Vestibular Rehabilitation - How the Therapy Works, Proposed Benefits, and Exercises Involved in The Rehabilitation Process

What Is Vestibular Rehabilitation?

The vestibular system is what controls and regulates body balancing and more. When somebody has gone through vestibular injury, vestibular disease, or stroke, one needs to retrain the body on how to go about with all its basic balancing functions. Such individuals may have trouble standing or lying still as well. Vestibular retraining or rehabilitation therapy is a set of exercises to retrain the body, addressing the above issues. Basically, it involves training the eyes, ears, brain, and spinal column with balancing and coordination.

How Does Vestibular Rehabilitation Work?

The vestibular system is responsible for collecting information about one’s balance. It lies in the inner ear, right beside the hearing organs. This structure perceives all the head and body movements like vibrations, rotations, accelerations, and tilts. And it sends this information from the inner ears to the brain along the vestibular nerve. And the brain sends that information along the spinal column and to all the balancing centers. This is a highly complex mapping system. The vestibular system acts incredibly fast with the involvement of nerve cells or neurons, which keep firing up electrical signals to collect and send information. The vestibular spinal reflex sends information from the ears toward all parts of the body- to our shoulders, hips, and legs.

Basically, one can understand and feel whatever is happening in the environment and ensure we stay steady and balanced. The inner ear communicates almost instantly with our eyes too. And between the ears and the eyes, we have a very fast-moving pathway known as a vestibular-ocular reflex. When someone undergoes vestibular exercises or training programs, one teaches the ears, brain, spinal cord, and eyes how to receive this information and use it effectively to keep the body steady.

Who can Benefit From a Vestibular Rehabilitation Process?

The rehabilitation process helps those suffering from vestibular diseases and other conditions that affect body balance. Anybody with the following issues may benefit from it:

• Benign paroxysmal positional vertigo.

• Those affected by stroke or head trauma.

• Inflammation of the vestibular nerve.

• Conditions with long-lasting dizziness, brain fog, and frequent falls.

• Meniere's disease, which involves dizzy spells and hearing loss.

• Vestibular migraine.

• Vision issues with head movement and difficulties focusing.

• Stiff neck.

What Are the Various Training Exercises Involved in Vestibular Rehabilitation?

Vestibular therapy is often individually customized and scheduled. One needs to understand the areas that require correction and tailor the therapy accordingly. It is essentially based on which movement of the body has errors and how one can methodically give the body access to new movements or new stillness. The doctor or professional therapist will assess the individual and understand what movements one finds vulnerable and difficult. It is also about building strength. Vestibular compensation exercises train the brain to regain control over movements to maintain balance and minimize dizzy spells. One may practice methods like Cawthorne Cooksey exercises to bring in this effect. Some of the following moves are performed:

1. Exercises Performed in Lying Position - Involves eye movements. One may be asked to move the eyes up and down and side to side. Also, to train the focusing act by looking at the finger as it is taken closer and away from the face. With the individual lying down, the head is bent forward and backward. Also, repeatedly turn the head from side to side.

2. Exercises Performed in a Sitting Position - One may do all the above-mentioned eye movements and head movements in a sitting position. Along with that, one may be asked to shrug the shoulders and rotate them. Another move is to bend forward and pick up something from the floor. The same is done with things placed on either side of the floor.

3. Exercises Performed in Standing Position - All the exercises mentioned above will be repeated in a standing position. Apart from that, one may be asked to alternatively stand up and sit down from a chair. It should be practiced with the eyes open and then with the eyes closed. Then gradually, try to turn around between sitting and standing. Another exercise involves throwing a ball from one hand to the other, with hands raised above eye level. And do the same behind the knees, with the upper body bent forward.

4. Exercise That Involves Moving Around - One may be asked to walk down a slope and walk back up the slope. Also, there may be some games like throwing and catching a ball. One will be practicing activities that involve aiming at something by stooping and stretching the body on the go.

5. Exercises That Involve Gaze Stabilization - They involve exercises to train the eyes to focus on an object when the individual’s head is in motion. Also, to improve vision, one may be asked to gaze at something held at eye level. Next, turn the head from side to side, keeping the eyes focused on the objects. Gradually, the speed of head movement is increased. This is done in repeated sets, increasing the focusing time as one advance with the ability to focus. And then, the same focusing act is done with the head moving up and down instead of side to side. In the long run, this exercise is performed in different positions and backgrounds.

6. Canalith Repositioning Maneuvers - For those who are suffering from benign paroxysmal positional vertigo, doctors perform two types of head movements to minimize the symptoms. They are Epley’s maneuver and Semont maneuver. Both aim at repositioning the tiny calcium carbonate crystals stuck to the inner ear, affecting one’s sense of balance. It is usually performed at a healthcare facility by a knowledgeable professional.

7. Brandt - Daroff Exercises - These are also helpful for those suffering from benign paroxysmal positional vertigo by vestibular compensation. This involves sitting and lying down, alternatively tilting the neck to the opposite side while lying down. It is performed in repeated sets holding the positions for thirty seconds to one minute.

How Long Does Vestibular Rehabilitation Take to Show Effects?

Usually, these exercises are performed twice a week. The duration of the rehabilitation program is based on individual needs. Some start showing progress within two to three weeks. And for some, it takes longer than that. Most of the exercises cause dizziness and balance issues in the beginning. It is important to start slow with short repetitions and increase the activities gradually.

Conclusion:

Vestibular rehabilitation exercises can be done with the eyes closed, eyes open, in stillness, with movements, sitting, standing, or lying. They can be done with head movements, without head movements, or with foot positions like walking, squatting, or bending over. The training should continue until the ears, eyes, spinal cord, and brain starts to process them and accept the changes without causing exaggerated symptoms. One should have the perseverance to go on with the therapy till the end to get the best outcomes. Endurance pays. And most importantly, seek out the help of a qualified professional who can guide one through the entire rehabilitation process.