Article

Visual vertigo (VV) symptoms improve only when customized vestibular
rehabilitation (VR) integrates exposure to optokinetic stimuli (OK). However,
equipment is expensive, biweekly sessions are not standard practice, and therapy
is often unsupervised. METHODS: A controlled, parallel-group comparison was made
of patients' responses to an 8-week customized program incorporating OK training
via a full-field visual environment rotator (group OKF) or DVD
(an optokinetic
disc or drum rotating at 40 degrees or 60 degrees s(-1)), supervised (group OKS)
or unsupervised (group OKU).
A total of 60 participants with chronic peripheral
vestibular symptoms were randomly allocated to 1 of 3 treatment groups: group OKF
(n = 20) or OKS (n = 20), in which participants attended weekly sessions and were
prescribed customized home exercises incorporating the DVD, or group OKU (n = 20)
who practiced customized exercises and the DVD unsupervised. Treatment response
was assessed at baseline and at 8 weeks with dynamic posturography, Functional
Gait Assessment (FGA), and questionnaires for symptoms, symptom triggers, and
psychological state. RESULTS: No significant between-group differences were
present at baseline or at post interventions. All groups showed significant
within-group improvements for vestibular (ie, lightheadedness), VV, and autonomic
symptoms (P < .05). Posturography and FGA improved significantly for groups OKF
and OKS (P </= .01) as well as anxiety scores for group OKS
(P < .05) and
depression for group OKF (P < .05). Migraine significantly affected VV
improvement (migraineurs improved more; P = .01). The drop-out rate was 55% for
group OKU and 10% for each supervised group (P < .01). CONCLUSIONS: The DVD may
be an effective and economical method of integrating OK into VR. However, rehabilitation should be supervised for greater compliance and improvements,
particularly for postural stability and psychological state.

Langue : ANGLAIS