The New Vestibular Rehabilitation Approach
Two Different Approaches to Vestibular Rehabilitation Therapy (VRT)
There is a great difference between conventional vestibular rehabilitation and modern neurological brain based vestibular rehabilitation practices. This difference is discussed below as well as in my blog post about the two differet approaches.
The two approaches: Conventional vs. Brain-Based
Conventional vestibular rehabilitation: Most conventional vestibular rehabilitation is performed by a physical therapist or audiologist. These clinicians have been taught that 80% of all vertigo, dizziness and balance problems result from the vestibular (balance) mechanisms in the ear malfunctioning. Crystals in the ear cause the balance problems in the patient. This is known as Benign Paroxysmal Positional Vertigo or BPPV. The therapies conventionally employed in these cases are standardized “repositioning therapies” that are to reset the crystals in the year and stop the problems. These are followed by a series of standardized vestibular exercises for the patient to perform. This is old school thinking.
Neurological brain-based vestibular rehabilitation, on the other hand, has a more contemporary and neuroscientific approach to vertigo, dizziness and balance issues. The neuroscience communities have known for at least the past 10 years that 80% or more of all these balance issues start in the brain. The Grey’s Anatomy text states “the brain or central nervous system controls and coordinates all the Systems of the body.” This includes the vestibular system. There are three major areas of the brain that contribute to the balance in humans. The frontal cortex (neuroprocessor), cerebellum (neurocalibrator) and central vestibular nucleus (neurointegrator) in the brain stem. These all control and synchronize a person having perfect balance, gait and coordination. Any one or combination of the above when not functioning properly can cause a varying degree of vertigo, dizziness or balance problems. The key to success in vestibular cases is the initial comprehensive brain-based functional neurological examination. You must find out what areas in the brain are not working or synchronized with each other if you want to give the patient long-term and lasting relief. This is new school thinking.
I offer a complimentary initial examination in my office to find out if the brain is the cause of your vertigo, dizziness or balance issues. The examination must be very comprehensive and takes approximately 2 hours.
Vestibular System & Treatment
The vestibular system includes the parts of the inner ear and the brain that help control balance and eye movements. If the system is damaged by disease, aging or injury, vestibular disorders can result. Symptoms may include vertigo, dizziness and imbalance among others.
The type and severity of vestibular disorder symptoms can vary considerably, and be frightening and difficult to describe. People affected by vestibular disorders may be perceived as inattentive, lazy, overly anxious, or seeking attention. They may have trouble reading or doing simple arithmetic. Functioning in the workplace, going to school, performing a routine daily task, or just getting out of bed in the morning may be difficult.
With any of these conditions previously mentioned it is important to get a proper diagnosis and possibly begin vestibular disorder treatment.
The following is a list of symptoms that have been reported by people with vestibular disorders. Not all symptoms will be experienced by every person, and other symptoms are possible. An inner ear disorder may be present even in the absence of obvious or severe symptoms. It is important to note that most of these individual symptoms can also be caused by other unrelated neurological conditions.
Vestibular Disorder Symptoms
VERTIGO & DIZZINESS:
- spinning or whirling sensation
- an illusion of self or world moving (vertigo)
- lightheaded, floating or rocking sensation (dizziness)
- sensation of being heavily weighted or pulled in one direction.
BALANCE OR SPATIAL ORIENTATION:
- imbalance, stumbling
- difficulty walking straight or turning a corner
- clumsiness or difficulty with coordination
- difficulty maintaining straight posture
- tendency to look downward to confirm the location of ground
- head may be held in a tilted position
- tendency to touch or hold onto something when standing, or to touch or hold the head while seated
- sensitivity to changes in walking surfaces or footwear
- chronic muscle and joint pain (due to constantly balancing self).
- trouble focusing or tracking objects with eyes
- objects or words on a page seem to jump, float, blur or may appear double
- sensitivity to different types of light
- increased night blindness
- difficulty walking in the dark
- poor depth perception.
- hearing loss
- distorted or fluctuating hearing
- tinnitus (ringing, roaring, buzzing, or other noises in ear, sensitivity to loud noises
- noises increase vertigo, dizziness, balance problems.
COGNITIVE AND PSYCHOLOGICAL:
- difficulty paying attention
- short term memory lapses
- difficulty comprehending or learning
- mental fatigue
- also: nausea, ear pain, headaches, slurred speech, or sensitive to weather.
If you have experienced any of the symptoms above please contact me to set up a proper diagnosis and to discuss vestibular disorder treatment.