Vestibular Rehabilitation

Rating

Category: Allied Health Options

Injury Type: Acute

What is it?

One of the symptoms of whiplash is dizziness. As a result of a whiplash injury, the receptors in the neck can be damaged which creates dizziness and disturbances in control of posture and balance. One of the means of addressing these balance problems is Vestibular Rehabilitation. This is a specific form of physiotherapy that helps to develop compensatory strategies for various balance problems. Once the cause and source of the problem is correctly diagnosed, a variety of exercises are undertaken. These include head and neck exercises, eye exercises, balance exercises and walking exercises. During these activities patients may be instructed to keep their eyes open or closed. Usually, depending on the patient requirement, exercises are tailored to suit their injury and subsequent symptoms.

How does it work?

The goals of Vestibular Rehabilitation are to improve balance, minimise falls, and decrease feelings of dizziness. This is achieved by improving the function of the vestibular system and also addressing central (brain) adaptation and compensation. By tapping into alternate strategies within the nervous system, compensation can occur for deficits in the vestibular system. The nervous system uses the control of eye, head and body movements to ensure that people’s posture and position is adequately maintained.

Is it effective?

There are two recently published studies on the effectiveness of Vestibular Rehabilitation in the whiplash context. While both studies only included a small number of patients, the results across the board indicated that when treated with Vestibular Rehabilitation patients suffering from whiplash reported better balance, reduced disability, returned to work and improvement in activities of daily living. In some instances this positive effect lasted up to three months after the treatment. A recent systematic review concluded that Vestibular Rehabilitation should be recommended to people with dizziness following a whiplash injury but further research is required to ascertain why it is effective.

Are there any disadvantages?

Provision of vestibular rehabilitation should be based on appropriate assessment and diagnostic standards. Not all patients with dizziness subsequent to whiplash are eligible for Vestibular Rehabilitation.

Where do you get it?

As Vestibular Rehabilitation is a specific form of physiotherapy, Physiotherapists who are specifically trained in the provision of Vestibular Rehabilitation can perform these treatment techniques. Contact the Australian Physiotherapy Association for Physiotherapists trained in Vestibular Rehabilitation.

Recommendations

While the evidence base for this treatment is limited, the results are promising. More research is needed to strengthen current evidence and to identify if Vestibular Rehabilitation is useful as a stand alone therapy or used in conjunction with other physiotherapy treatments.

Key References

  • Australian Physiotherapy Association 2006, The Australian Physiotherapy Association, viewed 30 October 2007, .
  • Hansson, E 2007, 'Vestibular rehabilitation; for whom and how; a systematic review' Advances in Physiotherapy, vol.9, no 3, pp. 106-116.
  • Hansson, E, Mansson N, Ringsberg, K & Hakansson, A 2006, 'Dizziness Among Patients With Whiplash-Associated Disorder: A Randomised Controlled Trial', Journal of Rehabilitation Medicine, vol. 38, no.6, pp. 387-390.
  • Tuo, K, Cheng, Y & Kao, C 2006, 'Vestibular Rehabilitation in a Patient with Whiplash-associated Disorders', Journal of Chinese Medical Association, vol. 69, no. 12, pp. 591-595.
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