What is Vestibular Rehabilitation Therapy?
The vestibular apparatus is a small structure located in the inner ear that is important for balance. People with vestibular disorders often experience debilitating symptoms including dizziness, vertigo, nausea, fatigue and problems with vision and balance. These symptoms are often accompanied by secondary symptoms including reduced strength, loss of range of motion, and increased tension (particularly in the neck and shoulder region), usually resulting in muscle fatigue and headaches.

Vestibular Rehabilitation Therapy (VRT) is a specialized form of therapy that encourages the central nervous system to compensate for the inner ear deficit that may be causing dizziness or problems with balance.

VRT can help with a variety of vestibular problems, including:

• Benign paroxysmal positional vertigo (BPPV) (see below)
• Reduced inner ear function on one or both sides due to Ménière’s disease
• Labyrinthitis
• Vestibular neuritis

Even people with long-term, unresolved inner ear disorders who have undergone a period of medical management may still benefit. VRT can also help people with an acute or abrupt loss of vestibular function, for example, following surgery.

Benign Paroxysmal Positional Vertigo (BPPV)

Benign Paroxysmal Positional Vertigo (BPPV) is a very common cause of vestibular dysfunction. Miniscule particles called otoconia move into an area of the vestibular system where they don’t belong and trigger quite debilitating vertigo and dizziness. If this is found to be the cause of symptoms during the assessment, physiotherapy treatment may involve a specialized form of VRT called a canalith repositioning procedure, often referred to as the Epley maneuver. Research shows that the repositioning manoeuvre works to significantly improve symptoms on the first effort, 80-90% of the time.

VRT Assessment

To begin with, the physiotherapist will complete a thorough assessment that includes:

• Observing and measuring posture, balance, gait, and noting any compensatory strategies
• Eye-head coordination tests
• Screening of the cervical spine
• Questionnaires measuring the frequency and severity of symptoms and associated lifestyle changes.

VRT Treatment

Following assessment, a treatment plan is developed comprising of head, body and eye exercises that retrain the brain to recognize and process signals from the vestibular system, and coordinate them with information provided by our sensory system (vision and proprioception (joint position sense)). The aim is to desensitize the balance system to movements that provoke symptoms, and increase home-based activities and exercise in order to strengthen muscles, regain confidence and improve overall fitness.

Some of the exercise and activities may at first cause an increase in symptoms as the body and brain attempt to sort out the new pattern of movements. However, in most cases balance improves over time if the exercises are correctly and consistently performed. Muscle tension, headaches, and fatigue will diminish, and symptoms of dizziness, vertigo, and nausea will decrease or disappear. Often, VRT is so successful that no other treatment is required.