Research Advances in Vestibular
Rehabilitation Mechanism and Treatment

doi:10.12114/j.issn.1007-9572.2021.01.104

Abstract

Abstract:

Recent years have seen rapid advances in clinical diagnosis and treatment of vestibular diseases, especially vestibular evaluation and rehabilitation technologies, greatly promoting the developments in individualization and precision of rehabilitation for peripheral and central vestibular diseases. The vestibular rehabilitation helps to correct inappropriate strategy of equilibrium and/or to accelerate a good but slow compensation phenomenon, effectively improve vestibular, visual, and proprioceptive inputs to balance coordination control ability, improve the compensatory function of central nervous system, so as to reduce or eliminate the symptoms of dizziness, vertigo, and balance instability, eventually restoring the normal vestibular status. Given this background, we reviewed the advances in mechanisms of rehabilitation, pre-rehabilitation evaluation, rehabilitation program formulation and treatment regarding vestibular diseases, offering insights into clinical implementation and research concerning vestibular rehabilitation in China.

Key words: Neurological rehabilitation, Vestibular diseases, Repair, Adaptation, physiological, Acclimatization, Mechanism of action, Review

摘要：

近年来，前庭疾病的临床诊治水平快速提高，尤其是前庭评价技术和新的前庭康复技术的发展，极大地推动了外周及中枢前庭疾病康复的个体化、精准化的发展。前庭康复训练可通过纠正不恰当的代偿策略和/或加速良好代偿的过程，有效地提高患者的前庭觉、视觉和本体觉对平衡的协调控制能力，改善中枢神经系统的代偿功能，从而减轻或消除患者的头晕、眩晕和不稳症状，最终达到前庭康复状态。在此背景下，本文就前庭康复机制、康复前评估、方案制定及治疗进展等进行综述，以期为国内前庭康复的临床应用及研究提供重要参考。

关键词: 前庭疾病, 神经康复, 修复, 适应, 生理学, 习服, 作用机制, 综述

CLC Number:

R764.34 R493

QI Xiaoyuan, SONG Ning, GU Ping, YANG Xu.

Research Advances in Vestibular Rehabilitation Mechanism and Treatment [J]. Chinese General Practice, 2022, 25(11): 1399-1405.

祁晓媛,宋宁,顾平等. 前庭康复机制及治疗的研究进展[J]. 中国全科医学, 2022, 25(11): 1399-1405. DOI: 10.12114/j.issn.1007-9572.2021.01.104.

Figures/Tables 3

References 68

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类别	评价项目
身体功能变化	动态视敏度，凝视稳定性试验，视觉模拟量表，视觉眩晕模拟量表，摇头与感觉整合试验，改良的平衡感觉相互作用临床试验，强化Romberg试验，运动敏感性商，眩晕症状量表
身体结构变化	脑结构、脊髓和相关结构、内耳结构、心血管结构系统评价
活动参与情况	动态步态指数，功能性步态评价，步行速度测试，坐位到直立测试，功能性前伸，起立和行走试验，Berg平衡量表，平衡评价系统试验及其简化版，活动特定的平衡信心量表，眩晕评价量表，加州大学洛杉矶分校头晕问卷，眩晕障碍问卷，前庭疾病日常活动量表，前庭活动和参与量表，前庭康复获益问卷
环境因素影响	供个人消费的产品或物质，个人室内、室外移动和运输的产品及技术，灯光，直系亲属，健康专业人员，健康服务、系统和政策

类别	评价项目
身体功能变化	动态视敏度，凝视稳定性试验，视觉模拟量表，视觉眩晕模拟量表，摇头与感觉整合试验，改良的平衡感觉相互作用临床试验，强化Romberg试验，运动敏感性商，眩晕症状量表
身体结构变化	脑结构、脊髓和相关结构、内耳结构、心血管结构系统评价
活动参与情况	动态步态指数，功能性步态评价，步行速度测试，坐位到直立测试，功能性前伸，起立和行走试验，Berg平衡量表，平衡评价系统试验及其简化版，活动特定的平衡信心量表，眩晕评价量表，加州大学洛杉矶分校头晕问卷，眩晕障碍问卷，前庭疾病日常活动量表，前庭活动和参与量表，前庭康复获益问卷
环境因素影响	供个人消费的产品或物质，个人室内、室外移动和运输的产品及技术，灯光，直系亲属，健康专业人员，健康服务、系统和政策

治疗	建议	证据级别
扫视训练^a	强烈反对	Ⅰ
平滑跟踪训练^a	强烈反对	Ⅰ
针对训练	中等建议	Ⅱ
指导训练	中等建议	Ⅱ
凝视稳定性训练，每天12~20 min^b	专家意见	Ⅴ

治疗	建议	证据级别
扫视训练^a	强烈反对	Ⅰ
平滑跟踪训练^a	强烈反对	Ⅰ
针对训练	中等建议	Ⅱ
指导训练	中等建议	Ⅱ
凝视稳定性训练，每天12~20 min^b	专家意见	Ⅴ

症状/行为	前庭康复	认知行为疗法
站姿和步态僵硬（包括共存的功能性步态障碍）	正常站姿（放松的姿势，正常的体质分布）；正常步态（放松的步态，自然的步态，消除不必要的辅助步态）	减少过度的身体警觉，消除对头晕或摔倒的恐惧
运动敏感	习服锻炼（逐渐增加头部、眼睛和身体活动）	减少身体过度警觉，脱敏策略与理疗相辅相成
视觉依赖	习服训练（逐渐暴露于日益复杂模式和移动的视觉刺激）	减少身体过度警觉，脱敏策略与理疗相辅相成
规避刺激环境	逐渐暴露	对抗预期性焦虑，促进逐渐暴露