Vestibular Rehabilitation is an exercise-based program based on a detailed assessment by a trained vestibular Physiotherapist. VRT is effective in reducing, dizziness, vertigo and balance problems, there by minimize the risk of falls and helps to improve the quality of life in people with vestibular dysfunction. BPPV or the free-floating crystals in the inner ear is the common cause of Vertigo and the diagnosis is made with a test called Dix-Hallpike.
There is peripheral vestibular system which is in your inner ear and central processing is done by vestibular nucleus and cerebellum which in your brain. The vestibular system receives input from the inner ear, joint position sensation, visual signals and movements. These inputs are integrated in the vestibular nuclear complex and produces necessary output to move your eyes and body. These complex processes are monitored by cerebellum.
Vestibular impairment is the cause of vertigo in as many as 45% of people complaining of dizziness. BBPV of free-floating crystals in one or more of the canals in your inner ear is the common cause of Vertigo in people over the age of 50yrs.The other factors which causes vestibular dysfunction are head trauma (whiplash /concussion), Vestibular system degeneration, Vestibular neuritis, Meniere’s disease, Acoustic neuroma (benign tumour), barotrauma (trauma due to excessive pressure), ototoxicity.
Vestibular Rehabilitation – BPPV
Loss of vestibular function in both ears can result in poor balance, difficulty walking in darkness, and uneven surface and also poor vision with head movements. These problems might result in social isolation and activity limitation. Vestibular rehabilitation in these cases can improve postural stability and vision during head movements, but there can be residual problems. Your vestibular physiotherapist will teach compensatory strategies to use in challenging situation, gaze and postural stability exercise to help you manage your limitations. The exercise program and the progression are usually customized for each patient.
The initial screening includes collecting a detailed history of your problem, tests for BPPV, assessment of visual problems, neurological test, visual screening and various balance test. Initial assessment will also help to differentiate between the vestibular problems due to dysfunction in your inner ear and dysfunction in the parts of brain which controls your balance and coordination.
Following your first assessment your Physiotherapist will develop personalised exercise-based treatment plans including clinic-based treatment and home exercise program. Your exercise will be reviewed during the follow up visits and progressed as needed to help you with the recovery. Some of the exercise may provoke your symptoms in the initial period, because these exercises are meant to encourage your brain to compensate for the problems in your inner ear. Your Physiotherapist will decide on the intensity and repetition of the exercise and it is very important to incorporate exercise in to your daily routine as advised by your Physiotherapist.
Physiotherapy treatment plan may include eye and head movement exercise. exercise to improve standing balance and walking, specific techniques performed in the clinic to reposition the loose crystals in your inner ear if you have BPPV, advice on falls prevention and education and advice on planning and pacing your activities of daily living to improve confidence and function.