I recently saw on a poster at a Medical Devices exhibition that an engineer was developing a vestibular prosthesis, analagous to a cochlear implant. I expressed surprise, as I could not think of any clinical application. He then said he was thinking of bilateral vestibular failure, which could well be a long-term option.
The balance of such case will be dependent mainly on his visual and proprioceptive organs. Rehabilitation will include visuomascular control of his balance plus strict precautions to avoid darkness during walking and to keep small lighted lamb at home during night. This patient has to avoid swimming and climbing mountain. This patient can tolerate standing with closed eyes or with open eyes in the darkness but he can not tolerate walking with closed eyes or with open eyes in dark places. This patient can not taste direction except with open eyes during day time. I think vestibular prosthesis implantation will be valuable curative option on condition of presence of a functioning vestibular nerves.
Dear Dr. Anthony, would you send to me the detail of this poster or any link talking about this amazing vestibular prosthesis.
Regards.
Dr.Hazem.
Dear Hazem,
There are two groups developing the vestibular implant in USA and Switzerland respectively.
Still preliminary data, but sounds promising!
"There are two groups developing the vestibular implant in USA and Switzerland"
And one in London, I think. I am still not clear how useful this would be. Surely someone with unilateral vestibular neuritis would not be a candidate?
Vestibular prosthesis is the hope for bilateral vestibular loss that is most of the time unresponsive to rehabilitation physiotherapy. The Geneva-Maastricht group (Guyot, Kingma and others) has presented promising initial human experiments results. John Hopkins group (Della Santina) in advanced animal studies of multichanel prosthesis implant.
The single best source for answering your question is "Vestibular Rehabilitation," a book by Herdman.
(No conflict of interest on my part.)
With this population, we will look at using the CDP technology and the mismatch of surface versus visual dependency with these patients as often they become highly visually dependent. We then apply a sensory re-weighting load technique to balance out the visual versus surface dependency to allow the patient to maximize the use of each efficiently - it is amazing how well they do despite no vestibular function.
Interestingly, we have dabbled with the VOXX socks and orthotics group as their technology, albeit a little pseudo-science, has demonstrated increased somatosensory balance score on the SOT on the CDP with repeated testing suggesting the sock improve somatosensory cues and thus improve balance performance.
Article Bilateral vestibulopathy: Diagnostic criteria Consensus docu...
The criteria are in this classification, so each patient should be evaluated independently. I recommend that you use the ICF to classify it within an operating profile and that this new table (profile) helps you make therapeutic decisions.
Cheers