Vestibular rehabilitation is a treatment technique for individuals with peripheral vestibular disorders that are disorders of the inner ear. It includes benign paroxysmal positional vertigo, Vestibular neuritis and Post-traumatic vertigo. These disorders lead to symptoms such as vertigo, dizziness and balance dysfunction.
In vestibular rehabilitation, a problem-oriented approach is used in which exercises are customised to address your specific needs. Your physiotherapist will help you by first doing a comprehensive examination to identify the type of vestibular disorder that you are suffering from.
Then an exercise program is designed based on the type of vestibular disorder that you have. This could include habituation exercises and gaze stabilization exercises for dizziness and gaze instability due to vestibular neuritis. It could include balance training if dizziness affects your balance.
For benign paroxysmal positional Vertigo, depending upon which ear canal is involved, different repositioning exercises are used such as Epley’s maneuver, Dix-Hallpike maneuver and Brandt-Daroff technique.
Along with these exercises, education is a very important part of vestibular rehabilitation. Your specially trained Registered Physiotherapist will provide the relevant information regarding your condition. They will explain how to deal with the difficulties due to the disorder and what you can expect from the Vestibular Rehabilitation.
Your Registered Physiotherapist will reassess you from time to time to measure your response to the Physiotherapy through a questionnaire named the Dizziness handicap inventory. Special tests that are timed and a test for your Balance may be performed.
Getting treatment from a specially trained, Registered Physiotherapist will help you to fix the problem. Early treatment will help to prevent the risks of falling due to poor balance and dizziness.
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Vestibular rehabilitation is an exercise-based program based on a detailed assessment by a trained vestibular Physiotherapist. VRT is effective in reducing, dizziness, vertigo and balance problems, there by minimize the risk of falls and helps to improve the quality of life in people with vestibular dysfunction. BPPV or the free-floating crystals in the inner ear is the common cause of Vertigo and the diagnosis is made with a test called Dix-Hallpike. The initial screening includes collecting a detailed history of your problem, tests for BPPV, assessment of visual problems, neurological test, visual screening and various balance test. Initial assessment will also help to differentiate between the vestibular problems due to dysfunction in your inner ear and dysfunction in the parts of brain which controls your balance and coordination.VRT is aslo effective in vestibular dysfunction following surgeries in your inner ear.
In the initial phase your doctor may prescribe medication to supress your symptoms and also medication for nausea. If you have inner ear infection then you may be on steroids or antibiotics.Your Doctor decides on the appropriate medication, dosage and duration of intake.Vestibular suppressants are normally not continued for long term as it can slow down the process of compensation.
Following your first assessment your Physiotherapist will develop personalised exercise-based treatment plans including clinic-based treatment and home exercise program. Your exercise will be reviewed during the follow up visits and progressed as needed to help you with the recovery. Some of the exercise may provoke your symptoms in the initial period, because these exercises are meant to encourage your brain to compensate for the problems in your inner ear. Your Physiotherapist will decide on the intensity and repetition of the exercise and it is very important to incorporate exercise in to your daily routine as advised by your Physiotherapist.
BPPV is the most common cause of vertigo due to vestibular dysfunction due to your inner ear pathology and most likely to occur over the age of 50. Vestibular dysfunction can develop due to head trauma, surgical trauma in your inner ear, Labyrinthitis, neuritis, migraine, vestibular system degeneration, Meniere’s disease, barotrauma (increased pressure in the inner ear for e.g. in scuba diving) and ototoxicity (toxicity from antibiotics like gentamycin).
Physiotherapy treatment plan may include eye and head movement exercise. exercise to improve standing balance and walking, specific techniques performed in the clinic to reposition the loose crystals in your inner ear if you have BPPV, advice on falls prevention and education and advice on planning and pacing your activities of daily living to improve confidence and function.
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