Balance & Vestibular Program

Conditions Benefiting from Therapy

The following conditions could benefit from Adventist Rehabilitation Hospital's Vestibular Rehabilitation Program:

• Benign Paroxysmal Positional Vertigo (BPPV) - a balance and dizziness disorder caused by detached crystals from the inner ear that can interfere with the vestibular system. The result can cause a spinning or whirling sensation called vertigo that usually occurs for a few seconds after specific movements, such as getting in/out of bed, and can return sporadically for years if left untreated.
• Recovery After Removal of Acoustic Neuroma - surgery to remove tumor often results in unilateral vestibular dysfunction.
• Central or Neurological Vertigo - caused by problems in the balance centers of the brain such as stroke, multiple sclerosis, brain tumors/cysts and abnormalities of the upper spine or back of cerebellum.
• Motion Sensitivity
• Vestibular Neuritis - an infection of the vestibular nerve.
• Cerebellar Dysfunction - involves a part of the brain that is responsible for coordination. When not properly functioning, it can cause imbalance and difficulty with stabilizing eye movements. Persons whose cerebellum does not work well are generally clumsy and unsteady and have a staggering gait. The most common cause of damage to the cerebellum is stroke, head trauma or disease.
• Other conditions in the ear resulting in problems with dizziness and balance.

Evaluations

The following types of evaluations, performed by a physical therapist trained in vestibular rehabilitation, will help determine your best possible treatment plan:

• Interview with patient regarding chief complaint, symptoms and functional limitations
• Comprehensive balance/postural control evaluation using functional, outcome-based measures
• Assessment of muscle strength, tone, range of motion, sensation and posture
• Neuromuscular evaluation
• Occulomotor Visual Motor Assessment - measured by infrared video goggles and visual observation to evaluate eyemovements in varied testing positions
• Balance Assessment - measured by standardized tests

Treatment Goals

The program's patient specific treatment goals for vestibular/balance rehabilitation usually include:

• Decrease symptoms, such as dizziness
• Increase independence in activities of daily living
• Decreased incidence of falls
• Enhance postural control
• Improve balance
• Remove debris from semi-circular canal to alleviate benign positional proximal vertigo when needed

Therapy & Exercises

Vestibular rehabilitation therapy and exercises train the brain to relearn alternative visual and sensing of relative body cues to maintain balance and gait. They may include:

• Canalith Repositioning Treatment - is a specific maneuver that involves moving the patient's head in a sequence of positions for a certain time period in order to reposition the crystals around the semicircular canals to the proper place in the inner ear.
• Gaze Stabilization Exercises - work to improve the vestibulo-ocular reflex.
• Balance Retraining - Exercises designed to improve coordination of muscle responses as well as the organization of sensory information from eyes, ears and tactile/muscle receptors for balance control.
• Vestibular Habituation/Adaptation or Substitution Exercises - Specific movements or positions that provoke the patient's dizziness. The patient is asked to repeat these movements until the brain becomes accustomed to the response or adapts to the conflicting information. This process resolves the conflict between the brain and the ear.

Referrals

Most referrals for patients with vestibular disorders come primarily from otolaryngologists (ENTs) and neurologists, but our therapists will accept a referral from any physician after appropriate medical diagnostic testing has been completed. The referral should include specific diagnosis and be for physical therapy - vestibular/balance training.

To schedule an appointment for evaluation, call 240-864-6200.