Vestibular Rehabilitation

What is vestibular rehabilitation?

Vestibular rehabilitation is an exercise approach to the remediation of disequilibrium and dizziness symptoms associated with peripheral vestibular pathology. A common neuro-otological approach to managing the dizzy patient with balance problems is to administer medication designed to suppress vestibular function. However, many of the medications used for inner ear disorders have the disadvantage of potential habituation and sedating side effects that frequently limit the patient's ability to perform useful activities.

Vestibular rehabilitation is an alternative form of treatment involving specific exercises designed to (1) decrease dizziness; (2) increase balance function; (3) increase general activity levels. The exercise program is designed to promote central nervous system compensation for the inner ear deficits. Patients are asked to exercise daily at home and to visit the physical therapist or occupational therapist during an initial period of four to six weeks.

Which patients need therapy?

Not all patients who have an inner ear disorder need vestibular rehabilitation. Patients who do not demonstrate a spontaneous resolution of symptoms such as dizziness and disequilibrium within six months of their onset may benefit from therapy. In these patients, the central nervous system seems unable to adequately compensate for the inner ear deficit.

Many patients have undergone a period of medical management using medications to suppress vestibular function and reduce symptoms, with little or no success. Symptoms become chronic, often lasting for periods of months or years. These patients with unresolved inner ear disorders may significantly improve their symptoms following vestibular rehabilitation.

Another type of patient who may benefit from vestibular rehabilitation is the one with acute or abrupt loss of vestibular function. Patients who have surgery for unresolved vestibular problems will benefit from a vestibular rehabilitation program designed to help the patient effectively compensate for his or her inner ear disorder.

Does therapy succeed?

Several patient studies have been done to examine the effect of vestibular habituation therapy on dizziness symptoms. These studies are unanimous in demonstrating a decrease in symptoms of dizziness and disequilibrium after exercise therapy. One study compared the effectiveness of specific habituation therapy to a general exercise program in decreasing vertigo complaints in patients with a variety of vestibular pathologies. Results supported vestibular habituation therapy over a general exercise program for the remediation of positional vertigo.

Is a physician's referral needed to enter therapy?

Vestibular rehabilitation programs are designed to remediate vertigo and disequilibrium associated with peripheral vestibular abnormalities. There are many causes of dizziness, not all the result of vestibular deficits. Therefore it is critical that patients entering a therapy program have a confirmed diagnosis of vestibular pathology. Most referrals will come from otolaryngologists or neurologists. If there is some question about the nature of the underlying disorder in patients who are referred from other sources, an otology consult may be requested by the treating therapist.

How will the therapist assess my problems?

Balance and gait assessment includes completion of a test that allows comparison of the patient's level of balance function to his or her age group. In addition, static and dynamic balance skills are assessed including balance during gait. A test of sensory interaction in balance is performed in order to assess the patient's ability to use vestibular inputs for orientation when deprived of other sensory inputs. Finally, the patient's use of appropriate movement strategies in balance control is examined.

Vertigo assessment begins with a dizziness questionnaire to determine frequency and severity of dizziness symptoms and to document lifestyle changes resulting from balance and dizziness problems. In addition, the patient is asked to move in and out of 21 different positions requiring head and trunk motion in specific planes of motion. The patient is asked to report the presence and intensity of dizziness symptoms; the duration of dizziness is timed, and a vertigo score is calculated from the intensity and duration measures. Other symptoms such as nausea, sweating and nystagmus are recorded.

After assessment, a list of patient problems is generated; short-and long-term goals are established, and, if appropriate, the patient is begun on a specific exercise program based on his or her individual assessment findings.

What happens in the exercise program?

The treatment of a patient with inner ear disorders focuses on improving balance function, decreasing dizziness symptoms through vestibular habituation exercises, and increasing overall activity levels for long-term retention of gains made in therapy. In some instances, a patient may receive only vestibular habituation exercises if balance function is not affected.

Vestibular habituation exercises. Successful remediation of dizziness is dependent on determining the specific movements and/or positions that provoke the patient's dizziness or vertigo. These exercises are based on the rationale that through repeated exposure to the specific stimulus causing the vertigo, the brain will habituate or attenuate the vertigo response. The patient is asked to keep a daily diary logging frequency of exercise and noting changes in symptoms.

Balance retraining exercises. Balance retraining involves exercises designed to improve coordination of muscle responses as well as the organization of sensory information for balance control. Again, the emphasis is on a home program of exercise including gradual involvement in a daily aerobic exercise activity such as walking or biking to insure the patient maintains improvements.

In addition to their home program, patients are seen in the therapy department one to two times per week for an average of four to six weeks. During outpatient therapy, progress is monitored; home exercise is modified, and specific balance retraining occurs.

Back to Top