Vestibular Rehabilitation Therapy
Vestibular rehabilitation therapy (VRT) is a type of physiotherapy that helps to improve balance and reduce dizziness. VRT exercises help to retrain the brain to process information from the vestibular system, which controls balance and eye movement.
How Our Inner Ear Controls Our Balance
The inner ear is made up of two parts: the cochlea, which hears sound, and the vestibular system, which controls balance. The vestibular system has three semicircular canals (the horizontal, posterior, and anterior), which are filled with fluid. The movement of our head causes the fluid in the canals to move. This bending of tiny hairs inside the canals sends signals to our brain about our head’s position.
There are two small organs in the vestibular system called the utricle and saccule. These organs contain tiny crystals of calcium carbonate (otoconia). When we move our heads, the otoconia shift and bend hairs inside the utricle and saccule. This sends a signal to the brain about our head’s position in space.
The vestibular system is responsible for sending signals to the brain about our balance and eye movement. These signals help us to keep our balance when we are walking, running, or standing still.
The ear is the organ that detects sound. It not only receives sound, but also aids in balance and body position. The ear is part of the auditory system.
Why Am I Dizzy?
Dizziness is a common symptom of vestibular disorders. vestibular disorders are problems with the inner ear or brain that can cause dizziness, vertigo, and problems with balance.
There are many different causes of dizziness, but most can be divided into two main categories:
Central causes: These are caused by problems in the brain, such as stroke, head injury, or migraine.
Peripheral causes: These are caused by problems in the inner ear or vestibular systems, such as Meniere’s disease or Benign Paroxysmal Positional Vertigo (BPPV).
How Can Vestibular Rehabilitation Therapy Help?
Vestibular rehabilitation therapy is a type of physical therapy that helps to improve balance and reduce dizziness. VRT exercises help to retrain the brain to process information from the vestibular system, which controls balance and eye movement.
VRT can be used to treat a variety of vestibular disorders, including:
BPPV
Meniere’s disease
Vestibular neuritis
Labyrinthitis
Post-concussion syndrome
Migraine-related dizziness
Bilateral Vestibular Hypofunction
VRT exercises are designed to help the brain adapt to the new information it is receiving from the vestibular system. The goal of VRT is to reduce or eliminate symptoms, improve balance, and help you return to your normal activities.
If you are experiencing dizziness, balance problems, or vertigo, vestibular rehabilitation therapy may be right for you. Contact a physiotherapist to learn more about VRT and to find out if it is right for you.
What is BPPV?
Benign paroxysmal positional vertigo (BPPV) is a type of vestibular disorder that causes episodes of dizziness or vertigo. BPPV occurs when the tiny calcium crystals in the inner ear become dislodged and float into one of the semicircular canals. When this happens, the canal becomes sensitive to changes in position, such as when you turn your head. This can cause a false sense of movement, known as vertigo.
BPPV is a common cause of dizziness, and it affects people of all ages. However, it is most common in people over the age of 50.
There are two main types of BPPV:
Canalithiasis: This type occurs when the calcium crystals become dislodged and float freely in the semicircular canal.
Cupulolithiasis: This type occurs when the calcium crystals become attached to the cupula, a small membrane in the semicircular canal.
BPPV can usually be remedied with vestibular rehabilitation therapy (VRT). With VRT exercises, the goal is to help retrain the brain back to its natural state of processing information from the vestibular system. As a result, symptoms related to BPPV should start decreasing or go away altogether.
What is Meniere’s Disease?
Meniere’s disease is a type of vestibular disorder that causes episodes of vertigo, hearing loss, tinnitus, and a feeling of fullness in the ear. Meniere’s disease is thought to be caused by a build-up of fluid in the inner ear. This can cause the pressure in the ear to increase, which can damage the ear. Meniere’s disease is thought to be caused by a buildup of fluid in the inner ear. This can cause the pressure in the ear to increase, which can damage the auditory auditory nerve and lead to hearing loss.
Meniere’s disease is most common in people aged 20-50, and while it occurs slightly more often in women than men, there is no cure. However, treatments exist that can help lessen symptoms and halt any further damage to the ear.
Vestibular rehabilitation therapy (VRT) is an effective, exercise-based treatment for Meniere’s disease that helps the brain more efficiently process information from the vestibular system. This can often result in a decrease or complete end of Meniere’s symptoms.
What is Vestibular Neuritis?
Vestibular neuritis is a type of vestibular disorder that causes episodes of vertigo. Vestibular neuritis is thought to be caused by inflammation of the vestibular nerve, which controls balance and eye movement. The exact cause of the inflammation is unknown, but it is thought to be due to a viral infection.
Vestibular neuritis most often affects adults aged 20-60, and while it can occur at any age, it is more common in people over the age of 40. There is no cure for vestibular neuritis, but treatments exist that can help lessen symptoms and improve quality of life.
Vestibular rehabilitation therapy (VRT) is an effective vestibular neuritis treatment that exercises the brain to process information from the vestibular system, which then lessens or removes symptoms.
What is Labyrinthitis?
Labyrinthitis is a type of vestibular disorder that causes episodes of vertigo. Labyrinthitis is thought to be caused by inflammation of the labyrinth, which is a structure in the inner ear that helps control balance and eye movement. The exact cause of the inflammation is unknown, but it is thought to be due to a viral infection.
Labyrinthitis most often affects adults aged 20-60, and while it can occur at any age, it is more common in people over the age of 40. There is no cure for labyrinthitis, but treatments exist that can help lessen symptoms and improve quality of life.
One treatment option for labyrinthitis is vestibular rehabilitation therapy (VRT). VRT exercises help to retrain the brain to process information from the vestibular system, which can help to reduce or eliminate symptoms of labyrinthitis.
What is Post-Concussion Syndrome?
Post-concussion syndrome (PCS) is a type of vestibular disorder that can occur after a head injury. It is thought to be caused by damage to the vestibular system, which controls balance and eye movement. Symptoms of PCS can include vertigo, headaches, dizziness, fatigue, anxiety, and insomnia.
While PCS can occur at any age, it is most common in people aged 15-24. There is no cure for PCS, but treatments exist that can help lessen symptoms and improve quality of life.
One treatment option for post-concussion syndrome is vestibular rehabilitation therapy (VRT). VRT exercises help to retrain the brain to process information from the vestibular system.
What is Migraine-Related Dizziness?
Migraine-related dizziness (MRD) is a type of vestibular disorder that is thought to be caused by the changes in brain activity that occurs during a migraine. Symptoms of MRD can include vertigo, nausea, and vomiting.
While MRD can occur at any age, it is most common in people aged 15-24. There is no cure for MRD, but treatments exist that can help lessen symptoms and improve quality of life.
One option to treat migraine-related dizziness is vestibular rehabilitation therapy (VRT). VRT exercises help the brain learn how to process information from the vestibular system again, which can reduce or eliminate symptoms of MRD.
What is Bilateral Vestibular Hypofunction?
Bilateral vestibular hypofunction (BVH) is a type of vestibular disorder that is caused by a decrease in the function of the vestibular system on both sides. The vestibular system controls balance and eye movement. Symptoms of BVH can include vertigo, unsteadiness, and difficulty walking.
While BVH can occur at any age, it is most common in people over the age of 40. There is no cure for BVH, but treatments exist that can help lessen symptoms and improve quality of life.
One treatment option for bilateral vestibular hypofunction is vestibular rehabilitation therapy (VRT). VRT helps the brain learn how to process information
How Long is a Typical Vestibular Rehabilitation Program?
A typical vestibular rehabilitation program lasts for 6-8 weeks. During this time, patients will work with a therapist to gradually increase their exposure to vestibular stimuli. This exposure will help the brain learn how to process information from the vestibular system again, which can reduce or eliminate symptoms.
After the initial 6-8 week program, some patients may need to continue therapy on a less frequent basis. This is typically done through home exercises and/or Balance and Fall Prevention classes offered through community organizations.
What Are Some Vestibular Rehabilitation Exercises?
Some vestibular rehabilitation exercises that may be used to help treat vestibular disorders include:
Balance exercises
Gait training
Stationary bike riding
Treadmill walking
Head-turning exercises
Eye movement exercises
Gaze stabilization exercises
These exercises gradually expose the brain to vestibular stimuli, which helps the brain learn how to process information from the vestibular system again. This can reduce or eliminate symptoms.
Balance Exercises:
These exercises help improve balance and coordination. They can be done standing or sitting and can be progressed as patients get stronger. Examples of balance exercises include single-leg stance, tandem walking, and step-ups.
Gait Training:
Gait training helps patients learn how to walk safely and effectively. It can be done with or without assistive devices such as canes or walkers. Examples of gait training exercises include heel-to-toe walking and marching in place.
Stationary Bike Riding:
Riding a stationary bike is a good way to expose the brain to vestibular stimuli while also getting some cardiovascular exercise. Patients should start slowly and gradually increase their speed and intensity as tolerated.
Treadmill Walking:
Walking on a treadmill is another good way to expose the brain to vestibular stimuli while also getting some cardiovascular exercise. Patients should start slowly and gradually increase their speed and intensity as tolerated.
Head Turning Exercises:
These exercises help train the brain to process information from the vestibular system. They can be done sitting or standing and should be performed slowly and smoothly. Examples of head-turning exercises include side-to-side turns and neck rolls.
Eye Movement Exercises:
These exercises help train the brain to process information from the vestibular system. They can be done sitting or standing and should be performed slowly and smoothly. Examples of eye movement exercises include saccades, smooth pursuits, and gaze stabilization.
Gaze Stabilization Exercises:
These exercises help improve visual function and reduce dizziness. They can be done sitting or standing and should be performed slowly and smoothly. Examples of gaze stabilization exercises include fixation on a target while moving the head, and following a moving target.
Can All Physiotherapists do Vestibular Rehabilitation Therapy?
No. Physiotherapists who have completed specialized training in vestibular rehabilitation therapy are able to provide this type of therapy. In Canada, there are a few programs that offer this type of training. You can ask your physiotherapist if they have undergone this type of training. At Bergin Motion is Barrie we have physiotherapists who have the proper training and specialize in VRT.
How Long Is a Typical VRT program?
The length of a VRT program depends on the individual and the severity of their condition. Some people may see improvement in their symptoms after a few weeks, while others may require several months of therapy. It is important to follow your physiotherapist’s recommendations in order to get the most benefit from therapy.
How Do I Find a Vestibular Rehabilitation Therapist?
You can search for a vestibular rehabilitation therapist in your area by using the search tool on the website of the Canadian Physiotherapy Association.
Is Vestibular Rehabilitation Right For Me?
If you are experiencing dizziness, vertigo, or imbalance, vestibular rehabilitation therapy may be right for you. The best way to find out is to book an assessment with a physiotherapist who specializes in this type of therapy.
At Bergin Motion in Barrie, we will do a thorough assessment to see what the root cause of your problem is and whether VRT is the best treatment option for you. We will also provide you with some exercises to do at home to help improve your symptoms. Contact us today to book an assessment!
Additional Resources
Vestibular Disorder Association article explaining vestibular rehabilitation therapy, VRT.
The Cleveland Clinic article on vestibular rehabilitation therapy.
About the Author
Alex Bergin PT is a certified physiotherapist and one of the owners of Bergin Motion. Bergin Motion is a family-run Barrie Physiotherapy Clinic located in Barrie’s Southend. Alex specializes in acquired brain injury rehabilitation. Alex is a certified NDT practitioner. Neuro Development Therapy is a specialized hands-on treatment technique that promotes mobility, balance, core strength and gross motor skills in a playful and fun and dynamic way. Alex is part of a team at Bergin Motion in Barrie, Ontario that works with all kinds of neurological issues.
Bergin Motion
Is a family owned physiotherapy company built by the Bergin family. Our family has served as physiotherapists in the Barrie area for over 30 years, spanning two generations. We are passionate about this community and helping people achieve their highest potential. Book with us now!