Bronstein Adolfo M, Pavlou Marousa
Department of Clinical Neuroscience, Imperial College London, UK.
Handb Clin Neurol. 2013;110:189-208. doi: 10.1016/B978-0-444-52901-5.00016-2.
This chapter addresses the important and undertreated problem of balance disorders. The chapter has a simplified summary of the physiology of balance problems in order to set the scene. The issue of assessment is next addressed with discussion of important tests including the Berg Balance Scale and the Get Up and Go Test, and others. Posturography is discussed as well as assessment of the gravitional vertical. The assessment of vestibular function is of key importance and discussed in some detail. The focus of the chapter is on balance rehabilitation. Re-training of postural alignment and of sensory strategies are key but adaptation of the environment and re-training of cognitive strategies are also helpful in individual cases. Vestibular exercises can also be used. The chapter then critically analyses the efficacy of these treatments in specific balance disorders such as in stroke, Parkinson disease, polyneuropathies, multiple sclerosis, and vestibular disorders. Overall, there is a growing body of evidence that balance rehabilitation improves symptoms, function, and quality of life for those troubled by these disabling problems.
本章论述了平衡障碍这一重要且未得到充分治疗的问题。为了做好铺垫，本章对平衡问题的生理学进行了简要概述。接下来讨论评估问题，介绍了包括伯格平衡量表、起立行走测试等重要测试。还讨论了姿势描记法以及重力垂线评估。前庭功能评估至关重要，并进行了较为详细的讨论。本章重点在于平衡康复。姿势矫正和感觉策略的再训练是关键，但环境调整和认知策略的再训练在个别情况下也有帮助。也可以采用前庭锻炼。然后本章批判性地分析了这些治疗方法在特定平衡障碍（如中风、帕金森病、多发性神经病、多发性硬化症和前庭障碍）中的疗效。总体而言，越来越多的证据表明，平衡康复可改善受这些致残问题困扰者的症状、功能和生活质量。
