Vestibular Rehabilitation Exercises

Why is it that Vestibular Rehabilitation Exercises are so important in recovery from vertigo?

Nature has a very efficient system, known as the vestibular compensatory mechanism by which the balance function of the body is brought back to normal inspite of a damaged organ of balance (labyrinth). When one of the labyrinths is partially or fully damaged, the damage is usually permanent. 1t does not regenerate. However, a person with a deranged labyrinth will NOT remain unstable throughout life. The vestibular compensatory mechanism is nature’s way of treating vestibular disorders. The more the vestibular stimuli like head movements, walking etc. the better does this compensatory mechanism develop.

Vestibular Rehabilitation Exercises (VRT) Physical therapy for vertigo, are a form of coordinated head, body and eye movements which help to relieve the patient’s symptoms and help the giddy patient to return to normal day to day activities early.

When the acute symptoms of dizziness pass off, start normal physical activities as soon as possible so the vestibular compensatory mechanism develops properly. Drugs prescribed for the acute phase of vertigo also sedate the central nervous system as a side effect. This can inhibit compensation and should therefore be tapered off as soon as the vertigo is under control.

Also lack of vestibular stimuli can inhibit  the vestibular compensatory mechanism. Avoid staying in a dark room (lack of visual stimuli) or lying down in bed (lack of proprioceptive stimuli) or remaining immobile (lack of labyrinthine stimuli). These jeopardize the proper development of compensation. Hence, normal physical activity and exercises are a very important part of therapy in balance disorder management.

Vestibular rehabilitation exercises act in 3 ways:

ADAPTATION ~ is the process by which the brain learns to adapt itself to the changed vestibular scenario, i.e. improper signals coming from the damaged balance organ. The function of the vestibulo-ocular reflex system (system connecting eyes and ears) is to stabilise the image of the surroundings in the retina and keep it at its most sensitive point – the fovea. In derangement of the visual input and balance organ inputs, this mechanism is jeopardized.

The gaze stabilisation exercises help adapt and retrain the vestibular reflex system so that it can effectively bring about the stabilization of images in the retina and avoid the unwanted retinal-slip in spite of there being a defect in the visual/labyrinth inputs. Retinal slip means slipping of images in the retina and is one of the major causes of vertigo, which occurs as a result of a defective vestibulo-ocular reflex system.

HABITUATION ~ is the process by which the vertiginous patient is repeatedly exposed to the mismatched sensory input. This repetitive exposure to the “error” situation induces changes in the brain such that the brain becomes used to (conditioned to) the mismatched sensory input.

The head and body movement exercises in the vestibular rehabilitation exercises help to enhance habituation.

COMPENSATION ~ means the proper and fullest utilisation of the remaining sensory components viz.- the visual and proprioceptive senses and also the unaffected labyrinth. The improper input coming from the defective labyrinth is thus overruled.. The brain is trained to use the remaining senses (visual & proprioception) more effectively and efficiently such that they compensate for the partial loss of function of one labyrinth.

The static & dynamic balance exercises in the vestibular rehabilitation exercises help to enhance habituation

One of the objectives of the vestibular rehabilitation exercises is to deliberately and systematically provoke tolerable spells of vertigo so that the tolerance level is built-up. Hence some vertigo in the initial stages may occur but passes off with time. Diligence, regularity and perseverance are essential.

The exercises are performed for 5-10 minutes 2 to 3 times daily.

Care to be taken before full recovery from vertigo?

Balance is maintained by 3 sources of input to the brain – Inner ear, the main balance organ, Eyes ­visual information & Sensory inputs ftom feet, ankle and legs which keep us in touch with the floor

When the main balance organ in the inner ear does not function normally because of damage or disease, dependance on the other 2 sources of input become of prime importance:

Dependance on vision – Information the brain obtains ftom the eyes Dependance on information from contact with the floor through the skin, joint position awareness, muscle tone awareness

Environmental Modifications at home and place of work

I). Adequate lighting. when walking through dark rooms, keep lights or night lights on all the time

2). Removal of thick carpeting and small rugs.

3). Nonskid flooring; Care on slippery floors

4). Make sure, the floors at home are free from obstructions. Maintain a clear a path to your bathroom Objects that could entangle your feet or could injure you are removed, should you have a fall.

5). Stable tables and chairs which can support the individual if required.

6). Reorganization of cabinets and shelves to minimize bending and reaching.

7). Stairs with railings.

Behavioral modifications

  1. Learn to plan physical movements consciously.
  2. Avoid hurried movements. Each movement is broken into numbers and performed one at a time.
  3. Work sitting down if possible.
  4. Fix vision on distant objects for stability.
  5. Light touch on objects for balance.
  6. Restrict rapid head movements.
  7. Avoid walking with individuals or with crowds.
  8. Avoiding driving at rught and in poor visibility, stormy weather, etc.
  9. Take great care when walking on soft rugs, carpeted floors, sand or loose gravel etc.
  10. Do not carry large objects which obstruct the view in front.
  11. Use two or more pillows at night and see if it feels better.
  12. Avoid sleeping on the side that precipitates or increases the vertigo.
  13. In the morning, get up slowly and sit on the edge of the bed for a minute.
  14. Avoid bending down to pick up things, and extending the head, such as to get something out of a cabinet.
  15. Avoid any movement that twists the head on the neck in general
  16. Be careful when at office, the beauty parlor when lying back, having ones hair washed, when participating  in sports activities and when lying flat on your back.

Special care in dangerous situations

I). Stay off chairs, stools, ladders, roofs for risk of falling and serious injury;.

2). Special care in the kitchen, near an open flame.

3). Extra care crossing roads. Avoid heights.

4). Avoid swimming and diving till after full recovery

5). Stay off chairs, stools, ladders, roofs

6). Avoid driving till full recovery.

7). Avoid riding on two wheelers till full recovery