Vestibular rehabilitation: rationale and indications.

Treatment options of the patient with dizziness include medication, rehabilitation with physical therapy, surgery, counseling, and reassurance. Here the authors discuss vestibular rehabilitation for patients with benign paroxysmal positional vertigo (BPPV), unilateral vestibular loss or hypofunction, and bilateral vestibular loss/hypofunction. They describe the different mechanisms for recovery with vestibular rehabilitation, the exercises that are used, and which ones are best.

Dizziness and vertigo: emergencies and management.

The cause of dizziness in patients seen in the emergency room can usually be determined by a focused evaluation that consists of identifying three key features in the history and five key elements of the clinical examination. This article discusses the most common causes of dizziness, how to use this approach, and management of these cases in the emergency room.

A Prototype Head-Motion Monitoring System for In-Home Vestibular Rehabilitation Therapy.

This work reports the use of a head-motion monitoring system to record patient head movements while completing in-home exercises for vestibular rehabilitation therapy. Based upon a dual-axis gyroscope (yaw and pitch, ± 500-degrees/sec maximum), angular head rotations were measured and stored via an on-board memory card. The system enabled the clinician to document exercises at home.

Efficacy of gaze stability exercises in older adults with dizziness.

Background And Purpose: The purpose of this study was to determine whether the addition of gaze stability exercises to balance rehabilitation would lead to greater improvements of symptoms and postural stability in older adults with normal vestibular function who reported dizziness.

Methods: Participants who were referred to outpatient physical therapy for dizziness were randomly assigned to the gaze stabilization (GS) group (n = 20) or control (CON) group (n = 19). Dizziness was defined as symptoms of unsteadiness, spinning, a sense of movement, or lightheadedness.

Nystagmus during attacks of vestibular migraine: an aid in diagnosis.

Introduction: An estimated one-fourth to one-third of patients with migraine will experience vertigo associated with their migraine attacks. Vestibular migraine frequently presents as a diagnostic challenge as objective neurological findings consistent with this entity have not been well described.

Objective: The aim of this study is to characterize eye movements of patients presenting with nystagmus during attacks of migrainous vertigo.

Oculomotor strategies and their effect on reducing gaze position error.

Objective: Vestibular adaptation exercises have been shown to improve gaze stability during active head rotation in individuals with vestibular hypofunction. Little is known, however, of the types of eye movements used during passive head rotation and their effect on gaze stability in individuals with vestibular hypofunction. The primary purpose of this study was to determine differences in oculomotor strategies and their effect on stabilizing gaze during ipsilesional passive and active head rotations in vestibular hypofunction.

Unnecessary diagnostic tests often obtained for benign paroxysmal positional vertigo.

Background: Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo prompting patients to seek medical treatment. Diagnosis is made by identifying characteristic nystagmus with positional testing (e.g.

Dizziness.

Dizziness is an imprecise term used to describe various symptoms, each of which has a different pathophysiologic mechanism and significance. In 80% of outpatients presenting with dizziness, it is severe enough to require medical intervention. This article describes causes, assessment, and management of dizziness.

The reliability of the Vestibular Autorotation Test (VAT) in patients with dizziness.

Objective: To establish intrarater and interrater reliability of the Vestibular Autorotation Test (VAT) (Western Systems Research Inc., Pasadena, CA) in a clinical sample of individuals reporting dizziness.

Study Design: Ninety-eight patients with reports of dizziness referred for vestibular function testing performed repeated trials of horizontal VAT.

Screening for vestibular disorders: a study of clinicians' compliance with recommended practices.

Background: Dizziness and vertigo are very common patient complaints encountered by clinicians in both primary as well as specialty care in otolaryngology and neurology. Vestibular impairment is an underlying cause in as many as 45% of people complaining of dizziness. Most causes of vestibular impairment can be effectively treated; however, the diagnosis is frequently missed.

Horizontal saccade disconjugacy in strabismic monkeys.

Purpose: Previous studies have shown that binocular coordination during saccadic eye movement is affected in humans with large strabismus. The purpose of this study was to examine the conjugacy of saccadic eye movements in monkeys with sensory strabismus.

Methods: The authors recorded binocular eye movements in four strabismic monkeys and one unaffected monkey.

Recovery of dynamic visual acuity in bilateral vestibular hypofunction.

Objective: To determine the effect of vestibular exercises on the recovery of visual acuity during head movement in patients with bilateral vestibular hypofunction (BVH).

Design: Prospective, randomized, double-blinded study.

Setting: Outpatient clinic, academic setting.

Incomitance in monkeys with strabismus.

Purpose: Rhesus monkeys reared with restricted visual environment during their first few months of life develop large ocular misalignment (strabismus). The purpose of this study was to describe 'A and V' patterns and DVD in these animals during fixation and eye movements and suggest that this form of rearing produces animals that are suitable model to study the mechanisms that might cause 'A/V' pattern incomitant strabismus and dissociated vertical deviation (DVD) in humans.

Methods: Eye movements were recorded during fixation, smooth-pursuit and saccades using binocular search coils in one monkey with esotropia, three monkeys with exotropia and one normal monkey.

Latent nystagmus: vestibular nystagmus with a twist.

Background: Latent nystagmus is a horizontal binocular oscillation that is evoked by unequal visual input to the 2 eyes. It develops primarily in humans with congenital esotropia.

Objective: To investigate the interrelationship between latent and peripheral vestibular nystagmus and their corollary neuroanatomical pathways.

Optimizing the sensitivity of the head thrust test for identifying vestibular hypofunction.

Background And Purpose: The head thrust test (HTT) is used to assess the vestibulo-ocular reflex. Sensitivity and specificity for diagnosing unilateral vestibular hypofunction (UVH) in patients following vestibular ablation is excellent (100%), although sensitivity is lower (35%-39%) for patients with nonsurgically induced UVH. The variability of the test results may be from moving the subject's head outside the plane of the lateral semicircular canals as well as using a head thrust of predictable timing and direction.

Cervico-ocular reflex in normal subjects and patients with unilateral vestibular hypofunction.

Objective: To determine whether the cervico-ocular reflex contributes to gaze stability in patients with unilateral vestibular hypofunction.

Study Design: Prospective study.

Setting: Tertiary referral center.

Role of the dorsolateral pontine nucleus in visual-vestibular behavior.

Visual-vestibular behavior depends on signals traveling in climbing and mossy fiber pathways. Our study examined the role of the dorsolateral pontine nucleus (DLPN), a major component of the cortico-ponto-cerebellar mossy fiber pathway. DLPN neurons discharge in relation to smooth pursuit and during visual stimulation, indicating a potential role in visually guided motor learning in the vestibulo-ocular reflex (VOR).

Conjugate adaptation of saccadic gain in non-human primates with strabismus.

In this study, we have used the double-step paradigm to test saccadic gain adaptation during monocular viewing in one normal monkey, two monkeys with exotropia, and one monkey with esotropia. In this paradigm, the target for the saccade is displaced during the saccade, resulting in a consistent visual error. Studies in normal humans and monkeys have shown that the brain responds to this consistent visual error by gradually changing saccade gain.

Recovery of dynamic visual acuity in unilateral vestibular hypofunction.

Objective: To determine the effect of vestibular exercises on the recovery of visual acuity during head movement in patients with unilateral vestibular hypofunction.

Study Design: Prospective, randomized, double-blind study.

Setting: Ambulatory referral center.

Dizziness.

There are several causes of dizziness, each of which requires a different form of management. Virtually all causes of dizziness can be treated with medication, diet, or physical therapy. This article discusses the most common causes of dizziness and management.

Vertical dynamic visual acuity in normal subjects and patients with vestibular hypofunction.

Objective: This study was designed to measure visual acuity during active vertical head movement and to examine its relationship to subjective reports of oscillopsia.

Study Design: This was a prospective, clinical study.

Setting: The study was performed in a tertiary, ambulatory referral center.

Animal models for visual deprivation-induced strabismus and nystagmus.

The development of gaze-stabilizing systems depends on normal vision during infancy. Monkeys reared with binocular lid suture (BLS) for the first 25-40 days of life have strabismus, optokinetic nystagmus deficits, latent nystagmus, and decreased binocular cells in the visual cortex and nucleus of the optic tract. When BLS is extended to 55 days, pendular and congenital nystagmus also occurs.