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PREHAB vs. REHAB - presurgical treatment in vestibular schwannoma surgery enhances recovery of postural control better than postoperative rehabilitation : Retrospective case series

Tjernström, Fredrik LU ; Fransson, Per Anders LU ; Kahlon, Babar LU ; Karlberg, Mikael LU ; Lindberg, Sven LU ; Siesjö, Peter LU and Magnusson, Måns LU (2018) In Journal of Vestibular Research: Equilibrium and Orientation 27(5-6). p.313-325
Abstract

OBJECT: To evaluate post-surgical postural stability when treating patients with remaining vestibular function with intratympanic gentamicin (PREHAB) prior to schwannoma surgery. METHOD: 44 consecutive patients with some form remaining vestibular function scheduled for vestibular schwannoma surgery. 20 were medically deafferented with intratympanic gentamicin before surgery and 24 were not. Both groups were of the same age, had the same tumor size, same type of surgery, and same perioperative sensory rehabilitation (training exercises), and no surgical complications. Postural stability measured as energy expenditure while standing on a force platform during vibratory stimulation of the calf muscles, performed prior to surgery (or... (More)

OBJECT: To evaluate post-surgical postural stability when treating patients with remaining vestibular function with intratympanic gentamicin (PREHAB) prior to schwannoma surgery. METHOD: 44 consecutive patients with some form remaining vestibular function scheduled for vestibular schwannoma surgery. 20 were medically deafferented with intratympanic gentamicin before surgery and 24 were not. Both groups were of the same age, had the same tumor size, same type of surgery, and same perioperative sensory rehabilitation (training exercises), and no surgical complications. Postural stability measured as energy expenditure while standing on a force platform during vibratory stimulation of the calf muscles, performed prior to surgery (or gentamicin treatment) and 6 months after surgery. RESULTS: Patients pretreated with gentamicin had significantly better postural stability at the time for follow-up (p < 0.05) and displayed a better adaptive capacity when faced with a postural challenge (p < 0.01). They were also able to use vision more efficiently to control their stability (p < 0.05). CONCLUSIONS: By separating the sensory loss (through intratympanic gentamicin, that ablates the remaining vestibular function) from the intracranial surgical trauma, the postural control system benefited from a better short-term (adaptation) and long-term (habituation) recovery, when experiencing a postural challenge or resolving a sensory conflict. The benefits could be attributed to; active and continuous motor learning as the vestibular function slowly attenuates; no concomitant central nervous dysfunction due to effects from neurosurgery, thus allowing time for a separate unimpeded recovery process with more limited challenges and objectives; and the initiation and certain progression of sensory reweighting processes allowed prior to surgery. In contrast, worse compensation could be due to; immobilization from nausea after surgery, harmful amount of stress and cognitive dysfunction from the combination of surgical and sensory trauma and an abrupt vestibular deafferentation and its consequences on sensory reweighting.

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author
publishing date
type
Contribution to journal
publication status
published
subject
keywords
gentamicin, postural control, rehabilitation, Schwannoma
in
Journal of Vestibular Research: Equilibrium and Orientation
volume
27
issue
5-6
pages
13 pages
publisher
IOS Press
external identifiers
  • scopus:85048078780
ISSN
0957-4271
DOI
10.3233/VES-170626
language
English
LU publication?
no
id
60896efd-4260-4fd0-bde3-240daab55abd
date added to LUP
2018-06-20 14:15:26
date last changed
2019-01-13 06:14:04
@article{60896efd-4260-4fd0-bde3-240daab55abd,
  abstract     = {<p>OBJECT: To evaluate post-surgical postural stability when treating patients with remaining vestibular function with intratympanic gentamicin (PREHAB) prior to schwannoma surgery. METHOD: 44 consecutive patients with some form remaining vestibular function scheduled for vestibular schwannoma surgery. 20 were medically deafferented with intratympanic gentamicin before surgery and 24 were not. Both groups were of the same age, had the same tumor size, same type of surgery, and same perioperative sensory rehabilitation (training exercises), and no surgical complications. Postural stability measured as energy expenditure while standing on a force platform during vibratory stimulation of the calf muscles, performed prior to surgery (or gentamicin treatment) and 6 months after surgery. RESULTS: Patients pretreated with gentamicin had significantly better postural stability at the time for follow-up (p &lt; 0.05) and displayed a better adaptive capacity when faced with a postural challenge (p &lt; 0.01). They were also able to use vision more efficiently to control their stability (p &lt; 0.05). CONCLUSIONS: By separating the sensory loss (through intratympanic gentamicin, that ablates the remaining vestibular function) from the intracranial surgical trauma, the postural control system benefited from a better short-term (adaptation) and long-term (habituation) recovery, when experiencing a postural challenge or resolving a sensory conflict. The benefits could be attributed to; active and continuous motor learning as the vestibular function slowly attenuates; no concomitant central nervous dysfunction due to effects from neurosurgery, thus allowing time for a separate unimpeded recovery process with more limited challenges and objectives; and the initiation and certain progression of sensory reweighting processes allowed prior to surgery. In contrast, worse compensation could be due to; immobilization from nausea after surgery, harmful amount of stress and cognitive dysfunction from the combination of surgical and sensory trauma and an abrupt vestibular deafferentation and its consequences on sensory reweighting.</p>},
  author       = {Tjernström, Fredrik and Fransson, Per Anders and Kahlon, Babar and Karlberg, Mikael and Lindberg, Sven and Siesjö, Peter and Magnusson, Måns},
  issn         = {0957-4271},
  keyword      = {gentamicin,postural control,rehabilitation,Schwannoma},
  language     = {eng},
  month        = {01},
  number       = {5-6},
  pages        = {313--325},
  publisher    = {IOS Press},
  series       = {Journal of Vestibular Research: Equilibrium and Orientation},
  title        = {PREHAB vs. REHAB - presurgical treatment in vestibular schwannoma surgery enhances recovery of postural control better than postoperative rehabilitation : Retrospective case series},
  url          = {http://dx.doi.org/10.3233/VES-170626},
  volume       = {27},
  year         = {2018},
}