{"id":7101,"date":"2025-12-05T18:40:32","date_gmt":"2025-12-05T17:40:32","guid":{"rendered":"https:\/\/kineaphp.fr\/?p=7101"},"modified":"2025-12-05T20:03:28","modified_gmt":"2025-12-05T19:03:28","slug":"reeducation-vestibulaire-distinguer-les-differentes-pathologies","status":"publish","type":"post","link":"https:\/\/kineaphp.fr\/?p=7101","title":{"rendered":"R\u00e9\u00e9ducation vestibulaire : distinguer les diff\u00e9rentes pathologies"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\">Introduction<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Objectifs<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Diff\u00e9rencier les principales pathologies vestibulaires<\/li>\n\n\n\n<li>Ma\u00eetriser l&rsquo;examen clinique et les tests diagnostiques<\/li>\n\n\n\n<li>Choisir le traitement adapt\u00e9 \u00e0 chaque pathologie<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Concepts cl\u00e9s<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>La r\u00e9\u00e9ducation repose sur :\n<ul class=\"wp-block-list\">\n<li>la compensation centrale<\/li>\n\n\n\n<li>la plasticit\u00e9 neuronale<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Le diagnostic diff\u00e9rentiel guide la prise en charge<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">Anatomie vestibulaire<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Syst\u00e8me p\u00e9riph\u00e9rique<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>3 canaux semi-circulaires : d\u00e9tection des rotations<\/li>\n\n\n\n<li>Utricule &amp; saccule : gravit\u00e9 et acc\u00e9l\u00e9rations lin\u00e9aires<\/li>\n\n\n\n<li>Nerf vestibulaire : transmission de l&rsquo;information<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Syst\u00e8me central<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Noyaux vestibulaires : int\u00e9gration multisensorielle et g\u00e9n\u00e9ration des r\u00e9flexes vestibulo-oculaire (RVO) et vestibulo-spinal(RVS)<\/li>\n\n\n\n<li>Cervelet : calibre et adaptation<\/li>\n\n\n\n<li>Cortex : perception et int\u00e9gration<\/li>\n<\/ul>\n\n\n\n<p><strong>A retenir<\/strong><\/p>\n\n\n\n<p>Le vestibule d\u00e9tecte, les noyaux vestibulaires g\u00e9n\u00e8rent les r\u00e9flexes, le cervelet les calibre et les adapte, et le cortex les int\u00e8gre, les r\u00e9gule et en fait une perception consciente<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">VPPB<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Signes clinique<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Aigu : vertige bref (en g\u00e9n\u00e9ral &lt;1 minute) d\u00e9clench\u00e9 par les changements de position<\/li>\n\n\n\n<li>Chronique : instabilit\u00e9 persistante \u00e0 la marche \/ position statique<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Diagnostic clinique<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Man\u0153uvre de Dix-Hallpike \u2192 canal post\u00e9rieur (nystagmus torsionnel + vertical sup<\/li>\n\n\n\n<li>Roll Test \u2192 canal lat\u00e9ral (nystagmus horizontal g\u00e9otropique ou ag\u00e9otropique)<\/li>\n\n\n\n<li>Caract\u00e9ristique : latence courte + \u00e9puisabilit\u00e9 \u00e0 la r\u00e9p\u00e9tition<\/li>\n<\/ul>\n\n\n\n<p>Traitement<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Man\u0153uvres de repositionnement (Epley, S\u00e9mont, Lempert)<\/li>\n<\/ul>\n\n\n\n<ol class=\"wp-block-list\">\n<li>R\u00e9\u00e9ducation vestibulaire si instabilit\u00e9 r\u00e9siduelle<\/li>\n<\/ol>\n\n\n\n<h3 class=\"wp-block-heading\">Consignes post manoeuvre VPPB<\/h3>\n\n\n\n<p>Reprendre les activit\u00e9s normales imm\u00e9diatement.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Bouger la t\u00eate normalement, sans restriction.<\/li>\n\n\n\n<li>Dormir dans la position habituelle.<\/li>\n\n\n\n<li>Informer : vertiges\/naus\u00e9es l\u00e9gers possibles 24\u201348h (20\u201330%).<\/li>\n\n\n\n<li>Contr\u00f4le dans 3\u20135 jours pour v\u00e9rifier efficacit\u00e9 ou r\u00e9cidive.<\/li>\n<\/ul>\n\n\n\n<p>En synth\u00e8se<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Ce qu\u2019il faut dire : \u00ab Vous pouvez bouger et dormir normalement. \u00bb<\/strong><\/li>\n\n\n\n<li><strong>Ce qu\u2019il faut \u00e9viter : consignes restrictives inutiles (ne pas bouger, dormir assis, etc.).<\/strong><\/li>\n\n\n\n<li><strong>Contr\u00f4le syst\u00e9matique dans 3\u20135 jours pour suivi clinique.<\/strong><\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">D\u00e9ficit vestibulaire unilat\u00e9ral aigu (DVUA ou n\u00e9vrite)<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Pr\u00e9sentation clinique<\/h3>\n\n\n\n<p>Grand vertige rotatoire continu (24\u201372 h) avec :<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Nystagmus spontan\u00e9 horizontal (vers le c\u00f4t\u00e9 sain)<\/li>\n\n\n\n<li>Instabilit\u00e9 posturale s\u00e9v\u00e8re (chute du c\u00f4t\u00e9 atteint)<\/li>\n\n\n\n<li>Naus\u00e9es \/ vomissements importants<\/li>\n\n\n\n<li>Sans perte auditive \u2192 oriente vers atteinte purement vestibulaire<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Evolution en 2 phases<\/h3>\n\n\n\n<p><strong>Aigu\u00eb<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Nystagmus horizontal battant vers le c\u00f4t\u00e9 sain<\/li>\n\n\n\n<li>HIT \/ vHIT positif du c\u00f4t\u00e9 atteint (d\u00e9ficit du r\u00e9flexe vestibulo-oculaire)<\/li>\n\n\n\n<li>Instabilit\u00e9 majeure (station debout difficile voire impossible)<\/li>\n\n\n\n<li>Vertiges intenses durant 1 \u00e0 3 jours<\/li>\n<\/ul>\n\n\n\n<p><strong>Phase chronique<\/strong> (compensation centrale)<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Instabilit\u00e9 r\u00e9siduelle aux mouvements rapides de t\u00eate<\/li>\n\n\n\n<li>\u00c9tourdissements<\/li>\n\n\n\n<li>D\u00e9ficit calorique unilat\u00e9ral<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Prise en charge<\/h3>\n\n\n\n<p>Phase aigu\u00eb : vestibulo-suppresseurs \u2192 courte dur\u00e9e (\u2264 72 h)\u2192 Objectif : soulager les sympt\u00f4mes sans bloquer la compensation centrale<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Phase de r\u00e9cup\u00e9ration : r\u00e9\u00e9ducation vestibulaire +++<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">R\u00e9\u00e9ducation pr\u00e9coce<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Plus la r\u00e9\u00e9ducation est d\u00e9but\u00e9e t\u00f4t, plus la r\u00e9cup\u00e9ration est rapide et compl\u00e8te, moins le risque de vertiges chroniques r\u00e9siduels<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<p>Maladie de M\u00e9ni\u00e8re<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Triade symptomatique<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>1. Vertiges rotatoires (20 min \u00e0 plusieurs heures)<\/li>\n\n\n\n<li>2. Hypoacousie fluctuante pr\u00e9dominant sur les fr\u00e9quences graves<\/li>\n\n\n\n<li>3. Acouph\u00e8nes + pl\u00e9nitude d&rsquo;oreille<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Evolution<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Crises r\u00e9cidivantes \u2192 perte auditive neurosensorielle progressive<\/li>\n\n\n\n<li>Atteinte bilat\u00e9rale : 20\u201340 % des cas (\u00e9volution \u00e0 long terme)<\/li>\n\n\n\n<li>Instabilit\u00e9 intercritique croissante avec la dur\u00e9e de la maladie<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Traitement et r\u00f4le du kin\u00e9<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Crise : vestibulo-suppresseurs + anti\u00e9m\u00e9tiques (\u2264 72 h), repos relatif<\/li>\n\n\n\n<li>Cas invalidants : gentamicine intratympanique \u00b1 cortico\u00efdes, chirurgie en dernier recours<\/li>\n\n\n\n<li>Kin\u00e9 : \u00e9ducation th\u00e9rapeutique, r\u00e9\u00e9ducation vestibulaire, gestion de l\u2019instabilit\u00e9 post-crise<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">D\u00e9sorganisation sensorielle<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Caract\u00e9ristiques<\/h3>\n\n\n\n<p>Vertiges non rotatoires, d\u00e9s\u00e9quilibre et d\u00e9sorientation spatiale sans atteinte vestibulaire p\u00e9riph\u00e9rique<\/p>\n\n\n\n<p>D\u00e9clench\u00e9s par :<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Mouvements passifs (voiture, bateau, avion)<\/li>\n\n\n\n<li>Environnements visuels dynamiques (foule, supermarch\u00e9, \u00e9crans)<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Evaluation<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Bilan vestibulaire n\u00e9gatif (pas de d\u00e9ficit p\u00e9riph\u00e9rique)<\/li>\n\n\n\n<li>Questionnaires valid\u00e9s \n<ul class=\"wp-block-list\">\n<li>DHI (Dizziness Handicap Inventory)<\/li>\n\n\n\n<li>Motion Sensitivity Quotient (MSQ)<\/li>\n\n\n\n<li>Niigata PPPD Questionnaire (si suspicion de PPPD)<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Tests fonctionnels :\n<ul class=\"wp-block-list\">\n<li>CTSIB \/ mCTSIB \u2192 \u00e9value la d\u00e9pendance sensorielle<\/li>\n\n\n\n<li>Posturographie dynamique \u2192 r\u00e9solution des conflits sensoriels<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<p><\/p>\n\n\n\n<h3 class=\"wp-block-heading\">R\u00e9\u00e9ducation<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Habituation : exposition gradu\u00e9e et r\u00e9p\u00e9t\u00e9e aux stimuli visuels ou posturaux d\u00e9clencheurs<\/li>\n\n\n\n<li>Conflits visuo-vestibulaires : entra\u00eenement optocin\u00e9tique, r\u00e9alit\u00e9 virtuelle immersive valid\u00e9e<\/li>\n\n\n\n<li>Int\u00e9gration sensorielle : r\u00e9apprentissage du sensor reweighting pour r\u00e9soudre les conflits multisensoriels<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">3 types d&rsquo;exercices en r\u00e9\u00e9ducation vestibulaire<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Habituation<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>D\u00e9finition <\/strong>: R\u00e9duire progressivement les sympt\u00f4mes par exposition contr\u00f4l\u00e9e et r\u00e9p\u00e9t\u00e9e aux stimuli d\u00e9clencheurs.<\/li>\n\n\n\n<li><strong>M\u00e9canisme <\/strong>: D\u00e9sensibilisation centrale \u2192 r\u00e9duction de la r\u00e9activit\u00e9 neuronale et de l\u2019activit\u00e9 des centres \u00e9m\u00e9tiques\/anxiog\u00e8nes. <\/li>\n\n\n\n<li><strong>Principe <\/strong>: \u00ab S\u2019exposer pour s\u2019habituer \u00bb \u2013 extinction progressive de la r\u00e9ponse aversive.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Adaptation<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>D\u00e9finition<\/strong> : Am\u00e9liorer la performance du syst\u00e8me vestibulaire r\u00e9siduel par des exercices sollicitant les interactions sensorielles.<\/li>\n\n\n\n<li><strong>M\u00e9canisme <\/strong>: Plasticit\u00e9 c\u00e9r\u00e9belleuse \u2192 modification du gain du r\u00e9flexe vestibulo-oculaire (VOR).<\/li>\n\n\n\n<li><strong>Principe <\/strong>: \u00ab Faire mieux avec moins\u00bb \u2013 optimisation du vestibuled\u00e9ficitaire<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Substitution<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>D\u00e9finition : D\u00e9velopper des strat\u00e9gies compensatoires via la vision et la proprioception.<\/li>\n\n\n\n<li>M\u00e9canisme : Repond\u00e9ration sensorielle centrale \u2192 augmentation du poids des signaux visuels et proprioceptifs.<\/li>\n\n\n\n<li>Principe : \u00ab Compenser par d\u2019autres voies \u00bb \u2013 suppl\u00e9er la fonction vestibulaire.<\/li>\n\n\n\n<li>Formes :\n<ul class=\"wp-block-list\">\n<li>Sensorielle \u2192 vision\/proprioception<\/li>\n\n\n\n<li>Comportementale \u2192 ajustements moteurs<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h3 class=\"wp-block-heading\">Quand arr\u00eater la r\u00e9\u00e9ducation vestibulaire ?<br>Crit\u00e8res d\u2019arr\u00eat positifs<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Objectifs fonctionnels atteints \u2192retour aux activit\u00e9s sans limitation.<\/li>\n\n\n\n<li>R\u00e9duction cliniquement significative des vertiges \/ instabilit\u00e9.<\/li>\n\n\n\n<li>Scores normalis\u00e9s : DHI \u2264 30, ABC \u226580Tests d\u2019\u00e9quilibre et VOR compens\u00e9s.<\/li>\n\n\n\n<li>Am\u00e9lioration \u2265 18 pts au DHI =significative<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Crit\u00e8res d\u2019arr\u00eat n\u00e9gatifs<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Plateau th\u00e9rapeutique \u2265 3\u20134semaines malgr\u00e9 progression adapt\u00e9e.<\/li>\n\n\n\n<li>Aggravation persistante malgr\u00e9 ajustements du programme.<\/li>\n\n\n\n<li>Comorbidit\u00e9s intercurrentes limitant la participation.<\/li>\n\n\n\n<li>Non-adh\u00e9sion : exercices &lt;3\u00d7\/semaine.<\/li>\n\n\n\n<li>Avant arr\u00eat \u2192 r\u00e9\u00e9valuer diagnostic, programme et observance.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Approche centr\u00e9e patient &amp; EBP<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>D\u00e9cision partag\u00e9e \u2192 le patient peut interrompre \u00e0 tout moment.<\/li>\n\n\n\n<li>Explorer les motifs : attentes,contraintes, am\u00e9lioration,motivation.<\/li>\n\n\n\n<li>Proposer suivi \u00e0 distance ou exercices autonomes.<\/li>\n\n\n\n<li>R\u00e9\u00e9valuation toutes les 2\u20133semaines pour maintenir la motivation.<\/li>\n\n\n\n<li>Outils : DHI, ABC, FGA, mCTSIB<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">Points cl\u00e9s \u00e0 retenir<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">D\u00e9marche diagnostique<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>1. Anamn\u00e8se pr\u00e9cise : dur\u00e9e, d\u00e9clencheurs, sympt\u00f4mes associ\u00e9s<\/li>\n\n\n\n<li>2. Recherche de perte auditive \u2192 oriente (M\u00e9ni\u00e8re \/ non M\u00e9ni\u00e8re)<\/li>\n\n\n\n<li>3. Tests adapt\u00e9s : Dix-Hallpike, Roll test, HIT\/VHIT<\/li>\n\n\n\n<li>4. Traitement align\u00e9 sur le diagnostic<\/li>\n\n\n\n<li>Red Flags \u2192 orientation m\u00e9dicale imm\u00e9diate (c\u00e9phal\u00e9es, diplopie, d\u00e9ficit neurologique, chute sansvertige, HINST)<\/li>\n<\/ul>\n\n\n\n<p>R\u00e8gles d&rsquo;or<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>VPPB : bref + positionnel \u2192 man\u0153uvre de repositionnement + r\u00e9\u00e9ducation si instabilit\u00e9 r\u00e9siduelle<\/li>\n\n\n\n<li>DVUA (n\u00e9vrite) : constant + sans surdit\u00e9 \u2192 r\u00e9\u00e9ducation pr\u00e9coce (id\u00e9alement &lt; 3 jours)<\/li>\n\n\n\n<li>M\u00e9ni\u00e8re : crises + surdit\u00e9 + acouph\u00e8nes \u2192 \u00e9ducation + r\u00e9\u00e9ducation<\/li>\n\n\n\n<li>Plus la prise en charge est pr\u00e9coce, meilleure est la r\u00e9cup\u00e9ration.<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<p>HINTS : pour \u00e9carter une cause centrale du vertige<\/p>\n\n\n\n<p>HINTS : Head Impulse &#8211; Nystagmus &#8211; Test of skew<\/p>\n\n\n\n<p>Objectif : identifier si un syndrome vestibulaire aigu (SVA) rel\u00e8ve d&rsquo;une atteinte centrale (AVC post\u00e9rieur) ou p\u00e9riph\u00e9rique ( DVUA).<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"686\" height=\"214\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/12\/image-26.avif\" alt=\"\" class=\"wp-image-7108\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/12\/image-26.avif 686w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/12\/image-26-300x94.avif 300w\" sizes=\"auto, (max-width: 686px) 100vw, 686px\" \/><\/figure>\n\n\n\n<p>Interpr\u00e9tation rapide du HINTS<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Signes p\u00e9riph\u00e9riques (HIT+, Nystagmus unidirectionnel, Skew-) : origine p\u00e9riph\u00e9rique probable<\/li>\n\n\n\n<li>Plus d&rsquo;un signe central -> Suspicion AVC post -> Imagerie urgente (IRM)<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">Troubles vestibulaires<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Troubles vestibulaires p\u00e9riph\u00e9riques(TVP)<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Pathologies de l\u2019oreille interne ou du nerf vestibulaire<\/li>\n\n\n\n<li>\u2193 signaux sensoriels t\u00eate (position\/mouvement) <\/li>\n\n\n\n<li>\u2192atteinte de d\u00e9tection<\/li>\n<\/ul>\n\n\n\n<p><strong>Objectifs <\/strong>: Restaurer VOR, adaptation + substitution<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Troubles vestibulaires centraux (TVC)<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Atteinte noyaux vestibulaires, cervelet, tronc c\u00e9r\u00e9bral ou cortex<\/li>\n<\/ul>\n\n\n\n<p>Perturbation int\u00e9gration multisensorielle (vestibule\/vision\/somesth\u00e9sie)<\/p>\n\n\n\n<p><strong>Objectifs <\/strong>: compensation centrale, adaptation + substitution + habituation<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">3 types d\u2019\u00e9xercices en r\u00e9\u00e9ducation vestibulaire (bonus)<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">M\u00e9canismes de plasticit\u00e9<\/h3>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"738\" height=\"483\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/12\/image-28.avif\" alt=\"\" class=\"wp-image-7110\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/12\/image-28.avif 738w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/12\/image-28-300x196.avif 300w\" sizes=\"auto, (max-width: 738px) 100vw, 738px\" \/><\/figure>\n\n\n\n<p><\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Synth\u00e8se des 3 m\u00e9canismes<\/h3>\n\n\n\n<p><strong>Habituation <\/strong>: Plasticit\u00e9 synaptique et d\u00e9sensibilisation centrale<br>Principe : Exposition gradu\u00e9e + R\u00e9p\u00e9tition espac\u00e9e = Consolidation durable<\/p>\n\n\n\n<p><strong>Adaptation <\/strong>: Plasticit\u00e9 c\u00e9r\u00e9belleuse et recalibrage du VOR<br>Principe : G\u00e9n\u00e9rer une erreur r\u00e9tinienne \u2192 Recalibrage c\u00e9r\u00e9belleux \u2192 Am\u00e9lioration du gain VOR<br><strong>Substitution <\/strong>: Re-pond\u00e9ration sensorielle et strat\u00e9giescompensatoires<\/p>\n\n\n\n<p>Principe : Optimiser les entr\u00e9es sensorielles alternatives + strat\u00e9gies oculomotrices compensatoires<\/p>\n\n\n\n<p><\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"822\" height=\"412\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/12\/image-27.avif\" alt=\"\" class=\"wp-image-7109\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/12\/image-27.avif 822w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/12\/image-27-300x150.avif 300w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/12\/image-27-768x385.avif 768w\" sizes=\"auto, (max-width: 822px) 100vw, 822px\" \/><\/figure>\n\n\n\n<p><br><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Introduction Objectifs Concepts cl\u00e9s Anatomie vestibulaire Syst\u00e8me p\u00e9riph\u00e9rique Syst\u00e8me central A retenir Le vestibule d\u00e9tecte, les noyaux vestibulaires g\u00e9n\u00e8rent les r\u00e9flexes, le cervelet les calibre et les adapte, et le cortex les int\u00e8gre, les r\u00e9gule&hellip;<\/p>\n<p class=\"more-link-wrapper\"><a href=\"https:\/\/kineaphp.fr\/?p=7101\" class=\"more-link\">Continue Reading<span class=\"screen-reader-text\"> \u00ab\u00a0R\u00e9\u00e9ducation vestibulaire : distinguer les diff\u00e9rentes pathologies\u00a0\u00bb<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[396],"tags":[],"class_list":["post-7101","post","type-post","status-publish","format-standard","hentry","category-champs-specifiques-champ-tete"],"_links":{"self":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts\/7101","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=7101"}],"version-history":[{"count":10,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts\/7101\/revisions"}],"predecessor-version":[{"id":7121,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts\/7101\/revisions\/7121"}],"wp:attachment":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=7101"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=7101"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=7101"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}