Vestibular rehabilitation is an evidence-based treatment designed to improve symptoms related to vestibular disorders. This specialized therapy can be life-changing for those suffering from balance issues, dizziness, vertigo, or other related complications. While it may sound complex, vestibular rehabilitation can be simple yet effective.
This article will provide an overview of vestibular rehabilitation, its benefits, how it works, and why it may be an essential part of your care.
What is Vestibular Rehabilitation?
Vestibular rehabilitation refers to a focused form of neurological therapy specifically addressing underlying vestibular disorders. The vestibular system (the inner ear) is a sensory system located within the brain that helps maintain balance, stabilize vision, and orient the body in space.
While the vestibular system is primarily responsible for this function, the visual system is also heavily involved in vestibular rehabilitation.
When this system malfunctions, it can result in dizziness, vertigo, imbalance, emotional instability, and other related symptoms.
Vestibular rehabilitation therapy (VRT) focuses on recalibrating the vestibular system by using exercises that encourage the brain to adapt to these disruptions.
Understanding the Vestibular System
The vestibular system, primarily housed in the inner ear, plays a crucial role in detecting head movement and positioning changes. This system comprises three semicircular canals that detect rotational movements and two otolithic organs that detect linear acceleration and gravity.
And while that may not mean much to you from the outset, know that this system is vital for helping you navigate the world.
When these components work together correctly, they send accurate signals to the brain to help maintain balance and coordinate movement. If the system isn’t working as well as it could, signals sent to the brain can become inconsistent, leading to symptoms such as dizziness, vertigo, or balance problems.
An easy analogy to consider is that good inputs equate to good outputs. When inputs become altered or inaccurate, they affect the outputs of the brain, body, and ability to function in the world. That’s how vestibular symptoms manifest.
Common Vestibular Disorders
There are several common vestibular disorders that vestibular rehabilitation aims to treat, including:
Benign Paroxysmal Positional Vertigo (BPPV)
BPPV is a condition where tiny crystals (calcium carbonate) in the inner ear become dislodged, causing brief episodes of vertigo when the head changes position.
Meniere’s Disease
Meniere’s Disease manifests as acute episodes of vertigo, loss of hearing, tinnitus (ringing in the ears), and sensations of fullness in the ear.
Vestibular Neuritis
Vestibular neuritis is an acute or chronic inflammation of the vestibular nerve, often resulting in intense vertigo, imbalance, and nausea.
Labyrinthitis
Similar to vestibular neuritis, Labyrinthitis involves hearing loss due to inflammation of the vestibular nerve and the cochlea.
Chronic Subjective Dizziness (CSD)
CSD yields persistent dizziness or unsteadiness without vertigo that lasts for three months or more.
Persistent Postural-Perceptual Dizziness (PPPD)
Similar to CSD, PPPD is characterized by persistent dizziness or unsteadiness, often triggered by changes in posture, complex visual stimuli, or motion. It’s not usually associated with actual movement or a specific physical cause. Still, it is a functional neurological disorder that typically arises after an episode of acute dizziness, such as vestibular neuritis, BPPV, or a vestibular migraine.
How Vestibular Rehabilitation Works
Vestibular rehabilitation involves an individually tailored exercise-based program designed by a trained physical therapist, functional neurologist, or rehabilitation specialist. The exercises aim to alleviate symptoms through a process called “neuroplasticity,” which allows the brain to compensate for the malfunctioning vestibular system by using other sensory inputs like vision and proprioception (awareness of body position).
Neuroplasticity describes the brain’s natural ability to change and adapt to the environment over time, where neurons can “fire and wire” together to create new connections.
It is estimated that each neuron can form up to 10,000 connections with other neurons, allowing you to learn a new skill, improve a specific function, and learn throughout your lifetime.
Considering this neuroplasticity model, vestibular rehabilitation’s ultimate focus is to rewire the brain to compensate for dysfunction. Furthermore, the focus should be on alleviating symptoms while also improving the individual’s quality of life.
Critical Components of Vestibular Rehabilitation
Habituation Exercises
These therapies involve repetitive exposure to movements or situations that provoke symptoms. Over time, the brain becomes less sensitive to these stimuli, reducing symptoms like dizziness or vertigo. Once again, these changes are possible due to neuroplastic changes in the central nervous system and brain.
Gaze Stabilization Visual Exercises
These visual exercises aim to improve control of eye movements, particularly during head motion, which can help stabilize vision. A common gaze stabilization exercise is to focus on a fixed target while moving the head from side to side or up and down. It’s also essential to utilize depth perception and postural changes with these therapies, as most people are actively moving in their environment when their symptoms are present.
Balance Retraining
These exercises aim to improve balance and steadiness through tasks challenging the body’s ability to maintain equilibrium. Activities may involve standing on different surfaces, walking with head movements, or practicing balance on one leg. It may also include using exercise balls, head-laser therapies, and integrating the head, neck, and body.
Canalith Repositioning Maneuvers
These maneuvers, such as the Epley maneuver and horizontal canal barbecue roll maneuvers, are specifically designed to treat BPPV. These maneuvers focus on moving the displaced crystals within the inner ear back to their proper position to reduce episodes of vertigo.
Who Can Benefit from Vestibular Rehabilitation?
Vestibular rehabilitation can benefit a wide range of individuals experiencing vestibular-related symptoms. People with conditions such as vertigo, dizziness, imbalance, and vision instability often benefit from this therapy.
Additionally, those recovering from concussions, traumatic brain injuries (TBI), or a stroke that has affected their vestibular system may also find relief through vestibular rehabilitation. Older adults are another group that usually benefit from this form of therapy, as they’re more at risk for falls due to balance issues.
Key Signs You Might Need Vestibular Rehabilitation
- Persistent dizziness or vertigo
- Frequent falls or difficulty maintaining balance
- Blurred or unstable vision, especially during movement
- Nausea or disorientation, especially with head movements
- Difficulty focusing or concentrating
If you experience any of these symptoms, you should visit a healthcare professional for further investigation. Providers such as a neurologist, functional neurologist, physical therapist, or an EENT (eyes, ear, nose, and throat) specialist can help determine whether vestibular rehabilitation is an appropriate course of treatment.
Benefits of Vestibular Rehabilitation
The primary benefit of vestibular rehabilitation is reducing or eliminating symptoms like dizziness, vertigo, and imbalance. However, the benefits go beyond just symptom management.
Individuals undergoing vestibular rehabilitation usually experience improvements in their overall quality of life. With the use of visual and vestibular therapy, patients may also report improvements in their headaches, neck pain, cognitive processing, and fatigue.
It’s essential to treat the person, not just the symptoms. That’s why you must find a provider who can perform an in-depth neurological and orthopedic examination to understand the cause of your symptoms.
Symptom Reduction
Many individuals who undergo vestibular rehabilitation often report a significant reduction in symptoms. Depending on the underlying condition, dizziness, vertigo, and imbalance may decrease within days or weeks of starting the program.
These improvements can lead to increased confidence in daily activities, reducing the likelihood of falls and injury.
But just because you’ve done vestibular rehabilitation doesn’t mean you’re out of the clear. And for those who have done vestibular rehabilitation and are still dealing with symptoms, there may be more to the story regarding other underlying symptoms.
Don’t lose hope if you’ve tried vestibular rehabilitation and haven’t seen improvements. It comes in many different forms and from many different providers!
Enhanced Mobility and Independence
Vestibular rehabilitation helps individuals regain mobility and independence by improving balance and coordination. Whether walking, driving, or standing up without feeling lightheaded, patients often find they can return to everyday routines with fewer limitations.
Most people who have dealt with symptoms of dizziness and vertigo will tell you how debilitating it can be. Vestibular rehabilitation aims to eliminate these symptoms and help people maximize their quality of life.
Improved Mental Health
Living with chronic dizziness or balance issues can significantly affect a person’s mental health, often leading to anxiety, depression, and social withdrawal. Vestibular rehabilitation can help restore a sense of normalcy, reducing the stress associated with movement and improving overall emotional well-being.
We also know that the vestibular system has distal connections to the brain’s emotional (limbic) centers and autonomic nervous system.
Because of this, there are opportunities to help people improve their mental wellness while eliminating symptoms of distress and dizziness.
Prevention of Future Issues
Vestibular rehabilitation can potentially help prevent future falls and injuries for older adults, in particular. By addressing balance issues and improving strength and coordination, the therapy provides long-term benefits that reduce the risk of serious complications from falls.
Of course, it’s best to use these therapies proactively to avoid falls and injuries, but very few seek them for that reason. Most find vestibular treatment once they have symptoms.
What to Expect During Vestibular Rehabilitation
Vestibular rehabilitation is highly individualized, so your treatment plan must depend on the specific disorder and symptoms you’re experiencing. A thorough neurological and orthopedic assessment by a trained medical provider is typically the first step.
This evaluation might include questions about your medical history, assessing your posture and gait, and tests to evaluate your balance, coordination, and eye movements.
At The Neural Connection, we perform in-depth bedside neuro-orthopedic testing to assess your condition comprehensively. We then follow up with objective visual testing using Videonsytagmography to establish objective baselines.
Frequency and Duration
The frequency of vestibular rehabilitation sessions can vary from clinic to clinic. In many instances, individuals may need to attend vestibular therapy several times a week initially, tapering off as symptoms improve. In other situations, patients do better with time between visits to recover and focus on optimizing general health habits like sleep and low-grade exercise.
Each rehabilitation session usually lasts 30 to 60 minutes, and the entire course of treatment may range from a few weeks to several months. In some instances, we’ve had patients come into the clinic for 3 hours a day for five consecutive days as a neurorehabilitation week. We’ve seen significant improvements in patients with this approach when paired together with follow-up and at-home therapies.
At-Home Exercises
In addition to in-clinic therapy, patients often perform visual and vestibular exercises to perform at home. These exercises are essential to the rehabilitation process, as they help reinforce the progress made during therapy sessions.
Regular practice of these exercises is essential to achieving the best results. Clinically, we’ve seen patients continue to make progress in their symptoms when they adhere to home therapies.
FAQs About Vestibular Rehabilitation
How long does vestibular rehabilitation take to see results?
The timeline for symptomatic improvement varies depending on the individual and the specific condition. Some people notice improvement within a few sessions, while others may take several weeks or months to experience significant benefits. Results also vary depending on underlying inflammation, digestive issues, and cervical spine problems.
Can vestibular rehabilitation cure vertigo?
Cure is a powerful word, but it’s possible to eliminate symptoms. Vestibular therapy can often effectively manage and reduce vertigo symptoms, particularly in conditions like BPPV. However, the treatment’s success depends on the underlying cause of vertigo, which, once again, can be complex.
Is vestibular rehabilitation safe for older adults?
Yes, vestibular rehabilitation is safe and highly beneficial for older individuals, especially those at risk of falls due to balance problems. The exercises are typically low-impact and can be adapted to suit different levels of physical ability. Unfortunately, older individuals are more susceptible to falls and injuries, as balance becomes compromised as we age. Preventative vestibular rehabilitation is also a great way to ensure balance later in life.
Do I need a referral to start vestibular rehabilitation?
In some cases, a referral from a primary care provider may be required, especially if you’re seeking treatment through insurance. However, many physical therapy and functional neurology clinics accept patients without a referral.
Are there any side effects of vestibular rehabilitation?
It’s common to experience mild symptoms, such as dizziness or imbalance, during the initial stages of therapy as the brain adjusts to the exercises. These symptoms typically lessen over time. And if your provider has experience treating these symptoms, they can prepare you for what lies ahead.
When starting vestibular therapy, it’s crucial to understand expectations. Sometimes, things can get worse before they get better, but that doesn’t mean they have to. Clinical practice is called “practice“ for a reason; we’re always finding ways to become better and improve our skill sets.
How do I find a qualified vestibular rehabilitation therapist?
Look for functional neurologists and physical therapists with specialized training or vestibular rehabilitation certifications. Many professionals who focus on neurological or balance disorders will also be well-versed in this therapy.
It’s always best to look at patient reviews to better understand a provider and clinic. At The Neural Connection, we’re proud to say we’ve acquired 88+ 5-Star Google Reviews from happy patients who have made significant progress with their dizziness, post-concussion, and migraine symptoms!
Conclusion
Vestibular rehabilitation should be a targeted and effective solution for those struggling with vestibular disorders. Through customized exercises, patients can improve their balance, decrease symptoms of dizziness, and improve their overall quality of life.
If you’re still experiencing symptoms like vertigo, dizziness, or feelings of imbalance, consult with an experienced healthcare professional. They can determine if vestibular rehabilitation is the right treatment for you and point you in the right direction.
And if you’ve looked everywhere but have yet to find the answers you’ve been looking for, we’re just a phone call away. Click the link below to schedule your free consultation!
*Note: The information provided in this article is for educational purposes only and does not constitute a doctor-patient relationship. Patients are advised to consult their medical provider or primary care physician before trying any remedies or therapies at home.
