めまいリハビリテーションの段階的治療戦略.

―代償不全の前庭障害―

抄録

　Some patients with uncompensated vestibular hypofunction present with a long history of persistent severe problems in posture and mobility that are intractable to any treatment.
　We examined whether graded vestibular balance rehabilitation would alleviate the dizziness and balance problems, and increase the safety and independence of patients with chronic balance disorders following unilateral vestibular loss. The stepwise treatment program for vestibular balance rehabilitation developed at our clinic consists of vestibular adaptation training (Step 1), sensory reweighing training (Step 2), and vestibular substitution training (Step 3). This rehabilitation program is intended at promoting the central vestibular adaptation process, altering the vestibular, visual and somatosensory inputs, and encouraging the use of the sensory substitution system with a human (brain)-machine interface as a substitute for the diminished vestibular input, for transmitting information about the patient's head position to the tongue. Clinical trials were performed to investigate the degree to which the stepwise multimodal approach might be effective for chronic balance disorder in subjects with unilateral decompensated vestibular loss. Some interventions for rehabilitation were selected and customized for each patient in accordance with the level of their compensation for postural control and sensory dependence.
　Improvements in the balance performance were noted in 64.4% of all the subjects after the Step 1 training. Of the 31 subjects (35.6%) who failed to improve with the step 1 program, 14 (45.2%) showed improvements after the Step 2 training. All of the subjects who failed to show improvement after the Step 1 and 2 training programs showed pronounced improvements after the Step 3 training.
　These results suggest that programmatic stepwise multimodal approach to vestibular rehabilitation yields beneficial effect in patients with balance disorder secondary to vestibular decompensation.