PHYSICAL THERAPY MANAGEMENT OF PERIPHERAL VESTIBULAR DYSFUNCTION - 2 CLINICAL CASE-REPORTS

We describe the treatment of two patients with peripheral vestibular d ysfunction using a novel, staged exercise program. Response to treatme nt was documented The first patient, a 62-year-old woman with unilater al vestibular dysfunction (UVD) and a 6-month history of disequilibriu m following herpes zoster oticus resulting in damage to the right inne r ear, was treated with an 8-week course of vestibular physical therap y. During the 8 weeks, the patient attended weekly physical therapy se ssions and was trained to perform vestibular adaptation exercises on a daily basis at home. The second patient, a 53-year-old woman with pro gressive disequilibrium secondary to profound bilateral vestibular hyp ofunction (BVH), was treated with a 16-week course of vestibular physi cal therapy. During the first 8 weeks, the patient attended weekly phy sical therapy sessions and was trained to perform vestibular adaptatio n and substitution exercises on a daily basis at home. During the seco nd 8 weeks, the patient continued performing vestibular physical thera py exercises at home independently. Vestibular function (sinusoidal ve rtical axis rotation testing), postural control (clinical tests and po sturography), stability during the performance of selected activities of daily living (ADLs), and self-perception of symptoms and handicap w ere measured prior to and at the conclusion of treatment for both pati ents and at the midpoint of treatment for the patient with BVH. After 8 weeks of treatment, both patients reported improvements in self-perc eption of symptoms and handicap and demonstrated objective improvement s in clinical balance tests, posturography, and several kinematic indi cators of stability during the performance of selected ADLs Further im provements were noted in the patient with BVH after 16 weeks of treatm ent Improvements in postural control were noted after 8 weeks of treat ment for the patient with UVD and after 16 weeks for the patient with BVH. Vestibular function improved during the course of treatment for t he patient with UVD only. These case reports describe two different in dividualized treatment programs and document self-reported and laborat ory-measured functional improvements in two patients with vestibular d eficients-one with unilateral damage and one with bilateral damage.