vestibularPT.com

Dizziness affects 15-20% of individuals, adding up to 7.5 million people. The incidence of dizziness increases with age, along with the risk of injury associated with dizziness and falls.

There are many causes of dizziness:

• vestibular system (inner ear)
• heart
• central nervous system (brain)
• vision problems
• neuropathy
• neurodegenerative diseases
• anxiety
• nutrition and hydration
• migraine
• cervical spine (neck)

Physical therapists and occupational therapists are trained in differential diagnosis, determining the root cause of a patient's symptoms and determining if vestibular rehab is appropriate or if the patient's condition requires the skills of another specialist. Physical therapists my provide vestibular rehab services in an outpatient clinic, inpatient hospitals, home health setting, urgent care or emergency department.

The vestibular system works in coordination with the visual system and with the muscles, joints, and musculoskeletal system to understand the body's position in and movement through space. When one of these systems is not functioning properly, the result is dizziness, imbalance and falls. The job of a vestibular therapist is to investigate. To assess each of these systems and determine what is causing the problem. Is it a sensory problem affecting the ear, eyes, or musculoskeletal system? Is it an integration problem affecting the brain's ability to process the information? Is it a motor control problem with the function of the nerves, joints, muscles? And just what do we do about it to help the patient feel better? 

Examination 

Vestibular therapists will use tools, such as infrared videogoggles, an eye occluder, a reflex hammer, tuning fork, balance pad.

The following systems should be assessed:

• Eyes: quality of movement and ability to coordinate the eyes
• Vestibular system: how the body responds to head movement and positional changes
• Brain and nerves: coordination of the extremities, sensation, motor control, postural stability
• Cervical spine: cervical spine for mobility, strength and joint position awareness
• Balance: standing balance, challenging balance by closing the eyes, moving feet together or one in front of the other, walking and turning the head, bending, reaching  

Vestibular Rehabilitation

Vestibular rehabilitation may consist of repositioning maneuvers if the crystals of the inner ear have been displaced, causing positional vertigo. It may include movements to improve coordination of the head and eyes, to improve balance on various surfaces and in different environments. Balance challenges may include sitting, standing, bending, turning, throwing and catching, turning the head while maintaining balance, balancing while performing other motor or cognitive tasks. Vestibular therapists may use tools such as a laser positioned on the head to improve awareness of the head position in space, or videos moving through different environments to challenge the eyes and ears to work together.