Balance and Vision Laboratory, Neuroscience Research Australia, Sydney, Australia (C.N.R., M.C.S., P.D.C., W.V.C.F., C.J.T., A.A.M.); Graduate School of Biomedical Engineering, University of New South Wales, Sydney, Australia (C.N.R., A.A.M.); Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland (M.C.S.); Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland (M.C.S., A.A.M.); Royal North Shore Hospital, Sydney, Australia (P.D.C.); and School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia (A.A.M.).
J Neurol Phys Ther. 2021 Apr 1;45(2):87-100. doi: 10.1097/NPT.0000000000000348.
This was a double-blinded randomized controlled study to investigate the effects of once-daily incremental vestibulo-ocular reflex (VOR) training over 1 week in people with chronic peripheral vestibular hypofunction.
A total of 24 patients with peripheral vestibular hypofunction were randomly assigned to intervention (n = 13) or control (n = 11) groups. Training consisted of either x1 (control) or incremental VOR adaptation exercises, delivered once daily for 15 minutes over 4 days in 1 week. Primary outcome: VOR gain with video-oculography. Secondary outcomes: Compensatory saccades measured using scleral search coils, dynamic visual acuity, static balance, gait, and subjective symptoms. Between-group differences were analyzed with a linear mixed-model with repeated measures.
There was a difference in the VOR gain increase between groups (P < 0.05). The incremental training group gain increased during active (13.4% ± 16.3%) and passive (12.1% ± 19.9%) head impulse testing (P < 0.02), whereas it did not for the control group (P = 0.59). The control group had reduced compensatory saccade latency (P < 0.02). Both groups had similarly improved dynamic visual acuity scores (P < 0.05). Both groups had improved dynamic gait index scores (P < 0.002); however, only the incremental group had improved scores for the 2 walks involving head oscillations at approximately 2 Hz (horizontal: P < 0.05; vertical: P < 0.02), increased gait speed (P < 0.02), and step length (P < 0.01) during normal gait, and improved total Dizziness Handicap Inventory (P < 0.05).
Our results suggest incremental VOR adaptation significantly improves gain, gait with head rotation, balance during gait, and symptoms in patients with chronic peripheral vestibular hypofunction more so than conventional x1 gaze-stabilizing exercises.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A336).
这是一项为期一周的双侧、随机、对照研究，旨在观察每日一次的递增前庭眼反射（VOR）训练对慢性周围性前庭功能减退患者的影响。
共纳入 24 例周围性前庭功能减退患者，随机分为干预组（n = 13）和对照组（n = 11）。训练包括 x1（对照组）或递增 VOR 适应练习，每周 4 天，每天 15 分钟。主要结局：视频眼震图 VOR 增益。次要结局：使用巩膜搜索线圈测量的代偿性扫视、动态视敏度、静态平衡、步态和主观症状。采用重复测量线性混合模型分析组间差异。
两组间 VOR 增益增加存在差异（P < 0.05）。递增训练组在主动（13.4%±16.3%）和被动（12.1%±19.9%）头脉冲测试中增益增加（P < 0.02），而对照组无变化（P = 0.59）。对照组代偿性扫视潜伏期缩短（P < 0.02）。两组动态视敏度评分均提高（P < 0.05）。两组动态步态指数评分均提高（P < 0.002）；但只有递增组在大约 2 Hz 的头部摆动的 2 次行走中（水平：P < 0.05；垂直：P < 0.02）、步态速度（P < 0.02）和步长（P < 0.01）提高，且在正常行走时总眩晕残障量表（Dizziness Handicap Inventory，DHI）评分提高（P < 0.05）。
我们的结果表明，与传统的 x1 凝视稳定练习相比，递增 VOR 适应显著改善慢性周围性前庭功能减退患者的增益、头部旋转时的步态、步态时的平衡和症状。
视频摘要可供作者提供更多见解（观看视频，请访问：http://links.lww.com/JNPT/A336）。
