Vestibular Rehabilitation Therapy

Vestibular rehabilitation therapy (VRT) is an exercise-based specialized physiotherapeutic intervention designed to promote central nervous system compensation, an adaptation based on neural plasticity and motor learning principles.
VRT can help with a variety of vestibular problems, including benign paroxysmal positional vertigo (BPPV) and the unilateral or bilateral vestibular hypofunction (reduced inner ear function on one or both sides) associated with Meniere’s disease, labyrinthitis, and vestibular neuritis. Even individuals with long-term unresolved inner ear disorders. VRT can also help people with an acute or abrupt loss of vestibular function following surgery for vestibular problems. More recently VRT is being practiced in a range of central vestibular dysfunctions caused by various neurological disorders.

 

 

Goals of Vestibular Rehabilitation Therapy

  • By improving vestibular function and promoting mechanisms of central adaptation and compensation, VRT aims to do the following:

  • Improve balance

  • Minimize falls

  • Decrease subjective sensations of dizziness

  • Improve stability during locomotion

  • Reduce overdependence on visual and somatosensory inputs

  • Improve neuromuscular coordination

  • Decrease anxiety and somatization due to vestibular disorientation

What is Vestibular Rehabilitation and Balance Retraining?

  • A movement/exercise approach with the goals of:

  • Decreasing or eliminating dizziness/vertigo

  • Improving balance function and safety

  • Improving visual-motor control and tolerance of motion

  • Increasing activity levels

  • Reducing falls or risks for falls what are the Symptoms of Inner Ear Vestibular Pathology?

  • Dizziness/vertigo

  • Imbalance/unsteadiness

  • Visual motor disturbances/nausea

Because the vestibular system interacts with so many other parts of the nervous system, secondary symptoms of memory problems, muscular stiffness/imbalance/weakness, fatigue, headaches and anxiety may be experienced.


What are some of the Causes of Inner Ear Vertigo and Imbalance?

  • Viral/bacterial infections

  • Trauma

  • Meniere's Disease

  • Neuromas

  • Ototoxicity

  • Vascular ischemia

  • Benign positional vertigo

Who would benefit from vestibular rehabilitation and balance retraining?
Persons suffering from vertigo and imbalance that do not demonstrate a spontaneous resolution of symptoms within 3-4 weeks.

What is involved in the therapy?
A thorough evaluation process is conducted to determine a comprehensive problem list affecting the person's ability to function. 4 main areas are addressed:
Neuromuscular evaluation
Visual-Motor Assessment - measured by infrared video goggles and visual observation
Balance Assessment - measured by standardized tests and a computerized force plate
Vertigo Assessment
Specific goals for the patient are developed and the exercise/movement program is initiated.

Effects of Spinal cor injury

There are many potential complications related to spinal cord injury that may require specific treatment. These complications include:

  • Urinary Tract Infections Or Urinary Incontinence (Inability To Control The Flow Of Urine), 

  • Bowel Incontinence (Inability To Control Bowel Movements), 

  • Pressure Sores, 

  • Infections In The Lungs (Pneumonia), 

  • Blood Clots, 

  • Muscle Spasms, 

  • Chronic Pain, And 

  • Depression.

Vestibular habituation/adaptation exercises:
Specific movements or positions that provoke the patient's dizziness are provided and the patient is asked to repeat these movements until the brain habituates the response or adapts to the conflicting information. This process resolves the conflict between the brain and the ear.


Visual-motor exercises:
The ear nerve has a connection that goes to the eye muscles and can affect the person's ability to maintain their gaze and focus. If dysfunction is identified in this mechanism, visual-motor exercises for gaze stabilization and eye-head coordination are included.
Canalith Repositioning Procedures for Benign Positional Vertigo:


A specific maneuver involves moving the patient's head in a sequence of positions for a certain time period in order to move the "ear rocks" or otoconia around the semicircular canals to reposition them into the proper place in the inner ear. This procedure is 95% effective in eliminating benign positional vertigo in 1-4 visits.


Balance retraining exercises:
Exercises designed to improve coordination of muscle responses as well as the organization of sensory information from eyes, ears and tactile/muscle receptors for balance control (measured by a computerized force plate).


Frequency
Patients are typically seen on an outpatient basis once every 1-2 weeks and provided a specific daily home program that is upgraded as appropriate. This program addresses the specific problems and goals of the individual patient.

Balance is a feeling derived from being whole and complete; it's a sense of harmony. It is essential to maintaining quality in life and work

“Believe you can and you’re halfway there.” –Theodore Roosevelt

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