Vestibular Therapy and How You Can Perform Them at Home

What is vestibular therapy?

Vestibular rehabilitation (VR), also known as vestibular rehabilitation therapy (VRT), is a specialized form of physical therapy used to treat vestibular disorders and their symptoms which are characterized by:

dizziness
vertigo
trouble with balance
posture
vision

These primary signs can result in symptoms such as nausea, fatigue, and blurred vision. All symptoms of vestibular dysfunction can significantly decrease quality of life, causing mental-emotional issues such as anxiety, depression, and greatly impair an individual’s ability to move. Decreased mobility can causes reduction in muscle mass resulting in weaker muscles, less flexibility in joints, and poor stamina, as well as decreased social and occupational activity. Vestibular rehabilitation therapy can be used in addition to cognitive behavioral therapy in order to reduce anxiety and depression resulting from impairments in activities of daily living.

Vestibular Physical Therapy

Vestibular Physical Therapy is a type of treatment created to help you recover from dizziness, unsteadiness or vertigo. This therapy can help you recuperate quickly and return to your previous level of functioning.

What is Vestibular Therapy used for?

Vestibular Therapy is used to treat a number of conditions such as:

· Recurrent Vestibulopathy - Recurrent vestibulopathy is described as an illness of undefined cause characterized by more than one episode of vertigo of duration characteristic of that occurring with hydrops but in the absence of auditory or clinical neurological symptoms or signs.

· Post-Concussion Syndrome (PCS) - Post-Concussion Syndrome, occurs when concussion patient symptoms last longer than what we would anticipate their expected-recovery period to be. Symptoms for syndrome are headaches, concentration issues and headaches. Recovery is tough to predict as it ranges from weeks to months.

· Mal de Debarquement (MDD) - This is a rare and relatively generally not well understood disorder of the vestibular system which results in a phantom perception of self-movement and generally presents as rocking, bobbing or swaying. The symptoms are usually aggravated when the patient is in a stationary position such as when one is sleeping or sitting still.

· Vestibular Neuritis/Labyrinthitis - Inflammatory reactions to the inner ear or the nerves that are part of the inner eat to brain connection will cause this condition. It usually begins after and cold or infection.

· Unilateral Vestibular Hypo function (UVH) - This is caused when one side of your inner ears system is affected most notably the peripheral vestibular system.

· Persistent Postural Perceptual Dizziness (PPPD) - This condition is defined by a chronic type of dizziness that occurs due issues with your vestibular system. This condition has been linked to increased changes in behavioral patterns like obsessive-compulsive personality, mild depression & anxiousness.

Vestibular Therapy Exercises at home

Cawthorne-Cooksey exercises are home exercises for vestibular issues. Below we will outline what they are and the steps to follow when doing them. They are broken down into 4 different starting positions; in bed/sitting, sitting, standing, and moving about.

In bed or sitting exercises

Eye movement exercise: You want to do these exercises one at a time. You want to start moving your eyes slowly and then gradually pick up the pace by doing the below;

· Up and down

· From side to side

· Focusing on finger moving from three feet to one foot away from face

Head movement exercise: You want to do these exercises after the eye movement exercises. Once again start slow and pick up pace as you get used to it .

· Bending head your forwards and backwards

· Turning your head from side to side

Sitting exercises

While seated you want to do the following exercises;

1. Do the same eye movements and head movements as above.

2. Shoulder shrugs with shoulder rotations as well

3. Bending forward and picking objects up from the floor

Standing exercises

These exercises are meant to be done while standing.

1. Eye, head and shoulder movements as while seated

2. Change from a sitting to a standing position with eyes open, then closed (not advised for the elderly with postural hypertension)

3. Throwing a ball from one hand to the other hand above eye level

4. Change from a sitting to a standing position, turning around in between

5. Going from sitting to standing position and rotating your full body in between this movement.

Moving about

1. Walk up and down a slope

2. Walk up and down steps

3. Throw and catch a ball

4. Any game involving bending, stretching, and aiming (for example, bowling)

5. Walk across the room with your eyes open and then your eyes closed

Vestibular Therapy for Concussion

Vestibular Therapy's, like its name suggest aims to help improve the vestibular system and help get a patient to increase balance and spatial orientation.

Concussion symptoms can include dizzy spells and balance irregularities for a person. It can affect the vestibular system, which is why vestibular therapy is such an important factor in recovery.

Exercises Helpful for Concussion and part of Vestibular Therapy

1. Gaze Stabilization Exercise - The Vestibular System plays an important role in our vision. The purpose of gaze stabilization exercises is to improve the control we have over our eyes when we are moving our heads. The Vestibulo-ocular reflex helps you to stay focused on an object even if your head is in motion.

An exercise that helps with gait stabilization is done as follows;

Sit upright in a chair, draw a circle in the center of the paper. Hold the paper in your hand at arm's length, keep it at eye level. While focusing on the circle, turn your head side to side. Move as fast as you can without getting the circle blurry. Do this exercise for a minute.

2. Habituation Exercise - This exercise is used for the patients who get increased dizziness with visual stimuli and self-induced motion. The tenet of this therapy is that you expose yourself to the visual stimuli or movements that aggravate symptoms, it is thought with prolonged exposure to these movement/stimuli that you will build a tolerance and it will be easier for you to handle them. An example of this would be if rotating your head to the right would cause dizziness, in order to habituate you would slowly turn your head to the right to increase symptoms.

3. Balance and Exertion Training - Once your dizziness has improved it is important to focus on balance and exertional training. As dizziness is linked the vestibular system it is important to make sure that your balance improves and that we can do all of the activities we used to do before our injury.

Vestibular Therapy for Vertigo

Vertigo is one the main culprits in vestibular system disorders. These conditions generally have to do with your inner ear canal. Vertigo presents as a feeling of dizziness and movement that takes place without any accompanying motion.

Vestibular therapy helps in treating vertigo in multiple ways; Generally, each patient is unique but physical therapy has been shown to help many patients improve with their vertigo. Physical therapy helps to alleviate and fix the issues causing vertigo. There are three core vestibular therapy methods which are applicable in all cases: Habituation, Gaze stabilization, and balance training.

Vestibular Exercises Done at Home

Purpose of At-Home Vestibular Exercises:

The main purpose of vestibular exercises is to help patients regain their sense of balance. This is done by;

1) Training the movement of our eyes.

2) Train our body to balance.

3) The third is to counteract the movements that would cause dizziness or lack of balance.

Next Steps

It is always recommended to see a health care practitioner if you are exhibiting symptoms such as dizziness, loss of coordination and/or balance. A healthcare provider can help give you an accurate diagnosis and based on that diagnosis help retrain your brain and your body to decrease any vestibular and/or vertigo type symptoms. They can help guide you with a phased exercise program as well as providing you education on what movements you should avoid.

To talk to one of our expert physiotherapist on Vertigo, book here and we’ll help you feel better.