What is Vestibular Rehabilitation Therapy?

Vestibular rehabilitation therapy (VRT) is a specialized form of physical therapy designed to alleviate complaints that arise in a wide variety of balance disorders. Balance disorders are related to the vestibular system of the body, responsible for the maintenance of balance and body posture. This exercise-based program aims to reduce symptoms such as vertigo, dizziness, gaze instability, imbalance, and falls. On an estimate, ninety million Americans experience dizziness at least once in their lifetime, with a significant population developing permanent balance deficits followed by functional limitations.

Vestibular therapy is, thus, a domain that involves helping such patients to habituate and adapt to the abovementioned deficits. It employs the use of specialized exercises that result in gaze and gait stabilization. Most VRT exercises target head movements and postures that are essential in stimulating and retraining the vestibular system. These exercises and other interventional modalities are often unique and tailored according to the needs of the patient.

How prevalent are Vestibular complaints?

As previously mentioned, dizziness is a very common compliant observed in individuals of all ages. In individuals with age greater than 70 years, dizziness is the most common cause of medical consultation. It also poses a high risk of falls in this population, making falls the leading cause of severe injury and death in persons older than 65 years. Multiple studies estimate as many as half of all cases of dizziness linked with vestibular disorders. The National Health and Nutrition Examination Survey recorded patients with symptomatic vestibular dysfunction to have a 12-fold increase in the odds of falling.

Who benefits from Vestibular therapy?

Following individuals are frequently recommended with Vestibular therapy: 

  • Patient with a stable vestibular lesion,
  • Patients with a history of head injuries,
  • Patients suffering from psychogenic vertigo,
  • Elderly patients with dizziness,
  • Patients suffering from vertigo with uncertain etiology,
  • and patients suffering from Benign Paroxysmal Positional Vertigo (BPPV).

What are the aims of Vestibular Therapy?

This problem-oriented approach promotes mechanisms such as adaptation and compensation of the vestibular system to achieve the following goals:

  • To improve balance,
  • To minimize the fall risk,
  • To increase body strength,
  • To restore the prior level of movement/function
  • To improve head and neck movement,
  • To decrease frequency and sensations of dizziness,
  • To strengthen stability during motion,
  • To maximize the coordination between muscles and the nervous system,
  • And to reduce anxiety and somatization associated with vestibular disorientation etc.

Types of exercise included in Vestibular Therapy?

The selection of exercises employed in VRT depends upon the vestibular-related problems identified in clinical assessments. The three principal methods of exercises commonly prescribed include:

1) Habituation

Habituation exercises are employed when the symptoms of dizziness are product self-motion and/or visual stimuli. These are recommended in patients with increased complaints of dizziness with movement such as during quick head movements, or with changing positions (example: bending over or looking up to reach above their heads). 

Habituation exercises are also appropriate for individuals experiencing increased dizziness in visually stimulating environments, like in cinema halls, shopping, grocery stores, etc. and/or when walking over patterned surfaces or shiny floors. 

The mechanics proposed behind these exercises is to reduce the frequency and severity of dizziness through repeated exposure to specific movements or visual stimuli that provoke it in the first place. With a dedicated and effective therapy, the brain adapts to ignore the abnormal signals it receives from the inner ear with these stimuli that give rise to dizziness.

2)Gaze Stabilization

Gaze Stabilization exercises are employed to improve control over eye movements and to maintain a clear vision during head movements. These exercises are suitable for patients with complaints of sight disturbances, reporting difficulty in focusing on a single object while the head is in motion. These exercises include fixating the gaze of the patient at an object while the head repeatedly moves around. The other variant comprises employing vision and other somatosensation (body sense) as a substitute for the damaged vestibular system.

3) Balance Training

Balance Training includes exercises that improve the steadiness of a person to facilitate the successful performance of activities of daily life, work, and leisure. Examples include the use of visual and/or somatosensory cues, stationary positioning and dynamic movements, coordinated movement strategies, and dual tasks (that is performing a task while balancing). 


What professionals are a part of the Vestibular Therapy Team?

An effective VRT program is carried out by a multidisciplinary team with specialized physicians and healthcare providers. This team usually consists of a physician specialized in the evaluation and treatment of balance disorders (typically an otolaryngologist, neuro-otologist, or neurologist), a vestibular therapist or physical therapist, and an occupational therapist.


Can Vestibular Therapy be carried out at home?

Yes, VRT is devised to be supervised by a therapist, with exercises that can easily be carried out in settings such as the home. The patient can also engage in these custom-designed exercises at home several times a day without therapist supervision once educated and trained. These exercises start with minimal skill requirement than gradually the complexity is increased as compensation and habituation occur. The individuals going through VRT then require regular follow-up visits with the therapist until compensation and habituation are complete and optimal balance is attained.

Dr. Anique Ali


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