Authors (including presenting author) :
Wong GHS(1), Chao CYL(1), Liu BKP (1), Yeung SCS (1), CHU TC(2), Chan ACM(1)
Affiliation :
(1)Physiotherapy Department, (2)Department of Ear, Nose and Throat, Queen Elizabeth Hospital
Introduction :
Dizziness/vertigo is one of the most common chief complaints in general populations, especially those elderly. The symptoms are always annoying that greatly affect the psychosocial well-being of the sufferers. Vestibular hypofunction is one of the most prevalent causes of dizziness and the affected people commonly presents with disequilibrium and gait disturbance which potentially increase the risk of fall and affect the quality of life. There is emerging evidence suggested that “Physiotherapy Vestibular Rehabilitation Program” plays an essential role for managing symptoms of dizziness/vertigo and disequilibrium associated with vestibular pathology.
Objectives :
To evaluate the effects of vestibular rehabilitation program for managing symptoms of dizziness/vertigo, vestibular function, balance and gait performance, and impact on activity of daily living in people with unilateral and bilateral vestibular hypofunction.
Methodology :
It was a pretest posttest study design. Patients with vestibular hypofunction referred to Physiotherapy Outpatient Department for vestibular rehabilitation program from December 2016 to November 2020 were recruited. The program was an exercise-based treatment regime that designed to promote vestibular adaptation, substitution and habituation with the goals to improve gaze stability, postural control, dizziness/vertigo symptoms and activities of daily living. It consisted 90 minutes of 6 to 8 sessions of repetitive exercises and protocols that ameliorate motion provoked symptoms, reset the precision of the vestibular ocular reflex and enhancing postural stability and equilibrium. The exercises were incorporated with the use of advanced technologies of Computerized Dynamic Posturography and Virtual Reality Interactive-Treadmill gait training.
Result & Outcome :
Eighty patients (16 males: 64 females) with mean age 56.1±12.9 year-old received the vestibular rehabilitation training. The average duration of dizziness symptoms was 37.2 months. On completion of the program, patients reported an average of 77% improvement of their condition according to Numeric Global Rating of Change Scale (NGRCS). The averaged Visual Analog Scale (VAS) of dizziness and vertigo symptoms significantly decreased from 5.0±2.5 to 1.9±2.1(p< 0.001). The Chinese version of Dizziness Handicap Inventory (DHI) score that indicated the self-perceived handicap level caused by dizziness was significantly reduced from 44.5±±20.1 to 22.2±18.5(p< 0.001). For balance and gait performance, both the Berg Balance Scale (BBS) and Dynamic Gait Index (DGI) score showed statistically significant improvement from 53.4±±3.4 to 55.5±1.4(p< 0.001) and 22.9±1.7 to 23.7±0.9(p< 0.001) respectively after the training. For postural stability measures, the composite score of Sensory Organization Test (SOT) improved from 63.8±14.1 to 75.1±1.4(p< 0.001). Regarding the vestibular function, there was statistically significant improvement in Dynamic Visual Acuity Test (DVA) over left (p=0.002) and right (p=0.028) side of vestibular systems after the completion of the program. The Activities-specific Balance Confidence scale (ABC) scored also improved from 70.7±17.7 to 81.0±15.9(p< 0.001), indicating a higher competency in maintaining balance and stability.
Vestibular rehabilitation program was effective to improve dizziness and vertigo symptoms, promote vestibular functions, postural stability and gait control, as well as enhance independences of daily activities and balance confidence in people with peripheral vestibular hypofunction.
