Peripheral Vestibular Hypofunction (Clinical Guidelines)

Peripheral Vestibular Hypofunction (PVH) is defined as the complete or partial loss of function of the vestibular nerves and/or peripheral vestibular sensory organs. This can be unilateral or bilateral and is often caused by inflammation of the vestibular nerve. PVH is often characterised by symptoms such as :

• Vertigo = the sensation of spinning

• Oscillopsia = a visual disturbance where objects appear to oscillate.

• Disequilibrium = unsteadiness and imbalance

• Gait/postural instability = difficulty balancing.

These symptoms can significantly affect a person’s ability to complete their daily activities, spatial navigation, memory, executive function and attention therefore having a negative effect on quality of life. It also places individuals at a greater risk of falls which can result in further injury.

The current evidence-based approach for the management of PVH is 4 different exercise based components which address the associated impairments, activity limitations and participation restrictions. These components are:

1. Gaze Stability Exercises = exercises that aim to reduce symptoms by causing adaptation and substitution of the vestibular reflex.

2. Habituation Exercises = exercises that aim to reduce symptoms by repeating exposure to stimuli that provoke symptoms to reproduce behavioural responses.

3. Gait & Balance Exercises = exercises that aim to optimise the function of postural systems. This may include balance exercises that challenge static and dynamic balance, saving responses and balance inputs.

4. Walking Programs for Endurance = graduated walking programs for endurance as physical deconditioning is often a secondary complication of vestibular hypofunction.

The current practice guidelines for the management of PVH recommend that physiotherapists offer vestibular physiotherapy training to those with acute, sub acute and chronic PVH. This includes in-clinic sessions and the development of a home program which includes balance, gait training and gaze stability exercises. This is recommended to continue with treatment until the initial goals of treatment have been achieved, symptoms have resolved, balance and vestibular function has been restored or progress has significantly plateaued. At PROmotion we have a number of staff including Josie Harris who can assist with assessment and management of PVH. To book in call 9284 4405 or book online via this link.

Reference:

Hall, C. D., Herdman, S. J., Whitney, S. L., Anson, E. R., Carender, W. J., Hoppes, C. W., Cass, S. P., Christy, J. B., Cohen, H. S., Fife, T. D., Furman, J. M., Shepard, N. T., Clendaniel, R. A., Dishman, J. D., Goebel, J. A., Meldrum, D., Ryan, C., Wallace, R. L. & Woodward, N. J (2022) Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Updated Clinical Practice Guideline From the Academy of Neurological Physical Therapy of the American Physical Therapy Association. Journal of Neurological Physical Therapy, 46 DOI: 10.1097/NPT.0000000000000382.