Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Evidence-Based Clinical Practice Guideline: FROM THE AMERICAN PHYSICAL THERAPY ASSOCIATION NEUROLOGY SECTION.
Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Evidence-Based Clinical Practice Guideline: FROM THE AMERICAN PHYSICAL THERAPY ASSOCIATION NEUROLOGY SECTION.
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DOI：
10.1097/npt.0000000000000120
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发表时间：
2016-04
期刊：
影响因子：
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通讯作者：
Woodhouse SN
中科院分区：
文献类型：
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作者：
Hall CD;Herdman SJ;Whitney SL;Cass SP;Clendaniel RA;Fife TD;Furman JM;Getchius TS;Goebel JA;Shepard NT;Woodhouse SN
补充数字内容在文本中可用。未代偿性前庭功能减退导致姿势不稳定、头部运动时视觉模糊以及头晕和/或失衡的主观主诉。我们试图回答这个问题，“前庭运动是否能有效地促进外周（单侧或双侧）前庭功能减退患者的功能恢复？”在1985年之后发表的5个数据库中进行了文献的系统综述，并检索了5个相关出版物的其他来源。文章类型包括荟萃分析、系统综述、随机对照试验、队列研究、病例对照系列和人类受试者病例系列，以英文发表。确定了135篇文章与本临床实践指南相关。基于强有力的证据和利大于弊的优势，临床医生应该为单侧和双侧前庭功能减退伴前庭功能障碍和功能限制的患者提供前庭康复治疗。基于强有力的证据和弊大于利的优势，临床医生不应将自主扫视或平滑追踪眼球运动单独（即，没有头部运动）作为凝视稳定性的特定练习。基于中等程度的证据，临床医生可能会提供特定的运动技术，以针对已识别的损伤或功能限制。基于适度的证据和考虑到患者的偏好，临床医生可以提供监督前庭康复。根据从证据中推断出的专家意见，临床医生可以规定每天至少进行3次凝视稳定性练习，作为家庭锻炼计划的一部分。根据从证据中推断的专家意见（监督访视范围：2-38周，平均= 10周），临床医生可能会考虑为患者提供充分的监督前庭康复课程，以了解该计划的目标以及如何独立管理和进步。作为一般指南，没有影响活动性的显著合并症和急性或亚急性单侧前庭功能减退的人可能需要每周一次监督会议，持续2至3周;慢性单侧前庭功能减退的人可能需要每周一次会议，持续4至6周;双侧前庭功能减退的人可能需要每周一次会议，持续8至12周。除了有监督的会议，患者还提供每日家庭锻炼计划。这些建议旨在为物理治疗师和临床医生提供指导，以优化接受前庭康复的外周前庭功能减退患者的康复结果。视频摘要可从作者获得更多见解（参见视频，补充数字内容1，http：//links.lww.com/JNPT/A124）。
Supplemental Digital Content is Available in the Text. Uncompensated vestibular hypofunction results in postural instability, visual blurring with head movement, and subjective complaints of dizziness and/or imbalance. We sought to answer the question, “Is vestibular exercise effective at enhancing recovery of function in people with peripheral (unilateral or bilateral) vestibular hypofunction?” A systematic review of the literature was performed in 5 databases published after 1985 and 5 additional sources for relevant publications were searched. Article types included meta-analyses, systematic reviews, randomized controlled trials, cohort studies, case control series, and case series for human subjects, published in English. One hundred thirty-five articles were identified as relevant to this clinical practice guideline. Based on strong evidence and a preponderance of benefit over harm, clinicians should offer vestibular rehabilitation to persons with unilateral and bilateral vestibular hypofunction with impairments and functional limitations related to the vestibular deficit. Based on strong evidence and a preponderance of harm over benefit, clinicians should not include voluntary saccadic or smooth-pursuit eye movements in isolation (ie, without head movement) as specific exercises for gaze stability. Based on moderate evidence, clinicians may offer specific exercise techniques to target identified impairments or functional limitations. Based on moderate evidence and in consideration of patient preference, clinicians may provide supervised vestibular rehabilitation. Based on expert opinion extrapolated from the evidence, clinicians may prescribe a minimum of 3 times per day for the performance of gaze stability exercises as 1 component of a home exercise program. Based on expert opinion extrapolated from the evidence (range of supervised visits: 2-38 weeks, mean = 10 weeks), clinicians may consider providing adequate supervised vestibular rehabilitation sessions for the patient to understand the goals of the program and how to manage and progress themselves independently. As a general guide, persons without significant comorbidities that affect mobility and with acute or subacute unilateral vestibular hypofunction may need once a week supervised sessions for 2 to 3 weeks; persons with chronic unilateral vestibular hypofunction may need once a week sessions for 4 to 6 weeks; and persons with bilateral vestibular hypofunction may need once a week sessions for 8 to 12 weeks. In addition to supervised sessions, patients are provided a daily home exercise program. These recommendations are intended as a guide for physical therapists and clinicians to optimize rehabilitation outcomes for persons with peripheral vestibular hypofunction undergoing vestibular rehabilitation. Video Abstract available for more insights from the author (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A124).