Postural compensation for vestibular loss and implications for rehabilitation.
OBJECTIVE
This chapter summarizes the role of the vestibular system in postural control so that specific and effective rehabilitation can be designed that facilitates compensation for loss of vestibular function.


METHODS
Patients with bilateral or unilateral loss of peripheral vestibular function are exposed to surface perturbations to quantify automatic postural responses. Studies also evaluated the effects of audio- and vibrotactile-biofeedback to improve stability in stance and gait.


RESULTS
The most important role of vestibular information for postural control is to control orientation of the head and trunk in space with respect to gravitoinertial forces, particularly when balancing on unstable surfaces. Vestibular sensory references are particularly important for postural control at high frequencies and velocities of self-motion, to reduce trunk drift and variability, to provide an external reference frame for the trunk and head in space; and to uncouple coordination of the trunk from the legs and the head-in-space from the body CoM.


CONCLUSIONS
The goal of balance rehabilitation for patients with vestibular loss is to help patients 1) use remaining vestibular function, 2) depend upon surface somatosensory information as their primary postural sensory system, 3) learn to use stable visual references, and 4) identify efficient and effective postural movement strategies.
Horak
Fay B
FB
Department of Neurology and Biomechanical Engineering, Oregon Health and Science University, 3181 SW Sam Jackson Park Road OP32, Portland, OR 97239, USA. horaf@ohsu.edu
D000222:Adaptation, Physiological / Q000502:physiology; D001676:Biofeedback, Psychology / Q000379:methods; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation; D006801:Humans; D026741:Physical Therapy Modalities / Q000639:trends; D004856:Postural Balance / Q000502:physiology*; D011597:Psychomotor Performance / Q000502:physiology; D020127:Recovery of Function / Q000502:physiology; D012027:Reflex, Vestibulo-Ocular / Q000502:physiology*; D015837:Vestibular Diseases / Q000503:physiopathology* / Q000534:rehabilitation*; D014722:Vestibule, Labyrinth / Q000502:physiology*