitude: some preliminary observations. J Am Acad Audiol 2014; 25 (03) 237-243
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Akin FW, Murnane OD, Panus PC, Caruthers SK, Wilkinson AE, Proffitt TM. The influence of voluntary tonic EMG level on the vestibular-evoked myogenic potential. J Rehabil Res Dev 2004; 41 (3B): 473-480
    CrossrefPubMedGoogle Scholar
  • 7 Karino S, Ito K, Ochiai A, Murofushi T. Independent effects of simultaneous inputs from the saccule and lateral semicircular canal. Evaluation using VEMPs. Clin Neurophysiol 2005; 116 (07) 1707-1715
    CrossrefPubMedGoogle Scholar
  • 8 Lee KJ, Kim MS, Son EJ, Lim HJ, Bang JH, Kang JG. The usefulness of rectified VEMP. Clin Exp Otorhinolaryngol 2008; 1 (03) 143-147
    CrossrefPubMedGoogle Scholar
  • 9 McCaslin DL, Fowler A, Jacobson GP. Amplitude normalization reduces cervical vestibular evoked myogenic potential (cVEMP) amplitude asymmetries in normal subjects: proof of concept. J Am Acad Audiol 2014; 25 (03) 268-277
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Welgampola MS, Colebatch JG. Vestibulocollic reflexes: normal values and the effect of age. Clin Neurophysiol 2001; 112 (11) 1971-1979
    CrossrefPubMedGoogle Scholar
  • 11 Basta D, Todt I, Ernst A. Normative data for P1/N1-latencies of vestibular evoked myogenic potentials induced by air- or bone-conducted tone bursts. Clin Neurophysiol 2005; 116 (09) 2216-2219
    CrossrefPubMedGoogle Scholar
  • 12 McNerney KM, Burkard RF. The vestibular evoked myogenic potential (VEMP): air- versus bone-conducted stimuli. Ear Hear 2011; 32 (06) e6-e15
    CrossrefPubMedGoogle Scholar
  • 13 Gabelić T, Krbot Skorić M, Adamec I, Barun B, Zadro I, Habek M. The vestibular evoked myogenic potentials (VEMP) score: a promising tool for evaluation of brainstem involvement in multiple sclerosis. Eur J Neurol 2015; 22 (02) 261-269 , e21
    CrossrefPubMedGoogle Scholar
  • 14 Rosengren SM, Welgampola MS, Colebatch JG. Vestibular evoked myogenic potentials: past, present and future. Clin Neurophysiol 2010; 121 (05) 636-651
    CrossrefPubMedGoogle Scholar
  • 15 Shalaby NM, Ramzy GM, Mona A. others. Assessment of the vestibule-spinal reflex in migraine patients. Egypt J Neurol Psychiat Neurosurg 2010; 47: 67-74
    Google Scholar
  • 16 Skorić MK, Adamec I, Pavičić T. et al. Vestibular evoked myogenic potentials and video head impulse test in patients with vertigo, dizziness and imbalance. J Clin Neurosci 2017; 39: 216-220
    CrossrefPubMedGoogle Scholar
  • 17 Vanspauwen R, Wuyts FL, Van De Heyning PH. Validity of a new feedback method for the VEMP test. Acta Otolaryngol 2006; 126 (08) 796-800
    CrossrefPubMedGoogle Scholar
  • 18 Wang C-T, Young Y-H. Comparison of the head elevation versus rotation methods in eliciting vestibular evoked myogenic potentials. Ear Hear 2006; 27 (04) 376-381
    CrossrefPubMedGoogle Scholar
  • 19 Zapala DA, Brey RH. Clinical experience with the vestibular evoked myogenic potential. J Am Acad Audiol 2004; 15 (03) 198-215
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Ebben WP. A brief review of concurrent activation potentiation: theoretical and practical constructs. J Strength Cond Res 2006; 20 (04) 985-991
    PubMedGoogle Scholar
  • 21 Kawakita H, Kameyama O, Ogawa R, Hayes KC, Wolfe DL, Allatt RD. Reinforcement of motor evoked potentials by remote muscle contraction. J Electromyogr Kinesiol 1991; 1 (02) 96-106
    CrossrefPubMedGoogle Scholar
  • 22 Prochazka A, Hulliger M, Zangger P, Appenteng K. ‘Fusimotor set’: new evidence for α-independent control of γ-motoneurones during movement in the awake cat. Brain Res 1985; 339 (01) 136-140
    CrossrefPubMedGoogle Scholar
  • 23 Burden A. How should we normalize electromyograms obtained from healthy participants? what we have learned from over 25years of research. J Electromyogr Kinesiol 2010; 20 (06) 1023-1035
    CrossrefPubMedGoogle Scholar
  • 24 Brantberg K, Granath K, Schart N. Age-related changes in vestibular evoked myogenic potentials. Audiol Neurotol 2007; 12 (04) 247-253
    CrossrefPubMedGoogle Scholar
  • 25 Choi S-J. Age-related functional changes and susceptibility to eccentric contraction-induced damage in skeletal muscle cell. Integr Med Res 2016; 5 (03) 171-175
    CrossrefPubMedGoogle Scholar
  • 26 Ashford A, Huang J, Zhang C. et al. The cervical vestibular-evoked myogenic potentials (cVEMPs) recorded along the sternocleidomastoid muscles during head rotation and flexion in normal human subjects. J Assoc Res Otolaryngol 2016; 17 (04) 303-311
    CrossrefPubMedGoogle Scholar
  • 27 Kim JD. et al. The effects of test positions and acoustic stimulations on the vestibular evoked myogenic potentials. J Korean Balance Soc 2007; 6: 21-28
    Google Scholar
  • 28 Kim JH, Park JM, Yong SY, Kim JH, Kim H, Park SY. Difference of diagnostic rates and analytical methods in the test positions of vestibular evoked myogenic potentials. Ann Rehabil Med 2014; 38 (02) 226-233
    CrossrefPubMedGoogle Scholar
  • 29 Giannakopoulos NN, Hellmann D, Schmitter M, Krüger B, Hauser T, Schindler HJ. Neuromuscular interaction of jaw and neck muscles during jaw clenching. J Orofac Pain 2013; 27 (01) 61-71
    CrossrefPubMedGoogle Scholar
  • 30 Connor M, Naves LA, McCleskey EW. Contrasting phenotypes of putative proprioceptive and nociceptive trigeminal neurons innervating jaw muscle in rat. Mol Pain 2005; 1: 31
    CrossrefPubMedGoogle Scholar
  • 31 Hoy KE, Fitzgerald PB, Bradshaw JL, Armatas CA, Georgiou-Karistianis N. Investigating the cortical origins of motor overflow. Brain Res Brain Res Rev 2004; 46 (03) 315-327
    CrossrefPubMedGoogle Scholar
  • 32 Ebben WP, Flanagan EP, Jensen RL. Jaw clenching results in concurrent activation potentiation during the countermovement jump. J Strength Cond Res 2008; 22 (06) 1850-1854
    CrossrefPubMedGoogle Scholar