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Vestibular "PREHAB"

Magnusson, Måns LU ; Kahlon, Babar LU ; Karlberg, Mikael LU ; Lindberg, Sven LU ; Siesjö, Peter LU and Tjernström, Fredrik LU (2009) In Annals of the New York Academy of Sciences 1164. p.257-262
Abstract
A sudden unilateral loss or impairment of vestibular function causes vertigo, dizziness, and impaired postural function. In most occasions, everyday activities supported or not by vestibular rehabilitation programs will promote a compensation and the symptoms subside. As the compensatory process requires sensory input, matching performed motor activity, both motor learning of exercises and matching to sensory input are required. If there is a simultaneous cerebellar lesion caused by the tumor or the surgery of the posterior cranial fossa, there may be a risk of a combined vestibulocerebellar lesion, with reduced compensatory abilities and with prolonged or sometimes permanent disability. On the other hand, a slow gradual loss of unilateral... (More)
A sudden unilateral loss or impairment of vestibular function causes vertigo, dizziness, and impaired postural function. In most occasions, everyday activities supported or not by vestibular rehabilitation programs will promote a compensation and the symptoms subside. As the compensatory process requires sensory input, matching performed motor activity, both motor learning of exercises and matching to sensory input are required. If there is a simultaneous cerebellar lesion caused by the tumor or the surgery of the posterior cranial fossa, there may be a risk of a combined vestibulocerebellar lesion, with reduced compensatory abilities and with prolonged or sometimes permanent disability. On the other hand, a slow gradual loss of unilateral function occurring as the subject continues well-learned everyday activities may go without any prominent symptoms. A pretreatment plan was therefore implemented before planned vestibular lesions, that is, "PREHAB." This was first done in subjects undergoing gentamicin treatment for morbus Meniere. Subjects would perform vestibular exercises for 14 days before the first gentamicin installation, and then continue doing so until free of symptoms. Most subjects would only experience slight dizziness while losing vestibular function. The approach-which is reported here-was then expanded to patients with pontine-angle tumors requiring surgery, but with remaining vestibular function to ease postoperative symptoms and reduce risk of combined cerebellovestibular lesions. Twelve patients were treated with PREHAB and had gentamicin installations transtympanically. In all cases there was a caloric loss, loss of VOR in head impulse tests, and impaired subjective vertical and horizontal. Spontaneous, positional nystagmus, subjective symptoms, and postural function were normalized before surgery and postoperative recovery was swift. Pretreatment training with vestibular exercises continued during the successive loss of vestibular function during gentamicin treatment, and pre-op gentamicin ablation of vestibular function offers a possibility to reduce malaise and speed up recovery. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
vestibular, compensation, PREHAB, rehabilitation, recovery, schwannoma
in
Annals of the New York Academy of Sciences
volume
1164
pages
257 - 262
publisher
New York Academy of Sciences
external identifiers
  • wos:000267019700036
  • pmid:19645909
  • scopus:66149094963
ISSN
0077-8923
DOI
10.1111/j.1749-6632.2009.03778.x
language
English
LU publication?
yes
id
6b8ecf15-d4c3-4442-8682-d69345d023b3 (old id 1441717)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/19645909?dopt=Abstract
date added to LUP
2009-07-27 15:32:04
date last changed
2017-01-08 03:42:57
@article{6b8ecf15-d4c3-4442-8682-d69345d023b3,
  abstract     = {A sudden unilateral loss or impairment of vestibular function causes vertigo, dizziness, and impaired postural function. In most occasions, everyday activities supported or not by vestibular rehabilitation programs will promote a compensation and the symptoms subside. As the compensatory process requires sensory input, matching performed motor activity, both motor learning of exercises and matching to sensory input are required. If there is a simultaneous cerebellar lesion caused by the tumor or the surgery of the posterior cranial fossa, there may be a risk of a combined vestibulocerebellar lesion, with reduced compensatory abilities and with prolonged or sometimes permanent disability. On the other hand, a slow gradual loss of unilateral function occurring as the subject continues well-learned everyday activities may go without any prominent symptoms. A pretreatment plan was therefore implemented before planned vestibular lesions, that is, "PREHAB." This was first done in subjects undergoing gentamicin treatment for morbus Meniere. Subjects would perform vestibular exercises for 14 days before the first gentamicin installation, and then continue doing so until free of symptoms. Most subjects would only experience slight dizziness while losing vestibular function. The approach-which is reported here-was then expanded to patients with pontine-angle tumors requiring surgery, but with remaining vestibular function to ease postoperative symptoms and reduce risk of combined cerebellovestibular lesions. Twelve patients were treated with PREHAB and had gentamicin installations transtympanically. In all cases there was a caloric loss, loss of VOR in head impulse tests, and impaired subjective vertical and horizontal. Spontaneous, positional nystagmus, subjective symptoms, and postural function were normalized before surgery and postoperative recovery was swift. Pretreatment training with vestibular exercises continued during the successive loss of vestibular function during gentamicin treatment, and pre-op gentamicin ablation of vestibular function offers a possibility to reduce malaise and speed up recovery.},
  author       = {Magnusson, Måns and Kahlon, Babar and Karlberg, Mikael and Lindberg, Sven and Siesjö, Peter and Tjernström, Fredrik},
  issn         = {0077-8923},
  keyword      = {vestibular,compensation,PREHAB,rehabilitation,recovery,schwannoma},
  language     = {eng},
  pages        = {257--262},
  publisher    = {New York Academy of Sciences},
  series       = {Annals of the New York Academy of Sciences},
  title        = {Vestibular "PREHAB"},
  url          = {http://dx.doi.org/10.1111/j.1749-6632.2009.03778.x},
  volume       = {1164},
  year         = {2009},
}