Does Otolith Organ Dysfunction Influence Outcomes After a Customized Program of Vestibular Rehabilitation?

Murray, Kate E.; Phillips, Bev; Waterston, John

doi:10.1097/npt.0b013e3181dde5dd

Cited by 9 publications

(6 citation statements)

References 23 publications

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“…Return to work is an important measure of the benefit of any VPT program; however, few researchers have incorporated a measure of return to work. In 4 level II studies 223,224,248,249 and 4 level III studies, 24,112,129,192 individuals' perceived disability has been reported to positively change after rehabilitation. Although the disability rating scale includes ability to work as a portion of the instrument, no studies specifically report how frequently people with peripheral vestibular hypofunction are able to return to work in the same occupation and capacity after VPT.…”

Section: Quality Of Life: Harm/benefits Ratiomentioning

confidence: 99%

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

180

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: Quality Of Life: Harm/benefits Ratiomentioning

confidence: 99%

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

180

203

View full text Add to dashboard Cite

show abstract

“…Improvements in driving have been noted in others with chronic unilateral hypofunction after an exercise program. 105 In 2 level II studies and 3 level III studies, patients' perceived disability has been reported to positively change after rehabilitation. This disability scale includes ability to work as a portion of the instrument, yet no studies specifically report how frequently people are able to return to work effectively after vestibular rehabilitation (level II: Giray et al, 50 Shepard et al, 68 Telian et al 82 ; level III: Shepard et al, 73 Telian et al 60 ).…”

Section: Action Statements and Research Recommendationsmentioning

confidence: 99%

Vestibular Rehabilitation for Peripheral Vestibular Hypofunction

Hall

Herdman

Whitney

et al. 2016

Journal of Neurologic Physical Therapy

362

152

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“…This is important because VR is based upon principles of vestibular adaptation of semicircular canal/VOR input. There is some evidence that combined otolith dysfunction and canal dysfunction does not negatively impact rehabilitation outcomes [69]; however, the study did not include individuals with mTBI or otolith-only dysfunction. In contrast, Basta et al [66] have shown that traditional VR is not effective for many patients with otolith disorders.…”

Section: Treatmentmentioning

confidence: 99%

Vestibular consequences of mild traumatic brain injury and blast exposure: a review

et al. 2017

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The purpose of this article is to review relevant literature on the effect of mild traumatic brain injury (mTBI) and blast injury on the vestibular system. Dizziness and imbalance are common sequelae associated with mTBI, and in some individuals, these symptoms may last for six months or longer. In war-related injuries, mTBI is often associated with blast exposure. The causes of dizziness or imbalance following mTBI and blast injuries have been linked to white matter abnormalities, diffuse axonal injury in the brain, and central and peripheral vestibular system damage. There is some evidence that the otolith organs may be more vulnerable to damage from blast exposure or mTBI than the horizontal semicircular canals. In addition, benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder following head injury that is treated effectively with canalith repositioning therapy. Treatment for (non-BPPV) mTBI-related vestibular dysfunction has focused on the use of vestibular rehabilitation (VR) augmented with additional rehabilitation methods and medication. New treatment approaches may be necessary for effective otolith organ pathway recovery in addition to traditional VR for horizontal semicircular canal (vestibulo-ocular reflex) recovery.

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Does Otolith Organ Dysfunction Influence Outcomes After a Customized Program of Vestibular Rehabilitation?

Cited by 9 publications

References 23 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

Vestibular Rehabilitation for Peripheral Vestibular Hypofunction

Vestibular consequences of mild traumatic brain injury and blast exposure: a review

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