Postural disorders in patients with dizziness: From postural analysis to vestibular rehabilitation programs

Abstract

Postural control is regulated by a feedback and feedforward mechanism in which the central nervous system integrates several afferent information and constantly modulates the tone of the tonic postural system through efferent inputs. However, in pathological conditions, this mechanism is altered due to the non-physiological afferent inputs coming from the aberrant sensory organ. In particular, because of the vestibular system provides information regards sense of position and perception of movement of the head in the space, it represents a fundamental postural receptor in order to maintain static and dynamic body balance. Therefore, in vestibular disorders such as in patients suffering from dizziness, body balance and postural stability result altered or compromised. Although the vestibular system is able to adapt its properties during vestibular compensation, previous researches suggest that this physiological adaptation strategy does not allow for maximum system capacity. For this reason, rehabilitation programs that comprise visuo-vestibular exercises are recommended to improve the vestibulo-ocular reflex (VOR) maximising the vestibular compensation/adaptation in these patients. An instrumental postural analysis, i.e. a posturography evaluation including a static and a dynamic test, should be carried out before and after the vestibular rehabilitation program in order to measure the initial body balance ability (before) and any improvement (after) in static and dynamic body balance determined by the exercises. The aim of this chapter is to present the management of postural disorders in vestibular dysfunctions (in particular in patients with dizziness) from the postural evaluation to the many different protocols of vestibular rehabilitation proposed over the years in the scientific literature.