Vestibular rehabilitation is a form of therapy aiming to alleviate the primary and secondary symptoms caused by vestibular disorders.
The vestibular system consist of a peripheral vestibular system on each side (part of our inner ear) and the vestibular nerves to the brainstem. It sends information about movement and gravity to the central nervous system where the information is conveyed through areas of the brain and brainstem to assist in our sense of steadiness and harmony. You may get disorders of the inner ear itself, or from a problem in conveying and processing the information in the central nervous system.
The vestibular system works in conjunction with our proprioceptive system (ie joint, muscle and tendon receptors) and visual system to help us answer two questions:
- Where is the environment in relation to me
- Where am I in my environment.
If there is a mismatch between these three system we might experience a range of symptoms like:
- Poor balance
- Postural distortions
- Visual disturbance
- Neck pain
- Cognitive disturbances (ie poor concentration or memory disturbances)
There are many causes of vestibular dysfunction and its associated symptoms. A thorough history and examination will be performed to determine the cause of your symptoms.
Vestibular rehabilitation has been shown effective in treating conditions like:
- Menieres disease
- Benign paroxysmal positional vertigo (BPPV)
- Unilateral vestibular loss
- Persisitent postural-perceptual diziness (PPPD).
Vestibular rehabilitation can also be useful as part of whiplash rehabilitation, in conjunction with other therapies, or in the treatment of migraines (vestibular migraine).
Usually a combination of therapies are performed in office combined with a rehab program that can be performed at home.
Hansson EE, Persson L, Malmström EM. Influence of vestibular rehabilitation on neck pain and cervical range of motion among patients with whiplash-associated disorder: a randomized controlled trial. J Rehabil Med. 2013 Sep;45(9):906-10.
Helminski, J.O., et al., Effectiveness of Particle Repositioning Maneuvers in the Treatment of Benign Paroxysmal Positional Vertigo: A Systematic Review. Physical Therapy, 2010. 90(5): p. 663-678.
Hilton, M.P. and D.K. Pinder, The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo. Cochrane Database Syst Rev, 2014(12): p. CD003162.
McDonnell, M.N. and S.L. Hillier, Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database Syst Rev, 2015. 1: p. CD005397.
Popkirov, S. et al, Persistent postural-perceptual dizziness (PPPD): a common, characteristic and treatable cause of chronic dizziness. Practical Neurology, 2018. 18(3-4)
Treleaven J. Dizziness, unsteadiness, visual disturbances, and postural control: implications for the transition to chronic symptoms after a whiplash trauma. Spine (Phila Pa 1976). 2011 Dec 1;36(25 Suppl):S211-7.
Treleaven J. Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control–Part 2: case studies. Man Ther. 2008 Jun;13(3):266-75.
Treleaven J. Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control. Man Ther. 2008 Feb;13(1):2-11.