It depends what is causing the vestibular disturbance in the first place.
Vestibular disorders are generally divided into peripheral and central. The
evidence would suggest that pts. with peripheral disturbances will benefit
most from Vestibular Rehabilitation (VR). Those with central vestibular
disorders will benefit to a lesser extent (or not at all) and will tend to
take longer to do so. The symptoms your patient is complaining of are also
important. Cawthorne Cooksey exercises are habituation exercises and are
designed to habituate the patient to vertigo. In order for them to be
effective they must bring on the patient's symptoms of vertigo/dizziness.
The idea then is that the patient brings on the symptoms with the exercises
3-4 times a day in order to promote habituation. A balance disorder with no
vertigo is probably best treated with balance exercises.
It is also important to note whether the patients condition is fluctuating
(e.g. meniere's) or not. The evidence would suggest that patients with
fluctuating disorders do not benefit from VR as they are unable to
continually compensate for an unstable disorder. Do you know whether your
patient is central or peripheral? It is always useful in these patients to
know what their diagnosis is...more often than not a definite diagnosis it
is not clear but usually the physician can tell you whether it is central or
peripheral.
A good overview of VR is in physical therapy. Herdman SJ. Advances in the
treatment of vestibular disorders. Physical Therapy, 77(6):602-18, 1997
Jun.(96 ref)
> -----Original Message-----
> From: Paul Sumner [SMTP:[log in to unmask]]
> Sent: Wednesday, February 28, 2001 11:54
> To: [log in to unmask]
> Subject: vestibular disturbance
>
> i have a patient with worsening vestibular disturbance affecting balance.
> Does anyone out there know about Cawthorn? exs and if they are applicable.
>
> thanks
>
> Jo MCSP UK
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