轻度脑外伤后前庭功能障碍康复研究进展

doi:10.3969/j.issn.1006-9771.2020.07.008

摘要/Abstract

摘要：

脑外伤是指由于外力导致的脑部创伤性结构损伤和/或脑功能的生理损伤。轻度脑外伤后易出现持续性头晕、眩晕和平衡障碍等前庭功能相关问题。前庭康复训练对轻度脑外伤后前庭功能恢复有积极作用。本文综述轻度脑外伤后前庭功能障碍的可能机制、前庭功能常见的评估方法和前庭康复治疗新进展。

关键词: 轻度脑外伤, 前庭功能障碍, 康复, 综述

Abstract:

Traumatic brain injury (TBI) would result in structural injury and/or physiological disruption of brain. Mild traumatic brain injury (mTBI) can result in vestibular dysfunctions, such as dizziness, vertigo and imbalance. Vestibular rehabilitation is effective on vestibular dysfunction after mTBI. This paper reviewed the possible mechanisms of vestibular dysfunction caused by mTBI, the common assessments of vestibular function and the new progress in vestibular rehabilitation.

Key words: mild traumatic brain injury, vestibular dysfunction, rehabilitation, review

中图分类号:

R651.1

杨洪友,江汉宏,庞超,娄强,丛文娟,郑遵成. 轻度脑外伤后前庭功能障碍康复研究进展[J]. 《中国康复理论与实践》, 2020, 26(7): 780-783.

YANG Hong-you,JIANG Han-hong,PANG Chao,LOU Qiang,CONG Wen-juan,ZHENG Zun-cheng. Advance in Rehabilitation for Vestibular Dysfunction after Mild Traumatic Brain Injury (review)[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(7): 780-783.

图/表 1

参考文献 46

[1]	Hyder A A, Wunderlich C A, Puvanachandra P, et al. The impact of traumatic brain injuries: a global perspective[J]. NeuroRehabilitation, 2007, 22(5): 341-353. doi: 10.3233/NRE-2007-22502
[2]	Management of Concussion/mTBI Working Group. VA/DoD Clinical Practice Guideline for Management of Concussion/Mild Traumatic Brain Injury[J]. J Rehabil Res Dev, 2009, 46(6): 1-68. doi: 10.1682/JRRD.2008.03.0038
[3]	Kleffelgaard I, Soberg H L, Tamber A L, et al. The effects of vestibular rehabilitation on dizziness and balance problems in patients after traumatic brain injury: a randomized controlled trial[J]. Clin Rehabil, 2019, 33(1): 74-84. doi: 10.1177/0269215518791274 pmid: 30056743
[4]	Hoffer M E, Gottshall K R, Moore R, et al. Characterizing and treating dizziness after mild head trauma[J]. Otol Neurotol, 2004, 25(2): 135-138. doi: 10.1097/00129492-200403000-00009
[5]	Valovich McLeod T C, Hale T D. Vestibular and balance issues following sport-related concussion[J]. Brain Inj, 2015, 29(2): 175-184. doi: 10.3109/02699052.2014.965206
[6]	Dikmen S, Machamer J, Fann J R, et al. Rates of symptom reporting following traumatic brain injury[J]. J Int Neuropsychol Soc, 2010, 16(3): 401-411. doi: 10.1017/S1355617710000196
[7]	Alsalaheen B A, Mucha A, Morris L O, et al. Vestibular rehabilitation for dizziness and balance disorders after concussion[J]. J Neurol Phys Ther, 2010, 34(2): 87-93. doi: 10.1097/NPT.0b013e3181dde568 pmid: 20588094
[8]	McDonnell Michelle N, Hillier Susan L, Vestibular rehabilitation for unilateral peripheral vestibular dysfunction [J]. Cochrane Database Syst Rev, 2015, 1: CD005397.
[9]	Bush M L, Dougherty W. Assessment of vestibular rehabilitation therapy training and practice patterns[J]. J Community Health, 2015, 40(4): 802-807. doi: 10.1007/s10900-015-0003-7
[10]	Reddy C C, Collins M W. Sports concussion: management and predictors of outcome[J]. Curr Sports Med Rep, 2009, 8(1): 10-15. doi: 10.1249/JSR.0b013e31819539ca
[11]	Ponsford J, Nguyen S, Downing M, et al. Factors associated with persistent post-concussion symptoms following mild traumatic brain injury in adults[J]. J Rehabil Med, 2018, 51(1): 32-39. doi: 10.2340/16501977-2492
[12]	Fay T B, Yeates K O, Taylor H G, et al. Cognitive reserve as a moderator of postconcussive symptoms in children with complicated and uncomplicated mild traumatic brain injury[J]. J Int Neuropsychol Soc, 2010, 16(1): 94-105. doi: 10.1017/S1355617709991007
[13]	Thompson T L, Amedee R. Vertigo: a review of common peripheral and central vestibular disorders[J]. Ochsner J, 2009, 9(1): 20-26.
[14]	Arshad Q, Roberts R E, Ahmad H, et al. Patients with chronic dizziness following traumatic head injury typically have multiple diagnoses involving combined peripheral and central vestibular dysfunction[J]. Clin Neurol Neurosurg, 2017, 155:17-19. doi: 10.1016/j.clineuro.2017.01.021
[15]	Hall C D, Herdman S J, Whitney S L, et al. Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Evidence-Based Clinical Practice Guideline: from the American Physical Therapy Association Neurology Section[J]. J Neurol Phys Ther, 2016, 40(2): 124-155. doi: 10.1097/NPT.0000000000000120
[16]	Kleffelgaard I, Soberg H L, Bruusgaard K A, et al. Vestibular rehabilitation after traumatic brain injury: case series[J]. Phys Ther, 2016, 96(6): 839-849. doi: 10.2522/ptj.20150095 pmid: 26586860
[17]	Ouchterlony D, Masanic C, Michalak A, et al. Treating benign paroxysmal positional vertigo in the patient with traumatic brain injury: effectiveness of the canalith repositioning procedure[J]. J Neurosci Nurs, 2016, 48(2): 90-99. doi: 10.1097/JNN.0000000000000186 pmid: 26895567
[18]	Mutlu B, Serbetcioglu B. Discussion of the dizziness handicap inventory[J]. J Vestib Res, 2013, 23(6): 271-277. doi: 10.3233/VES-130488
[19]	Yip C W, Strupp M. The Dizziness Handicap Inventory does not correlate with vestibular function tests: a prospective study[J]. J Neurol, 2018, 265(5): 1210-1218. doi: 10.1007/s00415-018-8834-7
[20]	Merritt V C, Meyer J E, Arnett P A. A novel approach to classifying postconcussion symptoms: the application of a new framework to the Post-Concussion Symptom Scale[J]. J Clin Exp Neuropsychol, 2015, 37(7): 1-12. doi: 10.1080/13803395.2014.983465
[21]	Merritt V C, Bradson M L, Meyer J E, et al. Evaluating the test-retest reliability of symptom indices associated with the ImPACT Post-Concussion Symptom Scale (PCSS)[J]. J Clin Exp Neuropsychol, 2018, 40(4): 377-388. doi: 10.1080/13803395.2017.1353590
[22]	Grigol T A, Silva A M, Ferreira M M, et al. Dizziness Handicap Inventory and Visual Vertigo Analog Scale in vestibular dysfunction[J]. Int Arch Otorhinolaryngol, 2016, 20(3): 241-243. doi: 10.1055/s-00025477
[23]	Corwin D J, Propert K J, Zorc J J, et al. Use of the vestibular and oculomotor examination for concussion in a pediatric emergency department[J]. Am J Emerg Med, 2019, 37(7): 1219-1223. doi: 10.1016/j.ajem.2018.09.008
[24]	Angeli S I, Velandia S, Snapp H. Head-shaking nystagmus predicts greater disability in unilateral peripheral vestibulopathy[J]. Am J Otolaryngol, 2011, 32(6): 522-527. doi: 10.1016/j.amjoto.2010.11.004 pmid: 21306790
[25]	Gimeno-Vilar C, Rey-Martinez J, Perez N. Active versus passive head-shaking nystagmus[J]. Acta Otolaryngol, 2007, 127(7): 722-728. doi: 10.1080/00016480600987800
[26]	Pérez Vázquez P, Rodríguez Prado N, Sequeiros Santiago G, et al. Diagnostic value of head-shaking nystagmus in vestibular clinical evaluation[J]. Acta Otorrinolaringol Esp, 2005, 56(7): 300-304. doi: 10.1016/S0001-6519(05)78619-2
[27]	Longridge N S, Mallinson A I. The Dynamic Illegible E-test: A Technique for Assessing the Vestibulo-ocular Reflex[J]. Acta Otolaryngol, 1987, 103(3-4): 273-279.
[28]	Vital D, Hegemann S C A, Straumann D, et al. A new dynamic visual acuity test to assess peripheral vestibular function[J]. Arch Otolaryngol Head Neck Surg, 2010, 136(7): 686-691. doi: 10.1001/archoto.2010.99
[29]	Marquez C, Lininger M, Raab S. Establishing normative change values in visual acuity loss during the Dynamic Visual Acuity Test[J]. Int J Sports Phys Ther, 2017, 12(2): 227-232. pmid: 28515977
[30]	Fife T D, Tusa R J, Furman J M, et al. Assessment: vestibular testing techniques in adults and children: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology[J]. Neurology, 2000, 55(10): 1431-1441. pmid: 11094095
[31]	Howell D R, Osternig L R, Chou L S. Return to activity after concussion affects dual-task gait balance control recovery[J]. Med Sci Sports Exerc, 2015, 47(4): 673-680.
[32]	Yeh J R, Lo M T, Chang F L, et al. Complexity of human postural control in subjects with unilateral peripheral vestibular hypofunction[J]. Gait Posture, 2014, 40(4): 581-586. doi: 10.1016/j.gaitpost.2014.06.016
[33]	Liu J, Zhou R, Liu B, et al. Sensory organization test principally reflects utricular function[J]. Acta Otolaryngol, 2017, 137(11): 1143-1148. doi: 10.1080/00016489.2017.1342143
[34]	Shim D B, Song M H, Park H J. Typical sensory organization test findings and clinical implication in acute vestibular neuritis[J]. Auris Nasus Larynx, 2018, 45(5): 916-921. doi: S0385-8146(17)30584-9 pmid: 29258799
[35]	Honaker J A, Janky K L, Patterson J N, et al. Modified head shake sensory organization test: sensitivity and specificity[J]. Gait Posture, 2016, 49:67-72. doi: S0966-6362(16)30103-5 pmid: 27372458
[36]	Broglio S P, Collins M W, Williams R M, et al. Current and emerging rehabilitation for concussion: a review of the evidence[J]. Clin Sports Med, 2015, 34(2): 213-231. doi: 10.1016/j.csm.2014.12.005
[37]	Marshall S, Bayley M, McCullagh S, et al. Updated clinical practice guidelines for concussion/mild traumatic brain injury and persistent symptoms[J]. Brain Inj, 2015, 29(6): 688-700. doi: 10.3109/02699052.2015.1004755
[38]	潘晓峰, 刘红梅. 手法复位联合个性化前庭康复训练治疗良性阵发性位置性眩晕的疗效[J]. 中国康复, 2015, 30(5): 368-369.
	Pan X F, Liu H M. Therapeutic effect of manual reduction combined with personalized vestibular rehabilitation training on benign paroxysmal positional vertigo[J]. Chin J Rehabil, 2015, 30(5): 368-369.
[39]	刘斌, 段作伟, 张海峰, 等. 前庭康复训练治疗良性发作性位置性眩晕患者残余头晕的疗效观察[J]. 中华物理医学与康复杂志, 2017, 39(11): 860-862.
	Liu B, Duan Z W, Zhang H F, et al. Effect of vestibular rehabilitation training on residual dizziness in patients with benign paroxysmal positional vertigo[J]. Chin J Phys Med Rehabil, 2017, 39(11): 860-862.
[40]	Aligene K, Lin E. Vestibular and balance treatment of the concussed athlete[J]. NeuroRehabilitation, 2013, 32(3): 543-553. doi: 10.3233/NRE-130876 pmid: 23648608
[41]	Porciuncula F, Johnson C C, Glickman L B. The effect of vestibular rehabilitation on adults with bilateral vestibular hypofunction: a systematic review[J]. J Vestib Res, 2012, 22(5-6): 283-298. doi: 10.3233/VES-120464 pmid: 23302709
[42]	Crane B T, Schubert M C. An adaptive vestibular rehabilitation technique[J]. Laryngoscope, 2018, 128(3): 713-718.
[43]	Whitney S L, Alghadir A H, Anwer S. Recent evidence about the effectiveness of vestibular rehabilitation[J]. Curr Treat Options Neurol, 2016, 18(3): 1-15. doi: 10.1007/s11940-015-0385-y
[44]	Klatt B N, Carender W J, Lin C C, et al. A conceptual framework for the progression of balance exercises in persons with balance and vestibular disorders[J]. Phys Med Rehabil Int, 2015, 2(4): 1044-1063.
[45]	曹春婷, 李琪, 刘媛媛, 等. 头-眼运动训练视频在前庭康复中的应用[J]. 中国耳鼻咽喉头颈外科, 2017, 24(5): 245-247.
	Cao C T, Li Q, Liu Y Y, et al. Application of the video of head-eye movement training in vestibular rehabilitation[J]. Chin Arch Otolaryngol Head Neck Surg, 2017, 24(5): 245-247.
[46]	Sessoms P H, Gottshall K R, Collins J D, et al. Improvements in gait speed and weight shift of persons with traumatic brain injury and vestibular dysfunction using a virtual reality computer-assisted rehabilitation environment[J]. Mil Med, 2015, 180(3S): 143-149. doi: 10.7205/MILMED-D-14-00385

测试	操作	阳性指征
HIT	检查者双手固定患者头部,嘱患者注视检查者鼻尖;检查者将患者头部向一侧快速旋转(约30°),同时观察眼球运动情况	患者眼球不能固视检查者鼻尖,而是随着头转动方向运动,提示一侧前庭功能损害
摇头眼震测试	患者佩戴Frenzel镜或Goggles镜,闭眼,头部前倾约30°,左右摆动45°,频率3 Hz,30次;测试时患者尽量主动完成;如果主动测试无眼球震颤,由检查者再次进行被动测试	观察到连续5个眼震,且不低于3°/s时,为阳性
DVA	患者坐位,如有需要可佩戴矫正镜;在固定头部的情况下,检查者用视力检查表检查患者视力;检查者前后移动患者头部,频率1~2 Hz,范围40°~60°,并检测患者视力	在头部固定和头部运动两种状态下,视力检查表行差> 2行