• Vertigo.
• Ménière disease.
• Benign paroxysmal positional vertigo (BPPV).
• Labyrinthitis.
• Vestibular neuritis.
• Migraine headache.
• Falling risk.

To understand how therapy works, it helps to know why you may feel dizzy and how your body manages balance.

Your sense of balance relies on the relationship between your central nervous system (brain) and your sensory system. Your sensory system includes:

Your vestibular labyrinth in your inner ear: This includes your semicircular canals (loops), which react when you turn your head, and otolith organs that react to gravity and movement.

Your vision: Your eyes send your brain impulses that show where your body is in relation to other objects.

Your feeling sensations of your skin, joints, and muscles: When your body moves, your body senses changes in pressure, muscle activation or relaxation, and changes in joint position. Your tissues send signals to your brain, telling it where your body is in relation to your environment.

Your central nervous system integrates this information together so it can tell your body how to maintain balance. When something interferes or one system is not giving accurate information, your central nervous system can’t process information correctly. Thus, causing symptoms of dizziness and imbalance. Vestibular rehabilitation therapy helps restore those connections, ultimately reducing your symptoms. ¹

You will need to have your symptoms evaluated by your primary Physician, Neurologist, or ENT. You may be sent to visit an audiologist for a vestibular test battery.

Balance issues and dizziness may affect you in different ways. Your therapist will tailor vestibular rehabilitation therapy to your specific need. They will show you how to do specific exercises so you can exercise at home. Therapy may include these exercises:

• Eye movement control also called gaze stabilization exercises. These are used to improve the ability to stabilize an image during movement.
• Habituation exercises are used to treat symptoms of dizziness with self motion. Such as dizziness when turning around, changing positions of the head, and quick turns. These exercises are also used when dizziness is increased with busy visual environments like shopping malls, grocery stores, and watching TV. The goal of habituation exercise is to reduce the dizziness through repeated exposure to specific movements or visual stimuli that provokes patients’ dizziness. These exercises are designed to mildly, or at the most, moderately provoke the patients’ symptoms of dizziness. Over time, with good compliance and perseverance, the dizziness intensity can reduce due to the brain learning to ignore the abnormal signal.³
• Balance retraining. This will include static, dynamic, and reactive exercises that challenge the innate balance strategies, reflexes, and sensory integration systems necessary for keeping your balance in all situations.
• Stretching and strengthening. Muscle strength and flexibility is necessary in order for your body to produce the appropriate balance strategies.
• For patients with Benign Paroxysmal Positional Vertigo (BPPV), the exercise methods described above are not appropriate to resolve this type of vestibular disorder. Through assessment, the type of BPPV is identified, and depending on the type, different repositioning maneuvers can be performed to help resolve the spinning that occurs due to position changes.³

An important part of the VRT is to establish an exercise program that can be performed regularly at home. Compliance with the home exercise program is essential to help achieve rehabilitation and patient goals.

Along with exercise, patient and caregiver education is an integral part of VRT. Many patients find it useful to understand the science behind their vestibular problems, as well as how it relates to the difficulties they may have with functioning in everyday life. Education is important for patients because it takes away much of the mystery of what they are experiencing, which can help reduce anxiety that may occur as a result of their vestibular disorder.^1,2,3

How much therapy you’ll need depends on why you have dizziness or balance issues, and how you respond to therapy. Most people have six to eight sessions. Some people may only need one or two sessions. Other people may need several months of ongoing treatment, including doing exercises on their own.

Evidence has shown that vestibular rehabilitation can be effective in improving symptoms related to many vestibular disorders. In addition, it has been shown to reduce risk of falling, improve balance, reduce symptoms of dizziness, improve ability to stabilize your vision, and increase your body strength.

Treatment strategies used in rehabilitation can also be beneficial for secondary problems. Secondary problems like nausea and/or vomiting, reduced ability to focus or concentrate, headaches, and fatigue can arise as a secondary complication of a vestibular disorder.

Symptoms due to vestibular disorders and secondary complications can diminish quality of life and can impact all aspects of life from economic to social participation as well as can contribute to emotional problems, like anxiety and depression. Additionally, one of the consequences of having a vestibular disorder is that the symptoms frequently cause people to adopt a sedentary lifestyle in order to avoid bringing on, or worsening, dizziness and imbalance that occurs with movement. As a result, decreased muscle strength and flexibility, increased joint stiffness, and reduced stamina can occur from this lifestyle. Therapy can reduce this life changing impact.

For most people who have a vestibular disorder, the deficit is permanent because the amount of restoration of vestibular function is very small. However, after vestibular system damage, symptoms can reduce and function can improve because of compensation. This occurs because the brain learns to use other senses (vision and somatosensory – body sense) to substitute for the deficient vestibular system. For many, compensation occurs naturally over time, but for patients whose symptoms do not reduce and who continue to have difficulty returning to daily activities, VR can assist in recovery by promoting compensation.³

Vestibular rehabilitation therapy doesn’t cause physical risks. There’s always the chance therapy won’t completely resolve your dizziness or balance issues. This is particularly true if you’re not able to do the prescribed exercises on your own.

When patients participate in VR, different factors can impact the potential for recovery. For example, the type of vestibular disorder affects recovery. Patients that have a stable vestibular disorder, such as vestibular neuritis or labyrinthitis, have the best opportunity to have a satisfactory resolution of symptoms. When patients have a progressive vestibular disorder, like with multiple sclerosis, or a fluctuating condition, like with Migraine and Meniere’s, which causes spontaneous attacks of dizziness or vertigo, compensation can be difficult to achieve, and therefore, success with VR is more difficult. There are also differences in response to VR depending on whether you have one or both inner ears involved, or whether the problem lies within the vestibular parts of the brain as opposed to the ear(s).

Other Factors the can limit recovery include sedentary lifestyle, pain, presence of Other Medical Conditions, certain medications or multiple medications, emotional concerns, and decompensation. ³

Decompensation results in a symptomatic relapse. This can be due to different emotional and/or physical stressors, like personal or job-related pressures, periods of inactivity, a bad cold or flu, extreme fatigue or chronic lack of sleep, changes in medication, or sometimes surgery.   Although it is important for patients to consult with their physician to make sure nothing new has occurred, returning to the exercises that promoted the initial compensation can help promote recovery again. Additionally, recovery after de-compensation usually occurs more quickly as compared to the initial compensation.³

1. https://my.clevelandclinic.org/health/treatments/15298-vestibular-rehabilitation
2. Han BI, Song HS, Kim JS. Vestibular rehabilitation therapy: review of indications, mechanisms, and key exercises. J Clin Neurol. 2011 Dec;7(4):184-96. doi: 10.3988/jcn.2011.7.4.184. Epub 2011 Dec 29. PMID: 22259614; PMCID: PMC3259492.
3. https://vestibular.org/article/diagnosis-treatment/treatments/vestibular-rehabilitation-therapy-vrt/

Additional Resources:

https://vestibular.org/
www.anpt.org
Dr. Behr vestibular MD https://www.vestibularmd.com/

Heal my headache by David Buchholz

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