Treatment options for patients with chronic vestibular dysfunction have included observation following diagnostic evaluation, pharmacologic management, and surgery. Basic science investigation suggests that central nervous system compensation for peripheral vestibular symptoms may be counter-productive in patients with vestibular dysfunction. Customized physical exercise which repeatedly exposes the patient to vestibular sensory conflict may enhance recovery, yet this modality is rarely utilized in the United States. Preliminary data suggest that customized vestibular habituation therapy (VHT) is a safe, effective treatment modality. Accessible programs of VHT could provide great relief to patients with considerable disability who lack other treatment options. VHT may also obviate the need for vestibular surgery when continued symptoms are due to lack of compensation rather than ongoing labyrinthine dysfunction. Moreover, this modality could provide a safe, rational, and ethical nonsurgical control treatment for prospective trials of surgical treatment. A three-year clinical investigator development award (CIDA) is proposed. This will include clinical investigations related to VHT addressing the following aims: 1.) To objectify the assessment of patients with chronic vestibular dysfunction. 2) To assess the therapeutic effectiveness of VHT through a prospective, randomized, controlled trial involving patients with chronic vestibular dysfunction. 3) To determine the role of dynamic posturography in VHT by comparing the predictive value of alternative, less expensive methodology in the design of treatment protocols. An extensive program of training in clinical research design and biostatistical analysis is also proposed for the Principal Investigator. This will facilitate the future design and administration of ongoing local and multi-institutional prospective clinical trials to address unanswered questions in the field of neurology, especially those related to vestibular dysfunction.
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