Vestibular Rehabilitation and Factors That Can Affect Outcome

Abstract

This review will discuss the developmental, environmental, medical, psychological, visual, and other sensory-related factors that affect recovery after vestibular dysfunction. A general overview of the evidence for vestibular rehabilitation for patients with peripheral and central vestibular disorders is provided. Recent findings suggest that age, physical activity, certain congenital disorders, length of symptoms, musculoskeletal, visual and neuromuscular comorbidities, cognition, sleep, and medications are all factors that influence the effectiveness and outcome of vestibular rehabilitation. Psychological factors that also affect outcome include anxiety, depression, fear of movement, and fear of falling. Recovery in patients with vestibular disorders may be enhanced if the practitioner recognizes and attempts to remediate modifiable factors.

The INVEST trial: a randomised feasibility trial of psychologically informed vestibular rehabilitation versus current gold standard physiotherapy for people with Persistent Postural Perceptual Dizziness

“…The findings still provide a strong signal for efficacy that supports the justification for a full-scale efficacy study. Participants in this current study had a high level of dizziness handicap and a median illness duration of 2 years, which is usually associated with a poor prognosis [ 42 ], indicating that these may be important factors to consider as treatment effect modifiers in a full-scale trial. Since treatment effects were not universal, we believe there is further scope for the intervention to be improved.…”

“…Vestibular rehabilitation therapy (VRT) is an established exercise-based treatment for people with structural vestibular disorders [ 26 ] that is usually recommended for people with PPPD [ 27 , 41 ]. However, the exercises must be carefully graded to avoid intolerable symptom provocation and psychological factors are known to negatively affect outcome [ 42 ]. There is limited evidence in favour of CBT in PPPD [ 10 ], although one study reported short-term relief [ 20 ].…”

Subjective perception of activity level: A prognostic factor for developing chronic dizziness after vestibular schwannoma resection?

“…These factors thus only partially explain the variation in outcome concerning chronic dizziness after VS resection. Another potential influencing factor is the level of physical activity, as it is assumed that repetition of movement is needed to stimulate central vestibular compensation (15)(16)(17)(18)(19). The preoperative level of physical activity was previously investigated and it was concluded that a higher level of physical activity before surgery led to better balance performance after VS resection (20, 21).…”

Postconcussion Depressive Symptoms and Clinical Assessment Associations in Adolescents

“…The vestibular system is involved in sensorimotor functions aiding balance (measured using the BESS) as well as ocular-motor function (measured using the VOMS) (12). The literature suggests an association between vestibular dysfunction and heightened anxiety and/or depression (12,13). These connections lead to the hypothesis that balance performance and vestibular ocular-motor function would be negatively associated with reported depressive symptoms after concussion.…”

“…These analyses aim to deepen the previous literature's findings that increased depressive symptoms result in increased postconcussion symptoms after injury (11). Research suggests a connection between vestibular dysfunction and heightened anxiety and/or depression (12,13). Therefore, it was hypothesized that concussed adolescents who present with depressive symptoms after injury would exhibit heightened balance and vestibular impairment.…”