Vestibular Rehabilitation Therapy (VRT)

Bilateral Vestibular Loss (BVL or BL)

This page is intended to be a reference for physical therapists who are providing vestibular physical therapy.

Timothy C. Hain, MD Page last modified: July 14, 2009

The general procedures for bilateral vestibular loss are identical to the procedures for unilateral vestibular loss. However, bilateral loss patients have less vestibular function to fall back on than the unilateral loss patients. Instead of recalibrating, they have to use substitution to a greater extent.

They have to think more about what they are doing - -plan ahead, avoid dangerous situations. They generally don't drive at night. They don't climb ladders or work on the roof.

The following protocol is loosely based on Tee et al, 2005;

Goals of VRT

• Increase gaze stablity
• Reduce symptoms of dizziness
• improve postural and gait stability
• improve independence in ADL such as driving and shopping
• Increase cardiovascular conditioning

Procedures

• Gaze Stabilization Exercises
• Balance and gait training
• Visual dependence training
• Physical Conditioning

References:

• Badke, M. B., et al. (2004). "Outcomes after rehabilitation for adults with balance dysfunction." Arch Phys Med Rehabil 85(2): 227-33.
• Brown KE, Whitney SL, Wrisley DM and Furman JM (2001). "Physical therapy outcomes for persons with bilateral vestibular loss." Laryngoscope 111(10): 1812-7.
• Cowand JL and others. Efficacy of vestibular rehabilitation. Otolaryngology Head&Neck surgery 118(1)49-54, 1998
• Cohen HS, Kimball KT Increased independence and decreased vertigo after vestibular rehabilitation. Otolaryngol Head Neck Surg 2003 Jan;128(1):60-70
• Dix MR, and Hood JD (ed). Vertigo. Wiley and Sons, Chinchester, 1984
• Herdman SJ (ed). Vestibular Rehabilitation (Contemporary... . F.A. Davis Co, Philadelphia, 2000
• Herdman SJ, Hall CD, Schubert MC, Das VE, Tusa RJ. Recovery of dynamic visual acuity in bilateral vestibular hypofunction. Arch Otolaryngol HNS 2007;133:383-389
• Horak FB et al. Effects of vestibular rehabilitation on dizziness and imbalance. Otol HNS 1992:106-175
• Krebs, D.E., et al., Double-blind, placebo-controlled trial of rehabilitation for bilateral vestibular hypofunction: preliminary report. Otolaryngol Head Neck Surg, 1993. 109(4): p. 735-41.
• Krebs, D. E., et al. (2003). "Vestibular rehabilitation: useful but not universally so." Otolaryngol Head Neck Surg 128(2): 240-50.
• Smith-Wheelock et al: American J. Otol, May 1991, 218-25
• Tee LH, Chee NWC. Vestibular rehabilitation for the Dizzy Patient. Ann Acad Med Singapore 2005:34:289-94
• Telian SA, Shepard NT. Update on vestibular rehabilitation therapy. Oto Clin NA, 29:357-71, 1996

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