Habituation Exercises Versus Proprioceptive Training in Benign Paroxysmal Positional Vertigo

Study Overview
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Brief Summary
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The aim of this research is to compare the effects of habituation exercises versus proprioceptive training on vertigo, balance, dizziness and quality of life in the individuals having benign paroxysmal positional vertigo. A randomized controlled trial that will include total 39 participants .The first group will receive habituation exercises for six weeks, three times per week for thirty minutes, along with conventional vestibular rehabilitation therapy. The second group will receive proprioceptive training for six weeks, three times per week for 30 minutes, along with vestibular rehabilitation therapy. The third group will only receive vestibular rehabilitation therapy. Data collected will be analyzed through SPSS 25.

Detailed Description
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Benign paroxysmal positional vertigo is the most common presentation of peripheral vestibular disorder characterized by features like vertigo, nausea, vomiting, imbalance and increased risk of fall . Among all vestibular disorders, BPPV accounts for almost 20% and mostly affects the female gender as compared to the male gender. This type of disorder mainly involves the remoteness of otoliths in the semi-circular canal; most commonly the posterior canal is involved. A comparative study on posterior canal BPPV including modified Epley procedure alone and Epley procedure combined with vestibular rehabilitation. This cross sectional study illustrated that the results of Epley maneuver only were as same as effectual as with VRT(vestibular Rehabilitation therapy) by reducing the symptoms of residual unsteadiness in that particular population. Among all vertiginous disorders BPPV is most common. Vestibular rehabilitation was conducted as therapeutic option and its effects on balance and quality of life were being assessed. Dizziness Handicap Inventory was being used as outcome measure scale. The difference in signs of dizziness and quality of life in benign paroxysmal positional vertigo were investigated. Three groups were taken including one with BPPV, the second one with balance deficits (non-BPPV) and the last group involved healthy participants. The study concluded that the patients with BPPV had reduced HRQOL (health related Quality of life), tiredness and increased risk of fall. Dizziness associated with bed mobility is an indicator for the need of diagnoses and treatment thus, repositioning maneuvers had good impact on reducing the severity. The effects of conventional vestibular rehabilitation recurrence rates on benign paroxysmal positional vertigo aimed to find the impacts on otolith dysfunction. Although repositioning movements were proved fruitful yet the recurrence rates were high in older population as compared to young. Vestibular therapy including habituation exercises decreases the risks of recurrence in benign paroxysmal positional vertigo. As balance impairments are common in individuals with vertigo and dizziness. Proprioceptive training was proved more efficient than vestibular therapy in reducing the chances of fall in elder population. BBS (berg balance scale) and TUG (Time up and Go test) were conducted to assess balance and risk of fall in older people. Systematic review of the previous literature on the efficacy of vestibular rehabilitation therapy in benign paroxysmal positional vertigo.12 studies were based on inclusion criteria and the effectiveness of vestibular rehabilitation only and in combination with repositioning maneuver and also in comparison with it. Habituation exercises were included in VR therapeutic intervention, Conclusion were in favor of vestibular therapy as it showed reduction in discomfort caused by the condition. Efficacy of vestibular therapy protocol to determine its effects on quality of life and postural balance. Randomized controlled trial was performed on 20 individuals. Outcome measure scales like DHI (dizziness handicap inventory), VAS (vertigo visual analogue scale) were used and it was observed that with vestibular rehabilitation there were consequences like better quality of life and reduced signs of vertigo and dizziness were achieved. According to previous study there was a lack of control group in previous evidence whereas this study will focus on control as well as interventional groups. In previous literature, both of these therapeutic options i.e., habituation exercises and proprioceptive training were used in combination but in this study the comparison will be done between two exercise protocols. Consequences will be manipulated for balance, vertigo, dizziness and quality of life.

Official Title
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Effects of Habituation Exercises Versus Proprioceptive Training on Dizziness, Vertigo, Balance and Quality of Life in Benign Paroxysmal Positional Vertigo

Conditions
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Benign Paroxysmal Positional Vertigo

Intervention / Treatment
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* Other: Habituation exercises + vestibular treatment
* Other: proprioceptive training + vestibular therapy
* Other: conventional vestibular treatment


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Chronic vestibular disorder Diagnosed BPPV patients Normal vision Score of > 1 on VAS for vertigo Score of > 50 on DHI questionnaire Ability to follow the command Exclusion Criteria: CNS involvement Orthopedic problem Unable to answer a simple verbal command Head injury or brain trauma Not medically diagnosed with any vestibular disorder

Ages Eligible for Study
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Minimum Age: 30 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: habituation exercises<br>head and eye movements first slowly then rapidly, head and body movements e.g., picking object from the ground standing and rotation in standing | Other: Habituation exercises + vestibular treatment<br>* Exercises will include Intensity: 10 repetitions of each set Frequency= 3 sessions per week for 6 weeks. Time= 30 minutes<br>|
| Experimental: proprioceptive training<br>Single leg stance (right side) + Single leg stance (left side) Lifting of right knee as high as comfortable and then alternative knee Tandem walking ,Toe walking ,Heel walking | Other: proprioceptive training + vestibular therapy<br>* Exercise protocol will include Time= total session of 30 minutes . Each exercise will be hold for 30 seconds . Frequency= 3 session per week for 6 weeks Intensity= 10 repetitions and 3 sets<br>|
| Active Comparator: Conventional vestibular therapy<br>Epley's Manuever | Other: conventional vestibular treatment<br>* Epley's Manuever. Frequency= It will be performed once in a week . Time= 10-15 minutes per session<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Berg balance scale | Consists of 14 tasks and total score of 56.score of 0-20 indicates severe fall risk, 20-45 includes moderate risk of fall and 45-60 illustrates thr functional balances state. | 6th week | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| dynamic gait index | Assess the likelihood of falling in older adults.total score is of 24.score less than 19 is predictive of fall risks. | 6th week | 
| Dizziness handicap inventory | Measure of patients perception of dizziness.subscales included are functional, physical and emotional. | 6th week | 
| visual vertigo analogue scale | This scale rates the intensity of visual vertigo in nine challenging situations of visual motions and categorized as having no (0), Mild (0.1-40), moderate (40.01-70) or severe (70.01-100) symptoms. | 6th week | 
| Activities specific balance confidence scale | Assess the older individuals balance confidence in performing daily life activities. This scale comprises of a wide continuum of less and more challenging activities. | 6th week | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Habituation exercises, Proprioceptive training, Vertigo, Dizziness, Balance, benign paroxysmal positional vertigo