BALANCE AND VESTIBULAR REHABILITATION

Presented by: Neha tabbassum Khan M.P.T. 1st yr(Neuro) nehatabbassum@gmail.com

OF MOVEMENT TO ACHIEVE A GOAL REQUIRING UPRIGHT POSTURE.

IT IS ABILITY TO CONTROL Definition BASE OF SUPPORT IN GIVEN COG OVER THE
SENSORY ENVIRONMENT.(1)

VESTIBULAR SYSTEM IS RESPONSIBLE FOR MAINTAINING BALANCE,
POSTURE AND THE BODY'S ORIENTATION IN SPACE. THIS SYSTEM ALSO REGULATES LOCOMOTION AND OTHER MOVEMENTS AND KEEPS OBJECTS IN VISUAL FOCUS AS THE BODY MOVES(2)

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. ‡Parietal & Insular regions of Cortex. ‡VOR. .Introduction Peripharal Sensory Perception Somatosensory System Visual System Vestibular System ‡ Labryinths ‡Otoliths Central Sensory Perception ‡Through Brainstem ‡Connections between vestibular nu.Thalamus & Cerebellum. Reticular formation.

Gaze Stabilization Smooth Pursuit Visual Tracking ‡VSR. .role of Semicircular canals & otoliths.VOR. Automatic Postural Responses ‡Ankle strategy ‡Hip strategy ‡Suspensory strategy ‡Stepping strategy Anticipatory Postural Adjustments ‡A response in advance to counteract the coming forces. Volitional Postural Movements ‡These are under conscious control.Motor Components Of Balance Reflexes.

Examination History ‡Dizzinessvertigo. Tests & Measures ‡VAS ‡Dizziness handicap Inventory ‡Motion Sensitivity Quotient Physical examination‡Observation of Nystagmus ‡Head Thrust Test . ‡Dysequillibrium ‡Oscillopsia . ‡Duration ‡Circumstances of symptoms. lightheadedness.

‡Dynamic visual Acuity Test.Multidirectional Reach. which is based on the visual. 2004) Sensory Organization Test. 2004) .Hallpike. Balance Tests: Quite Standing. Sharpened Rhomberg¶s Test.Rhomberg¶s Test. Functional Reach Test.. & vestibular systems to maintain standing balance (Chaudhry et al. (Dieterich. Active Standing.Dix Maneuver .This test provides an outcome variable called an equilibrium score. proprioceptive.‡Head shaking Induce nystagmus ‡Positional Testing. One leg Stand Test.

Functional Scales‡Berg balance Scale ‡Timed Up and Go Test. Houglum. 1999. 2005 . Clark. (Carmeli et al. 2002) ‡Dynamic Gait Index ‡Four Square Step Test. (McCrady & Amato.. 2004. 2004) Anemaet & Moffa-Trotter.

.INTERVENTIONS Benign paroxysmal positionl vertigo ‡Canalith Repositioning Maneuver(CRM).

‡Liberatory (Semont) maneuver .

‡Brandt-Daroff Exercises .

Unilateral Vestibular Dysfunction Gaze stability exercises .

Sitting. (Gabilan et al) . Head. ‡Graded. Standing ‡Shoulder & Trunk ‡Sit to Stand ‡Walking up and down slope/steps Postural stability exercises. eyes open to eyes closed ‡Eye.slow to quick.Motion sensitivity training Cwathrone Cooksey Exercises-habituation exercises (1944). Aquatic physiotherapy.in Lying.

‡Balance exercises. ‡Exercise in pool. ‡Enhancement of somatosensory and vision to maintain postural stability.‡Bilateral Vestibular Hypofunction ‡Gaze stability exercises. .

Virtual Reality (2007 Cochrane review claimed that this study had been the only study which reached statistical significance in comparing different forms of vestibular rehabilitation) oTai chi Tai Chi was found to balance improvement via the vestibular component of the sensory organization test in healthy.oComputer-aided rehabilitation. 2004) oElectrotactile stimulation (Camila de Giacomo et al 2007) . elderly subjects (Tsang & Hui-Chan.

Central Vestibular Hypofunction ‡ Ensure fall prevention strategies and safety precautions. ‡Follow up. ‡ Patient instructions for Home Exercises. ‡Patient education is very important. ‡Recovery for bilateral loss is six month or more. ‡Restricting movement may delay recovery. ‡Head movement should be encouraged. . Points to consider. ‡Recovery with unilateral loss can occur within 6-8 weeks. ‡ Educate patient in compensatory strategies to assist gaze stability. ‡Supervised exercise works best. ‡Rehabilitation should begin early.

1992 ‡Three groups of patients with chronic vestibular complaints (VRT. et al.Does VRT really Works? Horak. general activity) ‡Those who used VRT showed the greatest improvement in functional performance ‡General Activity improved to a lesser degree ‡Medicated showed the least improvement Fujino. tranquilizers. and anticonvulsants achieve the same level of compensation as patients not on meds ± length of therapy significantly longer on medications . 1996 Two groups: Medication and Medication with VRT 8-weeks ± exercise with medication had less symptoms Shepard. medication. et al. 1990 Patients taking vestibular suppressants. antidepressant.

2002) . et al. Plasticity ± changes in central connections to compensate for peripheral disturbances (Wriseley et al. regardless of age. 1995 ‡General VRT versus Customized Programs ‡64% using general therapy had complete resolution ‡85% using a customized had complete resolution Efficacy of Vestibular Rehabilitation (Review) (Whitney. Telian and Shepard. 2000) ‡Review of 87 articles on VRT ‡PNS disorders that are stable demonstrate better outcomes than CNS ‡PT intervention works in most cases of vestibular disorders.

Badaracco. Home Program (Used DHI and VAS) ‡Prospective Study ‡N=125 ‡Conclusion: Supervised demonstrated improved DHI and VAS scores ‡Regardless of age. G.Efficacy of VRT on Chronic ULV Dysfunction (2003) ‡Purpose: Supervised vs. Number 3.. Number 3/March 2006 . A. Vestibular rehabilitation therapy seems to be a safe and efficacious therapeutic option in children with peripheral vestibular disturbances.) Volume 126. 2005 Jul. D. E. De Angelis.. Tufarelli. pp.26(4):699-703). 259-266(8) . Vestibular rehabilitation and 6-month follow-up using objective and subjective measures (Meli. gender. (Otol Neurotol. Zimatore. C.. or disability level Vestibular rehabilitation therapy in children..

Improvement in objective test results was also seen. These results were stable at follow-up.All patients showed an improvement in quality of life and a reduction in handicap due to dizziness.) .a cognitive process where one learns what to expect from ones actions. An example of this is a recent study by Herdman et al (2007) showing recovery of better vision in persons with bilateral vestibular loss was attributed to "centrally programmed eye movements". Formation of internal models -. Cochrane Review BPPV ± Epley Maneuver helps reduce vertigo VRT for ULV Currently in protocol (Cochrane Database of Systematic Reviews 2007. but there was no correlation between subjective and objective measures. A correlation was found between different subjective measures. Issue 4.

Perracini MR. Munhoz MS. [Medline]. Gananc FF Age may not be a factor in outcome: a study published in 2008 found that patients who underwent aquatic physiotherapy for vestibular rehabilitation achieved improvement in dizziness symptoms.18(2-3):139-46.4 . Venosa AR. use of vestibular suppressant medications. and time since symptom onset. Bittar RS  Aquatic physiotherapy for vestibular rehabilitation in patients with unilateral vestibular hypofunction: exploratory prospective study. Laryngoscope.117(8):1482-7. Venosa and Bittar recently published a study showing that VRT for acute vertigo lessens the duration of symptoms and the need for vestibular suppressants. balance. 2008. Aug 2007.Vestibular rehabilitation exercises in acute vertigo. and quality of life regardless of age. [Medline] Gabilan YP. J Vestib Res.

Conclusions ‡VRT re-caliberates and reorganizes the balance system naturally without drugs. ‡Proper diagnosis of the problem. . ‡Medications only suppress the symptoms ± not fix the problem. ‡Proper treatment by a proper provider. ‡VRT proves to be beneficial for management of vestibular disorders.

Laryngoscope. T.References 1. (1944). et al. J Chart Soc Physiother 106-7." Arch Phys Med Rehabil 85(2): 227-33 . The effect of age on vestibular rehabilitation outcomes. Physical Rehabilitation (fifth edition)Susan B o¶Sullivan Thomas J Schmitz pg no. 3. The physiological basis for head exercises.10: 1785-90. Balance and Vestibular Disorders Pg. 4. 999-1029. B. Cawthorne. Whitney. M.. et al (2003).Badke. 112. "Outcomes after rehabilitation for adults with balance dysfunction. 5.no-732-774 Darcy &Umphred. 2. (2004).

Otol Neurotol.6. Bento RF. Zimatore. Number 3/March 2006 .1. A. Vestibular rehabilitation therapy in children.1.1. De Angelis.1. Bittar RS. Pedalini ME. Tufarelli. Lorenzi MC. pp.Medeiros IR.) Volume 126. [Medline] . Badaracco. D.Vestibular rehabilitation and 6-month follow-up using objective and subjective measures (Meli. Formigoni LG. E.26(4):699-703. C. Jul 2005. 259-266(8) 7. Number 3. G.

rv .VIDEO: virtual reality training in balance problem.

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