Abstract
Background and Purpose Persistent dizziness and balance problems have been reported in some patients with unilateral vestibular pathology. The purpose of this case series was to address the examination and treatment of musculoskeletal dysfunction in patients with unilateral vestibular hypofunction.
Case Description The musculoskeletal system was evaluated with the Global Physiotherapy Examination, dynamic balance was measured during walking with triaxial accelerometers positioned on the lower and upper trunk, and symptoms and functional limitations were assessed with standardized self-report measures. The 4 included patients had symptoms of severe dizziness that had lasted more than 1 year after the onset of vestibular dysfunction and a moderate level of perceived disability. Musculoskeletal abnormalities typically included postural misalignment, restricted abdominal respiration, restricted trunk movements, and tense muscles of the upper trunk and neck. The patients attended a modified vestibular rehabilitation program consisting of body awareness exercises addressing posture, movements, and respiration.
Outcomes After the intervention, self-reported symptoms and perceived disability improved. Improvements in mobility and positive physical changes were found in the upper trunk and respiratory movements. The attenuation of mediolateral accelerations (ie, body oscillations) in the upper trunk changed; a relatively more stable upper trunk and a concomitantly more flexible lower trunk were identified during walking in 3 patients.
Discussion The recovery process may be influenced by self-inflicted rigid body movements and behavior strategies that prevent compensation. Addressing physical dysfunction and enhancing body awareness directly and dizziness indirectly may help patients with unilateral vestibular hypofunction break a self-sustaining cycle of dizziness and musculoskeletal problems. Considering the body as a functional unit and including both musculoskeletal and vestibular systems in examination and treatment may be important.
Footnotes
Both authors provided concept/idea/project design, writing, data collection and analysis, and facilities/equipment. Dr Wilhelmsen provided project management and patients. Dr Kvåle provided institutional liaisons and consultation (including review of manuscript before submission).
The authors acknowledge Richard A. Clendaniel, PT, PhD, Doctor of Physical Therapy Division, Duke University Medical Center, Duke University, for his assistance with the language in this presentation. They also acknowledge Stein Helge Glad Nordahl, MD, PhD, and Frederik Goplen, MD, PhD, both from the National Centre for Vestibular Disorders, Department of Otorhinolaryngology/Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway, for their contributions in examining the patients, and Heidi Ann Fiske, PT, specialist in psychomotor physical therapy, for the work she has done in treating patients with UVH.
This work was approved by the Regional Committee for Medical Research Ethics in Western Norway (REK Vest no. 143.98) and the Norwegian Social Science Data Service (NSD no. 8766).
- Received February 21, 2013.
- Accepted February 16, 2014.
- © 2014 American Physical Therapy Association
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