Saanichton Physical Therapy Blog

Vestibular Rehabilitation

Vestibular Rehabilitation

By Vanessa Service, Physiotherapist

What does my vestibular system do?

Your vestibular system’s job is to process sensory information that is required to control balance and eye movements. This means that information from the inner ear, the visual system, and from the muscles and joints is analysed by the brain. Integrating this information allows you to1:

– Maintain clear sight while you move your head,

– Figure out the orientation of your head in space in relation to gravity,

– Identify how fast and in which direction your are moving, and

– Make fast and automatic adjustments to your posture so you can maintain balance (stay in your desired position).

In other words, your vestibular system coordinates your movement with your balance, allowing you to navigate through and adapt to the world. It is this process that allows you to walk down the sidewalk, to step off a curb, to sit down and stand up again and to turn your head while walking. Anytime your head moves through space you’re depending on your vestibular system.

What are vestibular disorders and what are the symptoms?

If the vestibular system encounters disease or injury, such as a viral infection or head trauma, the result may be a vestibular disorder. However, aging, some medications, and genetic or environmental factors may also cause vestibular conditions.

Symptoms of damage to the vestibular system may include:

– Vertigo (a sense of the world spinning around you)

– Dizziness (feeling lightheaded or floating/rocking in space)

– Imbalance and special disorientation (stumbling, staggering, drifting to one side while walking)

– Difficulty with changes in walking surfaces

– Tinnitus (ringing or buzzing in the ears)

– Discomfort in busy visual environments (such as the grocery store) or when looking at screens/television

Examples of vestibular disorders include:

  • Benign paroxysmal positional vertigo or BPPV (a common condition where loose debris or “crystals” collect in a part of the inner ear)
  • Vestibular neuritis or labyrinthitis.
  • Migraine associated vertigo
  • Concussion
  • Endolymphatic hydrops
  • Acoustic neuroma
  • Meniere’s disease

How can a vestibular physiotherapist help?

The effect of a vestibular condition on a person’s life can be profound. Dizziness and balance problems are often a barrier to activities of daily living, to independence, and to engaging with the community. This negative impact on daily function and socialization may also contribute to anxiety and depression. As such, appropriate management of vestibular conditions is an essential component to improving quality of life for individuals and families affected by vestibular disorders.

A vestibular therapist will interview you about the history of your symptoms and perform a series of vestibular, balance, and visual tests. Treatment will depend on what is found in the assessment. For example, if you are diagnosed with BPPV, your therapist will perform a manoeuvre to reposition the associated crystals. Other vestibular disorders are treated with specific exercises and strategies that your vestibular therapist will teach you and help you progress through to reach your specific goals.

Although for most people a vestibular disorder is permanent, an exercise based plan can be designed to reduce dizziness, vertigo, and balance and gaze stability problems1. This is made possible by your brain’s incredible ability to adapt its other systems in order to effectively compensate for an improperly functioning vestibular system. Vestibular rehabilitation is a non-invasive and drug free intervention that helps to promote and maximize the amount of compensation that occurs. Current research supports the use of vestibular rehabilitation in the management of vestibular conditions2, demonstrating reduced dizziness, balance issues, and increased independence with regard to activities of daily living 3. Additionally, no adverse effects associated with vestibular rehabilitation have been reported2. As such, vestibular rehabilitation can provide a pathway to improved quality of life for those living with a vestibular condition.

References:

1. About Vestibular Disorders (n.d) Retrieved from https://vestibular.org/understanding-vestibular-disorder

2. Hillier SL et al., Vestibular rehabilitation for unilateral peripheral vestibular dysfunction, Cochrane Database of Systematic Reviews 3, 2011.

3. Cohen HS, Kimball KT Increased independence and decreased vertigo after vestibular rehabilitation. Otolaryngol Head Neck Surg 2003 Jan;128(1):60-70