Question
How important is balance training with vestibular patients? Is the DGI the best tool to measure change?
Answer
Balance training is extremely important with people who have vestibular dysfunction. When we look at the postural control system, there are three pieces of sensory data that we use to maintain balance: vision, vestibular, and somatosensory. Vestibular is the only one of those pieces of sensory data that orients us to gravity, and it is the job of the vestibular system to resolve conflicts among the sensory systems.
Think about this. When you are sitting in a parked car and the person next to you pulls away, you may slam on the brakes even though you are not moving, because you had a sensory conflict. Your visual flow told you that you were moving. Your vestibular system and your somatosensory system told you that you were not moving, but you slammed on the brakes anyway because you were afraid. It is the job of the vestibular system to resolve the conflict. When you have vestibular dysfunction, you might lose input from gravity. You might lose spatial orientation to the upright position and the ability to resolve conflict.
You have to do balance training to get people back to baseline. If not, they are going to be falling anytime they are in a low light situation or any time the surface is a little uneven. Whether or not the DGI is the best tool to measure change would depend on the change you are measuring. It is the best tool to measure change in gait that is being impacted by vestibular loss as it has the head turn and the stair components. It is not the best tool to measure improvements in the VOR. You will want to do the dynamic visual acuity test to measure improvement in the VOR. I also do not think it is the best tool to measure improvements in gait. Personally, I like to test gait speed. Measure gait speed for 20 feet with both fast and self-selected speeds and see what happens. I think that the TUG is even a little better as far as gait change measurement, because with the TUG, you have to accelerate and decelerate. That gives you better data. If you want to see if gait is improving as a result of vestibular intervention, then I would say yes, the DGI is the best tool.
