Document Detail

Postural compensation for vestibular loss.
MedLine Citation:
PMID:  19645883     Owner:  NLM     Status:  MEDLINE    
To what extent can remaining sensory information and/or sensory biofeedback (BF) compensate for loss of vestibular information in controlling postural equilibrium? The primary role of the vestibulospinal system is as a vertical reference for control of the trunk in space, with increasing importance as the surface becomes increasingly unstable. Our studies with patients with bilateral loss of vestibular function show that vision or light touch from a fingertip can substitute as a reference for earth vertical to decrease variability of trunk sway when standing on an unstable surface. However, some patients with bilateral loss compensate better than others, and found that those with more complete loss of bilateral vestibular function compensate better than those with measurable vestibulo-ocular reflexes. In contrast, patients with unilateral vestibular loss (UVL) who reweight sensory dependence to rely on their remaining unilateral vestibular function show better functional performance than those who do not increase vestibular weighting on an unstable surface. Light touch of <100 grams or auditory biofeedback can be added as a vestibular vertical reference to stabilize trunk sway during stance. Postural ataxia during tandem gait in patients with UVL is also significantly improved with vibrotactile BF to the trunk, beyond improvements due to practice. Vestibular rehabilitation should focus on decreasing hypermetria, decreasing an overdependence on surface somatosensory inputs, increasing use of any remaining vestibular function, substituting or adding alternative sensory feedback related to trunk sway, and practicing challenging balance tasks on unstable surfaces.
Fay B Horak
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Review    
Journal Detail:
Title:  Annals of the New York Academy of Sciences     Volume:  1164     ISSN:  1749-6632     ISO Abbreviation:  Ann. N. Y. Acad. Sci.     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-08-03     Completed Date:  2009-08-18     Revised Date:  2014-09-13    
Medline Journal Info:
Nlm Unique ID:  7506858     Medline TA:  Ann N Y Acad Sci     Country:  United States    
Other Details:
Languages:  eng     Pagination:  76-81     Citation Subset:  IM    
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MeSH Terms
Gait Ataxia / physiopathology,  rehabilitation
Vestibule, Labyrinth / physiopathology*
Grant Support
004082//PHS HHS; R01 DC004082/DC/NIDCD NIH HHS; R01 DC004082-09/DC/NIDCD NIH HHS

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