Vestibular Rehabilitation Therapy Guide
- By Dizzy & Vertigo Institute
- June 30, 2021
You’ll be hard-pressed to find any dizziness treatment program that doesn’t include Vestibular Rehabilitation Therapy (VRT). VRT is a customized set of visual and physical therapies designed to alleviate the symptoms of vestibular disorders and other sources of imbalance.
There’s nothing generic or pre-planned about VRT. It’s tailored entirely to the dizzy patient’s situation. However, there are overarching types or categories of therapies that are standard in most VRT programs.
First and foremost, though, when is Vestibular Rehabilitation Therapy used?
Purpose of Vestibular Rehabilitation Therapy
Dizziness is the symptom of nearly everything. Therefore, the first question that dizzy patients often ask themselves is, “Why Am I Dizzy?“
Then, it’s the Vestibular Audiologist’s job to assess the dizzy patient’s case. First, diving into the patient’s history. What makes them dizzy? What type of dizziness are they experiencing? How long do symptoms last?
With an understanding of what’s going wrong, the Vestibular Audiologist then focuses on why it’s going wrong. They do this through a series of vestibular tests designed to find the malfunctions in a patient’s balance system.
The eyes, the ears, the brain, and the spine all compose the balance system. Each part of the balance system collects different information on movements, rotations, accelerations, and tilts. Then, this information is sent to the brain in order to come to a “consensus” on balance.
Based on this information, our bodies have programmed two natural reflexes to react and correct our balance:
- Vestibular-Ocular Reflex – Eyes and inner ear instruments communicate to align eye and head movements.
- Vestibular-Spinal Reflex – Central Nervous System (and muscles) and inner ear instruments communicate to align body movements and vestibular balance.
These fine-tuned reflexes help our bodies maintain steady, grounded, and balanced. But if any information from the parts of the balance system aren’t aligning or agreeing, our brain cannot communicate how to correct our balance.
Vestibular testing addresses both the patient’s subjective symptoms and data from highly specialized vestibular equipment to determine the source of the balance problem. As we did for Mark Cuban not long ago.
What is VRT?
And so with Vestibular Rehabilitation Therapy (or Vestibular Retraining as it is sometimes called), we use a number of exercises and equipment to retrain the body, the brain, the inner ear, and the eyes to properly communicate.
The overarching types of VRT treatments include:
- Balance Training – Strengthening the muscles used to balance.
- Gaze Stabilization – Reset the eyes’ perceived sense of balance.
- Habituation – Building up a patient’s internal defenses against dizziness triggers.
- Canalith Repositioning – Re-aligning the inner ear instruments used to detect balance.
VRT is entirely customized to the patient’s case. Vestibular Audiologists (like ourselves) or Physical Therapists create a plan and range of exercises specifically addressing the data collected on the patient’s vestibular system.
If everything goes according to plan, VRT promotes the human body’s ability to compensate. Essentially, compensation is the brain’s way of finding “balance shortcuts” to recalibrate your balance.
In normal functioning adults, compensation happens naturally. However, for the dizzy patient, we use VRT to speed up and promote this process of compensation.
In the next few sections, we’ll explore each of the high-level categories of exercises used in VRT. Of course, the specific use of each varies from patient to patient.
Every house needs a great foundation. You can hang the nicest paintings, lay the shiniest tile floor, and install top-of-the-line appliances. But if your foundation is rotten, that house is going to eventually come tumbling down.
Balance training is the foundation of dizziness treatment (but not always the first stage of treatment).
Realistically, everyone needs to be doing exercises to strengthen their core (and thus their balance) not just dizzy patients. However, for dizzy patients, it is especially important.
- Doing a task while balancing on a plank or a ball (or anything that is not dangerous).
- Coordinated dynamic and stationary movements.
- Triggering somatosensory system with coordinated prompts.
The purpose of balance training therapy is to improve stability and build confidence in the patient. We want dizzy patients to be able to carry out daily activities like walking, turning, and bending without losing balance.
Balance training is one part of therapy we would encourage you to do at home as well. Yoga, tai chi, and core strengthening exercises are great ways to do so.
An unsteady hand cannot draw a straight line, just like an unsteady eye cannot comprehend stability. The purpose, then, of gaze stabilization is to correct the unsteady eye through a set of synchronized head and eye movements. Patients will focus on an object while asked to make certain head movements. This is the underlying principle of gaze stabilization.
At the Dizzy & Vertigo Institute, we utilize virtual reality and visually immersive environments to administer these therapies.
The vestibular rehab therapy ranges from simple visual stimulation with ocular tracking to highly complex and advanced head and body movements. The treatment really depends on the diagnosis and the patient’s tolerance levels. It’s like getting into cold water. Some people need to be eased in while others can jump in headfirst.
You would never walk into the gym and head right for the 50lb dumbbells if it were your first time there (or coming off an injury). Your muscles require repetition in order to get stronger and advance to lifting heavier weights. Similarly, your brain needs to strengthen its ability to make sense of the input from the eyes, ears, and somatosensory system.
Brains need time to learn the difference between correct and error signals. Processing these signals takes repetitions. And repetitions form habits.
For example, putting patients through repetitive, aggravating head movements, body movements, and/or visually demanding stimulation all build habits of overcoming dizzy triggers.
It may not be fun at first. Similar to waking up with sore muscles the day after a workout, habituation training can be exhausting for the brain. But the soreness signals progress.
When treating patients with BPPV, the first treatments we turn to are the Semont Maneuver or the Epley Maneuver – canalith repositioning maneuvers.
Basically, they are maneuvers we use to physically reposition the displaced otoconia (aka crystals) into their appropriate placement within the semicircular canals in the ear. The otoconia play a vital role in the balance system. So when they’re out of place, then the body feels out of alignment.
In the span of 15 minutes (the time it takes to change bedsheets) we can cure positional vertigo! Pending a proper diagnosis, these maneuvers have an approximate success rate of 80%.
Of course, if the wrong ear or semicircular canal is diagnosed or patients try to do this on their own without a trained professional, the result can be making things worse and more uncomfortable than they were before.
Honestly, that goes for all of the treatments above. Dizziness can be a very frustrating invisible symptom to live with. And the home remedies always seem so enticing. But like trying to diet while working in a cake factory, working on your dizziness without proper help can be a futile task.
Are You Dizzy?
Are you playing Google Search Doctor? Trying to find the remedies that will hopefully cure your dizziness? You’ve likely come across many at-home vertigo remedies involving odd head maneuver videos and tutorials.
However, you wouldn’t try to reset a broken bone on your own. So why try to fix your dizziness alone?
It can be dangerous to try and solve the cause of your dizziness on your own. Given the large number of causes of dizziness and vertigo, you might be trying to remedy the wrong problem.
That’s why it’s best to defer to experts in the field.
Find a Vestibular Audiologist. Fixing balance issues is their entire focus.
Our team at the Dizzy & Vertigo Institute specializes in bringing dizzy patients back to a dizzy-free life. And we’re eager to help YOU!
We offer in-person or telehealth appointments in order to fit your needs.
Schedule an appointment with us or give us a call at (310) 954-2207.
And we look forward to hearing from you!