Vestibular Therapy, Indianapolis
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Vestibular Rehabilitation
Vestibular Rehabilitation: Vestibular rehabilitation is defined as a form of physical therapy ttreatment that involves specific forms of therapeutic exercises and repositioning maneuvers designed to decrease dizziness, increase balance function and increase general activity levels.
Epidemiology
1. Dizziness or balance disorder is among the 25 most common reasons Americans see the physicians accounting for more than 5 million visits per year.
2. 42% of the adult population will complain of dizziness to their doctors at least once in their life time.
3. Falls are the leading cause of fatal and non-fatal injuries in people 65 years and older.
4. The cost of medical care for patients with balance disorders has been estimated to exceed $ 1 billion per year in the U.S.
Vestibular System: It involves the peripheral components made of the utricle, saccule and the three semi-circular canals and the vestibular nerve. The central part includes the vestibular nucleus, cerebellum and other parts of the brain to which information is being relayed through the vestibular nerve. Finally, the motor output system which consists of nerves emanating from various parts of the central nervous system to the vestibular apparatus, the neck and other peripheral parts of the body that contributes towards balance maintenance.
Any damage to the peripheral components of the vestibular system, be it partial or complete can be treated through various vestibular rehabilitation procedures. However, no evidence exists if these same treatment techniques are as effective in treating lesions of the central components of the vestibular system.
Diagnostic Procedures: These are usually performed by the audiologist and interpreted by the Otorhynolaryngologist. These include:
1. Electronystagmography (ENG) or the Videonystagmography (VNG). This is considered to be the Gold Standard for testing unilateral vestibular lesions.
2. Rotational Chair Test
3. Vestibular Autorotation Test (VAT).
4. CT scan and MRI
5. Audiology
6. Computerized Posturography
7. Physical examination- Hallpike-Dix test and the Roll test.
Treatment Procedures
About 40 years back, Cooksey and Cawthorne were the first to develop exercises aimed at treating patients with balance disorders. These included various exercises for the head and neck and the upper extremities. However, over the past fifteen years with major advances in the understanding of neurophysiology of the central nervous systems to adapt itself secondary to the damages in the peripheral component of the vestibular system lead to significant changes in the treatment strategies aimed at reducing balance disorders. They are:
1. Adaptation exercises: This is used for the recovery of the vestibulooccular (VOR) reflex gain as well as balance re-training exercises for the improvement of the vestibulospinal reflex (VSR).
2. Canal Repositioning Techniques (CRT): This is used for repositioning otoconia/calcium carbonate crystals in the semicircular canals.
3. Habituation exercises: This is used to progressively decrease the response to repeated stimulus.
4. Substitution: This is used to encourage reliance/training of the other two systems that contribute towards balance maintenance namely, the somatosensory and the visual systems.
Clinical Guideline
This far, no specific clinical guideline has been developed for vestibular rehabilitation. However, there are possibly some general guidelines used to guide in the diagnosis and treatment of vestibular problems.
1. If symptoms change:
· Possibly peripheral
· Canalith RepositioningTechnique, adaptation, habituation and modification
· BPPV 1-3 treatments, unilateral vestibular lesion 6-8 weeks, bilateral vestibular loss 6-24 months
2. If symptoms are unchangeable:
- Possibly central
- Substitution, education, modification
- Central 6-24 months
Outcome Measures
In a study involving 23 subjects with chronic vestibular dysfunction, Szturm and colleagues have found adaptation exercises to be far superior and effective than those exercises developed initially by Cooksey and Cawthorne in reducing symptoms of dizziness and nystagmus.
Horak et al compared the effects of vestibular rehabilitation, general exercises and medications in treating peripheral vestibular lesions. The study showed that the rehabilitation group showed 88%- 211% improvement in balance over baseline measurements as opposed to no change in the other two groups. However, dizziness improved in all the three groups. Hence it was suggested that vestibular rehabilitation was good treating patients who had symptoms of both dizziness and disequilibrium.
In a clinically controlled study by Herdman et al, it was found that vestibular adaptation exercises significantly reduced symptoms of disequilibrium and postural sway as compared to the control group in patients following acoustic neuroma resection.
In another study by Gill-Body and colleagues, two groups- one with unilateral and the other bilateral vestibular hypofunction, demonstrated significant improvement in symptoms of dizziness and disequilibrium as measured by the Dizziness Handicap Inventory. Also, objectively measured clinical balance tests showed significant improved scores.
In another study by Norre et al, two techniques, namely the adaptation techniques and the liberatory maneuver were being compared in the treatment of peripheral vestibular dysfunction. No significant changes were noted in the outcome measures of dizziness or nystagmus, proving that both techniques were equally effective in the treatment of vestibular dysfunction. However, each technique had its own advantage and disadvantage. The adaptation technique required many treatment sessions, but was however more comfortable in treating the elderly population as the technique was more gentle and subtle. On the other hand, the liberatory technique lasted only one to two sessions and thus more beneficial monetary wise. However, this technique was not really well tolerated by the elderly population, thereby causing increased drop-outs or side effects such as vomiting.
From these studies, as a physical therapist in Indianapolis, I am convinced that vestibular rehabilitation is a rapidly growing and well suited technique in the treatment of peripheral vestibular disorders. In terms of the treatment techniques, I would select the technique that would be most appropriate for that specific individual. For example, I would choose the more gentle form of rehabilitation like adaptation exercise in case of an elderly. However, if the individual was young, then I would consider the more aggressive technique, since it would save both money and time.
Your health is vital. So if you are seeking for the best care looking for physical therapy in Indianapolis, please visit Victor Physical Therapy for the care that you or your loved one deserves. Come see the best physical therapist Indianapolis.
Victor Gnanapragasam, PT, DPT, FAAOMPT.
3939 S Emerson Ave.,Ste B
Phone: 3178006448
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