HABITUATION THERAPY FOR CHRONIC VESTIBULAR DYSFUNCTION

慢性前庭功能障碍患者的治疗选择有 包括诊断评估后的观察，药理学 管理和手术。基础科学调查表明，中央 神经系统对外周前庭症状的补偿可能是 在前庭功能障碍的患者中会产生相反的效果。定制 反复使病人暴露在前庭的体育锻炼 感觉冲突可能会促进康复，但这种方式很少使用 在美国。初步数据显示，定制的前庭 习惯性治疗是一种安全、有效的治疗方法。 VHT的可获得性计划可以为患者提供极大的缓解 缺乏其他治疗选择的相当大的残疾。VHT还可以 当症状持续时，不再需要前庭手术。 缺乏补偿，而不是持续的迷路功能障碍。 此外，这种模式可以提供一种安全、理性和道德的 外科治疗前瞻性试验的非手术对照治疗。 建议设立一个为期三年的临床研究人员发展奖(CIDA)。 这将包括与VHT相关的临床研究，解决 目标如下：1.对慢性阻塞性肺疾病患者的客观评估 前庭功能障碍。2)评价VHT的治疗效果 通过一项前瞻性、随机、对照试验，研究对象为 慢性前庭功能障碍。3)确定动力的作用 比较Alternative、Less对VHT患者姿势图的预测价值 治疗方案设计中的昂贵方法。 广泛的临床研究设计和培训计划 还建议对首席调查员进行生物统计分析。 这将促进未来正在进行的本地 和多机构前瞻性临床试验以解决未得到答复的问题 神经学领域的问题，尤其是与前庭有关的问题 功能障碍。

Treatment options for patients with chronic vestibular dysfunction have included observation following diagnostic evaluation, pharmacologic management, and surgery. Basic science investigation suggests that central nervous system compensation for peripheral vestibular symptoms may be counter-productive in patients with vestibular dysfunction. Customized physical exercise which repeatedly exposes the patient to vestibular sensory conflict may enhance recovery, yet this modality is rarely utilized in the United States. Preliminary data suggest that customized vestibular habituation therapy (VHT) is a safe, effective treatment modality. Accessible programs of VHT could provide great relief to patients with considerable disability who lack other treatment options. VHT may also obviate the need for vestibular surgery when continued symptoms are due to lack of compensation rather than ongoing labyrinthine dysfunction. Moreover, this modality could provide a safe, rational, and ethical nonsurgical control treatment for prospective trials of surgical treatment. A three-year clinical investigator development award (CIDA) is proposed. This will include clinical investigations related to VHT addressing the following aims: 1.) To objectify the assessment of patients with chronic vestibular dysfunction. 2) To assess the therapeutic effectiveness of VHT through a prospective, randomized, controlled trial involving patients with chronic vestibular dysfunction. 3) To determine the role of dynamic posturography in VHT by comparing the predictive value of alternative, less expensive methodology in the design of treatment protocols. An extensive program of training in clinical research design and biostatistical analysis is also proposed for the Principal Investigator. This will facilitate the future design and administration of ongoing local and multi-institutional prospective clinical trials to address unanswered questions in the field of neurology, especially those related to vestibular dysfunction.