Vestibular Rehabilitation Therapy

When the vestibular organs of balance are damaged with disease or injury, there is conflict of information to the brain about the equilibrium and motion often resulting in dizziness, vertigo, and imbalance.Brain has tremendous plasticity so it usually adapts to the situation  (An amazing process called Nature’s mechanism of vestibular compensation) and many people recover from these symptoms on their own after a few weeks.

Nature’s compensation process for imbalance can be accelerated by Vestibular Rehabilitation Therapy.

What is Vestibular rehabilitation Therapy (VRT)?

Vestibular rehabilitation therapy (VRT) is a form of physical therapy that uses specialized exercise to enhance nature’s compensatory mechanism for imbalance due to inner ear disorder (Peripheral Vestibular System) which helps in retraining of brain to recognize and process signals from inner ear in coordination with Eye (Vision) and Muscle and joints (Proprioception). It also helps to desensitize the balance system to movements that provoke the symptoms.

VRT is effective in a variety of vestibular problems, including benign paroxysmal positional vertigo (BPPV),  Ménière’s disease, labyrinthitis, and vestibular neuritis.

What are the Benefits Of VRT

Reduce fall risk level
Increase safety and independence
Decrease feelings of dizziness and unsteadiness
Accelarating mechanism of central adaptation
Improve mobility

How Vestibular Rehabilitation Therapy works?

Most VRT works at three ways— Adaptation, Compensation and Habituation

Adaptation — Head-eye coordination exercises which stimulate brain help the eye-ear reflex work in a coordinated manner.  It also stimulates the balance portion of the ear.   It is critical that the head turn separately from the rest of your body in order for the ear to receive proper inputs.

Compensation— Balance retraining exercises which help to reduce unsteadiness by utilizing vision, sensory system and postural system more effectively to keep the balance.

Habituation – continually repeating the actions that bring on the symptoms of dizziness or vertigo will eventually accustom the body to those actions.

Exercise Protocols

Vestibular rehabilitation exercises focus on gaze stability and gait stability. Gait stability includes both static and dynamic balance exercises.
I. Adaptation exercises Vestibulo-Ocular Reflex (VOR) stimulation exercises -
(Vestibule – means balance organ of Inner Ear & Ocular- means Related to eye)

When some object is moving towards one side, the eyes must also move along with it to keep it in focus, this stable gaze and visual focus (to stabilize the image of the surroundings in the retina) during active and passive head movement is maintained by Vestibulo-Ocular reflex.

When one side vestibular labyrinth is damaged this system does not work. So person will not be able to keep the image of the moving object in the visual focus (on retina) and this retinal slips cause vertigo.

Eye movements are controlled by extra ocular muscle activity, under the control of an image stabilization. Adaptation exercises are basically retraining of the extra ocular muscles to stabilize the gaze while focusing on a stationary object and follow a moving object by moving head.

Ia. Gaze stability and ocular control exercise

1.  Focusing with Head Turns  (Head Eye Coordination exercise)

     This exercise helps in stabilizing the gaze with quick, short head movements.

  • Sit in a comfortable chair and hold a card with a 1 inch letter written on it at arms length in front of you.
  • While keeping eyes focused on the letter move your head from side to side approx. 30 degrees.   .
  • Increase speed of head movement with each progression.
  • As function improves, move the card opposite to the head movement while keeping the eyes focused on the letters.
  • Move the head to the left and the card to the right keeping the eyes focused on the letters.
  • Begins slowly and increase the speed as the test progresses. Progress from sitting to standing to a sharpened stance.
  • Post the card on the wall with a plain background and progress to posting on a wall with a busy patterned background.

2.   Horizontal and Diagonal Head Movements)

       This exercise helps to keep the vision stable with head movements.

  • Sit in a comfortable chair with feet flat on the floor and hands on thighs.
  • Have a target situated to your right and to your left as well as in the center.
  • Quickly turn only your head and eyes to the right target pause for 2-3 seconds and then return to the middle target and pause for 2-3 seconds.
  • Repeat 15-20 times
  • Repeat the sequence to the left and center.
II. Compensation exercises Ocular motor exercises
III. Habituation exercises
Combined category exercises(At a grocery store or mall)

Exercise Protocols for Individual Patients

On the Basis of symptoms of individual patient Specific Vestibular Program is designed tailored to fit need of the patient.

Extent and location of damage of vestibular system, state of visual and proprioceptive systems, General physical health, motor skills, cognitive abilities, anxiety states and integrity of the cerebellum are taken into consideration.

These custom-designed exercises are to be done at home several times a day which begins at the minimal skill level and complexity is increased as compensation and habituation occur.

Patients have regular follow-up visits with the therapist until compensation and habituation are complete and optimal balance is attained.

Caution - Someone should be there by the side of the patient to support in the case of imbalance as often people experience increased dizziness shortly after starting a vestibular therapy program. Caution should be used while doing these exercises, especially standing and walking exercises.

Our Specialist

Dr. Nitish Jhawar

Fellow Advance Laparoscopic Surgery
Fellow Colorectal Surgery USA
Senior Laparoscopic & Colorectal Surgeon
Phone No: +91 9322 229 159
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