What happens in a VRT assessment?
The trained and specialized therapist does a thorough evaluation of the person’s medical history, symptoms, onset of symptoms, provocations, fall history, loss of function, and work/school/driving status. Specific movement assessments include:
- Eye-head movements using specialized technology of infrared video goggles to observe and record results are assessed. The inner ear nerve has a neural pathway that goes from the ear to the brain and then to the eyes for eye stability and eye-head coordination. When this pathway is disrupted by a vestibular disorder, the eyes may jerk abnormally causing a condition called nystagmus. The jerking of the eyes can cause people to experience symptoms of vertigo, poor tolerance of visual motion, bouncing vision (oscillopsia), light sensitivity, and blurred vision. The direction the eyes jerk can indicate what part, and which ear the vestibular disorder is located.
- Vertigo/dizziness assessments are done to determine what specific movements and situations provoke the person’s vertigo or dizziness symptoms. The specific provocations, the intensity of symptoms, and the duration of how long it takes for the person’s symptoms to subside are all recorded. In which head or body movements the person experiences vertigo can be indicative of what part of the inner ear is dysfunctional.
- Balance and gait (walking) assessments include standing or walking on a force plate that works with a computer monitor in front of the patient (posturography), help to determine the patient’s balance abilities. These posturography standardized test results are compared to people their age and size to determine if their balance is normal or abnormal. Other clinical balance tests include standing on one foot, stepping, walking tandem, walking with head movements, turning, walking up/down stairs/inclines and on different surfaces. Sensory organization tests include having the patient walk/stand with surface changes and with/without vision to determine how much they are using their visual and proprioceptive systems for balance instead of their vestibular systems.
- Physical assessments of ankle and hip mobility for balance, range of joint motion, sensations, and general strength are included.
What is the treatment?
Based upon the evaluation results, goals are set, and treatment begins.
Treatment consists of specific prescribed exercises that the patient does in the clinic and the patients are also provided a specific daily home program with the instructions in writing with diagrams. Categories of exercises include:
- Repositioning maneuvers for benign paroxysmal positional vertigo (BPPV) if needed.
- Vestibular habituation and adaptation exercises to build up tolerances for motion, and to resolve the conflict between the brain and inner ear
- Motion de-sensitization
- Eye head movements and videos/APPs of visual exercises
- Balance, gait and safety training and assessing the need for assistive or mobility devices
- Education, resources and emotional support
Are the exercises difficult and do they make the dizziness worse?
The exercises appear simplistic, but they are working a complicated system. Patients often have an increase of symptoms when they first begin the exercises because they are working a weak system. Just like when someone begins a physical exercise program the muscles ache before they increase in strength. Symptoms should abate within 30-60 minutes after the exercises. If they are lasting longer the therapist will modify the program to the patient’s tolerances. If the patient continues the prescribed exercises, the symptoms typically steadily improve with time and repetitions within 3-4 weeks (dependent upon the diagnosis).
Are there precautions with VRT?
The biggest precaution is safety and that the patient understands how to safely do the exercises at home, to monitor the symptoms and to have effective communications so the therapist can appropriately update or modify the programs. Specific lists of things the patient should be aware of, and to contact the therapist regarding are given to the patient and patient education is provided at each VRT session.
Does VRT work?
Yes, this is an extremely successful program with outstanding results in symptom reduction and in many cases elimination, but the success depends upon the compliance of the patient and /or family. The patient must understand that therapy is a process. In some cases, as in BPPV, there may be symptom resolution in 1-2 visits. But in many vestibular cases, it may take 2-3 months (longer or shorter dependent upon diagnosis and response to treatment) for symptom resolution.