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Vestibular Physical Therapy in Individuals With Cognitive Impairment

A Theoretical Framework

Klatt, Brooke N., PT, DPT, PhD; Ries, Julie D., PT, PhD; Dunlap, Pamela M., PT, DPT; Whitney, Susan L., PT, DPT, PhD, ATC, FAPTA; Agrawal, Yuri, MD, MPH, FACS

Journal of Neurologic Physical Therapy: April 2019 - Volume 43 - Issue - p S14–S19
doi: 10.1097/NPT.0000000000000266
Special Interest Articles

Falls are a major health care concern in individuals with Alzheimer disease (AD) and their caregivers. Vestibular impairment is a known risk factor for falls, and individuals with AD have been shown to have an increased prevalence of vestibular loss compared with age-matched controls. Vestibular physical therapy (VPT) is effective in improving balance and reducing fall risk in cognitively-intact persons with vestibular impairment. However, the effectiveness of VPT in improving balance and reducing falls in individuals with AD who have vestibular loss has never been explored.

Summary of Key Points: In this article, we apply prevailing ideas about rehabilitation and motor learning in individuals with cognitive impairment (IwCI) to VPT.

Recommendations for Clinical Practice: We propose a modification of current evidence-based VPT protocols for IwCI using the strength-based theoretical framework that emphasizes the motor learning abilities of IwCI. In addition, we highlight the importance of establishing an excellent rapport with IwCI, and present key strategies for optimizing the therapeutic relationship. In ongoing work, we are assessing the efficacy of this modified VPT protocol in IwCI to improve balance and reduce falls.

Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland (B.N.K., Y.A.); Department of Physical Therapy, Marymount University, Arlington, Virginia (J.D.R.); and Department of Physical Therapy, University of Pittsburgh, Pennsylvania (P.M.D., S.L.W.).

Correspondence: Brooke N. Klatt, PT, DPT, PhD, UPMC Eye and Ear Institute (Room 433), 203 Lothrop Street, Pittsburgh, PA 15213 (

Dr Yuri Agrawal is receiving grant funding from NIA (#RO1 AG057667), NIH/NIDCD (#R03 DC015583), and NIH/NIDCD (#K23 DC013056).

The authors declare no conflict of interest.

© 2019 Academy of Neurologic Physical Therapy, APTA