What is vestibular therapy

Our vestibular rehabilitation program aims to help children and adults reduce dizziness resulting from a variety of inner ear disorders and neurologic conditions, including benign paroxysmal positional vertigo BPPV , post-concussion syndrome and vestibular migraines.

View all care locations. You should be evaluated by your physician before starting therapy to rule out other causes of dizziness or balance impairment. You can get a referral for therapy form a primary physician, geriatrician, otolaryngologist or neurologist. Our therapists treat dizziness and balance issues related to:.

Schedule an appointment with one of our vestibular therapists to find a treatment that can help relieve your vestibular symptoms.

The goals of vestibular therapy may differ depending on the underlying conditions causing your dizziness. Our Helpline team are also here to answer your questions and provide practical and emotional support.

Call Vestibular compensation is a process that allows the brain to regain balance control and minimise dizziness symptoms when there is damage to, or an imbalance between, the right and left vestibular organs balance organs in the inner ear. Essentially, the brain copes with the disorientating signals coming from the inner ears by learning to rely more on alternative signals coming from the eyes, ankles, legs and neck to maintain balance.

Please note that you should not attempt any of these exercises without first seeing a specialist or physiotherapist for a comprehensive assessment, advice and guidance. Your GP can refer you. Some of these exercises will not be suitable for everyone, and some are only suitable for certain conditions. The aims of the Cawthorne-Cooksey exercises include relaxing the neck and shoulder muscles, training the eyes to move independently of the head, practising good balance in everyday situations, practising the head movements that cause dizziness to help the development of vestibular compensation , improving general co-ordination and encouraging natural unprompted movement.

You should be assessed for an individual exercise programme to ensure you are doing the appropriate exercises. You could ask if it is possible for a friend or relative to be with you at the assessment.

It can be helpful if someone else learns the exercises and helps you with them. You will be given guidance on how many repetitions of each exercise to do and when to progress to the next set of exercises. As a general rule, you should build up gradually from one set of exercises to the next, spending one to two minutes on each exercise.

You might find that your dizziness problems get worse for a few days after you start the exercises, but you should persevere with them. For example, 0 through to 5 for the severity of your symptoms 0 being no symptoms and 5 being severe symptoms. It would be advisable to start each exercise at a level that you would rate as a 2 or 3 on the rating scale i. You would then only move on to the next exercise once the current exercise evoked a 0 on the scale, for three days in a row.

Please be aware that it may take a few days for you to get used to the exercises. It may be advised not to undertake exercises that you would rate a 4 or 5 on the scale.

A diary such as the one below might help you to keep track of the exercises and help with knowing when to make each one harder. Make sure that you are in a safe environment before you start any of the exercises to reduce the risk of injury. Do not complete any exercises if you feel that you are risk of falling without safety measures in place to stop this.

It is also important to note that you may experience mild dizziness whilst doing these exercises. This is completely normal. It is advised not to complete more than 10 of each of the exercises below.

They should be completed slowly at first. As the exercise becomes easier over time you can start to do them more quickly. Change from a sitting to a standing position with eyes open, then closed please note this is not advised for the elderly with postural hypertension.

The aim of gaze stabilisation exercises is to improve vision and the ability to focus on a stationary object while the head is moving. Progressions with this exercise can include placing the target letter on a busy background. You should start the exercise whilst seated and then move on to standing. It is thought that BPPV may be caused by crystals also known as otoconia becoming dislodged from their normal place inside the inner ear, and moving into another area within the ear that is responsible for sensing rotation the semicircular canals.

When the crystals move around in this part of the ear it causes dizziness. Gaze Stabilization exercises are used to improve control of eye movements so vision can be clear during head movement.

These exercises are appropriate for patients who report problems seeing clearly because their visual world appears to bounce or jump around, such as when reading or when trying to identify objects in the environment, especially when moving about. There are two types of eye and head exercises used to promote gaze stability.

The choice of which exercise s to use depends on the type of vestibular disorder and extent of the disorder. Balance Training exercises are used to improve steadiness so that daily activities for self-care, work, and leisure can be performed successfully. Additionally, balance exercises should be designed to reduce environmental barriers and fall risk.

For patients with Benign Paroxysmal Positional Vertigo BPPV , the exercise methods described above are not appropriate to resolve this type of vestibular disorder. Through assessment, the type of BPPV is identified, and depending on the type, different repositioning maneuvers can be performed to help resolve the spinning that occurs due to position changes. 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. The therapist will document the type and intensity of symptoms and discuss the precipitating circumstances. The therapist will screen the visual and vestibular systems to observe how well eye movements are being controlled. Testing assesses sensation which includes gathering information about pain , muscle strength, extremity and spine range of motion, coordination, posture, balance, and walking ability.

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.

Along with exercise, patient and caregiver education is an integral part of VRT. Many patients find it useful to understand the science behind their vestibular problems, as well as how it relates to the difficulties they may have with functioning in everyday life. A therapist can also provide information about how to deal with these difficulties and discuss what can be expected from VRT.

Education is important for patients because it takes away much of the mystery of what they are experiencing, which can help reduce anxiety that may occur as a result of their vestibular disorder. The exercises can sometimes be tedious; however, committing to doing them is key to helping you achieve success.

Setting up a regular schedule so that you incorporate them into your day is very important. Exercises may, at first, make your symptoms seem worse.

But with time and consistent work, your symptoms should steadily improve, and then, you will find that you are able to participate more in the activities of your daily life. When patients participate in VR, different factors can impact the potential for recovery. For example, the type of vestibular disorder affects recovery. Patients that have a stable vestibular disorder, such as vestibular neuritis or labyrinthitis, have the best opportunity to have a satisfactory resolution of symptoms.

There are also differences in response to VR depending on whether you have one or both inner ears involved, or whether the problem lies within the vestibular parts of the brain as opposed to the ear s. Symptomatic relapses can occasionally occur because the brain de-compensates. Additionally, recovery after de-compensation usually occurs more quickly as compared to the initial compensation.

The Vestibular Disorders Association VeDA provides a directory of health professionals who are specially trained to assess and treat vestibular disorders. This online directory offers users the ability to search for providers according to specialty and geographical location. To locate this online directory, visit vestibular. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database of Systematic Reviews , Issue 1. DOI: