Vestibular Rehabilitation: Useful but not Universally so

Abstract

VR is helpful for most patients in providing locomotor stability, but further work is needed to determine the factors that prevent VR from being effective for all patients with vestibulopathy.

Vestibular Rehabilitation for Peripheral Vestibular Hypofunction

“…There is one additional level I randomized controlled trial that included a significant proportion of individuals with bilateral vestibular hypofunction (53 of the 86) who completed 12 weeks of vestibular rehabilitation. 54 On the basis of improved gait biomechanics (preferred gait speed, decreased double support time, and decreased vertical center of mass excursion), Krebs and colleagues determined that patients with vestibular hypofunction benefitted from vestibular rehabilitation as compared with a placebo control group. As described previously, vestibular rehabilitation included a staged progression of gaze stability, balance, and gait retraining exercises.…”

“…Although the unilateral vestibular hypofunction group had more stable and faster gait characteristics at baseline than the bilateral vestibular hypofunction group, both groups' gait characteristics improved significantly with rehabilitation. 54 …”

Effectiveness of conventional versus virtual reality based vestibular rehabilitation in the treatment of dizziness, gait and balance impairment in adults with unilateral peripheral vestibular loss: a randomised controlled trial

“…These variables have been identified by Krebs et al (2003) [8] as the most significant discriminators of success following vestibular rehabilitation The Dynamic Gait Index (DGI)[23] will also be assessed.…”

“…Vestibular rehabilitation is a safe, effective and non-invasive treatment for the sequelae of UVL [5,6]. Subjectively, balance impairment is rated as more problematic than dizziness or vertigo [7] and while meta-analysis has demonstrated a clear benefit for the reduction in dizziness and vertigo symptoms, a less convincing effect has been shown for reducing balance and gait impairment [5,8]. Most studies have measured the outcome of vestibular rehabilitation on subjective symptoms, static balance, and visual acuity during head movement and but have not measured in any detail its effect on gait impairment.…”

Principles of vestibular physical therapy rehabilitation

“…Persons with both peripheral and central vestibular disorders have the poorest prognosis. (Whitney/Rossi and the Brown paper) Not all people, regardless of diagnosis, are helped with vestibular rehabilitation (Krebs et al, 2003) as the prognostic factors that affect outcome are not well understood.…”