Vestibular rehabilitation is effective in reducing dizziness and vertigo and associated falls and improving quality of life in people with disorders involving balance mechanisms.
Good balance is important in life. Normally, we do not find it difficult to cross the road, stand up from a chair or get out of bed in the morning. A healthy balance system uses information from the brain, inner ear, eyes and joints to help guide (or navigate?) us through the day. However, if our balance system becomes impaired these daily activities can be dangerous. Symptoms can include dizziness and vertigo, as well as, problems with hearing, vision, concentration and memory.
Balance disorders and dizziness are a growing public health concern across all ages. These disorders are one of the top reasons for older patients seeing their GP. If left untreated, increased unsteadiness, anxiety and loss of confidence and independence can develop. Along with an increased risk of falls, these factors can have a detrimental effect on everyday life.
The vestibular system is made up of three essential parts:
The Eyes, Proprioception, The Inner Ear.
The eyes send signals to the brain, called visual cues, that identify how our body is orientated in relation of the objects around us.
Proprioception, sometimes called our sixth sense, involves the brain receiving signals from receptors in our skin, muscles and joints. These receptors are sensitive to stretch and pressure. These sensory cues help our brain to determine where our body is in the surrounding space. For example, signals from our neck tell the brain which direction the head is turned. Likewise, signals from the ankle deliver key information on limb movement and conditions underfoot e.g. icy pavement.
The inner ear contains the vestibular apparatus; which is made up in part by the utricle, saccule and three semi-circular canals. The utricle and saccule detect gravity (vertical) and linear movement. While the semi-circular canals are filled with fluid that detect rotation. For example, when we turn our head this fluid moves tiny hairs within the canals which send a signal to the brain about the specific movement.
Most common disorders
Benign Paroxysmal Positional Vertigo (BPPV) - A condition resulting from loose debris that collects within the inner ear. BPPV can develop after a head injury, or because of the degeneration of the inner ear hairs during ageing.
Cervicogenic Dizziness - Disequilibrium and disorientation in patients with neck problems that include cervical trauma, cervical arthritis, and others.
Concussion - Often occur after a head injury and temporarily affect brain function which disturbs the vestibular system.
Labyrinthitis and Vestibular Neuritis - Inflammation from a viral infection than result in damage to hearing and vestibular function (labyrinthitis) or damage to the vestibular system only (vestibular neuritis).
Migraines Associated Vertigo - A type of migraine which symptoms effect the ears, vision and balance. Unlike other types of migraine, a headache is not always present.
Meniere’s Disease - A progressive condition, which relates to abnormal fluid pressure in the inner ear. Pressure changes in the middle ear result in swelling of the Eustachian tube or presence of fluid in the middle ear. The exact cause is unknown but poor fluid drainage in your ear may be one contributing factor.
Assessment and Diagnosis at Sportswise
Your specialist physiotherapist will ask questions to understand your symptoms and how they developed. You will then be given tests to assess muscles of the eye, balance, body positioning, neck, and the vestibular system.
The specialist will be looking for nystagmus, dizziness, nauseous and will try to reproduce your symptoms. Once they can find the source of the problem, they can help to determine the best course of treatment.
You may undertake positional vertigo testing such as the Dix-Hallpike procedure. This involves lying down quickly, but safely and with assistance, which will tell us if you have BPPV or another vestibular condition.
What is Vestibular Rehabilitation?
Vestibular rehabilitation is an exercise-based programme to encourage the central nervous system to compensate for problems in the inner ear. Following thorough examination, specialist physiotherapists develop personalised exercise-based management plans including home exercise programmes.
A management plan may include:
Eye and head movement exercises
Exercises to improve standing balance and walking
Specific techniques to reposition fragments in the inner ear which cause dizziness in BPPV
Education and advice on activities of daily living to improve confidence & function
Advice on falls reduction/prevention.
Download our Vestibular Physiotherapy.PDF for more information.