Vestibular disorders include pathology of the vestibular labyrinth, eighth cranial nerve and/or central vestibular structures. The vestibular system is an integral part of a persons ability to maintain balance, gaze stability and a correct interpretation of his or her body in relationship to the environment.

Symptoms of vestibular dysfunction include but are not limited to imbalance, nausea, dizziness, true vertigo, blurry vision, poor depth perception, loss of balance when walking, falling, confusion, and disorientation. In many cases, persons with vestibular dysfunction are unable to work or care for themselves or their families. In severe cases, patients may become completely debilitated and bed ridden.

 

Vestibular Rehabilitation

Vestibular Rehabilitation is an exercise based approach aimed at alleviating these problems. Exercises are used to maximize central nervous system compensation for vestibular pathology. Evaluation and treatment of persons admitted to this program is administered by a licensed physical therapist who is specially trained in vestibular rehabilitation.

The following is a detailed description of therapies rendered at the Balance Therapeutics Program at South Shore Neurologic Associates:

GAZE STABILIZATION

Gaze stabilization is the ability to hold the visual world steady while the head and/or body is moving. The vestibulo-ocular reflex (VOR) helps to provide gaze stability when the head moves at speeds of 2 Hz or faster. Unfortunately, vestibular impaired individuals have decreased abiliy to utilize their VOR. The vestibular system, however, has a remarkable ability to adapt and make long term changes in the neuronal response to input. Retinal slip during the VOR exercise is the error signal that initiates the adaptation process. The purpose of the VOR exercise is the error signal that initiates the adaptation process. The purpose of the VOR exercise is to repeatedly stimulate the central nervous system with this error signal. Over time, the brain will compensate and interpret the signal as normal thus providing gaze stability and a reduction in symptoms of dizziness, nausea, and imbalance.

Close monitoring of patients through these exercises is necessary secondary to the delicate balance between over stimulation or under stimulation of the vestibular system, in which case the brain would not coompensate, and an optimal level of stimulation. Physical Therapists specially trained in vestibular rehabilitation instruct and guide patients through this progression on an individual basis.

BALANCE RETRAINING

Performance of balance activities requires the integration of three sensory and motor systems. Accurate input and interpretation of inpput from the visual, proprioceptive, and vestibular systems is necessary for a person to possess "good" balance.

Balance training is performed statically and dynamically. Static balance activities used for training include romberg, sharpened romberg (heel to toe position) and standing on one leg. Exercises are made more challenging and incorporate the use of the vestibular system as patients improve by altering the surface they stand on (e.g.: foam, trampoline, tilt board), performing activities with eyes closed and lastly incorporating head motions while maintaining balance.

Dynamic balance is trained by performance of activities including ambulation with head turns, full body turns and marching in place. Dynamic activies are made more challenging as the patient improves by altering the surface (e.g.: balance beam, treadmill), and performance with eyes open and eyes closed.

Progress in static and dynamic balance is objectively measured by timing activities (increased speed of ambulation or increased time in position), by reduction of number of falls or losses of balance and by the reduction or abatement of symptoms.

MOTION SENSITIVITY

Motion sensitive patients are treated by habituation techniques. The exercises include repetition of aggravating positions (e.g.: rolling, bending, head shaking, turning). Progress is noted by decrease in symptoms evoked by these motions.

GENERAL CONDITIONING

Vestibular impaired patients often become sedentary secondary to complications of this disorder and require improvement in aerobic capacities, reaction times and balance. General conditioning equipment such as a treadmill, stationary bicycle and rowing machine are used to address these issues.

Each patient is evaluated, treated biweekly and given a tailor made home exercise program which is to be performed two to three times daily. The total duration of the rehabilitation depends on the diagnosis, the severity of the dizziness and the patients response to treatment, but in general patients remain on the program eight to twelve weeks for peripheral disorders and twelve to sixteen if there is central involvement.