Comparison of Incremental Vestibulo-ocular Reflex Adaptation Training Versus x1 Training in Patients With Chronic Peripheral Vestibular Hypofunction: A Two-Year Randomized Controlled Trial

被引：7

作者：

Rinaudo, Carlo N. ^{[1
,2
]}

Schubert, Michael C. ^{[1
,3
,4
]}

Cremer, Phillip D. ^{[1
,5
]}

Figtree, William V. C. ^{[1
]}

Todd, Christopher J. ^{[1
]}

Migliaccio, Americo A. ^{[1
,2
,4
,6
]}

机构：

[1] Neurosci Res Australia, Balance & Vis Lab, Cnr Barker St & Easy St, Sydney, NSW 2031, Australia

[2] Univ New South Wales, Grad Sch Biomed Engn, Sydney, NSW, Australia

[3] Johns Hopkins Univ, Dept Otolaryngol Head & Neck Surg, Lab Vestibular NeuroAdaptat, Baltimore, MD USA

[4] Johns Hopkins Univ, Dept Otolaryngol Head & Neck Surg, Baltimore, MD USA

[5] Royal North Shore Hosp, Sydney, NSW, Australia

[6] Univ Newcastle, Sch Biomed Sci & Pharm, Newcastle, NSW, Australia

来源：

JOURNAL OF NEUROLOGIC PHYSICAL THERAPY | 2021年 / 45卷 / 04期

基金：

澳大利亚国家健康与医学研究理事会;

关键词：

gaze stability; vestibular hypofunction; vestibular rehabilitation; vestibulo-ocular reflex; DYNAMIC VISUAL-ACUITY; REHABILITATION; BALANCE; DIZZINESS; RECOVERY;

D O I：

10.1097/NPT.0000000000000369

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background and Purpose: A crossover, double-blinded randomized controlled trial to investigate once-daily incremental vestibulo-ocular reflex (VOR) adaptation (IVA) training over 2 years in people with stable and chronic peripheral vestibular hypofunction. Methods: Twenty-one patients with peripheral vestibular hypofunction were randomly assigned to intervention-then-control (n = 12) or control-then-intervention (n = 9) groups. The task consisted of either x1 (control) or IVA training, once daily every day for 15 minutes over 6-months, followed by a 6-month washout, then repeated for arm 2 of the crossover. Primary outcome: vestibulo-ocular reflex gain. Secondary outcomes: compensatory saccades, dynamic visual acuity, static balance, gait, and subjective symptoms. Multiple imputation was used for missing data. Between-group differences were analyzed using a linear mixed model with repeated measures. Results: On average patients trained once daily 4 days per week. IVA training resulted in significantly larger VOR gain increase (active: 20.6% +/- 12.08%, P = 0.006; passive: 30.6% +/- 25.45%, P = 0.016) compared with x1 training (active: -2.4% +/- 12.88%, P = 0.99; passive: -0.6% +/- 15.31%, P = 0.68) (P < 0.001). The increased IVA gain did not significantly reduce with approximately 27% persisting over the washout period. x1 training resulted in greater reduction of compensatory saccade latency (P = 0.04) and increase in amplitude (P = 0.02) compared with IVA training. There was no difference between groups in gait and balance measures; however, only the IVA group had improved total Dizziness Handicap Inventory (P = 0.006). Discussion and Conclusions: Our results suggest IVA improves VOR gain and reduces perception of disability more than conventional x1 training. We suggest at least 4 weeks of once-daily 4 days-per-week IVA training should be part of a comprehensive vestibular rehabilitation program.

引用

页码：246 / 258

页数：13