Vestibular Rehabilitation and Otolith Dysfunction

前庭康复和耳石功能障碍

• 批准号: 9215539
• 负责人: COURTNEY HALL
• 金额: --
• 依托单位: JAMES H QUILLEN VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-01-01 至 2017-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9215539
• 关键词: Acceleration; Affect; Age; Astronauts; Balance training; Blast Cell; Blast Injuries; Caring; Case Study; Centrifugation; Cerebellum; Characteristics; Chronic; Clinical; Clinical Research; Craniocerebral Trauma; Data; Disease; Dizziness; Economics; Effectiveness; Elderly; Environment; Equilibrium; Exercise; Financial compensation; Force of Gravity; Functional disorder; Gait; Goals; Head; Head Movements; Health; Healthcare; Impairment; Incidence; Individual; Injury; Intervention; Irrigation; Labyrinth; Measures; Mediating; Medical; Microgravity; Mission; Musculoskeletal Equilibrium; Noise; Noise-Induced Hearing Loss; Organ; Outcome; Outcome Measure; Outpatients; Participant; Pathology; Patient Care; Patients; Peripheral; Pilot Projects; Population; Posture; Protocols documentation; Randomized; Recording of previous events; Recovery; Reflex action; Rehabilitation Outcome; Rehabilitation therapy; Research Design; Retinal; Risk Factors; Rotation; Savings; Semicircular canal structure; Sense Organs; Sensory; Signal Transduction; Space Flight; Stimulus; Symptoms; System; Testing; Training; Traumatic Brain Injury; Vestibular loss; Veterans; Visit; Visual; Visual system structure; Work; age related; base; conditioning; cost; deconditioning; design; effective intervention; equilibration disorder; experience; falls; gait rehabilitation; gaze; improved functioning; mild traumatic brain injury; novel; novel therapeutic intervention; otoconia; posture instability; public health relevance; response; somatosensory; symptomatic improvement; treatment choice; vestibulo-ocular reflex

 DESCRIPTION (provided by applicant): Emerging evidence suggests that otolith organ dysfunction of the vestibular system occurs in Veterans with dizziness and imbalance related to mild traumatic brain injury/blast exposure. It is unclear if standard vestibular rehabilitation is effective for individuals with otolith dysfunction This pilot project is designed to examine the effectiveness of vestibular rehabilitation and a novel treatment approach. The primary function of the vestibular (inner ear balance) system is to maintain gaze and postural stability. The vestibular system is comprised of two types of sensory organs (semicircular canals and otolith organs) with unique contributions to balance. Loss of vestibular function can occur in one or more vestibular sensory organs. Symptoms of vestibular loss include dizziness, postural instability, and/or visual blurring. Moreover, the incidence of falls is greater in individuals with vestibular loss than in healthy individuals of th same age (Herdman et al., 2000). Recent studies suggest that otolith dysfunction is a fairly common finding in individuals with a history of head trauma/blast exposure and/or noise induced hearing loss (Akin & Murnane, 2011; Akin et al., 2012). Therefore, otolith dysfunction may be a significant health concern for the Veteran population, and determining optimal intervention for otolith dysfunction is relevant to VA healthcare. Vestibular Rehabilitation (VR) is the treatment o choice for patients experiencing dizziness, imbalance, and mobility impairments related to vestibular dysfunction. VR typically includes gaze stability exercises, gait and balance training, and general conditioning. Gaze stability exercises are based on the concepts of adaptation and substitution with the goal of facilitating vestibular compensation of the semicircular canal-mediated angular vestibulo-ocular reflex (aVOR). A critical signal to induce adaptation is retinal slip during head movements; thus, adaptation exercises involve head rotation while focusing on a target. Studies of individuals with vestibular dysfunction suggest that VR results in decreased subjective complaints and improved function in many but not all patients (Herdman et al., 2012). Many factors that might influence recovery, such as the involvement of different vestibular sensory organs (semicircular canals versus otolith organs) have not been examined to determine their impact on recovery. Most studies examining the effectiveness of VR have used only tests of VOR function (caloric and rotational tests) that measure hSCC to determine vestibular loss. Thus, little is known about interventions to facilitate vestibular compensation of the otolith organs. Recent studies have demonstrated adaptation following otolith organ stimulation using centrifugation (or linear acceleration). The concept of using centrifugation for otolith adaptation may be similar to using gaze stability exercises for aVOR adaptation. Astronauts who received centrifugation (i.e., off-axis rotation) during in-space flight did not exhibit the typical deconditioning of the otolith-ocular reflex (Buytaert et al., 2013). In a case study, Akin et al. (2013) demonstrated improved symptoms and balance following centrifugation of a patient with chronic unilateral vestibular hypofunction. The purpose of this project is to determine if centrifugation is an effective intervention strategy in the treatment of Veterans with otolith dysfunction. Specific Aim 1 is designed to determine the effect of standard vestibular rehabilitation on otolith dysfunction. Veterans with dizziness/imbalance related to otolith dysfunction will be randomized to a staged intervention of 4 weeks of gaze stability exercises followed by 4 weeks of balance and gait exercises. By providing the intervention in a staged manner we will be able to isolate critical components of rehabilitation of otolith dysfunction. Specific Aim 2 is designed to examine the extent to which centrifugation impacts outcomes for individuals with otolith dysfunction. Veterans with dizziness/imbalance related to otolith dysfunction will be randomized to a staged intervention of 4 weeks of centrifugation (otolith organ stimulation) followed by 4 weeks of balance and gait exercises. Outcome measures of symptom intensity, balance, and gait will be compared.

 描述（由申请人提供）： 新的证据表明，前庭系统的耳石器官功能障碍发生在与轻度创伤性脑损伤/爆炸暴露相关的头晕和不平衡的退伍军人中，目前尚不清楚标准前庭康复对于耳石功能障碍的个体是否有效。前庭康复和新颖治疗方法的有效性 前庭（内耳平衡）系统的主要功能是维持凝视和姿势稳定性 前庭系统由两种类型的感觉器官组成。 （半规管和耳石器官）对平衡具有独特的作用。前庭功能丧失可能发生在一个或多个前庭感觉器官中。前庭功能丧失的症状包括头晕、姿势不稳定和/或视力模糊。前庭丧失的个体比同龄的健康个体更大（Herdman 等人，2000 年）。最近的研究表明，耳石功能障碍在患有前庭丧失的个体中相当常见。头部外伤/爆炸暴露和/或噪音引起的听力损失的病史（Akin & Murnane，2011；Akin 等人，2012）因此，耳石功能障碍可能是退伍军人群体的一个重要健康问题，并确定最佳干预措施。耳石功能障碍与 VA 医疗保健相关，前庭康复 (VR) 是治疗与前庭功能障碍相关的头晕、不平衡和活动障碍的患者的选择，通常包括凝视稳定性练习、步态和平衡训练以及一般调节训练基于适应和替代的概念，目的是促进半规管介导的前庭眼角反射（aVOR）的前庭补偿，诱导适应的关键信号是。头部运动期间视网膜滑动；因此，适应练习涉及头部旋转，同时专注于前庭功能障碍患者的研究表明，VR 可以减少许多但并非所有患者的主观抱怨并改善功能（Herdman 等人，2017）。等人，2012）。许多可能影响恢复的因素，例如不同前庭感觉器官（半规管与耳石器官）的参与尚未经过检查以确定其对恢复的影响，大多数研究仅使用了 VR 的有效性。 VOR 功能测试（热量和旋转测试）测量 hSCC 以确定前庭损失，因此，对于促进前庭代偿的干预措施知之甚少。 最近的研究表明，使用离心（或线性加速）刺激耳石器官后会产生适应。使用离心进行耳石适应的概念可能类似于使用接受离心（即离场）的凝视稳定性练习。太空飞行期间的轴旋转）并未表现出耳石眼反射的典型失调（Buytaert 等人，2013 年）。 Akin 等人 (2013) 的研究表明，慢性单侧前庭功能减退症患者在离心后症状和平衡得到改善。该项目的目的是确定离心是否是治疗退伍军人的有效干预策略。 具体目标 1 旨在确定标准前庭康复对耳石功能障碍的影响。患有与耳石功能障碍相关的头晕/不平衡的退伍军人将被随机分配进行 4 周的凝视稳定性练习，然后进行 4 周的平衡和平衡训练。通过分阶段提供干预，我们将能够分离出耳石功能障碍康复的关键组成部分，具体目标 2 旨在检查离心对结果的影响程度。对于患有耳石功能障碍的退伍军人，将随机接受为期 4 周的离心（耳石器官刺激）的分阶段干预，然后进行 4 周的平衡和步态练习，以衡量症状强度、平衡、和步态将进行比较。