Vestibular Rehabilitation Therapy
August 12, 2022
Being dizzy, disoriented, or unsteady on your feet is unpleasant. It can make daily activities difficult but can also be dangerous as it increases the risk of falls and related injuries. By focusing on the inner ear disorders and neurologic conditions that can cause this feeling, vestibular rehabilitation therapy (VRT) aims to reduce dizziness and prevent these injuries from occurring.
What is Vestibular Rehabilitation Therapy?
For those with issues related to dizziness and disorientation, vestibular therapy is a part of their physical therapy. It focuses on exercises designed by a specialist to improve balance and reduce problems related to their dizziness.
Who Can Perform VRT?
Physical therapists perform vestibular therapy, many of whom have additional certifications in neurologic specialties. Therapists can also specialize in vestibular exercises and maneuvers to manage vertigo. PT Solutions has a team of certified vestibular therapists focused on treating issues with the vestibular system.
When Should You Undergo VRT?
A physical therapist will use a detailed history of your health and a series of assessments to determine if you are a candidate for vestibular therapy. They may assess your visual stability, oculomotor function, standing balance, stability while walking, neck mobility and tenderness, and inner ear positional testing. If these tests indicate that vestibular rehabilitation will be beneficial, the therapist will develop a comprehensive treatment plan to improve your function in these areas.
What Conditions Does VRT Treat?
Some conditions that can be treated with VRT include:
- Benign Paroxysmal Positional Vertigo (BPPV)
- Vestibular Neuritis/Labyrinthitis
- Unilateral Vestibular Hypofunction (UVH)
- Vestibular Migraine
- Persistent Postural Perceptual Dizziness (PPPD)
- Mal de Debarquement (MDD)
- Cervicogenic Dizziness
- Post-Concussion Syndrome (PCS)
- Neurological conditions like stroke, traumatic brain injury, etc.
- Recurrent Vestibulopathy
Most conditions related to persistent dizziness are candidates for VRT.
Is Vertigo Treated by VRT?
One of the most common reasons people seek vestibular rehabilitation therapy is for vertigo, particularly benign paroxysmal positional vertigo, or BPPV. This occurs when calcium particles (called canaliths) are dislodged from their usual location and collect in the inner ear. When this happens, the inner ear incorrectly signals the brain about head and body movements. This creates the sensation of vertigo, meaning feeling off-balance or dizzy.
By strengthening the vestibular system, VRT can help reduce these symptoms and help your other senses to compensate for vertigo.
Benefits of VRT
Most people will feel some improvement after a single session of vestibular rehabilitation therapy. This may be very mild or marked, depending on the severity of symptoms and the design of each program. Typically, benefits build from there, with incremental improvement seen throughout the program. If you see no change after a few sessions, your therapist may work with you to create a new plan to better address your concerns.
Is There a Chance That Dizziness Will Recur After Treatment?
The goal of VRT is for the patient to learn ways to compensate for weaknesses in their vestibular system. Usually, if a program is followed and kept up over time, dizziness is reduced or eliminated for long periods. Not performing a maintenance/home program is a common reason for recurrent dizziness. However, as conditions worsen, symptoms may reappear and need further treatment. For this reason, VRT is sometimes seen as a short-term solution but is very effective in making daily life more pleasant and manageable.
VRT Treatment Details
How Much Does a Session Cost?
The cost of vestibular rehabilitation therapy will depend on location, your provider, the duration of your therapy, and insurance coverage. Many plans cover the service as a comprehensive physical therapy treatment plan. Still, you should always check with your provider and insurance company. Please reach out to a PT Solutions clinic near you for a more detailed explanation of your out-of-pocket expenses.
How Many Sessions are Needed?
Depending on the underlying condition and goals, a patient may seek VRT on a short-term or an ongoing basis. Typically, patients will have one to two weekly sessions for about 6 to 8 weeks. Programs also require some exercises to be done at home. Based on the severity of symptoms, diagnosis, and response, the program can last several months or be completed in several weeks.
How Do I Get Started?
In some cases, another doctor may refer you to a physical therapist who can perform vestibular therapy. However, you can also seek care if you feel you are a good candidate. An initial visit will be a consultation that determines if you are someone who will benefit from VRT. Be sure to find a physical therapist who specializes in the techniques used in vestibular therapy, and come prepared to share your symptoms with them.
What Should I Expect at the First Session?
The first session will usually involve a number of assessments, both physical and verbal. You will discuss your general medical history and any concerns you have, including symptoms that make you suspect a vestibular issue. They will also assess areas including your balance, leg strength and flexibility, gait, visual stability and mobility, strength and mobility in the neck and arms, and positional testing such as inner ear exams. Based on the results of these tests, a physical therapist will determine if VRT can help and what a plan will look like.
Your first session may also include beginning exercises as a part of this plan. Examples include:
- Vision stability training
- Posture training
- Stretching and strengthening exercises
- Balance retraining
- Walking exercises
- Neck mobility and stretching exercises
- Ergonomic training
Frequently Asked Questions
Q: What is the Vestibular System?
A: The vestibular system is a sensory system in the body that is responsible for providing our brain with input about motion, head position, and spatial orientation. It also assists with motor function that helps with balance, stabilizes the head and body during movement, and maintains posture. The vestibular system is crucial for normal movement and equilibrium.
The sensations involved in the vestibular system begin in the ear and use a series of tubes and canals to connect with the brain.
Q: What Is Gaze Stabilization?
A: Gaze stabilization is a kind of exercise used in vestibular rehabilitation therapy that seeks to improve eye movements as they adjust to head movements. When you move your head, your vision should still be clear. Depending on the type of vestibular condition you have and how severe it is, you may need gaze stabilization to prevent blurriness during movement. A common example is fixating the eyes on an object while repeatedly moving the head back and forth or up and down for several minutes.
Q: What Is Habituation?
A: Exercises meant to correct dizziness as it relates to self-motion and visual stimulation is known as habituation. These exercises are very beneficial in cases of dizziness with movement, motion sickness, and those who report dizziness in a visually stimulating environment. The goal of habituation is to reduce symptoms through repeated exposure to specific movements or visual stimuli, provoking mild symptoms until the central nervous system is better able to habituate the stimuli. Over time, the symptoms should decrease.
Q: What Is Balance Training?
A: Balance training is a series of exercises designed to improve steadiness to allow patients to participate in daily activities with less risk of falling. A therapist will ensure each exercise is both challenging and safe enough to avoid falls during therapy. Eventually, this should improve the ability to walk on uneven ground or in the dark. A comprehensive program may aim to improve the ability to sit, stand, walk, turn, bend over, and reach while maintaining balance.
Q: Does VRT Help Vertigo?
A: Vertigo that is caused by Benign Paroxysmal Positional Vertigo (BPPV) is commonly treated through VRT. A therapist will first assess your inner ears through positional testing, which puts your head in various positions to try and reproduce the sensation of vertigo, to determine if you are a fit. If so, the therapist will then use repositioning maneuvers to treat the specific type of BPPV that has been identified.
Some individuals will continue to experience more general dizziness and imbalance over time, even after the use of repositioning maneuvers. In these cases, other exercises like balance training may be recommended.
Q: Does VRT Hurt?
A: The exercises used in VRT can often be tedious but are usually not painful. However, you are likely to experience symptoms during many exercises as your body adjusts and learns to compensate. You should expect to experience some mild to moderate dizziness or disorientation during a session as a part of your recovery. But with time and consistency, you will see these symptoms decrease both during and after sessions.
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