Vestibular Rehabilitation Exercises to Improve Gait, Balance, and Dynamic Visual Acuity in Patients With Vestibular Hypofunction

## Brief Summary

Unilateral vestibular hypofunction (UVH) is a condition characterized by reduced or absent function of one vestibular system and commonly results in dizziness, impaired postural control, gait difficulties, reduced dynamic visual acuity, and increased risk of falls. These impairments can substantially affect functional independence and quality of life. Vestibular rehabilitation therapy (VRT) is an exercise-based physiotherapy approach designed to promote central vestibular compensation through gaze stabilization, habituation, balance, and gait training. However, the evidence comparing the additional benefits of VRT with conventional physiotherapy, particularly in the local population, remains limited. Therefore, this study was conducted to determine and compare the effects of VRT and conventional physiotherapy on balance, gait, dynamic visual acuity, and dizziness-related disability in patients with chronic unilateral vestibular hypofunction.

A single-blinded randomized controlled trial was conducted on 58 participants aged 38-60 years with chronic unilateral vestibular hypofunction. Participants were randomly allocated into an experimental group and a control group, with 29 participants in each group. The experimental group received conventional physiotherapy combined with vestibular-specific rehabilitation, including VOR x1/x2 gaze stabilization, postural stability exercises, and habituation exercises. The control group received conventional physiotherapy consisting of core strengthening and gait training without vestibular-specific interventions. Both groups received treatment twice weekly for eight weeks, with each session lasting approximately 45 minutes. Outcome measures included the Timed Up and Go (TUG) test for functional mobility, Dynamic Visual Acuity (DVA) for visual stability, Dizziness Handicap Inventory (DHI) for dizziness-related disability, and Tandem Romberg testing for balance.

The findings demonstrated greater improvements in the experimental group across the assessed outcomes. TUG performance improved, while DVA and DHI scores showed marked improvement, indicating better visual stability and reduced dizziness-related disability. Romberg performance also improved substantially, reflecting enhanced postural stability and balance control. In comparison, the control group demonstrated smaller or inconsistent changes, particularly in DVA, DHI, and functional mobility. Statistical analysis was performed using non-parametric tests because most study variables were not normally distributed. Within-group comparisons were conducted using the Wilcoxon Signed-Rank Test, while between-group comparisons were performed using the Mann-Whitney U Test.

The study concluded that vestibular rehabilitation therapy is an effective intervention for improving balance, dynamic visual acuity, and dizziness-related disability in patients with unilateral vestibular hypofunction. The experimental group showed greater improvements in postural stability, visual stability, and perceived disability than the conventional physiotherapy group. However, no significant between-group difference was observed for TUG, suggesting that conventional physiotherapy may provide adequate improvement in basic functional mobility. Overall, the findings support incorporating vestibular rehabilitation into physiotherapy management of UVH to enhance sensory integration and functional recovery.

The study recommends early initiation of VRT, individualized exercise programs, and emphasis on home exercises to improve adherence and long-term outcomes. Future research should involve larger samples, multicenter studies, longer follow-up periods, and investigation of optimal exercise dosage and progression.