Interaction between Vestibular Compensation Mechanisms and Vestibular Rehabilitation Therapy: 10 Recommendations for Optimal Functional Recovery (original) (raw)
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Top-down approach to vestibular compensation: Translational lessons from vestibular rehabilitation
Brain Research, 2012
This review examines vestibular compensation and vestibular rehabilitation from a unified translational research perspective. Laboratory studies illustrate neurobiological principles of vestibular compensation at the molecular, cellular and systems levels in animal models that inform vestibular rehabilitation practice. However, basic research has been hampered by an emphasis on 'naturalistic' recovery, with time after insult and drug interventions as primary dependent variables. The vestibular rehabilitation literature, on the other hand, provides information on how the degree of compensation can be shaped by specific activity regimens. The milestones of the early spontaneous static compensation mark the re-establishment of static gaze stability, which provides a common coordinate frame for the brain to interpret residual vestibular information in the context of visual, somatosensory and visceral signals that convey gravitoinertial information. Stabilization of the head orientation and the eye orientation (suppression of spontaneous nystagmus) appear to be necessary by not sufficient conditions for successful rehabilitation, and define a baseline for initiating retraining. The lessons from vestibular rehabilitation in animal models offer the possibility of shaping the recovery trajectory to identify molecular and genetic factors that can improve vestibular compensation.
Vestibular compensation: the neuro-otologist’s best friend
Journal of Neurology, 2016
Why vestibular compensation (VC) after an acute unilateral vestibular loss is the neuro-otologist's best friend is the question at the heart of this paper. The different plasticity mechanisms underlying VC are first reviewed, and the authors present thereafter the dual concept of vestibulo-centric versus distributed learning processes to explain the compensation of deficits resulting from the static versus dynamic vestibular imbalance. The main challenges for the plastic events occurring in the vestibular nuclei (VN) during a post-lesion critical period are neural protection, structural reorganization and rebalance of VN activity on both sides. Data from animal models show that modulation of the ipsilesional VN activity by the contralateral drive substitutes for the normal push-pull mechanism. On the other hand, sensory and behavioural substitutions are the main mechanisms implicated in the recovery of the dynamic functions. These newly elaborated sensorimotor reorganizations are vicarious idiosyncratic strategies implicating the VN and multisensory brain regions. Imaging studies in unilateral vestibular loss patients show the implication of a large neuronal network (VN, commissural pathways, vestibulocerebellum, thalamus, temporoparietal cortex, hippocampus, somatosensory and visual cortical areas). Changes in gray matter volume in these multisensory brain regions are structural changes supporting the sensory substitution mechanisms of VC. Finally, the authors summarize the two ways to improve VC in humans (neuropharmacology and vestibular rehabilitation therapy), and they conclude that VC would follow a ''top-down'' strategy in patients with acute vestibular lesions. Future challenges to understand VC are proposed. Keywords Unilateral vestibular loss Á Vestibular compensation Á Static deficits recovery Á Dynamic deficits recovery Á Animal models Á Human brain imaging
Current concepts and future approaches to vestibular rehabilitation
Journal of neurology, 2016
Over the last decades methods of vestibular rehabilitation to enhance adaptation to vestibular loss, habituation to changing sensory conditions, and sensory reweighting in the compensation process have been developed. However, the use of these techniques still depends to a large part on the educational background of the therapist. Individualized assessment of deficits and specific therapeutic programs for different disorders are sparse. Currently, vestibular rehabilitation is often used in an unspecific way in dizzy patients irrespective of the clinical findings. When predicting the future of vestibular rehabilitation, it is tempting to foretell advances in technology for assessment and treatment only, but the current intense exchange between clinicians and basic scientists also predicts advances in truly understanding the complex interactions between the peripheral senses and central adaptation mechanisms. More research is needed to develop reliable techniques to measure sensory de...
EFFICACY OF VESTIBULAR REHABILITATION
Otolaryngologic Clinics of North America, 2000
This article is a summary of the research on the effectiveness of vestibular rehabilitation in patients with vestibular disorders. The literature on patients with peripheral, central, combined peripheral and central disorders, and panic and anxiety disorders is reviewed. The positive outcomes of intervention are highlighted.
NeuroRehabilitation, 2020
BACKGROUND: Only a few studies in the literature demonstrate the effect of vestibular rehabilitation (VR) on all vestibular receptor organs. Furthermore, very little evidence of the effect of VR on isolated otolith dysfunction (IOD) is available. OBJECTIVE: The study aimed to investigate the effect of VR on all vestibular receptor organs in patients with different types of unilateral vestibular hypofunction (UVH). METHODS: We enrolled 80 patients with three different types of UVH; combined and isolated loss of semicircular canal and otolith organ function. All patients performed a 12-week customized program of VR and received a full battery of vestibular function tests, before and after the VR. The DHI and SF-36 were performed before, after 6 weeks, and 12 weeks of the VR. RESULTS: Parameters of the caloric test, video head impulse test, ocular and cervical vestibular evoked myogenic potentials were significantly improved after VR. A total of 59 (74%) patients fully recovered, with ...
NeuroRehabilitation, 2019
BACKGROUND: The minimal number of studies have documented the impact of Vestibular rehabilitation (VR) on the recovery rate of patients with Chronic Unilateral Vestibular Hypofunction (CUVH) and Bilateral Vestibular Hypofunction (BVH). OBJECTIVES: The goal of the study was to show and compare the impact of vestibular rehabilitation (VR) in patients with CUVH and BVH. METHODS: We analysed the data of 30 patients with CUVH and 20 with BVH treated with VR. The patients with CUVH during their eight-week treatment were controlled every two weeks, while the patients with BVH were controlled every three months during their one-year treatment; they filled in the DHI and ABC questionnaires every time. RESULTS: In both groups of patients, there was significantly less disablement between the initial and final DHI scores (from 59-20 in CUVH and 74-41 in BVH group). There was a significant increase in the balance confidence between the initial and final ABC Scale in both groups of patients (from 49.5-90% in CUVH and 42-73% in BVH group). CONCLUSIONS: Well-planned and individually adjusted system of vestibular exercises leads to a significant decrease in clinical symptoms and improvement of functioning and confidence in activities in both the CUVH and the BVH patients.
Vestibular Rehabilitation Outcome in Patients with Vestibular Neuronitis
Romanian Journal of Neurology, 2011
Objectives: Our study evaluates the benefits of vestibular rehabilitation (VR) in patients with vestibular neuronitis and tries to identify appropriate assessment tools for monitoring the outcome. Material and methods: Fourteen patients with vestibular neuronitis were included in a prospective study conducted in the Institute of Phono-Audiology and Functional ENT Surgery Bucharest. All patients underwent a combined medical (betahistine 48 mg per day) and physical (VR exercises) treatment. The recovery was assessed through clinical examination (nystagmus, Romberg and Unterberger tests), computerized dynamic posturography and several physical performance tests (Berg Balance Scale, Short Physical Performance Battery, Performance Oriented Balance and Mobility Assessment and Dynamic Gait Index), both at fi rst visit and 30 days after treatment. Results: After one month of VR, statistically significant improvements (p<0.05) were found in clinical aspects, computerized dynamic posturogr...
The Value of Vestibular Rehabilitation in Patients with Bilateral Vestibular Dysfunction
The Journal of International Advanced Otology, 2017
The value of vestibular rehabilitation in patients with bilateral vestibular dysfunction was investigated. MATERIALS and METHODS: This study assessed 17 patients (9 males, 8 females) with bilateral vestibular dysfunction. Vestibular rehabilitation continued for 1.5 months. Videonystagmography tests (including oculomotor testing, positional testing, and caloric tests), vestibular evoked myogenic potential (VEMP) testing, and computerized dynamic posturography were performed during the pre-, mid-, and post-treatment periods. The patients underwent cranial and internal acoustic canal MRI. Consultant physicians from the neurology and physical medicine and rehabilitation departments reviewed all patients. RESULTS: The post-treatment anteroposterior somatosensorial (APSO), anteroposterior global (APGLO), mediolateral visual (MLVI), and mediolateral global values and anteroposterior and mediolateral trials and conditions were significantly higher than those measured in the pre-treatment period. Similarly, mid-treatment values of the APSO, APGLO, and the anteroposterior sensory organization test (SOT) 2 were significantly higher than those measured in the pre-treatment period. CONCLUSION: Vestibular rehabilitation was effective in patients with bilateral vestibular dysfunction. As the vestibular rehabilitation duration increased, so did the efficacy of the treatment.