Vestibular Rehabilitation
Vestibular Rehabilitation is an evidence-supported approach to managing dizziness, vertigo, motion sensitivity, balance and postural control issues that occur due to vestibular dysfunction. Patients with vestibular impairment present with issues with gaze stability, motion stability and balance. Vestibular rehabilitation is focused on re-educating these areas of pathology or dysfunction.
Patients with vestibular impairment typically experience issues with gaze stability, motion stability, and balance and postural control. Vestibular rehabilitation is, therefore, focused on addressing these areas of pathology or dysfunction. However, the specific treatment approach will depend on the pathology and each patient’s unique presentation. It is, therefore, essential to have a detailed understanding of the vestibular system when treating this patient group.
Patients presenting with symptoms of vertigo will be thoroughly assessed by their physiotherapist to determine the source of dysfunction. This assessment incorporates the examination of nystagmus using Frenzel goggles. These are used to accurately diagnose benign paroxysmal positional vertigo (BPPV) and other vertigo-related conditions by capturing involuntary eye movements. By removing the ability to visually fixate, this assessment tool allows for accurate identification of the affected inner ear canals, which enables faster and more precise diagnosis, and thus facilitates the implementation of more efficacious treatment programmes.
Common Symptoms of Vertigo can include:
- Vertigo
- Dizziness
- Nystagmus (involuntary eye movement)
- Compromised gaze stability
- Disequilibrium/unsteadiness
- Light headiness/disorientation
- Poor balance
- Difficulty focusing, reading
- Poor concentration
- Headaches
- Motion sensitivity
- Brain Fog (confusion, forgetfulness, poor focus, impaired ability to multi-task, and mental exhaustion)
- Falling
- Neck pain
- Fatigue
- Nausea
- Poor tolerance of busy environments
Conditions that can cause symptoms of Vertigo can include:
- Benign Paroxysmal Positional Vertigo (BPPV) – The most common cause of vertigo, due to displacement of otoconia (small crystals of calcium carbonate) from the maculae of the inner ear, into the fluid-filled semi-circular canals.
- Vestibular Neuritis or Labyrinthitis – viral infection of the inner ear.
- Meniere’s disease – a fluctuating disorder of the inner ear affecting hearing and balance.
- Vestibular Migraine – vestibular symptoms due to migraine.
- Cervical Vertigo / Cervicogenic dizziness – dizzy symptoms due to neck stiffness.
- Acoustic Neuroma – benign tumour on the vestibular nerve.
- Stroke
- Auto toxicity – adverse reaction of the inner ear to specific medications.
- Mal de Debarquement (MDD) – unsteadiness following a boat journey.
- Perilymphatic fistula – a defect in the membranes separating the fluid filled inner ear form the air-filled middle ear, which can result in vertigo, dizziness, hearing loss and tinnitus
- Post head trauma- such as whiplash or concussion
- Age-related vestibular system degeneration – leading to an increased falls-risk
Vestibular Rehabilitation Plan
Following assessment, your physiotherapist will design a Vestibular Rehabilitation Plan with you to address your specific symptoms. This programme may include some, or all, of the following components:
- Initial Assessment: A thorough evaluation of balance, gait, eye movements, and dizziness triggers to identify the specific vestibular disorder (for example BPPV, vestibular neuritis).
- Canalith Repositioning Manoeuvres: These are specific physical manoeuvres performed in the clinic to treat BPPV (vertigo caused by the displacement of crystals in the inner ear).
- Gaze Stabilization Exercises: Techniques to improve control of eye movements, allowing clear vision during head movement. Examples include visual fixation on a target while performing linear or rotational movements of the head.
- Habituation Exercises: Targeted exercises that deliberately induce mild dizziness in a controlled and gentle manner, to desensitize the brain to the movements that provoke symptoms.
- Balance and Gait Training: Exercise therapy focused on core strengthening, gait re-edicuation, and the performance of balance and proprioceptive exercises.
- Home Exercise Program: A bespoke daily routine designed to be performed at home. Patients are advised that commitment to their programme is required for up to 6-8 weeks, to achieve optimal results.