Rehabilitation for vestibular and metavestibular disorders

Vestibular pathology of various origins, in addition to dizziness and imbalance, can lead to metavestibular disorders, which manifest themselves as spatial disorientation and navigation disorders and often remain unrecognised, but can hinder the recovery of such patients and reduce their quality of life. Vestibular rehabilitation is currently undergoing active development. It has been well studied and has proven effective in peripheral vestibulopathy. However, in cases of central vestibular dysfunction and metavestibular disorders, its results are not yet clear-cut and require further research. It is known that the vestibular system is involved not only in maintaining balance, but also in cognitive functions, primarily in the implementation of visual-spatial functions. In this regard, patients with vestibular disorders may experience problems with concentration when solving various cognitive tasks, and conversely, the presence of cognitive impairments may exacerbate existing vestibular dysfunction. Vestibular rehabilitation promotes vestibular compensation through neuroplasticity, which improves statokinetic control and spatial orientation. This process consists of three components: recovery, habituation, and adaptation. In addition to physical exercises, it is advisable to include cognitive training in the vestibular rehabilitation programme, as this combination has a more pronounced positive effect on recovery. To increase the effectiveness of vestibular rehabilitation, it is reasonable to add betahistine dihydrochloride, which has been shown to be effective in numerous placebo-controlled studies, to the complex therapy as a drug capable of accelerating vestibular compensation. In addition to using standard scales and questionnaires, it is currently proposed to objectify the effect of vestibular rehabilitation based on the study of saccadic response patterns and the assessment of grey matter volume in specific areas of the brain, measured using structural neuroimaging. Further study of the mechanisms linking vestibular disorders with cognitive function will contribute to improving the effectiveness of rehabilitation for patients with various vestibular pathologies.