Pavlou Marousa, Lingeswaran Ari, Davies Rosalyn A, Gresty Michael A, Bronstein Adolfo M
GKT School of Biomedical Sciences, King's College London Dept. of Physiotherapy, London, UK.
J Neurol. 2004 Aug;251(8):983-95. doi: 10.1007/s00415-004-0476-2.
Patients with chronic vestibular symptoms are common in neurological practice but the most effective treatment remains an open question. The purpose of our study was to conduct a controlled, between-group comparison of patients' responses to a customised exercise regime (Group C, for customised) versus treatment additionally incorporating simulator based desensitisation exposure (Group S, for simulator) integrating whole-body or visual environment rotators. Forty chronic peripheral vestibular patients who had previously undergone conventional vestibular rehabilitation without notable improvement were randomly assigned into Group C or S. Individuals attended therapy sessions twice weekly for eight weeks and were provided with a customised home programme. Response to treatment was assessed at four-week intervals with dynamic posturography, vestibular time constants, and questionnaires concerning symptoms, symptom-triggers and emotional status. At final assessment posturography and subjective scores had significantly improved for both groups, although Group S showed greater improvement. A statistically significant improvement for visual vertigo symptom scores was noted only for Group S (p < 0.01; total improvement 53.5 %). Anxiety and depression levels significantly decreased for both groups; improvements were significantly correlated particularly to improvements in visual vertigo (SCQ) (p < 0.01; r = 0.53 and r = 0.57, respectively). Significant differences were noted between groups (p = 0.02) for posturography scores. Vestibular time constants showed no notable change in either group.
Both groups improved but exposure to simulator motion gave overall better results. These effects were also observed in psychological symptoms and partly relate to simulator effects on visual vertigo symptoms. Visual motion and visuo-vestibular conflict situations should be incorporated in the rehabilitation of patients with refractory dizziness.
慢性前庭症状患者在神经科临床中很常见，但最有效的治疗方法仍是一个悬而未决的问题。我们研究的目的是进行一项对照的组间比较，比较患者对定制运动方案（C组，即定制组）与额外纳入基于模拟器的脱敏暴露治疗（S组，即模拟器组）的反应，后者整合了全身或视觉环境旋转器。40名先前接受过传统前庭康复但无明显改善的慢性外周前庭疾病患者被随机分为C组或S组。患者每周参加两次治疗课程，为期八周，并获得定制的家庭训练计划。每隔四周通过动态姿势描记法、前庭时间常数以及关于症状、症状触发因素和情绪状态的问卷来评估治疗反应。在最终评估时，两组的姿势描记法和主观评分均有显著改善，尽管S组改善更大。仅S组的视觉眩晕症状评分有统计学显著改善（p < 0.01；总体改善53.5%）。两组的焦虑和抑郁水平均显著降低；改善与视觉眩晕（SCQ）的改善尤其显著相关（p < 0.01；r分别为0.53和0.57）。姿势描记法评分在组间有显著差异（p = 0.02）。两组的前庭时间常数均无明显变化。
两组均有改善，但接触模拟器运动总体效果更好。这些效果在心理症状中也有体现，部分与模拟器对视觉眩晕症状的影响有关。视觉运动和视-前庭冲突情况应纳入难治性头晕患者的康复治疗中。
