Vertigo / Dizziness / Vestibular Rehabilitation

Vestibular Rehabilitation

What is vestibular rehabilitation?

Vestibular rehabilitation is an exercise approach to decrease disequilibrium and dizziness symptoms associated with peripheral vestibular ("inner ear") pathology. A common neurological 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 (decreased effectiveness) and sedating side effects that frequently limit the patient's ability to perform useful activities. Vestibular rehabilitation is an alternative form of treatment involving specific exercises designed to (1) decrease dizziness; (2) increase balance function; (3) increase general activity levels. The exercise program is designed to promote central nervous system compensation for the inner ear deficits. Patients are asked to exercise daily at home and to visit the physical therapist during an initial period of 4-6 weeks.

Which Patients Need Vestibular Therapy?

Not all patients who have an inner ear disorder need vestibular rehabilitation. Patients who do not demonstrate a spontaneous resolution of dizziness and disequilibrium within 4 weeks of their onset may benefit from therapy. In these patients, the central nervous system seems unable to adequately compensate for inner ear deficit. Many patients have undergone a period of medical management using medication 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 may significantly improve their symptoms following vestibular rehabilitation. An example of people in this category would be people diagnosed with labyrinthitis or vestibular neuritis ("inner ear infections") or people who have known unilateral or bilateral vestibular deficits.

Another type of patient who may benefit from vestibular rehabilitation is one with abrupt or acute loss of vestibular function (i.e. benign positional paroxysmal vertigo). Also, patients who have surgery for unresolved vestibular problems will benefit from a vestibular rehabilitation program designed to help the patient effectively compensate for his/her inner ear disorder.

Physician’s Referral

Vestibular rehabilitation programs are designed to decrease vertigo and disequilibrium associated with peripheral vestibular abnormalities. There are many causes of dizziness, not all the result of vestibular deficits. Therefore it is recommended that patients entering a therapy program have seen their family doctor or a specialist regarding their symptoms. Typically the specialist will be an otolaryngologist or a neurologist.

Common conditions

BPPV (Benign Paroxysmal Positional Vertigo)
BPPV causes dizziness because of debris in the inner ear. The debris is actually crystals in the inner ear that have moved from their usual location ("otoliths") to an area in the inner ear that is responsible for sensing head motion ("semicircular canals"). When you are suffering from this condition a simple head tilt or lying down can trigger vertigo (spinning sensation) that is short lived. The episodes of vertigo are intermittent and may resolve on their own and return again spontaneously. BPPV can be spontaneous at the onset, but can also be triggered by head injury, vestibular damage, aging, or infection.

The treatment for BPPV is fairly straight forward and typically very successful on the first visit!

Cervicogenic Dizziness (Neck dysfunction)
Occasionally problems with your neck can trigger dizziness. This dizziness is generally not described as spinning, but can feel like a sense of imbalance or unsteadiness with head movement. A physiotherapist can assess your cervical spine and determine whether your symptoms are derived from your spine or of vestibular origin.

Vestibular Damage
The vestibular system can be damaged in many ways: viral infections (labyrinthitis, vestibular neuritis), fluctuating fluid levels in the inner ear (Meniere's Disease), trauma from head injury (vestibular concussion), benign tumours and degeneration from aging.

When the vestibular system is damaged it has little ability to repair itself. The body recovers by having part of the brain that controls balance re-calibrate itself to compensate for the unmatched signals being sent from the damaged and well ears. This compensation occurs naturally in most people. Some patients require help from vestibular rehabilitation therapy in order to recover from an injury to the vestibular system.

The website has helpful information regarding vestibular disorders and vestibular rehabilitation. Our therapists will also be happy discuss any questions or concerns you have during your appointment!

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