Vestibular rehabilitation is considered an appropriate and valuable treatment approach for patients with vestibular hypofunction. This chapter provides the reader with the background necessary to treat patients with vestibular hypofunction. The chapter covers mechanisms of recovery as the basis for the exercise approaches used and similarities and differences among the various treatments and guidelines for the progression of the exercises. We provide a review of literature that supports the use of these exercises. Finally, we provide case studies to illustrate the decision-making process in developing exercise programs.
The previously used nomenclature to describe the exercises used in the treatment of vestibular hypofunction needs to be revised in light of recent findings on the mechanisms underlying improvement in physical function. The previously described “Adaptation” and “Substitution” exercises are together called “Gaze Stabilization” exercises.
The goals of physical therapy intervention are to (1) decrease the patient's disequilibrium (sense of being off-balance) and oscillopsia (visual blurring during head movement), (2) improve the patient's functional balance
especially during ambulation, (3) improve the patient's ability to see clearly during head movement, (4) improve the patient's overall general physical condition, (5) enable the patient to return to a more normal level of activity and participation in society, and (6) reduce the patient's social isolation. Patients are usually seen by the physical therapist on an outpatient basis, although the initial interventions often occur while the patient is in the hospital. Several centers within the United States and England employ physical therapists who screen for vestibular dysfunction in the emergency room. An important part of the rehabilitation process is the establishment of a home exercise program. The physical therapist must motivate the patient and ensure exercise compliance. To do so, the physical therapist must identify the patient's own goals and clarify to the patient the treatment goals as well as the potential effects of exercise.
Several different mechanisms are involved in the recovery of function following unilateral vestibular loss (UVL). These mechanisms include cellular recovery, spontaneous reestablishment of the tonic-firing rate centrally, adaptation of residual vestibular function, the substitution of alternative strategies for the loss of vestibular function, and habituation of unpleasant sensations. The following section relates the changes that are seen following UVL to the mechanisms of recovery.
Cellular recovery suggests that the receptors or neurons that were damaged and initially stopped functioning may recover. This has been demonstrated for vestibular hair cells in nonprimate mammals following aminoglycoside-induced loss.1,2 There appears to be some functional recovery related to the anatomic recovery of hairs cells although there is a persistent deficit.3 It is unclear at this time whether recovery of hair cells is a significant factor in recovery of vestibular function in human beings.
Spontaneous Nystagmus, Skew Deviation, and Postural Asymmetries in ...