使用单向旋转改善前庭功能障碍患者的前庭系统不对称性
1Department of Physiology,Shahid Beheshti University of Medical Sciences and Health Services, 2Audiology and Dizziness Center,Dey General Hospital, 3Department of Speech-Language Pathology,SUNY Buffalo State, 4Department of Rehabilitation Science, School of Public Health and Health Professions,State University of New York at Buffalo, 5Center for Hearing and Deafness, Department of Communicative Disorders and Sciences,State University of New York at Buffalo
Summary
提出了一种新的康复方法，用于在非对称反应的患者中重新平衡前庭系统，包括向弱侧单向旋转。通过直接修改前庭通路，而不是增强补偿的多感官方面，不对称可以在1-2个会话内规范化，并显示出持久效果。
Abstract
前庭系统提供有关头部运动的信息，并调解反射，有助于在日常活动中平衡控制和凝视稳定。前庭传感器位于头部两侧的内耳，并投射到脑干中的前庭核。前庭功能障碍通常是由于双方输入之间的不对称。这导致两个耳朵的神经输入不对称，这会产生旋转的错觉，表现为眩晕。前庭系统具有令人印象深刻的补偿能力，有助于重新平衡在中央一级处理来自两侧感觉端器官的不对称信息。为了促进补偿，诊所采用各种康复方案;然而，他们主要使用练习，以改善多感官整合。最近，视觉-庭训练也被用来改善有补偿性单侧病变的动物的前庭反射（VOR）。本文介绍了一种重新平衡人体两侧前庭活动的新方法。此方法由在黑暗中的五个单向旋转（峰值速度 320°/s）向较弱的一侧旋转。该方法的有效性在16例VOR不对称患者中连续的双盲临床试验中显示（通过响应正弦旋转的方向优势进行测量）。在大多数情况下，VOR不对称在一次会话后减少，在前两个会话中一周内达到正常值，其影响持续长达6周。再平衡效应是由于较弱方的VOR响应增加和来自较强方的反应减少。研究结果表明，单向旋转可以作为一种监督康复方法，以减少长期前庭功能障碍患者的VOR不对称。
Introduction
前庭功能障碍是一种常见的疾病，在40岁以上的成年人中患病率为+35%。大多数前庭障碍导致两侧输入之间的不对称，导致称为眩晕的旋转错觉。在缺乏正常前庭功能的情况下，即使是简单的日常活动也可能具有挑战性。前庭功能障碍通常由前庭反射（VOR）量化。在自然活动（如行走或跑步）期间，VOR 以与头部运动相同的速度以相反的方向移动眼睛。这种反射有±5 ms的短延迟，它通过简单的三神经元弧2在水平平面中介导。信息从前庭受体传到前庭核，然后传到腹腔运动神经元。这些眼部运动可使日常活动期间水平凝视稳定。VOR响应顺时针和逆时针旋转的对称性是对前庭功能的重要测试。
单侧前庭功能障碍产生中央补偿性变化和集中驱动的外围变化，以克服有缺陷的不对称VOR和由此产生的前庭不平衡。即使在永久性前庭病变（如单侧前庭神经切除术）之后，眩晕和伴随症状也会在短时间内（几天到几周）改善。由于这种能力，前庭系统一直是研究神经通路适应和补偿的模型。此前已经表明，中央前庭通路的变化可以通过基于作者之一（N.R.）在大约20年前提出的假设的单向旋转实现。其他研究也显示，感觉通路的不同部分，包括前庭核（VN）4，5，6，7，8，小球通路的补偿性变化在VN两侧9，小脑输入10，和前庭外围11之间。这些补偿性变化导致双方VN神经元的活动出现新的平衡。
尽管前庭系统能够补偿来自两只耳朵的不对称输入，但研究表明，对快速运动的反应从未得到完全补偿。现在已知，自然前庭补偿不使用系统的全部容量，补偿的VOR反应可以改善在动物参加了视觉前庭训练14，15。众所周知，前庭康复练习通过增强平衡控制的（非前庭）多感官特性，改善慢性不平衡问题患者的补偿。18,19,20,21.这些前庭康复练习的目标是使用生理或行为方法改善症状，以及病人的生活质量和独立性22，23。
本文所述是一种康复方法，使用单向旋转对”较弱”的一侧（图1A）。这种方法的基本思想来自Hebbian的可塑性，其中神经连接在受到刺激时会变得更强。这种方法专门修改前庭输入，而不是加强多感官整合，这是其他前庭康复练习的基础。先前的研究表明，单向旋转减少VOR不对称在1-2个会话的单方面前庭功能障碍3患者。这种影响主要是由于反应较低的一方的活动增加，以及反应较高的一方的活动略有下降。这种变化最有可能通过中央路径的修改（例如，加强一个透面通路（如 VN 连接或电子输入的变化）来调节。实际上，这种技术可以作为长期前庭不对称者前庭康复的监督方法。
Protocol
这里提供的数据和以前发表的3份数据是根据伊朗德黑兰沙希德·贝赫什蒂医科大学伦理委员会的建议和经伊朗政府批准的一项议定书获得的。大学机构审查委员会。 1. 参与者筛选和准备 招募有一年以上平衡问题史的参与者。注：前庭补偿在病变后的第一个月最为有效。选择一年的时间点是为自然补偿提供足够的时间，以到达其高原，并确保患者?…
Representative Results
通过测量在康复3后70分钟的0.2赫兹（40μ/s）正弦旋转测试的VOR，评估单向旋转的短期影响。图 2显示了 VOR 响应两个方向旋转期间的峰值眼速（图 2A）和 DP 的变化（图 2B）。在单向旋转后，对低响应 （LR） 的侧方向旋转的响应增加，对相反方向的旋转响应（响应较强的方向 [HR]）减少，?…
Discussion
这里介绍的康复方法包括在黑暗中对前庭不平衡和VOR不对称患者反应较差（LR）侧进行重复的单向旋转。大多数康复技术加强多感官整合，以提高平衡16，17，18，19，20。此处介绍的方法针对前庭通路，其影响可以通过 LR 端 VN 响应的增加和 HR 端 VN 响应的减少来解释。这些影?…
Disclosures
The authors have nothing to disclose.
Acknowledgements
N.R.得到了沙希德·贝赫什蒂医学科学和卫生服务大学的研究基金的支持。S. G. S. 得到 NIDCD R03 DC015091 赠款的支持。
Materials
| VEST operating and analysis software | NeuroKinetics | ||
| Electronystagmograph | Nicolet | Spirit Model 1992 | Equipment used for collecting the data presented in the Results section |
| I-Portal NOTC (Neurotologic Test Center) | NeuroKinetics | Equipment shown for current studies and shown in the movie |
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Cite This Article
Rassaian, N., Sadeghi, N. G., Sabetazad, B., McNerney, K. M., Burkard, R. F., Sadeghi, S. G. Using Unidirectional Rotations to Improve Vestibular System Asymmetry in Patients with Vestibular Dysfunction. J. Vis. Exp. (150), e60053, doi:10.3791/60053 (2019).