Interaction between Vestibular Compensation Mechanisms and Vestibular Rehabilitation Therapy: 10 Recommendations for Optimal Functional Recovery

Abstract

This review questions the relationships between the plastic events responsible for the recovery of vestibular function after a unilateral vestibular loss (vestibular compensation), which has been well described in animal models in the last decades, and the vestibular rehabilitation (VR) therapy elaborated on a more empirical basis for vestibular loss patients. The main objective is not to propose a catalog of results but to provide clinicians with an understandable view on when and how to perform VR therapy, and why VR may benefit from basic knowledge and may influence the recovery process. With this perspective, 10 major recommendations are proposed as ways to identify an optimal functional recovery. Among them are the crucial role of active and early VR therapy, coincidental with a post-lesion sensitive period for neuronal network remodeling, the instructive role that VR therapy may play in this functional reorganization, the need for progression in the VR therapy protocol, which is based mainly on adaptation processes, the necessity to take into account the sensorimotor, cognitive, and emotional profile of the patient to propose individual or “à la carte” VR therapies, and the importance of motivational and ecologic contexts. More than 10 general principles are very likely, but these principles seem crucial for the fast recovery of vestibular loss patients to ensure good quality of life.

Clinicoetiological pattern and pharmacotherapy practices in patients with new onset vertigo: findings from a prospective multicenter registry in India

“…Early betahistine pharmacotherapy with active concomitant vestibular rehabilitation is highly recommended for early recovery compared with treatment alone. [29][30][31] This synergistic effect could not be elicited from the study data. Although the recommended dose of betahistine in vertigo is 48 mg per day, physicians prescribed a lower daily dose of betahistine, ~16 mg (average dose: 15.6±5.26 mg) in our study.…”

Vertigo Perception and Quality of Life in Patients after Surgical Treatment of Vestibular Schwannoma with Pretreatment Prehabituation by Chemical Vestibular Ablation

“…Anxiety, depression, and social factors are further factors important for the final level of handicap after sudden vestibular loss including labyrinth surgery [11, 12]. …”

Neuro-otology- some recent clinical advances

“…Therapeutic unilateral vestibular deafferentation of the affected ear with vestibular nerve section, surgical labyrinthectomy or intratympanic gentamicin injections can do this but at the risk (~25 %) of producing mild, but permanent, subjective imbalance [54], annoying for both patient and doctor, and needing immediate intensive vestibular rehabilitation [55]. Intratympamic dexamethasone might be just as good and should not produce imbalance [56].…”