Regain Your Balance: A Simple Guide to Vestibular Rehabilitation Therapy

Vestibular Rehabilitation Therapy: What It Is & How it works?

Vestibular disturbances referred to a disruption in the functioning of the vestibular system, which responsible for maintaining balance and spatial orientation. When there’s disturbance, it can lead to symptoms like dizziness, vertigo, poor balance, nausea, lightheadedness and visual disturbances. Vestibular rehabilitation is an evidence-based approach to managing these issues.

Who needs to have this treatment?

• Vertigo
• Benign paroxysmal positional vertigo (BPPV)
• Vestibular neuritis
• Traumatic brain injury
• Migraine headache
• Labyrinthitis

Our GOALS of treatment included:

• Reduction of symptoms
• Improve postural control and balance
• Improve gaze stability (able to see clearly during head movement)
• Resume daily activities without discomfort

Treatment approaches

Static Postural Control Exercises: Improve balance stability and control when stationary

1. 1. Stand feet apart
   2. Stand feet together (Level 1)
   3. Semi tandem stand (Level 2)
   4. Tandem stance (Level 3)
   5. Single leg stands (Level 4)
   6. Balance on unstable surface (Eg. folded yoga mat)

Dynamic Postural Control Balance Exercises: Enhance balance during movement, help to prevent falls and improve functional mobility

1. 1. Normal walking with turning head
   2. Heel-to-toe walking/Tandem walking
   3. Stepping over small obstacles (Eg. boxes)
   4. Dynamic weight shift
      • Shifting weight from one leg to another leg while standing or on an uneven surface

Gaze stabilization exercises: Improve visual focus during head movements

1. VOR (Vestibulo-Ocular Reflex) Exercises

• • VOR x1:

1. 1. 1. Focus on a target (Eg. a black dot on a wall).
      2. Slowly turn your head left and right while keeping your eyes focus on the target.
      3. Aim for 1-2 minutes, increasing speed as tolerated.

• • VOR x2:

1. 1. 1. Similar to VOR x, but move your head side to side while also moving the target in the opposite direction.
      2. This is more challenging and helps train the eyes to maintain focus despite head movement.

2. Head Movements with Fixed Gaze

• • Head Nods:

1. 1. 1. Keep your eyes focused on a target while nodding your head up and down.
      2. Start slowly, then gradually increase speed.

• • Diagonal Head Turns:

1. 1. 1. Look at a target and turn your head diagonally (Eg., looking at the upper left corner, then the lower right) while maintaining focus.

• Near-Far Focus Exercises

1. 1. Hold a small object (like a pen) close to your face and focus on it.
   2. Slowly move it away while maintaining focus, then bring it back close.
   3. Repeat several times to enhance focus flexibility.

• Reading While Moving

1. 1. Read a book or text while gently moving your head side to side or up and down.
   2. This simulates real-life situations where you need to read while in motion.

• Visual Tracking Exercises

1. 1. Use a moving object (like a ball or your finger) and track its motion with your eyes without moving your head.
   2. This can improve the coordination between eye and head movements

Habituation exercises: Reduce sensitivity to movements that trigger symptoms

• Patient is asked to perform a number of repetitions of a specific movement that causes mild to moderate
• The specific movements or exercises were chosen based on which movements/ situation that provokes symptoms such as head turns, change in body position or walk with head movements.

Postural training: Promote better body alignment and movement strategies

1. 1. Awareness of body positions:

• • • Understanding of body alignment and position in space

1. 2. Balance strategies:

• • • Learning to use different strategies for maintaining balance: hip, ankle and stepping strategies

1. 3. Coordination of movements:

• • • Improving the coordination between the visual, vestibular and proprioceptive systems

1. 4. Strengthening core muscles:

• • • Core strength to support overall stability

Implementation Tips:

• Symptoms must return to baseline before continuing
• It is necessary to wait an additional 30 seconds after each repetition
• It is not possible to habituate headaches, oscillopsia or nausea
• Frequency: 2-3 times per day; 2-3 movement patterns per set; 2-3 repetitions per movement pattern
• Professional guidance: Advisable to work with a physiotherapist to tailor the exercises to specific needs

References

Han, B. I., & Han, B. I. (2021). Vestibular rehabilitation therapy: review of indications, mechanisms, and key exercises. Simplified Vestibular Rehabilitation Therapy, 1-16.

Muir, S. W., Berg, K., Chesworth, B., Klar, N., & Speechley, M. (2010). Balance impairment as a risk factor for falls in community-dwelling older adults who are high functioning: A prospective study. Physical Therapy, 90(3), 338–347. https://doi.org/10.2522/ptj.20090163

Physiopedia. (n.d.). The 4-stage balance test. Physiopedia. https://www.physio-pedia.com/The_4-Stage_Balance_Test

Vestibular Disorders Association (VeDA). (n.d.). Vestibular rehabilitation therapy (VRT). Vestibular Disorders Association. https://vestibular.org/article/diagnosis-treatment/treatments/vestibular-rehabilitation-therapy-vrt/

Prepared by:

Pea Wan Theng

Your Physio Connaught