Faculty of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, 35340, Turkey.
Department of Neurology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
J Neurol. 2022 Dec;269(12):6246-6253. doi: 10.1007/s00415-022-11250-4. Epub 2022 Jul 8.
To investigate the effects of an individualized vestibular rehabilitation (VR) program on balance and gait performance and on self-perceived handicap in a group of vestibular migraine (VM) patients with associated anxiety.
An 8-week prospective clinical trial of a VR program was conducted on 74 VM patients. The effects were evaluated with the modified Clinical Test of Sensory Integration in Balance (mCTSIB), the Dynamic Gait Index (DGI), and the Dizziness Handicap Inventory (DHI) before and after VR. The Panic Agoraphobic Spectrum Self-Report version (PAS-SR) was used to assess the patients' level of anxiety.
DGI and DHI parameters significantly improved after VR (p < 0.05). The fall rates of mCTSIB were significantly decreased on foam with eyes closed (chi-square: 4.934, p = 0.026), and on foam with head back and eyes closed (chi-square: 7.451, p = 0.006). Forty-three (58.1%) of 74 VM patients had panic-anxiety complaints in terms of PAS scores (a score of > 46 points indicates the presence of anxiety). Balance and gait performance as measured by DGI (p = 0.000), DHI (p = 0.000), and mCTSIB (p < 0.05) improved significantly after VR in both groups of VM patients: those with and without anxiety complaints (PAS scores > 46 points and < 46 points, respectively).
Even VM patients with anxiety complaints benefited from vestibular exercises, and their imbalance complaints and perceived levels of handicap/disability improved. Individual specific vestibular exercises created with a clinical decision-making process provide functional improvement through vestibular compensation mechanisms. VR should be included in the treatment programs of VM patients with either high or low anxiety levels to improve vestibular function.
探讨个体化前庭康复（VR）方案对伴有焦虑的前庭性偏头痛（VM）患者平衡和步态功能以及自我感知障碍的影响。
对 74 例 VM 患者进行为期 8 周的 VR 方案前瞻性临床研究。使用改良临床感觉整合平衡测试（mCTSIB）、动态步态指数（DGI）和头晕障碍量表（DHI）在 VR 前后评估效果。使用广泛性焦虑障碍量表自评量表（PAS-SR）评估患者的焦虑程度。
VR 后 DGI 和 DHI 参数显著改善（p<0.05）。mCTSIB 闭眼泡沫上跌倒率显著降低（卡方：4.934，p=0.026），头后靠闭眼泡沫上跌倒率显著降低（卡方：7.451，p=0.006）。74 例 VM 患者中有 43 例（58.1%）根据 PAS 评分有惊恐焦虑症状（评分>46 分表示存在焦虑）。DGI（p=0.000）、DHI（p=0.000）和 mCTSIB（p<0.05）评估的 VR 后 VM 患者的平衡和步态功能均显著改善，无论 VM 患者是否有焦虑症状（PAS 评分分别>46 分和<46 分）。
即使有焦虑症状的 VM 患者也受益于前庭锻炼，其平衡障碍和感知障碍程度得到改善。通过临床决策过程制定的个体化特定前庭锻炼通过前庭代偿机制提供功能改善。对于焦虑程度较高或较低的 VM 患者，应将 VR 纳入治疗方案，以改善前庭功能。
