1/10. Acrophobia and pathological height vertigo: indications for vestibular physical therapy?BACKGROUND AND PURPOSE: Acrophobia (fear of heights) may be related to a high degree of height vertigo caused by visual dependence in the maintenance of standing balance. The purpose of this case report is to describe the use of vestibular physical therapy intervention following behavioral therapy to reduce a patient's visual dependence and height vertigo. CASE DESCRIPTION: Mr N was a 37-year-old man with agoraphobia (fear of open spaces) that included symptoms of height phobia. Exposure to heights triggered symptoms of dizziness. Intervention. Mr N underwent 8 sessions of behavioral therapy that involved exposure to heights using a head-mounted virtual reality device. Subsequently, he underwent 8 weeks of physical therapy for an individualized vestibular physical therapy exercise program. OUTCOMES: After behavioral therapy, the patient demonstrated improvements on the behavioral avoidance test and the Illness Intrusiveness Rating Scale, but dizziness and body sway responses to moving visual scenes did not decrease. After physical therapy, his dizziness and sway responses decreased and his balance confidence increased. DISCUSSION: Symptoms of acrophobia and sway responses to full-field visual motion appeared to respond to vestibular physical therapy administered after completion of a course of behavioral therapy. Vestibular physical therapy may have a role in the management of height phobia related to excessive height vertigo.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/10. The team approach to treatment of the dizzy patient.This report describes how a rehabilitation team treats dizziness and vestibular disorders. Team members include a nurse, physician, audiologist, physical therapist, occupational therapist, and a research scientist. Although unusual, this multidisciplinary approach, involving a close-knit group of professionals, is of great benefit in the treatment of vestibular and balance disorders.- - - - - - - - - - ranking = 0.1keywords = physical (Clic here for more details about this article) |
3/10. rehabilitation exercise for treatment of vestibular disorder: a case study.vertigo and dizziness are common symptoms in the general population. While the clinical picture is well known and widely described, there are different interpretations of Benign Paroxysmal Positional vertigo. The purpose of this case report was to describe the treatment of a 56 year old woman with complains of positional vertigo for 35 consecutive years. She suffered from a sudden onset of rotatory, unilateral horizontal canal type benign paroxysmal positional vertigo (BPPV). The symptoms started a day after falling from a bus, where she injured her head. Otherwise her medical history was unremarkable. She was treated with an individualized home exercise program of eye movement exercises, Brandt/Daroff exercises, and general conditioning exercises (i.e., laying on the left side from sitting on the bed, while the head rotated 45 degrees to the right, waiting for about one minute; twice a day on gradual basis, not laying on the side all the way, but to use enough pillows to lay about at 60 degrees). Four weeks from the start of physical therapy, the patient was free of symptoms, even when her neck was in the extended position.- - - - - - - - - - ranking = 0.1keywords = physical (Clic here for more details about this article) |
4/10. Physical therapy program for vestibular rehabilitation.dizziness and balance disorders are among the most frustrating problems for many physicians to treat. Traditional interventions such as medication or surgical procedures offer limited improvement for many patients. Although generic habituation exercises have existed for years, the merits of vestibular rehabilitation are only beginning to be recognized. Current retrospective studies indicate that 85 percent of patients with chronic vestibular dysfunction gain at least partial relief of their symptoms after undergoing vestibular rehabilitation, with approximately 30 percent of patients being completely cured. This modality provides a valuable and rational complement to current established methods of treating the patient with dizziness. Many physicians and physical therapists may be unfamiliar with these new techniques and require clarification of the actual therapeutic approaches in use. This article describes the current evaluation and treatment approach utilized in the vestibular rehabilitation program at the University of michigan Medical Center.- - - - - - - - - - ranking = 0.1keywords = physical (Clic here for more details about this article) |
5/10. Bilateral perilymph fistula in an adult.Sudden hearing loss is a symptom caused by a variety of diseases, among them also a perilymph fistula. The occurrence of bilateral perilymph fistula is rare, and was reported only associated with head trauma. A case of a bilateral perilymph fistula, without head trauma in an adult construction worker is reported. To the best of our knowledge this is the first bilateral case caused by physical effort to be reported in the literature.- - - - - - - - - - ranking = 0.1keywords = physical (Clic here for more details about this article) |
6/10. Clinical and molecular genetics of Usher syndrome.Usher syndrome is an autosomal-recessive disorder manifested by hearing impairment, retinitis pigmentosa (RP), and variable vestibular deficit. Recent progress in the characterization of the genetics of Usher syndrome has shown that this disorder is phenotypically and genetically complex. This progress impacts the approach of the clinicians in the study of patients who may potentially have Usher syndrome. There are three major phenotypic classes: Usher I, II, and III. Usher I is distinguished from Usher II by having a more severe audiologic involvement and by the presence of vestibular areflexia. Usher III has a progressive hearing loss with variable vestibular involvement. A minimum of three genes have been identified as being responsible for Usher I; two have been identified as being responsible for Usher II. It is not yet clear whether other manifestations such as progressive hearing loss, associated mental retardation, or other physical anomalies are associated with the known Usher genes or whether they represent as yet undiscovered genetic disorders. As progress towards the identification of the Usher genes is made, the clinician will gradually gain new and effective diagnostic procedures for the identification and delineation of the usher syndromes.- - - - - - - - - - ranking = 0.1keywords = physical (Clic here for more details about this article) |
7/10. Physical therapy management of peripheral vestibular dysfunction: two clinical case reports.We describe the treatment of two patients with peripheral vestibular dysfunction using a novel, staged exercise program. Response to treatment was documented. The first patient, a 62-year-old woman with unilateral vestibular dysfunction (UVD) and a 6-month history of disequilibrium following herpes zoster oticus resulting in damage to the right inner ear, was treated with an 8-week course of vestibular physical therapy. During the 8 weeks, the patient attended weekly physical therapy sessions and was trained to perform vestibular adaptation exercises on a daily basis at home. The second patient, a 53-year-old woman with progressive disequilibrium secondary to profound bilateral vestibular hypofunction (BVH), was treated with a 16-week course of vestibular physical therapy. During the first 8 weeks, the patient attended weekly physical therapy sessions and was trained to perform vestibular adaptation and substitution exercises on a daily basis at home. During the second 8 weeks, the patient continued performing vestibular physical therapy exercises at home independently. Vestibular function (sinusoidal vertical axis rotation testing), postural control (clinical tests and posturography), stability during the performance of selected activities of daily living (ADLs), and self-perception of symptoms and handicap were measured prior to and at the conclusion of treatment for both patients and at the midpoint of treatment for the patient with BVH. After 8 weeks of treatment, both patients reported improvements in self-perception of symptoms and handicap and demonstrated objective improvements in clinical balance tests, posturography, and several kinematic indicators of stability during the performance of selected ADLs. Further improvements were noted in the patient with BVH after 16 weeks of treatment. Improvements in postural control were noted after 8 weeks of treatment for the patient with UVD and after 16 weeks for the patient with BVH. Vestibular function improved during the course of treatment for the patient with UVD only. These case reports describe two different individualized treatment programs and document self-reported and laboratory-measured functional improvements in two patients with vestibular deficients--one with unilateral damage and one with bilateral damage.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
8/10. Clinical correlates of sudden auditory-vestibular loss in a cochlear implant patient.The precise electrophysiologic mechanism for sudden sensorineural auditory-vestibular loss has yet to be defined. No human models exist for this idiopathic phenomenon. A 67-year-old cochlear implant (CI) patient experienced what could be termed a "typical" acute sudden auditory-vestibular loss. Vestibular and CI electrical psychophysical changes were monitored over a 22-month period. Once the acute vestibular problems diminished, CI electrical parameters returned to near pre-episode levels. Some improvement occurred in rotational chair phase lag and asymmetry. While improving, platform posturography continued to show difficulty performing sensory organization tests V and VI. These clinical findings may imply that ganglion cell and neuronal population are responsible for the auditory findings in sudden auditory-vestibular loss. Secondly, a CI patient may serve as an ideal human model for further study of this phenomenon, should it occur.- - - - - - - - - - ranking = 0.1keywords = physical (Clic here for more details about this article) |
9/10. Vestibular dysfunction in a child with embryonic exposure to accutane.Children with a history of embryonic exposure to Accutane (isotretinoin) are at great risk for major physical malformations, brain malformations, and decreased intelligence. A case is presented of a 4-year 7-month-old black male with a history of embryonic exposure to Accutane who was born with embryopathy that includes bilateral major ear deformities. The child has a significant bilateral conductive hearing loss, and, in addition, a left sided sensorineural loss. Vestibular function testing revealed evidence of peripheral and central vestibular dysfunction. A course of diphenhydramine hydrochloride and Donnatal (phenobarbital, hyoscyamine sulfate, atropine sulfate, and scopolamine hydrobromide) significantly alleviated the symptoms of vestibular dysfunction. Otologic management of these children should include clinical documentation of the external deformities, evaluation of cochlear function, and early auditory habilitation. Vestibular function should also be evaluated in all children with a history of embryonic exposure to isotretinoin.- - - - - - - - - - ranking = 0.1keywords = physical (Clic here for more details about this article) |
10/10. Large vestibular aqueduct syndrome: an overlooked etiology for progressive childhood hearing loss.If a drastic change in hearing has occurred in a child following a minor head trauma, change in barometric pressure, or physical exertion, large vestibular aqueduct syndrome (LVAS) should be considered. Most audiologists are unaware of LVAS or do not suspect it, in part due to the presence of a conductive component. LVAS can be seen in conjunction with Mondini's dysplasia or may appear by itself and is easily identified by a computed tomography scan. We present five cases of LVAS and discuss the natural history, audiologic and imaging findings, and relevant literature.- - - - - - - - - - ranking = 0.1keywords = physical (Clic here for more details about this article) |
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