Vestibular Rehabilitation for Peripheral Vestibular Hypofunction

Hall, Courtney D.; Herdman, Susan J.; Whitney, Susan L.; Cass, Stephen P.; Clendaniel, Richard A.; Fife, Terry D.; Furman, Joseph M.; Getchius, Thomas S.D.; Goebel, Joel A.; Shepard, Neil T.; Woodhouse, Sheelah N.

doi:10.1097/npt.0000000000000120

Cited by 365 publications

(180 citation statements)

References 103 publications

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“…He explained that he was able to implement the activities he learned from therapy to quickly resolve any episodes of dizziness. It was recommended that the patient continue performing his vestibular exercises of ×1 viewing and smooth pursuits 3 times a day for a total of 20 -40 minutes to help maintain optimal function [31].…”

Section: Discussionmentioning

confidence: 99%

“…The patient also received a home exercise program (HEP) to supplement the exercises performed within the clinic. He was instructed to perform his adaptation exercises two to three times a day for a total of 20 minutes a day and to perform at least 20 minutes of posture stability HEP exercises [8] [31]. At the beginning of each consequent therapy session, the patient was asked if he performed his exercises and was asked to demonstrate the activities to ensure compliance with the program.…”

Section: Implementation Of Interventions/re-assessmentmentioning

confidence: 99%

“…Short-term goals were to be accomplished in the four weeks which included: decreasing DHI score to 50 on DHI and increasing ABCs score to 82%. The primary focus within the first four weeks was to improve his acute unilateral vestibular hypofunction and to prepare him for more complex challenges with VR [31]. Clinical practice guidelines recommend that patients with acute unilateral vestibular hypofunction should have supervised therapy for two to three weeks [31].…”

Section: Plan Of Carementioning

confidence: 99%

“…During the first four weeks, the patient engaged in vestibular rehabilitation therapy [8] [31]. Exercises performed were to improve gaze stability, enhance eye movements, increase postural stability, decrease vertigo, and improve activities of well-being [8].…”

Section: Implementation Of Interventions/re-assessmentmentioning

confidence: 99%

“…The primary focus within the first four weeks was to improve his acute unilateral vestibular hypofunction and to prepare him for more complex challenges with VR [31]. Clinical practice guidelines recommend that patients with acute unilateral vestibular hypofunction should have supervised therapy for two to three weeks [31]. Research has shown that patients suffering from vestibular deficits may require up to 8 weeks of vestibular therapy before seeing significant improvement [30].…”

Section: Plan Of Carementioning

confidence: 99%

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Improving Balance through Virtual Reality and Physical Therapy Integration

Esguerra¹,

Johnson²

2017

IJCM

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Background and Purpose: Virtual reality (VR) is an innovative technology that shows promise in the assistance of physical therapy (PT). This case report explores the use of virtual reality with a patient suffering from unilateral vestibular hypofunction (UVH). Case Description: The patient is a 50-year-old male who was referred to physical therapy following a motor vehicle accident. The patient was diagnosed with having an acute left UVH, accompanied by reports of dizziness, imbalance and gait disturbances which impaired him from his work in construction. Intervention: The patient was seen two to three times a week for 40-minute sessions along with an individualized home exercise program. Interventions included vestibular rehabilitation exercises, balance training, gait training, and VR. The goals of VR were to provide taskspecific simulations to improve postural balance, decrease anxiety through exposure therapy, and improve smooth eye pursuits to improve static balance. Outcomes: Outcomes used included subjective questionnaires such as the Activities-Specific Balance Confidence survey and the Dizziness Handicap Inventory (DHI) as well as functional tests like the Sensory Organization Test, Motor Control Test, and the Functional Gait Assessment (FGA). Outcome measures were performed at initial evaluation, at the 10th visit, and again at discharge. Notable improvements were seen on DHI and FGA scores. Conclusion: Dizziness, confidence, balance, and gait improved following vestibular rehabilitation combined with VR. Outcomes of this case suggest that virtual reality in conjunction with vestibular rehabilitation therapy is effective in improving deficits of unilateral vestibular hypofunction. Additionally, the use of VR in this case report suggests this can be an effective tool for intervention to facilitate patient-specific goals.

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Section: Discussionmentioning

confidence: 99%

Section: Implementation Of Interventions/re-assessmentmentioning

confidence: 99%

Section: Plan Of Carementioning

confidence: 99%

Section: Implementation Of Interventions/re-assessmentmentioning

confidence: 99%

Section: Plan Of Carementioning

confidence: 99%

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Improving Balance through Virtual Reality and Physical Therapy Integration

Esguerra¹,

Johnson²

2017

IJCM

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Characterization of Head-Trunk Coordination Deficits After Unilateral Vestibular Hypofunction Using Wearable Sensors

Paul

Dibble

Walther

et al. 2017

JAMA Otolaryngol Head Neck Surg

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Instrumented Gait Analysis to Identify Persistent Deficits in Gait Stability in Adults With Chronic Vestibular Loss

Grove

Whitney

Pyle

et al. 2021

JAMA Otolaryngol Head Neck Surg

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IMPORTANCERegaining the ability to walk safely is a high priority for adults with vestibular loss. Thus, practitioners need comprehensive knowledge of vestibulopathic gait to design, provide, and/or interpret outcomes of interventions. To date, few studies have characterized the effects of vestibular loss on gait.OBJECTIVES To investigate the use of an instrumented 2-minute walk test in adults with vestibular loss, to further characterize vestibulopathic gait, and to assess whether those with chronic vestibular loss have enduring gait deficits. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study, conducted between April 3, 2018, and June 27, 2019, recruited adults 20 to 79 years of age from an academic, tertiary, hospital-based, ambulatory care setting who were healthy or had confirmed unilateral or bilateral vestibular hypofunction. Of the 43 adults who were screened from convenience and referred samples, 2 declined, and 7 were excluded because of health conditions. EXPOSURES The main exposure was the instrumented 2-minute walk test, which was conducted with participants using wearable inertial measurement units while they walked a 10-m path at their self-selected speed and turned 180°in their self-selected direction at either end. MAIN OUTCOMES AND MEASURESThe primary measures were spatiotemporal gait metrics (eg, stride length [SL] and peak whole-body turning velocity). Multivariate analysis of variance was used to assess between-group differences. Validity was assessed using the area under the curve from receiver operator characteristic analyses.RESULTS Data from 17 healthy adults (mean [SD] age, 39.27 [11.20] years; 13 [76%] female) and 13 adults with vestibular loss (mean [SD] age, 60.50 [10.81] years; 6 [46%] female) were analyzed. Very large between-group differences were found for SL (left) (estimated marginal mean [SE] for healthy vs vestibular groups, 1.47 [0.04] m vs 1.31 [0.04] m; Cohen d, 1.35; 95% CI, 0.18-2.52), SL (right) (estimated marginal mean [SE] for healthy vs vestibular groups, 1.46 [0.04] m vs 1.29 [0.04] m; Cohen d, 1.44; 95% CI, 0.25-2.62), and peak turn velocity (estimated marginal mean [SE] for healthy vs vestibular groups, 240.17 [12.78]°/s vs 189.74 [14.70]°/s; Cohen d, 1.23; 95% CI, 0.07-2.40). The area under the curve was 0.79 (95% CI, 0.62-0.95) for SL (left), 0.81 (95% CI, 0.64-0.97) for SL (right), and 0.86 (95% CI, 0.72-0.99) for peak turn velocity. CONCLUSIONS AND RELEVANCEIn this cross-sectional study, instrumented gait analysis had good discriminative validity and revealed persistent deficits in gait stability in those with chronic vestibular loss. The findings of this study suggest that these clinically and functionally meaningful deficits could be targets for vestibular rehabilitation.

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Vestibular Rehabilitation for Peripheral Vestibular Hypofunction

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 365 publications

References 103 publications

Improving Balance through Virtual Reality and Physical Therapy Integration

Improving Balance through Virtual Reality and Physical Therapy Integration

Characterization of Head-Trunk Coordination Deficits After Unilateral Vestibular Hypofunction Using Wearable Sensors

Instrumented Gait Analysis to Identify Persistent Deficits in Gait Stability in Adults With Chronic Vestibular Loss

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