Vestibular Physiotherapy

What is Vestibular Physiotherapy?

Vestibular rehabilitation is an exercise programme designed to retrain and influence the vestibular (inner ear) balance system so an individual feels less dizzy and more stable. Evidence has shown that vestibular rehabilitation can be effective in improving symptoms related to many vestibular (inner ear balance) disorders. Conditions such as visual vertigo, labyrinthitis, BPPV, cervical vertigo and post- concussion syndrome may benefit from such specialised therapy.

The IPS physiotherapy service is one of only a very small number of physiotherapy clinics in Wales that offers expert vestibular physiotherapy. Our highly trained and specialist vestibular physiotherapist has worked in this field of physiotherapy for 8 years and regularly attends courses and conferences to ensure that her knowledge and skills are up to date with the latest research and clinical findings.

Movement and function can be affected by these disorders as people tend to avoid movements that make them feel dizzy or off balance. This actually worsens their balance as the body?s internal balance systems are not being used as often as they would be normally, leading to worsened functional balance and mobility. A vicious cycle ensues as people lose confidence in moving. Secondary problems can then develop such as stiff painful joints, muscle weakness and decreased mobility due to this more sedentary lifestyle adopted. The impact that vestibular disorders can have on an individual?s quality of life can also contribute to emotional problems such as anxiety and depression. Vestibular Rehab aims to work on and improve the problems related to the vestibular disorder, helping the individual return to improved function and enhancing their overall quality of life.

During participation in vestibular rehabilitation, it is common for people?s symptoms to feel a little worse initially but this is a positive sign that the exercises are working.

The main principles of vestibular rehabilitation aim to encourage a vestibular compensation of the brain. This is the central nervous system?s ability to readjust to the problems caused by the vestibular weakness.


Several principles used in vestibular rehabilitation assist in achieving this compensation:


Habituation: this decreases dizziness through repeated exposure to the specific triggers that provoke dizziness.
Substitution: the use and development of other body systems such as vision, somatosensory (joint receptor) cues and postural strategies.
Adaptation: enhancing the gaze stability function of the eyes and the body?s postural control systems.

Generic balance training can boost the effectiveness of the specific vestibular rehab and may also be prescribed, and this balance training may include visual and joint position sense work, functional movement, and dual and multi-tasking exercises.

A vestibular rehabilitation programme will be established by a highly specialised vestibular physiotherapist. This is to ensure a programme specifically tailored to the individual is devised, as a customised programme is vital to gain the best and most effective results.


BPPV

This condition gives the person a false sensation that the world around the body is spinning. It can be triggered by certain movements such as going from sitting to lying, rolling over in bed or moving the head up and down. The duration of the spinning feeling normally lasts anywhere between 5 seconds and 2 minutes at a time.

BPPV is caused when crystals of the inner ear (of which have a very important role in balance) become loose and move into the wrong part of the ear. Very often BPPV will resolve all on its own. However, for those who do not get better quickly on their own, repositioning manoeuvres performed by a trained specialist can move the crystals back to where they should be. This can offer instant relief in most cases.


Labyrithitis

Labyrinthitis is inflammation of the part of the inner ear called the labyrinth. The labyrinth controls balance and hearing. When the organs of the ear are inflamed the information sent to the brain will be different from the affected ear. This can make people feel dizzy, disorientated and/or nauseous.


PPPD (Persistent Postural Perceptual Dizziness)

This condition presents itself as a feeling of dizziness and unsteadiness for almost every day over many months. Fatigue, stress, complex visual stimuli and movement can bring these symptoms on.


Vestibular Neuritis

This condition is simultaneously used with labyrithitis. Vestibular neuritis is an infection and inflammation of the inner ear causing feelings of dizziness disorientation and nausea.


Post Concussion Syndrome

Vestibular rehabilitation can be very effective in managing dizziness, vertigo and imbalance following a concussion. Vestibular rehabilitation aims at normalising an individual?s vestibular responses following the concussion.

Head trauma can directly damage the vestibular organ as well as the brain stem and other neurological pathways and lead to vestibular disorders. Often, patients get a BPPV following trauma to the head due to dislodgement of the crystals in the inner ear during the impact.


Cervical Vertigo

Cervical vertigo is dizziness related to neck posture and neck movement. Cervical vertigo is often caused by arthritis of the neck, whiplash injuries, neck trauma or surgery to the neck.

Receptive input from the neck participates in the coordination of eye, head and body posture as well as awareness of the body in space. Neck mechanisms are also directly involved in balance control, and cardiovascular control. Therefore experiencing dizziness with neck movements could be due to one or more reasons. Specialist Vestibular physiotherapy will be able to differentiate the cause of the cervical vertigo and advise on appropriate treatment.

Typical treatment for cervical vertigo will include neck range of movement exercises, manual therapy, postural advice and treatments to decrease neck muscle tension.

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