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Vestibular and Balance Therapy

What is a Vestibular Disorder?
The vestibular system includes the parts of the inner ear and brain that process the sensory information involved with controlling balance and eye movements. If disease or injury damages these processing areas, vestibular disorders can result. Vestibular disorders can also result from or be worsened by genetic or environmental conditions, or occur for unknown reasons.

The most commonly diagnosed vestibular disorders include benign paroxysmal positional vertigo (BPPV)labyrinthitis or vestibular neuritisMénière’s diseasesecondary endolymphatic hydrops, and perilymph fistula. Vestibular disorders also include superior canal dehiscenceacoustic neuromaototoxicityenlarged vestibular aqueduct, and mal de débarquement. Other problems related to vestibular dysfunction include migraine associated vertigo and complications from autoimmune disorders and allergies.

Prevalence and Incidence
Because of difficulties posed by accurately diagnosing and reporting vestibular disorders, statistics estimating how common they are, how often they occur, and what social impacts they have range widely. Yet even the lowest estimates reflect the fact that vestibular disorders occur frequently and can affect people of any age.

One recent large epidemiological study estimates that as many as 35% adults aged 40 years or older in the United States—approximately 69 million Americans—have experienced some form of vestibular dysfunction.  According to the National Institute on Deafness and Other Communication Disorders (NIDCD), a further 4% (8 million) of American adults report a chronic problem with balance, while an additional 1.1% (2.4 million) report a chronic problem with dizziness alone. Eighty percent of people aged 65 years and older have experienced dizziness,  and BPPV, the most common vestibular disorder, is the cause of approximately 50% of dizziness in older people.  Overall, vertigo from a vestibular problem accounts for a third of all dizziness and vertigo symptoms reported to health care professionals. "I can't do things I used to enjoy. How can a problem with my ear affect my mood and concentration?" Symptoms of chronic dizziness or imbalance can have a significant impact on the ability of a disabled person to perform one or more activities of daily living such as bathing, dressing, or simply getting around inside the home, affecting 11.5% of adults with chronic dizziness and 33.4% of adults with chronic imbalance. The painful economic and social impacts of dizziness are significantly underestimated.

Living with a Vestibular Disorder

Living with a vestibular disorder can affect a person's life in many ways.

The vestibular system is central to a person’s core functioning. A damaged or diseased vestibular system, therefore, affects not only how you feel, but how you are able to perform day-to-day activities.
With or without a diagnosis, a dizzy person can be overwhelmed and confused. Many people need guidance about how to self-educate and how to help family members and friends understand their experience and the daily challenges they face.

Treatment through Vestibular Rehabilitation
The treatment of a patient with and inner ear disorder focuses on determining a specific plan based on the individual diagnosis and symptoms. At CVPH, the patient will receive a thorough evaluation by a trained physical therapist 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 signaling 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 avoidances help decrease the number of instances of dizziness and nausea but 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 exercise may be used in order to help the patient's brain adapt to new signaling 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 signaling 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 a CVPH 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 Maneuvers:

When the patient has been affected by BPPV canal repositioning maneuvers 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 maneuver will be used to dislodge or reposition the debris within the affected canal. Repositioning take on average 1-3 visits

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