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Vestibular Rehabilitation

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
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
Meniere's Disease
Vascular ischemia
Benign Paroxysmal Positional Vertigo (BPPV)
Mal de Debarquement syndrome (MdDS)
Vestibular migraine
Persistent Postural Perceptual Dizziness (PPPD)
Multiple Sclerosis (MS)
Cerebrovascular accident (CVA)
Cerebellar Disorders
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:
Neuromuscular evaluation
Visual Motor Assessment
measured by infrared video goggles and visual observation
measured by standardized tests and a computerized forceplate
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.
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
Benign Positional Vertigo
(N=10,000 patients)
Vestibular neuronitis
(N=1,500 patients)
Disequilibrium of Aging
(N=500, includes fall reduction)
Labyrinthine concussion (Dizziness)
(N=400 patients)
Acoustic neuroma
(N=100 patients)
(N=45 patients)
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