An Intro to Vestibular Rehabilitation: What It Is and When You Should Seek Help

Vestibular Rehabilitation is a form of therapy that primarily uses exercises to help treat conditions associated with the vestibular system, or the inner ear. Vestibular disorders most commonly occur in older individuals with nearly 85% of people ages 80+ having vestibular dysfunction and 75% of people ages 70+ having balance impairment. Because vestibular dysfunction can significantly affect balance, the risk of falling is increased by 8-fold.  

What is the Vestibular System and How Does it Work?

The vestibular system is a sensory system that allows one to keep their balance, maintain upright posture, and stabilize their head and body during movement. It is organized into three main categories: sensory input, central processing, and motor output. The body uses sensory input from visual, vestibular, and proprioceptive (the awareness of position and movement of the body) systems. The vestibular system itself is primarily made up of the bony and membranous labyrinths, which include the semicircular canals and the otolith organs. The sensory information is then transmitted to the vestibular nuclear complex and cerebellum in the brain. The brain then communicates via motor neurons to create eye and postural movements. 

Vestibular dysfunction often results in signs and symptoms such as vertigo, dizziness, imbalance, nystagmus (involuntary, rhythmic movement of the eyes in a side-to-side, up and down or circular motion), and compromised gaze stability (the ability of the eyes to fixate a stable point when the head is moving in space).

What Does a Vestibular Appointment Involve? 

Your vestibular appointment will involve a detailed assessment of gait, balance, coordination, cervical spine range of motion and strength, the oculomotor system (i.e. movement of the eyes), the vestibulo-ocular system (i.e. gaze stabilization), and a BPPV (Benign Paroxysmal Positional Vertigo) assessment. 

Your physiotherapist will then determine the cause of your symptoms and design an appropriate treatment plan, including in-clinic physiotherapy and a home exercise program as indicated. Treatments will likely include vision exercises, balance exercises, gait exercises, habituation exercises (purposefully doing movements that will make the patient dizzy, with the goal of having the body get used to it over time), and other exercises to re-integrate the visual and vestibular system. 

What Will Recovery Look Like?

Recovery can vary depending on the type of vestibular condition. An improved prognosis is associated with less initial disability, those seen earlier after onset, and symptoms that are provoked only by movement. A study by Hall et al discovered that “strong evidence indicates that vestibular rehabilitation provides clear and substantial benefit to patients with acute or subacute unilateral vestibular hypofunction, so, with the exception of extenuating circumstances, vestibular rehabilitation should be offered to all patients who are still experiencing symptoms…or imbalance due to unilateral vestibular hypofunction” (137). With BPPV, the efficacy of complete resolution of symptoms after one treatment ranges from 71%- 93.5% depending on the type of BPPV variant. Moreover, Rossi-Izquierdo et al provided evidence that vestibular rehabilitation can “decisively improve balance in elderly patients with instability which can lead in turn to a reduction in falls.” Decompensation, or a recurrence in symptoms, may occur with fatigue or stress, prolonged periods of inactivity, illness or occasionally a change in certain medications. 

If you, or anyone you know, is suffering from dizziness, vertigo, or any of the symptoms mentioned above, book an appointment to start recovering today!

References: 

Cronin, Gaye. Vestibular Atlanta, 11 Mar. 2020, https://vestibularatlanta.com/specialized knowledge-and-skills-in-adult-vestibular-rehabilitation-for-occupational-therapy-practice/. Accessed 16 Nov. 2021.  

Hall, Courtney D., et al. “Vestibular Rehabilitation for Peripheral Vestibular Hypofunction.” Journal of Neurologic Physical Therapy, vol. 40, no. 2, 2016, pp. 124 - 155.,   https://doi.org/10.1097/npt.0000000000000120. 

Health Jade Team. “Vestibular System.” Health Jade,  

https://www.google.com/url?sa=i&url=https%3A%2F%2Fhealthjade.net%2Fvestibular system%2F&psig=AOvVaw0V4gN4q 

6GzJ3AcFO6c13S&ust=1637154343691000&source=images&cd=vfe&ved=0CAgQjRxq FwoTCPCR86r5nPQCFQAAAAAdAAAAABAD. Accessed 16 Nov. 2021. 

“Know Your Brain: Vestibular System.” @Neurochallenged, 15 Nov. 2015, https://neuroscientificallychallenged.com/posts/know-your-brain-vestibular-system.  

Rossi-Izquierdo, Marcos, et al. “Vestibular Rehabilitation in Elderly Patients with Postural Instability: Reducing the Number of Falls—a Randomized Clinical Trial.” Aging Clinical and Experimental Research, vol. 30, no. 11, 2018, pp. 1353–1361.,  

https://doi.org/10.1007/s40520-018-1003-0.  

Tonks, Bernard. “Vestibular Rehabilitation: A Comprehensive Introduction.” Vestibular Rehab: A Comprehensive Introduction. Vestibular Rehab: A Comprehensive Introduction, 13 Apr. 2021.

Eden Graham, Resident Physiotherapist 

Eden completed her Master of Science in Physical Therapy at the University of Toronto and Honours Bachelor of Science in Kinesiology at McMaster University. While at McMaster, she was able to gain extensive experience in exercise prescription through working as a Strength and Conditioning Coach for the Men’s and Women’s Varsity Basketball Teams and a Personal Trainer at McMaster’s gym “The Pulse.”

Eden has practiced in a variety of environments including outpatient orthopaedics, complex continuing care, post-acute care rehabilitation, and general internal medicine. She has completed post-graduate courses in Manual Therapy, Acupuncture, Assessment and Treatment of the Lymphatic System, and Vestibular Rehabilitation. She is truly passionate about helping people, with a treatment style that includes soft tissue release, joint mobilizations, acupuncture, and a strong emphasis on exercise programming. 

Eden has always been passionate about the impact of an active and balanced lifestyle on someone’s psychological and physical well-being! In her spare time, she loves to stay active by going to F45 or Barry’s Bootcamp classes, lifting weights, running, spinning, and dancing! She also loves to cook and bake, and always strives to find “healthier versions” of more indulgent recipes.