平衡のニューロリハビリテーション

―慢性平衡障害への対応－

抄録

Neurorehabilitation for patients with intractable persistent dizziness is a specific treatment modality to decrease dizziness and balance problems and to increase safety and independence in patients with vestibular and balance disorders The neurorehabilitation treatment program in this study consisted of vestibular balance rehabilitation therapy specified in Nara Medical University (VBRT-NMU) to advance the central vestibular adaptation process and to substitute visual and somatosensory input for the impaired vestibular function, and a new therapy using the sensory substitution system with a human (brain)-machine interface which substitutes for diminished vestibular input by transmitting information about the patient's head position to the tongue. The clinical trials were performed to investigate how effective VBRT-NMU was for chronic balance disorders in subjects with unilateral vestibular loss and whether the new sensory substitution training could become a new treatment tool for severe balance problems intractable to VBRT-NMU. Some interventions for rehabilitation were selected and customized for each patient in accordance with the level of their compensation for postural control and their sensory dependence. Dynamic gait function and quality of life (QOL) assessments were tested using Functional Gait Assessment (FGA) and the Dizziness Handicap Inventory (DHI), respectively, before and after all training sessions.
Improvements in the DHI and FGA were respectively noted in 88.9% and 90.7% of all subjects with unilateral vestibular loss examined in the VBRT-NMU program. All subjects for whom the VBRT-NMU failed showed pronounced improvements in their balance performance due to the vestibular sensory substitution training. The average scores of FGA and DHI significantly improved from 16.2 to 25.6 and 49.2 to 25.7, respectively, in 8 weeks. These results suggests that the program-based approach to vestibular rehabilitation such as an individualized VBRT-MNU could provide a beneficial effect in the treatment of balance disorder for patients who have a long term history of unilateral peripheral vestibular etiologies, and the vestibular substitution device is a possible new rehabilitation tool for subjects with a persistent severe problem in posture and mobility, intractable to any treatment.