Case Report Vestibular Rehabilitation Decreases Fall Risk and Improves Gaze Stability for an Older Individual with Unilateral Vestibular Hypofunction

2007 ◽  
Vol 30 (3) ◽  
pp. 121-127 ◽  
Author(s):  
Erin Horning ◽  
Sharon L. Gorman
Keyword(s):  
Case Report ◽  
Fall Risk ◽  
Vestibular Rehabilitation ◽  
Gaze Stability ◽  
Vestibular Hypofunction

Tai Chi and vestibular rehabilitation effects on gaze and whole-body stability

2004 ◽  
Vol 14 (6) ◽  
pp. 467-478 ◽  
Author(s):  
Chris A. McGibbon ◽  
David E. Krebs ◽  
Steven L. Wolf ◽  
Peter M. Wayne ◽  
Donna Moxley Scarborough ◽  
...  
Keyword(s):  
Significant Relationship ◽  
Postural Stability ◽  
Intervention Program ◽  
Tai Chi ◽  
Vestibular Rehabilitation ◽  
Whole Body ◽  
Gaze Control ◽  
Gaze Stability ◽  
Vestibular Hypofunction ◽  
The Relationship

Tai Chi (TC) is a comparatively new intervention for peripheral vestibular hypofunction, which is often treated with vestibular rehabilitation (VR). We compared gaze stability (GZS), whole-body stability (WBS) and footfall stability (FFS) during locomotion among 26 people with vestibulopathy (VSP), randomized into two treatment arms (13 TC and 13 VR). Each intervention program was offered for 10 weeks. GZS improved more for VR than for TC, but WBS (and FFS) improved more for TC than for VR. There was a significant relationship between changes in GZS and WBS for the VR subjects (r = 0.60, p = 0.01), but not for TC subjects. There was a significant relationship between changes in WBS and FFS for both VR (r = 0.65, p < 0.01) and TC (r = 0.58, p = 0.02) groups; the relationship disappeared in the VR but not the TC group when controlling for GZS. These findings suggest that VR and TC both benefit patients with VSP but via differing mechanisms. Moreover, these data are the first to test the assumption that improving gaze control among patients with VSP perforce improves postural stability: it does not. We conclude that GZS is most improved in those who receive VR, but that TC improves WBS and FFS without improving GZS, suggesting patients with VSP can rely on non-gaze related mechanisms to improve postural control.

Improved Oculomotor Physiology and Behavior After Unilateral Incremental Adaptation Training in a Person With Chronic Vestibular Hypofunction: A Case Report

2019 ◽  
Vol 99 (10) ◽  
pp. 1326-1333 ◽  
Author(s):  
Carlo N Rinaudo ◽  
Michael C Schubert ◽  
Phillip D Cremer ◽  
William V C Figtree ◽  
Christopher J Todd ◽  
...  
Keyword(s):  
Case Report ◽  
Control Period ◽  
Extended Period ◽  
Vestibular Rehabilitation ◽  
Head Movements ◽  
Head Impulse Test ◽  
Slow Phase ◽  
Vestibular Hypofunction ◽  
Vestibulo Ocular Reflex ◽  
Vor Adaptation

Abstract Background and Purpose Traditional vestibular rehabilitation therapies are effective in reducing vestibular hypofunction symptoms, but changes to the vestibulo-ocular reflex (VOR) are minimal. This controlled case report describes an increase in VOR after 6 months of incremental VOR adaptation (IVA) training in a person with chronic unilateral vestibular hypofunction. Case Description The participant was a 58-year-old female with a confirmed (Neurologist P.D.C.) left vestibular lesion stable for 2 years prior to entering a clinical trial examining the effects of daily IVA training. She was evaluated monthly for self-reported symptoms (dizziness handicap inventory), VOR function (video head impulse test), and VOR behavior (Dynamic Visual Acuity test). Intervention consisted of 6 months of 15 minutes per day unassisted training using the IVA training regime with a device developed in our laboratory. The take-home device enables the VOR response to gradually normalize on the ipsilesional side via visual-vestibular mismatch training. The intervention was followed by a 6-month wash-out and 3-month control period. The control condition used the same training device set to function like standard VOR training indistinguishable to the participant. Outcomes After the intervention, ipsilesional VOR function improved substantially. The VOR adapted both via a 52% increase in slow-phase response and via 43% earlier onset compensatory saccades for passive head movements. In addition, the participant reported fewer symptoms and increased participation in sports and daily activities. Discussion Here, a participant with chronic vestibular hypofunction showing improved oculomotor performance atypical for traditional vestibular rehabilitation therapies, subsequent to using the newly developed IVA technique, is presented. It is the first time to our knowledge an improvement of this magnitude has been demonstrated as well as sustained over an extended period of time.

Case Report: Management of a Patient with mTBI and Vestibular Hypofunction with the Binasal Occlusion Technique

2018 ◽  
pp. 87-90
Keyword(s):  
Case Report ◽  
Visual Motion ◽  
Hand Movement ◽  
Motion Sensitivity ◽  
Vestibular Hypofunction ◽  
First Case ◽  
Neurological Exam ◽  
History Of ◽  
Occlusion Technique ◽  
Visual Vertigo

Background: Binasal Occlusion (BNO) is a clinical technique used by many neurorehabilitative optometrists in patients with mild traumatic brain injury (mTBI) and increased visual motion sensitivity (VMS) or visual vertigo. BNO is a technique in which partial occluders are added to the spectacle lenses to suppress the abnormal peripheral visual motion information. This technique helps in reducing VMS symptoms (i.e., nausea, dizziness, balance difficulty, visual confusion). Case Report: A 44-year-old AA female presented for a routine eye exam with a history of mTBI approximately 33 years ago. She was suffering from severe dizziness for the last two years that was adversely impacting her ADLs. The dizziness occurred in all body positions and all environments throughout the day. She was diagnosed with vestibular hypofunction and had undergone vestibular therapy but reported little improvement. Neurological exam revealed dizziness with both OKN drum and hand movement, especially in the left visual field. BNO technique resulted in immediate relief of her dizziness symptoms. Conclusion: To our knowledge, this is the first case that illustrates how the BNO technique in isolation can be beneficial for patients with mTBI and vestibular hypofunction. It demonstrates the success that BNO has in filtering abnormal peripheral visual motion in these patients.

Two conditions to fully recover dynamic canal function in unilateral peripheral vestibular hypofunction patients

2021 ◽  
pp. 1-15
Author(s):  
Michel Lacour ◽  
Alain Thiry ◽  
Laurent Tardivet
Keyword(s):  
Crucial Role ◽  
Recovery Process ◽  
Head Impulse Test ◽  
Additional Parameter ◽  
Vestibular Loss ◽  
Horizontal Canal ◽  
Lateral Canal ◽  
Gaze Stability ◽  
Vestibular Hypofunction ◽  
Anterior Canal

BACKGROUND: The crucial role of early vestibular rehabilitation (VR) to recover a dynamic semicircular canal function was recently highlighted in patients with unilateral vestibular hypofunction (UVH). However, wide inter-individual differences were observed, suggesting that parameters other than early rehabilitation are involved. OBJECTIVE: The aim of the study was to determine to what extent the degree of vestibular loss assessed by the angular vestibulo-ocular reflex (aVOR) gain could be an additional parameter interfering with rehabilitation in the recovery process. And to examine whether different VR protocols have the same effectiveness with regard to the aVOR recovery. METHODS: The aVOR gain and the percentage of compensatory saccades were recorded in 81 UVH patients with the passive head impulse test before and after early VR (first two weeks after vertigo onset: N = 43) or late VR (third to sixth week after onset: N = 38) performed twice a week for four weeks. VR was performed either with the unidirectional rotation paradigm or gaze stability exercises. Supplementary outcomes were the dizziness handicap inventory (DHI) score, and the static and dynamic subjective visual vertical. RESULTS: The cluster analysis differentiated two distinct populations of UVH patients with pre-rehab aVOR gain values on the hypofunction side below 0.20 (N = 42) or above 0.20 (N = 39). The mean gain values were respectively 0.07±0.05 and 0.34±0.12 for the lateral canal (p <  0.0001), 0.09±0.06 and 0.44±0.19 for the anterior canal (p <  0.0001). Patients with aVOR gains above 0.20 and early rehab fully recovered dynamic horizontal canal function (0.84±0.14) and showed very few compensatory saccades (18.7% ±20.1%) while those with gains below 0.20 and late rehab did not improve their aVOR gain value (0.16±0.09) and showed compensatory saccades only (82.9% ±23.7%). Similar results were found for the anterior canal function. Recovery of the dynamic function of the lateral canal was found with both VR protocols while it was observed with the gaze stability exercises only for the anterior canal. All the patients reduced their DHI score, normalized their static SVV, and exhibited uncompensated dynamic SVV. CONCLUSIONS: Early rehab is a necessary but not sufficient condition to fully recover dynamic canal function. The degree of vestibular loss plays a crucial role too, and to be effective rehabilitation protocols must be carried out in the plane of the semicircular canals.

scholarly journals Gaze Stability, Dynamic Balance and Participation Deficits in People with Multiple Sclerosis at Fall-Risk

2018 ◽  
Vol 301 (11) ◽  
pp. 1852-1860 ◽  
Author(s):  
Hina Garg ◽  
Leland E. Dibble ◽  
Michael C. Schubert ◽  
Jim Sibthorp ◽  
K. Bo Foreman ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Fall Risk ◽  
Dynamic Balance ◽  
Gaze Stability

Aquatic physiotherapy for vestibular rehabilitation in patients with unilateral vestibular hypofunction: Exploratory prospective study

2008 ◽  
Vol 18 (2-3) ◽  
pp. 139-146
Author(s):  
Yeda P.L. Gabilan ◽  
Mônica R. Perracini ◽  
Mario S.L. Munhoz ◽  
Fernando F. Gananç
Keyword(s):  
Symptom Onset ◽  
Stability Index ◽  
Vestibular Rehabilitation ◽  
Therapeutic Effects ◽  
Self Perception ◽  
Vestibular Loss ◽  
Tertiary Referral Center ◽  
Vestibular Hypofunction ◽  
Computerized Posturography ◽  
Stability Indexes

Purpose: To explore the effects of aquatic physiotherapy on individuals with unilateral vestibular hypofunction and examine the association of therapeutic effects with age, time since symptom onset and use of antivertigo medication. Study design: Exploratory study. Setting: Tertiary referral center. Patients: Twenty-one patients presenting chronic dizziness with uncompensated unilateral vestibular loss. Intervention: All patients underwent a regimen of 10 sessions of aquatic physiotherapy for vestibular rehabilitation. Main outcome measures: Patient evaluation prior to and following rehabilitation involved the application of the Brazilian version of the Dizziness Handicap Inventory (DHI), dynamic computerized posturography and the self-perception scale of dizziness intensity. Statistical analysis compared average variables prior to and following rehabilitation using the Student t test. Results: Brazilian DHI total scores were lower following rehabilitation (p = 0.001). Posturography revealed a reduction in the variation of body displacement following rehabilitation in the average stability and anterior/posterior stability indexes (p = 0.001) and in the average medial/lateral stability index (p = 0.003). Self-perception of dizziness intensity was lower following rehabilitation (p = 0.001). No association between age, time since symptom onset and use of antivertigo medication and rehabilitation therapeutic effects were found. Conclusion: Unilateral vestibular hypofunction patients undergoing aquatic physiotherapy for vestibular rehabilitation achieved an improvement in quality of life, body balance and self-perception of dizziness intensity, regardless of age, time since symptom onset, and use of antivertigo medication.

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