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OBJECTIVES
1) Compare and contrast the pathophysiology of common disorders of the vestibular system
2) Describe the medical and surgical management of common vestibular disorders
3) Differentiate between signs and symptoms caused by peripheral versus central vestibular pathology
4) Describe the physical therapist management of individuals with vestibular dysfunction
5) Discuss the physical therapy goals and expected outcomes of vestibular rehabilitation
6) Discuss the common causes of cerebellar pathology
7) Describe the physical therapist management of individuals with movement dysfunction secondary to cerebellar damage
8) Discuss the physical therapy goals and expected outcomes of rehabilitation for individuals with movement dysfunction secondary to cerebellar damage
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CASE A, PART I
Mrs. O’Hara, a 55-year-old woman, is experiencing episodes of “dizziness,” beginning 2 weeks ago. She reports that her initial episode of “dizziness” occurred while she was rolling over in bed from her right to left side, and she describes feeling as if “the room was spinning.” The episode lasted for a few seconds and went away by keeping her head completely still. She had mild nausea but no vomiting. The “dizziness” returned when she attempted to get out of bed to go the bathroom, lessened once she was upright, and worsened when she went to lie back down in bed. Mrs. O’Hara also noted that, over the past 2 weeks, the spinning sensations occurred when she looked up to reach for something in a cupboard in her kitchen or when she looked down to put on her shoes. While sitting, she has no symptoms. She notes that her symptoms started after she slipped on a patch of ice that caused her to fall and hit her head.
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ANATOMY AND PHYSIOLOGY OF THE VESTIBULAR SYSTEM
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The anatomy and physiology of the vestibular system and its role in the control of eye movements (via the vestibulo-ocular reflex) and postural stability (via the vestibulospinal reflex) are discussed in Chapter 6.
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DISORDERS OF THE VESTIBULAR SYSTEM
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Disorders of the vestibular system are common, especially among the elderly. One large epidemiological study estimated that as many as 35% of adults aged 40 years or older in the United States (approximately 69 million Americans) have experienced some form of vestibular dysfunction,1 which increases to 50% of community-dwelling adults older than 80 years reporting dizziness.2 Elderly individuals with dizziness also report memory problems and anxiety more frequently than non-dizzy elderly, which negatively impacts their quality of life.3
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Vestibular disorders can be categorized by their location into peripheral and central vestibular disorders. Peripheral vestibular disorders involve the inner ear vestibular structures and/or the vestibular nerve. Central vestibular disorders primarily result from damage to the vestibular nuclei, the cerebellum, and the brainstem, including vestibular pathways within the brainstem that mediate vestibular reflexes (i.e., vestibulo-ocular reflex [VOR] and the vestibulospinal reflex [VSR]).