Vestibular rehabilitation is a specifchic individualized exercise-based program
designed to promote the brain’s compensation for inner ear deficits. It can help
with a variety of vestibular problems, like the unilateral or bilateral vestibular
hypofunction (reduced inner ear function on one or both sides) associated with Ménière’s
disease, labyrinthitis, and vestibular neuritis or mechanical dysfunctions like
benign paroxysmal positional vertigo (BPPV) where specific manoeuvres are performed
to correct this problem. Even individuals with long-term unresolved inner ear disorders
and balance concerns who have undergone a period of medical management with little
or no success may benefit. It can also help people with an acute or abrupt loss
of vestibular function following surgery for vestibular problems. The balance retraining
component is also effective for clients who don’t necessarily have a vestibular
problem, but have orthopaedic or central disorders, multiple sclerosis, proprioceptive
problems, or vision changes affecting their equilibrium. Vestibular disorders can
come from pathologies in any area of this complex system. They can be gradual or
due to factors such motor vehicle accidents, injury to the head, falls, contact
sport, medications, infections, brain-related problems, aging, or secondary to other
diseases or trauma.
The ability to maintain balance comes from the brain receiving and accurately interpreting
the sensory input from three systems - the eyes, the muscles and joints, and the
vestibular organs in the inner ears. The vestibular system sends signals primarily
to the neural structures that control our eye movements, head movement/position
and to the muscles that keep us upright. The signals to our eyes provide the anatomical
basis of the vestibulo-ocular reflex, which
is required for clear vision, and the signals to the muscles control our posture
and are necessary to keep us upright.
Semicircular canals: interpret rotational signals.
- Anterior Canal
- Posterior Canal
- Horizontal Canal
Otoliths: interpret linear accelerations.
Cochlea: It is the auditory portion of the inner ear. It contains
the organ of corti - the sensory organ of hearing.
Vestibular disorders can come from pathologies in any area of this complex system.
They can be gradual or due to factors such motor vehicle accidents, injury to the
head, falls, contact sport, medications, infections, brain-related problems, aging,
or secondary to other diseases or trauma.
Symptoms can include dizziness, vertigo, imbalance, blurry vision, motion sensitivity,
nausea, poor concentration, muscle guarding/restriction of movement, decreased activity
levels or social interaction, anxiety and depression. The patients may have trouble
reading, concentrating, focusing, and difficulty walking straight or turning a corner,
or doing simple arithmetic. Functioning in the workplace, going to school, performing
routine daily tasks, or just getting out of bed in the morning may be difficult
for some people.
The symptoms of vestibular disorders may be mild, lasting only few seconds or minutes;
or they may be severe, resulting in total disability. Not all symptoms will be experienced
by every person with an inner ear disorder, and other symptoms are possible. An
inner ear disorder may be present even in the absence of obvious or severe symptoms.
Vestibular rehabilitation is a specific individualized exercise-based program designed
to promote the brain’s compensation for inner ear deficits. It can help with a variety
of vestibular problems, like the unilateral or bilateral vestibular hypofunction
(reduced inner ear function on one or both sides) associated with Ménière’s disease,
labyrinthitis, and vestibular neuritis or mechanical dysfunctions like benign paroxysmal
positional vertigo (BPPV) where specific manoeuvres are performed to correct this
problem. Even individuals with long-term unresolved inner ear disorders and balance
concerns who have undergone a period of medical management with little or no success
may benefit. It can also help people with an acute or abrupt loss of vestibular
function following surgery for vestibular problems. The balance retraining component
is also effective for clients who don’t necessarily have a vestibular problem, but
have orthopaedic or central disorders, multiple sclerosis, proprioceptive problems,
or vision changes affecting their equilibrium.
Assessment includes:
- Thorough evaluation of the vestibular and balance system which includes medical
history observing/measuring posture, cranial nerves, static and dynamic balance,
propioception, eye-head co-ordination tests, gait and other compensatory strategies.
- Nystagmus analysis using an infrared camera in black-out goggles which provides
information about the inner ear and its connections in the brain.
- An assessment of fall risk.
- Completion of questionnaire measuring the frequency and severity of symptoms and
associated lifestyle changes.
- Education on dizziness or balance problems
Treatment includes:
- Mechanical problems like benign paroxysmal positional vertigo (BPPV) are corrected
- by canalith repositioning manoeuvres utilizing the infrared goggle technology which
enables specific identification of involved canal/ear.
- Exercises to promote central adaptation for vestibular dysfunction like specific
head, body and eye exercises, combination of static and dynamic balance retraining,
gait retraining, gaze stabilization, desensitizing the balance system to movements
that provoke symptoms and training for motion sensitivity.
- Balance retraining and fall prevention strategies are effective for clients who
do not necessarily have a vestibular problem, but have orthopaedic (such as cervicogenic
dizziness) or central disorders, propioceptive problems, or vision changes affecting
their equilibrium.
- Development of a goal oriented individualized treatment plan that may be performed
both in clinic and at home to maximize independence and early return to their day-to-day
activities.