The effect of vestibular rehabilitation on adults with bilateral vestibular hypofunction: A systematic review

Abstract

Purpose: Adults with bilateral vestibular hypofunction (BVH) experience significant disability. A systematic review assessed evidence for vestibular rehabilitation (VR). Number of studies: 14 studies. Materials/methods: Search identification of studies based on inclusion criteria: (a) population: adults with BVH of peripheral origin; (b) interventions: vestibular exercises, balance training, education, or sensory prosthetics; (c) comparison: single interventions or compared to another psychophysical intervention, placebo, or healthy population; (d) outcomes: based on International Classification of Functioning, Disability and Health (ICF) Body Functions and Structure, Activity, and Participation; (e) study designs: prospective and interventional, Levels of Evidence I to III per Centre of Evidence-based Medicine grading. Coding and appraisal based on ICF framework and strength of evidence synthesis. Results: Five Level II studies and nine Level III studies: All had outcomes on gaze and postural stability, five with outcomes on gait speed and perceptions of oscillopsia and disequilibrium. Conclusions: (a) Moderate evidence strength on improved gaze and postural stability (ICF-Body Functions) following exercise-based VR; (b) Inadequate number of studies supporting benefit of VR on ICF-Participation outcomes; (c) Sensory prosthetics in early phase of development. Clinical relevance: Moderate evidence strength in support of VR from an impairment level; clinical practice and research needed to explore interventions extending to ICF-Activity and Participation.

CANVAS an update: Clinical presentation, investigation and management

“…Whilst evidence exists for the utility of intensive neurological physiotherapy in the management of cerebellar disease [14,15] and similarly vestibular rehabilitation in the treatment of bilateral peripheral vestibulopathies [13,23,36], there does not appear to be any published data on the combination of these two therapies in the management of patients with compound deficits of cerebellar, vestibular and somatosensory impairment. Anecdotally, we find significant benefit in referring our patients for individualised combination neurological and vestibular rehabilitation, which are performed regularly by the patient and reviewed periodically by a specialist physiotherapist.…”

When vestibular rehabilitation can assist: findings with use of data mining

“…Even, in this study the improvement in dizziness was more significant in patients with VM than those with comorbid tension-type headache which is consistent with our findings since headache in our dataset also included comorbid tension-type. Furthermore, the symptoms difficulty of walking in darkness, difficulty walking on uneven surfaces and oscillopsia are the major symptoms of BVP [25]. VRT is indeed useful for treating chronic BVP, but the reasons why a limited number of patients show improvement are to be defined [26].…”

Vestibular rehabilitation ameliorates chronic dizziness through the SIRT1 axis

“…Physical exercise intervention has been recognized as an effective treatment strategy for the management of symptoms associated with vestibular dysfunction that manifests as dizziness and imbalance related to body position or movement in patients with dizziness (Porciuncula et al, 2012). Falone et al (2012) showed that exercise training enhances human SIRT1 expression in the hippocampus, and Lezi et al reported that exercise training upregulates SIRT1, AMPK and PGC-1 function in the liver and brain (Lezi et al, 2013).…”