Vestibular rehabilitation

Vestibular rehabilitation expertise at the Centre for Clinical Physiotherapy

One in four adults under 65 years of age report problems with dizziness and vertigo and almost half of those diagnosed with a vestibular condition have lingering symptoms that affect their ability to work and require ongoing sick leave.  

Dizziness is a common factor in unexplained falls in that present to A&E departments and untreated or ongoing vestibular related balance disorders may lead to falls, stress and anxiety as well as fear-avoidance behaviours (1).

One of the most common forms of dizziness experienced by patients is that caused by an inner ear viral infection resulting in vestibular neuronitis or labyrinthitis (if there is additional hearing loss).  

Patients will often complain of the sudden onset of severe symptoms of vertigo (room spinning), along with unsteadiness, difficulty walking, nausea and vomiting.  

Most patients recover from these symptoms with medical intervention and medication.  However, some patients experience ongoing and lingering symptoms that include balance problems, unsteadiness, veering when walking and a muggy head. These symptoms can continue for weeks, months or years after the initial onset and can have a profound effect on quality of life.  

Those patients referred to ENT services may be diagnosed with a peripheral unilateral or bilateral vestibular hypofunction following an assessment with an ENT Consultant and Vestibular Function Tests.  They can also assess for other causes such as vestibular migraine, Meniere’s disease and central causes such as vestibular neuroma or stroke.  

Benign paroxysmal positional vertigo (BBPV) is another common form of dizziness that can occur after acute vestibular neuronitis or labyrinthitis or sometimes after a knock or bump to the head.  Patients complain of momentary vertigo caused by a change of head or body position.  It usually occurs with bending, looking up, moving into and out of bed and turning over in bed.  It is caused by crystals from the otolith organs within the labyrinth moving into the semi-circular canals, most commonly the posterior canal.  

Physiotherapy is very effective in helping patients with all of these problems.

Vestibular rehabilitation is a treatment programme designed to help the patient compensate for the inner ear disorder.  They are taken through a comprehensive assessment and then given a tailored programme of exercises to work on at home.  

Those with BPPV are treated with appropriate repositioning manoeuvres such as the Epley manoeuvre.  This can be 80% effective after the first treatment (2).  

Another treatment involves education, head and eye movements, balance exercises and promoting the return to physical activity.  

1. Physiotherapy Works Vestibular Rehabilitation.  The Chartered Society of Physiotherapy.    http://www.csp.org.uk/publications/physiotherapy-works-vestibular-rehabilitation

2. Epley JM. The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 1992 Sep;107(3):399-404 

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