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International guidelines for education in vestibular rehabilitation therapy

Authors:
  • Neuro Physiotherapy Practice Esch-sur-Alzette Luxembourg

Abstract

The Barany Society Ad Hoc Committee on Vestibular Rehabilitation Therapy has developed guidelines for developing educational programs for continuing education. These guidelines may be useful to individual therapists who seek to learn about vestibular rehabilitation or who seek to improve their knowledge bases. These guidelines may also be useful to professional organizations or therapists who provide continuing education in vestibular rehabilitation. We recommend a thorough background in basic vestibular science as well as an understating of current objective diagnostic testing and diagnoses, understanding of common tests used by therapists to assess postural control, vertigo and ability to perform activities of daily living. We recommend that therapists be familiar with the evidence supporting efficacy of available treatments as well as with limitations in the current research.
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... Značajan je oslonac pri izradbi ovih Smjernica Radna skupina pronašla u vrlo malome broju radova koji se ovom temom bave na sustavan i sveobuhvatan način. [6][7][8][9] Dosadašnja iskustva pokazala su da liječnici bolje provode smjernice u čijem su stvaranju sami su djelovali prilagođujući svjetske spoznaje i iskustva svojim vlastitima, kao i specifičnim radnim uvjetima i mogućnostima zdravstvenoga sustava. ...
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Vestibular Rehabilitation is a planned, individually‐tailored exercise system that speeds up the process of central compensation of the damaged vestibular system. In medicine, it was introduced by Cawthorne and Cooksey in the middle of the last century. For years, there have been controversies about the importance and effectiveness of this type of treatment. Numerous well-designed, prospective clinical studies that have been conducted in recent decades have demonstrated the significance of vestibular exercises, as well as their beneficial effect on the speed and degree of patients’ recovery so that an increased impulse has been experienced just in recent decades. Vestibular hypofunction, be it an acute or chronic disorder, a one-sided, or bilateral phenomenon, is rather a common predicament for a practitioner physician, especially the one dealing with the dizziness problems. Although the vestibular rehabilitation is an elective treatment for most of these disorders, it is still quite neglected and seriously underestimated. These Guidelines aim to assist the physicians and physiotherapists in equalizing the access to the patients with unilateral and bilateral vestibular hypofunction, avoiding unnecessary variations in vestibular rehabilitation application. They are neither a tutorial nor the only and accurate source, but they provide for an evidence-based framework for decision-making, not replacing the importance of clinical judgment. Thus, the purpose of these Guidelines is to determine who should be treated and when, how, and how long the treatment should be administered. They take into account the evidence of metadata while analyzing the available medical literature, as well as our long-standing experience in dealing with such patients.
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Objectives: This guideline provides evidence-based recommendations on managing benign paroxysmal positional vertigo (BPPV), which is the most common vestibular disorder in adults, with a lifetime prevalence of 2.4 percent. The guideline targets patients aged 18 years or older with a potential diagnosis of BPPV, evaluated in any setting in which an adult with BPPV would be identified, monitored, or managed. This guideline is intended for all clinicians who are likely to diagnose and manage adults with BPPV. Purpose: The primary purposes of this guideline are to improve quality of care and outcomes for BPPV by improving the accurate and efficient diagnosis of BPPV, reducing the inappropriate use of vestibular suppressant medications, decreasing the inappropriate use of ancillary tests such as radiographic imaging and vestibular testing, and to promote the use of effective repositioning maneuvers for treatment. In creating this guideline, the American Academy of Otolaryngology-Head and Neck Surgery Foundation selected a panel representing the fields of audiology, chiropractic medicine, emergency medicine, family medicine, geriatric medicine, internal medicine, neurology, nursing, otolaryngology-head and neck surgery, physical therapy, and physical medicine and rehabilitation. Results: The panel made strong recommendations that 1) clinicians should diagnose posterior semicircular canal BPPV when vertigo associated with nystagmus is provoked by the Dix-Hallpike maneuver. The panel made recommendations against 1) radiographic imaging, vestibular testing, or both in patients diagnosed with BPPV, unless the diagnosis is uncertain or there are additional symptoms or signs unrelated to BPPV that warrant testing; and 2) routinely treating BPPV with vestibular suppressant medications such as antihistamines or benzodiazepines. The panel made recommendations that 1) if the patient has a history compatible with BPPV and the Dix-Hallpike test is negative, clinicians should perform a supine roll test to assess for lateral semicircular canal BPPV; 2) clinicians should differentiate BPPV from other causes of imbalance, dizziness, and vertigo; 3) clinicians should question patients with BPPV for factors that modify management including impaired mobility or balance, CNS disorders, lack of home support, and increased risk for falling; 4) clinicians should treat patients with posterior canal BPPV with a particle repositioning maneuver (PRM); 5) clinicians should reassess patients within 1 month after an initial period of observation or treatment to confirm symptom resolution; 6) clinicians should evaluate patients with BPPV who are initial treatment failures for persistent BPPV or underlying peripheral vestibular or CNS disorders; and 7) clinicians should counsel patients regarding the impact of BPPV on their safety, the potential for disease recurrence, and the importance of follow-up. The panel offered as options that 1) clinicians may offer vestibular rehabilitation, either self-administered or with a clinician, for the initial treatment of BPPV and 2) clinicians may offer observation as initial management for patients with BPPV and with assurance of follow-up. The panel made no recommendation concerning audiometric testing in patients diagnosed with BPPV. Disclaimer: This clinical practice guideline is not intended as a sole source of guidance in managing benign paroxysmal positional vertigo. Rather, it is designed to assist clinicians by providing an evidence-based framework for decision-making strategies. The guideline is not intended to replace clinical judgement or establish a protocol for all individuals with this condition, and may not provide the only appropriate approach to diagnosing and managing this problem.