Central vestibular dysfunction: don’t forget vestibular rehabilitation

ABSTRACT

Introduction

Vestibular rehabilitation (VR) is now a subject of active studies and has been shown to be effective for multiple vestibular disorders, peripheral or central. VR is a physical therapy that helps train the central nervous system to compensate for vestibular dysfunction. There is moderate to strong evidence that VR is safe and effective for the management of peripheral vestibular dysfunction. Nonetheless, the studies on how VR works on central vestibular dysfunction remains scanty.

Areas covered

This article addressed the rehabilitation strategies and possible mechanisms, including how central vestibular function might improve upon rehabilitation. In addition, it provides some examples concerning the effect of VR on central vestibular dysfunction.

Expert opinion

VR works on the vestibular system through repetition of specific physical exercises that activate central neuroplastic mechanisms to achieve adaptive compensation of the impaired functions. VR has become a mainstay in the management of patients with dizziness and balance dysfunction. Individualized VR programs are a safe and effective treatment option for a large percentage of patients with central vestibular disease reporting imbalance and dizziness. Exploration of various treatment strategies and possible mechanisms will help develop the best and personalized VR treatment for patients with central vestibular dysfunction.

KEYWORDS:

• Vestibular rehabilitation
• central vestibular dysfunction
• vestibular migraine
• persistent postural-perceptual dizziness
• multiple sclerosis
• cerebellar stroke
• vestibulo-ocular reflex

Article highlights

• Vestibular rehabilitation (VR) has increasingly become an extensively accepted non-drug, non-invasive and physical treatment choice, and has been gradually used as a routine treatment.

• Vestibulo-ocular reflex (VOR) suppression and VOR memory are commonly used for rehabilitation of central vestibular hyperfunction. Anti-saccade, and memory-guided saccade are commonly used for rehabilitation of central fixation dysfunction.

• This study gives some examples that VR is efficacious for the treatment for the central vestibular dysfunction, such as vestibular migraine (VM), multiple sclerosis (MS), persistent postural-perceptual dizziness (PPPD), cerebellar stroke and explains their mechanisms.

• The study paved the way to the further exploration on the rehabilitative mechanisms in central vestibular diseases and to the future development of more-targeted and effective VR alternatives for the central vestibular dysfunction.

Declaration of interests

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in this manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The study was supported by a grant from the National Natural Science Foundation of China (No. 81873701) and the National Natural Science Foundation of China (No.82171152).