Vestibular Rehabilitation and Otolith Dysfunction

前庭康复和耳石功能障碍

• 批准号: 9033183
• 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/9033183
• 关键词: Acceleration; Affect; Age; Astronauts; Balance training; Blast Cell; Caring; Case Study; Centrifugation; Cerebellum; Characteristics; Chronic; Clinical; Clinical Research; Craniocerebral Trauma; Data; Disease; Dizziness; Economics; Effectiveness; Elderly; Environment; Equilibrium; Exercise; Exhibits; 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; 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; Staging; Stimulus; Symptoms; System; Testing; 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; 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）： 新兴的证据表明，前庭系统的耳石器官功能障碍发生在与轻度脑外伤/爆炸暴露有关的退伍军人中。目前尚不清楚标准的前庭康复是否对耳石功能障碍的个体有效，该试点项目旨在检查前庭康复和一种新型治疗方法的有效性。前庭（内耳平衡）系统的主要功能是保持目光和姿势稳定性。前庭系统的两种类型的感觉器官（半圆形管和耳石器官）具有独特的平衡贡献。一个或多个前庭感觉器官可能会出现前庭功能的丧失。前庭丧失的症状包括头晕，姿势不稳定和/或视觉模糊。此外，前庭损失的个体的跌倒事件要比同年龄的健康个体更大（Herdman等，2000）。最近的研究表明，耳石功能障碍是具有头部创伤/爆炸史和/或噪声引起的听力损失的个体中相当普遍的发现（Akin＆Murnane，2011； Akin等，2012）。因此，耳石功能障碍可能对退伍军人人群来说是一个重大的健康问题，并且确定耳石功能障碍的最佳干预与VA医疗保健有关。前庭康复（VR）是患有与前庭功能障碍有关的头晕，失衡和行动不足障碍的患者的治疗方法。 VR通常包括凝视稳定性练习，步态和平衡训练以及一般条件。凝视稳定性练习是基于适应和取代的概念，目的是促进前庭介导的半圆形管介导的角骨前庭反射（avor）的赔偿。引起适应的关键信号是头部运动过程中的视网膜滑动。因此，适应练习涉及头部旋转，同时专注于目标。对前庭功能障碍的个体的研究表明，VR会导致许多但不是所有患者的受试者投诉和功能改善的改善（Herdman等，2012）。尚未检查许多可能影响恢复的因素，例如不同的前庭感觉器官（半圆形管与耳石器官）的参与以确定其对恢复的影响。大多数研究VR有效性的研究仅使用了测量HSCC来确定前庭损失的VOR功能（热量和旋转测试）的测试。关于促进前庭补偿的干预措施知之甚少 耳石器官。最近的研究表明，使用离心（或线性加速度）的耳石器官刺激后适应。使用离心机适应的概念可能类似于使用凝视稳定性练习进行Avor适应。在空间飞行过程中接受离心（即离轴旋转）的宇航员不存在耳石 - 眼反射的典型解结（Buytaert等，2013）。在案例研究中，Akin等人。 （2013年）表明，慢性单侧前庭功能不全的患者离心后，症状得到改善和平衡。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 耳石功能障碍。特定目标1旨在确定标准前庭康复对耳石功能障碍的影响。与耳石功能障碍相关的头晕/失衡的退伍军人将随机分为4周的注视稳定练习，然后进行4周的平衡和步态练习。通过以阶段的方式提供干预措施，我们将能够隔离耳石功能障碍的康复的关键组成部分。特定目标2旨在检查离心对耳石功能障碍患者的结局的程度。与耳石功能障碍相关的头晕/失衡的退伍军人将随机分为4周离心（耳石器官模拟），然后进行4周的平衡和步态练习。将比较症状强度，平衡和步态的结果度量。