Thanks to wide central connections the vestibular system is not merely involved in reflexes, but it is also connected to cognitive processes. A growing body of literature suggests that it has a substantial impact on cognitive function. These cognitive interactions include memory, attention, mental imagery, body awareness and social cognition. Spatial working memory (SWM) is a kind of short-term memory that allows to temporarily store and manipulate spatial information. It has a limited capacity and is quite vulnerable to interference. The single most important nonverbal task for assessment of visuo-spatial working memory (VSWM) is the Corsi block tapping task (CBTT), also known as the Corsi Span Test. We evaluated 263 patients suffering from chronic unilateral or bilateral vestibular loss (VL) by eCorsi Block-Tapping test before and after 5 days of instrumental vestibular training (IVT). The data were compared with those of 834 subjects submitted to the same test: 430 healthy people (HP) and 404 patients suffering from chronic VL but not treated by IVT. At all ages, the Corsi block test score was extremely statistically significantly higher (p < 0.0001) in HP than in both groups of VL. The score showed a statistically significant difference with age and sex in healthy subjects as younger males obtained the best results. Our study confirms the significant interference of the vestibular input on VSWM and impairment of this cognitive function in patients suffering from chronic UL or BIL. It also shows that IVT is able to improve VSWM even in cases where the deficit is greater. KEY WORDS: spatial working memory, corsi block-tapping test, vestibular pathology, vestibular rehabilitation training RIASSUNTO Grazie ad ampie connessioni centrali il sistema vestibolare non evoca solo riflessi ma è anche collegato a processi cognitivi. Un numero sempre maggiore di studi suggerisce che ha un impatto sostanziale sulle funzioni cognitive. Queste interazioni cognitive comprendono la memoria, l'attenzione, l'immaginario mentale, la consapevolezza del corpo e la cognizione sociale. La memoria operativa spaziale è un tipo di memoria a breve termine che consente di archiviare e manipolare temporaneamente le informazioni spaziali. Ha una capacità limitata ed è piuttosto vulnerabile alle interferenze. Il test non verbale più importante per la valutazione della memoria di lavoro visuo-spaziale (VSWM) è il test a blocchi di Corsi, noto anche come il Test di span di Corsi. A tal fine, abbiamo valutato col test eCorsi Block-Tapping 263 pazienti affetti da deficit vestibolare cronico unilaterale o bilaterale (VL), prima e dopo 5 giorni di training vestibolare strumentale (IVT). I dati sono stati confrontati con quelli di altri 834 soggetti sottoposti allo stesso test: 430 persone sane (HP) e 404 pazienti affetti da VL cronica ma non trattati con IVT. A tutte le età il punteggio del test di Corsi era significativamente più alto (p < 0,0001) negli HP rispetto a entrambi i gruppi di VL. Il punteggio era significativamente più alto anche nei g...

SUMMARY Driving is not only a physical task, but is also a mental task. Visual inputs are indispensable in scanning the road, communicating with other road users and monitoring in-vehicle devices. The probability to detect an object while driving (conspicuity) is very important for assessment of driving effectiveness, and correct choice of information relevant to the safety of driving determines the efficiency of a driver. Accordingly, eye fixation and eye movements are essential for attention and choice in decision making. Saccades are the most used and effective means of maintaining a correct fixation while driving. In order to identify the features of the most predisposed subjects at high driving performances and those of the high-level sportsmen, we used a special tool called Visual Exploration Training System. We evaluated by saccade and attentional tests various groups of ordinary drivers, past professional racing drivers, professional truck drivers and professional athletes. Males have faster reaction time compared to females and an age below 30 seems to guarantee better precision of performance and accuracy in achieving all visual targets. The effect on physical activity and sports is confirmed. The performances of the Ferrari Driver Academy (FDA) selected students who were significantly better than those of a group of aspiring students and amateur racing drivers probably thanks to individual predisposition, training and so-called ‘ neural efficiency ’.

Objectives: The development of pneumolabyrinth without previous head trauma is a rare event; the associated symptoms may be nonspecific, and they can simulate various cochleo-vestibular pathological entities. The aim of the present study is to describe one of these rare occurrences, characterized by a peculiar onset. Methods: We report a case of stapes fracture secondary to ear pick penetration into the middle ear with a pneumolabyrinth that caused a recurrent paroxysmal positional vertigo (PPV) mimicking a canalolithiasis. Results: The patient developed a profound left sensorineural hearing loss and an intractable PPV with “migrant” features. A pneumolabyrinth was visualized with high-resolution computed tomography. A perilymphatic fistula (PLF) with stapes fracture was found while performing an explorative tympanotomy. After the surgical treatment of the PLF, the patient no longer complained of vestibular symptoms. Conclusions: To our knowledge, this is the fifth case of traumatic pneumolabyrinth simulating a canalolithiasis without previous history of temporal bone trauma and/or middle ear surgery. A pneumolabyrinth should be suspected in case of patients presenting recurrent intractable PPV after ear trauma.

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Hearing loss and chronic vestibular pathologies require brain adaptive mechanisms supported by a cross-modal cortical plasticity. They are often accompanied by cognitive deficits. Spatial memory is a cognitive process responsible for recording information about the spatial environment and spatial orientation. Visual-spatial working memory (VSWM) is a kind of short-term working memory that allows spatial information to be temporarily stored and manipulated. It can be conditioned by hearing loss and also well-compensated chronic vestibular deficit. Vestibular rehabilitation and hearing aid devices or training are able to improve the VSWM. We studied 119 subjects suffering from perinatal or congenital hearing loss, compared with 532 healthy subjects and 404 patients with well-compensated chronic vestibular deficit (CVF). VSWM was evaluated by the eCorsi test. The subjects suffering from chronic hearing loss and/or unilateral or bilateral vestibular deficit showed a VSWM less efficient than healthy people, but much better than those with CVF, suggesting a better multimodal adaptive strategy, probably favored by a cross-modal plasticity which also provides habitual use of lip reading. The sport activity cancels the difference with healthy subjects. It is therefore evident that patients with this type of deficit since childhood should be supported and advised on a sport activity or repeated vestibular stimulation.