Vestibular Rehabilitation Therapy (VRT) is a specialized form or branch of physical therapy that addresses the inner ear or vestibular system specifically with gaze stabilization, habituation, adaptation, and compensatory drills. These exercises typically involve a lot of head and eye movement which is essential for stimulating and retraining the vestibular system. This results in an improvement in vestibuloocular control, an increase in the gain of the vestibuloocular reflex (VOR), better postural strategies, and an increased degree of motor control for movement.
The goals of Vestibular Physical Therapy include:
- Reduce dizziness and vertigo
- Reduce falls and improve stability with gait
- Improve gaze stability with movement
- Reduce visual motion sensitivity (motion sickness)
- Return to functional daily life without imbalance or dizziness
All physical therapists receive a brief education in this type of therapy however only those who specialize in Vestibular Physical Therapy should be a part of the team in treating vestibular diagnoses including Benign Paroxysmal Positional Vertigo/BPPV, Vestibular Neuritis, Ménières disease, Perilymphatic Fistula, Acoustic Neuroma, Vestibular Migraine, Superior Canal Dehiscence, and Concussions. A vestibular therapist considers several factors before designing an individualized vestibular rehabilitation program including the extent and location of the damage to the vestibular system, any visual issues (trifocal lenses, strabismus/’lazy eye’, macular degeneration, etc.), co-morbidities that affect sensation (numbness and tingling due to neuropathies, multiple sclerosis, etc.), physical/muscular strength, current medications, and the integrity of the cerebellum.
Once the therapist designs the individualized Vestibular Physical Therapy program based on their diagnosis, the patient is expected to do much of the exercises on their own at home. They then return for additional sessions as adaptation and compensation occurs for progression of their given exercises with increased complexity that mimic their functional activities of daily living. It is also important to perform exercises in the clinic that require guarding for safety but adequately challenge balance. It is imperative that the patient understands that they must provoke their symptoms of dizziness in order to make the symptoms go away. I often use the analogy with my patients, “If you are doing squats at the gym, you better feel your thighs burn or else you didn’t work them very hard. The same goes for vestibular exercises, you have to provoke dizziness or you aren’t working the vestibular system hard enough.”
At APRS we have 4 practicing vestibular specialists, 2 of which are Emory Certified Vestibular Specialists. We pride ourselves on this specialized form of therapy and believe it is imperative to collaborate with other members of the team in the community including otolaryngologists, ENT physicians, neuro-otolaryngologists, neurologists, and primary care physicians.
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Kelsey Housman, PT, DPT
Certified Vestibular Therapist