Vestibular decompensation in labyrinthectomized rats placed in weightlessness during parabolic flight

Vestibular Decompensation Following COVID-19 Infection in a Person With Compensated Unilateral Vestibular Loss: A Rehabilitation Case Study

BACKGROUND AND PURPOSE

Surgical removal of a vestibular schwannoma (vestibular schwannoma resection; VSR) results in a unilateral vestibular hypofunction with complaints of dizziness and imbalance. Although the anatomic lesion is permanent, recovery of balance and diminution of dizziness occurs through central neurophysiologic compensation. Compensation of the system is maintained through daily activity. Unfortunately, interruption of stimulus, such as decreased activities due to illness, can cause decompensation. Decompensation is described as the return of symptoms consistent with that experienced during the initial insult/injury (eg, dizziness, oscillopsia, balance difficulty). This case study describes a reoccurrence of vestibular dysfunction in a person with a history of VSR following hospitalization and protracted recovery from a COVID-19 infection. It further documents her recovery that may be a result of vestibular rehabilitation.

CASE DESCRIPTION

A 49-year-old woman (M.W.) with a surgical history of VSR (10 years prior) and a medical history of significant COVID-19 infection, resulting in an intensive care unit stay and prolonged use of supplemental oxygen, presented to physical therapy with persistent dizziness and imbalance. The video head impulse test confirmed unilateral vestibular hypofunction.

INTERVENTION

M.W. attended biweekly vestibular rehabilitation for 6 weeks and completed daily home exercises.

OUTCOMES

At discharge, M.W. demonstrated improvements in patient-reported outcomes (Dizziness Handicap Inventory), functional testing (MiniBEST, 2-Minute Walk Test), and gaze stability measures (video head impulse testing, dynamic visual acuity).

DISCUSSION

Vestibular decompensation preluded by a COVID-19 infection caused a significant decrease in functional mobility. Vestibular rehabilitation targeted at gaze and postural stability effectively reduced symptoms and facilitated recovery to M.W.'s pre-COVID-19 level of function. Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A458 ).

Interaction between Vestibular Compensation Mechanisms and Vestibular Rehabilitation Therapy: 10 Recommendations for Optimal Functional Recovery

This review questions the relationships between the plastic events responsible for the recovery of vestibular function after a unilateral vestibular loss (vestibular compensation), which has been well described in animal models in the last decades, and the vestibular rehabilitation (VR) therapy elaborated on a more empirical basis for vestibular loss patients. The main objective is not to propose a catalog of results but to provide clinicians with an understandable view on when and how to perform VR therapy, and why VR may benefit from basic knowledge and may influence the recovery process. With this perspective, 10 major recommendations are proposed as ways to identify an optimal functional recovery. Among them are the crucial role of active and early VR therapy, coincidental with a post-lesion sensitive period for neuronal network remodeling, the instructive role that VR therapy may play in this functional reorganization, the need for progression in the VR therapy protocol, which is based mainly on adaptation processes, the necessity to take into account the sensorimotor, cognitive, and emotional profile of the patient to propose individual or "à la carte" VR therapies, and the importance of motivational and ecologic contexts. More than 10 general principles are very likely, but these principles seem crucial for the fast recovery of vestibular loss patients to ensure good quality of life.

The vestibular system is integral in regulating plastic alterations in the pressor response to free drop mediated by the nonvestibular system

Microgravity resulting from free drop elicits a pressor response that involves both vestibular and nonvestibular pathways. In rats reared under a 3G environment for 2 weeks, plastic alterations in both vestibular- and nonvestibular-mediated responses are induced; specifically, the pressor responses involving both pathways are reduced [C. Abe, K. Tanaka, C. Awazu, H. Chen, H. Morita, Plastic alteration of vestibulo-cardiovascular reflex induced by 2 weeks of 3-G load in conscious rats, Exp. Brain Res. 181 (2007) 639-646]. It is currently unknown whether plastic alterations in the nonvestibular system depend on the vestibular system. To examine this topic, the pressor response to free drop was compared between rats with and without vestibular lesion (VL) reared under 1G or 3G environments. The pressor response to free drop was 34+/-3mmHg in vestibular intact rats reared under 1G, and was significantly attenuated in rats reared under a 3G environment for 2 weeks (13+/-3mmHg); however, the pressor response was similar between VL-1G (18+/-3mmHg) and VL-3G (19+/-3mmHg) rats. Therefore, the 3G environment induced plastic alterations in the pressor response to free drop mediated by both the vestibular and nonvestibular systems, and the vestibular system is indispensable for induction of the plastic alteration of the nonvestibular-meidated pressor response to free drop.