Vestibulo-Ocular Reflex Adaptation Training During Acute-Care Management Following Unilateral Vestibular Schwannoma Resection: A Case Report

Background: Vestibular schwannoma is a benign tumorous growth arising from the vestibulocochlear nerve which can cause dangerous mass-effect pressures in the skull base. Surgical resection of these growths is common but can cause residual hearing and vestibular loss. Vestibulo-ocular reflex training is a vital component of vestibular rehabilitation for these patients to reduce dizziness and imbalance symptoms. Case Description: This case report follows a 26-year-old male presenting with seizure and hydrocephalus secondary to a known partially cystic vestibular schwannoma causing cerebrospinal fluid obstruction and brainstem compression. Urgent two-staged resection of the tumor was achieved via retrosigmoid craniotomy. Interventions: Physical therapy was then initiated post-operatively. VOR adaptation training was implemented to counteract symptoms of imbalance with upright mobility, and lower extremity strength training was utilized to avoid deconditioning. Functional balance training and family training interventions were also heavily involved in achieving readiness for home discharge. Outcome Measures: At discharge the patient demonstrated proficiency with transfers, ambulation, and stair navigation with aid of a front-wheeled walker and guarding provided by family members. His Tinetti POMA and AM-PAC “six-clicks” scores demonstrate significant improvements in balance and gait and indicate a low-fall risk upon home discharge. Discussion: The dosing parameters used in this patient’s VOR adaptation home program are novel and present multiple areas for future research in vestibular rehabilitation. The purpose of this case report is to highlight the successful implementation of VOR adaptation exercises and patient-specific functional balance training during the acute stage of recovery following unilateral vestibular schwannoma resection.