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Head-Movement-Emphasized Rehabilitation in Bilateral Vestibulopathy
Objective: Although there is evidence that vestibular rehabilitation is useful for treating chronic bilateral vestibular hypofunction (BVH), the mechanisms for improvement, and the reasons why only some patients improve are still unclear. Clinical rehabilitation results and evidence fromeye-head con...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6057116/ https://www.ncbi.nlm.nih.gov/pubmed/30065695 http://dx.doi.org/10.3389/fneur.2018.00562 |
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author | Lehnen, Nadine Kellerer, Silvy Knorr, Alexander G. Schlick, Cornelia Jahn, Klaus Schneider, Erich Heuberger, Maria Ramaioli, Cecilia |
author_facet | Lehnen, Nadine Kellerer, Silvy Knorr, Alexander G. Schlick, Cornelia Jahn, Klaus Schneider, Erich Heuberger, Maria Ramaioli, Cecilia |
author_sort | Lehnen, Nadine |
collection | PubMed |
description | Objective: Although there is evidence that vestibular rehabilitation is useful for treating chronic bilateral vestibular hypofunction (BVH), the mechanisms for improvement, and the reasons why only some patients improve are still unclear. Clinical rehabilitation results and evidence fromeye-head control in vestibular deficiency suggest that headmovement is a crucial element of vestibular rehabilitation. In this study, we assess the effects of a specifically designed head-movement-based rehabilitation program on dynamic vision, and explore underlying mechanisms. Methods: Two adult patients (patients 1 and 2) with chronic BVH underwent two 4-week interventions: (1) head-movement-emphasized rehabilitation (HME) with exercises based on active head movements, and (2) eye-movement-only rehabilitation (EMO), a control intervention with sham exercises without head movement. In a double-blind crossover design, the patients were randomized to first undergo EMO (patient 1) and–after a 4-week washout–HME, and vice-versa (patient 2). Before each intervention and after a 4-week follow-up patients’ dynamic vision, vestibulo-ocular reflex (VOR) gain, as well as re-fixation saccade behavior during passive headmotion were assessed with the head impulse testing device–functional test (HITD-FT). Results: HME, not EMO, markedly improved perception with dynamic vision during passive head motion (HITD-FT score) increasing from 0 to 60% (patient 1) and 75% (patient 2). There was a combination of enhanced VOR, as well as improved saccadic compensation. Conclusion: Head movement seems to be an important element of rehabilitation for BVH. It improves dynamic vision with a combined VOR and compensatory saccade enhancement. |
format | Online Article Text |
id | pubmed-6057116 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-60571162018-07-31 Head-Movement-Emphasized Rehabilitation in Bilateral Vestibulopathy Lehnen, Nadine Kellerer, Silvy Knorr, Alexander G. Schlick, Cornelia Jahn, Klaus Schneider, Erich Heuberger, Maria Ramaioli, Cecilia Front Neurol Neurology Objective: Although there is evidence that vestibular rehabilitation is useful for treating chronic bilateral vestibular hypofunction (BVH), the mechanisms for improvement, and the reasons why only some patients improve are still unclear. Clinical rehabilitation results and evidence fromeye-head control in vestibular deficiency suggest that headmovement is a crucial element of vestibular rehabilitation. In this study, we assess the effects of a specifically designed head-movement-based rehabilitation program on dynamic vision, and explore underlying mechanisms. Methods: Two adult patients (patients 1 and 2) with chronic BVH underwent two 4-week interventions: (1) head-movement-emphasized rehabilitation (HME) with exercises based on active head movements, and (2) eye-movement-only rehabilitation (EMO), a control intervention with sham exercises without head movement. In a double-blind crossover design, the patients were randomized to first undergo EMO (patient 1) and–after a 4-week washout–HME, and vice-versa (patient 2). Before each intervention and after a 4-week follow-up patients’ dynamic vision, vestibulo-ocular reflex (VOR) gain, as well as re-fixation saccade behavior during passive headmotion were assessed with the head impulse testing device–functional test (HITD-FT). Results: HME, not EMO, markedly improved perception with dynamic vision during passive head motion (HITD-FT score) increasing from 0 to 60% (patient 1) and 75% (patient 2). There was a combination of enhanced VOR, as well as improved saccadic compensation. Conclusion: Head movement seems to be an important element of rehabilitation for BVH. It improves dynamic vision with a combined VOR and compensatory saccade enhancement. Frontiers Media S.A. 2018-07-17 /pmc/articles/PMC6057116/ /pubmed/30065695 http://dx.doi.org/10.3389/fneur.2018.00562 Text en Copyright © 2018 Lehnen, Kellerer, Knorr, Schlick, Jahn, Schneider, Heuberger and Ramaioli. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Neurology Lehnen, Nadine Kellerer, Silvy Knorr, Alexander G. Schlick, Cornelia Jahn, Klaus Schneider, Erich Heuberger, Maria Ramaioli, Cecilia Head-Movement-Emphasized Rehabilitation in Bilateral Vestibulopathy |
title | Head-Movement-Emphasized Rehabilitation in Bilateral Vestibulopathy |
title_full | Head-Movement-Emphasized Rehabilitation in Bilateral Vestibulopathy |
title_fullStr | Head-Movement-Emphasized Rehabilitation in Bilateral Vestibulopathy |
title_full_unstemmed | Head-Movement-Emphasized Rehabilitation in Bilateral Vestibulopathy |
title_short | Head-Movement-Emphasized Rehabilitation in Bilateral Vestibulopathy |
title_sort | head-movement-emphasized rehabilitation in bilateral vestibulopathy |
topic | Neurology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6057116/ https://www.ncbi.nlm.nih.gov/pubmed/30065695 http://dx.doi.org/10.3389/fneur.2018.00562 |
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