Vestibular Rehabilitation In Patients Research Articles

Role of Vestibular Rehabilitation in Patients with Superior Semicircular Canal Dehiscence Syndrome

Superior canal dehiscence syndrome (SCDS) described in 1998 is a disorder characterized by vertigo in response to loud sounds, pulsatile tinnitus, conductive hyperacusis, autophony and chronic disequilibrium. While resurfacing and/or plugging of the superior canal may improve autophony and reduce dizziness handicap, it can result in immediate and long-term deficits in VOR function, necessitating vestibular rehabilitation (VR) during the early post-operative recovery period. Case description: a 34- year-old man with a history of autophony, pulsatile tinnitus and audible eye movements in his right ear. He denied any vertigo or disequilibrium. Immediately after surgical plugging he presented severe vertigo and disequilibrium as well as deterioration of right hearing loss. Due to persistent instability, VR was performed for five months after surgery with improved outcomes. Our purpose is to emphasize and increase awareness in surgeons, especially in Latin America, the importance of VR immediately after surgery. Additionally, we make some comments about the surgical decisions in two patients with otosclerosis and SCDS and the importance of VR.

Effects of Different Durations and Frequencies of Vestibular Rehabilitation in Patients With Residual Symptoms After Benign Paroxysmal Positional Vertigo Repositioning.

This study aimed to explore the effects of different duration and daily frequency of vestibular rehabilitation (VR) in patients with residual symptoms after benign paroxysmal positional vertigo (BPPV) successful repositioning. Patients with successful BPPV repositioning (n = 118) were divided into 3 groups according to VR duration and frequency: group A (n = 30; 15 minutes, 3 times/day), group B (n = 30; 30 minutes, 3 times/day), group C (n = 28; 15 minutes, 6 times/day), and control group D (n = 30; no VR). All patients completed the dizziness handicap inventory (DHI) and vestibular rehabilitation benefit questionnaire (VRBQ) at baseline and after 2 and 4 weeks. The emotional scores and the proportion of severe dizziness disability in the DHI scores were significant differences between VR groups A to C and control group D after 2 and 4 weeks (all P < .05). There were significant differences in total DHI and VRBQ scores among the VR groups A to C after 2 and 4 weeks (all P < .05). Interestingly, emotion scores were not significantly different in group A (P = .385), group B (P = .569), and group C (P = .340) between 2 and 4 weeks. Meanwhile at 2 weeks, the difference in motion-provoked dizziness score between group A and B was statistically significant (P = .02). A total VR duration over 4 weeks can reduce dizziness and improve VR benefits in routine therapy in patients with residual dizziness after successful BPPV repositioning. Emotional improvement can be observed after 2 weeks. VR may help to relieve motion-provoked dizziness earlier if patients are willing to consider increasing the duration to more than 15 minutes.

Navigating unsteady ground: vestibular rehabilitation in postural perceptual positional dizziness: A narrative review

Persistent Postural-Perceptual Dizziness (PPPD) is a multifaceted and incapacitating disorder characterized by persistent dizziness and instability. Vestibular rehabilitation has arisen as a promising therapeutic strategy, aiming to mitigate symptoms and enhance patients' overall well-being. However, this therapy is not without its set of challenges and controversies. This narrative review delves into Vestibular Rehabilitation in Patients with Persistent Postural-Perceptual Dizziness (PPPD), revealing several pivotal themes. The challenges associated with diagnosing PPPD, its inherent heterogeneity, and the often-intertwined psychological aspects add complexity to treatment decisions. Despite these obstacles and ongoing debates, vestibular rehabilitation stands as a promising therapeutic path, underscoring the significance of continuous research and individualized care in the management of this intricate and debilitating condition.

Effects of Early Vestibular Rehabilitation in Patients With Acute Vestibular Disorder: A Systematic Review and Meta-Analysis.

To investigate the effect of early vestibular rehabilitation on physical function and dizziness in patients with acute vestibular disorders. The electronic databases examined included PubMed (MEDLINE), Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE (via Dialog), and PEDro. The inclusion criteria in terms of the study participants were patients 20 years and older with an acute unilateral peripheral vestibular disorder. We included individual randomized controlled trials (RCTs), cluster-RCTs, quasi-RCTs, and crossover trials. The outcomes were gait, balance (eyes open, eyes close), activities of daily living, dizziness, and vestibular function. Early vestibular rehabilitation was defined as rehabilitation within 14 days of vestibular disorder onset or surgery. Main outcome measures were gait, balance (eyes open, eyes close), activities of daily living, dizziness, and vestibular function. Twelve trials involving 542 participants were included. Early vestibular rehabilitation improved the Dizziness Handicap Inventory by -7.18 (95% confidence interval [CI], -10.48 to -3.88), balance during eyes close by -1.40 (95% CI, -2.42 to -0.39), and dizziness by -1.47 (95% CI, -2.74 to -0.21) compared with no intervention or placebo. The present study demonstrated that early vestibular rehabilitation improved the Dizziness Handicap Inventory, balance (eyes close), and subjective dizziness in a patient with acute vestibular disorders. This result indicates that early vestibular rehabilitation can promote vestibular compensation.

Vestibular rehabilitation in patients after vestibular schwannoma surgery

Vestibular rehabilitation in patients after vestibular schwannoma surgery

Effects of vestibular rehabilitation in patients with unilateral vestibular hypofunction

Purpose: To investigate the effect of physiotherapy on the balance parameters and fall risk in patients with unilateral vestibular hypofunction (UVH). Patients and Methods: Thirty patients diagnosed with UVH were included in the study. The number of falls, Visual Analog Scale, Modified Clinical Test for Sensory Interaction in Tandem and Balance, and dynamic visual acuity assessments was performed before and after treatment. The patients were included in an individual treatment program for 8 weeks. Physiotherapy sessions were given at 2-week intervals. Along with the level of development of the treatment applied to the patients, it was requested perform a home exercise program with ten repetitions three times a day. Results: After 8 weeks of vestibular rehabilitation, it was observed that the balance parameters of the participants improved and the number of falls decreased. Statistically significant results were obtained in the Eyes-closed Tandem test (P = 0.001). Significant changes occurred in the modified Clinical Test results for Sensory Interaction in Balance from 0.37 ± 0.19 s to 0.93 ± 0.11 s (P = 0.001). Vestibular symptoms and dynamic visual acuity scores also improved after treatment (P = 0.001). Conclusion: It was concluded that the physiotherapy program applied to our patients with UVH positively affected fall risk and significantly improved balance parameters.

Factors affecting the outcome of vestibular rehabilitation in patients with peripheral vestibular disorders

ObjectivePrevious studies have reported that developmental, environmental, medical, psychological, visual, and other sensory-related factors can influence the outcome of vestibular rehabilitation. However, only a few studies have used patient's daily lives as the main outcome. In addition, in some studies, rehabilitation was not supervised by a physical therapist. This study aimed to determine the factors associated with the outcome of physical-therapist-supervised vestibular rehabilitation in patients with peripheral vestibular disorders, with the impact of dizziness on quality of life as the main outcome. MethodsThis retrospective cohort study included 47 patients with peripheral vestibular disorders. A physical therapist provided 40 min of vestibular rehabilitation once a week for 4 weeks. Age, sex, disease duration, Dizziness Handicap Inventory (DHI), Timed Up-and-Go test (TUG), Dynamic Gait Index (DGI), Functional Gait Assessment (FGA), Activity-Specific Balance Confidence Scale (ABC scale), and Hospital Anxiety and Depression Scale (HADS) were investigated. Multiple regression analysis was performed, with the DHI rate of change before and after the intervention as the objective variable. ResultsVestibular rehabilitation improved all outcomes. In the multiple regression analysis, the ABC scale was identified as a factor that significantly influenced the DHI rate of change (β = -0.428, p < 0.01). ConclusionA higher ABC scale score was associated with a lower DHI rate of change (i.e., better improvement). Therefore, it may be important to assess psychological aspects, especially confidence in balance, when implementing vestibular rehabilitation in patients with peripheral vestibular disorders.

Vestibular rehabilitation in patients with vestibular peripheral vertigo

Objective:To evaluate the efficacy of vestibular rehabilitation in patients with anterior peripheral vertigo and analyze its influencing factors. Methods:From January 2018 to June 2021, 153 cases with peripheral vertigo diseases（including 47 cases of benign positional paroxysmal vertigo, 38 cases of Meniere's disease, 26 cases of sudden deafness with vertigo, 23 cases of vestibular migraine and 19 cases of vestibular neuritis） were enrolled. One hundred and three cases were treated with vestibular rehabilitation combined with drugs, and 50 cases only treated with drugs were used as controls. Self-rating scale and vertigo disorder scale were evaluated at the beginning of treatment, 4 weeks and 8 weeks, respectively. The curative effects of the two groups were tested by t-test, and the independent risk factors affecting the curative effects were analyzed by multiple linear regression. Results:There was no difference in clinical data, self-assessment scale and vertigo disorder scale between the two groups（P>0.05）. At 4 and 8 weeks, the scores of self-assessment scale and vertigo disorder scale in the experimental group were better than those in the control group（all P<0.01）, and the curative effect at 8 weeks was better than that at 4 weeks, especially the decrease of emotional score during walking and the proportion of severe vertigo disability（all P<0.01）. The scores of self-rating scale and vertigo disorder scale of the cases with benign positional paroxysmal vertigo and vestibular neuritis were better than Meniere's disease, vestibular migraine and sudden deafness with vertigo（P<0.05）. Headache（P<0.05） and severe vertigo disorder before intervention（P<0.01） were independent risk factors affecting the efficacy of vestibular rehabilitation. Conclusion:Vestibular rehabilitation combined with anti-vertigo drugs in the treatment of vestibular peripheral vertigo is better than that of only using drugs, especially in improving the degree of emotional disorder and vertigo disability. It is more suitable for benign positional paroxysmal vertigo and vestibular neuritis, while the effect of combined headache or severe vertigo is relatively poor.

Evaluating Oculomotor Tests before and after Vestibular Rehabilitation in Patients with Parkinson's Disease: A Pilot Pre-Post Study.

Introduction The elderly population is commonly affected by balance and gait disorders that increase the risk of falls. Pivotal systems for efficient postural control are sensory, motor, visual, vestibular, and cognitive. Disruption in any of these systems could lead to postural instability. Vestibular rehabilitation is a set of exercises that positively affect the primary components of the central sensory-motor integration, including somatosensory, visual, and vestibular systems. Accordingly, we hypothesized that vestibular rehabilitation exercises might improve both oculomotor functions and upright postural control in patients with Parkinson's disease. Materials and Methods 11 idiopathic Parkinson's patients voluntarily participated in this study based on inclusion criteria: central vestibular dysfunction and the Hoehn and Yahr scale scores less than or equal to 3. Videonystagmography (VNG) and the Berg Balance Scale (BBS) scores were measured at the baseline. Then, the patients underwent vestibular rehabilitation training for 24 sessions (3 sessions per week). The VNG and BBS were measured again after 48 hours of the completion of the last session of the training. Result After completing vestibular rehabilitation sessions, there were significant improvements in balance (P ≤ 0.001). Eye-tracking and gaze function statistically improved in 7 patients and 6 patients, respectively. Conclusion Vestibular rehabilitation produced positive effects on oculomotor function and balance in a small cohort of people with PD. Consequently, it could be considered as a possible effective intervention for Parkinson's patients. This trial is registered with IRCT201709123551N6.

Effectiveness of virtual reality-based vestibular rehabilitation in patients with peripheral vestibular hypofunction.

The rehabilitation of classical peripheral vestibular disorders is long and costly. Recently, interactive systems based on virtual reality (VR) technology have reduced the cost of vestibular rehabilitation therapy (VRT) and made the process more enjoyable. This study aims to investigate the effects of VR-based VRT in patients diagnosed with peripheral vestibular hypofunction (PVH). In this study, a VR-based VRT program that utilized Sony Playstation®4 VR Head Mounted Display was applied to 25 patients (between 18-60) diagnosed with PVH. PVH was diagnosed by evaluating the patients' clinical histories, the findings in the "Micromedical Technologies VisualEyes Spectrum" videonystagmography (VNG) and the "Micromedical Aqua Stim" model bithermal water caloric tests. VR-based VRT program was applied to the patients for 4 weeks, 2 sessions per week, 8 sessions in total. Each session lasted around 30 to 40 min. All patients underwent the Dizziness Handicap Inventory (DHI), Sensory Organization Test (SOT), Adaptation Test (ADT), Limits of Stability (LOS), and Rhythmic Weight Shift (RWS) before, after, and 8-week follow-up of the VRT program. In addition, the Cybersickness Survey was applied to the patients at the end of the VR-based VRT session every week. The DHI mean scores of the patients were 54.60, 19.20, and 16.84, respectively, before, just after, and at the 8-week follow-up VRT (p < 0.001). The mean SOT composite score of the patients was obtained as 58.08 before VRT; 77.16 after VRT and 76.40 at 8-week after VRT (p < 0.000). On the other hand, the values in the 'movement velocity' and "direction control" parameters of the patients in LOS and RWS showed a significant improvement after VRT compared to before VRT (p < 0.000). From before VRT to 8 weeks after VRT, the patient's oscillation averages in the 'toes up' and 'toes down' positions in ADT reduced progressively (p < 0.000). This study demonstrates that implementing a VR-based VRT protocol may be an efficient option to improve posture stability and the quality of life in patients with PVH. In addition, VR-based vestibular rehabilitation therapy has shown to be effective for PVH patients in the mid-term.

Incremental Velocity Error as a New Treatment in Vestibular Rehabilitation (INVENT VPT) Trial: study protocol for a randomized controlled crossover trial

BackgroundA clinical pattern of damage to the auditory, visual, and vestibular sensorimotor systems, known as multi-sensory impairment, affects roughly 2% of the US population each year. Within the population of US military service members exposed to mild traumatic brain injury (mTBI), 15–44% will develop multi-sensory impairment following a mild traumatic brain injury. In the US civilian population, multi-sensory impairment-related symptoms are also a common sequela of damage to the vestibular system and affect ~ 300–500/100,000 population. Vestibular rehabilitation is recognized as a critical component of the management of multi-sensory impairment. Unfortunately, the current clinical practice guidelines for the delivery of vestibular rehabilitation are not evidence-based and primarily rely on expert opinion. The focus of this trial is gaze stability training, which represents the unique component of vestibular rehabilitation. The aim of the Incremental Velocity Error as a New Treatment in Vestibular Rehabilitation (INVENT VPT) trial is to assess the efficacy of a non-invasive, incremental vestibular adaptation training device for normalizing the response of the vestibulo-ocular reflex.MethodsThe INVENT VPT Trial is a multi-center randomized controlled crossover trial in which military service members with mTBI and civilian patients with vestibular hypofunction are randomized to begin traditional vestibular rehabilitation or incremental vestibular adaptation and then cross over to the alternate intervention after a prescribed washout period. Vestibulo-ocular reflex function and other functional outcomes are measured to identify the best means to improve the delivery of vestibular rehabilitation. We incorporate ecologically valid outcome measures that address the common symptoms experienced in those with vestibular pathology and multi-sensory impairment.DiscussionThe INVENT VPT Trial will directly impact the health care delivery of vestibular rehabilitation in patients suffering from multi-sensory impairment in three critical ways: (1) compare optimized traditional methods of vestibular rehabilitation to a novel device that is hypothesized to improve vestibulo-ocular reflex performance, (2) isolate the ideal dosing of vestibular rehabilitation considering patient burden and compliance rates, and (3) examine whether recovery of the vestibulo-ocular reflex can be predicted in participants with vestibular symptoms.Trial registrationClinicalTrials.gov NCT03846830. Registered on 20 February 2019.

Vestibular Rehabilitatiоn in Vestibular Migraine

The search for possible ways to minimize dizziness in patients with vestibular migraine is especially relevant in the aspect of individualized complex vestibular rehabilitation. Aim. To study the possibilities of complex individualized vestibular rehabilitation in patients with vestibular migraine. Material and methods. The study included 122 patients (40 men and 82 women) aged 18 to 50 years, with significant vestibular migraine. We used the Dizziness Handicap Inventory scale for assessing dizziness and a 5-point Scale for subjective assessment of the severity of dizziness and a special complex method including a set of vestibular exercises, a method of the computer stabilometry with biofeedback. Objective control of vestibular rehabilitation was carried out with the help of stabilometric testing. Results and discussion. Positive dynamics were observed when analyzing the data of the physical, functional and emotional subscales of the Dizziness Handicap Inventory and the Scale of Subjective Assessment of the Dizziness Severity. In addition, the presented stabilometric diagnostics made it possible to fix the difference between the initial condition of patients with vestibular dysfunction and after 3 months of the special vestibular rehabilitation.Тhere was a statistically significant decrease in the basic stabilometric parameters: the area of the statokinesiogram (median area, mm² – 254 (95% CI 222-285)) and the rate of deviation of the center of pressure (median speed, mm/s – 21 (95% CI 17-24)) as well as a decrease in the shifts of the spectrum energy in the low-frequency and high-frequency spectrum that indicates an improvement in stability. The presented method for influencing the compensatorycapabilities of regulatory mechanisms in patients with vestibular migraine positively affects the efficiency of the equilibrium system as a whole, optimizing postural stability in this category of patients. Conclusion. An individually selected comprehensive program of vestibular gymnastics and hardware rehabilitation techniques on the stabilographic platform with biofeedback helps to improve postural stability and minimize dizziness in patients with vestibular migraine.

The Effect of Supervision in Vestibular Rehabilitation in Patients with Acute or Chronic Unilateral Vestibular Dysfunction: A Systematic Review.

The investigation of supervised vestibular rehabilitation treatment role for individuals with dizziness and imbalance due to peripheral, unilateral vestibular disorders. Cochrane, PubMed, and Physiotherapy Evidence Database (PEDro) were utilized to identify relevant studies. The key search terms used were "Vestibular Rehabilitation and Unilateral Vestibular Hypofunction," "Vestibular Rehabilitation and Unilateral Vestibular Loss," and "Vestibular Rehabilitation and Supervision." A manual search was performed by exploring the references of included articles to identify studies not captured through the computer-based searches. The quality of the studies was assessed according to the PEDro scale. Inclusion criteria were: 1) studies with patients, aged from 18 to 80 years, with acute or chronic dizziness and disequilibrium due to unilateral vestibular dysfunction, 2) randomized control trials (RCTs), 3) studies comparing supervised vestibular rehabilitation program with an unsupervised vestibular rehabilitation program or home-based training or standard care or placebo, and 4) articles written in the English language. Studies reporting cases of vertigo and imbalance due to possible recurrent pathologies, acute benign paroxysmal positional vertigo, or central neurological/orthopedic deficits, were excluded. A total of 448 articles were retrieved from the systematic database search strategy. Five of them were included in the systematic review after full-text analysis, plus one more after manual searching of their references. All studies involved supervised vestibular rehabilitation treatment programs compared with unsupervised home training, the performance of daily activities and, standard care. Based on PEDro's scoring system, one study rated as high-quality RCT, three studies were considered of fair quality and one scored as low-quality RCT. Although most RCTs report better outcomes with a supervised vestibular rehabilitation treatment program regarding the emotional status, dizziness, and balance improvement, this systematic review failed to provide a strong evidence that supervision is superior to unsupervised protocols in patients with UNH. The self-reported subjective measures used by the included RCTs represent a serious limitation of their results.

The efficacy and strategy of individualized vestibular rehabilitation in patients with intractable vertigo

Objective: To explore the prognosis of individualized vestibular rehabilitation (VR) in patients with intractable vertigo and work out an effective and normative rehabilitation program. Methods: A total of 35 patients diagnosed with intractable vertigo who visited Eye & ENT Hospital of Fudan University from September 2017 to December 2019 were enrolled. All the participants consisted of 15 males and 20 females, aged from 24 to 71 years old, and underwent an individualized VR. Follow-ups were conducted at 2 and 4 weeks post-rehabilitation. Assessments consisted of self-rating anxiety scale (SAS), dizziness handicap inventory scale (DHI), activities-specific balance confidence sacle (ABC), computerized dynamic posturography (CDP), and video-electronystagmograph (VNG) were performed. Results: SAS, DHI, ABC scores gradually improved after VR. The scores of SAS scale of pre-VR, 2 and 4 weeks post-VR were 41±8, 37±8 and 36±8, respectively. The scores of DHI were 56(40, 78), 46(22, 74), 16(6, 76), respectively. Meanwhile, the scores of ABC were 80±17, 87±11 and 91±9, respectively. There were significant statistical differences of aforementioned three scale scores at different time points (P=0.020, P<0.01, P=0.002), which was not influenced by age and gender (all P>0.05). No interactive effects were revealed among age, gender and time (all P>0.05). The improvement of vestibular function to control balance was statistically significant after 2-and 4-week rehabilitation (both P<0.001). The value of directional preponderance was significantly improved after 4-week VR (P=0.007), while no obvious improvement was found after 2 weeks treatment (P=0.593). There was a statistically significant difference in the value of unilateral weakness (UW) between pre-VR and post-VR since 2 weeks (P=0.001). Conclusion: Individualized VR in patients with intractable vertigo can not only eliminate anxiety, control dizziness, increase activities of daily life, but also improve the function of vestibulo-spinal and vestibulo-ocular reflex pathways.

A Protocol on Effect of Gaze Exercises and Balance Regimen on Quality of Life of Patients with Peripheral-Vertigo

Background: As vertigo is been one of the most common condition affecting the individual functionally,physically and emotionally and result in some form of disability. Most of physiotherapy interventionproves to be effective in vestibular rehabilitation of patients with vestibular disorders. Gaze stabilizationexercises are effective and some suggest balance training is also effective in vestibular rehabilitation. Butthere is minimal literature on combination of both exercise protocol. Aim: To find out the effect of Gazestabilization Exercises and balance training on quality of life of patients with Peripheral Vertigo. Methods:30 participants with vertigo due to peripheral pathology will be selected on the basis of inclusion, exclusionand head impulse test. The patient will be evaluating using Visual analogue scale, Dizziness HandicapInventory, Berg Balance Scale and Dynamic Gait Index Scale. The participants will be distributed into twocategories. Group- A will receive gaze stabilization exercise and Group- B will receive balance trainingalong with gaze stabilization exercise. Participants will be evaluating post-treatment. Conclusion: Thisstudy concluded that there may be significant reduction in vertigo symptoms and improved Quality of Lifein peripheral vertigo by using combine effect of Gaze Exercise with Balance Training

Effect of vestibular rehabilitation on change in health-related quality of life in patients with dizziness and balance problems after traumatic brain injury: A randomized controlled trial.

ObjectiveSecondary analysis, testing the effect on change in health-related quality of life of group-based vestibular rehabilitation in patients with mild-moderate traumatic brain injury, dizziness and balance problems.DesignA single-blind randomized controlled trial.SubjectsA total of 65 patients aged 16–60 years with a Rivermead Post-concussion Symptoms Questionnaire dizziness score ≥2, and DizzinessHandicap Inventory score >15 points. Data collection was performed at baseline 3.5 (standard deviation (SD) 2.1) months post-injury, end of intervention, and 4.4 (SD 1.0) months after baseline.MethodsQuality of Life after Brain Injury was the main outcome. Independent variables were demographic and injury variables, Hospital Anxiety and Depression Scale, changes on the Rivermead Post-concussion Symptoms Questionnaire (RPQ3 physical and RPQ13 psychological/cognitive), and Vertigo Symptom Scale-Short Form.ResultsMean age of participants was 39.4 years (SD 13.0); 70.3% women. Predictors of change inthe Quality of Life after Brain Injury were receiving the vestibular rehabilitation (p =0.049), baseline psychological distress (p =0.020), and changein RPQ3 physical (p =0.047) and RPQ13 psychological/cognitive (p =0.047). Adjusted R2 was 0.399,F=6.13, p < 0.001.ConclusionThere was an effect in favour of the intervention group in improvement in health-related quality of life. Changes on the Rivermead Post-concussion Symptoms Questionnaire were also associated with change on the Quality of Life after Brain Injury.LAY ABSTRACTThis paper is the first to present results of a vestibular rehabilitation intervention study on changes in health-related quality of life in patients with dizziness and balance problems after mild-to-moderate traumatic brain injury. The intervention group received exercises and guidance aimed at self-efficacy and how to cope with their dizziness and balance problems. In addition, both the intervention and control groups received treatment as usual, comprising multidisciplinary rehabilitation at a university hospital. The main result was measured as change on the Quality of Life after Brain Injury questionnaire. Post-concussion symptoms, vertigo and psychological distress were also measured. The study showed that the group receiving the vestibular rehabilitation intervention underwent more improvement in health-related quality of life than the group receiving usual treatment alone. Other factors that influenced the improvement in quality of life were psychological distress at the start of the study and fewer post-concussion symptoms.

Virtual Reality Vestibular Rehabilitation in 20 Patients with Vertigo Due to Peripheral Vestibular Dysfunction.

BackgroundVestibular compensation is disrupted in patients with chronic vestibular syndrome. Vestibular rehabilitation is an exercise therapy that optimizes the process of vestibular compensation. This study aimed to evaluate virtual reality (VR) vestibular rehabilitation in 20 patients with vertigo due to peripheral vestibular dysfunction at a single center.Our study aim was to initially assess the impact of using virtual reality technology in vestibular rehabilitation.Material/MethodsThe subjects were 20 patients with unilateral vestibular hypofunction (UVH), as confirmed by videonystagmography. These were divided into 2 groups: Group 1 underwent vestibular rehabilitation using virtual reality and Group 2 was treated by conventional therapy. A VSS-SF questionnaire and the VAS scale were used to assess the effects and levels of patient satisfaction with therapy.ResultsBoth groups demonstrated significantly (P<0.001) lower values on the VSS-SF scales and VAS scales when assessed after treatment as compared to before treatment. Those undergoing conventional therapy reported significantly more severe symptoms on the VAS scale than did Group 1 at their second and third therapy visits. Indeed, Group 1 patients that underwent rehabilitation with the virtual reality component awarded significantly higher (P=0.015) levels of subjective satisfaction when compared to Group 2.ConclusionsWe found that virtual reality vestibular rehabilitation in patients with vertigo due to peripheral vestibular dysfunction was as effective as conventional rehabilitation, with significantly increased levels of patient satisfaction.

Human Vestibulo-Ocular Reflex Adaptation Reduces when Training Demand Variability Increases.

One component of vestibular rehabilitation in patients with vestibulo-ocular reflex (VOR) hypofunction is gaze-stabilizing exercises that seek to increase (adapt) the VOR response. These prescribed home-based exercises are performed by the patient and thus their use/training is inherently variable. We sought to determine whether this variability affected VOR adaptation in ten healthy controls (× 2 training only) and ten patients with unilateral vestibular hypofunction (× 1 and × 2 training). During × 1 training, patients actively (self-generated, predictable) move their head sinusoidally while viewing a stationary fixation target; for × 2 training, they moved their outstretched hand anti-phase with their head rotation while attempting to view a handheld target. We defined the latter as manual × 2 training because the subject manually controls the target. In this study, head rotation frequency during training incrementally increased 0.5-2Hz over 20min. Active and passive (imposed, unpredictable) sinusoidal (1.3-Hz rotations) and head impulse VOR gains were measured before and after training. We show that for controls, manual × 2 training resulted in significant sinusoidal and impulse VOR adaptation of ~ 6% and ~ 3%, respectively, though this was ~two-thirds lower than increases after computer-controlled × 2 training (non-variable) reported in a prior study. In contrast, for patients, there was an increase in impulse but not sinusoidal VOR response after a single session of manual × 2 training. Patients had more than double the variability in VOR demand during manual × 2 training compared to controls, which could explain why adaptation was not significant in patients. Our data suggest that the clinical × 1 gaze-stabilizing exercise is a weak stimulus for VOR adaptation.

Research on the Effects of a Web-Based System With Oculomotor and Optokinetic Stimuli on Vestibular Rehabilitation.

The variety and use of technologies used in vestibular rehabilitation are very limited. The purpose of this study was to investigate the effects of a Web-based system on vestibular rehabilitation in patients with vestibular hypofunction. A total of 20 patients with unilateral vestibular hypofunction were randomly assigned to two groups. Conventional vestibular rehabilitation was applied to the control group, whereas the study group received treatment with the Web-based system supporting the vestibulo-ocular reflex with oculomotor and optokinetic stimulus (Simulation of Vestibulo-Ocular Reflex Exercises). Vestibular and balance tests, oculomotor level, the Tampa Kinesiophobia Scale, and the Dizziness Handicap Inventory were used to evaluate the treatment's efficacy. Vestibular symptoms and findings, balance tests, oculomotor functions, Tampa Kinesiophobia Scale, and Dizziness Handicap Inventory improved significantly in both groups after the interventions (P < 0.05). In the intergroup analysis, improvement was found in eyes closed Romberg, semitandem, and left one-foot position balance tests in favor of the study group (P < 0.05). The new vestibular technology, Simulation of Vestibulo-Ocular Reflex Exercises, was found to be effective in vestibular rehabilitation.

Does vestibular rehabilitation improve postural control of subjects with chronic subjective dizziness?

Postural control is the ability to maintain equilibrium and orientation in a gravitational environment. Patients with chronic subjective dizziness have some troubles with their postural stability. The present study aimed to assess the benefit of home-based vestibular rehabilitation in patients with chronic subjective dizziness using computerized dynamic posturography. Therefore, 100 subjects, between 19 to 86 years, diagnosed with dizziness were included in the study. Computerized dynamic posturography was performed to assess postural stability. Vestibular rehabilitation programs included exercises tailored to the particular needs of each patient. After vestibular rehabilitation, patients were re-examined using the same tests. Posturographic data were analyzed and compared for before and after vestibular rehabilitation findings. The mean composite scores before the intervention (58,92 ±11,64) was significantly (p<0.01) lower than the mean composite scores after vestibular rehabilitation (73,83 ± 8,26). This result is found to be statistically significant. In conclusion it could be suggested that the effectiveness of vestibular rehabilitation could be verified by means of computerized dynamic posturography as a concrete method.