The vestibular system is a complex set of structures that sends sensory information from the inner ear to the eyes and the brain. It is responsible for making us aware of movement and spatial orientation. For example, it tells us which way is up, which direction we are moving, how to counteract a loss of balance to remain upright, and if we are standing straight or leaning forward, backward, or to one side.
Common symptoms of a vestibular disorder include dizziness, a spinning sensation (vertigo), involuntary repetitive eye movements (nystagmus), ringing in the ears (tinnitus), and loss of balance. It can also result in nausea, hearing loss, anxiety, poor memory, inability to concentrate, and other cognitive problems.
With the vestibular system being so complex, there are numerous causes of problems. These include concussion, more severe traumatic brain injury, neck trauma, dislodged calcium crystals in the ear, some medications, ear infections, nervous system disease, and poor circulation.
In some cases, the vestibular system can be restored by removing the cause, such as changing medications or use of the Epley Maneuver to relocate calcium crystals. In most cases though, the goal of vestibular rehabilitation is to re-teach the brain so it learns to adapt to the sensory signals by compensating appropriately.
Vestibular rehabilitation is a type of physiotherapy. If the cause cannot be removed, there are three categories of treatments that can be used to help the vestibular system “recalibrate.”
Habituation: Habituation exercises are not pleasant but if you stick with it, you are very likely to see improvement. These exercises are specific to your individual triggers – the movements that result in symptoms or make them worse. Why would we do that? Because it is this repetition of the trigger that teaches the brain to adapt or ignore the sensory signal.
Gaze Stabilization: Some vestibular disorders make the eyes jumpy, resulting in difficulty reading or balancing. Gaze stabilization exercises, like staring at an object while moving your head, or following a moving object while moving your head in the opposite direction, improve control of eye movements and ease symptoms.
Balance Training: Balance training exercises improve stability and steadiness. Specific movements for the exercises will depend on the underlying disorder, but are designed to retrain the brain and how it perceives your interaction with the environment.
The most important thing to know about vestibular rehabilitation is that the therapeutic exercises need to be performed regularly and repeatedly in order to see improvement. If you have a vestibular disorder, you’ll know it’s worth it!
Physiotherapists are the primary providers of vestibular rehabilitation, but this really depends on your individual symptoms and their cause. In the treatment of concussion, for example, occupational therapists may work with physiotherapists and other health care providers to implement an overall concussion management treatment plan.
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