Treating Vestibular Disorders

Author: Jess Hennell (Physiotherapist) – Special Interest in Vestibular Disorders

“Vertigo and dizziness affects more than 1/3 of people over the age of 50” – RACGP

It can lead to people requiring time off work, presentations to the emergency department and falls resulting in serious injuries or fractures. Vertigo is a type of dizziness that feels as though the room around you is spinning. The severity of symptoms can range from mild to severe and may involve nausea and vomiting. 

Upon diagnosing the type of Vertigo a person has, various Vestibular rehabilitation techniques can be recommended and prescribed. For Benign Paroxysmal Vertigo (BPPV), various canal repositioning techniques can be implemented to address the canal in concern. With other Vestibular conditions a range of exercises and treatments are prescribed after a detailed assessment. These treatments may include gaze stability exercises, habituation/compensatory strategies and balance/falls prevention exercises. (7) Time is spent to educate clients to ensure they are completing their exercises at the correct level and to encourage them to return to normal life activities. 

Clients are reviewed regularly during their treatment period and treatments will be progressed at the frequency that best suits the individual. Both research studies and our clinical experience indicate that the longer an individual waits for treatment the more an individual can develop activity avoidance behaviour. This can exacerbate their symptoms and impact on their quality of life.

Specific Exercises

Rehabilitation program can include gaze stability exercises, habituation and balance/postural control 

Reducing Symptoms

Symptoms that can be improved with vestibular rehab can include dizziness, vertigo and imbalance

Jess demonstrating a Hall-pike manoeuvre

Who benefits from Vestibular Rehab?

Clients who are experiencing:
 –  Dizziness
 –  Vertigo
 –  Feeling off balance
 –  Falls or near misses for falls
 –  Visual blurring with head movement (1)
 
 There is strong to moderate evidence that vestibular rehab is safe and effective for a range of peripheral vestibular conditions (1, 2) including:
 –  BPPV
 –  Vestibular neuritis or Labyrinthitis
 –  Post removal of Acoustic Neuroma

Vestibular rehab can also be used to assist with:
–  Persistent postural-perceptual dizziness (3PD) (3)
–  Post concussion syndrome (4)
–  Multiple sclerosis (5)
–  Meniere’s disease (residual symptoms between episodes) (6) 

3 reasons to refer for Vestibular Rehab

­1) Early initiation of Vestibular rehabilitation may result in improved recovery of balance, reduced symptom complaints and improved functional recovery (1)
2) For clients with BPPV, treating with an appropriate canal repositioning technique can reduce falls in this population by around 65% (8)
3) It can improve both symptoms and function and result in benefits to quality of life!  (1)

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