Vestibular Rehabilitation

What is Vestibular Rehabilitation and Balance Retraining?

A movement/exercise approach with the goals of:

Decreasing or eliminating dizziness/vertigo

improving balance, gait, and safety.

Improving visual motor control and tolerance of motion

Increasing activity levels

Reducing falls or risks for falls

Improving reflexes and sensory organization

What are the Symptoms of Inner Ear Vestibular Pathology?

Dizziness / vertigo

Imbalance / unsteadiness

Visual motor disturbances

Nausea

Headaches

Bouncing Vision

Nystagmus (Jerky eyes)

Motion Disturbances

Gait Disturbances

Because the vestibular system interacts with so many other parts of the nervous system, secondary symptoms of memory problems, muscular stiffness, imbalance, weakness, fatigue and anxiety may be experienced.

What are some of the causes of vertigo and imbalance?

Viral / bacterial infections

Trauma

Meniere's Disease

Ototoxicity

Vascular ischemia

Benign Paroxysmal Positional Vertigo (BPPV)

Mal de Debarquement syndrome (MdDS)

Vestibular migraine

Seizures

Persistent Postural Perceptual Dizziness (PPPD)

Multiple Sclerosis (MS)

Cerebrovascular accident (CVA)

Cerebellar Disorders

Tumors

Concussion

Childhood Vertigo

Cervical injuries

Who would benefit from vestibular rehabilitation and balance retraining?

Persons suffering from chronic, episodic, acute vertigo, motion disorders, and imbalance.

What is involved in the therapy?

A thorough evaluation process is conducted to determine a comprehensive problem list affecting the person's ability to function. 4 main areas are addressed:

01

Neuromuscular evaluation

02

Visual Motor Assessment

measured by infrared video goggles and visual observation

03

Balance
Assessment

measured by standardized tests and a computerized forceplate

04

Vertigo
Assessment

05

Developmental of equilibrium and protective reflexes

Specific goals for the patient are developed and the exercise/movement program is initiated.

Vestibular habituation / adaptation exercises

Specific movements or positions that provoke the patient's dizziness are provided and the patient is asked to repeat these movements until the brain habituates the response or adapts to the conflicting information. This process resolves the conflict between the brain and the ear.

Compensation - Stimulating remaining sensory and motor systems to compensate for a loss of vestibular function

Visual motor exercises

The ear nerve has a connection that goes to the eye muscles and can affect the person's ability to maintain gaze, focus and tolerate visual motion. If dysfunction is identified in this vestibular ocular mechanism, visual motor exercises including Custom designed APPs are used for gaze stabilization, eye head coordination, optokinetic, fusion, and visual motion.

Canalith Repositioning Procedures for Benign Positional Vertigo

Specific Maneuvers (including Epley, Semont, Half Summersault, log roll, etc) involves moving the patient's head in a sequence of positions for a certain time period in order to move the "ear rocks" or otoconia around the semicircular canals to reposition them into the proper place in the inner ear. This procedure is 95% effective in eliminating benign positional vertigo in 1-4 visits.

Balance retraining exercises

Exercises designed to improve coordination of muscle responses as well as the organization of sensory information from eyes, ears and tactile/muscle receptors for balance control (measured by a computerized forceplate). Posture, gait, equilibrium, and reflex training are included.

Frequency

Patients are typically seen on an outpatient basis once every 1-2 weeks and provided a specific daily home program that is upgraded as appropriate. This program addresses the specific problems and goals of the individual patient.

Outcomes of Vestibular Therapy

Diagnosis Outcome

0%

Benign Positional Vertigo

(N=10,000 patients)

0%

Vestibular neuronitis

(N=1,500 patients)

0%

Disequilibrium of Aging

(N=500, includes fall reduction)

0%

Labyrinthine concussion (Dizziness)

(N=400 patients)

0%

Acoustic neuroma

(N=100 patients)

0%

Ototoxicity

(N=45 patients)

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