The vestibular therapy, also called vestibular rehabilitation therapy or VRT, is a specialized, non-invasive treatment designed to combat chronic dizziness and lightheadedness having their cause inner ear disorders.
The therapy consists of performing exercises to improve visual orientation, eye motor skills and balance. The therapy is usually guided by an occupational therapist or by a physiotherapist. It usually includes exercises to perform both in medical facilities and at home.
Objectives of vestibular therapy
Some people experience episodes of dizziness and sickness associated with syndromes and diseases that affect the inner ear. For example, benign paroxysmal positional vertigo, Meniere’s disease or labyrinthitis.
When leaning or turning, the person becomes dizzy to the point of losing balance and motor coordination necessary to perform daily activities such as driving, walking or doing almost any job.
The symptoms can very negatively affect the patient’s quality of life and become a disabling cause. The vestibular therapy pursues that the patient learns to overcome and take better episodes of dizziness and vertigo and can gain autonomy and quality of life.
For most patients, damage to the inner ear is permanent, because the ability to recover vestibular function is very small. But vestibular therapy has proven to be an effective tool for improving symptoms through central compensation.
Vestibular rehabilitation therapy does not improve vestibular function itself, but trains the brain (central nervous system) to use signals from other sensory organs to interpret body position and movement, for example visual and somatosensory signals (peripheral nervous system).
The compensation process usually occurs naturally over time, the person becomes accustomed to the symptoms and their brain learns to compensate, but in many people this process is too slow or not enough to resume daily activity; in these cases, vestibular therapy stimulates the compensation process with these objectives:
- Improve balance
- Minimize falls
- Reduce subjective feeling of dizziness
- Improve stability during displacement
- Reduce over-dependence of visual and somatosensory perception
- Improve motor coordination
- Reduce the anxiety associated with disorientation and dizziness.
Vestibular rehabilitation includes several strategies, including substitution strategies, prediction strategies and cognitive strategies. The patient is also usually taught to generate the symptoms intentionally as a habituation mechanism.
Substitution strategies use techniques with alternative sensory pathways to direct movement. For example, exercises are performed to maintain head stability using the cervico-ocular reflex (COR) instead of the vestibular-ocular reflex (VOR).
Habituation exercises use the adaptive capacity of the central nervous system to modulate the neuronal response to signals from the vestibular system. The first habituation exercises were described in 1940 by Cawthorne and Cooksey. In a basic way, they consist of eye, head and body exercises that cause dizziness, trying to fatigue the vestibular system and that the brain compensates for habituation to the stimulus.
Many patients go through periods of frustration with vestibular therapy, because it requires perseverance and time to obtain results that really improve daily life, however, in the medium-long term, vestibular therapy has proven to be quite effective.
Vestibular therapy exercises
Vestibular therapy is usually part of a multidisciplinary program that includes, at least, a physician experienced in evaluating and treating balance disorders, usually an otolaryngologist or neurologist, and a firiostherapist, occupational therapist, or both.
The exercises can be divided into two large groups, visual exercises and body exercises. Visual exercises consist of routines designed to improve the visual perception of stationary objects; subsequently, exercises are introduced to improve eye movement and the tracking of moving objects.
The exercises must be done both in rehabilitation facilities and in daily life. The goal is for the brain to compensate for the false balance information of the inner ear with information generated through visual perception.
The corporal exercises try that the person improves the sensation of balance during the movement, especially during daily movements as to sit down and rise of a chair or to walk.
It is very frequent that patients who experience vertigo when moving compensate by changing the shape and posture during movement. For example, many patients get used to walking, swinging from one side to the other to maintain balance. It would be something like walking on a train or a boat.
With these movements somatosensory signals are generated that reinforce the sensation of movement and balance and compensate for the incorrect vestibular signals. At the same time, the corporal exercises try to correct slowly the postural compensations so that the patient returns to have a normal posture.
In other words, instead of compensating for vestibular function with bad postural changes, it is trained to compensate with other strategies.
Rehabilitation programs can be divided into several stages or levels. First you start with eye exercises to adjust the visual perception. Subsequently, head movements combined with eye exercises are introduced.
Once the results are achieved with the head movements, a little more progress is made and movements of arms, shoulders and trunk are introduced. In the next stage, practical activities are carried out with movements that require balance, such as sitting and getting up, and finally walking and other activities for the patient to gain autonomy.