Huy P Tran Ba, Charfi S
Service ORL, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010, Paris, France.
Ann Otolaryngol Chir Cervicofac. 2008 Nov;125(5):273-81. doi: 10.1016/j.aorl.2008.06.003. Epub 2008 Sep 18.
Today vestibular rehabilitation has an important place in managing chronic vertigo and balance disorders. It is based on the principle of completing and/or accelerating the physiological processes of central compensation when, for one reason or another, these processes cannot be put in place to offset a vestibular deficit. From a practical point of view, this compensation uses and reinforces the compensatory strategies that are activated spontaneously, but incompletely, by the patient, i.e., adaptation, substitution, and habituation strategies. These techniques call on physical exercises and/or instrumental techniques that should be adapted to the patient based on the clinical workup and paraclinical instrumental assessment done by a trained specialist, which will identify side involved, the central or peripheral character of the disorder, the current degree of central compensation, and the patient's ability to use various sensory inputs. In addition to the acute vestibular deficits, the best indications are chronic dizziness stemming from unilateral or bilateral peripheral vestibular deficit, or a nonprogressive central but stabilized deficit, with incomplete compensation, whatever the patient's age. Measures should be applied to the disorder as the patient describes it, with the number of sessions specified.
如今,前庭康复在慢性眩晕和平衡障碍的管理中占据重要地位。它基于这样一个原则:当由于某种原因,中枢代偿的生理过程无法启动以抵消前庭缺陷时,要完成和/或加速这些生理过程。从实际角度来看,这种代偿利用并强化了患者自发激活但未完全激活的代偿策略,即适应、替代和习惯化策略。这些技术需要借助体育锻炼和/或仪器技术,这些应根据训练有素的专家进行的临床检查和辅助临床仪器评估来针对患者进行调整,这将确定受累侧、障碍的中枢或外周特征、当前的中枢代偿程度以及患者利用各种感觉输入的能力。除急性前庭缺陷外,最佳适应症是由单侧或双侧外周前庭缺陷引起的慢性头晕,或非进行性但已稳定的中枢性缺陷且代偿不完全,无论患者年龄如何。应根据患者描述的病症采取相应措施,并明确规定疗程数量。