Skip to main content

Vestibular rehabilitation in elderly patients with central vestibular dysfunction: a prospective, randomized pilot study

AGE volume 35, pages 2315–2327 (2013)Cite this article

Abstract

For the vestibular system, aging is associated with degenerated otoconia and loss of hair cells, vestibular afferents, and cells in the vestibular nuclei. Further neurodegenerative processes involve cortical, extrapyramidal motor, and cerebellar structures. Dizziness is quite common in the elderly, limiting their mobility and activities. The role of vestibular rehabilitation in these patients is controversial. The present prospective, randomized, preliminary investigation aimed to compare the effect of a 6-week posturography-assisted vestibular rehabilitation protocol (30 min a week) combined with a home-based exercise program (group A, 14 randomly assigned elderly patients) with the same home-based exercise program alone (group B, 14 randomly assigned elderly patients) for treating dizziness due to central vestibular dysfunction in elderly patients. The outcomes were analyzed using the 25-item Dizziness Handicap Inventory (DHI) and computerized posturography. After rehabilitation, group A scored significantly better in the DHI for the functional (p = 0.0016) and emotional (p = 0.01) domains and total score (p = 0.001); only the emotional domain improved significantly in group B (p = 0.038). Group A improved significantly in some posturographic parameters in the motor tests (reaction time, movement velocity, and endpoint excursion), while group B experienced more limited improvements. Our preliminary results with a program of posturography-assisted vestibular rehabilitation, and home-based exercises are more promising than with home-based exercises alone. A new study on a larger series of elderly patients with central vestibular dysfunctions is currently underway at Padova University, considering the effect of a protocol involving rehabilitation with computerized posturography alone and the relationship between outcomes and the duration of rehabilitation programs.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

References

  • Badke MB, Shea TA, Miedaner JA, Grove CR (2004) Outcomes after rehabilitation for adults with balance dysfunction. Arch Phys Med Rehabil 85:227–233

    PubMed  Article  Google Scholar 

  • Brown KE, Whitney SL, Marchetti GF, Wrisley DM, Furman JM (2006) Physical therapy for central vestibular dysfunction. Arch Phys Med Rehabil 87:76–81

    PubMed  Article  Google Scholar 

  • Cakrt O, Chovanec M, Funda T, Kalitová P, Betka J, Zverina E, Kolar P, Jerabek J (2010) Exercise with visual feedback improves postural stability after vestibular schwannoma surgery. Eur Arch Otorhinolaryngol 267:1355–1360

    PubMed  Article  Google Scholar 

  • Chaudhry H, Bukiet B, Ji Z, Findley T (2011) Measurement of balance in computer posturography: Comparison of methods—a brief review. J Bodyw Mov Ther 15:82–91

    PubMed  Article  Google Scholar 

  • Clarke AH (2010) Laboratory testing of the vestibular system. Curr Opin Otolaryngol Head Neck Surg 18:425–430

    PubMed  Article  Google Scholar 

  • Eleftheriadou A, Skalidi N, Velegrakis GA (2012) Vestibular rehabilitation strategies and factors that affect the outcome. Eur Arch Otorhinolaryngol 269:2309–2316

    PubMed  Article  Google Scholar 

  • Furman JM, Whitney SL (2000) Central causes of dizziness. Phys Ther 80:179–187

    PubMed  CAS  Google Scholar 

  • Furman JM, Raz Y, Whitney SL (2010) Geriatric vestibulopathy assessment and management. Curr Opin Otolaryngol Head Neck Surg 18:386–391

    PubMed  Article  Google Scholar 

  • Goto F, Tsutsumi T, Ogawa K (2011) The Japanese version of the Dizziness Handicap Inventory as an index of treatment success: Exploratory factor analysis. Acta Otolaryngol (Stockh) 131:817–825

    Article  Google Scholar 

  • Guidetti G (1997) Diagnosi e terapia dei disturbi dell’equilibrio. Editore Marrapese, Roma

    Google Scholar 

  • Hillier SL, McDonnell M (2011) Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database Syst Rev 2:CD00539

    Google Scholar 

  • Hirvonen TP, Aalto H, Pyykkö I (1997) Stability limits for visual feedback posturography in vestibular rehabilitation. Acta Otolaryngol (Stockh) 529:104–107

    Article  CAS  Google Scholar 

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

    PubMed  Article  CAS  Google Scholar 

  • Jahn K, Zwergal A, Schniepp R (2010) Gait disturbances in old age: Classification, diagnosis, and treatment from a neurological perspective. Dtsch Arztebl Int 107:306–315

    PubMed  Google Scholar 

  • 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 51:264–267

    PubMed  Article  Google Scholar 

  • Moreira Bittar RS, de Giacomo CC (2011) Vestibular rehabilitation with biofeedback in patients with central imbalance. Braz J Otorhinolaryngol 77:356–361

    Article  Google Scholar 

  • Marioni G, Fermo S, Zanon D, Broi N, Staffieri A (2012) Early rehabilitation for unilateral peripheral vestibular disorders: A prospective, randomized investigation using computerized posturography. Eur Arch Otorhinolaryngol (in press)

  • Suarez H, Arocena M, Suarez A, De Artagaveytia TA, Muse P, Gil J (2003) Changes in postural control parameters after vestibular rehabilitation in patients with central vestibular disorders. Acta Otolaryngol (Stockh) 123:143–147

    Article  CAS  Google Scholar 

  • Trato J, Johnson EG (2010) Differential diagnosis and management of a patient with peripheral vestibular and central nervous system disorders: A case study. J Man Manip Ther 18:159–65

    PubMed  Article  Google Scholar 

Download references

Acknowledgments

This study was supported in part by grant no. 60A07-3774/11 (G. Marioni) from the University of Padova. The authors thank Frances Coburn for correcting the English version of the paper and Rosa Marchioro and Sergio Tomasin for their photographic contribution.

Author information

Affiliations

  1. Department of Neurosciences, Otolaryngology Section, University of Padova, Via Giustiniani 2, 35128, Padova, Italy

    Gino Marioni, Salvatore Fermo, Marco Lionello, Elena Fasanaro & Alberto Staffieri

  2. Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital of Würzberg, Würzberg, Germany

    Marco Lionello

  3. Department of Medicine, DIMED, University of Padova, Padova, Italy

    Luciano Giacomelli & Enzo Manzato

  4. U.O. Gravi Cerebrolesioni Acquisite, Ospedale Riabilitativo Motta di Livenza, Motta di Livenza, Italy

    Stefania Zanon

  5. Department of Neurosciences, Otolaryngology Section Treviso Branch, University of Padova, Treviso, Italy

    Claudia Staffieri

  6. University of Padova, Venezia Branch, Italy

    Franco Dall’Igna

  7. CNR, Aging Section, Institute of Neurosciences, Padova, Italy

    Enzo Manzato

Authors
  1. Gino Marioni
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Salvatore Fermo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marco Lionello
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elena Fasanaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Luciano Giacomelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Stefania Zanon
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Claudia Staffieri
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Franco Dall’Igna
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Enzo Manzato
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Alberto Staffieri
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gino Marioni.

Appendix

Appendix

The preferred posturography-assisted vestibular rehabilitation program involved the following sequence of shifts in body weight: (1) center to anterior to center (LOS ranging from 50 to 70 %, pacing from 5 to 7 s, duration 2 min); (2) center to right lateral to center (LOS ranging from 50 to 70 %, pacing from 5 to 7 s, duration 2 min); (3) center to posterior to center (LOS ranging from 50 to 70 %, pacing from 5 to 7 s, duration 2 min); (4) center to left lateral to center (LOS ranging from 50 to 70 %, pacing from 5 to 7 s, duration 2 min); (5) anterior to posterior to anterior (LOS ranging from 50 to 70 %, pacing from 5 to 7 s, duration 2 min); (6) left lateral to right lateral to left lateral (LOS ranging from 50 to 70 %, pacing from 5 to 7 s, duration 2 min); (7) right anterior to left posterior to right anterior (LOS ranging from 50 to 70 %, pacing from 5 to 7 s, duration 2 min); (8) left anterior to right posterior to left anterior (LOS ranging from 50 to 70 %, from 5 to 7 s, duration 2 min); (9) circling to right or clockwise (LOS ranging from 50 to 70 %, pacing from 5 to 7 s, duration 2 min); and (10) circling to left or counterclockwise (LOS ranging from 50 to 70 %, pacing from 5 to 7 s, duration 2 min).

About this article

Cite this article

Marioni, G., Fermo, S., Lionello, M. et al. Vestibular rehabilitation in elderly patients with central vestibular dysfunction: a prospective, randomized pilot study. AGE 35, 2315–2327 (2013). https://doi.org/10.1007/s11357-012-9494-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11357-012-9494-7

Keywords

  • Central vestibular disorder
  • Elderly patients
  • Vestibular rehabilitation
  • Computerized posturography
  • Home-based exercise program