What is a Vestibular Disorder, and what are the symptoms of it?

The vestibular system is a sensory organ in the inner that helps an individual maintain equilibrium. Diseases, infections, trauma, autoimmune disorders, or sometimes unknown causes can lead to Vestibular System Dysfunction. Symptoms from a vestibular dysfunction include nausea, dizziness, Vertigo, blurriness or gaze jumping problems, fogginess in the brain, decreased quality of life, imbalance, and risk for falling.

What is Vestibular Rehabilitation?

Vestibular rehabilitation is a specialized kind of physical therapy that helps overcome problems caused by vestibular disorders. The goal of vestibular rehabilitation is to reduce Vertigo, dizziness, gaze instability, and imbalance.

Physical Therapists trained in Vestibular Rehabilitation Treatment use exercise-based programs to reduce Vertigo, dizziness, gaze instability (blurriness), and imbalance and falls.

The room spins when I am moving my head. Why is this happening?

Individuals can also suffer vertigo due to calcium crystals called otoconia or canaliths in the inner ear falling out of place. This causes the individual to experience the sensation of room spinning when they change their head position like rolling over in bed, or bending and lifting their head this is called Benign Paroxysmal Positional Vertigo (BPPV)


Will I be able to get rid of Vertigo? Can my symptoms be improved? Does the treatment work?


The approach to improving the symptoms caused by vestibular dysfunction is teaching patients methods to utilize the other sensory systems to improve equilibrium or Balance. In technical words, these are called compensatory strategies.

Physical therapists utilize four fundamental approaches while prescribing the exercises.

  • Canalith Repositioning Maneuver (CRT Maneuvers) and Exercises
  • Habituation Exercises
  • Gaze Stability Exercises
  • Substitution Exercises

Treatment of Benign Paroxysmal Positional Vertigo

Canalith Repositioning Procedure/Maneuver

Canalith repositioning procedure/ maneuver is the treatment for BPPV. We all have small calcium crystals generally attached to the otolith membrane in the inner ear's utricle(vestibule). These crystals can fall out of place or displace due to trauma, infection, aging, or sometimes without any known reason. When the head moves, the crystals reposition, and a person experiences a  sensation of the room spinning.  Physical Therapists trained in vestibular rehabilitation watch eye movements during the changed head positions and determine the canal's precise location where these crystals are displaced. Patients experience nausea, dizziness, and a sensation of the room spinning with head positional changes.

At Asara Physical Therapy & Balance Clinic, we use Infrared video Frenzel glasses to watch for eye movements. Using the goggles allows us to magnify the eye movements and replay the eye movements to improve our diagnostic accuracy.

The treatment consists of moving the head in different positions to reposition the crystals using gravity to move inside the semicircular canals and fall back into place(Utricle). 

Repositioning the crystals back into place helps treat Vertigo experienced by patients.

The procedure's success is confirmed by watching for the eye movement's stability with the infrared video Frenzel glasses and taking the patient through these positions again. CRP is beneficial, with an approximate cure rate of 80%.


Can I perform the maneuver at home?


For patients who require more than one attempt to reposition, the Physical therapist also teaches the patient how to redirect the crystals at home by teaching them ways to move. Home maneuver improves the success rate. Research also suggests that performing a home maneuver reduces the chances of recurrence by 67%. As you can understand, accurate diagnosis and prescribing the exercise specific to your condition is very important.


Habituation Exercises:

Abnormality of the vestibular system can cause symptoms of dizziness and motion sensitivity. Patients can experience dizziness with head movements or body movements like rolling, turning, bending down, looking up, etc., 

Physical therapists identify which movements trigger the symptoms of dizziness and design exercises specific to the triggering motions. Symptom provocation is the intent of the exercises in mild to moderate severity. With ongoing practice, the brain learns to ignore the abnormal signals from the vestibular system. The patient will be able to experience less intensity or frequency of dizziness. 

Complete resolution of symptoms is crucial before starting the next exercise to allow for vestibular recovery.


Gaze Stability Exercises:

Patients who suffer from disorders in the vestibular system report a sensation of blurriness or environment jumping while their head moves while reading or looking at a visually busy environment while walking or moving around. 

Problems with gaze stability occur because the vestibular system is functioning at a lower level. Exercises can help improve gaze stability. A physical therapist can design unique activities based on the extent of vestibular loss experienced by the patient.

Patients report a feeling of blurriness or jumping of alphabets or environment when they are moving their head or with functional movements such as walking, standing, climbing stairs, etc.,


Substitution Exercises:

Problems with vestibular organs of both ears can cause severe compromise of the vestibular system. Treatment focuses on teaching substitution exercises designed to utilize other sensory systems such as the visual system, somatosensory system, and muscular system to maintain balance and equilibrium.