What is Vestibular Rehabilitation?

Vestibular rehabilitation, or balance retraining therapy (BRT), is a scientifically based and clinically valid therapeutic modality for the treatment of persistent dizziness and postural instability due to incomplete compensation after peripheral vestibular or central nervous system (CNS) injury. Balance retraining therapy is also of significant benefit for fall prevention in the elderly patient after suffering from multiple sensory and motor impairment.

Patients with inner ear disorders are often referred to physical therapy for primary symptoms of dizziness, balance disorders and visual motor disturbances. In addition, many of these patients have developed secondary symptoms associated with reduced activity levels. Secondary symptoms include decrease strength, loss of range-of-motion, increased tension, particularly in the cervical and shoulder region, leading to muscle fatigue and headaches. Physical Therapy helps alleviate primary and secondary symptoms.

The symptoms result from a medical pathology within the vestibular system that reduces the patient's ability to move about his or her environment without imbalance, vertigo, and visual motor disturbances. Even moderate dizziness can result in a significant disabling condition that can diminish quality of life. This can result in medical, economical, and social dysfunction.

What is the frequency of inner ear disorders?

The problem of dizziness and disequilibrium associated with peripheral vestibular pathology is significant, second only to low-back complaints in frequency and symptoms. A common neuro-otological approach to managing the dizzy patient with balance problems is to administer medication designed to suppress vestibular function. However, many of the medications used for inner ear disorders have the disadvantage of potential habituation and sedating side effects that frequently limits the patient's ability to perform useful activities.

Vestibular rehabilitation is the treatment of choice and in most cases is medically necessary, involving specific exercises designed to 1). decrease or eliminate dizziness, 2). Increase balance function and safety, 3). Improve visual motor control, and 4). Increase general activity levels. The exercise program is designed to either promote CNS compensation for inner ear deficits or correct the pathology.

Patients are asked to exercise daily at home and to visit the physical therapist during the initial period of 8 - 10 visits.

Which patients need Vestibular Rehabilitation?

Not all patients who have inner ear disorders need vestibular rehabilitation. Patients who do not demonstrate a spontaneous resolution of symptoms such as disequilibrium or dizziness with 3 - 4 weeks of their onset will benefit from physical therapy. In these patients, the central nervous system seems unable to adequately compensate for the inner ear deficit. Many patients have undergone a period of medical management using medications to suppress vestibular function and reduce symptoms, with little or no success. Symptoms become chronic, often lasting for periods of months or years. These patients with unresolved inner ear disorders typically significantly improve following vestibular rehabilitation.

What happens in the exercise program?

The treatment of a patient with inner ear disorders focuses on improving balance function, decreasing dizziness symptoms through vestibular habituation exercises, improving occulomotor control, and increasing overall activities for long-term retention of gains made in therapy. In some instances, a patient may receive only vestibular habituation or repositioning exercises if balance function is not affected.

Successful remediation of dizziness is dependent on determining the specific movements and/or positions that provoke the patient's dizziness or vertigo. These exercises are based on the rationale that through repeated exposure to the specific stimulus causing the vertigo, the brain will habituate or soothe the vertigo response. The patient is asked to keep a daily log noting frequency of exercises and changes in symptoms.

Visual movements to improve gaze stabilization, tracking, scanning and eye-head coordination due to abnormal vestibular-ocular reflex movements associated with inner ear pathology.

Balance retraining involves exercises designed to improve coordination of muscle responses as well as the organization of sensory information for balance control. Again, the emphasis is on a home program of exercise including gradual involvement in a daily exercise activity such as walking to insure the patient maintains movements. Safety and appropriate balance strategies are emphasized. During outpatient therapy, progress is monitored, home exercises are modified and updated with safety emphasized, and specific balance retraining exercises are involved.

This maneuver involves moving the patient's head in a sequence of proper positions for a designated amount of time, and by this means move "ear rocks" or otoconia around the semicircular canal to dump them into a proper position in the inner ear. There is a specific 48hr. protocol for the patient to follow after this procedure. This type of treatment may result in correcting the BPPV within 1 - 4 treatments.

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