Vestibüler Rehabilitasyon
Özet
Vestibüler sistem periferal ve santral bileşenlerden oluşmakta olup, her iki yapının hastalıkları klinik açıdan önemli semptomlara yol açmaktadır. Periferal vestibüler sistemde en sık görülen patolojiler arasında benign paroksismal pozisyonel vertigo, bilateral vestibüler disfonksiyon ve Ménière hastalığı yer alırken; santral vestibüler sistem bozuklukları çoğunlukla Parkinson hastalığı, inme, vestibüler migren, multiple skleroz ve travmatik beyin hasarına bağlı olarak ortaya çıkmaktadır. Vestibüler sistemin değerlendirilmesi hasta bildirimine dayalı ölçümler ile objektif ve subjektif testlerden oluşmaktadır. Vestibüler uyarılmış miyojenik potansiyel, video baş impuls testi, Dix–Hallpike manevrası, head-shaking ve head-thrust testleri, kova testleri ve döner sandalye testleri yaygın kullanılan objektif yöntemlerdir. Bunlara ek olarak Fukuda stepping testi, Babinski–Weil testi, Past-Pointing testi ve tandem yürüme testi gibi subjektif değerlendirme araçları da yer almaktadır. Vestibüler rehabilitasyon habituasyon, adaptasyon ve substitüsyon mekanizmalarını içeren egzersiz temelli bir tedavi yaklaşımıdır. Temel hedef bakış ve duruş stabilitesini geliştirmek, vestibüler sisteme ait semptomları azaltmak ve bireylerin günlük yaşam aktivitelerini iyileştirmektir. Ayrıca vestibüler rehabilitasyon Frenkel egzersizleri, gaze stabilizasyon egzersizleri, Cawthorne–Cooksey egzersizleri ve Brandt–Daroff manevraları gibi çeşitli yaklaşımları içermektedir.
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