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Neuropsychologia ] (]]]]) ]]]–]]]

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Neuropsychologia
journal homepage: www.elsevier.com/locate/neuropsychologia

Vestibular stimulation modifies the body schema


Christophe Lopez a,b,n,1, Helene-Marianne Schreyer a,2, Nora Preuss a,2, Fred W. Mast a
a
Department of Psychology, University of Bern, Bern, Switzerland
b
Laboratoire de Neurosciences Intégratives et Adaptatives, UMR 7260, Centre National de la Recherche Scientifique (CNRS), Aix-Marseille Université, Marseille, France

a r t i c l e i n f o abstract

Article history: Mental body representations are flexible and depend on sensory signals from the body and its surrounding.
Received 1 December 2011 Clinical observations in amputees, paraplegics and brain-damaged patients suggest a vestibular contribu-
Received in revised form tion to the body schema, but studies using well-controlled psychophysical procedures are still lacking. In
21 March 2012
Experiment 1, we used a tactile distance comparison task between two body segments (hand and
Accepted 10 April 2012
forehead). The results showed that objects contacting the hand were judged longer during caloric vestibular
stimulation when compared to control thermal stimulation. In Experiment 2, participants located four
Keywords: anatomical landmarks on their left hand by pointing with their right hand. The perceived length and width
Vestibular system of the left hand increased during caloric vestibular stimulation with respect to a control stimulation. The
Body schema
results show that the body schema temporarily adjusts as a function of vestibular signals, modifying the
Body image
internal representation of the hand size. The data provide evidence that vestibular functions are not limited
Touch
Caloric vestibular stimulation to postural and oculomotor control, and extend the contribution of the vestibular system to bodily
Bodily consciousness cognition. The findings from this study suggest the inclusion of vestibular signals into current models of
Multisensory integration body representations and bodily self-consciousness.
& 2012 Elsevier Ltd. All rights reserved.

1. Introduction visually enlarged arm; Taylor-Clarke, Jacobsen, & Haggard, 2004)


and proprioceptive-tactile conflicts (e.g. during the Pinocchio illu-
Mental body representations have long been considered as sion; de Vignemont, Ehrsson, & Haggard, 2005).
rather rigid maps, but recent studies provide firm evidence about One fundamental aspect of mental body representations con-
their malleability (Berlucchi & Aglioti, 2009; Serino & Haggard, cerns the so-called body schema (e.g. Gallagher, 2005; de Vignemont,
2010). In neurological patients, lesions and seizures in brain regions 2010). According to Serino and Haggard (2010) the body schema
involved in body representations can temporarily or permanently ‘‘represents the positions of body parts in space, relative to each
modify the perceived size and shape of the entire body and other. It is of primarily proprioceptive origin, short-lived, and
individual body segments (Dieguez, Staub, & Bogousslavsky, updated as our bodies move. It serves to guide our actions and
2007). There is also a large amount of data indicating that in our interactions with the external world’’ (p. 229). This type of
neurologically normal population, mental body representations representation of the body configuration includes the size and shape
continuously adjust as a function of exteroceptive and propriocep- of body segments, i.e. body’s metric properties that need to be taken
tive sensory signals (reviews in Serino & Haggard, 2010; de into account during grasping and reaching objects. The multisensory
Vignemont, 2010). Multisensory conflicts have been used as a foundations of the body schema have been investigated a long time
particularly interesting means to demonstrate the malleability of ago, but a strong emphasis has been put on the proprioceptive
mental body representations. For example, the perceived size of system. Holmes and Spence (2004), for example, wrote ‘‘that the
body parts, measurable by the comparison of tactile distances body schema should not necessarily be restricted to proprioceptive
applied over various body segments, can be manipulated by view- and somatosensory modalities alone, but should also incorporate
ing distorted visual feedback from the body (e.g. when looking at a visual and perhaps auditory information’’. Recently, cognitive neu-
roscience has made substantial advances in understanding the
multisensory mechanisms that underlie the body schema by manip-
n
Corresponding author at: Universität Bern, Institut für Psychologie, Abteilung
ulating signals from the visual, tactile and proprioceptive systems
für Kognitive Psychologie, Wahrnehmung und Methodenlehre, Muesmattstrasse,
45, 3012 Bern, Switzerland.
and, more recently, from the auditory system (Botvinick & Cohen,
E-mail address: christophe.lopez@univ-amu.fr (C. Lopez). 1998; de Vignemont et al., 2005; Dieguez, Mercier, Newby, & Blanke,
1
Current address: Laboratoire de Neurosciences Intégratives et Adaptatives, 2009; Tajadura-Jimenez et al., 2009; Taylor-Clarke et al., 2004;
UMR 7260 CNRS – Aix-Marseille Université, Center St Charles, Pôle 3C – Case B 3, Tsakiris & Haggard, 2005). However, the majority of studies on the
Place Victor Hugo 13331 Marseille Cedex 03, France. Tel.: þ 33 4 13 55 08 41;
multisensory foundations of the body schema did not take into
fax: þ 33 4 13 55 08 44.
2
Helene-Mariane Schreyer and Nora Preuss contributed equally to the account a contribution of vestibular signals. This is indeed surprising
present study. given the fact that the body schema is continuously updated when

0028-3932/$ - see front matter & 2012 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.neuropsychologia.2012.04.008

Please cite this article as: Lopez, C., et al. Vestibular stimulation modifies the body schema. Neuropsychologia (2012), http://dx.doi.org/
10.1016/j.neuropsychologia.2012.04.008
2 C. Lopez et al. / Neuropsychologia ] (]]]]) ]]]–]]]

the body moves. The vestibular system is specialized in coding elongate’’ (p. 117). Interestingly, Bonnier introduced the term
three-dimensional body rotations and translations and body orien- ‘‘aschématie’’ (meaning ‘‘loss’’ of the schema) to account for the
tations with respect to gravity (Angelaki & Cullen, 2008). Conse- various disorders of topographic body representations, including
quently, relatively little is known about the influence of vestibular the volume, shape and position of the body and body segments,
signals on mental body representations. Exclusively focusing on and he suggested that vestibular disorders evoke distortions of this
visual and tactile perception may hamper the elaboration of more (body) ‘‘schema’’ (see Vallar & Rode, 2009). Recently, Rode et al.
comprehensive multisensory models of the body schema. Although (2012) described a patient suffering from vestibular disorders due
some recent work in philosophy of mind has noted this shortcoming to a brainstem lesion with the concomitant sensation of macro-
(Macpherson, 2011), and despite recent attempts to include vestib- somatognosia restricted to the face. The authors showed that
ular signals in neuroscientific models of the bodily self (Blanke & vestibular stimulation temporarily alleviated the distorted percep-
Metzinger, 2009), the interactions between the vestibular system tion of the face, suggesting that vestibular signals can act on the
and other sensory systems remain largely underappreciated. neural basis of the body schema. Moreover, it was found that
The contribution of the vestibular signals to the body schema caloric vestibular stimulation (CVS, the irrigation of the auditory
has nevertheless been recognized by some neurophysiologists like canal with cold or warm water or air) can change the morpholo-
Paillard (1991), for whom ‘‘the ubiquitous geotropic constraint gical, postural and kinetic characteristics of phantom limbs in
[i.e. gravitational acceleration, which is detected and coded by paraplegics, and thus their body schema (Le Chapelain, Beis,
vestibular receptors] dominates the [body-, world-, object- and Paysant, & Andre, 2001). Similarly, in amputees, CVS evoked the
retina-centered] reference frames that are used in the visuomotor perception of a phantom limb in patients who did not experience
control of actions and perceptions, and thereby becomes a crucial phantoms before, or altered the phantom perception in those who
factor in linking them together’’ (p. 472, our italics). According to experienced phantoms already, indicating that CVS can influence
Paillard, gravity signals would therefore help merging and giving mental representations of a non-existing body segment (André,
coherence to the various references frames underpinning the body Martinet, Paysant, Beis, & Le Chapelain, 2001). In addition to this,
schema. Human beings have evolved under a constant gravita- there is evidence for a beneficial influence of CVS on various bodily
tional field on Earth, and this physical constraint has shaped our disorders of neurological origin (e.g. disownership for body parts,
body representations. Therefore, grasping and reaching actions anosognosia and hemisanesthesia; see Bottini et al., 1995; Rode
performed under gravity are constrained by gravito-inertial forces et al., 1992). These findings have in common that they all suggest a
and preconscious internal models of gravity (McIntyre, Zago, vestibular influence on the brain regions representing the body
Berthoz, & Lacquaniti, 2001). Reaching a target during body structure. Whereas previous studies relied on self-reports there
rotations generates Coriolis and centrifugal torques that tend to still is a paucity of well-controlled psychophysical experimental
deviate the hand from its optimal trajectory. It has been suggested procedures. To our knowledge, tactile detection and illusory own-
that vestibular signals generated during body movements are used ership for body parts were measured in healthy participants during
to correct the hand location and trajectory (Guillaud, Simoneau, & vestibular stimulation (Ferre, Sedda, Gandola, & Bottini, 2011;
Blouin, 2011). In conclusion, there is evidence that vestibular Lopez, Lenggenhager, & Blanke, 2010), but these studies were not
signals update the body schema during hand actions (Bresciani designed to assess changes of the perceived size and shape of body
et al., 2002) and that they shape the way we perform actions and segments. Since previous reports did not investigate large popula-
interact with objects in the environment. tions of patients or did not use well-controlled paradigms, the
While the influence of vestibular signals on hand location and present study aims at testing vestibular-induced modifications of
motion is well-documented, the role of vestibular signals on the the perceived size of body parts in a more controlled manner when
representation of the body’s metric properties, i.e. the perceived compared to previous studies. The hypothesis that vestibular
shape and size of the body, is less clear. Some reports from signals contribute to the body schema (more specifically the body’s
parabolic flight missions (creating temporary weightlessness) point metric properties) is based on electrophysiological recordings in
out that the lack of gravitational input disorganizes the body animals showing that vestibular signals project to somatosensory
schema to the point that some participants experience a ‘‘tele- areas such as the hand and neck representations of the primary
scoping motion of the feet down and the head up internally somatosensory cortex (Schwarz, Deecke, & Fredrickson, 1973;
through the body’’, reversing the participant’s body orientation Schwarz & Fredrickson, 1971, review in Lopez & Blanke, 2011).
(Lackner, 1992). Animal data confirm an influence of vestibular The secondary somatosensory cortex, insula and retroinsular
signals on body representations since microgravity can perma- cortex also receive vestibular afferents (Bottini et al., 2001, 1995;
nently disorganize the somatosensory maps in the primary soma- Lopez, Blanke, & Mast, in press). The anatomical overlap of tactile
tosensory cortex (Zennou-Azogui, Bourgeon, & Xerri, 2011). Clinical and proprioceptive maps with vestibular maps provides the neural
observations provide compelling evidence that vestibular informa- basis for vestibular influence on body representations (Lopez et al.,
tion contributes to the body schema. Acute vestibular vertigo and 2008). In a first experiment, we investigated the body schema by
total vestibular deafferentation induce a drastic mismatch between means of tactile signals in order to infer the relative metric
vestibular, visual and somatosensory signals, leading to distortions properties of two body parts. Importantly, it has been proposed
of the body schema (Lopez & Blanke, 2007; Lopez, Halje, & Blanke, that ‘‘tactile input must be scaled by a pre-existing body model in
2008; Sang, Jauregui-Renaud, Green, Bronstein, & Gresty, 2006; order to compute the size of the objects touching the skin’’ (Longo
Schilder, 1935). About 100 years ago, Bonnier (1905, 1907) et al., 2010; p. 659). Therefore, the potential influence of vestibular
described distortions of the perceived shape and size of the body stimulation on the body schema can be measured by a change in
in patients with vestibular disorders. One of his patients ‘‘felt that the perceived size of objects touching the body surface. We used a
he was divided into two persons’’, while another patient ‘‘felt his well-controlled paradigm based on the comparison of tactile
head became enormous, immense, losing itself in the air; his body distances applied to separate body parts (de Vignemont et al.,
disappeared and his whole being was reduced to only his face’’. 2005; de Vignemont, Majid, Jola, & Haggard, 2008; Taylor-Clarke
Schilder (1935) described in his monograph The image and appear- et al., 2004). This procedure has been shown to provide a sensitive
ance of the human body some forms of alteration of the body measure to assess modifications of the body schema due to visual
schema in vestibular patients who experienced that the ‘‘neck and proprioceptive stimulation. We manipulated tactile signals
swell during dizziness’’, ‘‘extremities had become larger’’, ‘‘hands from the palm (left hand) because its neurophysiological properties
became larger and moved in different directions’’ and ‘‘feet seem to have been well-described (Knibestöl & Vallbo, 1980), and we

Please cite this article as: Lopez, C., et al. Vestibular stimulation modifies the body schema. Neuropsychologia (2012), http://dx.doi.org/
10.1016/j.neuropsychologia.2012.04.008
C. Lopez et al. / Neuropsychologia ] (]]]]) ]]]–]]] 3

compared this representation with that of a non-lateralized body 2.1.2. Caloric vestibular stimulation
part (the sagittal line of the forehead). In a second experiment, we We used caloric vestibular stimulation (CVS), which consists of injecting a
constant air flow into the auditory canals through a short plastic tube (Airmatic II,
assessed the body schema without involving tactile signals (Longo
GN Otometrics, Taastrup, Denmark). During CVS, warm air (47 1C) was injected in
& Haggard, 2010). This task allowed to measure directly the the right ear and at the same time cold air (20 1C) was injected in the left ear. This
representations of the body’s metric properties and did not involve stimulation induces a perceived body motion to the right, and activates mostly the
comparisons between two body parts. Participants localized four right cerebral hemisphere, in which the left hand is predominantly represented
anatomical landmarks on their left hand by pointing in darkness on (Lopez & Blanke, 2011). In order to control for unspecific effects caused by CVS
(tactile and auditory stimulation), we applied a sham stimulation that consists of
a digitizing tablet in order to obtain measurements of the injecting a constant air flow at body temperature (37 1C) simultaneously in both
perceived length and width of the participant’s hand. During both ears. This stimulation produces exactly the same test conditions, with the only
experiments, we provided exactly the same binaural CVS known to difference that there is no vestibular stimulation.
activate the right cerebral hemisphere, in which the left hand is
represented. Based on overlapping neural networks between 2.1.3. Materials for the tactile distance judgment
tactile, proprioceptive and vestibular signals (Bottini et al., 2005, The participants were blindfolded and they positioned their hand, palms up,
on padded armchairs. Experimental procedures were adapted from the studies by
1995; Lopez & Blanke, 2011), and in combination with clinical
Taylor-Clarke et al. (2004) and de Vignemont et al. (2005), in which tactile stimuli
findings showing the effects of CVS on the body schema (André were applied manually to the skin using solenoids or spheres, a condition in which
et al., 2001; Le Chapelain et al., 2001), we hypothesized that CVS the pressure applied to the skin can vary across trials. We improved the procedure
would modify the hand representation when compared to a by constructing a device that allows for controlling the pressure acting on the skin
control thermal stimulation at body temperature. surface (for similar procedures, see Ferre et al., 2011). Tactile stimuli were delivered
using a pair of plastic rods separated by distances of 10 mm, 20 mm, 30 mm and
40 mm (Fig. 1A). The plastic rods were screwed onto a rectangular piece of wood,
allowing for the precise adjustment of the distance between the participant’s hand
2. Methods and results and this support by varying the length of each plastic rod under the support
(distance h1). A rectangular box was attached to the participant’s left hand and
another rectangular box was attached to their forehead. The shape of the boxes was
2.1. Experiment 1: tactile distance judgments designed to fit the shape of the hand and the curvature of the forehead, and they
were attached to the body using Velcros strips (Fig. 1B). Two screws were mounted
2.1.1. Participants vertically on the boxes and were designed to receive the support for the tactile
The data were obtained from 18 students (age: 21  35 years; mean age7 SD: stimuli (see Fig. 1C for an illustration of the hand box; similar procedures were used
25 74 years) who received credits for their participation. All of them were right- for the forehead box). On each of these screws, a screw nut served to adapt for each
handed (mean laterality quotient, Edinburgh Handedness inventory (Oldfield, participant the distance (distance h2) between the support for the tactile stimuli
1971): þ 777 21%). Experimental procedures were approved by the Ethics and their left hand or the midline of their forehead. Before the experiment proper,
Committee of the Faculty of Human Sciences, University of Bern, and participants each tactile stimulus was tested and the distances h1 and h2 were adapted to the
gave written informed consent. morphology of the participant’s left hand and forehead. Importantly, due to the

adjustable
height (h2)
8c
m

12 cm
4.5 cm

adjustable
height (h1)

4 tactile distances

10 mm

20 mm

30 mm

40 mm

Fig. 1. Experimental set-up for the tactile distance comparisons task. (A) Wooden support for the tactile stimuli. Two plastic rods separated by distances ranging from 10
to 40 mm are screwed on a rectangular piece of wood. (B) Schematic representation of the hand box designed to receive the tactile stimuli. (C) The support for the tactile
stimuli can be inserted in the hand box and is held in place by two screws. The adjustment of distances h1 and h2 for each participant allows for applying constant tactile
stimuli on the palmar surface of the left hand.

Please cite this article as: Lopez, C., et al. Vestibular stimulation modifies the body schema. Neuropsychologia (2012), http://dx.doi.org/
10.1016/j.neuropsychologia.2012.04.008
4 C. Lopez et al. / Neuropsychologia ] (]]]]) ]]]–]]]

presence of the screw nuts on the boxes, the pressure applied on the hand was 2.1.6. Eye movements recording
maintained constant across trials. After the experiment proper, eye movements were recorded by videonystag-
mography (eVNG, BioMed, Jena, Germany) during 45s of CVS and sham stimula-
tion. We computed the mean slow phase velocity of the nystagmus in degrees
per second as in previous reports (Lopez, Borel, Magnan, & Lacour, 2005) and
2.1.4. Experimental procedures included in the final analysis only those participants who exhibited a clear caloric
The tactile distance comparison task was conducted during two conditions: nystagmus (n¼15; 3 participants were excluded due to the absence of a clear
CVS and sham stimulation. There were two blocks of CVS and two blocks of sham caloric nystagmus). The nystagmus served as a control for effective vestibular
stimulation, presented in a counterbalanced order across participants. Each block stimulation by means of CVS.
consisted of the following procedures: Participants were initially seated on a
tiltable chair with their head pitched forward by 301 and they received CVS or
sham for 2 min. Participants were subsequently pitched backward by 901 until 2.1.7. Results
their head was tilted 601 with respect to the vertical. In this position, the We quantified the percentage of times participants experienced the tactile
horizontal semicircular canals were oriented vertically, providing a maximal effect stimulus applied on the hand as longer than the same tactile distance applied on the
of CVS (for a detailed description see Mast, Merfeld, and Kosslyn (2006)). During forehead. This analysis included only trials presenting same tactile distances on the
CVS, participants performed the tactile distance comparison task. The experi- hand and forehead. A repeated-measures ANOVA revealed a higher occurrence of
menter applied one tactile stimulus on the left hand immediately followed by one the perception of the hand being longer than the forehead during CVS (mean7
tactile stimulus on the forehead (this procedure was used in half of the SEM: 58.373.1%) when compared to sham stimulation (48.872.9%; F1,14 ¼ 8.9;
participants, while in the other half the tactile stimulus on the left hand followed Po0.05) (Fig. 2B). A distance applied on the hand was perceived as longer than the
the stimulus applied to the forehead). The participants were required to answer as same distance applied on the forehead during CVS in 12 out of 15 participants
quickly and spontaneously as possible whether the longer distance was felt on (Fig. 2A). Two participants had comparable results during CVS and sham and only
their hand or forehead. For each condition (CVS and sham) 28 tactile stimuli were one participant showed the opposite pattern. This result indicates that CVS can
applied in a randomized order: Similar distances between the hand and the induce a change in the perceived length of external objects touching the left hand.
forehead were applied 16 times in total (the pairs 10–10 mm, 20–20 mm, 30– Additional recordings indicate that binaural CVS evoked a nystagmus with a
30 mm, 40–40 mm were each applied 4 times) and trials with the hand stimulus mean slow phase eye velocity of 4.1 7 3.41/s. No nystagmus was evoked during
longer than the forehead stimulus (20–10 mm, 30  20 mm, 40–30 mm), or the sham stimulation. The analysis of the questionnaire data revealed a stronger
forehead stimulus longer than the hand stimulus (10–20 mm, 0–30 mm, 30– illusory self-motion during CVS (mean strength of illusory motion: 3.17 0.5) when
40 mm) were applied 12 times in total. The 28 tactile stimuli were presented in compared to sham stimulation (0.77 0.2; F1,14 ¼ 28; P o 0.001). The analysis of the
two separate blocks lasting for about 3 min each. After the completion of each Cox and Swinson questionnaire (two-sided paired t-tests) revealed stronger
block, participants were turned back to the upright position for 5 min of rest and ratings after CVS than sham stimulation for several items related to bodily
they filled out questionnaires. sensations (Fig. 2C). Particularly, during CVS, participants reported feeling ‘spacy’,
being detached from their own body and the surroundings, and not being in
control of their self.

2.1.5. Subjective reports


Participants filled-out a questionnaire designed to evaluate self-motion during 2.2. Experiment 2. localization of anatomical landmarks
CVS and sham stimulation (adapted from (Lenggenhager, Lopez, & Blanke, 2008)
and (Lopez et al., 2010)). They reported the magnitude of the sensation of body Results from Experiment 1 indicate a change in tactile size judgment on the
motion using a 7-point scale ranging from 0 (‘‘no motion’’) to 6 (‘‘strong motion’’). left hand relative to the forehead. The representation of the left hand is lateralized
Participants also filled out the Cox & Swinson (2002) questionnaire to evaluate in the right cerebral hemisphere, whereas the representation of the forehead’s
bodily sensations resembling possible depersonalization symptoms immediately medial skin is poorly lateralized (Bittar, Nandi, Carter & Aziz, 2005; Iannetti et al.,
after CVS or sham stimulation (Sang et al., 2006). This questionnaire contains 28 2003). Given the fact that CVS activates the right hemisphere, we hypothesized
items and we extracted those items related to bodily sensations such as ‘‘Body that it has modified the representation of the left hand. Experiment 2 was
feels strange/different in some way’’, ‘‘Body feels numb’’ and ‘‘Feeling detached or designed to directly test the hypothesis according to which CVS has led to an
separated from body’’. Participants rated the intensity of each item using a 5-point increase in the perceived hand size. We used a paradigm to obtain an objective
scale ranging from 0 (‘‘does not occur’’) to 4 (‘‘very severe’’). measure of the representation of the body’s metric properties without involving

CVS CVS%
80 CVS 80 CVS 1.8 sham sham% 80
sham sham
1.6

Frequency of reported sensation (%)


70
70 70
mean % hand longer than forehead

1.4
60
% hand longer than forehead

Intensity of subjective report

60 60 1.2
50
1.0
50 50 40
0.8
30
40 40 0.6
20
0.4
30 30
0.2 10

20 20 0.0 0
Q1 Q2 Q3 Q4 Q5

Fig. 2. Influence of vestibular stimulation on the tactile distance comparison task and bodily sensations. (A) The percentage of trials for which the tactile stimulus applied
on the left hand is reported as longer than the same stimulus applied on the forehead is illustrated for each participant (P1  P15). (B) Histograms depict the average
data7 SEM (Po 0.05). (C) Rating of 5 item questionnaires from the depersonalization-derealization questionnaire after CVS and sham stimulation (Cox & Swinson, 2002).
Leftward y-axis and histograms depict the mean intensity ( 7 SEM) of each sensation. Rightward y-axis and lines depict the occurrence (in %) of each bodily sensation. Q1:
Feel ‘‘spacy’’ or ‘‘spaced out’’; Q2: Feeling of not being in control of self; Q3: Surroundings seem strange or unreal; Q4: Feeling of detachment or separation from
surroundings; Q5: Feeling detached or separated from your body (P o0.05, t-tests on the intensity of the rating).

Please cite this article as: Lopez, C., et al. Vestibular stimulation modifies the body schema. Neuropsychologia (2012), http://dx.doi.org/
10.1016/j.neuropsychologia.2012.04.008
C. Lopez et al. / Neuropsychologia ] (]]]]) ]]]–]]] 5

tactile stimulation. In addition, this task did not involve comparisons between two increase in the perceived length of the left hand (P o0.05, one-sided paired t-test),
body parts. as hypothesized from Experiment 1. The data also indicate a significant increase in
the perceived width of the left hand (P o0.05, one-sided paired t-test). As for
2.2.1. Participants Experiment 1, questionnaire analyses showed a stronger illusory self-motion
The data were obtained from 17 participants (age: 22  29 years; mean during CVS when compared to sham stimulation (F1,16 ¼ 7.54; Po 0.05). The Cox
age7 SD: 25 7 2 years). All of them were right-handed (mean laterality quotient, and Swinson’s questionnaire revealed that participants reported stronger changes
Edinburgh Handedness inventory (Oldfield, 1971): þ79 7 20%). in bodily perceptions (e.g. ‘‘body feels strange or different in some way’’) during
CVS than sham stimulation (Po 0.05, two-sided paired t-test).

2.2.2. Materials for the localization task


Experimental procedures were adapted from Longo and Haggard (2010).
Participants were blindfolded and they positioned their left hand, palm down, 3. Discussion
on a table in front of them so that their hand was aligned with their body mid-
sagittal plane. The hand was positioned under a digitizing tablet. The participants
The results indicate that tactile stimuli applied on the left hand
were asked to locate four anatomical landmarks on the dorsal surface of their left
hand: the knuckle of the little finger, the knuckle of the index finger, the tip of were perceived as longer during CVS than during a control
the middle finger and the wrist. Each anatomical landmark was initially shown to stimulation not activating vestibular receptors (Experiment 1) and
the participant and stickers were applied to the skin on the corresponding location that CVS increased the perceived length and width of the left hand
(see Fig. 3B and C). Participants used a stylus to indicate with their right hand the during a task requiring to locate anatomical landmarks on the hand
location of the landmarks. The digitizing tablet automatically recorded the x and y
(Experiment 2). Altogether, the data indicate that vestibular stimu-
coordinates of the location indicated by the participant.
lation was able to modify the instantaneous representation of body
2.2.3. Experimental procedures
segments, suggesting an influence of vestibular signals on the
The localization of anatomical landmarks was conducted during one block of neural mechanisms underlying the body schema. The present
CVS and one block of sham stimulation, presented in a counterbalanced order study provides further evidence that body representations are
across participants. CVS and sham stimulation were applied in the same way as for not rigid but rather adapt to sensory signals originating from the
Experiment 1 (see Mast et al., 2006). Participants performed the localization task
body and its environment (review in Serino & Haggard, 2010). The
when lying backwards and while receiving CVS in their outer ear canals. For each
condition (CVS and sham), participants judged the location of the four anatomical data from this study extend previous findings showing changes in
landmarks in four blocks. Each block consisted of 10 consecutive pointings to the perceived size and posture of body segments during experimental
same anatomical landmark. The order in which they had to locate the landmarks manipulation of bodily signals. This is the case, for example, during
was randomized across participants. For each participant, we calculated the mean muscular vibrations and activation of proprioceptive receptors (de
x and y coordinates of the perceived position of each anatomical landmark. Hence,
it was possible to obtain an objective measure of the perceived length of the hand
Vignemont et al., 2005; Ehrsson, Kito, Sadato, Passingham, & Naito,
(Euclidean distance between the tip of the middle finger and the wrist) and of the 2005; Lackner, 1988), during presentation of distorted visual
width of the hand (Euclidean distance between the knuckle of the little finger and feedback from the body (Taylor-Clarke et al., 2004), and during
the knuckle of the index finger). After completion of each block, participants were tactile illusions (Bruno & Bertamini, 2010; Dieguez et al., 2009).
turned back to the upright position for 5 min of rest and they filled out the same
Here, we show distortions of the body schema during vestibular
questionnaires as for Experiment 1.
stimulation. Although the contribution of vestibular signals to the
2.2.4. Results
coding of whole-body movements and orientation is obvious, its
Fig. 3A illustrates the perceived length and width of the left hand during CVS contribution to body segments perception may appear less evident.
and sham stimulation. The analysis of the pointing task revealed a significant However, it has been suggested that vestibular signals are

Fig. 3. Influence of vestibular stimulation on the localization of anatomical landmarks. (A) The mean perceived width (distance between the knuckle of the little finger and
the knuckle of the index finger) and length (distance between the tip of the middle finger and the wrist) of the left hand is represented for CVS and sham stimulation. Error
bars represent SEM. (B, C) The perceived location of the four anatomical landmarks is illustrated for each participant during CVS (part B) and sham stimulation (part C). The
photograph of the hand represents the hand of one participant with the four anatomical landmarks and does not reflect the average hand size or hand position in the
population.

Please cite this article as: Lopez, C., et al. Vestibular stimulation modifies the body schema. Neuropsychologia (2012), http://dx.doi.org/
10.1016/j.neuropsychologia.2012.04.008
6 C. Lopez et al. / Neuropsychologia ] (]]]]) ]]]–]]]

important to code for fine arm reaching movements (Bresciani indicating that vestibular signals interact with the body model
et al., 2002). Importantly, the central nervous system uses vestib- of various segments. In the same vein, several authors reported
ular signals to elaborate an internal model of gravity, referencing the co-occurrence of vestibular illusions and distortions of the
arm movements and position (McIntyre et al., 2001). body schema in brain-damaged and epileptic patients (Blanke,
In addition to this, vestibular signals control the tonus and Landis, Spinelli, & Seeck, 2004; Hécaen & de Ajuriaguerra, 1952;
contractions of limb muscles through vestibulospinal reflexes Heydrich, Lopez, Seeck, & Blanke, 2011). Thus, distortions in
(Britton et al., 1993) and this information is fed back to the brain mental body representations can either be caused by pathological
to update the current posture of the body. Therefore, vestibular conditions affecting the peripheral vestibular sensors or at cor-
signals are involved in sensorimotor circuits between the brain and tical levels processing vestibular signals.
body parts. Vestibular signals project to multiple multisensory brain regions
The data demonstrate that a tactile distance applied on the (review in Lopez & Blanke, 2011), and the cortical processing of
skin is perceived as longer during CVS than during sham stimula- vestibular information can possibly account for the behavioral results
tion. The question is whether this change in the perception of we found in this study. Several brain areas are associated with
external objects reflects a perceived enlargement or reduction of vestibular–somatosensory interactions. First, electrophysiological
the body part that is in contact with these objects. A previous recordings in monkeys showed convergence of tactile, proprioceptive
study by de Vignemont et al. (2005) used similar experimental and vestibular signals in the primary somatosensory cortex. For
procedures and provides a clear conclusion. They evoked the example, areas 3aHv and 3aNv are two vestibular regions located in
experience of an elongation of the index finger by vibrating biceps the hand and neck representations of the primary somatosensory
muscles and asked participants to perform a tactile distance cortex (Schwarz et al., 1973; Schwarz & Fredrickson, 1971). Second,
comparison task (between the finger and the forehead). They interactions of tactile, proprioceptive (from the legs and neck) and
showed that ‘‘a tactile distance feels bigger when the stimulated vestibular signals were reported in the parieto-insular vestibular
body part feels temporarily elongated’’ (de Vignemont et al., cortex (Grüsser, Pause, & Schreiter, 1990) and in the intraparietal
2005; p. 1288). In another study by Bruno and Bertamini cortex (Bremmer, Klam, Duhamel, Ben Hamed, & Graf, 2002).
(2010), the participant’s hand was stroked synchronously with a Neuroimaging studies in humans also revealed that vestibular regions
rubber hand, the size of which was enlarged or reduced. When overlap with somatosensory regions in the insular, retroinsular and
their hand was synchronously stroked with an enlarged rubber secondary somatosensory cortex, as well as in the premotor cortex
hand, participants judged an external object touching the stroked and supramarginal gyrus (Bottini et al., 2001, 1995). The temporo-
hand to be larger than an identical object touching the contral- parietal junction is yet another candidate because it is the site of
ateral (unstimulated) hand. Conversely, they judged an external convergence of various sensory signals from the body and its
object to be smaller when they were exposed to a reduced rubber environment (Lopez et al., 2008). Indeed, electrical stimulations of
hand. The authors concluded that the altered mental representa- the temporo-parietal junction in a conscious epileptic patient mod-
tion of the hand modified the interpretation of active touch ified body representations (e.g., the patient’s arm appeared shorter)
(Bruno & Bertamini, 2010). Data from Experiment 1 showed that and evoked vestibular sensations (Blanke, Ortigue, Landis, & Seeck,
CVS modifies a tactile size judgment on the left hand relative to 2002). This study provided a direct demonstration of a brain region
the forehead. However, the results do not permit to draw firm commonly involved in the conscious experience of the shape and size
conclusions about whether CVS has led to an increase in the of body segments and in vestibular processing. However, more work
perceived hand size or to a decrease in the perceived forehead is needed to precisely determine vestibular-somatosensory interac-
size. The latter is unlikely because the representation of the tions, but the wide range of vestibular projections at the cortical level
medial forehead on which the tactile stimuli were applied is suggests that such interactions can occur in several brain regions
poorly lateralized. Neuroimaging studies and deep brain stimula- simultaneously.
tion showed no lateralization of the forehead neither in the We believe that the present research will have theoretical and
primary nor in the secondary somatosensory cortex (Iannetti conceptual impacts by pointing out the importance to include
et al., 2003; Bittar et al., 2005). The paradigm we used activates vestibular signals and vestibular representations in current multi-
the right cerebral hemisphere (see Lopez et al., in press) in which sensory models of the body schema. However, not much is known
the left hand is more dominantly represented (Ruben et al., 2001). about the exact mechanisms by which vestibular signals con-
In Experiment 2, we demonstrated that CVS led to an increase in struct the body schema. On the basis of the effects of CVS on the
the perceived hand size with respect to a control stimulation. shape and size of phantom limbs, André et al. (2001) proposed
Previous psychophysical experiments demonstrated that the that the vestibular system ‘‘triggers the procedure of reconstruc-
body’s metric properties (such as the distance between the tion of the global body schema’’ (p. 190). Others have proposed
knuckles of the little and index fingers) are based on a body that vestibular signals link the different spatial references frames
model (Longo & Haggard, 2010). Therefore, the fact that the on which bodily processing is based on (Lopez & Blanke, 2007).
perceived length and width of the left hand were increased We have proposed that the multisensory vestibular cortex (that
during CVS demonstrates the influence of vestibular signals on overlaps with the somatosensory cortex) should be important for
the body schema. the body schema, because it integrates signals from the personal
To date, the influence of vestibular signals upon body schema (tactile, proprioceptive) space, the allocentric (visual) space, and
has been suggested by subjective reports in various clinical the gravitational, or geocentric, space (vestibular otolithic sig-
populations. For example, in lower limb amputees, CVS evoked nals). Therefore, this cortex has the capacity to combine several
a change in the shape or position of the phantom limb (André reference frames, to maintain the unity of the spatial experience,
et al., 2001). Disturbance in the coding of vestibular signals can and therefore the potential to contribute to the neural represen-
also lead to abnormal bodily perceptions (fore reviews, see Lopez tation of the body schema and the body’s metric properties
& Blanke, 2007; Lopez et al., 2008). Oto-neurological patients (the shape, size and weight of the different body segments).
suffering from vestibular dysfunctions (such as Menie re’s disease) In conclusion, our data indicate that vestibular signals influence
may report changes in the perceived shape and size of the body the body schema in healthy participants. Importantly, the data
(Bonnier, 1905, 1907; Schilder, 1935; Rode et al., 2012). These provide further evidence that vestibular functions are not limited
authors have described enlargement, elongation, or increase in to postural and oculomotor reflexes, and extend the contribution
the volume at the level of the hands, neck, feet and face, of the vestibular system to bodily cognition. We hope that our

Please cite this article as: Lopez, C., et al. Vestibular stimulation modifies the body schema. Neuropsychologia (2012), http://dx.doi.org/
10.1016/j.neuropsychologia.2012.04.008
C. Lopez et al. / Neuropsychologia ] (]]]]) ]]]–]]] 7

findings will inspire other researchers to include vestibular Ferre, E. R., Sedda, A., Gandola, M., & Bottini, G. (2011). How the vestibular system
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Hécaen, H., & de Ajuriaguerra, J. (1952). Méconnaissances et hallucinations corpor-
K. Wegmüller, V. Gashaj and C. Mozzini Vellen for technical elles. Intégration et désintégration de la somatognosie. Paris: Masson.
support. This study was supported by the Swiss National Science Heydrich, L., Lopez, C., Seeck, M., & Blanke, O. (2011). Partial and full own-body
Foundation (SINERGIA project ‘Balancing Self and Body’: CRSII1- illusions of epileptic origin in a child with right temporoparietal epilepsy.
Epilepsy & Behavior, 20, 583–586.
125135). C. Lopez is supported by the Volkswagenstiftung’s
Holmes, N. P., & Spence, C. (2004). The body schema and the multisensory
European Platform for Life Sciences, Mind Sciences, and the representation(s) of peripersonal space. Cognitive Processing, 5(2), 94–105.
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