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Dizziness affects about 15% to over 20% of adults yearly in large population-based studies and vestibular vertigo accounts for about a quarter of dizziness complaints (Neuhauser, 2016). Also, aging substantially affects the vestibular sensory system, and vestibular impairment is highly prevalent in older adults, with nearly 50% of individuals over age 60 demonstrating some form of vestibular physiologic loss (Agrawal et al., 2019). Indeed, dizziness and imbalance are among the most common symptoms in community-dwelling older adults with consequences in gait, falls and difficulties in daily living, with a negative impact on the quality of life (Agrawal et al., 2019). Additionally, a population-based study concluded that patients visiting the emergency department for acute peripheral vertigo were at a higher risk of a new injury for up to a year (Kim et al., 2020). The handicap created by dizziness has been associated with substantial social costs (Agrawal et al., 2018).
The vestibular system is integral to balance control, locomotion, and spatial navigation. It consists of sensory organs, cortical, and subcortical structures. The vestibular apparatus of the inner ear is the primary input for the vestibular system. Loss of vestibular function is a debilitating condition that causes vertigo, nausea, spontaneous nystagmus, oscillopsia, disequilibrium, and gait/postural instability. One of the reasons for this is the affection of the angular vestibulo-ocular reflex (VOR) when eye velocity does not match exactly head velocity in the opposite direction and equal magnitude (Michel & Alain, 2020). This will impact the performance of daily activities like driving, walking, and working, with negative changes in quality of life, leading to anxiety, depression, and sometimes triggering chronic conditions like persistent-postural-perceptual dizziness (3PD). Improvement of these signs and symptoms requires movement-induced error signals for recovery to occur (Hall et al., 2021).
Vestibular rehabilitation is a complex phenomenon associated with deep brain neuroplastic changes involving processes of adaptation, habituation, and substitution. The goal is to control dizziness and improve static and dynamic balance stability and visuo-vestibular interactions in circumstances that provoke a mismatch in sensory information processing (Bergeron et al., 2015). It is a safe and effective intervention for peripheral unilateral (UVH) and bilateral vestibular hypofunction (BVH) (Hall et al., 2020; McDonell & Hillier, 2015; Porciuncula et al., 2012; Sulway, 2019).