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Platform Tilt Perturbation as an Intervention for People With Chronic Vestibular Dysfunction

Winkler, Patricia A. PT, DSc, NCS; Esses, Barbara MD

Journal of Neurologic Physical Therapy: September 2011 - Volume 35 - Issue 3 - p 105–115
doi: 10.1097/NPT.0b013e31822a2af9
Research Articles

Background and Purpose: Training to improve responses to perturbations may be beneficial for individuals with unilateral vestibular dysfunction. We evaluated the effects of an incrementally increasing surface tilt perturbation intervention for individuals with chronic vestibular pathology on gait, activities of daily living, and dizziness.

Methods: Participants (n = 29) were randomly assigned to 1 of 3 groups. The first group received random surface tilt perturbations of increasing angles and speed, half of the trials with vision-occluding goggles, 3 times weekly for 3 weeks (P group). The second group received tilt perturbation intervention (as above) plus a home program of vestibular rehabilitation exercises (P+EX group). The third group performed only the vestibular rehabilitation exercises (EX group). Outcome measures included temporospatial gait measures, Dynamic Gait Index (DGI), Dizziness Handicap Inventory (DHI), Patient Specific Functional Scale (PSFS), and a Perceived Outcomes Scale (POS).

Results: The P and P+EX groups showed greater improvement on the PSFS and the POS compared to the EX group. DGI scores indicated decreased fall risk in 8 of 9 individuals who participated in P or P+EX training and who initially scored below the 19-point cutoff score. Both the P and P+EX groups showed significant within-group changes on some gait characteristics, DGI, DHI, PSFS, and POS measures. The EX group showed within-group change only on the DHI.

Discussion and Conclusion: Surface tilt perturbation training appears to be more effective for improving abilities at the activities and participation levels than vestibular exercises alone. In addition, tilt perturbation training reduced fall risk as measured by the DGI.

Assistant Professor, School of Physical Therapy, Regis University (P.A.W.); and Denver Ear Associates (B.E.)

Correspondence: 7995 Lodgepole Tr. Lone Tree, CO. 80124 (

This study was partially funded by The Sponsored Projects Academic Research Council (SPARC) of Regis University.

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© 2011 Neurology Section, APTA