1. Vestibular Rehabilitation: Finding Your Balance
Stephanie Jimenez, DPT
SMH Outpatient Therapy

2. What We’ll Be Talking About
How common are vestibular disorders?
The vestibular system.
Most common types of vestibular disorders.
What causes vestibular disorders?
Symptoms of vestibular disorders.
What is vestibular rehabilitation therapy?
What goals will be achieved through therapy?
What type of exercises are involved in therapy?
Would I benefit from vestibular rehabilitation therapy?

3. Vestibular Disorders: How Common Are They?
Vestibular disorders can affect people of any age.
As many as 35% of adults aged 40 years or older in the U.S. have experienced some form of vestibular disorder.
Currently children are not typically screened, despite new awareness of pediatric vestibular disorders. As a result, children frequently fail to receive medical treatment for their symptoms.

4. The Vestibular System
Involves the inner ear, the eyes and areas of the brain that process the sensory information involved with directing balance and eye movements.
Central to a person’s core functioning, acting as the body’s GPS system.

5. Vestibular Disorders: Most Common Types
Vestibular disorders are not easy to diagnose. On average, patients consult 4 or 5 doctors before receiving a diagnosis.
Benign Paroxysmal Positional Vertigo (BPPV)
Labyrinthitis or Vestibular Neuritis
Ménière’s Disease
Secondary Endolymphatic Hydrops

6. Vestibular Disorders: What Is The Cause?
Disease or injury impairs processing areas.
Genetic or environmental conditions.
Unexplained reasons.

7. Symptoms Of Vestibular Disorders
Vertigo and Dizziness
Cognitive Impacts
Imbalance and Spatial Disorientation
Psychological Impacts
Nausea or Vomiting
Visual Disturbances
Fatigue
Hearing Changes

8. Symptoms Of Vestibular Disorders
Diminishes quality of life and impacts all aspects of daily living
Often cause sedentary lifestyles leading to:
Decreased muscle strength/flexibility
Increased joint stiffness
Reduced stamina

9. Vestibular Rehabilitation Therapy (VRT)
Customized exercises that target each person’s specific problem.
Can eliminate or drastically reduce symptoms by stimulating central nervous system compensation for vestibular deficits.
Many people experience permanent deficits because the vestibular system does not regenerate effectively. Through compensation, you can feel better and function more safely.
This is due to the brain’s ability to learn how to use other senses and parts of the brain to substitute for the deficient vestibular system.

10. Vestibular Rehabilitation Therapy (VRT)
The extent of recovery that can be gained through compensation is determined by the function and health of the compensatory areas of the nervous system.
Compensation happens naturally over time for many, but for people with symptoms that do not reduce, and continue to struggle resuming daily activities, VRT can help with recovery by promoting compensation.

11. Vestibular Rehabilitation Therapy (VRT)
VRT begins with a comprehensive clinical assessment.
Detailed history of symptoms and how the symptoms affect daily activities.
Therapist documents type and intensity of symptoms and discusses the precipitating circumstances.
Information about medications, hearing or vision problems, other medical issues, history of falls, previous and current activity level, and your living situation will be gathered. 

12. Vestibular Rehabilitation Therapy (VRT)
During the assessment, different tests will be administered to more objectively evaluate the problem.
The therapist will screen the visual and vestibular systems to observe how well eye movements are being controlled.
These tests assess sensation which includes gathering information about pain, muscle strength, extremity and spine range of motion, coordination, posture, balance, and walking ability. 

13. Vestibular Rehabilitation Therapy (VRT)
Your therapist will develop a customized exercise plan from the findings of the clinical assessment, results from laboratory testing and imaging studies, and input from you about your goals for rehabilitation.
An important part of VRT is establishing an exercise program that can be performed at home.
Compliance with the program is essential to help achieve rehabilitation and personal goals.

14. Vestibular Rehabilitation Therapy (VRT)
Along with exercise, patient and caregiver education is an important part of VRT.
It is very useful to understand the science behind your vestibular problem, as well as how it relates to the difficulties that may arise with functioning in everyday life.
Your therapist is able to help take away the mystery of what you’re experiencing, which can help reduce anxiety that may occur as a result of your vestibular disorder.

15. What Goals Will Be Achieved?
Decreased dizziness and visual symptoms
Increase in balance and walking functions
Increase in general activity levels

16. What Type Of Exercises Are Involved?
Depending on the vestibular-related problem(s) identified and related symptoms, three principal methods of exercise can be prescribed:
Habituation
Gaze Stabilization
Balance Training

17. Habituation Exercises
Designed to treat symptoms of dizziness that occur because of self-motion or visual stimuli.
Appropriate if you experience increased dizziness when moving around:
Quick head movements
Bending over
Looking up to reach above head
Appropriate if you experience increased dizziness in visually stimulating environments:
Shopping malls or grocery stores
Watching T.V.
Walking over patterned surfaces or shiny floors

18. Habituation Exercises
Not suited for dizziness symptoms that are spontaneous in nature and do not worsen because of head motion or visual stimuli.
Goal
Reduce dizziness through repeated exposure to specific movements or visual stimuli that provoke your dizziness.
Over time and with good compliance and perseverance, the intensity of dizziness will decrease as the brain learns to ignore the abnormal signals received from the inner ear.

19. Habituation Exercises

20. Gaze Stabilization Exercises
Designed to improve the coordination of eye and head movements.
Appropriate if you experience problems seeing clearly because visual world appears to bounce or jump around.
Especially helpful for patients with poor to no vestibular function, such as patients with bilateral (both sides) inner ear damage.
Two types of exercises depending on the type and extent of vestibular disorder.
Gaze shifting and remembered target exercises use sensory substitution to promote gaze stability.

21. Gaze Stabilization Exercises
The first type incorporates fixating on an object while repeatedly moving head back and forth or up and down.
The second type is designed to use vision and body sense as substitutes for the damaged vestibular system.

22. Balance Training Exercises
Designed to improve balance so that daily activities for self-care, work, and leisure can be performed successfully.
Helps improve:
Standing
Bending
Reaching
Turning
Walking/Running
Walking outside on uneven ground or in the dark

23. Balance Training Exercises
The exercises need to be moderately challenging but safe enough so patients do not fall while doing them.
Features of the balance exercises that are manipulated to make them challenging, include: 
Visual and/or somatosensory cues.
Stationary positions and dynamic movements.
Coordinated movement strategies (movements from ankles, hips, or a combination of both).
Dual tasks (performing a task while balancing).

24. Balance Training Exercises

25. VRT Exercises
VRT exercises are not difficult to learn, but to achieve maximum success you must be committed to doing them.
Since exercises can sometimes be tedious, setting up a regular schedule to incorporate exercises into daily life is very important.
At first, exercises might make symptoms seem worse. But with time and consistent work, symptoms should steadily decrease, meaning participation in activities of daily life will be easier.

26. Would I Benefit From VRT?
A variety of vestibular problems can be treated through VRT, including symptoms that often follow certain corrective surgical procedures for vestibular disorders.
Even individuals with long-term unresolved inner ear disorders who have undergone a period of medical management—with little or no success— may benefit.
VRT can also help people with an acute or abrupt loss of vestibular function following surgery for vestibular problems.

27. Would I Benefit from VRT?
It is important to note that not all dizziness is caused by vestibular deficits, making it critical that anyone considering a VRT program have a confirmed diagnosis of vestibular pathology.
Most referrals come from an Otolaryngologist or Neurologist.
The treating therapist may request an otology consult if there is a dispute about the nature of the underlying disorder in individuals who are referred from other sources.

28. Thank you!
SMH’s Outpatient Rehab Center offers Vestibular Rehabilitation Therapy. For more information or to schedule an appointment, please call (985)