Vestibular disorders cause vertigo and disequilibrium, which may be accompanied by malaise, inactivity, and decreased independence in activities of daily living, at tremendous cost to society. Among the few treatment options, surgery is not indicated in most cases, and medication may be contraindicated or in effective in the long term. The use of repetitive head movement exercises to reduce the vertigo and disequilibrium has become popular but little empirical data support the effectiveness of these exercise programs, and extraneous variables confound many of the reports. Well-controlled studies of exercise paradigms for treating the sequelae of vestibular impairments are needed to develop efficacious, cost-effective treatments for these problems without the use of medication or surgery. By systematically varying the treatment parameters, this study will determine the effectiveness of structured programs of head movement exercises in reducing vertigo, improving postural control, and increasing independence in performing essential daily life tasks. Subjects diagnosed with one of two chronic peripheral vestibular impairments - either chronic vestibulopathy or labyrinthine concussion - will be tested for the short- and long-term effects of five different conditions: 1) spontaneous recovery without intervention, 2) home exercise program without increased attention, 3) home program with increased attention, 4) weekly out-patient head exercise program plus home program, and 5) weekly out-patient head exercise program without home program to control for the effects of increased attention and increased activity level. The home program will include repetitive pitch, roll, and yaw head movements; the attention will be a weekly telephone call. The out-patient programs will be given in the laboratory by a physical therapist and will include repetitive exercises that stimulate head movements and visual/vestibular interaction. All subjects will have been diagnosed with either a peripheral vestibulopathy or a labyrinthine concussion. All subjects will have had vertigo for at least three months prior to referral to the study; no subjects will take vestibular-suppressant medications while participating in the study.
The specific aims will be to: 1) determine the contribution of the following factors to recovery: spontaneous compensation without intervention, increased attention, and head movement exercises, 2) determine if treatment effects are retained after treatment ceases, and 3) determine if subjects with two different diagnoses (chronic vestibulopathy and labyrinthine concussion) respond differently to treatment. Subjects will be tested five times: the pre-test, a post-test after four weeks of treatment, and subsequent tests one month, two months, and three months after the end of treatment. The measures will be posturography scores, attacks of vertigo per day, intensity of vertigo, and level of independence in activities of daily living.
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