Why the cerebellar shutdown/clampdown hypothesis of vestibular compensation is inconsistent with neurophysiological evidence

Abstract

BACKGROUND: Vestibular compensation is the process by which the central nervous system (CNS) attempts to adapt to the loss of vestibular sensory inputs. As such, the compensation process is critically involved in the vestibular rehabilitation programs that are implemented by physical therapists for patients with vestibular disorders. One hypothesis regarding vestibular compensation, which has persisted in some of the published vestibular compensation literature and particularly on some vestibular and physical therapy websites, is the ‘cerebellar shutdown’ or ‘cerebellar clampdown’ hypothesis proposed by McCabe and Ryu in 1969. This hypothesis proposes that the cerebellum inhibits neuronal activity in the bilateral vestibular nuclei (VN) following unilateral vestibular loss (UVL), causing the VN contralateral to the UVL to be electrically silent during the early phases of vestibular compensation. Despite a wealth of evidence against this idea, it has gained traction amongst some physical therapists and has implications for vestibular rehabilitation early in the compensation process. CONCLUSIONS: In this paper it is argued that the ‘cerebellar shutdown’ or ‘clampdown’ hypothesis is inconsistent with well accepted neurophysiological and imaging evidence and that it is also logically flawed.