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VESTIBULAR REHABILITATION THERAPY (VRT)

VESTIBULAR REHABILITATION THERAPY (VRT). GP Study Day 28/01/12 Mairead Collins MISCP. What is VRT?. An exercise-based approach designed to maximise CNS compensation for Vestibular pathology Not new!

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VESTIBULAR REHABILITATION THERAPY (VRT)

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  1. VESTIBULAR REHABILITATIONTHERAPY (VRT) GP Study Day 28/01/12 Mairead Collins MISCP

  2. What is VRT? • An exercise-based approach designed to maximise CNS compensation for Vestibular pathology • Not new! • Cawthorne & Cooksey 1940s – people who moved more did better, people should perform provoking movements • Recent studies advocate customised approach

  3. Who is VRT suitable for? • Vestibular Neuritis/Labyrinthitis • Benign Paroxysmal Positional Vertigo (BPPV) • Bilateral Vestibular Hypofunction • Menieres’ Disease • Central causes of vertigo – brainstem infarct, cerebellar infarct, MS etc.. (BPPV should be treated first with a particle repositioning maneouvre)

  4. Symptoms of Vestibular Impairment • ‘Dizziness’ on certain head movements • Vertigo, nausea, vomiting • General loss of balance – often worse in darkness/uneven surfaces • Increased symptoms in crowded places/with visual stimuli • Reduced activity due to avoidance of activities that provoke symptoms

  5. Treatment Approach • Three exercise approaches are used to reduce impairments (gaze instability, dizziness and postural instability) • Use of Vestibular suppressants?? • Adaptation • Habituation • Substitution

  6. What does Physiotherapy involve? • Initial assessment including subjective & objective outcome measures • An individualised home execise programme is drawn up for the patient to work on at home & is progressed as necessary (usually fortnightly) • In-house vestibular & balance re-education • Advice & Education • Generally expect to see improvement within 2-3 months

  7. Goals of VRT • Reduce symptoms of dizziness & nausea • Improve postural and gait stability • Reduce falls risk • Improve independence in ADLs • Increase cardiovascular conditioning • Decrease anxiety, fear & social isolation

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