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Vestibular Rehabilitation - An Overview

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Vestibular rehabilitation therapy is a series of exercises done to alleviate problems caused by vestibular disorders such as vertigo and dizziness.

Medically reviewed by

Dr. Vinay. S. Bhat

Published At October 7, 2022
Reviewed AtMarch 30, 2023

What Is Vestibular Rehabilitation?

The vestibular rehabilitation program is an exercise program that is designed by a vestibular physical therapist. It is done in patients with vestibular disorders. It involves a series of exercises done so as to improve the symptoms of vestibular disorder, such as dizziness, vertigo, imbalance, and falls. A customized exercise plan is made to assess the laboratory findings, clinical assessment, and other tests performed. This exercise plan will vary from patient to patient on the severity of the symptoms and on the age of the patient.

The recovery from the disease will vary and depend upon activity level, pain, and other medical conditions. For people with a vestibular disorder, there is no permanent treatment, but this exercise will help the body get adjusted to it. This is because the brain will learn to use the other senses, like vision and body sense, to compensate for the deficient vestibular system. For most people, the compensation will happen on its own over time, but for some people, this will not happen, and in such people, vestibular rehabilitation will help to overcome this.

What Are the Indications for Vestibular Rehabilitation?

Vestibular rehabilitation is indicated in patients with dizziness, benign paroxysmal positional vertigo, Meniere's syndrome, imbalance, vertigo, neck-related dizziness, stroke, brain injury, and migraines.

The symptoms which can be treated with vestibular rehabilitation are:

  • Imbalance and need to take support while walking so as not to fall.

  • Neck stiffness and pain.

  • Vertigo (the feeling that the environment around is spinning).

  • Generalized dizziness.

  • Frequent falls.

  • Headache.

For rehabilitation, the following are assessed:

  • The way you walk (gait).

  • Visual stability and mobility.

  • Neck mobility and neck and arm strength.

  • Positional testing.

  • Inner exam.

  • Balance.

  • Leg strength/ flexibility.

After the evaluation, a treatment plan is made. The objective of the treatment is to limit the symptom so that it does not affect the day-to-day living of the patients and reduce the risk of falling and hence, improve the quality of life.

What Are the Types of Exercises Included in Vestibular Rehabilitation?

Depending on the vestibular-related problem, there are three principal methods of exercise, they are:

  • Habituation.

  • Gaze stabilization.

  • Balance training.

1) Habituation Exercise

Habituation exercises are designed to treat patients with dizziness upon sudden movement. Habituation exercises are aimed at addressing the dizziness caused due to self-motion or visual stimuli. This exercise is indicated in patients who feel dizzy upon sudden head movements, like when they suddenly bend or look upwards. This is appropriate for patients who complain of increased dizziness in visually stimulating environments like shopping malls and grocery shops when watching tv and when walking over patterned floors or shiny carpets and shiny floors. The goal of this exercise is to reduce dizziness through repeated exposure to the causative factors. What they do in these exercises is to provoke the patient's symptoms of dizziness. Over time the brain learns to adjust to the stimuli.

2) Gaze Stabilization

The objective of this exercise is to improve eye stability on stationary objects while the head is moving. It will help to control eye movements. These patients will feel like the world appears to bounce or jump around when trying to identify the objects in the environment.

The therapist will make you do the following exercises in order to assess the patient and to decide which exercise suits the patient.

  • Look straight and fix your eye on an alphabet at eye level in front of you.

  • Turn your head side to side, keeping your eyes stable on the alphabet, increase the speed of your head movement and slow down when you feel too dizzy.

  • Repeating the exercises for a longer time brings on mild to moderate symptoms; on repeated doing, the time duration till the symptom appears will increase. Gradually the patient will be able to do it three to five times per day.

3) Balance Training Exercises

Balance training exercises are done to improve steadiness so that patients can lead normal lives. Exercises are designed so as to address the underlying different balance problems. The aim of these exercises is to improve the patients' stability while walking and to reduce fall risks. For patients with benign paroxysmal positional vertigo (BPPV), this type of exercise is not suitable as these exercises will not resolve this condition.

What to Expect From Vestibular Rehabilitation?

The vestibular rehabilitation therapy is done on an outpatient basis. The patient is consulted by a licensed physical therapist. Prior to the treatment, detailed case history is taken, and other assessments are done. Also, the therapist will take the details of how the condition is affecting the daily living of the patient. Other than that, they will collect information about medications, hearing or vision problems, and other medical conditions. Depending upon all these factors, exercises are custom-designed for each patient. Expected vestibular rehabilitation outcomes include:

  • Decreased risk of falling.

  • Decreased dizziness.

  • Improved balance.

  • Improved ability to stabilize the vision.

  • Increased confidence in maintaining balance while walking or doing other activities.

  • Improved neck movements and reduced symptoms.

How Successful Is Vestibular Rehabilitation Therapy?

Vestibular rehabilitation therapy has good outcomes for patients suffering from vestibular disorders. Sometimes vestibular rehabilitation is the only treatment required, and in some other cases, it might be advised pre or post-surgery. Patients who follow the instructions given by the therapist in a proper way seem to have good results on balance and dizziness problems.

What Factors Can Impact the Recovery?

For patients undergoing vestibular rehabilitation, various factors can impact the results. The following is discussed below:

  • For patients with progressive vestibular disorders like multiple sclerosis, migraine, and Meniere's syndrome, success with VR is difficult as compensation can be difficult to achieve.

  • Whether one or both the ear is affected.

  • The problem lies within the vestibular part of the brain rather than the vestibular part of the ear.

  • Sedentary lifestyle.

  • Pain.

  • Presence of other medical conditions.

  • Certain medications.

Conclusion

Vestibular rehabilitation is a set of exercises that are advised for patients having vestibular-related problems. These exercises are designed by a specially trained vestibular physical therapist. These exercises advised are specifically designed for each patient according to the condition suffering and also depend upon the patient's other conditions. These patients suffering from dizziness and balance-related problems will learn to get adjusted and have a better quality of life.

Frequently Asked Questions

1.

What Are the Symptoms of Vestibular Problems?

Vertigo and dizziness are the two symptoms of vestibular problems. The symptoms include disorientation, blurred vision, and spinning sensations. Less common symptoms include anxiety, fear, nausea, vomiting, and arrhythmia.

2.

What Differentiates Vertigo From Vestibular Balance Disorder?

Vertigo is a symptom of vestibular balance disorder, and it feels like spinning due to loss of vestibular balance control. In contrast, vestibular balance disorder arises as a result of infection or injury to the inner ear.

3.

What Causes Vestibular Balance Disorders?

Vestibular disorders affect orientation and balance. Factors that affect vestibular balance include infections, certain medications, traumatic injury to the brain, poor circulation in the ear, and calcium debris in the semicircular canals. The other factors include aging, genetics, and environmental problems.

4.

What Does Vestibular Rehabilitation Include?

Vestibular rehabilitation involves exercises depending on the vestibular-related problem. The exercises include habituation, gaze stabilization, and balance training. The exercises are designed to treat patients with dizziness, improve eye stability on stationary objects while the head is moving, and improve steadiness so patients can lead normal lives.

5.

How To Perform Vestibular Rehabilitation?

Vestibular rehabilitation involves three types of exercises depending on the cause. 
  - Habituation exercise is indicated in patients who feel dizzy upon sudden head movements, like when they suddenly bend or look upwards. This is appropriate for patients who complain of increased dizziness in visually stimulating environments like shopping malls and grocery shops when watching Tv and walking over patterned floors or shiny carpets and shiny floors. In these exercises, the therapist provokes the patient's symptoms of dizziness, and over time the brain learns to adjust to the stimuli.
- The gaze stabilization exercise involves the following steps:
  - Look straight and fix your eye on an alphabet at eye level in front of you.
  - Turn your head side to side, keeping your eyes stable on the alphabet, increase the speed of your head movement and slow down when you feel too dizzy.
  - Repeating the exercises for a longer time brings on mild to moderate symptoms; on repeated doing, the time duration till the symptom appears will increase. - Gradually the patient will be able to do it three to five times per day.
  - Balance training exercises are done to improve steadiness so that patients can lead normal lives. Exercises are designed to address the underlying different balance problems. The aim of these exercises is to improve the patients' stability while walking and to reduce fall risks.

6.

Do Vestibular Problems Cause Tiredness?

The symptoms of vestibular balance disorders include fatigue, poor concentration, nausea, hearing loss, and ringing in the ear.  The vestibular nerve sends sensory messages to the brain and maintains the body's posture and balance. Swelling or trauma to the vestibular nerve can cause dizziness and vertigo. One might also feel tired.

7.

Is Vestibular Rehabilitation Efficacious?

Vestibular rehabilitation focuses on treating the symptoms of vestibular disorders such as dizziness, vertigo, gaze instability, imbalance, visual disturbances, and falls. There is evidence that proves vestibular rehabilitation is effective in improving the quality of life in patients with vestibular disturbances. Visual rehabilitation also treats secondary symptoms such as decreased stamina, muscle, joint stiffness, and worsening of the previous symptoms.

8.

What Is The Time Taken for Vestibular Rehabilitation Therapy to Work?

Vestibular rehabilitation therapy has good outcomes for patients suffering from vestibular disorders. Sometimes vestibular rehabilitation is the only treatment required, and in some other cases, it might be advised pre or post-surgery. Patients who follow the instructions properly given by the therapist have good results with balance and dizziness problems within 6 to 8 weeks.

9.

Why Do I Suffer From Dizziness After Vestibular Therapy?

Vestibular rehabilitation involves adapting the brain to new patterns to resolve vestibular balance disorders' symptoms. After doing the vestibular exercise, the brain attempts to adapt to it, and hence, many people may suffer from increased but manageable dizziness and fatigue. Sometimes, vestibular exercises can affect the neck causing neck problems and can make you feel worse.

10.

Can Vestibular Exercises Be Overdone?

Vestibular rehabilitation exercises can cause manageable nausea, vomiting, and dizziness. As these exercises affect the brain, one should not overdo them. Also, the span of exercises depends on the severity of dizziness. So, it must not be overdone.

11.

How Is Living With Vestibular Disorders?

People with vestibular disorders can easily fatigue in a crowded environment, so they must avoid bright lights, altitude changes, and rapid movements. People with ear infections suffer from altitude changes, so flights must be avoided for traveling. People with vestibular disorders also suffer from vision problems, so powerful and progressive lenses should be avoided.

12.

Can You Do Vestibular Therapy at Home?

Vestibular exercises are prescribed based on the diagnosis and severity of the condition by the occupational therapist. Home-based exercises help treat vestibular balance disorders. Therefore, home-based exercises must be done as and when prescribed by the therapist.

13.

How to Relax a Vestibular Nerve?

The vestibular nerve can be calmed down by vestibular suppressing drugs, which are not to be taken for more than three days. These drugs include Diazepam, Lorazepam, and Meclizine. These drugs reduce dizziness and are not recommended for long-term use.

14.

What Are the Effects of Vestibular Disorder on the Eyes?

A common problem associated with vestibular disorder is a vision problem. People with visual disturbances cannot focus on a particular object. They have spinning sensations called vertigo, vision bounce or oscillopsia, and double vision or diplopia. To treat vision problems, the first approach must be made to treat the type of vestibular disorder. The treatment generally involves medication, physical therapy, or surgery.
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Dr. Vinay. S. Bhat
Dr. Vinay. S. Bhat

Otolaryngology (E.N.T)

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