About Vestibular Therapy

Vestibular therapy involves very specific physical therapy exercises that address both static and dynamic balance as well as different aspects of visual coordination as they relate to the vestibular system (inner ear). Vestibular therapy uses a set of individualized exercises, prescribed by a physician and carried out by a specialized type of physical therapist. The goal of vestibular therapy is to retrain the vestibular, somatosensory, and visual systems to more effectively communicate between each other as well as the central nervous system (CNS). As a result of technological changes, there have been many advances in the field of vestibular therapy, resulting in better care for the patient. The field has dramatically broadened to include the evaluation and manipulation of complex interactions among input and output sensory strategies for maintenance of balance and dynamic visual stabilization.

The Physical Therapist

Vestibular therapy is performed a by physical therapist who has specific training in treating vestibular disorders. Physical therapy education programs cover the general basis for vestibular rehabilitation, but few programs have made it a part of their core curricula. Therefore, our physical therapists have additional specialized training in vestibular therapy in addition to their general education. Expertise in treating vestibular patients is developed over time by attending advanced courses, through site visits to centers with extensive experience in the field, and through personal clinical experience.

Indications and Process of Vestibular Rehabilitation

Most dizziness and imbalance symptoms are related to inner ear disorders, which can resolve spontaneously with normal, everyday activities. However, when symptoms of dizziness and imbalance persist beyond even a brief period of time, balance and visual input and output strategies can change, thus causing long term problems. It is this group of patients that suffer most from their chronic symptoms and who would benefit most from a vestibular therapy. The alleviation of symptoms associated with balance/dizziness problems can be accelerated with vestibular therapy.

The initial phase of vestibular therapy begins before you even go to the therapist. It begins with diagnostic testing and a visit with the physician. Diagnostic testing is preformed to challenge and evaluate the many aspects of the balance systems, giving a holistic view on how a patient may benefit from therapy. Following testing, the doctor will interpret and evaluate each diagnostic test. Once the physician has a complete understand of your entire balance systems: vestibular, somatosensory, and visual, he will be able to determine what treatment protocol should be prescribed for you. Generally speaking, patients with the following conditions will benefit from vestibular therapy:

• Benign Paroxysmal Positional Vertigo BPPV
• Concussions
• Motion Sickness
• Chronic Imbalance
• Meniere’s Disease
• Other Disorders

At the end of your visit, the physician will instruct you if and when therapy will be the most beneficial. Generally, patients will have a short period of time on medications or other forms of therapeutics to allow the vestibular system to stabilize. This process of stabilizing the vestibular system may take anywhere from 1 day to 2 weeks. Once this process has begun, vestibular therapy exercises can be used to teach the patient’s system how to adapt, substitute, habituate, or compensate in order to improve their overall balance. In the early stages of treatment, patients typically experience a sense of worsening (this is expected and is why there is a gradual progression into high level exercises). The symptoms worsen because prior to treatment the patient’s vestibular system has made a number of natural adjustments which allow the patient to function reasonably well, as long as they stay within a limited range of activity. Therapy causes the central nervous system (CNS) to begin to move away from its previous habits toward more effective sets of patterns. This allows the patient a much broader range of tolerable activity and a return to “normal life”. As a result, patients may become quite uncomfortable during the first few visits, and may require reinforcement, support, and/or encouragement. A typical treatment program may involve about 6-8 formal sessions, usually twice per week for three to four weeks. After that period of time a great majority of patients are scheduled to follow for either once a week or on an as-needed basis. The largest portion of the rehabilitation process is preformed by the patient at their home.

Vestibular Therapy is not for Everyone

Not all patients with balance deficits will benefit from vestibular therapy. If the patient’s individual balance problem is not specifically related to their vestibular system, they will not benefit. Some non-vestibular problems that can cause dizziness or imbalance include:

• Cervical myelopathy
• Low blood pressure
• Medication reactions (other than ototoxicity)
• Transient Ischemic attacks (TIAs)

Expected Results from Vestibular Therapy

The majority of patients who are suffering from chronic dizziness and imbalance have a normal central nervous system. Therefore, the potential for improving the patient’s symptoms is quite favorable with appropriate care. When vestibular therapy is performed by a trained vestibular rehabilitation specialist, improvement can be seen in 80-90% of patients. This prognosis however is not seen when there is a significant central nervous system abnormality or complete (bilateral) absence of inner ear function. Failure of vestibular therapy will also occur if there are ongoing inner ear fluctuations; therefore, a combination of vestibular therapy and medical treatment is needed in conjunction with one another. The combination of treatments, from your therapist and physician, allow the brain to adjust in a stable environment. If the vestibular system is not stable, vestibular therapy alone will not cure your symptoms. Therapeutic medication, in most cases, will be indicated in order to allow inner ear fluctuations to stop, prior to the initiation of vestibular therapy.