Functional Recovery in Balance and Mobility After Vestibular Rehabilitation in a Patient with Posterior Canal BPPV: An Case Report
DOI:
https://doi.org/10.62383/quwell.v2i1.2256Keywords:
Balance, BPPV, CARE Guidelines, Case Report, Mobility, Vestibular Rehabilitation TherapyAbstract
Benign paroxysmal positional vertigo (BPPV) is a common cause of peripheral vestibular dysfunction, often resolving with canalith repositioning maneuvers (CRM). However, residual dizziness and imbalance may persist, impairing functional mobility. This case report describes a 55 year old female diagnosed with right posterior canal BPPV through a positive Dix Hallpike test. Following successful CRM, she reported residual postural instability and difficulty walking. A structured four week vestibular rehabilitation therapy (VRT) program was implemented, consisting of habituation (Brandt Daroff), adaptation (gaze stability, VOR x1, VOR x2), sensory substitution, and progressive balance training, delivered three times weekly for 45 minutes per session. Balance and mobility were assessed using the Berg Balance Scale (BBS) and Timed Up and Go (TUG) test at baseline and after the intervention. Results showed improvement in BBS from 42/56 to 53/56 (+11 points) and a reduction in TUG from 14.8 to 9.6 seconds (−5.2 seconds), both exceeding minimal detectable change values for older adults. The patient reported complete resolution of dizziness, increased walking confidence, and return to independent daily activities without adverse effects. This case suggests VRT as a valuable adjunct to CRM in BPPV patients with residual functional deficits, warranting further research in larger controlled studies.
References
Balatsouras, D. G., Koukoutsis, G., Fassolis, A., Moukos, A., & Apris, A. (2018). Benign paroxysmal positional vertigo in the elderly: Current insights. Clinical Interventions in Aging, 13, 2251–2266. https://doi.org/10.2147/CIA.S144134
Büki, B., Simon, L., Garab, S., Lundberg, Y. W., Jünger, H., & Straumann, D. (2011). Sitting-up vertigo and trunk retropulsion in patients with benign positional vertigo but without positional nystagmus. Journal of Neurology, Neurosurgery & Psychiatry, 82(1), 98–104. https://doi.org/10.1136/jnnp.2009.199208
Byun, Y. J., Levy, D. A., Nguyen, S. A., Brennan, E., & Rizk, H. G. (2021). Treatment of vestibular migraine: A systematic review and meta-analysis. Laryngoscope, 131(1), 186–194. https://doi.org/10.1002/lary.28546
Chen, J., Zhang, S., Cui, K., & Liu, C. (2021). Risk factors for benign paroxysmal positional vertigo recurrence: A systematic review and meta-analysis. Journal of Neurology, 268(11), 4117–4127. https://doi.org/10.1007/s00415-020-10175-0
Faralli, M., Lapenna, R., Giommetti, G., Pellegrino, C., & Ricci, G. (2016). Residual dizziness after the first BPPV episode: Role of otolithic function and of a delayed diagnosis. European Archives of Oto-Rhino-Laryngology, 273(10), 3157–3165. https://doi.org/10.1007/s00405-016-3947-z
Halker, R. B., Barrs, D. M., Wellik, K. E., Wingerchuk, D. M., & Demaerschalk, B. M. (2008). Establishing a diagnosis of benign paroxysmal positional vertigo through the Dix-Hallpike and side-lying maneuvers: A critically appraised topic. The Neurologist, 14(3), 201–204. https://doi.org/10.1097/NRL.0b013e31816f2820
Hall, C. D., Herdman, S. J., Whitney, S. L., Cass, S. P., Clendaniel, R. A., Fife, T. D., Furman, J. M., Getchius, T. S. D., Goebel, J. A., Shepard, N. T., & Woodhouse, S. N. (2016). Vestibular rehabilitation for peripheral vestibular hypofunction: An evidence-based clinical practice guideline: From the American Physical Therapy Association Neurology Section. Journal of Neurologic Physical Therapy, 40(2), 124–155. https://doi.org/10.1097/NPT.0000000000000120
Kao, W. T. K., Parnes, L. S., & Chole, R. A. (2017). Otoconia and otolithic membrane fragments within the posterior semicircular canal in benign paroxysmal positional vertigo. Laryngoscope, 127(3), 709–714. https://doi.org/10.1002/lary.26115
Katz-Leurer, M., Rotem, H., Keren, O., & Meyer, S. (2009). Balance abilities and gait characteristics in post-traumatic brain injury, cerebral palsy and typically developed children. Developmental Neurorehabilitation, 12(2), 100–105. https://doi.org/10.1080/17518420902800928
Lee, J. D., Kim, C. H., Hong, S. M., Kim, S. H., Suh, M. W., Kim, M. B., Shim, D. B., Chu, H., Lee, N. H., Kim, M., Hong, S. K., & Seo, J. H. (2017). Prevalence of vestibular and balance disorders in children and adolescents according to age: A multi-center study. International Journal of Pediatric Otorhinolaryngology, 94, 36–39. https://doi.org/10.1016/j.ijporl.2017.01.012
Lopez-Escamez, J. A., Molina, M. I., & Gamiz, M. J. (2006). Anterior semicircular canal benign paroxysmal positional vertigo and positional downbeating nystagmus. American Journal of Otolaryngology, 27(3), 173–178. https://doi.org/10.1016/j.amjoto.2005.09.010
Popkirov, S., Stone, J., & Holle-Lee, D. (2018). Treatment of persistent postural-perceptual dizziness (PPPD) and related disorders. Current Treatment Options in Neurology, 20(12), 50. https://doi.org/10.1007/s11940-018-0535-0
Prokopakis, E., Vlastos, I. M., Tsagournisakis, M., Christodoulou, P., Kawauchi, H., & Velegrakis, G. (2013). Canalith repositioning procedures among 965 patients with benign paroxysmal positional vertigo. Audiology and Neurotology, 18(2), 83–88. https://doi.org/10.1159/000343579
Schlick, C., Schniepp, R., Loidl, V., Wuehr, M., Hesselbarth, K., & Jahn, K. (2016). Falls and fear of falling in vertigo and balance disorders: A controlled cross-sectional study. Journal of Vestibular Research: Equilibrium & Orientation, 25(5–6), 241–251. https://doi.org/10.3233/VES-150564
von Brevern, M., Bertholon, P., Brandt, T., Fife, T., Imai, T., Nuti, D., & Newman-Toker, D. (2017). Benign paroxysmal positional vertigo: Diagnostic criteria. Consensus document of the Committee for the Classification of Vestibular Disorders of the Bárány Society. Acta Otorrinolaringológica Española, 68(6), 349–360. https://doi.org/10.1016/j.otorri.2017.02.007
Wiener-Vacher, S. R., Quarez, J., & Le Priol, A. (2018). Epidemiology of vestibular impairments in a pediatric population. Seminars in Hearing, 39(3), 229–242. https://doi.org/10.1055/s-0038-1666815
You, P., Instrum, R., & Parnes, L. (2019). Benign paroxysmal positional vertigo. Laryngoscope Investigative Otolaryngology, 4(1), 116–123. https://doi.org/10.1002/lio2.230
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Quantum Wellness : Jurnal Ilmu Kesehatan

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.



