Vestibular Rehabilitation

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What is Vestibular Rehabilitation?

Vestibular rehabilitation is designed for the diagnosis and treatment of dizziness conditions such as benign paroxysmal positional vertigo (BPPV), vertigo, meniere's disease, labyrinthitis, neuritis, imbalance and the management of concussion-related symptoms. The vestibular system in conjunction with your vision and sensation is how your body maintains balance and posture. It is responsible for relaying information to the brain about changes in your head position, corrects your body position and maintains the positions of your eyes during movement. Any problems in the vestibular system can lead to a mismatch in signals between the systems responsible for balance leading to dizziness or vertigo and poor balance. Physiotherapy is included in the comprehensive assessment and management of disorders of the peripheral vestibular system in children and adults. 

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What is included in Vestibular Rehabilitation?

Dizziness affects 1 in 2 people at some point in their life and reported as one of the reasons for medical visits due to falls and fears of falling which can have negative consequences such as loss of independence and reduced quality of life. Vestibular rehabilitation through physiotherapy is supported by strong evidence demonstrating its efficacy in improving symptoms and functional outcomes for a wide range of vestibular disorders. This makes it a trusted treatment option recommended by healthcare providers. Vestibular physiotherapy can help you manage symptoms such as dizziness and vertigo by allowing you to regain better control over your symptoms and learn self-management strategies. Vestibular rehabilitation is important for the several reasons:

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• The primary goal of vestibular rehabilitation is to improve balance and reduce dizziness or vertigo symptoms and reduce the risk of falls. This is crucial for restoring functional abilities that may have been compromised due to vestibular disorders

• Vestibular disorders can significantly increase the risk of falls, especially in older adults. By improving balance and reducing symptoms, vestibular rehabilitation helps lower the risk of falls and their associated injurie

• Dizziness, vertigo, and imbalance can severely impact a person's quality of life by limiting activities, causing anxiety, and affecting overall well-being. Effective vestibular rehabilitation can alleviate these symptoms, leading to a better quality of life.

• Vestibular rehabilitation programs are tailored to each individual based on their specific symptoms, functional limitations, and goals. This personalized approach ensures that treatment is targeted and effective.

• Vestibular rehabilitation helps promote adaptive processes within the vestibular and somatosensory (visual and touch) systems, allowing for compensation of vestibular deficits over time.

Overall, vestibular rehabilitation plays a crucial role in restoring function, reducing symptoms, and enhancing the overall well-being of individuals affected by vestibular disorders. It combines physical therapy techniques with patient education and exercises designed to improve balance, stability, and confidence in everyday activities.

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What type of conditions are managed under vestibular rehabilitation?

• Benign Paroxysmal Positional Vertigo (BPPV)

• Post-concussion syndrome 

• Vestibular neuritis/Labyrinthitis 

• Migraine-associated vertigo (MAV)

• Meniere's disease

• Acoustic neuroma

• Degenerative changes 

• Cervicogenic dizziness 

• Post COVID dizziness

• Vestibular Migraine

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What can I Expect During the Cogent Vestibular Rehabilitation Program?

Overall, a vestibular assessment in physiotherapy aims to identify the specific issues affecting your balance and determine the most suitable interventions to improve your symptoms and functional ability. During your vestibular assessment, the physiotherapist will assess the function of the vestibular system and complete the following.​

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The physiotherapist will gather information about your symptoms, medical history, and any events or conditions that could have triggered your symptoms (like head trauma or infections). During clinical examination, a series of tests and maneuvers will be carried out to assess different aspects of vestibular function including:

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• Balance Tests such as as standing with eyes open/closed, standing on different surfaces (e.g., foam), or performing specific balance exercises.

• Gaze Stability is sued to assess how well you can maintain focus on a visual target while your head is moving.

• Positional Testing involves specific head and body movements to provoke symptoms when BPPV is suspected.

• Vestibulo-Ocular Reflex (VOR) Testing is sued to assess how well your eyes move in response to moving your head.

• Gait Analysis helps to observe walking patterns and detect any abnormalities related to balance.

• Special tests like the Epley maneuver may be done by the physiotherapist to reposition displaced crystals within the inner ear in BPPV.

The physiotherapist may use standardized scales to quantify symptoms and assess changes over time. Based on the findings from the assessment, the physiotherapist will educate you about your condition, discuss prognosis, and develop a treatment plan tailored to your needs. This plan may include exercises to improve balance, habituation exercises to reduce sensitivity to motion, or techniques to manage symptoms of dizziness.

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• Repositioning manoeuvres – If you are diagnosed with BPPV, the physiotherapist will guide your your head and body through movement patterns that promote stimulation of the inner ear organ and can relocate otoliths (crystals).

• Vestibular Rehabilitation Therapy exercises – Usually includes eye and head stabilization, visual targeting/motion, movement desensitization, balance and body stability, gait and movement coordination, among other exercises as part of your home exercise program specific to your assessment findings. 

• Activity Modifications and Education – You will receive advice on appropriate adaptations to your daily activities including work, school and leisure. You may be instructed to avoid certain things such as direct sunlight, driving and engage in other activities that are safer such was walking with a sunshade often or in a different way such as dimming the brightness on your computer/tablet screen. 

Depending on symptom severity and treatment response, your physiotherapist  schedule follow-up visits to track progress and adjust the treatment plan.