Effectiveness of Gaze Stability Exercises on Balance and Activities of Daily Living Among Patients Suffering Vertigo With Vestibular Neuritis in Saudi Arabia: A Pilot Clinical Trial, Telerehabilitation Study

Balance and stability are important components for daily activities. Individuals need appropriate posture and coordination of various body parts for them to perform basic movements needed when doing various activities. The body requires a strong balance to perform day-to-day activities such as walking up and downstairs, bending, as well as lifting things from the ground. Lack of this balance, which can occur because of ear infections, accidents, and aging, generally can result in decreased quality of life. Nichols-Larsen et al., (2016) mentioned that vestibular neuritis is the second most common cause of vertigo and patients are complained of balance disturbance after head movements. Most healthcare facilities as well as health fitness centers use exercises to improve balance and stability in patients with balance problems. Examples of such balance exercises include gaze stability exercises. This literature reviews the effectiveness of gaze stability with balance exercises in enhancing balance, activities of daily living and reducing the risk of falling among patients suffering from vertigo due to vestibular neuritis in Riyadh.

2.1. Overview of Gaze Stability Exercises Gaze stability exercises are part of vestibular rehabilitation therapy exercises. The exercises have become part of healthcare plans for patients with vestibular dysfunction . The exercises aim at improving vestibular ocular reflex (VOR), visual acuity during head movements, as well as reducing vertigo and dizziness. The therapy also improves postural stability, hence improving the quality of life among those affected. This, in turn, helps the patients achieve their activities of daily living. Gaikward mentions that the therapy works by promoting and stimulating vestibular adaptation and substitution to various stimuli provided during the exercises. Horizontal and vertical head movements with a fixed vision on a certain target induce retinal slip, which in turn increases the gain of vestibular response. However, achieving sustained vestibular response requires repeated exercises. Thus, most gaze stability exercises are prescribed for a long duration to achieve this response. Commonly used prescription is about four to five exercises in a day. The total exercises should last for an average of thirty minutes.

2.2. Effectiveness of Gaze Stability Exercises There are several studies and researches on vestibular rehabilitation therapy. A systematic analysis of most of these studies shows gaze stability exercises to be effective in achieving balance and postural stability. A recent study by Roh and Lee (2019) found a positive correlation between vestibular rehabilitation therapy and the improvement of balance and stability. According to their results, dynamic postural stability among patients with balance problems significantly improved after providing gaze stability exercises twice per week for four weeks. The researchers used various forms of gaze stability exercises, including, eyeball, pursuit, saccadic, and vergence eye movements as well as vestibular ocular reflex exercise. Thus, these exercises proved effective in reducing vertigo, dizziness, and achieving balance among those affected.

Vestibular rehabilitation therapy also improves the overall health status of affected individuals as well as increasing the quality of their life. Tsukamoto et al., (2015) found an improvement in the quality of life among twenty patients diagnosed with vestibular disease. The intensity of dizziness also improved among these patients, with postural stability and balance improving in more than eight percent of the patients. Thus, the negative impacts of various vestibular diseases, including vestibular neuritis, can be minimized by prescribing well-coordinated and supervised gaze stability exercises.

Khanna and Singh (2014) saw related findings in another study. However, according to their results, improvement in postural stability and balance requires repeated exposure to interventions for a significant duration. The duo provided gaze stability exercises for two consecutive days per week for a duration of six weeks. The patients conducted the exercises three times per day with each session lasting for forty to sixty minutes. Moreover, vestibular rehabilitation therapy to be more effective if two or more types of exercises can be combined during the interventions. Those who were receiving balance training in addition to gaze stability exercises had a significant improvement in their balance and stability compared to those receiving either of the two therapies alone.