Vestibular Rehabilitation Therapy

Have you ever experienced dizziness or vertigo?  Have you had issues with balance and stability?  Have you woken up in the morning and rolled over in bed only to find the room spinning?  Vestibular disorders are surprisingly common and can be quite debilitating.  It has been reported that as many as 35% of adults aged 40 years or older in the United States have experienced some form of vestibular dysfunction.  The good news is that there are effective methods to reduce or completely eliminate symptoms through vestibular therapy.

What is Vestibular Rehabilitation Therapy?

Vestibular Rehabilitation Therapy (VRT) is a specialized form of physical therapy designed to treat vertigo, dizziness, disequilibrium and imbalance caused by the vestibular (inner ear) system.  VRT utilizes exercises to promote central nervous system compensation for inner ear deficits. With the properly designed program and treatment, people who are suffering from vestibular disorders can resume daily activities, increase their stability, reduce their risk of falling and enhance their quality of life.

What is the Vestibular System?

The vestibular system is a sensory system located within the inner ear.  It is responsible for providing our brain with information about head motion, head position and spatial orientation.  It is involved with motor functions that allow us to keep our balance, stabilize our head and body during movement and maintain postural control.  The vestibular system is made up of three semi-circular canals and two pockets, called the otolith organs.  This system, along with input from vision and proprioception (joints and muscles), helps us maintain our sense of balance and stability.

Who can benefit from VRT?

Many people suffer from dizziness and vestibular disorders that may benefit from VRT.  However, the potential for recovery depends on the type of vestibular disorder.  Stable disorders have better chances of improvement than progressive disorders.  Unilateral lesions (only one ear affected by a vestibular disorder) generally have a better chance of recovery as compared to those with bilateral lesions (both ears are affected).  It is also important to remember that not all dizziness disorders are caused by the vestibular system.

Vestibular disorders that can benefit from therapy include:

  • Benign Paroxysmal Positional Vertigo (BPPV)
  • Vestibular neuritis
  • Labyrinthitis
  • Acoustic neuroma
  • Post traumatic vertigo (ie: after a car accident)
  • Ototoxicity
  • Even for situations where the diagnosis is unclear, such as disequilibrium in the elderly, therapy can often prove helpful.
    • In older adults with symptoms of dizziness and no documented vestibular deficits, the addition of vestibular-specific gaze stability exercises to standard balance rehabilitation results in a greater reduction in fall risk.

Disorders not as likely to benefit from vestibular therapy include:

  • Meniere’s disease
  • Perilymphatic fistula
  • Disorders without a vestibular problem, such as low blood pressure, medication reactions, anxiety and depression.

How does it work?

Vestibular Rehabilitation Therapy (VRT) helps with recovery by promoting compensation and adaptation.  For most people with a vestibular disorder, the deficit is permanent.  However, people can feel better and restore function through compensation.  This occurs because the brain learns to use other senses (vision and somatosensory) to substitute for the deficient vestibular system.  A thorough clinical evaluation will first be performed by a trained vestibular physical therapist to identify specific deficits.  Then a customized exercise based program is created to help treat the vestibular related problems.  Three principle methods of exercise can be prescribed.  These include habituation exercises, gaze stabilization exercises and/or balance training.  These exercises can often provoke symptoms initially, but with time become easier as the brain and body adapt.

Benign Paroxysmal Positional Vertigo (BPPV):

BPPV is the most common vestibular disorder and cause of vertigo (vertigo is the false sense of spinning).  It is defined as a disorder of the inner ear characterized by repeated episodes of positional vertigo.  BPPV is more common in the older population and many cases happen for no apparent reason.  It involves the displacement of tiny inner ear crystals.  Treatment of BPPV involves canalith repositioning treatments.  A trained vestibular therapist evaluates and makes an assessment as to which ear and canal is affected.  Techniques are then performed involving specific head and body movements to reposition the crystals in the inner ear.  Your therapist may also give you similar specific exercises involving head and body movements to perform at home.

If you have a vestibular disorder, there are options for treatment.  A trained vestibular therapist can help make an assessment and refer out to the correct specialist if needed.  With therapy, vestibular disorders can become manageable and a return to daily and recreational activities is possible. .

In good health,
Gabrielle Schneider , FRCms, SFMA, ART

References :

  1. Agrawal, Y., Carey, J. P., Della Santina, C. C., Schubert, M. C., & Minor, L. B. (2009).  “Disorders of balance and vestibular function in US adults.”  Archives of Internal Medicine. 169(10): 938-944.  doI: 10.1001/archinternmed.2009.66
  2. Han, B. I., Song, H. S., & Kim, J. S. (2011). “Vestibular Rehabilitation Therapy: Review of Indications, Mechanisms and Key Exercises.” Journal of Clinical Neurology, 7(4): 184-196.  doi: 10.3988/jcn.2011.7.4.184
  3. Hain, T. C. (). What is Balance and Vestibular Rehabilitation Therapy? Retrieved from https://www.brainline.org/article/what-balance-and-vestibular-rehabilitation-therapy
  4. Kundakci, B., Sultana, A., Taylor, A. J., & Alshehri, M. A. (2018). “The effectiveness of exercise-based vestibular rehabilitation in adult patients with chronic dizziness: A systematic review. Pubmed Central. doi: 10.12688/f1000research.14089.1
  5. McDonnell, M. N. & Hillier, S. L. (2015).  “Vestibular rehabilitation for unilateral peripheral vestibular dysfunction.”  Cochrane Reviews.  https://doi.org/10.1002/14651858.CD005397.pub4
  6. Vestibular Disorders Association. Vestibular Disorders: An Overview. Retrieved from https://vestibular.org/article/what-is-vestibular/about-vestibular-disorders/

Image credit :
https://www.news-medical.net/health/Types-of-Vertigo.aspx
https://en.wikipedia.org/wiki/Inner_ear#/media/File:Blausen_0329_EarAnatomy_InternalEar.png

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