Balance improvement in patients with benign paroxysmal positional vertigo Increased Independence and Decreased Vertigo after Vestibular Rehabilitation Balance disorders in the elderly and the benefit of balance exercise. The effect of early customized vestibular rehabilitation on balance after acoustic neuroma resection Systematic approach to benign paroxysmal positional vertigo in the elderly. 
Simulator based rehabilitation
in refractory dizziness Tai Chi and vestibular rehabilitation effects on gaze and whole-body stability. Tai Chi: improving functional balance and predicting subsequent falls in older persons. Effects of specific rehabilitation for dizziness among patients in primary health care. A randomized controlled trial. Effects of balance training in elderly people with nonperipheral vertigo and unsteadiness Eficacy of vestibular rehabilitation on chronic unilateral vestibular dysfunction Effectiveness of Treatments for Benign Paroxysmal Positional Vertigo of the Posterior Canal Vestibular Rehabilitation in Individuals with Inner-Ear Dysfunction: A Pilot Study Randomized Controlled Trial of Vestibular Rehabilitation Combined with Cognitive-Behavioral Therapy for Dizziness in Older People Decreased Ataxia and Improved Balance after Vestibular Rehabilitation Vestibular rehabilitation exercises in acute vertigo. Effects of home training and additional physical therapy on recovery after acute unilateral vestibular loss- a randomized study Falls among dizzy patients in primary healthcare: an intervention study with control group Changes in a repetitive head movement task after vestibular rehabilitation Effectiveness of Primary CareBased Vestibular Rehabilitation for Chronic Dizziness Rehabilitation after acute vestibular disorders. Recovery of dynamic visual acuity in bilateral vestibular hypofunction.
Objective : To investigate the effect of an additional vestibular stimulated exercise programme on balance for patients with benign paroxysmal positional vertigo . Design : R and omized controlled trial . Setting : Medical centre . Subjects : Twenty-six subjects with benign paroxysmal positional vertigo involving the unilateral posterior semicircular canal . Interventions : Subjects were r and omized into experimental or control groups . Thirteen subjects in the experimental group received the canalith repositioning manoeuvre and vestibular stimulated exercise training three times a week for four weeks . Thirteen subjects in the control group received only the canalith repositioning manoeuvre . Main measures : Static balance tests , t and em walk test , Dynamic Gait Index and subjective rating of the intensity of vertigo were measured at baseline , two-week and four-week assessment s. Results : Compared with the control group , subjects in the experimental group demonstrated a statistically significant improvement in single leg stance with eyes closed at the two-week assessment ( P<0.05 ) . Furthermore , stance on foam surface with eyes closed , single-leg stance with eyes closed , and Dynamic Gait Index at the four-week assessment were also significantly improved ( P<0.05 ) . Conclusion : The present study demonstrated that additional exercise training , which emphasizes vestibular stimulation , can improve balance ability and functional gait performance among patients with benign paroxysmal positional vertigo who had already undergone the canalith repositioning manoeuvre OBJECTIVE : We sought to determine the effectiveness in decreasing some symptoms , such as vertigo , and increasing performance of daily life skills after vestibular rehabilitation . STUDY DESIGN AND SETTING : Patients who had chronic vertigo due to peripheral vestibular impairments were seen at a tertiary care center . They were referred for vestibular rehabilitation  and were assessed on  vertigo intensity and frequency with the use of the Vertigo Symptom Scale , the Vertigo H and icap Question naire , the Vestibular Disorders Activities of Daily Living Scale , and the Dizziness H and icap Inventory . They were then r and omly assigned to 1 of 3 home program treatment groups . RESULTS : Vertigo decreased and independence in activities of daily living improved significantly . Improvement was not affected by age , gender , or history of vertigo . CONCLUSION : For many patients a simple home program of vestibular habituation head movement exercises is related to reduction in symptoms and increasing independence in activities of daily living Symptoms of balance disorders including ' unsteadiness ' , ' dizziness and vertigo ' are common in the elderly and commonly found in general practice in medicine . There are many causes of balance disorders and vary from one person to another . Disorder of the internal ear or vestibular end-organ type is one cause . Unsteadiness of somato-sensory or proprioception is common in the elderly so is degenerative disorder of central control in brain . The elderly are prone to many chronic illnesses or disorders which are causes of balance disorder or give rise to more rapid degeneration of the central nervous system i.e. high blood pressure , diabetes mellitus , heart disease , proprioception and joint problems , arthritis and muscular weakness due to lack of good health and exercise . The objectives of this research study were to find the etiologies of balance disorders and how Balance Exercises and the ' National Health Service ' can be of benefit in helping to prevent them . 1565 elderly inhabitants ( age > or = 60 years ) of 20 communities adjacent to Siriraj Hospital were selected for study . Among these , 625 persons had a history of balance disorders . Among those , 256 had symptoms during the week selected for examination . The average age was 66 years old , women outnumbered men with a ratio of 2.4:1 . The common underlying causes were hypertension in 32.4 % , diabetes mellitus 13.8 % , arthritis 8.1 % , and heart disease 4.4 % respectively . All are still taking one or more types of drug . The subjects were r and omly divided into two groups for the study purpose of effectiveness of balance exercise . Group 1 did not perform the head balance exercise and Group 2 performed the head balance exercise . Audiometric testing showed impaired hearing in 90 % of the subjects . The majority slowed hearing loss in high frequencies . Testing of middle ear function found 75 % of Group 1 to have normal middle ear function 77 % of Group 2 . Brainstem Electrical Response Audiometry ( BERA ) showed normal response latencies of in 96 % of group 1 and 94 % of Group 2 . Poor morphology of waveform was found in 12 % of Group 1 and 16 % of Group 2 . Doppler sonography for intra-cranial blood flow measurement showed abnormal flow of the ICA in 17.6 % of group 1 and 20.16 % of group 2 . Basilar arterial abnormal flow was found in 77.6 % of Group 1 and 80.6 % of Group 2 respectively . The flow of ICA was improved after 8 weeks in both groups . The measurement of balance by Posturography showed 86.7 % abnormality in Group 1 and 83.5 % abnormality in Group 2 ( and the majority due to inner ear problems but many cases had a mixture of joints and CNS problems too ) . Results of the self-evaluation ( by question aires ) showed the elderly to have symptoms of light headedness in 51 % and loss of balance in 29 % , Vertigo with rotation occurred in 23.6 % . 49 % of the symptoms were intermittent , 56.4 % experienced a ' fall " . On question ing about the benefit and performance of Head and Neck Exercises , 82.8 % found the exercises were easy to perform , 56.4 % said the results were very beneficial Objective : To compare the effect of early customized vestibular rehabilitation with general instructions in patients after acoustic neuroma surgery . Setting : Tertiary referral centre . Subjects : Fifty-three patients after surgery . Design : A prospect i ve assessor-blinded , r and omized controlled trial . Interventions : After stratification for age ( < 50 years ; ≥50 years ) , patients were r and omly allocated into groups receiving general instructions or customized vestibular rehabilitation protocol s for 12 weeks . Outcome measures : St and ing Balance Sum , Timed Up and Go test , T and em Gait and Dynamic Gait Index . Balance performance was assessed preoperatively , at discharge ( one week after surgery ) , three , six , nine , 12 , 26 and 52 weeks after surgery . Results and discussion : All subjects clearly improved within the first six weeks after surgery . However , older subjects receiving vestibular rehabilitation performed significantly ( P<0.05 ) better on st and ing balance , Timed Up and Go test and T and em Gait , when compared with the older group that received only general instructions . This effect persisted up to 12 weeks and also became apparent on the Dynamic Gait Index . In addition , the older vestibular rehabilitation group had better balance scores at 12 weeks when compared with their original preoperative scores ( P<0.05 ) . This pattern remained even up to one year after surgery ( P<0.05 ) . Conclusion : In patients over 50 , early vestibular rehabilitation facilitates recovery of postural control after acoustic neuroma surgery . Customized vestibular rehabilitation should be given in addition to general instructions that stress the need of exposure to movement . Retention of the early beneficial effects even one year after surgery stresses the importance of customized vestibular rehabilitation OBJECTIVE We evaluated the effectiveness of a management approach that combines the canalith repositioning maneuver ( CRM ) and vestibular rehabilitation ( VR ) in the treatment of benign positional paroxysmal vertigo ( BPPV ) in elderly persons . STUDY DESIGN AND SETTING Forty-seven patients ( > /=70 years old ) with the diagnosis of unilateral posterior semicircular canal BPPV formed the study population . This study has 2 parts . In the first part , patients were r and omly assigned to 1 of 2 groups : the CRM and avoidance ( no treatment ) . Patients were evaluated 1 month after the first visit . Those patients not responding to treatment were enrolled in the second part of the study , treated with an individualized combination of CRM and VR , and then reevaluated 3 months later . RESULTS Statistically significant improvement of vertigo and provoked nystagmus in 64 % of patients in the CRM group compared with the no-treatment group . After the addition of VR , 77 % of all patients improved . CONCLUSION A combination of CRM and VR improves  BPPV in the elderly . SIGNIFICANCE These findings suggest that although CRM is more effective than no treatment , VR can be added to improve the results in the treatment of BPPV Abstract . Patients with chronic vestibular symptoms are common in neurological practice but the most effective treatment remains an open question . The purpose of our study was to conduct a controlled , between – group comparison of patients ’ responses to a customised exercise regime ( Group C , for customised ) versus treatment additionally incorporating simulator based desensitisation exposure ( Group S , for simulator ) integrating whole – body or visual environment rotators .  Forty chronic peripheral vestibular patients who had previously undergone conventional vestibular rehabilitation without notable improvement were r and omly assigned into Group C or S. Individuals attended therapy sessions twice weekly for eight weeks and were provided with a customised home programme . Response to treatment was assessed at four – week intervals with dynamic posturography , vestibular time constants , and question naires concerning symptoms , symptom – triggers and emotional status . At final assessment posturography and subjective scores had significantly improved for both groups , although Group S showed greater improvement . A statistically significant improvement for visual vertigo symptom scores was noted only for Group S ( p < 0.01 ; total improvement 53.5 % ) . Anxiety and depression levels significantly decreased for both groups ; improvements were significantly correlated particularly to improvements in visual vertigo ( SCQ ) ( p < 0.01 ; r = 0.53 and r = 0.57 , respectively ) . Significant differences were noted between groups ( p = 0.02 ) for posturography scores . Vestibular time constants showed no notable change in either group . Conclusions : Both groups improved but exposure to simulator motion gave overall better results . These effects were also observed in psychological symptoms and partly relate to simulator effects on visual vertigo symptoms . Visual motion and visuo – vestibular conflict situations should be incorporated in the rehabilitation of patients with refractory dizziness Tai Chi ( TC ) is a comparatively new intervention for peripheral vestibular hypofunction , which is often treated with vestibular rehabilitation ( VR ) . We compared gaze stability ( GZS ) , whole-body stability ( WBS ) and footfall stability ( FFS ) during locomotion among 26 people with vestibulopathy ( VSP ) , r and omized into two treatment arms ( 13 TC and 13 VR ) . Each intervention program was offered for 10 weeks . GZS improved more for VR than for TC , but WBS ( and FFS ) improved more for TC than for VR . There was a significant relationship between changes in GZS and WBS for the VR subjects ( r=0.60 , p=0.01 ) , but not for TC subjects . There was a significant relationship between changes in WBS and FFS for both VR ( r=0.65 , p < 0.01 ) and TC ( r=0.58 , p=0.02 ) groups ; the relationship disappeared in the VR but not the TC group when controlling for GZS . These findings suggest that VR and TC both benefit patients with VSP but via differing mechanisms . Moreover , these data are the first to test the assumption that improving gaze control among patients with VSP perforce improves postural stability : it does not . We conclude that GZS is most improved in those who receive VR , but that TC improves WBS and FFS without improving GZS , suggesting patients with VSP can rely on non-gaze related mechanisms to improve postural control PURPOSE To determine whether improved functional balance through a Tai Chi intervention is related to subsequent reductions in falls among elderly persons . METHODS Two hundred fifty-six healthy , physically inactive older adults aged 70 - 92 ( mean age + /- SD = 77.48 + /- 4.95 ) , recruited from a local health system in Portl and , OR , participated in a 6-month r and omized controlled trial , with allocation to Tai Chi or exercise stretching control , followed by a 6-month postintervention follow-up . Functional balance measures included Berg balance scale , dynamic gait index , and functional reach , assessed during the 6-month intervention period ( baseline , 3-month , and 6-month intervention endpoint ) and again at the 6-month postintervention follow-up . Fall counts were recorded during the 6-month postintervention follow-up period . Data were analyzed through intention-to-treat analysis of variance and logistic regression procedures . RESULTS Tai Chi participants who showed improvements in measures of functional balance at the intervention endpoint significantly reduced their risk of falls during the 6-month postintervention period , compared with those in the control condition ( odds ratio ( OR ) , 0.27 , 95 % confidence interval ( CI ) , 0.07 - 0.96 for Berg balance scale ; OR , 0.27 , 95 % CI , 0.09 - 0.87 for dynamic gait index ; OR , 0.20 , 95 % CI , 0.05 - 0.82 for functional reach ) . CONCLUSIONS Improved functional balance through Tai Chi training is associated with subsequent reductions in fall frequency in older persons OBJECTIVE To investigate whether specific rehabilitation for patients with dizziness has any effect on clinical balance measures and /or the apprehension of dizziness measured with a visual analogue scale ( VAS ) . DESIGN R and omized controlled trial . SUBJECTS Forty-two patients , 50 years or older with dizziness of central or age-related origin , identified in primary health care . METHOD The patients were r and omized to either an intervention or a control group . The intervention included balance training and vestibular rehabilitation in group sessions twice a week for six weeks . All patients were assessed at baseline , after six weeks and after three months with five different balance measures and visual analogue scale . RESULTS Statistically significant differences were found between the two groups comparing results at baseline and after six weeks regarding st and ing one leg eyes closed ( SOLEC ) on right foot ( p = 0.011 ) . Results of SOLEC right foot after three months differed significantly between the groups ( p=0.033 ) as did SOLEC left foot ( p=0.035 ) . No difference between the groups were found in the Romberg test , figure of eight , walking heel to toe , ' stops walking when talking ' , st and ing one leg eyes open or estimating the experience of dizziness measured with visual analogue scale . CONCLUSIONS Balance training and vestibular rehabilitation improved the ability to st and on one leg with eyes closed in persons with dizziness aged 50 years or over Objective : To evaluate the effect of balance training in group in elderly people with nonperipheral vertigo and unsteadiness . Design : R and omized controlled study . Setting : Ear , nose and throat department , University Hospital , Sweden . Subjects : Twenty-three elderly subjects with nonperipheral vertigo and /or unsteadiness r and omized into training group and control group . Intervention : The training group attended balance training in group twice a week for eight weeks . Main outcome measures : Timed static balance tests , walking tests and six sensory organization tests on EquiTest dynamic posturography were performed before and after the training period . Besides , the patients estimated their vertigo and unsteadiness on a visual analogue scale ( VAS ) before and after the training period . Results : The training group improved significantly in st and ing on one leg with eyes open , walking forward on a line , walking speed , in three out of six tests on dynamic posturography and estimated less vertigo and unsteadiness measured with VAS . No changes were seen in the control group . Conclusion : Balance training in elderly people with nonperipheral vertigo and unsteadiness seems to improve both objective and perceived balance Objective : To assess the efficacy of vestibular rehabilitation exercises on patients with chronic unilateral vestibular dysfunction . Design : Prospect i ve study . Setting : Physical Medicine and Rehabilitation Clinic and Otolaryngology Clinic of a tertiary referral hospital . Subjects : One-hundred and twenty-five patients with unilateral chronic vestibular dysfunction were included in the study . Interventions : Eight-week , two-staged ( clinic and home ) vestibular rehabilitation programme with components of Cawthorne-Cooksey and Norre exercises was applied . Main outcome measures : Dizziness H and icap Inventory ( DHI ) and visual analogue scale ( VAS ) were completed three times ( at the beginning , end of the second week and end of the treatment ) . Results : Data for 112 patients in the first stage and 93 patients in the second stage were evaluated because of insufficient compliance of the other patients . The mean DHI score was decreased from 50.42 ± 24.12 points to 21.21 ± 15.97 points ( p < 0.001 ) at the end of first two weeks , and to 19.93 ± 19.33 points at the end of the whole treatment . The mean VAS score was decreased from 5.87 ± 2.27 to 2.02 ± 1.75 ( p < 0.001 ) at the end of second week , and to 1.51 ± 1.29 at the end of eighth week . In respect to both VAS and DHI scores , improvement was noted in 67 patients ( 77.4 % ) . Age , gender and disability level had no predictive value about therapy outcome . Conclusions : There was a fast recovery in the supervised exercise session , whereas there was no significant difference in the home exercise session . These findings suggest that either supervised exercise is better than home exercise or that 10 supervised sessions are sufficient to get the end result Objective : To determine which common , nonpharmacological , nonsurgical treatments are most effective for treatment of benign paroxysmal positional vertigo ( BPPV ) . Study Design : Prospect i ve , r and omized , sham-controlled . Patients : Patients ( n = 124 ) with BPPV of the posterior semicircular canal . Setting : Tertiary care center . Interventions : R and om assignment to one of five groups : modified canalith repositioning maneuver ( CRP ) , modified liberatory maneuver ( LM ) , sham maneuver , Br and t and Daroff 's exercise , and vertigo habituation exercises . Subjects received a st and ard educational lecture about BPPV and the purpose of the intervention . No vestibular-suppressant medication or special instructions for head positioning were used . Post-tests were given at 1 week after treatment and at approximately 3 months and 6 months later . Main Outcome Measures : Vertigo intensity and frequency . Results : Multilevel analyses showed that vertigo decreased significantly after  LM , CRP  , and Br and  t-Daroff exercise ;  those three groups did not differ significantly . The habituation group did not differ from sham , Br and t-Daroff , LM , or CRP groups . Changes in scores were maintained throughout the 6-month follow-up period . Conclusion : LM , CRP , and exercises are all effective interventions ; patient education plus the sham maneuver , however , had some beneficial effect . These results support two possible mechanisms of BPPV : displaced otoconia and a neural mechanism affecting interpretation of semicircular canal signals A r and omised control prospect i ve study was carried out examining patient outcomes after performing a 10-week vestibular home exercise programme .  Thirty-two adults with vestibular dysfunction who reported vestibular symptoms negatively affecting daily life were enrolled . Test subjects were provided with an individualised vestibular rehabilitation programme design ed by a physiotherapist . Control subjects received a set of strength and endurance exercises only . All subjects performed their exercises 3 times a day for 10 weeks .  Subjective and objective patient measures were collected at 0 , 6 , 10 and 26 weeks . Results showed that both groups improved after beginning exercise , and that test subjects significantly benefited compared to the controls . These benefits were long term and measurable 6 months later . This study provides evidence that individualised vestibular exercises promote better outcomes for patients with vestibular dysfunction OBJECTIVE : To evaluate the effectiveness of vestibular rehabilitation combined with cognitive behavioral therapy in the treatment of dizziness in older people . STUDY DESIGN AND SETTING : A r and omized controlled design was used with patients recruited via an advertisement . Nine patients completed treatment and 10 served as waiting-list controls . The intervention lasted 7 weeks with 5 weekly group sessions and consisted of vestibular exercises . Cognitive behavioral therapy components were added to promote relaxation , reduce anxiety , and avoidance of feared situations and movements . RESULTS : Statistically significant improvements on walking time , 2 dizziness provocative movements , and on the Dizziness H and icap Inventory , but no effects on the Romberg or anxiety and depression . Of the treated patients , 89 % reached statistical significant improvement on the total inventory score . CONCLUSION : Cognitive behavioral therapy combined with vestibular rehabilitation decreases  dizziness in older people . SIGNIFICANCE : These findings indicate that cognitive behavioral therapy can be combined with vestibular rehabilitation in the treatment of dizziness OBJECTIVES : To determine the effects of vestibular rehabilitation on  gait ataxia and balance . SETTING : Tertiary care center . STUDY DESIGN : Subjects were patients with chronic vertigo due to peripheral vestibular impairments , referred for vestibular rehabilitation .  They were assessed on the Timed Up and Go test , ataxia during a path integration test , computerized dynamic posturography , level of vertigo , independence in activities of daily living , and psychological locus of control . They were r and omly assigned to three home program treatment groups . RESULTS : Ataxia decreased significantly , and posturography scores and time to perform Timed Up and Go improved significantly , for all subjects . Improvements were significantly related to scores on the ambulation subtest of the Vestibular Disorders Activities of Daily Living Scale , decreases in vertigo , and increases in locus of control . CONCLUSIONS : For many patients , a simple home program of vestibular habituation head movement exercises is related to reduced symptoms of imbalance during stance and gait . ( Otolaryngol Head Neck Surg 2004;130:418–25 . OBJECTIVES /HYPOTHESIS To evaluate the effect of vestibular rehabilitation exercises in the early stages of peripheral vestibular disorders . STUDY DESIGN Prospect i ve , r and omized trial . Patients were blinded to assignment groups . METHODS The study group ( 45 patients ) performed exercises for adaptation of the vestibulo-ocular reflex ; the control group ( 42 patients ) performed placebo exercises . Both groups were instructed to use dimenhydrinate ( up to 150 mg/d ) if symptomatic , irrespective of exercises . Patients were evaluated by visual analogue scale , physical examination , and need to use the medication .  All patients were adults and symptomatic for less than 5 days . RESULTS The study and control groups were comparable in terms of demographics data and duration and intensity of symptoms . Study group patients recovered faster than controls and used less medication . By 10 to 14 days after the intervention , 43 % of study group and 5 % of control group patients had no significant symptoms ( P < .001 ) , and 67 % of study group and 3 % of control group patients needed no medication ( P < .001 ) . Although both groups had no significant symptoms by the end of the follow-up period ( 21 days ) , 14 % of the study group patients were still using medication , compared with 83 % of the placebo group patients ( P < .001 ) . CONCLUSIONS Vestibular exercises are effective in reducing the duration of symptoms and the need of medication of patients in the early stages of peripheral vestibular disorders Objective : To evaluate the effects of additional physical therapy on recovery after acute unilateral vestibular loss given to patients receiving home training . Design : R and omized controlled trial . Setting : Ear , nose and throat departments in three hospitals . Subjects : Fifty-four patients ( mean age 52 years ) with acute unilateral vestibular loss within the last week confirmed with electronystagmography testing were included . Patients with central neurologic or auditory symptoms or other vertigo disease were excluded . Interventions : Home training with or without additional physical therapy 12 times during 10 weeks . Main measures :  Electronystagmography testing was performed before and after the training period . Clinical static ( Romberg?s test , sharpened Romberg?s test , st and ing on foam and st and ing on one leg ) and dynamic ( walking forward and backward on a line ) balance tests and subjective ratings of vertigo and balance problems on a visual analogue scale were done one week , 10 weeks and six months after the start of training . Results : Similar changes were seen in the two training groups . Conclusions : No significant differences in outcome regarding balance function or perceived symptoms were found between home training with or without additional physical therapy The objective of this study is to investigate whether vestibular rehabilitation can improve balance , reduce self-perceived h and icap because of dizziness and , if possible , reduce falls among dizzy patients in primary healthcare . The study also finds out which of the balance measures and measure of self-perceived h and icap , if any , predicted the risk of falls . The design of this study is an intervention study with control group . Fifty-eight patients , 65 years and older , with multisensory dizziness were taken as participants . The intervention group trained vestibular rehabilitation twice a week for 9 weeks . All patients were assessed at baseline and after 3 months , with four different  balance measures  and the  Dizziness H and icap Inventory .  After 6 , 9 and 12 months , a follow-up by telephone was performed and , at 12 months , the patients also filled out a  Dizziness H and icap Inventory question naire . Statistically significant differences were found between the groups between baseline and 3 months in one static balance measure and in one dynamic measure ( P=0.038 and 0.044 ) . In total , 40  falls were reported , 31 were classified as intrinsic falls , 26 of them caused by vertigo and nine falls were classified as extrinsic . No difference was found between the two groups in proportions of patients who fell . Poor ability to st and in t and em stance doubled the risk for falls . Vestibular rehabilitation can improve balance in elderly patients with multisensory dizziness . Vertigo is a common cause of falls in this group of patients and vestibular rehabilitation is a feasible treatment . Die vorliegende Studie soll untersuchen , ob eine vestibuläre Rehabilitation das Gleichgewicht infolge von Schwindel verbessern , die damit verbundene selbst wahrgenommene Behinderung senken und – falls möglich – die Sturzhäufigkeit unter benommenen Patienten bei der primärärztlichen Versorgung senken kann . Die Studie untersucht ferner , welche der Gleichgewichtsmessungen und welche Messung der selbst wahrgenommenen Behinderung , wenn überhaupt , das Sturzrisiko voraussagen kann . Die Studie ist vom Aufbau her eine Interventions studie mit einer Kontrollgruppe . An der Studie nahmen insgesamt 58 Patienten i m Alter von 65 Jahren und älter mit multisensorischem Schwindel teil . Die Interventions gruppe unterzog sich neun Wochen lang zweimal pro Woche einer vestibulären Rehabilitation . Alle Patienten wurden unter Zuhilfenahme von vier verschiedenen Gleichgewichtsmaßnahmen und des DHI ( Dizziness H and icap Inventory ) gegenüber Baseline und nach drei Monaten evaluiert . Nach 6 , 9 und 12 Monaten f and eine nachfassende telefonische Befragung statt , und nach 12 Monaten füllten die Patienten zusätzlich noch einen DHI-Fragebogen aus . Bei einer statischen Gleichgewichtsmessung sowie bei einer dynamischen Messung wurden statistisch signifikante Unterschiede zwischen den Gruppen gegenüber Baseline und nach drei Monaten beobachtet ( P=0.038 und 0.044 ) . Insgesamt wurden 40 Stürze gemeldet , von denen 31 als intrinsische Stürze klassifiziert , 26 von ihnen von Schwindelanfällen hervorgerufen und 9 als extrinsische Stürze klassifiziert wurden . Hinsichtlich des Anteils der Patienten , die einen Sturz erlitten , konnte kein Unterschied zwischen beiden Gruppen beobachtet werden . Durch die verminderte Fähigkeit , eine T and emstellung einzunehmen , verdoppelte sich die Sturzgefahr . Eine vestibuläre Rehabilitation kann das Gleichgewicht bei älteren Patienten mit multisensorischen Schwindelanfällen verbessern . Schwindel ist gerade bei dieser Patientengruppe eine häufige Sturzursache , und eine vestibuläre Rehabilitation ist eine praktikable Beh and lungs method e. El objetivo de este estudio fue investigar si con la rehabilitación vestibular , en el ámbito de la atención primaria de salud , se logra mejorar el equilibrio postural , reducir el grado de la discapacidad percibida a causa del mareo y , de ser posible , disminuir el número de caídas de los pacientes afectos de mareos . El estudio también investiga cuáles de los parámetros de valoración del equilibrio postural y de la discapacidad percibida sirvieron para predecir el riesgo de caídas . Se trata de un estudio de intervención donde se utilizó un grupo de referencia . Los sujetos del estudio fueron 58 pacientes de 65 años de edad o más afectos de mareo multisensorial . El grupo de intervención recibió terapia de rehabilitación vestibular 2 veces a la semana durante 9 semanas . Se valoró a todos los pacientes al inicio del estudio y 3 meses después de iniciado éste , y se utilizaron 4 parámetros de valoración del equilibro postural , y el Cuestionario Sobre la Discapacidad por Mareos . A los 6 , 9 y 12 meses se realizó una entrevista de seguimiento por vía telefónica y a los 12 meses se pidió a los pacientes responder el Cuestionario Sobre la Discapacidad por Mareos . Se hallaron diferencias estadísticamente significativas entre ambos grupos en relación con los result ados obtenidos al inicio del estudio y los obtenidos pasados 3 meses , en un parámetro de valoración del equilibrio estático y en un parámetro de valoración del equilibrio dinámico ( P=0.038 y 0.044 ) . Se notificaron un total de 40 caídas , 31 de las cuales se clasificaron como caídas intrínsecas ; 26 , como caídas por vértigo ; y 9 , como caídas extrínsecas . No se hallaron diferencias entre los dos grupos estudiados en cuanto a la proporción de pacientes que sufrieron caídas . La incapacidad de mantener la postura en tándem duplicó el riesgo de sufrir caídas . Con la rehabilitación vestibular se logra mejorar el equilibrio postural en pacientes ancianos con mareo multisensorial . El vértigo fue una causa frecuente de caídas en este grupo de pacientes , y la rehabilitación vestibular result a un tratamiento factible . Cette étude avait pour objet d'établir si la rééducation vestibulaire peut améliorer l'équilibre , réduire l'auto-perception du h and icap due à la sensation de vertige et , si possible , réduire le nombre de chutes chez les patients victimes de vertiges dans les services de santé primaire . L'étude détermine également lesquelles , parmi les mesures d'équilibre et les mesures d'auto-perception du h and icap , le cas échéant , sont prédictives des risques de chutes . Cette étude est conçue comme une étude d'intervention , avec groupe de contrôle . 58 patients de 65 ans et plus souffrant de sensations de vertige multisensorielles ont été choisis comme sujets d'étude . Le groupe d'intervention a suivi une formation à la rééducation vestibulaire deux fois par semaine pendant 9 semaines . Tous les patients ont été évalués au départ et après trois mois , avec quatre mesures d'équilibres différentes ainsi que le  « Dizziness H and icap Inventory »  . Après 6 , 9 et 12 mois , un suivi téléphonique a été assuré et , au bout de 12 mois , les patients ont également rempli un question naire Dizziness H and icap Inventory . Des différences statistiques significatives ont été identifiées parmi les groupes entre les mesures de départ et les mesures après 3 mois pour une mesure d'équilibre statique et une mesure dynamique ( P=0.038 et 0.044 ) . En tout , 40 chutes ont été signalées , 31 classées comme intrinsèque , 26 comme provoquées par le vertige et 9 classées comme extrinsèques . Aucune différence n'a été identifiée entre les deux groupes en terme de proportions d'individus victimes de chutes . Une déficience au niveau de la capacité à se tenir debout en appui bipodal entraîne un doublement des risques de chute . La rééducation vestibulaire peut améliorer l'équilibre des patients âgés souffrant de sensations sensorielles de vertige . Le vertige est un facteur de chute très rép and u parmi ce groupe de patients , et la rééducation vestibulaire en est un traitement possible Objective : Many papers describe vestibular rehabilitation programmes to reduce vertigo and disequilibrium caused by peripheral vestibular disorders , but few studies have assessed performance on purpose ful activities . This study determined if performance on a purpose ful activity improves after vestibular rehabilitation exercises , and if the speed of treatment exercises influences performance . Setting : Medical school practice ; tertiary care facility . Subjects : Fifty-three patients with chronic vertigo caused by peripheral vestibular weakness . Interventions : Subjects performed vestibular rehabilitation head movement exercises to habituate vertigo , in either slow or rapid movement groups . Main measures : Time to perform a repetitive head movement task and intensity of vertigo elicited by that task , question naires about independence in activities of daily living and reported usual intensity of vertigo . Results : Both groups significantly decreased the time to perform the task and the intensity of elicited vertigo . Results were related to improved independence in activities of daily living and to decreased vertigo . Conclusion : Vertigo decreases and speed of head movement improved after a programme of vestibular rehabilitation , regardless of speed of treatment exercises . A simple purpose ful activity can be useful to evaluate improvements after vestibular rehabilitation Context  Chronic dizziness  is a common and difficult to manage symptom among primary care patients .  Vestibular rehabilitation exercises improve symptoms in some patients , but primary care setting s infrequently use this treatment . Contribution The authors r and omly assigned patients to a 30- to 40-minute session during which a nurse in a primary care setting taught them vestibular exercises or to a control group . Patients assigned to the nurse intervention had significantly greater improvement in dizziness symptoms than patients in the control group . Implication s Nurse-delivered vestibular rehabilitation is a feasible and effective treatment option for primary care patients with chronic dizziness .  The Editors Dizziness is a very common symptom , with a prevalence as high as 25 % in the general population ( 1 , 2 ) . One in 10 working-age adults report some degree of h and icap due to dizziness ( 2 ) ; 2 % experience chronic , frequent , substantially h and icapping episodes ( 3 ) . More than 1 in 5 people older than 60 years of age have current dizziness that has led to substantial disability , medical consultation , or medication use ( 4 ) . Dizziness is also associated with falls , fear of falling , and loss of independence in older people ( 5 , 6 ) . The most common cause of dizziness presenting in primary care is peripheral vestibular disorder . Psychiatric factors , which often accompany medical disorders , are also common causes . Serious cardiovascular or neurologic disease is rare ( 1 , 7 - 11 ) . A multifactorial syndrome is common in older people ( 12 ) . Because of the numerous causes , patients may present in various specialties , but most are managed in primary care ( 8) . Treatment typically consists of  reassurance and antivertiginous and antiemetic drugs  to relieve symptoms ( 8 , 13 - 15 ) . However , several review s of the management of dizziness have concluded that no medication in current use has well-established curative or prophylactic value or is suitable for long-term palliative use . These review s have called for evaluation of an exercise-based form of treatment known as vestibular rehabilitation ( 14 - 16 ) . The central element of vestibular rehabilitation is a program of grade d exercises that consist of eye , head , and body movements design ed to stimulate the vestibular system . This stimulation promotes central compensation , which is neurologic adaptation to the altered input from the damaged labyrinth ( 13 , 17 , 18 ) . These exercises also help patients to overcome fear and avoidance of activities that elicit disorientation and to regain skill and confidence in balance ( 19 ) . Studies in secondary care ( for example , otolaryngology , neurootology , or balance centers ) have provided some evidence that vestibular rehabilitation may be an effective treatment for dizziness result ing from various conditions , including peripheral vestibular disorder , benign paroxysmal positional vertigo , anxiety , multifactorial dizziness in the elderly , and head injury ( 20 - 26 ) . However , to date , no r and omized , controlled trials of vestibular rehabilitation that conform to Consoli date d St and ards of Reporting Trials ( CONSORT ) criteria ( 27 ) have been reported ; therefore , the efficacy and effectiveness of vestibular rehabilitation remain difficult to estimate . For example , some studies do not use intention-to-treat analysis ( 20 , 22 - 26 ) , some have very few participants in trials ( 21 , 22 ) , and some use unpublished subjective outcome measures rather than measures with known reliability and validity ( 21 , 25 , 26 ) . Currently , vestibular rehabilitation is rarely made available to the many patients who are managed at the primary care level . It is a simple therapy with no requirement for equipment ; therefore , if effective , it would be highly suitable for more widespread provision in primary care . An earlier nonblinded r and omized , controlled trial ( 28 ) has provided a preliminary positive evaluation of the efficacy of  vestibular rehabilitation  in a primary care sample that involved patients with various causes of the disorder . After 2 home visits from a research nurse with specialist training in vestibular rehabilitation , the treatment group demonstrated a decrease in symptom severity , reduced h and icap , and better postural control ( 28 ) . In the present study , we assessed the effectiveness of a single session of vestibular rehabilitation delivered by primary care nurses . Methods Design We used a single-blind r and omized , controlled design to compare vestibular rehabilitation with usual medical care . Participants were assessed at baseline and then r and omly assigned to the intervention group . At 3 months , a research assistant who was blinded to treatment status reassessed each participant . In a single crossover design ( 29 ) , during the next 3 months , the usual medical care group received vestibular rehabilitation , and both groups were reassessed by the blinded research assistant at 6 months . The South and West Local Research Ethics Committee and the South East Local Research Ethics Committee approved the study , and all participants gave signed informed consent . Participants We recruited participants in 2001 and 2002 from 20 general practice s within a 30-mile radius of Southampton , United Kingdom , and included inner-city , suburban , and rural practice s. Participating practice s had participants with varying levels of social deprivation , as assessed from census data ( Jarman scores [ 30 ] ranged from 6.49 to 29.11 ; mean , 8.65 ) . Practice staff used the medical records in the practice to identify all patients with dizziness during the past 2 years . After we screened for exclusion criteria , patients were invited by letter to participate in the study . Practice s used the following search terms to identify potentially suitable patients from their computerized data bases ( terms used varied according to how patient data were recorded by the practice ): vertigo , dizziness , Mnire disease , ENT [ ear , nose , throat ] referral , balance problems , vestibular , prochlorperazine , cinnarizine , betahistine , and diuretics . Patients could also be directly recruited by their general practitioner , and posters displayed in practice s informed patients that they could ask to participate . Exclusion criteria were as follows : identifiable nonlabyrinthine cause of dizziness in patient records , duration of dizziness less than 2 months during the past 2 years , medical contraindications for making required head movements ( for example , severe cervical disorder ) , and serious comorbid conditions ( for example , life-threatening condition or progressive central disorder ) . Before r and omization , we also excluded patients if they were no longer found to be dizzy at the baseline assessment or if none of the rehabilitation exercises provoked dizziness . In this context , the rehabilitation exercises served as a screening test to identify patients with movement-provoked dizziness , which is typical of vestibular imbalance and should therefore respond to vestibular rehabilitation . After baseline assessment to confirm eligibility and obtain data for stratification , participants were r and omly assigned by an administrative assistant with no previous contact with the patient . Allocation , concealed in opaque sealed envelopes , was based on block r and omization within practice ( block size , 4 ) after stratification for severity of symptoms on the Vertigo Symptom ScaleShort Form ( 28 ) ( Figure 1 ) ( low severity , < 12 points ; high severity , 12 points ) . On the basis of findings from the previous primary care study ( 28 ) , we estimated that with a sample size of 86 patients per group , we should be able to detect an effect size of 0.5 on the Vertigo Symptom ScaleShort Form with a 2-tailed significance level of 5 % and 90 % power . After we made the exclusions ( Figure 2 ) , 87 patients were r and omly assigned to the usual medical care group and 83 were assigned to the treatment group . Figure 1 . Vertigo Symptom Scale ( short form ) . Figure 2 . Participants at each stage of the trial . Intervention The nurses ( n= 23 ) attended a single half-day group training session at which they learned how to teach patients to carry out vestibular rehabilitation exercises at home ( Table 1 and Appendix 1 video ) . For a full description of the material s used by nurses , see Appendix 2A ( rationale for nurse and patient education ) , Appendix 2B ( workshop structure for nurse training ) , Appendix 2C ( schedule for vestibular rehabilitation sessions ) , and the Appendix Figure ( patient therapy monitoring sheet ) . The vestibular rehabilitation program was focused on a professionally design ed treatment booklet for patients ( Appendix 3A [ booklet ] and Appendix 3B [ supplement to booklet for patients with Mnire disease ] ) and was developed by using principles of behavior change derived from theory and research on adherence ( techniques included eliciting and addressing concerns , providing evidence of efficacy , requiring the patient to make a specific goal plan and written commitment , monitoring and reinforcing progress , and teaching skills to cope with setbacks ) ( 31 , 32 ) . Patients were actively involved in adapting the exercise program to suit their symptoms , capabilities , and lifestyle . Nurses saw patients individually for 30 to 40 minutes to take them through the booklet and gave additional support and advice by telephone at 1 and 3 weeks after this initial session ( Appendix 2C ) . Participants in both groups remained free to continue their usual medical care , including use of medications and referral to specialties . Appendix 3A . Treatment booklet for patients titled " Balance Retraining : Exercises Which Speed Recovery from Dizziness and Unsteadiness . " The booklet was written by Dr. Lucy Yardley , who retains copyright for this booklet . Appendix Figure . Patient therapy monitoring sheet . Table 1 . Steps of Nurse-Delivered Vestibular Rehabilitation Outcome Measures The primary outcome measures were self-reported spontaneous and provoked symptoms of dizziness , dizziness-related quality of life , and objective measurement of postural OBJECTIVES To assess the efficacy of rehabilitation for dizzy patients after recent acute vestibular disturbance . METHODS Forty patients recently hospitalised for an acute episode of rotational vertigo which lasted days were r and omly divided into two groups . The first group ( 20 patients ; group R ) underwent active rehabilitation , while the second group ( 20 patients ; group C ) were told only to ' perform their daily activities ' . Group R subjects underwent a total of 10 sessions of rehabilitation , including exercises on a stabilometric platform , point de mire and a series of five exercises repeated five times daily . All patients performed static stabilometry ( posturography ) , undertook the dynamic gait index test , and completed a  dizziness h and icap question  naire and a  visual analogue scale for anxiety  , at baseline and on completion . RESULTS At 25 days , the rehabilitated patients obtained better results for all recorded outcomes , compared with the control group . The greatest difference in the rehabilitated subjects , compared with the control group , was for the dynamic gait index test ; however , this difference was not statistically significant . The visual analogue scale anxiety score was statistically significantly more reduced in rehabilitated patients compared with control patients . Control patients maintained a higher visual dependence for postural control . CONCLUSIONS These results would appear to support the effectiveness of a supervised exercise programme for patients following acute onset of vestibular disturbance . A correlation was found in both groups between dynamic gait index results and anxiety . In our experience , a rehabilitation programme seems to reduce dependence on visual cues for postural control OBJECTIVE To determine the effect of vestibular exercises on the recovery of visual acuity during head movement in patients with bilateral vestibular hypofunction ( BVH ) . DESIGN Prospect i ve , r and omized , double-blinded study . SETTING Outpatient clinic , academic setting . PATIENTS Thirteen patients with BVH , aged 47 to 73 years . INTERVENTION One group ( 8 patients ) performed vestibular exercises design ed to enhance remaining vestibular function , and the other ( 5 patients ) performed placebo exercises . MAIN OUTCOME MEASURES Measurements of dynamic visual acuity ( DVA ) during predictable head movements using a computerized test ; measurement of intensity of oscillopsia using a visual analog scale . RESULTS As a group , patients who performed vestibular exercises showed a significant improvement in DVA ( P = .001 ) , whereas those performing placebo exercises did not ( P = .07 ) . Only type of exercise  ( ie , vestibular vs placebo ) was significantly correlated with change in DVA . Other factors examined , including age , time from onset , initial DVA , and complaints of oscillopsia and disequilibrium , were not significantly correlated with change in DVA . Change in oscillopsia did not correlate with change in DVA . CONCLUSIONS Use of vestibular exercises is the main factor involved in recovery of DVA in patients with BVH . We theorize that exercises may foster the use of central ly programmed eye movements that could substitute for the vestibulo-ocular reflex . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00411216
OBJECTIVE to summarize the results of clinical trials on vestibular rehabilitation ( VR ) in middle-aged and elderly people with vestibular disorders .