Rehabilitation is essential for patients with disabling symptoms of dizziness, vertigo, and unsteadiness caused by disorders of the vestibular system. A special issue of The Journal of Neurologic Physical Therapy (JNPT) presents an update on new and emerging vestibular rehabilitation techniques, highlighting the physical therapist's role on the multidisciplinary teams providing patient care and research. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, and pharmacy.
The special issue provides physical therapists and other professionals with an update on new developments in vestibular rehabilitation. "We hope that this Special Issue will help clinicians explore some new innovations and discoveries in physical therapist examination and treatment of persons with vestibular disorders," according to guest editors Michael C., Schubert, P.T., Ph.D., and Susan L. Whitney, P.T., Ph.D. "This issue of JNPT is unique," commented Special Issue Editor Kathleen M. Gill-Body, DPT, PT, NCS who also serves as an Associate Editor of JNPT. "Emerging data is reported for specific components of vestibular rehabilitation, and for some specialized patient populations, reflecting the more sophisticated research questions that are being asked now that the overall efficacy of vestibular rehabilitation has been established by prior studies. What was particularly exciting to me was to see preliminary data reported by several authors, and to review the authors' interpretation of the meaning and clinical relevance of their findings." The full issue is available on the journal website: http://journals.lww.com/jnpt/.
New Technologies and Emerging Techniques for Vestibular Rehabilitation
The supplement includes nine research papers and reviews, authored by an invited panel of international experts at the forefront of research and practice in vestibular rehabilitation. "The topics covered are diverse and so is the authors' expertise," Drs. Schubert and Whitney write. "The authors include physical therapists, engineers, and physicians who work to enhance the care of persons with vestibular disorders."
The original mainstay of treatment for people with vestibular disorders was developed in the 1950s and included a set of simple, progressive exercises—called Cawthorne-Cooksey exercises—designed to manage dizziness and improve balance following damage to the inner ear. More recently, techniques have been developed to address specific problems with gaze and postural instability, motion sensitivity, and vertigo in patients with a variety of different vestibular disorders such as benign paroxysmal positional vertigo, Meniere's disease, brain injury, and others.
Several papers report on the use of advanced technologies, such as a "balance vest" that provides patients with vibrotactile feedback to help them relearn balance function. Other topics include computerized techniques to help restore steady vision during head movements (gaze stability) and to document improvements in the ability to focus on tasks in the presence of distractions (perceptual and motor inhibition).
One study uses a device similar to a mirrored "disco ball" to provide optokinetic stimulation for patients with vestibular disorders. 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.
Physical Therapists Play Key Roles in Research and Treatment
Other articles in the special issue document the benefits of vestibular rehabilitation for specific groups of patients. One study shows that gaze stability exercises can reduce the risk of falling in older adults with vestibular disorders. Another paper is one of the first reports on the effectiveness of vestibular rehabilitation on vestibular-visual-cognitive function following blast-induced head trauma sustained by soldiers in Iraq or Afghanistan.
Similarly, a third study reports improvements in dizziness, walking and balance after participation in a customized vestibular physical therapy program in children and adults with concussion. Other articles included in the special issue evaluate the comparative benefits of different types of vestibular rehabilitation exercises (habituation exercises versus gaze stability exercises) to reduce dizziness and improve gaze stability, as well as the influence of damage to the otolith organs of the inner ear on outcomes following vestibular rehabilitation. Such studies are essential to document the effectiveness of specific rehabilitation techniques for specific groups of patients with different types of vestibular disorders.
Physical therapists play a central role in vestibular rehabilitation—not only as care providers, but also in helping to advance new research in the field. The next wave of vestibular rehabilitation approaches could include virtual reality feedback and training, vestibular prostheses (implants), and even stem cell techniques, according to Drs. Schubert and Whitney. They encourage physical therapists to collaborate with researchers in evaluating these new techniques—as well as in pointing out patient problems in need of new rehabilitation approaches and helping to maximize the value of new technologies.
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