Balance-Vestibular Rehabilitation Therapy (VRT)
Introduction
Vestibular Rehabilitation Therapy (VRT) is an individualised exercise- based programme for those suffering from central or peripheral vestibular problems. There is good scientific evidence to support VRT as a clinically valid treatment option that is non-invasive and not reliant on medication.
Conditions where VRT can help:
- Conditions affecting the peripheral vestibular system (inner ear) such as:
- Benign Paroxysmal Positional Vertigo (BPPV)
- Unilateral or bilateral vestibular hypofunction- this is where there is damage to one or both inner ears following a virus, surgery or drug toxicity
- Menière’s Disease in the later stages where there is loss of inner ear function and balance problems
- Elderly with dizziness, balance problems and increased risk of falling
- Conditions affecting the central vestibular system such as:
- Strokes affecting the cerebellum (balance centre in the brain)
- Traumatic Brain Injury or concussion
- Vestibular migraine
- Motion sensitivity
- Anxiety induced dizziness
Who provides VRT?
In NZ it is predominantly Physiotherapists who provide VRT. Not all Physiotherapists are trained in this specialty area so you need to find one who is. Your Physiotherapist will carry out a thorough assessment to determine what is causing your symptoms. This will include taking a history of your symptoms and general health and performing tests to diagnose BPPV and vestibular hypofunction. Questionnaires may be used to get a base line measure of your symptoms and a balance assessment may be carried out.
Other vestibular conditions- diagnosis and treatment
Other vestibular tests include general eye movement tests to test the central system (brain) and very quick head movements to test the vestibulo-ocular reflex (VOR). This reflex enables us to maintain focus while we move our heads quickly such as when crossing the road. This reflex is damaged when there is loss of function in one or both inner ears.
In cases where there is vestibular loss of function, the exercises are designed to retrain the VOR and/or promote reprogramming of your brain to cope with the loss of inner ear function (central nervous system compensation). They include head, body and eye exercises to improve gaze stability and balance while you are moving your head.
Where there is hypersensitivity to movement the exercises are designed to desensitise the vestibular system using a progressive programme of movements that provoke your symptoms at a level that you can tolerate. These programmes will also include balance exercises when indicated.
The aims of VRT are to improve gaze stability, improve balance, decrease vertigo, dizziness and visual symptoms, decrease anxiety and increase fitness and activity levels. Often people stop moving their heads when they are dizzy as they either think they are doing harm or to avoid the unpleasant sensation. However this is the worst thing you can do. You will recover much faster if you remain active.
VRT exercises need to increase your symptoms to be effective. Your Physiotherapist will structure your programme to progress exercises at a pace that you can tolerate.
How do you get referred?
Your GP can refer you as can your specialist Neurologist or ENT specialist. However you don’t need to wait for them to refer you as you can self refer to a Physiotherapist. If further investigation is required they will refer you back to your GP to arrange testing with an Otolaryngologist or Neurologist.
- Assoc. Prof. Cynthia Darlington