Vestibular rehabilitation is a specialized form of physiotherapy used to treat vestibular disorders or symptoms, characterized by dizziness, vertigo, and trouble with balance, posture, and vision. Some treatment methods seek to eliminate the cause of vestibular dysfunction, while others allow the brain to compensate for dysfunction without targeting the source. Presently in Canada, physiotherapy assessment and treatment of vestibular dysfunction is a rapidly growing and well-developed component of the overall management of dizzy patients.
Dizziness and balance problems account for 5 to 10 percent of all physician visits and affect approximately 50 percent of all adults at some time. One in 10 working-age adults report some degree of disability due to dizziness and 2% experience chronic, frequent, substantially debilitating episodes. Furthermore, dizziness is the number one reason for physician visits by people over the age of 65. In the elderly population, dizziness is also associated with falls, fear of falling and loss of independence.
Common symptoms that can be helped with Vestibular Rehabilitation include:
Vertigo (sense of spinning)
Dizziness at rest
Dizziness or altered vision with head movements
Neck tightness, stiffness and/or pain
Imbalance (difficulty getting up or walking without holding onto something)
Headaches
Frequent falls
Patients typically referred for Vestibular Rehabilitation have been diagnosed with a vestibular condition including:
Benign Paroxysmal Positional Vertigo (BPPV)
Vestibular Neuritis/Labyrinthitis
Unilateral Vestibular Hypofunction (UVH)
Vestibular Migraine
Mal de Debarquement (MDD)
Ménière's disease
Cervicogenic Dizziness
Post Concussion Syndrome (PCS)
Neurological conditions (i.e. stroke, traumatic brain injury)
Of these, the two most common conditions are BPPV and vestibular neuritis/labyrinthitis.
1) BPPV - Benign Paroxysmal Positional Vertigo, or BPPV, is the most common cause of vertigo due to a peripheral vestibular disorder. It accounts for 20 to 30% of all patients seen for vertigo. It occurs in adults of all ages, although it is more common among older individuals. Patients with BPPV complain of vertigo and possibly nausea when bending forward, looking up, rolling over in bed, and lying down flat. Other complaints associated with BPPV include balance problems that may last for hours or days after the episodic vertigo has stopped.
Inside your ear there are a number of organs that monitor the movement of your head as well as your head’s position in relation to gravity. For a number of reasons, special motion detecting otoconia (commonly referred to as "crystals") can become dislodged from their usual location and move into one of the semicircular canals of your vestibular system. This then causes that canal to become sensitive to specific changes in head positions and cause a sensation of spinning when provoked.
A series of specific head movements, guided by one of our physiotherapists, can be used to move the crystals back to their usual location which can help drastically improve vertigo symptoms. Many studies have shown rates of resolution well into the 90% range within just a few appropriate treatments. Further exercises can will be taught and practiced to help resolve any lingering symptoms as well as to prevent future recurrences.
2) Vestibular neuritis and labyrinthitis - these disorders result from an infection that inflames the inner ear or the nerves connecting the inner ear to the brain. This inflammation disrupts the transmission of sensory information from the ear to the brain. The brain integrates balance signals sent through the vestibular nerve from the right ear and the left ear. When one side is infected, it sends faulty signals. The brain thus receives mismatched information, resulting in vertigo, dizziness, and difficulties with balance, vision, or hearing may result.
Symptoms of neuritis can be mild or severe, ranging from subtle dizziness to a violent spinning sensation (vertigo). They can also include nausea, vomiting, unsteadiness and imbalance, difficulty with vision, and impaired concentration. Sometimes the symptoms can be so severe that they affect the ability to stand up or walk. Labyrinthitis may produce the same symptoms, along with tinnitus (ringing or noises in the ear) and/or hearing loss.
If symptoms of dizziness or imbalance are chronic and persist for several months, vestibular rehabilitation exercises can help to retrain the brain’s ability to adjust to the vestibular imbalance. These exercises can help the brain adapt to the altered signals resulting from labyrinthitis or neuritis through a process known as compensation. Your physiotherapist can recommend specific exercises based on your assessment findings.
At InReach Online Physio, both myself and Shannon Lim provide Vestibular Rehabilitation. If you have any questions, feel free to send us an email at inreachphysio@gmail.com. We also offer complimentary 15 minute telehealth appointments if you'd like to learn more about Vestibular Rehabilitation and how we can help.
By: Chris Kennedy, Registered Physiotherapist
Chris provides online physio (aka telephysio, virtual physio, telerehab) to patients all over British Columbia including Haida Gwaii, Fort St James, Fraser Lake, Fort St John, Fort Nelson, Dease Lake, Dawson Creek, Hudson's Hope, Mackenzie and Stewart. She also collaborates with the First Nations Health Authority to provide service. Chris lives in Squamish, BC.
Clendaniel, R. A., & Herdman, S. J. (2014). Vestibular rehabilitation. Philadelphia, PA: Davis.
Sealy, A (2021). Dizziness: A practical, evidence based intro to Vestibular Assessment, Treatment & Rehab. Online TrustMe Ed lecture. Accessed April 17, 2021: https://trustme-ed.com/lectures/dizziness-a-practical-evidence-based-intro-to-vestibular-assessment-treatment-rehab
Shupert, C. Labyrinthitis & Vestibular Neuritis. Accessed April 18, 2021: https://vestibular.org/article/diagnosis-treatment/types-of-vestibular-disorders/labyrinthitis-and-vestibular-neuritis/