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...
Main Authors: | , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Frontiers Media S.A.
2018-07-01
|
Series: | Frontiers in Neurology |
Subjects: | |
Online Access: | https://www.frontiersin.org/article/10.3389/fneur.2018.00562/full |
id |
doaj-630cf771969a4b02a3bbb728135d0032 |
---|---|
record_format |
Article |
spelling |
doaj-630cf771969a4b02a3bbb728135d00322020-11-24T21:40:38ZengFrontiers Media S.A.Frontiers in Neurology1664-22952018-07-01910.3389/fneur.2018.00562373925Head-Movement-Emphasized Rehabilitation in Bilateral VestibulopathyNadine Lehnen0Nadine Lehnen1Nadine Lehnen2Silvy Kellerer3Alexander G. Knorr4Alexander G. Knorr5Cornelia Schlick6Klaus Jahn7Klaus Jahn8Erich Schneider9Maria Heuberger10Maria Heuberger11Cecilia Ramaioli12Cecilia Ramaioli13Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar,Technical University of Munich, Munich, GermanyGerman Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, GermanyInstitute of Medical Technology, Brandenburgische Technische Universität, Cottbus, GermanyGerman Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, GermanyCenter for Sensorimotor Research, Ludwig Maximilians University, Munich, GermanyDepartment of Electrical and Computer Engineering, Institute for Cognitive Systems, Technical University of Munich, Munich, GermanyGerman Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, GermanyGerman Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, GermanyDepartment of Neurology,Schoen Clinic Bad Aibling, Bad Aibling, GermanyInstitute of Medical Technology, Brandenburgische Technische Universität, Cottbus, GermanyGerman Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, GermanyDepartment of Neurology, Ludwig Maximilians University, Munich, GermanyGerman Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, GermanyInstitute of Medical Technology, Brandenburgische Technische Universität, Cottbus, GermanyObjective: 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.https://www.frontiersin.org/article/10.3389/fneur.2018.00562/fullvestibular rehabilitationbilateral vestibular hypofunctionre-fixation saccadesvestibulo-ocular reflexHITD-FTdynamic vision |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Nadine Lehnen Nadine Lehnen Nadine Lehnen Silvy Kellerer Alexander G. Knorr Alexander G. Knorr Cornelia Schlick Klaus Jahn Klaus Jahn Erich Schneider Maria Heuberger Maria Heuberger Cecilia Ramaioli Cecilia Ramaioli |
spellingShingle |
Nadine Lehnen Nadine Lehnen Nadine Lehnen Silvy Kellerer Alexander G. Knorr Alexander G. Knorr Cornelia Schlick Klaus Jahn Klaus Jahn Erich Schneider Maria Heuberger Maria Heuberger Cecilia Ramaioli Cecilia Ramaioli Head-Movement-Emphasized Rehabilitation in Bilateral Vestibulopathy Frontiers in Neurology vestibular rehabilitation bilateral vestibular hypofunction re-fixation saccades vestibulo-ocular reflex HITD-FT dynamic vision |
author_facet |
Nadine Lehnen Nadine Lehnen Nadine Lehnen Silvy Kellerer Alexander G. Knorr Alexander G. Knorr Cornelia Schlick Klaus Jahn Klaus Jahn Erich Schneider Maria Heuberger Maria Heuberger Cecilia Ramaioli Cecilia Ramaioli |
author_sort |
Nadine Lehnen |
title |
Head-Movement-Emphasized Rehabilitation in Bilateral Vestibulopathy |
title_short |
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_sort |
head-movement-emphasized rehabilitation in bilateral vestibulopathy |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Neurology |
issn |
1664-2295 |
publishDate |
2018-07-01 |
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. |
topic |
vestibular rehabilitation bilateral vestibular hypofunction re-fixation saccades vestibulo-ocular reflex HITD-FT dynamic vision |
url |
https://www.frontiersin.org/article/10.3389/fneur.2018.00562/full |
work_keys_str_mv |
AT nadinelehnen headmovementemphasizedrehabilitationinbilateralvestibulopathy AT nadinelehnen headmovementemphasizedrehabilitationinbilateralvestibulopathy AT nadinelehnen headmovementemphasizedrehabilitationinbilateralvestibulopathy AT silvykellerer headmovementemphasizedrehabilitationinbilateralvestibulopathy AT alexandergknorr headmovementemphasizedrehabilitationinbilateralvestibulopathy AT alexandergknorr headmovementemphasizedrehabilitationinbilateralvestibulopathy AT corneliaschlick headmovementemphasizedrehabilitationinbilateralvestibulopathy AT klausjahn headmovementemphasizedrehabilitationinbilateralvestibulopathy AT klausjahn headmovementemphasizedrehabilitationinbilateralvestibulopathy AT erichschneider headmovementemphasizedrehabilitationinbilateralvestibulopathy AT mariaheuberger headmovementemphasizedrehabilitationinbilateralvestibulopathy AT mariaheuberger headmovementemphasizedrehabilitationinbilateralvestibulopathy AT ceciliaramaioli headmovementemphasizedrehabilitationinbilateralvestibulopathy AT ceciliaramaioli headmovementemphasizedrehabilitationinbilateralvestibulopathy |
_version_ |
1725925436849913856 |