Vestibular rehabilitation: advances in peripheral and central vestibular disorders

Abstract

Purpose of review Rehabilitation for persons with vertigo and balance disorders is becoming commonplace and the literature is expanding rapidly. The present review highlights recent findings of both peripheral and central vestibular disorders and provides insight into evidence related to new rehabilitative interventions. Risk factors will be reviewed to create a better understanding of patient and clinical characteristics that may effect recovery among persons with vestibular disorders. Recent findings Clinical practice guidelines have recently been developed for peripheral vestibular hypofunction and updated for benign paroxysmal positional vertigo. Diagnoses such as persistent postural-perceptual dizziness (PPPD) and vestibular migraine are now defined, and there is growing literature supporting the effectiveness of vestibular rehabilitation as a treatment option. As technology advances, virtual reality and other technologies are being used more frequently to augment vestibular rehabilitation. Clinicians now have a better understanding of rehabilitation expectations and whom to refer based on evidence in order to improve functional outcomes for persons living with peripheral and central vestibular disorders. Summary An up-to-date understanding of the evidence related to vestibular rehabilitation can assist the practicing clinician in making better clinical decisions for their patient and hopefully result in optimal functional recovery.

Benign paroxysmal positional vertigo, dizziness, and health-related quality of life among older adults in a population-based setting

“…However, the evidence for general exercise to improve balance among older adults in general is weak [41]. Hopefully, vestibular training can be a way to improve balance and lessen the dizziness symptoms [42] In our study, the prevalence of BPPV diagnosed through the side-lying maneuver was high, but the frequency of nystagmus during the test was substantially lower. One probable reason for this is that we did not use Frenzel´s glasses or goggles with infrared video camera, making nystagmus more difficult to detect.…”

Effectiveness of Vestibular Training for Balance and Dizziness Rehabilitation in People with Multiple Sclerosis: A Systematic Review and Meta-Analysis

“…First, it is the first systematic review and meta-analysis based on randomised controlled trials to be carried out with the aim of studying the effectiveness of vestibular rehabilitation in multiple sclerosis. As Dunlap et al [40] assert, there was a gap in the knowledge about the topic in this population. Second, the current review concludes that this intervention is at least as effective as other exercise-based interventions and more effective than no intervention.…”

Rehabilitación vestibular con posturografía dinámica

“…Sin embargo, su inestabilidad, habitualmente referida como inseguridad con la deambulación o bipedestación estática, sí se debe a una inadecuada recepción e integración de la información proporcionada por los sistemas vestibular, somatosensorial y visual. Pueden ser pacientes con patología del sistema nervioso central (infartos de fosa posterior o enfermedad de Parkinson) o pacientes que presentan inseguridad por miedo a las caídas (inestabilidad tras VPPB o en el vértigo postural perceptual persistente, VPPP) [11,12]. Desarrollan patrones de rigidez corporal que dan lugar a una disminución de los límites de estabilidad y por tanto de su movilidad.…”

“…Cabe destacar que, estudios recientes sobre el tratamiento de la migraña vestibular mediante rehabilitación, han demostrado un mejor control postural en situaciones de deprivación y conflicto visual en los periodos intercrisis. De esta forma, se conseguiría una disminución de la inestabilidad y ansiedad asociadas [12,13] aunque los datos son débiles para apoyar su efectividad.…”