What you Need to Know about Vestibular Rehabilitation

Our sense of balance and spatial orientation is largely controlled by a sensory system located in the inner ear. It is called the vestibular system and it sends signals to the muscles that keep us upright and those that control eye movements based on linear accelerations and rotational movements.  These balance signals are transmitted by the auditory nerve, which is why many people who suffer from hearing loss also have balance issues.

How then do deaf people get around?  

The two systems are not entirely dependent on one another.   Most deaf people adapt quite quickly and never suffer from balance issues. The same cannot be said for older patients. As people age, they tend to experience some degree of hearing loss. This can and often does lead to a vestibular deficiency, which increases the risk of dizziness in elderly individuals. Falls are now the leading cause of serious injury and death for Americans over the age of 65. According to reliable estimates, nearly half of these accidents may be the result of a vestibular disorder.

Dizziness or vertigo is a common symptom of both central and peripheral vestibular disorders.  There are more than a dozen different disorders in total, including vestibular neuritis, perilymphatic fistula, labyrinthitis, acoustic neuroma, migraine, and multiple sclerosis.  The good news is that the dizziness and balance issues that are normally associated with these disorders can be treated with physical therapy.

Vestibular Rehabilitation Therapy (VRT) utilizes specialized exercises that help patients improve their gait and gaze stabilization.  Most of these drills involve head movements, since they are necessary to stimulate, manage, and restrain the vestibular system.  Though it is relatively new, VRT therapy has proven highly effective at resolving common symptoms, especially dizziness and vertigo.

How does it work?

As we mentioned earlier, the reason why deaf people seldom suffer the common symptoms of vestibular deficiencies is that they adapt quickly. The goal of all VRT exercise programs is to help people compensate for their disorder or disease.   For most patients it is not an easy road, but symmetry and equilibrium can be restored with regular practice.  Like most exercises, people who are in better overall shape are likely to respond more quickly.  Older patients, in particular, may not respond as expeditiously, since their sensory functions and general motor coordination may not be operating at high levels. This does not mean that vestibular rehabilitation therapy (VRT) cannot help them. However, they should seek out therapists who work mostly with elderly patients.

Basic Goals  

The primary purpose of all VRT programs is to improve balance during locomotion.  This will help minimize falls and bouts of dizziness and vertigo.  Though it is generally the result of physical factors, there is also a psychological component to the training. People who suffer from vestibular disorder are more likely to experience anxiety as a result of their condition. In other words, they start getting dizzy and they start to panic, which only serves to increase their risk of accidental injury.  VRT programs help patients deal with their anxiety and hopefully avoid injury.

Why it works

The things we call instincts are really nothing more than primary motor responses that allow us to react to certain situations and stimuli. When they stop working, our bodies can adapt or compensate for these deficiencies, but it takes time and practice. Alternate or secondary motor responses can be utilized to help patients manage the symptoms of disequilibrium and vertigo that are often the result of a vestibular disorder.  Learning how to control head, eye, and body movements, position, and posture will help. It is also important to maintain a stable gaze.  

The most frustrating part of VRT training is that new patients have to constantly remind themselves of things that once came naturally.  Having to tell yourself to keep a steady gaze or to stand up straight is not something most adults do on a regular basis. That said, most patients get used to it and after a few months no longer have to remind them themselves what they must to reestablish equilibrium.

Finding the right VRT program
 
There are several important factors a therapist and his patient must consider before they begin an exercise program. The first and most significant is the location and extent of the damage to the vestibular system. It is also crucial to consider age, physical strength, and motor skills. Patients with certain acute disorders of the vestibular system may not benefit from these programs.

Like most forms of physical therapy, patients are expected to perform regular exercises at home. As they gain more confidence and their symptoms improve, they may only have to see their therapist on a limited basis. When optimal balance is achieved, they can discontinue their sessions altogether.  However, some therapists recommend regular follow-ups, which may be a good idea, depending on the vestibular disorder.   

The information provided in this article is for informational purposes only. It is not a substitute for medical advice. All medical information presented should be discussed with your healthcare professional. Remember, the failure to seek timely medical advice can have serious ramifications. We urge you to discuss any current health related problems you are experiencing with a healthcare professional immediately.