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Vestibular rehabilitation

From the Editors

Inflammation or infections affecting the inner ear can set the world spinning. Fortunately, with time and proper treatment, dizziness and vertigo frequently go away on their own. But sometimes they persist, even after an acute illness such as labyrinthitis (see our July newsletter feature). If you experience persistent dizziness or imbalance that disrupt your life for several weeks or more, your doctor may refer you to a physical therapist for vestibular and balance rehabilitation.

Vestibular rehabilitation exercises can help retrain the brain's ability to compensate for the imbalance — much like a weak muscle needs to be exercised to regain its strength. Vestibular rehabilitation involves specific exercises to improve balance and diminish the feeling of dizziness.

The goals of this therapy are to stay active and to learn to maintain your everyday routine despite the balance concerns. Although it may seem counterintuitive, doing so helps the normal mechanisms within your brain and central nervous system and your musculoskeletal system adapt to the changes you're experiencing.

Lasting impressions
When your vestibular system is damaged, your brain receives conflicting messages about movement and your body's position in space. That causes the dizziness or vertigo. Your natural inclination may be to try to avoid rapid movements in order to avoid these symptoms. But remaining relatively inactive for long periods of time doesn't stimulate your brain to change and adapt.

Adaptation often occurs naturally with experience, as you move around and carry out daily activities. In order for your brain to adapt, it needs to continue receiving signals from the balance organs — even if the signals are abnormal. Eventually, your brain resets itself to other sources of sensory input. For example, if your inner ear on the left side stops functioning, your balance system may gradually switch to a heavier reliance on the organs of your right ear. When compensation is complete, you'll rarely notice the dizziness and vertigo anymore.

If your sense of balance hasn't righted itself following an inner ear disorder such as labyrinthits, your risk of falling and injuring yourself is increased. In older adults, falls are a major cause of disability and death.

Elements of the program
Vestibular and balance rehabilitation can be an important factor in preventing falls. Typically, a physical therapist works with you to design an exercise program customized to your needs and built around an assessment that generally includes:

  • Musculoskeletal evaluation to assess your strength, coordination and flexibility skills

  • Balance and gait assessments that are compared with those of others in your age group and that test the interaction of your balance organs

  • Questions about the frequency and severity of your symptoms, when and where they occur, and what factors might make them worse

  • Rating your level of dizziness and vertigo as you change in and out of various positions

  • Assessment of your ability to control eye movement while your head is in motion
Typically, your therapist will recommend a number of exercises that you can do at home on a regular basis, in between visits to the physical therapy center. For example, you may be requested to do exercises in which you focus on a visual target 5 to 10 feet away while moving from a sitting position to a standing position and back again with your eyes open. You may then be asked to repeat the procedure with your eyes closed. Other simple exercises may include watching a target at arm's length and moving your head quickly to the right and left while keeping the target in focus. This activity can be repeated several times a day.

At first, these exercises may make you dizzy, so you usually start with just a few repetitions at a time. But soon your brain becomes accustomed to the movements — it finds ways to compensate. Duration and intensity of the exercises can gradually be increased. As you continue your program, the dizziness and vertigo will begin to fade away.

Your therapist also may give you exercises to increase your strength and coordination of muscle responses — to improve your balance control. This might include a daily walking program. The goal is to get back to your normal, active daily routine as quickly as you can.

    Staying active
    Even after finishing a formal therapy program, it's important to stay physically active. If your body goes through a period of inactivity, such as during a bout with the flu or after minor surgery, your brain may forget some of its compensation methods. To correct this, you'll need to retrain your balance system. This can be done by regularly performing the exercises that were initially prescribed to you, until the dizziness and vertigo go away. Generally, the signs and symptoms will recede more quickly the second time around.

    Many people have found that tai chi is a helpful way to maintain leg strength and balance after vestibular compensation is complete. It's often included as part of an active therapy program — but talk to your doctor before starting any exercise program.

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