European Archives of Oto-Rhino-Laryngology

, Volume 268, Issue 11, pp 1569–1574 | Cite as

What is the most effective vestibular rehabilitation technique in patients with unilateral peripheral vestibular disorders?

  • Marcos Rossi-Izquierdo
  • Sofia Santos-Pérez
  • Andrés Soto-Varela
Otology

Abstract

Vestibular rehabilitation has been found to be effective and safe in patients with instability. There is insufficient evidence, however, for distinguishing between the efficacies of different rehabilitation techniques. The objective of this study is to verify whether there are differences between two instrumental vestibular rehabilitation techniques, computerised dynamic posturography (CDP) and optokinetic stimulation (OKN), in order to establish the optimal strategy for each patient. We conducted a prospective, comparative study of the two techniques (CDP and OKN) in patients with instability due to chronic unilateral peripheral vestibular disorder. We randomly included 12 patients in each group, performing the evaluation with the Dizziness Handicap Inventory and the CDP with the sensorial organisation test (SOT), rhythmic weight shift and limits of stability (LOS). We found a statistically significant improvement in both groups in average balance score according to the SOT. In the OKN group, however, improvement was greater in visual preference. The CDP group showed greater benefits in the visual and vestibular input and LOS. Patients with poor vestibular and visual input or with reduced LOS will benefit more from an exercise protocol with CDP. Patients with poor visual preference, however, are ideal candidates for rehabilitation with OKN.

Keywords

Computerised dynamic posturography Optokinetic stimulation Vestibular rehabilitation Instability Unilateral peripheral vestibular disorders 

Notes

Conflict of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

References

  1. 1.
    Santos S, Soto A, Rossi M, Elhendi W, Labella T (2007) Tratamiento rehabilitador de los trastornos del equilibrio. Diseño de un protocolo general con la posturografía dinámica computerizada. An Otorrinolaringol Ibero Am 34(5):465–484Google Scholar
  2. 2.
    Hillier SL, Hollohan V (2007) Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database Syst Rev 4:CD005397Google Scholar
  3. 3.
    Herdman SJ, Hall CD, Schubert MC, Das VE, Tusa RJ (2007) Recovery of dynamic visual acuity in bilateral vestibular hypofunction. Arch Otolaryngol Head Neck Surg 133:383–389PubMedCrossRefGoogle Scholar
  4. 4.
    Kao CL, Chen LK, Chern CM, Hsu LC, Chen CC, Hwang SJ (2010) Rehabilitation outcome in home-based versus supervised exercise programs for chronically dizzy patients. Arch Gerontol Geriatr 51(3):264–267PubMedCrossRefGoogle Scholar
  5. 5.
    Rossi-Izquierdo M, Soto-Varela A, Santos-Pérez S, Sesar-Ignacio A, Labella Caballero T (2009) Vestibular rehabilitation with computerized dynamic posturography in patients with Parkinson’s disease: improving balance impairment. Disabil Rehabil 31(23):1907–1916PubMedCrossRefGoogle Scholar
  6. 6.
    Brown KE, Whitney SL, Marchetti GF, Wrisley DM, Furman JM (2006) Physical therapy for central vestibular dysfunction. Arch Phys Med Rehabil 87:76–81PubMedCrossRefGoogle Scholar
  7. 7.
    Burton MJ, Monsell EM, Rosenfeld RM (2008) Extracts from The Cochrane Library: vestibular rehabilitation for unilateral peripheral vestibular dysfunction (review). Otolaryngol Head Neck Surg 138(4):415–417PubMedCrossRefGoogle Scholar
  8. 8.
    Jongkees LBW, Maas JPM, Philipszoon AJ (1962) Clinical nystagmography. A detailed study of electronystagmography in 341 patients with vertigo. Pract Otorhinolaryng 24:65–93Google Scholar
  9. 9.
    Bartual Pastor J (1998) Pruebas calóricas. In: Bartual Pastor J, Pérez Fernández N (eds) El sistema vestibular y sus alteraciones. Masson, Barcelona, pp 221–237Google Scholar
  10. 10.
    Pérez N, Garmendia I, Martín E, García-Tapia R (2000) Cultural adaptation of 2 questionnaires for health measurement in patients with vertigo. Acta Otorrinolaringol Esp 51(7):572–580PubMedGoogle Scholar
  11. 11.
    Nashner LM (2001) Computerize dynamic posturography. In: Goebel JA (ed) Practical management of the dizzy patient. Lippincott Williams & Wilkins, Philadelphia, pp 143–170Google Scholar
  12. 12.
    Rossi Izquierdo M, Soto Varela A, Santos Pérez S, Labella Caballero L (2008) Análise prospectivo dos resultados da reabilitação vestibular mediante posturografía dinâmica computorizada em pacientes com instabilidade. Clin Inves Otorri 2(1):12–16Google Scholar
  13. 13.
    Vitte E, Semont A, Berthoz A (1994) Repeated optokinetic stimulation in conditions of active standing facilitates recovery from vestibular deficits. Exp Brain Res 102(1):141–148PubMedCrossRefGoogle Scholar
  14. 14.
    Black FO, Angel CR, Pesznecker SC, Gianna C (2000) Outcome analysis of individualized vestibular rehabilitation protocols. Am J Otol 21:543–551PubMedGoogle Scholar
  15. 15.
    Wrisley DM, Stephens MJ, Mosley S, Wojnowski A, Duffy J, Burkard R (2007) Learning effects of repetitive administrations of the sensory organization test in healthy young adults. Arch Phys Med Rehabil 88(8):1049–1054PubMedCrossRefGoogle Scholar
  16. 16.
    Perez N, Martin E, Garcia-Tapia R (2003) Dizziness: relating the severity of vertigo to the degree of handicap by measuring vestibular impairment. Otolaryngol Head Neck Surg 128(3):372–381PubMedCrossRefGoogle Scholar
  17. 17.
    Whitney SL, Wrisley DM, Brown KE, Furman JM (2004) Is perception of handicap related to functional performance in persons with vestibular dysfunction? Otol Neurotol 25(2):139–143PubMedCrossRefGoogle Scholar
  18. 18.
    Bronsteim AM, Vision, vértigo (2004) Some visual aspects of vestibular disorders. J Neurol 251:381–387CrossRefGoogle Scholar
  19. 19.
    Shepard NT, Telian SA (1995) Programmatic vestibular rehabilitation. Otolaryngol Head Neck Surg 112:173–182PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Marcos Rossi-Izquierdo
    • 1
  • Sofia Santos-Pérez
    • 2
  • Andrés Soto-Varela
    • 2
  1. 1.Department of OtolaryngologyUniversity Hospital Lucus AugustiLugoSpain
  2. 2.Department of OtolaryngologyUniversity Hospital of Santiago de CompostelaSantiago de CompostelaSpain

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