Title : The effect of a home-based central vestibular programme on nystagmus, smooth-pursuit, balance and gait following stroke
Abstract:
Dizziness and falls represent significant complications in stroke rehabilitation, affecting up to 70% of survivors. Falling, consequently, is one of the drivers for increased morbidity post-stroke and survivors have recorded high rates of fractures, as a result of falling. In contrast, high risk of falls has been attributed to balance deficits and are rarely associated with vestibular systems disorders. Vestibular Rehabilitation Therapy (VRT) has been discovered to enhance central compensation and functional outcomes. However, its implementation in resource-limited settings in South Africa and globally remains poorly understood.
Objectives: The objectives of the study were to evaluate the effectiveness of a structured home-based central VRT programme for addressing nystagmus, smooth-pursuit deficits, balance impairments, and gait problems in stroke survivors.
Method: The study was a randomised controlled trial in which 31 stroke survivors with central vestibular dysfunction were allocated to experimental or control groups. Both groups received a six-week stroke rehabilitation programme; the experimental group additionally completed a structured home-based central VRT programme. Outcomes were assessed at baseline, immediately post-intervention, and six weeks post-intervention.
Results: The results of Stage demonstrated that the experimental group achieved greater reductions in nystagmus and superior improvements in smooth pursuit (27% to 67% normal versus 31% to 46%), balance performance, and Dynamic Gait Index scores (13.5±3.3 to 15.8±4.6 versus 12.1±4.9 to 12.3±4.8; p=0.043).
Conclusion: The study concluded that a six-week home-based central VRT programme effectively alleviates vestibular dysfunction symptoms in stroke survivors. Sustained benefits post intervention suggests adequate consolidation of vestibular compensation.
Significance: Capacity building among physiotherapists is essential for consistent implementation of evidence-based vestibular rehabilitation in resource-limited settings.
Keywords: vestibular rehabilitation, stroke, nystagmus, smooth pursuit, balance, gait, home-Based programme, physiotherapy.
