Vestibular (Balance) Rehabilitation

Dizziness, vertigo and imbalance are just a few of the symptoms patients with vestibular disorders may have. Patients may also experience nausea, hearing changes, anxiety, fatigue and trouble concentrating.

There are several causes and types of vestibular disorders that can be determined by your physician. A thorough evaluation will determine the type of vestibular deficit and its effect on balance, which will lead to an appropriate course of therapy. The most common causes include:

Benign Paroxysmal Positional Vertigo (BPPV)

BPPV is one of the most common types of peripheral vertigo. Its exact cause is unknown. It becomes more common as we age – sometimes following a head trauma, but many times the cause is unknown. The symptoms are caused by debris that has collected within a canal in the inner ear. The debris consists of small calcium carbonate crystals, often called “ear rocks,” that move through the canal as head position changes. This sends incorrect signals to the brain and produces the sensation of vertigo.

Activities such as getting out of bed, bending over, or looking up when reaching for something overhead will often provoke the symptoms. Symptoms may not occur all the time, and they may occur with only one or all of the activities.

Vestibular Neuritis &Labyrinthitis

Vestibular neuritis and labyrinthitis are caused by an irritation of the vestibular nerve within the inner ear due to an infection. The infection is typically viral and can be preceded by any systemic viral infection like the common cold. The infection can move to the inner ear and cause irritation of the vestibular nerve. The irritation of the nerve results in an often sudden attack of vertigo and possible nausea. The symptoms are initially severe and can last for a period of one to four days with gradual improvement over the next several weeks. For many people, the symptoms will resolve on their own. For others, activities like driving, walking through the grocery store, crowds, malls or airports continue to cause dizziness and imbalance. These individuals may also notice difficulty concentrating, fuzzy vision and symptoms worsening with fatigue.

Treatment through Vestibular Rehabilitation

If you have a vestibular disorder, we will provide an evaluation to determine the best course of therapy for your vestibular deficit and its effect on your balance and quality of life.

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Vestibular Rehabilitation Therapy (VRT)

When the vestibular system has been affected due to one of the above conditions, the brain cannot rely on the information it is receiving from the vestibular system. Your ability to maintain balance is now dependent on vision and signaling from muscles and joints. This can lead you to compensate for the change by avoiding various head positions and movements because these increase their symptoms. The avoidances help decrease the number of instances of dizziness and nausea, but result in headache, muscle stiffness, fatigue and decreased ability for the brain to adapt to the change in the vestibular system. Overall these avoidances make symptoms worse and increase the need for Vestibular Rehabilitation Therapy (VRT). VRT includes:

  • Gaze-Stabilization Exercises:

    Adaptation exercise may be employed in order to help your brain adapt to new signaling from the affected vestibular system. Visual fixation on a target during head movement is a key gaze-stabilization exercise given to assist in this retraining.

  • Balance Retraining Exercises:

    When the vestibular system has been affected by vestibular neuritis or labyrinthitis, the nerve signaling related to balance and walking has also changed. Balance retraining involves exercises designed to improve coordination of muscular responses as well as the organization of sensory information (from eye sight and the vestibular system) for balance control.

  • Canal Repositioning Maneuvers:

    When the patient has been affected by BPPV, canal repositioning maneuvers are indicated. During the evaluation, the blocked canal will be identified. Once the location has been detected, a canal repositioning maneuver will be used to dislodge or reposition the debris within the affected canal.