Vestibular Rehabilitation

Abstract

After acute unilateral loss of peripheral vestibular function, numerous oculomotor and postural deficits appear; these deficits can be subdivided into static and dynamic categories. Static signs include paralytic spontaneous nystagmus and postural symptoms such as falling to the affected side. These symptoms usually diminish or disappear entirely even medical intervention. This recovery of normal function is due to the plasticity inherent in the central vestibular system, even in the absence of recovery of the vestibular function on the affected side (static vestibular compensation). Dynamic signs include depressed and asymmetrical vestibulo-ocular reflex (VOR). Vestibular rehabilitation is known to be useful for the improvement of dynamic signs after unilateral vestibular loss. The aim of vestibular rehabilitation is to promote dynamic vestibular compensation and sensory substitution by visual and somatosensory input. Moderate to strong evidence from several high-quality randomized controlled trials exists to support the efficacy and safety of vestibular rehabilitation in managing unilateral peripheral vestibular dysfunction. Moderate evidence also exists supporting the ability of vestibular rehabilitation to resolve symptoms and improve function within the mid-term. In this article, evidence for vestibular rehabilitation and the mechanisms underlying static and dynamic vestibular compensation will be introduced.