Vestibular Rehabilitation
Introduction
Our balance and equilibrium help us to stay upright when standing,
to know where we are in relation to gravity, and to walk, run, and
move without falling. Vestibular functioning depends on information
from many systems, including auditory, vision, and proprioception.
When a person's balance is impaired, he or she may report
symptoms of unsteadiness, wooziness, disorientation, or blurred
vision, or experience a sensation of movement. Additional symptoms
that can accompany the balance problem can include nausea,
vomiting, diarrhea, faintness, changes in heart rate and blood
pressure, fear, anxiety, or panic.
Problems with balance and dizziness can be a significantly
disabling condition. It can affect simple activities of daily
living such as getting out of bed, reaching for objects, or taking
a shower. The Centers for Disease Control and Prevention (CDC;
2003) estimate that nearly half of individuals in the United States
have experienced some balance problem at some point in their lives.
Populations at risk for balance problems include those who have
suffered head trauma, individuals in occupations where gravity and
motion change rapidly such as divers and pilots, and the elderly.
The elderly are particularly vulnerable for vestibular problems due
to the changes in function associated with aging. The CDC (2008)
report that an elderly person is treated in an emergency room for a
fall every 18 seconds, and every 35 minutes an elderly person dies
from fall-related injuries.
Feelings of vertigo or disequilibrium can persist after any
acute injury to the vestibular system due to poor central nervous
system compensation. In addition, some patients will develop
postural control strategies that make them unsteady in certain
situations. These patients often benefit from a program of
vestibular and balance rehabilitation. The ASHA policy documents on
the Role of Audiologists in Vestibular and Balance Rehabiliation
(1999a, 1999b, 1999c) indicate that canalith repositioning
procedures and consultation to and/or serving as a member of a
multidisciplinary team managing patients with balance disorders
and/or dizziness are within the scope of practice for audiologists.
Typically, appropriately trained physical or occupational
therapists provide comprehensive vestibular rehabilitation
programs.
Access Audiology
is pleased to present a paper on vestibular rehabilitation by one
of our colleagues from the field of physical therapy, Deanna Dye.
In her article, "
Rehabilitation Options
for Patients With Dizziness and Imbalance
," Dr. Dye, Associate Professor of Physical Therapy at Idaho
State University (ISU), presents an overview of various forms of
vestibular rehabilitation. Dr. Dye and Dr. Jeff Brockett, Assistant
Professor of Audiology, operate the ISU Dizziness and Balance
Clinic. The efficacy of the use of vestibular and balance
rehabilitation programs for the management of patients with balance
and dizziness complaints has been well documented in recent years.
It is important that audiologists have a clear understanding of not
only the anatomy and physiology of the vestibular system and
underlying pathologies associated with balance problems and
assessment of balance disorders but also treatment options. Having
this knowledge will enable the audiologist to be a key member of
the patient's vestibular management team.
Sharon L. Beamer, AuD, CCC-A
ASHA Associate Director for Audiology Professional
Practices
References
American Speech-Language-Hearing Association. (1999a).
Role of audiologists in vestibular and balance rehabilitation:
Guidelines
[Guidelines]. Available from
www.asha.org/policy
.
American Speech-Language-Hearing Association. (1999b).
Role of audiologists in vestibular and balance rehabilitation:
Position statement
[Position Statement]. Available from
www.asha.org/policy
.
American Speech-Language-Hearing Association. (1999c).
Role of audiologists in vestibular and balance rehabilitation:
Technical report
[Technical Report]. Available from
www.asha.org/policy
.
Centers for Disease Control and Prevention. (2003).
National Health and Nutrition Examination Survey: Balance
procedures manual
. Washington, DC: U.S. Department of Health and Human Services.
Centers for Disease Control and Prevention. (2008).
Preventing falls in older adults
. Retrieved from
www.cdc.gov/ncipc/duip/preventadultfalls.htm
.
This article first appeared in the Vol. 7, No. 4, July/August
2008 issue of
Access Audiology
.