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Advanced Center for Specialty Care
Chicago, Illinois
312-236-3642
773-296-5500

©2007 Advanced Center for Specialty Care. All rights reserved.

 

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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