The value of close monitoring in vestibular rehabilitation therapy

Itani, Malak; Koaik, Youssef; Sabri, A

doi:10.1017/s0022215116009750

Cited by 6 publications

(6 citation statements)

References 16 publications

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“…Two studies (Ertugrul and Emre Soylemez,173 level II; Itani et al,179 level III) did not find an effect of age on rehabilitation outcomes for individuals with various peripheral vestibular disorders. Lorin et al213 (level IV) reported that increasing age was not associated with functional outcomes after VPT.…”

Section: Update and Revision Of Guidelinesmentioning

confidence: 94%

“…Three studies evaluated the effect of gender on the efficacy of VPT, and none demonstrated a significant effect of gender on recovery. One level III study found no effect of gender on multiple vestibular rehabilitation outcomes in individuals with BVH112 and 2 other level III studies found no effect of gender on DGI (Itani et al179) or DHI (Ertugrul and Emre Soylemez173) scores in individuals with various peripheral vestibular disorders.…”

Section: Update and Revision Of Guidelinesmentioning

confidence: 99%

“…Four articles reviewed included individuals with BVH in studies testing the effects of various forms of VPT: Ricci et al 136 (level I), Patarapak et al 178 (level III), Itani et al 179 (level III), and Szturm et al 180 (level IV). However, the participant samples in these studies were a mixture of individuals with both BVH and UVH.…”

Section: Evidence Updatementioning

confidence: 99%

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

Hall

Herdman

Whitney

et al. 2021

Journal of Neurologic Physical Therapy

199

203

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Background: Uncompensated vestibular hypofunction can result in symptoms of dizziness, imbalance, and/or oscillopsia, gaze and gait instability, and impaired navigation and spatial orientation; thus, may negatively impact an individual's quality of life, ability to perform activities of daily living, drive, and work. It is estimated that one-third of adults in the United States have vestibular dysfunction and the incidence increases with age. There is strong evidence supporting vestibular physical therapy for reducing symptoms, improving gaze and postural stability, and improving function in individuals with vestibular hypofunction. The purpose of this revised clinical practice guideline is to improve quality of care and outcomes for individuals with acute, subacute, and chronic unilateral and bilateral vestibular hypofunction by providing evidence-based recommendations regarding appropriate exercises. Methods: These guidelines are a revision of the 2016 guidelines and involved a systematic review of the literature published since 2015 through June 2020 across 6 databases. Article types included meta-analyses, systematic reviews, randomized controlled trials, cohort studies, case-control series, and case series for human subjects, published in English. Sixty-seven articles were identified as relevant to this clinical practice guideline and critically appraised for level of evidence. Results: Based on strong evidence, clinicians should offer vestibular rehabilitation to adults with unilateral and bilateral vestibular hypofunction who present with impairments, activity limitations, and participation restrictions related to the vestibular deficit. Based on strong evidence and a preponderance of harm over benefit, clinicians should not include voluntary saccadic or smooth-pursuit eye movements in isolation (ie, without head movement) to promote gaze stability. Based on moderate to strong evidence, clinicians may offer specific exercise techniques to target identified activity limitations and participation restrictions, including virtual reality or augmented sensory feedback. Based on strong evidence and in consideration of patient preference, clinicians should offer supervised vestibular rehabilitation. Based on moderate to weak evidence, clinicians may prescribe weekly clinic visits plus a home exercise program of gaze stabilization exercises consisting of a minimum of: (1) 3 times per day for a total of at least 12 minutes daily for individuals with acute/subacute unilateral vestibular hypofunction; (2) 3 to 5 times per day for a total of at least 20 minutes daily for 4 to 6 weeks for individuals with chronic unilateral vestibular hypofunction; (3) 3 to 5 times per day for a total of 20 to 40 minutes daily for approximately 5 to 7 weeks for individuals with bilateral vestibular hypofunction. Based on moderate evidence, clinicians may prescribe static and dynamic balance exercises for a minimum of 20 minutes daily for at least 4 to 6 weeks for individuals with chronic unilateral vestibular hypofunction and, bas...

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Section: Update and Revision Of Guidelinesmentioning

confidence: 94%

Section: Update and Revision Of Guidelinesmentioning

confidence: 99%

See 1 more Smart Citation

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

Hall

Herdman

Whitney

et al. 2021

Journal of Neurologic Physical Therapy

199

203

View full text Add to dashboard Cite

show abstract

“…Later, more specific approaches were used based on physiological or behavioral rationales, which were more effective in decreasing the magnitude of symptoms experienced by patients and increasing their independence during daily activities (17, 18). Recently, it has been shown that customized and supervised exercises are more beneficial than unsupervised (e.g., performed alone at home) or general fitness exercises (19–24).…”

Section: Introductionmentioning

confidence: 99%

Rebalancing the Vestibular System by Unidirectional Rotations in Patients With Chronic Vestibular Dysfunction

et al. 2019

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Introduction: Vestibular dysfunction is a common disorder that results in debilitating symptoms. Even after full compensation, the vestibulo-ocular reflex (VOR) could be further improved by using rehabilitation exercises and visual-vestibular adaptation. We hypothesized that in patients with asymmetric vestibular function, the system could be rebalanced by unidirectional rotations toward the weaker side (i.e., a pure vestibular stimulation).Methods: Sixteen subjects (5 female and 11 male, 43.2 ± 17.0 years old) with chronic vestibular dysfunction that was non-responsive to other types of medical treatment were recruited for the study (ClinicalTrials.gov Identifier: NCT01080430). Subjects had VOR asymmetry quantified by an abnormal directional preponderance (DP) with rotation test and no previous history of central vestibular problems or fluctuating peripheral vestibular disorders. They participated either in the short-term study (one session) or the long-term study (7 visits over 5 weeks). Rehabilitation consisted of five trapezoid unidirectional rotations (peak velocity of 320°/s) toward the weaker side. Care was taken to slowly stop the rotation in order to avoid stimulation in the opposite direction during deceleration. To study the short-term effect, VOR responses were measured before and 10, 40, and 70 min after a single unidirectional rotational rehabilitation session. For long-term effects, the VOR gain was measured before and 70min after rehabilitation in each session.Results: We observed a significant decrease in VOR asymmetry even 10 min after one rehabilitation session (short-term study). With consecutive rehabilitation sessions in the long-term study, DP further decreased to reach normal values during the first 2 sessions and only one subjects required further rehabilitation after week 4. This change in DP was due to an increase in responses during rotations toward the weaker side and a decrease in VOR responses during rotations in the other direction.Conclusion: Our results show that unidirectional rotation can reduce the VOR imbalance and asymmetry in patients with previously compensated vestibular dysfunction and could be used as an effective supervised method for vestibular rehabilitation even in patients with longstanding vestibular dysfunction.

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“…Supervised vestibular rehabilitation exercises seem superior to home exercises, where they provide better patient compliance. Furthermore, it allows the therapist to regularly assess patients' progress and provide them with feedback on their performance [56][57][58].…”

Section: Discussionmentioning

confidence: 99%

Fall risk assessment and effect of vestibular rehabilitation in the elderly population

Fawzan

Kozou

Baki

et al. 2022

Egypt J Otolaryngol

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Background Accidental falls in elderly represent a major healthcare problem; they are a major cause of accidental death in people above 65 years of age. They result in both physical and psychological trauma, where fear of falling is a major consequence that leads to a vicious cycle that makes elderlies more isolated and dependent, making them more vulnerable to falls. Falls are multifactorial, where dizziness is a common factor in elderlies. Thus, a multi-systemic approach is essential for the assessment of balance functions; it also serves as a guide for treatment planning, either in the presence of a cause-specific pathology or when presbyvestibulopathy is the sole issue. Vestibular rehabilitation is useful in training elderlies to improve their dizziness and balance functions. Aim The aim of the study is to assess fall risk in elderly participants and to assess the role of customized vestibular rehabilitation in decreasing dizziness and falls in elderlies identified to be at risk of falling. Results All elderlies diagnosed at fall risk showed statistically significant improvement in dizziness handicap inventory, dynamic gait index, and computerized dynamic posturography after vestibular rehabilitation. As for dizziness, handicap inventory participants showed statistically significant improvement in the total score and in each of its three aspects (functional, emotional, and physical) after vestibular rehabilitation. The Dynamic Gait Index showed statistically significant improvement after vestibular rehabilitation, where they all became non-fallers. Subjects improved significantly in sensory organization test, limits of stability, vestibular stimulation test, motor control test, and faller assessment test of computerized dynamic posturography. Performance on the subjective assessment test was not significantly correlated to the objective assessment methods. The Dynamic Gait Index is sensitive in the detection of elderlies at risk of falling. Conclusions Falls in elderlies is an important subject that must be taken seriously due to its major consequences. Full balance assessment is crucial for offering customized vestibular rehabilitation, which has proved to be useful in minimizing dizziness and fall risk in elderlies.

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The value of close monitoring in vestibular rehabilitation therapy

Cited by 6 publications

References 16 publications

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

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

Rebalancing the Vestibular System by Unidirectional Rotations in Patients With Chronic Vestibular Dysfunction

Fall risk assessment and effect of vestibular rehabilitation in the elderly population

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