Management of Unilateral Vestibular Hypofunction (UVH)

Interventions of Unilateral Vestibular Hypofunction (UVH)

Goals of Interventions:

1. The patient will demonstrate improved stability of gaze during head movement.
2. The patient will demonstrate diminished sensitivity to motion.
3. The patient will demonstrate improved static and dynamic postural stability.
4. The patient will be independent in the proper performance of a home exercise program that includes walking.

👉👉Patients with UVH should be informed that recovery time after initiating vestibular rehabilitation is 6 to 8 weeks.

Gaze Stability Exercises

1. The purpose of these exercises is to improve the VOR and other systems that are used to assess the stability with head motion.
2. Vestibular adaptation exercises are designed to expose patients to retinal slip.
3. Retinal slip occurs when the image of an object moves off the fovea of the retina resulting in visual blurring.
4. The two primary exercises of vestibular adaptation are:
1. Exercise 1:
1. The patient is asked to move the head horizontally and vertically as quickly as possible while maintaining focus on a stable target.
2. A good target to use is a business card, asking the patient to focus on a word or a letter within a word.
2. Exercise 2
1. The patient is asked to move the head and target in opposite directions while focusing on the target.
5. Increasing the difficulty by the use of varying the distance from which the patient performs the exercises, moving the head more rapidly, and performing the exercise while standing or walking.
6. The computerized DVA test is useful to improve gaze stability for individuals with UVH and TBI.

Postural Stability Exercises

1. The purpose of postural stability exercises is to improve balance by encouraging the development of balanced strategies. 
2. The table shows Balance Exercises and Progression.

Table: Balance Exercises and Progression
Begin with	Progression	Purpose
1. Stand with feet shoulder-width apart, arm across the chest	Bring seat closer together Close eyes Stand on a sofa, cushion, or foam	Enhance the use of vestibular cues for balance by decreasing the base of support. Eyes closed increases reliance on vestibular cues for balance.
2. Practice ankle sways: medial-lateral and anterior-posterior	Doing circles sways. Close eyes.	Teaches the patient to use a correct ankle strategy.
3. Attempt to walk with the heel touching toes on a firm surface.	Do the same exercise on the carpet.	Enhance the use of vestibular cues or balance by decreasing the base of support. Doing the exercise on carpet alters proprioceptive input and increasing difficulty.
4. Practice walking 5 steps and turning 180°	Making smaller turns Close eyes	Turning provides a greater challenge to the vestibular system.
5. Walk and move the head side to side, up and down.	Counting backwards from 100 by threes.	Use distracting cognitive or motor demands to challenge balance.

Habituation Exercises

1. Habituation Exercises are prescripted when a patient with a UVH has continual complaints of dizziness.
2. Habituation is defined as deduction in response to a repeatedly performed movement.
3. To determine which habituation exercise to be prescribe, the physical therapist must determine the provoking positions first.
4. When a position elicits a mild to moderate dizziness, the patient remains in the provoking position for 30 seconds or until symptoms are gone.
5. The patient is provided with the home exercise program based on the results of the positional test.
6. The exercises are designed to reduce the dizziness and the patient should be encouraged that the symptoms normally decrease within two weeks.
7. If after two weeks the symptoms are no better, the habitation exercises should first be changed.
8. If this is not helpful then the patient should be referred to either a physical therapist with special training in vestibular rehabilitation or a physician for further evaluation.