Assessing co-existing deficits. This part of the assessment refers to the identification and assessment of co-existing sensory- motor or neuromusculoskeletal deficits that people with vestibular disorders may have. Musculoskeletal assessment People with vestibular disorders often restrict head and trunk movement and acquire a sedentary lifestyle to avoid triggering symptoms of vertigo and oscillopsia (Xxxxx et al., 1997; Bronstein et al., 2005) which can lead to secondary musculoskeletal impairments (Xxxxxxx and Xxxxxx, 2011; Xxxxx et al., 2015; Xxxxxxx et al., 2016). Such impairments may include muscle tension- around the neck and upper back, decreased range of motion, and pain in the cervical and thoracolumbar region as well as secondary muscle weakness which may act as an additional contribution to person’s balance confidence, postural stability (Xxxxxx et al., 1993), and increase their falls risk. The importance of assessing and addressing such musculoskeletal problems and impairments is also, because these may affect people’s treatment outcome and overall recovery (Xxxxxxx and Sparto, 2011). For example, stiffness of the cervical and lumbar spine may affect the head and body movements (Xxxxx et al., 2015), thus, the exercise performance during VRT (Xxxxxxx et al., 2016; Xxxxxxx et al., 2020). Lack of active cervical range of motion may contribute to less compliance in terms of performing various VOR exercises as well as more functional exercises such as walking with head turns or looking up. Also, people with pain or reduced active range of motion in their lumbar spine and core strength may find it difficult performing vestibular exercises which involve various body movements such as bending over and turning around. However, at present, it is not known if reduced strength of postural muscles, and/or reduced spinal mobility of the cervical, thoracic, or lumbar region, interferes with VRT (Whitney et al., 2020). Neuromuscular assessment People with chronic peripheral vestibular disorders usually have normally coordinated muscle activation in the arms, legs, and trunk as well as normal spatial and temporal characteristics of movement (Xxxxxxx et al., 1989; Xxxxx and Xxxxxx, 1994). Some stroke like neurological signs may be present during acute attacks such as sudden numbness or weakness in the face, speech difficulties, trouble walking or lack of co-ordination in people with VM, but these usually subside after the acute attack finishes (xxx Xxxxxxx, 2005). However, there is evidence th...
