The efficacy of vestibular rehabilitation in patients with chronic unilateral vestibular dysfunction

Abstract

Objectives: Vestibular rehabilitation leads to a gradual diminution of the subjective and objective symptoms that accompany the vestibular disorders. The aim of the study was to compare the impact of 2 different types of vestibular rehabilitation on vestibular compensation in patients with chronic unilateral vestibular dysfunction. Material and Methods: The study was conducted on a group of 58 subjects (43 females and 15 males) aged 40-64 years, who presented with chronic unilateral vestibular dysfunction and were hospitalized. The patients were randomly assigned to either of the 2 groups established. The study was conducted in a 6-week period. Group 1 consisted of patients who underwent customized group vestibular rehabilitation in an outpatient setting. The program was performed once a week for 1 h 30 min, under the supervision of a physiotherapist and a physiatrist. Group 2 was instructed to perform Cawthorne-Cooksey exercises and simple balance exercises twice a day for 15 min. Results: An improvement in the outcomes of the Dynamic Gait Index as well as the Berg Balance Scale was statistically significant for group 1. The time for fulfilling the task in the Timed Up and Go Test improved in both groups (p < 0.05). The subjective estimation of the symptoms evaluated with the use of the Dizziness Handicap Inventory and the Visual Analogue Scale revealed a statistically significant improvement in both groups, yet it was higher in group 1. Conclusions: The compensation achieved after 6 weeks of the customized, supervised outpatient rehabilitation program in group 1 was superior to the results of the home-based unsupervised Cawthorne-Cooksey and balance exercises.

Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Updated Clinical Practice Guideline From the Academy of Neurologic Physical Therapy of the American Physical Therapy Association

“…The individual's position was progressed from lying down, to sitting, standing, and eventually walking. More recent studies have compared modified Cawthorne-Cooksey exercises to the original protocol,136 or have utilized Cawthorne-Cooksey exercises as the comparative home program,117 or have combined Cawthorne-Cooksey exercises with other adjunctive treatments including deep breathing or proprioceptive exercises 137…”

“…A level II RCT by Smółka et al117 compared customized VPT to Cawthorne-Cooksey exercises for individuals with chronic UVH. The intervention lasted 6 weeks.…”

“…In these studies, the exercise programs consisted of a progression of balance challenges, usually incorporating head movements and walking, as well as GSE, and habituation exercises. Three studies also included an endurance component (walking) 113,117,192. All of these studies included regular clinic visits, 1 to 2 times a week, and daily home exercises monitored for compliance 113,117,136,192…”

“…The individual's position was progressed from lying down, to sitting, standing, and eventually walking. More recent studies have compared modified Cawthorne-Cooksey exercises to the original protocol, 136 or have utilized Cawthorne-Cooksey exercises as the comparative home program, 117 or have combined Cawthorne-Cooksey exercises with other adjunctive treatments including deep breathing or proprioceptive exercises. 137 Current VPT in the United States is an exercise-based approach that includes a combination of 4 different exercise components to address the impairments, activity limitations, and participation restrictions identified during evaluation:…”

“…Since 2015, 2 level I studies, 113,136 4 level II studies, 117,133,164,165 and 2 level III studies 166,167 relevant to this group of individuals were identified. Meldrum et al 113 in a 2-center, assessor-blinded RCT (level I) explored the effect of VR exercises compared with VPT on changes in gait speed, DVA, DGI, anxiety and depression, Vestibular Rehabilitation Benefits Questionnaire (VRBQ), and Activities-specific Balance Confidence Scale (ABC) in individuals with UVH and symptoms greater than 6 weeks.…”