A critical period for rehabilitation of unilateral vestibular hypofunction patients with the unidirectional rotation paradigm - Acute phase effectiveness

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Unilateral vestibular hypofunction (UVH) patients underwent vestibular rehabilitation using two protocols aligned with the unidirectional rotation paradigm. One group received active gaze stabilization with head impulse testing, whereas the second group performed passive whole-body rotations on a rotatory chair; rotations targeted the hypofunction side and training dose was matched. Angular vestibulo-ocular reflex gain and horizontal-canal directional preponderance served as primary outcomes across early and late rehabilitation windows. Significant improvements occurred only in early subgroups, with increased aVOR gain and reduced directional preponderance, while late 1 and late 2 groups showed no meaningful change. The findings support acute-phase effectiveness and extend the critical-period concept from animal models to UVH rehabilitation.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Article Notes

Received and accepted

Abstract

Protocols and outcomes

Background

Vestibular symptoms and compensation

Vestibular rehabilitation and the unidirectional rotation paradigm

Rationale and prior evidence

Lacour M, Tardivet L, Thiry A. A critical period for rehabilitation of unilateral vestibular hypofunction patients with the unidirectional rotation paradigm. J Rehab Therapy.2020;2(1):16-22 Journal of Rehabilitation Therapy Original Clinical Paper Open Access A critical period for rehabilitation of unilateral vestibular hypofunction patients with the unidirectional rotation paradigm Michel Lacour1*, Laurent Tardivet2, Alain Thiry3 1Neurosciences Department, Aix-Marseille University/CNRS, Marseille, France 2Otorhinolaryngology Department, CHU Nice, 30 Voie Romaine, 06000 Nice, France 3Physiotherapist, 29 Bd Dubouchage, 06000 Nice, France Article Info | Article Notes
Received: March 11, 2020
Accepted: April 10, 2020 | | --- | | *Correspondence:
Lacour Michel, Neurosciences Department, Aix-Marseille University/CNRS, Marseille, France; 21, Impasse des Vertus 13710 Fuveau, [France. Email: michel.lacour0802@gmail.com](France. Email: michel.lacour0802@gmail.com). | | ©2020 Lacour M. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License. | | Keywords:
Unilateral vestibular hypofunction patients
Vestibular rehabilitation
Unidirectional rotation paradigm
Angular vestibulo-ocular reflex
Directional preponderance
Critical period | Abstract Unilateral vestibular hypofunction (UVH) patients were submitted to a vestibular rehabilitation (VR) program with two different protocols based on the unidirectional rotation paradigm. One group (N=28) was submitted to active gaze stabilization exercises with the head impulse test (HIT), and a second group (N=31) with the passive whole-body rotation on a rotatory chair. Head or body rotations were always performed to the hypofunction side anda similar number of training sessions were used in each group (2 times a week for four weeks) . Patients in each group were subdivided into three subgroups based on the time delay between onset of the disease and beginning of VR (early VR: the first two weeks after onset; late 1 VR: third and fourth weeks after onset; late 2 VR: one month and more after onset) . The angular vestibuloocular reflex (aVOR) and the directional preponderance (DP) regarding the horizontal canals were the main outcomes. The results pointed to similar findings with the two protocols, characterized by a significant improvement of the aVOR gain on the hypofunction side, responsible for the significant decrease of the DP in the horizontal canals. These powerful changes were observed in the early subgroups only. No significant modifications were found in the late 1 and late 2 subgroups. The data clearly attest to the effectiveness of the unidirectional rotation paradigm when performed in the acute phase of the disease, thus extending to UVH patients the concept of critical period for VR already demonstrated in animal models. Background Acute unilateral vestibular hypofunction (UVH) induces in both animals and humans many vestibular symptoms including spinning vertigo, spontaneous nystagmus, posture and gait imbalance, oscillopsia, and associated neuro-vegetative symptoms (nausea and vomiting) .1 Most of the static deficits like spontaneous vestibular nystagmus and head tilt fully recover over weeks or months in a process referred to vestibular compensation while the dynamic deficits poorly recover, as illustrated by the angular vestibular ocular reflex2. It has been shown however that brain reorganizationscan help the patients to recover their dynamic vestibular functions by means of sensory substitution mechanisms3, new behavioural strategies4,5, and changes in the brain functional connectivity as well6. If there is really a spontaneous compensation of the vestibular deficits7, the time to achieve the full recovery remains however relatively long (up to one year in UVH patients) and the final level of compensation is not optimal in many cases due to inappropriate strategies or avoidance beh

FAQs

How were the two rehabilitation protocols structured in this study?

One group performed active gaze stabilization exercises with head impulse test–based practice, and the other group received passive whole-body rotations on a rotatory chair. Rotations were directed toward the hypofunction side, with matched training frequency across groups.

Which outcomes were used to evaluate rehabilitation effectiveness?

The angular vestibulo-ocular reflex (aVOR) and directional preponderance (DP) for the horizontal canals were the main outcomes.

When did patients show significant improvements after rehabilitation?

Significant changes—improved aVOR gain on the hypofunction side and decreased directional preponderance—were observed only in the early subgroups. Late 1 and late 2 subgroups showed no significant modifications.

Sep 5, 2026

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