Rieducazione. Department of Rehabilitation Medicine, Emory University School of Medicine, Georgia, USA.

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1 Rieducazione Curr Opin Neurol Feb;26(1): doi: /WCO.0b013e32835c5ec4. Vestibular rehabilitation. Herdman SJ. Department of Rehabilitation Medicine, Emory University School of Medicine, Georgia, USA. PURPOSE OF REVIEW: This review examines the research from 2011 through 2012 on treatment efficacy in two common vestibular disorders - vestibular hypofunction and benign paroxysmal positional vertigo (BPPV). RECENT FINDINGS: Significant numbers of randomized controlled trials now support the use of specific exercises for the treatment of patients with unilateral peripheral vestibular hypofunction. We do not know if some treatment approaches are more effective than others. There is preliminary evidence that head movement may be the component critical to recovered function and decreased symptoms. Some patient characteristics and initial assessment results appear to predict treatment outcome but the evidence is incomplete. Treatment of posterior canal BPPV canalithiasis is well established. New evidence supports certain treatments for horizontal canal BPPV. SUMMARY: Treatments for unilateral vestibular hypofunction and for posterior canal BPPV are effective; however, there are many as yet unanswered questions such as why some patients with vestibular hypofunction do not improve with a course of vestibular exercises. We also do not know what would be the best treatment for anterior canal BPPV or for multiple-canal involvement BPPV. Acta Otolaryngol Mar;133(3): doi: / Epub 2012 Nov 6. Vestibular rehabilitation using the Nintendo Wii Balance Board - a user-friendly alternative for central nervous compensation. Sparrer I, Duong Dinh TA, Ilgner J, Westhofen M. Department of Otorhinolaryngology & Plastic Surgery, RWTH Aachen University, Aachen, Germany.

2 Conclusion: The Nintendo Wii Balance Board is a cost-effective and user-friendly alternative to other popular frequently used systems that aid vestibular compensation, particularly in elderly patients. In addition, further treatment in the home environment is possible. Objective: This cohort study was designed to investigate the impact of the Nintendo Wii Balance Board as a visual compensation device after acute vestibular neuritis. Methods: Subjects were randomly assigned to one of two treatment groups. Group A (n = 37) performed customized exercises with the Nintendo Wii Balance Board. Group B (n = 34) performed only two elected exercises as a control group for comparison of the results. Both groups underwent additive therapy with steroids (intravenous) in decreasing doses (250 mg decreasing to 25 mg over 10 days). The Sensory Organization Test (SOT), Dizziness Handicap Inventory (DHI), Vertigo Symptom Scale (VSS), and Tinneti questionnaire were evaluated immediately before treatment (baseline), at the end of treatment, i.e. at day 5, and after 10 weeks. Results: The early use of a visual feedback system in the context of the balance training supports the central nervous vestibular compensation after peripheral labyrinthine disorders. Patients in group B (without training) required a longer in-patient stay (average 2.4 days, SD 0.4) compared with patients following early Wii rehabilitation. The absence of nystagmus under Frenzel's goggles in group A was observed 2.1 days (SD 0.5) earlier than in group B. Group A showed significantly better results in the SOT, DHI, VSS, and Tinneti questionnaire at all time points measured (p < 0.05) [PubMed - in process] J Vestib Res. 2011;21(5): doi: /VES International guidelines for education in vestibular rehabilitation therapy. Cohen HS, Gottshall KR, Graziano M, Malmstrom EM, Sharpe MH, Whitney SL; Barany Society Ad Hoc Committee on Vestibular Rehabilitation Therapy. Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Neck Surgery, Baylor College of Medicine, Houston, TX, USA. hcohen@bcm.edu The Barany Society Ad Hoc Committee on Vestibular Rehabilitation Therapy has developed guidelines for developing educational programs for continuing education. These guidelines may be useful to individual therapists who seek to learn about vestibular rehabilitation or who seek to improve their knowledge bases. These guidelines may also be useful to professional organizations or therapists who provide continuing education in vestibular rehabilitation. We recommend a thorough background in basic vestibular science as well as an understating of current objective diagnostic testing and diagnoses, understanding of common tests used by therapists to assess postural control, vertigo and ability to perform activities of daily living. We recommend that therapists be familiar with the evidence supporting efficacy of available treatments as well as with limitations in the current research [PubMed - indexed for MEDLINE]

3 NeuroRehabilitation. 2011;29(2): doi: /NRE Behavioral aspects of vestibular rehabilitation. Staab JP. Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA. Behavioral factors are an integral part of the overall morbidity of patients with vertigo, dizziness, and balance disorders. Anxiety, depression, and more importantly, loss of balance confidence and sense of debility and handicap beleaguer patients with acute and chronic vestibular symptoms. Vestibular rehabilitation originated as a physical therapy, but a careful look at its research development and clinical applications show it to be as much, or perhaps more, a behavioral intervention. More patients referred for vestibular rehabilitation require habituation to chronic vestibular symptoms and motion sensitivity than compensation for active peripheral or central vestibular deficits. Vestibular rehabilitation may exert a positive effect on behavioral morbidity, but the benefits are somewhat uneven and do not always correlate with physical improvements. Health anxiety (i.e., excessive worry about the cause and consequences of physical symptoms) is an emerging concept in clinical psychiatry and psychology. It may offer an important key to understanding the debility and handicap experienced by many patients with vestibular symptoms and enhance the ability of vestibular rehabilitation to ameliorate their suffering [PubMed - indexed for MEDLINE] Phys Ther Jan 17. [Epub ahead of print] Vestibular Rehabilitation for Unilateral Peripheral Vestibular Dysfunction. Brodovsky JR, Vnenchak MJ. J.R. Brodovsky, PT, MSPT, Outpatient Physical Therapy, MossRehab Einstein at Elkins Park, 60 E Township Line Rd, Elkins Park, PA (USA). This excerpt was created in the absence of an abstract.<leap> highlights the findings and application of Cochrane reviews and other evidence pertinent to the practice of physical therapy. The Cochrane Library is a respected source of reliable evidence related to health care. Cochrane systematic reviews explore the evidence for and against the effectiveness and appropriateness of interventions-medications, surgery, education, nutrition, exercise-and the evidence for and against the use of diagnostic tests for specific conditions. Cochrane reviews are designed to facilitate the decisions of clinicians, patients, and others in health care by providing a careful review and interpretation of research studies published in the scientific literature.(1) Each article in this PTJ series summarizes a Cochrane review or other scientific evidence on a

4 single topic and presents clinical scenarios based on real patients or programs to illustrate how the results of the review can be used to directly inform clinical decisions. This article focuses on an adult patient with unilateral peripheral vestibular hypofunction. Could a physical therapist-guided vestibular rehabilitation program decrease his symptoms and improve his function? [PubMed - as supplied by publisher] J Vestib Res. 2012;22(5-6): doi: /VES The effect of vestibular rehabilitation on adults with bilateral vestibular hypofunction: a systematic review. Porciuncula F, Johnson CC, Glickman LB. Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA. fsp2102@columbia.edu PURPOSE: Adults with bilateral vestibular hypofunction (BVH) experience significant disability. A systematic review assessed evidence for vestibular rehabilitation (VR). NUMBER OF STUDIES: 14 studies. MATERIALS/METHODS: Search identification of studies based on inclusion criteria: (a) population: adults with BVH of peripheral origin; (b) interventions: vestibular exercises, balance training, education, or sensory prosthetics; (c) comparison: single interventions or compared to another psychophysical intervention, placebo, or healthy population; (d) outcomes: based on International Classification of Functioning, Disability and Health (ICF) Body Functions and Structure, Activity, and Participation; (e) study designs: prospective and interventional, Levels of Evidence I to III per Centre of Evidence-based Medicine grading. Coding and appraisal based on ICF framework and strength of evidence synthesis. RESULTS: Five Level II studies and nine Level III studies: All had outcomes on gaze and postural stability, five with outcomes on gait speed and perceptions of oscillopsia and disequilibrium. CONCLUSIONS: (a) Moderate evidence strength on improved gaze and postural stability (ICF-Body Functions) following exercise-based VR; (b) Inadequate number of studies supporting benefit of VR on ICF-Participation outcomes; (c) Sensory prosthetics in early phase of development.

5 CLINICAL RELEVANCE: Moderate evidence strength in support of VR from an impairment level; clinical practice and research needed to explore interventions extending to ICF-Activity and Participation [PubMed - in process]