Age-Related Vestibular Dysfunction; Vestibulo-Ocular Reflex, Dynamic Visual Acuity, Dizziness and Falls: A Review

Abstract

Background: Vestibular and vision functions are important contributors to posture control and fall avoidance. This review examines how the vestibulo-ocular reflex can be rehabilitated to help restore postural control. Methods: PubMed searches (7th April 2021) using the terms ‘vestibulo-ocular reflex’, ‘imbalance and vestibular dysfunction’, ‘vestibular dysfunction and dizziness’, ‘dynamic visual acuity’, ‘vestibular dysfunction rehabilitation’, and ‘gaze stabilization exercises’ yielded 4986, 495, 3576,1830, 3312, and 137 potentially useful publications respectively. Selections of those which were found to be the most relevant and representative of a balanced and current account of these topics, as well as selections from the most relevant reports referenced in those publications, were included in this review. Results: Just as there are age-related losses of static visual acuity even when there are no specific visual pathologies diagnosed, patients may also present with age-related loss of vestibular functions in the absence of specific vestibular pathologies. For example, cases of dizziness which are diagnosed as idiopathic might be usefully classified as age-related as the basis for the initiation of rehabilitation exercises. Conclusions: Apart from age-related loss of vestibular functions, cases diagnosed as having a particular form of vestibular pathology may have that condition exacerbated by age-related losses of vestibular functions. The effects of vestibular rehabilitation gaze stability exercises in patients with vestibular dysfunction are well established and include both improved dynamic acuity and postural stability. Improvements in posture control following rehabilitation of the vestibulo-ocular reflex are apparently due to improved peripheral and/or central vestibular balance control which has occurred in conjunction with enhanced gaze stability. The complex nature of increased fall risk suggests that an interdisciplinary approach to rehabilitation that includes vestibulo-ocular reflex rehabilitation appears likely to be associated with optimum outcomes for both pathological and age-related cases.