Vestibüler Rehabilitasyona Güncel Bakış

Vestibüler rehabilitasyon periferik ve santral vestibüler sistem hastalıklarında kullanılan bir tedavi yöntemidir. Vestibüler rehabilitasyonun amacı insan beynindeki adaptif ve kompansatuar mekanizmaları harekete geçirmektir. Başlıca endikasyonları, vestibüler hipofonksiyon ve benign paroksismal pozisyonel vertigodur. Stabil olup henüz kompanzasyon mekanizması tamamlanmamış vestibüler sistem lezyonlarında önerilmektedir. Spesifik ve spesifik olmayan tedavi yöntemleri bulunmaktadır. Spesifik tedavi yöntemleri arasında habitüasyon, adaptasyon, substitüsyon ve otolitlerin yeniden pozisyonlandırılması gelirken, spesifik olmayan metotlar arasında endurans egzersizleri, yürüme ve denge ile ilgili spesifik kas gruplarının güçlendirilmesi gelmektedir. Vestibüler rehabilitasyonda uygulanan diğer tedavi seçenekleri vibrotaktil geri besleme, sanal gerçeklik ve vestibüler elektriksel stimülasyondur. Vestibüler rehabilitasyon, dalgalanma gösteren vestibüler kayıplarda, devam eden labirent patolojilerinde ve yavaş progresyon gösteren bir tümör varlığında faydasızdır

Anahtar Kelimeler:

Vertigo, vestibüler hipofonksiyon, vestibüler rehabilitasyon

Current Look at Vestibular Rehabilitation

Vestibular rehabilitation is a treatment method which is used for peripheral and central vestibular system disorders. The aim of vestibular rehabilitation is to activate the adaptive and compensatory mechanisms in the brain. The main indications are vestibular hypofunction and benign paroxysmal positional vertigo. It is recommended in stable vestibular lesions with incomplete compensation mechanism. There are specific and non-specific treatment options. Specific treatment methods include habituation, adaptation, substitution and otolith repositioning, whilst non-specific methods are endurance exercises and strengthening of the specific muscle groups related to ambulation and balance. Other treatment options used in vestibular rehabilitation are vibrotactile feedback, virtual reality and vestibular electrical stimulation. Vestibular rehabilitation techniques are not beneficial in fluctuant vestibular loss, ongoing labyrinth pathologies and slow progressing tumors.

Keywords:

Vertigo, vestibular hypofunction, vestibular rehabilitation,

PDF

___

1. Thompson TL, Amedee R. Vertigo: a review of common peripheral and central vestibular disorders. Ochsner J 2009;9:20-6.
2. Han BI, Song HS, Kim JS. Vestibular rehabilitation therapy: review of indications, mechanisms, and key exercises. J Clin Neurol 2011;7:184-96. [CrossRef]
3. Cawthorne T. Vestibular injuries. Proc R Soc Med 1946;39:270-3.
4. Cooksey FS. Rehabilitation in vestibular injuries. Proc R Soc Med 1946; 39:273-8.
5. Shepard NT, Telian SA, Smith-Wheelock M, Raj A. Vestibular and balance rehabilitation therapy. Ann Otol Rhinol Laryngol 1993;102:198-205. [CrossRef]
6. Boyer FC, Percebois-Macadré L, Regrain E, Lévêque M, Taïar R, Seidermann L, et al. Vestibular rehabilitation therapy. Neurophysiol Clin 2008;38:479-87. [CrossRef]
7. Porciuncula F, Johnson CC, Glickman LB. The effect of vestibular rehabilitation on adults with bilateral vestibular hypofunction: a systematic review. J Vestib Res 2012;22:283-98.
8. Herdman SJ. Advances in the treatment of vestibular disorders. Phys Ther 1997;77:602-18.
9. Pavlou M. The use of optokinetic stimulation in vestibular rehabilitation. JNPT 2010;34:105-10.
10. Pavlou M, Shumway-Cook A, Horak FB, Yardley L, Bronstein AM. Rehabilitation of balance disorders in the patient with vestibular pathology. In: Bronstein AM, Brandt T, Woollacott MH, Nutt JG. Clinical Disorders of Balance, Posture and Gait, 2nd ed. Arnold, London, 2004:317-43.
11. Shepard NT, Telian SA, Smith-Wheelock M. Habituation and bal¬ance retraining therapy. A retrospective review. Neurol Clin 1990;8:459-75.
12. Hillier SL, McDonnell M. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database Syst Rev 2011;16:CD005397.
13. Herdman SJ. Vestibular rehabilitation. Curr Opin Neurol 2013;26:96-101. [CrossRef]
14. Yardımcı S, İncesulu A, Kuran G, Kurukahvecioğlu S, Erkam Ü. Posterior Semisirküler Kanal Orijinli Benign Paroksismal Pozisyonel Vertigoda Modifiye Epley Manevrasının Etkinliği. K.B.B ve BBC Dergisi 2002;10:8-15.
15. Hall SF, Ruby RR, McClure JA. The mechanics of benign paroxysmal vertigo. J Otolaryngol 1979;8:151-8.
16. Schuknecht HF. Cupulolithiasis. Arch Otolaryngol 1969;90:765-78. [CrossRef]
17. Dix MR, Hallpike CS. The pathology symptomatology and diagnosis of certain common disorders of the vestibular system. Proc R Soc Med 1952;45:341-54.
18. Epley JM. The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 1992;107:399-404.
19. Hunt WT, Zimmermann EF, Hilton MP. Modifications of the Epley (canalith repositioning) manoeuvre for posterior canal benign paroxysmal positional vertigo (BPPV). Cochrane Database Syst Rev 2012;4:CD008675.
20. Brandt T, Daroff RB. Physical therapy for benign paroxysmal positional vertigo. Arch Otolaryngol 1980;106:484-5. [CrossRef]
21. Amor-Dorado JC, Barreira-Fernández MP, Aran-Gonzalez I, Casariego-Vales E, Llorca J, González-Gay MA. Particle repositioning maneuver versus BrandtDaroff exercise for treatment of unilateral idiopathic BPPV of the posterior semicircular canal: a randomized prospective clinical trial with short- and long-term outcome. Otol Neurotol 2012;33:1401-7. [CrossRef]
22. Helminski JO, Janssen I, Hain TC. Daily exercise does not prevent recurrence of benign paroxysmal positional vertigo. Otol Neurotol 2008;29:976-81. [CrossRef]
23. Pavlou M, Kanegaonkar RG, Swapp D, Bamiou DE, Slater M, Luxon LM. The effect of virtual reality on visual vertigo symptoms in patients with peripheral vestibular dysfunction: a pilot study. J Vestib Res 2012;22:273-81.
24. Carmona S, Ferrero A, Pianetti G, Escolá N, Arteaga MV, Frankel L. Galvanic vestibular stimulation improves the results of vestibular rehabilitation. Ann N Y Acad Sci 2011;1233:E1-7. [CrossRef]
25. Telian SA, Shepard NT, Smith-Wheelock M, Kemink JL. Habituation therapy for chronic vestibular dysfunction: preliminary results. Otolaryngol Head Neck Surg 1990;103:89-95.
26. Keim RJ, Cook M, Martini D. Balance rehabilitation therapy. Laryn¬goscope 1992;102:1302-7. [CrossRef]
27. Furman JM, Balaban CD, Pollack IF. Vestibular compensation in a patient with a cerebellar infarction. Neurology 1997;48:916-20. [CrossRef]