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Chapter Objectives

Upon completion of this chapter, the learner should be able to:

  1. Identify the primary anatomical structures involved with vestibular-related pathology.

  2. Recognize impairments associated with a vestibular dysfunction.

  3. Identify mechanisms of recovery from a vestibular dysfunction.

  4. Identify indications for vestibular rehabilitation therapy.

  5. Design general treatment strategies for vestibular rehabilitation, incorporating associated principles.

  6. Design treatment strategies for stable unilateral versus bilateral vestibular hypofunction.

  7. Design treatment strategies for benign paroxysmal positional vertigo.

  8. Predict expected patient outcomes for given treatment strategies.

Introduction to Vestibular Interventions

Persons with vestibular disorders exhibit symptoms primarily relating to motion sensitivity, gaze stability (i.e., the ability to visually fixate on a target during brief, rapid head movements), and postural stability, which were introduced in Chapter 8, Examination and Evaluation of Vestibular Function. In most cases, everyday activities (e.g., walking, going to the grocery store) help promote compensation for vestibular impairments even when the individual is not involved in a vestibular rehabilitation program. The compensatory process requires that sensory input be coordinated with motor activity. Therefore, optimal intervention strategies require both motor learning of exercises and matching of sensory input. The goal of vestibular rehabilitation therapists is to optimize patient recovery by addressing gaze stability, motion sensitivity, and postural stability deficits through customized therapeutic exercise and patient education.

In addition to postural instability, patients may report movement-related impairments (see details in Chapter 8) including dizziness (i.e., a nonspecific sense of unsteadiness in which a person feels as if she may fall), vertigo (i.e., a subjective illusion of rotary movement, or “spinning”; the person feels as if the room is spinning or she is spinning in the room), oscillopsia (i.e., a false illusion of movement or “oscillation” of the environment or objects in the environment), fatigue, and/or audiological symptoms. Audiological symptoms may include tinnitus (i.e., the perception of “ringing in the ears” in the absence of a true environmental sound), aural fullness/pressure, hearing loss, and/or sensitivity to sounds. Vestibular symptoms, particularly with benign paroxysmal positional vertigo (BPPV), usually include vertigo (i.e., room spinning) and nystagmus elicited with position changes (e.g., lying down, rolling over in bed, looking up). Nystagmus is involuntary, rhythmic, rapid eye movements often associated with vestibular or cerebellar pathology.

Because the vestibular system is highly integrated with the visual system, it is imperative to examine both systems to more confidently identify the etiologies of the symptoms and to apply the most appropriate plan of care/interventions. The vestibular examination is discussed in detail in Chapter 8. In this chapter, we briefly review the primary reflexes of the inner ear because most treatment strategies are based on impairments in this area.

The vestibular system influences two very important reflex functions that help to maintain gaze and postural control and contribute to the perception of movement in space. The vestibulo-ocular reflex (VOR) provides gaze stability in response to ...

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