Research in Vestibular Science

Original Articles

Satisfaction and Effect Research on Virtual Reality-Based Vestibular Exercise for the Elderly Patients with Chronic Unilateral Vestibulopathy: Kwang-Dong Choi, Seo-Young Choi; Res Vestib Sci. 2020;19(4):127-132. Published online December 15, 2020; DOI: https://doi.org/10.21790/rvs.2020.19.4.127

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Abstract PDF: Objectives
To survey the satisfaction of customized vestibular exercise using virtual reality system with mobile head-mounted display (HMD) in the elderly patients with chronic unilateral vestibulopathy, we analyzed questionnaires before and after exercise.
Methods
Sixteen patients (male, 6; median age, 69 years [interquartile range, 65–75 years]) with chronic unilateral vestibulopathy were prospectively enrolled from March 1 to December 31 in 2018. They exercised once a week for 20 to 25 minutes for 4 weeks using the HMD inserted the virtual reality exercise program. Dizziness visual analogue scale (DAS), Korean vestibular disorders activities of daily living scale (ADL), and visual vertigo analogue scale (VVAS) were performed before and after the exercise. After all of the program, the patients were surveyed to measure the satisfaction for the tool and effect of exercise.
Results
DAS, ADL, and VVAS were significantly improved after the vestibular exercise. No one answered unsatisfactory, and at least 62.5% of the patients satisfied the used tool and exercise program. The patients of 50% answered that they satisfied or very satisfied to the efficacy of exercise program. The patients who recovered VVAS more after the exercise were more satisfied to our tools and efficacy of exercise program.
Conclusions
Customized vestibular exercise using virtual reality system with HMD can not only improve dizziness and quality of life, but also made more satisfied to the elderly patients with chronic unilateral vestibulopathy.

Factors Associated with Patient Satisfaction in Customized Vestibular Exercise: A Pilot Study: Hye Soo Ryu, Min Young Lee, Jae Yun Jung, Ji Eun Choi; Res Vestib Sci. 2019;18(3):71-77. Published online September 15, 2019; DOI: https://doi.org/10.21790/rvs.2019.18.3.71; Retraction in: Res Vestib Sci 2020;19(4):149

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Customized Vestibular Rehabilitation in the Patients with Bilateral Vestibulopathy: A Pilot Study in One Referred Center: Kwang-Dong Choi, Seo-Young Choi; Res Vestib Sci. 2019;18(3):64-70. Published online September 15, 2019; DOI: https://doi.org/10.21790/rvs.2019.18.3.64

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Abstract PDF: Objectives
Bilateral vestibulopathy is characterized with unsteadiness and oscillopsia when walking or standing, worsening in darkness and/or on uneven ground. To establish the effect of customized vestibular rehabilitation in bilateral vestibulopathy, we analyzed the questionnaires and functional status before and after treatment.
Methods
Among 53 patients with customized vestibular rehabilitation from January 1st to November 30th in 2018, 6 patients (3 males; median age, 71 years; range, 54–75 years) who regularly exercised with good compliance were retrospectively enrolled. They were educated and trained the customized vestibular rehabilitation once a month or two by a supervisor during 40 minutes, and then exercised at home for 30 minutes over 5 days in a week. Dizziness handicap inventory (DHI), Korean vestibular disorders activities of daily living scale (vADL), Beck’s depression index (BDI), test for dynamic visual acuity (DVA), and Timed Up and Go test (TUG) were performed before and after the customized vestibular rehabilitation.
Results
The patients exercised for median 5.5 months (range, 2–10 months) with the customized methods of vestibular rehabilitation, which included gaze and posture stabilization and gait control exercises. DHI score and TUG was improved after rehabilitation (DHI before vs. after rehabilitation=33 vs. 16, p=0.027, TUG before vs. after rehabilitation=12 vs. 10, p=0.026). BDI, DVA, and vADL scores did not differ between before and after treatment.
Conclusions
Customized vestibular rehabilitation can improve dizziness and balance state in bilateral vestibulopathy. The steady exercises adapted individual peculiarities is the most important for vestibular rehabilitation.

Reviews

Vestibular Rehabilitation after Traumatic Head Injury with Dizziness: Sung Kyun Kim, Seok Min Hong; Res Vestib Sci. 2019;18(2):32-37. Published online June 15, 2019; DOI: https://doi.org/10.21790/rvs.2019.18.2.32

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Abstract PDF: The vestibular symptoms such as dizziness and imbalance that occurred after traumatic head/brain injury were caused by a combination of central factors such as abnormalities of white matter, diffuse axonal injury and microhemorrhage, and peripheral factors like decreased vestibulo-ocular reflex caused by the energy transmitted to the semicircular canal and otolith organs. These symptoms can affect on the patient's overall physical, cognitive, emotional, and quality of life. There have been reports that vestibular rehabilitation for the treatment of dizziness and imbalance after head trauma can promote vestibular compensation, stabilize of the gaze movements, and also affect the treatment outcomes of the associated injuries. The frequency, duration, and number of people participating in vestibular rehabilitation varied with each study, and physical therapy, occupational therapy, cognitive counseling, medication treatment, duration of treatment for associated injuries were also variable. Most studies have shown that many patients who get the vestibular rehabilitation have a significantly reduced time to return to work and sports activities, and may be able to speed up the recovery of vestibular symptoms. However, further research is needed on its long-term effects. In addition, patients with traumatic head/brain injuries are more susceptible to injuries of other organs as well as vestibular disorders, therefore consideration of treatment planning for associated injuries including precise evaluation mental support, and cognitive therapy is expected to be more effective with vestibular rehabilitation therapy.

Review for Update on Vestibular Rehabilitation: Eun Ju Jeon; Res Vestib Sci. 2016;15(2):31-38. Published online June 15, 2016

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Abstract PDF: Vestibular rehabilitation (VR) is valuable tool to manage balance problem in various kinds of diseases. Over the last decades, numerous studies on the effect of VR have been reported. Recently, systematic analysis integrating the individual studies have been tried and the results suggest that VR is safe and effective management for the acute/chronic and unilateral/bilateral peripheral vestibular dysfunction, and also for the elderly people. VR relieves dizziness and improves gaze stability, postural stability, parameters of gait, and activities of daily living. Currently released "Clinical practice guideline of VR on peripheral vestibular dysfunction" support and assist the use of VR in clinical field. More research is needed to develop uniform evaluation tool to measure the symptomatic and functional status of the patients and individualized efficient rehabilitation programs. It is expected that device for VR incorporating new technologies such as virtual reality will be developed in near future.

Vestibular Rehabilitation for Patient with Bilateral Peripheral Vestibular Deficit: Hyun Woo Park, Seong Ki Ahn; Res Vestib Sci. 2016;15(1):1-4.

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Abstract PDF: Bilateral vestibular deficit affects far fewer patients than unilateral deficit, and thus has been understudied. When bilateral vestibular organs are injured, loss of input of vestibulo-ocular and vestibulo-spinal reflex that normally stabilize the eyes and body, affected patients suffer blurred vision during head movement, postural instability, and disequilibrium. Vestibular rehabilitation therapy is an exercise-based treatment program designed to promote vestibular adaptation and substitution. The rationale for the exercises, which originated from the observation that patients who were active recovered faster, was based on the supposition that the head movements that provoke the patient’s dizziness play an important role in hastening the recovery process. Here the author reviews the clinical manifestation and treatment of bilateral vestibular deficit that include vestibular rehabilitation therapy and vestibular device that studied today.

Vestibular Rehabilitation in Central Dizziness: Byung In Han, Pan Woo Ko, Ho Won Lee, Hyun Ah Kim, Hyung Lee; Res Vestib Sci. 2015;14(4):97-100.

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Abstract PDF: Vestibular rehabilitation therapy (VRT) is an exercise-based treatment program designed to promote vestibular adaptive and compensatory mechanisms already existing in the human brain. Although the evidence is sparse for improvement in subjects with central vestibular dysfunction following VRT, it improves postural stability in cerebellar diseases and reduces subjective complaints and fall risk in Parkinson disease. Possible mechanisms of recovery after central nervous system lesions may include neural sprouting, vicarious functions, functional reorganization, substitution, and plasticity. VRT regimens for patients with central causes should include balance and gait training, general strengthening and flexibility exercises, utilization of somatosensory and vision and utilization of alternate motor control strategies. VRT would be an option to relieve the symptoms of the many patients who have central dizziness.

Vestibular Rehabilitation for Patients with Unilateral Peripheral Vestibular Deficit: Chang Geun Song, Sung Kwang Hong; Res Vestib Sci. 2015;14(3):61-66.

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Abstract PDF: Unilateral peripheral vestibular deficit can occur from a different etiology including viral infection, trauma, ear surgery or idiopathic. Patients with sudden unilateral vestibular deficit usually complain of whirling vertigo, postural imbalance and ipsilesional lateropulsion, which gradually recover over a few weeks by vestibular compensation mechanism. Vestibular rehabilitation therapy has been accepted as helpful exercise based training program with strong evidence for acceleration of vestibular compensation in unilateral vestibular deficit. Here the authors described the current issue regarding vestibular rehabilitation in unilateral vestibular hypofunction from the informative literature review.

Original Articles

Effect of Elderly Organized Vestibular Rehabilitation for Presbystasis: Tae Hoo Kim, Beom Gyu Kim, Chul Young Heo, Jae Seok Lee, Il Seok Park, Yong Bok Kim, Tae Won Jang, Seong Ki Ahn; Res Vestib Sci. 2010;9(2):58-63.

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Abstract PDF: Background and Objectives Recently, The number of patients who have been complaining of the vertigo or dizziness has been increasing due to rapid growth of the elderly population and senile change. Aging is associated with decreased balance abilities, resulting in an increased risk of fall. The purpose of this study is to analyze the result of elderly organized vestibular rehabilitation therapy for presbystasis. Materials and Methods A prospective study was performed on elderly population over sixty-five years. 148 dizzy patients who were admitted to Hallym University Medical Center. We recruited 64 consecutive patients with a diagnosis of presbystasis and treatment of rehabilitation. They were asked to complete the Korean vestibular disorders activities of daily living scale (K-VADL) for the functional aspect before and two to twelve weeks after elderly organized vestibular rehabilitation therapy. The result was analyzed by statistical methods. Results The K-VADL scores were decreased in patient of presbystasis compared with first questionnaire. There were statistically significant differences in the K-VADL scores between before and after rehabilitation therapy. Conclusion Most patients can effectively and safely utilize the modified vestibular rehabilitation therapy. Our results suggest that the vestibular rehabilitation therapy could provide a recovery for dizzy symptoms in presbystasis.

The Effect of Balance Exercise Using Exercise Ball on Balance Function of Elderly: Suk Joon Lee, Jai Hwan Hyun, Yong Soo Lee, Hyun Ju Lee, Hyun Jung Lee, Jae Yun Jung, Chung Ku Rhee; J Korean Bal Soc. 2007;6(2):132-137.

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Abstract PDF: Background and Objectives: Vestibular rehabilitation is an important therapy to treat dizziness in elderly. The aim of this study is to evaluate the effect of balance and resistance exercises in improving balance function in elderly. Methods: Sixty elderlies between the age of 65 to 80 years old were divided into two groups; the control group and exercise group. The exercise group carried out balance and resistance exercises using an exercise ball for 60 minutes each time, 3 times/week for 16 weeks. The elderlies in both groups went through sensory organization test (SOT) and motor control test (MCT) of Equi test pre-series of exercise and post-series of exercise. Results: Conditions 4 and 6 of SOT in control group and conditions 3, 4, 5, and 6 of exercise group showed significantly higher scores in post-exercise compared to those of pre-exercise status. In condition 4, the score was significantly higher in exercise group compared to that of control group. In sensory analysis, the visual and vestibule analyses ratio of post-exercise were significantly higher compared to those of pre-exercise status. The visual analysis ratio of exercise group was significantly higher compared to that of control group. In MCT, the latency of medium forward of exercise group was significantly decreased compared to that of control group in post-exercise status. Conclusion: The results of this study showed that the balance and resistance exercises using an exercise ball was effective in improving various scores and ratio of SOT and sensory analyses in the elderly. This kind of exercises appears to improve balance function in the elderly. The balance and resistance exercises using exercise ball may be effective exercises to improve balance function of chronic dizziness including presbyastasis.

A New Treatment Strategy of Ageotrophic Horizontal Canal Benign Paroxysmal Positional Vertigo: Gyu Cheol Han, Hyung Gyu Jeon, Jin Myung Huh; J Korean Bal Soc. 2002;1(1):113-117.

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Abstract PDF: Background
and Objectives : Ageotrophic nystagmus in the horizontal canal BPPV has been explained as a result of cupulolithiasis theory, and has been reported to have the less therapeutic response to conservative rehabilitations than the other type BPPV . Though methods to detach the debris with vibrator have been introduced, the effect has been questioned and it’s not physiologic. Materials and Method : We introduce a new head shaking-forced prolonged position method as a more convenient method, and report typical 2 cases of ageotrophic horizontal canal BPPV managed with it and analyzed results of 25 cases all told.
Results
and conclusion : The average number of rehabilitation was less than two, and loss of direction changing positional nystagmus could be observed immediately after rehabilitation.

Clinical Analysis of Bilateral Vestibulopathy: Chung Ku Rhee, M.D.; J Korean Bal Soc. 2002;1(1):103-107.

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Abstract PDF: From retrospective review of medical charts of patients diagnosed as bilateral vestibulopathy during the past seven years, this study investigated incidence, etiologies, symptoms, vestibular function test findings; electronystagmography (ENG) studies, rotatory chair testing, and posturography, and post-vestibular rehabilitation (VRT) follow-up results. we have an incidence of 1.2% of all the 3423 patients who have undergone vestibular function test. Ototoxicity was the first known etiology and we had a lot of patients of idiopathic bilateral vestibulopathy. Most patients in our study had experiences of sudden onset vertigo rather than slowly progressive symptoms. The most frequently complained symptoms were dysequilibrium and oscillopsia. Post-VRT courses were better in patients whose initial gain of vestibulo-ocular reflex(VOR) was high or ascending type.

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