眩暈病人的物理治療原則

　　　　　頭暈，指的是頭重腳輕、昏昏的、或想吐的感覺。有的病人伴隨有眩暈 的症狀，即感覺自已在轉;或轉動幻視，即感覺周遭環境在轉的症狀。多數病人 會因此而失去平衡，有跌倒的危險。臨床上，越來越多的病人有中樞性或周圍性 的頭暈或眩暈的症狀而接受物理治療。本文主旨乃在回顧與眩暈病人的物理治療 原則有關的文獻．以作為物理治療師之臨床參考。 眩暈症狀的產生，主要與前庭系統的功能有關。而前庭系統的功能主要在感知身 體的動作、引導人體保持垂直、控制身體的重心、以及維持頭部穩定。前庭功能 缺失後，其功能的恢復主要來自三種機制，即自發性的復原、前庭的適應功能、 以及功能代償等。眩暈病人必需學會利用視覺及體感覺來代償所喪失的前庭功 能，或學習整合不同感覺回饋(即前庭、視覺及體感覺的回饋)之間的訊息，才能 達到功能上的進步。 物理治療的原則包括完整的評估及以前庭系統為訓練目標的訓練計畫。完整的前 庭評估包括病史及耳科檢查之查閱，下肢肌力、感覺、肌肉張力、顫抖現象、協 調能力等之檢查，以及動、靜態平衡，感覺整合與站立平衡測驗，步態，以活動 為基礎之平衡評估、及前庭系統的動作敏感度測試等。治療計畫除病患的衛教 外，應包括前庭適應運動、平衡再訓練、及一般性體能訓練等。最終以減輕眩暈 症狀、改善平衡、及減少功能障礙為目標。 國外文獻均指出前庭系統的物理治療訓練可有效減輕症狀、改善功能，是物理治 療一門新興領域，然而國內的相關研究尚屬起步．希望本文可以引起臨床治療師 對前庭物理治療的興趣，以提供病人更好的服務。(中華物療誌1995:20(2):182-196)
　　　　　Dizziness, a sense of lightheadedness, faint-ing, or nauseating, can be accompanied by ver-tigo, the illusion of self-movement, or oscillopsia,the illusory movement of a stationary visual tar-get. Patients complaining dizziness related symp-toms may experience imbalance and requirephysical therapy to relieve their symptoms. Thepurpose of this article is to review principlesof physical therapy management for the dizzypatients. The vestibular system dysfunction ofteninduces dizziness. The primary roles of the ves-tibular system are: sensing and perceiving self-motion, orienting the body to vertical, control-ling the center of mass, and stabilizing the head.Three mechanisms are related to the recoveryfrom vestibular deficits: spontaneous recovery,vestibular adaptation, and substitution. In orderto maintain balance and avoid dizzy, a personmust be able to substitute the impaired vesti- bular feedback information with the visual orsomatosensory information; or able to integratethe three senses efficiently and accurately. The principles of physical therapy are anintegrated systems evaluation and a treatmentprogram for the vestibular system. The integratedsystems evaluation includes a history survey,evaluation of muscle strength, sensation, muscletone, tremor, coordination, static and dynamicbalance, gait, and motion sensitivity. The physicaltherapy training program includes patient education, vestibular habituation exercises, balanceretraining, and general re-conditioning exercises. It has been shown that vestibular exercisesare effective in reducing dizzy and improvingbalance for patients with vestibular deficits. Thedomestic clinicians may follow the principlesof physical therapy outlined in this review andprovide better care for dizzy patient&.(JPTA ROC1995;20(2):182-196)