VRT (vestibular rehabilitation)
Dizziness is quite a disabling symptom. The inner ear or the Vestibular system is one of the main balance organs in the body that coordinates with your eyes, brain and your joint receptors to maintain balance. Any disease or dysfunction of this system can result in symptoms like vertigo, tinnitus (ringing in your ears), plugged ear sensations, hearing loss and loss of balance. The science of treating disorders of the vestibular system is termed as Vestibular rehabilitation therapy (VRT). The Vestibular therapists at Acadia work in conjunction with your physician, specialist and audiologist wherever applicable, to co-ordinate your treatments effectively.
What conditions are treated in vestibular rehabilitation?
Vestibular rehabilitation therapy (VRT) is a combination of maneuvers and exercises designed to achieve Central nervous system compensation for inner ear disorders. Some of the common conditions dealt in VRT are:
- Benign Paroxysmal Positional Vertigo ( BPPV)
- Vestibular Neuritis
- Meniere’s disease
- Cervicogenic dizziness
What is the rationale behind VRT?
Vestibular diseases and injuries often result in inadequate vestibular compensation which can result in symptoms like dizziness, vertigo, disequilibrium and balance problems. There is an over reliance on visual and Proprioceptive ( joint position sense) inputs and faulty movement strategies to compensate for symptoms like dizziness and nausea. VRT aims to retrain the brain in relearning proper vestibular compensation in coordination with appropriate visual and Proprioceptive strategies. The treatments could either be aimed at desensitizing the vestibular system or provoking symptoms in achieving habituation ( Habituation exercises are based on the idea that repeated exposure to a provocative stimulus (eg, head movements) will lead to a reduction of the motion-provoked symptoms)
What is done in VRT? What are it's effects?
The initial assessment in VRT commences with a thorough subjective followed by a clinical examination that includes Neurological and Cervical screening, Oculomotor, visual acuity and auditory screening and positional tests to determine the nature and side of vestibular loss.
BPPV, albeit dramatic in presentation, is relatively easy to treat and involves Canalith repositioning maneuvers or liberating maneuvers to shift the otoconia from either the semicircular canals or cupula back to the utricle and saccule. It is often resolved in 1- 3 sessions and has a relatively high success rate of 90 to 95%.
Management of other unilateral or bilateral vestibular lesions including Vestibular neuritis, labyrinthitis and Ototoxicity is based on the aforementioned principles of vestibular compensation and adaptation. The program often includes components of Gaze stabilization, oculomotor retraining, Habituation, Proprioceptive and balance retraining.
In Meniere’s disease, the focus of VRT is during remission, in reducing visual dependency and cervical Hypomobility from compensatory movements. VRT can also help patients with an acute or abrupt loss of vestibular function following surgery for vestibular problems.
A significant part of VRT is the home program, tailored to the specific vestibular deficit and the patient’s home and work demands.
Most of our Vestibular clientele often have an initial medical screening and investigations, but there is a small but significant group that we often see as first contact practitioners. In some of these patients, we often require further auditory, vestibular and Neurological investigations. Owing to this, we routinely communicate with our referring physicians and specialists.