Let's Break to Educate: Vestibular Rehabilitation Therapy

Video Transcription

Hello. My name is Jennifer Burus. I'm a physical therapist with CHI Saint Joseph Health – Outpatient Rehabilitation. Thanks for joining me today for Let's Break to Educate. 

The topic for today is vestibular therapy. We're going to talk about what vestibular therapy is, what a patient could expect to experience if they come for vestibular therapy, and how that experience might be a little different if they have BPPV, which is a very common cause of vertigo, especially in older adults. 

What is vestibular therapy? 

So, what is vestibular therapy? Vestibular rehabilitation therapy is a specialized type of therapy intended to help with the direct and indirect problems caused by vestibular disorders. So, these are disorders of the inner ear or the parts of the brain that process the information from the inner ear. It's an exercise-based program designed to reduce symptoms like vertigo and dizziness, difficulty keeping your vision stable when your head is moving, imbalance or falls.

The goal of vestibular therapy is to use a patient-oriented approach to develop tolerance to movement and retrain the brain to compensate for the inner ear's deficits. This is accomplished by tailoring exercises to the patient's specific problems. Based on the problems that the therapist identifies for that individual patient, there are three common types of exercise used: 

• Habituation
• Gaze stabilization
• Balance training 

Habituation

Habituation exercises are for people who get dizziness or have symptoms when they move their body in certain ways, motion sensitivity, or when they have movement in their visual field; so, visual motion sensitivity. 

The goal of habituation exercises is to reduce the dizziness through repeated exposure to the movement or visual stimuli that provokes the patient's symptoms. The symptoms provoked are mild. They recover with a relatively short rest period, and the patient is always allowed to recover to their baseline symptom level before going on to another exercise or returning to their daily activity. 

Over time, and with repetition, the brain learns to ignore incorrect signals coming from the inner ear, and the patient's dizziness while doing these things decreases. 

Gaze Stabilization

Gaze stabilization exercises are used to improve control of eye movements when the head is moving. Your inner ear contributes to this through a reflex that ties your inner ear to the muscles that attach to your eyeball, so that as you move your head, your eyes counter that movement, and you can keep looking at whatever you're looking at and it stays stable and clear and easy to see. 

Patients with vestibular disorders often have issues where when they move their head, the visual world blurs or bounces; they can't keep that focus stable, and it causes them to feel disoriented. So, these types of exercises are designed for patients that have those issues. 

Balance Training

Balance training is to improve steadiness during daily activities and should be designed so that the balance exercise is selected — so after the patient's specific balance-related problems. his might be decreased strength and range of motion. It might be poor endurance. It might be poor reaction time with loss of balance, learning to use your visual cues or your sensation to help with your balance, or balancing while distracted, multitasking. 

Ultimately, balance training is to improve walking and bending, reaching, turning and even higher level activities like running or recreational activities so that a patient can move safely and confidently through their world. 

What to Expect During Vestibular Therapy

So, what should a patient expect if they come for vestibular therapy? Well, first you're going to be seen by a licensed physical therapist or occupational therapist who's had advanced postgraduate training in vestibular therapy. 

We begin with a comprehensive clinical assessment that includes collecting information about the symptoms that the patient is experiencing and how those symptoms are affecting their daily life. We're going to take information on the type of symptoms, duration and the frequency, and talk quite a bit about what provokes the symptoms, or what situations they have difficulty with.

We also gather information about medications, hearing and vision problems, other medical history issues, history of falls, previous and current activity level and the patient's living situation. The examination includes tests that are designed to help us determine the patient's specific deficits. So, we're going to screen the visual system and the vestibular system, looking at control of eye movements and motion sensitivity. We're going to look at sensation, muscle strength, range of motion in the legs and spine, coordination, posture, balance, and walking ability. 

A customized exercise plan is then developed based on the findings of that assessment, with input from the patient about what their goals are for rehabilitation. An important part of that plan is the home exercise plan. The patients need to have something that they can safely and regularly participate in outside of their therapy appointments so that they can get in enough repetitions to drive the kind of change that we need to see and meet their goals.

Another large component of vestibular therapy is education. A lot of our patients come to us with little to no previous information or experience with vestibular disorders or the type of therapy that goes along with them. So, helping the patient understand what's going on and why they're doing what they're doing, especially when we might be asking them to repeatedly do something that makes them dizzy is very important. 

What is BPPV (Benign Paroxysmal Positional Vertigo)?

And then finally, BPPV, what is it? How is it treated? BPPV, benign paroxysmal positional vertigo, is the most common cause of vertigo, which is a spinning sensation. It is a mechanical problem of the inner ear. It occurs when the calcium carbonate crystals called otoconia that are normally in one part of the inner ear - and they're generally embedded in a gel - they become dislodged and they migrate into another part of the inner ear called the semicircular canals where they are not supposed to be. These particles can interfere with the normal movement of fluid in those canals and cause the inner ear to send signals to the brain incorrectly about head movement, and this causes vertigo.

So, if a patient comes to therapy with BPPV, they're not going to be treated with the methods that we previously described. They're going to be assessed by a therapist to determine what type of BPPV they have, so, where those crystals have migrated to, and then we're going to be using repositioning exercises called maneuvers to correct that. Most patients are generally treated and recover within one to two treatments with the maneuvers, although some patients do require a little bit longer. 

After the BPPV has been treated and the vertigo is resolved, most patients have no further issues, and they're discharged from therapy after a little education about the condition and what to do if the condition recurs.

Occasionally, some patients will have lingering lightheadedness or a sense of being off-balance. If this does not recover on its own within a few days, then those patients might benefit from being assessed and treated by the previously discussed techniques. 

So, I hope that that was a helpful introduction to the world of vestibular therapy. Thank you for joining me for Let's Break to Educate. If you have any additional questions, please feel free to contact us at the office at 859.629.7375, or visit our website at www.CHISaintJosephHealth.org. 

Thanks. Have a good day.