A new study compares whether a conventional or modified vestibular rehabilitation (VR) protocol works best to help improve balance control among patients with chronic dizziness.

Published recently online in The American Journal of Physical Medicine & Rehabilitation, the study compared the Conventional Cawthorne and Cooksey protocol (CCC) which the study authors write “consists basically of eye, head, and trunk exercises,” with a “multimodal” Cawthorne and Cooksey protocol (MCC), which includes “flexibility, cognition, sensory interaction, and muscle strength exercises,” according to a news story that appeared on the American Physical Therapy Association’s (APTA) news site.

The story explains that in the study, researchers divided 82 older participants with chronic dizziness into two groups. Each group participated in 16 VR sessions over a 2-month period (two 50-minute sessions per week for 8 weeks). Both the CCC and MCC protocols consisted of four stages, with 1 week focused on exercises performed while lying down and the other 3 weeks focused on exercised performed while standing and walking.

The study participants were also educated on VR and falls prevention, and received instructions for daily home exercises.

Outcomes were assessed post-treatment (8 weeks) and 3 months later using primarily the Dynamic Gait Index (DGI). Secondary measures included the timed up-and-go test (TUG)—both TUGcognitive and TUGmanual—the sit-to-stand test, the multidirectional functional reach test, the Romberg and sensorial Romberg tandem and unipedal stance tests, and a hand-grip strength test using a manual hydraulics dynamometer, the release continues.

Per the news story, the researchers found a significant improvement in DGI scores among both groups, with an average increase of 2.8 points on the 24-point scale between baseline and post-treatment. Additionally, with the exception of the forward functional reach test, the Romberg sensorial (eyes open), and the unipedal stance (eyes closed), “the remaining secondary outcomes showed significant differences between evaluation periods.” The gains were sustained at the 3-month follow-up.

The researchers write that the MCC protocol resulted in “superior” results in two static balance tests, and the approach may be “preferable to the CCC protocol for patients with worse baseline assessments of those measurements,” according to the news story.

However, the researchers continue to write, per the news story, the improvements in the test scores didn’t necessarily translate into fewer falls, for two reasons: the treatment duration “was less than recommended by falls prevention guidelines,” and the balance improvement itself may prompt individuals to expose themselves to “challenging activities and environments that were avoided in the past.”

Still, the researchers write, VR resulted in improvements in static and dynamic balance control, a result that “reveals the importance of exercises in general for vestibular compensation and to restore body balance.”

The researchers conclude, regarding which protocol to use, that, “it is up to the physiotherapist to choose which protocol is more suitable … considering the patient’s balance assessment, the resources available, the therapeutic setting, and patient preference,” the news story notes.

[Source: American Physical Therapy Association]