What Is Vestibular Rehabilitation?

Vestibular (inner ear disorder) rehabilitation (VR), or vestibular rehabilitation therapy (VRT) is a specialized form of therapy intended to alleviate both the primary and secondary problems caused by vestibular disorders. It is an exercise-based program designed to reduce vertigo and dizziness, gaze instability, and imbalance and falls. For most people with a vestibular disorder, the deficit is permanent because the amount of restoration of vestibular function is very small.

However, after vestibular system damage, people can feel better, and function can return through compensation. This occurs because the brain learns to use other senses (vision and somatosensory, i.e., body sense) to substitute for the deficient vestibular system. The health of particular parts of the nervous system (brainstem and cerebellum, visual, and somatosensory sensations) is important in determining the extent of recovery that can be gained through compensation.

What Causes Dizziness Related To Vestibular Disorder?

Each year, more than 10 million patients visit a physician due to dizziness. It is the most common complaint of patients over the age of 75, but it can occur in patients of any age. The vestibular disorder is most commonly caused by aging, head injury, and viral infection. Dizziness due to the inner ear or vestibular disorders are not serious but are often a sign of mechanical problems. Dizziness can be a symptom of the inner ear or side effect of medications, a sign of neck dysfunction or a more serious problem related to the heart or brain. People who suffer from vestibular disorders often complain of symptoms of vertigo, visual disturbance, dizziness, and imbalance. Other symptoms that can arise from inner ear disorders such as vestibular are nausea and vomiting, fatigue and reduced ability to concentrate. These symptoms can result from a dysfunction of the balance organs of the inner ear or dysfunction of one or more parts of the central nervous system that helps process spatial and balance information. The body maintains the balance of sensory information from three systems:

• Vestibular System (inner ear)
• Proprioception (touch sensors in the spine, trunk, and feet)
• Vision

The sensory input from these three systems is processed and integrated into the brainstem. Feedback messages are sent to the eyes to help maintain steady vision and to the muscles to maintain and help balance and posture.

What Are The Most Common Symptoms Of Vestibular Disorders?

The following are the most common symptoms that can be helped with vestibular rehabilitation:

• Dizziness or blurry vision with head movements
• Neck tightness, stiffness, and pain
• Imbalance or the need to hold onto objects when walking
• Headaches
• Frequent falls
• Generalized “dizziness, wooziness and foggy head” feelings
• Vertigo/spinning

Who Benefits From Vestibular Rehabilitation?

Vestibular rehabilitation is an effective treatment for patients experiencing dizziness and balance disorders. Patients typically referred for vestibular rehabilitation therapy are those diagnosed with dizziness, imbalance, vertigo, Meniere’s syndrome, benign paroxysmal positional vertigo (BPPV), neck-related dizziness, and migraines. Other candidates are patients who have had a stroke or brain injury or who frequently fall. The goals of the rehabilitation are to facilitate compensation after the vestibular dysfunction has occurred to decrease symptoms of vertigo and dizziness and improve balance facilitating a return to previous activities. Clinical evidence suggests that vestibular rehabilitation combined with medication can be more effective to improve symptoms and function.

What Can You Expect From Your Physical Therapy Visit?

At your appointment, a physical therapist will evaluate your symptoms and review your medical history. Your assessment will include all or part of the following areas:

• Balance and leg strength/flexibility
• Gait (how you walk)
• Visual stability and mobility
• Neck mobility and neck and arm strength
• Positional testing, including an inner ear exam

A plan of care is developed based on our therapist’s findings. The goal of your treatment plan is to improve any deficits identified. This is achieved by customizing exercises to address each person’s specific problem(s). Therefore, before an exercise program can be designed, a comprehensive clinical examination is needed to identify problems related to the vestibular disorder. Depending on the vestibular-related problem(s) identified, three principal methods of exercise can be prescribed:

• Habituation
• Gaze Stabilization
• Balance Training

These exercises will improve your ability to function in activities of everyday living, reduce your risk of falling, and ultimately, and improve your quality of life.