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Efficacy of Gaze Stability Exercises in Older Adults With Dizziness

Hall, Courtney D. PT, PhD; Heusel-Gillig, Lisa PT, DPT; Tusa, Ronald J. MD, PhD; Herdman, Susan J. PT, PhD

Journal of Neurologic Physical Therapy: June 2010 - Volume 34 - Issue 2 - pp 64-69
doi: 10.1097/NPT.0b013e3181dde6d8

Background and Purpose: The purpose of this study was to determine whether the addition of gaze stability exercises to balance rehabilitation would lead to greater improvements of symptoms and postural stability in older adults with normal vestibular function who reported dizziness.

Methods: Participants who were referred to outpatient physical therapy for dizziness were randomly assigned to the gaze stabilization (GS) group (n = 20) or control (CON) group (n = 19). Dizziness was defined as symptoms of unsteadiness, spinning, a sense of movement, or lightheadedness. Participants were evaluated at baseline and discharge on symptoms, balance confidence, visual acuity during head movement, balance, and gait measures. The GS group performed vestibular adaptation and substitution exercises designed to improve gaze stability, and the CON group performed placebo eye exercises designed to be vestibular neutral. In addition, both groups performed balance and gait exercises.

Results: There were no baseline differences (P > .05) between the GS and CON groups in age, sex, affect, physical activity level, or any outcome measures. Both groups improved significantly in all outcome measures with the exception of perceived disequilibrium. However, there was a significant interaction for fall risk as measured by Dynamic Gait Index (P = .026) such that the GS group demonstrated a significantly greater reduction in fall risk compared with the CON group (90% of the GS group demonstrated a clinically significant improvement in fall risk versus 50% of the CON group).

Discussion and Conclusions: This study provides evidence that in older adults with symptoms of dizziness and no documented vestibular deficits, the addition of vestibular-specific gaze stability exercises to standard balance rehabilitation results in greater reduction in fall risk.

Rehabilitation Research and Development Center (C.D.H., S.J.H.), Atlanta Veterans Administration, Decatur, Georgia; Department of Rehabilitation Medicine (C.D.H., L.H.-G., S.J.H.); Department of Neurology (R.J.T.); and Department of Otolaryngology-Head and Neck Surgery (R.J.T., S.J.H.), Emory University, Atlanta, Georgia.

Supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Rehabilitation Research and Development Service, grant no. C4168P.

The contents do not represent the views of the Department of Veterans Affairs or the United States Government.

Correspondence: Courtney D. Hall, E-mail:

© 2010 Neurology Section, APTA