Vestibular rehabilitation for migraine-associated dizziness

The purpose of this study was to investigate the effects of a vestibular rehabilitation program on patients with the diagnosis of migraine-associated dizziness. Subjects were placed in four groups as follows: idiopathic migraine-associated dizziness; idiopathic migraine-associated dizziness and associated benign positional vertigo; posttraumatic migraine-associated dizziness; and posttraumatic migraine-associated dizziness and benign positional vertigo. Vestibular rehabilitation therapy was administered to all patients. Criterion measurements included the dizziness handicap inventory, activities-specific balance confidence scale, computerized dynamic posturography performance, and dynamic gait index. After vestibular physical therapy, all subjects showed significant improvement in the dizziness handicap, activities-specific balance confidence, dynamic gait, and computerized dynamic posturography measures. Patients with migraine-associated dizziness can benefit from physical therapy intervention. The results of this study are important in considering the approach to vertiginous migraine patients with and without head injury

Delivery of drugs to the inner ear

Inner ear delivery of medicines has been a rapidly expanding field in otolaryngology. This technique provides a minimally invasive way of managing a number of otolaryngologic diagnoses and promises to provide a therapeutic option for previously untreatable disorders. The purpose of this review is to examine the literature that has been published recently (since January of 2005) in this field and to explore how this new literature has impacted on current practices. While there was a significant volume of work done in this area from 1995 to 2004, publication in this area has slowed considerably. The literature focuses on two areas: the treatment of Ménière's disease with gentamicin and the treatment of sudden sensorineural hearing loss with steroids. The most promising area in this field, which is the development of new medicines to treat a variety of disorders, has not progressed over the last 2 years. Recent peer-reviewed publications have not had a significant impact on the transtympanic treatment of Ménière's disease or sudden sensorineural hearing loss. We will review the current practices in these two areas, discuss the newest developments and examine how we can progress the field over the next several years

Improvements in dizziness and imbalance results from using a multi disciplinary and multi sensory approach to Vestibular Physical Therapy - A case study

This paper discusses a case study of a 41 year old active duty male service member who sustained a motorcycle accident and head trauma and underwent multidisciplinary vestibular physical therapy for treatment. He was initially treated with traditional physical therapy applications of treadmill walking and standing balance with some symptom improvements, but was not able to maintain a running speed that would allow him to remain on active duty status. Further treatment utilizing a Computer Assisted Rehabilitation Environment (CAREN) was performed in order to increase difficulty levels and recover more functionality. This treatment is able to elicit vestibular deficits seen in the community as it requires subjects to walk and balance while performing tasks within a virtual scenario with platform motion, visual surround and flow, and cognitive processing. After six weeks of therapy, twice weekly, improvements in clinical vestibular measures were observed as well as walking speed and patient confidence. The subject was able to return to full duty after treatment. This case study provides supportive evidence that multidimensional tasking in a virtual environment provides a safe but demanding form of vestibular therapy for patients needing more challenging tasks than those provided with traditional therapy techniques. Those persons requiring higher levels of performance before returning to work (e.g. pilots, special operators, etc.) may find this type of therapy beneficial

Early Vestibular Physical Therapy Rehabilitation for Meniere's Disease

Meniere disease includes symptoms of fluctuating hearing loss, tinnitus, and subjective ear fullness accompanied by episodic vertigo. Along with these symptoms, patients with chronic Meniere often develop symptoms of disequilibrium and unsteadiness that extend beyond the episodic attacks and contribute to the total disability and reduced quality of life attributed to the disease. Vestibular rehabilitation physical therapy has been used only after vestibular ablation has stabilized the vestibular loss, and for patients stably managed on medical therapy who exhibit no fluctuation in symptoms. This article reviews the data substantiating current applications of vestibular therapy, including improvements in subjective and objective balance outcome measures, and explores the possible extension of vestibular rehabilitation to treatment of patients exhibiting continued fluctuating vestibular loss

Post-traumatic dizziness

This chapter explores that closed head injury (CHI) and associated traumatic brain injury (TBI) are becoming increasingly common in modern society. Faster motorized vehicles, bigger, stronger athletes, and the continued desire to push things to the extreme are just some of the many reasons that more individuals are affected by CHI now than in the past. The chapter discusses that TBI can be divided into three classes: mild, moderate, and severe. It reviews the classification scheme as it applies to all classes of head injury. It describes how neurophysiologic testing plays a role in assigning individuals into diagnostic categories and aids in the treatment of this group of patients. Often, due to cognitive deficits, these head injury patients do not get the care they need for their vestibular disorder. The chapter concludes that understanding how to best use technology to diagnose and treat these patients is critical in their management, and essential if hope to return these individuals to a normal life

Active head movements facilitate compensation for effects of prism displacement on dynamic gait

Study design: Four groups, between-subjects study. Objectives: To investigate the effects of exercise on adaptation of normal subjects who had been artificially spatially disoriented. Background: Many patients referred for rehabilitation experience sensory changes, due to age or disease processes, and these changes affect motor skill. The best way to train patients to adapt to these changes and to improve their sensorimotor skills is unclear. Using normal subjects, we tested the hypothesis that active, planned head movement is needed to adapt to modified visual input. Methods and Measures: Eighty male and female subjects who had normal balance on computerized dynamic posturography (CDP) and the dynamic gait index (DGI), were randomly assigned to four groups. All groups donned diagonally shift lenses and were again assessed with CDP and DGI. The four groups were then treated for 20 min. Group 1 (control group) viewed a video, Group 2 performed exercise that involved translating the entire body through space, but without separate, volitional head movement, Group 3 performed exercises which all incorporated volitional. planned head rotations, and Group 4 performed exercises that involved translating the body (as in Group 2) and incorporated volitional, planned head motion (as in Group 3). All subjects were post-tested with CDP and DGI, lenses were removed, and subjects were retested again with CDP and DGI. Results: The groups did not differ significantly on CDP scores but Groups 3 and 4 had significantly better DGI scores than Groups 1 and 2. Conclusions: Active head movement that is specifically planned as part of the exercise is more effective than passive attention or head movements that are not consciously planned, for adapting to sensorimotor change when it incorporates active use of the changed sensory modality, in this case head motion

Prognostic assessments of medical therapy and vestibular testing in post-traumatic migraine-associated dizziness patients

OBJECTIVE: The aim of this study was to characterize our clinical population of patients suffering with post-traumatic migraine-associated dizziness (PTMAD) and determine any associations with medical interventions and vestibular testing metrics to help predict response to treatments. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral center. SUBJECTS AND METHODS: The electronic medical records of 83 patients presenting to a tertiary referral center who were given a diagnosis of PTMAD and who had been treated were retrospectively reviewed. General characteristics, clinical treatment, pre- and post-vestibular therapy testing metrics, and success and failure outcomes were assessed. Patients were assigned into responder and nonresponder groups related to their headaches and evaluated at two specific time points. Medication failures and vestibular test metrics were compared to identify and predict clinical outcomes. RESULTS: Seventy-two of 82 patients (88%) were analyzed at two time points. Use of verapamil, topiramate, gabapentin, amitryptiline, and valproic acid showed no comparative treatment benefit in responders compared to nonresponders ( P = 0.294). Findings associated with successful treatments include response to initial medication (P = 0.001), final dynamic gait index (DGI) scores ( P = 0.029), final vertical dynamic visual acuity test (DVAT) scores (up, 0.007; down, 0.006), and both final and change in computerized dynamic posturography-sensory organization test (CDP-SOT) scores ( P = 0.001, P = 0.032). The antipsychotic quetiapine was specifically associated with outcome failures ( P = 0.003). CONCLUSION: Specific prophylactic antimigraine medications were not associated with improved outcomes in PTMAD patients. Initial clinical responses and vestibular test metrics may guide physicians to predict successful outcomes

Blunt and blast head trauma: different entities

Mild traumatic brain injury (mTBI) caused by blast-related and blunt head trauma is frequently encountered in clinical practice. Understanding the nuances between these two distinct types of injury leads to a more focused approach by clinicians to develop better treatment strategies for patients. In this study, we evaluated two separate cohorts of mTBI patients to ascertain whether any difference exists in vestibular-ocular reflex (VOR) testing (n = 55 enrolled patients: 34 blunt, 21 blast) and vestibular-spinal reflex (VSR) testing (n = 72 enrolled patients: 33 blunt, 39 blast). The VOR group displayed a preponderance of patients with blunt mTBI, demonstrating normal to high-frequency phase lag on rotational chair testing, whereas patients experiencing mTBI from blast-related causes revealed a trend toward low-frequency phase lag on evaluation. The VSR cohort showed that patients with posttraumatic migraine-associated dizziness tended to test higher on posturography. However, an indepth look at the total patient population in this second cohort reveals that a higher percentage of blast-exposed patients exhibited a significantly increased latency on motor control testing as compared to patients with blunt head injury (p < .02). These experiments identify a distinct difference between blunt-injury and blast-injury mTBI patients and provide evidence that treatment strategies should be individualized on the basis of each mechanism of injury