Inledning: Yrsel är ett av de symtom som uppstår vid stroke i cerebellum och hjärnstammen på grund av cirkulatorisk insufficiens i den posteriora cirkulationen. Vestibulär rehabilitering (VR) är den rehabiliteringsform som idag används på patienter med yrsel, oberoende av orsak till yrseln. VR fokuserar på att utsätta patienten för de moment som skapar yrsel för att starta en habituering i hjärnan. Vi upplever en klinisk kunskapslucka vid fysioterapeutiska interventioner för strokepatienter med yrsel vilket skapar svårighet att ge denna patientgrupp evidensbaserad rehabilitering. Syfte: Syftet med studien var att överblicka nuvarande fysioterapeutiska interventioner för behandling av yrsel orsakad av stroke i cerebellum och hjärnstammen. Metod: En systematisk litteraturstudie genomfördes i databaserna PubMed, Amed, Cinahl, Scopus, SweMed+ och PEDro. I studien inkluderades artiklar av randomize controlled trial (RCT) och artiklar av icke RCT design. Granskningsverktyget PEDro användes för att bedöma inkluderade artiklarnas kvalitet. Resultat: Totalt granskades fyra artiklar vilket resulterade i tre olika kategorier av interventioner och signifikanta resultat vid delar av de inkluderade utfallsmåtten. Konklusion: Artiklarna som inkluderades i studien visar på att VR ger minskade symtom av yrsel och förbättrad balans hos patienter med stroke i cerebellum och hjärnstammen.

Zusammenhänge der visuell-vestibulären Interaktion im Kortex des Menschen sollten auf grafisch individuell rekonstruierten und entfalteten Kortexoberflächen dargestellt und in Bezug zu den bisher vor allem aus tierexperimentellen Studien gewonnenen Daten (Guldin & Grüsser, 1998) diskutiert werden. Durch die Experimente sollte ein Beitrag zu einem grundlegenden Verständnis räumlicher Orientierungsprozesse beim Menschen geleistet werden. Mittels funktioneller Kernspintomografie (fMRI) wurden fünf Probanden untersucht, welche während zweier Experimente mit jeweils einem vestibulärem sowie einem visuellen Reiz stimuliert wurden (vestibuläre kalorische Stimualtion, visuelle Bewegungsstimulation). Bei den gemessenen Probanden kam es jeweils bei mindestens einem der zwei vestibulären Datensätze (li./re. kalorische Spülung) in der Conjunction Analysis zu Überlappungen mit den dargestellten Arealen der visuellen Stimulation. Es konnte ein weitverzweigtes System von visuell-vestibulären kortikalen Arealen dargestellt werden, mit Aktivierungen des präcentralen Kortex, Teilen des Sulcus centralis, der hinteren Insel, des hinteren Sulcus Cinguli, des Sulcus intraparietalis, sowie des lateralen Okzipitallappens. Interindividuelle Unterschiede manifestierten sich in der Größe der Überlappungen und deren genauer Lokalisation im jeweiligen Sulcus. Die Ergebnisse bestätigten einen Teil der aus tierexperimentellen Studien bekannten Beobachtungen. Erstmals konnte beim Menschen eine vestibuläre Erregung des MT/MST-Komplexes, wie es im Macaque-Affen beschrieben wurde (Bremmer et al., 1999) belegt werden. Ebenso wurde die Multimodalität von MT/MST und des Arelas PIVC im humanen Kortex erstmals beschrieben. / We aimed to identify convergence between visual and vestibular afferents in the human cortex on individually unfolded cortical hemispheres by functional magnetic resonance imaging (fMRI). Furthermore analogies with studies in different non-human primates (Guldin & Gruesser, 1998) were discussed. Five normal subjects were examined with fMRI with two separate experimental paradigms. We implemented caloric vestibular stimulation as first experiment, additionally visual motion stimulation was executed. In at least one out of two vestibular datasets (right, left caloric stimulation) overlaps in the conjunction analysis with the visual motion paradigm occurred. A wide-spread system of cortical visual-vestibular convergence was shown. The activation map comprised foci in the precentral cortex, parts of the central sulcus, the posterior insula, the posterior cingular sulcus, the intraparietal sulcus and the lateral occipital sulcus. Individual differences occurred in respect to the size of convergence and specific localization within the sulci. The results partly confirm observations made in non-human primates. For the first time vestibular input to the MT/MST-complex was shown, as describe in the macaque (Bremmer et al., 1999). Additional multimodal input was seen in area PIVC.

The first purpose of this thesis was to examine whether sensorimotor therapy utilizing the training program ”Retraining for Balance” might be an appropriate technique for sensorimotor proficiency. The second purpose was to gain increased understanding of the effects of sensorimotor therapy on the physical and psychological development of children and youth. A third purpose was to put sensorimotor therapy in a wider perspective through a somewhat novel extension of the theoretical framework. Two naturalistic studies were conducted. Paper I was quantitative and comprised 232 children (181 boys and 51 girls) divided into three groups (1) a younger group (7 years or younger, n=65), (2) a middle group (8 to 10 years old, n=91) and, (3) an older group (11 years old or older, n=76). The participants presented attentional and motor difficulties before starting therapy. The treatment period was in average close to 3 years. Results indicated significant improvements concerning sensorimotor skills in all age groups. Paper II was a qualitative study, which included the records of 8 children (7 boys and 1 girl) randomly selected from the cohort of 232 children. The analysis used the EPP-method and yielded 3 overarching themes, which together formed “the kinesthetic-vestibular developmental model”. The model illustrated how Introductions of sensorimotor exercises pushed the therapy process forward due to periods of Regression and Transformation. The results were generalized to the remaining 224 children in the cohort by comparing each participant’s records with “the kinesthetic-vestibular developmental model”. The tentative conclusion was that sensorimotor therapy according to the method “Retraining for Balance” might constitute a complement to treatment of ADHD, DCD and LD but controlled studies are necessary before more decisive conclusions can be drawn. / Baksidestext   This thesis had three purposes. (1) to examine whether sensorimotor therapy (SMT) using the training program ”Retraining for Balance” might be a proper technique for sensorimotor proficiency. (2) to gain increased understanding of the effects of SMT on physical and psychological development and, (3) to put SMT in a wider perspective by an extension of the theoretical framework. Two naturalistic studies were conducted. Paper I, which was quantitative, comprised 232 children who presented attentional and motor difficulties. The cohort was divided into three groups depending on age and results after therapy indicated improvements in all groups. Paper II, a qualitative study, selected records of 8 children from the cohort. Analysis yielded 3 overarching themes, which together formed “the kinesthetic-vestibular developmental model” illustrating how Introductions of exercises pushed the process forward due to Regressions and Transformations. The results were generalized to the remaining 224 children. The tentative conclusion of this thesis was that SMT might constitute a complement to treatment of ADHD, DCD and LD but controlled studies are necessary before decisive conclusions can be drawn.