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by Diane Parrish, PT Common Symptoms of Vestibular Dysfunction

izziness has multiple possible causes.

toms may also be a result of head trauma, temporal bone fracture, acoustic neuroma, use of antibiotics such as gentimiacin, and unknown etiologies.

When people experience difficulties with dizziness, balance, and related symptoms, the everyday experiences of walking in a crowd, riding in a car, or shopping in a store can be


Initially, the patient may experience constant symptoms. Over time, the symptoms may persist and be exacerbated by head movements or walks in visually stimulating environments such as the grocery store or a crowd of people. Vision might become blurred or bounce with head movement (oscillopsia). Disequilibrium is common due to an altered vestibular input. Walking in the dark and on uneven surfaces is usually more challenging. The person may require an assistive device to aid for safety during walking. The symptoms of dizziness may persist over several months, especially if the person is on a vestibular suppressant.
Inability to Concentrate Decreased Neck Motion Headaches Fatigue Feeling that the World Is Spinning Uneven Gait Inability to Walk in a Straight Line Loss of Balance

85% of dizziness is the result of a peripheral vestibular system disorder and can be treated with occupational and physical therapy.

difficult. If your patients are experiencing these symptoms, it is important for them to realize they are not alone. Dizziness is

the third most frequent reason people seek medical attention and 85% of dizziness is the result of a peripheral vestibular system disorder and can be treated with occupational and physical therapy.

If available, the therapist will refer A Unilateral Vestibular Loss (UVL) or a vestibular hypofunction is one specific diagnosis that has symptoms of dizziness. Any weakness in the vestibular system is considered a hypofunction. In the case of a UVL, the hypofunction is affecting only one of the paired vestibular organs (semicircular canals) or the vestibular nerve. The patient will usually have a history of abrupt-onset dizziness which often follows a viral infection, upper respiratory infection, or inner ear infection. UVL sympto an electronystagmography (ENG) test from an otolaryngologist to assist in determining the extent of damage and selecting an appropriate treatment. An MRI is used to rule out a tumor. The therapist performs clinical tests to assess balance, strength, oculomotor control, and dynamic visual acuity (visual acuity when moving the head). A treatment program is tailored for each person based on the deficits noted during these clinical tests.
Oscillopsia (difficulty focusing eyes when moving ones head)

About the Author Diane Parrish, PT, has been conducting assessments and developing individual treatment plans for people with vestibular disorders since 1995. Diane has completed both the Vestibular Rehabilitation Competency Course and the Advances in Vestibular Rehabilitation Recertification Course at Emory University under the direction of Susan Herdman, PT, PhD, FAPTA. The course instructors were leading professionals from universities around the country. The course content included diagnostic testing, differential diagnosis, research findings, and evidencebased treatments for various conditions, such as: vestibular hypofunction, benign paroxysmal positional vertigo, central vestibular disorders, cerebellar ataxia, balance deficits, cervicogenic dizziness, acoustic neuroma, post-surgical care and psychogenic causes of dizziness. To obtain competency, participants passed a practical exam, written exam and video exam. Diane is a member of VEDA, the Vestibular Disorder Association. She is also a member of the American Physical Therapy Association.

any studies have supported the effec-

Because the vestibular system is sensitive to context for the frequency of head movements, the treatment must use varying speeds of head movement (Lisberger et al., 1983). Shepard and Telian, 1995, demonstrated that a specific, customized vestibular program is superior to a generalized exercise program for improving dizziness and dynamic posturography, and decreasing motion sensitivity and asymmetry of vestibular function. Herdman et al., also found less disequilibrium after vestibular exercises. Physician diagnostic testing and diagnosis coordinates with vestibular rehabilitation to significantly reduce the symptoms of patients with a unilateral vestibular loss.

tiveness of exercises to reduce the symptoms of a UVL (Paige, 1992; Stzurm et al., 1994; Horak et al.,

a specific, cus- 1992). The primary tomized vestibu- approach is through lar program is adaptation exercises. The exercises superior to a generalized exer- are designed to change the brains cise program
interpretation of vestibular inputs and improve the accuracy of that interpretation to alleviate the dizziness and improve the vestibular and oculomotor interaction. Adaptation of the vestibular system is induced by retinal slip during head movements. (Gauthier et al., 1975; Miles et al., 1983; Herdman, 1995).

Gauthier, G.M., Robinson D.A., Adaptation of the human vestibuloocular reflex to magnifying lenses, Brain Res. 1975; 92:331-335. Herdman, S.J., Clendaniel, R.A., Mattox, D.E., Holliday, M.J., and Niparko, J.K., Vestibular adaptation exercises and recovery: Acute stage after acoustic neuorma resection, Otolaryngol Head and Neck Surgeon 1995; 113:77-87. Horak, F.B., Jones-Rycewicz, C., Black, F.O., Shumway-Cook, A., Effects of vestibular rehabilitation on dizziness and imbalances, Otolaryngol Head and Neck Surgeon 1992; 106:175-180. Lisberger, S.G., Miles, F.A., and Optican, L.M., Frequency-selective adaptation: evidence for channels in the vestibuloocular reflex, J Neuroscience 1983; 3:1234. Paige, G.D., Senescence of human visual-vestibular interaction 1. Vestibuloocular reflex and adaptive plasticity with aging, J Vestibular Res 1992; 2:133-151. Shepard, N.T., and Telian, S.A., Programmatic vestibular rehabilitation, Otolaryngol Head and Neck Surgeon 1995; 12:173. Szturm, T., Ireland, D.J., LessingTurner, M., Comparison of different exercise programs in the rehabilitation of patients with chronic peripheral vestibular dysfunction, J Vestibular Res 1994; 4:461.