What is included in an exercise-based approach to rehabilitation of vertebrobasilar stroke?

Updated: Aug 09, 2021
  • Author: Vladimir Kaye, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
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An exercise-based approach has been successful in the treatment of vestibular disorders, due to several possible mechanisms. These include adaptation, substitution, habituation, and repositioning.

With adaptation by the central vestibular system, the brain modulates the gain of the vestibular response, attempting to correct for a retinal slip (error signal) caused by the decreased gain of the VOR. The VOR training strategy includes focusing on a stationary or moving target while rotating the head, resulting in a retinal slip that facilitates adaptation.

Substitution for the loss of function by the remaining intact visual and somatosensory systems is used in treating patients with bilateral vestibular lesions (complete or partial loss of both labyrinths).

Habituation for postural vertigo results in decreased response to repeated provoking stimuli. Patients move into the provoking position 2-3 times during each session, and repeat these sessions 3-5 times per day.

Repositioning maneuvers (eg, Epley maneuver) are used for positional vertigo, based on the mechanical displacement of the debris from the affected canal(s) by a series of head movements. Alternating eye patches or prisms can help diplopia.

General conditioning also is incorporated into the overall rehabilitation plan, encouraging an increase in the performance of ADL as tolerated.

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