Circuit Training on Vertigo, Oscillopsia and Dizziness in Vestibular Hypo Function Hypo- Functions
Condition: Vestibular Disorder
MeSH terms: Vertigo; Vestibular Diseases; Dizziness
Study type: Interventional

Summary: 
      In this research, the main purpose is to determine the effects of Circuit Training consisting
      of Structured Vestibular rehabilitation Program under the strict supervision of
      Neuro-Therapist versus Medicines and General (simple) Rehabilitation (only Home-based) in
      community-dwelling population of people diagnosed with Vestibular disorders. A booklet
      consisting of general instructions, simple vestibular exercises which are to be made a part
      of daily routine, specific diet plan and specific precautions to be taken by patients
      reporting with vertigo, oscillopsia and dizziness will also be provided to all the patients.
      This is a community service addition, added so that everyone in the society can have easy
      access to the instructions, will be cost effective, and will reduce their visits to the
      therapist.
    

Detailed description: 
      People diagnosed with vestibular disorders often experience dizziness , oscillopsia, trouble
      with vision, balance or mobility. The vestibular disorders that are called unilateral and
      peripheral (UPVD) are those that affect one side of the vestibular system (unilateral)and
      (BPVD) are those affect both sides of the vestibular system (bilateral) and only the portion
      of the system that is outside of the brain (peripheral-part of the inner ear). Examples of
      these disorders include benign paroxysmal positional vertigo (BPPV), vestibular neuritis,
      labyrinthitis, one-sided Ménière's disease or vestibular problems following surgical
      procedures such as labyrinthectomy or removal of an acoustic neuroma. Vestibular
      rehabilitation for these disorders is becoming increasingly used and involves various
      movement-based regimes.

      Dizziness, oscillopsia and disequilibrium are common complaints reported by adults during
      visits to their doctor. Dizziness, oscillopsia, vertigo and disequilibrium are not a
      disease-they are symptoms that can result from a vestibular disorder or from difficulties
      unrelated to the inner ear, such as cardiovascular, neurological, metabolic, vision, or
      psychological disorders. However, as many as 45% of people with dizziness symptoms have
      problems in the vestibular system (balance organs of the inner ear.

      Vestibular rehabilitation therapy (VRT) is an exercise-based program for reducing the
      symptoms of vertigo, dizziness, oscillopsia and disequilibrium with vestibular pathology
      (disease or disorder). A common neuro-otological approach for managing such symptoms is to
      prescribe medication that suppresses vestibular function. However, in the long term, such
      suppressants can interfere with a person's ability to make necessary adaptations. In
      addition, many of these medications cause drowsiness that may limit a person's ability to be
      active.

      Vestibular habituation exercises have been recommended for these non-Ménière's patients.
      Although the exercises are popular, there are only a few studies in patients with chronic
      unilateral vestibular dysfunction. Those studies were performed with limited cases or with a
      wide variety of diagnoses. Herdman et al.,in their review, stressed that studies were
      retrospective, nonrandomized, consisting of groups that were not comparable, uncontrolled
      studies and, although they offer interesting descriptions of the patient population, do not
      provide the evidence necessary to justify the use of these exercises for treatment.

      the previous study conducted a research in 2009 to find the Short-term effects of vestibular
      rehabilitation in patients with chronic unilateral vestibular dysfunction, a randomized
      controlled study. Their objective was to evaluate the short-term effects of vestibular
      rehabilitation on a symptom, disability, balance, and postural stability in patients with
      chronic unilateral vestibular dysfunction. Significant improvements were seen in symptom,
      disability, balance, and postural stability in chronic unilateral vestibular dysfunction
      after an exercise program.

      in 2013 study was conducted on finding out the effects of Vestibular rehabilitation with
      virtual reality in Meniere disease. Their aim was to verify the effect of a virtual
      reality-based balance rehabilitation program for patients with Meniere disease. They
      concluded that Virtual reality-based balance rehabilitation effectively improved dizziness,
      quality of life, and limit of stability of patients with Meniere's disease.

      in 2006 a study was conducted to Compare between Oculomotor Rehabilitation and Vestibular
      Electrical Stimulation in Unilateral Peripheral Vestibular Deficit. The aim of their study
      was to evaluate the effects of oculomotor rehabilitation (group 2) on static balance and a
      dizziness handicap and to compare those with the effects to vestibular electrical stimulation
      (group 1). Analysis of the equilibrium system subcomponents did not show any variation.
      Oculomotor exercises, employed in most rehabilitative protocols and including head movements
      to improve vestibular adaptation, have proved to reduce the perceived overall impairment and
      postural sway in patients with recent unilateral vestibular disorders, even though the
      disorders are not associated with head movements. Comparison of our two study groups did not
      show any significant difference, revealing that both forms of therapy are effective.

      in 2013, a study evaluated the feasibility of integrating vestibular rehabilitation and
      cognitive behaviour therapy (VR-CBT) for people with persistent dizziness in primary care.
      This was a prospective single-group pre- and post-test study. Participants reported that the
      VR-CBT was relevant and led to an improvement in function.Dizziness Handicap Inventory (DHI)
      scores improved beyond a minimal important change in two out of five participants, and
      preferred gait velocity increased beyond a minimal important change in two out of three
      participants. The current tests and VR-CBT treatment protocols were feasible. Some changes
      are suggested to optimize the protocols, before conducting a randomized controlled trial.

      Up-till now a properly structured Circuit Training consisting of Vestibular Rehabilitation
      exercises, in which each exercise is designed such that it specifically focus on each and
      every symptom separately has not developed. So, in this research a Circuit Training
      consisting of Vestibular exercises, each exercise included is focusing on a specific goal
      separately
    

Intervention name(s): Experimental; Active Comparator
Intervention type(s): Other; Other
Intervention description(s): The Circuit Training will be consisting of:
Habituation Exercises
Exercises for the gaze stability (The two exercises are specifically for the patients who reported a high score on oscillopsia severity questionnaire
Exercises to improve Saccade Latency.
Adaptation Exercises
Substitution Exercises
Postural Control Exercises
General Conditioning Activities
Cawthorne-Cooksey Exercises
Ocular Motor Exercises
Gait Exercises
Treatment to Decrease Sensitivity to Motion in the Environment; Medicines as prescribed by the ear, nose, and throat (ENT) specialist and Home-based exercise Programme (Simple and general vestibular rehabilitation exercises) will be recommended to the patients to perform. ( Not under the supervision of neuro-therapist)
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Two groups
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Dizziness; Exercise; Vestibular; Vertigo