Authors (including presenting author) :
Poon CY (1), Leung YH (1), Lo CHM (1), Yan FP (1)
Affiliation :
(1) Physiotherapy Department, Yan Chai Hospital
Keyword 1: :
Vestibular Rehabilitation
Keyword 2: :
Craniosacral Therapy
Introduction :
Vestibular Rehabilitation (VR) is a well-established, evidence-based treatment for vestibular-related disorders, which are common causes of dizziness and balance problems. Lam et al. (2006) evaluated adults with dizziness in the Emergency Department in Hong Kong, around 31% had peripheral vestibular disorder. These conditions can significantly impact quality of life and increase the risk of falls, especially in older adults. In addition to these traditional VR techniques, emerging insights suggest that adjunct therapies, such as Craniosacral Therapy (CST), may further enhance outcomes. CST is a manual therapy using light touch to release tension in the head and spine, aiming to improve cerebrospinal fluid flow, calm the central nervous system, and restore the inner ear's balance system, potentially easing dizziness, headaches, and anxiety associated with balance issues. A study showed that the value of Dizziness Handicap Inventory (DHI) improved significantly in VR combined with the manual therapy group (including CST) post intervention (p < 0.001), 1 month post intervention (p = 0.003) and 6 month post intervention (p = 0.004) compared with the control group, (Sedeño-Vidal et al., 2022). A new program of combining VR and CST to treat cases with vestibular disorder started in 2025 in Yan Chai Hospital (YCH) in order to provide higher service quality.
Objectives :
The aim of this study is to evaluate the efficacy of the combination program of VR and CST.
Methodology :
Patients with a diagnosis of vestibular disorder were included to a VR program. They were assessed individually and treatment including otolith reposition maneuver, balance training, habilitation exercises and education pamphlet were provided. They were recruited to VR & CST group once their symptoms were related to craniosacral disorder and were treated with conventional VR combined with the new treatment approach CST. Each patient was followed up with a consultation session every 1-2 weeks to monitor progress. Outcome measures including Numeric Global Rate of Change Scale (NGRCS), Visual Analogue Scale for dizziness (VAS), and Dizziness handicap Inventory (DHI), 4-item Dynamic Gait Index (4-DGI) were assessed before and after participation in the program.
Result & Outcome :
From January 2025 to December 2025, 229 patients, in which 176 were female and 53 were male, with mean age 64.5±12.7 were reviewed and 163 of them (71.2%) completed the program. There were 196 and 33 patients in the conventional VR group and the new VR & CST group respectively. The number of sessions in VR & CST group (4.9±3.5) was significantly higher than that in VR group 3.3±3.1 (p=0.007, 95% CI 0.5 to 2.8). The NGRCS in VR & CST group(6.8±2.7) was significantly higher than that in VR group (4.9±3.8) (p=0.016, 95% CI 0.4 to 3.5). Both groups showed significant decrease in DHI and significant increase in 4-DGI without interaction effect between groups. In VR group, the mean DHI and 4-DGI score were significantly 35.2 ±24.0 decrease to 24.0±22.7 (p< 0.001, 95% CI 8.1 to 14.2) and 11.0±2.1 improved to 11.3±1.9 (p< 0.001, 95% CI -0.5 to -0.2) respectively. In VR & CST group, the mean DHI and 4-DGI score were significantly 39.4 ±23.8 decrease to 27.0±24.2 (p< 0.001, 95% CI 5.3 to 19.6) and 11.0±1.4 improved to 11.5±1.3 (p< 0.001, 95% CI -0.8 to -0.2) respectively. There was significant reduction in VAS in VR group ( 2.3±2.4 vs 0.8±1.4, p< 0.001, 95% CI 1.1 to 1.8) while no significant difference in VR & MRF group ( 3.4±2.7 vs 1.2±1.3, p0.096), without interaction effect between groups in VAS. It was found that the VR & CST program could further enhance the improvement of symptoms than the conventional VR. However, there were no additional effects on emotional outcomes and gait stability in cases with vestibular disorder. Further elevations are needed for the combined effects of VR and CST on vestibular deficit cases as CST is a new treatment technique in YCH Physiotherapy Department and thus the sample size was small.
