October is National Physical Therapy Month. For our patients with vestibular disorders, vestibular rehabilitation therapy (VRT) can be effective in improving their symptoms.
People with vestibular disorders often experience problems with vertigo, dizziness, visual disturbance, and/or imbalance. Symptoms due to vestibular disorders can diminish quality of life and impact all aspects of daily living. Additionally, vestibular disorders frequently cause people to adopt a sedentary lifestyle in order to avoid worsening their dizziness and imbalance. As a result, decreased muscle strength and flexibility, increased joint stiffness, and reduced stamina can occur.
For most people with a vestibular disorder, the deficit is permanent. However, after vestibular system damage, people can feel better and function can return through compensation. This occurs as the brain learns to use other senses to substitute for the deficient vestibular system. With compensation, vestibular symptoms will decrease as the brain recalibrates and fine tunes incoming signals from the inner ear. However, when damage to the vestibular system is permanent there is the potential for symptoms to return. For many, compensation occurs naturally over time, but for people whose symptoms do not reduce and who continue to have difficulty returning to daily living activities, vestibular rehabilitation therapy (VRT) can help with recovery by promoting compensation.
Vestibular rehabilitation therapy (VRT) is a specialized form of therapy intended to alleviate both the primary and secondary problems caused by vestibular disorders. It is an exercise-based program primarily designed to reduce vertigo and dizziness, gaze instability, and/or imbalance and falls. Evidence has shown that vestibular rehabilitation can be effective in improving symptoms related to many vestibular (inner ear/balance) disorders.
The goal of VRT is to use a problem-oriented approach to promote compensation. This is achieved by customizing exercises to address each person’s specific problem(s). Therefore, before an exercise program can be designed, a comprehensive clinical examination is needed to identify problems related to the vestibular disorder. Over time and with good compliance and perseverance, the intensity of the patient’s dizziness will decrease as the brain learns to ignore the abnormal signals it is receiving from the inner ear.
What should patients expect from vestibular rehabilitation?
VRT is usually performed on an outpatient basis, although in some cases, the treatment can be initiated in the hospital. Patients are seen by a licensed physical or occupational therapist with advanced post-graduate training.
VRT begins with a comprehensive clinical assessment that should include collecting a detailed history of the patient’s symptoms and how these symptoms affect their daily activities. The therapist will document the type and intensity of symptoms and discuss the precipitating circumstances. The assessment also includes administering different tests to more objectively evaluate the patient’s problems. The therapist will screen the visual and vestibular systems to observe how well eye movements are being controlled. A customized exercise plan is developed from the findings of the clinical assessment, results from laboratory testing and imaging studies, and input from patients about their goals for rehabilitation. An important part of the VRT is to establish an exercise program that can be performed regularly at home. Compliance with the home exercise program is essential to help achieve rehabilitation and patient goals. VRT exercises are not difficult to learn, but to achieve maximum success; patients must be committed to doing them.