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Modalités de compensation de la fonction d'équilibration après déafférentation vestibulaire unilatérale aiguë

Abstract : Postural control is a multidetermined system based on central integration of visual, somesthesic and vestibular peripheral information. This complex integration permits a context-specific motor response to maintain equilibrium. Damage to any of these balance regulation systems influences the common output of the postural system resulting in postural instability. In case of vestibular lesion, as acoustic neuroma and its surgical removal, initial vertigo and gaze and postural control disturbances occur, corresponding to unilateral vestibular deafferentation (uVD). After uVD, a process called vestibular compensation leads to decrease of symptoms and improvement of global balance functions. A prospective study aimed to assess the differential contribution of sensory inputs to the regulation of posture during the recovery process after acoustic neuroma removal. Twenty-seven patients with acoustic neuroma underwent vestibular and posturographic testings, shortly before and eight days, one month and three months after surgical removal of the tumour. This study showed, immediately after vestibular deafferentation, deterioration in postural performances. In quiet stance, postural performances were altered, especially in eyes closed conditions and in sensory challenged situations. One month, and more particularly three months after surgery, restoration and even improvement of balance performances occurred, associated with a lower number of falls, development of more appropriate sensorimotor strategies and better resolution of sensorial conflicts. Balance disturbances and movement situations followed the same time-course. The time-course of the perturbation and the recovery of postural control was similar to the changes occurring in vestibular function. The three modalities of postural control regulation are perturbed just after surgical removal of acoustic neuroma, wich alters the compensation gradually developed during growth of neuroma. uVD leads to perturbations in head positions detection and its displacements relative to trunk, but also interferes with the somatosensory and visual pathways. The time-course implementation of central adaptive mechanisms, characterized by substitution by other sensory afferences and new behavioural strategies, leads to a recovery of balance control with an improvement of balance performance of all the modalities of postural control.
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Cécile Parietti-Winkler. Modalités de compensation de la fonction d'équilibration après déafférentation vestibulaire unilatérale aiguë. Médecine humaine et pathologie. Université Henri Poincaré - Nancy 1, 2006. Français. ⟨NNT : 2006NAN10173⟩. ⟨tel-01776018⟩



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