What is Vestibular Rehabilitation Therapy?

The term Vestibular Rehabilitation refers to the treatment of the whole balance system with a focus on the Vestibular system.

The Vestibular system is a very specialized and unique built-in equilibrium system. But it is only one player on your Balance Team.

Why is it so special? The anatomy is complex yet simple and works so closely with so many other systems. Vestibular function influences almost everything we do and every movement we make. It is truly where balance and movement matter.

Information comes into the vestibular system. It relays an interpretation to your brain and your brain tells your body how to move and respond. That’s how and why balance and movement are so connected, so co-dependent and so rocking cool! But more on the “rocks” later….

Where is it located?

Generally speaking, it is in the inner ear located deep enough to be behind your eyeballs. I bet you had no idea it was in that deep in your head.

Our balance system is made of 5 systems working cohesively together.

  1. Musculoskeletal -This is the traditional stuff PT’s treat to keep you moving. Muscles, tendons and ligaments are important for strength to hold you up against gravity and for carrying out balance reactions.
  2. Visual System (Oculomotor)- Your eyes take in a large volume of information. There is an amazing reflex called you Vestibular Ocular Reflex. It is a pretty awesome reflex. It is the way your eyeballs talk to your inner ear and talk to your brain. The primary job is to keep your gaze stable while your head is in motion. All at a super lightning fast speed.
  3. Somatosensory System- Your somatosensory system is the system that takes in balance information and information about where you are in space. This sensory system utilizes input from the balance sensors in your feet, ankles, knees, hips-pretty much every joint in your body. There are also sensors in your tendons. So there is a lot of information collected to analyze every single movement about the ground underneath you and how you are moving your body through space. This is the system that differentiates between firm and soft and level and unlevel surfaces.
  4. Vestibular System-This is the coolest system of all! The vestibular system is a membranous labyrinth carved out in a bony labyrinth in your skull located deep back behind your eyes. You have one organ on either side of your body. That means if you lose function in one vestibular organ, you have one as back up! You balance may not be as good but you are at least still getting input. Inside the canals are fluid, hair cells and crystals called otoliths or otoconia. Some people call them “rocks”! The crystals sit in a pile on top of the hair cells, kind of like pebbles on stalks of wheat. When you move or bend your head, even the slightest little bit, the weight of the otoconia bends the hair cells and that sends a signal to your brain that you are on the move! Very similar to how the winds bends the stalks of wheat to make a wave.
  5. Central Nervous System -Not everyone considers your brain the 5th system of balance but I do! The Visual, Somatosensory and Vestibular systems are all input systems and somebody has to put all that information together!! Luckily, our brains do that information processing and sends a motor plan out to your musculoskeletal system to execute a movement or balance reaction.

So why does someone need Vestibular Rehabilitation?

There is a long list of possible injuries and dysfunctions that can happen to each of the Balance System components. And…..since one system affects the balance of another system……sometimes when one thing is off, it can set off the other systems. Sometimes, because of the redundancy of the programming, other systems can be strengthened to support or even substitute for an underfunctioning system.

During a Vestibular Assessment, all systems are assessed separately and as a team. Then a rehabilitation plan can be designed specific to the individual. Understanding the source helps to specify the techniques to promote the optimal response and recovery.

What are the most common things treated in Vestibular Rehab?

The primary issues addressed with Vestibular Rehab are Dizziness and Falls.

What is Dizziness?

Dizziness can generally be described in two different ways.

Lightheadedness is dizziness with the absence of spinning and usually feels like you are about to pass out. Lightheadedness is typically associated with dehydration, low blood pressure or orthostatic hypotension (the occurrence of a significant drop in blood pressure when transferring from sit to stand), or medication side effects, sometimes known as polypharmacy. A good medication and nutrition review in partnership with your doctors can usually provide insight.

Vertigo is the sensation of spinning, typically that the world is spinning around you. The most common cause for sensations of vertigo is BPPV-Benign Paroxysmal Positional Vertigo. What a tongue twister that is!! Let me break it down for you:

Benign- Non-life threatening

Paroxysmal- Sudden

Positional- Provoked by certain positions

Veritgo- Spinning

So BPPV is: The non-life threatening, sudden onset of spinning provoked certain positions. Got it? Great.

BPPV can be caused by many things: falling and hitting your head and literally “knocking your rocks loose”, high forces like roller coasters, injuries, surgeries and the rolling in and out of different positions, illness or for no reason at all! Essentially what happens is the pebbles that we talked about earlier become dislodged in one place and travel to a part of the system they are not supposed to be in and alter the signals to the brain.

BPPV commonly causes that sensation of spinning when rolling in bed, sitting up from lying down, looking up at a shelf, looking down at your shoes.

BPPV can be assessed easily and quickly from lying you down and watching your eyes. We look for something called nystagmus. Nystagmus is a temporary directional beating of the eyes. The direction of the eye motion tells us where the pebbles are and how we can flush them out!

The treatment tends to be simple as well. Ever seen one of those little mazes with the pinball in it as as a birthday party favor, well, we sort of do that to your head! We just have to roll you in a certain sequence and roll that pinball out of the wrong canal! Many times it can be cleared in one maneuver!

So let us help settle your spinning head with a vestibular assessment today!