What is vestibular rehabilitation?
Vestibular rehabilitation is an exercise approach to the remediation of disequilibrium and dizziness symptoms associated with peripheral vestibular pathology.
At SMC, our vestibular rehabilitation is a treatment involving specific exercises designed to (1) decrease dizziness; (2) increase balance function; (3) increase general activity levels. Our exercise program is designed to promote central nervous system compensation for the inner ear deficits.
For the first four to 6 weeks, your vestibular rehabilitation will be with one of our physical or occupational therapist and then progress to a daily exercise routine at home.
How does physical therapy help?
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?
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.
How will the therapist assess my problems?
Our therapist will conduct an assessment of function in a patient with inner ear dysfunction focuses on three major areas: (1) evaluation of the musculoskeletal system; (2) balance and gait assessment, and (3) vertigo assessment.
Musculoskeletal assessment includes general range-of-motion, strength, sensation and coordination.
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 an assessment, short-and long-term goals are established, and, the patient can begin their customized exercise program.
What happens in the exercise program?
The exercise program will focus 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.
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.