Many conditions can mimic Vestibular Disorders such as: head injuries, concussions, Parkinson’s disease, multiple sclerosis and other neurological conditions; but true vestibular disorders are caused by crystals in the ear and their abnormal movement. Evidence suggests that early treatment of inner ear problems is helpful in decreasing dizziness.
Therapy for vestibular disorders takes many forms. The type of exercise utilized depends upon the unique problems that the individual demonstrates during evaluation. Some exercises are geared toward helping with balance, some with helping the brain resolve differences in the inner ear signals, and some with improving the ability to visually focus. In addition, general exercise is often prescribed to improve overall physical health and well-being.
Vestibular Rehabilitation includes:
Visual targeting and tracking exercises
Convergence exercise for near and far visual shifting
Gait or walking and mobility exercises
Neck stretching and core strengthening
Dual or multiple stimuli coordination
Postural training and education on ergonomics
Not all inner ear problems are the same, so not everyone will do the same exercises. Your physical therapist will determine which exercises will be most helpful on the basis of your dizziness and/or balance concerns
The Epley maneuver, for example, may be performed to reposition crystals, but performing this maneuver for someone with dizziness caused by a concussion would likely not be helpful.
Vestibular rehabilitation exercises allow for central brain compensation to occur, which realigns the function of your vestibular system’s impairments. This compensation can typically be divided into three categories:
Adaptation: This is a process where nerve impulses in the brain are able to shift or “adapt” to the incorrect signals from the damaged vestibular system. This gradual shift allows your brain to recalibrate itself.
Habituation: This process allows you to gradually desensitize yourself to vestibular movement and stimulation if you are repeatedly exposed to it.
Substitution: This recovery principle uses other body functions or strategies to replace the missing vestibular function
Here are some examples of common vestibular exercises used in vestibular rehabilitation.
Habituation Exercises:
These exercises are used to treat symptoms of dizziness that are produced because of head motion or visual stimuli. Patients typically report increased dizziness when they turn their heads quickly, with position changes like bending forwards to tie their shoes, or looking upwards.
The primary purpose of a habituation exercise is to reduce symptoms through repeated exposure to specific movements or visual stimuli that provoke dizziness. These exercises are designed to provoke a mild level of symptoms to allow the central nervous system to gradually “habituate” (or ‘get used to’) the stimuli. The increase in symptoms should only be temporary and should return back to baseline after 15-20 minutes, with more consistency it eases and prevents dizziness.
Gaze Stabilization Exercises:
These exercises are used to improve visual acuity and steadiness during head movements. These exercises are recommended for patients who report that their visual world appears to wiggle, shake, shift, or move when reading, walking, changing position, or when trying to identify objects in the environment. A very common exercise to promote gaze stability involves working on your VOR, or vestibular-ocular reflex, by fixating on an object while you repeatedly move your head back-and-forth or up-and-down for several minutes.