Efeitos das manobras de reposição otolítica associadas a exercícios personalizados de fisioterapia vestibular em idosas com vertigem posicional paroxística benigna (VPPB): relato de casos

Abstract

Introduction: Benign Paroxysmal Positional Vertigo (BPPV) is the most common type of vestibular disorder in the elderly population. The classic treatment for this condition is the Otolith Replacement Maneuver (ORM) and, although it is the gold standard for the treatment of BPPV, individuals may still experience postural instability for a few weeks after the maneuver. Therefore, Vestibular Physiotherapy (VF) exercises are recommended to improve remaining symptoms. Objective: to investigate the effects of otolith replacement maneuvers associated with Vestibular Physiotherapy exercises and kinesiotherapy exercises aimed at strengthening the lower limbs (LL) in elderly women with BPPV. Methods: this is a study of case reports, retrospective and descriptive in nature. Two elderly women participated, aged 65 and 80 years, with a clinical diagnosis of BPPV, from the extension project “Vestibular rehabilitation in patients with otoneurological disorders'', carried out at the Department of Physiotherapy of the Federal University of Rio Grande do Norte (UFRN) , Central Campus. The presence of BPPV, as well as the diagnosis of the affected canal, were assessed using the Dix-Hallpike and Supine Roll Test; the intensity of dizziness was measured using the Numeral Rating Scale (NRS); static balance using the modified Clinical Test of Sensory Integration and Balance (mCTSIB), sensitized Romberg test (tandem) and Unipodal Support (AU); dynamic balance using the Dynamic Gait Index (DGI) and quality of life using the Dizziness Handicap Inventory (DHI). Individuals underwent an intervention protocol containing MRO, followed by personalized VF exercises and kinesiotherapy exercises aimed at strengthening the lower limbs. Results: Vertiginous symptoms ceased after MRO, but patients still reported dizziness and/or imbalance. After applying the personalized exercises, a decrease in the intensity of dizziness, an improvement in static balance, an improvement in dynamic balance through gait and a considerable reduction in the impact of dizziness on quality of life were observed. Conclusion: a combined MRO protocol with personalized Vestibular Physiotherapy exercises in elderly women with BPPV showed positive effects on symptoms of dizziness, body balance, gait and improved quality of life.