Citation

Wilhelmsen K, Kvåle A. Phys. Ther. 2014; 94(7): 1024-1033.

Affiliation

K. Wilhelmsen, PT, PhD, Department of Occupational Therapy, Physiotherapy, and Radiography, Faculty of Health and Social Sciences, Bergen University College, Møllendalsveien 6, Bergen, Norway 5009, and National Centre for Vestibular Disorders, Department of Otorhinolaryngology/Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway.

Copyright

(Copyright © 2014, American Physical Therapy Association)

DOI

10.2522/ptj.20130070

PMID

24557651

Abstract

Background and PurposePersistent dizziness and balance problems are reported in some patients following unilateral vestibular pathology. The purpose of this case series is to address the examination and treatment of musculoskeletal dysfunction seen in patients with unilateral vestibular hypofunction (UVH).Case DescriptionThe musculoskeletal system was evaluated with the Global Physiotherapy Examination, dynamic balance was measured during walking using tri-axial accelerometers positioned on the lower and upper trunk, symptoms and functional limitations were assessed with standardized self-report measures. The four patients had symptoms of severe dizziness lasting more than a year after the onset of the vestibular dysfunction with 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 participated in a modified vestibular rehabilitation program consisting of body awareness exercises addressing posture, movements and respiration.OutcomesFollowing intervention self-reported symptoms and perception of disability improved. Improvements in mobility and positive physical changes were particularly found in the upper trunk and in respiratory movements. The attenuation of medio-lateral accelerations in the upper trunk changed; a relatively more stable upper and concomitantly more flexible lower trunk was identified during walking in three patients.DiscussionThe recovery process is possibly influenced by self-inflicted rigid body movements and behaviour strategies that prevent compensation. By addressing physical dysfunctions and enhancing body awareness directly, and dizziness indirectly, it may be possible to break a self-sustaining circle of dizziness and musculoskeletal problems in patients with UVH. Considering the body as a functional unit and including both the musculoskeletal and vestibular systems in the examination and treatment may be important.

Language: en