The “New” Vestibular Rehabilitation Approach
Two Different Approaches to Vestibular Rehabilitation
There is a great difference between conventional vestibular rehabilitation and modern neurological brain based vestibular rehabilitation practices.
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 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.
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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 understand that the average patient has almost no knowledge about the brain. After all, when was the last time your primary care physician discussed your brain function with you? This is why encourage people to schedule an initial examination in my office to find out if the brain is the cause of their vertigo, dizziness, or balance issues. The examination must be very comprehensive and takes approximately 2 hours. The brain is very complex and you cannot find out what is wrong with you in a 10-minute office visit.