The role of rehabilitation for treatment of older adults with dizziness and balance disorders is reviewed. Theories related to functional recovery from peripheral and central vestibular disorders are presented. Suggestions on which older adults might benefit from vestibular rehabilitation therapy are presented. Promising innovative rehabilitation strategies and technologies that might enhance recovery of the older adult with balance dysfunction are discussed.
Meniere disease includes symptoms of fluctuating hearing loss, tinnitus, and subjective ear fullness accompanied by episodic vertigo. Along with these symptoms, patients with chronic Meniere often develop symptoms of disequilibrium and unsteadiness that extend beyond the episodic attacks and contribute to the total disability and reduced quality of life attributed to the disease. Vestibular rehabilitation physical therapy has been used only after vestibular ablation has stabilized the vestibular loss, and for patients stably managed on medical therapy who exhibit no fluctuation in symptoms. This article reviews the data substantiating current applications of vestibular therapy, including improvements in subjective and objective balance outcome measures, and explores the possible extension of vestibular rehabilitation to treatment of patients exhibiting continued fluctuating vestibular loss.
Conclusion: These preliminary results indicate the efficacy of the electrotactile vestibular substitution system in improving patients’ symptoms of vestibulopathy, and constitute evidence of successful sensory substitution.
from the Journal of Laryngology and Otology
We analyzed the effect of 2-week individualized visual feedback-based balance training on the postural control of patients undergoing retrosigmoid microsurgical removal of vestibular schwannoma. We performed prospective evaluation of 17 patients allocated into two groups: feedback group (9 patients, mean age 37 years) and standard physiotherapy group (8 patients, mean age 44 years). Patients in both the groups were treated once per day by intensive rehabilitation from 5th to 14th postoperative day. Rehabilitation of patients in the feedback group was performed using the visual feedback and force platform. Results were evaluated on the beginning and at the end of rehabilitation program (e.g. 5th and 14th postoperative day). Outcome measures included posturography during quiet stance under four different conditions by the modified Clinical Test for Sensory Interaction of Balance. Body sway was evaluated from center of foot pressure. Compensation of Center of pressure (CoP) parameters in stance on firm surface was similar in the control and feedback groups. However, in stance on foam surface with eyes closed the patients from the feedback group were better compensated and CoP parameters differed significantly (p < 0.05). This prospective clinical study suggests that specific exercises with visual feedback improve vestibulospinal compensation in patients after vestibular schwannoma surgery and thus can improve their quality of life.
Auditory and vestibular medicine is becoming more accepted as a specialty in its own right. Recent advances in the field have been instrumental in the understanding of the scientific foundations, pathophysiology, clinical approach and management of patients with hearing and vestibular disorders. This paper will review these advances.
The aim of this trial was to evaluate long-term (after six months) effects of successful vestibular rehabilitation in patients with acute unilateral vestibular loss (AUVL) in relation to static and dynamic balance, hypertension, headache, disturbed sleep and physical exercise habits. A group of 42 patients were included. For comparison, an age and gender matched healthy reference group was used, consisting of 56 subjects. The assessments were static and dynamic balance performances with the Romberg test, a sharpened Romberg test (SREC), standing on one leg with eyes open/closed (SOLEO/SOLEC) and a 10-m walking test, with and without head movements. A questionnaire concerning the occurrence of hypertension, headache, disturbed sleep and physical exercise habits was also administered. The AUVL group walked significantly slower and took shorter steps (p <0.001) compared to the subjects in the reference group. Significantly impaired performances were also found in the AUVL group in SREC (p<0.01) and SOLEC (p <0.05) compared to the reference group. A significantly larger proportion of patients with AUVL (26%) used anti-hypertensive medication compared to the reference group (4%) (p <0.01). This study demonstrated that AUVL patients, after vestibular rehabilitation and compensation, still have long-term static and dynamic balance problems. We have also found that patients who have suffered from AUVL have a higher prevalence of hypertension compared to a reference group.