Experiencing Dizziness? What Vestibular Rehabilitation is All About

Experiencing Dizziness? What Vestibular Rehabilitation is All About

by Cole Rehabilitation

Vestibular disorders are thought to be the most common cause of dizziness in older people, responsible for almost half of reported dizziness in the elderly.  Vestibular disorders may cause dizziness, vertigo, concentration difficulty, and fatigue, which can affect a person’s daily functioning, social relationships, and quality of life.

The ability to balance depends on sensory information from the vestibular system( or inner ear).  The vestibular system receives information from your ears, your eyes, and proprioception – sensory receptors from the muscles and joints (or the sensation) of your feet.

The vestibular system of the inner ear provides the brain with information about changes in head movement. If this system is not functioning properly, dizziness, vertigo, and imbalance can result.

Vestibular-system problems can be caused by a variety of influences, including viral infections of the inner ear.  Allergies may cause changes in the inner ear fluids or middle ear pressure because of swelling of the Eustachian tube and production of fluid in the middle ear.  The number of nerve cells in the vestibular system becomes smaller with age, and degeneration of hair cells in the inner ear is believed to occur with aging, resulting in dizziness, vertigo, and hearing loss.

BPPV (Benign Paroxysmal Positional Vertigo)
BPPV is one of the most common of all vestibular disorders, caused by head injury including whiplash in people under the age of 50.  BPPV is a disorder that causes vertigo, dizziness, nausea and other symptoms due to tiny crystals that have collected within a part of the inner ear.  These crystals are made up of calcium carbonate (or “ear rocks”).  Because of head trauma, infection, or even aging, these small crystals can migrate and send inaccurate signals to the brain causing dizziness and other symptoms.

Symptoms of BPPV are almost always precipitated by a change in head position with respect to gravity.  Getting out of bed or rolling over in bed are  common “problem” motions.  Some people feel dizzy and unsteady when they tip their heads back to look up.  BPPV may be present for a few weeks, then stop, then return again.

BPPV Treatment
The Epley Maneuver is very effective in treating BPPV. The goal of the maneuver is to move the detached crystals out of one of the semicircular canals.  The maneuver involves a series of specifically patterned head and trunk movements performed by a trained professional – a physical therapist, who closely watches for the characteristic jumping of eye movements (nystagmus) with each position change.

Vestibulo-Ocular Reflex (VOR)
The VOR performs to maintain stable vision during head movement (eye-head coordination).  The evaluation is performed to assess a person’s ability to maintain fixed eyes during horizontal and vertical head movement of varying speed.  Treatment exercises are used to improve eye coordination when the head is still and in motion. The person repeats exercises in supported sitting position, and progress to standing and walking as tolerated.

Vestibular Rehabilitation Therapy (VRT)
The goal of VRT is to retrain the brain to recognize and process signals from the vestibular system in coordination with information from vision and proprioception. This often involves desensitizing the balance system to movements that provoke symptoms.

A qualified therapist will first perform a thorough evaluation. This includes observing posture, balance, movement, gait, and compensatory strategies. The physical therapist will develop an individualized treatment plan that includes specific head, body, and eye exercises. Often, treatment may include exercises to strengthen muscles and increase daily activity tolerance.

Balance improves if the exercises are correctly and consistently performed, in most cases. Muscle tension, headaches, and fatigue will diminish, and symptoms of dizziness, vertigo, and nausea will decrease or disappear. Exercises to improve dynamic balance are appropriate for nearly all vestibular disorders.

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