Preface

There are several additions to the fourth edition of Vestibular Rehabilitation. One change is the addition of Richard A. Clendaniel as the coeditor. Rick is a clinician, educator, and researcher with many years of experience in vestibular rehabilitation, vestibular function testing, and vestibular physiology. His contributions to the field have been of benefit to many clinicians and researchers as well as to patients. The other changes in this edition of Vestibular Rehabilitation are the exploration of new areas of “vestibular” rehabilitation including current evidence that supports the use of the gaze stabilization exercises in patients with non-vestibular dizziness and the use of new technologies in exercise programs.

The practice of vestibular rehabilitation faces numerous challenges in the coming years, as does all health care. We must be more efficient in our assessments and treatments. We must provide evidence that the patient is improving through the application of functional outcome measures. We must be able to defend our choice of treatment based on research establishing the benefits of specific exercises or establishing that a specific exercise is not beneficial. We must be able to support our recommendation on the need for further treatment based on measures that suggest the patient has or has not reached the optimal level of recovery. We need to address the psychological state of the patient as well as the physical problems and their consequences.

As you should hope, the evidence supporting the treatment of patients with vestibular deficits has increased since the last edition 7 years ago. So once again, we have extended the material presented to include several new chapters to reflect and to challenge our understanding of the assessment and treatment of vestibular disorders. One new chapter is on management of patients with chronic subjective dizziness and is a nice complement to the chapter of psychological problems in patients with dizziness. Another chapter tackles a current “hot topic”— management of patients with vestibular dysfunction from concussion. Finally, a third new chapter explores the role of emerging technologies such as virtual reality, sensory substitution devices, and most excitedly, vestibular implants, which will undoubtedly require new treatment approaches. Of course, all chapters contain new material, from management of tinnitus to the newer treatments that have been proposed for anterior and horizontal semicircular canal BPPV. We have added “point and counterpoint” sections in some chapters that highlight the differing opinions about assessment and treatment. The number of videos has been increased to include more examples of eye movement abnormalities and to provide visual examples of some of the newer treatments.

The many chapters in this book are designed to provide you with a foundation for all these challenges, but more importantly, the chapters will hopefully give you the basis from which you can continue to apply new information in your practice for the betterment of all your patients.