Article

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 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 found
during surgery of the posterior cranial fossa, there may be a risk of a combined
vestibulo-cerebellar 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 everyday
activities may go without any prominent symptoms. We therefore implemented a pre
treatment plan before planned vestibular lesions (prehab). This was first done in
subject undergoing gentamicin treatment for Meniere's disease (MD). Subjects
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. We then expanded
the approach to patients with brainstem tumours requiring surgery but with
remaining vestibular function to ease postoperative symptoms and reduce risk of
combined cerebello-vestibular lesions. This patient group was given gentamicin
installations trans-tympanically before tumour sugary and then underwent prehab.
In all cases there was a caloric loss, loss of VOR evident in the head impulse
tests, impaired subjective vertical and horizontal, and reduced caloric function
induced by the pre-surgery gentamicin treatment. The prehab eliminated
spontaneous and positional nystagmus, subjective symptoms, and postural function
up before surgery and allowed for rapid postoperative recovery.The concept of
'pre-lesion rehabilitation' where training is introduced before a planned lesion
and if possible paralleled with a gradual function loss expands the potential of
rehabilitation. Here it was used for vestibular lesions but it is possible that
similar approaches may be developed for other situations, which include
foreseeable loss of function.

Langue : ANGLAIS