Aquatic physiotherapy for vestibular rehabilitation in patients with unilateral vestibular hypofunction: comparative study

All the pacients receive nutricion orientation just once before the exercise protocol begin. NUTRITION ORIENTATION Eating well in the morning, less at lunch and much less at night, avoid keep themselves without food more than 3 hours Avoid carbohydrates and refined sugars. Use sweeteners like sucralose or stevia. Do not use aspartame. Avoid pasta and fatty foods and products that increase the salt (Ajinomoto, soy sauce, seasonal, soup knor) .. Eat slowly and chew food thoroughly. Avoid alcohol and smoking. Do not take more than three cups of coffee or black tea daily. Drink water. Do not take medicines without medical advice. Sleep weel. Avoid excess. After the nutrition orientation, the participants are randomised to undergo only one of these three types of rehabilitation (i.e. Aquatic Physiotherapy OR Cawthorne and Cooksey exercises OR Aquatic Relaxation exercises). 1) AQUATIC PHYSIOTHERAPY Phase 1 Adaptation in the water The patient maintains the orthostatic posture with the aid of the physiotherapist at 1.30m depth. Phase 2 Separation The patient maintains the upright position, at the same depth but without the therapist’s aid, maintaining the posture for 2 minutes. Phase 3 Postural Transference From the sitting position on the stair step, the patient stands up and sits down, maintaining their support base, with the feet in parallel, comfortably separated, and touching the floor, but not the pool edge. Postural correction and respiratory orientation is performed when necessary. Phase 4 Rotational Control of the Trunk In a sitting position, the patient performs maximum trunk rotation, without altering the sustaining base associated with arm flexion and abduction, crossing the median line at the water surface level and returning to the initial position. Phase 5 Rotational control of the trunk associated with mobile target tracking The therapist throws a ball to the patient’s right and left sides. The patient must focus on the ball and follow its displacement in order to rebound it back along the same trajectory, using a combined movement of eyes and head, without altering the sustaining base. Phase 6 Gait with thrust The patient experiences the buoyancy force in the water with the therapist’s aid, changing the level of body immersion, while respecting the patient’s height. The patient is released progressively until they achieve an independent gait (from 1.30 m to 1.50 m deep), back and forth, with eyes opened, eyes closed, head rotations and turbulence created by the therapist. Phase 7 Up and Down the stairs The patient is instructed to go up and down the stairs to different heights with eyes opened, eyes closed, head rotation and with turbulence created by the therapist. Phase 8 Sitting position on a float Sitting on a float, lower limbs free, the patient starts making sequential movement of pedaling, crossing arms at the median line at surface water level, eyes opened, eyes closed, head rotation and with the turbulence created by the therapist. Phase 9 Sitting position on a float associated with mobile target tracking In the same position as the previous phase, the therapist throws the ball towards the patient’s right and left sides. The patient must focus on the ball and follow its movement to rebound it along the same trajectory, performing an associated movement with the eyes and head. Phase 10 Upright buoyancy In the orthostatic position, wearing feet floats, the patient performs small jumping movements associated with crossing arms at the median line at surface water level, eyes opened, eyes closed, head rotation and with turbulence created by the therapist. Phase 11 Upright buoyancy associated with mobile target tracking In the same position as the previous phase, the therapist throws the ball towards the patient’s right and left sides. The patient must focus on the ball and follows its displacement to rebound it along the same trajectory. Phase 12 Control of movement with maximum turbulence In the orthostatic posture with a water jet aimed towards the patient, while performing up and down knee flexions for 5 minutes. 2) CAWTHORNE AND COOKSEY EXERCISES A) Eye and head movement, sitting down – first slowly, than faster: 1) Look up and down; 2) Look tot the right and to the left; 3) Bring your fingers closer and farther, looking at it; 4) Move your head (slowly and then faster) to the right and to the left, with open eyes; 5) Move your head (slowly and then faster) up and down, with open eyes; 6) Repeat 4 and 5 with closed eyes. B) Head and body movement, sitting down: 1) Place an object on the floor. Take it and bring it above your head and place it on the floor again (look at the object the whole time). 2) Shrink your shoulders and make circular movements; 3) Bend forward and take an object through the back and front of your knees. C) Standing up exercises: 1) Repeat A and B2; 2) Sit down and stand up, sit down and stand up again; 1) Sit down and stand up; Sit down and stand up again with closed eyes; 2) Stand up, but turn to the right while standing; 3) Stand up, but turn to the left while standing; 4) Thow a small ball from one hand to the other (above the horizon level); 5) Thow a small ball from one hand to the other under your knees and alternatively. Other activities to improve balance: 1) Clim up and downstairs (use handrail, if necessary); 2) Stand up and take sudden 90 degreesturns (first with open eyes, then with closed eyes); 3) While wlaking, look to the right and to the left (as if you were reading labels in the market; 4) Practice standing on one foot with the right foot then the left foot), first with open eyes, then with closed eyes; 5) Stand up, on a soft surface: a) Walk on the surface to get used to it; b) Walk on the tip of your feet first with open eyes, then with closed eyes; c) Practice exercise 4 on a soft surface; 6) Circle around a person that is on the center that thows a large ball (wich should be thrown back); 7) Walk around the room cith closed eyes 3) AQUATIC RELAXATION EXERCISES In the water the patient with the physiotherapist at 1.30m depth maintains the sitting position on the stair step, maintaining their support base, with the feet in parallel, comfortably separated. Postural correction and respiratory orientation is performed when necessary. Perform: with arm flexion and abduction, crossing the median line at the water surface level and returning to the initial position. Arm flexion / extension. Arm aduction / adduction. Performs maximum trunk rotation, without any alteration of the sustaining base associated with arm abduction, cross the median line at the water surface level and return to the initial position. Cross arms forward With arm flexion and abduction, cross the median line at the water surface level and return to the initial position. With arm flexion and abduction into the side right and left, to meet the other arm. r Move to the side and arm forward. The same anterior motion, associated with trunk rotation: Extension an knee right at a time, with abduction of the arm right.. Extension an knee left at a time, with abduction of the arm left Each one of the protocol exercise have this frequency and duration: 3 sessions per week in 40 minutes sessions; overall duration: 10 sessions. For the first 3 weeks, 3 sessions a week, and then only 1 session in the final week to end the protocol. mode of administration: one-on-one with a physiotherapist.