Recent evidence in the literature shows that the vestibular system can be modified, or habituated, with repeated presentation of a stimulus. This concept may be applied to the clinical problem of vertigo caused by vestibular neurotomy, the surgical procedure used to remove an acoustic neuroma. Excision of the vestibular nerve causes sere postoperative vertigo, impaired oculomotor control, and disequilibrium. These symptoms, particularly the vertigo and disequilibrium, are extremely disabling, although they eventually subside in most patients. Descriptive papers in the literature report the use of although they eventually subside in most patients. Descriptive papers in the literature report the use of habituating exercises to reduce the vertigo and disequilibrium caused by chronic vestibular disorders, but little research data supports their efficacy. No studies to date have addressed the rehabilitation of acutely postoperative vestibular neurectomy patients. Study of these patients would provide a well-controlled clinical model of habituation in the impaired vestibular system, and would provide some information about potentially beneficial rehabilitation procedures that can be given without the use of medication. This study, will examine the efficacy of a structured, postoperative, beside exercise program in reducing vertigo and improving postural and oculomotor control. The study will test the hypothesis that a graded exercise program given during the first 5 days after surgery will relieve the postoperative symptoms and hasten the normalization of function.
Specific aims i nclude determining rate and amount of recovery after surgery, determining the efficacy of postsurgical in-patient rehabilitation, and determining which preoperative tests best predict postoperative recovery. Subjects will be tested on seven different occasions: (1) preoperatively, in the laboratory with caloric irrigation, harmonic acceleration and other oculomotor tests, and tests of head stability, dynamic posture, gait, independence in performing activities of daily living, and intensity of vertigo; (2-5) postoperatively, at discharge, in the laboratory, on all measures examined preoperatively; (7) postoperatively, four weeks after discharge, in the laboratory, on all measures, again. Two treatment groups will be used. Half the subjects will receive equal attention bedside, without exercises.
| Cohen, Helen S (2015) A Career in Inquiry. Am J Occup Ther 69:6906150010p1-2 |
| Cohen, Helen S; Kimball, Kay T; Jenkin, Herman A (2002) Factors affecting recovery after acoustic neuroma resection. Acta Otolaryngol 122:841-50 |
| Cohen, H S (2000) Vestibular disorders and impaired path integration along a linear trajectory. J Vestib Res 10:15-Jul |
