Advertisement

Current Otorhinolaryngology Reports

, Volume 5, Issue 3, pp 160–166 | Cite as

Vestibular Rehabilitation: Review of Indications, Treatments, Advances, and Limitations

  • Joanna Burzynski
  • Shaleen Sulway
  • John A. Rutka
Otology: Vestibular Disorders (J Rutka, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Otology: Vestibular Disorders

Abstract

Purpose of Review

Vestibular disorders result in symptoms that significantly impact an individual’s quality of life. Vestibular rehabilitation therapy (VRT) has, for many years, been used as an effective means of treating patients and their vestibular-related symptoms. For clinicians, it is crucial to stay up to date with the current best evidence in VRT in order to optimize patient management.

Recent Findings

Current evidence is in support of VRT for treating patients with a variety of vestibular disorders, both central and peripheral. High level evidence studies support the use of treatment techniques of adaptation and substitution for gaze stabilization, habituation, balance and gait training, and canalith repositioning maneuvers. Recent evidence has also examined and found promising results with technological innovations that are targeted at those with bilateral vestibular hypofunction and insufficient gains with a standard exercise-based program. Nevertheless, factors such as anxiety overlay/depression, time when beginning therapy, and adherence may have an impact on how a patient will do with his/her VRT program and should be acknowledged.

Summary

Quantifiable and evidence-based literature supports the use of VRT for patients with a variety of vestibular disorders and their associated symptoms. The clinician needs to become familiar with each patient’s complaints and goals, as well as any potential barriers to positive outcomes with VRT, and combine this with their knowledge of current evidence-based literature in order to develop the optimal program for each unique patient.

Keywords

Vestibular Dizziness Vertigo Rehabilitation Compensation Balance 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

This article was made possible from funding through the Hertz Multidisciplinary Neurotology Clinic at UHN.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Blackwell DL, Lucas JW, Clarke TC. Summary health statistics for U.S. adults: National Health Interview Survey, 2012. National Center for Health Statistics. Vital Health Stat. 2014;10(260). Contract No.: 260.Google Scholar
  2. 2.
    Ward BK, Agrawal Y, Hoffman HJ, Carey JP, Della Santina CC. Prevalence and impact of bilateral vestibular hypofunction: results from the 2008 US National Health Interview Survey. JAMA Otolaryngol Head Neck Surg. 2013;139(8):803–10.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Agrawal Y, Carey JP, Della Santina CC, Schubert MC, Minor LB. Disorders of balance and vestibular function in US adults: data from the National Health and Nutrition Examination Survey, 2001–2004. Arch Intern Med. 2009;169:938–44.CrossRefPubMedGoogle Scholar
  4. 4.
    Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and non-fatal falls among older adults. Inj Prev. 2006;12(5):290–5.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Cawthorne T. The physiological basis for head exercises. J Chartered Soc Physiother. 1944;3:106–7.Google Scholar
  6. 6.
    Cooksey FS. Rehabilitation in vestibular injuries. Proc R Soc Med. 1946;39(5):273–8.PubMedPubMedCentralGoogle Scholar
  7. 7.
    •• McDonnell MN, Hillier SL. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database Syst Rev. 2015;1. An updated Cochrane review (39 studies, 2,441 participants) demonstrated a statistically significant effect for VRT over control/ no intervention. High quality RCT’s demonstrated improvement in function and resolution of symptoms with VRT in the medium term. With one exception, treatment of BPPV did better in the short term with specific physical (repositioning) procedures than exercise based VRT. Google Scholar
  8. 8.
    Arnold SA, Stewart AM, Moore HM, Karl RC, Reneker JC. The effectiveness of vestibular rehabilitation interventions in treating unilateral peripheral vestibular disorders: a systematic review. Physiother Res Int. 2015.Google Scholar
  9. 9.
    •• Hall CD, Herdman SJ, Whitney SL, Cass SP, Clendaniel RA, Fife TD, et al. Vestibular rehabilitation for peripheral vestibular hypofunction: an evidence-based clinical practice guideline. J Neurol Phys Ther. 2016;40(2):124–55. This systematic review identified strong evidence with a preponderance of benefit over harm that VRT should be offered to individuals with unilateral and bilateral vestibular impairments. Recommendations for therapists and clinicians were based on best available evidence. Treatment timetables for unilateral (acute and chronic) and bilateral peripheral vestibular impairments were noted. Google Scholar
  10. 10.
    Herdman SJ, Hall CD, Maloney B, Knight S, Ebert M, Lowe J. Variables associated with outcome in patients with bilateral vestibular hypofunction: preliminary study. J Vestib Res. 2015;25(3–4):185–94.CrossRefPubMedGoogle Scholar
  11. 11.
    Porciuncula F, Johnson CC, Glickman LB. The effect of vestibular rehabilitation on adults with bilateral vestibular hypofunction: a systematic review. J Vestib Res. 2012;22:283–98.PubMedGoogle Scholar
  12. 12.
    Helminski JO, Zee DS, Janssen I, Hain TC. Effectiveness of particle repositioning maneuvers in the treatment of benign paroxysmal positional vertigo: a systematic review. Phys Ther. 2010;90(5):663–78.CrossRefPubMedGoogle Scholar
  13. 13.
    Prokopakis E, Vlastos IM, Tsagournisakis M, Christodoulou P, Kawauchi H, Velegrakis G. Canalith repositioning procedures among 965 patients with benign paroxysmal positional vertigo. Audiol Neurootol. 2013;18(2):83–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Hunt WT, Zimmermann EF, Hilton MP. Modifications of the Epley (canalith repositioning) manoeuvre for posterior canal benign paroxysmal positional vertigo (BPPV). Cochrane Database Syst Rev. 2012;4:CD008675.Google Scholar
  15. 15.
    Bruintjes TD, Companjen J, van der Zaag-Loonen HJ, van Benthem PP. A randomised sham-controlled trial to assess the long-term effect of the Epley manoeuvre for treatment of posterior canal benign paroxysmal positional vertigo. Clin Otolaryngol. 2014;39(1):39–44.CrossRefPubMedGoogle Scholar
  16. 16.
    • Hilton M, Pinder D. The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo. Cochrane Database Syst Rev. 2014;(12):CD003162. In a review of 11 RCT’s, the Epley manoeuvre demonstrated comparable treatment success with Semont and Gans manoeuvres but was superior to Brandt-Daroff exercises for BPPV. Despite short-term success, recurrence rates for BPPV were 36% overall. Google Scholar
  17. 17.
    Liu Y, Wang W, Zhang AB, Bai X, Zhang S. Epley and Semont maneuvers for posterior canal benign paroxysmal positional vertigo: a network meta-analysis. Laryngoscope. 2016;126(4):951–5.CrossRefPubMedGoogle Scholar
  18. 18.
    •• Bhattacharyya N, Gubbels SP, Schwartz SR, Edlow JA, El-Kashlan H, Fife T, et al. Clinical practice guideline: benign paroxysmal positional vertigo (update). Otolaryngol Head Neck Surg. 2017;156(3_suppl):S1–S47. This updated guideline endorsed by numerous societies provides 14 specific recommendations for management of BPPV including a well thought visual diagnostic algorithm for treatment. Google Scholar
  19. 19.
    Mandalà M, Santoro GP, Asprella Libonati G, Casani AP, Faralli M, Giannoni B, et al. Double-blind randomized trial on short-term efficacy of the Semont maneuver for the treatment of posterior canal benign paroxysmal positional vertigo. J Neurol. 2012;259(5):882–5.Google Scholar
  20. 20.
    Chen Y, Zhuang J, Zhang L, Li Y, Jin Z, Zhao Z, et al. Short-term efficacy of Semont maneuver for benign paroxysmal positional vertigo: a double-blind randomized trial. Otol Neurotol. 2012;33(7):1127–30.Google Scholar
  21. 21.
    Casani AP, Nacci A, Dallan I, Panicucci E, Gufoni M, Sellari-Franceschini S. Horizontal semicircular canal benign paroxysmal positional vertigo: effectiveness of two different methods of treatment. Audiol Neurotol. 2011;16:175–84.CrossRefGoogle Scholar
  22. 22.
    Mandala M, Pepponi E, Santoro GP, et al. Double-blind randomized trial on the efficacy of the Gufoni maneuver for treatment of lateral canal BPPV. Laryngoscope. 2013;123:1782–6.CrossRefPubMedGoogle Scholar
  23. 23.
    • Ribeiro KM, Freitas RV, Ferreira LM, Deshpande N, Guerra RO. Effects of balance vestibular rehabilitation therapy in elderly with benign paroxysmal positional vertigo: a randomized controlled trial. Disabil Rehabil. 2016;24:1–9. Elderly patients receiving balance VRT and canolith repositioning procedures (CRP’s) had better dynamic balance than those only receiving CRP’s. Adverse events from falls can be further avoided with the addition of these 2 therapies. Google Scholar
  24. 24.
    • Bressi F, Vella P, Casale M, Moffa A, Sabatino L, Lopez MA, et al. Vestibular rehabilitation in benign paroxysmal positional vertigo: reality or fiction? Int J Immunopathol Pharmacol. 2017;30(2):113–22. This systematic review suggests that VRT and CRP’s have a synergistic effect when combined in the elderly (see above reference). While VRT does not reduce recurrence rates for BPPV it seems to reduce its unpleasantness. VRT can be used when spinal co-morbidities contraindicate CRP’s. Google Scholar
  25. 25.
    Alsalaheen BA, Mucha A, Morris LO, et al. Vestibular rehabilitation for dizziness and balance disorders after concussion. J Neurol Phys Ther. 2010;34:87–93.CrossRefPubMedGoogle Scholar
  26. 26.
    Marshall S, Bayley M, McCullagh S, et al. Updated clinical practice guidelines for concussion/mild traumatic brain injury and persistent symptoms. Brain Inj. 2015;29:688–700.CrossRefPubMedGoogle Scholar
  27. 27.
    Moore BM, Adams JT, Barakatt E. Outcomes following a vestibular rehabilitation and aerobic training program to address persistent post-concussion symptoms. J Allied Health. 2016;45(4):e59–68.PubMedGoogle Scholar
  28. 28.
    Schneider KJ, Meeuwisse WH, Nettel-Aguirre A, et al. Cervicovestivular rehabilitation in sport-related concussion: a randomized controlled trial. Br J Sports Med. 2014;48:1294–8.CrossRefPubMedGoogle Scholar
  29. 29.
    Balci BD, Akdal G, Yaka E, et al. Vestibular rehabilitation in acute central vestibulopathy: a randomized controlled trial. J Vestib Res. 2013;23:259–67.PubMedGoogle Scholar
  30. 30.
    Dai CY, Huang YH, Chou LW, et al. Effects of primary caregiver participation in vestibular rehabilitation for unilateral neglect patients with right hemispheric stroke: a randomized controlled trial. Neuropsychiatr Dis Treat. 2013;9:477–84.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Alghadir AH, Iqbal ZA, Whitney SL. An update on vestibular physical therapy. J Chin Med Assoc. 2013;76:1–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Schubert MC, et al. Mechanism of dynamic visual acuity recovery with vestibular rehabilitation. Arch Phys Med Rehabil. 2008;89(3):500–7.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Schubert MC, Migliaccio AA, Della Santina CC. Modification of compensatory saccades after a VOR gain recovery. J Vestib Res. 2006;16(6):285–91.PubMedPubMedCentralGoogle Scholar
  34. 34.
    Schubert MC, Hall CD, Das V, et al. Oculomotor strategies and their effect on reducing gaze position error. Otol Neurotol. 2010;31:228–31.CrossRefPubMedGoogle Scholar
  35. 35.
    Whitney SL, Alghwiri A, Alghadir A. Physical therapy for persons with vestibular disorders. Curr Opin Neurol. 2015;28(1):61–8.CrossRefPubMedGoogle Scholar
  36. 36.
    Matsugi A, Ueta Y, Oku K, Okuno K, Tamaru Y, Nomura S, et al. Effect of gaze-stabilization exercises on vestibular function during postural control. Neuroreport. 2017;28(8):439–43.Google Scholar
  37. 37.
    Pavlou M, Bronstein AM, Davies RA. Randomized trial of supervised versus unsupervised optokinetic exercise in persons with peripheral vestibular disorders. Neurorehabil Neural Repair. 2013;27(3):208–18.CrossRefPubMedGoogle Scholar
  38. 38.
    Thompson KJ, Goetting JC, Staab JP, Shepard NT. Retrospective review and telephone follow-up to evaluate a physical therapy protocol for treating persistent postural-perceptual dizziness: a pilot study. J Vestib Res. 2015;25(2):97–103.PubMedGoogle Scholar
  39. 39.
    Pavlou M, Kanegaonkar RG, Swapp D, Bamiou DE, Slater M, Luxon LM. The effect of virtual reality on visual vertigo symptoms in patients with peripheral vestibular dysfunction: a pilot study. J Vestib Res. 2012;22:273–81.PubMedGoogle Scholar
  40. 40.
    Alahmari KA, Sparto PJ, Marchetti GF, Redfern MS, Furman JM, Whitney SL. Comparison of virtual reality based therapy with customized vestibular physical therapy for the treatment of vestibular disorders. IEEE Trans Neural Syst Rehabil Eng. 2014;22(2):389–99.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Bergeron M, Lortie CL, Guitton MJ. Use of virtual reality tools for vestibular disorders rehabilitation: a comprehensive analysis. Adv Med. 2015.Google Scholar
  42. 42.
    Garcia AP, Gananca MM, Cusin FS, et al. Vestibular rehabilitation with virtual reality in Meniere’s disease. Braz J Otorhinolaryngol. 2013;79:366–74.CrossRefPubMedGoogle Scholar
  43. 43.
    Meldrum D, Herdman S, Vance R, Murray D, Malone K, Duffy D, et al. Effectiveness of conventional versus virtual reality-based balance exercises in vestibular rehabilitation for unilateral peripheral vestibular loss: results of a randomized controlled trial. Arch Phys Med Rehabil. 2015;96(7):1319–28.Google Scholar
  44. 44.
    Szturm T, Reimer KM, Hochman J. Home-based computer gaming in vestibular rehabilitation of gaze and balance impairment. Games Health J. 2015;4(3):211–20.CrossRefPubMedGoogle Scholar
  45. 45.
    Park MK, Kim KM, Jung J, Lee N, Hwang SJ, Chae SW. Evaluation of uncompensated unilateral vestibulopathy using the modified clinical test for sensory interaction and balance. Otol Neurotol. 2013;34(2):292–6.CrossRefPubMedGoogle Scholar
  46. 46.
    Matsuda PN, Taylor CS, Shumway-Cook A. Evidence for the validity of the modified dynamic gait index across diagnostic groups. Phys Ther. 2014;94(7):996–1004.CrossRefPubMedGoogle Scholar
  47. 47.
    Nilsagård Y, Kollén L, Axelsson H, Bjerlemo B, Forsberg A. Functional gait assessment: reliability and validity in people with peripheral vestibular disorders. Int J Ther Rehabil. 2014;21(8):367–73.CrossRefGoogle Scholar
  48. 48.
    Writer HS, Arora RD. Vestibular rehabilitation: an overview. Int J Otorhinolaryngol Clin. 2012;4(1):54–69.CrossRefGoogle Scholar
  49. 49.
    Wei SH, Chen PY, Chen HJ, Kao CL, Schubert MC. Visual afference mediates head and trunk stability in vestibular hypofunction. J Clin Neurosci. 2016;29:139–44.CrossRefPubMedGoogle Scholar
  50. 50.
    Klatt BN, Carender WJ, Lin CC, Alsubaie SF, Kinnaird CR, et al. A conceptual framework for the progression of balance exercises in persons with balance and vestibular disorders. Phys Med Rehabil Int. 2015;2(4):1044.PubMedPubMedCentralGoogle Scholar
  51. 51.
    Tsukamoto HF, Costa Vde S, Silva RA Jr, Pelosi GG, Marchiori LL, Vaz CR, et al. Effectiveness of a vestibular rehabilitation protocol to improve the health-related quality of life and postural balance in patients with vertigo. Int Arch Otorhinolaryngol. 2015;19(3):238–47.Google Scholar
  52. 52.
    Karapolat H, Celebisoy N, Kirazli Y, et al. Is vestibular rehabilitation as effective in bilateral vestibular dysfunction as in unilateral vestibular dysfunction? Eur J Phys Rehabil Med. 2014.Google Scholar
  53. 53.
    Ricci NA, Aratani MC, Caovilla HH, Gananca FF. Effects of vestibular rehabilitation on balance control in older people with chronic dizziness: a randomized clinical trial. Am J Phys Med Rehabil. 2016;95(4):256–69.CrossRefPubMedGoogle Scholar
  54. 54.
    Verdecchia DH, Mendoza M, Sanguineti F, Binetti AC. Outcomes after vestibular rehabilitation and Wii(R) therapy in patients with chronic unilateral vestibular hypofunction. Acta Otorrinolaringol Esp. 2014;65(6):339–45.CrossRefPubMedGoogle Scholar
  55. 55.
    Maciaszek J, Osinski W. Effect of Tai Chi on body balance: randomized controlled trial in elderly men with dizziness. Am J Chin Med. 2012;40(2):245–53.CrossRefPubMedGoogle Scholar
  56. 56.
    Chen PY, Hsieh WL, Wei SH, Kao CL. Interactive wiimote gaze stabilization exercise training system for patients with vestibular hypofunction. J Neuroeng Rehabil. 2012;9:77.CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Sienko KH, Balkwill MD, Oddsson LI, et al. The effect of vibrotactile feedback on postural sway during locomotor activities. J Neuroeng Rehabil. 2013;10:93.CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Goebel JA, Sinks BC, Parker BE Jr, Richardson NT, Olowin AB, Cholewiak RW. Effectiveness of head-mounted vibrotactile stimulation in subjects with bilateral vestibular loss: a phase 1 clinical trial. Otol Neurotol. 2009;30(2):210–6.CrossRefPubMedGoogle Scholar
  59. 59.
    Guinand N, van de Berg R, Cavuscens S, Stokroos RJ, Ranieri M, Pelizzone M, et al. Vestibular implants: 8 years of experience with electrical stimulation of the vestibular nerve in 11 patients with bilateral vestibular loss. ORL J Otorhinolaryngolody Relat Spec. 2015;77(4):227–40.Google Scholar
  60. 60.
    Golub JS, Ling L, Nie K, et al. Prosthetic implantation of the human vestibular system. Otol Neurotol. 2014;35:136–47.CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    Wuehr M, Decker J, Schniepp R. Noisy galvanic vestibular stimulation: an emerging treatment option for bilateral vestibulopathy. J Neurol. 2017.Google Scholar
  62. 62.
    Iwasaki S, Yamamoto Y, Togo F, Kinoshita M, Yoshifuji Y, Fujimoto C, et al. Noisy vestibular stimulation improves body balance in bilateral vestibulopathy. Neurology. 2014;82:969–75.Google Scholar
  63. 63.
    Fujimoto C, Yamamoto Y, Kamogashira T, Kinoshita M, Egami N, Uemura Y, et al. Noisy galvanic vestibular stimulation induces a sustained improvement in body balance in elderly adults. Sci Rep. 2016;6:37575.Google Scholar
  64. 64.
    Bhattacharyya N, Baugh RF, Orvidas L, et al. Clinical practice guideline: benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 2008;139:S47–81.CrossRefPubMedGoogle Scholar
  65. 65.
    Herman SJ, Tusa RJ. Complications of the canalith repositioning procedure. Arch Otolaryngol Head Neck Surg. 1996;122(3):281–6.CrossRefGoogle Scholar
  66. 66.
    Epley JM. The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 1992;107:399–404.CrossRefPubMedGoogle Scholar
  67. 67.
    Toupet M, Ferrary E, Bozorg Grayeli A. Effect of repositioning maneuver type and postmaneuver restrictions on vertigo and dizziness in benign positional paroxysmal vertigo. ScientificWorldJournal. 2012;2012:162123.CrossRefPubMedPubMedCentralGoogle Scholar
  68. 68.
    De Stefano A, Dispenza F, Citraro L, Petrucci AG, Di Giovanni P, Kulamarva G, et al. Are postural restrictions necessary for management of posterior canal benign paroxysmal positional vertigo? Ann Otol Rhinol Laryngol. 2011;120(7):460–4.Google Scholar
  69. 69.
    Mostafa BE, Youssef TA, Hamad AS. The necessity of post-maneuver postural restriction in treating benign paroxysmal positional vertigo: a meta-analytic study. Eur Arch Otorhinolaryngol. 2013;270(3):849–52.CrossRefPubMedGoogle Scholar
  70. 70.
    Papacharalampous GX, Vlastarakos PV, Kotsis GP, Davilis D, Manolopoulos L. The role of postural restrictions after BPPV treatment: real effect on successful treatment and BPPV’s recurrence rates. Int J Otolaryngol. 2012;2012:932847.CrossRefPubMedPubMedCentralGoogle Scholar
  71. 71.
    Tjernstrom F, Fransson PA, Holmberg J, Karlberg M, Magnusson M. Decreased postural adaptation in patients with phobic postural vertigo—an effect of an “anxious” control of posture? Neurosci Lett. 2009;454:198–202.CrossRefPubMedGoogle Scholar
  72. 72.
    Odman M, Maire R. Chronic subjective dizziness. Acta Otolaryngol. 2008;128:1085–8.CrossRefPubMedGoogle Scholar
  73. 73.
    Staab JP, Ruckenstein MJ, Solomon D, Shepard NT. Serotonin reuptake inhibitors for dizziness with psychiatric symptoms. Arch Otolaryngol Head Neck Surg. 2002;128:554–60.CrossRefPubMedGoogle Scholar
  74. 74.
    Huppert D, Strupp M, Rettinger N, Hecht J, Brandt T. Phobic postural vertigo—a long-term follow-up (5 to 15 years) of 106 patients. J Neurol. 2005;252:564–9.CrossRefPubMedGoogle Scholar
  75. 75.
    Vereeck L, et al. The effect of early customized vestibular rehabilitation on balance after acoustic neuroma resection. Clin Rehabil. 2008;22:698–713.CrossRefPubMedGoogle Scholar
  76. 76.
    Whitney SL, Alghadir AH, Anwer S. Recent evidence about the effectiveness of vestibular rehabilitation. Curr Treat Options Neurol. 2016;18(3):12.CrossRefGoogle Scholar
  77. 77.
    Itani M, Koaik Y, Sabri A. The value of close monitoring in vestibular rehabilitation therapy. J Laryngol Otol. 2017;131(3):227–31.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Joanna Burzynski
    • 1
  • Shaleen Sulway
    • 1
  • John A. Rutka
    • 1
  1. 1.Department of Otolaryngology, Toronto General HospitalUniversity Health Network (UHN)TorontoCanada

Personalised recommendations