Vestibular Rehabilitation

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Overview

The vestibular system includes the parts of the inner ear and brain that process the sensory information involved with controlling balance and eye movements. If disease or injury damages these processing areas, vestibular disorders can result. Vestibular disorders can also result from or be worsened by genetic or environmental conditions, or occur for unknown reasons. One recent large epidemiological study estimates that as many as 35% of adults aged 40 years or older n the United States have experienced some form of vestibular dysfunction requiring physical therapy involving vestibular rehabilitation.


Anatomy

The vestibular system consists of 5 organs: 3 semicircular canals that are sensitive to angular accelerations (head rotations) and 2 otolith organs that are sensitive to linear (or straight-line) accelerations.  Their unique arrangement allows them to detect specific head movements.  The central nervous system integrates the information from the vestibular system to stabilize gaze during head motion by means of the vestibulo- ocular reflex (VOR) and to modulate muscle tone.

Symptoms

Common symptoms include chronic dizziness or imbalance, spinning or whirling sensation, lightheadedness or rocking sensation. These symptoms can be presents while sitting still, in specific positions or with movement, and can have significant impact on the ability of a person to perform activities of daily life.

Common Disorders

  • Benign Paroxysmal Positional Vertigo (BPPV)- Benign Paroxysmal Positional Vertigo (BPPV) is the most common vestibular disorder, causing a false sensation of spinning. BPPV is a mechanical problem in the inner ear that occurs when some of the calcium carbonate crystals (otoconia) that are normally embedded in gel in the utricle become dislodged and migrate into one or more of the three fluid-filled semicircular canals. When enough of these particles accumulate in one of the canals they interfere with the normal fluid movement that these canals use to sense head motion, causing the inner ear to send false signals to the brain. 
    • Benign- it is not life threatening
    • Proxymal- it comes in sudden, brief spells
    • Positional- it gets triggers by certain head positions or movements
    • Vertigo- a false sense of rotational movement
  • Labyrinthitis and vestibular neuritis – The two vestibular nerves in your inner ear send your brain information about your spatial navigation and balance control. When these nerves become inflamed, it creates conditions known as labyrinthitis and vestibular neuritis. This inflammation disrupts the transmission of sensory information from the ear to the brain. Symptoms include dizziness, nausea, loss of hearing and/or vertigo. Several factors can cause this condition, including infections and viruses.
    • Neuritis (inflammation of the nerve) affects the nerve branch associated with balance 
    • Labyrinthitis  (inflammation of the labyrinth) affects both branches of the vestibulo-cochlear nerve, resulting in hearing changes and dizziness.
  • Menieres disease- Meniere’s disease is an inner ear disease that typically affects one ear.  This disease can cause pressure or pain in the ear, severe cases of dizziness, hearing loss and a ringing or roaring noise (tinnitus). People with Meniere’s disease will have sudden dizzy spells after experiencing tinnutis or muffled hearing. Although there is no known exact cause of Meniere’s disease, researchers believe that it has something to do with high pressure of the fluid in part of the inner ear.  Potential causes or trigger of Meniere’s disease include head injury, allergies, stress, smoking, fatigue, family history, inflection of the inner, just to name a few.

Treatment

A thorough physical examination will usually establish the diagnosis of vestibular disorders. The underlying cause of vestibular disorders will help direct treatment and plank of care. Most instances of vestibular disorders can be successfully treated conservatively (physical therapy, chiropractic, massage, etc.) with the Epley maneuver and VOR exercises.


  



1. Agrawal Y, Carey JP, Della Santina CC, Schubert MC, Minor LB. Disorders of balance and vestibular function in US adults. Arch Intern Med. 2009;169(10): 938-944.

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New Wave Physical Therapy & Sports Rehabilitation

7125 Turner Road, Rockledge, Florida 32955, United States

P: (321) 961-3805 (call/text) F: (321) 362-4678

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