What is the Vestibular System?
The body maintains balance with sensory information from three systems:
- Proprioception (body positional sense, touch sensors in the feet, trunk, and spine)
- Vestibular system (inner ear)
Sensory input from these three systems is integrated and processed by the brain-stem. The vestibular system, which includes the central system (the brain and brainstem) and the peripheral system (the inner ear and the pathways to the brainstem) has two main functions.
- It allows your eyes to stay focused when your head is moving.
- It keeps you from falling over by sending signals to the muscles in your body that control balance.
What is a Vestibular Disorder?
When the vestibular system is affected by disease or injury, the brain cannot get the correct information from them about balance and motion and a vestibular disorder can result. Some common causes of vestibular disorders include:
- Head Trauma including a concussion (this is a frequent cause of vestibular disorders in people under age 50)
- Vestibular system degeneration, which occurs primarily in an elderly population
- Ear infections such as otitis media; inner ear infection such as labyrinthitis or neuritis
The most commonly diagnosed vestibular disorder is benign paroxysmal positional vertigo (BPPV).
Signs and Symptoms of Vestibular Disorders:
- Vertigo (spinning in the environment)
- Imbalance or disequilibrium
- Blurry or bouncy vision
- Hearing changes
- Problems with coordination, thinking, and memory
What is Vestibular Rehabilitation?
Vestibular Rehabilitation is a specialized form of physiotherapy which aims to alleviate symptoms caused by vestibular disorders. It is an individual exercise-based program intended to reduce vertigo and dizziness, gaze instability, and/or imbalance and falls.
What to expect from your first visit for Vestibular Rehabilitation?
Prior to your first Physiotherapy Vestibular Assessment, you will be asked to complete an intake form (either online or you can arrive early and complete it in the clinic) which helps gather more details about your symptoms and medical history.
In the clinic, a Registered Physiotherapist who has specialized training in Vestibular Rehabilitation and Concussion Management, will perform an initial assessment to understand the nature of your vestibular disorder. This will include a detailed subjective history, specific visual and vestibular tests, motion sensitivity testing, balance and walking tests and test to determine the presence of BPPV. From this evaluation, a specific and individual exercise program will be created which may include balance retraining exercises, visual exercises, habituation exercises and gaze stability exercises. If BPPV is detected, repositioning manoeuvres can be performed during the initial visit.
Please wear comfortable clothes that you can easily move in and bring any medical imaging or reports that you may be relevant.
It is typical that many of these tests could aggravate your symptoms and you may not wish to drive after this assessment.
How often do I need to do Vestibular Rehabilitation?
After your Initial assessment in the clinic, you will be provided with an exercise program which should be done daily according to the specifications provided by your physiotherapist. Although everyone is different, typically you would be seen in clinic weekly or biweekly for 6-8 weeks.
Do I need a doctor’s referral to begin Vestibular Rehabilitation?
A doctor’s referral is not required to have a Physiotherapy Vestibular Assessment, but because the causes of dizziness are so varied, medical assessment is highly recommended prior to initiating vestibular rehabilitation.
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