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Vestibular Rehabiliation

WHAT IS VESTIBULAR REHABILITATION?

Vestibular

Vestibular Rehabilitation is the use of specific exercises to eliminate or reduce vestibular problems and their secondary effects.

During your initial assessment your physiotherapist will identify the exact circumstances that provoke your symptoms, for example rolling over in bed, turning your head to reverse the car, walking on uneven ground or in the dark.

If appropriate you will be given an exercise program that has been designed to address your specific problems that were identified in your initial assessment.

Exercise programs usually involve repeated exposure to the circumstances which challenge your vestibular system until its response becomes more normal. That is, you no longer feel dizzy, nauseous, lose your balance or have blurred vision in those situations. This occurs due to a process called “vestibular compensation”. As you progress you will be challenged in different ways to continue to get the maximal benefits from your program.

WHAT IS THE VESTIBULAR SYSTEM?

Vestibular

The Vestibular system consists of the semi-circular canals (see picture) and the Otoliths (utricle and saccule) in the inner ear, on both sides of the head, as well as specific parts of the base of the brain (the brainstem) called the vestibular nuclei.

Information from the inner ear travels along the vestibular nerves to the brainstem. This information is analysed and the brain responds by sending messages along nerves to the muscles of the limbs, body and eyes. In this way the vestibular system is involved in the control of balance, and coordination of eye and head movements. This enables us to sit, stand and walk without falling, and to maintain clear vision, no matter the position or speed of movement of the head.

Problems in one inner ear can lead to an imbalance in the information coming to the brainstem resulting in one or more of the following:

  • Vertigo – sense that the world, or sometimes self, spinning or moving
  • Dizziness – various sensations including spinning or wooziness in the head
  • Light headedness
  • Blurred vision – often when moving your head
  • Disequilibrium – the sense of being off balance
  • Veering to one side when walking
  • Falls
  • Motion Sensitivity – dizziness, imbalance and/or nausea triggered by changes in position, repeated movements, or travelling in a vehicle

Problems in the inner ear on both sides of the head are often more severe than those experienced by people with problems on one side only. When only one side is affected the unaffected side can take over some of the role of the damaged side and compensate for the loss, resulting in minimal reduction in function. However, when both sides are affected the vestibular system has difficulty functioning normally. As a result you might experience:

Blurred vision when moving your head, walking or in a moving vehicle, this often results in:

  • Objects in the distance appearing to jump or bounce
  • Difficulty reading street signs
  • Difficulty recognising people’s facial features at a distance.

Disequilibrium – the sense of being off balance and unsteadiness in standing or walking, especially with head movements, on uneven surfaces and in poorly lit or dark environments Falls.

In addition, secondary effects can develop, particularly in cases where the vestibular problems have been present for a while. These occur as a result of avoiding movements or activities that provoke your symptoms or make you feel unsafe. They can include:

  • Stiffness and/or pain in the neck from restricting head or eye movements
  • Headaches or eye aches
  • Reduced fitness or stamina
  • Inability or reduced ability to participate in recreational and sporting pursuits, or to perform certain work/home duties

Many patients have neck pain and headaches associated with their vertigo, dizziness or imbalance. Musculo-skeletal physiotherapy can provide some relief for these symptoms, however, if the problem is vestibular in origin then the neck pain and headaches are usually secondary problems. In this case treatment of the neck will not have a lasting effect and only resolution of the vertigo, dizziness or imbalance will achieve this.

WHY VESTIBULAR REHABILITATION CAN HELP?

Numerous research studies have demonstrated the effectiveness of vestibular rehabilitation as opposed to general balance and conditioning programs. Many patients report that they have had “balance retraining” and found it did not help them. However, frequently these patients were seen by therapists who lacked specialised training and certification, and they did not receive a specific program targeting their individual needs.

The types of progressions you might be given include performing exercises:

  • Involving more complex eye and head movement combinations
  • In less stable positions such as sitting, standing and then walking
  • Doing exercises slowly and then progressing to faster as able
  • With your eyes open and then with eyes closed
  • Standing on a firm surface such as the floor and progressing to an unstable surface such as carpet, grass or a cushion.

TYPES OF CONDITIONS THAT MAY BENEFIT:

Benign Paroxysmal Positional Vertigo (BPPV)

Treatment depends on the type and site and includes particle repositioning manoeuvres such as the Epley, Roll or Semont. The Epley manoeuvre has been shown in recent research to be the most effective in management of BPPV & is used in this practice for posterior canal canalithiasis, which is the most common type of presentation.

Other vertigo dizziness and / or balance problems:

  • Early stage and chronic hypofunction following labyrinthitis or vestibular neuronitis
  • Following vascular insult to the labyrinth, brainstem or cerebellum
  • Pre and post surgery for Acoustic Neuroma
  • Vestibular symptoms associated with MS, stroke or tumor
  • Vestibular hypofunction secondary to ototoxicity
  • Age related vestibular problems
  • Falls or fear of falling
  • Motion Sensitivity
  • Dizziness, imbalance and nausea triggered by position changes, repetitive activities or traveling in a vehicle

Ocular Dizziness

Dizziness, imbalance, & an array of other symptoms including nausea & fatigue triggered by visual stimuli such as computers, reading, crowded environments or traffic.

Mal de Debarquement Syndrome:

Ongoing illusion of movement lasting weeks to years after travel by boat, plane or train. Symptoms include feelings of rocking, floating or swaying sometimes accompanied by imbalance & nausea. Symptoms are often more noticeable when still or after quick movements, and improve with constant steady movement. Most individuals with this diagnosis are women between the ages of 40 and 50 and they develop symptoms after disembarking which may persist for months or even years.

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