両側前庭機能低下に対する前庭リハビリテーション

抄録

　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 vestibulo-ocular 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.