Unilateral Head Impulses Training in Uncompensated Vestibular Hypofunction

Abstract

The aim of this paper is to report a case of a young woman with unilateral vestibular chronic failure with a poorly compensated vestibuloocular reflex during rapid head rotation. Additionally, she developed migraine symptoms during the treatment with associated chronic dizzy sensations and blurred vision. Her report of blurred vision only improved after she completed a rehabilitation program using fast head impulse rotations towards the affected side for 5 consecutive days. We discuss why we elected this form of treatment and how this method may be useful for different patients.

Association of the Video Head Impulse Test With Improvement of Dynamic Balance and Fall Risk in Patients With Dizziness

“…21,22 However, more recent studies using a specific VOR adaptation protocol (incremental velocity error signal) 28 have shown that the high-frequency VOR gain (measured using head impulses) can improve after training. 8 Furthermore, a study in monkeys with unilateral labyrinthectomy showed an increase in the high-frequency VOR gain and reduced gain asymmetry after a training paradigm that involved ipsilesionalonly rotation. 29 Together, these data in humans 8,28 and monkeys 29 reveal that the high-frequency VOR gain after vestibular loss is modifiable and dependent on the unique training methods.…”

Patient-Reported and Performance Outcomes Significantly Improved in Elderly Patients with Vestibular Impairment following Rehabilitation: A Retrospective Study

“…Taken together, our results point to the importance of VR programs, regardless of the diagnosis of vestibular disorders. The rehabilitation program in this study consisted of exercises of adaptation and/or habituation and/or substitution, depending on each patient, twice a week in the rehabilitation clinic, and daily at the patient's home [ 7 , 20 ]. Clinical practice guidelines for vestibular hypofunction suggest that the number of visits may need to be varied in accordance with comorbidities that can affect movement and psychological functioning [ 12 ].…”

“…The VR program consisted of 10 twice weekly sessions in the rehabilitation clinic and daily exercises at the patient's home. It was based on the treatment protocol published in Binetti et al [ 7 ] and Verdecchia et al [ 20 ], with adaptation exercises and/or habituation and/or substitution exercises determined and adapted in accordance with an assessment of the patient. Subjects received vestibular and balance rehabilitation provided by three physical therapists with specialized training in the treatment of balance and vestibular disorders.…”

“…The objective of the VR program is to encourage compensation after peripheral and central vestibular disorders, thus reducing symptoms of dizziness and vertigo and the risk of falls, while increasing confidence in equilibrium and encouraging the return to activities of daily living [ 5 , 7 ]. The efficacy of vestibular rehabilitation can be evaluated using performance-based outcome measures such as gait speed (GS), timed up and go (TUG) [ 8 ], and patient-reported outcome measures such as the dizziness handicap inventory (DHI) [ 9 – 11 ].…”

Vestibular Function Measured Using the Video Head Impulse Test in Congenital Nystagmus and Vertigo: A Case Report

“…The protocol includes a new variation called SHIMP (suppression head impulses) which, when used alongside the HIMP, completes the study of vestibular lesions (8). Ample evidence has shown the clinical utility of the vHIT when diagnosing unilateral and bilateral peripheral vestibular lesions (9)(10)(11) and to study the evolution of these lesions [spontaneous (12,13) and after treatment (14)(15)(16)(17)(18)(19)] to identify patients with poor prognosis for disability-preventing early rehabilitation (20,21). vHIT can also be employed to monitor head impulse training and VOR ongoing compensatory strategies (12,19,22,23), to study new clinical patterns evidenced on 3D video head impulse test (7,24), and to diagnose central vestibular lesions, distinguishing these from peripheral lesions (25,26).…”