Transcript Vestibular Rehabilitation - Slidell Memorial Hospital

Vestibular Rehabilitation:
Finding Your Balance
STEPHANIE JIMENEZ, DPT
SMH OUTPATIENT THERAPY
What We’ll Be Talking About

How common are vestibular disorders?
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The vestibular system.
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Most common types of vestibular disorders.
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What causes vestibular disorders?
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Symptoms of vestibular disorders.
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What is vestibular rehabilitation therapy?
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What goals will be achieved through therapy?
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What type of exercises are involved in therapy?
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Would I benefit from vestibular rehabilitation therapy?
Vestibular Disorders:
How Common Are They?
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Vestibular disorders can affect people of any age.
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As many as 35% of adults aged 40 years or older in the U.S. have
experienced some form of vestibular disorder.
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Currently children are not typically screened, despite new awareness of
pediatric vestibular disorders. As a result, children frequently fail to receive
medical treatment for their symptoms.
The Vestibular System
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Involves the inner ear, the eyes
and areas of the brain that
process the sensory information
involved with directing balance
and eye movements.
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Central to a person’s core
functioning, acting as the body’s
GPS system.
Vestibular Disorders:
Most Common Types

Vestibular disorders are not easy to diagnose. On average,
patients consult 4 or 5 doctors before receiving a diagnosis.
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Benign Paroxysmal Positional Vertigo (BPPV)
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Labyrinthitis or Vestibular Neuritis
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Ménière’s Disease
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Secondary Endolymphatic Hydrops
Vestibular Disorders:
What Is The Cause?

Disease or injury impairs processing areas.
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Genetic or environmental conditions.
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Unexplained reasons.
Symptoms Of Vestibular Disorders
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Vertigo and Dizziness
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Cognitive Impacts
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Imbalance and Spatial
Disorientation
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Psychological Impacts
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Nausea or Vomiting
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Fatigue
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Visual Disturbances
Hearing Changes
Symptoms Of Vestibular Disorders
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Diminishes quality of life and impacts all aspects of daily living
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Often cause sedentary lifestyles leading to:
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Decreased muscle strength/flexibility
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Increased joint stiffness
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Reduced stamina
Vestibular Rehabilitation Therapy (VRT)
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Customized exercises that target each person’s specific problem.
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Can eliminate or drastically reduce symptoms by stimulating central nervous system
compensation for vestibular deficits.
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Many people experience permanent deficits because the vestibular system does not
regenerate effectively. Through compensation, you can feel better and function
more safely.
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This is due to the brain’s ability to learn how to use other senses and parts of the brain to
substitute for the deficient vestibular system.
Vestibular Rehabilitation Therapy (VRT)
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The extent of recovery that can be gained through compensation is
determined by the function and health of the compensatory areas of the
nervous system.
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Compensation happens naturally over time for many, but for people with
symptoms that do not reduce, and continue to struggle resuming daily
activities, VRT can help with recovery by promoting compensation.
Vestibular Rehabilitation Therapy (VRT)
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VRT begins with a comprehensive clinical assessment.
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Detailed history of symptoms and how the symptoms affect daily activities.
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Therapist documents type and intensity of symptoms and discusses the
precipitating circumstances.
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Information about medications, hearing or vision problems, other medical
issues, history of falls, previous and current activity level, and your living
situation will be gathered.
Vestibular Rehabilitation Therapy (VRT)

During the assessment, different tests will be administered to more
objectively evaluate the problem.
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The therapist will screen the visual and vestibular systems to observe how
well eye movements are being controlled.
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These tests assess sensation which includes gathering information about
pain, muscle strength, extremity and spine range of motion, coordination,
posture, balance, and walking ability.
Vestibular Rehabilitation Therapy (VRT)
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Your therapist will develop a customized exercise plan from the findings of
the clinical assessment, results from laboratory testing and imaging studies,
and input from you about your goals for rehabilitation.
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An important part of VRT is establishing an exercise program that can be
performed at home.
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Compliance with the program is essential to help achieve rehabilitation and
personal goals.
Vestibular Rehabilitation Therapy (VRT)
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Along with exercise, patient and caregiver education is an important part
of VRT.
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It is very useful to understand the science behind your vestibular problem,
as well as how it relates to the difficulties that may arise with functioning in
everyday life.
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Your therapist is able to help take away the mystery of what you’re
experiencing, which can help reduce anxiety that may occur as a result of
your vestibular disorder.
What Goals Will Be Achieved?
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Decreased dizziness and visual symptoms
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Increase in balance and walking functions
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Increase in general activity levels
What Type Of Exercises Are Involved?
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Depending on the vestibular-related problem(s)
identified and related symptoms, three principal
methods of exercise can be prescribed:
1)Habituation
2)Gaze
Stabilization
3)Balance
Training
Habituation Exercises
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Designed to treat symptoms of dizziness that occur because of self-motion or visual
stimuli.
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Appropriate if you experience increased dizziness when moving around:
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Quick head movements
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Bending over
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Looking up to reach above head
Appropriate if you experience increased dizziness in visually stimulating environments:
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Shopping malls or grocery stores
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Watching T.V.
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Walking over patterned surfaces or shiny floors
Habituation Exercises
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Not suited for dizziness symptoms that are spontaneous in nature and do
not worsen because of head motion or visual stimuli.
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Goal

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Reduce dizziness through repeated exposure to specific movements or visual
stimuli that provoke your dizziness.
Over time and with good compliance and perseverance, the intensity of
dizziness will decrease as the brain learns to ignore the abnormal signals
received from the inner ear.
Habituation Exercises
Gaze Stabilization Exercises
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Designed to improve the coordination of eye and head movements.
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Appropriate if you experience problems seeing clearly because visual world appears to
bounce or jump around.
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Especially helpful for patients with poor to no vestibular function, such as patients with
bilateral (both sides) inner ear damage.
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Two types of exercises depending on the type and extent of vestibular disorder.
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Gaze shifting and remembered target exercises use sensory substitution to promote gaze stability.
Gaze Stabilization Exercises
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The first type
incorporates fixating on
an object while
repeatedly moving
head back and forth or
up and down.
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The second type is designed
to use vision and body sense
as substitutes for the
damaged vestibular system.
Balance Training Exercises
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Designed to improve balance so that daily activities for self-care,
work, and leisure can be performed successfully.
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Helps improve:
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Standing
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Bending
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Reaching
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Turning
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Walking/Running
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Walking outside on uneven ground or in the dark
Balance Training Exercises
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The exercises need to be moderately challenging but safe enough so
patients do not fall while doing them.
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Features of the balance exercises that are manipulated to make them
challenging, include:
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Visual and/or somatosensory cues.
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Stationary positions and dynamic movements.
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Coordinated movement strategies (movements from ankles, hips, or a
combination of both).
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Dual tasks (performing a task while balancing).
Balance Training Exercises
VRT Exercises
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VRT exercises are not difficult to learn, but to achieve maximum
success you must be committed to doing them.
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Since exercises can sometimes be tedious, setting up a regular
schedule to incorporate exercises into daily life is very important.
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At first, exercises might make symptoms seem worse. But with time
and consistent work, symptoms should steadily decrease, meaning
participation in activities of daily life will be easier.
Would I Benefit From VRT?
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A variety of vestibular problems can be treated through VRT,
including symptoms that often follow certain corrective surgical
procedures for vestibular disorders.
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Even individuals with long-term unresolved inner ear disorders who
have undergone a period of medical management—with little or
no success— may benefit.
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VRT can also help people with an acute or abrupt loss of vestibular
function following surgery for vestibular problems.
Would I Benefit from VRT?
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It is important to note that not all dizziness is caused by vestibular
deficits, making it critical that anyone considering a VRT program
have a confirmed diagnosis of vestibular pathology.
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Most referrals come from an Otolaryngologist or Neurologist.
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The treating therapist may request an otology consult if there is a
dispute about the nature of the underlying disorder in individuals
who are referred from other sources.
Thank you!
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SMH’s Outpatient Rehab Center offers
Vestibular Rehabilitation Therapy. For more
information or to schedule an appointment,
please call (985) 280-2750.