Introduction :
People with vestibular disorders often complain of vertigo, dizziness, gaze disturbance and gait imbalance. It is reported that around 20% to 30% of the general population suffers from dizziness (Karatas, 2008).The most common vestibular disorders include vestibular hypofunction and benign paroxysmal positional vertigo (BPPV). These can be caused by vestibular neuritis, acoustic neuroma and detachment of otoconia etc. Vestibular Rehabilitation (VR) including adaptation, habituation and substitution exercises, particle repositioning maneuvers and balance training is supported by evidence that can effectively improve the symptoms of vestibular disorders (Ricci et al., 2010). Moreover, early initiation of vestibular rehabilitation was shown to be able to improve overall symptoms and shorten the time of return to normal life (Ferry et al., 2023; Kamo et al., 2023). Under the collaboration with Otorhinolaryngologists (ENT) in Yan Chai Hospital, a new structured VR program was established to provide patients with fast track rehabilitation. Suitable patients were referred to physiotherapy in the first ENT consultation so that patients can receive earlier physiotherapy when patients were waiting for further investigation such as magnetic resonance Imaging, videonystagmography, etc.
Methodology :
Patients with a diagnosis of vestibular disorder, including BPPV and vestibular hypofunction, were recruited to a VR program. They were assessed individually and treatment including otolith repositioning maneuver, balance training, habituation exercises and education pamphlet were provided. Each patient was followed up with a consultation session every 1-2 weeks to monitor progress. Outcome measures including Numeric Global Rate of Change Scale (NGRCS), Visual Analogue Scale for dizziness (VAS), and Dizziness handicap Inventory (DHI), 4-item Dynamic Gait Index (4-DGI) were assessed before and after participation in the program.
Result & Outcome :
From January 2022 to November 2023, 193 patients, in which 142 were female and 51 were male, with mean age 62.5±13.2 were reviewed and 158 of them (81.9%) completed the program. An average of 2.6±2.7 sessions was attended. 127 (80.4%) of discharged patients were able to complete the program within 3 sessions. NGCRS was 6.6±3.0. The mean VAS, DHI and 4-DGI score were significantly decreased from 4.5±2.7 (pre-treatment) to 1.6±2.0 (post-treatment) (p<0.001, 95% CI 2.4 to 3.4), 41.3 ±23.0 decrease to 24.0±22.2 (p<0.001, 95% CI 12.7 to 21.8) and 11.5±5.5 improved to 11.9±5.4 (p=0.003, 95% CI -0.6 to -0.1) respectively. It was found that the VR program could enhance improvement of symptoms, emotional outcomes and gait stability in cases with vestibular disorder. The VR program was shown to be time-efficient and cost-effective in reducing vestibular symptoms, as the majority could finish the program within 3 sessions with promising outcomes.
References
Karatas, M. (2008). Central vertigo and dizziness: epidemiology, differential diagnosis, and common causes. The neurologist, 14(6), 355-364.
Ricci, N. A., Aratani, M. C., Doná, F., Macedo, C., Caovilla, H. H., & Ganança, F. F. (2010). A systematic review about the effects of the vestibular rehabilitation in middle-age and older adults. Brazilian Journal of Physical Therapy, 14, 361-371.
Ferry, B., Means, G., Green, C., Risoli, T., Martinez, C., Vomer, R. P., 2nd, Reinke, E., Pyles, C., & Bytomski, J. (2023). Early Initiation of Vestibular Therapy Following Sports-Related Concussions: A Retrospective Cohort Study. Cureus, 15(5), e39764.
Kamo, T., Ogihara, H., Azami, M., Momosaki, R., & Fushiki, H. (2023). Effects of Early Vestibular Rehabilitation in Patients With Acute Vestibular Disorder: A Systematic Review and Meta-Analysis. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology, 44(9), e641–e647.
