Effectiveness of Vestibular Rehabilitation Therapy in Patients with Cerebellar Ataxia with Bilateral Vestibulopathy (CABV)

Objective: To evaluate the benefit of vestibular rehabilitation therapy (VRT) in the management patients with Cerebellar Ataxia with Bilateral Vestibulopathy (CABV).

Background: CABV is a rare degenerative syndrome with impairment of both central and peripheral vestibular pathways. Compensatory eye movement reflexes such as the vestibulo-ocular reflex (VOR) and central oculomotor pathways affecting smooth pursuit, gaze handling and cancelling the VOR are affected; this results in postural and gait instability, and dizziness with rapid head movements The benefit of VRT in CABV patients has not been established.

Methods: A retrospective review was performed on a cohort of fourteen patients who were diagnosed with CABV in a multidisciplinary neuro-otology clinic and participated in VRT. All patients included in the study completed their suggested course of VRT. The following clinical measures were assessed before starting and after finishing VRT: 1) Dizziness Handicap Inventory (DHI), 2) Dynamic Gait Index (DGI), 3) The Activities-Specific Balance Confidence (ABC) Scale 4) number of falls, 5) Positive Affective Negative Affective Score (PANAS), 6) Modified Clinical Test of Sensory Interaction in Balance, condition four (MCTSIB, eye closed, foam surface), 7) Dynamic Visual Acuity (DVA) test, and 8) gait speed(ft./sec).

Results: Following VRT, patients were found to have improved balance on MCTSIB (8 vs 19 seconds, p=0.017) and a reduced number of falls (10 vs. 3 falls, p=0.02). No statistically significant improvements were seen in DHI, DGI, ABC, PANAS, DVA and gait speed (p>0.05).

Conclusions: CABV patients who underwent VRT were found to have a reduction in the number of falls and better postural stability. However, VRT was not found to improve patients’ overall subjective perception of their symptoms (DHI, PANAS) or their gait stability (gait speed, DGI, ABC).