Loathe.

I have a couple of issues with certain points raised:

1) i think there is an definite difference between vestibular rehabilitation and balance rehabilitation. Balance rehab being the wider context of all the varying contributors to postural control.

2) Obviously all patients who have a stroke wont have a central nystagmus - but the topic in question was specifically about cerebellar stroke.

3) Elderly people with normal neuro and seemingly central issues: depends on what aspect of the oculomotor assessment and the contribution of age related changes e.g. saccadic eye movements

4) "I do not agree that central vestibular issues do not respond to physiotherapy, I would agree if one said this takes time. And our current knowledge on neuroplasticity suggests thus,In some patients habituation will never occur, other aspects of your overall vestibular rehabilitation will help accomodate for this...i.e your somatosensory strategies etc...as i have said you cannot use these strategies effectively without stimulating some aspects of your vestibular system..." - in terms of habituation with vestibular rehab its more to do with dizziness and its broad spectrum of symptoms.

5) "My point is, we deal with patients individually, what we find is what we aim to correct...assumming all patients are similar is the first error to managing anyone..." - how patrionizing is this?

6) "What should be important is, what is the problem with this patient? once that rings in our minds, then we can start to solve that problem...

We just have to manage our patients individually and not follow generic textbook advise...

Lets manage what we see based on what we know now...." - again very patronizing.

7) I still stand by the assertion that these cerebellar ataxias dont improve from specific vestibular rehabiliation. Depending on other issues they may improve with balance rehabilitation and training of other sensory strategies.