Physiotherapeutic intervention in vestibular system dysfunction: a pragmatic approach to benign paroxysmal positional vertigo

Abstract

Introduction: The Benign Paroxysmal Positional Vertigo is characterized by a rotating dizziness that lasts for seconds and has a high prevalence among the dysfunction of the vestibular system. The BPPV can be treated by vestibular physiotherapy that uses cephalic maneuvers and proprioceptive stimuli to correct dysfunctions. Objective: Describe the clinical effect of an pragmatic approach as a therapeutic resource in the treatment of BPPV. Methods: This is an uncontrolled experimental study, which included patients from the outpatient physiotherapy sector from Hospital Universitário Gaffrée e Guinle, whose main complaint was rotational vertigo, dizziness, postural instability or imbalance, regardless of gender and over 18 years of age. In addition to collecting sociodemographic data, the patients were evaluated by means of Jacobson's vestibular dysfunction index (VDI - modified), before and after performing cephalic maneuvers and vestibular exercises. Results: 34 individuals were selected, which 85% of them were female and the average age was 59.6 years old (± 13.6). All individuals presented alterations in the posterior canal, with the most frequent diagnosis being unilateral canalithiasis-type BPPV on the right (68%) followed by unilateral canalithiasis-type BPPV on the left (32%). No individual presented otoliths towards the lateral semicircular canals, nor adhered to the dome (cupulitiasis). The comparison between the averages of the MODIFIED VDI before (47.6 ± 5.6) and after the intervention (3.1 ± 2.1) revealed that the proposed treatment was clinically effective for the study population (p = 0.001). The calculation of the effect size showed that the intervention had a great clinical effect Cohens´d = 2.73 (2.01-2.44; 95% CI). Conclusion: Physiotherapeutic maneuvers aimed exclusively at the vestibular system were clinically effective for the population studied.