Principles of vestibular physical therapy rehabilitation

Whitney, Susan L.; Sparto, Patrick J.

doi:10.3233/nre-2011-0690

Cited by 58 publications

(32 citation statements)

References 113 publications

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“…These recovery strategies are recruited by specific exercises that are designed to decrease dizziness (a percept), improve static and dynamic balance function (motor performance), and increase general activity levels (restoration of daily activities) (Herdman and Whitney, 2007; Whitney and Sparto, 2011). Because they involve self-generated activity, the exercises provide stimulation to foster integration (compensation) of the somatosensory, visual, and vestibular information processing for graded levels of skilled spatial orientation.…”

Section: Vestibular Rehabilitation As An Experimental Approach To mentioning

confidence: 99%

“…The therapy progression can be summarized from the literature (Herdman and Whitney, 2007; Whitney and Sparto, 2011) as follows. If a patient is incapable of standing safely, they remain seated and perform active eye and head movements while fixating on a point in a lighted room.…”

Section: Top-down Strategies In Clinical Assessment and Vestibularmentioning

confidence: 99%

“…A vestibular physical therapy program integrates exercise procedures that are designed to improve performance of the vestibulo-ocular reflex (VOR), cervico-ocular reflex (COR), depth perception (DP), somatosensory retraining (SS), dynamic gait, and aerobic function (Herdman and Whitney, 2007; Whitney and Sparto, 2011). The VOR and COR exercises engage plasticity of these reflex pathways.…”

Section: Top-down Strategies In Clinical Assessment and Vestibularmentioning

confidence: 99%

“…The status of VOR function and eye tracking function at the initiation of therapy are an important factor in selecting initial therapeutic procedures and interim target outcomes. Patients simply cannot master somatosensory exercise and PNF skills without at first gaining control of eye motion and eye-head coordination (Herdman and Whitney, 2007; Whitney and Sparto, 2011). As a result, a great deal of time and attention is directed, both initially and throughout therapy, at challenging the VOR and gaze control.…”

Section: Top-down Strategies In Clinical Assessment and Vestibularmentioning

confidence: 99%

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Top-down approach to vestibular compensation: Translational lessons from vestibular rehabilitation

2012

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This review examines vestibular compensation and vestibular rehabilitation from a unified translational research perspective. Laboratory studies illustrate neurobiological principles of vestibular compensation at the molecular, cellular and systems levels in animal models that inform vestibular rehabilitation practice. However, basic research has been hampered by an emphasis on ‘naturalistic’ recovery, with time after insult and drug interventions as primary dependent variables. The vestibular rehabilitation literature, on the other hand, provides information on how the degree of compensation can be shaped by specific activity regimens. The milestones of the early spontaneous static compensation mark the re-establishment of static gaze stability, which provides a common coordinate frame for the brain to interpret residual vestibular information in the context of visual, somatosensory and visceral signals that convey gravitoinertial information. Stabilization of the head orientation and the eye orientation (suppression of spontaneous nystagmus) appear to be necessary by not sufficient conditions for successful rehabilitation, and define a baseline for initiating retraining. The lessons from vestibular rehabilitation in animal models offer the possibility of shaping the recovery trajectory to identify molecular and genetic factors that can improve vestibular compensation.

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Section: Vestibular Rehabilitation As An Experimental Approach To mentioning

confidence: 99%

Section: Top-down Strategies In Clinical Assessment and Vestibularmentioning

confidence: 99%

Section: Top-down Strategies In Clinical Assessment and Vestibularmentioning

confidence: 99%

Section: Top-down Strategies In Clinical Assessment and Vestibularmentioning

confidence: 99%

See 2 more Smart Citations

Top-down approach to vestibular compensation: Translational lessons from vestibular rehabilitation

2012

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“…B., ob weniger Symptome auftreten oder die Patienten nun in der Lage sind, Objekte störungsfrei zu fixieren oder zu verfolgen. Die Adaptation (Trainierbarkeit) erfolgt innerhalb kurzer Trainingseinheiten, Fortschritte sind häufig nach einigen Tagen und Wochen festzustellen [29][30] [31].…”

Section: Schlussfolgerungen Für Die Behandlungunclassified

Testsequenzen für den Praktiker

Kubat¹,

Schulze²

2019

manuelletherapie

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ZusammenfassungOkulomotorische Tests sind bei Patienten mit kraniozervikalen Symptomen wie Nacken-, Kopf- und Gesichtsschmerzen, Schwindel, Gleichgewichtsstörungen oder Ohrsensationen eine Notwendigkeit, um adäquat und zielgerichtet behandeln zu können.Dieser 2. Teil der Artikelreihe zu Tests bei kraniozervikalen Beschwerden beschreibt die Anwendung und den Nutzen okulomotorischer Tests wie dem Blickfolge-, Sakkaden-, Vergenz- und Kopfimpulstest.

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Patient-Reported Disability After Computerized Posturographic Vestibular Retraining for Stable Unilateral Vestibular Deficit

David

Shahnaz

2022

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Individuals with persistent unilateral vestibular deficits experience loss of quality of life and increased risk of falling, and they have few well-supported options for effective treatment.OBJECTIVES To evaluate whether vestibular retraining using computerized dynamic posturography is associated with reduced participant-reported disability for patients with an objectively assessed unilateral peripheral vestibular deficit and to assess the feasibility of conducting a randomized clinical trial of vestibular retraining using computerized dynamic posturography. DESIGN, SETTING, AND PARTICIPANTSThis single-group cohort study was conducted from April 29 to July 23, 2021, in a tertiary neurotology clinic among 13 individuals with a stable unilateral vestibular deficit present for more than 6 months, confirmed with videonystagmography and vestibular evoked myogenic potential testing. Statistical analysis was performed from July 7, 2021, to January 25, 2022.INTERVENTIONS Twelve twice-weekly sessions of posturography-assisted vestibular retraining with prescribed weight shifting tasks guided by an interactive display. MAIN OUTCOMES AND MEASURESChange in scores on the Dizziness Handicap Inventory (DHI), the Activities-Specific Balance Confidence (ABC) Scale, and the Falls Efficacy Scale-International (FES-I), which participants completed before and after retraining to measure their perception of their disability. They also completed posturography measurements. Secondary outcomes included tolerability of the intervention and rate of completion of the full protocol.RESULTS A total of 13 participants (8 men [62%]; median age, 51 years [range, 18-67 years]) were enrolled. All 13 participants completed the intervention and all follow-up. After treatment, the median changes in scores were −16 points (95% CI, −20 to 2) for the DHI, −9 (95% CI, −14 to 1) for the FES-I, and 11.9 (95% CI, 0-17.3) for the ABC Scale. Eight participants (62%) improved by greater than the minimum clinically important difference (MCID) for the DHI, whereas 4 (31%) exceeded the MCID for the ABC Scale, and 3 (23%) exceeded the MCID for the FES-I. Participants with moderate to severe disability at baseline (n = 7) had a larger magnitude of improvement in DHI scores than those with mild disability (n = 6) (−18 [95% CI, −78 to 2] vs −1 [95% CI, −8 to 16]). Six of the 7 patients (86%) with moderate to severe disability improved by greater than the MCID for DHI, wherease 4 of 7 patients (57%) improved by greater than the MCID for the ABC Scale, and 3 of 7 patients (43%) improved by greater than the MCID for the FES-I.CONCLUSIONS AND RELEVANCE This cohort study suggests that computerized, dynamic posturography-assisted retraining was associated with clinically meaningful improvements in participant-reported disability among those with stable unilateral vestibular deficit and moderate to severe disability. Further studies should compare posturography-assisted vestibular retraining with conventional physical therapy rehabilitation techniques.

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Principles of vestibular physical therapy rehabilitation

Cited by 58 publications

References 113 publications

Top-down approach to vestibular compensation: Translational lessons from vestibular rehabilitation

Top-down approach to vestibular compensation: Translational lessons from vestibular rehabilitation

Testsequenzen für den Praktiker

Patient-Reported Disability After Computerized Posturographic Vestibular Retraining for Stable Unilateral Vestibular Deficit

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