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      Compensación vestibular Translated title: Vestibular compensation

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          Abstract

          RESUMEN Introducción y objetivos: La compensación vestibular es el conjunto de procesos que se ponen en marcha cuando tiene lugar una lesión a nivel vestibular sea cual sea el origen y la magnitud de la misma. Una vez establecida la lesión los mecanismos de compensación del daño son variados y se establecen diferentes líneas de actuación. Material y métodos: Revisión narrativa. Resultados: Para conocer cómo mejorar el estado de nuestros pacientes es importante saber cómo funciona la compensación vestibular y a qué niveles podemos actuar para acelerar el proceso de recuperación. Conclusiones: Es importante conocer los mecanismos de compensación vestibular para adecuar la terapia a cada paciente y así mejorar su calidad de vida.

          Translated abstract

          ABSTRACT Introduction: Vestibular compensation is the term used to describe the mechanisms triggered when there is damage in the vestibular system regardless of its origin. When suffering from an injure in vestibular area there are a wide range of compensatory responses that will involve different approaches. Material and methods: Narrative revision. Results: In order to improve the quality of life for our patients and to correctly work with them to accelerate the restoration process it is important to become acquainted with how vestibular compensation works. Conclusions: Vestibular compensation mechanisms are important to adapt the therapy to each patient and thus improve their quality of life.

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          Most cited references56

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          Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Evidence-Based Clinical Practice Guideline

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            Vestibular compensation: the neuro-otologist’s best friend

            Why vestibular compensation (VC) after an acute unilateral vestibular loss is the neuro-otologist’s best friend is the question at the heart of this paper. The different plasticity mechanisms underlying VC are first reviewed, and the authors present thereafter the dual concept of vestibulo-centric versus distributed learning processes to explain the compensation of deficits resulting from the static versus dynamic vestibular imbalance. The main challenges for the plastic events occurring in the vestibular nuclei (VN) during a post-lesion critical period are neural protection, structural reorganization and rebalance of VN activity on both sides. Data from animal models show that modulation of the ipsilesional VN activity by the contralateral drive substitutes for the normal push–pull mechanism. On the other hand, sensory and behavioural substitutions are the main mechanisms implicated in the recovery of the dynamic functions. These newly elaborated sensorimotor reorganizations are vicarious idiosyncratic strategies implicating the VN and multisensory brain regions. Imaging studies in unilateral vestibular loss patients show the implication of a large neuronal network (VN, commissural pathways, vestibulo-cerebellum, thalamus, temporoparietal cortex, hippocampus, somatosensory and visual cortical areas). Changes in gray matter volume in these multisensory brain regions are structural changes supporting the sensory substitution mechanisms of VC. Finally, the authors summarize the two ways to improve VC in humans (neuropharmacology and vestibular rehabilitation therapy), and they conclude that VC would follow a “top-down” strategy in patients with acute vestibular lesions. Future challenges to understand VC are proposed.
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              Vestibular compensation and substitution.

              This is a very brief update on the major papers since August 1998. Unilateral vestibular loss causes oculomotor, postural and sensory symptoms, all of which would be appropriate responses in a healthy person to a strong maintained angular and linear acceleration stimulus directed towards the healthy side. Within hours or days these static symptoms (so called because they are present without any externally imposed vestibular stimulation) reduce, and their progressive disappearance is called 'vestibular compensation'. However, careful testing with natural vestibular stimuli shows that the dynamic vestibular response after unilateral vestibular loss to passively imposed vestibular stimuli does not recover; it is usually asymmetric and functionally ineffective. Major recent developments are: (1) the permanent asymmetrical and functionally ineffective dynamic rotational vestibulo-ocular reflex responses to passive natural vestibular stimulation after unilateral vestibular loss and canal blocks in human patients; (2) evidence for the substitution of other sensory input and responses during vestibular compensation; (3) perceptual testing using visual perception of a horizontal line to confirm permanent otolith dysfunction; (4) the clear and substantial differences in post-unilateral vestibular loss vestibulo-ocular reflex responses between passive and active head turning; and (5) new results in brainstem physiology explaining the disappearance of static symptoms.
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                Author and article information

                Journal
                orl
                Revista ORL
                Rev. ORL
                Ediciones Universidad de Salamanca (Salamanca, Salamanca, Spain )
                2444-7986
                March 2020
                : 11
                : 1
                : 19-28
                Affiliations
                [1] Zamora orgnameSACYL orgdiv1Complejo Asistencial de Zamora orgdiv2Servicio de Otorrinolaringología España
                [2] Salamanca orgnameSACYL orgdiv1Complejo Asistencial Universitario de Salamanca orgdiv2Servicio de Otorrinololaringología España
                Article
                S2444-79862020000100003 S2444-7986(20)01100100003
                10.14201/orl.21381
                fe994317-6349-42e9-bda8-b6a409f30bb8

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 09 October 2019
                : 02 September 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 56, Pages: 10
                Product

                SciELO Spain

                Categories
                Artículo de revisión

                mecanismos,vestibular nucleus,vestibular loss,postural instability,compensación vestibular,lesión vestibular,mechanisms,vestibular compensation,equilibrio,núcleos vestibulares

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