Does physiotherapy assessment and management of vertigo in people admitted to sub-acute rehabilitation after an injurious fall decrease the rate of falls in the first three months at home after discharge?

1. An initial vestibular physiotherapy screen to identify patients with a vestibular dysfunction will be undertaken within a week of admission on all patients admitted to the sub-acute rehabilitation unit following an injurious fall. a) This screen will include i. An oculomotor assessment - clinical assessment of eye movement control in sitting ii. Clinical assessment of the vestibular-ocular reflex in sitting - the ability to move the head while maintaining focus on a specific point (stable gaze) iii. Clinical assessment of dynamic visual acuity in sitting - a comparison of the ability to read standard Snellen eye chart keeping the head still and then while moving the head from side to side iv. Positional testing to screen for Benign Paroxysmal Positional Vertigo (BPPV) with the standard clinical assessments of the Hall-pike Dix or side-lying test (lying down from sitting) and the roll test in supine b) the clinical assessment will take a maximum of 30 minutes c) the assessment will be undertaken in the physiotherapy gym by an appropriately trained staff physiotherapist 2. An appropriately trained staff physiotherapist will provide individualised vestibular rehabilitation protocols to all patients with a vestibular dysfunction on screening. This will be undertaken during usual physiotherapy rehabilitation sessions in the gym. i. if BPPV is identified, the appropriate repositioning manouvres will be undertaken second daily until resolution of symptoms, taking a maximum of 15 minutes per session. No other vestibular rehabilitation exercises will commence until the BPPV has been resolved. ii. if a vestibular system deficit is identified, appropriate gaze stability and / or vestibular rehabilitation exercises will be undertaken, for a maximum of 30 minutes per day, every day during the rehabilitation admission iii. if a vestibular deficit is not identified, the participant will be allocated to the control group and will undertake usual sub-acute physiotherapy rehabilitation as detailed below iii. all exercise interventions will be initially undertaken one-on-one and face to face, during the physiotherapy rehabilitation session in the physiotherapy gym. If participants are safe and able to undertake specific gaze stability exercises independently, each will be provided with an exercise sheet to enable independent practice. iv. participants will keep an individual exercise record to monitor adherence v. frequency and duration of all interventions will be at the discretion of the treating physiotherapist 3. 72 hours before discharge, a final vestibular assessment will be undertaken for those participants who were identified as having a vestibular dysfunction on initial assessment to ensure BPPV has not recurred or developed. 4. Discharge written home exercise programs incorporating appropriate vestibular rehabilitation exercises if appropriate will be provided by the treating physiotherapist, and will include the same format exercise record that has been used during the inpatient admission.