Vestibular rehabilitation and 6-month follow-up using objective and subjective measures

Conclusions. Vestibular rehabilitation improves quality of life by reducing the degree of handicap, improving the ability to perform everyday tasks and providing long-term rehabilitation stability (at 6 months). Recovery of the vestibulo-ocular reflex and the vestibulo-spinal reflex efficiency was proven by the objective results obtained in this study. Vestibular rehabilitation improves both subjective and objective parameters, although no significant correlation between these two indices was found. Objective. To determine the outcome of subjective and objective parameters and long-term rehabilitation stability after vestibular rehabilitation in 43 patients with vestibular disorders. Material and methods. The subjective tests used were the Medical Outcomes Study 36-item Short Form, the Dizziness Handicap Inventory and the Activity-specific Balance Confidence scale. The objective tests used were video-oculoscopy, dynamic visual acuity, the Equitest and the Dynamic Gait Index. All indices were evaluated before and after rehabilitation and at follow-up. Results. All patients showed an improvement in quality of life and a reduction in handicap due to dizziness. Improvement in objective test results was also seen. These results were stable at follow-up. A correlation was found between different subjective measures, but there was no correlation between subjective and objective measures.     

Vestibular rehabilitation outcomes in chronic vertiginous patients through computerized dynamic visual acuity and Gaze stabilization test.

OBJECTIVE: To evaluate the efficiency of the rehabilitative protocols in patients with labyrinthine hypofunction, focusing on computerized dynamic visual acuity test (DVAt) and Gaze stabilization test (GST) specifically evaluating the vestibulo-oculomotor reflex (VOR) changes due to vestibular rehabilitation. DESIGN: Consecutive sample study. SETTING: Day hospital in Ears, Nose, and Throat Rehabilitation Unit. SUBJECTS: Thirty-two patients with chronic dizziness with a mean age of 60.74 years. INTERVENTION: Patients performed one cycle of 12 daily rehabilitation sessions (2 h each) consisting of exercises aimed at improving VOR gain. The rehabilitation program included substitutional and/or habitudinal exercises, exercises on a stability platform, and exercises on a moving footpath with rehabilitative software. MAIN MEASURES: Dizziness Handicap Inventory and Activities-specific Balance Confidence Scale. Computerized dynamic posturography, computerized DVAt, and GST. RESULTS: The patients significantly improved in all the tests. CONCLUSION: Vestibular rehabilitation improved the quality of life by reducing the handicap index and improving the ability in everyday tasks. The recovery of the vestibular-ocular reflex and vestibular-spinal reflex efficiency was objectively proven by instrumental testing. The DVAt and the GST allow to objectively quantify the fixation ability at higher frequencies and speeds (main VOR function). Moreover, these new parameters permit to completely evaluate vestibular rehabilitation outcomes, adding new information to the generally used tests that only assess vestibulospinal reflex.     

Acute vestibulopathy with simultaneous bilateral involvement of the vestibulo-ocular reflex limited to the low-frequency range

We report a novel type of idiopathic bilateral vestibulopathy with acute simultaneous involvement of the vestibulo-ocular reflex limited to the low-frequency range. A 64-year-old female presented with dizziness, oscillopsia, and difficulty walking. She did not experience rotatory vertigo and did not show any nystagmus. Vestibular function tests showed absent caloric responses in both ears, while vestibulo-ocular reflex (VOR) gains in the video head impulse test (vHIT) were preserved in all six semicircular canals. Cervical and ocular vestibular evoked myogenic potentials in response to air-conducted sound were absent on both sides. Since the caloric test and vHIT measures low-frequency and high-frequency VOR, respectively, we diagnosed the patient as having a bilateral VOR deficit limited to the low-frequency range. During a 1-year follow-up with vestibular rehabilitation, the subjective symptom of dizziness gradually recovered while recovery of vestibular function was minimal.     

A matched-pair comparison of two cochlear implant systems

OBJECTIVES: To compare the overall performance of two implant systems based on audiologic outcome, tinnitus handicap, and quality of life using objective and subjective measures. DESIGN: Retrospective cohort study. SETTING: Sunnybrook & Women's College Health Science Centre. METHODS: Two matched groups, with 24 Nucleus 22 SPEAK (Advanced Bionics, Symlar, CA) and 24 Clarion CIS (Cochlear Corporation, Sydney, Australia), were selected. Patients were administered survey forms to evaluate subjective tinnitus and dizziness symptomatology, as well as a 27-item tinnitus handicap questionnaire. Both groups were administered survey forms to assess the frequency of implant use, the subjective benefit derived, and the perceived impact on quality of life. The 36-Item Short-Form (SF-36) Health Survey was administered as a measure of quality of life at 6 months postimplant. Standardized open-set speech recognition parameters were evaluated at 24 months postimplant. Vestibular function was determined by pre-and postimplant electronystagmography with caloric testing. The first author was blinded to implant type during data collection and analysis RESULTS: Cochlear implantation yielded a significant 22% reduction in overall tinnitus handicap (p < .05). There was a 27% reduction in vestibular function that failed to show statistical significance (p = .78). There was no significant reduction in vestibular function postimplant in either group. The average open-set speech perception responses at 24 months postimplant were monosyllabic word recognition 45%, phoneme recognition 65%, and sentence recognition 86.5%. There was no significant difference with respect to implant type. Overall, 76% of implantees reported satisfaction with the amount of subjective benefit they received from their implants. Furthermore, 96% reported an overall positive impact on quality of life. CONCLUSION: Overall, there was no significant difference between the two multichannel devices studied using the present software and hardware configurations.     

Vestibular rehabilitation for migraine-associated dizziness

The purpose of this study was to investigate the effects of a vestibular rehabilitation program on patients with the diagnosis of migraine-associated dizziness. Subjects were placed in four groups as follows: idiopathic migraine-associated dizziness; idiopathic migraine-associated dizziness and associated benign positional vertigo; posttraumatic migraine-associated dizziness; and posttraumatic migraine-associated dizziness and benign positional vertigo. Vestibular rehabilitation therapy was administered to all patients. Criterion measurements included the dizziness handicap inventory, activities-specific balance confidence scale, computerized dynamic posturography performance, and dynamic gait index. After vestibular physical therapy, all subjects showed significant improvement in the dizziness handicap, activities-specific balance confidence, dynamic gait, and computerized dynamic posturography measures. Patients with migraine-associated dizziness can benefit from physical therapy intervention. The results of this study are important in considering the approach to vertiginous migraine patients with and without head injury.     

Otolith-ocular responses in patients with surgically confirmed unilateral peripheral vestibular loss

The chronic effects of unilateral peripheral vestibular loss (UPVL) are influenced by vestibular compensation. This study documents the balance-related symptoms and quantitative vestibular laboratory testing of 20 patients with surgically confirmed UPVL. Included are measures of the semicircular canal-ocular reflex, the otolith-ocular reflex, and both static and dynamic semicircular canal-otolith-interaction. This study differs from previous studies of patients with UPVL in that a large number of patients with surgically confirmed lesions were tested with three types of off-vertical axis rotation, several of the patients had anatomically preserved superior vestibular nerves, and self-perceived level of disability related to dizziness and imbalance were available. Results confirmed previously reported changes in the vestibulo-ocular reflex of patients with UPVL. Also, there was no apparent effect of anatomically preserving the superior vestibular nerve during surgical resection of vestibular schwannomas based on either subjective or objective measures of vestibular dysfunction. Further, there were no apparent correlations between subjective measures of dizziness and imbalance and objective measures of vestibulo-ocular function. These results have clinical implications for the management of patients with unilateral vestibular loss and provide insights into the process of vestibular compensation especially with respect to the otolith-ocular reflex.     

Effects of vestibular rehabilitation and social reinforcement on recovery following ablative vestibular surgery

This study investigated the relative effects of vestibular rehabilitation (VR) and social reinforcement (SR) on recovery following ablative vestibular surgery. Twenty-four subjects were randomly assigned to three treatment groups of either VR with SR, VR without SR, or general range of motion (ROM) exercises with SR. Outcome measures included equilibrium scores in dynamic posturography, asymmetry index in rotation testing, motion sensitivity quotient (MSQ), and dizziness handicap inventory (DHI). A multiple comparison of the overall outcome measures showed no significant differences in group performance over an 8-week period. When individual outcome measures were compared, MSQ and DHI results at the end of the 8-week treatment period revealed less motion sensitivity and dizziness handicap in groups who received VR, with or without SR, as compared with the group who received ROM exercises. These results suggest that after a vestibular injury most patients can effectively utilize central compensation mechanisms to recover from such an injury, regardless of the type of therapeutic intervention used. On the other hand, the reduction in motion sensitivity and dizziness handicap for patients who received VR could indicate a more rapid and complete recovery for these patients. This investigation is continuing as a long-term follow-up study to determine whether there are any long-term benefits in participating in a VR program.     

Aquatic physiotherapy: a vestibular rehabilitation option

IntroductionVestibular rehabilitation is a fundamental resource for vestibular symptom control. Its performance in the aquatic environment is considered safe for the physical activities of the elderly, because they act simultaneously on musculoskeletal disorders and balance improvement.ObjectiveTo evaluate the effects of an aquatic physiotherapy protocol in individuals with peripheral vestibular alterations.MethodsThis was an interventional case study with a paired intentional sample of four subjects, who were selected for convenience. The subjects, all of them diagnosed with peripheral vestibulopathy, were submitted to twelve sessions of aquatic physiotherapy for vestibular rehabilitation, being evaluated for dizziness in three moments: initial, after six sessions and at the end of the sessions. The tests applied were: unipodal support to measure static balance, the Fukuda stepping test, which estimates the dynamic balance and the dizziness handicap inventory protocol, aimed at verifying how dizziness influences daily life.ResultsWhen analyzing the static balance, initially the individuals were in the adaptive and abnormal dimensions, and all reached normality at the end of the protocol. Regarding the dynamic balance, the individuals initially showed marked impairment in the angular deviation, mainly to the side of pathology (75% to the left and 25% to the right), achieving improvement at the end of the study. However, it failed to reach statistical significance. The dizziness handicap inventory showed a statistically significant difference in its totality (p = 0.0414), which addresses the physical, functional and emotional factors.ConclusionIn conclusion, the aquatic physiotherapy protocol for vestibular rehabilitation of patients with peripheral impairment was positively assessed by the participants, considering the improvement in dizziness (static and dynamic) and its impact on daily activities.     

Prediction of fall risk reduction as measured by dynamic gait index in individuals with unilateral vestibular hypofunction.

OBJECTIVE: To determine the effect of vestibular rehabilitation on reduction of fall risk in individuals with unilateral vestibular hypofunction and to identify those factors that predict fall risk reduction. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral center. PATIENTS: Forty-seven patients with unilateral vestibular hypofunction, aged 28 to 86 years, who were at risk for falls on initial assessment. INTERVENTION: All patients underwent vestibular rehabilitation including adaptation exercises, designed to improve gaze stability, and gait and balance exercises. MAIN OUTCOME MEASURES: Fall risk (Dynamic Gait Index), visual acuity during head movements (Dynamic Visual Acuity), and subjective complaints were measured initially, at 2-week intervals, and at completion of physical therapy. RESULTS: As a group, the patients had significantly reduced risk for falls (p <0.001) after rehabilitation. Time from onset of symptoms did not affect the efficacy of vestibular rehabilitation. Both older (> or = 65 yr) and younger (< 65 yr) adults showed significant reductions in fall risk with vestibular rehabilitation (p <0.001). However, a significantly greater proportion (Chi2= 0.016) of older adults remained at risk for falls at discharge compared with young adults (45% versus 11%). Initial Dynamic Gait Index and Dynamic Visual Acuity scores predicted fall risk reduction in patients with unilateral vestibular hypofunction. A model was developed using initial Dynamic Gait Index and Dynamic Visual Acuity scores to predict fall risk reduction. CONCLUSIONS: Vestibular rehabilitation is effective in significantly reducing fall risk in individuals with unilateral vestibular deficit. The model predicts fall risk reduction with good sensitivity (77%) and specificity (90%).     

Vestibular rehabilitation on a budget.

OBJECTIVE: This study was conducted to compare the results of an office-based vestibular rehabilitation program with the results from other larger programs in the literature. METHOD: Using a retrospective chart review, 138 dizzy patients seen in a tertiary medical centre were asked to perform directed exercises. Significant subjective improvement reported by the patients. RESULTS: Sixty-six percent of patients improved with this form of vestibular rehabilitation after 1 month. The results compare favourably with improvement rates from other centres in the literature with large, multidisciplinary teams. CONCLUSION: Vestibular rehabilitation therapy can be effectively administered from an office-based program.     

Balance dysfunction and recovery after surgery for superior canal dehiscence syndrome

OBJECTIVE To characterize (1) the impairment and recovery of functional balance and (2) the extent of vestibular dysfunction and physiological compensation following superior canal dehiscence syndrome (SCDS) surgical repair. DESIGN Prospective study. SETTING Tertiary referral center. PARTICIPANTS Thirty patients diagnosed as having SCDS. INTERVENTIONS Surgical plugging and resurfacing of SCDS. MAIN OUTCOME MEASURES Balance measures were assessed in 3 separate groups, each with 10 different patients: presurgery, postoperative short-term (<1 week), and postoperative long-term (≥6 weeks). Vestibular compensation and function, including qualitative head impulse tests (HITs) in all canal planes and audiometric measures, were assessed in a subgroup of 10 patients in both the postoperative short-term and long-term phases. RESULTS Balance measures were significantly impaired immediately but not 6 weeks after SCDS repair. All patients demonstrated deficient vestibulo-ocular reflexes for HITs in the plane of the superior canal following surgical repair. Unexpectedly, spontaneous or post-head-shaking nystagmus beat ipsilesionally in most patients, whereas contrabeating nystagmus was noted only in patients with complete canal paresis (ie, positive HITs in all canal planes). There were no significant deviations in subjective visual vertical following surgical repair (P =?.37). The degree of audiometric air-bone gap normalized 6 weeks after surgery. CONCLUSIONS All patients undergoing SCDS repair should undergo a postoperative fall risk assessment. Nystagmus direction (spontaneous and post-head-shaking) seems to be a good indicator of the degree of peripheral vestibular system involvement and central compensation. These measures correlate well with the HIT.     

Effects of vestibulo-ocular reflex exercises on vestibular compensation after vestibular schwannoma surgery.

OBJECTIVE: To assess vestibular function in a large group of vestibular schwannoma patients so that we could determine whether simple vestibular exercises speed vestibular dysfunction recovery after tumor removal surgery. STUDY DESIGN: A prospective investigation of the vestibular dysfunction experienced by patients in the first 12 weeks after surgery. SETTING: Vestibular investigation unit at a tertiary referral institution. PATIENTS: Sixty-five patients with identified vestibular schwannoma referred for preoperative vestibular investigations. Thirty-two men and 33 women, with a mean age 51 years (range, 24-77 yr). INTERVENTIONS: There were 27 control patients, 30 exercise patients, and 8 patients that had balance physiotherapy. Exercise patients began simple vestibulo-ocular reflex gaze stabilization exercises 3 days after surgery. MAIN OUTCOME MEASURES: Postoperative vestibular function testing was performed at 2 to 3, 6 to 7, and 10 to 12 weeks after surgery. Objective measurements of vestibular compensation status were as follows: spontaneous nystagmus and sinusoidal harmonic acceleration asymmetry and gain values. Dizziness Handicap Inventory questionnaires were used to assess subjective perceptions. RESULTS: The main findings were reduced dispersion in vestibulo-ocular reflex asymmetry at 2 to 3 weeks, reduced mean in asymmetry at 6 to 7 weeks, less dizziness/imbalance according to the Dizziness Handicap Inventory questionnaire, and that preoperative caloric tests did not predict postoperative severity of vestibular systems. CONCLUSION: This large study provided unique evidence that a program of simple vestibular exercises and education can speed the rate of compensation after vestibular schwannoma surgery.     

Vestibular rehabilitation therapy in children.

OBJECTIVES: Vestibular disturbances are underdiagnosed in children. However, balance impairment may compromise the normal development of affected children. The appropriate therapeutic approach has not been agreed on for this age group. Vestibular rehabilitation therapy has excellent results in adults, but very few data exist regarding its results in children. We evaluated through clinical assessment and computerized dynamic posturography the outcome of children with peripheral vestibular disturbances undergoing vestibular rehabilitation therapy and observed the influence of learning and of central nervous system maturation on posturography retest results. METHODS: Sixteen children (10 boys and 6 girls) with peripheral vestibular disorders (mean age, 8 yr 7 mo) constituted the cohort and were consecutively treated with vestibular rehabilitation therapy. Symptomatic children underwent pre- and posttreatment computerized dynamic posturography. Their outcome was clinically assessed. Another 16 asymptomatic children, paired by sex and age, underwent two computerized dynamic posturography procedures with the same time interval as that of the symptomatic group. RESULTS: All children completed the treatment. Total recovery of symptoms occurred in nine (56.3%) patients, whereas a dramatic partial recovery was observed in the remaining seven (43.7%) children. Posturography Conditions 5 and 6, the vestibular ratio of the sensory analysis, and the composite equilibrium score had a significant quantitative improvement after vestibular rehabilitation therapy. No adverse reactions occurred to the exercises. No statistically significant posturography changes were observed in the asymptomatic children. CONCLUSION: Vestibular rehabilitation therapy seems to be a safe and efficacious therapeutic option in children with peripheral vestibular disturbances.     

基于移动互联网的前庭康复训练指导平台的开发与应用

前庭康复训练是治疗前庭疾病、改善眩晕症状的重要手段。缘于此类患者数量较多、训练场地不足、康复师缺乏以及医疗用费等因素,前庭康复训练在各级医院的开展受到限制。随着智能手机和移动互联网的普及使用,居家康复锻炼、远程指导成为可能。基于B/S 模式结构进行设计,研发成功“前庭康复训练远程指导平台”,支持智能手机移动终端无线接入,分为IOS及安卓版本。该平台的建立为患者居家进行前庭康复功能锻炼远程指导、疗效评估及随访等提供更为便捷、顺畅有效的途径,提高前庭康复的效率和依从性,并降低前庭康复的技术壁垒、场地限制以及人力成本。论文对该平台的功能设计、相关技术实现以及运行效果论述。     

Vestibular rehabilitation therapy in combination with transcranial direct current stimulation (tDCS) for treatment of chronic vestibular dysfunction in the elderly: a double-blind randomized controlled trial

IntroductionDizziness and imbalance are common dysfunctions in the elderly. Vestibular rehabilitation therapy is an effective method to alleviate chronic dizziness in patients with vestibular dysfunction. Transcranial direct current stimulation has reportedly improved balance function in patients with vestibular dysfunction.ObjectiveThis study was conducted to investigate the therapeutic efficacy of vestibular rehabilitation combined with transcranial direct current stimulation in elderly patients with vestibular dysfunction.MethodsIn a double-blinded randomized controlled trial, 36 elderly patients with chronic vestibular dysfunction were randomly assigned to either vestibular rehabilitation and transcranial direct current stimulation (n = 18) or vestibular rehabilitation alone (n = 18) group. The transcranial stimulation protocol consisted of multisession bifrontal electrical stimulation of the dorsolateral prefrontal cortex (2 mA intensity and 20 min duration), followed by rehabilitation exercises. The vestibular rehabilitation protocol consisted of habituation and adaptation exercises combined with gait exercises during a three week period. The primary outcome of this study was the dizziness handicap inventory score, and the secondary outcomes were activities-specific balance confidence and Beck anxiety inventory scores.ResultsFor the dizziness handicap score, the repeated-measures analysis of variance showed a significant main effect of “time”, “stimulation” and stimulation × time interaction effect. There was a significant reduction in the overall dizziness handicap score with “time” for both the groups, which was more pronounced in the vestibular rehabilitation and electrical stimulation group. In terms of activities-specific balance confidence change scores, we found a significant main effect of “time” and “stimulation” main factors, but this effect for stimulation × time interaction was not significant. For the Beck anxiety score, we observed a significant main effect of “time”, but no evidence for the main effect of the “stimulation” factor.ConclusionBifrontal transcranial direct current stimulation in combination with vestibular rehabilitation therapy is a promising approach to improve chronic vestibular symptoms in the elderly.     

Clinical use of subjective visual horizontal and vertical in patients of unilateral vestibular neuritis.

OBJECTIVES: Subjective visual horizontal (SVH) and subjective visual vertical (SVV) used to assess otolith dysfunction and ipsilesional deviation of SVV and SVH in unilateral vestibular dysfunction is well known. The goal of this study was to investigate the clinical use of SVH/SVV and a dizziness scale in the clinical setting of acute unilateral vestibular neuritis. METHODS: Thirty-five patients with unilateral vestibular neuritis were investigated. Every patient was diagnosed by physical examination and electronystagmography. Subjective visual horizontal and SVV were assessed during the acute or subacute period; the Dizziness Handicap Inventory (DHI) and Vestibular Disorder Activities of Daily Living Scale (VADL) were used for a self-dizziness scale at the same time. All patients underwent rehabilitation therapy. Subjective visual horizontal/SVV and DHI/VADL were assessed again approximately 4 weeks later. Postrehabilitation SVH/SVV and DHI/VADL data were compared with initial data. RESULTS: Dizziness Handicap Inventory and VADL were improved after 4 weeks of rehabilitation, and the deviation toward ipsilesional side SVH and SVV was also improved. CONCLUSION: These results demonstrate that SVH and SVV correlated with clinical dizziness symptoms in patients with acute unilateral vestibular neuritis. Therefore, SVH and SVV would be useful tools for the evaluation of clinical manifestations of unilateral vestibular neuritis.     

Vestibular schwannoma growth rates in neurofibromatosis type 2 natural history consortium subjects.

OBJECTIVE: To determine the amount of growth in vestibular schwannomas in Neurofibromatosis type 2 (NF2) patients from diagnosis through short-term (up to 2 yr) and long-term (up to 4 yr) follow-up. STUDY DESIGN: Retrospective magnetic resonance imaging (MRI) films were obtained on subjects enrolled in the NF2 Natural History study and examined for changes in vestibular schwannoma size over time. SETTING: Data were collected from nine foreign and domestic NF2 centers, including hospital-based, academic, and tertiary care centers. SUBJECTS: NF2 patients with MRI data and at least one follow-up examination within 9 months to 2 years of diagnosis were included; n=56 patients with 84 lesions for evaluation of growth. INTERVENTION: Routine, clinically obtained, magnetic resonance images were digitized and measured using image management software. Short-term follow-up was defined as up to 2 years (n=84 lesions), and long-term follow-up was defined as 3 to 4 years (n=29 lesions). OUTCOME MEASURES: Vestibular schwannoma size was assessed using anterior-posterior, medial-lateral, and greatest diameter linear measurements. RESULTS: Vestibular schwannomas increased in size (at least 5 mm) in 8% of the vestibular schwannomas across short-term follow-up. At long-term follow-up, 13% of the tumors had increased in size. On average, schwannomas increased in greatest diameter 1.3 mm per year across short-term follow-up. CONCLUSION: Slightly greater than 1 in 10 diagnosed NF2-related vestibular schwannomas increased in size by at least 5 mm by 4 years of follow-up, if still untreated at that time.     

Technique for the assessment of vestibular compensation--clinical observation/quantitative neuro-otometry?]

PROBLEM: Reliable evaluation of vestibular compensation in indispensable to determine whether labyrinth surgery or vestibular neurectomy is indicated. It is also important for postoperative follow-up. Vestibular compensation can manifest itself differently in distinct frequency ranges. METHOD: Twenty volunteers were examined in five distinct situations of daily vestibular stimulation. Measurement of angular and linear head acceleration was performed using accelerometers fixed on the volunteers' head. A 200 Hz AD fed data to a PC database. FFT was used for data analysis. RESULTS: Stimulus frequency of the vestibular system varies between 0.01 and 2 Hz. Most of the patients suffering from vestibular lesions showed a reduced vestibulo ocular reflex (VOR) below 0.1 Hz. In all cases of unilateral vestibular function loss, there was a correlation between the symptoms during movement and the corresponding frequency range of the distinct motion pattern. Rotatory vestibular pendular testing was used to document vestibular disorders in patients who had normal findings in routine vestibular testing. DISCUSSION: Clinical use of rotatory vestibular pendular testing results must be performed using broad stimulus frequency spectra (0.01-0.06 Hz). This method must be used in preoperative examination before labyrinth surgery as well as in estimating individual tolerance for vestibular stimulation in daily situations.     

Vestibular disorders in presenile and senile patients

Vestibular function and dynamic vision were studied in healthy subjects over 60 years of age using functional tests based on computer stabilography. The vestibuloocular reflex was analysed in the test with highly active head shaking. A decline in vestibular function efficiency, somatosensory dissociations were found. Specific features of vestibuloocular interaction in the older patients are shown.     

Feasibility and effectiveness of providing vestibular rehabilitation for dizzy patients in the community

Since the majority of people with dizziness in the community are never referred for specialist testing and treatment, the purpose of this study was to investigate whether it was desirable and feasible to provide vestibular rehabilitation for this patient population. Demand for therapy was assessed by a survey of 9198 working age people randomly sampled from six general practices. One in 10 respondents reported current, handicapping dizziness, but fewer than 2% of those with dizziness severe enough to merit treatment proved suitable and willing to attend hospital for testing and rehabilitation. Nevertheless, vestibular rehabilitation was clearly beneficial for the 16 patients who completed the therapy programme, as their scores on measures of symptoms, disability, handicap and postural stability improved significantly post-therapy to near-normal levels. We conclude that there is a need for provision of vestibular rehabilitation in primary care for patients with dizziness in the community.