Section 3-Medical and Surgical Management. And Section 4- Rehabilitation Assessment and Management. Each section almost reads as a separate book. I read section four before section one without any difficulty in following the material. However, all you have to do is install the program, right click the icon, select 'Properties', 'Compatability', 'Compatability Mode', 'Windows 95', 'Apply'.
A must for any PT treating vestibular patients By Paul Neil Czujko This book presents in an orderly fashion the anatomy of the vestibular system, diagnosis and goes into detail regarding diagnostics and how to structure a vestibular evaluation. The CD is great addition as it reviews tests and procedures with video and audio. I use it as a valuable reference in the clinic frequently.
Thorough review of vestibular system. A great read prior to any vestibular course. Posting Komentar. Sabtu, 11 Oktober [S The vestibular group was taken through supervised adaptation and substitution exercises to improve gaze stability, whereas the control group performed saccadic eye movements against a Ganzfeld a large featureless background with their head stationary. Exercises were done 4 to 5 times daily for 20 to 30 minutes plus 20 minutes of gait and balance exercises for 4 weeks, with adherence monitored and progressed as indicated.
On average, there was no change in Dynamic Visual Acuity in the control group and no control subject achieved normal Dynamic Visual Acuity for their age. The same experimental design was used to examine the effect of exercises in patients with bilateral vestibular hypofunction. Thus, saccadic eye movement exercises did not facilitate recovery of gaze stability as measured by Dynamic Visual Acuity.
Aggregate evidence quality: Level II. Based on 1 level I and 2 level II randomized controlled trials examining whether one type of vestibular exercise is more beneficial than another. In addition, 2 level II studies compared a traditional vestibular exercise with a novel exercise.
Unknown; there is a potential for patients to perform an exercise that will not address their primary problems. Importance of identifying the most appropriate exercise approach to optimize and accelerate recovery of balance function and decreasing distress, improving functional recovery to activities of daily living, and reducing fall risk.
Possible exclusions include active Meniere disease or those with impairment of cognitive or general mobility function that precludes adequate learning and carryover or otherwise impedes meaningful application of therapy. On the basis of the few randomized trials, clinicians may offer targeted exercise techniques to accomplish specific goals for improvement in exercise programs eg, exercises related to gaze stability and visual motion sensitivity for improved stability of the visual world and decreased sensitivity to visual motion; head movements in a habituation format to decrease sensitivity to head movement provoked symptoms; and activities related to body sway control for improved general stance and gait.
Few studies have examined whether any one vestibular exercise is more beneficial than another. A few studies have compared a standard vestibular exercise eg, Cawthorne-Cooksey exercises with a novel exercise eg, moving platform practice.
Of the 14 randomized clinical trials initially thought to compare the standard vestibular exercise approaches gaze stabilization, adaptation, habituation, substitution, Cawthorne-Cooksey , only 3 actually compared different exercise approaches with vestibular rehabilitation for peripheral vestibular hypofunction. Two other randomized controlled trials examined the concept that particular exercises should be used to accomplish specific goals.
Both groups improved significantly in the Sensory Organization Test and symptom scores; however, the optokinetic stimulus group improved more in the symptom measures. Although the optokinetic stimulus group seems to have improved more in the Sensory Organization Test score, the customized exercise group had higher better scores to begin with and therefore there may have been a ceiling effect for that group. In a level II study, Clendaniel 62 studied 7 patients with chronic uncompensated unilateral vestibular hypofunction on the basis of caloric testing or clinical examination.
Both patient groups also performed balance and gait exercises and were provided a home exercise program. Both groups were to perform the exercises 3 times daily over a 6-week period. Exercise adherence averaged In this preliminary study, both exercise interventions resulted in improved self-reported ability to perform daily activities, decreased sensitivity to movement, and better visual acuity during head movements.
However, because of the small number of subjects in the study and the fact that some patients had normal values on the outcome measures at baseline, further research is strongly recommended. In another level II study, Szturm et al 63 examined postural stability Sensory Organization Test and vestibular asymmetry rotary chair and optokinetic testing in patients with chronic uncompensated unilateral vestibular hypofunction.
Patients were randomly assigned to perform either vestibular rehabilitation gaze stability and balance exercises performed in the clinic and as a home program or control exercises Cawthorne-Cooksey exercises performed only as an unsupervised home program.
The vestibular rehabilitation group showed improvement in both postural stability and vestibular symmetry, whereas those performing the Cawthorne-Cooksey exercises did not. The study, however, has several limitations. Second, the investigators examined vestibulo-ocular reflex gain asymmetry by rotational testing, which is insensitive to unilateral vestibular hypofunction.
Finally, because one group was supervised and the other group was not, the differences in outcome may be attributed to a supervision effect rather than to the type of exercise. Two studies provide support for using particular exercises for specific problems.
One, a level I study by McGibbon et al 64 randomly assigned 53 patients with vestibular hypofunction and documented gait and balance impairments to either a group-based vestibular exercise intervention or a group-based Tai Chi exercise intervention.
Subjects met once a week for 10 weeks in small groups for 70 minutes of exercise. The study demonstrated that balance exercises Tai Chi selectively improved whole body stability during a step-up and step-down test, whereas vestibular exercises adaptation and eye-head exercises selectively improved gaze stability. The role of severity of vestibular hypofunction unilateral vs bilateral is unclear. In a level II study, Jauregui-Renaud et al 65 compared the effectiveness of Cawthorne-Cooksey exercises, Cawthorne-Cooksey exercises plus training in breathing rhythm, and Cawthorne-Cooksey exercises plus proprioceptive exercises.
The outcome measures included disability Dizziness Handicap Inventory and static balance in patients with chronic vestibular hypofunction. Although all 3 groups showed improvement in Dizziness Handicap Inventory scores and in static balance, the group performing Cawthorne-Cooksey exercises plus breathing training was more likely to have a meaningful clinical improvement in Dizziness Handicap Inventory scores and the patients performing Cawthorne-Cooksey plus proprioceptive exercises had decreased sway during static balance tests.
Although not conclusive, the results from these 2 studies support the concept of exercise specificity in the treatment of patients with vestibular hypofunction. Pavlou et al 66 examined the effect of different virtual reality experiences on outcome in patients with unilateral peripheral vestibular hypofunction. Patients were randomly allocated to a virtual reality regime incorporating exposure to a static group S or dynamic group D virtual reality environment.
Participants practiced vestibular exercises, twice weekly for 4 weeks, inside a virtual crowded square environment. Both groups also received a vestibular exercise home program to practice on days not attending clinic. A third group D1 completed both the static and dynamic virtual reality training.
Outcome measures included the Dynamic Gait Index and questionnaires concerning symptom triggers and psychological state. Those groups who performed exercises within the dynamic virtual reality environment D and D1 had significantly better Visual Vertigo Scores than those who performed exercises inside the static virtual reality environment S.
In contrast, depression scores increased only in group S. The Dynamic Gait Index did not differ across groups; however, many subjects were already within the normal range before the initiation of the intervention. The investigators concluded that use of dynamic virtual reality environments should be considered as a useful adjunct to vestibular exercises for patients with chronic vestibular disorders and visual vertigo symptoms. Research Recommendation 4: There is sufficient evidence that vestibular exercises compared with no or placebo exercises is effective; thus, future research efforts should be directed to comparative effectiveness research.
Researchers should directly compare different types of vestibular exercise in large clinical trials to determine optimal exercise approaches.
Clinicians may offer supervised vestibular physical therapy in patients with unilateral or bilateral peripheral vestibular hypofunction. Aggregate evidence quality : Level II. Benefits: Possibly better adherence with a supervised exercise program. There is an increased cost and time spent traveling associated with supervised vestibular rehabilitation. Supervised vestibular rehabilitation appears to promote adherence and continued performance of vestibular exercises, which may lead to improved outcomes.
Persons with impairment of cognition or moderate-severe mobility dysfunction may need supervision to benefit from vestibular rehabilitation. People who are fearful of falling may not do well in an unsupervised exercise program. Patients who live at a distance may not be able to participate in supervised vestibular rehabilitation.
Several studies Levels I 63 and II 21 , 45 , 67 — 69 demonstrate that patients may respond better to customized, supervised rehabilitation than to generic exercises or solely a home program. The reason for these differences may be that supervised vestibular rehabilitation promotes adherence and continued performance of vestibular exercises, which may lead to improved outcomes. Two studies examined the effect of supervision during the acute stages of vestibular dysfunction with different outcomes.
Kammerlind et al 70 in a level I study compared a supervised versus a home training group of vestibular exercises that included gaze stability, balance, and gait exercises. All patients received oral and written instructions for the vestibular exercises in the hospital and were instructed to exercise 15 minutes per day. The supervised group received 3 additional supervised physical therapy sessions in the hospital. Once discharged home, the supervised group received 10 additional supervised visits.
At 1 week, 10 weeks, and 6 months postdischarge, both groups improved in measures of balance and symptoms of vertigo, but were not different from each other. A level I study in postsurgical acute patients compared patients who started exercises in the hospital with a control group who did no exercise. The average age of Kammerlind et al's participants was 52 years, so the study outcomes may reflect the age of patients versus the role of supervision.
Teggi et al, 45 in a level II study, compared a supervised exercise program with usual activity for patients hospitalized for an acute episode of vertigo. Twenty-five days later, the group that underwent a supervised exercise program had better outcomes on all measures Dynamic Gait Index, computerized Clinical Test of Sensory Interaction on Balance, Dizziness Handicap Inventory, and a Visual Analog Scale for anxiety , with the greatest change noted in the Dynamic Gait Index.
The results of this study are confounded by differences in exercises vestibular exercises vs daily activities and may explain the difference in outcomes compared with Kammerlind et al. Kao et al, 67 in a level II study, compared supervised and home-based unsupervised vestibular rehabilitation. Both groups performed seated and standing eye movements and adaptation exercises, as well as walking with head turns.
The supervised group received an initial evaluation and individualized treatment plan followed by three minute sessions per week with a physical therapist. The home group participants received an individualized treatment plan on the basis of an initial evaluation and were not seen again by the physical therapist until outcomes were assessed at 2 months. The subjects self-selected their treatment group, with 28 choosing supervised rehabilitation and 13 choosing home-based or unsupervised rehabilitation.
There are several limitations of this study that limit generalizability including small sample size, no randomization, and assessors that were not blinded to group. Optokinetic training for visual vertigo was utilized in a level I study. All subjects also received a customized program of gaze and postural stability exercises to perform at home. Pavlou et al 71 concluded that supervision promotes greater adherence and improvements in postural stability and psychological state.
In a subsequent study, she reported that additional advice or encouragement might improve adherence in a home-based program. Monitoring of the exercise program may have value, as demonstrated by Shepard et al 73 in a level III study. The investigators reported that nausea, emesis, and vertigo provoked by exercises could be managed by stopping the exercise session and resuming the exercises at the next session.
In most cases, they found this approach to successfully allow continued participation. In those cases where this was not successful, they suggested that antiemetic or vestibular suppressant medication may be required. Recommendations for use of antiemetic drugs should be carefully considered because of concerns about slowing central compensation. For example, Strupp et al 42 limited antiemetic use to a maximum of 3 days because of concerns for slowed vestibular compensation.
Failure to return to the clinic, 66 , 71 , 74 failure to comply with the exercise program, 67 , 74 and illness have been noted as reasons for why people do not complete a program of vestibular exercises. In Pavlou's work, those with an unsupervised exercise program had higher dropout rates. Research Recommendation 5. Researchers should include measures of adherence to understand the impact of supervision.
Researchers need to incorporate intent-to-treat research designs to understand dropout rates related to supervision. Aggregate evidence quality: Level V. Based on lack of direct evidence on exercise dose. Best practice based on the clinical experience of the guideline development team and guided by the evidence. Risk of increased nausea and possible emesis when exercises are performed during the most acute stage. Some physicians may want to delay exercises during the early postoperative stage in some patients because of risk of bleeding or cerebrospinal fluid leak.
Benefit of gaze stability exercises in patients with unilateral vestibular hypofunction has been demonstrated in numerous level l and level II studies; however, the frequency and intensity of the exercises is based on extrapolation from research studies rather than based on direct evidence.
There are few studies to date that have examined in what ways if any exercise dose frequency and intensity affects outcomes in patients with unilateral or bilateral vestibular hypofunction. Two studies examined the influence of exercise intensity on outcomes. One group performed exercises with rapid head movements ie, approximately Hz and the other group performed exercises with slow head movements approximately 0. They reported both groups improved equally in vertigo intensity, vertigo frequency, and on a functional repetitive head movement task, suggesting that the dose intensity frequency of head movement was not a factor in recovery.
There are some limitations to the study that confound the interpretation of the data however. First, it is not clear that the groups were equivalent at baseline on the timed repetitive head movement task and second, the data suggest that the time to perform the repetitive head movement task did not improve until 4 months after initiation of exercises.
Although far from ideal, some information on exercise dose can be found by comparing the findings from multiple studies. Acute and subacute postoperative patients: Two level I and 1 level II studies have examined the effect of gaze stabilization exercises on the recovery of patients during the early postoperative period after vestibular schwannoma resection.
Chronic unilateral vestibular hypofunction: Four studies 2 level I and 2 level II , each examining the effect of vestibular rehabilitation on outcomes in patients with chronic unilateral vestibular hypofunction, included sufficient details on the type, frequency, and duration of exercise to provide some guideline as to exercise dose in these patients.
In these studies, patients performed the gaze stability exercises 3 to 5 times per day for a total of 20 to 40 minutes each day. The data suggest that a minimum performance of the exercises 3 times per day for a total of 20 minutes daily may be sufficient to induce recovery.
Research Recommendation 6. Researchers should examine the impact of frequency, intensity, time, and type of exercises on rehabilitation outcomes. Researchers should determine the difficulty of exercises and how to progress patients in a systematic manner.
Clinicians may use achievement of primary goals, resolution of symptoms, or plateau in progress as reasons for stopping therapy. Aggregate evidence quality : Level V. Based on extrapolation from methodology and results in 69 studies, it may be advisable to consider the following in the decision to stop treatment:. More efficient management of treatment duration, avoiding cessation of treatment before optimal recovery is achieved, or continuing treatment for unreasonably protracted periods.
Protracted treatment is costly to the payer, the patient, and the clinician who are not seeing documented improvement, and to other patients who are waiting to receive treatment. No concrete stopping rules have been explored in the research; however, numerous level I through IV studies provide comments and findings that can assist in the decision-making process. It is the patient's decision whether or not to participate in vestibular rehabilitation and when to stop vestibular rehabilitation. Patients with impaired cognition or moderate to severe mobility dysfunction may need a greater number of treatment sessions, so using the treatment duration based on research which typically excludes these patients may not be appropriate.
Patients with moderate to severe motion sensitivity may also benefit from a greater number of treatment sessions. In a level II study, patients taking vestibular-suppressant medication required additional treatment sessions 11 weeks vs 9 weeks before plateau. There are no studies that have specifically examined decision rules for stopping vestibular rehabilitation in those with unilateral or bilateral peripheral vestibular hypofunction. An investigator's a priori decision relative to the research design determines the length of the intervention; thus, the duration of treatment is protocol-driven and not based on patient outcomes.
Furthermore, the length of the study intervention may affect a patient's willingness to participate in the study. Thus, we cannot extrapolate from research studies to create clinical stopping rules on the basis of current research design.
Implicit reasons for stopping therapy in a clinic setting ideally include the patient no longer being symptomatic, goals being met, or a plateau being reached. Deterioration of clinical status was cited as a reason for 9 of the 37 patients showing an increased Dizziness Handicap Inventory score in a level II study by Perez et al 80 and seems an obvious reason to pause or stop treatment; however, if worsening of subjective complaints is a factor in the consideration to stop treatment, the following studies may provide some guidance.
A level IV study found that nausea, body shift, dizziness, and stress were increased during first 2 weeks of intervention, but subsided by week 2. However, more persistent worsening symptoms should be carefully considered a reason to discontinue therapy. Numerous factors were identified by researchers to exclude patients from studies or to drop subjects from study participation.
These factors may also provide guidance for stopping or deferring therapy if a patient is not showing progress. Factors include 1 progressive, fluctuating, or unstable vestibular conditions ie, vestibular schwannoma, episodes of spontaneous vertigo, unrepaired perilymphatic fistula, and active Meniere disease ; 2 musculoskeletal conditions affecting the ability to stand or perform exercises; 3 central nervous system or other neurologic diseases or conditions eg, head injury affecting balance, motor control, muscle strength, or somatosensation; 4 significant cardiac problems; 5 severe visual disorders or blindness; 6 cognitive impairment affecting comprehension; 7 severe migraine; and 8 psychological conditions.
In Shepard et al's level II study in , those with head injury showed a substantially less reduction in symptoms than the rest of the subjects and comprised a significantly higher percentage of those showing no change or worsening. Pretreatment disability could also be considered when deciding whether or not to discontinue therapy in a patient, as patients with high disability scores may be more resistant to change and may be less likely to improve on the basis of 2 level II studies 68 , 82 and 2 level III studies.
On the basis of expert opinion extrapolated from the evidence, clinicians may consider providing adequate supervised vestibular rehabilitation sessions for the patient to understand the goals of the program and how to manage and progress themselves independently.
However, the researchers did not provide justification for the length of treatment time chosen for their studies. As a general guide, persons without significant comorbidities that affect mobility and with acute or subacute unilateral vestibular hypofunction may only need 1 time per week supervised sessions for 2 to 3 sessions; persons with chronic unilateral vestibular hypofunction may need 1 time per week supervised sessions for 4 to 6 weeks; and persons with bilateral vestibular hypofunction may need a longer course of treatment 1 time per week supervised sessions for weeks than persons with unilateral vestibular hypofunction.
Finally, on the basis of expert opinion, the advisory panel recommends that before stopping therapy for patients who remain symptomatic or have not met their goals, consultation with another vestibular physical therapist colleague would be advisable. Research Recommendation 7: Researchers should determine optimal duration of vestibular rehabilitation for favorable outcomes and the factors that impact functional recovery.
Aggregate evidence quality : Age : Level I. Based on 4 level I randomized controlled trials and 2 level II quasiexperimental studies. Sex : Level III. Time from onset : Level III. Based on 1 level I randomized controlled trial and 3 level III studies, 1 with contradictory results to the others. Comorbidities : Level III.
Use of vestibular-suppressant medications: Level III. Peripheral neuropathy may increase risk of falling and negatively impact rehabilitation outcomes. Vestibular rehabilitation has been shown to improve outcomes regardless of the time from onset; however, the potential harm decreased quality of life, falls to initiating rehabilitation later warrants initiating rehabilitation as soon as possible.
Little evidence is available to make decisions about how to consider factors that may affect outcomes. Cost and availability of patient time and transportation may play a role, especially with older patients who may have transportation issues. Several non-disease-related modifying factors—including age, sex, time from onset of symptoms to start of rehabilitation, comorbidities, and use of vestibular-suppressant medications—have been evaluated for their impact on vestibular rehabilitation outcomes.
Age: Increased age does not affect potential for improvement with vestibular rehabilitation. Clinicians should offer vestibular rehabilitation to older adults with the expectation of good outcomes.
Sex: Sex may not impact rehabilitation outcomes and clinicians may offer vestibular rehabilitation to males and females with expectation of similar outcomes.
Evidence quality: III; recommendation strength: weak. Time from onset acute : Earlier intervention improves rehabilitation outcomes; thus, vestibular rehabilitation may be started as soon as possible after acute onset of vertigo. Time from onset chronic : Vestibular exercises have been shown to improve outcomes regardless of the time from onset; however, the potential for harm related to decreased quality of life or falls suggests that clinicians may initiate rehabilitation as soon as possible.
Comorbidities: Anxiety, migraine, and peripheral neuropathy may negatively impact rehabilitation outcomes. Vestibular-suppressant medications: Long-term use of valium or meclizine may negatively impact patient recovery. Several non-disease-related modifying factors have been evaluated in various studies. These factors include age, sex, time from onset of symptoms until starting vestibular rehabilitation, comorbidities, and use of vestibular-suppressant medications.
The level of evidence for these studies ranged from level I to level III. Eleven studies evaluated the effect of age and none demonstrated a significant effect of age on the efficacy of vestibular rehabilitation. Six studies evaluated the influence of age on vestibular rehabilitation in patients with unilateral vestibular hypofunction; of these, 3 studies had an evidence level of I, 19 , 40 , 83 1 study had an evidence level of II, 69 and 2 studies had an evidence level of III.
Three studies evaluated the effect of sex, and none demonstrated a significant effect of sex on the efficacy of vestibular rehabilitation. Two of these—1 level II 69 and 1 level III 2 —evaluated the influence of sex on vestibular rehabilitation in patients with unilateral vestibular hypofunction. One level II study evaluated the influence of sex on vestibular rehabilitation in patients with various diagnoses including both peripheral and central vestibular deficits.
Two level I studies examined the effects of vestibular exercises solely in the acute stage after resection of vestibular schwannoma. Herdman et al 18 started vestibular exercises 3 days postsurgery and continued until discharge from the hospital.
Participants randomized to receive gaze stability exercises were less symptomatic and had better postural stability at discharge than the placebo group. Enticott et al 16 compared a cohort of patients who were randomized to vestibular exercises gaze stability exercises versus a control group starting on postoperative day 3. The vestibular group had lower perceived disability based on the Dizziness Handicap Inventory over the course of 12 weeks.
Six studies of patients with chronic vestibular hypofunction evaluated the effect of time from onset of symptoms until starting vestibular rehabilitation. Four studies evaluated patients with unilateral vestibular hypofunction with conflicting results. One level III study indicated that earlier intervention produced better results. A level II study of patients with various diagnosis including both peripheral and central vestibular deficits also found no effect of time from onset of symptoms until starting vestibular rehabilitation.
Five studies evaluated the effect of comorbidities on response to vestibular rehabilitation. Two studies evaluated the influence of anxiety. In a study of patients with unilateral peripheral vestibular deficits, anxiety was found to result in decreased balance confidence on the basis of level III evidence. A single study reported a negative effect of peripheral neuropathy on vestibular rehabilitation in patients with peripheral vestibular disorders on the basis of level II evidence.
Aranda et al 89 examined a mixed population of individuals with unilateral or bilateral vestibular hypofunction and diabetes with or without peripheral neuropathy. They found that individuals with peripheral neuropathy had no improvement on measures of standing balance with eyes open and closed on a firm surface, and eyes open on a compliant surface; individuals without peripheral neuropathy demonstrated significant improvements in these test conditions.
These findings suggest that peripheral neuropathy may have a negative impact on recovery of function. Two studies 1 level I 90 and 1 level III 91 investigated the impact of migraine on rehabilitation outcomes and found that individuals with vestibular dysfunction and migraine had poorer outcomes in terms of quality of life as measured by the Dizziness Handicap Inventory.
Another level I study reported that patients with migraine improved in symptoms of visual vertigo more than patients without migraine. Two studies have examined the impact of medications on outcomes. A level II study found that patients with vestibular hypofunction who were treated with valium or meclizine daily had no improvement in postural sway over a 6-week treatment period.
Another study, on the basis of level III evidence, reported that patients with various disorders who were using centrally active medications, such as vestibular suppressants, antidepressants, tranquilizers, and anticonvulsants, required a longer duration of therapy to achieve the same benefit as compared with patients who were not using medications. Research Recommendation 8. Researchers should perform longitudinal studies.
Researchers should examine time from onset and see whether it affects short- and long-term outcomes. Clinicians should offer vestibular rehabilitation to persons with peripheral vestibular hypofunction. Based on randomized trials and descriptive studies. There are improved quality of life and psychological outcomes in persons undergoing vestibular rehabilitation when compared with controls who receive sham or no exercise interventions. Neck pain, motion sickness, and nausea have been reported as side effects of rehabilitation and these can affect quality of life.
Dizziness as a side effect of the exercises could increase psychological distress in some patients. Preponderance of benefit, although not all patients improve with vestibular rehabilitation.
There is sufficient evidence of improved quality of life and reduced psychological distress with vestibular rehabilitation. Cost and availability of patient time, location of the vestibular rehabilitation clinic, and transportation may play a role.
Although vestibular rehabilitation was not provided, Sun et al 92 recently reported via a quality of life survey that persons with bilateral vestibular loss had impaired quality of life plus loss of work days as a result of their dizziness.
Although the Dizziness Handicap Inventory was designed to measure the handicapping effects of dizziness, it has also been used as a measure of quality of life to record improvements over time. The improvements in the Dizziness Handicap Inventory and the Activities-Specific Balance Confidence scale suggest that persons are less dizzy and have improved perception of balance after a course of vestibular rehabilitation. Occasional mentions were made about side effects of the vestibular rehabilitation program and that not all patients improve.
Herdman et al 2 recently reported in a level III study that anxiety and depression were associated with lower balance confidence scores, a quality of life measure in persons with unilateral hypofunction. This suggests that coexisting anxiety and depression might potentially diminish potential beneficial effects of an exercise program. Cohen and Kimball, 75 in a level II study, reported nausea as a side effect of the exercise program, which could affect quality of life.
Almost half of their subjects had central vestibular disorders. Meli et al 99 level III studied 42 people prospectively and followed up at 6 months to determine whether they had improved after a course of vestibular rehabilitation. The Medical Outcomes Study 36 item-short form improved in their subjects, except bodily pain and vitality.
Younger subjects reported worse Medical Outcomes Study 36 item-short form scores, suggesting that dizziness may have more effect on their lives with work and possibly a busier schedule than the older adults studied. Return to work is an important measure of the benefit of any exercise program; however, virtually no researchers have incorporated a measure of return to work.
Chen et al, 81 in a level IV trial, reported that in 3 of 3 of their subjects they were able to return to work and drive. All had chronic symptoms before starting the Wiimote gaze stabilization exercise program. Improvements in driving have been noted in others with chronic unilateral hypofunction after an exercise program.
This disability scale includes ability to work as a portion of the instrument, yet no studies specifically report how frequently people are able to return to work effectively after vestibular rehabilitation level II: Giray et al, 50 Shepard et al, 68 Telian et al 82 ; level III: Shepard et al, 73 Telian et al Pavlou et al also reported positive changes on the Hospital Anxiety and Depression—A and B Scale plus the Spielberger State Trait Anxiety Inventory, suggesting that after rehabilitation their subjects were less anxious.
Teggi et al 45 reported that a Visual Analog Scale for anxiety improved when compared with control subjects at 25 days posthospitalization for acute vertigo level II.
The exercise group participated in 10 sessions that included dynamic posturography training and gaze stabilization exercises. There is emerging evidence that psychological distress and anxiety are decreased with exercise in persons with vestibular hypofunction.
Research Recommendation 9. Researchers should examine the concept of return to work. Areas for study include job requirements that may be difficult for patients with vestibular hypofunction, job modification, or assistive technology to allow return to work, criteria for return to work or disability assignment, indicators for return to safe driving. The following strategies are provided as suggestions for clinicians to implement the action statements of this CPG, but are not an exhaustive list.
Many variables affect the successful translation of evidence into practice, and clinicians need to assess their own practice environment and clinical skills to determine the best approach to implement the action statements as individuals. Build relationships with referral sources to encourage early referral of persons with peripheral vestibular hypofunction.
Share the JNPT Perspectives for Patients that accompanies this article with patients and others who are interested in learning about the management of dizziness related to vestibular disorders. Researchers should examine rehabilitation outcomes in children with confirmed vestibular dysfunction on the basis of vestibular laboratory tests.
Research Recommendation 4: There is sufficient evidence that vestibular exercises compared with no or placebo exercises are effective; thus, future research efforts should be directed to comparative effectiveness research. A history of inner ear problems 5. All of these techniques "involve some degree of innovative technology to assess treatment effectiveness, measurement of vestibular function, or reveal behavior in people with vestibular dysfunction," Drs.
Schubert and Ryan write. In the begining please aviod from doing the full step at the same session. Once all the movement succussfully done, you can practice the whole 20 movement at the same time. This Bal Ex modul can be completed after 2 weeks till 5 months. Please dont do the exercise or session if you have the symptom of : - Chest pain - Shortness of breath - Felling fainting - Severe neck or back injury Contraindication for this therapy Low blood pressure Medication reactions other than ototoxicity Migraine associated vertigo although it has been reported to be helpful nonetheless, e.
P and late latency response P1 and N1 did show some improvement after using Bal Ex. Plasticity 2. Formation of internal models 3. Learning of limits 4. Sensory weighting Factors that lead to poor compensation?
Handbook of vestibular medicine. London: Whur Publishers, Bal Ex Zuraida-shah rotatory chair 4. Wheelsaver 6. Bal Ex Foot 7. Wheelsaver is an automatic control device that can be used in any existing wheelchair or a new wheelchair.
With low cost, patients are able to own an electric wheelchair or automated to facilitate their movement. As we note an electric wheelchair very high price and some fetch more than RM 10, Gold Medal award for Zuraida z et al.
Open navigation menu. Close suggestions Search Search. User Settings. Skip carousel. Carousel Previous. Carousel Next. What is Scribd? Explore Ebooks. Bestsellers Editors' Picks All Ebooks.
Explore Audiobooks.
0コメント