Department of Otolaryngology-Head and Neck Surgery, Division of Otology/Neurotology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada.
J Vestib Res. 2022;32(5):479-485. doi: 10.3233/VES-210058.
To evaluate the benefit of vestibular rehabilitation therapy (VRT) in the management of patients with idiopathic cerebellar ataxia with bilateral vestibulopathy (iCABV).
iCABV is a hindbrain degenerative disorder with impairment of both central and peripheral vestibular pathways. There is combined failure of four compensatory eye movement systems including the vestibulo-ocular reflex (VOR), optokinetic reflex, smooth pursuit and the visually enhanced vestibulo-ocular reflex (VVOR). Phenotypic presentation includes postural and gait instability, oscillopsia and dizziness with active head movement. The benefit of VRT in iCABV patients has not been established.
A retrospective review was performed on a cohort of twelve patients diagnosed with iCABV in a multidisciplinary neuro-otology clinic. All participated in VRT and completed their suggested course of VRT. The following clinical measures were assessed before starting and after finishing VRT: 1) Dizziness Handicap Inventory (DHI), 2) Activities-Specific Balance Confidence (ABC) Scale, 3) Catastrophization scale, 4) Positive Affective Negative Affective Score (PANAS), 5) Dynamic Gait Index (DGI) and 6) Modified Clinical Test of Sensory Interaction in Balance (mCTSIB). The number of falls historically was recorded in addition to gait speed (ft./sec).
Following VRT, patients were found to have improved balance on mCTSIB (condition 4 : 7 vs 18 seconds, P = 0.04) and a better postural stability with a reduced number of falls (p = 0.01). No statistically significant improvement was seen in the DHI, ABC, Catastrophization scale, DGI, PANAS and gait speed (p > 0.05).
iCABV patients who underwent VRT were found to have a better postural stability and reduced risk of falls. VRT was not found to significantly improve patients' overall subjective perception of their symptoms or their psychological status.
评估前庭康复治疗（VRT）在双侧前庭病伴特发性小脑性共济失调（iCABV）患者管理中的益处。
iCABV 是一种后脑退行性疾病，影响中枢和外周前庭通路。四个补偿性眼球运动系统（包括前庭眼反射[VOR]、视动反射、平滑追踪和视觉增强前庭眼反射[VVOR]）均出现联合衰竭。表型表现包括姿势和步态不稳、视动震颤和主动头部运动时头晕。VRT 在 iCABV 患者中的益处尚未确定。
对多学科神经耳科诊所诊断为 iCABV 的 12 例患者进行回顾性研究。所有患者均接受 VRT 治疗，并完成了建议的 VRT 疗程。在开始和结束 VRT 之前评估以下临床指标：1）头晕残疾量表（DHI），2）活动特异性平衡信心量表（ABC），3）灾难化量表，4）积极情感消极情感量表（PANAS），5）动态步态指数（DGI）和 6）改良临床感觉相互作用平衡测试（mCTSIB）。此外，还记录了历史上的跌倒次数以及步态速度（英尺/秒）。
VRT 后，患者 mCTSIB 上的平衡能力有所提高（条件 4：7 秒与 18 秒，P=0.04），姿势稳定性提高，跌倒次数减少（p=0.01）。DHI、ABC、灾难化量表、DGI、PANAS 和步态速度无显著改善（p>0.05）。
接受 VRT 的 iCABV 患者发现姿势稳定性更好，跌倒风险降低。VRT 并未显著改善患者对自身症状的整体主观感知或心理状态。
