Vestibular Rehabilitation

Patients who come to the Brainstorm with a vestibular disorder may have a variety of symptoms. Common symptoms of a vestibular disorder include dizziness, vertigo, and imbalance. Patients may also experience nausea, hearing changes, anxiety, fatigue, and trouble concentrating. 

At Brainstorm, patients with a vestibular disorder will receive a thorough evaluation to determine the type of vestibular deficit and its effect on the patient’s balance and quality of life. 

There are several causes and types of vestibular disorders which can be determined by your practitioners. 

The most commonly seen disorders at Brainstorm include: 

  • Benign Paroxysmal Positional Vertigo (BPPV) 

BPPV is one of the most common types of peripheral vertigo. Its exact cause is unknown. It becomes more common as we age, may begin following a head trauma, or may be idiopathic (cause unknown). Symptoms are due to debris that has collected within a canal in the inner ear. The debris consists of small calcium carbonate crystals often referred to as “ear rocks”. These calcium carbonate crystals move through the canal as the head position changes. This sends incorrect signalling to the brain producing the sensation of vertigo. Provoking head positions and movements are often getting in or out of bed, bending over as to pick something up off the floor or tie shoes, or looking up when reaching for something overhead. These symptoms may not occur every time you do one of the previous activities and may occur with only one or all of them. 

  • Vestibular Neuritis and Labyrinthitis 

Vestibular Neuritis and Labyrinthitis are caused by an irritation of the vestibular nerve within the inner ear due to an infection. The infection is typically viral and can be preceded by any systemic viral infection like the common cold. The infection can move to the inner ear and cause irritation of the vestibular nerve. The irritation of the nerve results in an often sudden attack of vertigo and possible nausea. The symptoms are initially severe and can last for a period of 1-4 days with gradual improvement over the next several weeks. For many people, these symptoms will resolve on their own. For others, activities like driving, walking through the grocery store, crowds, malls, airports, or just going down the street continue to cause dizziness and imbalance. These individuals may also notice difficulty concentrating, fuzzy vision and symptoms worsening with fatigue. 

BPPV and Vestibular Neuritis/Labyrinthitis are the two most commonly seen and treated vestibular disorders at Brainstorm. There are many other causes of dizziness and vertigo. It is important to see your physician to discuss your symptoms and receive a proper diagnosis prior to beginning vestibular rehabilitation.


Treatment through Vestibular Rehabilitation 

The treatment of a patient with an inner ear disorder focuses on determining a specific plan based on the individuals diagnosis and symptoms. At Brainstorm the patient will receive a thorough evaluation to determine this specific plan. 

Vestibular Rehabilitation Therapy (VRT) 

When the vestibular system has been affected due to one of the above conditions the brain cannot rely on the information it is receiving from the vestibular system. The patient’s ability to maintain balance is now dependent on vision and signalling from muscles and joints. This can lead the patient to compensate for the change by avoiding various head positions and movements because these increase their symptoms. The avoidance helps to decrease the number of instances of dizziness and nausea but result in headache, muscle stiffness, fatigue and decreased ability for the brain to adapt to the change in the vestibular system. Overall these avoidances make symptoms worse and increase the need for VRT. 

VRT includes: 

  • Gaze Stabilization Exercises

When a patient has had vestibular neuritis or labyrinthitis the information the brain receives from the vestibular system has been changed. Adaptation exercises may be used in order to help the patient’s brain adapt to new signalling from the affected vestibular system. Visual fixation on a target during head movement is a key gaze stabilization exercise given to assist in this retraining. 

  • Balance Retraining Exercises

When the vestibular system has been affected by vestibular neuritis or labyrinthitis the nerve signalling related to balance and walking has also changed. When this occurs, balance training is also indicated. Balance retraining involves exercises designed to improve coordination of muscular responses as well as the organization of sensory information (eye sight, vestibular system) for balance control. 

In addition to a home program, patients are seen by the physical therapist one to two times each week for an average of four to six weeks. During this time progress is monitored, the home exercise program is modified and specific balance retraining occurs. 

  • Canal Repositioning Manoeuvres

When the patient has been affected by BPPV canal repositioning manoeuvres are indicated. During the evaluation it will be determined what canal the debris lies in. Once the physical therapist has determined this, a canal repositioning manoeuvre will be used to dislodge or reposition the debris within the affected canal.

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Vestibular Rehabilitation