# Progress in Balance Function and Vestibular Symptoms Following Vestibular Rehabilitation in a Patient With Left Cerebellar Infarction

## TL;DR

This case study shows that vestibular rehabilitation can improve balance in a stroke patient, but vertigo symptoms remain unchanged.

## Contribution

Reports a case study on vestibular rehabilitation effectiveness in a patient with left cerebellar infarction.

## Key findings

- Balance function improved significantly after 28 days of vestibular rehabilitation.
- Vertigo and specific nystagmus symptoms showed no improvement despite rehabilitation.
- Mini-BESTest score increased from 3/28 to 26/28 points.

## Abstract

Vertigo and balance impairment are the primary symptoms of vestibular impairment. These symptoms affect an individual’s activities of daily living (ADL) and quality of life (QOL). In patients with stroke, vestibular symptoms vary depending on the area of damage, making it crucial to assess the appropriateness and effectiveness of vestibular rehabilitation (VR) according to each symptom and affected region. Here, we aimed to report the progress of balance function and vestibular symptoms after VR in a patient with left cerebellar infarction.

A 50-year-old male patient with left cerebellar infarction presented with mild trunk ataxia. Despite these mild impairments, the patient experienced vertigo and unsteadiness while standing and walking, necessitating assistance for fall prevention. The patient underwent VR for 28 days, including vestibulo-ocular reflex (VOR) cancellation exercises and habituation exercises. Subjective visual vertical (SVV), nystagmus, VOR cancellation test, grading of lateropulsion (GoL), Mini-Balance Evaluation Systems Test (Mini-BESTest), timed up and go test (TUG), modified Clinical Test of Sensory Interaction and Balance (mCTSIB) using a stabilometer, and self-reported vertigo intensity using a numeric rating scale (NRS) were measured biweekly.

Compared with the initial assessment, the patient’s performance on the SVV, VOR cancellation test, GoL, and TUG improved at the final assessment. Furthermore, on the Mini-BESTest, the score improved from 3/28 points to 26/28 points. All parameters of the mCTSIB using a stabilometer improved in the eyes-closed condition using foam rubber. However, left-beat nystagmus after head shaking, left-gaze nystagmus when gazing to the left, and vertigo during postural changes did not change.

Although VR in patients with left cerebellar infarction may improve balance function, its effectiveness against vertigo requires further investigation. These findings suggest that the mechanisms underlying the vestibular function in vertigo and balance are distinct. Future investigations are required to explore the effects of VR on lesions in the vestibular regions, considering the timing of the intervention, suitable cases, and appropriate frequency of sessions in greater detail.