This article originally appeared in the Spring 2024 issue of On The Level.
Denise Schneider, DPT, FAAOMPT
Effectiveness of Specific and Individual Instructions by a Physical Therapist to Improve Outcomes For Vestibular Rehabilitation at Home
The Vestibular System
The vestibular system, composed of the inner ear and parts of the brain, works in conjunction with other body systems to provide balance and stability.
When the vestibular system is not working properly, an individual may experience dizziness, imbalance, vertigo, motion sensitivity, and/or falls. This can have a detrimental effect on one’s physical and emotional well-being. People may experience hindrance with daily activities, decreased ability to participate in activities outside the home, a progressive sedentary lifestyle, a lack of independence, and an increased risk for falls. Furthermore, the emotional toll that it takes on a person potentially includes fear of movement, avoidance of social interactions, anxiety, depression, and lack of self-esteem.
Vestibular Rehabilitation Therapy
Vestibular Rehabilitation Therapy (VRT) is recommended and proven to be a successful treatment option for those who suffer from vestibular disorders. A trained vestibular therapist will perform a comprehensive evaluation. Based on the evaluation findings, the therapist will prescribe specific exercises; determine the frequency and duration of treatment; progress the patient in subsequent sessions; and provide patient education and instruction.
Literature supports that specific and individualized VRT is key in providing optimal outcomes to decrease symptoms and improve balance.
Research
The referenced article set out to assess the outcomes of a booklet-based home VRT program provided by an expert physiotherapist.
Sixty-eight (68) people suffering from dizziness and balance disorders of greater than three months participated in the study until completion. They were included in the study if their symptoms were a result of either a peripheral hypofunction or a central vestibular disorder. The participants were equally divided into a control group and an intervention group. Both groups received a standardized evaluation by a physiotherapist. The subjective portion included seven self-report questionnaires to assess the impact of symptoms on: emotional, functional, and physical well being; confidence when performing activities; concerns with falling; causes of symptoms and imbalance; and barriers to participating in the program. The objective portion of the exam assessed balance and gait.
Following the evaluation, participants in each group were issued a VRT booklet consisting of 16 exercises with instructions to perform exercises 20 minutes, twice per day.
The key difference between groups was the way the interventions were prescribed:
- The participants in the intervention group were given certain exercises based on their evaluation findings. They received individualized instructions on how to perform hand picked exercises, they were provided exercise demonstrations, and they were given instructions regarding positioning, repetitions, and progression of exercises.
- The control group did not receive additional instructions or advice beyond what was described in the booklet.
The groups were followed up at the 4 and 8 week marks.
Results
The results of the study show that although both groups made improvements, the intervention group demonstrated superior results over the control group in all categories. This demonstrates that specific instructions from a physiotherapist for a booklet based VRT program decreases symptoms, decreases fear of falling, improves physical function, improves compliance to an exercise program, and improves quality of life.
Summary
The detrimental effects of vestibular disorders range depending on the individual and diagnosis, and often cause significant turmoil physically and emotionally. An evaluation by a trained therapist is essential to determine an individualized treatment program resulting in optimal outcomes. Progression towards symptom resolution and function is an ongoing process, requiring modification and advancement of interventions. Although a booklet-based program can provide benefit, for optimal outcomes, a program guided by an expert is the best bet.