{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T18:39:19Z","timestamp":1770748759005,"version":"3.50.0"},"reference-count":20,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2023,11,1]],"date-time":"2023-11-01T00:00:00Z","timestamp":1698796800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100005339","name":"American Academy of Neurology","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005339","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","award":["I01CX002086"],"award-info":[{"award-number":["I01CX002086"]}],"id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["movementdisorders.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Movement Disorders"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Cervical dystonia (CD) is an intricate neurological condition with motor and nonmotor symptoms. These include disruptions in visual perception, self\u2010orientation, visual working memory, and vestibular functions. However, the specific impact of CD on perceiving self\u2010motion direction, especially with isolated visual or vestibular stimuli, remains largely unexplored.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>This study aimed to examine the effects of CD on linear motion perception, hypothesizing impaired heading discrimination in both vestibular and visual tasks, and that such deficits correlate with the disease severity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We employed a cutting\u2010edge motion platform to precisely control whole\u2010body linear motion. Through repeated two\u2010alternative forced\u2010choice tasks, we assessed vestibular heading direction discrimination. Participants observed dynamic star clouds in immersive virtual reality and indicated their perceived self\u2010motion direction, evaluating visual heading direction discrimination. Sensitivity to direction variations and response accuracy errors were analyzed using robust Gaussian cumulative distribution psychometric functions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Heading perception is impaired in individuals with CD, particularly evident in vestibular heading discrimination. CD severity correlated with elevated thresholds for both vestibular and visual heading discrimination. Surprisingly, lateralized CD did not introduce bias in either system, suggesting widespread disruption over localized effects.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Contrary to previous beliefs, our findings challenge the idea that CD\u2010related heading discrimination issues mainly arise from peripheral vestibular effects. Instead, abnormal proprioceptive input from dystonic neck muscles introduces noise into the central mechanism integrating visual, vestibular, and proprioceptive signals. These insights into spatial navigation deficits have implications for future CD research. \u00a9 2023 The Authors. <jats:italic>Movement Disorders<\/jats:italic> published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mds.29612","type":"journal-article","created":{"date-parts":[[2023,11,2]],"date-time":"2023-11-02T00:07:14Z","timestamp":1698883634000},"page":"2116-2121","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Unraveling the Twist: Spatial Navigational Challenges in Cervical Dystonia"],"prefix":"10.1002","volume":"38","author":[{"given":"Hanieh","family":"Agharazi","sequence":"first","affiliation":[{"name":"National VA Parkinson Consortium Center, Neurology Service, Louis Stokes Cleveland VA Medical Center  Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7264-1312","authenticated-orcid":false,"given":"Alexander","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology Case Western Reserve University  Cleveland Ohio USA"},{"name":"Movement Disorders Center Neurological Institute, University Hospitals  Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aratrik","family":"Guha","sequence":"additional","affiliation":[{"name":"National VA Parkinson Consortium Center, Neurology Service, Louis Stokes Cleveland VA Medical Center  Cleveland Ohio USA"},{"name":"Department of Biomedical Engineering Case Western Reserve University  Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Palak","family":"Gupta","sequence":"additional","affiliation":[{"name":"National VA Parkinson Consortium Center, Neurology Service, Louis Stokes Cleveland VA Medical Center  Cleveland Ohio USA"},{"name":"Department of Biomedical Engineering Case Western Reserve University  Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4772-2823","authenticated-orcid":false,"given":"Aasef G.","family":"Shaikh","sequence":"additional","affiliation":[{"name":"National VA Parkinson Consortium Center, Neurology Service, Louis Stokes Cleveland VA Medical Center  Cleveland Ohio USA"},{"name":"Department of Neurology Case Western Reserve University  Cleveland Ohio USA"},{"name":"Movement Disorders Center Neurological Institute, University Hospitals  Cleveland Ohio USA"},{"name":"Department of Biomedical Engineering Case Western Reserve University  Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,11]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awr224"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.5334\/tohm.466"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00878528"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.22736"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.2466\/pms.1994.78.3c.1363"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2017.00066"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2020.01434"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000008916"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.49.3.290"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.54.1.39"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.52.1.57"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.50.5.580"},{"key":"e_1_2_10_14_1","first-page":"219","article-title":"Vestibular involvement in spasmodic torticollis: an old hypothesis with new data from otolith testing","volume":"42","author":"Diamond SG","year":"1988","journal-title":"Adv Otorhinolaryngol"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.3109\/00016489509125193"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.870120514"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-642-65920-1_1"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awg230"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awn168"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1152\/jn.1976.39.3.601"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1038\/nn1935"}],"container-title":["Movement Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/movementdisorders.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mds.29612","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T10:51:36Z","timestamp":1760957496000},"score":1,"resource":{"primary":{"URL":"https:\/\/movementdisorders.onlinelibrary.wiley.com\/doi\/10.1002\/mds.29612"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11]]},"references-count":20,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2023,11]]}},"alternative-id":["10.1002\/mds.29612"],"URL":"https:\/\/doi.org\/10.1002\/mds.29612","archive":["Portico"],"relation":{},"ISSN":["0885-3185","1531-8257"],"issn-type":[{"value":"0885-3185","type":"print"},{"value":"1531-8257","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11]]},"assertion":[{"value":"2023-05-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-09-05","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-11-01","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}