The effects of rotational platform training on balance and ADLs

Patients with vestibular dysfunction complain of postural instability and disorientation long after the central compensation is thought to be complete. Previously it has been demonstrated that patients with unilateral vestibular loss who orient more to vertical have better perceived functional status. We proposed that performing balance training with surface perturbations at velocities that target the vestibular system would lead to increased reliance on vestibular information, and therefore improve function. The purpose of this study was to determine whether patients who train using repetitive platform perturbations at these vestibular dependent velocities demonstrate improved postural stability and greater functional abilities than patients who perform traditional balance therapy. Twelve subjects with chronic vestibular and balance dysfunction (age 58 ± 15 years; 3 males, 8 females) and 4 healthy control subjects (age 62 ± 23 years; 4 females) participated. Patients were randomized into 3 groups: clinical balance training (CBT n=3) and training with ramp platform perturbations (4 deg amplitude) either at vestibular (1, 2, 4 deg/sec; VESTIB n=6) or at non-vestibular velocities (0.5, 8, 16 deg/sec; Non-VESTIB n=3). The healthy control subjects completed training at vestibular velocities. Subjects' kinematic and kinetic responses to ramp rotational platform perturbations (0.5, 1, 2, 4, 8, 16 deg/sec at 6 deg amplitude), and scores on the Activities-specific Balance Confidence Scale (ABC), Dizziness Handicap Inventory (DHI), Vestibular Activities of Daily Living Scale (VADL) and Functional Gait Assessment (FGA) were compared before and after the 2 week, 3x/week training sessions. Control subjects demonstrated minimal change in orientation to vertical during platform rotations following training. The VESTIB group demonstrated greater improvements in orientation to vertical during ramp perturbations following training than the Non-VESTIB or CBT groups. Both the CBT and VESTIB groups demonstrated improvements on a composite clinical score incorporating the ABC, DHI, VADL, and FGA following training whereas the Non-VESTIB group did not demonstrate improvement. These preliminary results indicate that training using platform rotations may be an effective intervention for improving postural control following vestibular loss. Further research is needed to explore the efficacy of incorporating rotational platform training with clinical balance training.