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    Vestibular Rehabilitation Exercises & Therapy

    Vestibular rehabilitation is an important part of management in patients with vertigo, imbalance, and dizziness. These patients often feel that their problem becomes worse during head and neck movements or during walking. Balance disorders can occur due to many causes related to the inner ear, central nervous system, and systemic causes. A thorough history followed by clinical examination and vestibular evaluation will help the clinician diagnose the underlying cause of dizziness. After deciphering the cause of vertigo, the site of involvement within the balance system is ascertained and degree of weakness is measured.

    Research has shown that vestibular physiotherapy is highly effective in promoting recovery in vestibular and balance disorders, such as reduced vestibular function due to various causes like infection, trauma, inflammation or tumor. Exercises cannot be given in a “one size fits all” manner. In fact, exercises given without determining the underlying balance deficit may not only be unhelpful to the patient, they may actually make the patient feel worse.

    Vestibular disorders lead to reduced function of vestibular system involved in maintaining the balance of the body. Vestibular rehabilitation works by helping the central nervous system develop alternate strategies to stabilize the patient. The exercises progressively help the patient to balance themselves by using different cues. This is called compensation. Patients with poor compensation present with chronic vestibular insufficiency which is characterized by instability and difficulty in focusing.

    Rehab needs to be progressively changing in difficulty level, speed, and head position to be able to achieve optimum benefits by challenging the existing weak balance system in different ways. Doing the same exercises for long durations do not stimulate the nervous system, and hence will not be useful after a certain time. The exercises prescribed to the patient are tailored according to their needs.

    Benign paroxysmal positional vertigo (BPPV) is treated by canalith repositioning maneuvers (CRM). The maneuver required is decided according to the position of the otolith crystal within the inner ear. Some BPPV patients may have residual dizziness after the CRM which requires specific rehabilitation protocols to help the patient feel more stable.

    The exercises work by promoting different areas of function – habituation, gaze stabilization, and improvement of balance and gait.

    1.Habituation Exercises:

    These exercises are based on the concept that repeated exposure to provocative positions will result in reduction of the symptoms. As habituation and desensitization  sets in, these movements can be performed with faster speeds.

    2. Eye – Head Coordination Exercises:

    These exercises are designed to improve the ability to focus during head movement and reduce symptoms of dizziness.

    3.  Balance and gait exercises:

    These exercises involve challenging the vestibular balance system by removing or altering visual and somatosensory cues. They are designed to improve balance and confidence when walking. They are also aimed at targeting different stabilizing techniques like ankle and hip strategies to reduce the risk of falls.

    Vestibular physiotherapy can be delivered as a home exercise program that is performed three times a day, or with supervised classes. The supervised classes use different equipment like stabilometry , trampoline, exercise balls, and different kinds of platforms to train patients in different techniques. Different techniques like virtual reality and augmented reality environments are used for patients with phobias like fear of heights, difficulty in slability in crowded areas or malls, motion sickness, seasickness ,etc. Assessment is done at the beginning and end of rehab programs to ascertain the improvement in balance and stability. Any further weak functional areas can then be addressed as well to make sure that the patient reaches an optimum compensation level. Both approaches have been found to result in significant changes in dizziness and balance measures. Improvement should be expected within 4–6 weeks. Some patients may require more prolonged therapy. Home exercise programs are given to the patient in the form of a free app in which the videos of the exercises to be performed are available. These exercise videos are changed at prescribed intervals to make sure that the rehab program is progressive and tailored to the needs of the patient.

    There are a number of factors that affect how long a vestibular physiotherapy program will take and these include:

    *How long you have been dizzy
    *How regularly you do the vestibular exercises
    *How significant the symptoms of imbalance are
    *Which other medical problems you have
    *Presence of any emotional or psychological issues.

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