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Vestibular rehabilitation strategies and factors that affect the outcome

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Abstract

Ever since the introduction of Cawthorne–Cooksey exercises, vestibular rehabilitation (VR) has been gaining popularity in the treatment of the dizzy patient. Numerous studies support the effectiveness of VR in improving balance/walking skills, eye–head coordination and the quality of life of the patient. Different rehabilitation protocols have been used to treat patients with peripheral and central vestibular disorders. Assessment of the patients’ progress is based on the patients’ selfperception of dizziness and their functional skills. Factors such as age, medication, time of onset of vertigo and home based VR have been evaluated on their effect on the rehabilitation’s outcome. The aim of this review is to evaluate rehabilitation strategies and discuss the factors that affect the outcome.

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References

  1. Monzani D, Casolari L, Guidetti G, Rigatelli M (2001) Psychological distress and disability in patients with vertigo. J Psychosom Res 50(6):319–323

    Article  PubMed  CAS  Google Scholar 

  2. Gresty MA, Hess K, Leech J (1977) Disorders of the vestibulo-ocular reflex producing oscillopsia and mechanisms compensating for loss of labyrinthine function. Brain 100:693–716

    Article  PubMed  CAS  Google Scholar 

  3. Wrisley DM, Pavlou M (2005) Physical therapy for balance disorders. Neurol Clin 23(3):855–874 (vii–viii)

    Article  PubMed  Google Scholar 

  4. Denham T, Wolf AM (1997) Vestibular rehabilitation. Rehabil Manag 10(3):93–94 (144)

    CAS  Google Scholar 

  5. Herdman SJ (1997) Advances in the treatment of vestibular disorders. Phys Ther 77(6):602–618

    PubMed  CAS  Google Scholar 

  6. Herdman SJ (1998) Role of vestibular adaptation in vestibular rehabilitation. Otolaryngol Head Neck Surg 119(1):49–54

    Article  PubMed  CAS  Google Scholar 

  7. Shepard NT, Telian SA, Smith-Wheelock M (1990) Habituation and balance retaining therapy. Neuro Clin 5:459–475

    Google Scholar 

  8. Herdman SJ, Schubert MC, Tusa RJ (2001) Strategies for balance rehabilitation: fall risk and treatment. Ann N Y Acad Sci 942:394–412

    Article  PubMed  CAS  Google Scholar 

  9. Pavlou M, Lingeswaran A, Davies R, Gresty M, Bronstein A (2004) Simulator based rehabilitation in refractory dizziness. J Neurol 251:983–995

    Article  PubMed  Google Scholar 

  10. Rossi-Izquierdo M, Santos-Pérez S, Soto-Varela A (2011) What is the most effective vestibular rehabilitation technique in patients with unilateral peripheral vestibular disorders? Eur Arch Otorhinolaryngol 268(11):1569–1574 (Epub 2011 Feb 22)

    Article  PubMed  Google Scholar 

  11. Mulavara AP, Richards JT, Ruttley T, Marshburn A, Nomura Y, Bloomberg JJ (2005) Exposure to a rotating virtual environment during treadmill locomotion causes adaptation in heading direction. Exp Brain Res 166(2):210–219

    Article  PubMed  CAS  Google Scholar 

  12. Polat S, Uneri A (2010) Vestibular substitution: comparative study. J Laryngol Otol 124(8):852–858 (Epub 2011 Dec 29)

    Article  PubMed  CAS  Google Scholar 

  13. Cakrt O, Chovanec M, Funda T, Kalitová P, Betka J, Zverina E, Kolár P, Jerábek J (2010) Exercise with visual feedback improves postural stability after vestibular schwannoma surgery. Eur Arch Otorhinolaryngol 267(9):1355–1360 (Epub 2010 Mar 30)

    Article  PubMed  Google Scholar 

  14. Basta D, Singbartl F, Todt I, Clarke A, Ernst A (2008) Vestibular rehabilitation by auditory feedback in otolith disorders. Gait Posture 28(3):397–404 (Epub 2008 Mar 17)

    Article  PubMed  Google Scholar 

  15. Cohen HS, Sangi-Haghpeykar H (2010) Canalith repositioning variations for benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 143(3):405–412

    Article  PubMed  Google Scholar 

  16. Han BI, Song HS, Kim JS (2011) Vestibular rehabilitation therapy: review of indications, mechanisms, and key exercises. J Clin Neurol 7(4):184–196 (Epub 2011 Dec 29)

    Article  PubMed  Google Scholar 

  17. Hansson EE, Månsson NO, Håkansson A (2004) Effects of specific rehabilitation for dizziness among patients in primary health care: a randomized controlled trial. Clin Rehabil 18(5):558–565

    Article  PubMed  Google Scholar 

  18. Kammerlind AS, Ledin TE, Odkvist LM, Skargren EI (2005) Effects of home training and additional physical therapy on recovery after acute unilateral vestibular loss: a randomized study. Clin Rehabil 19(1):54–62

    Article  PubMed  Google Scholar 

  19. Powell LE, Myers AM (1995) The Activities-specific Balance Confidence (ABC) Scale. J Gerontol A Biol Sci Med Sci 50A(1):M28–M34

    Article  PubMed  CAS  Google Scholar 

  20. Cohen HS, Kimball KT, Adams AS (2000) Application of the vestibular disorders activities of daily living scale. Laryngoscope 110(7):1204–1209

    Article  PubMed  CAS  Google Scholar 

  21. Jacobson GP, Newman CW (1990) The development of the Dizziness Handicap Inventory. Arch Otolaryngol Head Neck Surg 116(4):424–427

    Article  PubMed  CAS  Google Scholar 

  22. Yardley L, Masson E, Verschuur C, Haacke N, Luxon L (1992) Symptoms, anxiety and handicap in dizzy patients: development of the vertigo symptom scale. J Psychosom Res 36(8):731–741

    Article  PubMed  CAS  Google Scholar 

  23. Dannenbaum E, Chillingaryan G, Fung J (2011) Visual vertigo analogue scale : an assessment questionnaire for visual vertigo. J Vestib Res 21(3):153–159

    PubMed  Google Scholar 

  24. Schubert MC, Tusa RJ, Grine LE, Herdman SJ (2004) Optimizing the sensitivity of the head thrust test for identifying vestibular hypofunction. Phys Ther 84(2):151–158

    PubMed  Google Scholar 

  25. Walker MF, Zee DS (2000) Bedside vestibular examination. Otolaryngol Clin N Am 33(3):495–506

    Article  CAS  Google Scholar 

  26. Goebel JA, Hanson JM, Langhofer LR et al (1995) Head-shake vestibulo-ocular reflex testing: comparison of results with rotational chair testing. Otolaryngol Head Neck Surg 112:203–209

    Article  PubMed  CAS  Google Scholar 

  27. Badaracco C, Labini FS, Meli A, De Angelis E, Tufarelli D (2007) Vestibular rehabilitation outcomes in chronic vertiginous patients through computerized dynamic visual acuity and gaze stabilization test. Otol Neurotol 28(6):809–813

    Article  PubMed  Google Scholar 

  28. Podsiadlo D, Richardson S (1991) The timed ‘‘Up & Go’’: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39:142–148

    PubMed  CAS  Google Scholar 

  29. Shumway-Cook A, Woolacott M (2001) Motor Control: theory and practical applications, 2nd edn. Williams and Wilkins, Baltimore

    Google Scholar 

  30. Wrsley DM, Marchetti GF, Kuharsky DK et al (2004) Reliability, internal consistency, and validity of data obtained with the functional gait assessment. Phys Ther 84:906–918

    Google Scholar 

  31. Hamid MA, Hughes GB, Kinny SE (1991) Specificity and sensitivity of dynamic posturography: a retrospective analysis. Acta Otolaryngol Suppl 481:596–600

    Article  PubMed  CAS  Google Scholar 

  32. Jung JY, Kim JS, Chung PS, Woo SH, Rhee CK (2009) Effect of vestibular rehabilitation on dizziness in the elderly. Am J Otolaryngol 30(5):295–299 (Epub 2009 Feb 6.46)

    Article  PubMed  Google Scholar 

  33. Berg KO, Wood-Dauphinee SL, Williams JI, Maki B (1992) Measuring balance in the ederly: validation of an instrument. Can J Public Health 83(Suppl 2):S7–S11

    PubMed  Google Scholar 

  34. Meli A, Zimatore G, Badaracco C, De Angelis E, Tufarelli D (2006) Vestibular rehabilitation and 6-month follow-up using objective and subjective measures. Acta Otolaryngol 126(3):259–266

    PubMed  CAS  Google Scholar 

  35. Badke MB, Miedaner JA, Shea TA, Grove CR, Pyle GM (2005) Effects of vestibular and balance rehabilitation on sensory organization and dizziness handicap. Ann Otol Rhinol Laryngol. 114(1 Pt 1):48–54

    PubMed  Google Scholar 

  36. Cohen HS, Kimball KT (2004) Decreased ataxia and improved balance after vestibular rehabilitation. Otolaryngol Head Neck Surg 130(4):418–425

    Article  PubMed  Google Scholar 

  37. Corna S, Nardone A, Prestinari A, Galante M, Grasso M, Schieppati M (2003) Comparison of Cawthorne–Cooksey exercises and sinusoidal support surface translations to improve balance in patients with unilateral vestibular deficit. Arch Phys Med Rehabil 84(8):1173–1184

    Article  PubMed  Google Scholar 

  38. Cohen HS, Kimball KT (2004) Changes in a repetitive head movement task after vestibular rehabilitation. Clin Rehabil 18(2):125–131

    Article  PubMed  Google Scholar 

  39. Hillier SL, McDonnell M (2011) Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database Syst Rev 16(2):CD005397

    Google Scholar 

  40. Herdman SJ, Schubert MC, Das VE, Tusa RJ (2003) Recovery of dynamic visual acuity in unilateral vestibular hypofunction. Arch Otolaryngol Head Neck Surg 129(8):819–824

    Article  PubMed  Google Scholar 

  41. Krebs DE, Gill-Body KM, Parker SW, Ramirez JV, Wernick-Robinson M (2003) Vestibular rehabilitation: useful but not universally so. Otolaryngol Head Neck Surg 128(2):240–250

    Article  PubMed  Google Scholar 

  42. Badke MB, Shea TA, Miedaner JA, Grove CR (2004) Outcomes after rehabilitation for adults with balance dysfunction. Arch Phys Med Rehabil 85(2):227–833

    Article  PubMed  Google Scholar 

  43. Vereeck L, Wuyts FL, Truijen S, De Valck C, Van de Heyning PH (2008) The effect of early customized vestibular rehabilitation on balance after acoustic neuroma resection. Clin Rehabil 22(8):698–713

    Article  PubMed  Google Scholar 

  44. Herdman SJ, Clendaniel RA, Mattox DE, Holliday MJ, Niparko JK (1995) Vestibular adaptation exercises and recovery: acute stage after acoustic neuroma resection. Otolaryngol Head Neck Surg 113(1):77–87

    Article  PubMed  CAS  Google Scholar 

  45. Cohen E (1992) Vestibular rehabilitation reduces functional disability. Otolaryngol Head Neck Surg 107:638–643

    PubMed  CAS  Google Scholar 

  46. Herdman SJ, Blatt P, Schubert MC, Tusa RJ (2000) Falls in patients with vestibular deficits. Am J Otol 21(6):847–851 (43)

    PubMed  CAS  Google Scholar 

  47. Brown KE, Whitney SL, Wrisley DM, Furman JM (2001) Physical therapy outcomes for persons with bilateral vestibular loss. Laryngoscope 111(10):1812–1817

    Article  PubMed  CAS  Google Scholar 

  48. Yardley L, Kirby S (2006) Evaluation of booklet-based self-management of symptoms in Ménière disease: a randomized controlled trial. Psychosom Med 68(5):762–769

    Article  PubMed  Google Scholar 

  49. Yardley L, Beech S, Zander L, Evans T, Weinman J (1998) A randomized controlled trial of exercise therapy for dizziness and vertigo in primary care. Br J Gen Pract 48(429):1136–1140

    PubMed  CAS  Google Scholar 

  50. Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67(6):361–370

    Article  PubMed  CAS  Google Scholar 

  51. Teggi R, Caldirola D, Fabiano B, Recanati P, Bussi MJ (2009) Rehabilitation after acute vestibular disorders. Laryngol Otol 123(4):397–402 (Epub 2008 June 13)

    Article  CAS  Google Scholar 

  52. Brown K, Whitney S, Marchetti G, Wrisley D, Furman J (2006) Physical therapy for central vestibular dysfunction. Arch Phys Med Rehabil 87:76–81

    Article  PubMed  Google Scholar 

  53. Suarez H, Muse P, Suarez A, Arocena M (2001) Assessment of the risk of fall, related to visual stimulation, in patients with central vestibular disorders. Acta Otolaryngol 121:220–224

    Article  PubMed  CAS  Google Scholar 

  54. Strupp M, Arbusow V, Maag KP, Gall C, Brandt T (1998) Vestibular exercises improve central vestibulospinal compensation after vestibular neuritis. Neurology 51(3):838–844

    Article  PubMed  CAS  Google Scholar 

  55. Venosa AR, Bittar RS (2007) Vestibular rehabilitation exercises in acute vertigo. Laryngoscope 117(8):1482–1487

    Article  PubMed  Google Scholar 

  56. Krebs DE, Gill-Body KM, Riley PO, Parker SW (1993) Double-blind, placebo-controlled trial of rehabilitation for bilateral vestibular hypofunction: preliminary report. Otolaryngol Head Neck Surg 109(4):735–741

    PubMed  CAS  Google Scholar 

  57. Telian SA, Shepard NT, Smith-Wheelock M, Hoberg M (1991) Bilateral vestibular paresis: diagnosis and treatment. Otolaryngol Head Neck Surg 104(1):67–71

    PubMed  CAS  Google Scholar 

  58. Wrisley DM, Whitney SL, Furman JM (2002) Vestibular rehabilitation outcomes in patients with a history of migraine. Otol Neurotol 23(4):483–487

    Article  PubMed  Google Scholar 

  59. Gottshall KR, Moore RJ, Hoffer ME (2005) Vestibular rehabilitation for migraine-associated dizziness. Int Tinnitus J 11(1):81–84

    PubMed  Google Scholar 

  60. Gottshall KR, Topp SG, Hoffer ME (2010) Early vestibular physical therapy rehabilitation for Meniere’s disease. Otolaryngol Clin N Am 43(5):1113–1119

    Article  Google Scholar 

  61. El-Kashlan, Shepart NT, Arts A et al (1998) Disability from vestibular symptoms after acoustic neuroma resection. Am J Otol 19:104–111

    PubMed  CAS  Google Scholar 

  62. Cohen HS, Kimball KT (2005) Effectiveness of treatments for benign paroxysmal positional vertigo of the posterior canal. Otol Neurotol 26(5):1034–1040

    Article  PubMed  Google Scholar 

  63. Banfield GK, Wood C, Knight J (2000) Does vestibular habituation still have a place in the treatment of benign paroxysmal positional vertigo? J Laryngol Otol 114(7):501–505

    Article  PubMed  CAS  Google Scholar 

  64. Chang WC, Yang YR, Hsu LC, Chern CM, Wang RY (2008) Balance improvement in patients with benign paroxysmal positional vertigo. Clin Rehabil 22(4):338–347

    Article  PubMed  CAS  Google Scholar 

  65. Roberts RA, Gans RE, DeBoodt JL, Lister JJ (2005) Treatment of benign paroxysmal positional vertigo: necessity of postmaneuver patient restrictions. J Am Acad Audiol 16(6):357–366

    Article  PubMed  Google Scholar 

  66. Casqueiro JC, Ayala A, Monedero G (2008) No more postural restrictions in posterior canal benign paroxysmal positional vertigo. Otol Neurotol 29(5):706–709

    Article  PubMed  Google Scholar 

  67. Hain TC, Helminski JO, Reis IL, Uddin MK (2000) Vibration does not improve results of the canalith repositioning procedure. Arch Otolaryngol Head Neck Surg 126(5):617–622

    PubMed  CAS  Google Scholar 

  68. Jáuregui-Renaud K, Padrón LAV, Gómez NSC (2007) The effect of vestibular rehabilitation supplemented by training of the breathing rhythm or proprioception exercises, in patients with chronic peripheral vestibular disease. J Vestib Res 17(1):63–72

    PubMed  Google Scholar 

  69. Tsang WW, Hui-Chan CW (2004) Effect of 4- and 8-wk intensive Tai Chi Training on balance control in the elderly. Med Sci Sports Exerc 36(4):648–657

    Article  PubMed  Google Scholar 

  70. Shepard NT, Telian SA (1995) Programmatic vestibular rehabilitation. Otolaryngol Head Neck Surg 112:173

    Article  PubMed  CAS  Google Scholar 

  71. Szturm T, Ireland DJ, Lessing-Turner M (1994) Comparison of different exercise programs in the rehabilitation of patients with chronic peripheral vestibular dysfunction. J Vestib Res 4:461–479

    PubMed  CAS  Google Scholar 

  72. Horak FB, Jones-Rycewicz C, Black FO, Shymway-Cook A (1992) Effects of vestibular rehabilitation on dizziness and imbalance. Otolaryngol Head Neck Surg 106:175–180

    PubMed  CAS  Google Scholar 

  73. Giray M, Kirazli Y, Karapolat H, Celebisoy N, Bilgen C, Kirazli T (2009) Short-term effects of vestibular rehabilitation in patients with chronic unilateral vestibular dysfunction: a randomised controlled study. Arch Phys Med Rehabil 90(8):1325–1331

    Article  PubMed  Google Scholar 

  74. Black FO, Angel CR, Pesznecker SC, Gianna C (2000) Outcome analysis of individualized vestibular rehabilitation protocols. Am J Otol 21(4):543–551

    PubMed  CAS  Google Scholar 

  75. Cohen E, Kimball KT (2003) Increased independence and decreased vertigo after vestibular rehabilitation. Otolaryngol Head Neck Surg 128:60–70

    Article  PubMed  Google Scholar 

  76. Yardley L, Donovan-Hall M, Smith HE, Walsh BM, Mullee M, Bronstein AM (2004) Effectiveness of primary care-based vestibular rehabilitation for chronic dizziness. Ann Intern Med 141(8):598–605

    PubMed  Google Scholar 

  77. 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):264–267 (Epub 2009 Dec 21)

    Article  PubMed  Google Scholar 

  78. Rascol O, Hain TC, Brefel C, Benazet M, Clanet M, Montastruc JL (1995) Antivertigo medications and drug-induced vertigo. Pharmacol Rev Drugs 50(5):777–791

    CAS  Google Scholar 

  79. Kulcu DG, Yanik B, Boynukalin S, Kurtais Y (2008) Efficacy of a home-based exercise program on benign paroxysmal positional vertigo compared with betahistine. J Otolaryngol Head Neck Surg 37(3):373–379

    PubMed  Google Scholar 

  80. Karapolat H, Celebisoy N, Kirazli Y, Bilgen C, Eyigor S, Gode S, Akyuz A, Kirazli T (2010) Does betahistine treatment have additional benefits to vestibular rehabilitation? Eur Arch Otorhinolaryngol 267(8):1207–1212 (Epub 2010 Feb 21)

    Article  PubMed  Google Scholar 

  81. Fujino A, Tokumasu K, Okamoto et al (1996) Vestibulat training for acute unilateral vestibular disturbances: Its efficacy in comparison with antivertigo drug. Acta Otolaryngol(Stockh) 524:21–26

    Article  CAS  Google Scholar 

  82. Whitney SL, Wrisley DM, Marchetti GF, Furman JM (2002) The effect of age on vestibular rehabilitation outcomes. Laryngoscope 112(10):1785–1790

    Article  PubMed  Google Scholar 

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Eleftheriadou, A., Skalidi, N. & Velegrakis, G.A. Vestibular rehabilitation strategies and factors that affect the outcome. Eur Arch Otorhinolaryngol 269, 2309–2316 (2012). https://doi.org/10.1007/s00405-012-2019-2

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