Vestibular rehabilitation for bilateral vestibulopathy

Abstract

前庭障害患者はめまい感,不安定感などをはじめ とした不快な症状を有する。これを軽減させる手段 の一つに前庭リハビリテーション(以下,前庭リ ハ)がある。2016年にアメリカ理学療法士協会によ って,末梢前庭機能低下に対する前庭リハの診療ガ イドラインが出版された。これによると,一側前 庭機能低下(unilateral vestibulopathy:UVP),両 側前庭機能低下(bilateral vestibulopathy:BVP)に 対する前庭リハはともにエビデンスレベルI(I~ IVでIが最も高い),推奨度A(A~DでAが最も Postural control is coordinated by the vestibular, somatosensory, and visual systems. Maintenance of equilibrium requires proper functioning of these systems. Vestibular rehabilitation is a form of physical therapy for disorders of the vestibular system. A practice guideline on vestibular rehabilitation for peripheral vestibular hypofunction was published by the American Physical Therapy Association in 2016. The rate of improvement is lower in cases of bilateral vestibulopathy as compared to those of unilateral vestibulopathy. There have been no reports of adequate functional recovery in cases of bilateral vestibulopathy. Vestibular rehabilitation includes gaze stability exercises, habituation exercises, substitution exercises, and balance training. Exercises tailored to the individual and performed under supervision are more effective than those performed alone at home. Vestibular rehabilitation tends to be monotonous in its approach, and it often takes long before improvement begins to be noted. This usually results in patients dropping out of the protocol. In recent years, there has been an increasing number of reports on vestibular rehabilitation using virtual reality. Virtual reality involves the use of screens and head-mounted displays. It has been found to lead to improvement of the vestibuloocular reflex, postural control, dizziness handicap inventory, and quality of life. Using virtual reality games for vestibular rehabilitation may lead to patients enjoying and immersing themselves more in the rehabilitation process. It may improve their motivation, and ultimately lead them to continue and help them persevere with vestibular rehabilitation. In this paper, we discuss vestibular rehabilitation, especially for patients with bilateral vestibulopathy, and vestibular rehabilitation using virtual reality. シンポジウム「Bilateral vestibulopathy: How to treat and manage?」