Assessment and Treatment Planning
Effective vestibular rehabilitation begins with comprehensive assessment that identifies specific deficits and functional limitations to guide individualized treatment planning. This assessment process goes beyond simply diagnosing the type of vestibular disorder to understand how the disorder affects each person's unique circumstances, activities, and goals. The assessment typically includes detailed history-taking, physical examination, functional testing, and goal-setting that forms the foundation for personalized treatment programs.
The history-taking process explores not just the medical aspects of the vestibular disorder but also its impact on daily life, work activities, recreational pursuits, and psychological well-being. Therapists assess which specific movements or activities trigger symptoms, what functional limitations have developed, and how the person has adapted their lifestyle to manage symptoms. Understanding these individual patterns helps identify the most important treatment targets and guides exercise selection. For example, a teacher who experiences dizziness when looking up at the whiteboard will need different exercises than a construction worker who has difficulty with balance on uneven surfaces.
Physical examination in vestibular rehabilitation includes specialized tests that assess different aspects of vestibular and balance function. The head impulse test evaluates the vestibulo-ocular reflex by having patients focus on a target while the therapist makes quick head movements, revealing deficits in gaze stabilization. The Dynamic Gait Index assesses balance during various walking tasks, including walking while turning the head, changing speed, and navigating obstacles. The Dix-Hallpike maneuver tests for BPPV, while the Functional Gait Assessment evaluates balance during complex locomotor tasks. These tests help identify specific deficits that can be targeted with appropriate exercises.
Balance assessment typically includes both static and dynamic tests performed under different sensory conditions. Static balance might be assessed by timing how long someone can stand on one foot or in tandem position with eyes open and closed. Dynamic balance assessment includes tests like the Timed Up and Go test, which measures the time required to stand up, walk a short distance, turn around, and sit back down. More sophisticated balance testing might include computerized posturography, which measures postural sway under different sensory conditions, providing detailed information about reliance on different sensory systems for balance control.
Gaze stability assessment examines the ability to maintain clear vision during head movements, which is often impaired in vestibular disorders. This might involve reading an eye chart while moving the head side to side or up and down, or tracking a moving target while the head is stationary. The degree of visual blurring or symptoms experienced during these tests helps guide the intensity and progression of gaze stabilization exercises. Some clinics use sophisticated equipment like video head impulse testing (vHIT) to provide precise measurements of vestibulo-ocular reflex function.
Motion sensitivity assessment identifies specific movements or visual stimuli that provoke symptoms, which is crucial for developing effective habituation exercise programs. This might involve having patients perform various head and body movements while rating their symptom response, or exposing them to different visual motion stimuli to identify triggers. The Motion Sensitivity Test provides a standardized way to assess and track changes in motion sensitivity over time, helping to monitor treatment progress and adjust exercise programs accordingly.
Functional assessment focuses on real-world activities that are limited by vestibular symptoms. This might include assessing performance during dual-task activities like walking while talking or carrying objects, evaluating comfort in different environmental conditions like crowded spaces or moving vehicles, or testing specific occupational or recreational activities that are important to the individual. Understanding these functional limitations helps ensure that treatment addresses the activities most important to each person's quality of life and goals.