A person suffering from vertigo has dizziness, instability and an increased risk of falls. It is important to find out the underlying condition causing vertigo to be able to understand how to treat it.
Balance and equilibrium of the body are controlled by the central nervous system depending on inputs from 3 areas – the eyes (visual), the inner ear (vestibular) and the joints and muscles (proprioceptive). If there is a disorder affecting any of these areas, the brain needs to reweigh the sensory inputs to make the body stable. This is called Central Compensation. Vestibular rehabilitation is aimed at promoting central compensation. It is important to start exercises as soon as possible to get the best and lasting results of treatment.
Vestibular evaluation will allow your doctor to understand which system/systems are affected leading to vertigo. The systems which need to be evaluated include
Vestibulo-ocular reflex (VOR) – this is a very quick reflex which enables images to be kept stable on the fovea of the retina during head movement. If this reflex is weak, the person will have blurred vision or instability during head movement.
Vestibulospinal reflex (VSR) – this reflex helps in keeping the body stable during movement. Problems with this reflex will make the person unsteady especially on standing and walking.
Otolith system – This system controls the linear acceleration of the body which stables the body in 3 dimensions – the yaw, pitch and roll. Defects in the otolith system lead to a feeling of constant instability or being pushed.
Central programming – different parts of the brain are involved in integrating the sensory information received from the periphery. Cognitive function is also very important. Any disorder of central programming will make the patient and more prone to falls.
According to site of weakness, age, any associated disorders like back or knee pain, the vestibular rehabilitation exercises are planned.
For VOR disorders – gaze stabilization, tracking and exercises aimed at the movement of head and neck are prescribed.
An example is given below –
Step 1 – Look at a distant object.
Step 2 – Move your head side to side keeping your gaze stable on the object.
Step 3 – Move your head up and down keeping your eyes on the object.
For VSR disorders, exercises are aimed at the lower body and promote maintaining balance in challenging situations. Activities are aimed at promoting different ankle, knee and hip strategies to balance on irregular surfaces
An example is given below
Step 1 – Stand with your feet together
Step 2 – Take a step forward keeping the feet about 25cm apart.
Step 3 – Take a step backwards keeping feet together again.
Exercises which are prescribed usually start as low intensity, slow exercises which are steadily increased in speed and complexity. Repeating the same exercises for long durations will not help promote recovery as the vestibular system will get used to the same repeated activity. Compensation requires the system to be challenged to have a greater impact.
Always do exercises under supervision or in the presence of another person who can help you in the unlikely event of a fall.
According to the severity of symptoms, Vestibular rehabilitation is given as home exercise or in the clinic under the supervision of a therapist. The therapists at NeuroEquilibrium’s Advanced Vertigo and Balance Clinics give rehabilitation through highly sophisticated equipment that enables them to monitor the results and modify exercises according to the progress of the patient.
Check for an appointment and rehabilitation therapy here.