Simplified Vestibular Rehabilitation Therapy

By Byung In Han

This book describes a streamlined version of vestibular rehabilitation therapy (VRT), an exercise-based approach that is of proven value in the treatment of vertigo and dizziness. This simplified form of VRT is intended for use in primary healthcare facilities. As Dr. Han had practiced martial art and ballet, he could pick out necessary movements from those art forms. The selected movements were used to make the VRT exercises. The opening part describes the indications for and the principles of VRT and provides general information on key exercises. The role of VRT in patients with central dizziness is then discussed. The remainder of the book offers clear, precise guidance on the exercises used in simplified VRT, covering general exercises, gaze stability exercises, postural stability exercises, and habituation exercises. The text is supported by numerous photographs that will help both clinicians and patients to implement the exercises correctly and effectively.

• Language: English
• Publisher: Springer
• Release date: Mar 25, 2021
• ISBN: 9789811598692

Book preview

Byung In Han

Simplified Vestibular Rehabilitation Therapy

1st ed. 2021

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Byung In Han

Do Neurology Clinic, Daegu, South Korea

ISBN 978-981-15-9868-5e-ISBN 978-981-15-9869-2

https://doi.org/10.1007/978-981-15-9869-2

© Springer Nature Singapore Pte Ltd. 2017, 2021

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Foreword

I am delighted that Dr. Han publishes Vestibular Rehabilitation Therapy. Vestibular rehabilitation programs capitalize on the innate plasticity of the balance system to advance the natural compensation process and to hasten recovery. Vestibular rehabilitation therapy should be the mainstay in managing all forms of central as well as peripheral vestibular disorders.

Dr. Han is a unique figure. After residency training in neurology, he had worked at a private neuro-otology clinic for several years before he opened his own clinic. Besides a neuro-otologist, he is an artist mostly interested in drawing portraits with charcoal pencils. He also had been trained for Hapkido, a Korean martial art, and ballet. This book is the result of all these experiences. Fortunately, I had an opportunity to write papers on benign paroxysmal vertigo and several books with him. He has got many talents and is really enthusiastic in every aspect both clinically and academically.

This book contains the key information for vestibular rehabilitation therapy in a simplified way using illustrations drawn by the author himself and photographs taken by a professional photographer. This book is based on his personal experience as a clinician running a private clinic, and would be especially useful for the care of ambulatory patients in the primary healthcare facilities.

Ji-Soo Kim

Preface

I became interested in vestibular rehabilitation therapy (VRT) during the time I was working as the vice-president of the Oh Neurology Clinic between 2005 and 2007. Since then I have written two review articles on VRT [1, 2] but could not afford to have VRT room.

Since 2008, I came to run my own primary clinic, Do Neurology Clinic, and realized that it was a challenge for me to deliver the therapeutic results that my patients with dizziness deserve. Like many of us who operate a primary clinic, I do not have a specialized therapist, equipment, and/or space for exercise therapy. So, I designed and developed my own exercise program, simplified VRT (sVRT). sVRT is a streamlined version of VRT, intended for use in primary healthcare facilities for ambulatory patients. sVRT is a product of a comprehensive review of domestic and foreign literature merged with my own experiences in Hapkido, a Korean martial art, and ballet.

The exercises for sVRT include a variety of movements. Those movements performed by me and professional dancer were recorded in footage in a way that is easy for the patients to follow along. The recorded footages were edited with titles, music, and narration. The final footages were displayed on a monitor and the patients follow on. sVRT requires readily accessible resources: a display monitor, one instructor, and a chair.

I have applied sVRT to my patients with dizziness and realized that sVRT was safe and effective. Also, sVRT has received positive reviews from the 29th Bárány Society Meeting 2016 in Seoul, Korea [3], where I introduced sVRT to the audiences. These optimistic outputs lead me to decide to publish this book.

I am grateful to Kyungtae Kang and Hye Jung Lee, students of Kyungpook National University, School of Medicine, for the editing; Hyun Ah Kim for the choreographic photo model; Eun Hye Shin, Hyun-jin Goo, Hye-min Jung, and Myeong-ji Lim for the photo model; and last but not the least, Je Yeon Ahn for the photos. I sincerely wish for this book to benefit both the patients and the therapists practicing sVRT. Furthermore, I hope my work will lay the groundwork for clinicians developing more intuitive and effective therapeutic exercises.

November 5, 2019, Byung In Han, MD, PhD, President. Do Neurology Clinic.

References

1.

Han BI, Ko PW, Lee HW, Kim HA, Lee H. Vestibular rehabilitation in central dizziness. Res Vestib Sci. 2015 Dec;14(4):97–100.

2.

Han BI, Kim JS, Song HS. Vestibular rehabilitation therapy: review. J Clin Neurol. 2011 December;7(4):184–96.

3.

Han BI, Simplified vestibular rehabilitation therapy. 29th International Barany Society Meeting. Seoul 2016 June.

Byung In Han

Daegu, South Korea

Contents

1 Vestibular Rehabilitation Therapy:​ Review of Indications, Mechanisms, and Key Exercises 1

1.​1 Introduction 1

1.​2 Indications 1

1.​3 Natural Course of Peripheral Vestibular Lesions 2

1.​4 Principles of VRT 3

1.​4.​1 Enhancing Gaze Stability 3

1.​4.​2 Enhancing Postural Stability 5

1.​4.​3 Decreasing Vertigo 9

1.​4.​4 Improving Activities of Daily Living 11

1.​5 Factors Affecting Recovery 11

1.​6 Practicing Exercise 12

1.​6.​1 Principles of the Exercises 12

1.​6.​2 Components of the Exercises 12

1.​6.​3 Exercise Modification 12

1.​6.​4 Exercise Frequency and Duration 13

1.​6.​5 How to Progress 13

1.​6.​6 Special Situations 14

1.​7 Summary 14

References 14

2 Vestibular Rehabilitation in Central Dizziness 17

2.​1 Introduction 17

2.​2 Usefulness of VRT for Selected Central Dizziness 18

2.​3 Cerebellar Degeneration 18

2.​4 Parkinson Disease (PD) 19

2.​5 Conclusion 19

References 20

3 Implementing the Exercises 21

3.​1 Assessments for VRT 21

3.​2 Exercises for VRT 22

sVRT Exercises and YouTube Link 23

3.​2.​1 Gaze Stability Exercises 27

3.​2.​2 Postural Stability Exercises 38

3.​2.​3 Habituation Exercises 68

3.​3 General Exercises 80

3.​3.​1 Warming-Up Exercises 80

3.​3.​2 Cooling-Down Exercises 84

3.​3.​3 Shoulder Stretch 86

3.​3.​4 Upper Cross Syndrome Exercises 92

3.​3.​5 Leg Stretches Using a Chair 93

3.​3.​6 Leg Stretching 99

3.​3.​7 Leg Strengthening Exercises Using a Chair 103

3.​3.​8 Leg Strengthening Exercises 108

3.​3.​9 Lower Cross Syndrome Exercises 113

3.4 Software Do Smart® and the Equipment Balance Pro® for sVRT 115

About the Author

Dr. Han

is a neurologist and the President of Do Neurology Clinic and Do Balance Center. His major interests are headache, dizziness, tinnitus, sleep problems, and vestibular rehabilitation therapy.

He has published several books and papers including several SCI and non-SCI journals. The transcranial Doppler exam of Do Neurology Clinic was recognized as a national representative technique in 2010. He has made presentations and research posters regarding dizziness, tinnitus, and vestibular rehabilitation therapy in several national and international symposiums. Besides his busy schedules, he also involves himself in community and charitable activities, such as volunteering to visit local nursing home together with his staff.

Dr. Han is a man of many talents. He is an accomplished violinist, is an artist with an emphasis on drawing portraits with charcoal pencils, and has also practiced Hapkido, a Korean martial art, for 6 years which has allowed him to become a Hapkido master of the third degree. He uses these talents to serve his staff and community to provide quality treatment and a safer environment for the colorful people of Daegu.

Education

MD, Kyungpook National University School of Medicine, Daegu, South Korea, 1986–1990

MS, Pusan National University School of Medicine, Pusan, South Korea, 2004–2006

PhD, Kyungpook National University School of Medicine, Daegu, South Korea, 2007−2009

© Springer Nature Singapore Pte Ltd. 2021

B. I. HanSimplified Vestibular Rehabilitation Therapyhttps://doi.org/10.1007/978-981-15-9869-2_1

1. Vestibular Rehabilitation Therapy: Review of Indications, Mechanisms, and Key Exercises

Byung In Han¹  

(1)

Do Neurology Clinic, Daegu, South Korea

Keywords

Vestibular rehabilitation therapyBalance rehabilitation therapyBalance retraining therapyGaze stabilityPostural stabilityHabituation

This chapter refers to a published paper: Han BI, Ko PW, Lee HW, Kim HA, Lee