Vestibular Rehabilitation Therapy

• Also known as VRT
• Patients with inner ear disorders are often referred to physical therapy for treatment of imbalance and movement related dizziness.
• Symptoms result from pathology within the vestibular system that reduces a person’s ability to move within the home and environment without imbalance or vertigo
• Dizziness often interferes with one’s ability to perform daily activities including household management and employment, significantly reducing one’s quality of life
• Patients often complain of decreased balance on compliant surfaces or in the dark and often when walking in a visually distracting environment
• Dizziness is a symptom of a deficit within the peripheral or central nervous system
• Vestibular rehabilitation is designed to decrease dizziness, increase balance function and increase general activity levels

Diagnosis and Treatment of Vestibular Disorders

1. Benign Paroxysmal Positional Vertigo (BPPV)

• Dizziness is thought to be due to debris free floating within the inner ear which triggers dizziness when in certain positions
• Symptoms of BPPV include dizziness or vertigo (sensation that the room is spinning around you), lightheadedness, imbalance, and nausea
• Symptoms are provoked often when getting out of bed, laying flat, or rolling over in bed
• People often feel dizzy looking up or when bending down to pick up objects from the floor
• An intermittent pattern is common
• Diagnosis is made through history and physical exam
• ENG testing may be utilized to look for characteristic nystagmus (jumping of eyes)
• Treatment consists of maneuvers that are intended to move the debris out of the sensitive part of the ear into a location where the debris can dissolve
• Treatment lasts approximately 15 minutes following diagnosis of BPPV
• The Semont maneuver involves a procedure in which a patient is quickly moved from lying on one side to lying on the other side
• The Epley maneuver involves a series of head and body movements designed to move the debris through the inner ear canal
• The patient will be instructed on positioning precautions to be followed after the treatment session
• Follow-up is required one week post repositioning maneuver to assure improvement in symptoms

2. Peripheral Vestibular Loss

• These patients report dizziness at a lightheaded and imbalance sensation that results from a deficit in the vestibular-occular reflex
• The vestibular ocular reflex enables one to stabilize their eyes and gaze while performing head and body movements
• When the two ears detect head and body movement at a different rate, nystagmus is produced, giving one a sensation of lightheadedness or imbalance
• Vestibular rehabilitation is an exercise approach to remediating disequilibrium and dizziness symptoms associated with peripheral vestibular pathology
• It involves an exercise program to promote compensation of the central nervous system for the deficits within the inner ear
• Patients are asked to perform a short exercise program at home two to three times daily
• The patient then follows up with the physical therapist one time every week to every other week to advance the home exercise program as needed

 

• Treatment of a unilateral peripheral vestibular loss is often required following treatment of BPPV
• Treatment often included balance retraining particularly on compliant or soft surfaces and in dark environments
• Doctors commonly prescribe vestibular suppressant medications for patients who complain of dizziness
• A disadvantage to taking this medication is that it interrupts the potential habituation and produces sedating side effects which may limit a patient in daily activities

Individuals not likely to benefit from vestibular therapy:

• Persons without vestibular problems
• Persons with low blood pressure
• Persons with medication reactions
• Persons who have suffered transient ischemic attack (TIA)

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