REHABILITATION APPROACH IN PATIENTS AFTER STROKE IN THE VERTEBROBASILAR SYSTEM

Abstract

Strokes in the vertebrobasilar system often damage structures important for balance control (vestibular nuclei, brainstem, cerebellum) and lead to vertigo, nystagmus, nausea, vomiting and ataxia. Vestibular function senses rotational and linear acceleration of the head, assists in spatial orientation, and stabilizes eye movements during postural control. This function is critical for maintaining balance, walking speed, and reducing the risk of falls. Central vestibular disorders have different mechanisms than peripheral ones and require a specific rehabilitation approach. The purpose of the report is to present contemporary approaches for vestibular rehabilitation and to investigate the effect of personalized vestibular rehabilitation treatment in patients after vertebrobasilar stroke. Materials and methods: Three patients after a stroke in the VBS were studied, with a mean age of 80.7 years. The patients were treated for 6 days in the Neurology Department, and rehabilitation program began on average 11 days after the stroke. They underwent a 7-day rehabilitation course, twice a day, combining gaze stabilization exercises (VOR exercises), balance and equilibrium exercises, as well as different types of walking with active head movement. Results: The results of Berg balance scale demonstrate a significant improvement in the patients’ condition – from an average of 5/56 points at admission to 50.3/56 at discharge. Subjectively, symptoms such as vertigo and dizziness have almost completely disappeared. At first, these symptoms appeared when turning over in bed and sitting up. At the end, they only occurred with quick and sudden head movements, and in one of the patients, with loud sound stimuli and bright lights. The patients gained confidence and absolute independence in their mobility, including going up and down stairs. Conclusion: Vestibular rehabilitation is an effective intervention in patients after vertebrobasilar stroke. Individualization, early initiation (when clinically safe) and integration into a multidisciplinary rehabilitation program improve clinical outcomes. Vestibular rehabilitation appears to be a promising therapeutic approach for many post-stroke patients and deserves further research as a potential standard treatment method.