CHAPTER 21: Physical Therapy Assessment of Vestibular Hypofunction

Introduction

Patients with peripheral vestibular hypofunction differ with respect to the onset and clinical course of their disability and to the final level of recovery, depending on the type and extent of vestibular deficit. Despite these differences, such patients have many of the same symptoms—dizziness, lightheadedness, vertigo, nystagmus, blurred vision, postural instability, fear of movement, gait disturbances, and occasional falling.¹ In addition, these patients may experience anxiety, depression, and fear related to their disability.^2–6 In fact, people with vestibular dysfunction report that they are significantly impaired by their disability.^7–9 As a result of one or more of these symptoms, patients with peripheral vestibular hypofunction often cope with their disability by avoiding certain movements and decreasing their activity level.¹⁰ This habit, if not treated, will lead to the unfortunate results of physical deconditioning and an alteration of the patient's lifestyle.^10,11

The purpose of this chapter is to provide an overview of patient problems and the key components of the clinical examination as well as the more comprehensive examination. We use the International Classification of Functioning, Disability and Health (ICF) scheme for the organization of this chapter.¹² The ICF was developed by the World Health Organization specifically to provide a framework for the “description of health-related states” that includes both positive experiences and negative consequences of disease.¹² This scheme consists of three domains that can be used to describe the effects of different disorders or diseases on a person's health, with a number of environmental and personal factors that affect each of those domains (Box 21-1).

The ICF model differs from other models of disablement in that it provides a more comprehensive depiction of the health of an individual. The model shifts the emphasis away from impairment and disability to a more balanced perspective that includes “health.” Table 21-1 provides a description of how one can choose a self-report tool for use with persons with vestibular dysfunction based on which areas of the ICF are included in the measure (Fig. 21.1). Use of the ICF enables comparison of similar constructs across cultures to better describe rehabilitation outcomes.