Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Updated Clinical Practice Guideline From the Academy of Neurologic Physical Therapy of the American Physical Therapy Association

Journal of Neurologic Physical Therapy

Hall, C. D., Herdman, S. J., et al. (2022).

Journal of Neurologic Physical Therapy, 46(2), 118-177.

This updated guideline from the Academy of Neurologic Physical Therapy, a component of American Physical Therapy Association, provides recommendations for clinicians offering vestibular rehabilitation to recover function in patients with acute, subacute, or chronic peripheral vestibular hypofunction. The intended audience for this guideline includes physical therapists and other clinicians offering vestibular rehabilitation, individuals with vestibular dysfunction and their family members, educators, researchers, policy makers, and payers. Recommendations for vestibular rehabilitation activities within the scope of Audiology practice are provided in this summary.

Academy of Neurologic Physical Therapy of the American Physical Therapy Association

This clinical practice guideline is an update of an earlier guideline published in 2016 by the American Physical Therapy Association - Neurology Section. Changes in content from the prior guideline include the following:<br /> <ul> <li><span style="color: #333333;">New evidence from 18 randomized clinical/controlled trials, 9 prospective and 8 retrospective cohort studies</span></li> <li><span style="color: #333333;">Expanded action statement profiles to explicitly state quality improvement opportunities, intentional vagueness, and implementation and audit.</span></li> <li><span style="color: #333333;">New evidence in support of earlier initiation of vestibular rehabilitation, within the first two weeks of acute onset of unilateral vestibular hypofunction (UVH)</span></li> <li><span style="color: #333333;">Support for consideration of a variety of balance training modalities</span></li> <li><span style="color: #333333;">New recommendations regarding balance exercise dosage for individuals with chronic UVH and bilateral vestibular hypofunction</span></li> <li><span style="color: #333333;">Stronger recommendation regarding therapy cessation decision-making</span></li> <li><span style="color: #333333;">Expanded recommendations on factors that may impact rehabilitation outcomes</span></li> </ul>

Recommendations for prescribed vestibular programs for patients with peripheral hypofunction are as follows:<br /> <ul> <li>Individuals with peripheral vestibular hypofunction should be offered supervised vestibular rehabilitation. This is true for chronic unilateral hypofunction and bilateral hypofunction (Class I Evidence, Grade A Recommendation).</li> <li>Vestibular rehabilitation should be provided with the intention of improving quality of life (Level I Evidence, Grade A Recommendation).</li> <li>Therapy should be terminated upon achievement of primary goals and resolution of symptoms, normalized balance and vestibular function, or a plateau in progress (Class II Evidence, Grade B Recommendation).</li> <li>Clinicians may evaluate factors that modify rehabilitation outcomes in their patients when considering and/or implementing vestibular rehabilitation (e.g. age, gender, time since onset, comorbidities, and medications; Class I-II Evidence, Grade A-B Recommendation).&nbsp;</li> </ul>

Recommendations for specific exercise-based treatments for patients with peripheral vestibular hypofunction are as follows:<br /> <ul> <li>Clinicians should offer individualized exercise techniques to target impairments, activity limitations, and/or participation restrictions (Class II Evidence, Grade B Recommendation).</li> <li>Clinicians should not offer saccadic or smooth-pursuit exercises as specific exercises for gaze stability for individuals with peripheral vestibular hypofunction (Class I Evidence, Grade A Recommendation).</li> <li>Clinicians may prescribe static and dynamic balance exercises for a minimum of 20 minutes daily for at least 4-6 weeks for individuals with chronic unilateral vestibular hypofunction (Class II Evidence, Grade C Recommendation).</li> </ul>

Expert opinion recommendations for specific exercise-based treatments for patients with peripheral vestibular hypofunction are as follows:<br /> <ul> <li>Clinicians may consider prescribing static and dynamic balance exercises for individuals with acute or subacute unilateral vestibular hypofunction, however no specific dose recommendations can be made at this time (Class II Evidence, Grade D Recommendation).</li> <li>Clinicians may consider prescribing static and dynamic balance exercises for 6-9 weeks for individuals with bilateral vestibular hypofunction (Class III-IV Evidence, Grade D Recommendation).&nbsp;</li> </ul>