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Vestibular Rehabilitation (VR)

Questions

What is Vestibular rehabilitation (VR)?

Vestibular rehabilitation (VR), or vestibular rehabilitation therapy (VRT) is a specialized form of therapy intended to alleviate both the primary and secondary problems caused by vestibular disorders. It is an exercise-based program primarily designed to reduce vertigo and dizziness, gaze instability, and/or imbalance and falls. For most people with a vestibular disorder, the deficit is permanent because the amount of restoration of vestibular function is very small. However, after the vestibular system damage, people can feel better and function can return through compensation. This occurs because the brain learns to use other senses (vision and somatosensory, i.e. body sense) to substitute for the deficient vestibular system. The health of particular parts of the nervous system (brainstem and cerebellum, visual, and somatosensory sensations) is important in determining the extent of recovery that can be gained through compensation.

How does it work?

At your appointment, a physical therapist will evaluate your symptoms and review your medical history. Your assessment will include all or part of the following areas:

 

  • Balance and/or leg strength/flexibility
  • Gait (how you walk)
  • Visual stability and mobility
  • Neck mobility and neck and arm strength
  • Positional testing, including an inner ear exam

 

The goal of VRT is to use a problem-oriented approach to promote compensation. This is achieved by customizing exercises to address each person’s specific problem(s). Before an exercise program can be designed, a comprehensive clinical examination is needed to identify problems related to a vestibular disorder. Depending on the vestibular-related problem(s) identified, three principal methods of exercise can be prescribed:

1) Habituation, 2) Gaze Stabilization, and/or 3) Balance Training.

Conditions/Symptoms treated

Patients typically referred for vestibular rehabilitation therapy are those diagnosed with dizziness, imbalance, vertigo, Meniere’s syndrome, benign paroxysmal positional vertigo (BPPV), neck-related dizziness, and migraines. Other candidates are patients who have had a stroke or brain injury or who frequently fall. Common Conditions/symptoms that can be helped with vestibular rehabilitation include:

  • Dizziness or blurry vision with head movements
  • Neck tightness, stiffness, and/or pain
  • Imbalance or the need to hold onto objects when walking
  • Headaches
  • Frequent falls
  • Generalized “dizziness, wooziness and foggy head” feelings
  • Vertigo/spinning

Who will benefit?

Vestibular rehabilitation has been very promising for people experiencing symptoms of dizziness, pressure in the ear, nausea, ringing in the ears, chronic headaches, or imbalance. In most cases, if patients continue to perform the exercises they have learned, balance, and dizziness problems decrease significantly or completely disappear. Vestibular physical therapy can get you better sooner than you anticipate. 

One of the most common Vestibular diagnoses is Benign Paroxysmal Positional Vertigo or BPPV. Physical therapy has been successful in the treatment of BPPV. For BPPV, rehabilitation may require just a few short therapy sessions focused on repositioning maneuvers. However, if the symptoms are related to another diagnosis, the process may take a few weeks of exercises that gradually progress. Most patients will have success with a significant reduction in symptoms or possibly a complete resolution of their symptoms after completing Vestibular physical therapy, and drastically improving their quality of life.

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