An estimated 90 million Americans (42% of the current population) experience dizziness at least once in their lifetime. Some patients develop permanent balance deficits with subsequent functional limitations.
Vestibular rehabilitation therapy (VRT) is a form of physical therapy that uses specialized exercises that result in gaze and gait stabilization. Most VRT exercises involve head movement, and head movements are essential in stimulating and retraining the vestibular system. Vestibular rehabilitation therapy has been a highly effective modality for most adults and children with disorders of the vestibular or central balance system. In a number of studies, customized VRT programs were significantly more effective than generic exercises in resolving symptoms.
The majority of imbalance conditions can be helped through vestibular rehabilitation. The goal of treatment is to minimize dizziness, improve balance and prevent falls by restoring normal function of the vestibular system.
Patients who are typically referred for vestibular rehabilitation therapy are those diagnosed with dizziness, imbalance, vertigo, Meniere's syndrome, benign paroxysmal positional vertigo (BPPV), neck-related dizziness and migraines. Other candidates are patients who have had a stroke or brain injury or who frequently fall.
A thorough assessment of symptoms by a clinician, as well as a careful detailed medical history, is vital for accurate diagnosis. After confirming the diagnosis, appropriate medical management is followed by physical therapy (PT) referral.
Using the evaluation results, the therapist will develop an individualized treatment plan that includes specific head, body, and eye exercises to be performed both in the therapy setting and at home. These exercises are designed to retrain the brain to recognize and process signals from the vestibular system and coordinate them with information from vision and proprioception. This often involves desensitizing the balance system to movements that provoke symptoms, and increasing home-based activities and exercise in order to strengthen muscles.
Depending on the diagnosis and collaboration with the physician, the in-office treatment with the therapist may also involve a specialized form of VRT called a canalith repositioning procedure, the most common of which is referred to as the Epley maneuver. However, there are a number of possible repositioning procedures for various disorders, so thorough evaluation is required to determine which of these procedures is indicated for your problem.
Some of the exercise and activities may at first cause an increase in symptoms as the body and brain attempt to sort out the new pattern of movements. Because of this, people sometimes give up on VRT, thinking it is making their vestibular disorder worse. However, in most cases balance improves over time if the exercises are correctly and faithfully performed. Many times, VRT is the best and only treatment.