Vestibular rehabilitation: clinical benefits to patients with Parkinson's disease

Abstract

-Objective: To evaluate the effectiveness of the vestibular rehabilitation (VR) exercises by means of an assessment before and after the application of the Brazilian version of the Dizziness Handicap Inventory (DHI) questionnaire. Method: Twelve patients were studied, the following procedures were carried out: anamnesis, otorhinolaryngological and vestibular evaluation, and the application of the DHI before and after the VR. Results: Clinically resting tremors and subjective postural instability were the motor complaints most frequently associated with complaints of vertigo in 12 cases (100%); in the vestibular exam, all the patients presented abnormalities, frequently from the uni and bilateral peripheral vestibular deficiency syndromes in 10 cases (83.3%); there was significant improvement in the physical, functional and emotional aspects of the DHI after the completion of the VR. Conclusion: The VR following the Cawthorne and Cooksey protocol were shown to be useful in managing subjective complaints of several aspects evaluated in this protocol.KEY WORDS: Parkinson's disease, rehabilitation, vestibular function tests. Reabilitação vestibular: utilidade clínica em pacientes com doença de ParkinsonResumo -Objetivo: Avaliar a eficácia dos exercícios de reabilitação vestibular (RV) por meio de avaliação pré e pós-aplicação da versão brasileira do questionário Dizziness Handicap Inventory (DHI). Método: Estudou-se 12 pacientes e realizaram-se os seguintes procedimentos: anamnese, avaliação otorrinolaringológica, vestibular e aplicação do DHI pré e pós RV. Resultados: Do ponto de vista clínico, o tremor de repouso e a instabilidade postural subjetiva foram às queixas motoras mais freqüentes associadas às queixas de vertigem em 12 casos (100%); no exame vestibular, todos os pacientes apresentaram anormalidades, com freqüência das síndromes vestibulares periféricas deficitárias uni e bilaterais em 10 casos (83,3%); houve melhora significativa dos aspectos físico, funcional e emocional do DHI após a realização da RV. Conclusão: A RV seguindo o protocolo de Cawthorne e Cooksey mostrou-se útil no manejo de queixas subjetivas de diversos aspectos avaliados neste protocolo. PALAVRAS-CHAVE: doença de Parkinson, testes de função vestibular, reabilitação.

Vestibular Rehabilitation of Older Adults with Dizziness

“…66 Head and eye movement exercises were shown to be clinically beneficial in a patient diagnosed with PD with resting tremor and vertigo. 48 The patient's subjective complaints of vertigo were reported to be improved after VRT, and objective measures of gait and posture also demonstrated improvement. The use of VRT may promote the central compensatory mechanism by means of neural plasticity.…”

“…[44][45][46] Exercises were found to be effective in people with chronic vestibular disorders (even with a history of symptoms lasting more than 20 years), patients with conditions that affect the function of the balance system (eg, stroke, Parkinson disease), and in people with anxiety and depression. [47][48][49] Telian and colleagues 50 found that 59% of patients with vestibular dysfunction had dramatic improvements in their dizziness and resolution of symptoms that affect their lifestyle after vestibular rehabilitation. In the same report, 23% of patients, despite some residual symptoms, had considerable improvement after therapy.…”

“…The use of VRT may promote the central compensatory mechanism by means of neural plasticity. 48 Rossi-Izquierdo and colleagues 85 studied vestibular rehabilitation in a group of patients with PD who were at risk of falling using the TUG test. Patients who had scores greater than 15.9 seconds on the TUG were selected for the study.…”

A physical therapist classification system for persons with complaints of dizziness and balance dysfunction

“…62 The risk of a fall and the report of dizziness in patients with PD can significantly be reduced with balance training 17 or VREs. 63,64 However, falls in patients with PD are not solely caused by dizziness but have been related to tremor, freezing, retropulsion, and rigidity. 62 All causes of falls should be assessed and addressed early in the course of rehabilitation in order to improve clinical outcomes.…”

Principles of rehabilitation for common chronic neurologic diseases in the elderly

“…The reason is because of the integration of the signals from the visual, somatosensory and vestibular system is damaged during the progress of disease. 26 The disrupted signal process leads to alteration of postural control and, thus, increases the risk of falls. 27 Appropriate assistive devices for ambulation are suggested for patients with PD.…”