Macdougall Hamish Gavin, Curthoys Ian S
Vestibular Research Laboratory, School of Psychology, The University of Sydney Sydney, NSW, Australia.
Front Neurol. 2012 Feb 28;3:21. doi: 10.3389/fneur.2012.00021. eCollection 2012.
the recent measures of saccadic responses to high acceleration head turns during human vestibular compensation and their possible implications for recovery after unilateral vestibular loss (UVL). New measurement techniques have provided additional insights into how patients recover after UVL and have given clues for vestibular rehabilitation. Prior to this it has not been possible to quantify the level of function of all the peripheral vestibular sense organs. Now it is. By using vestibular-evoked myogenic potentials to measure utricular and saccular function and by new video head impulse testing to measure semicircular canal function to natural values of head accelerations. With these new video procedures it is now possible to measure both slow phase eye velocity and also saccades during head movements with natural values of angular acceleration. The present evidence is that after UVL there is little or no restoration/compensation of slow phase eye velocity responses to natural head accelerations. It is doubtful as to whether the modest changes in slow phase eye velocity to small angular accelerations are functionally effective during compensation. On the other hand it is now clear that saccades can play a very important role in helping patients compensate and return to a normal lifestyle. Preliminary evidence suggests that different patterns of saccadic response may predict how well patients recover. Furthermore it may be possible to train patients to produce more effective saccadic patterns in the first days after their unilateral loss and possibly improve their compensation process. Some patients do learn new strategies, new behaviors, to conceal their inadequate vestibulo-ocular response but when those strategies are prevented from operating by using passive, unpredictable, high acceleration natural head movements, as in the head impulse test, the vestibular loss can be demonstrated. It is those very strategies which the tests exclude, which may be the cause of their successful compensation.
人类前庭代偿过程中对高加速度头部转动的扫视反应的最新测量方法，以及它们对单侧前庭丧失（UVL）后恢复的可能影响。新的测量技术为UVL患者的恢复方式提供了更多见解，并为前庭康复提供了线索。在此之前，无法量化所有外周前庭感觉器官的功能水平。现在可以了。通过使用前庭诱发肌源性电位来测量椭圆囊和球囊的功能，并通过新的视频头脉冲测试来测量半规管功能至头部加速度的自然值。通过这些新的视频程序，现在可以在头部以自然角加速度运动期间测量慢相眼速度和扫视。目前的证据表明，UVL后，对自然头部加速度的慢相眼速度反应几乎没有或没有恢复/代偿。对于慢相眼速度对小角加速度的适度变化在代偿期间是否具有功能有效性存在疑问。另一方面，现在很清楚，扫视在帮助患者代偿并恢复正常生活方式方面可以发挥非常重要的作用。初步证据表明，不同的扫视反应模式可能预测患者恢复的程度。此外，有可能在患者单侧丧失后的头几天训练他们产生更有效的扫视模式，并可能改善他们的代偿过程。一些患者确实学会了新的策略、新的行为来掩盖他们不充分的前庭眼反应，但当这些策略通过使用被动、不可预测的高加速度自然头部运动（如在头脉冲测试中）而无法起作用时，前庭丧失就会显现出来。正是这些测试所排除的策略可能是他们成功代偿的原因。
