title: Examination and treatment of patients with unilateral vestibular damage, with focus on the musculoskeletal system: a case series.
abstract: OBJECTIVE
  Persistent dizziness and balance problems have been reported in some patients with unilateral vestibular pathology. The purpose of this case series was to address the examination and treatment of musculoskeletal dysfunction in patients with unilateral vestibular hypofunction.
  
  
  METHODS
  The musculoskeletal system was evaluated with the Global Physiotherapy Examination, dynamic balance was measured during walking with triaxial accelerometers positioned on the lower and upper trunk, and symptoms and functional limitations were assessed with standardized self-report measures. The 4 included patients had symptoms of severe dizziness that had lasted more than 1 year after the onset of vestibular dysfunction and a moderate level of perceived disability. Musculoskeletal abnormalities typically included postural misalignment, restricted abdominal respiration, restricted trunk movements, and tense muscles of the upper trunk and neck. The patients attended a modified vestibular rehabilitation program consisting of body awareness exercises addressing posture, movements, and respiration.
  
  
  RESULTS
  After the intervention, self-reported symptoms and perceived disability improved. Improvements in mobility and positive physical changes were found in the upper trunk and respiratory movements. The attenuation of mediolateral accelerations (ie, body oscillations) in the upper trunk changed; a relatively more stable upper trunk and a concomitantly more flexible lower trunk were identified during walking in 3 patients.
  
  
  CONCLUSIONS
  The recovery process may be influenced by self-inflicted rigid body movements and behavior strategies that prevent compensation. Addressing physical dysfunction and enhancing body awareness directly and dizziness indirectly may help patients with unilateral vestibular hypofunction break a self-sustaining cycle of dizziness and musculoskeletal problems. Considering the body as a functional unit and including both musculoskeletal and vestibular systems in examination and treatment may be important.
authors.affiliation: K. Wilhelmsen, PT, PhD, Department of Occupational Therapy, Physiotherapy, and Radiography, Faculty of Health and Social Sciences, Bergen University College, Møllendalsveien 6, Bergen, Norway 5009, and National Centre for Vestibular Disorders, Department of Otorhinolaryngology/Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway. kwi@hib.no.
authors.forename: Kjersti
authors.initials: K
authors.lastname: Wilhelmsen
authors.affiliation: A. Kvåle, PT, PhD, Physiotherapy Research Group, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
authors.forename: Alice
authors.initials: A
authors.lastname: Kvåle
mesh_terms: D000328:Adult; D000368:Aged; D001364:Awareness / Q000502:physiology*; D004244:Dizziness / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D010808:Physical Examination; D026741:Physical Therapy Modalities; D004856:Postural Balance; D015837:Vestibular Diseases / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation*; D016138:Walking / Q000502:physiology*