Vestibular Balance Therapy for Vestibular Disorders

(VBT-C Trial)

Overseen By Jill Meredith

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: University of Alabama at Birmingham

Disqualifiers: Neurologic conditions, Illiteracy, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 9

Duration: 8 weeks

15 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It might be best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of Vestibular Balance Therapy for Vestibular Disorders?

Research shows that vestibular physical therapy, which is similar to Vestibular Balance Therapy, can help reduce symptoms like dizziness and imbalance in people with vestibular disorders. It also emphasizes the importance of fall prevention and improving quality of life. ^{1 2 3 4 5}

How is Vestibular Balance Therapy different from other treatments for vestibular disorders?

Vestibular Balance Therapy is unique because it focuses on specialized exercises to improve balance and reduce dizziness by retraining the brain to compensate for inner ear deficits, unlike other treatments that may rely more on medication or surgery. This therapy emphasizes exercises that target both the vestibulo-ocular (eye movement) and vestibulospinal (balance and posture) pathways, making it a comprehensive approach to managing vestibular disorders. ^{1 6 7 8 9}

What is the purpose of this trial?

This trial tests a home-based balance therapy for children with hearing loss and balance issues. The program involves specific exercises done at home with regular therapist check-ins. It aims to see if the therapy is practical and beneficial for improving balance and coordination.

Research Team

Jennifer B Christy, PhD

Principal Investigator

University of Alabama at Birmingham

Eligibility Criteria

This trial is for children aged 6-12 with severe to profound sensorineural hearing loss (SNHL) who can commit, along with their caregiver, to an 8-week home-based vestibular balance therapy program. They must have had a vision test within the last year or be willing to undergo one. Children with other neurological conditions, poor reading or picture identification skills, current vestibular therapy, or uncorrected vision issues are not eligible.

Inclusion Criteria

I have been diagnosed with severe to profound hearing loss.

I am between 6 and 12 years old.

My child and I agree to follow through with the balance therapy at home.

Exclusion Criteria

You have vision problems that can't be fixed and are not related to balance issues.

I am currently undergoing therapy for balance issues.

I have a neurological condition that is not sensorineural hearing loss.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Baseline Testing

Participants undergo a comprehensive battery of vestibular function and balance tests

1 week

1 visit (in-person)

Treatment

Participants engage in an 8-week home-based vestibular balance therapy program with weekly in-person checks

8 weeks

8 visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

Treatment Details

Interventions

• Sham Intervention
• Vestibular Balance Therapy

Trial Overview The study tests a home-based vestibular balance therapy designed for children with vestibular hypofunction. Over eight weeks, participants will perform exercises five times per week and have weekly check-ins with a physical therapist. The aim is to assess the feasibility of this program and its preliminary impact on function before planning a larger trial.

Participant Groups

Group I: VBP Intervention Group Experimental Treatment 1 Intervention

Children coded as abnormal on functional tests (FT) (n=12) will participate in an 8-week 5X/week home-based VBT program. At the initial visit (T0), the PI will instruct the participants (caregiver and child) in the program and provide all materials. The exercises will be led by the caregiver, with weekly in person checks by the PI to progress and provide coaching. The child/caregiver will complete a daily log to report activities and level of enjoyment. VBT will be done 5 days/week and will include 4 key categories of exercises, each lasting 5 minutes (20 minutes total of exercise per day). The 4 categories, explained below, include: 1) Times 1 (X1) Viewing, 2) Gaze Shifting, 3) Static Balance, 4) Dynamic Balance. The proposed VBT home program will include 10 minutes of gaze stabilization exercises, and 10 minutes of balance training.

Group II: Sham Intervention Placebo Group 1 Intervention

Sham Intervention (not to be compared to intervention - for feasibility only): Aim 1 is to establish the feasibility of a control intervention to be used in future studies. Therefore, 3 participants who score above the set criterion for the Functional Tests (FT) (i.e., they do not need VBT) will participate in an 8-week sham intervention. At T0, the PI will instruct the participants to do the sham intervention, led by the caregiver with weekly checks to control for attention bias. The sham intervention will be done for 20 minutes per day and will consist of 10 minutes of focused reading a book of the child's choice and 10 minutes of active play. The child and caregiver will complete a daily activity log documenting the activity and level of enjoyment.

Who Is Running the Clinical Trial?

University of Alabama at Birmingham

Lead Sponsor

Trials

1,677

Recruited

2,458,000+

Foundation for Physical Therapy Research

Collaborator

Trials

4

Recruited

1,600+

Foundation for Physical Therapy Research

Collaborator

Trials

3

Recruited

1,500+

Findings from Research

Vestibular physical therapy (VPT) is an evidence-based treatment aimed at reducing symptoms like vertigo, dizziness, and imbalance, which can significantly improve patients' quality of life.

The therapy emphasizes patient safety and includes fall risk assessments to prevent falls, making it a comprehensive approach to managing vestibular disorders.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Vestibular Physical Therapy and Fall Risk Assessment. Carender, WJ., Grzesiak, M., Telian, SA.[2021]

Vestibular rehabilitation therapy (VRT) significantly improves balance in stroke patients, with a standardized mean difference (SMD) of 0.59, particularly effective for those who had a stroke within the last 6 months (SMD of 0.56).

VRT also enhances gait function, showing a significant improvement in the Timed Up-and-Go test with a mean difference of -4.32 seconds, especially for patients who experienced a stroke within 6 months, indicating moderate certainty of its efficacy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Vestibular rehabilitation therapy on balance and gait in patients after stroke: a systematic review and meta-analysis. Meng, L., Liang, Q., Yuan, J., et al.[2023]

The study established the minimal clinically important difference (MCID) for the Activities-specific Balance Confidence Scale (ABC), Functional Gait Assessment (FGA), and Gait Speed (GS) in individuals with vestibular disorders, with values of 18.1%, 4 points, and 0.09 m/s respectively, based on a sample of 222 to 237 subjects.

These MCID values, derived using an anchor-based approach with the Dizziness Handicap Inventory (DHI) as a reference, provide important benchmarks for assessing meaningful improvements in gait and balance following vestibular rehabilitation therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Estimating the minimal clinically important difference for balance and gait outcome measures in individuals with vestibular disorders. Wellons, RD., Duhe, SE., MacDowell, SG., et al.[2022]

Supervised vestibular rehabilitation treatment programs generally show better outcomes in improving emotional status, dizziness, and balance in individuals with unilateral vestibular disorders, based on a systematic review of six randomized control trials.

However, the review did not find strong evidence that supervised programs are significantly superior to unsupervised or home-based training, highlighting limitations in the self-reported measures used in the studies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Effect of Supervision in Vestibular Rehabilitation in Patients with Acute or Chronic Unilateral Vestibular Dysfunction: A Systematic Review. Lilios, A., Chimona, T., Nikitas, C., et al.[2023]

Vestibular physical therapy significantly improved balance and functional outcomes in 48 patients with central vestibular dysfunction, as shown by various assessment measures after an average of 5 therapy visits over 5 months.

Patients with severe disability at baseline experienced greater improvements, although those with cerebellar dysfunction showed the least progress, indicating that the type of vestibular dysfunction may influence therapy effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Physical therapy for central vestibular dysfunction. Brown, KE., Whitney, SL., Marchetti, GF., et al.[2007]

Vestibular physical therapy is effective in managing symptoms of vestibular dysfunction, such as dizziness and imbalance, particularly for individuals with peripheral vestibular disorders, as supported by various studies including controlled trials.

Emerging evidence also suggests that vestibular rehabilitation may benefit individuals with central vestibular disorders, indicating its potential broader application in treating different types of vestibular dysfunction.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An update on vestibular physical therapy. Alghadir, AH., Iqbal, ZA., Whitney, SL.[2022]

Combining vasoactive medical treatment with optokinetic and statokinetic training significantly improves the condition of patients with balance disorders, as measured by the modified Dizziness Handicap Inventory questionnaire.

The psychiatric status of patients plays a crucial role in the effectiveness of the rehabilitation program, indicating that mental health may influence treatment outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Experiences with complex vestibular rehabilitation. Szirmai, A.[2015]

In a study of 69 patients with chronic unilateral vestibular hypofunction, vestibular rehabilitation therapy combined with Wii® therapy significantly reduced dizziness handicap, as shown by a decrease in the Dizziness Handicap Inventory score from a median of 40 to 24 (P<.0001).

The therapy also improved balance and visual stability, with the Dynamic Gait Index score increasing from a median of 21 to 23 and dynamic visual acuity improving from a median of 2 to 1, both with statistical significance (P<.0001).

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Outcomes after vestibular rehabilitation and Wii® therapy in patients with chronic unilateral vestibular hypofunction. Verdecchia, DH., Mendoza, M., Sanguineti, F., et al.[2022]

Vestibular Rehabilitation Therapy (VRT) is an effective treatment for many patients with vestibular disorders and balance dysfunctions, helping to improve their symptoms.

The paper outlines various assessment methods and treatment strategies for VRT, emphasizing its importance in managing balance-related issues in patients seeking help from otolaryngologists.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Vestibular rehabilitation therapy for the patient with dizziness and balance disorders. Girardi, M., Konrad, HR.[2005]

References

1. United States pubmed.ncbi.nlm.nih.gov

Vestibular Physical Therapy and Fall Risk Assessment. [2021]

2. England pubmed.ncbi.nlm.nih.gov

Vestibular rehabilitation therapy on balance and gait in patients after stroke: a systematic review and meta-analysis. [2023]

3. Netherlands pubmed.ncbi.nlm.nih.gov

Estimating the minimal clinically important difference for balance and gait outcome measures in individuals with vestibular disorders. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

The Effect of Supervision in Vestibular Rehabilitation in Patients with Acute or Chronic Unilateral Vestibular Dysfunction: A Systematic Review. [2023]

5. United States pubmed.ncbi.nlm.nih.gov

Physical therapy for central vestibular dysfunction. [2007]

6. Netherlands pubmed.ncbi.nlm.nih.gov

An update on vestibular physical therapy. [2022]

7. United States pubmed.ncbi.nlm.nih.gov

Experiences with complex vestibular rehabilitation. [2015]

8. Spain pubmed.ncbi.nlm.nih.gov

Outcomes after vestibular rehabilitation and Wii® therapy in patients with chronic unilateral vestibular hypofunction. [2022]

9. United States pubmed.ncbi.nlm.nih.gov

Vestibular rehabilitation therapy for the patient with dizziness and balance disorders. [2005]