Vestibular Rehabilitation - An Overview

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 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, depending on the severity of the symptoms and 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 that 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 one walks (gait).

• Visual stability and mobility.

• Neck mobility and neck and arm strength.

• Positional testing.

• Inner examination.

• Balance.

• Leg strength or flexibility.

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

What Is the Process of Vestibular Rehabilitation Therapy?

Balance issues and dizziness are related. One way to manage symptoms of dizziness, such as imbalance, is through vestibular rehabilitation therapy. Knowing more about the causes of extreme vertigo and how the body maintains equilibrium may help better comprehend how therapy operates.

• Dizziness - When something interferes with the sensation of spatial orientation, dizziness results. The brain determines the body's position in relation to its surroundings, which is known as spatial orientation. Following that, one might experience dizziness or vertigo.

• Balance - The interaction between the brain's central nervous system and its sensory organs determines how balanced one feels. The sensory system consists of the inner ear's vestibular labyrinth, eyes, muscles, joints, and skin.

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 instruct to do the following exercises to assess the patient and to decide which exercise suits the patient.

• Look straight and fix the eye on an alphabet at eye level in front.

• Turn the head side to side, keeping the eyes stable on the alphabet. Increase the speed of the head movement and slow down when one feels too dizzy.

• Repeating the exercises for a longer time brings on mild to moderate symptoms; on repeated doing, the time duration until 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 designed to improve steadiness so that patients can lead normal life. They aim to address the underlying balance problems, improve the patients' stability while walking, and reduce fall risks. However, this type of exercise is not suitable for patients with benign paroxysmal positional vertigo (BPPV), as it 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. A detailed case history is taken before the treatment and other assessments are done. Also, the therapist will provide details about 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 are 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 ears are 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.

What Is the Average Duration of a Vestibular Rehabilitation Course?

That is contingent upon the particular circumstances. The reason behind the dizziness or balance problems, as well as how one reacts to treatment, will determine the degree of therapy one needs. Some individuals only require one or two sessions. Certain individuals might require continuous care for several months, which would involve self-directed exercises.

What to Anticipate Following This Treatment?

That is contingent upon the particular circumstances. Most people who stick to their exercise regimen generally experience less balance and dizziness problems.

When to Visit a Medical Professional?

Rarely do problems arise from vestibular rehabilitation therapy. However, if individuals are exercising alone and experience any of the following symptoms, they should speak with their doctor:

• An abrupt shift or variation in hearing.

• A painful or uncomfortable feeling of fullness or pressure in the ear.

• The ears are ringing more or new.

• Fluid leaking from the ears.

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 are specifically designed for each patient according to the patient's condition 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.