Vestibular rehabilitation
Symptoms of vestibular dysfunction can significantly decrease quality of life, introducing mental-emotional issues such as anxiety and depression, and greatly impair an individual, causing them to become more sedentary.
These repositioning maneuvers are particularly effective for treating benign paroxysmal positional vertigo (BPPV), a normal vestibular condition.
Vestibular disorders can be diagnosed using several different kinds of assessments, some of which include examination of an individual's ability to maintain posture, balance, and head position.
Some diagnostic tests are more easily performed in a clinical setting than others but relay less specific information to the tester, and vice versa.
The reflex test consists of pouring water into the external auditory canal of a patient and observing nystagmus, or involuntary eye movement.
[2] Visual perception testing can assess a patient's ability to determine vertically- and horizontally-oriented objects, but with a limited degree of specificity.
Some diagnoses that result in non-vestibular dizziness are concussions, Parkinson's disease, cerebellar ataxia, normal-pressure hydrocephalus, leukoaraiosis, progressive supranuclear palsy, and large-fiber peripheral neuropathy.
For example, phobic postural vertigo (PPV) occurs when an individual with obsessive-compulsive characteristics experiences a sense of imbalance, despite the absence of balance issues.
Chronic subjective dizziness (CSD) is a similar condition characterized by persistent vertigo, hypersensitivity to motion stimuli, and difficulty with precise visual tasks.
Canalithiasis is characterized by a dislodged otolith particle, called otoconia, that floats in the fluid in one of the three vestibular canals and cause the feeling of dizziness with vision disturbances.
[3] Canalith repositioning treatments (CRT) aim to move debris in the inner ear out of the semicircular canal in order to treat benign paroxysmal positional vertigo.
CRT has 5 key elements: Early attempts to treat BPPV involved similar processes that were believed to be habituation exercises, but more likely dislodged and dissolved debris.
[2] The limitations of vestibular rehabilitation therapy are the overall health and function of the nervous system, especially the brainstem, cerebellum, and visual and somatosensory centers.
A factor that can positively affect the outcome is starting the therapy as soon as possible, one study found that early intervention in patients with unilateral peripheral disorders correlated to a significantly lower Dizziness Handicap Inventory (DHI) score.
[9] There is evidence that vestibular rehabilitation therapy increases the "balance, quality of life, and functional capacity" of patients with multiple sclerosis.
[7] In a study of 109 children, an association between completion of vestibular rehabilitation and improvement of concussion symptoms and visuovestibular performance was found.
A different study found that vestibular and physical therapy were linked to a shorter recovery period, resulting in a more rapid return to sports.
[10] The DHI is a 25-item questionnaire that is a cost-effective and simple tool that has the ability to analyze the effects of vestibular therapy on concussion symptoms.
[10] The lower the DHI, the less symptomatic a patient is and a decrease of 18 points or more from pre to post vestibular therapy intervention is considered clinically significant.
The Academy of Neurologic Physical Therapy and the Vestibular Rehabilitation Special Interest Group are working to have the APTA establish VR as an official specialty offered by the ABPTS.
[12] The American Musculoskeletal Institute (AMSI) offers a 3-day course that results in a therapist being designated a Certified Vestibular Rehabilitation Specialist (Cert.
[13] Members of the American Occupational Therapy Association (AOTA) who obtain specialty certification in low-vision rehabilitation are equipped to treat vision issues that arise from vestibular dysfunction or disorders.
