Vestibular Clinical Guidance Tool

Clinical Guidance Tool

Diagnosis & Treatment of Peripheral Vestibular Hypofunction

1 History

2 Exam

3 Summary

Step 1: Patient History & Subjective Report

Primary Symptoms (Select all that apply)

Dizziness/Fogginess

Vertigo (Spinning)

Oscillopsia (Bouncing Vision)

Imbalance/Unsteadiness

Symptom Onset

Sudden

Gradual

Post-Trauma/Whiplash

Key Triggers & Patient Notes

Step 2: Clinical Examination Findings

Head Impulse Test (HIT)

Positional Testing (Dix-Hallpike)

Spontaneous Nystagmus (at rest)

Balance Assessment

Step 3: Clinical Summary & Treatment Plan

Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: A Guideline Summary

This 2022 clinical practice guideline from the Academy of Neurologic Physical Therapy provides updated, evidence-based recommendations for vestibular rehabilitation for individuals with peripheral vestibular hypofunction.

The guideline emphasizes that vestibular physical therapy (VPT) is strongly recommended for adults with acute, subacute, and chronic unilateral and bilateral vestibular hypofunction. The goal of VPT is to improve symptoms, gaze stability, and overall function.

Key Recommendations

A central recommendation is that vestibular rehabilitation should be supervised by a clinician.
The guideline strongly advises against using isolated saccadic or smooth-pursuit eye movements (without head movement) for gaze stability training.
Targeted exercises, including virtual reality and augmented sensory feedback, may be used to address specific patient needs.

Exercise Dosage Recommendations

The guideline provides specific recommendations for the duration and frequency of exercises, which are summarized in the tables below.

Gaze Stabilization Exercises

Condition	Frequency	Total Daily Duration	Total Treatment Time
Acute/Subacute Unilateral Vestibular Hypofunction	3 times per day	At least 12 minutes	Not specified
Chronic Unilateral Vestibular Hypofunction	3 to 5 times per day	At least 20 minutes	4 to 6 weeks
Bilateral Vestibular Hypofunction	3 to 5 times per day	20 to 40 minutes	~5 to 7 weeks

Source: Hall et al., 2022

Static and Dynamic Balance Exercises

Condition	Total Daily Duration	Total Treatment Time
Chronic Unilateral Vestibular Hypofunction	At least 20 minutes	4 to 6 weeks
Bilateral Vestibular Hypofunction	Not specified	6 to 9 weeks

Source: Hall et al., 2022

Factors Influencing Outcomes

Several factors can modify the outcomes of vestibular rehabilitation.

Age: While increased age doesn't negatively impact the potential for improvement, recovery may be slower in older adults.
Comorbidities: Conditions such as anxiety, depression, and cognitive impairment may affect outcomes.
Early Intervention: New evidence supports starting therapy early, particularly within the first two weeks of acute symptoms.

Stopping Therapy

Therapy may be discontinued when a patient meets certain criteria, such as:

Achievement of primary goals
Resolution of symptoms
Normalized balance and vestibular function
Progress has plateaued

These guidelines help clinicians optimize care and improve the quality of life for individuals with peripheral vestibular hypofunction.