Did your incompetent stroke medical 'professionals' fail at creating protocols back in 2016? So, they were COMPLETELY INCOMPETENT BY DOING NOTHING?
Why hasn't the incompetent board of directors fired them all? I take no prisoners in trying to get stroke solved to 100% recovery, a ton of people need to be fired!
Send me hate mail on this: oc1dean@gmail.com. I'll print your complete statement with your name and my response in my blog. Or are you afraid to engage with my stroke-addled mind? Your patients need an explanation of why you aren't working on 100% recovery protocols.
Why isn't your 'professional' solving stroke?
Laziness? Incompetence? Or just don't care? NO leadership? NO strategy? Not my job? Not my Problem
Vestibular rehabilitation in patients with stroke: A comprehensive review of past and current evidence
- Open
Abstract
In 2016, the American Physical Therapy Association Neurology Section published clinical practice guidelines titled “Vestibular Rehabilitation (VR) for Peripheral Vestibular Hypofunction.” These guidelines recommend that physicians should provide VR to individuals with peripheral vestibular hypofunction, emphasizing its importance in managing dysfunctions of the vestibular system. Previous systematic reviews or studies on vestibular function have concluded that VR has positive effects on central vestibular disorders. More recently, a systematic review has found that there are positive effects of VR on ambulatory performance in stroke patients. Evidence is consistently being added regarding the positive impact of VR in patients with a history of stroke who are currently living with dizziness, balance, and gait impairments. However, there are still many unanswered questions in this area. Most studies lack complementary quantitative vestibular function testing and uniform standards for the timing and frequency of the VR. Furthermore, the methods of VR are carried out in a general fashion without catering to the individual, resulting in a lack of understanding of the mechanisms of various VR approaches. In future, much work needs to be done to solve these questions. The objective of this review is to investigate and validate the impact of VR on stroke patients while assessing the associated methodologies for determining its effectiveness. In particular, this review aims to offer a thorough evaluation of the advantages and drawbacks of employing VR in stroke rehabilitation.
Introduction
Vestibular rehabilitation (VR) focuses on promoting central compensation for the vestibular dysfunction dating back to 70 years ago. During the 1940s, Cawthorne and Cooksey discovered exercises that encourage eye and head movements to help the individuals with vestibular injuries.[1]
From this point on, the application of VR on individuals with vestibular pathologies has exponentially increased, and more refined and efficacious interventions are increasingly being adopted. Based on substantial evidence, in 2016, the American Physical Therapy Association Neurology Section clinical practice guidelines titled “VR for Peripheral Vestibular Hypofunction” suggested that VR should be provided to persons with peripheral vestibular impairments and dysfunction.[2] Vestibular hypofunction is a diverse disorder affecting the peripheral and, less commonly, the central vestibular system, resulting in symptoms such as dizziness and/or balance disturbances.[3,4] This is a significant milestone for VR and the first-ever clinical practice guideline developed specifically for VR.
The revised clinical practice guidelines of 2022 reinforced the original 2016 recommendations and further emphasized that VR provides indisputable and substantive benefits to individuals with peripheral vestibular hypofunction.[5] Previous studies have also suggested positive effects of VR on central vestibular disorders,[6–9] brain structure disorders[10] and dysfunctions,[11] and traumatic brain injury.[7,12] In acute vertigo patients, 11%–59.5%[13,14] of cases are related to stroke, and 12.5% of emergency room visits with vestibular dysfunction are attributed to cerebrovascular accidents.[15]
Given these findings, stroke patients can potentially experience significant improvements in both function and performance with VR. similarly to individuals with peripheral vestibular disease who undergo VR treatment. Therefore, VR holds significant promise as a simple and effective rehabilitation method for improving neural function following ischemic stroke. The aim of the review is to consolidate evidence and investigate the effects and corresponding methods of VR in patients with stroke, highlighting the need for a more comprehensive approach to patient care.
Vestibular Rehabilitation in Stroke
Stroke is a primary cause of neurologic disability, resulting in both cognitive and motor function impairments.[16] In an effort to broaden treatment eligibility and ensure more patients receive timely and safe treatment, various trials have been conducted.[17–19] Recent reviews suggest that new methods, such as those promoting neuroprotection, can effectively decrease brain damage after a stroke, as well as stimulate neuroplasticity, angiogenesis, and neurogenesis,[20] However, further investigation is needed to better understand the various inflammatory factors involved during and after a stroke. The creation of simple and effective rehabilitation techniques to restore neural function postischemic stroke is of utmost urgency.[21]
VR is not frequently included in the American Heart Association/American Stroke Association’s stroke rehabilitation guidelines[22] and the Canadian Best Practice Working Group.[23] During clinical practice, physical therapists mainly concentrate on improving motor dysfunction in patients with stroke; yet, eye movement disorders are found in almost three-fourths of stroke survivors and must be considered within the context of poststroke recovery.[24] Patients exhibiting gaze-evoked nystagmus in all directions, resulting from cerebellar dysfunction or isolated horizontal saccade impairment due to pontine lesions affecting the paramedian pontine reticular formation, may require focused intervention.[25] Strokes in the anterior inferior cerebellar artery territory, encompassing all lesions impacting the vestibular root entry, fasciculus, or nucleus, could potentially be linked to horizontal vestibulo-ocular reflex (VOR) abnormalities.[26]
The VOR is crucial for sustaining visual stability when the head rotates quickly by inducing an opposite rotation of the eyes. Injuries to the VOR can result in retinal image slip in response to quick head movements, consequently impacting visual perception.[27] The vestibular system plays an essential role in preserving balance and spatial orientation in our everyday life.[28] Patients with vestibular dysfunction may experience falls that can be attributed to impaired postural control, ultimately setting back their stroke recovery by several months. Thus, addressing VOR early on can potentially shorten the rehabilitation process and improve patients’ outcomes.
A comprehensive analysis conducted recently revealed positive outcomes of VR intervention on gait performance in individuals with stroke.[29] However, no comprehensive analysis or meta-analyses have evaluated the comprehensive effect and method of VR in stroke patients with varying symptoms, such as vertigo, hemiparesis, disequilibrium, impaired smooth pursuit of eye movements, and VOR cancellation. VR may prove to be the most efficient method when tailored to each patient’s specific deficits, devoid of any complex exercise tools, or a spacious rehabilitation room.[30]
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