The Big Three: How Vestibular, Vision, and Proprioception Shape Balance, Brain Function, and Beyond
October 28, 2025
In the world of clinical neurology, we often refer to “The Big Three”—the vestibular, visual, and proprioceptive (somatosensory) systems. These sensory systems work together to give your brain important information in order for it to answer two critical questions – “Where am I in my environment?” and “Where is my environment in relation to me?” This allows you to maintain balance, posture, muscle tone, regulate your autonomic tone and even cognitive clarity.
But what happens when this triad is out of sync?
Let’s dive into the science behind this powerful trio and the brain region that integrates their input—the medial vestibular nucleus—and explore how sensory mismatch can create dysfunction, and more importantly, how we can recalibrate and rehabilitate these systems for profound healing.
🧠 The Brain’s Multisensory Integrator: The Medial Vestibular Nucleus
At the heart of this sensory integration lies a remarkable structure deep in the brainstem: the medial vestibular nucleus (MVN). This area is unique in the brain—a true multisensory hub that converges information from the inner ear (vestibular), body awareness (proprioception), and visual input to form a coherent map of your body in space (1)(2)(3).
What makes the MVN special?
- It is the only region in the brain that houses this level of three-way multisensory integration at the cellular level.
- It operates at a subconscious level, constantly comparing and contrasting incoming sensory feedback to maintain equilibrium.
- It serves as a command center for motor output, influencing balance, gait, posture, eye movements, muscle tone, and autonomic responses like heart rate and blood pressure.
When the data from these systems align correctly, the brain delivers accurate and coordinated output. But if one system is off—even slightly—the brain gets confused.
⚠️ Sensory Mismatch: When The Big Three Don’t Agree
Imagine trying to drive with a malfunctioning GPS, speedometer, or windshield. That’s what happens to your brain when vestibular, visual, and proprioceptive systems are giving conflicting information—a phenomenon known as sensory mismatch (2)(5).
Common symptoms of sensory mismatch include:
- Dizziness or unsteadiness
- Chronic neck or back tightness
- Visual fatigue or eye tracking issues
- Disorientation or “brain fog”
- Autonomic symptoms like nausea, palpitations, or lightheadedness
- Poor balance or falls
- Difficulty with multitasking or memory
Over time, the brain begins to compensate for the mismatch, but these compensations are often maladaptive—leading to chronic tightness, imbalance between flexor and extensor muscle tone, and inefficient movement patterns.
Other compensations involve upregulating the visual system. This can lead to things like visually induced dizziness, visual motion sensitivity, dizziness or anxiety with moving the head while walking, motion sickness, car sickness, etc. This is common with individuals that have PPPD (Persistent Postural-Perceptual Dizziness).
🧬 How Integration Affects Muscle Tone and Movement
One of the lesser-known effects of poor sensory integration is how it alters muscle tone—especially through the vestibulospinal and reticulospinal tracts that descend from the brainstem to the spinal cord (4)(5). This is particularly evident in persistent tightness of the neck, hamstrings, and calves as these three areas relate heavily to maintaining equilibrium and balance.
When integration is off:
- The brain may upregulate tone in certain muscle groups (e.g., tight traps, hamstrings, paraspinals) to stabilize the body.
- There’s often asymmetry in muscle tone or reflex activity, contributing to chronic pain or stiffness.
- Postural reflexes become unbalanced, making everyday movements feel off or difficult.
In patients with Parkinson’s disease, for example, we often see this play out as:
- Rigidity and stooped posture (from altered flexor/extensor tone)
- Freezing of gait (from impaired sensorimotor integration)
- Visual-vestibular mismatch leading to impaired navigation or falls
This isn’t just a motor issue—it’s a multisensory integration issue.
From Balance to Behavior: How Vestibular Dysfunction Impacts Cognition and Mental Health
While we often associate vestibular issues with dizziness and balance problems, research increasingly shows that vestibular dysfunction is also strongly linked to impairments in attention, spatial memory, emotional regulation, and executive function (6)(7)(8). That’s because the vestibular system projects widely throughout the brain, influencing not only movement and orientation, but also key areas responsible for cognition and mood.
At the same time, regions of the brainstem responsible for vestibular integration are also in charge of vital autonomic functions like heart rate, blood pressure, digestion, and reflexive postural control. From a neurological standpoint, the brain prioritizes survival above all else—and when under stress or dysfunction, it will divert resources to protect these foundational systems, even if it comes at the cost of higher-level processes like focus, learning, memory, and emotional resilience.
This helps explain why individuals with vestibular dysfunction often report feeling:
- Foggy or disoriented
- Mentally fatigued or unfocused
- Slower with memory and processing
- Less emotionally regulated or resilient
This overlap also sheds light on why vestibular dysfunction is not just a balance issue—it has been associated with increased rates of psychiatric symptoms like anxiety, panic disorders, depersonalization, and dissociation (9)(10). These are not merely emotional reactions to feeling dizzy; they may stem from disrupted sensory integration at the brainstem level, where the systems responsible for both balance and mood regulation intersect.
🧠 Neurological Rehabilitation: Recalibrating the Big Three
At our Carmel, IN clinic, our neurological rehabilitation programs are designed to retrain and recalibrate these systems by providing targeted, meaningful stimulation to the areas that need it most.
Our approach includes:
- Vestibular therapy using VOG/VNG diagnostics & rehabilitation (like the Spryson Dx200 + NeuroAI) to precisely identify imbalances or dysfunction
- Proprioceptive retraining through chiropractic adjustments, whole-body vibration (WBV), laser feedback movement and others
- Visual and ocular-motor training, including saccade therapy, vergence retraining, and gaze stability exercises.
- Multi-sensory recalibration protocols that combine head-eye movement, balance training, and somatosensory feedback to rebuild proper integration.
- Brainstem modulation using PEMF, neuromodulation, and metabolic support to enhance neuroplasticity.
These interventions don’t just address symptoms—they restore the brain’s ability to make sense of the world again.
🌐 Why It Matters
The body is not compartmentalized—and neither is the brain.
Balance, stability, cognition, pain, and posture are all outputs that depend on the accuracy of inputs. The medial vestibular nucleus serves as the “auditor” of this system, ensuring everything lines up before motor output is generated (1)(2).
If you’re experiencing dizziness or vertigo, unexplained tightness, chronic fatigue, or cognitive changes, the root cause may not be your muscles or eyes—but how your brainstem is interpreting the Big Three.
👣 Next Steps
At Nexus Neuro, we specialize in identifying and correcting these hidden imbalances using cutting-edge technology, evidence-based neurological rehab, and personalized care.
Ready to recalibrate your brain and body?
Click below to schedule a diagnostic session and discover how balance begins in the brain.
References
- Cullen, K. E. (2012). The vestibular system: multimodal integration and encoding of self‐motion for motor control. Frontiers in Neurology. PMC.
- Carriot, J., et al. (2015). Rapid adaptation of multisensory integration in vestibular–cerebellar circuits when the vestibular input becomes unreliable. Frontiers in Systems Neuroscience.
- Medrea, I., et al. (2013). Multisensory integration in early vestibular processing in the brainstem. Journal of Physiology.
- Bronstein, A. M. (2016). Multisensory integration in balance control. In Handbook of Clinical Neurology: Balance Disorders.
- Carriot, J., et al. (2013). Multimodal Integration of Self‑Motion Cues in the Brainstem and Cerebellum. Journal of Neuroscience.
- Guo, J., et al. (2024). Vestibular dysfunction leads to cognitive impairments. PMC.
- Smith, L. J., Wilkinson, D., Bodani, M., Surenthiran, S. (2024). Cognition in vestibular disorders: state of the field, challenges, and priorities for the future. Frontiers in Neurology.
- Tele‑Heri, B., et al. (2021). Vestibular stimulation may drive multisensory processing. Brain. MDPI.
- Aedo‑Sanchez, C., et al. (2024). Vestibular dysfunction and its association with cognitive impairment. PMC.
- Koc Apaydın, Z., et al. (2025). Vestibular and balance dysfunction in ADHD and cognitive disengagement syndrome. Molecular and Cellular Pediatrics.
- Gurvich, C., Maller, J. J., et al. (Year). Vestibular insights into cognition and psychiatry. (Semantic Scholar).
- James, D. J., Glaze, L. E. (2006). Mental Health Problems of Prison and Jail Inmates. Bureau of Justice Statistics.