Top-down approach to vestibular compensation: Translational lessons from vestibular rehabilitation

Abstract

This review examines vestibular compensation and vestibular rehabilitation from a unified translational research perspective. Laboratory studies illustrate neurobiological principles of vestibular compensation at the molecular, cellular and systems levels in animal models that inform vestibular rehabilitation practice. However, basic research has been hampered by an emphasis on ‘naturalistic’ recovery, with time after insult and drug interventions as primary dependent variables. The vestibular rehabilitation literature, on the other hand, provides information on how the degree of compensation can be shaped by specific activity regimens. The milestones of the early spontaneous static compensation mark the re-establishment of static gaze stability, which provides a common coordinate frame for the brain to interpret residual vestibular information in the context of visual, somatosensory and visceral signals that convey gravitoinertial information. Stabilization of the head orientation and the eye orientation (suppression of spontaneous nystagmus) appear to be necessary by not sufficient conditions for successful rehabilitation, and define a baseline for initiating retraining. The lessons from vestibular rehabilitation in animal models offer the possibility of shaping the recovery trajectory to identify molecular and genetic factors that can improve vestibular compensation.

Physiological, vestibulo-ocular and cervicogenic post-concussion disorders: An evidence-based classification system with directions for treatment

“…Current evidence suggests that vestibular rehabilitation programmes that utilize a 'top-down' approach and are customized to the patient's specific vestibulo-ocular deficits are the most successful [41]. Vestibular rehabilitation programmes should be designed to improve function of the VOR, the cervicoocular reflex (COR), depth perception, somatosensory retraining, dynamic gait and aerobic conditioning [41]. Each of these areas can be addressed with home therapy programmes that utilize specific exercises that increase in difficulty according to the patient's impairments and progress.…”

“…The underlying goal of vestibular rehabilitation is to recalibrate depth and spatial perception under static and dynamic conditions by re-establishing efficient integration of the vestibular, visual and somatosensory sub-systems. Current evidence suggests that vestibular rehabilitation programmes that utilize a 'top-down' approach and are customized to the patient's specific vestibulo-ocular deficits are the most successful [41]. Vestibular rehabilitation programmes should be designed to improve function of the VOR, the cervicoocular reflex (COR), depth perception, somatosensory retraining, dynamic gait and aerobic conditioning [41].…”

Visuo-vestibular contributions to anxiety and fear

“…Desensitization exercises train individuals to tolerate an abnormal response. On a practical level, vestibular physical therapy procedures focus on vestibulo-ocular reflex, cervico-ocular reflex, depth perception, somatosensory retraining, dynamic gait exercises, and improved aerobic function (Balaban et al, 2012;Herdman and Whitney, 2007;Whitney and Sparto, 2011). Exercises that promote awareness of somatosensory inputs also enhance a participant's confidence in height situations (Whitney et al, 2005).…”

First trial response to sudden support surface displacement: The effect of vestibular compensation

“…This is of particular interest because the responses in the noncompensated patients were usually markedly hypermetric and a FTE would be of benefit, indicating an ability to stabilize progressively. These patients have in common several dysfunctionalities [17] and are the subject for particular methods of rehabilitation [18].…”