Comparison of Cawthorne-Cooksey exercises and sinusoidal support surface translations to improve balance in patients with unilateral vestibular deficit

OBJECTIVE: To compare the effectiveness of vestibular rehabilitation by using Cawthorne-Cooksey exercises with that of instrumental rehabilitation. DESIGN: The main study (n=32) used a pre-post rehabilitation (A-B) design; the ancillary studies used a subset of 11 patients 1 month before rehabilitation versus pre-post rehabilitation (A-A-B design) and 9 patients pre-post rehabilitation versus 1 month after (A-B-B design). SETTING: Division of physical therapy and rehabilitation at a scientific institute in Italy. PARTICIPANTS: Patients (Cawthorne-Cooksey, n=17; instrumental rehabilitation, n=15) with a complete or incomplete unilateral vestibular lesion due to ischemic, inflammatory, cranial nerve VIII sectioning, or unknown cause. INTERVENTIONS: Cawthorne-Cooksey exercises or instrumental rehabilitation training consisting of standing with eyes open (EO) or closed (EC) on a platform moving, relative to the subjects, in the anteroposterior (AP) or mediolateral direction, at a sinusoidal translation frequency of 0.2 or 0.6Hz; training sessions for both interventions were twice daily, 30 minutes per session, for 5 days. MAIN OUTCOME MEASURES: Body sway and subjective score of sway during quiet stance with EO or EC, with feet 10cm apart (FA) or together (FT); the standard deviation of the AP displacement of the malleolus, hip, and head during AP platform translations; the Dizziness Handicap Inventory (DHI); and performance-oriented evaluation of balance and gait (according to Tinetti). RESULTS: Both interventions improved patients' balance. Under each postural and visual condition, both groups showed reduction in body sway, and the post rehabilitation sway values approached those observed in normal subjects; improvement was significantly better for instrumental rehabilitation under FA EO, FA EC, and FT EC conditions. All patients reported a subjective feeling of increased steadiness. Sway recorded 1 month before treatment did not differ from that at the start of treatment. The follow-up evaluation showed persistence of effect. Parallel to the improved stability, a decrease in the SD of the displacement of hip and head in balancing on the movable platform was present in both groups; improvement was better in the instrumental rehabilitation group than the Cawthorne-Cooksey group under the EC condition. Balance and gait assessment improved to the same extent in both groups. Scores on the physical, functional, and emotional questions of the DHI improved significantly in both groups after treatment, but to a larger extent in the instrumental rehabilitation patients. CONCLUSIONS: Both Cawthorne-Cooksey and instrumental rehabilitation are effective for treating balance disorders of vestibular origin. Improvement affects both control of body balance and performance of activities of daily living. The larger decrease in body sway and greater improvement of DHI after instrumental rehabilitation suggests that it is more effective than Cawthorne-Cooksey exercises in improving balance control.