Vestibular Rehabilitation

657 Pages·2014·8.556 MB·English

by  Susan J. Herdman, Richard Clendaniel

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Steven L. Wolf, PT, PhD, FAPTA, Editor-in-Chief
Fundamentals of Musculoskeletal Imaging, 4th Edition
Lynn N. McKinnis, PT, OCS
Pharmacology in Rehabilitation, 4th Edition
Charles D. Ciccone, PT, PhD
Modalities for Therapeutic Intervention, 5th Edition
Susan L. Michlovitz, PT, PhD, CHT, James W. Bellew, PT, EdD, and Thomas P. Nolan,
Jr., PT, MS, OCS
Wound Healing: Alternatives in Management, 4th Edition
Joseph M. McCulloch, PT, PhD, CWS, FAPTA
Luther C. Kloth, PT, MS, CWS, FAPTA
For more information on each title
in the Contemporary Perspectives in Rehabilitation series,
go to www.fadavis.com
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Susan J. Herdman, PT, PhD, FAPTA
Professor Emerita
Emory University School of Medicine
Emory University
Atlanta, Georgia
Richard A. Clendaniel, PT, PhD
Assistant Professor
Department of Community and Family Medicine
Doctor of Physical Therapy Division
Duke University School of Medicine
Duke University Medical Center
Durham, North Carolina
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This book is dedicated to “serendipity.” The serendipity that led to me walking into a patient’s
room one weekend and finding there the person who would become my doctoral advisor. The
serendipity that led to that surprising day when, after years of saying “no” to treating patients for
their dizziness, I saw my first patient with BPPV and was forever “hooked” by that patient’s
gratitude. The serendipity that led to me working at Hopkins and NIH. The serendipity that led to
four colleagues sitting down and planning a competency-based course in Vestibular
Rehabilitation that we thought would last maybe 3 or 4 years. The serendipity that put so many
wonderful opportunities in my life. The serendipity that put so many incredible people in my life.
The grace that led me to take advantage of it all.
SJH
I would like to dedicate this book to my family who has supported me throughout, to my
colleagues who have contributed to this book and to my education, and to my friend, colleague,
mentor, and coeditor whose knowledge, guidance, and inspiration have been critical to my
professional growth.
RAC
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Foreword
Benjamin Franklin once said, “Life’s tragedy is that we themselves. Undoubtedly, Dr. Herdman has assembled
get old too soon and wise too late”. While there is substan- the next generation of contributors. Amongst the 34 in-
tial wisdom in that statement, I can think of at least one dividuals whose collective efforts define the 4th edition
exception that might set old Ben on his rear, or is it ear? It of Vestibular Rehabilitation, 14 are first timers and all
is hard to believe that 20 years have passed since the first possess the skill and knowledge to become persistent con-
edition of Vestibular Rehabilitation was published. Yet tributors to subsequent editions. As one reads Chapters 3
even at its birth there w as considerable wisdom in its (Laurie King), 6 (Anne Galgon), 7 (Natalia Ricci), 13
words. At that time the responsibility for evaluating and (Steve Benton), 14 (Rosalyn Schneider), 17 (Yew Ming
rehabilitating patients presenting with dizziness and Chan), 19 (Jeffrey Staab), 20 (Jeff Hoder), 24 (Jennifer
vestibular compromise was restricted to a select few, and Braswell Christy), 26 (Laura Morris and Kim Gottshall),
this area of rehabilitation had not emerged as a specialty. 28 (Courtney Hall and Dara Meldrum) and 30 (Lisa
Susan Herdman recognized a need to train rehabilitation Heusel-Gillig and Courtney Hall), please kno w that
clinicians to better understand and treat the postural com- while these individuals might not be the sole author of
promise generated through visual deficits, headache or those respective contributions, their effort to revise pre-
other maladies that would adversely impact the quality of vious content was substantial and the resulting quality
life of those unfortunate enough to have acquired vestibu- of their work is outstanding.
lar pathologies. The extent to which this knowledge has In this edition, all chapters have been updated and
grown over these two decades and with it, the interest of new cases permeate the management chapters to illus-
students and clinicians is truly extraordinary. Throughout trate how patients with specific problems are treated. The
this time Vestibular Rehabilitation has remained the “go thought-provoking and problem solving nature of the
to” text for specialists in this area while also serving as a clinical chapters are supported by the necessity to foster
critical reference source for all neurorehabilitationists. evidence based references, a fundamental tenet of all vol-
All contributors to the Contemporary Perspectives umes in the Contemporary Perspectives in Rehabilitation
in Rehabilitation series have always prided themselves series. While the 3rd edition of Vestibular Rehabilitation
on maintaining the infrastructural integrity of its foun- was accompanied by 68 videos, this edition has over 100.
dation…….evidence based referencing, problem solving The videos include normal and abnormal e ye move-
presentations and the latest and most novel data or treat- ments, assessment procedures, demonstrations of some
ment techniques. Vestibular Rehabilitationcontinues to exercises, and gait assessments. Chapters emphasizing
adhere to these principles and undoubtedly the result has tinnitus, novel approaches in the assessment and treat-
been a steadfast allegiance to its content from amongst ment of anterior and horizontal canal benign paroxysmal
its followers…….teachers, clinicians and students. The positional vertigo (BPPV), and data on outcomes in
fact that the content has been updated consistently at patients with unilateral and bilateral vestibular hypofunc-
5 year intervals speaks to the dedication shown by its con- tion are distinctly new to the 4th edition. The manage-
tributing authors, many of whom have persisted through ment of patients with chronic subjecti ve dizziness
several editions. Throughout this time, Dr. Herdman has represents another addition to the text. These are patients
amassed a larger international cohort of knowledgeable who present with chronic dizziness and motion sensitiv-
clinicians, many of whom have come to assist her in ity that often is accompanied by variable amounts of anx-
what arguably might be called the most popular (and in- iety and phobic behavior.
tense) vestibular rehabilitation course in the United The text has been further contemporized through
States, if not the world. Many of those once considered the addition of a chapter on the management of patients
novices are now positioned to disseminate information with vestibular problems precipitated from head trauma
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viii FOREWORD
including etiologies from post-concussion syndrome restore optimal balance, reduce dizziness or improve the
caused by blast injuries. Regrettably there is ample rea- consequences of migraine, as examples.
son to believe that the incidence of this problem may be The contributions from vestibular neurorehabilitation
profoundly underestimated. If so, then this category of therapists and specialty physicians are woven along a highly
patient will present unique challenges to vestibular re- integrated network. Over each edition, the blend of input
habilitation clinicians and the treatment components from these specialists becomes more tightly coupled. This
may well incorporate a need to foster compliance b e- fluidity may go unrecognized by students, b ut suffice to
cause of concomitant behavioral changes. Additional in- say, there are very few courses, let alone text books, in which
formation is contained in information regarding emerging the content amongst different specialists, both physician
technologies for the treatment of patients with vestibular and non-physician, can be assembled and transmitted so
disorders. Such rehabilitation includes novel biofeedback smoothly. Herein rests an opportunity to learn from a panel
alternatives, use of virtual reality and gaming, such as of experts who would be very difficult to assemble collec-
the Wii. These advances, while challenging, provoke op- tively. As I concluded in a previous Foreword, the sum of
portunities to discover and implement new approaches these parts is truly greater than its whole………
towards enlisting functional plasticity to achie ve en-
hanced quality of life. We can be rest assured that Steven L. Wolf, Ph.D., PT, FAPTA, FAHA
advances in technologies and de vices will continue
Series Editor
to make their way into the armamentarium of tools to
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Preface
There are several additions to the fourth edition of Vestibu- since the last edition 7 years ago. So once again, we have
lar Rehabilitation. One change is the addition of Richard extended the material presented to include se veral new
A. Clendaniel as the coeditor. Rick is a clinician, educator, chapters to reflect and to challenge our understanding
and researcher with many years of experience in vestibular of the assessment and treatment of vestibular disorders.
rehabilitation, vestibular function testing, and vestibular One new chapter is on management of patients with
physiology. His contributions to the field have been of chronic subjective dizziness and is a nice complement to
benefit to many clinicians and researchers as well as to pa- the chapter of psychological problems in patients with
tients. The other changes in this edition of Vestibular Re- dizziness. Another chapter tackles a current “hot topic”—
habilitation are the e xploration of ne w areas of management of patients with vestibular dysfunction from
“vestibular” rehabilitation including current evidence that concussion. Finally, a third new chapter explores the role
supports the use of the gaze stabilization exercises in pa- of emerging technologies such as virtual reality, sensory
tients with non-vestibular dizziness and the use of new substitution devices, and most excitedly, vestibular im-
technologies in exercise programs. plants, which will undoubtedly require new treatment ap-
The practice of vestibular rehabilitation faces numer- proaches. Of course, all chapters contain new material,
ous challenges in the coming years, as does all health care. from management of tinnitus to the newer treatments that
We must be more efficient in our assessments and treat- have been proposed for anterior and horizontal semicircu-
ments. We must provide evidence that the patient is improv- lar canal BPPV. We have added “point and counterpoint”
ing through the application of functional outcome measures. sections in some chapters that highlight the differing opin-
We must be able to defend our choice of treatment based ions about assessment and treatment. The number of
on research establishing the benefits of specific exercises or videos has been increased to include more e xamples of
establishing that a specific exercise is not beneficial. We eye movement abnormalities and to provide visual exam-
must be able to support our recommendation on the need ples of some of the newer treatments.
for further treatment based on measures that suggest the pa- The many chapters in this book are designed to pro-
tient has or has not reached the optimal le vel of recovery. vide you with a foundation for all these challenges, b ut
We need to address the psychological state of the patient as more importantly, the chapters will hopefully give you
well as the physical problems and their consequences. the basis from which you can continue to apply new in-
As you should hope, the e vidence supporting the formation in your practice for the betterment of all your
treatment of patients with vestibular deficits has increased patients.
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