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Balance

We use our eyes, our brain, our body muscles and our balance organs in the inner ear to keep ourselves upright and steady. If one or more of these complex systems are damaged by disease, infection or injury, and you experience symptoms of dizziness or unsteadiness, you may benefit from VRT.

What is Vestibular Rehabilitative Therapy?

Vestibular Rehabilitation is an exercise-based therapy program used to treat balance and dizziness disorders. It is based on the body’s natural ability to heal itself and compensate for injury. Certain body, head and eye movements strengthen this ability to compensate, and with a focused exercise program, patients can improve their functional balance. Each patient will be assessed in order to develop an Individualized Treatment plan which may include:

Balance Retraining

Involves exercises designed to improve coordination of muscular responses as well as the organization of sensory information for balance control.

Adaptation Exercises

May be used in order to help the patient’s brain adapt to new signaling from the damaged vestibular system. Gaze stabilization techniques is an example of an adaptation exercise.

Substitution Exercises

Are used to promote balance and reduce falls by using other sensory stimuli (e.g., visual or somatosensory input) to substitute for absent or reduced vestibular function. Ball Toss exercise is an example of a substitution exercise.

Combination Therapy

Some exercises use both adaptation and substitution strategies. Ankle Sway is an example of this type of exercise.

No two exercise treatment plans are exactly alike. Your exercise program is developed by identifying your deficits. For example: if your symptoms have been linked to an inner ear problem, you will also learn how to do some self-treatment exercises. Continuing an exercise plan at home can help prevent and/or treat new dizziness and balance episodes.

Who Will Benefit from VRT?

Patients who are typically referred for vestibular rehabilitation therapy are those diagnosed with dizziness, imbalance, vertigo, Meniere’s syndrome, benign paroxysmal positional vertigo (BPPV), neck-related dizziness and migraines. Other candidates are patients who have had a stroke or brain injury or who frequently fall.

How Long is Treatment?

Some programs only last one or two sessions. Other programs may last up to a few months. The length of the treatment program depends on the needs of the patient, the severity of the symptoms
and the cause of the problem. A patient’s motivation level and response to therapy will also be a factor. Exercises are done 1-2 per day for approximately 10-20 minutes each session.

How Will VRT Help Me?

The majority of patients have tried to find help for their balance disorder, but were often told “you’ll just have to live with it”. It is important to remember that therapy and outcome is just as unique as each patient’s problem. VRT can be a successful therapy for many patients when other treatments have failed.

The goal of VRT is to improve functional balance during movements; to improve visual symptoms during head movements; to decrease disequilibrium; to increase overall physical condition/general activity/endurance levels which will promote better prognosis; and to decrease social isolation.

Improvements will not happen immediately. Treatment means hard work over time. Patients are expected to feel dizzy and sometimes nauseous. Take it easy in the beginning stages and then progress to harder exercises as time goes on. Talk to your treatment provider to discuss your expectations and what to expect during your sessions.

What is BPPV?

Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo – the sudden sensation that you’re spinning or that the inside of your head is spinning. Dizziness episodes occur when the patient moves their head or gets out of bed in a particular manner.

How is BPPV Treated?

One type of treatment for BPPV is called “Canalith-repositioning Maneuvers”. It is a series of head movements that move displaced “calcium crystals” out of the semi-circular canals within the inner ear. Research suggests that this form of dizziness treatment is more effective than medication or other forms of exercised-based therapy. Symptoms can resolve after 1-2 sessions for most patients.

How Can an Audiologist Help in the Assessment and/or Treatment of the Dizzy Patient?

For most dizzy patients, their otologist or physician will use medical history combined diagnostic tests to rule out non-ear related types of dizziness. Once other medical or emergency type causes have been excluded, an audiologist can help. Audiologists can perform special tests to help determine the cause of dizziness and the treatment needed. It is estimated that over 85% of dizziness is ear related, most of which is easily diagnosed with the help of advanced technology and a highly trained staff, like that found at Auburn and Mountain Hearing Centres.

After the balance exam and once a diagnosis by a physician have been determined, there may be multiple treatment options available. Treatment for dizziness has been proven effective for most ear related dizziness. Recommendations by your physician may include physical or vestibular therapy, medication, diet management and occasionally surgical intervention. Recommendations by your audiologist may include vestibular rehabilitation, which is a series of exercises or maneuvers designed to improve balance and reduce complaints of dizziness.

Balance Assessments Include

Audiometric Evaluation or Hearing Tests

A hearing test is often critical to determine the type and location of the vestibular problem, regardless of the presence or absence of hearing loss. The hearing and balance systems share a common location as well as nerve position and fluids, so hearing or ear problems can often provide good information concerning dizziness.

Videonystagmography (VNG)

Evaluates the function of the vestibular or balance portion of the inner ear. Eye movements are measured while the inner ear is stimulated. Stimulation may be produced by eye movement, head
movement, body position changes, or the presentation of cool and warm air, or water into the inner ear. Auburn and Mountain Hearing Centre uses air.

Balance Function Tests

Include a series of progressive balance challenges to determine the relationships of vision, Somatosensory (skin, joints and muscles) and the vestibular system and their affects on balance.

Otoacoustic Emissions

Otoacoustic Emissions evaluates the function of the inner ear; the test simply identifies if there is inner ear function but does not measure the amount of hearing. The test can be performed while the patient is awake but he/she has to be quiet and still.

A complete vestibular, or dizzy, assessment will take about two hours. The test is painless but you may feel dizzy or nauseated for some time after the appointment. It is recommended that you arrange for someone to drive you home following your appointment.

Frequently Asked Questons

Can I still take medication prior to the exam?

Medication prescribed for dizziness should not be taken. A patient is encouraged to follow the provided instructions, which basically prohibit any medication other than life sustaining medication. If a patient is still in doubt, they should contact the prescribing doctor.

Will the test make me sick?

The testing procedures cause some patients to become nauseated. For this reason, patients are instructed not to eat three hours prior to the exam.

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