Efficacy of Combining Conventional Vestibular Rehabilitation with Whole Body Vibration and Galvanic Vestibular Stimulation on Balance of Patients with Uncompensated Unilateral Vestibular Neuritis
,
Abstract
Background and Aim: Previous studies have demonstrated that uncompensated Unilateral Vestibular Neuritis (UVN) is the most prevalent cause of dizziness. Use of Conventional Vestibular Rehabilitation (CVR) has some limitations. The use of tool-based rehabilitation methods can be more pleasant to these patients and encourage them to complete the rehabilitation course. This study aimed to compare the effects of combining CVR with Whole Body Vibration (WBV) and Galvanic Vestibular Stimulation (GVS) on balance function in patients with UVN.
Methods: In this study, 51 patients with uncompensated UVN aged 30-50 years were randomly divided into three groups of 17, including CVR (group 1), CVR+WBV (group 2), and CVR+WBV+GVS (group 3). The interventions included four weeks of CVR, twenty 5-minute sessions of WBV, and eight 20-minute sessions of GVS. Outcome measures were postural control parameters, Vestibulo-Ocular Reflex (VOR) gain asymmetry, cervical Joint Position Sense Error (JPSE), and Dizziness Handicap Inventory (DHI) score that were assessed before and after interventions.
Results: Of 51 patients, 45 completed the study. There was a significant improvement in all measured variables in all groups, where the group 2 and group 3 showed significantly greater improvement than the group 1 in posturography results, cervical JPSE, and DHI score (p<0.05). There was no significant difference among the groups in the VOR gain asymmetry (p>0.05).
Conclusion: The CVR, CVR+WBV and CRV+WBV+GVS can improve the balance of UVN patients among which CVR+WBV and CRV+WBV+GVS are more effective. Combining CVR with WBV and GVS leads to additional therapeutic effects in UVN patients.
1. Huang HH, Chen CC, Lee HH, Chen HC, Lee TY, Tam KW, et al. Efficacy of Vestibular Rehabilitation in Vestibular Neuritis: A Systematic Review and Meta-analysis. Am J Phys Med Rehabil. 2024;103(1):38-46. [DOI:10.1097/PHM.0000000000002301]
2. Dieterich M, Brandt T. Vestibular Lesions of the Central Vestibular Pathways. In: Herdman SJ, Clendaniel RA. Vestibular rehabilitation. 4th ed. Philadelphia: F. A. Davis Company; 2014. p. 59-84.
3. Bergeron M, Lortie CL, Guitton MJ. Use of Virtual Reality Tools for Vestibular Disorders Rehabilitation: A Comprehensive Analysis. Adv Med. 2015;2015:916735. [DOI:10.1155/2015/916735]
4. Rosiak O, Krajewski K, Woszczak M, Jozefowicz-Korczynska M. Evaluation of the effectiveness of a Virtual Reality-based exercise program for Unilateral Peripheral Vestibular Deficit. J Vestib Res. 2018;28(5-6):409-15. [DOI:10.3233/VES-180647]
5. Moossavi A, Mehrkian S, Hamzehpour F, Bakhshi E. Development and assessment of validity and reliability of the Persian version of vestibular rehabilitation benefit questionnaire. Aud Vestib Res. 2018;27(2):65-71.
6. Herdman SJ, Whitney SL. Physical therapy treatment of vestibular hypofunction. In: Herdman SJ, Clendaniel RA. Vestibular rehabilitation. 4th ed. Philadelphia: F. A. Davis Company; 2014. p. 394-431.
7. Curthoys IS, Halmagyi GM. Vestibular compensation. Adv Otorhinolaryngol. 1999;55:82-110. [DOI:10.1159/000059059]
8. Meldrum D, Herdman S, Moloney R, Murray D, Duffy D, Malone K, et al. Effectiveness of conventional versus virtual reality based vestibular rehabilitation in the treatment of dizziness, gait and balance impairment in adults with unilateral peripheral vestibular loss: a randomised controlled trial. BMC Ear Nose Throat Disord. 2012;12:3. [DOI:10.1186/1472-6815-12-3]
9. Meldrum D, Herdman S, Vance R, Murray D, Malone K, Duffy D, et al. Effectiveness of conventional versus virtual reality-based balance exercises in vestibular rehabilitation for unilateral peripheral vestibular loss: results of a randomized controlled trial. Arch Phys Med Rehabil. 2015;96(7):1319-28.e1. [DOI:10.1016/j.apmr.2015.02.032]
10. Deveze A, Bernard-Demanze L, Xavier F, Lavieille JP, Elziere M. Vestibular compensation and vestibular rehabilitation. Current concepts and new trends. Neurophysiol Clin. 2014;44(1):49-57. [DOI:10.1016/j.neucli.2013.10.138]
11. Blouin J, Vercher JL, Gauthier GM, Paillard J, Bard C, Lamarre Y. Perception of passive whole-body rotations in the absence of neck and body proprioception. J Neurophysiol. 1995;74(5):2216-9. [DOI:10.1152/jn.1995.74.5.2216]
12. Moezy A, Olyaei G, Hadian M, Razi M, Faghihzadeh S. A comparative study of whole body vibration training and conventional training on knee proprioception and postural stability after anterior cruciate ligament reconstruction. Br J Sports Med. 2008;42(5):373-8. [DOI:10.1136/bjsm.2007.038554]
13. Ko MS, Sim YJ, Kim DH, Jeon HS. Effects of Three Weeks of Whole-Body Vibration Training on Joint-Position Sense, Balance, and Gait in Children with Cerebral Palsy: A Randomized Controlled Study. Physiother Can. 2016;68(2):99-105. [DOI:10.3138/ptc.2014-77]
14. Bonanni R, Cariati I, Romagnoli C, D’Arcangelo G, Annino G, Tancredi V. Whole Body Vibration: A Valid Alternative Strategy to Exercise? J Funct Morphol Kinesiol. 2022;7(4):99. [DOI:10.3390/jfmk7040099]
15. Alam MM, Khan AA, Farooq M. Effect of whole-body vibration on neuromuscular performance: A literature review. Work. 2018;59(4):571-83. [DOI:10.3233/WOR-182699]
16. Nam GS, Nguyen TT, Kang JJ, Han GC, Oh SY. Effects of Galvanic Vestibular Stimulation on Vestibular Compensation in Unilaterally Labyrinthectomized Mice. Front Neurol. 2021;12:736849. [DOI:10.3389/fneur.2021.736849]
17. Wuehr M, Nusser E, Krafczyk S, Straube A, Brandt T, Jahn K, et al. Noise-Enhanced Vestibular Input Improves Dynamic Walking Stability in Healthy Subjects. Brain Stimul. 2016;9(1):109-16. [DOI:10.1016/j.brs.2015.08.017]
18. Wardman DL, Taylor JL, Fitzpatrick RC. Effects of galvanic vestibular stimulation on human posture and perception while standing. J Physiol. 2003;551(Pt 3):1033-42. [DOI:10.1113/jphysiol.2003.045971]
19. Strupp M, Bisdorff A, Furman J, Hornibrook J, Jahn K, Maire R, et al. Acute unilateral vestibulopathy/vestibular neuritis: Diagnostic criteria. J Vestib Res. 2022;32(5):389-406. [DOI:10.3233/VES-220201]
20. Halmagyi GM, Chen L, MacDougall HG, Weber KP, McGarvie LA, Curthoys IS. The Video Head Impulse Test. Front Neurol. 2017;8:258. [DOI:10.3389/fneur.2017.00258]
21. Lacour M, Tardivet L, Thiry A. Posture Deficits and Recovery After Unilateral Vestibular Loss: Early Rehabilitation and Degree of Hypofunction Matter. Front Hum Neurosci. 2022;15:776970. [DOI:10.3389/fnhum.2021.776970]
22. McDonnell MN, Hillier SL. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database Syst Rev. 2015;1(1):CD005397. [DOI:10.1002/14651858.CD005397.pub4]
23. Smółka W, Smółka K, Markowski J, Pilch J, Piotrowska-Seweryn A, Zwierzchowska A. The efficacy of vestibular rehabilitation in patients with chronic unilateral vestibular dysfunction. Int J Occup Med Environ Health. 2020;33(3):273-82. [DOI:10.13075/ijomeh.1896.01330]
24. Ardıç FN, Alkan H, Tümkaya F, Ardıç F. Effectiveness of wholebody vibration or biofeedback postural training as an add-on to vestibular exercises rehabilitation therapy in chronic unilateral vestibular weakness: A randomized controlled study. J Vestib Res. 2021;31(3):181-90. [DOI:10.3233/VES-190753]
25. Meldrum D, Jahn K. Gaze stabilisation exercises in vestibular rehabilitation: review of the evidence and recent clinical advances. J Neurol. 2019;266(Suppl 1):11-18. [DOI:10.1007/s00415-019-09459-x]
26. Hamidi Nahrani M, Akbari M, Maarefvand M. Relationship between vestibulo-ocular reflex gain and dizziness handicap inventory score to predict effectiveness of vestibular rehabilitation. Aud Vestib Res. 2021;30(4):273-9. [DOI:10.18502/avr.v30i4.7445]
27. Kilic G, Temirbekov D, Ata G, Algun ZC. Effects of Vestibular Rehabilitation in Patients with Unilateral Vestibular Hypofunction. Indian J Otolaryngol. 2023;29(1):33-8. [DOI:10.4103/indianjotol.indianjotol_172_22]
28. Sprenger A, Spliethoff P, Rother M, Machner B, Helmchen C. Effects of perceptible and imperceptible galvanic vestibular stimulation on the postural control of patients with bilateral vestibulopathy. J Neurol. 2020;267(8):2383-97. [DOI:10.1007/s00415-020-09852-x]
29. Shaabani M, Lotfi Y, Karimian SM, Rahgozar M, Hooshmandi M. Short-term galvanic vestibular stimulation promotes functional recovery and neurogenesis in unilaterally labyrinthectomized rats. Brain Res. 2016;1648(Pt A):152-62. [DOI:10.1016/j.brainres.2016.07.029]
30. Özel Aslıyüce Y, Demirel A, Ülger Ö. Investigation of Joint Position Sense and Balance in Individuals With Chronic Idiopathic Neck Pain: A Cross-Sectional Study. J Manipulative Physiol Ther. 2022;45(3):188-95. [DOI:10.1016/j.jmpt.2022.06.006]
31. Moreira-Marconi E, da Cunha de Sá-Caputo D, Sartorio A, Bernardo-Filho M. Hormonal Responses to Vibration Therapy. In: Rittweger J, editor. Manual of Vibration Exercise and Vibration Therapy. Cham: Springer; 2020. p. 169-84.
32. Khavarghazalani B, Adel Ghahraman M, Hoseinabadi R, Jalaie S, Kouhi A, Yazdani N. Combining Vestibular Rehabilitation and Noisy Galvanic Vestibular Stimulation for Treatment of Unilateral Vestibulopathy: A Randomized Controlled Trial. Aud Vestib Res. 2023;32(4):272-83. [DOI:10.18502/avr.v32i4.13591]
33. Lacour M, Bernard-Demanze L. Interaction between Vestibular Compensation Mechanisms and Vestibular Rehabilitation Therapy: 10 Recommendations for Optimal Functional Recovery. Front Neurol. 2015;5:285. [DOI:10.3389/fneur.2014.00285]
34. Amiri P, Mohebbi A, Kearney R. Experimental Methods to Study Human Postural Control. J Vis Exp. 2019;(151). [DOI:10.3791/60078]
35. Tseng SY, Lai CL, Ko CP, Chang YK, Fan HC, Wang CH. The Effectiveness of Whole-Body Vibration and Heat Therapy on the Muscle Strength, Flexibility, and Balance Abilities of Elderly Groups. Int J Environ Res Public Health. 2023;20(2):1650. [DOI:10.3390/ijerph20021650]
36. Eder J, Kellerer S, Amberger T, Keywan A, Dlugaiczyk J, Wuehr M, et al. Combining vestibular rehabilitation with noisy galvanic vestibular stimulation for treatment of bilateral vestibulopathy. J Neurol. 2022;269(11):5731-7. [DOI:10.1007/s00415-022-11033-x]
2. Dieterich M, Brandt T. Vestibular Lesions of the Central Vestibular Pathways. In: Herdman SJ, Clendaniel RA. Vestibular rehabilitation. 4th ed. Philadelphia: F. A. Davis Company; 2014. p. 59-84.
3. Bergeron M, Lortie CL, Guitton MJ. Use of Virtual Reality Tools for Vestibular Disorders Rehabilitation: A Comprehensive Analysis. Adv Med. 2015;2015:916735. [DOI:10.1155/2015/916735]
4. Rosiak O, Krajewski K, Woszczak M, Jozefowicz-Korczynska M. Evaluation of the effectiveness of a Virtual Reality-based exercise program for Unilateral Peripheral Vestibular Deficit. J Vestib Res. 2018;28(5-6):409-15. [DOI:10.3233/VES-180647]
5. Moossavi A, Mehrkian S, Hamzehpour F, Bakhshi E. Development and assessment of validity and reliability of the Persian version of vestibular rehabilitation benefit questionnaire. Aud Vestib Res. 2018;27(2):65-71.
6. Herdman SJ, Whitney SL. Physical therapy treatment of vestibular hypofunction. In: Herdman SJ, Clendaniel RA. Vestibular rehabilitation. 4th ed. Philadelphia: F. A. Davis Company; 2014. p. 394-431.
7. Curthoys IS, Halmagyi GM. Vestibular compensation. Adv Otorhinolaryngol. 1999;55:82-110. [DOI:10.1159/000059059]
8. Meldrum D, Herdman S, Moloney R, Murray D, Duffy D, Malone K, et al. Effectiveness of conventional versus virtual reality based vestibular rehabilitation in the treatment of dizziness, gait and balance impairment in adults with unilateral peripheral vestibular loss: a randomised controlled trial. BMC Ear Nose Throat Disord. 2012;12:3. [DOI:10.1186/1472-6815-12-3]
9. Meldrum D, Herdman S, Vance R, Murray D, Malone K, Duffy D, et al. Effectiveness of conventional versus virtual reality-based balance exercises in vestibular rehabilitation for unilateral peripheral vestibular loss: results of a randomized controlled trial. Arch Phys Med Rehabil. 2015;96(7):1319-28.e1. [DOI:10.1016/j.apmr.2015.02.032]
10. Deveze A, Bernard-Demanze L, Xavier F, Lavieille JP, Elziere M. Vestibular compensation and vestibular rehabilitation. Current concepts and new trends. Neurophysiol Clin. 2014;44(1):49-57. [DOI:10.1016/j.neucli.2013.10.138]
11. Blouin J, Vercher JL, Gauthier GM, Paillard J, Bard C, Lamarre Y. Perception of passive whole-body rotations in the absence of neck and body proprioception. J Neurophysiol. 1995;74(5):2216-9. [DOI:10.1152/jn.1995.74.5.2216]
12. Moezy A, Olyaei G, Hadian M, Razi M, Faghihzadeh S. A comparative study of whole body vibration training and conventional training on knee proprioception and postural stability after anterior cruciate ligament reconstruction. Br J Sports Med. 2008;42(5):373-8. [DOI:10.1136/bjsm.2007.038554]
13. Ko MS, Sim YJ, Kim DH, Jeon HS. Effects of Three Weeks of Whole-Body Vibration Training on Joint-Position Sense, Balance, and Gait in Children with Cerebral Palsy: A Randomized Controlled Study. Physiother Can. 2016;68(2):99-105. [DOI:10.3138/ptc.2014-77]
14. Bonanni R, Cariati I, Romagnoli C, D’Arcangelo G, Annino G, Tancredi V. Whole Body Vibration: A Valid Alternative Strategy to Exercise? J Funct Morphol Kinesiol. 2022;7(4):99. [DOI:10.3390/jfmk7040099]
15. Alam MM, Khan AA, Farooq M. Effect of whole-body vibration on neuromuscular performance: A literature review. Work. 2018;59(4):571-83. [DOI:10.3233/WOR-182699]
16. Nam GS, Nguyen TT, Kang JJ, Han GC, Oh SY. Effects of Galvanic Vestibular Stimulation on Vestibular Compensation in Unilaterally Labyrinthectomized Mice. Front Neurol. 2021;12:736849. [DOI:10.3389/fneur.2021.736849]
17. Wuehr M, Nusser E, Krafczyk S, Straube A, Brandt T, Jahn K, et al. Noise-Enhanced Vestibular Input Improves Dynamic Walking Stability in Healthy Subjects. Brain Stimul. 2016;9(1):109-16. [DOI:10.1016/j.brs.2015.08.017]
18. Wardman DL, Taylor JL, Fitzpatrick RC. Effects of galvanic vestibular stimulation on human posture and perception while standing. J Physiol. 2003;551(Pt 3):1033-42. [DOI:10.1113/jphysiol.2003.045971]
19. Strupp M, Bisdorff A, Furman J, Hornibrook J, Jahn K, Maire R, et al. Acute unilateral vestibulopathy/vestibular neuritis: Diagnostic criteria. J Vestib Res. 2022;32(5):389-406. [DOI:10.3233/VES-220201]
20. Halmagyi GM, Chen L, MacDougall HG, Weber KP, McGarvie LA, Curthoys IS. The Video Head Impulse Test. Front Neurol. 2017;8:258. [DOI:10.3389/fneur.2017.00258]
21. Lacour M, Tardivet L, Thiry A. Posture Deficits and Recovery After Unilateral Vestibular Loss: Early Rehabilitation and Degree of Hypofunction Matter. Front Hum Neurosci. 2022;15:776970. [DOI:10.3389/fnhum.2021.776970]
22. McDonnell MN, Hillier SL. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database Syst Rev. 2015;1(1):CD005397. [DOI:10.1002/14651858.CD005397.pub4]
23. Smółka W, Smółka K, Markowski J, Pilch J, Piotrowska-Seweryn A, Zwierzchowska A. The efficacy of vestibular rehabilitation in patients with chronic unilateral vestibular dysfunction. Int J Occup Med Environ Health. 2020;33(3):273-82. [DOI:10.13075/ijomeh.1896.01330]
24. Ardıç FN, Alkan H, Tümkaya F, Ardıç F. Effectiveness of wholebody vibration or biofeedback postural training as an add-on to vestibular exercises rehabilitation therapy in chronic unilateral vestibular weakness: A randomized controlled study. J Vestib Res. 2021;31(3):181-90. [DOI:10.3233/VES-190753]
25. Meldrum D, Jahn K. Gaze stabilisation exercises in vestibular rehabilitation: review of the evidence and recent clinical advances. J Neurol. 2019;266(Suppl 1):11-18. [DOI:10.1007/s00415-019-09459-x]
26. Hamidi Nahrani M, Akbari M, Maarefvand M. Relationship between vestibulo-ocular reflex gain and dizziness handicap inventory score to predict effectiveness of vestibular rehabilitation. Aud Vestib Res. 2021;30(4):273-9. [DOI:10.18502/avr.v30i4.7445]
27. Kilic G, Temirbekov D, Ata G, Algun ZC. Effects of Vestibular Rehabilitation in Patients with Unilateral Vestibular Hypofunction. Indian J Otolaryngol. 2023;29(1):33-8. [DOI:10.4103/indianjotol.indianjotol_172_22]
28. Sprenger A, Spliethoff P, Rother M, Machner B, Helmchen C. Effects of perceptible and imperceptible galvanic vestibular stimulation on the postural control of patients with bilateral vestibulopathy. J Neurol. 2020;267(8):2383-97. [DOI:10.1007/s00415-020-09852-x]
29. Shaabani M, Lotfi Y, Karimian SM, Rahgozar M, Hooshmandi M. Short-term galvanic vestibular stimulation promotes functional recovery and neurogenesis in unilaterally labyrinthectomized rats. Brain Res. 2016;1648(Pt A):152-62. [DOI:10.1016/j.brainres.2016.07.029]
30. Özel Aslıyüce Y, Demirel A, Ülger Ö. Investigation of Joint Position Sense and Balance in Individuals With Chronic Idiopathic Neck Pain: A Cross-Sectional Study. J Manipulative Physiol Ther. 2022;45(3):188-95. [DOI:10.1016/j.jmpt.2022.06.006]
31. Moreira-Marconi E, da Cunha de Sá-Caputo D, Sartorio A, Bernardo-Filho M. Hormonal Responses to Vibration Therapy. In: Rittweger J, editor. Manual of Vibration Exercise and Vibration Therapy. Cham: Springer; 2020. p. 169-84.
32. Khavarghazalani B, Adel Ghahraman M, Hoseinabadi R, Jalaie S, Kouhi A, Yazdani N. Combining Vestibular Rehabilitation and Noisy Galvanic Vestibular Stimulation for Treatment of Unilateral Vestibulopathy: A Randomized Controlled Trial. Aud Vestib Res. 2023;32(4):272-83. [DOI:10.18502/avr.v32i4.13591]
33. Lacour M, Bernard-Demanze L. Interaction between Vestibular Compensation Mechanisms and Vestibular Rehabilitation Therapy: 10 Recommendations for Optimal Functional Recovery. Front Neurol. 2015;5:285. [DOI:10.3389/fneur.2014.00285]
34. Amiri P, Mohebbi A, Kearney R. Experimental Methods to Study Human Postural Control. J Vis Exp. 2019;(151). [DOI:10.3791/60078]
35. Tseng SY, Lai CL, Ko CP, Chang YK, Fan HC, Wang CH. The Effectiveness of Whole-Body Vibration and Heat Therapy on the Muscle Strength, Flexibility, and Balance Abilities of Elderly Groups. Int J Environ Res Public Health. 2023;20(2):1650. [DOI:10.3390/ijerph20021650]
36. Eder J, Kellerer S, Amberger T, Keywan A, Dlugaiczyk J, Wuehr M, et al. Combining vestibular rehabilitation with noisy galvanic vestibular stimulation for treatment of bilateral vestibulopathy. J Neurol. 2022;269(11):5731-7. [DOI:10.1007/s00415-022-11033-x]
| Files | ||
| Issue | Vol 34 No 4 (2025) | |
| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/avr.v34i4.19955 | |
| Keywords | ||
| Vestibular neuritis vestibular rehabilitation whole body vibration galvanic vestibular stimulation | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Jahangard A, Ashrafi M, Heidari F. Efficacy of Combining Conventional Vestibular Rehabilitation with Whole Body Vibration and Galvanic Vestibular Stimulation on Balance of Patients with Uncompensated Unilateral Vestibular Neuritis. Aud Vestib Res. 2025;34(4):336-346.
