Alleviation of vertigo symptoms using an intensive vestibular, neuromuscular and eye movement therapy protocol
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1
Carrick Institute, United States
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2
Life University, United States
Objective: Demonstrate the ability of an intensive vestibular and neuromuscular rehabilitation protocol to reduce subjective and objective findings associated with intermittent vertigo and dizziness five years post-concussion.
Clinical Features: Subject was a 36-year-old female in the 36th week of her pregnancy with her second child. She reported a five-year history of episodic vertigo with severe dizziness that began after a head injury. Her vertigo occurred sporadically with and without movement of the head and neck. Head extended position exacerbated the dizziness, and noted muscle guarding was present with any head extension movements. Right sided neck and hip pain were noted in addition to temporomandibular joint (TMJ) fixations upon opening and closing of the mouth. The subject also described having increased anxiety since her head injury. Finger tapping with the left hand was decreased. Hesitancy with left rapid alternating movements (RAM) was noted. Foot tapping on left side was arrhythmic and slowed compared to right. All three movements were rated as a one on the Unified Parkinson Disease Rating Scale (UPDRS). Video-oculography (VOG) showed low frequency and low amplitude right beating nystagmus in the dark without fixation. Reversal to a left beating nystagmus occurred periodically throughout testing. Optokinetic responses were markedly decreased in amplitude and frequency in the vertical and horizontal planes. All canal positional testing without fixation was unremarkable.
Interventions: Subject was seen for a four-day intensive period consisting of three treatment sessions a day. Follow-up treatment occurred after two days of rest and one more final day of treatment two months after the initial visit. Vestibular rehabilitation consisted of the following: gaze fixation on a single dot with whole body rotations to the left, canal repositioning maneuvers, vergence eye movements with brock beads, and gaze stabilization exercises. In addition, spinal and extraspinal joint manipulation and left complex proximal joint movements were performed. Home exercises were given to the subject to complete between office visits.
Outcomes: Marked improvement was shown in the optokinetic responses in both amplitude and frequency in the horizontal and vertical planes. There was a reduction in amplitude and frequency of right beating nystagmus in the dark following treatment. Finger tapping, RAM, and foot tapping were all rated as a zero on the UPDRS scale. There was reported improvement in motion sickness, dizziness, neck and hip pain, as well as level of anxiety after the four-day intensive. Upon follow-up two months post initial treatment, the subject reported that she hadn’t experienced any further transient bouts of vertigo.
Conclusions: A protocol of intensive vestibular and neuromuscular therapy has shown marked improvement in subjective and objective findings related to intermittent vertigo. Further research is needed to ensure that the results can be replicated.
Keywords:
Vertigo,
Vestibular Rehabilitation,
sporadic dizziness,
Pregnancy,
eye movement therapy
Conference:
International Symposium on Clinical Neuroscience 2018, Orlando, Florida, United States, 24 May - 26 May, 2018.
Presentation Type:
Poster
Topic:
Clinical Applications in health, disease, and injury to the nervous system
Citation:
Patterson
FE,
Weston
NW and
Esposito
SE
(2018). Alleviation of vertigo symptoms using an intensive vestibular, neuromuscular and eye movement therapy protocol.
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience 2018.
doi: 10.3389/conf.fneur.2018.60.00112
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Received:
01 Apr 2018;
Published Online:
14 Dec 2018.
*
Correspondence:
Mr. Nicholas W Weston, Life University, Marietta, United States, nicholas.weston@student.life.edu