Rehabilitex, Inc. | Vestibular Rehabilitation

Approximately 90 million Americans will experience dizziness at least once in their lifetime. This is 42% of the population! 80% of these people are most likely to have a vestibular component to their condition. Once all other medical factors that may cause dizziness have been ruled out, the vestibular system must be considered. Vestibular rehabilitation is not offered in all therapy clinics. It is a specialized branch in physical therapy.

Our specialty clinic here at Rehabilitex has vestibular rehabilitation available to help those who suffer from vestibular dysfunctions.

The vestibular system is responsible for providing us with our sense of balance and movement. When it is not functioning properly, it can cause a wide variety of frightening and uncomfortable sensations. The most frequently reported symptoms are dizziness, unsteadiness, or a sense of being off balance, vertigo, and nausea. The interaction between the vestibular system and the central nervous system (CNS) may also affect vision, muscle function, memory, and concentration. This eventually results in headaches, motion sickness, and muscle aches in the neck and back.

What is Vestibular Rehabilitation Therapy?

Vestibular Rehabilitation Therapy (VRT) is a form of rehabilitation that uses physical therapy to focus on the retraining of various systems (related to the inner ear) to improve a patient’s symptoms of dizziness and/or imbalance. There are three systems that the body uses to maintain our sense of balance and equilibrium. These are the visual, vestibular (inner ear), and somatosensory (proprioceptive) systems. Proprioception is defined as the ability to recognize posture, movement, and changes in equilibrium in relation to ones own body. The proprioceptive system utilizes the muscles and joints of the body in order to relay information about position sense. When one of these systems does not function properly, dizziness and imbalance may occur.

A patient is assessed by the physical therapist to determine whether their “dizziness” is due to positional vertigo (BPPV), vestibular hypofunction, generalized imbalance, or other involvement. Once this is assessed, a treatment plan can be implemented. A patient’s treatment may include Particle Repostitioning Therapy, habituation or adaptation exercises, a general strengthening/conditioning program, and/or balance and gait training.

Particle Repositioning Therapy (PRT) is the preferred treatment choice for a patient that has BPPV. Please refer to “What is BPPV?” for additional information.

Habituation/adaptation exercises involve performing small, controlled repeated doses of movements and activities that provoke dizziness in order to desensitize the balance system. For example, many patients complain of dizziness with moving their head left and right. Due to the fact that this leads to increased dizziness, many people will then move slower and avoid moving their head altogether. This will lead to a further decline in their tolerance to movement. When they are forced to move their head quickly, they feel even worse. Through the use of VRT and with the guidance of a vestibular physical therapist, a patient's symptoms of dizziness can be significantly lessened or even completely resolved when trained to move in specific movement patterns.
Balance and gait training is another integral component in the rehabilitation process with patients that have complaints of dizziness and/or imbalance. Retraining a patient’s ability to walk and perform daily activities with better control and balance allows for better quality of life and decreases the potential for a risk to fall. There are many strategies and techniques that a patient can learn with a trained physical therapist to improve their balance and walking, such as better use of the lower extremities and improved trunk control.

What is dizziness?

Many people tend to describe their symptoms as some form of “dizziness”. It is a symptom that a person may experience in a variety of disorders or conditions. It can be described as a sensation of spinning or whirling, light headedness (heavy head or cloudy feeling is often described), and off balance. In some cases visual changes and nausea accompany “dizziness”.

What is Benign Paroxysmal Positional Vertigo (BPPV)?

Benign Paroxysmal Positional Vertigo (also known as BPPV) is a very common form of dizziness that many patients describe as the sensation of the room spinning or moving around them. It is a form of dysfunction of the vestibular system. The inner ear (the vestibular system) has three semicircular canals: the lateral canal (horizontal), the superior (anterior) canal, and the posterior canal. At the end of these canals is an organ called the utricle. The utricle has small crystals that are embedded into the utricular membrane. These crystals are called otoconia. BPPV occurs due to the displacement of the otoconia into one of the semicircular canals. The onset of symptoms typically occurs with activities such as bending, reaching up, lying down, getting up from a lying position, and rolling over.

The best treatment for BPPV is through the use of Particle Repositioning Therapy (PRT). By moving the head and body through a series of movements, the otoconia move through the canal and back into the utricle. This must be done by a trained professional and treatment is most accurate through the use of videonystagmography (VNG). A VNG is the gold standard used for the assessment of BPPV. A VNG assesses nystagmus (which is defined as involuntary eye jerk movements). The nystagmus that may be seen could indicate a potential inner ear problem that the trained physical therapist can identify. A patient wears goggles with a camera attached to it. This camera allows the therapist to view the eye movements simultaneously while the patient is being placed in the various positions. These positions stimulate the inner ear and will trigger the eyes to move in certain ways if there is a problem. This occurs due to the fact that the vestibular system and visual system work together. This information will allow the physical therapist to treat the problem accordingly.

If it is determined that a patient is positive for BPPV, the physical therapist will then take the patient through a series of positions/movements to move the otoconia back into the utricle. The patient is then educated on a specific protocol to assist in maintaining the otoconia in the utricle. In many cases there are residual symptoms of “dizziness” or imbalance that a patient may feel even if the positional vertigo has resolved. In these cases, additional physical therapy intervention may be indicated. Treatment for these patients may include but is not limited to balance and gait retraining, strengthening, as well as head and eye coordination exercises.

What type of testing is performed with VRT?

There are numerous tests that a skilled physical therapist can perform on patients to determine what the problem is and what would be the appropriate treatment intervention. As mentioned previously, the patient may be assessed with the VNG if indicated. In addition, the physical therapist may assess a patient’s strength, coordination, balance, and various tests that assess a patients walking and functional movement patterns. The physical therapist may challenge a patients “dizziness” by assessing their balance on altered surfaces (such as foam) and with visual stimulation. This allows the physical therapist to determine a patient’s visual tolerance as well as their capability with various surfaces that may affect their balance (i.e. walking on gravel or grass). Once it is determined what the objective findings of the patient are, the physical therapist can set up an appropriate treatment plan that is individualized for the patient’s specific needs.

How does the vestibular system work?

The vestibular system is located within the inner ear. It is made up of a fluid system in which movement of this fluid transmits information to the central nervous system (CNS). The CNS, in turn, interprets this information and then senses motion and allows for good postural and balance control. The inner ear functions to interpret posture, rotation, acceleration, and deceleration. When there is a deficit within the vestibular system, the outcome equals a loss of balance/equilibrium.

How does a patient get evaluated at Rehabilitex?

Our patients are evaluated by our specialty trained physical therapists in which all potential contributing factors are addressed. The evaluation includes:

A cervical screen — looking at the neck to determine if there are any deficits leading to dizziness.

Strength assessment

Postural and movement analysis

Coordination and balance assessment

vestibular occular reflex assessment (head and eye coordination testing)

Our physical therapists also use a Video-Nystagmography machine (VNG) that allows for a more detailed assessment of specific movement patterns of the patients eyes in order to determine what could potentially be wrong with the vestibular system. In other words, certain abnormal movements of the eyes can indicate a problem within the vestibular system.

What tests are typically performed when dealing with dizziness?

Many times doctors will order an MRI or CT Scan, which are diagnostic tests to rule out any abnormality within the brain. A common test to determine inner ear involvement is a vestibular test battery. This involves a series of tests that assesses the function of the inner ear and is considered the gold standard.

Do I need to see a doctor for physical therapy treatment of my dizziness?

Ohio law does not require a physician prescription to see a physical therapist. Some insurance companies may require a prescription.

Ohio law requires all MEDICARE patients must be under the care of a doctor and needs a prescription or referral for physical therapy intervention. The doctor can fax the prescription. Our fax number is (440) 498-9725.

What to expect from Rehabilitex...

Our specialty trained physical therapists take pride in the treatment of vestibular disorders and truly care about the outcome of each and every one of our patients. Our therapists closely monitor our patients' treatment program to ensure patients are performing their exercises accurately and safely. We are always readily available to address any concerns of our patients.

Read actual testimonies from patients that have taken part in our VRT program with great success!

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