The Effect of Whole Body Vibration and Galvanic Vestibular Stimulation Combined with Vestibular Rehabilitation on Balance in patients with Uncompensated Unilateral Vestibular Neuritis
,
Abstract
Background and aim: Previous studies have demonstrated that uncompensated Unilateral Vestibular Neuritis (UVN) is a most prevalent cause of dizziness. Despite the many advantages, use of Conventional Vestibular Rehabilitation (CVR) in UVN patients have limitations. The use of tool-based rehabilitation methods can be more pleasant to patients and encourage them to complete the rehabilitation course. This study aimed to compare the effects of combined Whole Body Vibration (WBV), Galvanic Vestibular Stimulation (GVS) and CVR in patients with UVN.
Methods: UVN patients in the age range of 30 to 50 years were randomly divided into three groups with 17 participants each. first group received of CVR, the second group received CVR+WBV, and the third group received CVR+WBV+GVS, which included four weeks of CVR, twenty 5-minute sessions of WBV and eight 20-minute sessions of GVS. Outcome measurements were postural control parameters, Vestibulo-Ocular Reflex (VOR) gain asymmetry, joint position sense error (JPSE) and Dizziness Handicap Inventory (DHI) scores that were assessed at baseline and after four weeks.
Results: There was a significant improvement in all measured variables after the CVR, CVR+WBV and CRV+WBV+GVS treatments. Moreover, the CVR+WBV and CRV+WBV+GVS groups showed significantly greater improvement than the CVR group in posturography results, JPSE and DHI score (p < 0.05) except VOR gain asymmetry (p > 0.05).
Conclusion: CVR, CVR+WBV and CRV+WBV+GVS treatments effectively improve balance function. CVR+WBV and CRV+WBV+GVS training shows additional therapeutic effects in UVN patients. When CVR combined with WBV and GVS, shows 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. 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]
17. 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]
18. 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]
19. 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]
20. 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]
21. 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]
22. 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):273-282. [DOI:10.13075/ijomeh.1896.01330]
23. Kalaoğlu E, Faruk Bucak Ö, Kökçe M, Özkan M, Çetin M, Atasoy M, et al. High-frequency whole-body vibration activates tonic vibration reflex. Turk J Phys Med Rehabil. 2023;69(1):46-51. [DOI:10.5606/tftrd.2023.10854]
24. Ardıç FN, Alkan H, Tümkaya F, Ardıç F. Effectiveness of whole-body 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]
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. 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]
17. 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]
18. 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]
19. 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]
20. 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]
21. 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]
22. 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):273-282. [DOI:10.13075/ijomeh.1896.01330]
23. Kalaoğlu E, Faruk Bucak Ö, Kökçe M, Özkan M, Çetin M, Atasoy M, et al. High-frequency whole-body vibration activates tonic vibration reflex. Turk J Phys Med Rehabil. 2023;69(1):46-51. [DOI:10.5606/tftrd.2023.10854]
24. Ardıç FN, Alkan H, Tümkaya F, Ardıç F. Effectiveness of whole-body 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]
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| Vestibular neuritis vestibular rehabilitation whole body vibration galvanic vestibular stimulation | ||
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How to Cite
1.
Jahangard A, Ashrafi M, Heidari F. The Effect of Whole Body Vibration and Galvanic Vestibular Stimulation Combined with Vestibular Rehabilitation on Balance in patients with Uncompensated Unilateral Vestibular Neuritis. Aud Vestib Res. 2025;.
