Analysis of the efficacy of different timing of vestibular rehabilitation interventions in the acute phase of vestibular neuritis
-
摘要: 目的 探讨不同的前庭康复治疗时机对前庭神经炎急性期患者的恢复疗效。方法 选取2019年12月-2021年7月于门诊及住院接受治疗的前庭神经炎患者31例，随机分为前庭康复组(VRT组)及一般治疗组，其中VRT组按照发病至前庭康复开始的病程分为1周组(11例)和2周组(10例)。比较1周组、2周组及一般治疗组(10例)患者治疗后1个月、3个月的优势偏向(DP)、半规管轻瘫(UW)、前庭眼反射的增益值(VOR)、头晕症状障碍评分(DHI)、Berg平衡量表(BBS)评分及焦虑自评量表(SAS)评分的差异。结果 VRT组和一般治疗组的DP值、UW值、VOR增益值、DHI评分及SAS评分差异均有统计学意义(P < 0.05)，而BBS评分差异无统计学意义(P>0.05)。1周组和2周组两两比较，DP值、VOR增益值和UW值的差异均有统计学意义(P < 0.05)，DHI评分和SAS评分比较差异无统计学意义(P>0.05)。结论 VRT可加速前庭神经炎患者前庭代偿、缓解眩晕症状及焦虑症状，建议1周内开展，疗效更佳。Abstract: Objective To investigate the impact of time interval from symptoms onset to vestibular rehabilitation on the recovery of patients in the acute phase of vestibular neuritis.Methods Thirty-one patients with vestibular neuritis treated in outpatient and inpatient settings from December 2019 to July 2021 were selected and randomly divided into vestibular rehabilitation group and general treatment group. The vestibular rehabilitation group was subdivided into early-intervention group (1-week after symptom onset) and late-intervention group (2-week after symptom onset) according to the interval from the onset to vestibular rehabilitation. The differences in DP, UW, VOR, DHI, BBS and SAS values at 1 month and 3 months after treatment were compared among early-intervention group(11 cases), late-intervention group (10 cases) and general treatment group(10 cases).Results For patients in the vestibular rehabilitation group and the general treatment group, DP, UW, VOR gain, DHI score and SAS score were significantly different after treatment (P < 0.05) and no significant difference was found in BBS score (P>0.05). Pairwise comparisons between early-intervention and late-intervention group showed that the DP, UW and VOR gain were significantly different (P < 0.05), while the score of DHI and SAS were not significantly different (P>0.05).Conclusion Vestibular rehabilitation therapy can accelerate vestibular compensation, relieve vertigo symptoms and anxiety symptoms in patients with vestibular neuritis. It is better to be carried out within 1 week after symptom onset.
-
Key words:
- vestibular rehabilitation therapy /
- vestibular neuritis /
- vertigo
-
-
表 1 3组患者治疗前临床资料的比较
X ±S 项目 VRT组 一般治疗组(n=10) F/χ2/H值 P值 1周组(n=11) 2周组(n=10) 年龄/岁 43.27±15.07 47.2±10.15 44.2±15.51 0.23 0.78 性别/例 女 4 5 6 1.18 0.55 男 7 5 4 病变侧/例 左 6 5 5 0.06 0.97 右 5 5 5 病程/d 2.82±0.40 9.20±0.57 6.20±1.15 17.97 < 0.01 DP/% 72.00±8.31 56.90±11.54 59.60±14.46 4.22 0.03 UW/% 68.82±6.75 52.20±15.76 55.20±17.26 5.10 0.01 患侧水平半规管增益值 0.39±0.13 0.46±0.09 0.43±0.14 1.48 0.25 患侧前半规管增益值 0.61±0.14 0.58±0.23 0.63±0.23 0.14 0.88 DHI 62.19±5.20 48.70±5.61 39.00±5.72 5.74 0.01 BBS 12.91±14.33 22.20±19.02 19.70±11.05 3.47 0.17 SAS 48.48±3.05 44.70±3.20 50.35±3.20 0.81 0.46 
下载: 导出CSV
表 2 3组患者治疗后前庭功能及主观症状评分的比较
X ±S 项目 治疗后1个月 治疗后3个月 1周组 2周组 一般治疗组 1周组 2周组 一般治疗组 UW 32.45±1.691)2) 39.82±1.681) 45.88±1.62 23.88±1.201)2) 28.98±1.201) 33.94±1.15 DP 31.72±3.181)2) 44.54±3.201) 55.87±3.12 18.55±1.871)2) 25.96±1.871) 32.94±1.82 患侧水平半规管增益 0.66±0.031)2) 0.57±0.031) 0.48±0.03 0.87±0.031)2) 0.73±0.031) 0.59±0.03 患侧前半规管增益 0.78±0.29 0.74±0.31 1.24±0.31 0.92±0.57 0.83±0.13 0.81±0.04 DHI 7.17±1.961) 12.38±1.90 22.03±2.03 1.84±1.041) 4.25±1.02 7.92±1.08 BBS 55.63±0.46 55.46±0.48 55.85±0.48 56.01±0.11 55.99±0.12 55.80±0.12 SAS 35.07±2.041) 35.58±1.831) 48.63±2.03 26.67±2.381) 28.00±1.701) 36.08±1.65 与一般治疗组比较，1) P < 0.05；与2周组比较，2) P < 0.05。
下载: 导出CSV
-
[1] Zwergal A, Dieterich M. Vertigo and dizziness in the emergency room[J]. Curr Opin Neurol, 2020, 33(1): 117-125. doi: 10.1097/WCO.0000000000000769
[2] Liao L, Zhou Z, Chen G, et al. Sacral Neuromodulation Using a Novel Device with a Six-contact-point Electrode for the Treatment of Patients with Refractory Overactive Bladder: A Multicenter, Randomized, Single-blind, Parallel-control Clinical Trial[J]. Eur Urol Focus, 2022: S2405-4569(22)00083-9.
[3] 李斐, 鞠奕, 张甦琳, 等. 前庭神经炎诊治多学科专家共识[J]. 中华老年医学杂志, 2020, 39(9): 985-994. doi: 10.3760/cma.j.issn.0254-9026.2020.09.001
[4] Meldrum D, Jahn K. Gaze stabilisation exercises in vestibular rehabilitation: review of the evidence and recent clinical advances[J]. J Neurol, 2019, 266(Suppl 1): 11-18.
[5] Han BI, Song HS, Kim JS. Vestibular rehabilitation therapy: review of indications, mechanisms, and key exercises[J]. J Clin Neurol, 2011, 7(4): 184-196. doi: 10.3988/jcn.2011.7.4.184
[6] 王璟, 周玉娟, 余菁, 等. 优势偏向在外周性眩晕患者前庭功能评估中的意义[J]. 中华耳鼻咽喉头颈外科杂志, 2017, 52(3): 200-204. https://www.cnki.net/KCMS/detail/detail.aspx?dbcode=IPFD&filename=ZGZP201712001324&dbname=IPFDLAST2020
[7] Grosch M, Lindner M, Bartenstein P, et al. Dynamic whole-brain metabolic connectivity during vestibular compensation in the rat[J]. Neuroimage, 2021, 226: 117588. doi: 10.1016/j.neuroimage.2020.117588
[8] Lacour M, Tighilet B. Plastic events in the vestibular nuclei during vestibular compensation: the brain orchestration of a "deafferentation" code[J]. Restor Neurol Neurosci, 2010, 28(1): 19-35.
[9] Hall CD, Herdman SJ, Whitney SL, et al. Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Updated Clinical Practice Guideline From the Academy of Neurologic Physical Therapy of the American Physical Therapy Association[J]. J Neurol Phys Ther, 2022, 46(2): 118-177.
[10] 陈瑛, 庄建华, 李斐, 等. 视频头脉冲试验检测前庭神经炎急性期半规管的受损情况及其恢复特点的应用[J]. 第二军医大学学报, 2018, 39(1): 97-100. https://www.cnki.com.cn/Article/CJFDTOTAL-DEJD201801017.htm
[11] Fu W, He F, Wei D, et al. Recovery Pattern of High-Frequency Acceleration Vestibulo-Ocular Reflex in Unilateral Vestibular Neuritis: A Preliminary Study[J]. Front Neurol, 2019, 10: 85. doi: 10.3389/fneur.2019.00085
[12] Michel L, Laurent T, Alain T. Rehabilitation of dynamic visual acuity in patients with unilateral vestibular hypofunction: earlier is better[J]. Eur Arch Otorhinolaryngol, 2020, 277(1): 103-113.
[13] Van Nechel C, Bostan A, Duquesne U, et al. Visual Input Is the Main Trigger and Parametric Determinant for Catch-Up Saccades During Video Head Impulse Test in Bilateral Vestibular Loss[J]. Front Neurol, 2018, 9: 1138.
[14] Tarnutzer AA, Bockisch CJ, Buffone E, et al. Disease-specific sparing of the anterior semicircular canals in bilateral vestibulopathy[J]. Clin Neurophysiol, 2016, 127(8): 2791-2801.
[15] Allum J, Honegger F. Correlations Between Multi-plane vHIT Responses and Balance Control After Onset of an Acute Unilateral Peripheral Vestibular Deficit[J]. Otol Neurotol, 2020, 41(7): e952-e960.
[16] Kammerlind AS, Ledin TE, Odkvist LM, et al. Effects of home training and additional physical therapy on recovery after acute unilateral vestibular loss--a randomized study[J]. Clin Rehabil, 2005, 19(1): 54-62.
[17] 焦粤农, 林颖, 张欣睿, 等. 沉浸式虚拟现实系统辅助前庭功能康复的应用[J]. 临床耳鼻咽喉头颈外科杂志, 2020, 34(5): 447-451. https://d.wanfangdata.com.cn/periodical/lcebyhkzz202005015
[18] Tokle G, Mørkved S, Bråthen G, et al. Efficacy of Vestibular Rehabilitation Following Acute Vestibular Neuritis: A Randomized Controlled Trial[J]. Otol Neurotol, 2020, 41(1): 78-85.
[19] Vander Vegt CB, Hill-Pearson CA, Hershaw JN, et al. A Comparison of Generalized and Individualized Vestibular Rehabilitation Therapy in a Military TBI Sample[J]. J Head Trauma Rehabil, 2022.
[20] Casani AP, Gufoni M, Capobianco S. Current Insights into Treating Vertigo in Older Adults[J]. Drugs Aging, 2021, 38(8): 655-670.
-