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"Medicina Sportiva" Nr.5 - 2006

Vestibular rehabilitation and balance retraining

Burt Mistiaen
University of Bruges, Belgium

The subject of this presentation is to propose a protocol for rehabilitation of balance after a seriously assesment, beging from our case that was a 35 year old female complains of headaches and dizziness beginning two months ago. She is not sure what started it, except that she was showing her young daughter how to twirl the baton, she threw it up in the air, looking up to watch it, and when she looked down again after catching it she was dizzy to the point of nausea and vomiting. The symptoms have subsided somewhat, but are still aggravated by looking upwards. Her least symptomatic position is sitting in an armchair with her head supported. After this case we made a study 65patients, age20-89years (mean52), at least 2 month history of symptoms (mean 3.1 yrs).

The questions in all these cases are:
What are your hypotheses as to the possible origin of this woman’s problems?
What do you know about her condition?
What do you need to know in order to begin your examination and intervention?
Why do problems occur?

Is important to know some aspects regards general considerations about dizziness and pathogeny of this. So exist two great aspects of mechanisms that perturbe posture control: peripheral systems used for maintaining upright posture; central postural control(3)...Mechanisms

Possible causes of dizziness:a) central nervos system disease-tumors, cerebral concussion/contussion, cranial nerve VIII neuroma, vestibular neuritis, ottis media, labyrinthine disease, iatrogenic causes (drugs, surgery) postural hypotension; b) other possible causes of dizzeness-toxins, migraine, metabolic, hematologic cardiovascular disease, cervicogenic dysfunction, anxiety disoders, vertebral insuffciency.

Assesment in dizzeness include assesment of all components of balance and posture and also physical examination for help differential diagnosis and establish the corect diagnostic(1).
1.Head eye coordination-vestibulo-ocular reflex: goal is to stabilize image on retina ( head movements while walking or chewing). Abnormal reflex suggests vestibular system involvement.
2. Vestibular provides information on:speed of head movement, direction of head movement, acceleration of head movement, position of head in reference to gravity, loss can be unilateral or bilateral(2).xicity
Vestibular function assesment using electronystamography(ENG) include tests wich use electrodes to measure eye movements, relative to head movements(rotating chair, calorics, vestibular autototation test).
3. Somatosensory: proprioception, pressure, touch, stretch, etc. Provides information on body part position (in space, in relation to other body parts).
4.In physical assesment are important specific tests like: vertebral artery test(fig.1) for facility the diagnostic of nystagmus.

Fig. 1 Normal Vestibular Function using ENG(2)
Fig. 2-vertebral artery test

Propose of treatment the vestibular and balance impairments

Theoretical basis for treatment

1. Treatment of vestibular problems-after, we have known the diagnostic, using the results of assesment we can say if the origin of dizzeness are from central or peripheric side. If central exercise approach, compensate. If peripheral we use exercise for reposition.

2. The first problem is to exclude the habituation factoros, that involve pathologic response, and to eliminate the provocative stimulus.

3. The second problem is to create a new adaptation of neurophysiologic phenomenons and so to slow decline in afferent neuronal responses.

4. The third aspect is to development the mechanisms of compensation.
In our study we begin from a classification of all impairments and the therapeutic way in each impairment.

Table 1

Graphic 1


1.Aspinall W,(1990), Clinical testing for the craniovertebral hypermobility syndrome, JOSPT 12(2):47-54.
2.Baloh, (1998) , Repositioning Maneuver (Epley),
Lancet, Volume 352(9143).December 5,.1841-1846
3.Foster CA, Baloh RW. (1995), Episodic vertigo. In: Rakel RE, ed. Conn's current therapy, 47th edn. 4.Philadelphia: WB Saunders: 837-41.
4. MageeDJ (2002) OrthopedicPhysicalAssessment, 3rded. WB Saunders Co, Philadelphia, ISBN 0-7216-6290-0.

Realizator Web - Dr.Gabriel Panait Informatiile apartin S.Ro.M.S - persoana contact Dr.Mirela Vasilescu

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23 martie 2006
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