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Rehabilitation is essential for patients with disabling symptoms of dizziness, vertigo and unsteadiness caused by disorders of the vestibular system. These patients are now benefiting from new and emerging techniques provided by multidisciplinary teams in vestibular rehabilitation (Journal of Neurologic Physical Therapy, June 2010).
The original mainstay of vestibular disorder treatment, developed in the 1950s, included a set of simple, progressive exercises called Cawthorne-Cooksey exercises that were designed to manage dizziness and improve balance following damage to the inner ear. Newer techniques 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, Ménière's disease and brain injury.
Advanced technologies include a balance vest that provides patients with vibrotactile feedback to help them relearn balance function. Computerized techniques help restore gaze stability and document improvements in perceptual and motor inhibition.
Vestibular rehabilitation has been found to benefit specific groups of patients. For example, it is effective in improving the vestibular-visual-cognitive function of soldiers with blast-induced head trauma. In addition, gaze stability exercises can reduce the risk of falling in older adults 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," stated Michael Schubert, PhD, PT, and Susan Whitney, PhD, PT.
Researchers have evaluated the comparative benefits of different types of vestibular rehabilitation 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 rehabilitation. These studies are essential to document the effectiveness of specific rehabilitation techniques for specific groups of patients with different types of vestibular disorders.
"More sophisticated research questions are being asked now that the overall efficacy of vestibular rehabilitation has been established," stated Kathleen Gill-Body, DPT.
The next wave of vestibular rehabilitation approaches could include virtual reality feedback and training, vestibular prostheses (implants), and stem cell techniques.
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